Absolute and relative outcomes of psychotherapies for eight mental disorders: a systematic review and meta-analysis.

Psychotherapies are first-line treatments for most mental disorders, but their absolute outcomes (i.e., response and remission rates) are not well studied, despite the relevance of such information for health care users, providers and policy makers. We aimed to examine absolute and relative outcomes of psychotherapies across eight mental disorders: major depressive disorder (MDD), social anxiety disorder, panic disorder, generalized anxiety disorder (GAD), specific phobia, post-traumatic stress disorder (PTSD), obsessive-compulsive disorder (OCD), and borderline personality disorder (BPD). We used a series of living systematic reviews included in the Metapsy initiative (www.metapsy.org), with a common strategy for literature search, inclusion of studies and extraction of data, and a common format for the analyses. Literature search was conducted in major bibliographical databases (PubMed, PsycINFO, Embase, and the Cochrane Register of Controlled Trials) up to January 1, 2023. We included randomized controlled trials comparing psychotherapies for any of the eight mental disorders, established by a diagnostic interview, with a control group (waitlist, care-as-usual, or pill placebo). We conducted random-effects model pairwise meta-analyses. The main outcome was the absolute rate of response (at least 50% symptom reduction between baseline and post-test) in the treatment and control conditions. Secondary outcomes included the relative risk (RR) of response, and the number needed to treat (NNT). Random-effects meta-analyses of the included 441 trials (33,881 patients) indicated modest response rates for psychotherapies: 0.42 (95% CI: 0.39-0.45) for MDD; 0.38 (95% CI: 0.33-0.43) for PTSD; 0.38 (95% CI: 0.30-0.47) for OCD; 0.38 (95% CI: 0.33-0.43) for panic disorder; 0.36 (95% CI: 0.30-0.42) for GAD; 0.32 (95% CI: 0.29-0.37) for social anxiety disorder; 0.32 (95% CI: 0.23-0.42) for specific phobia; and 0.24 (95% CI: 0.15-0.36) for BPD. Most sensitivity analyses broadly supported these findings. The RRs were significant for all disorders, except BPD. Our conclusion is that most psychotherapies for the eight mental disorders are effective compared with control conditions, but absolute response rates are modest. More effective treatments and interventions for those not responding to a first-line treatment are needed.

We Might Have a Sports Gambling Problem and It Is Not What You Think: A Commentary.

The 2018 Supreme Court decision on Murphy v. National Collegiate Athletic Association brought not only a change in the United States commercial gambling landscape, but also considerable speculation across public forums about whether expanded sports gambling causes new, distinct, and greater harm than existing legal forms of gambling. This commentary brings into the focus that the definition of this form of gambling has recently begun to shift without a theoretical basis or empirical evidence. To bring evidence to bear, there is a need for a precise operational definition of sport gambling and greatly clarity to the questions that can drive knowledge generation.

The Influence of Gambling on Mood State and Alcohol Cravings.

Several decades of research have experimentally investigated the influence of alcohol on gambling. However, there has been only minimal experimental exploration of how gambling influences alcohol use. The aim of the current project was to evaluate how gambling influenced mood state and alcohol cravings through randomized experimental design when analyzed with comparison conditions.College students (N = 76) who reported regular alcohol use, gambling within the past year, and being college basketball fans were randomly assigned to watch a video of an exciting basketball game, watch a nondysphoric basketball game, watch a movie, or engage in slot machine gambling. Participants who watched exciting sports or engaged in gambling to reported more energized mood states and higher urges to drink compared to those who watched nondysphoric sports or a movie. These results suggest that the context of gambling may prime individuals to want to consume alcohol.

Cognitive-behavioral treatment for gambling harm: Umbrella review and meta-analysis.

The aim of the current umbrella review and meta-analysis was to evaluate the methodological rigor of existing meta-analyses on cognitive-behavioral treatment (CBT) for gambling harm. The Cochrane Database of Systematic Reviews, PsycINFO, and PubMed were searched for meta-analyses of CBT for gambling harm among individuals aged 18 years and older. The search yielded five meta-analyses that met inclusion criteria, representing 56 unique studies and 5389 participants. The methodological rigor for one meta-analyses was rated high, two were moderate, and two were critically low. Including only moderate- to high-quality meta-analyses, a robust variance estimation meta-analysis indicated that CBT significantly reduced gambling disorder severity (g = -0.91), gambling frequency (g = -0.52), and gambling intensity (g = -0.32) relative to minimal and no treatment control at posttreatment, suggesting 65%-82% of participants receiving CBT will show greater reductions in these outcomes than minimal or no treatment controls. Overall, there is strong evidence for CBT in reducing gambling harm and gambling behavior, and this evidence provides individuals, clinicians, managed care companies, and policymakers with clear recommendations about treatment selection.

What was a gap is now a chasm: Remote schooling, the digital divide, and educational inequities resulting from the COVID-19 pandemic.

COVID-19 resulted in the unexpected transition to remote learning for K-12 schools, exacerbating the existing digital divide and impacting the educational outcomes of marginalized youth. This article reviews the literature on the impacts of the pandemic on the educational outcomes of marginalized youth due to remote learning and the digital divide. Here, we provide an overview of the pandemic and remote schooling from an intersectional lens, discuss the impacts of the digital divide on learning for students during the pandemic, and then consider impacts on the delivery of special education supports. Additionally, we review the literature on the widening achievement gap in relation to the COVID-19 pandemic. Future directions for research and practice are discussed.

Contrasting the Effects of Alcohol and Alcohol Expectancies on Gambling Behavior.

The influence of alcohol on risk-taking may be through both pharmacological action and individual expectancies. A recent meta-analysis highlighted the need for evidence about the precise role of alcohol expectations on individuals' gambling behavior while under the influence of alcohol and a need to understand what specific gambling behaviors are influenced. This laboratory study investigated the effects of alcohol consumption and alcohol expectancies on gambling behavior in a sample of young adult men. Thirty-nine participants were randomly assigned to one of three experimental conditions in which they consumed alcohol, alcohol-placebo, or no-alcohol beverages and then played a computerized roulette game. The roulette game provided each participant with the same pattern of wins and losses and recorded gambling behavior including wagers made, number of spins, and final dollar amount remaining. Significant main effects were found between conditions on total number of spins with the alcohol and alcohol-placebo groups gambling significantly more than the no-alcohol group. The alcohol and alcohol-placebo groups were not statistically different. These findings support that individuals' expectations play an important role in understanding the effects of alcohol consumption on gambling; this effect may be primarily associated with persistence in wagering.

Effect of cognitive-behavioral techniques for problem gambling and gambling disorder: A systematic review and meta-analysis.

AIMS: To measure the effect of cognitive-behavioral techniques (CBTs) on gambling disorder severity and gambling behavior at post-treatment and follow-up. METHOD: Seven databases and two clinical trial registries were searched to identify peer-reviewed studies and unpublished studies of randomized controlled trials. The Cochrane Risk of Bias tool assessed risk of bias in the included studies. A random effect meta-analysis with robust variance estimation was conducted to measure the effect of CBTs relative to minimally treated or no treatment control groups. RESULTS: Twenty-nine studies representing 3991 participants were identified. CBTs significantly reduced gambling disorder severity (g = -1.14, 95% CI = -1.68, -0.60, 95% prediction interval [PI] = -2.97, 0.69), gambling frequency (g = -0.54, 95% CI = -0.80, -0.27, 95% PI = -1.48, 0.40) and gambling intensity (g = -0.32, 95% CI = -0.51, -0.13, 95% PI = -0.76, 0.12) at post-treatment relative to control. CBTs had no significant effect on follow-up outcomes. Analyses supported the presence of publication bias and high heterogeneity in effect size estimates. CONCLUSIONS: Cognitive-behavioral techniques are a promising treatment for reducing gambling disorder and gambling behavior; however, the effect of cognitive-behavioral techniques on gambling disorder severity and gambling frequency and intensity at post-treatment is overestimated, and cognitive-behavioral techniques may not be reliably efficacious for all individuals seeking treatment for problem gambling and gambling disorder.

Relative and Interactive Associations of Psychosocial Intervention and Alcoholics Anonymous Attendance With Alcohol Use Disorder Outcomes.

OBJECTIVE: Psychosocial intervention and Alcoholics Anonymous (AA)/mutual help organization attendance are both associated with alcohol use disorder (AUD) outcomes. However, no research has explored the relative or interactive associations of psychosocial intervention and AA attendance with AUD outcomes. METHOD: This was a secondary analysis of data from the Project MATCH (Matching Alcoholism Treatments to Client Heterogeneity) outpatient arm participants (N = 952), who were randomly assigned to complete 12-session cognitive-behavioral therapy (CBT, n = 301), 12-session 12-step facilitation (TSF, n = 335), or 4-session motivational enhancement therapy (MET, n = 316). Regression analyses tested the association of psychosocial intervention attendance only, AA attendance only (measured as past-90-day attendance immediately after psychosocial intervention, as well as 1 and 3 years after intervention), and their interaction with the percentage of drinking days and percentage of heavy drinking days after intervention, 1 year after intervention, and 3 years after intervention. RESULTS: When accounting for AA attendance and other variables, attending more psychosocial intervention sessions was consistently associated with fewer drinking days and heavy drinking days after intervention. AA attendance was consistently associated with a lower percentage of drinking days at 1 and 3 years after intervention, when accounting for psychosocial intervention attendance and other variables. Analyses failed to identify an interaction between psychosocial intervention attendance and AA attendance with AUD outcomes. CONCLUSIONS: Psychosocial intervention and AA attendance are robustly associated with better AUD outcomes. Replication studies comprising samples of individuals who attend AA more than once per week are needed to further test the interactive association of psychosocial intervention attendance and AA attendance with AUD outcomes.

Effects of cognitive behavioral techniques for gambling on recovery defined by gambling, psychological functioning, and quality of life: A systematic review and meta-analysis.

OBJECTIVE: Individuals who experience gambling harms report that sustained recovery involves changing both gambling behaviors and psychological symptoms, as well as building a meaningful life. However, there is limited understanding about the effect of cognitive behavioral (CB) techniques on psychological symptoms and quality of life. The purpose of the present study was to examine the effect of CB techniques for gambling-related harms on broader recovery outcomes such as psychological symptoms and quality of life. METHOD: A systematic article search was conducted to identify randomized controlled trials of CB techniques with nonactive and minimal treatment control groups that assessed psychological symptoms or quality of life as outcomes. Random-effects meta-analysis was used to examine the effect of CB techniques relative to nonactive and minimal treatment control groups. RESULTS: A total of nine studies representing 658 participants were included. Eight studies reported outcomes on depression and anxiety, three on substance use, and six on quality of life. CB techniques significantly reduced anxiety (g = -0.44) and depression (g = -0.35) at posttreatment, but not substance use. CB techniques also significantly increased quality of life at posttreatment (g = 0.40). There was a large amount of heterogeneity suggesting the magnitude of effects could vary significantly in future randomized trials. CONCLUSIONS: Future studies should examine the longitudinal associations between gambling harms, psychological symptoms, and quality of life and to assess whether changes in gambling harms throughout treatment precede or are a consequence of changes in psychological symptoms and quality of life. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Using machine learning to examine predictors of treatment goal change among individuals seeking treatment for alcohol use disorder.

INTRODUCTION: The goals of individuals seeking treatment for alcohol use disorder (AUD) are typically quantified as abstinent or nonabstinent (e.g., moderate drinking) goals. However, treatment goals can vary over time and be influenced by life circumstances. This study aims to identify predictors of treatment goal change and direction of change from baseline to six-month follow-up among individuals seeking treatment for AUD. METHODS: This study is a secondary analysis of data from the Relapse Replication and Extension Project. The study included participants who completed assessments at baseline and six-month follow-up in the analysis (n = 441). We used decision trees to examine 111 potential predictors of treatment goal change. The study cross-validated results using random forests. The team examined changes in goal between baseline and follow-up (Decision Tree 1) and quantified them as being toward or away from a complete abstinence goal (Decision Tree 2). RESULTS: Nearly 50 % of the sample changed their treatment goal from baseline to 6 months, and 68.7 % changed from a nonabstinence goal toward a complete abstinence goal. The study identified seven unique predictors of goal change. The most common predictors of changing a treatment goal were number of recent treatment sessions prior to enrolling in the study, other substance use, negative affect, anxiety, social support, and baseline drinks per drinking day. Participants with a greater number of recent treatment sessions and who sought social support were most likely to change their goal. Additionally, individuals with more substance use tended to change away from complete abstinence goals. Cross-validation supported baseline drinks per drinking day, social support, baseline maximum blood alcohol concentration (BAC), lifetime tobacco use, baseline average BAC, lifetime cocaine use, Inventory of Drinking Situations total score, and Situational Confidence Questionnaire average score as important predictors. CONCLUSIONS: This study identified seven unique predictors of treatment goal change while in AUD treatment. Prior treatment, drinking to cope, and social support were most associated with goal changes. This information can inform providers who seek to understand factors associated with treatment goal selection and changes in goals during treatment.

Text Comprehension Analyses to Improve Assessment Accuracy: Demonstration Using Gambling Disorder Screening.

Many individuals diagnosed with an addictive disorder are members of disadvantaged groups and obtain a high school education or less, yet self-report questionnaires widely used to identify symptoms of addictive disorders do not use best practices to ensure item clarity and comprehension. In the present study, we explore how advanced text-analysis technology can be used to guide the development of a diagnostic questionnaire with an emphasis on maximizing its readability and then test the accuracy of this questionnaire. In Study 1, a self-report questionnaire for symptoms of gambling disorder was created using best practices for item clarity and comprehension. In study 2 an experimental design was used to test whether the measure with enhanced readability, compared to a commonly used screening instrument, improved diagnostic symptom accuracy among samples of high school and college educated individuals. Subsequent analyses revealed that education was positively related to item comprehension, and participants who completed the maximized readability questionnaire correctly identified more symptoms of gambling disorder than participants who completed the comparison questionnaire, regardless of educational attainment. These studies indicate that the rate at which individuals accurately identify symptoms of psychopathology is strongly related to their educational attainment and the readability of the questionnaire items themselves.

Mechanisms of Behavior Change in Substance Use Disorder With and Without Formal Treatment.

This article provides a narrative review of studies that examined mechanisms of behavior change in substance use disorder. Several mechanisms have some support, including self-efficacy, craving, protective behavioral strategies, and increasing substance-free rewards, whereas others have minimal support (e.g., motivation, identity). The review provides recommendations for expanding the research agenda for studying mechanisms of change, including designs to manipulate putative change mechanisms, measurement approaches that expand the temporal units of analysis during change efforts, more studies of change outside of treatment, and analytic approaches that move beyond mediation tests. The dominant causal inference approach that focuses on treatment and individuals as change agents could be expanded to include a molar behavioral approach that focuses on patterns of behavior in temporally extended environmental contexts. Molar behavioral approaches may advance understanding of how recovery from substance use disorder is influenced by broader contextual features, community-level variables, and social determinants of health.

Using Decision Trees to Identify Salient Predictors of Cannabis-Related Outcomes.

Cannabis use continues to escalate among emerging adults and college attendance may be a risk factor for use. Severe cases of cannabis use can escalate to a cannabis use disorder, which is associated with worse psychosocial functioning. Predictors of cannabis use consequences and cannabis use disorder symptom severity have been identified; however, they typically employ a narrow set of predictors and rely on linear models. Machine learning is well suited for exploratory data analyses of high-dimensional data. This study applied decision tree learning to identify predictors of cannabis user status, negative cannabis-related consequences, and cannabis use disorder symptoms. Undergraduate college students (N = 7000) were recruited from nine universities in nine states across the U.S. Among the 7 trees, 24 splits created by 15 distinct predictors were identified. Consistent with prior research, one's beliefs about cannabis were strong predictors of user status. Negative reinforcement cannabis use motives were the most consistent predictors of cannabis use disorder symptoms, and past month cannabis use was the most consistent predictor of probable cannabis use disorder. Typical frequency of cannabis use was the only predictor of negative cannabis-related consequences. Our results demonstrate that decision trees are a useful methodological tool for identifying targets for future clinical research.

The Predicted Future of Psychotherapy: A Decennial e-Delphi Poll.

Whither psychotherapy in the 2030s? Following a decennial tradition, the authors conducted an e-Delphi poll on the future of psychotherapy in the United States. A panel of 56 psychotherapy experts participated in two rounds of predictions and achieved consensus on most items. The experts forecast multicultural, mindfulness, and cognitive-behavior therapies to increase the most, whereas classical psychoanalysis, reality therapy, and gestalt therapy to decrease the most. Technological, relationship-building, strength-oriented, skill-building, and self-change interventions were expected to rise. Master-level clinicians of multiple professions were projected to expand while psychiatrists to decline in the proportion of psychotherapy rendered. Therapy platforms with the highest likelihood of flourishing were videoconferencing, texting, smartphone applications, and multiple or flexible platforms. Short-term therapy, crisis intervention, and very short-term therapy were predicted to increase the most. Forecast scenarios with the highest likelihood were therapy personalization, treatment of health problems, requirement of evidence-based practices for insurance reimbursement, and integration of psychotherapy into primary care. Limitations of the Delphi methodology are elucidated, and practice implications for health-service psychologists are advanced.

The impact of marijuana use on cocaine use outcomes among patients in methadone maintenance treatment across five trials of contingency management.

OBJECTIVE: Cocaine use is prevalent among patients in methadone maintenance and a risk factor for poor treatment outcomes. Contingency management (CM) decreases cocaine use in this population, but little is known about its efficacy when marijuana use is present prior to or during treatment. METHOD: Data from five randomized CM trials (N = 557) were used to evaluate whether: (a) marijuana frequency (none, low, or high) prior to or during treatment impacts cocaine use outcomes and (b) marijuana use differentially impacts cocaine outcomes with standard care (SC) + CM versus SC alone. RESULTS: Relative to no marijuana use, low (ß = .28, p < .01) and high marijuana use (ß = .32, p < .05) during treatment were associated with roughly 1 week shorter duration of cocaine abstinence on average. Low marijuana use (ß = .71, p < .05) during treatment was associated with a lower proportion of negative cocaine samples during treatment relative to no marijuana use. Treatment group by marijuana use (before or during treatment) interactions on duration and proportion of cocaine abstinence during treatment were not significant. For longer term outcomes, in SC + CM, marijuana use during treatment did not impact cocaine abstinence 6 months post-baseline. In SC, low (OR = .44, p < .05) and high (OR = .26, p < .001) marijuana use during treatment decreased odds of cocaine abstinence at 6 months post-baseline relative to no use. CONCLUSIONS: Findings highlight the benefits of SC + CM and abstaining from marijuana use during active treatment. At 6 months postbaseline, SC + CM evidenced similar cocaine abstinence regardless of marijuana use levels during treatment, while those with low and high marijuana use showed decreased abstinence rates in SC only. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Contingency management for treatment attendance: A meta-analysis.

BACKGROUND: Treatment providers have applied contingency management (CM) treatment, an intervention that often rewards individuals for drug abstinence (i.e., ABS CM), to treatment engagement as well. However, we know little about the magnitude of treatment effects when providers target attendance behaviors (i.e., ATT CM). METHODS: This study conducted a systematic search to identify studies that included ATT CM, either in isolation or in combination with ABS CM. The study used meta-analysis to estimate the effect size of ATT CM and ABS CM + ATT CM on treatment attendance and drug abstinence. We identified a total of 10 studies including 12 CM treatments (6 ATT CM and 6 ABS CM + ATT CM) with 1841 participants. RESULTS: Results indicated a moderate effect (d = 0.47, 95% confidence interval (CI) [0.25, 0.69]) of ATT CM on attendance relative to non-reward active comparison conditions. Frequency of rewards was significantly associated with larger effect sizes. Results also indicated a small effect (d = 0.22, 95% CI [0.12, 0.33]) of ATT CM on abstinence outcomes relative to nonreward comparisons, p < 0.001. The study found no significant differences in attendance or abstinence between ATT CM and ABS CM + ATT CM (p's > 0.05). CONCLUSION: Overall, the results supported ATT CM for increasing treatment engagement, with smaller effects on abstinence. Effects on abstinence were smaller than those observed in prior meta-analyses focused on ABS CM. No significant differences existed in attendance or abstinence outcomes between ATT CM and ABS + ATT CM. However, future studies are needed to experimentally compare ABS CM + ATT CM to ABS CM, and ATT CM to determine additive effects. Clinics implementing CM should consider the differential effects between ATT CM and ABS CM when selecting target behavior(s).

Nonstigmatizing and Precise Terminology to Describe Processes and Outcomes in Addiction Medicine.

ABSTRACT: Scholarly journals and professional organizations in addiction medicine have recently discussed the importance of adopting nonstigmatizing and precise terminology. The present commentary expands that ongoing discussion to terms related to treatment processes and outcomes. Four implicit assumptions of stigmatizing and imprecise terms related to treatment processes and outcomes are overviewed, and research evidence against these assumptions is presented. The commentary ends with recommendations for the use of positive behavioral indicators of processes and outcomes and, more importantly, accompanying them with nonevaluative, objective descriptors of patients' behaviors.

Dropout from face-to-face, multi-session psychological treatments for problem and disordered gambling: A systematic review and meta-analysis.

OBJECTIVE: The aims of this systematic review and meta-analysis were to examine the overall prevalence of dropout from psychological treatments for problem gambling and gambling disorder and to examine how study, client, and treatment variables influenced dropout rates. METHOD: A systematic search was conducted to identify studies of cognitive and/or behavioral therapies and motivational interventions for problem gambling and gambling disorder. Meta-analysis was used to calculate an overall weighted dropout rate. Random effect meta-regressions were used to examine covariates of dropout rates. Mixed-effect subgroup analyses were used to examine moderators of dropout rates. RESULTS: The systematic search identified 24 studies (31 dropout rates) comprising 2,791 participants. Using a random-effects model, the overall weighted dropout rate was 39.1%, 95% CI [33.0%, 45.6%]. Increases in the percentage of married participants were significantly associated with lower dropout rates. Dropout rates were significantly higher when dropout was defined as attending all sessions of a treatment protocol compared to when defined as attending a prespecified number of sessions different from the total in the protocol and when defined as study therapists judging participants to be dropouts. Insufficient reporting of some gambling-related variables and other psychological symptom variables prevented a thorough examination of covariates and moderators. CONCLUSIONS: A large proportion of individuals drop out of treatment for problem gambling and gambling disorder. Future research should examine the reasons for dropout across marital statuses and should adopt dropout definitions that consider session-by-session symptom change. (PsycInfo Database Record (c) 2021 APA, all rights reserved).