Continuous outcome measurement in modern data‐informed psychotherapies

Lutz, Wolfgang; Rubel, Julian; Deisenhofer, Anne‐Katharina; Moggia, Danilo

doi:10.1002/wps.20988

Cited by 8 publications

(4 citation statements)

References 10 publications

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“…There is no reliable evidence to support a data-driv en decision algorithm for sequencing as yet. However, monitoring and feedback systems have been reported to increase the efficacy of psychotherapies by further personalizing and adapting interventions to the patients' response 53,54 . These will be tested in a future confirmatory trial.…”

Section: Discussionmentioning

confidence: 99%

Algorithm‐based modular psychotherapy vs. cognitive‐behavioral therapy for patients with depression, psychiatric comorbidities and early trauma: a proof‐of‐concept randomized controlled trial

Schramm,

Elsaesser,

Jenkner

et al. 2024

World Psychiatry

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Effect sizes of psychotherapies currently stagnate at a low‐to‐moderate level. Personalizing psychotherapy by algorithm‐based modular procedures promises improved outcomes, greater flexibility, and a better fit between research and practice. However, evidence for the feasibility and efficacy of modular‐based psychotherapy, using a personalized treatment algorithm, is lacking. This proof‐of‐concept randomized controlled trial was conducted in 70 adult outpatients with a primary DSM‐5 diagnosis of major depressive disorder, a score higher than 18 on the 24‐item Hamilton Rating Scale for Depression (HRSD‐24), at least one comorbid psychiatric diagnosis according to the Structured Clinical Interview for DSM‐5 (SCID‐5), a history of at least “moderate to severe” childhood maltreatment on at least one domain of the Childhood Trauma Questionnaire (CTQ), and exceeding the cut‐off value on at least one of three measures of early trauma‐related transdiagnostic mechanisms: the Rejection Sensitivity Questionnaire (RSQ), the Interpersonal Reactivity Index (IRI), and the Difficulties in Emotion Regulation Scale‐16 (DERS‐16). Patients were randomized to 20 sessions of either standard cognitive‐behavioral therapy alone (CBT) or CBT plus transdiagnostic modules according to a mechanism‐based treatment algorithm (MoBa), over 16 weeks. We aimed to assess the feasibility of MoBa, and to compare MoBa vs. CBT with respect to participants’ and therapists’ overall satisfaction and ratings of therapeutic alliance (using the Working Alliance Inventory ‐ Short Revised, WAI‐SR), efficacy, impact on early trauma‐related transdiagnostic mechanisms, and safety. The primary outcome for efficacy was the HRSD‐24 score at post‐treatment. Secondary outcomes included, among others, the rate of response (defined as a reduction of the HRSD‐24 score by at least 50% from baseline and a score <16 at post‐treatment), the rate of remission (defined as a HRSD‐24 score ≤8 at post‐treatment), and improvements in early trauma‐related mechanisms of social threat response, hyperarousal, and social processes/empathy. We found no difficulties in the selection of the transdiagnostic modules in the individual patients, applying the above‐mentioned cut‐offs, and in the implementation of MoBa. Both participants and therapists reported higher overall satisfaction and had higher WAI‐SR ratings with MoBa than CBT. Both approaches led to major reductions of depressive symptoms at post‐treatment, with a non‐significant superiority of MoBa over CBT. Patients randomized to MoBa were nearly three times as likely to experience remission at the end of therapy (29.4% vs. 11.4%; odds ratio, OR = 3.2, 95% CI: 0.9‐11.6). Among mechanism‐based outcomes, MoBa patients showed a significantly higher post‐treatment effect on social processes/empathy (p<0.05) compared to CBT patients, who presented an exacerbation on this domain at post‐treatment. Substantially less adverse events were reported for MoBa compared to CBT. These results suggest the feasibility and acceptability of an algorithm‐based modular psychotherapy complementing CBT in depressed patients with psychiatric comorbidities and early trauma. While initial evidence of efficacy was observed, potential clinical advantages and interindividual heterogeneity in treatment outcomes will have to be investigated in fully powered confirmation trials.

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Section: Discussionmentioning

confidence: 99%

Algorithm‐based modular psychotherapy vs. cognitive‐behavioral therapy for patients with depression, psychiatric comorbidities and early trauma: a proof‐of‐concept randomized controlled trial

Schramm,

Elsaesser,

Jenkner

et al. 2024

World Psychiatry

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“…The therapeutic process was constantly monitored using a Web-based monitoring tool. Real-time monitoring with feedback has been recommended as a standard of practice (Lambert, 2017) because it improves outcomes, reduces dropout (de Jong et al, 2021), and can be a prerequisite for the effective personalization of treatment (Lutz et al, 2022). For example, real-time monitoring may be used to track dysfunctional behavior using a diary card, thereby facilitating therapist behavior in accordance to the target hierarchy.…”

Section: Treatmentmentioning

confidence: 99%

How Important Is Reprocessing in Personalized Multicomponent Therapy? Analyzing Longitudinal Data of Inpatients With Severe PTSD

et al. 2023

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Treatment guidelines for complex presentations of posttraumatic stress disorder (PTSD) are often cautious about the reprocessing of traumatic memories and recommend multicomponent treatments that are widely used in clinical practice. Yet, the role of reprocessing in these multicomponent treatments remains unknown. Using naturalistic data of 97 patients treated for PTSD, we used a linear mixed model to investigate the role of reprocessing for the outcome at discharge and at 6-month follow-up. Treatment effects were significant and large (g = 0.91–1.05). The final model showed good fit and explained 51% of the variance. There was a significant main effect of time (B = −8.1 [−11.5; −4.8], p < 0.001), as well as a reprocessing by time interaction (B = −17.2 [−30.5; −3.8], p = 0.012), indicating better outcomes with higher levels of reprocessing. Hence, maximizing the amount of reprocessing used in multicomponent treatments for PTSD may significantly enhance outcomes.

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“…When the alert of one of these areas is activated, the therapist can access the CSTs that guide how to address that particular area (e.g., a clinical guideline on how to work on motivation to change). With this information, the therapist can modify their initial CF by counting on information to dynamically adapt it during the ongoing treatment Lutz et al, 2022a ).…”

Section: The Trier Treatment Navigator and Case Formulationmentioning

confidence: 99%

“…The current article addresses how CDSS can contribute to CF. On this aim, we review the background under which CDSS in psychotherapy have been developed and the implications of applying these systems in clinical practice (i.e., data-informed psychotherapy; Lutz, 2022;Lutz et al, 2022a). We present the Trier Treatment Navigator (TTN; Lutz et al, 2021b;Lutz et al, 2019), a CDSS developed in the context of the research-based clinical training programme of the University of Trier.…”

Section: Introductionmentioning

confidence: 99%

Data-Informed Case Formulation with the Trier Treatment Navigator

Moggia

Schaffrath

Bommer

et al. 2022

rdp

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The current article presents a way of practising case formulation using technology augmentation in the context of data-informed psychotherapy. First, we explain how case formulation guides the decision-making processes in psychotherapy and how decisions made under an intuitive clinical judgement can be biased. The use of actuarial methods is pointed out as a way of addressing these biases, mainly through clinical decision support systems based on statistical tools and machine learning algorithms. We present the Trier Treatment Navigator (TTN), a clinical decision support system developed in a University research-based clinical training programme. We show how the TTN can contribute to an initial case formulation and its dynamic adaptations during treatment with a clinical case. Finally, we discuss how case formulation and data-informed psychotherapy are aimed at the same goal: treatment personalisation. We argue that case formulation and data-informed psychotherapy enrich and feedback on each other.

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Continuous outcome measurement in modern data‐informed psychotherapies

Cited by 8 publications

References 10 publications

Algorithm‐based modular psychotherapy vs. cognitive‐behavioral therapy for patients with depression, psychiatric comorbidities and early trauma: a proof‐of‐concept randomized controlled trial

Algorithm‐based modular psychotherapy vs. cognitive‐behavioral therapy for patients with depression, psychiatric comorbidities and early trauma: a proof‐of‐concept randomized controlled trial

How Important Is Reprocessing in Personalized Multicomponent Therapy? Analyzing Longitudinal Data of Inpatients With Severe PTSD

Data-Informed Case Formulation with the Trier Treatment Navigator

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