Applying a multilevel approach to meta-analysis is a strong method for dealing with dependency of effect sizes. However, this method is relatively unknown among researchers and, to date, has not been widely used in meta-analytic research. Therefore, the purpose of this tutorial was to show how a three-level random effects model can be applied to meta-analytic models in R using the rma.mv function of the metafor package. This application is illustrated by taking the reader through a step-by-step guide to the multilevel analyses comprising the steps of (1) organizing a data file; (2) setting up the R environment; (3) calculating an overall effect; (4) examining heterogeneity of within-study variance and between-study variance; (5) performing categorical and continuous moderator analyses; and (6) examining a multiple moderator model. By example, the authors demonstrate how the multilevel approach can be applied to meta-analytically examining the association between mental health disorders of juveniles and juvenile offender recidivism. In our opinion, the rma.mv function of the metafor package provides an easy and flexible way of applying a multi-level structure to meta-analytic models in R. Further, the multilevel meta-analytic models can be easily extended so that the potential moderating influence of variables can be examined.

To investigate the association between mental disorders and recidivism in juveniles, a three-level meta-analysis of 20 manuscripts (17 independent studies, N = 5737 juveniles) was conducted. The study focused on internalizing disorders, externalizing disorders, and comorbid disorders (combinations of an internalizing and externalizing disorder). Small to moderate mean effect sizes were found for externalizing disorders (d = 0.415, p b 0.001) and comorbid disorders (d = 0.366, p b 0.001), and no relation was found between internalizing disorders and recidivism (d = 0.016, p = 0.877). For comorbid disorders, no significant variation was found between studies and between effect sizes within studies. Therefore, moderator analyses were only conducted for studies on internalizing and externalizing disorders. These analyses revealed that type of recidivism (e.g., rearrest, reincarceration), type of delinquency (e.g., overt and covert delinquency), and gender influenced the direction and magnitude of the associations between recidivism and internalizing and externalizing disorders.

Background Trauma-focused treatments for posttraumatic stress disorder (PTSD) are commonly delivered either once or twice a week. Initial evidence suggests that session frequency affects treatment response, but very few trials have investigated the effect of session frequency. The present study’s aim is to compare treatment outcomes of twice-weekly versus once-weekly sessions of two treatments for PTSD related to childhood trauma, imagery rescripting (ImRs) and eye movement desensitization and reprocessing (EMDR). We hypothesize that both treatments will be more effective when delivered twice than once a week. How session frequency impacts treatment response, whether treatment type moderates the frequency effect, and which treatment type and frequency works best for whom will also be investigated. Methods The IREM-Freq trial is an international multicenter randomized clinical trial conducted in mental healthcare centers across Australia, Germany, and the Netherlands. We aim to recruit 220 participants, who will be randomized to one of four conditions: (1) EMDR once a week, (2) EMDR twice a week, (3) ImRs once a week, or (4) ImRs twice a week. Treatment consists of 12 sessions. Data are collected at baseline until one-year follow-up. The primary outcome measure is clinician-rated PTSD symptom severity. Secondary outcome measures include self-reported PTSD symptom severity, complex PTSD symptoms, trauma-related cognitions and emotions, depressive symptoms, dissociation, quality of life, and functioning. Process measures include memory, learning, therapeutic alliance, motivation, reluctance, and avoidance. Additional investigations will focus on predictors of treatment outcome and PTSD severity, change mechanisms of EMDR and ImRs, the role of emotions, cognitions, and memory, the optimization of treatment selection, learned helplessness, perspectives of patients and therapists, the network structure of PTSD symptoms, and sudden treatment gains. Discussion This study will extend our knowledge on trauma-focused treatments for PTSD related to childhood trauma and, more specifically, the importance of session frequency. More insight into the optimal session frequency could lead to improved treatment outcomes and less dropout, and in turn, to a reduction of healthcare costs. Moreover, the additional investigations will broaden our understanding of how the treatments work and variables that affect treatment outcome. Trial registration Netherlands Trial Register NL6965, registered 25/04/2018.

Collaborative assessment methods (CAMs) involve working with clients during all phases of the assessment process, from goal definition to interpretation of the testing results to the recommendations and conclusions. In this article, we define CAMs, provide clinical examples, and then meta-analyze the published literature to assess their effectiveness on distal treatment outcomes. Our meta-analytic results indicate that CAMs have positive effects on three outcome domains: a moderate effect on treatment processes, a small-to-moderate effect on personal growth, and a small effect on symptom reduction. There is little research evidence on the immediate, in-session effects of CAMs. We include diversity considerations, training implications. and therapeutic practices grounded in this research evidence.

Self-report measures provide an important source of information in correctional/forensic settings, yet at the same time the validity of that information is often questioned because self-reports are thought to be highly vulnerable to self-presentation biases. Primary studies in offender samples have provided mixed results with regard to the impact of socially desirable responding on self-reports. The main aim of the current study was therefore to investigate-via a meta-analytic review of published studies-the association between the two dimensions of socially desirable responding, impression management and self-deceptive enhancement, and self-report measures with content of dynamic risk factors using the Balanced Inventory of Desirable Responding (BIDR) in offender samples. These self-report measures were significantly and negatively related with self-deception (r = -0.120, p < 0.001; k = 170 effect sizes) and impression management (r = -0.158, p < 0.001; k = 157 effect sizes), yet there was evidence of publication bias for the impression management effect with the trim and fill method indicating that the relation is probably even smaller (r = -0.07). The magnitude of the effect sizes was small. Moderation analyses suggested that type of dynamic risk factor (e.g., antisocial cognition versus antisocial personality), incentives, and publication year affected the relationship between impression management and self-report measures with content of dynamic risk factors, whereas sample size, setting (e.g., incarcerated, community), and publication year influenced the relation between self-deception and these self-report measures. The results indicate that the use of self-report measures to assess dynamic risk factors in correctional/forensic settings is not inevitably compromised by socially desirable responding, yet caution is warranted for some risk factors (antisocial personality traits), particularly when incentives are at play.

Background Specialized evidence-based treatments have been developed and evaluated for borderline personality disorder (BPD), including Dialectical Behavior Therapy (DBT) and Schema Therapy (ST). Individual differences in treatment response to both ST and DBT have been observed across studies, but the factors driving these differences are largely unknown. Understanding which treatment works best for whom and why remain central issues in psychotherapy research. The aim of the present study is to improve treatment response of DBT and ST for BPD patients by a) identifying patient characteristics that predict (differential) treatment response (i.e., treatment selection) and b) understanding how both treatments lead to change (i.e., mechanisms of change). Moreover, the clinical effectiveness and cost-effectiveness of DBT and ST will be evaluated. Methods The BOOTS trial is a multicenter randomized clinical trial conducted in a routine clinical setting in several outpatient clinics in the Netherlands. We aim to recruit 200 participants, to be randomized to DBT or ST. Patients receive a combined program of individual and group sessions for a maximum duration of 25 months. Data are collected at baseline until three-year follow-up. Candidate predictors of (differential) treatment response have been selected based on the literature, a patient representative of the Borderline Foundation of the Netherlands, and semi-structured interviews among 18 expert clinicians. In addition, BPD-treatment-specific (ST: beliefs and schema modes; DBT: emotion regulation and skills use), BPD-treatment-generic (therapeutic environment characterized by genuineness, safety, and equality), and non-specific (attachment and therapeutic alliance) mechanisms of change are assessed. The primary outcome measure is change in BPD manifestations. Secondary outcome measures include functioning, additional self-reported symptoms, and well-being. Discussion The current study contributes to the optimization of treatments for BPD patients by extending our knowledge on “Which treatment – DBT or ST – works the best for which BPD patient, and why?”, which is likely to yield important benefits for both BPD patients (e.g., prevention of overtreatment and potential harm of treatments) and society (e.g., increased economic productivity of patients and efficient use of treatments). Trial registration Netherlands Trial Register, NL7699, registered 25/04/2019 - retrospectively registered.

Objectives: New Perspectives (NP) aims to prevent that youth at onset of a criminal career will develop a more persistent criminal behavior pattern. The study aim was to examine whether NP was effective relative to care as usual in preventing and reducing (persistent) delinquency. Moreover, we examined improvements in secondary outcomes (e.g., peer and parent relationships and cognitive distortions) and other outcomes (e.g., substance use and self-esteem). Methods: At-risk youth (N = 101) aged 12 to 19 years were randomly assigned to the intervention group (NP, n = 47) or control group ('care as usual', n = 54). The effects of the NP intensive phase (3 months after program start) and aftercare phase (6 months after program start) were analyzed. Results: NP and care as usual did not differ on any of the outcome measures at both post-test occasions. The effects of NP were the same for boys and girls, different age groups, and ethnic groups. Conclusions: The overall null-effects are discussed, including implications for further research, policy, and practice.

Purpose Even though five to 11% of child-to-parent abuse (CPA) perpetrators are emerging adults (age 18–23 years), relevant risk factors underlying CPA in this group are understudied. Method A multilevel meta-analysis was performed on nine studies (450 effect sizes, N = 1,043), comprising eight static (e.g., age and gender of perpetrator) and dynamic (e.g., substance abuse, financial problems) risk factors. Results Emerging adults who fell victim of domestic violence, or had antisocial cognitions, authority problems, or empathy problems displayed CPA more often. Moderator analyses revealed that the relation between gender of perpetrator and CPA was moderated by gender of victim ( p = .033) and CPA type ( p = .021). Gender of victim ( p < .001) also moderated the relationship between single-parent household and CPA. Finally, the relation between witness to DV and CPA was moderated by age ( p = .007). Conclusions This was the first multilevel meta-analysis focusing exclusively on CPA displayed by emerging adults. The results can be used as a basis for further research into relevant risk factors for CPA in this group and hopefully contribute to the development of health care interventions to reduce chances of CPA occurring. Supplementary Information The online version contains supplementary material available at 10.1007/s10896-022-00469-4.