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Depression: HELP
Articles by Wolfgang Lutz
Based on 31 articles published since 2010
(Why 31 articles?)
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Between 2010 and 2020, Wolfgang Lutz wrote the following 31 articles about Depression.
 
+ Citations + Abstracts
Pages: 1 · 2
1 Review [Self-management interventions in the treatment of depressive disorders: ready for clinical practice?] 2019

Klein, Jan Philipp / Berger, Thomas / Hautzinger, Martin / Lutz, Wolfgang / Rose, Matthias / Späth, Christina / Schröder, Johanna / Hohagen, Fritz / Moritz, Steffen. · ·Fortschr Neurol Psychiatr · Pubmed #30891718.

ABSTRACT: Only about half of those suffering from a depressive disorder seek treatment. Self-management interventions are one way to reduce this treatment gap. These interventions are mostly based on evidence-based techniques of cognitive behavioural therapy, which are taught by a computer program instead of a therapist. Numerous studies have shown the effectiveness of these interventions. However, these studies also raise a number of questions. These concern the efficacy both in the external rating and in the long-term course and the efficacy in severe depressive symptoms or in combination with antidepressant medication. Finally, the question arises as to the use of these interventions in patients in clinical practice and in people who are not particularly Internet-savvy. We addressed these questions in a large randomized study (EVIDENT study). This study investigated the efficacy of Intervention deprexis®. The results of this study are summarised in this overview and placed in the context of other interventions available in Germany.

2 Clinical Trial How durable is the effect of low intensity CBT for depression and anxiety? Remission and relapse in a longitudinal cohort study. 2017

Ali, Shehzad / Rhodes, Laura / Moreea, Omar / McMillan, Dean / Gilbody, Simon / Leach, Chris / Lucock, Mike / Lutz, Wolfgang / Delgadillo, Jaime. ·Department of Health Sciences and Centre for Health Economics, University of York, York, UK. · Leeds Community Healthcare NHS Trust, Leeds, UK. · Centre for Clinical Practice, National Institute for Health and Care Excellence, Manchester, UK. · Hull York Medical School and Department of Health Sciences, University of York, York, United Kingdom. · South West Yorkshire Partnership NHS Foundation Trust and University of Huddersfield, Huddersfield, UK. · Department of Psychology, University of Trier, Trier, Germany. · Clinical Psychology Unit, Department of Psychology, University of Sheffield, Sheffield, UK. Electronic address: jaime.delgadillo@nhs.net. ·Behav Res Ther · Pubmed #28437680.

ABSTRACT: BACKGROUND: Depression and anxiety disorders are relapse-prone conditions, even after successful treatment with pharmacotherapy or psychotherapy. Cognitive behavioural therapy (CBT) is known to prevent relapse, but there is little evidence of the durability of remission after low intensity forms of CBT (LiCBT). METHOD: This study aimed to examine relapse rates 12 months after completing routinely-delivered LiCBT. A cohort of 439 LiCBT completers with remission of symptoms provided monthly depression (PHQ-9) and anxiety (GAD-7) measures during 12 months after treatment. Survival analysis was conducted to model time-to-relapse while controlling for patient characteristics. RESULTS: Overall, 53% of cases relapsed within 1 year. Of these relapse events, the majority (79%) occurred within the first 6 months post-treatment. Cases reporting residual depression symptoms (PHQ-9 = 5 to 9) at the end of treatment had significantly higher risk of relapse (hazard ratio = 1.90, p < 0.001). CONCLUSIONS: The high rate of relapse after LiCBT highlights the need for relapse prevention, particularly for those with residual depression symptoms.

3 Clinical Trial Sudden gains in routine care cognitive behavioral therapy for depression: A replication with extensions. 2017

Wucherpfennig, Felix / Rubel, Julian A / Hollon, Steven D / Lutz, Wolfgang. ·Clinical Psychology and Psychotherapy, Department of Psychology, University of Trier, D-54296 Trier, Germany. Electronic address: wucherpfennig@uni-trier.de. · Clinical Psychology and Psychotherapy, Department of Psychology, University of Trier, D-54296 Trier, Germany. · Department of Psychology, Vanderbilt University, TN 37240 Nashville, United States. ·Behav Res Ther · Pubmed #27846418.

ABSTRACT: BACKGROUND: Over the last decade, a substantial amount of findings have been reported on the association between sudden gains (large symptom improvements in a between-session interval) and treatment outcome. Accurate replications of previous findings are needed to tackle inconsistencies and to shed light on the clinical implications of sudden gains. This study investigates whether similar effects of sudden gains can be expected under routine care conditions, when the patients are comparable to those examined in the original study by Tang and DeRubeis (1999). METHOD: Using propensity score matching (PSM), 462 patients treated with cognitive behavioral therapy (CBT) under routine conditions were matched stepwise to patients of the original study on sudden gains, a randomized controlled CBT trial (RCT). RESULTS: After the application of PSM, the effects of sudden gains on treatment outcome were similar to those found by Tang and DeRubeis (1999). The closer the match between the RCT and the naturalistic sample, the more similar the association between sudden gains and treatment outcome. CONCLUSION: Sudden gains seem to have a significant impact on recovery rates, even in treatments under routine care. Results suggest that one important aspect of replication success is to control for confounding baseline covariates.

4 Article Health economic evaluation of a web-based intervention for depression: the EVIDENT-trial, a randomized controlled study. 2019

Gräfe, Viola / Berger, Thomas / Hautzinger, Martin / Hohagen, Fritz / Lutz, Wolfgang / Meyer, Björn / Moritz, Steffen / Rose, Matthias / Schröder, Johanna / Späth, Christina / Klein, Jan Philipp / Greiner, Wolfgang. ·Department of Health Economics and Health Care Management, School of Public Health, Bielefeld University, Universitätsstraße 25, 33615, Bielefeld, Germany. viola.graefe@uni-bielefeld.de. · Department of Clinical Psychology and Psychotherapy, University of Bern, Hochschulstrasse 6, 3012, Bern, Switzerland. · Department of Psychology, Eberhard Karls University Tuebingen, Schleichstraße 4, 72076, Tuebingen, Germany. · Department of Psychiatry and Psychotherapy, University of Luebeck, Ratzeburger Allee 160, 23538, Luebeck, Germany. · Department of Psychology, University of Trier, Am Wissenschaftspark 25, +2754296, Trier, Germany. · Research Department, Gaia AG, Hans-Henny-Jahnn-Weg, 5322085, Hamburg, Germany. · The Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany. · Department of Psychosomatic Medicine, Charité University Medical Center, Hindenburgdamm 30, 12200, Berlin, Germany. · The Institute for Sex Research and Forensic Psychiatry, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany. · Department of Health Economics and Health Care Management, School of Public Health, Bielefeld University, Universitätsstraße 25, 33615, Bielefeld, Germany. ·Health Econ Rev · Pubmed #31175475.

ABSTRACT: BACKGROUND: Depression often remains undiagnosed or treated inadequately. Web-based interventions for depression may improve accessibility of treatment and reduce disease-related costs. This study aimed to examine the potential of the web-based cognitive behavioral intervention "deprexis" in reducing disease-related costs. METHODS: Participants with mild to moderate depressive symptoms were recruited and randomized to either a 12-week web-based intervention (deprexis) in addition to care as usual (intervention group) or care as usual (control group). Outcome measures were health-related resource use, use of medication and incapacity to work as well as relating direct health care costs. Outcomes were assessed on patients' self-report at baseline, three months and six months. RESULTS: A total of 1013 participants were randomized. In both groups total direct health care costs decreased during the study period, but changes from baseline did not significantly differ between study groups. Numeric differences between study groups existed in outpatient treatment costs. They could be attributed to differences in changes of costs for psychotherapeutic treatment from baseline. Whereas costs for psychotherapeutic treatment decreased in the intervention group, costs increased in the control group (- 16.8% (€80) vs. + 14.7% (€60)) (t CONCLUSION: The study indicates the health economic potential of innovative e-mental-health programs. There is evidence to suggest that the use of deprexis over a period of 12 weeks leads to a decrease in outpatient treatment cost, especially in those related to different types of psychotherapeutic treatment.

5 Article Mindfulness and progressive muscle relaxation as standardized session-introduction in individual therapy: A randomized controlled trial. 2019

Mander, Johannes / Blanck, Paul / Neubauer, Andreas B / Kröger, Paula / Flückiger, Christoph / Lutz, Wolfgang / Barnow, Sven / Bents, Hinrich / Heidenreich, Thomas. ·Center for Psychological Psychotherapy, University of Heidelberg, Heidelberg, Germany. · German Institute for International Educational Research (DIPF), Frankfurt am Main, Germany. · Department of Clinical Psychology and Psychotherapy, University of Zürich, Zürich, Switzerland. · Department of Clinical Psychology and Psychotherapy, University of Trier, Trier, Germany. · Department of Clinical Psychology and Psychotherapy, University of Heidelberg, Heidelberg, Germany. · Department of Social Work, Health and Nursing, University of Applied Sciences Esslingen, Esslingen am Neckar, Germany. ·J Clin Psychol · Pubmed #30295914.

ABSTRACT: OBJECTIVE: There is scarce research on the effects of mindfulness in individual therapy. As many practitioners integrate mindfulness exercises into individual therapy, empirical evidence is of high clinical relevance. METHOD: We investigated the effects of a session-introducing intervention with mindfulness elements (SIIME) in a randomized, controlled design. The effects of SIIME on therapeutic alliance and symptomatic outcome were compared with progressive muscle relaxation (PMR) and treatment-as-usual (TAU) control conditions. The sample comprised 162 patients with anxiety and depression. RESULTS: Multilevel modeling revealed a significant symptom reduction and significant increase of alliance over the course of therapy. There were no significant time-condition interactions on outcome and alliance, indicating the comparable efficiency of all three treatment conditions. CONCLUSIONS: We found no advantage of SIIME versus PMR and TAU. Add-on mindfulness might not improve individual therapy related to alliance and outcome.

6 Article Feedback-informed treatment versus usual psychological treatment for depression and anxiety: a multisite, open-label, cluster randomised controlled trial. 2018

Delgadillo, Jaime / de Jong, Kim / Lucock, Mike / Lutz, Wolfgang / Rubel, Julian / Gilbody, Simon / Ali, Shehzad / Aguirre, Elisa / Appleton, Mark / Nevin, Jacqueline / O'Hayon, Harry / Patel, Ushma / Sainty, Andrew / Spencer, Peter / McMillan, Dean. ·Clinical Psychology Unit, Department of Psychology, University of Sheffield, Sheffield, UK. Electronic address: jaime.delgadillo@nhs.net. · Institute of Psychology, Leiden University, Leiden, Netherlands. · Centre for Applied Research in Health, University of Huddersfield, Huddersfield, UK; South West Yorkshire Partnership NHS Foundation Trust, Barnsley, UK. · Department of Psychology, University of Trier, Trier, Germany. · Department of Health Sciences, University of York, York, UK. · North East London National Health Service (NHS) Foundation Trust, London, UK. · Pennine Care NHS Foundation Trust, Hyde, UK. · Cheshire and Wirral Partnership NHS Foundation Trust, Winsford, UK. · Whittington Health NHS Trust, London, UK. · Cambridgeshire and Peterborough NHS Foundation Trust, Cambridge, UK. · Humber NHS Foundation Trust, Hessle, UK. · South West Yorkshire Partnership NHS Foundation Trust, Barnsley, UK. ·Lancet Psychiatry · Pubmed #29937396.

ABSTRACT: BACKGROUND: Previous research suggests that the use of outcome feedback technology can enable psychological therapists to identify and resolve obstacles to clinical improvement. We aimed to assess the effectiveness of an outcome feedback quality assurance system applied in stepped care psychological services. METHODS: This multisite, open-label, cluster randomised controlled trial was done at eight National Health Service (NHS) Trusts in England, involving therapists who were qualified to deliver evidence-based low-intensity or high-intensity psychological interventions. Adult patients (18 years or older) who accessed individual therapy with participating therapists were eligible for inclusion, except patients who accessed group therapies and those who attended less than two individual therapy sessions. Therapists were randomly assigned (1:1) to an outcome feedback intervention group or a treatment-as-usual control group by use of a computer-generated randomisation algorithm. The allocation of patients to therapists was quasi-random, whereby patients on waiting lists were allocated sequentially on the basis of therapist availability. All patients received low-intensity (less than eight sessions) or high-intensity (up to 20 sessions) psychological therapies for the duration of the 1-year study period. An automated computer algorithm alerted therapists in the outcome feedback group to patients who were not on track, and primed them to review these patients in clinical supervision. The primary outcome was symptom severity on validated depression (Patient Health Questionnaire-9 [PHQ-9]) and anxiety (Generalised Anxiety Disorder-7 [GAD-7]) measures after treatment of varying durations, which were compared between groups with multilevel modelling, controlling for cluster (therapist) effects. We used an intention-to-treat approach. This trial was prospectively registered with ISRCTN, number ISRCTN12459454. FINDINGS: In total, 79 therapists were recruited to the study between Jan 8, 2016, and July 15, 2016, but two did not participate. Of these participants, 39 (51%) were randomly assigned to the outcome feedback group and 38 (49%) to the control group. Overall, 2233 patients were included in the trial (1176 [53%] were treated by therapists in the outcome feedback group, and 1057 [47%] by therapists in the control group). Patients classified as not on track had less severe symptoms after treatment if they were allocated to the outcome feedback group than those in the control group (PHQ-9 d=0·23, B=-1·03 [95% CI -1·84 to -0·23], p=0·012; GAD-7 d=0·19, B=-0·85 [-1·56 to -0·14], p=0·019). INTERPRETATION: Supplementing psychological therapy with low-cost feedback technology can reduce symptom severity in patients at risk of poor response to treatment. This evidence supports the implementation of outcome feedback in stepped care psychological services. FUNDING: English NHS and Department of Health Sciences, University of York, York, UK.

7 Article Bridging the "digital divide": A comparison of use and effectiveness of an online intervention for depression between Baby Boomers and Millennials. 2018

Schneider, Brooke C / Schröder, Johanna / Berger, Thomas / Hohagen, Fritz / Meyer, Björn / Späth, Christina / Greiner, Wolfgang / Hautzinger, Martin / Lutz, Wolfgang / Rose, Matthias / Vettorazzi, Eik / Moritz, Steffen / Klein, Jan Philipp. ·Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany; Department of Sex Research and Forensic Psychiatry, University Medical Center Hamburg-Eppendorf, Hamburg, Germany. Electronic address: b.schneider@uke.de. · Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany. · Department of Clinical Psychology and Psychotherapy, University of Bern, Switzerland. · Department of Psychiatry and Psychotherapy, Lübeck University, Lübeck, Germany. · GAIA AG, Hamburg, Germany; Department of Psychology, City, University of London, London, UK. · Department of Health Economics and Health Care Management, Bielefeld University, Bielefeld, Germany. · Department of Psychology, Clinical Psychology and Psychotherapy, Eberhard Karls University Tübingen, Tübingen, Germany. · Department of Psychology, University of Trier, Trier, Germany. · Department of Psychosomatic Medicine, Charité University Medical Center, Berlin, Germany; Quantitative Health Sciences, Outcomes Measurement Science, University of Massachusetts Medical School, Worcester, MA, USA. · Institute of Medical Biometry and Epidemiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany. ·J Affect Disord · Pubmed #29751239.

ABSTRACT: BACKGROUND: Psychological online interventions (POIs) for depression have demonstrated promising effects. However, there are fewer randomized controlled studies on POIs among older adults with depression. The goal of the present study was to compare the use and efficacy of Deprexis, an online intervention for depression, among Millennials (18-35 years) and Baby Boomers (50-65 years). METHODS: We completed a secondary data analysis on a subset (N = 577) of participants in the EVIDENT trial, a parallel-groups, pragmatic, randomized, controlled single-blind study, which compared a 12-week POI (Deprexis) to care as usual (CAU). Outcomes were assessed at baseline, 3 months (post-assessment) and 6 months (follow-up). The main outcome of interest was change on self-rated depression severity (PHQ-9). RESULTS: Compared to Millennials, Boomers used the intervention significantly more often (d = 0.45) and for a longer duration (d = 0.46), and endorsed more positive attitudes towards POIs (d = 0.14). There was no significant Age Group by Intervention Group interaction for change in PHQ-9. The post-assessment between-group effect size (intervention vs. CAU control) for Millennials and Boomers were d = 0.26 and d = 0.39, respectively, and were stable at follow-up (d = 0.37 and d = 0.39). LIMITATIONS: Age-based dichotomization may not accurately represent participants' experiences with and use of technology. CONCLUSIONS: The POI examined in this trial was superior to CAU and was comparably effective among groups of adults defined as Millennials and Baby Boomers. Adults of the Baby Boomer generation who participate in POIs may have more positive attitudes towards POIs compared to their younger counterparts.

8 Article Individual treatment selection for patients with posttraumatic stress disorder. 2018

Deisenhofer, Anne-Katharina / Delgadillo, Jaime / Rubel, Julian A / Böhnke, Jan R / Zimmermann, Dirk / Schwartz, Brian / Lutz, Wolfgang. ·Clinical Psychology and Psychotherapy, Department of Psychology, University of Trier, Trier, Germany. · Clinical Psychology Unit, Department of Psychology, University of Sheffield, Sheffield, United Kingdom. · Dundee Centre for Health and Related Research, School of Nursing and Health Sciences, University of Dundee, Dundee, Scotland. · Department of Health Sciences, University of York, York, United Kingdom. ·Depress Anxiety · Pubmed #29659106.

ABSTRACT: BACKGROUND: Trauma-focused cognitive behavioral therapy (Tf-CBT) and eye movement desensitization and reprocessing (EMDR) are two highly effective treatment options for posttraumatic stress disorder (PTSD). Yet, on an individual level, PTSD patients vary substantially in treatment response. The aim of the paper is to test the application of a treatment selection method based on a personalized advantage index (PAI). METHOD: The study used clinical data for patients accessing treatment for PTSD in a primary care mental health service in the north of England. PTSD patients received either EMDR (N = 75) or Tf-CBT (N = 242). The Patient Health Questionnaire (PHQ-9) was used as an outcome measure for depressive symptoms associated with PTSD. Variables predicting differential treatment response were identified using an automated variable selection approach (genetic algorithm) and afterwards included in regression models, allowing the calculation of each patient's PAI. RESULTS: Age, employment status, gender, and functional impairment were identified as relevant variables for Tf-CBT. For EMDR, baseline depressive symptoms as well as prescribed antidepressant medication were selected as predictor variables. Fifty-six percent of the patients (n = 125) had a PAI equal or higher than one standard deviation. From those patients, 62 (50%) did not receive their model-predicted treatment and could have benefited from a treatment assignment based on the PAI. CONCLUSIONS: Using a PAI-based algorithm has the potential to improve clinical decision making and to enhance individual patient outcomes, although further replication is necessary before such an approach can be implemented in prospective studies.

9 Article Impact and change of attitudes toward Internet interventions within a randomized controlled trial on individuals with depression symptoms. 2018

Schröder, Johanna / Berger, Thomas / Meyer, Björn / Lutz, Wolfgang / Späth, Christina / Michel, Pia / Rose, Matthias / Hautzinger, Martin / Hohagen, Fritz / Klein, Jan Philipp / Moritz, Steffen. ·Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany. · Institute for Sex Research and Forensic Psychiatry, University Medical Center Hamburg-Eppendorf, Hamburg, Germany. · Department of Clinical Psychology and Psychotherapy, University of Bern, Bern, Switzerland. · Research Department, Gaia, Hamburg, Germany, and Department of Psychology, City University, London, United Kingdom. · Department of Psychology, University of Trier, Trier, Germany. · Department of Psychosomatic Medicine, Charité University Medical Center, Berlin, Germany. · Department of Psychology, Clinical Psychology and Psychotherapy, Eberhard Karls University Tübingen, Tübingen, Germany. · Department of Psychiatry and Psychotherapy, University of Lübeck, Lübeck, Germany. ·Depress Anxiety · Pubmed #29489038.

ABSTRACT: BACKGROUND: Most individuals with depression do not receive adequate treatment. Internet interventions may help to bridge this gap. Research on attitudes toward Internet interventions might facilitate the dissemination of such interventions by identifying factors that help or hinder uptake and implementation, and by clarifying who is likely to benefit. This study examined whether attitudes toward Internet interventions moderate the effects of a depression-focused Internet intervention, and how attitudes change over the course of treatment among those who do or do not benefit. METHODS: We recruited 1,004 adults with mild-to-moderate depression symptoms and investigated how attitudes toward Internet interventions are associated with the efficacy of the program deprexis, and how attitudes in the intervention group change from pre to post over a 3 months intervention period, compared to a control group (care as usual). This study consists of a subgroup analysis of the randomized controlled EVIDENT trial. RESULTS: Positive initial attitudes toward Internet interventions were associated with greater efficacy (η CONCLUSIONS: Internet interventions may be the most beneficial for individuals with positive attitudes toward them. Informing potential users about evidence-based Internet interventions might instill positive attitudes and thereby optimize the benefits such interventions can provide. Assessing attitudes prior to treatment might help identify suitable users.

10 Article Congruence of therapeutic bond perceptions and its relation to treatment outcome: Within- and between-dyad effects. 2018

Rubel, Julian A / Bar-Kalifa, Eran / Atzil-Slonim, Dana / Schmidt, Sebastian / Lutz, Wolfgang. ·Department of Psychology, University of Trier. · Department of Psychology, Bar Ilan University. ·J Consult Clin Psychol · Pubmed #29389143.

ABSTRACT: OBJECTIVE: The present study investigates the association between congruence of patients' and therapists' perceptions of the therapeutic bond and symptom improvement. METHOD: Bond congruence-outcome associations were examined on the within- and between-dyad level for 580 patients (mainly depression and anxiety) receiving cognitive-behavioral therapy. Symptom change was assessed on a session-to-session level as well as from pre- to posttreatment. For the between-dyad analyses, the truth and bias model was applied. For the within-dyad analyses, polynomial regression and response surface analysis were conducted. RESULTS: On the between-dyad level, higher temporal congruence between patients' and therapists' bond ratings (i.e., their correlation) was associated with better treatment outcomes. Additionally, the average discrepancy between therapists' and patients' bond ratings showed a significant quadratic association with treatment outcome. A tendency for therapists to moderately rate the bond lower than their patients' showed lowest posttreatment symptom scores. On the within-dyad level, we found that when patients' and therapists' ratings were in "agreement," higher bond scores were associated with fewer next-session symptoms. For "disagreement," the results showed that if therapists rated the bond as weak, whereas their patients rated it as strong, higher subsequent symptom distress was observed than if patients rated the bond as weak and their therapists rated it as strong. CONCLUSIONS: The present study highlights the importance of therapists being vigilant to session-to-session changes in the therapeutic bond to adjust their interventions accordingly. (PsycINFO Database Record

11 Article Linguistic analysis of patients with mood and anxiety disorders during cognitive behavioral therapy. 2018

Sonnenschein, Anke R / Hofmann, Stefan G / Ziegelmayer, Tobias / Lutz, Wolfgang. ·a Department of Psychology , University of Trier , Trier , Universitätsring 15, 54296 , Germany. · b Department of Psychology , Boston University , 648 Beacon Street, Boston , MA , 02215 , USA. ·Cogn Behav Ther · Pubmed #29345528.

ABSTRACT: We analyzed the verbal behavior of patients with mood or/and anxiety disorders during psychotherapy. Investigating the words people used, we expected differences due to cognitive and emotional foci in patients with depression vs. anxiety. Transcripts of therapy sessions from 85 outpatients treated with cognitive behavioral therapy were analyzed using the software program Linguistic Inquiry and Word Count. Multivariate group comparisons were carried out investigating the LIWC-categories first-person-singular pronouns, sad, anxiety and fillers. Differences between the three diagnostic groups were found in verbal utterances related to sadness (p = .05). No differences were found for first-person-singular pronouns and content-free fillers. Comparing the distinct groups "depression" and "anxiety", depressed patients used more words related to sadness (p = .01). Mood and anxiety disorders differ in the experience of emotions, but only slightly in self-focused attention. This points to differences in language use for different diagnostic groups and may help to improve diagnostic procedures or language-driven interventions which enhance therapists' attention to patients' verbal behavior.

12 Article The association between adherence and outcome in an Internet intervention for depression. 2018

Fuhr, Kristina / Schröder, Johanna / Berger, Thomas / Moritz, Steffen / Meyer, Björn / Lutz, Wolfgang / Hohagen, Fritz / Hautzinger, Martin / Klein, Jan Philipp. ·Department of Psychology, Clinical Psychology and Psychotherapy, Eberhard Karls University Tübingen, Tübingen, Germany. Electronic address: kristina.fuhr@uni-tuebingen.de. · Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Germany. · Department of Clinical Psychology and Psychotherapy, University of Bern, Bern, Switzerland. · GAIA AG, Hamburg, Germany; Department of Psychology, City University London, London, UK. · Department of Psychology, University of Trier, Trier, Germany. · Department of Psychiatry and Psychotherapy, Lübeck University, Lübeck, Germany. · Department of Psychology, Clinical Psychology and Psychotherapy, Eberhard Karls University Tübingen, Tübingen, Germany. ·J Affect Disord · Pubmed #29331706.

ABSTRACT: BACKGROUND: Adherence to Internet interventions is often reported to be rather low and this might adversely impact the effectiveness of these interventions. We investigated if patient characteristics are associated with adherence, and if adherence is associated with treatment outcome in a large RCT of an Internet intervention for depression, the EVIDENT trial. METHODS: Patients were randomized to either care as usual (CAU) or CAU plus the Internet intervention Deprexis. A total of 509 participants with mild to moderate depressive symptoms were included in the intervention group and of interest for the present study. We assessed depression symptoms pre and post intervention (12 weeks). Patient characteristics, a self-rating screening for mental disorders, attitudes towards online interventions, and quality of life were assessed before randomization. RESULTS: Adherence in this study was good with on average seven hours of usage time and eight number of sessions spent with the intervention. Some of the patient characteristics (age, sex, depressive symptoms, and confidence in the effectiveness of the program) predicted higher number of sessions in different models (explaining in total between 15 and 25% of variance). Older age (β = .16) and higher depressive symptoms (β = .15) were associated with higher usage duration. Higher adherence to the program predicted a greater symptom reduction in depressive symptoms over 12 weeks (number of sessions: β = .13, usage duration: β = .14), however, this prediction could mostly be explained by receiving guidance (β = .27 and .26). LIMITATIONS: Receiving guidance and symptom severity at baseline were confounded since only participants with a moderate symptom severity at baseline received e-mail support. Therefore no firm conclusions can be drawn from the association we observed between baseline symptom severity and usage intensity. CONCLUSIONS: We conclude that older age was associated with adherence and adherence was positively associated with outcome. The effects we have found were small however suggesting that adherence might also be influenced by further variables.

13 Article Processes of change after a sudden gain and relation to treatment outcome-Evidence for an upward spiral. 2017

Wucherpfennig, Felix / Rubel, Julian A / Hofmann, Stefan G / Lutz, Wolfgang. ·Department of Psychology, University of Trier. · Department of Psychological and Brain Sciences, Boston University. ·J Consult Clin Psychol · Pubmed #29189035.

ABSTRACT: OBJECTIVE: Sudden gains are sudden symptom improvements from 1 psychotherapy session to the next. This study investigates the processes that may facilitate treatment outcome after a sudden gain occurred. METHOD: A sample of 211 depressed patients who underwent cognitive-behavioral therapy was analyzed. Sudden gains were identified using a session-by-session self-report symptom measure. Patient ratings of general change factors (therapeutic alliance; coping skills) in the sessions before and after a sudden gain were investigated as predictors of outcome. Propensity score matching was used to compare sudden gain patients with similar patients who did not experience a sudden gain. RESULTS: Therapeutic alliance and coping skills increased in the postgain sessions. There were no comparable processes of change among patients without sudden gains. The therapeutic alliance was found to moderate the association between sudden gains and treatment outcome. CONCLUSION: Results suggest that sudden gains trigger change factors that facilitate the association between gains and treatment outcome. Patient-therapist dyads should work with sudden gains to consolidate symptom relief. (PsycINFO Database Record

14 Article Improving the efficiency of psychological treatment using outcome feedback technology. 2017

Delgadillo, Jaime / Overend, Karen / Lucock, Mike / Groom, Martin / Kirby, Naomi / McMillan, Dean / Gilbody, Simon / Lutz, Wolfgang / Rubel, Julian A / de Jong, Kim. ·Clinical Psychology Unit, Department of Psychology, University of Sheffield, UK. Electronic address: jaime.delgadillo@nhs.net. · Department of Health Sciences, University of York, UK. · Centre for Applied Research in Health, University of Huddersfield, South West Yorkshire Partnership NHS Foundation Trust, UK. · Leeds Community Healthcare NHS Trust, UK. · Department of Psychology, University of Trier, Germany. · Institute of Psychology, Leiden University, The Netherlands. ·Behav Res Ther · Pubmed #29024821.

ABSTRACT: AIMS: This study evaluated the impact of applying computerized outcome feedback (OF) technology in a stepped care psychological service offering low and high intensity therapies for depression and anxiety. METHODS: A group of therapists were trained to use OF based on routine outcome monitoring using depression (PHQ-9) and anxiety (GAD-7) measures. Therapists regularly reviewed expected treatment response graphs with patients and discussed cases that were "not on track" in clinical supervision. Clinical outcomes data were collected for all patients treated by this group (N = 594), six months before (controls = 349) and six months after the OF training (OF cases = 245). Symptom reductions in PHQ-9 and GAD-7 were compared between controls and OF cases using longitudinal multilevel modelling. Treatment duration and costs were compared using MANOVA. Qualitative interviews with therapists (N = 15) and patients (N = 6) were interpreted using thematic analysis. RESULTS: OF technology was generally acceptable and feasible to integrate in routine practice. No significant between-group differences were found in post-treatment PHQ-9 or GAD-7 measures. However, OF cases had significantly lower average duration and cost of treatment compared to controls. CONCLUSIONS: After adopting OF into their practice, this group of therapists attained similar clinical outcomes but within a shorter space of time and at a reduced average cost per treatment episode. We conclude that OF can improve the efficiency of stepped care.

15 Article Randomized controlled trial to evaluate the effects of personalized prediction and adaptation tools on treatment outcome in outpatient psychotherapy: study protocol. 2017

Lutz, Wolfgang / Zimmermann, Dirk / Müller, Viola N L S / Deisenhofer, Anne-Katharina / Rubel, Julian A. ·Clinical Psychology and Psychotherapy, Department of Psychology, University of Trier, D-54286, Trier, Germany. wolfgang.lutz@uni-trier.de. · Clinical Psychology and Psychotherapy, Department of Psychology, University of Trier, D-54286, Trier, Germany. ·BMC Psychiatry · Pubmed #28836954.

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.

16 Article Time to remission from mild to moderate depressive symptoms: One year results from the EVIDENT-study, an RCT of an internet intervention for depression. 2017

Klein, Jan Philipp / Späth, Christina / Schröder, Johanna / Meyer, Björn / Greiner, Wolfgang / Hautzinger, Martin / Lutz, Wolfgang / Rose, Matthias / Vettorazzi, Eik / Andersson, Gerhard / Hohagen, Fritz / Moritz, Steffen / Berger, Thomas. ·Department of Psychiatry and Psychotherapy, Lübeck University, Lübeck, Germany. Electronic address: philipp.klein@uksh.de. · Department of Psychiatry and Psychotherapy, Lübeck University, Lübeck, Germany. · Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany. · GAIA AG, Hamburg, Germany; Department of Psychology, City, University of London, London, United Kingdom. · Department of Health Economics and Health Care Management, Bielefeld University, Bielefeld, Germany. · Eberhard Karls University Tübingen, Department of Psychology, Clinical Psychology and Psychotherapy, Tübingen, Germany. · Department of Psychology, University of Trier, Germany. · Department of Psychosomatic Medicine, Charité University Medical Center, Berlin, Germany; Quantitative Health Sciences, Outcomes Measurement Science, University of Massachusetts Medical School, Worcester, MA, USA. · Department of Medical Biometry and Epidemiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany. · Department of Behavioural Sciences and Learning, Linköping University, Linköping, Sweden; Department of Clinical Neuroscience, Karolinska Institute, Stockholm, Sweden. · Department of Clinical Psychology and Psychotherapy, University of Bern, Bern, Switzerland. ·Behav Res Ther · Pubmed #28797829.

ABSTRACT: BACKGROUND: Internet interventions are effective in treating depressive symptoms but few studies conducted a long-term follow-up. The aim of this study was to test the effectiveness of an internet intervention in increasing the remission rate over a twelve months period. METHODS: A total of 1013 participants with mild to moderate depressive symptoms were randomized to either care as usual alone or a 12-week internet intervention (Deprexis) plus usual care. Self-rated depression severity (PHQ-9) was assessed regularly over twelve months. RESULTS: Remission rates over time were significantly higher in the intervention group (Cox regression: hazard ratio [HR] 1.31; p = 0.009). The intervention was more effective in the subgroup not taking antidepressant medication (Cox regression: HR 1.88; p < 0.001). PHQ-change from baseline was greater in the intervention group (linear mixed model [LMM]: p < 0.001) with the between-group effect gradually decreasing from d = 0.36 at three months to d = 0.13 at twelve months (LMM: group by time interaction: p < 0.001). CONCLUSION: This internet intervention can contribute to achieving remission in people with mild to moderate depressive symptoms, especially if they are not on antidepressant medication (Trial Registration: NCT01636752).

17 Article Does recruitment source moderate treatment effectiveness? A subgroup analysis from the EVIDENT study, a randomised controlled trial of an internet intervention for depressive symptoms. 2017

Klein, Jan Philipp / Gamon, Carla / Späth, Christina / Berger, Thomas / Meyer, Björn / Hohagen, Fritz / Hautzinger, Martin / Lutz, Wolfgang / Vettorazzi, Eik / Moritz, Steffen / Schröder, Johanna. ·Department of Psychiatry and Psychotherapy, Lübeck University, Lübeck, Germany. · Department of Clinical Psychology and Psychotherapy, University of Bern, Bern, Switzerland. · GAIA AG, Hamburg, Germany. · Department of Psychology, City University London, London, UK. · Department of Psychology, Clinical Psychology and Psychotherapy, Eberhard Karls University Tübingen, Tübingen, Germany. · Department of Psychology, University of Trier, Trier, Germany. · Department of Medical Biometry and Epidemiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany. · Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany. ·BMJ Open · Pubmed #28710212.

ABSTRACT: OBJECTIVE: This study aims to examine whether the effects of internet interventions for depression generalise to participants recruited in clinical settings. DESIGN: This study uses subgroup analysis of the results of a randomised, controlled, single-blind trial. SETTING: The study takes place in five diagnostic centres in Germany. PARTICIPANTS: A total of 1013 people with mild to moderate depressive symptoms were recruited from clinical sources as well as internet forums, statutory insurance companies and other sources. INTERVENTIONS: This study uses either care-as-usual alone (control) or a 12-week internet intervention (Deprexis) plus usual care (intervention). MAIN OUTCOME MEASURES: The primary outcome measure was self-rated depression severity (Patient Health Questionnaire-9) at 3 months and 6 months. Further measures ranged from demographic and clinical parameters to a measure of attitudes towards internet interventions (Attitudes towards Psychological Online Interventions Questionnaire). RESULTS: The recruitment source was only associated with very few of the examined demographic and clinical characteristics. Compared with participants recruited from clinical sources, participants recruited through insurance companies were more likely to be employed. Clinically recruited participants were as severely affected as those from other recruitment sources but more sceptical of internet interventions. The effectiveness of the intervention was not differentially associated with recruitment source (treatment by recruitment source interaction=0.28, p=0.84). CONCLUSION: Our results support the hypothesis that the intervention we studied is effective across different recruitment sources including clinical settings. TRIAL REGISTRATION NUMBER: ClinicalTrials.gov NCT01636752.

18 Article Defining and Predicting Patterns of Early Response in a Web-Based Intervention for Depression. 2017

Lutz, Wolfgang / Arndt, Alice / Rubel, Julian / Berger, Thomas / Schröder, Johanna / Späth, Christina / Meyer, Björn / Greiner, Wolfgang / Gräfe, Viola / Hautzinger, Martin / Fuhr, Kristina / Rose, Matthias / Nolte, Sandra / Löwe, Bernd / Hohagen, Fritz / Klein, Jan Philipp / Moritz, Steffen. ·Department of Psychology, University of Trier, Trier, Germany. · Departmemt of Psychology, University of Bern, Bern, Switzerland. · Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany. · Department of Psychiatry and Psychotherapy, Lübeck University, Lübeck, Germany. · GAIA AG, Hamburg, Germany. · Department of Health Economics and Health Care Management, Bielefeld University, Bielefeld, Germany. · Department of Psychology, Eberhard Karls University Tuebingen, Tuebingen, Germany. · Department of Psychosomatic Medicine, Charité University Medical Center, Berlin, Germany, Berlin, Germany. · Department of Psychosomatic Medicine and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany. ·J Med Internet Res · Pubmed #28600278.

ABSTRACT: BACKGROUND: Web-based interventions for individuals with depressive disorders have been a recent focus of research and may be an effective adjunct to face-to-face psychotherapy or pharmacological treatment. OBJECTIVE: The aim of our study was to examine the early change patterns in Web-based interventions to identify differential effects. METHODS: We applied piecewise growth mixture modeling (PGMM) to identify different latent classes of early change in individuals with mild-to-moderate depression (n=409) who underwent a CBT-based web intervention for depression. RESULTS: Overall, three latent classes were identified (N=409): Two early response classes (n=158, n=185) and one early deterioration class (n=66). Latent classes differed in terms of outcome (P<.001) and adherence (P=.03) in regard to the number of modules (number of modules with a duration of at least 10 minutes) and the number of assessments (P<.001), but not in regard to the overall amount of time using the system. Class membership significantly improved outcome prediction by 24.8% over patient intake characteristics (P<.001) and significantly added to the prediction of adherence (P=.04). CONCLUSIONS: These findings suggest that in Web-based interventions outcome and adherence can be predicted by patterns of early change, which can inform treatment decisions and potentially help optimize the allocation of scarce clinical resources.

19 Article Patients' in-session experiences and symptom change: Session-to-session effects on a within- and between-patient level. 2017

Rubel, Julian A / Rosenbaum, David / Lutz, Wolfgang. ·University of Trier, Germany. Electronic address: rubel@uni-trier.de. · University Hospital of Tuebingen, Department of Psychiatry and Psychotherapy, Germany. · University of Trier, Germany. ·Behav Res Ther · Pubmed #27998800.

ABSTRACT: OBJECTIVE: Knowledge of patients' in-session experiences that lead to symptom change in psychotherapy is limited. This study aims to investigate the within- and between-patient relationships between three in-session processes in psychotherapy (coping skills, therapeutic relationship quality, and emotional involvement) and symptom change on a session-by-session level. METHOD: Participants (n = 1550) with various disorders, including primarily depression and anxiety, were treated with CBT in a German outpatient clinic. Symptom distress was assessed before each session and patients' in-session experiences were assessed at the end of each session using session reports. Person-mean centering was applied to disaggregate within- and between-patients. Within- and between-patient process scores were tested in multilevel models as predictors of next session symptom change. RESULTS: On a within-patient level, better session-specific coping skills, better therapeutic alliance, and deeper emotional involvement were followed by next session symptom improvements. In a combined model, only coping skills specifically predicted next session symptom change. Additionally, these coping skills were especially helpful when combined with a better therapeutic relationship quality. On a between-patient level, better therapeutic alliance and more coping skills were associated with lower symptom scores during treatment, while deeper emotional involvement was associated with higher symptom scores. Testing these between-patient effects in a combined model left only coping skills (the more, the greater symptom improvement) and emotional involvement (the deeper, the less symptom improvement) as significant predictors. These two also exhibited a combined effect on symptom change on the between-patient level. DISCUSSION: The results highlight the importance of a thorough disaggregation of within- and between-patient variability in psychotherapy process-outcome research as well as the consideration of several potentially important time-varying covariates. While coping skills showed to be the most central for subsequent symptom change, therapeutic relationship quality only seemed to be a facilitative factor in enhancing these effects, but was not sufficiently helpful on its own.

20 Article The regression discontinuity design showed to be a valid alternative to a randomized controlled trial for estimating treatment effects. 2017

Maas, Iris L / Nolte, Sandra / Walter, Otto B / Berger, Thomas / Hautzinger, Martin / Hohagen, Fritz / Lutz, Wolfgang / Meyer, Björn / Schröder, Johanna / Späth, Christina / Klein, Jan Philipp / Moritz, Steffen / Rose, Matthias. ·Department of Psychosomatic Medicine, Center for Internal Medicine and Dermatology, Charité - Universitätsmedizin Berlin, Charitéplatz 1, 10117 Berlin, Germany. · Department of Psychosomatic Medicine, Center for Internal Medicine and Dermatology, Charité - Universitätsmedizin Berlin, Charitéplatz 1, 10117 Berlin, Germany; Population Health Strategic Research Centre, School of Health and Social Development, Deakin University, 221 Burwood Highway, Burwood, Victoria 3125, Australia. · Department of Clinical Psychology and Psychotherapy, University of Bern, Fabrikstrasse 8, Bern 3012, Switzerland. · Department of Psychology, Clinical Psychology and Psychotherapy, Eberhard Karls University Tübingen, Schleichstrasse 4, Tübingen 72074, Germany. · Department of Psychiatry and Psychotherapy, Lübeck University, Ratzeburger Allee 160, Lübeck 23538, Germany. · Department of Psychology, University of Trier, Trier 54286, Germany. · GAIA AG, Gertigstrasse 12-14, Hamburg 22303, Germany; Department of Psychology, City University London, Northampton Square, London EC1V 0HB, UK. · Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, Hamburg 20246, Germany. · Department of Psychosomatic Medicine, Center for Internal Medicine and Dermatology, Charité - Universitätsmedizin Berlin, Charitéplatz 1, 10117 Berlin, Germany; Outcomes Measurement Science, Department of Quantitative Health Sciences, University of Massachusetts Medical School, 55 Lake Avenue North, Worcester, MA 01655, USA. Electronic address: matthias.rose@charite.de. ·J Clin Epidemiol · Pubmed #27865902.

ABSTRACT: OBJECTIVES: To compare treatment effect estimates obtained from a regression discontinuity (RD) design with results from an actual randomized controlled trial (RCT). STUDY DESIGN AND SETTING: Data from an RCT (EVIDENT), which studied the effect of an Internet intervention on depressive symptoms measured with the Patient Health Questionnaire (PHQ-9), were used to perform an RD analysis, in which treatment allocation was determined by a cutoff value at baseline (PHQ-9 = 10). A linear regression model was fitted to the data, selecting participants above the cutoff who had received the intervention (n = 317) and control participants below the cutoff (n = 187). Outcome was PHQ-9 sum score 12 weeks after baseline. Robustness of the effect estimate was studied; the estimate was compared with the RCT treatment effect. RESULTS: The final regression model showed a regression coefficient of -2.29 [95% confidence interval (CI): -3.72 to -.85] compared with a treatment effect found in the RCT of -1.57 (95% CI: -2.07 to -1.07). CONCLUSION: Although the estimates obtained from two designs are not equal, their confidence intervals overlap, suggesting that an RD design can be a valid alternative for RCTs. This finding is particularly important for situations where an RCT may not be feasible or ethical as is often the case in clinical research settings.

21 Article Effects of a Psychological Internet Intervention in the Treatment of Mild to Moderate Depressive Symptoms: Results of the EVIDENT Study, a Randomized Controlled Trial. 2016

Klein, Jan Philipp / Berger, Thomas / Schröder, Johanna / Späth, Christina / Meyer, Björn / Caspar, Franz / Lutz, Wolfgang / Arndt, Alice / Greiner, Wolfgang / Gräfe, Viola / Hautzinger, Martin / Fuhr, Kristina / Rose, Matthias / Nolte, Sandra / Löwe, Bernd / Anderssoni, Gerhard / Vettorazzi, Eik / Moritz, Steffen / Hohagen, Fritz. ·Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany. ·Psychother Psychosom · Pubmed #27230863.

ABSTRACT: BACKGROUND: Mild to moderate depressive symptoms are common but often remain unrecognized and treated inadequately. We hypothesized that an Internet intervention in addition to usual care is superior to care as usual alone (CAU) in the treatment of mild to moderate depressive symptoms in adults. METHODS: This trial was controlled, randomized and assessor-blinded. Participants with mild to moderate depressive symptoms (Patient Health Questionnaire, PHQ-9, score 5-14) were recruited from clinical and non-clinical settings and randomized to either CAU or a 12-week Internet intervention (Deprexis) adjunctive to usual care. Outcomes were assessed at baseline, 3 months (post-assessment) and 6 months (follow-up). The primary outcome measure was self-rated depression severity (PHQ-9). The main analysis was based on the intention-to-treat principle and used linear mixed models. RESULTS: A total of 1,013 participants were randomized. Changes in PHQ-9 from baseline differed signixFB01;cantly between groups (t825 = 6.12, p < 0.001 for the main effect of group). The post-assessment between-group effect size in favour of the intervention was d = 0.39 (95% CI: 0.13-0.64). It was stable at follow-up, with d = 0.32 (95% CI: 0.06-0.69). The rate of participants experiencing at least minimally clinically important PHQ-9 change at the post-assessment was higher in the intervention group (35.6 vs. 20.2%) with a number needed to treat of 7 (95% CI: 5-10). CONCLUSIONS: The Internet intervention examined in this trial was superior to CAU alone in reducing mild to moderate depressive symptoms. The magnitude of the effect is clinically important and has public health implications.

22 Article Different people respond differently to therapy: A demonstration using patient profiling and risk stratification. 2016

Delgadillo, Jaime / Moreea, Omar / Lutz, Wolfgang. ·Leeds Community Healthcare NHS Trust, and Department of Health Sciences, University of York, UK. Electronic address: jaime.delgadillo@nhs.net. · Centre for Clinical Practice, National Institute for Health and Care Excellence, UK. · Department of Psychology, University of Trier, Germany. ·Behav Res Ther · Pubmed #26937855.

ABSTRACT: BACKGROUND: This study aimed to identify patient characteristics associated with poor outcomes in psychological therapy, and to develop a patient profiling method. METHOD: Clinical assessment data for 1347 outpatients was analysed. Final treatment outcome was based on reliable and clinically significant improvement (RCSI) in depression (PHQ-9) and anxiety (GAD-7) measures. Thirteen patient characteristics were explored as potential outcome predictors using logistic regression in a cross-validation design. RESULTS: Disability, employment status, age, functional impairment, baseline depression and outcome expectancy predicted post-treatment RCSI. Regression coefficients for these factors were used to derive a weighting scheme called Leeds Risk Index (LRI), used to assign risk scores to individual cases. After stratifying cases into three levels of LRI scores, we found significant differences in RCSI and treatment completion rates. Furthermore, LRI scores were significantly correlated with the proportion of treatment sessions classified as 'not on track'. CONCLUSIONS: The LRI tool can identify cases at risk of poor progress to inform personalized treatment recommendations for low and high intensity psychological interventions.

23 Article Clinical effectiveness of cognitive behavioral therapy for depression in routine care: A propensity score based comparison between randomized controlled trials and clinical practice. 2016

Lutz, Wolfgang / Schiefele, Anne-Katharina / Wucherpfennig, Felix / Rubel, Julian / Stulz, Niklaus. ·Clinical Psychology and Psychotherapy, Department of Psychology, University of Trier, D-54296 Trier, Germany. Electronic address: wolfgang.lutz@uni-trier.de. · Clinical Psychology and Psychotherapy, Department of Psychology, University of Trier, D-54296 Trier, Germany. Electronic address: schiefele@uni-trier.de. · Clinical Psychology and Psychotherapy, Department of Psychology, University of Trier, D-54296 Trier, Germany. Electronic address: wucherpfennig@uni-trier.de. · Clinical Psychology and Psychotherapy, Department of Psychology, University of Trier, D-54296 Trier, Germany. Electronic address: rubel@uni-trier.de. · Department of Psychology, University of Berne, Fabrikstrasse 8, CH-3012 Berne, Switzerland. Electronic address: niklaus.stulz@psy.unibe.ch. ·J Affect Disord · Pubmed #26433763.

ABSTRACT: BACKGROUND: The efficacy of cognitive behavioral therapy (CBT) for the treatment of depressive disorders has been demonstrated in many randomized controlled trials (RCTs). This study investigated whether for CBT similar effects can be expected under routine care conditions when the patients are comparable to those examined in RCTs. METHOD: N=574 CBT patients from an outpatient clinic were stepwise matched to the patients undergoing CBT in the National Institute of Mental Health Treatment of Depression Collaborative Research Program (TDCRP). First, the exclusion criteria of the RCT were applied to the naturalistic sample of the outpatient clinic. Second, propensity score matching (PSM) was used to adjust the remaining naturalistic sample on the basis of baseline covariate distributions. Matched samples were then compared regarding treatment effects using effect sizes, average treatment effect on the treated (ATT) and recovery rates. RESULTS: CBT in the adjusted naturalistic subsample was as effective as in the RCT. However, treatments lasted significantly longer under routine care conditions. LIMITATIONS: The samples included only a limited amount of common predictor variables and stemmed from different countries. There might be additional covariates, which could potentially further improve the matching between the samples. CONCLUSIONS: CBT for depression in clinical practice might be equally effective as manual-based treatments in RCTs when they are applied to comparable patients. The fact that similar effects under routine conditions were reached with more sessions, however, points to the potential to optimize treatments in clinical practice with respect to their efficiency.

24 Article Defining early positive response to psychotherapy: An empirical comparison between clinically significant change criteria and growth mixture modeling. 2015

Rubel, Julian / Lutz, Wolfgang / Kopta, Stephen Mark / Köck, Katharina / Minami, Takuya / Zimmermann, Dirk / Saunders, Stephen M. ·Department of Clinical Psychology and Psychotherapy. · Department of Psychology, University of Evansville. · Outpatient Clinic for Psychotherapy, University of Koblenz-Landau. · College of Education and Human Development, University of Massachusetts Boston. · Stephen M. Saunders, Department of Psychology, Marquette University. ·Psychol Assess · Pubmed #25496087.

ABSTRACT: Several different approaches have been applied to identify early positive change in response to psychotherapy so as to predict later treatment outcome and length as well as use this information for outcome monitoring and treatment planning. In this study, simple methods based on clinically significant change criteria and computationally demanding growth mixture modeling (GMM) are compared with regard to their overlap and uniqueness as well as their characteristics in terms of initial impairment, therapy outcome, and treatment length. The GMM approach identified a highly specific subgroup of early improving patients. These patients were characterized by higher average intake impairments and higher pre- to-posttreatment score differences. Although being more specific for the prediction of treatment success, GMM was much less sensitive than clinically significant and reliable change criteria. There were no differences between the groups with regard to treatment length. Because each of the approaches had specific advantages, results suggest a combination of both methods for practical use in routine outcome monitoring and treatment planning.

25 Article Negative affectivity as a transdiagnostic factor in patients with common mental disorders. 2014

Böhnke, Jan R / Lutz, Wolfgang / Delgadillo, Jaime. ·Mental Health and Addictions Research Group, Hull York Medical School & Department of Health Sciences, University of York, United Kingdom. Electronic address: jan.boehnke@york.ac.uk. · Clinical Psychology & Psychotherapy, Trier University, Germany. · Leeds Community Healthcare NHS Trust, United Kingdom. ·J Affect Disord · Pubmed #25012441.

ABSTRACT: BACKGROUND: Screening and monitoring systems are increasingly used in psychotherapy, but it has been questioned whether outcome measurement using multiple questionnaires is warranted. Arguably, type and number of assessment instruments should be determined by empirical research. This study investigated the latent factor structure of a multi-dimensional outcome measurement strategy used in English services aligned to the Improving Access to Psychological Therapies (IAPT) programme. METHODS: Factor analyses and structural equation models were performed on 11,939 intake assessments of outpatients accessing an IAPT service between 2008 and 2010. We examined whether three routinely employed instruments (PHQ-9 for depression, GAD-7 for anxiety, WSAS for functional impairment) assess empirically different dimensions. RESULTS: The instruments were found to assess mainly one general dimension and only some items of the GAD-7 and WSAS assess unique variance beyond this general dimension. In a structural equation model the disorder-specific factor scores were predicted by patients׳ diagnostic categories. LIMITATIONS: Since a large naturalistic data base was used, missing data for diagnoses and scale items were encountered. Diagnoses were obtained with brief case-finding measures rather than structured diagnostic interviews. CONCLUSION: Although the items seem to address mostly one dimension, some variance is due to differences between individuals in anxiety and impairment. While this generally supports multi-dimensional assessment in a primary care population, the clinical upshot of the study is to concentrate attention on transdiagnostic factors as a target for treatment.

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