Does psychotherapy for young adults in routine practice show similar results as therapy in randomized clinical trials?

Abstract

Previous research indicates that patients treated with psychotherapy in the community do not stay in treatment long enough to achieve clinically significant change. Because the average patient seeking treatment at a community center may not be as informed and motivated for change as the average patient participating in a research trial, the authors compared outcome among all patients presenting to a mental health clinic (n=416) and a subgroup of patients who started psychotherapy at the same clinic (n=101). Outcome was assessing using the Symptom Checklist-90, Inventory of Interpersonal Problems, and Global Assessment of Functioning. Results confirmed that outcome among all patients seeking the centre was worse than in an average clinical trial. However, patients who started psychotherapy after assessment achieved results comparable to those in RCT studies.

Abstract

Bisherige Forschung deutet an, dass Patienten, die in naturalistisch-ambulanter Gesundheitsversorgung mit Psychotherapie behandelt werden, nicht ausreichend lange in der Therapie verbleiben, um klinisch signifikante Verbesserungen zu erzielen. Da der Durchschnittspatient, der eine Behandlung in einem medizinischen Gesundheitszentrum sucht, nicht in gleichem Maße informiert und veränderungsmotiviert sein könnte, wie der Durchschnittspatient, der in einer Forschungsstudie teilnimmt, verglichen die Autoren Therapieergebnisse von Patienten, die sich in einer psychischen Poliklinik vorstellten (n=416), mit Patienten, die Psychotherapie im Rahmen einer klinischen Studie erhielten (n=101). Das Therapieergebnis wurde mit Hilfe der Symptom Checkliste-90, dem Inventar zur Erfassung interpersoneller Probleme und der Global Assessment of Functioning-Skala erfasst. Die Ergebnisse bestätigten, dass das Therapieergebnis für Patienten, die sich in einer psychischen Poliklinik vorstellten, schlechter war, verglichen mit Patienten in randomisiert-klinischen Studien. Allerdings, erreichten Patienten, welche Psychotherapie nach einer psychologischen Diagnostik begannen, Ergebnisse vergleichbar zu denen in RCT Studien.

Abstract

Des recherché précédents ont montré que les patients traits avec une psychothérapie dans la communauté ne restent pas suffisamment longtemps en traitement pour atteindre un changement clinique significatif. Dans la mesure o[ugrave] la moyenne des patients qui demandent un traitement dans un centre communautaire ne sont pas aussi informés et motivés au changement que la moyenne des patients participant à une recherche, les auteurs ont comparé les résultats entre des patients se présentant dans une clinique de santé mentale (n=416) et des patients qui commençaient une psychothérapie dans un essai clinique (n=101). Les résultats étaient mesurés à l'aide de la liste de contrôle des symptômes (SCL-90), de l'inventaire des problèmes interpersonnels (IIP), et de l’évaluation globale du fonctionnement (GAF). Les résultats ont confirmés que les résultats étaient moins bons pour les patients dans une clinique comparés aux patients des études randomisées contrôlées (RCTs). Cependant les patients qui commençaient la psychothérapie après une évaluation ont atteint des résultats comparables à ceux des études RCT.

Abstract

A investigação existente indica que pacientes tratados com psicoterapia na comunidade não se mantêm em tratamento o tempo suficiente em tratamento para atingir mudanças clinicamente significativas. Uma vez que a maior parte dos doentes que procuram tratamento em centros da comunidade poderão não estar tão informados e motivados para a mudança como a maior parte dos pacientes que participam em ensaios clínicos controlados, os autores compararam os resultados entre pacientes que se apresentaram numa clínica de saúde mental (n=416) e pacientes que iniciaram psicoterapia num ensaio clínico (n=101). Os resultados foram medidos usando o Symptom Checklist-90, Inventory of Interpersonal Problems, e Global Assessment of Functioning. Os dados encontrados confirmam que os resultados foram piores para os pacientes que se apresentaram no centro clínico, comparativamente com os pacientes em ensaios clínicos randomizados (RCTs). No entanto, pacientes que iniciaram psicoterapia depois de serem avaliados, atingiram resultados comparáveis com os participantes de estudos RCT.

Abstract

Ricerche precedenti indicano che i pazienti trattati con la psicoterapia in comunità, non restano in trattamento sufficientemente a lungo per poter ottenere un cambiamento clinicamente significativi. Tutto ciò potrebbe essere dovuto al fatto che il paziente medio in cerca di cure presso un centro comunitario potrebbe non essere così informato e motivato al cambiamento, come il paziente medio che partecipa ad una ricerca di processo. Gli autori hanno confrontato gli esiti ottenuti da pazienti afferenti ad un centro di salute mentale (n = 416) e i pazienti che hanno iniziato una psicoterapia inseriti in un trial clinico (n = 101). Per la valutazione sono stati utilizzati il Symptom Checklist-90 Inventory sui problemi interpersonali e il Global Assessment of Functioning. I dati ottenuti suggeriscono che il risultato è stato peggiore per i pazienti che derivano da un centro pubblico rispetto a quelli che sono stati inseriti in studi clinici randomizzati (RCT). Tuttavia, i pazienti che hanno iniziato una psicoterapia dopo la valutazione ottengono dei risultati comparabili a quelli ottenuti con gli RCT.

Abstract

Keywords:

• mental health services research
• outcome research
• psychoanalytic/psychodynamic therapy

Acknowledgements

Financial support for this study was obtained from the Sörmland County Council Research and Development Center (Landstinget Sörmlands FoU).

Notes

1. The reason for excluding patients with only one session is that it is impossible to calculate outcome with only one measurement. Also, the same procedure was used in the comparison studies (Hansen et al., 2002; Hansen & Lambert, 2003).

2. The two samples used in the study are not independent, but Sample 2 is included within Sample 1.

3. Dropout is difficult to define with this population because the length of therapy is often difficult to predict in advance. Therefore, we have chosen to define as dropouts only those patients who suddenly stopped coming for therapy without discussing this with their therapist. All others are considered treatment completers.

4. Hansen et al. (2002) used the OQ-45 as a dependent variable. It is clear from the results in Sample 2 that the GAF scale yields lower estimates of clinically significant change than the SCL-90 and IIP (see Table IV). Therefore, the comparison with the results of Hansen et al. (2002) is a bit unfair, but nevertheless it is obvious that Sample 1 as a whole did not do as well as Sample 2.