Readiness to change and therapy outcomes of an innovative psychotherapy program for surgical patients: results from a randomized controlled trial

Abstract

BackgroundReadiness to change is a pivotal construct for psychotherapy research and a major target of motivational interventions. Our primary objective was to examine whether pre-treatment readiness to change moderated therapy effects of Bridging Intervention in Anesthesiology (BRIA), an innovative psychotherapy approach for surgical patients. This stepped care program aims at motivating and supporting surgical patients with mental disorders to engage in psychosocial mental health care.MethodsThe major steps of BRIA are two motivational interventions with different intensity. The first step of the program consists of preoperative computer-assisted psychosocial self-assessment including screening for psychological distress and automatically composed computerized brief written advice (BWA). In the second step, patients participate in postoperative psychotherapy sessions combining motivational interviewing with cognitive behavioural therapy (BRIA psychotherapy sessions).We performed regression-based moderator analyses on data from a recent randomized controlled trial published by our research group. The sample comprised 220 surgical patients with diverse comorbid mental disorders according to ICD-10. The most frequent disorders were mood, anxiety, substance use and adjustment disorders. The patients had a mean age of 43.31 years, and 60.90% were women. In a regression model adjusted for pre-treatment psychological distress, we investigated whether readiness to change moderated outcome differences between (1) the BRIA psychotherapy sessions and (2) no psychotherapy / BWA only.ResultsMultiple regression analyses showed that readiness to change moderated treatment effects regarding the primary outcomes "Participation in psychosocial mental health care options at month 6" (p = 0.03) and "Having approached psychosocial mental health care options at month 6" (p = 0.048) but not regarding the secondary outcome "Change of general psychological distress between baseline assessment and month 6" (p = 0.329). Probing the moderation effect with the Johnson-Neyman technique revealed that BRIA psychotherapy sessions were superior to BWA in patients with low to moderate readiness, but not in those with high readiness.ConclusionsReadiness to change may act as moderator of the efficacy of psychosocial therapy. Combinations of motivational interviewing and cognitive behavioural therapy may be effective particularly in patients with a variety of mental disorders and low readiness to change.Trial registration clinicaltrials.gov Identifier: NCT01357694.

Psychologists’ Perspectives on the implementation of Psychological Therapy for Psychosis in the Acute Psychiatric Inpatient Setting

“…However, this was done where possible, given the scarce psychological resources in inpatient settings. This is at conflict which usual approaches to psychological therapy where "readiness" for psychological therapy is assessed (Krampe et al, 2017). The remainder of the themes required psychology to be adapted to the environmental restrictions of the inpatient ward and the necessary flexibility required to deliver psychology effectively.…”

Community sentence with Mental Health Treatment Requirement (MHTR); an exploration into offenders’ experience of psychological therapy

“…These factors can be continually reviewed by professionals involved in an MHTR, probation and an MHTR service user when evaluating engagement. Readiness to change has been found to be an indicator for treatment engagement and behavioural change (Krampe et al , 2017; Helder et al , 2017; Micic et al , 2018). MHTR professionals may include treatment preparedness scales within their assessment, as this may help predict treatment completion (Mitchell et al , 2017).…”

Informed Consent in Surgical Practice in Port Harcourt: How Informed are the Patients?

“…In family planning clinics, counselling session longer than 14 minutes has been reported to have little advantage on effectiveness of the counselling process [31]. A randomized controlled trial describing innovative psychotherapy program for surgical patients, varied counselling duration was reported depending on individual patient needs and usually not exceeding 50 minutes [32]. The duration of counselling session as reported by patient respondents varied widely from less than 5 minutes to just above 30 minutes.…”