Tailor-made versus standardized therapy of phobic patients

Schulte, Dietmar; Künzel, Rainer; Pepping, Georg; Schulte-Bahrenberg, Thomas

doi:10.1016/0146-6402(92)90001-5

Cited by 211 publications

(147 citation statements)

References 28 publications

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“…In addition, poor judgments by clinical staff can reduce intervention effectiveness. For example, one study found that allowing clinicians to individualize treatment packages for phobic patients was not beneficial relative to a fixed intervention and, in fact, was detrimental if clinicians chose to omit a particularly powerful component of treatment (Schulte et al, 1992).…”

Section: Clinical Judgmentmentioning

confidence: 99%

A Conceptual Framework for Adaptive Preventive Interventions

2004

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Recently, adaptive interventions have emerged as a new perspective on prevention and treatment.Adaptive interventions resemble clinical practice in that different dosages of certain prevention or treatment components are assigned to different individuals, and/or within individuals across time, with dosage varying in response to the intervention needs of individuals. To determine intervention need and thus assign dosage, adaptive interventions use prespecified decision rules based on each participant's values on key characteristics, called tailoring variables. In this paper, we offer a conceptual framework for adaptive interventions, discuss principles underlying the design and evaluation of such interventions, and review some areas where additional research is needed. Keywords adaptive interventions; prevention; research designFor most of the history of research-based interventions aimed at prevention and treatment, the composition and dosage of these interventions have been fixed, in other words, a single composition and dosage has been offered to all program participants. For example, a schoolbased drug abuse prevention curriculum might be delivered to all sixth graders. Every component of the intervention that may be necessary for any particular participant is included in the curriculum, and each child is given the same intervention. Although it is recognized that individuals may have different intervention needs, it is expected that the intervention is in no way diluted or made counterproductive if components that are particularly relevant for an individual are combined with components that may have less, or even no, relevance for that individual.Recently, adaptive interventions have emerged as a new perspective on research-based prevention and treatment. According to this perspective, the varying intervention needs of individuals may not be met optimally by using a single uniform composition and dosage. For this reason, an adaptive intervention assigns different dosages of certain program components across individuals, and/or within individuals across time. Dosage varies in response to the intervention needs of individuals, and dosages are assigned based on decision rules linking characteristics of the individual with specific levels and types of

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Section: Clinical Judgmentmentioning

confidence: 99%

A Conceptual Framework for Adaptive Preventive Interventions

2004

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“…In 156 gepubliceerde gevalsbeschrijvingen in vier belangrijke gedragstherapeutische tijdschriften, bleek slechts in twintig procent van de gevallen een verantwoording te worden afgelegd in de vorm van een functie-analyse over de toegepaste interventies (Haynes & O'Brien, 1990;Eelen & Van den Bergh, 1992). Verder vergeleek Schulte onlangs de waarde van een standaardbehandeling met die van een individu-specifieke behandeling van patiënten met diverse soorten fobieën (Schulte et al, 1992 In de rest van dit slothoofdstuk zullen drie (vooralsnog betrekkelijk speculatieve) zoekschema's worden toegelicht, die van waarde kunnen zijn bij het ontwikkelen van meer individu-specifieke behandelprotocollen voor agorafobische patiënten. Het eerste schema heeft in eerste instantie betrekking op het analyseren van klachten.…”

Section: Aanbevelingen Voor Andere Uitgangspunten In De Toekomstunclassified

Paniekmanagement en exposure in vivo bij paniekstoornis met agorafobie

Korrelboom¹,

Kernkamp²,

Hoogduin³

et al. 1995

DITH

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VTwee mensen wil ik speciaal bedanken. Allereerst Bobby Kernkamp. Zonder hem zou dit proefschrift er nooit zijn gekomen. Het begon als een aardigheidje om, werkend bij verschillende werkgevers, toch te kunnen samenwerken. Bobby, al zo dikwijls gewend om 'groter' te denken dan ik, maakte het tot een wetenschappelijk onderzoek waarop wij gezamenlijk zouden promoveren. Om het project niet uit de hand te laten lopen moesten we besluiten, veel later en in vriendschappelijk overleg, dat het werk gescheiden zou worden voltooid. Het is voor beiden, denk ik, een verstandig besluit geweest. Het project is pas echt afgelopen, wanneer ook zijn dissertatie klaar is.Dan is er mijn Rooie. Onmisbare hulp bij het temmen van mijn PC. Onmisbare steun door aan te moedigen waar dat nodig en te zwijgen waar dat verstandig was. Gezegend met een onganse behoefte aan slaap. Terwijl zij sliep kon ik, zonder al te veel gevoelens van schuld, 's ochtends plaatsnemen achter mijn bureau. In de weekends en op vrije dagen. Onmisbaar vooral als levenspartner en vriendin. Zonder haar zou het zeker uit de hand zijn gelopen. Ik dank haar. Ons leven zal voortaan een beetje anders zijn.

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“…However, the individualized protocol led to somewhat larger maintenance of gains at a six-month follow-up (Jacobson et al, 1989). In another study by Schulte and Künzel (1992), 120 participants with phobias were randomized to either manualized exposure treatment, individualized treatment, or a control condition in which a participant got a treatment based on another participant's individualized treatment plan. The results showed that the manualized approach outperformed the other conditions (Schulte & Künzel, 1992).…”

Section: Tailored and Individualized Cbt Variantsmentioning

confidence: 99%

Treating depression and its comorbidity : From individualized Internet-delivered cognitive behavior therapy to affect-focused psychodynamic psychotherapy

Johansson

2013

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Robert JohanssonTreating depression and its comorbidity From individualized Internet-delivered cognitive behavior therapy to aect-focused psychodynamic psychotherapy AbstractDepression is a major health problem which lowers the quality of life for the individual and generates huge costs for society. Comorbidity between depression and anxiety disorders seems to be the rule rather than the exception. Evidence shows that comorbidity has consistently been associated with a poorer prognosis and greater demands for professional help. Prevalence studies show that many individuals with depression lack access to adequate treatment. Delivering psychological treatments through the Internet in the format of guided self-help is an innovative treatment strategy that has the potential to reach a large number of people. A majority of these treatments have been Internetdelivered cognitive behavior therapy (ICBT). The treatments contain structured material and interventions in the form of self-help text and are accompanied with online support from a therapist. The overarching goal of this thesis has been to enhance Internet-delivered psychological treatments for depression and its comorbidity. To this end, three randomized controlled trials (Study II, III and IV) with a total of 313 participants were conducted. A prevalence study (Study I) was also conducted to provide an up-to-date estimate of the prevalence of depression, anxiety disorders, and their comorbidity in the Swedish general population.In Study II, the efficacy of an individualized ICBT intervention that directly targeted depression and comorbid symptoms was tested. The treatment was compared to a standardized ICBT protocol and an active control group in the form of an online discussion group.Recent meta-analyses support the efficacy of psychodynamic psychotherapy in the treatment of depression. An Internet-based treatment protocol for depression, which was based on psychodynamic psychotherapy rather than CBT, was developed. In Study III, the efficacy of that protocol was evaluated in the treatment of depression.Preliminary evidence indicates that a focus on affect experience and expression may enhance psychodynamic therapies. In Study IV, a new Internet-based psychodynamic protocol was developed that had a strong focus on affect. It targeted both depression and anxiety disorders. The efficacy of that treatment was evaluated in a sample with mixed depression and anxiety.Study I showed that more than every sixth individual in Sweden suffers from symptoms of depression and/or anxiety. Comorbidity between depression and anxiety was substantial and associated with higher symptom burden and lower health-related quality of life. Study II showed that the tailored ICBT protocol was effective in reducing symptoms of depression when compared to the control group. Among individuals with more severe depression and comorbidities, the tailored ICBT treatment worked better than standardized ICBT. Study III showed that the psychodynamic Internet-based psychotherapy was highly effect...

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Tailor-made versus standardized therapy of phobic patients

Cited by 211 publications

References 28 publications

A Conceptual Framework for Adaptive Preventive Interventions

A Conceptual Framework for Adaptive Preventive Interventions

Paniekmanagement en exposure in vivo bij paniekstoornis met agorafobie

Treating depression and its comorbidity : From individualized Internet-delivered cognitive behavior therapy to affect-focused psychodynamic psychotherapy

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