New analyses of the National Institute of Mental Health Treatment of Depression Collaborative Research Program: do different treatments reflect different processes?

To determine whether or not different therapies have distinct patterns of change, it is useful to investigate not only the end result of psychotherapy (outcome) but also the processes by which outcomes are attained. The present study subjected data from the National Institute of Mental Health Treatment of Depression Collaborative Research Program to survival analyses to examine whether the process of psychotherapy, as conceptualized by the phase model, differed between psychotherapy treatment approaches. Few differences in terms of progression through phases of psychotherapy were identified between cognitive behavior therapy and interpersonal therapy. Additionally, results indicate that phases of psychotherapy may not represent discrete, sequentially invariant processes.

Enhancing information pertaining to client characteristics to facilitate evidence-based practice.

OBJECTIVE: Evidence-based practice (EBP) includes utilization of empirically supported treatments, application of clinical expertise, and consideration of client characteristics. The following brief report aims to elucidate barriers in the study and dissemination of research regarding these client characteristics. DESIGN: Authors examined empirical papers cited on psychologicaltreatments.org (N = 338) and categorized each according to efficacy evidence available pertaining to gender, race/ethnicity, and socioeconomic status (SES). RESULTS: Gender was most commonly considered (7% of studies), with less than 2% of studies analyzing efficacy in relation to race/ethnicity or SES. CONCLUSIONS: Available findings are summarized according to disorder. Researchers are encouraged to attend to client variables in efficacy studies and suggestions are offered for training students to include client variables in EBP.

Naturalistic changes in subjective distress outside of therapy.

OBJECTIVES: To establish the effectiveness or efficacy of psychological interventions, it is important to understand the nature of changes that occur in the absence of therapy. DESIGN: In this study, clinically distressed college students from 2 universities (n = 228) completed the Outcome Questionnaire (OQ)-45.2 on a weekly basis throughout a single semester. RESULTS: Although 56.6% of the sample made no change or deteriorated, 43.4% made a reliable improvement. Change status was predicted by previous therapy experience and length of study participation. Multilevel growth modeling also indicated that participants' OQ-45.2 scores decreased over time (following a cubic trend) and the amount of decrease was associated with Time 1 OQ-45.2 scores. CONCLUSIONS: Limitations of the study and further implications for treatment outcome research are discussed.

Applications of the psychotherapy phase model to clinically significant deterioration.

While previous research on deterioration has focused on identifying individuals at risk for negative outcomes, little is known about the nature or pattern by which deterioration occurs. The problem of deterioration is especially salient in training clinics; a setting in which higher deterioration rates have been reported. Two studies were designed to test the applicability of the phase model to deterioration in a training clinic and to replicate the model with a training clinic referral-base sample. In Study 1, the course of therapy was monitored for 135 clients. For the 38 clients who deteriorated during therapy, a model where increased symptoms (demediation) reliably preceded both decreased functioning (dehabilitation) and decreased well-being (demoralization) was found. In Study 2, the same three phases were prospectively monitored for 914 undergraduate students on a weekly basis throughout a single semester. For the 158 individuals who deteriorated during this time, a model where demediation reliably preceded dehabilitation, which preceded demoralization was found. These results have clinical implications for the use of tailored intervention strategies focusing on the deterioration phases.