Measuring Psychotherapeutic Change With the Symptom Checklist SCL 90 R (original) (raw)
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Clinically significant change in psychotherapy for depressive disorders..pdf
Background: The assessment of change has been a problematic issue in psychotherapy research and has become increasingly important in the up rise of evidence-based practices. Methods: In the present paper, the clinical significance of the change of 243 patients who received one of nine treatments for depression was analysed using the Reliable Change Index [Jacobson, N.S., Follette, W.C., Revenstorf, D., 1984. Psychotherapy outcome research: Methods for reporting variability and evaluating clinical significance. Behav. Ther. 15, 336–352.] and normative comparisons (Equivalency Testing; [Kendall, P.C., Marrs-Garcia, A., Nath, S.R., Sheldrick, R.C., 1999. Normative comparisons for the evaluation of clinical significance. J. Consult. Clin. Psychol. 67, 285–299.]). While the first method addresses the question of whether or not the change that occurred was large enough to be attributable to treatment rather than to measurement error, the second method addresses the issue of comparing the level of functioning of treated individuals with non-clinical population. Hence, the nine treatments of depression were compared in terms of their reliability and clinical significance. Traditional statistical tests in treatment outcome studies were also conducted. Results: Findings support the importance of analysing the clinical significance of change during psychotherapy. While all but one treatment led to statistical significant changes in depressive symptoms, differences among treatments were found in terms of their reliability and clinical significance. Limitations: Small sample sizes and representativeness of each treatment warrant further replication of these results. Conclusions: Implications of the use of clinical significance testing in the exploration of empirical support for psychotherapy treatments in conjunction with traditional statistical analyses are discussed, which will be more readily useful and meaningful to clinicians who wish to embark in evidence-based practices.
Clinically significant change in psychotherapy for depressive disorders
Journal of Affective Disorders, 2009
Background: The assessment of change has been a problematic issue in psychotherapy research and has become increasingly important in the up rise of evidence-based practices. Methods: In the present paper, the clinical significance of the change of 243 patients who received one of nine treatments for depression was analysed using the Reliable Change Index [Jacobson, N.S., Follette, W.C., Revenstorf, D., 1984. Psychotherapy outcome research: Methods for reporting variability and evaluating clinical significance. Behav. Ther. 15, 336-352.] and normative comparisons (Equivalency Testing; [Kendall, P.C., Marrs-Garcia, A., Nath, S.R., Sheldrick, R.C., 1999. Normative comparisons for the evaluation of clinical significance. J. Consult. Clin. Psychol. 67, 285-299.]). While the first method addresses the question of whether or not the change that occurred was large enough to be attributable to treatment rather than to measurement error, the second method addresses the issue of comparing the level of functioning of treated individuals with non-clinical population. Hence, the nine treatments of depression were compared in terms of their reliability and clinical significance. Traditional statistical tests in treatment outcome studies were also conducted. Results: Findings support the importance of analysing the clinical significance of change during psychotherapy. While all but one treatment led to statistical significant changes in depressive symptoms, differences among treatments were found in terms of their reliability and clinical significance. Limitations: Small sample sizes and representativeness of each treatment warrant further replication of these results. Conclusions: Implications of the use of clinical significance testing in the exploration of empirical support for psychotherapy treatments in conjunction with traditional statistical analyses are discussed, which will be more readily useful and meaningful to clinicians who wish to embark in evidence-based practices.
In 1984, Jacobson, Follette, and Revenstorf defined clinically significant change as the extent to which therapy moves someone outside the range of the dysfunctional population or within the range of the functional population. In the present article, ways of operatmnalizing this definition are described, and examples are used to show how clients can be categorized on the basis of this definition. A reliable change index (RC) is also proposed to determine whether the magnitude of change for a given client is statistically reliable. The inclusion of the RC leads to a twofold criterion for clinically significant change.
Some methodological and statistical issues in the study of change processes in psychotherapy
Clinical Psychology Review, 2007
As the number of psychotherapies with demonstrated efficacy accumulates, an important task is to identify principles and processes of change. This information can guide treatment refinement, integration, and future development. However, the standard randomized control trial (RCT) design can limit the questions that can be asked and the statistical analyses that can be conducted. We discuss the importance of examining the shape of change, in addition to the importance of identifying mediators and moderators of change. We suggest methodological considerations for longitudinal data collection that can improve the kinds of therapy process questions that can be examined. We also review some data analytic approaches that are being used in other areas of psychology that have the potential to capture the complexity and dynamics of change in psychotherapy.
A new scale for assessing the quality of randomized clinical trials of psychotherapy
Comprehensive Psychiatry, 2010
Context: In 2004, the American Psychiatric Association's Committee on Research on Psychiatric Treatments appointed a subcommittee to investigate the status of empirical evidence with regard to psychodynamic psychotherapy. Objective: As a part of this effort, the committee developed a rating scale designed to assess the quality of randomized controlled trials (RCTs) of psychotherapy. Data Sources: A 25-item RCT of Psychotherapy Quality Rating Scale was generated by expert consensus. Interrater reliability, internal consistency, and validity testing were undertaken using 7 trained raters. Study Selection: A PubMed search was conducted to locate all RCTs of psychotherapies identified by their authors as being "psychodynamic" or "psychoanalytic" in origin and implementation. Data Extraction: A total of 69 RCTs were independently rated by 2 raters. Data Synthesis: The scale was found to have good interrater reliability (total score intraclass correlation = 0.76), internal consistency (Cronbach α = .87), and external validity. Conclusions: This scale establishes a new standard for the design and execution of psychotherapy RCTs and provides a systematic empirical method for evaluating the quality of published RCTs.
In a cross-cultural study using samples from China and Germany (n = 419), short forms of established mental health psychometric instruments were evaluated for their psychometric properties. These instruments were selected because they operationalize the different phases of Howard's phase model of psychotherapy: remoralization, remediation and rehabilitation. The main goal of the study was to determine if the short forms of these instruments could serve as means for quality management in a cross-cultural training project for cognitive behavioural therapy (CBT). Sufficient reliability and validity (convergent validity and sensitivity to pathology) were found in both cultures. At first glance, high intercorrelations of the tests suggested a one-dimensional model of mental health. However, an exploratory factor analysis and theoretical considerations favoured the alternative of differentiating mental health into eight sub-dimensions, whereby each of the sub-dimensions could be linked to basic or social emotions. These findings and their implications for quality management are discussed in some detail.