From Theory to Practice: A Transtheoretical Treatment and Training Model (4TM).

Background: In this paper, we present the conceptual background and clinical implications of a research-based transtheoretical treatment and training model (4TM). Method: The model implements findings from psychotherapy outcome, process, and feedback research into a clinical and training framework that is open to future research. Results: The framework is based on interventions targeting patient processes on a behavioral, cognitive, emotional, motivational, interpersonal, and systemic/socio-cultural level. The 4TM also includes a data-based decision support and feedback system called the Trier Treatment Navigator (TTN). Conclusion: We discuss important problems associated with clinical orientations solely based on one school of thought. We then contrast these concerns with a clinical and training framework that embraces ongoing research, serving as a guiding structure for process-based transtheoretical interventions. Such research-based psychological therapy can take both traditional and novel clinical developments as well as findings from psychotherapy research into account and be adaptively disseminated to a variety of patient populations.

The Trier Treatment Navigator (TTN) in action: Clinical case study on data-informed psychological therapy.

BACKGROUND: Although psychotherapy has shown to be effective for most patients, about one-third of patients do not benefit or deteriorate during treatment. Technical progress has allowed the integration of routine outcome monitoring (ROM) into treatment, helping therapists detect patients at risk for a nonresponse or poor outcome early on. Psychological therapy can be enhanced by providing therapists with individual treatment recommendations for these at-risk patients. One example of such a comprehensive feedback system is the Trier Treatment Navigator (TTN). OBJECTIVE/METHOD: This clinical case study aims to illustrate the implementation of the TTN in a cognitive behavioral therapy (CBT) outpatient clinic in the treatment of a 30-year-old patient called Ms. Daun, who has a recurrent depressive disorder. Based on this case, the benefits of applying information from ROM in psychotherapy, important context factors, and possible implementation issues are discussed. RESULTS/CONCLUSION: We conclude by encouraging practitioners to integrate ROM into their clinical thinking and daily practice.

Assessing treatment integrity in personalized CBT: the inventory of therapeutic interventions and skills.

The third wave of cognitive behavioral therapy (CBT) has increased the heterogeneity of today's CBT practice, while developments in patient-focused research are paving the road to the empirical personalization of CBT. This paper presents the development and psychometric properties of a therapy video rating instrument, which was designed to adequately assess the treatment integrity (adherence and competence) of modern, personalized CBT. The Inventory of Therapeutic Interventions and Skills (ITIS) was developed based on two existing CBT adherence and competence scales and augmented with third wave content and overarching therapeutic strategies. The instrument was then applied by graduate students and post-graduate clinicians to rate N = 185 therapy videos from N = 70 patients treated at a university outpatient clinic. Descriptive results, inter-rater reliability, item structure, and associations with session outcome and alliance were examined. Average inter-rater reliability was excellent for Interventions items and good for Skills items. Intercorrelations were low between Interventions items, but higher and significant between Skills items, which loaded on a single factor. Several ITIS items were shown to be predictive of session outcome and alliance, even after controlling for the nested data structure. Implications of these results for future research and clinical training are discussed.

What sticks? Patients' perspectives on treatment three years after psychotherapy: A mixed-methods approach.

Objective: In the present study, a patient-focused, mixed-methods approach was applied to relate patients' personal experiences of change processes during therapy to their long-term psychometric treatment outcomes. Method: Comprehensive follow-up quantitative assessments and qualitative interviews were conducted with n = 30 patients who had completed an integrative CBT treatment three years prior. Qualitative content analysis by two independent coders was used to categorize patients' subjective explanations of therapeutic change. Correlations were applied to relate the frequency and diversity of change factors to clinically significant change of symptom distress at post-treatment and 36-month follow-up. Cluster analysis was performed to identify clusters of patients with similar patterns of change factors. Results: Qualitative content analysis with good interrater reliability revealed five main categories: (1) Therapeutic relationship (2) Activating resources (3) Motivational clarification and insight (4) Action-oriented coping strategies (5) Healing therapeutic setting. Higher levels of change factors were associated with greater relief of symptoms at post-treatment and 36-month follow-up. Cluster analysis revealed three different groups of patients. Conclusions: The analysis provides insight into therapeutic change factors from the patient's perspective. Some categories are consistent with theoretically driven models of common factors. Results may help tailor psychotherapy to patients' individual needs.

Citizen scientists reveal: Marine litter pollutes Arctic beaches and affects wild life.

Recent data indicate accumulation areas of marine litter in Arctic waters and significant increases over time. Beaches on remote Arctic islands may be sinks for marine litter and reflect pollution levels of the surrounding waters particularly well. We provide the first quantitative data from surveys carried out by citizen scientists on six beaches of Svalbard. Litter quantities recorded by cruise tourists varied from 9-524gm-2 and were similar to those from densely populated areas. Plastics accounted for >80% of the overall litter, most of which originated from fisheries. Photographs provided by citizens show deleterious effects of beach litter on Arctic wildlife, which is already under strong pressure from global climate change. Our study highlights the potential of citizen scientists to provide scientifically valuable data on the pollution of sensitive remote ecosystems. The results stress once more that current legislative frameworks are insufficient to tackle the pollution of Arctic ecosystems.