Mental health of help-seeking outpatients pre and post COVID-19: A real-world data, multicentre study.

OBJECTIVE: A great deal of research addresses the mental health implications of the COVID-19 pandemic for the general population. Little is known about the implications for mental health of help-seeking outpatients and for the effectiveness of mental health services. The present study investigated the mental health and treatment response of help-seeking outpatients before and during the COVID-19 pandemic. METHOD: Routine outcome monitoring data from 3706 clients in the United States and Northern Europe was analysed using multilevel modelling with global subjective well-being as the dependent variable. RESULTS: As opposed to before the pandemic, during the pandemic, well-being scores were significantly higher at intake and improvement throughout treatment was significantly smaller in the US sample, while both were comparable in the EU sample. CONCLUSION: Although there is also evidence of less effective treatments since the pandemic, no conclusive picture emerges that portrays the impact of the pandemic on mental health as uniform. More research is needed to elucidate the impact of the pandemic on the help-seeking population.

Tropical forests are approaching critical temperature thresholds.

The critical temperature beyond which photosynthetic machinery in tropical trees begins to fail averages approximately 46.7 °C (Tcrit)1. However, it remains unclear whether leaf temperatures experienced by tropical vegetation approach this threshold or soon will under climate change. Here we found that pantropical canopy temperatures independently triangulated from individual leaf thermocouples, pyrgeometers and remote sensing (ECOSTRESS) have midday peak temperatures of approximately 34 °C during dry periods, with a long high-temperature tail that can exceed 40 °C. Leaf thermocouple data from multiple sites across the tropics suggest that even within pixels of moderate temperatures, upper canopy leaves exceed Tcrit 0.01% of the time. Furthermore, upper canopy leaf warming experiments (+2, 3 and 4 °C in Brazil, Puerto Rico and Australia, respectively) increased leaf temperatures non-linearly, with peak leaf temperatures exceeding Tcrit 1.3% of the time (11% for more than 43.5 °C, and 0.3% for more than 49.9 °C). Using an empirical model incorporating these dynamics (validated with warming experiment data), we found that tropical forests can withstand up to a 3.9 ± 0.5 °C increase in air temperatures before a potential tipping point in metabolic function, but remaining uncertainty in the plasticity and range of Tcrit in tropical trees and the effect of leaf death on tree death could drastically change this prediction. The 4.0 °C estimate is within the 'worst-case scenario' (representative concentration pathway (RCP) 8.5) of climate change predictions2 for tropical forests and therefore it is still within our power to decide (for example, by not taking the RCP 6.0 or 8.5 route) the fate of these critical realms of carbon, water and biodiversity3,4.

Measurement-based care professional practice guideline: Fine, but guidelines do not make good therapy.

Boswell et al. (2022) persuasively make the case for and propose professional practice guidelines (PPG) for measurement-based care (MBC). Although the evidence for MBC is robust, implementing MBC effectively in practice requires skills and processes not discussed in the PPG. We discuss five problems with the PPG for MBC: The "what's in a name?" problem, lack of actionable actions problem, the stopwatch problem, the stock market problem, and looking for the keys under the light problem. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Foraging ecology of critically endangered Eastern Pacific hawksbill sea turtles (Eretmochelys imbricata) in the Gulf of California, Mexico.

The Eastern Pacific hawksbill sea turtle population is one of the most endangered of all sea turtle species. Here, we examine the foraging ecology of 47 hawksbill turtles (40.5-90.3 cm CCL, mean = 54.1 ± 10.1 cm) around Isla San José, Gulf of California, Mexico by integrating information from passive acoustic telemetry, behavior recordings, fecal analysis, and habitat surveys. Tagged hawkbill turtles exhibited high site fidelity over months and years (tracking duration 1-1490 days, mean = 255 ± 373 days) to the location and benthic habitat where individuals were initially caught. Diet was dominated by benthic invertebrates and algae including sponges, algae, tunicates, and mangrove roots. The mean percent cover of these benthic food items was significantly greater in the mangrove estuary than in adjacent rocky and sandy reef habitats. The Isla San José foraging ground is a high-use area for hawksbills and should be granted national protection status.

Spatial covariation in nutrient enrichment and fishing of herbivores in an oceanic coral reef ecosystem.

Both natural and anthropogenic stressors are increasing on coral reefs, resulting in large-scale loss of coral and potential shifts from coral- to macroalgae-dominated community states. Two factors implicated in shifts to macroalgae are nutrient enrichment and fishing of reef herbivores. Although either of these factors alone could facilitate establishment of macroalgae, reefs may be particularly vulnerable to coral-to-algae phase shifts in which strong bottom-up forcing from nutrient enrichment is accompanied by a weakening of herbivore control of macroalgae via intense fishing. We explored spatial heterogeneity and covariance in these drivers on reefs in the lagoons of Moorea, French Polynesia, where the local fishery heavily targets herbivorous fishes and there are spatially variable inputs of nutrients from agricultural fertilizers and wastewater systems. Spatial patterns of fishing and nutrient enrichment were not correlated at the two landscape scales we examined: among the 11 interconnected lagoons around the island or among major habitats (fringing reef, mid-lagoon, back reef) within a lagoon. This decoupling at the landscape scale resulted from patterns of covariation between enrichment and fishing that differed qualitatively between cross-shore and long-shore directions. At the cross-shore scale, nutrient enrichment declined but fishing increased from shore to the crest of the barrier reef. By contrast, nutrient enrichment and fishing were positively correlated in the long-shore direction, with both increasing with proximity to a pass in the barrier reef. Contrary to widespread assumptions in the scientific literature that human coastal population density correlates with impact on marine ecosystems and that fishing effort declines linearly with distance from the shore, these local stressors produced a complex spatial mosaic of reef vulnerabilities. Our findings support spatially explicit management involving the control of anthropogenic nutrients and strategic reductions in fishing pressure on herbivores by highlighting specific areas to target for management actions.

Use of Psychics for Stress and Emotional Problems: A Descriptive Survey Comparison with Conventional Providers and Informal Helpers.

Conventional mental health treatments do not meet the needs of all who seek help: some consult informal and alternative providers. Researching the use and perceived benefits of these non-conventional sources of help may contribute to understanding help-seeking behavior and inform mental health policy. We explored the experiences of people consulting psychics (a type of alternative provider) for mental health needs, through comparisons with experiences of people consulting conventional and informal providers. An online survey sought feedback on help seeking for stress or emotional problems from 734 adults who had consulted a psychologist or counsellor; doctor or psychiatrist who prescribed medication; friend or family member; or psychic or similar alternative provider. Analyses included descriptive and inferential statistics and content analysis of textual responses. Problems were commonly described in symptom or disorder terminology with considerable overlap across groups. Content analysis of reasons for choice of helper identified four main categories-functional, reasoned, emotional, and passive-which differed significantly across groups (Cramer's V = 0.26), with consulting psychics predominantly a reasoned choice. Ratings of overall effectiveness of help by those consulting psychics were greater than for the three other groups (d = 0.31 to 0.42), with very few adverse outcomes in any group. Help seeking for stress or emotional problems includes consultations with psychics or similar alternative providers, with self-reported outcomes better than for conventional providers. Further research is warranted to establish whether psychic consultations may serve a useful public health function.

Spanish Versions of the Outcome Rating Scale and the Session Rating Scale: Normative Data, Reliability, and Validity.

Routine outcome monitoring (ROM) uses standardized measures to both track and inform mental health service delivery. Use of ROM has been shown to improve the outcome of psychotherapy when applied to different types of patients. The present research was designed to determine the reliability and validity of the Outcome Rating Scale (ORS) and the Session Rating Scale (SRS) in a sample of Spanish patients. After a controlled process of translation into the Spanish that is spoken and written in Spain (i.e., in Europe, as distinct from, e.g., Latin American Spanish), both measures were completed by patients of an outpatient mental health unit during eight sessions of psychotherapy. Sixty mental health patients filled out the ORS and 59 the SRS. In addition, the ORS was completed by 33 people who constituted the non-clinical sample. The cut-off of the ORS was 24.52 points, and the Reliable Change Index (RCI) was 9.15 points. ORS and SRS scores exhibited excellent internal consistency. The temporal stability of the SRS was adequate. The convergent and discriminant validity of the two measures were adequate. Regarding the factorial validity of the ORS and the SRS, in the third psychotherapy session, confirmatory factor analyses evidenced the existence of a unifactorial model. The predictive validity of SRS was acceptable. The ORS was sensitive to changes in patients' symptoms. In conclusion, compared to the original English versions of the ORS and SRS measures, the Spanish versions of the measures are also reliable and valid.

Caribbean reefs of the Anthropocene: Variance in ecosystem metrics indicates bright spots on coral depauperate reefs.

Dramatic coral loss has significantly altered many Caribbean reefs, with potentially important consequences for the ecological functions and ecosystem services provided by reef systems. Many studies examine coral loss and its causes-and often presume a universal decline of ecosystem services with coral loss-rather than evaluating the range of possible outcomes for a diversity of ecosystem functions and services at reefs varying in coral cover. We evaluate 10 key ecosystem metrics, relating to a variety of different reef ecosystem functions and services, on 328 Caribbean reefs varying in coral cover. We focus on the range and variability of these metrics rather than on mean responses. In contrast to a prevailing paradigm, we document high variability for a variety of metrics, and for many the range of outcomes is not related to coral cover. We find numerous "bright spots," where herbivorous fish biomass, density of large fishes, fishery value, and/or fish species richness are high, despite low coral cover. Although it remains critical to protect and restore corals, understanding variability in ecosystem metrics among low-coral reefs can facilitate the maintenance of reefs with sustained functions and services as we work to restore degraded systems. This framework can be applied to other ecosystems in the Anthropocene to better understand variance in ecosystem service outcomes and identify where and why bright spots exist.

Transesophageal echocardiography guidance for atrial-caval thrombus removal with the AngioVac system.

Thromboembolectomy is often guided with fluoroscopy. For intracardiac and great vessel thromboemboli, transesophageal echocardiography (TEE) can assess these thrombi, guide precise suction catheter placement, prevent intracardiac injury, and serve as a hemodynamic monitor. TEE can also be used to assess blood flow and thrombotic material reduction following embolectomy. TEE is a low-risk, high-value, real-time imaging modality that facilitates thromboembolectomy and increases patient safety.

Routine monitoring of therapeutic alliance to predict treatment engagement in a Veterans Affairs substance use disorders clinic.

Measurement-based care (MBC) can improve mental health treatment outcomes and is a priority within the Department of Veterans Affairs (VA). However, to date, MBC efforts within the VA have focused on assessment of psychological symptoms to the exclusion of psychotherapy process variables such as the therapeutic alliance that may predict treatment response. This quality improvement project involved the implementation of routine monitoring of alliance within a VA substance use disorder (SUD) clinic predominantly serving veterans with serious mental illness. Alliance ratings were provided by 98 veterans following group therapy sessions. Low alliance ratings were used by the clinicians (n = 4) leading the groups (n = 9) as opportunities to discuss veterans' treatment experience and increase engagement. Using multilevel models that accounted for the nested nature of the data and veteran demographics, alliance ratings showed a small increase over time (B = 0.075, p < .001, f2 = 0.033). In addition, maximum alliance rating (i.e., patients' highest rating of alliance across all observations) was significantly but modestly associated with attendance at both MBC group sessions and all SUD-related visits in the 3 months following the initial alliance rating (Bs = 0.96 and 1.79; ps = .006 and .004; f2s = 0.079 and 0.088, respectively). Average alliance rating, however, was not associated with treatment attendance (ps > .050). Findings suggest that assessment of alliance is feasible within a VA SUD clinic and may provide information signaling risk for disengagement that could be used for increasing treatment engagement. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

The Child Outcome Rating Scale: validating a four-item measure of psychosocial functioning in community and clinic samples of children aged 10-15.

Psychosocial functioning is considered an important and valued outcome in relation to young people's mental health as a construct distinct from psychiatric symptomology, especially in the light of an increasing focus on transdiagnostic approaches. Yet, the level of psychosocial functioning is rarely directly asked of young people themselves, despite the widespread recognition that the young person's perspective is valuable and is often at odds with those of other reporters, such as parents or professionals. One possible reason for this is that the field lacks a clear agreed tool to capture this information in a non-burdensome way. To begin to address this gap, this paper describes psychometric analysis of the Child Outcome Rating Scale (CORS), a brief and highly accessible self-report measure of young people's psychosocial functioning already used extensively by mental health professionals around the world but with only limited data on psychometric robustness. Using large community (n = 7822) and clinic (n = 2604) samples, we explore the factor structure, construct validity, internal consistency, differential item functioning, and sensitivity of the CORS. We found that the CORS stands up to psychometric scrutiny, having found satisfactory levels of reliability, validity, and sensitivity in this sample. We also found that the CORS is suitable for use with young people as old as 15 years old. That the CORS has been found to be psychometrically robust while being highly feasible (brief, simple, easy to administer) for use in busy clinical settings, combined with the fact that the CORS has already been widely adopted by clinicians and young people, suggests CORS may be an important tool for international use.

Does the working alliance mediate the effect of routine outcome monitoring (ROM) and alliance feedback on psychotherapy outcomes? A secondary analysis from a randomized clinical trial.

Little is known about the mechanisms through which routine outcome monitoring (ROM) influences psychotherapy outcomes. In this secondary analysis of data from a randomized clinical trial (Brattland et al., 2018), we investigated whether the working alliance mediated the effect of the Partners for Change Outcome Monitoring System (PCOMS), a ROM system that provides session-by-session feedback on clients' well-being and the alliance. Adult individuals (N = 170) referred for hospital-based outpatient mental health treatment were randomized to individual psychotherapy either with the PCOMS ROM system, or without (treatment as usual [TAU]). Treatment was provided by the same therapists (N = 20) in both conditions. A multilevel mediation model was developed to test if there was a significant indirect effect of ROM on client impairment at posttreatment through the alliance at 2 months' treatment controlled for first-session alliance. Alliance ratings increased more from session 1 to 2 months' treatment in the ROM than TAU condition, and alliance increase was associated with less posttreatment impairment. A significant indirect effect of ROM on treatment outcomes through alliance increase (p = .043) explained an estimated 23.0% of the effect of ROM on outcomes. The results were consistent with a theory of the alliance as one mechanism through which ROM works. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Psychometric Properties of the Outcome Rating Scale (ORS) in a Spanish Clinical Sample.

The Outcome Rating Scale (ORS) is an ultra-brief measure of well-being designed to track outcome in psychotherapy. This research studied the psychometric properties of the ORS in a Spanish clinical sample. One-hundred and sixty-five adult participants from different primary care centers of the city of Barcelona were recruited. The psychometric properties of the ORS in the sample were explored and described, comparing them to the properties of other instruments already validated in Spain. Our results showed good reliability (α = .91 [.88, .93]; α = .96; test re-test correlations from .61 to .84), good validity (convergent validity correlations with distress and symptoms measures from -.32 to -.76), and good sensitivity to change (pre-post comparison through Wilcoxon signed-rank test, Mdnpre = 31.0, Mdnpost = 19.6, z = -7.38, p < .05, r = .42). These results are consistent with previous findings in other countries. We conclude suggesting that the instrument can be applied to monitor outcome in psychotherapy and to test the effectiveness of treatments imparted with Spanish speaking clients. However, further research with the ORS in Spanish could provide more evidence of its psychometric properties.

Psychometric properties of the outcome rating scale (ORS) in a Spanish clinical sample

The Outcome Rating Scale (ORS) is an ultra-brief measure of well-being designed to track outcome in psychotherapy. This research studied the psychometric properties of the ORS in a Spanish clinical sample. One-hundred and sixty-five adult participants from different primary care centers of the city of Barcelona were recruited. The psychometric properties of the ORS in the sample were explored and described, comparing them to the properties of other instruments already validated in Spain. Our results showed good reliability (alfa = .91 [.88, .93]; alfa = .96; test re-test correlations from .61 to .84), good validity (convergent validity correlations with distress and symptoms measures from -.32 to -.76), and good sensitivity to change (pre-post comparison through Wilcoxon signed-rank test, Mdnpre = 31.0, Mdnpost = 19.6, z = -7.38, p < .05, r = .42). These results are consistent with previous findings in other countries. We conclude suggesting that the instrument can be applied to monitor outcome in psychotherapy and to test the effectiveness of treatments imparted with Spanish speaking clients. However, further research with the ORS in Spanish could provide more evidence of its psychometric properties

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Preliminary validation of the Rating of Outcome Scale and equivalence of ultra-brief measures of well-being.

Three brief psychotherapy outcome measures were assessed for equivalence. The Rating of Outcome Scale (ROS), a 3-item patient-reported outcome measure, was evaluated for interitem consistency, test-retest reliability, discriminant validity, repeatability, sensitivity to change, and agreement with the Outcome Rating Scale (ORS) and Outcome Questionnaire (OQ) in 1 clinical sample and 3 community samples. Clinical cutoffs, reliable change indices, and Bland-Altman repeatability coefficients were calculated. Week-to-week change on each instrument was compared via repeated-measures-corrected effect size. Community-normed T scores and Bland-Altman plots were generated to aid comparisons between instruments. The ROS showed good psychometric properties, sensitivity to change in treatment, and discrimination between outpatients and nonpatients. Agreement between the ROS and ORS was good, but neither the agreement between these nor that between ultrabrief instruments and the OQ were as good as correlations might suggest. The ROS showed incremental advantages over the ORS: improvements in concordance with the OQ, better absolute reliability, and less oversensitivity to change. The ROS had high patient acceptance and usability, and scores showed good reliability, cross-instrument validity, and responsiveness to change for the routine monitoring of clinical outcomes. (PsycINFO Database Record

In pursuit of truth: A critical examination of meta-analyses of cognitive behavior therapy.

OBJECTIVE: Three recent meta-analyses have made the claim, albeit with some caveats, that cognitive-behavioral treatments (CBT) are superior to other psychotherapies, in general or for specific disorders (e.g., social phobia). METHOD: The purpose of the present article was to examine four issues in meta-analysis that mitigate claims of CBT superiority: (a) effect size, power, and statistical significance, (b) focusing on disorder-specific symptom measures and ignoring other important indicators of psychological functioning, (c) problems inherent in classifying treatments provided in primary studies into classes of treatments, and (d) the inclusion of problematic trials, which biases the results, and the exclusion of trials that fail to find differences among treatments. RESULTS: When these issues are examined, the effects demonstrating the superiority of CBT are small, nonsignificant for the most part, limited to targeted symptoms, or are due to flawed primary studies. CONCLUSION: Meta-analytic evidence for the superiority of CBT in the three meta-analysis are nonexistent or weak.

Creating a climate for therapist improvement: A case study of an agency focused on outcomes and deliberate practice.

Recent evidence suggests that psychotherapists may not increase in effectiveness over accrued experience in naturalistic settings, even settings that provide access to patients' outcomes. The current study examined changes in psychotherapists' effectiveness within an agency making a concerted effort to improve outcomes through the use of routine outcome monitoring coupled with ongoing consultation and the planful application of feedback including the use of deliberate practice. Data were available for 7 years of implementation from 5,128 patients seen by 153 psychotherapists. Results indicate that outcomes indeed improved across time within the agency, with increases of d = 0.035 (p = .003) per year. In contrast with previous reports, psychotherapists in the current sample showed improvements within their own caseloads across time (d = 0.034, p = .042). It did not appear that the observed agency-level improvement was due to the agency simply hiring higher-performing psychotherapists or losing lower-performing psychotherapists. Implications of these findings are discussed in relation to routine outcome monitoring, expertise in psychotherapy, and quality improvement within mental health care. (PsycINFO Database Record

The working alliance in treatment of military adolescents.

OBJECTIVE: Although the working alliance-outcome association is well-established for adults, the working alliance has accounted for 1% of the variance in adolescent therapy outcomes. How the working alliance unfolds in therapy and is modeled in therapy studies may substantially affect how much variance is attributed to the working alliance. METHOD: The sample included 2,990 military youth who were treated by 98 therapists and attended at least 8 therapy sessions. The average age was 14.91 years (SD = 1.79). Each session, clients completed the Outcome Rating Scale as a measure of psychological well-being/distress and the Session Rating Scale as a measure of working alliance. We utilized 3 models to examine the working alliance-outcome association in therapy: (a) mono-method model (i.e., 1 rating of working alliance correlated with outcomes), (b) aggregate-assessment model (i.e., multiple sessions aggregated and correlated with outcomes), and (c) change-based model (i.e., changes in working alliance scores correlated with outcomes). RESULTS: Findings supported the change-based model. The amount of variance explained in youth outcomes via growth in working alliance scores in the change-based model was approximately 9.8%, which suggests that a key mechanism of client-perceived change for adolescents in therapy may be the continual development of the working alliance over the course of treatment. CONCLUSIONS: The monitoring of and continual promotion of the working alliance among military youth in the early phases of therapy may help therapists improve treatment outcomes.

Do psychotherapists improve with time and experience? A longitudinal analysis of outcomes in a clinical setting.

OBJECTIVE: Psychotherapy researchers have long questioned whether increased therapist experience is linked to improved outcomes. Despite numerous cross-sectional studies examining this question, no large-scale longitudinal study has assessed within-therapist changes in outcomes over time. METHOD: The present study examined changes in psychotherapists' outcomes over time using a large, longitudinal, naturalistic psychotherapy data set. The sample included 6,591 patients seen in individual psychotherapy by 170 therapists who had on average 4.73 years of data in the data set (range = 0.44 to 17.93 years). Patient-level outcomes were examined using the Outcome Questionnaire-45 and a standardized metric of change (prepost d). Two-level multilevel models (patients nested within therapist) were used to examine the relationship between therapist experience and patient prepost d and early termination. Experience was examined both as chronological time and cumulative patients seen. RESULTS: Therapists achieved outcomes comparable with benchmarks from clinical trials. However, a very small but statistically significant change in outcome was detected indicating that on the whole, therapists' patient prepost d tended to diminish as experience (time or cases) increases. This small reduction remained when controlling for several patient-level, caseload-level, and therapist-level characteristics, as well as when excluding several types of outliers. Further, therapists were shown to vary significantly across time, with some therapists showing improvement despite the overall tendency for outcomes to decline. In contrast, therapists showed lower rates of early termination as experience increased. CONCLUSIONS: Implications of these findings for the development of expertise in psychotherapy are explored. (PsycINFO Database Record