Pattern transitions in diary data of MDD patients: a mixed-methods multiple case study of psychotherapy dynamics.

Aim: Mixed-methods approaches promise a deep understanding of psychotherapeutic processes. This study uses qualitative and quantitative data from daily diary entries and daily self-assessments during inpatient treatment. The aim of the study is to get an insight into the similarities and differences between both types of data and how they represent self-organized pattern transitions in psychotherapy. While a complete correlation of results is not expected, we anticipate observing amplifying and subsidiary patterns from both perspectives. Materials and methods: Daily, five MDD patients wrote diaries and completed self-assessments using the Therapy Process Questionnaire, a questionnaire for monitoring the change dynamics of psychotherapy. The data were collected using the Synergetic Navigation System, an online tool for real-time monitoring. Diary entries of the patients described their experiences in everyday life. The qualitative text analysis was conducted using Mixed Grounded Theory, which provided categories representing the patients' ongoing experiences of transformation and stagnation. The time series data was analyzed using the dynamic complexity algorithm and the pattern transition detection algorithm. Results from qualitative and quantitative analyses were combined and compared. Following the process of data triangulation, the leading perspective came from the theory of self-organization. In addition to presenting the overall results for all five patients, we delve into two specific case examples in greater detail. Results: Specific and highly diversified diary entries of 5 patients were classified into the categories of perceived pattern stability, noticing improvement, broadening the perspective, critical instability, and experiencing moments of Kairos. Patients reported problems not only related to their disorder (e.g., lack of energy and hopelessness) but also to phases and steps of change, which could be related to the theory of self-organization (e.g., problem attractors, critical fluctuations, pattern transitions, and Kairos). Qualitative and quantitative analysis provide important supplementary results without being redundant or identical. Conclusion: Data triangulation allows for a comprehensive and multi-perspective understanding of therapeutic change dynamics. The different topics expressed in the diary entries especially help to follow micro-psychological processes, which are far from being a simple reaction to interventions. The way patients experience themselves being in stability or instability and stagnation or transformation is surprisingly close to the general features of self-organizing processes in complex systems.

Dynamic association between suicidal ambivalence and suicide risk among individuals with a history of suicide attempts.

OBJECTIVE: Suicide risk is highly fluctuating. There is a need for predictors of short-term change in suicide risk to optimize risk assessment and treatment, especially among individuals who already attempted suicide. METHODS: Based on 1776 daily assessments of 16 former psychiatric inpatients with a history of suicide attempts, we examined how suicidal ambivalence and, respectively, wish to die (WTD) and wish to live (WTL) predicted same-day and change in perceived suicide risk (i.e., next-day perceived suicide risk, controlled for same-day perceived suicide risk) in multilevel regression models. Additionally, based on the assumptions of nonlinear dynamics, we examined the associations between levels of fluctuations in the WTD/WTL and perceived suicide risk within the same time period. RESULTS: Suicidal ambivalence, WTD, and a WTL significantly correlated with same-day suicide risk. Suicidal ambivalence and WTD significantly predicted change in suicide risk. Fluctuations in WTD were significantly associated with concurrent suicide risk. CONCLUSION: The results suggest that suicidal ambivalence and WTD are drivers of suicide risk among individuals who already attempted suicide. The association between fluctuations in WTD and suicide risk was small and warrants further investigation on the practical utility as a warning sign.

A primer on sampling rates of ambulatory assessments.

The use of ambulatory assessments (AAs) as an approach to gather self-reported questionnaires or self-collected biochemical data is constantly increasing to investigate the experiences, states, and behaviors of individuals and their interaction with external situational factors during everyday life. It is often implicitly assumed that data from different sampling protocols can be used interchangeably, despite them assessing processes over different timescales in different intervals and at different occasions, which depending on the variables under study may result in fundamentally different dynamics. There are multiple temporal parameters to consider and while there is an abundance of sampling protocols that are applied regularly, to date, there is only limited empirical background on the influence different approaches may have on the data and findings. In this review, we aim to give an overview of commonly used types of AA in psychology, psychiatry, and biobehavioral research with a breakdown by temporal design parameters. Additionally, we discuss potential advantages and pitfalls associated with the various approaches. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Using Progress Feedback to Enhance Treatment Outcomes: A Narrative Review.

We face increasing demand for greater access to effective routine mental health services, including telehealth. However, treatment outcomes in routine clinical practice are only about half the size of those reported in controlled trials. Progress feedback, defined as the ongoing monitoring of patients' treatment response with standardized measures, is an evidence-based practice that continues to be under-utilized in routine care. The aim of the current review is to provide a summary of the current evidence base for the use of progress feedback, its mechanisms of action and considerations for successful implementation. We reviewed ten available meta-analyses, which report small to medium overall effect sizes. The results suggest that adding feedback to a wide range of psychological and psychiatric interventions (ranging from primary care to hospitalization and crisis care) tends to enhance the effectiveness of these interventions. The strongest evidence is for patients with common mental health problems compared to those with very severe disorders. Effect sizes for not-on-track cases, a subgroup of cases that are not progressing well, are found to be somewhat stronger, especially when clinical support tools are added to the feedback. Systematic reviews and recent studies suggest potential mechanisms of action for progress feedback include focusing the clinician's attention, altering clinician expectations, providing new information, and enhancing patient-centered communication. Promising approaches to strengthen progress feedback interventions include advanced systems with signaling technology, clinical problem-solving tools, and a broader spectrum of outcome and progress measures. An overview of methodological and implementation challenges is provided, as well as suggestions for addressing these issues in future studies. We conclude that while feedback has modest effects, it is a small and affordable intervention that can potentially improve outcomes in psychological interventions. Further research into mechanisms of action and effective implementation strategies is needed.

Psychological precursors of epileptic seizures.

Psychological stress is the most commonly self-reported precursor of epileptic seizures. However, retrospective and prospective studies remain inconclusive in this regard. Here, we explored whether seizures would be preceded by significant changes in reported stressors or resource utilization. This study is based on high-frequency time series through daily online completion of personalized questionnaires of 9-24 items in epilepsy outpatients and compared responses 1-14 days before seizures with interictal time series. Fourteen patients (79% women, age = 23-64 years) completed daily questionnaires over a period of 87-898 days (median = 277 days = 9.2 months). A total of 4560 fully completed daily questionnaires were analyzed, 685 of which included reported seizure events. Statistically significant changes in preictal compared to interictal dynamics were found in 11 of 14 patients (79%) across 41 items (22% of all 187 items). In seven of 14 patients (50%), seizures were preceded by a significant mean increase of stressors and/or a significant mean decrease of resource utilization. This exploratory analysis of long-term prospective individual patient data on specific stressors and personal coping strategies generates the hypothesis that medium-term changes in psychological well-being may precede the occurrence of epileptic seizures in some patients.

The best of both worlds? General principles of psychopathology in personalized assessment.

A complex systems approach to psychopathology proposes that general principles lie in the dynamic patterns of psychopathology, which are not restricted to specific psychological processes like symptoms or affect. Hence, it must be possible to find general change profiles in time series data of fully personalized questionnaires. In the current study, we examined general change profiles in personalized self-ratings and related these to four measures of treatment outcome (International Symptom Rating, 21-item Depression Anxiety and Stress Scale, daily symptom severity, and self-reflective capacity). We analyzed data of 404 patients with mood and/or anxiety disorders who completed daily self-ratings on personalized questionnaires during psychotherapy. For each patient, a principal component analysis was applied to the multivariate time series in order to retrieve an univariate person-specific time series. Then, using classification and regression methods, we examined these time series for the presence of general change profiles. The change profile classification yielded the following distribution of patients: no-shift (n = 55; 14%), gradual-change (n = 52; 13%), one-shift (n = 233; 58%), reversed-shift (n = 39; 10%) and multiple-shifts (n = 25; 6%). The multiple-shift group had better treatment outcome than the no-shift group on all outcome measures. The one-shift and gradual-change groups had better treatment outcome than the no-shift group on two and three outcome measures, respectively. Overall, this study illustrates that person-specific (idiographic) and general (nomothetic) aspects of psychopathology can be integrated in a complex systems approach to psychopathology, which may combine "the best of both worlds." (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Features of Self-Organization during the Process of Mindfulness-Based Stress Reduction: A Single Case Study.

Compared to the extensive evidence of the effectiveness of mindfulness-based interventions, there is only a limited understanding of their mechanisms of change. The three aims of this study are (1) to identify features of self-organization during the process (e.g., pattern transitions), (2) to obtain an impression of the effects of continuous self-assessments and feedback sessions on mindfulness-related stress reduction, and (3) to test the feasibility of high-frequency process monitoring and process feedback. Concerning aim (1), the specific hypothesis is that change will occur as a cascade of discontinuous pattern transitions emerging spontaneously in the sense of not being a reaction to external input. This single case study describes changing patterns of multiple time series that were produced by app-based daily self-assessments during and after an 8-week mindfulness-based stress reduction program. After this MBSR program, the participant (a female nurse) continued the self-assessment and the mindfulness practice for a further 10 months. The results confirm findings on the positive effects of mindfulness programs for healthcare professionals, especially on coping with work-related stress. The analysis of the time series data supports the hypothesis of self-organization as a possible mechanism of change manifesting as a cascade of phase transitions in the dynamics of a biopsychosocial system. At the end of the year, the participant reported a beneficial impact of daily monitoring and systematic feedback on the change process. The results underline the feasibility and usefulness of continuous high-frequency monitoring during and after mindfulness interventions.

Personality traits and complex problem solving: Personality disorders and their effects on complex problem-solving ability.

Complex problem solving (CPS) can be interpreted as the number of psychological mechanisms that allow us to reach our targets in difficult situations, that can be classified as complex, dynamic, non-transparent, interconnected, and multilayered, and also polytelic. The previous results demonstrated associations between the personality dimensions neuroticism, conscientiousness, and extraversion and problem-solving performance. However, there are no studies dealing with personality disorders in connection with CPS skills. Therefore, the current study examines a clinical sample consisting of people with personality and/or depressive disorders. As we have data for all the potential personality disorders and also data from each patient regarding to potential depression, we meet the whole range from healthy to impaired for each personality disorder and for depression. We make use of a unique operationalization: CPS was surveyed in a simulation game, making use of the microworld approach. This study was designed to investigate the hypothesis that personality traits are related to CPS performance. Results show that schizotypal, histrionic, dependent, and depressive persons are less likely to successfully solve problems, while persons having the additional behavioral characteristics of resilience, action orientation, and motivation for creation are more likely to successfully solve complex problems.

About-Weekly Pattern in the Dynamic Complexity of a Healthy Subject's Cellular Immune Activity: A Biopsychosocial Analysis.

In a previous integrative single-case study, we collected biological, psychological and social time-series data on a 25-year-old healthy woman over the course of 126 12-h intervals (63 days) and used urinary neopterin as an indicator of cellular immune activity [Schubert et al. 2012 (1)]. The present re-evaluation introduced Dynamic Complexity (DC) as an additional non-linear and non-stationary measure to further investigate the subject's biopsychosocial dynamics during the study. The new time series dealing with urinary neopterin complexity revealed a cyclic, circaseptan (about-weekly) repeating pattern (6.59 days). The only weekly reoccurring events over the course of the study that were associated with this immunological pattern were the in-depth interviews with the subject (mean distance between interviews: 6.5 days). Superposed epoch analysis (SEA) revealed a U-shaped relation between neopterin complexity and interviews, with a decrease in neopterin complexity before and during interviews and an increase after interviews. Furthermore, the complexity scores for irritation, anxiousness/depressiveness and mental activity were positively correlated with neopterin complexity. The results suggest that the interviews, which had been found to be related to the subject's need for educational and/or social accomplishment, were marked by stress (decrease in psycho-immunological flexibility and adaptability), which was then relieved after the interviews (increase in psycho-immunological flexibility and adaptability). It appears that the subject's cellular immune activity, as indicated by neopterin complexity, functionally mirrored the emotional meaning she ascribed to the in-depth interviews. This re-evaluation is in line with the view that biopsychosocial research requires multimodal analysis of single cases based on qualitative (e.g., in-depth interviews) and quantitative (e.g., time series analysis) data under conditions of "life as it is lived".

Stability and flexibility in psychotherapy process predict outcome.

Ten good outcome and ten poor outcome psychotherapy cases were compared to investigate whether or not the temporal stability and flexibility of their process variables can predict their outcomes. Each participant was monitored daily using the Therapy Process Questionnaire (TPQ), which has 43 items and seven sub-scales, and responses over time were analyzed in terms of correlation robustness and correlation variability across the TPQ sub-scales. "Correlation robustness" and "correlation variability" are two basic characteristics of any correlation matrix: the first is calculated as the sum of the absolute values of Pearson correlation coefficients, the second as the standard deviation of Pearson correlation coefficients. The results demonstrated that the patients within the poor outcome group had lower values on both variables, suggesting lower stability and flexibility. Furthermore, a higher number of cycles of increase and decrease in correlation robustness and variability of the TPQ sub-scales was observed within good outcome psychotherapies, suggesting that, these cycles can be considered as process-markers of good-outcomes. These results provide support for the validity of these quantitative process-parameters, correlation robustness and variability, in predicting psychotherapeutic outcomes. Moreover, the results lend support to the common clinical experience of alternating periods of flexibility and integration being beneficial to good psychotherapeutic processes.

Detecting pattern transitions in psychological time series - A validation study on the Pattern Transition Detection Algorithm (PTDA).

With the increasing use of real-time monitoring procedures in clinical practice, psychological time series become available to researchers and practitioners. An important interest concerns the identification of pattern transitions which are characteristic features of psychotherapeutic change. Change Point Analysis (CPA) is an established method to identify the point where the mean and/or variance of a time series change, but changes of other and more complex features cannot be detected by this method. In this study, an extension of the CPA, the Pattern Transition Detection Algorithm (PTDA), is optimized and validated for psychological time series with complex pattern transitions. The algorithm uses the convergent information of the CPA and other methods like Recurrence Plots, Time Frequency Distributions, and Dynamic Complexity. These second level approaches capture different aspects of the primary time series. The data set for testing the PTDA (300 time series) is created by an instantaneous control parameter shift of a simulation model of psychotherapeutic change during the simulation runs. By comparing the dispersion of random change points with the real change points, the PTDA determines if the transition point is significant. The PTDA reduces the rate of false negative and false positive results of the CPA below 5% and generalizes its application to different types of pattern transitions. RQA quantifiers also can be used for the identification of nonstationary transitions in time series which was illustrated by using Determinism and Entropy. The PTDA can be easily used with Matlab and is freely available at Matlab File Exchange (https://www.mathworks.com/matlabcentral/fileexchange/80380-pattern-transition-detection-algorithm-ptda).

What makes inpatient treatment for PTSD effective? Investigating daily therapy process factors.

OBJECTIVE: Therapeutic process factors including alliance and motivation are considered to play a key role in the treatment of post-traumatic stress disorder (PTSD). Yet, our understanding of change processes in therapy is mostly based on theoretical considerations with limited empirical evidence. In order to identify process characteristics of successful inpatient treatments of PTSD, we investigated the intraindividual, interindividual, and temporal associations of daily assessments of therapy process factors like motivation, alliance, and insight. METHOD: Therapy process questionnaire (TPQ) assessments were collected from 101 inpatients with PTSD over 50 days, resulting in 5050 assessments. Multilevel vector autoregressive (mlVAR) modelling was applied to investigate the networks of the TPQ factors in a subgroup with good outcome regarding PTSD symptomatology and a subgroup with less favourable outcome. RESULTS: The two subgroups differed markedly in their network models, suggesting that therapy processes might be different for those with good and those with poor treatment outcomes. CONCLUSIONS: Our results suggest that good treatment outcome is linked to a specific therapy process dynamic where mindfulness and insight lead to the kind of temporary well-being required to effectively engage with problems and negative emotions, while motivation to change ensures the continuity of confronting negative emotions and problems.

Personalized high-frequency monitoring of a process-oriented psychotherapeutic approach to seizure disorders: Treatment utilization and participants' feedback.

High-frequency monitoring of psychological variables has been recommended to monitor and manage psychotherapeutic processes. However, high-frequency monitoring might be regarded as burdensome for participating patients. This feasibility study applied the concept of high-frequency treatment monitoring in patients with seizures and psychiatric comorbidities in an outpatient neurology service. The treatment monitoring entailed the development of a personalized process questionnaire, daily online monitoring, and regular reflection of the current time series graphs. Participants' feedback on user-friendliness and usefulness of this treatment monitoring was evaluated quantitatively and qualitatively. Participants' compliance rates (CRs) of daily self-assessments after 6 months were correlated with their quantitative feedback on user-friendliness and usefulness and the number of scheduled treatment sessions during this time period. Twenty patients, 15 women/5 men, median age 48 years (range: 23-73 years), were recruited. The median number of scheduled sessions was 11 sessions (range: 6-22). Participants reported a high overall satisfaction with the user-friendliness and usefulness of treatment monitoring. No notable correlations could be found between CRs and quantitative feedback nor between CRs and the number of scheduled treatment sessions. Personalized high-frequency monitoring of psychological variables seems to be feasible to monitor and manage process-oriented psychotherapeutic care in patients with seizures and psychiatric comorbidities. The results support the user-friendliness and usefulness of high-frequency monitoring and suggest that high-frequency monitoring may be suitable for monitoring of low-frequent treatment sessions and patients with attendance issues. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Sexual symptoms in post-traumatic stress disorder following childhood sexual abuse: a network analysis.

BACKGROUND: Even though recent research indicates that sexual symptoms are highly prevalent in post-traumatic stress disorder following childhood sexual abuse and cause severe distress, current treatments neither address them nor are they effective in reducing them. This might be due to a lack of understanding of sexual symptoms' specific role in the often complex and comorbid psychopathology of post-traumatic stress disorder following childhood abuse. METHODS: Post-traumatic, dissociative, depressive, and sexual symptoms were assessed in 445 inpatients with post-traumatic stress disorder following childhood sexual abuse. Comorbidity structure was analyzed using a partial correlation network with regularization. RESULTS: A total of 360 patients (81%) reported difficulties engaging in sexual activities and 102 patients (23%) reported to suffer from their sexual preferences. Difficulties engaging in sexual activities were linked to depressive and hyperarousal symptoms, whereas sexual preferences causing distress were linked to anger and dissociation. Dissociative amnesia, visual intrusions, and physical reactions to trauma reminders were of central importance for the network. Dissociative amnesia, depressed mood, lack of energy, and difficulties engaging in sexual activities were identified as bridge symptoms. Local clustering analysis indicated the non-redundancy of sexual symptoms. CONCLUSIONS: Sexual symptoms are highly prevalent in survivors of childhood sexual abuse with post-traumatic stress disorder. Further research is needed regarding the link of difficulties engaging in sexual activities, depression, and post-traumatic stress disorder, as well as regarding the association of dissociation and sexual preferences causing distress. Sexual symptoms require consideration in the treatment of post-traumatic stress disorder following childhood sexual abuse.

Pathologically reduced neural flexibility recovers during psychotherapy of OCD patients.

Flexibility is a key feature of psychological health, allowing the individual to dynamically adapt to changing environmental demands, which is impaired in many psychiatric disorders like obsessive-compulsive disorder (OCD). Adequately responding to varying demands requires the brain to switch between different patterns of neural activity, which are represented by different brain network configurations (functional connectivity patterns). Here, we operationalize neural flexibility as the dissimilarity between consecutive connectivity matrices of brain regions (jump length). In total, 132 fMRI scans were obtained from 17 patients that were scanned four to five times during inpatient psychotherapy, and from 17 controls that were scanned at comparable time intervals. Significant negative correlations were found between the jump lengths and the symptom severity scores of OCD, depression, anxiety, and stress, suggesting that high symptom severity corresponds to inflexible brain functioning. Further analyses revealed that impaired reconfiguration (pattern stability) of the brain seems to be more related to general psychiatric impairment rather than to specific symptoms, e.g., of OCD or depression. Importantly, the group × time interaction of a repeated measures ANOVA was significant, as well as the post-hoc paired t-tests of the patients (first vs. last scan). The results suggest that psychotherapy is able to significantly increase the neural flexibility of patients. We conclude that psychiatric symptoms like anxiety, stress, depression, and OCD are associated with an impaired adaptivity of the brain. In general, our results add to the growing evidence that dynamic functional connectivity captures meaningful properties of brain functioning.

Process-oriented and personalized psychotherapeutic care for epilepsy: Interim results of a feasibility study.

BACKGROUND: There is great scientific and clinical interest in the effective integration of psychological treatments into comprehensive epilepsy care to optimize treatment outcomes and psychosocial functioning in people with epilepsy. Stepped care is a promising approach to accommodate personalized psychotherapeutic care in academic and regular outpatient settings. It aims at providing patients with the most adequate treatment duration, number of sessions, and treatment method while systematically monitoring their treatment processes. METHODS: This is an uncontrolled feasibility study of process-oriented and personalized psychotherapeutic care for epilepsy in a naturalistic setting. The objective of this study was to evaluate individual changes of health-related quality of life (QOLIE-31) and psychiatric comorbidity (BDI-II, BSI) in participants by applying the concept of the reliable change index (RCI) to outcomes that were obtained at baseline and six months after the beginning of the intervention. Additionally, we assessed the relationship between outcome scores, the number of attended sessions, and history of childhood trauma by linear regression models. RESULTS: Twenty patients [15 women/5 men, median age 48 years (range: 23-73 years)] were recruited. The median number of scheduled sessions was 11 (range: 6-22); there were no drop-outs. After psychotherapy quality of life (QOLIE-31), global distress (BSI) and depression (BDI-II) scores improved significantly (p-values: QOLIE-31: 0.03; BSI: 0.01; BDI-II: 0.01). The largest improvements were achieved for the emotional well-being subscale of the QOLIE-31 (47%, p-value: 0.02), the global severity index of the BSI (83%), and depression severity (BDI-II) (60%). Linear regression models did not reveal any significant association between interim changes, number of attended treatment sessions, and history of childhood trauma. CONCLUSION: The results suggest that process-oriented and personalized psychotherapeutic has low attrition and results in improved quality of life and reduced psychiatric symptoms in people with epilepsy. Our findings indicate that responsiveness to psychotherapy is not dependent on the number of attended treatment sessions. Participants with childhood trauma did not need more treatment sessions to achieve an improvement. More research is needed to understand and address mechanisms and precursors of responsiveness to psychotherapy.

High-frequency monitoring of personalized psychological variables during outpatient psychotherapy in people with seizures: An uncontrolled feasibility study.

BACKGROUND: This feasibility study applied the concept of daily systematic monitoring of personalized psychological variables and investigated patients' compliance in order to evaluate if its integration in outpatient psychotherapy is feasible and if patients found the development and daily application of personalized questionnaires user-friendly and useful. METHODS: A naturalistic sample of patients with epilepsy (PWE) was enrolled to participate in an outpatient psychotherapy program. A personalized process questionnaire was developed with each patient based on an individual psychological system's model at the outset of therapy. Daily time-stamped self-assessments were collected during outpatient psychotherapy. This process-monitoring was technically realized by an internet-based device for data collection and data analysis, the Synergetic Navigation System (SNS). The reflection of person-specific time series informed by patients' replies to their personalized process questionnaire was integrated in the therapy process. Compliance rates were assessed during a period of six months (i.e., 180 days) after the first entry of the questionnaire [compliance rate = (number of completed questionnaires/180) × 100]. User-friendliness and usefulness of this process monitoring were evaluated quantitatively. RESULTS: Twenty patients [15 women/5 men, median age 48 years (range 23-73 years)] were recruited. Compliance rates were high (median: 93%, range 31-100%) among the participants. Participants reported a high overall satisfaction with the application and user-friendliness of SNS. CONCLUSION: The results support the feasibility of high-frequency monitoring of personalized psychological processes during outpatient psychotherapy. Repeated daily assessments of a personalized questionnaire yield highly resolved, equidistant time series data, which gives insight into individual psychological processes during outpatient psychotherapy.

What too strict a method obscures about the validity of outcome measures.

Objective: To assess the outcome of psychotherapeutic treatments, psychotherapy researchers often compare pre- and post-treatment scores on self-report outcome measures. In this paper, the common assumption is challenged that pre-to-post decreasing and increasing outcome scores are indicative of successful and failed therapies, respectively.Method: The outcome of 29 psychotherapeutic treatments was evaluated by means of quantitative analysis of pre- and post-treatment scores on commonly used outcome measures (such as the Symptom Checklist-90-R, the Inventory of Interpersonal Problems, and the General Health Questionnaire-12), as well as through consensual qualitative research.Results: Overall, a moderate to low convergence between qualitative and quantitative evaluations of outcome was observed. Detailed analyses of six cases are presented in which pre-to-post comparisons of outcome measures proved misleading.Conclusions: It is concluded that psychotherapy outcome research might benefit from assessment strategies that are sensitive to the singularities of individual treatments and to the complexity of the phenomenon of therapeutic outcome. Furthermore, classical psychometric evaluations of the validity of outcome measures might be supplemented with less-systematic evaluations that take any contingent source of information on outcome into account.

Long-Term Effects of Home-Based Family Therapy for Non-responding Adolescents With Psychiatric Disorders. A 3-Year Follow-Up.

OBJECTIVE: Home-based treatment of families with low socio-economic status and multiple psychosocial problems (multi-problem families, MPFs) is gaining importance in clinical social epidemiology and health services research. The sustainability of the treatment is of special importance in order to breach transgenerational effects. METHODS: We examined outcome, effect size, and clinical significance of home-based treatment for 84 multi-problem families in a naturalistic setting. 48 of the families were available for a follow-up after 3 years. The baseline characteristics of these family systems included low collaboration, an increased family adversity index, minors with high rates of child psychiatric disorders, a high prevalence of comorbidity, low relational family functioning, and adolescents who refused any form of treatment or had unilaterally terminated different forms of treatment before. The home-based family therapy consisted of one or two face-to-face counseling sessions per week over an average of 28.8 months (SD = 19.2). The symptoms and competence of the adolescents, the caregivers, and the family structure were assessed with 13 variables. RESULTS: All variables showed significant improvement rates (pre- vs. post- treatment) with medium to high effect sizes (mean of Cohen's d = 1.04, range = 0.34 - 2.18). All variables showed a sustained or even further improvement at follow-up. CONCLUSION: This study provides evidence of statistically (p), practically (d), and clinically (RCI) significant changes in symptom and competence-related variables among adolescents and caregivers in MPFs with sustainable long-term effects in the 3-year follow-up period.