Psychotherapy for Chronic In- and Outpatients with Common Mental Disorders: The "Choose Change" Effectiveness Trial.

IF 16.3 1区医学 Q1 PSYCHIATRY Psychotherapy and Psychosomatics Pub Date : 2023-01-01 DOI:10.1159/000529411

Andrew T Gloster, Elisa Haller, Jeanette Villanueva, Victoria Block, Charles Benoy, Andrea H Meyer, Sandra Brogli, Veronika Kuhweide, Maria Karekla, Klaus Bader, Marc Walter, Undine Lang

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引用次数: 2

Abstract

Introduction: Treatment non-response occurs regularly, but psychotherapy is seldom examined for such patients. Existing studies targeted single diagnoses, were relatively small, and paid little attention to treatment under real-world conditions.

Objective: The Choose Change trial tested whether psychotherapy was effective in treating chronic patients with treatment non-response in a transdiagnostic sample of common mental disorders across two variants of treatment delivery (inpatient and outpatient).

Methods: The controlled nonrandomized effectiveness trial was conducted between May 2016 and May 2021. The study took place in two psychiatric clinics with N = 200 patients (n = 108 inpatients and n = 92 outpatients). Treatment variants were integrated inpatient care versus outpatient care based on acceptance and commitment therapy (ACT) for approximately 12 weeks. Therapists delivered individualized and non-manualized ACT. Main outcome measures were symptoms (Brief Symptom Checklist [BSCL]); well-being (Mental Health Continuum-Short Form [MHC-SF]), and functioning (WHO Disability Assessment Schedule [WHO-DAS]).

Results: Both inpatients and outpatients showed decreases in symptomatology (i.e., BSCL: d = 0.68) and increases in well-being and functioning (MHC-SF: d = 0.60 and WHO-DAS: d = 0.70), with more improvement in the inpatients during treatment. Both groups maintained gains 1 year following treatment, and the groups did not significantly differ from each other at this timepoint. Psychological flexibility moderated impact of stress on outcomes.

Conclusions: Psychotherapy as practiced under routine conditions is effective for a sample of patients with common mental disorders, a long history of treatment experience and burden of disease, in both inpatient and outpatient settings.

Trial registration: This study was registered in the ISRCTN registry on May 20, 2016, with the registration number ISRCTN11209732.

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常见病慢性住院和门诊患者的心理治疗:“选择改变”效果试验。

引言:治疗无反应时有发生，但很少对此类患者进行心理治疗检查。现有的研究针对单一诊断，相对较小，并且很少关注现实世界条件下的治疗。目的:选择改变试验测试了在两种治疗方式(住院和门诊)的常见精神障碍的跨诊断样本中，心理治疗对治疗无反应的慢性患者是否有效。方法:2016年5月- 2021年5月进行对照非随机疗效试验。该研究在两家精神病诊所进行，共有200名患者(108名住院患者和92名门诊患者)。治疗变体是基于接受和承诺治疗(ACT)的住院治疗与门诊治疗的综合治疗，持续约12周。治疗师提供个性化和非手动ACT。主要结局指标为症状(简要症状检查表[BSCL]);健康(精神健康连续简表[MHC-SF])和功能(世卫组织残疾评估表[WHO- das])。结果:住院患者和门诊患者均表现出症状减轻(即BSCL: d = 0.68)，幸福感和功能改善(MHC-SF: d = 0.60, WHO-DAS: d = 0.70)，住院患者在治疗期间改善较多。两组在治疗后1年均保持获益，在此时间点各组间无显著差异。心理灵活性调节压力对结果的影响。结论:在常规条件下进行心理治疗对住院和门诊有长期治疗经验和疾病负担的常见精神障碍患者样本有效。试验注册:本研究于2016年5月20日在ISRCTN注册中心注册，注册号为ISRCTN11209732。

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来源期刊

Psychotherapy and Psychosomatics 医学-精神病学

CiteScore

29.40

自引率

6.10%

发文量

期刊介绍： Psychotherapy and Psychosomatics is a reputable journal that has been published since 1953. Over the years, it has gained recognition for its independence, originality, and methodological rigor. The journal has been at the forefront of research in psychosomatic medicine, psychotherapy research, and psychopharmacology, and has contributed to the development of new lines of research in these areas. It is now ranked among the world's most cited journals in the field. As the official journal of the International College of Psychosomatic Medicine and the World Federation for Psychotherapy, Psychotherapy and Psychosomatics serves as a platform for discussing current and controversial issues and showcasing innovations in assessment and treatment. It offers a unique forum for cutting-edge thinking at the intersection of medical and behavioral sciences, catering to both practicing clinicians and researchers. The journal is indexed in various databases and platforms such as PubMed, MEDLINE, Web of Science, Science Citation Index, Social Sciences Citation Index, Science Citation Index Expanded, BIOSIS Previews, Google Scholar, Academic Search, and Health Research Premium Collection, among others.