The Experts below are selected from a list of 321 Experts worldwide ranked by ideXlab platform
Michael J. Lambert - One of the best experts on this subject based on the ideXlab platform.
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maximizing Psychotherapy Outcome beyond evidence based medicine
Psychotherapy and Psychosomatics, 2017Co-Authors: Michael J. LambertAbstract:Despite evidence that Psychotherapy has a positive impact on psychological disorders, 30% of patients fail to respond during clinical trials, and as many as 65% of patients in routine care leave treatment without a measured benefit. In addition, therapists appear to overestimate positive Outcomes in their patients relative to measured Outcomes and are particularly poor at identifying patients at risk for a negative Outcome. These problems suggest the need for measuring and monitoring patient treatment response over the course of treatment while applying standardized methods of identifying at-risk cases. Computer-assisted methods for measuring, monitoring, identifying potential deteriorators, and providing feedback to clinicians are described along with a model that explains why feedback is likely to be beneficial to patients. The results of 12 clinical trials are summarized and suggest that deterioration rates can be substantially reduced in at-risk cases (from baseline rates of 21% down to 13%) and that recovery rates are substantially increased in this subgroup of cases (from a baseline of 20% up to 35%) when therapists are provided this information. When problem-solving methods are added to feedback, deterioration in at-risk cases is further reduced to 6% while recovery/improvement rates rise to about 50%. It is suggested that the feedback methods become a standard of practice. Such a change in patterns of care can be achieved through minimal modification to routine practice but may require discussions with patients about their clinical progress.
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the relationship between session frequency and Psychotherapy Outcome in a naturalistic setting
Journal of Consulting and Clinical Psychology, 2015Co-Authors: David M Erekson, Michael J. Lambert, Dennis L EggettAbstract:Objective The dose-response relationship in Psychotherapy has been examined extensively, but few studies have included session frequency as a component of Psychotherapy "dose." Studies that have examined session frequency have indicated that it may affect both the speed and the amount of recovery. No studies were found examining the clinical significance of this construct in a naturalistic setting, which is the aim of the current study. Method Using an archival database of session-by-session Outcome Questionnaire 45 (OQ-45) measures over 17 years, change trajectories of 21,488 university counseling center clients (54.9% female, 85.0% White, mean age = 22.5) were examined using multilevel modeling, including session frequency at the occasion level. Of these clients, subgroups that attended therapy approximately weekly or fortnightly were compared to each other for differences in speed of recovery (using multilevel Cox regression) and clinically significant change (using multilevel logistic regression). Results Results indicated that more frequent therapy was associated with steeper recovery curves (Cohen's f2 = 0.07; an effect size between small and medium). When comparing weekly and fortnightly groups, clinically significant gains were achieved faster for those attending weekly sessions; however, few significant differences were found between groups in total amount of change in therapy. Conclusions Findings replicated previous session frequency literature and supported a clinically significant effect, where higher session frequency resulted in faster recovery. Session frequency appears to be an impactful component in delivering more efficient Psychotherapy, and it is important to consider in individual treatment planning, institutional policy, and future research.
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Corsini Encyclopedia of Psychology - Psychotherapy, Effectiveness of
The Corsini Encyclopedia of Psychology, 2010Co-Authors: Michael J. LambertAbstract:The effectiveness of Psychotherapy has been the subject of study since the 1930s. The activities that characterize Psychotherapy practice have evolved over time and today consist of hundreds of established procedures based on psychological theories aimed at reducing the symptoms of psychopathology. In this brief summary, some of the most notable findings are reviewed and their implications highlighted. Keywords: Psychotherapy Outcome; negative effects; efficiency of Psychotherapy; placebo effect; Outcomes management; Outcome measures; psychoactive medication
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using clinical significance in Psychotherapy Outcome research the need for a common procedure and validity data
Psychotherapy Research, 2009Co-Authors: Michael J. Lambert, Benjamin M OglesAbstract:It is recommended that an estimate of clinical significance be included in all Psychotherapy Outcome studies and that this estimate be based on the work of Jacobson and Truax (1991). The concept of clinical significance is defined and put in the context of broadly accepted statistical methods along with its advantages and a rationale for using the Jacobson methods. One implication of this recommendation is that the use of the term will have a standard meaning. Examples of loss of meaning are provided and suggest that conclusions about best practices will be affected unless such a voluntary step is taken. Some problems with the concept of clinical significance are noted and a call for validity studies is made.
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improving Psychotherapy Outcome the use of immediate electronic feedback and revised clinical support tools
Clinical Psychology & Psychotherapy, 2008Co-Authors: Karstin Slade, Michael J. Lambert, Cory S Harmon, David W Smart, Russ BaileyAbstract:The benefits of Psychotherapy have been well documented; however, 5–10% of clients worsen while in treatment and another minority shows no response. The effects of feedback timing (delayed or immediate) and type (progress feedback and Clinical Support Tool [CST] feedback), aimed at reducing deterioration and improving Outcomes, were examined in a sample of 1101 clients whose Outcome was contrasted across experimental groups and with two archival groups: a delayed progress feedback and CST feedback group (n = 1374) and a treatment-as-usual control group (n = 1445). Progress feedback to therapists improved Outcomes, especially for cases at risk for a negative Outcome, but direct progress feedback to clients did not. Effects were significantly enhanced by using the manual-based CST. There were no significant differences in Outcome between the 1-week-delayed CST feedback and 2-week-delayed CST feedback groups; however, clients in the week-delayed CST feedback timing condition attended three less sessions, on average, than their 2-week-delayed CST feedback counterparts while maintaining similar treatment gains. Results were interpreted as supporting the value of monitoring client progress and feeding back this information to therapists as well as assisting therapists in problem solving with cases at risk for treatment failure. Copyright © 2008 John Wiley & Sons, Ltd.
Eva Petkova - One of the best experts on this subject based on the ideXlab platform.
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history of sexual trauma moderates Psychotherapy Outcome for posttraumatic stress disorder
Depression and Anxiety, 2017Co-Authors: C John M D Markowitz, Yuval Neria, Karina Lovell, Page E Van Meter, Eva PetkovaAbstract:Background Moderators of differential Psychotherapy Outcome for posttraumatic stress disorder (PTSD) are rare, yet have crucial clinical importance. We tested the moderating effects of trauma type for three psychotherapies in 110 unmedicated patients with chronic DSM-IV PTSD. Methods Patients were randomized to 14 weeks of prolonged exposure (PE, N = 38), interpersonal Psychotherapy (IPT, N = 40), or relaxation therapy (RT, N = 32). The Clinician-Administered PTSD Scale (CAPS) was the primary Outcome measure. Moderator candidates were trauma type: interpersonal, sexual, physical. We fit a regression model for week 14 CAPS as a function of treatment (a three-level factor), an indicator of trauma type presence/absence, and their interactions, controlling for baseline CAPS, and evaluated potential confounds. Results Thirty-nine (35%) patients reported sexual, 68 (62%) physical, and 102 (93%) interpersonal trauma. Baseline CAPS scores did not differ by presence/absence of trauma types. Sexual trauma as PTSD criterion A significantly moderated treatment effect: whereas all therapies had similar efficacy among nonsexually-traumatized patients, IPT had greater efficacy among sexually traumatized patients (efficacy difference with and without sexual trauma: IPT vs. PE and IPT vs. RT P’s < .05), specifically in PTSD symptom clusters B and D (P’s < .05). Conclusions Few studies have assessed effects of varying trauma types on effects of differing psychotherapies. In this exploratory study, sexual trauma moderated PTSD Outcomes of three therapies: IPT showed greater benefit for sexually traumatized patients than PE or RT. The IPT focuses on affect to help patients determine trust in their current environments may particularly benefit patients who have suffered sexual assault.
Elbert Geuze - One of the best experts on this subject based on the ideXlab platform.
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Individual prediction of Psychotherapy Outcome in posttraumatic stress disorder using neuroimaging data
Translational Psychiatry, 2019Co-Authors: Paul Zhutovsky, Sanne J. H. Van Rooij, Guido A. Van Wingen, Mitzy Kennis, Miranda Olff, Rajat M. Thomas, Elbert GeuzeAbstract:Trauma-focused Psychotherapy is the first-line treatment for posttraumatic stress disorder (PTSD) but 30–50% of patients do not benefit sufficiently. We investigated whether structural and resting-state functional magnetic resonance imaging (MRI/rs-fMRI) data could distinguish between treatment responders and non-responders on the group and individual level. Forty-four male veterans with PTSD underwent baseline scanning followed by trauma-focused Psychotherapy. Voxel-wise gray matter volumes were extracted from the structural MRI data and resting-state networks (RSNs) were calculated from rs-fMRI data using independent component analysis. Data were used to detect differences between responders and non-responders on the group level using permutation testing, and the single-subject level using Gaussian process classification with cross-validation. A RSN centered on the bilateral superior frontal gyrus differed between responders and non-responder groups ( P _FWE
B. Milrod - One of the best experts on this subject based on the ideXlab platform.
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Psychodynamic Psychotherapy Outcome for Generalized Anxiety Disorder
American Journal of Psychiatry, 2009Co-Authors: B. MilrodAbstract:Dr. Falk Leichsenring and his colleagues report the results of a methodologically rigorous randomized, controlled trial of supportive-expressive psychodynamic Psychotherapy and cognitive-behavioral therapy (CBT) for generalized anxiety disorder in this issue of the Journal [I). The therapies were balanced for time, frequency, and therapist training.
Yuval Neria - One of the best experts on this subject based on the ideXlab platform.
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anterior hippocampal volume predicts affect focused Psychotherapy Outcome
Psychological Medicine, 2020Co-Authors: Benjamin Suarezjimenez, Yuval Neria, Amit Lazarov, John J Mann, Franklin R Schneier, Andrew J Gerber, Jacques P Barber, Dianne L Chambless, Barbara Milrod, John C. MarkowitzAbstract:BACKGROUND: The hippocampus plays an important role in psychopathology and treatment Outcome. While posterior hippocampus (PH) may be crucial for the learning process that exposure-based treatments require, affect-focused treatments might preferentially engage anterior hippocampus (AH). Previous studies have distinguished the different functions of these hippocampal sub-regions in memory, learning, and emotional processes, but not in treatment Outcome. Examining two independent clinical trials, we hypothesized that anterior hippocampal volume would predict Outcome of affect-focused treatment Outcome [Interpersonal Psychotherapy (IPT); Panic-Focused Psychodynamic Psychotherapy (PFPP)], whereas posterior hippocampal volume would predict exposure-based treatment Outcome [Prolonged Exposure (PE); Cognitive Behavioral Therapy (CBT); Applied Relaxation Training (ART)]. METHODS: Thirty-five patients with posttraumatic stress disorder (PTSD) and 24 with panic disorder (PD) underwent structural magnetic resonance imaging (MRI) before randomization to affect-focused (IPT for PTSD; PFPP for PD) or exposure-based treatments (PE for PTSD; CBT or ART for PD). AH and PH volume were regressed with clinical Outcome changes. RESULTS: Baseline whole hippocampal volume did not predict post-treatment clinical severity scores in any treatment. For affect-focused treatments, but not exposure-based treatments, anterior hippocampal volume predicted clinical improvement. Smaller AH correlated with greater affect-focused treatment improvement. Posterior hippocampal volume did not predict treatment Outcome. CONCLUSIONS: This is the first study to explore associations between hippocampal volume sub-regions and treatment Outcome in PTSD and PD. Convergent results suggest that affect-focused treatment may influence the clinical Outcome through the 'limbic' AH, whereas exposure-based treatments do not. These preliminary, theory-congruent, therapeutic findings require replication in a larger clinical trial.
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history of sexual trauma moderates Psychotherapy Outcome for posttraumatic stress disorder
Depression and Anxiety, 2017Co-Authors: C John M D Markowitz, Yuval Neria, Karina Lovell, Page E Van Meter, Eva PetkovaAbstract:Background Moderators of differential Psychotherapy Outcome for posttraumatic stress disorder (PTSD) are rare, yet have crucial clinical importance. We tested the moderating effects of trauma type for three psychotherapies in 110 unmedicated patients with chronic DSM-IV PTSD. Methods Patients were randomized to 14 weeks of prolonged exposure (PE, N = 38), interpersonal Psychotherapy (IPT, N = 40), or relaxation therapy (RT, N = 32). The Clinician-Administered PTSD Scale (CAPS) was the primary Outcome measure. Moderator candidates were trauma type: interpersonal, sexual, physical. We fit a regression model for week 14 CAPS as a function of treatment (a three-level factor), an indicator of trauma type presence/absence, and their interactions, controlling for baseline CAPS, and evaluated potential confounds. Results Thirty-nine (35%) patients reported sexual, 68 (62%) physical, and 102 (93%) interpersonal trauma. Baseline CAPS scores did not differ by presence/absence of trauma types. Sexual trauma as PTSD criterion A significantly moderated treatment effect: whereas all therapies had similar efficacy among nonsexually-traumatized patients, IPT had greater efficacy among sexually traumatized patients (efficacy difference with and without sexual trauma: IPT vs. PE and IPT vs. RT P’s < .05), specifically in PTSD symptom clusters B and D (P’s < .05). Conclusions Few studies have assessed effects of varying trauma types on effects of differing psychotherapies. In this exploratory study, sexual trauma moderated PTSD Outcomes of three therapies: IPT showed greater benefit for sexually traumatized patients than PE or RT. The IPT focuses on affect to help patients determine trust in their current environments may particularly benefit patients who have suffered sexual assault.