Translation of the Outcome Questionnaire-45 (OQ) into Japanese: A cultural adaptation.

OBJECTIVE: While there are several Japanese, qualitative, case studies examining psychotherapy outcome, there is a growing need for quantitative psychotherapy outcome research in Japan. This study adapted the Outcome Questionnaire-45 (OQ), one of the most common quantitative measures of clinical outcome, for use in Japan. METHOD: With the help of 6 translators and 116 native Japanese pilot respondents, the original OQ was translated into Japanese following Beaton et al.'s methodology and includes forward translation, synthesis, back translation, and expert committee meetings. RESULTS: The study produced four pre-final versions, two pretest version, and one pilot version of the Japanese OQ. With permission from the original questionnaire developers, a few items were modified to achieve cultural equivalence. The rigorous translation and adaptation processes, evaluated through the Translation Validity Index and Content Validity Index provided semantic, content, and conceptual equivalence between the English and Japanese versions. CONCLUSIONS: The current study partially validated the translation equivalence and cultural adaptation of the Japanese OQ. Study limitations and suggestions for further development are discussed.

Postdeployment mental health screening: an application of the Soldier Adaptation Model.

The Global War on Terrorism and its corresponding frequent and long deployments have resulted in an increase in mental health concerns among active duty troops. To mitigate these impacts, the Department of Defense has implemented postdeployment screening initiatives designed to identify symptomatic soldiers and refer them for mental health care. Although the primary purpose of these screenings is to identify and provide assistance to individuals, macrolevel reporting of screening results for groups can assist Commanders, who are charged with ensuring the wellbeing of their soldiers, to make unit-level interventions. This study assesses the utility of a metatheory of occupational stress, the Soldier Adaptation Model, in organizing feedback information provided to Army Commanders on their units' postdeployment screening results. The results of a combat brigade of 2319 soldiers who completed post-deployment screening following return from Iraq were analyzed using Structural Equation Modeling to assess the Soldier Adaptation Model's use for macrolevel reporting. Results indicate the Soldier Adaptation Model did not strengthen the macrolevel reporting; however, alcohol use and reckless driving were found to mediate the relationship between combat exposure and numerous mental health symptoms and disorders (e.g., post-traumatic stress disorder, anger, depression, anxiety, etc.). Research and practice implications are discussed.

Behavioral health clinicians endorse stellate ganglion block as a valuable intervention in the treatment of trauma-related disorders.

The stellate ganglion block (SGB) procedure has been used successfully for over 10 years to treat post-traumatic stress symptoms in thousands of US military service members, civilians, and veterans in select hospitals in Europe and North America. Primarily through targeting the autonomic nervous system, the SGB procedure serves as an invaluable adjunct to trauma-focused psychotherapy. Without published best practices for emerging therapies, clinicians are left on their own to determine how best to apply new treatments to their patient populations. The aim of this qualitative research was to compile attitudes and recommendations from therapists with expertise in using SGB for treating symptoms of post-traumatic stress disorder, so that their experiences could be disseminated widely to clinicians without SGB expertise. An 18-item survey was developed and distributed electronically to a group of behavioral health professionals of various specialties between May and June 2020. Of surveyed behavioral health clinicians with personal experience incorporating SGB into their trauma-focused psychotherapy, 95% of respondents would recommend SGB to a colleague as a useful tool for the treatment of trauma-related disorders. SGB was rated at least as useful as the most valuable interventions listed in the American Psychological Association Clinical Practice Guideline for the Treatment of Post-traumatic Stress Disorder with 100% of respondents characterizing SGB as 'Very Beneficial' or 'Somewhat Beneficial', and 0 respondents characterizing SGB as 'Not Helpful' or 'Harmful'. Given the feedback from this study, behavioral health providers should consider using SGB in conjunction with standard trauma-focused care.

Using a shared parameter mixture model to estimate change during treatment when termination is related to recovery speed.

OBJECTIVE: This study demonstrates how to use a shared parameter mixture model (SPMM) in longitudinal psychotherapy studies to accommodate missingness that is due to a correlation between rate of improvement and termination of therapy. Traditional growth models assume that such a relationship does not exist (i.e., assume that data are missing at random) and produce biased results if this assumption is incorrect. METHOD: We used longitudinal data from 4,676 patients enrolled in a naturalistic study of psychotherapy to compare results from a latent growth model and an SPMM. RESULTS: In this data set, estimates of the rate of improvement during therapy differed by 6.50%-6.66% across the two models, indicating that participants with steeper trajectories left psychotherapy earliest, thereby potentially biasing inference for the slope in the latent growth model. CONCLUSION: We conclude that reported estimates of change during therapy may be underestimated in naturalistic studies of therapy in which participants and their therapists determine the end of treatment. Because non-randomly missing data can also occur in randomized controlled trials or in observational studies of development, the utility of the SPMM extends beyond naturalistic psychotherapy data.

Acceptability and cost-effectiveness of military telehealth mental health screening.

Telehealth has been touted as one solution to the shortage of mental health providers within the military. Despite developing evidence for the equivalence of telehealth mental health care, there is no research that covers the use of telehealth for population mental health screening, a standard component of postdeployment medical screening. This paper summarizes soldier perceptions of three separate screening events in which telehealth was used and the cost-effectiveness of telehealth versus in-person implementations of the same screening. Soldiers who have not been through telehealth screening report a strong preference for in-person screening. Soldiers who have been through telehealth screening still report preference for in-person screening, but they express more ambivalence about the screening method. Using telehealth-only mental health screening for large numbers of soldiers within a compressed time frame is more expensive than in-person screening. Telehealth resulted in higher referral rates than in-person screening. Government and military leaders should use care when making decisions about telehealth implementation. Although telehealth for small numbers may be sufficiently equivalent and economical, there is no evidence of cost savings or improved acceptability for telehealth mental health post-deployment screening.

An analysis of therapist treatment effects: toward providing feedback to individual therapists on their clients' psychotherapy outcome.

This study examined data collected on over 5,000 clients seen by 71 therapists over a 6-year period in a University Counseling Center. Clients were given the Outcome Questionnaire-45 (OQ-45) on a session-by-session basis to track their treatment response. Data were also collected on therapists' theoretical orientation, years of experience, gender, and type of training. Data were analyzed using hierarchical linear modeling (HLM) to see if general therapist traits (i.e., theoretical orientation, type of training) accounted for differences in clients' rate of improvement. Data were then analyzed, again using HLM with therapists as a fixed effect, to compare individual therapists to see if there were significant differences in the efficiency of treatment. In addition, pre- minus posttest OQ-45 scores were examined to see if there were differences in the overall outcome of clients. There was a significant amount of variation among therapists' clients' rates of improvement. Therapist feedback reports were generated to summarize client outcome for individual providers in contrast to center averages and in an attempt to improve client outcome.