In a previous study, it was found that several constructs derived from a positive definition of mental health had changed during psychotherapy. It remains unclear whether they change as part of a single process together with symptomatic change, as part of separate processes, or whether a change in one of the variables predicts change in another variable. Our objective in this study was to examine the relationship between the observed changes and to establish temporal precedence that constitutes a necessary condition for causation. Sixty-two clients who underwent psychotherapy in a naturalistic setting completed questionnaires at 5 time points throughout treatment. The change scores for each client in each of the variables were calculated. The correlations between the changes' scores were tested. To examine the time order, we used autoregressive cross-lagged modeling. A negative correlation was found between the symptoms change score and the happiness change score, r(60) ϭ Ϫ0.53, p Ͻ .000. A positive correlation was detected between playfulness and happiness change scores, r(60) ϭ 0.31, p ϭ .014. Playfulness predicted subsequent levels of creativity, b ϭ 0.66, t(121) ϭ 2.1, p Ͻ .05. Honestyhumility levels predicted subsequent levels of creativity, b ϭ 0.65, t(121) ϭ 9.71, p Ͻ .001. The findings support the claim that the change in positive features of mental health is an independent process from symptomatic improvement. In addition, playfulness and honesty-humility temporally precede creativity, and thus might be part of a single change in a mental health construct that is positively defined.
Clinical Impact StatementQuestion: This article provides an exploration of the relationships between the changes during psychotherapy in positive characteristics of mental health (e.g., happiness, honesty, playfulness, creativity, and affiliative humor style) and between symptoms change. Findings: The change in positive features of mental health is mostly an independent process from symptomatic change. Playfulness and honesty might be the first step in a single change process of positive mental health construct that leads to improvement in creativity. Meaning: Clinicians will be able to use these measures to monitor several positive characteristics of mental health along with therapy and to evaluate a richer and fuller effect of their treatments beyond symptomatic change. Next Steps: Further research should focus on the process outcome paths that emerged from the cross-lagged analysis.
Our objective was to examine the effectiveness and efficiency of psychodynamic psychotherapy on the reduction in health care utilization and cost while controlling for age, gender, and year. Health care utilization and cost were examined yearly in 1,675 patients from 2 years before outpatient psychotherapy (i.e., baseline) to three consecutive years after psychotherapy in a naturalistic longitudinal design. A multilevel analytic approach (LMLM) was applied to account for repeated measures effect and missing data. In the year prior to psychotherapy, there was a significant increase in total cost compared with baseline (14.8%) and in use of health care services (primary and specialist doctors' visits and outsourced referrals). In the first year following therapy, there was a significant decrease in total cost (10%) and in use of health care services (all doctors' visits, imaging, and outsourced referrals). The decrease was to baseline levels or lower and was maintained for two additional years. Psychiatric medication usage increased significantly after psychotherapy and remained so. The overall cumulative decrease in total cost per patient over 3 years after therapy was 3,665.92 NIS, equalling a 69% average cost of psychotherapy. Further cost saving can be expected due to the reduction in sick leave, disability, and psychiatric hospitalization. These findings support the notion that providing outpatient psychodynamic psychotherapy can be financially beneficial to health care systems, although further research is required for causal inferences. Also, an increase in health care utilization along with scarce physical findings may indicate unaddressed psychological distress and warrant referral for mental assessment and possible psychotherapy.
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