The effectiveness of the Collaborative Assessment and Management of Suicidality (CAMS) compared to alternative treatment conditions: A meta-analysis.

INTRODUCTION: This meta-analysis aimed to test the efficacy of the Collaborative Assessment and Management of Suicidality (CAMS) intervention against other commonly used interventions for the treatment of suicide ideation and other suicide-related variables. METHOD: Database, expert, and root and branch searches identified nine empirical studies that directly compared CAMS to other active interventions. A random effects model was used to calculate the effect size differences between the interventions; additionally, moderators of the effect sizes were tested for suicidal ideation. RESULTS: In comparison to alternative interventions, CAMS resulted in significantly lower suicidal ideation (d = 0.25) and general distress (d = 0.29), significantly higher treatment acceptability (d = 0.42), and significantly higher hope/lower hopelessness (d = 0.88). No significant differences for suicide attempts, self-harm, other suicide-related correlates, or cost effectiveness were observed. The effect size differences for suicidal ideation were consistent across study types and quality, timing of outcome measurement, and the age and ethnicity of participants; however, the effect sizes favoring CAMS were significantly smaller with active duty military/veteran samples and with male participants. CONCLUSIONS: The existing research supports CAMS as a Well Supported intervention for suicidal ideation per Center of Disease Control and Prevention criteria. Limitations and future directions are discussed.

A Behavioral Economic Model of Help-Seeking for Depression.

Findings from the clinical psychology literature indicate that many who experience depression do not seek treatment when needed. This may be due to help-seeking models and interventions failing to account for the behavioral characteristics of depression that affect decision making (e.g., altered sensitivity to punishment and reward). Behavioral economics can provide a framework for studying help-seeking among individuals with depression that explicitly considers such characteristics. In particular, the authors propose that depression influences help-seeking by altering sensitivity to treatment-related gains and losses and to the delays, effort, probabilities, and social distance associated with those gains and losses. Additional biases in decision making (e.g., sunk-cost bias, default bias) are also proposed to be relevant to help-seeking decisions among individuals with depression. Strengths, limitations, and future directions for research using this theoretical framework are discussed. Taken together, a behavioral economic model of help-seeking for depression could assist in identifying those who are at greatest risk of going untreated and in creating more effective help-seeking interventions.

Supervisor variance in psychotherapy outcome in routine practice.

OBJECTIVE: Although supervision has long been considered as a means for helping trainees develop competencies in their clinical work, little empirical research has been conducted examining the influence of supervision on client treatment outcomes. Specifically, one might ask whether differences in supervisors can predict/explain whether clients will make a positive or negative change through psychotherapy. METHOD: In this naturalistic study, we used a large (6521 clients seen by 175 trainee therapists who were supervised by 23 supervisors) 5-year archival data-set of psychotherapy outcomes from a private nonprofit mental health center to test whether client treatment outcomes (as measured by the OQ-45.2) differed depending on who was providing the supervision. Hierarchical linear modeling was used with clients (Level 1) nested within therapists (Level 2) who were nested within supervisors (Level 3). RESULTS: In the main analysis, supervisors explained less than 1% of the variance in client psychotherapy outcomes. CONCLUSIONS: Possible reasons for the lack of variability between supervisors are discussed.

Can Low-Cost Strategies Improve Attendance Rates in Brief Psychological Therapy? Double-Blind Randomized Controlled Trial.

OBJECTIVES: To assess if telephone text message appointment reminders and orientation leaflets can increase the proportion of patients who attend brief interventions after being assessed as suitable for guided self-help following cognitive behavioral therapy principles. METHOD: Attendance was operationally defined as having accessed at least 1 therapy appointment. A secondary outcome was the proportion of attenders who completed or dropped out of therapy. After initial assessment, 254 patients with depression and anxiety disorders were randomly assigned to 1 of 3 groups: (a) usual waitlist control, (b) leaflet, (c) leaflet plus text message. Differences in the proportions of patients who started and completed therapy across groups were assessed using chi-square and logistic regression analyses. RESULTS: Overall, 63% of patients in this sample attended therapy. Between-group differences were not significant for attendance, x(2) (2) = 3.94, p = .14, or completion rates, x(2) (2) = 2.98, p = .23. These results were not confounded by demographic or clinical characteristics. CONCLUSIONS: Low-cost strategies appear to make no significant difference to therapy attendance and completion rates.