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Paul A. Pilkonis - One of the best experts on this subject based on the ideXlab platform.
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treatment expectancies patient alliance and outcome further analyses from the national institute of mental health treatment of depression Collaborative Research program
Journal of Consulting and Clinical Psychology, 2002Co-Authors: Bjorn Meyer, Paul A. Pilkonis, Janice L Krupnick, Matthew K Egan, Samuel J Simmens, Stuart M SotskyAbstract:: Prior analyses from the National Institute of Mental Health Treatment of Depression Collaborative Research Program indicated that patients' expectancies of treatment effectiveness (S. M. Sotsky et al., 1991) and the quality of the therapeutic alliance (J. L. Krupnick et al., 1996) predicted clinical improvement. These data were reanalyzed to examine the hypothesis that the link between treatment expectancies and outcome would be mediated by patients' contribution to the alliance. Among 151 patients who completed treatment, this hypothesis was supported, suggesting that patients who expect treatment to be effective tend to engage more constructively in session, which helps bring about symptom reduction. Therapists' expectancies for patient improvement also predicted outcome, although this association was not mediated by the alliance. None of the expectancy scales interacted with alliance ratings in the prediction of clinical improvement.
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when and how perfectionism impedes the brief treatment of depression further analyses of the national institute of mental health treatment of depression Collaborative Research program
Journal of Consulting and Clinical Psychology, 1998Co-Authors: Paul A. Pilkonis, Sidney J Blatt, Charles A Sanislow, David C Zuroff, Colin M BondiAbstract:: Perfectionism has previously been identified as having a significant negative impact on therapeutic outcome at termination in the brief (16-week) treatment of depression (S. J. Blatt, D. M. Quinlan, P. A. Pilkonis, & T. Shea, 1995) as measured by the 5 primary outcome measures used in the National Institute of Mental Health Treatment of Depression Collaborative Research Program (TDCRP). The present analyses of other data from the TDCRP indicated that this impact of perfectionism on therapeutic outcome was also found in ratings by therapists, independent clinical evaluators, and the patients and that this effect persisted 18 months after termination. In addition, analyses of comprehensive, independent assessments made during the treatment process indicated that perfectionism began to impede therapeutic gain in approximately 2/3 of the sample, in the latter half of treatment, between the 9th and 12th sessions. Implications of these findings are discussed, including the possibility that more perfectionistic patients may be negatively impacted by anticipation of an arbitrary, externally imposed termination date.
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characteristics of effective therapists further analyses of data from the national institute of mental health treatment of depression Collaborative Research program
Journal of Consulting and Clinical Psychology, 1996Co-Authors: Sidney J Blatt, Charles A Sanislow, David C Zuroff, Paul A. PilkonisAbstract:Analyses of the data of the National Institute of Mental Health-sponsored Treatment of Depression Collaborative Research Program have primarily examined the effects of types of treatment and patient characteristics on outcome, but scant attention has been directed toward evaluating the contributions of the therapist. With an aggregate of residualized therapeutic change scores of the 5 primary outcome measures for each patient at termination as an overall measure of improvement, an average therapeutic effectiveness measure was derived for each of the 28 therapists based on the outcome of the patients they saw in active treatment. The distribution of the therapists was divided into thirds, and comparisons indicate that more effective therapists are more psychological minded, eschew biological interventions (i.e., medication and electroconvulsive therapy) in their ordinary clinical practice, and expect outpatient treatment of depression to take longer than did moderately and less effective therapists. The National Institute of Mental Health (NIMH)-sponsored Treatment of Depression Collaborative Research Program (TDCRP), a comprehensive, well-designed, and carefully conducted multisite, randomized clinical trial, evaluated several forms of brief ( 16-20 session) outpatient treatment for depression. Prior analyses of these data compared the relative efficacy of four treatment conditions and the effects of patient characteristics on outcome, but little attention has been directed to evaluating the therapists and their contributions to the therapeutic process. Therapists' contribution to treatment outcome has long been of concern in psychotherapy Research (e.g., Beutler, Crago, & Arizmendi, 1986; Gurman & Razin, 1977). However, as noted
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interpersonal factors in brief treatment of depression further analyses of the national institute of mental health treatment of depression Collaborative Research program
Journal of Consulting and Clinical Psychology, 1996Co-Authors: Sidney J Blatt, David C Zuroff, Donald M Quinlan, Paul A. PilkonisAbstract:: Previous analyses of data from the National Institute of Mental Health Treatment of Depression Collaborative Research Program indicate minimal differences in therapeutic outcome among 3 brief treatments for depression, but patients' pretreatment level of perfectionism had a significant negative relationship with residualized measures of clinical improvement. The present analyses indicate that the quality of the therapeutic relationship reported by patients early in treatment contributed significantly to the prediction of therapeutic change. The quality of the therapeutic relationship was only marginally predictive of therapeutic gain at low and high levels of perfectionism, but significantly predicted therapeutic gain at moderate levels of perfectionism. These findings suggest that the extensive efforts to compare different manual-directed treatments need to be balanced by commensurate attention to interpersonal dimensions of the therapeutic process.
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initial severity and differential treatment outcome in the national institute of mental health treatment of depression Collaborative Research program
Journal of Consulting and Clinical Psychology, 1995Co-Authors: Irene Elkin, Stuart M Sotsky, John T Watkins, Tracie M Shea, Paul A. Pilkonis, Robert D. Gibbons, Donald HedekerAbstract:Random regression models (RRMs) were used to investigate the role of initial severity in the outcome of 4 treatments (cognitive-behavior therapy [CBT], interpersonal psychotherapy [IPT], imipramine plus clinical management [IMI-CM], and placebo plus clinical management [PLA-CM]) for outpatients with major depressive disorder seen in the National Institute of Mental Health Treatment of Depression Collaborative Research Program. Initial severity of depression and impairment of functioning significantly predicted differential treatment effects. A larger number of differences than previously reported were found among the active treatments for the more severely ill patients; this was due, in large part, to the greater power of the present statistical analyses.
Sidney J Blatt - One of the best experts on this subject based on the ideXlab platform.
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when and how perfectionism impedes the brief treatment of depression further analyses of the national institute of mental health treatment of depression Collaborative Research program
Journal of Consulting and Clinical Psychology, 1998Co-Authors: Paul A. Pilkonis, Sidney J Blatt, Charles A Sanislow, David C Zuroff, Colin M BondiAbstract:: Perfectionism has previously been identified as having a significant negative impact on therapeutic outcome at termination in the brief (16-week) treatment of depression (S. J. Blatt, D. M. Quinlan, P. A. Pilkonis, & T. Shea, 1995) as measured by the 5 primary outcome measures used in the National Institute of Mental Health Treatment of Depression Collaborative Research Program (TDCRP). The present analyses of other data from the TDCRP indicated that this impact of perfectionism on therapeutic outcome was also found in ratings by therapists, independent clinical evaluators, and the patients and that this effect persisted 18 months after termination. In addition, analyses of comprehensive, independent assessments made during the treatment process indicated that perfectionism began to impede therapeutic gain in approximately 2/3 of the sample, in the latter half of treatment, between the 9th and 12th sessions. Implications of these findings are discussed, including the possibility that more perfectionistic patients may be negatively impacted by anticipation of an arbitrary, externally imposed termination date.
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characteristics of effective therapists further analyses of data from the national institute of mental health treatment of depression Collaborative Research program
Journal of Consulting and Clinical Psychology, 1996Co-Authors: Sidney J Blatt, Charles A Sanislow, David C Zuroff, Paul A. PilkonisAbstract:Analyses of the data of the National Institute of Mental Health-sponsored Treatment of Depression Collaborative Research Program have primarily examined the effects of types of treatment and patient characteristics on outcome, but scant attention has been directed toward evaluating the contributions of the therapist. With an aggregate of residualized therapeutic change scores of the 5 primary outcome measures for each patient at termination as an overall measure of improvement, an average therapeutic effectiveness measure was derived for each of the 28 therapists based on the outcome of the patients they saw in active treatment. The distribution of the therapists was divided into thirds, and comparisons indicate that more effective therapists are more psychological minded, eschew biological interventions (i.e., medication and electroconvulsive therapy) in their ordinary clinical practice, and expect outpatient treatment of depression to take longer than did moderately and less effective therapists. The National Institute of Mental Health (NIMH)-sponsored Treatment of Depression Collaborative Research Program (TDCRP), a comprehensive, well-designed, and carefully conducted multisite, randomized clinical trial, evaluated several forms of brief ( 16-20 session) outpatient treatment for depression. Prior analyses of these data compared the relative efficacy of four treatment conditions and the effects of patient characteristics on outcome, but little attention has been directed to evaluating the therapists and their contributions to the therapeutic process. Therapists' contribution to treatment outcome has long been of concern in psychotherapy Research (e.g., Beutler, Crago, & Arizmendi, 1986; Gurman & Razin, 1977). However, as noted
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interpersonal factors in brief treatment of depression further analyses of the national institute of mental health treatment of depression Collaborative Research program
Journal of Consulting and Clinical Psychology, 1996Co-Authors: Sidney J Blatt, David C Zuroff, Donald M Quinlan, Paul A. PilkonisAbstract:: Previous analyses of data from the National Institute of Mental Health Treatment of Depression Collaborative Research Program indicate minimal differences in therapeutic outcome among 3 brief treatments for depression, but patients' pretreatment level of perfectionism had a significant negative relationship with residualized measures of clinical improvement. The present analyses indicate that the quality of the therapeutic relationship reported by patients early in treatment contributed significantly to the prediction of therapeutic change. The quality of the therapeutic relationship was only marginally predictive of therapeutic gain at low and high levels of perfectionism, but significantly predicted therapeutic gain at moderate levels of perfectionism. These findings suggest that the extensive efforts to compare different manual-directed treatments need to be balanced by commensurate attention to interpersonal dimensions of the therapeutic process.
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impact of perfectionism and need for approval on the brief treatment of depression the national institute of mental health treatment of depression Collaborative Research program revisited
Journal of Consulting and Clinical Psychology, 1995Co-Authors: Sidney J Blatt, Paul A. Pilkonis, Donald M Quinlan, Tracie M SheaAbstract:: Patients in the National Institute of Mental Health Treatment of Depression Collaborative Research Program (TDCRP) were administered at intake with the Dysfunctional Attitude Scale (DAS; A. N. Weissman & A. T. Beck, 1978). Factor analyses of the DAS in the TDCRP data as well as in several independent samples reveal two primary factors: an interpersonal factor, Need for Approval, and a self-critical factor, Perfectionism. This study explored the hypotheses that these factors, assessed prior to treatment, would have differential interactions with the two forms of psychotherapy evaluated in the TDCRP as well as differential relationships to various outcome measures (depression, clinical functioning, and social adjustment). DAS Perfectionism had consistently significant negative relationships with all the outcome measures in all four treatment conditions. Contrary to expectations, however, there were no significant interactions between the two DAS factors and the four types of brief treatment (cognitive-behavioral therapy, interpersonal therapy, imipramine, and placebo).
Tracie M Shea - One of the best experts on this subject based on the ideXlab platform.
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initial severity and differential treatment outcome in the national institute of mental health treatment of depression Collaborative Research program
Journal of Consulting and Clinical Psychology, 1995Co-Authors: Irene Elkin, Stuart M Sotsky, John T Watkins, Tracie M Shea, Paul A. Pilkonis, Robert D. Gibbons, Donald HedekerAbstract:Random regression models (RRMs) were used to investigate the role of initial severity in the outcome of 4 treatments (cognitive-behavior therapy [CBT], interpersonal psychotherapy [IPT], imipramine plus clinical management [IMI-CM], and placebo plus clinical management [PLA-CM]) for outpatients with major depressive disorder seen in the National Institute of Mental Health Treatment of Depression Collaborative Research Program. Initial severity of depression and impairment of functioning significantly predicted differential treatment effects. A larger number of differences than previously reported were found among the active treatments for the more severely ill patients; this was due, in large part, to the greater power of the present statistical analyses.
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impact of perfectionism and need for approval on the brief treatment of depression the national institute of mental health treatment of depression Collaborative Research program revisited
Journal of Consulting and Clinical Psychology, 1995Co-Authors: Sidney J Blatt, Paul A. Pilkonis, Donald M Quinlan, Tracie M SheaAbstract:: Patients in the National Institute of Mental Health Treatment of Depression Collaborative Research Program (TDCRP) were administered at intake with the Dysfunctional Attitude Scale (DAS; A. N. Weissman & A. T. Beck, 1978). Factor analyses of the DAS in the TDCRP data as well as in several independent samples reveal two primary factors: an interpersonal factor, Need for Approval, and a self-critical factor, Perfectionism. This study explored the hypotheses that these factors, assessed prior to treatment, would have differential interactions with the two forms of psychotherapy evaluated in the TDCRP as well as differential relationships to various outcome measures (depression, clinical functioning, and social adjustment). DAS Perfectionism had consistently significant negative relationships with all the outcome measures in all four treatment conditions. Contrary to expectations, however, there were no significant interactions between the two DAS factors and the four types of brief treatment (cognitive-behavioral therapy, interpersonal therapy, imipramine, and placebo).
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some conceptual and statistical issues in analysis of longitudinal psychiatric data application to the nimh treatment of depression Collaborative Research program dataset
Archives of General Psychiatry, 1993Co-Authors: Robert D. Gibbons, Irene Elkin, Stuart M Sotsky, Tracie M Shea, Donald Hedeker, Christine Waternaux, Helena C Kraemer, Joel B Greenhouse, Stanley D Imber, John T WatkinsAbstract:L studies have a prominent role in psychiatric Research; however, statistical methods for analyzing these data are rarely commensurate with the effort involved in their acquisition. Frequently the majority of data are discarded and a simple end-point analysis is performed. In other cases, so called repeated-measures analysis of variance procedures are used with little regard to their restrictive and often unrealistic assumptions and the effect of missing data on the statistical properties of their estimates. We explored the unique features of longitudinal psychiatric data from both statistical and conceptual perspectives. We used a family of statistical models termed random regression models that provide a more realistic approach to analysis of longitudinal psychiatric data. Random regression models provide solutions to commonly observed problems of missing data, serial correlation, time-varying covariates, and irregular measurement occasions, and they accommodate systematic person-specific deviations from the average time trend. Properties of these models were compared with traditional approaches at a conceptual level. The approach was then illustrated in a new analysis of the National Institute of Mental Health Treatment of Depression Collaborative Research Program dataset, which investigated two forms of psychotherapy, pharmacotherapy with clinical management, and a placebo with clinical management control. Results indicated that both person-specific effects and serial correlation play major roles in the longitudinal psychiatric response process. Ignoring either of these effects produces misleading estimates of uncertainty that form the basis of statistical tests of hypotheses.
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course of depressive symptoms over follow up findings from the national institute of mental health treatment of depression Collaborative Research program
Archives of General Psychiatry, 1992Co-Authors: Tracie M Shea, Irene Elkin, Stuart M Sotsky, John T Watkins, Paul A. Pilkonis, Edward E Beckham, J F Collins, Stanley D Imber, David R Glass, Regina T DolanAbstract:• We studied the course of depressive symptoms during an 18-month naturalistic follow-up period for outpatients with Major Depressive Disorder treated in the National Institute of Mental Health Treatment of Depression Collaborative Research Program. The treatment phase consisted of 16 weeks of randomly assigned treatment with the following: cognitive behavior therapy, interpersonal therapy, imipramine hydrochloride plus clinical management (CM), or placebo plus CM. Follow-up assessments were conducted at 6,12, and 18 months after treatment. Of all patients entering treatment and having follow-up data, the percent who recovered (8 weeks of minimal or no symptoms following the end of treatment) and remained well during follow-up (no Major Depressive Disorder relapse) did not differ significantly among the four treatments: 30% (14/46) for those in the cognitive behavior therapy group, 26% (14/53) for those in the interpersonal therapy group, 19% (9/48) for those in the imipramine plus CM group, and 20% (10/51) for those in the placebo plus CM group. Among patients who had recovered, rates of Major Depressive Disorder relapse were 36% (8/22) for those in the cognitive behavior therapy group, 33% (7/21) for those in the interpersonal therapy group, 50% (9/18) for those in the imipramine plus CM group, and 33% (5/15) for those in the placebo plus CM group. The major finding of this study is that 16 weeks of these specific forms of treatment is insufficient for most patients to achieve full recovery and lasting remission. Future Research should be directed at improving success rates of initial and maintenance treatments for depression.
Stuart A Scheingold - One of the best experts on this subject based on the ideXlab platform.
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home away from home Collaborative Research networks and interdisciplinary socio legal scholarship
Social Science Research Network, 2008Co-Authors: Stuart A ScheingoldAbstract:Interdisciplinary Research has long been suspect within the disciplines. Because the disciplines control recruitment, tenure, and promotion, it is difficult for interdisciplinary scholarship to gain traction in the academic world. Within socio-legal scholarship, the Law and Society Association has been instrumental in fostering interdisciplinary and, more recently, transnational Research. The association's latest and certainly one of its most promising interdisciplinary and international initiatives is the creation of Collaborative Research Networks (CRNs). These CRNs, while of relatively recent origin, have already contributed impressively. On the one hand, they have established structures and processes that provide opportunities, training, and rewards for interdisciplinary scholars. On the other hand, the CRNs have demonstrated the multiplicity of ways in which socio-legal scholarship can bring all manner of Research tools to bear on topics that cross disciplinary and national boundaries-incorporating the global and the local as well as the mediating forces and institutions betwixt and between.
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home away from home Collaborative Research networks and interdisciplinary socio legal scholarship
Annual Review of Law and Social Science, 2008Co-Authors: Stuart A ScheingoldAbstract:Interdisciplinary Research has long been suspect within the disciplines. Because the disciplines control recruitment, tenure, and promotion, it is difficult for interdisciplinary scholarship to gain traction in the academic world. Within socio-legal scholarship, the Law and Society Association has been instrumental in fostering interdisciplinary and, more recently, transnational Research. The association's latest and certainly one of its most promising interdisciplinary and international initiatives is the creation of Collaborative Research Networks (CRNs). These CRNs, while of relatively recent origin, have already contributed impressively. On the one hand, they have established structures and processes that provide opportunities, training, and rewards for interdisciplinary scholars. On the other hand, the CRNs have demonstrated the multiplicity of ways in which socio-legal scholarship can bring all manner of Research tools to bear on topics that cross disciplinary and national boundaries—incorporating t...
George R Saade - One of the best experts on this subject based on the ideXlab platform.
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diagnostic tests for evaluation of stillbirth results from the stillbirth Collaborative Research network
Obstetrics & Gynecology, 2017Co-Authors: Jessica M Page, Corette B Parker, Vanessa Thorsten, Uma M Reddy, Donald J Dudley, George R Saade, Carol J. R. Hogue, Donald R Coustan, Lauren Christiansenlindquist, Deborah L. ConwayAbstract:To estimate the usefulness of each diagnostic test in the work-up for potential causes of stillbirth. A secondary analysis of 512 stillbirths enrolled in the Stillbirth Collaborative Research Network from 2006 to 2008 was performed. The Stillbirth Collaborative Research Network was a multisite, geographically, racially, and ethnically diverse, population-based study of stillbirth in the United States. Participants underwent standardized evaluations that included maternal interview, medical record abstraction, biospecimen collection, fetal autopsy, and placental pathology. Also, most participants had a clinical work-up that included karyotype, toxicology screen, syphilis serology, antibody screen, fetal–maternal hemorrhage testing, and testing for antiphospholipid antibodies as well as testing performed on biospecimens for Research purposes. Previously, each participant had been assigned probable and possible causes of death using the Initial Causes of Fetal Death classification system. In this analysis, tests were considered useful if a positive result established (or helped to establish) this cause of death or a negative result excluded a cause of death that was suspected based on the clinical history or other results. The usefulness of each test was as follows: placental pathology 64.6% (95% confidence interval [CI] 57.9–72.0), fetal autopsy 42.4% (95% CI 36.9–48.4), genetic testing 11.9% (95% CI 9.1–15.3), testing for antiphospholipid antibodies 11.1% (95% CI 8.4–14.4), fetal–maternal hemorrhage 6.4% (95% CI 4.4–9.1), glucose screen 1.6% (95% CI 0.7–3.1), parvovirus 0.4% (95% CI 0.0–1.4), and syphilis 0.2% (95% CI 0.0–1.1). The utility of the tests varied by clinical presentation, suggesting a customized approach for each patient. The most useful tests were placental pathology and fetal autopsy followed by genetic testing and testing for antiphospholipid antibodies.
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factor v leiden prothrombin g20210a and methylene tetrahydrofolate reductase mutations and stillbirth the stillbirth Collaborative Research network
American Journal of Obstetrics and Gynecology, 2016Co-Authors: Robert M Silver, Corette B Parker, Vanessa Thorsten, Uma M Reddy, Donald J Dudley, George R Saade, Deborah L. Conway, Donald R Coustan, Carey Drewsbotsch, Radek BukowskiAbstract:Background An evaluation for heritable thrombophilias is recommended in the evaluation of stillbirth. However, the association between thrombophilias and stillbirth remains uncertain. Objective We sought to assess the association between maternal and fetal/placental heritable thrombophilias and stillbirth in a population-based, case-control study in a geographically, racially, and ethnically diverse population. Study Design We conducted secondary analysis of data from the Stillbirth Collaborative Research Network, a population-based case-control study of stillbirth. Testing for factor V Leiden, prothrombin G20210A, methylene tetrahydrofolate reductase C677T and A1298C, and plasminogen activating inhibitor (PAI)-1 4G/5G mutations was done on maternal and fetal (or placental) DNA from singleton pregnancies. Data analyses were weighted for oversampling and other aspects of the design. Odds ratios (OR) were generated from univariate models regressing stillbirth/live birth status on each thrombophilia marker. Results Results were available for ≥1 marker in 488 stillbirths and 1342 live birth mothers and 405 stillbirths and 990 live birth fetuses. There was an increased odds of stillbirth for maternal homozygous factor V Leiden mutation (2/488; 0.4% vs 1/1380; 0.0046%; OR, 87.44; 95% confidence interval, 7.88–970.92). However, there were no significant differences in the odds of stillbirth for any other maternal thrombophilia, even after stratified analyses. Fetal 4G/4G PAI-1 (OR, 0.63; 95% confidence interval, 0.43–0.91) was associated with decreased odds of stillbirth. Other fetal thrombophilias were similar among groups. Conclusion Most maternal and fetal thrombophilias were not associated with stillbirth. Maternal factor V Leiden was weakly associated with stillbirth, and the fetal PAI-1 4G/4G polymorphism was associated with live birth. Our data do not support routine testing for heritable thrombophilias as part of an evaluation for possible causes of stillbirth.
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stillbirth Collaborative Research network design methods and recruitment experience
Paediatric and Perinatal Epidemiology, 2011Co-Authors: Corette B Parker, Robert M Silver, Vanessa Thorsten, Marian Willinger, Uma M Reddy, Donald J Dudley, Carol J. R. Hogue, Matthew A Koch, Donald R Coustan, George R SaadeAbstract:The Stillbirth Collaborative Research Network (SCRN) has conducted a multisite, population-based, case-control study, with prospective enrollment of stillbirths and live births at the time of delivery. This paper describes the general design, methods, and recruitment experience. The SCRN attempted to enroll all stillbirths and a representative sample of live births occurring to residents of pre-defined geographic catchment areas delivering at 59 hospitals associated with five clinical sites. Live births <32 weeks gestation and women of African descent were oversampled. The recruitment hospitals were chosen to ensure access to at least 90% of all stillbirths and live births to residents of the catchment areas. Participants underwent a standardized protocol including maternal interview, medical record abstraction, placental pathology, biospecimen testing, and, in stillbirths, postmortem examination. Recruitment began in March 2006 and was completed in September 2008 with 663 women with a stillbirth and 1932 women with a live birth enrolled, representing 69% and 63%, respectively, of the women identified. Additional surveillance for stillbirth continued through June 2009 and a follow-up of the case-control study participants was completed in December 2009. Among consenting women, there were high consent rates for the various study components. For the women with stillbirth, 95% agreed to maternal interview, chart abstraction, and placental pathologic examination; 91% of the women with live birth agreed to all of these components. Additionally, 84% of the women with stillbirth agreed to a fetal postmortem examination. This comprehensive study is poised to systematically study a wide range of potential causes of, and risk factors for, stillbirth and to better understand the scope and incidence of the problem.
