Extreme deviations from expected recovery curves and their associations with therapeutic alliance, social support, motivation, and life events in psychosomatic in-patient therapy

Abstract

Objectives: Within the clinical support tools (CST) of the OQ-Analyst, the “Assessment for Signal Cases” (ASC) evaluates the therapeutic alliance, social support, motivation, and life events. We investigated whether the ASC covers domains of importance in treatment weeks with extreme deviations from expected recovery curves (ERCs). Methods: Psychosomatic in-patients were monitored weekly with the ASC and the “Outcome Questionnaire” (OQ-45). The ERCs of the OQ-45 empirical algorithm were used to define treatment weeks with extreme positive deviations (EPD), extreme negative deviations (END), or without extreme deviations (NO). Associations between the ASC scales and EPD as well as END were analyzed by multilevel models. Results: While each ASC scale was positively associated with EPD, only the social support and life events scales were negatively related to END. Conclusions: CSTs prioritizing social support and life events might be more effective in preventing treatment failure.

Obiettivi: Tra gli strumenti di supporto clinico (CST) dell'OQ-Analyst, la "Assessment for Signal Cases " (ASC) valuta l'alleanza terapeutica, il sostegno sociale, la motivazione e gli eventi di vita. Abbiamo studiato se l'ASC copre domini importanti nelle settimane di trattamento con deviazioni estreme dalle curve di recovery attese (ERCs). Metodi: sono stati monitorati settimanalmente pazienti ambulatoriali con patologia psicosomatica con l'ASC e la " Outcome Questionnaire " (OQ-45). Sono state usate le ERC dell'algoritmo empirico del OQ-45 per identificare le settimane di trattamento con deviazioni estreme positive (EPD), deviazioni estreme negative (END), o senza deviazioni estreme (NO). Sono state analizzate le associazioni tra le scale ASC e EPD, nonché quele END con modelli multilivello. Risultati: Mentre ogni scala ASC era associata positivamente con EPD, solo le scale del sostegno sociale ed eventi di vita erano negativamente correlate all'END. Conclusioni: i CST che privilegiano il sostegno sociale e gli eventi di vita potrebbero essere più efficaci nel prevenire il fallimento del trattamento.

Zusammenfassung: Ziele: Innerhalb der klinischen Entscheidungshilfen (engl. CST) des OQ-Analyst, evaluiert das Assessment for signal clients (ASC) die therapeutische Allianz, die soziale Unterstützung, die Motivation und die Lebensereignisse. Wir untersuchten, ob der ASC in Behandlungswochen mit extremen Abweichungen von den zu erwartenden Erholungskurven (engl. ERC) wichtige Bereiche abdeckt. Methode: Stationäre psychosomatische Patienten wurden wöchentlich mit dem ASC und dem Outcome Questionnaire (OQ-45) gemonitort. Die erwarteten ERCs der empirischen OQ-45 Algorithmen wurden zur Definition von Behandlungswochen mit extrem positiven Abweichungen (engl. EPD), extrem negativen Abweichungen (engl. END), oder ohne extreme Abweichungen (NO) verwendet. Assoziationen zwischen den ASC-Skalen und den EPD sowie den END wurden mittels Multilevel-Modellen analysiert. Ergebnisse: Während jede ASC-Skala positiv mit EPD assoziiert war, hingen nur die soziale Unterstützung und Lebensereignisse negativ mit END zusammen. Zusammenfassung: CSTs, welche die soziale Unterstützung und Lebensereignisse priorisieren, sind vielleicht effektiver in der Prävention von erfolglosen Behandlungen.

Objetivos: De entre as ferramentas de apoio à decisão clínica (FADC) do OQ-Analyst, a Assessment for Signal Cases (ASC) avalia a aliança terapêutica, o suporte social, a motivação, e os eventos de vida. Investigámos se a ASC abrange domínios importantes durante as semanas de tratamento com desvios extremos das curvas de recuperação esperada (CsRE). Métodos: Pacientes psicossomáticos em internamento foram monitorizados semanalmente com a ASC e o Outcome Questionnaire (OQ-45). A CRE do algoritmo empírico do OQ-45 foi utilizada para definir semanas de tratamento com desvios extremos positivos (DEP), desvios extremos negativos (DEN), ou sem desvios extremos (SD). As associações entre as escalas da ASC e os DEP e DEN foram analisadas através de modelos multinível. Resultados: Enquanto que cada escala da ASC foi positivamente correlacionada com os DEP, apenas as escalas de suporte social e eventos de vida foram negativamente associadas aos DEN. Conclusões: As FADCs que priorizem o suporte social e os eventos de vida poderão ser mais eficazes na prevenção do fracasso de um tratamento.

目的：在效果問卷分析的臨床支持工具(clinical support tools, CST)中，「個案警示評估」(Assessment for Signal Cases, ASC)所評量的包括有治療聯盟、社會支持、動機與生活事件，我們對 ASC 是否涵蓋極端偏離恢復曲線(expected recovery curves, ERCs)之治療週次的重要向度進行探討。方法：每週以ASC、「效果問卷」 (Outcome Questionnaire, OQ-45)監測心身症住院病患，以OQ-45實徵對數之ERCs界定出極端正向偏離 (extreme positive deviations, EPD)、極端負向偏離 (extreme negative deviations, END)或未極端偏離(NO)的治療週次。以多層次模式分析ASC量表與EPD、END的相關。結果：雖然每個ASC量表皆與EPD有正相關，但唯有社會支持與生活事件與END有負相關。結論：CSTs中在預防治療失敗上較為有效的是社會支持與生活事件。

關鍵字：監測、臨床支持工具、可觀的變化、心理治療歷程、心身症

Keywords:

• monitoring
• clinical support tools
• considerable change
• psychotherapeutic process
• psychosomatics

Parole chiave:

• monitoraggio
• strumenti di supporto clinico
• notevole cambiamento
• processo psicoterapeutico
• psicosomatica

Schlüsselwörter:

• Psychotherapeutisches Monitoring
• Feedback
• Effekt
• Outcome Questionnaire-45.2
• OQ-45

Notes

¹ The number of patients with END amounted to 38 in this paper. This sample differs from the 43 patients with END analyzed by Probst et al. (2013) since 5 of those 43 patients did not complete the ASC in their treatment weeks classified as END.