Paul Crits-Christoph

Measurement-based care (MBC) relies on repeated outcome assessment and feedback to guide clinical decision-making. Although recovery curves are central to many MBC systems, they have primarily been developed using session-by-session data. This study developed and validated recovery curves for the PHQ-8 and GAD-7 using monthly assessments within a naturalistic outpatient setting. We generated our recovery curves using mixed-effects models with symptom change over four months of treatment as the dependent variable ( N = 1124) and cross-validated the results in a second sample (PHQ-8 N = 734; GAD-7 N = 758). Models were evaluated for predictive performance and calibration. We examined additional baseline predictors and evaluated confidence interval thresholds for identifying patients at risk of treatment failure. Predictive performance was strong in the derivation sample (PHQ-8 R² = 0.44; GAD-7 R² = 0.47) and remained robust in validation (PHQ-8 R² = 0.37; GAD-7 R² = 0.40) with acceptable calibration. Baseline symptom severity was the only clinically meaningful predictor of recovery trajectories. A 60% one-sided confidence interval provided the optimal balance of sensitivity and alert frequency, identifying approximately 24–28% of patients as at risk of treatment failure at one month. We conclude that recovery curves for the PHQ-8 and GAD-7 can be effectively derived using monthly assessments and applied in real-world MBC settings.

Objective: To investigate the effectiveness of cognitive therapy (CT) and short‐term dynamic psychotherapy (STDP) among patients with greater severity, defined in several ways, in a community mental health setting. Method: Using data from a randomized noninferiority trial, we examined five baseline severity variables as potential moderators of treatment effects: depressive symptoms, interpersonal problems, mental functioning, physical functioning and quality of life. The outcome was a change in depressive symptoms over the course of up to 5 months of treatment. Linear mixed‐effects models were implemented to compare slopes of change over time. We hypothesized that CT would be superior to STDP for those with severe depressive symptoms, severe mental and physical functioning and severely impaired quality of life, but STDP would be superior to CT for those with severe interpersonal problems. Results: There was no evidence of superiority within any of the five severity domains. Conclusions: Findings inform the comparative effectiveness of CT and STDP among patients with greater severity and extend prior work by incorporating interpersonal, functioning and quality of life severity indicators.

A plethora of studies has exhibited the effectiveness of using measurement-based care feedback systems within mental health services to improve treatment outcomes; however, patient gender/race and patient-therapist matching on gender and race remain relatively unexplored as predictors/moderators in feedback studies. We conducted predictor/moderator analyses focusing on the relation of gender, race/ethnicity, and patient-therapist gender and race/ethnicity matching on two outcomes: patient self-reported levels of (1) functioning and (2) trust/respect within the therapeutic relationship. We used data from a randomized controlled trial studying the effectiveness of a feedback system comparing patient-reported levels of trust and respect towards their provider (together with symptom feedback) in comparison to symptom only feedback. We found that men improved in functioning more than women when their therapists received trust/respect feedback compared to symptom only feedback (F[1, 902] = 9.79, p = .002, d = 0.21). We also found that dyads matched on race/ethnicity but not gender, and those matched on gender but not race/ethnicity, improved in functioning over time more than dyads mismatched on both gender and race/ethnicity and those matched on both gender and race/ethnicity (F[1, 897] = 8.63, p = .0034, d = 0.20). On trust/respect outcomes, we found a gender difference over time (F[1, 759] = 6.61, p = .01, d = 0.19), a gender matching difference by feedback condition interaction (F[1, 757] = 5.25, p = .02, d = 0.17), and a racial/ethnic matching difference on trust/respect scores over time (F[1, 785] = 3.89, p = .049, d = 0.14). Male patients showed an initial decrease followed by a steady increase in trust/respect over time while female patients showed an initial increase followed by a steady decrease. Gender-matched therapeutic dyads showed higher levels of trust/respect compared to mismatched dyads when therapists received symptom only feedback, but this difference was not apparent when trust/respect feedback was provided. Dyads mismatched on race/ethnicity improved steadily in trust/respect over time, but matched dyads decreased in trust/respect after an initial increase. Future research should focus on the use of feedback systems to enhance outcomes for patients with specific gender and racial/ethnic identities.

Patient trust/respect toward their therapists may be an important component of patient-therapist relationships. This randomized controlled trial evaluated the impact of providing weekly feedback to therapists regarding patient ratings of trust/respect toward their therapist. Adult patients seeking mental health treatment at four community clinics (two community mental health centers and two community-based intensive treatment programs) were randomized to either having their primary therapist receive weekly symptom feedback-only or symptoms plus trust/respect feedback. Data were collected both prior to and during COVID-19. The primary outcome measure was a measure of functioning obtained weekly at baseline and the subsequent 11 weeks, with the primary analysis focusing on patients who received any treatment. Secondary outcomes included measures of symptoms and trust/respect. Among 233 consented patients, 185 had a postbaseline assessment and were analyzed for the primary and secondary outcomes (median age of 30 years; 5.4% Asian, 12.4% Hispanic, 17.8% Black, 67.0% White, 4.3% more than 1 race, and 5.4% unknown; 64.4% female). On the Patient-Reported Outcomes Measurement Information System Social Roles and Activities scale (primary outcome), the trust/respect plus symptom feedback group had significantly greater improvements over time than the symptom alone feedback group (p = .0006, effect size d = .22). Secondary outcome measures of symptoms and trust/respect also showed statistically significant greater improvement for the trust/respect feedback group. In this trial, trust/respect feedback to therapists was associated with significantly greater improvements in treatment outcomes. Evaluation of the mechanisms of such improvements is needed. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Objective: Previous research has documented associations between trauma and interpersonal problems. We examined the impact of trauma on interpersonal problems among depressed patients seeking treatment in a community mental health setting.Methods: A total of 453 patients seeking treatment and screened for a comparative effectiveness study of therapies for depression were included. We conducted analyses relating the 32‐item inventory of interpersonal problems (IIP‐32) to trauma measures.Results: 99.1% of the sample experienced a traumatic event. There were significant associations between the total number of traumas, the number of sexually and physically assaultive traumas, and both gender and race. The number of sexually assaultive traumas was significantly related to the IIP‐32 “too caring” subscale (simple r = 0.167, p < 0.001). Controlling for demographics and other IIP‐32 subscales, the total number of traumas remained significantly related to the IIP‐32 “too caring” domain (partial r = 0.163, p < 0.001).Conclusions: Traumatic events are prevalent among community populations and these experiences are associated with certain interpersonal problems. Trauma and interpersonal problems are key issues for the treatment of patients in the community mental health setting.

Psychotherapy randomized trials rarely have tested for the best fitting model for time effects. We examined the fit of different statistical models for examining time when repeated assessments of d...

To examine the association between adherence and competence in cognitive therapy (CT) techniques and change in positive compensatory skills and depressive symptoms within a community mental health ...