The effect of process and outcome feedback in highly distressed outpatients: A randomized controlled trial.

Objectives: Although process and outcome feedback is considered to be facilitative of psychotherapeutic processes, recent studies have suggested that such feedback may not produce the same effect when applied to highly distressed patients. This study examined the effect of process and outcome feedback in highly distressed patients treated in a public mental health center in Israel.Method: Patients (n = 197) were randomly allocated to receive feedback, or to treatment as usual. Therapists in the feedback condition received weekly reports, whereas therapists in the control group received no feedback. After attrition from study and treatment, a total of 123 cases were analyzed.Results: Feedback had no significant effect on either symptom reduction or on well-being. However, patients in the feedback group showed higher gains in alliance as compared to the treatment as usual group.Conclusion: Process and outcome feedback might have a potential beneficial effect of improving alliance for patients with severe symptomatology, with whom the establishment of an alliance can be challenging. The current findings also stress the need to continue to study the effect of feedback on therapy outcomes in diverse clinical settings. Limitations and directions for future research are discussed.

Routine measurement and feedback in support groups for parents of children with autistic spectrum disorder.

Support groups for parents of children with Autistic Spectrum Disorders (ASD) are very common in public mental health settings. These groups have been found to be helpful in reducing parental stress and providing parents with professional knowledge as well as peer support. Clinical experience, as well as parents' verbal feedback, often indicates that within these groups there are occasionally unmet needs that are not expressed during sessions. In this article we describe the benefits of using routine measurement and feedback as means to identify and address such needs. The article presents clinical examples of how routine measurement and feedback can assist group leaders in the delicate and often complex work of responding to both individual and group processes and in adapting group structure according to the specific needs of the individuals participating in the group. A demonstration of rupture and repair patterns, identified and facilitated by the use of feedback, is followed. Finally, we discuss the benefits of routine measurements in support groups that utilize a rolling group structure, as a means to accurately assess their effectiveness. We briefly conclude with the need for further studies on routine measurement of parents' groups, aimed at gaining knowledge needed to provide a better adjustment for both parents and children coping with ASD challenges. (PsycINFO Database Record

Implementing routine outcome monitoring in public mental health services in Israel: Shared and unique challenges.

OBJECTIVES: This study aimed to assess the feasibility, benefits, and challenges of routine outcome monitoring (ROM) in a public mental health centre in Israel. This is the first initiation of ROM implementation in a setting of a large psychiatric hospital, affiliated with the largest health maintenance organization in Israel, Clalit Health Services. METHODS: Four ambulatory units were invited to participate in the implementation of ROM. Prior to initiation of recruitment, staff meetings were held and broad descriptions of current knowledge regarding benefits and challenges were discussed. Upon initiation of recruitment, patients completed outcome and process questionnaires during each session, and reports of patients' progress were sent to therapists soon after sessions ended. RESULTS: One hundred sixty-three patients were invited to participate in measurement and feedback of therapy outcomes. Overall, 101 patients and 32 therapists agreed and actively participated in the implementation phase of ROM, producing 535 evaluated measurements and reports. Clinical, methodological, legal, administrative, and ethical aspects of the implementation were encountered and documented throughout the implementation process. CONCLUSIONS: Medical confidentiality issues, as well as the multidisciplinary nature of hospital staff work, serve as central and unique challenges for incorporating ROM in a public psychiatric hospital. Other challenges that were previously reported in other implementation studies were also encountered and included therapist overload and objections, attrition, and the need for organizational support. Recommendations for future pioneering efforts for ROM implementation in large psychiatric facilities are discussed.

Enhancement of latent inhibition in patients with chronic schizophrenia.

OBJECTIVES: Latent inhibition (LI) refers to the retarding effects of inconsequential stimulus preexposure on subsequent conditioning to that stimulus, and reflects the organism's capacity to ignore irrelevant stimuli. LI is disrupted in schizophrenia patients, due to faster learning of the association between the conditioned stimulus (CS) and an unconditioned stimulus (US). It was recently proposed that LI has an additional pole of abnormality indicated by LI persistence. METHODS: Two experiments were performed to test this hypothesis. Both experiments applied a new within-subject, visual recognition LI procedure in which the association between a cue (CS) and the target (US) is acquired. In Exp 1 the task was applied to healthy volunteers (n=21). In Exp 2 chronic schizophrenia patients (n=19) were compared to control subjects (n=20). RESULTS: In Exp 1 the subjects showed LI in the initial trials of cue-target pairings, and an attenuation of the phenomenon at later trials. In Exp 2 control subjects showed a pattern of response comparable to the subjects of Exp 1, while the patients showed LI only on the later trials of the task. CONCLUSIONS: This result suggests that patients with chronic schizophrenia showed LI persistence. The possible advantages of the new LI paradigm are discussed.