Mary Beth Connolly Gibbons

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.

Clinical or methodological significance of this article: this pooled post-hoc study identifies candidate moderators and process markers for future trials of electronic-communications dashboards. Ge...

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.

Despite the availability of evidence-based psychosocial and pharmacologic interventions for mental health concerns, access to care remains suboptimal. We present a time-efficient mental health treatment program designed to improve overall community access to evidence-based care. Quality of care within the time-efficient model was prioritized by focusing on a multifaceted program of evidence-based interventions and facilitating connections to long-term care when needed. We present the results of a proof-of-concept open trial that indicates that access to care can be improved while maintaining quality mental health services. The Time-Efficient, Evidence-Based, Accessible, Multidisciplinary approach includes time-limited care provided by a team of psychotherapists, psychiatrists, nurse practitioners, and case managers working in pods, supported by measurement-based care, to develop individualized treatment plans. We used data from the electronic health record to evaluate (a) access to care, (b) engagement, and (c) treatment outcomes for an initial sample of 1,726 patients. Patients waited on average 17 days to see a therapist and 20 days to see a psychopharmacologist. Patients received on average 10 sessions of psychotherapy and four medication management sessions. Fifty-seven percent remained in treatment for at least 3 months. Patients demonstrated large improvements in depression (d = 1.18) and anxiety (d = 1.20) with small to moderate effects for improvements in functioning (d = 0.40). By capitalizing on a package of evidence-based interventions delivered with equitable time limits, the Time-Efficient, Evidence-Based, Accessible, Multidisciplinary clinic demonstrates initial access while yielding good engagement in services and moderate to large treatment effects. (PsycInfo Database Record (c) 2025 APA, all rights reserved).

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.

Purpose Our goal was to develop brief pragmatic assessments of Behavioral Activation (BA) fidelity to support its dissemination in low-resource settings. Methods We used qualitative and quantitative methods across three investigations to develop pragmatic assessments rated from the perspective of therapists, patients, and observers: (1) we developed an initial comprehensive pool of 119 items and adapted/refined the item pool to 32 items through stakeholder focus groups and cognitive interviews; (2) independent blind judges rated each of items in the refined item pool on an early session of BA for 64 patients to support the selection of items based on predictive validity; and (3) we conducted a preliminary evaluation of the acceptability and feasibility of the assessments of BA fidelity from the perspective of therapists and patients. Results The internal consistency reliability for the 10-item total score was .83 rated from the perspective of independent observers. The assessment was completed by patients following 90% of sessions and by clinicians following 93% of sessions. Items were rated high on overall satisfaction by both therapists (M = 4.6, SD = 0.89) and patients (M = 4.8, SD = 0.41). Conclusion Our findings suggest that these brief assessments of BA fidelity are reliable, feasible, and acceptable to community stakeholders.

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...

Many individuals seeking mental health services for depression often suffer from a comorbid medical condition. The goal of the present study was to assess the presence of medical comorbidity in a community mental health center setting that primarily serves a Medicare and Medicaid population. characterize the types of comorbid medical conditions experienced in this setting, and explore the association between medical conditions on the alliance. attrition from services, and outcome. Medical diagnoses were collected from patient charts and structured clinical interviews from 353 participants who had a baseline assessment as part of a comparative effectiveness study of cognitive and dynamic therapies for major depressive disorder. We calculated the Charlson Comorbidity Index and the number of total medical diagnoses for each patient. Results from this study revealed that a high percentage of patients in this setting experienced a comorbid medical condition. No significant associations were found between the number of medical conditions or the Charlson Comorbidity Index and the alliance. No significant relationship was found between the number of medical conditions or the Charlson Comorbidity Index and early attrition from treatment or treatment outcome. However. exploratory analyses found that presence of a nervous system disorder was associated with relatively poorer treatment outcomes after initial engagement. Implications of these findings are discussed. Treatments for major depressive disorder may benefit from addressing the impact of medical disorders on physical functioning.

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 ...