A cohort study of engagement in telehealth psychotherapy versus in-person services.

Objective: Although telehealth psychotherapies have been studied for over 20 years, mental health services remained largely delivered in person until the COVID-19 pandemic forced clinics to reconsider the utility of telehealth psychotherapy. This study aims to compare patient engagement in in-person versus telehealth services in outpatient psychotherapy for mood and anxiety disorders.

Method: A cohort investigation was conducted, using a propensity score matched sample, extracted from an electronic health record (EHR) to compare engagement in psychotherapy for 762 patients who used in-person services before the pandemic to a cohort of 762 patients who used telehealth psychotherapy after the onset of COVID-19.

Gender, Race/Ethnicity, and Patient-Therapist Matching on Gender and Race/Ethnicity: Predictors/Moderators of the Effectiveness of Trust/Respect Feedback.

A plethora of studies has exhibited the effectiveness of using measurement-based care feedback systems within mental health services to improve treatment outcomes; however, patient gender/race and patient-therapist matching on gender and race remain relatively unexplored as predictors/moderators in feedback studies. We conducted predictor/moderator analyses focusing on the relation of gender, race/ethnicity, and patient-therapist gender and race/ethnicity matching on two outcomes: patient self-reported levels of (1) functioning and (2) trust/respect within the therapeutic relationship. We used data from a randomized controlled trial studying the effectiveness of a feedback system comparing patient-reported levels of trust and respect towards their provider (together with symptom feedback) in comparison to symptom only feedback.

The development of a comprehensive coding system for evaluating insight based on a clinical interview: The SUIP-I coding system.

Gaining insight is considered a cornerstone of psychodynamic psychotherapy. Existing tools used to measure insight mainly include patients' self-report questionnaires and external coding of therapy sessions. To expand on the available tools, the present study developed a comprehensive coding system for the Self-Understanding of Interpersonal Patterns Scales-Interview (SUIP-I; Gibbons & Crits-Christoph, 2017).

Adapting psychotherapy in collaborative care for treating opioid use disorder and co-occurring psychiatric conditions in primary care.

Introduction: Opioid use disorder (OUD) and psychiatric conditions commonly co-occur yet are infrequently treated with evidence-based therapeutic approaches, resulting in poor outcomes. These conditions, separately, present challenges to treatment initiation, retention, and success. These challenges are compounded when individuals have OUD and psychiatric conditions.

Efficacy and moderators of short-term psychodynamic psychotherapy for depression: A systematic review and meta-analysis of individual participant data.

Background: Short-term psychodynamic psychotherapy (STPP) is frequently used to treat depression, but it is unclear which patients might benefit specifically. Individual participant data (IPD) meta-analyses can provide more precise effect estimates than conventional meta-analyses and identify patient-level moderators. This IPD meta-analysis examined the efficacy and moderators of STPP for depression compared to control conditions.

Randomized controlled trial evaluating feedback to community-based therapists based on patient reports of trust and respect.

Objective: Patient trust/respect toward their therapists may be an important component of patient-therapist relationships. This randomized controlled trial evaluated the impact of providing weekly feedback to therapists regarding patient ratings of trust/respect toward their therapist.

Method: Adult patients seeking mental health treatment at four community clinics (two community mental health centers and two community-based intensive treatment programs) were randomized to either having their primary therapist receive weekly symptom feedback-only or symptoms plus trust/respect feedback.

The association between trauma and interpersonal problems in a United States community mental health setting.

Objective: Previous research has documented associations between trauma and interpersonal problems. We examined the impact of trauma on interpersonal problems among depressed patients seeking treatment in a community mental health setting.

Methods: A total of 453 patients seeking treatment and screened for a comparative effectiveness study of therapies for depression were included.

Initial Development of Pragmatic Behavioral Activation Fidelity Assessments.

Purpose: Our goal was to develop brief pragmatic assessments of Behavioral Activation (BA) fidelity to support its dissemination in low-resource settings.

Methods: We used qualitative and quantitative methods across three investigations to develop pragmatic assessments rated from the perspective of therapists, patients, and observers: (1) we developed an initial comprehensive pool of 119 items and adapted/refined the item pool to 32 items through stakeholder focus groups and cognitive interviews; (2) independent blind judges rated each of items in the refined item pool on an early session of BA for 64 patients to support the selection of items based on predictive validity; and (3) we conducted a preliminary evaluation of the acceptability and feasibility of the assessments of BA fidelity from the perspective of therapists and patients.

Results: The internal consistency reliability for the 10-item total score was .

Repeated assessments of depressive symptoms in randomized psychosocial intervention trials: best practice for analyzing symptom change over time.

Objective: Psychotherapy randomized trials rarely have tested for the best fitting model for time effects. We examined the fit of different statistical models for examining time when repeated assessments of depressive symptoms are the primary outcome.

Method: We used data from three studies comparing psychotherapy treatments for major depressive disorder.

The association between medical comorbidity and psychotherapy processes and outcomes for major depressive disorder in a community mental health setting.

Many individuals seeking mental health services for depression often suffer from a comorbid medical condition. The goal of the present study was to assess the presence of medical comorbidity in a community mental health center setting that primarily serves a Medicare and Medicaid population, characterize the types of comorbid medical conditions experienced in this setting, and explore the association between medical conditions on the alliance, attrition from services, and outcome. Medical diagnoses were collected from patient charts and structured clinical interviews from 353 participants who had a baseline assessment as part of a comparative effectiveness study of cognitive and dynamic therapies for major depressive disorder.

Insight as a mechanism of change in dynamic therapy for major depressive disorder.

This study aimed to investigate change in insight into maladaptive interpersonal patterns over the course of psychotherapy, as well as the specificity of insight as a change mechanism in dynamic treatments. A total of 100 patients received up to 16 sessions of either cognitive or dynamic therapy for major depressive disorder in a randomized clinical trial. Assessments of insight (Insight into Conflictual Relationship Patterns scale) and depression severity (Hamilton Depression Inventory) took place at the beginning of treatment, at month 2, and month 5.

EMBRACE: An EM-based bias reduction approach through Copas-model estimation for quantifying the evidence of selective publishing in network meta-analysis.

Systematic reviews and meta-analyses synthesize results from well-conducted studies to optimize healthcare decision-making. Network meta-analysis (NMA) is particularly useful for improving precision, drawing new comparisons, and ranking multiple interventions. However, recommendations can be misled if published results are a selective sample of what has been collected by trialists, particularly when publication status is related to the significance of the findings.

A Feasibility Study of Behavioral Activation for Major Depressive Disorder in a Community Mental Health Setting.

Behavioral activation (BA) is a well-supported treatment approach, but little research has been conducted on the effectiveness of this treatment within publicly funded community mental health settings. We examined the feasibility of conducting a randomized trial examining the effectiveness of nine sessions of BA as a treatment for major depressive disorder (MDD) in a community mental health clinic (CMHC) setting. Following adaptation of a BA manual and training of BA therapists, 80 patients seeking treatment at a CMHC were randomized, with a 3:1 randomization rate of BA to nine sessions of treatment as usual (TAU).

Use of cognitive techniques is associated with change in positive compensatory skills in the treatment of major depressive disorder in a community mental health setting.

To examine the association between adherence and competence in cognitive therapy (CT) techniques and change in positive compensatory skills and depressive symptoms within a community mental health setting. Adherence ratings were available for 97 individuals receiving CT for major depressive disorder. Assessments of adherence and competence were rated on one early session of CT.

Trust and respect in the patient-clinician relationship: preliminary development of a new scale.

Background: Trust and respect may be an important component of client-provider relationships. This study aimed to develop and report preliminary psychometric analyses of a new brief measure to evaluate a patient's level of trust and respect for their clinician. The scale was designed to be applicable in multiple healthcare contexts, with a particular focus on mental healthcare.

Insight into conflictual relationship patterns: Development and validation of an observer rating scale.

This study aimed to develop an observer-rated measure of Insight into Conflictual Relationship Patterns (ICR) applicable to audio- or videotapes of psychotherapy sessions and conduct a first psychometric evaluation. We investigated the item properties, principal components, reliability, and validity of the ICR in a naturalistic sample of  = 125 outpatients in psychodynamic psychotherapy. The ICR consists of 12 items that showed adequate item discrimination and item difficulty indices.

Psychiatry Outpatients' Willingness to Share Social Media Posts and Smartphone Data for Research and Clinical Purposes: Survey Study.

Background: Psychiatry research has begun to leverage data collected from patients' social media and smartphone use. However, information regarding the feasibility of utilizing such data in an outpatient setting and the acceptability of such data in research and practice is limited.

Objective: This study aimed at understanding the outpatients' willingness to have information from their social media posts and their smartphones used for clinical or research purposes.

Predictors of treatment attendance in cognitive and dynamic therapies for major depressive disorder delivered in a community mental health setting.

Objective: Our goal was to evaluate treatment attendance patterns, including both treatment completion and premature termination from treatment, for 2 evidence-based psychotherapies for major depressive disorder (MDD) delivered in a community mental health setting. We explored rates of premature termination across the course of treatment as well as the factors that predicted and moderated premature termination and treatment completion.

Method: This investigation included 237 patients with MDD who participated in a noninferiority trial comparing short-term dynamic psychotherapy (DT) to cognitive therapy (CT).

Instrumental variable analyses for causal inference: Application to multilevel analyses of the alliance-outcome relation.

To introduce readers to instrumental variable analyses for causal inferences using as an example a test of the hypothesis that the quality of the therapeutic alliance has a causal role in relation to the outcome of psychotherapy. We used data from a recent non-inferiority trial of cognitive and dynamic therapies for major depressive disorder in a community mental health setting. The data ( = 161) were analyzed using standard approaches as well as a multilevel 2-stage instrumental variables approach that allows for causal interpretations by removing the influence of unmeasured confounds.

Impact of a medical home model on costs and utilization among comorbid HIV-positive Medicaid patients.

Objectives: The Pennsylvania Chronic Care Initiative (CCI) was a statewide patient-centered medical home (PCMH) initiative implemented from 2008 to 2011. This study examined whether the CCI affected utilization and costs for HIV-positive Medicaid patients with both medical and behavioral health comorbidities.

Study Design: Nonrandomized comparison of 302 HIV-positive Medicaid patients treated in 137 CCI practices and 2577 HIV-positive Medicaid patients treated elsewhere.

Symptoms of anhedonia, not depression, predict the outcome of treatment of cocaine dependence.

The purpose of this paper is to reanalyze data from two studies to determine if anhedonia specifically, rather than depression overall, predicts treatment outcome for patients with cocaine use disorders. Measures of baseline anhedonia symptoms were created using anhedonia items from the Beck Depression Inventory (BDI) to re-examine National Institute on Drug Abuse Cocaine Collaborative Treatment study data (Crits-Christoph et al., 1999) and the contingency management group from the McKay et al.

Which patients benefit specifically from short-term psychodynamic psychotherapy (STPP) for depression? Study protocol of a systematic review and meta-analysis of individual participant data.

Introduction: Short-term psychodynamic psychotherapy (STPP) is an empirically supported treatment that is often used to treat depression. However, it is largely unclear if certain subgroups of depressed patients can benefit specifically from this treatment method. We describe the protocol for a systematic review and meta-analysis of individual participant data (IPD) aimed at identifying predictors and moderators of STPP for depression efficacy.

The Measurement of Cognitive Schemas: Validation of the Psychological Distance Scaling Task in a Community Mental Health Sample.

Objective: The purpose of this study was to examine the validity of the Psychological Distance Scaling Task (PDST), a measure of cognitive schema organization, in a community mental health setting. We also compared validity among African Americans and Caucasians.

Method: In order to accommodate participants with low education levels, 26 out of 80 PDST word stimuli were replaced with similar words at a lower reading level.

Mechanisms of change in cognitive therapy for major depressive disorder in the community mental health setting.

Objective: This study examined the relation of change in theory-relevant cognitive variables to depressive symptom change over the course of cognitive therapy, as well as the specificity of change mechanisms to cognitive therapy as compared with dynamic therapy.

Method: There were 237 adult outpatients who were randomized to either cognitive (n = 119) or dynamic (n = 118) therapy for major depressive disorder in a community mental health setting. Assessments of compensatory skills (Ways of Responding Community Version and Self-Report Version), dysfunctional attitudes (Dysfunctional Attitudes Scale), and depressogenic schemas (Psychological Distance Scaling Task) were obtained at baseline and months 1, 2, and 5 following baseline.

A Naturalistic Evaluation of Extended-Release Naltrexone in Clinical Practice in Missouri.

The purpose of this study was to compare the naturalistic outcomes of individuals with alcohol or opioid use problems who were treated with extended-release naltrexone (XR-NTX) to those treated with psychosocial treatment only and also to those treated with other medication-assisted therapies in Missouri during 2010 to 2011. We analyzed intake and discharge data collected as part of SAMHSA's Treatment Episode Data Set assessments. Patients who received XR-NTX during their treatment episode were compared, for those reporting alcohol (but not opioids) as their problem (N=21,137), to those who received oral naltrexone, acamprosate, and psychosocial treatment only, and for those who reported opioids as a problem (N=8996), to those receiving oral naltrexone, buprenorphine/naloxone, and psychosocial treatment only.