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BMC Psychiatry

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Open Access 01-12-2017 | Study protocol

Randomized controlled trial to evaluate the effects of personalized prediction and adaptation tools on treatment outcome in outpatient psychotherapy: study protocol

Authors: Wolfgang Lutz, Dirk Zimmermann, Viola N. L. S. Müller, Anne-Katharina Deisenhofer, Julian A. Rubel

Published in: BMC Psychiatry | Issue 1/2017

Abstract

Background

Psychotherapy is successful for the majority of patients, but not for every patient. Hence, further knowledge is needed on how treatments should be adapted for those who do not profit or deteriorate. In the last years prediction tools as well as feedback interventions were part of a trend to more personalized approaches in psychotherapy. Research on psychometric prediction and feedback into ongoing treatment has the potential to enhance treatment outcomes, especially for patients with an increased risk of treatment failure or drop-out.

Methods/design

The research project investigates in a randomized controlled trial the effectiveness as well as moderating and mediating factors of psychometric feedback to therapists. In the intended study a total of 423 patients, who applied for a cognitive-behavioral therapy at the psychotherapy clinic of the University Trier and suffer from a depressive and/or an anxiety disorder (SCID interviews), will be included. The patients will be randomly assigned either to one therapist as well as to one of two intervention groups (CG, IG2). An additional intervention group (IG1) will be generated from an existing archival data set via propensity score matching. Patients of the control group (CG; n = 85) will be monitored concerning psychological impairment but therapists will not be provided with any feedback about the patients assessments. In both intervention groups (IG1: n = 169; IG2: n = 169) the therapists are provided with feedback about the patients self-evaluation in a computerized feedback portal. Therapists of the IG2 will additionally be provided with clinical support tools, which will be developed in this project, on the basis of existing systems. Therapists will also be provided with a personalized treatment recommendation based on similar patients (Nearest Neighbors) at the beginning of treatment. Besides the general effectiveness of feedback and the clinical support tools for negatively developing patients, further mediating and moderating variables on this feedback effect should be examined: treatment length, frequency of feedback use, therapist effects, therapist’s experience, attitude towards feedback as well as congruence of therapist’s and patient’s evaluation concerning the progress. Additional procedures will be implemented to assess treatment adherence as well as the reliability of diagnosis and to include it into the analyses.

Discussion

The current trial tests a comprehensive feedback system which combines precision mental health predictions with routine outcome monitoring and feedback tools in routine outpatient psychotherapy. It also adds to previous feedback research a stricter design by investigating another repeated measurement CG as well as a stricter control of treatment integrity. It also includes a structured clinical interview (SCID) and controls for comorbidity (within depression and anxiety). This study also investigates moderators (attitudes towards, use of the feedback system, diagnoses) and mediators (therapists’ awareness of negative change and treatment length) in one study.

Trial registration

Current Controlled Trials NCT03107845. Registered 30 March 2017.

Ten specific questions will be asked e.g., “Due to feedback, I…”

…discussed with the patient his/her answers in the questionnaire
…tried to adjust my therapeutic interventions
…prepared the end of therapy
…etc. (for more details see Lutz et al., 2012)

The therapist should ask for feedback regularly to ensure his or her own understanding of the patient’s situation and the patient’s understanding of therapy. The therapist should acquire feedback in such a way that the patient does not feel tested or evaluated.

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Title: Randomized controlled trial to evaluate the effects of personalized prediction and adaptation tools on treatment outcome in outpatient psychotherapy: study protocol
Authors: Wolfgang Lutz
Dirk Zimmermann
Viola N. L. S. Müller
Anne-Katharina Deisenhofer
Julian A. Rubel
Publication date: 01-12-2017
Publisher: BioMed Central
Published in: BMC Psychiatry / Issue 1/2017
Electronic ISSN: 1471-244X
DOI: https://doi.org/10.1186/s12888-017-1464-2

Keynote webinar | Spotlight on sleep in brain health

Springer Medicine

Randomized controlled trial to evaluate the effects of personalized prediction and adaptation tools on treatment outcome in outpatient psychotherapy: study protocol

Abstract

Background

Methods/design

Discussion

Trial registration

Keynote webinar | Spotlight on sleep in brain health

Springer Medicine

Abstract

Background

Methods/design

Discussion

Trial registration

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