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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

The use of feedback to patients in therapy

Professor Janet Treasure

Kings College London

South London & Maudsley NHS Trust


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


Bien et al 1993 behavioural cognitive psychotherapy 21 347 356
Bien et al., 1993 psychotherapy research has an effect?Behavioural & Cognitive Psychotherapy, 21:347-356

  • Design Randomized clinical trial

  • Population Outpatient alcohol (VA)

  • Nation US (Albuquerque, NM)

  • N 32 adults

  • MI 1 session MET (+ TAU)

  • Comparison TAU

  • Follow-up 6 months post discharge


Bien et al 1993
Bien et al., 1993 psychotherapy research has an effect?

p<.05


Bien et al 19931
Bien et al., 1993 psychotherapy research has an effect?


Monti et al 1999 journal of consulting and clinical psychology 67 989 994
Monti et al., 1999 psychotherapy research has an effect?Journal of Consulting and Clinical Psychology, 67:989-994

  • Design Randomized clinical trial

  • Population Emergency room

  • Nation US (Providence, RI)

  • N 94 adolescents (18-19)

  • MI 1 session (35-40 min)

  • Comparison Standard care

  • Follow-up 6 months


Monti et al
Monti et al psychotherapy research has an effect?

  • MI plus personalised problem focused feedback

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


Monti et al 1999
Monti et al., 1999 psychotherapy research has an effect?

p<.05

p<.05

p<.01


Project match 1997 journal of studies on alcohol 58 7 29
Project MATCH, 1997 psychotherapy research has an effect?Journal of Studies on Alcohol, 58:7-29

  • Design Randomized clinical trial

  • Population Outpatient and aftercare

  • Nation US (9 sites)

  • N 1,726 adults

  • MI 4 session MET

  • Comparison 12 session CBT or TSF

  • Follow-up 15 months post-treatment


Content feedback met
Content Feedback MET psychotherapy research has an effect?

  • 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
Project MATCH, 1997 psychotherapy research has an effect?

p<.04

p<.003


Project match 1998 alcoholism clinical and experimental research 22 1300 1311
Project MATCH, 1998 psychotherapy research has an effect?Alcoholism: Clinical and Experimental Research, 22:1300-1311

p<.007

On percent days abstinent, MET = TSF > CBT



Swanson et al 1999 journal of nervous mental disease 187 630 635
Swanson et al., 1999 psychotherapy research has an effect?Journal of Nervous & Mental Disease, 187:630-635

  • Design Randomized clinical trial

  • Population Psychiatric inpatients

  • Nation US (New York)

  • N 121 inpatients

  • MI 2 sessions (15, 60 min) + TAU

  • Comparison TAU

  • Follow-up Transition to aftercare


Intervention
Intervention psychotherapy research has an effect?

  • 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
Swanson et al., 1999 psychotherapy research has an effect?

p<.01


The effect of feedback to patients on management of bulimia nervosa
The effect of feedback to patients on management of bulimia nervosa

  • Design Randomized clinical trial

  • Population DSMIV Bulimia Nervosa

  • Nation UK (London)

  • N 62

  • MI Letter, AQUASI + TAU

  • Comparison TAU

  • Follow-up BN symptoms



Summary of the evidence
Summary of the evidence nervosa

  • 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 management?

  • 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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