The alliance-outcome relationship in individual psychosocial treatment for schizophrenia and early psychosis: A meta-analysis

Browne, Julia; Wright, Abigail; Berry, Katherine; Mueser, Kim T.; Cather, Corinne; Penn, David L.; Kurtz, Matthew M.

doi:10.1016/j.schres.2021.04.002

Cited by 22 publications

(22 citation statements)

References 36 publications

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“…The presence of an active and trained therapist did not emerge as a significant factor, despite its emphasis in previous literature Psychological Medicine 5 (Browne et al, 2021;Fiszdon et al, 2016), although it did have an effect on CR outcomes (Vita et al, 2021). This finding could be explained by therapists enhancing the treatment rationale, encouraging the transfer of CR skill improvement into everyday life and the chances of participants using these skills through the development of a positive therapeutic alliance.…”

Section: Discussionmentioning

confidence: 67%

Acceptability of cognitive remediation for schizophrenia: a systematic review and meta-analysis of randomized controlled trials

et al. 2022

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Background Acceptability is an important factor for predicting intervention use and potential treatment outcomes in psychosocial interventions. Cognitive remediation (CR) improves cognition and functioning in people with a diagnosis of schizophrenia, but its acceptability, and the impact of participants and treatment characteristics, remain to be investigated. Few studies provide a direct measure of acceptability, but treatment drop-out rates are often available and represent a valid surrogate. Method The systematic search conducted for the most comprehensive CR outcomes database for schizophrenia was updated in December 2020. Eligible studies were randomized clinical trials comparing CR with any other control condition in patients diagnosed with schizophrenia spectrum disorders and that also reported drop-out in treatment and control arms separately. Acceptability was measured as odd-ratios (OR) of drop-out. Results Of 2119 identified reports, 151 studies, reporting 169 comparisons between CR and control interventions with 10 477 participants were included in the analyses. The overall rate of drop-out was 16.58% for CR programs and 15.21% for control conditions. In the meta-analysis, no difference emerged between CR interventions and controls [OR 1.10, 95% confidence interval (CI) 0.96–1.25, p = 0.177]. Factors improving acceptability were: inpatient only recruitment, participants with fewer years of education and lower premorbid IQ, the presence of all CR core elements, and the presence of techniques to transfer cognitive gains into real-world functioning. Conclusions CR for people diagnosed with schizophrenia is effective and has a good acceptability profile, similar to that of other evidence-based psychosocial interventions.

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Section: Discussionmentioning

confidence: 67%

Acceptability of cognitive remediation for schizophrenia: a systematic review and meta-analysis of randomized controlled trials

et al. 2022

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“…In a recent study by Browne et al, patients rating therapeutic alliances with their providers favorably was associated with patients having greater treatment engagement. 63 Similarly, providers or observers rating patient therapeutic alliances favorably was associated with greater treatment engagement and improved positive and negative symptoms. 63 In our analysis, 32.2% of the HDUPs and 33.3% of the LDUPs reported that study participants found AS at least somewhat difficult to use.…”

Section: Discussionmentioning

confidence: 99%

“… 63 Similarly, providers or observers rating patient therapeutic alliances favorably was associated with greater treatment engagement and improved positive and negative symptoms. 63 In our analysis, 32.2% of the HDUPs and 33.3% of the LDUPs reported that study participants found AS at least somewhat difficult to use. This contrasts with participants’ own reports of usability as reported in a separate post hoc analysis of the primary study, in which only 12% of the participants reported AS at least somewhat difficult to use.…”

Section: Discussionmentioning

confidence: 99%

Healthcare Provider Engagement with a Novel Dashboard for Tracking Medication Ingestion: Impact on Treatment Decisions and Clinical Assessments for Adults with Schizophrenia

Cochran¹,

Fang²,

Sonnenberg³

et al. 2022

NDT

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Schizophrenia is a severe, chronic condition accounting for disproportionate healthcare utilization. Antipsychotics can reduce relapse rates, but the characteristics of schizophrenia may hinder medication adherence. A phase 3b open-label clinical trial used aripiprazole tablets with sensor (AS; includes pills with ingestible event-marker, wearable sensor patches and smartphone application) in adults with schizophrenia. This post hoc analysis explored how healthcare providers' (HCPs) usage of a dashboard that provided medication ingestion information impacted treatment decisions and clinical assessments. Patients and Methods: Participants used AS for 3-6 months. HCPs were instructed to check the dashboard regularly, identify features used, and report impact on treatment decisions. After stratifying HCPs by frequency of dashboard checks and resulting treatment decisions, changes from baseline were calculated for Positive and Negative Syndrome Scale (PANSS), Clinical Global Impression (CGI)-Severity of Illness and CGI-Improvement (CGI-I), and Personal and Social Performance (PSP), and compared using Mann-Whitney U-tests and rank-biserial correlation coefficient (r) effect sizes. Results: To ensure sufficient opportunity for AS engagement, 113 participants who completed ≥3 months on study were analyzed. HCPs most often accessed dashboard data regarding medication ingestion and missed doses. HCPs recommended adherence counseling and participant education most often. Participants whose HCPs used the dashboard more and recommended adherence counseling and participant education (n=61) improved significantly more than participants with less dashboard-active HCPs (n=49) in CGI-I mean score (2.9 versus 3.4 [p=0.004]), total PANSS (mean change: −9.2 versus −3.1 [p=0.0002]), PANSS positive subscale (−3.2 versus −1.5 [p=0.003]), PANSS general subscale (−4.3 versus −1.2 [p=0.02]), and Marder factor for negative symptoms (−1.9 versus 0.0 [p=0.03]). Most HCPs found the dashboard easy to use (74%) and helpful for improving conversations with participants about their treatment plan and progress (78%). Conclusion: This provider dashboard may facilitate discussions with patients about regular medication-taking, which can improve patient outcomes.

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“…Therapeutic alliance (TA), or the relationship between therapist and client, is one of the most well‐understood common factors in psychotherapy research (Wampold, 2015) and is shown to predict positive outcomes cross‐diagnostically (Bourke et al, 2021; Browne et al, 2021; Cella & Wykes, 2019; Feinstein et al, 2015; Kidd et al, 2017; Shattock et al, 2018). TA is an important mediator across approaches in modern psychotherapy theory (Baier et al, 2020) and has been historically emphasized in specific disciplines such as psychoanalytic (e.g.…”

Section: Introductionmentioning

confidence: 99%

“…Therapeutic alliance is consistently found to be an important factor that contributes to positive outcomes for mental health treatments broadly (Cella & Wykes, 2019; Feinstein et al, 2015; Kidd et al, 2017; Shattock et al, 2018) and for people with serious mental illness specifically, such as psychosis (Bourke et al, 2021; Browne et al, 2021). For instance, a recent review including both longitudinal and cross‐sectional studies found that better TA for people with SMI is related to reduced symptoms, improved functioning, fewer re‐hospitalizations, reduced medication use and improved self‐esteem (Shattock et al, 2018).…”

Section: Introductionmentioning

confidence: 99%

Therapeutic alliance in a cognitive rehabilitation programme for people with serious mental illness: A qualitative analysis

et al. 2022

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Objective: Therapeutic alliance is an important element of evidence-based treatments for people diagnosed with a serious mental illness. Cognitive enhancement therapy (CET) is an efficacious cognitive rehabilitation programme that emphasizes coach-participant relationships. The purpose of this study was to examine experiences of therapeutic alliance among CET participants. Design: We used an exploratory qualitative approach. Methods: Semi-structured interviews were conducted with 24 participants diagnosed with a serious mental illness. Interview transcripts were analysed by three independent coders using thematic analysis. Results: Four themes related to therapeutic alliance emerged: (1) positive regard; (2) collaboration; (3) authenticity; (4) negative alliance. Conclusions: Findings suggest that therapeutic alliance is an important component of CET that bolsters the learning environment and ensures a positive group experience. Our qualitative analyses contribute greater understanding of how strong therapeutic relationships impact people with serious mental illnesses participating in evidence-based treatments beyond psychotherapy context.

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The alliance-outcome relationship in individual psychosocial treatment for schizophrenia and early psychosis: A meta-analysis

Cited by 22 publications

References 36 publications

Acceptability of cognitive remediation for schizophrenia: a systematic review and meta-analysis of randomized controlled trials

Acceptability of cognitive remediation for schizophrenia: a systematic review and meta-analysis of randomized controlled trials

Healthcare Provider Engagement with a Novel Dashboard for Tracking Medication Ingestion: Impact on Treatment Decisions and Clinical Assessments for Adults with Schizophrenia

Therapeutic alliance in a cognitive rehabilitation programme for people with serious mental illness: A qualitative analysis

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