The use of feedback to patients in therapy
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The use of feedback to patients in therapy. Professor Janet Treasure Kings College London South London & Maudsley NHS Trust. Contents. Models of feedback Process/ mechanisms of feedback Evidence for efficacy of feedback in psychotherapy

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The use of feedback to patients in therapy

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The use of feedback to patients in therapy

Professor Janet Treasure

Kings College London

South London & Maudsley NHS Trust


Contents

  • Models of feedback

  • Process/ mechanisms of feedback

  • Evidence for efficacy of feedback in psychotherapy

  • Can feedback be used as part of quality management?


Feedback-types

  • Risk

    Laboratory variables, Demographics etc

  • Change variables

    Stage of change, Self efficacy, Decisional balance, Process of change, symptom level/change, formulation


Mechanisms of Action of feedback

  • Informational/educational

  • Motivational/inspirational

  • Changing attitudes and beliefs

  • Provide support & a helpful relationship

  • Offering social norms and comparisons

  • Increasing engagement in the information

  • Providing critical risk, skill and protective factors


What is the evidence that feedback to clients in psychotherapy research has an effect?


Bien et al., 1993Behavioural & Cognitive Psychotherapy, 21:347-356

  • DesignRandomized clinical trial

  • PopulationOutpatient alcohol (VA)

  • NationUS (Albuquerque, NM)

  • N32 adults

  • MI1 session MET (+ TAU)

  • ComparisonTAU

  • Follow-up6 months post discharge


Bien et al., 1993

p<.05


Bien et al., 1993


Monti et al., 1999Journal of Consulting and Clinical Psychology, 67:989-994

  • DesignRandomized clinical trial

  • PopulationEmergency room

  • NationUS (Providence, RI)

  • N94 adolescents (18-19)

  • MI1 session (35-40 min)

  • ComparisonStandard care

  • Follow-up6 months


Monti et al

  • MI plus personalised problem focused feedback

  • Standard Care condition: handout drink/drive & list local treatment resources


Monti et al., 1999

p<.05

p<.05

p<.01


Project MATCH, 1997Journal of Studies on Alcohol, 58:7-29

  • DesignRandomized clinical trial

  • PopulationOutpatient and aftercare

  • NationUS (9 sites)

  • N1,726 adults

  • MI4 session MET

  • Comparison12 session CBT or TSF

  • Follow-up15 months post-treatment


Content Feedback MET

  • Comprehensive personalised feedback: problem/risk and current status with written explanation including , normative comparisons drinking rates, typical blood alcohol levels, personal risk factors – family history, tolerance, negative consequences drinks, LFTs , neuropsychological assessment


Project MATCH, 1997

p<.04

p<.003


Project MATCH, 1998Alcoholism: Clinical and Experimental Research, 22:1300-1311

p<.007

On percent days abstinent, MET = TSF > CBT


What about giving feedback in general Psychiatric settings?


Swanson et al., 1999Journal of Nervous & Mental Disease, 187:630-635

  • DesignRandomized clinical trial

  • PopulationPsychiatric inpatients

  • NationUS (New York)

  • N121 inpatients

  • MI2 sessions (15, 60 min) + TAU

  • ComparisonTAU

  • Follow-upTransition to aftercare


Intervention

  • 15 min session of feedback on their URICA scores at beginning of hospitalization

  • Description of instrument

  • Results in terms of profiles in previous research

  • Interpretation of results based on stage of change model

  • Discussion of patients views of results and how they may influence commitment to adhere to treatment recommendations

  • Later one hour review of problem and level of commitment to treatment (review feedback)


Swanson et al., 1999

p<.01


The effect of feedback to patients on management of bulimia nervosa

  • DesignRandomized clinical trial

  • PopulationDSMIV Bulimia Nervosa

  • NationUK (London)

  • N62

  • MILetter, AQUASI + TAU

  • ComparisonTAU

  • Follow-upBN symptoms


The effect of feedback on BN symptoms at 6/12 follow up

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Summary of the evidence

  • Personalised feedback has the potential for increasing the effectiveness of interventions.

  • Normative comparisons and details of risk and problem dimensions has been found to be as good as more extensive interventions in terms of engagement and outcome


Can/ should we use feedback to patients as part of quality management?And encourage them to give feedback to us?


Sue’s Feedback

  • Over the years I have had & recovered from an eating disorder, both anorexia & bulimia.  By taking part in the research questionnaire I was able to reflect on the BIG improvements I had made in my life and give myself a pat on the back . Recently I gave up smoking, I felt the time was right, the eating disorder was under control and I had just completed some research questionnaires so felt very positive.  About 6- 7 weeks after giving up smoking I received another research paper, at this point I had started to gain weight & feel quite bad.  Although my responses this time where not as positive, doing the paper allowed me to reflect again, and reinforce the positive aspects of not abusing food, me and my body.


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