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Frequencies and Predictors of Negative Effects in Routine Inpatient and Outpatient Psychotherapy: Two Observational Studies.

ABSTRACT: Negative effects of psychotherapy (NEP) include side effects, malpractice, and unethical behavior. Its setting-specific frequencies and predictors are mostly unknown. The two presented studies aim to investigate NEP and its predictors systematically across different treatment settings. In study 1, N = 197 patients of a German outpatient center were recruited, on average, 3.76 years after the termination of psychotherapy. In study 2, data from N = 118 patients of two German inpatient clinics were collected at admission (t 0), discharge (t 1), and 9-month follow-up (t 2). All participants evaluated the negative effects of their previous out- or inpatient psychotherapy with the Inventory for the Balanced Assessment of Negative Effects in Psychotherapy and a priori hypothesized predictors. At least one side effect was reported by 37.3% of inpatients (t 2) and 15.2% of outpatients. At least one case of malpractice and unethical behavior was reported by 28.8% of inpatients (t 2) and 7.1% of outpatients. Inpatients reported significantly more side effects (U = 14347, z = 4.70, p < 0.001, r = 0.26) and malpractice and unethical behavior (U = 14168, z = 5.21, p < 0.001, r = 0.29) than outpatients. Rates of severe malpractice in the form of breaking confidentiality and physical and sexual abuse were less than 1% in both settings. Predictors of side effects were prior experience with psychotherapy and current interpersonal difficulties in the outpatient setting and higher motivation for psychotherapy (t 0) in the inpatient setting. Predictors of malpractice and unethical behavior were younger age in the outpatient setting and poor therapeutic alliance, prior negative experience with malpractice and unethical behavior, and higher outcome expectations in the inpatient setting. NEP are common in both, in- and outpatient settings. Inpatients are at higher risk for the NEP than outpatients. To safeguard patients' wellbeing, the systematic assessment and distinction of side effects and malpractice and unethical behavior should gain more attention in research and clinical practice.

SUBMITTER: Gerke L

PROVIDER: S-EPMC7478145 | biostudies-literature | 2020

REPOSITORIES: biostudies-literature

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Frequencies and Predictors of Negative Effects in Routine Inpatient and Outpatient Psychotherapy: Two Observational Studies.

Gerke Leonie L Meyrose Ann-Katrin AK Ladwig Inga I Rief Winfried W Nestoriuc Yvonne Y

Frontiers in psychology 20200825

Negative effects of psychotherapy (NEP) include side effects, malpractice, and unethical behavior. Its setting-specific frequencies and predictors are mostly unknown. The two presented studies aim to investigate NEP and its predictors systematically across different treatment settings. In study 1, <i>N</i> = 197 patients of a German outpatient center were recruited, on average, 3.76 years after the termination of psychotherapy. In study 2, data from <i>N</i> = 118 patients of two German inpatien ...[more]

PMID: 32982878

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Project description:BackgroundOnly 11%-40% of those with a mental disorder in Germany receive treatment. In many cases, face-to-face psychotherapy is not available because of limited resources, such as an insufficient number of therapists in the area. New approaches to improve the German health care system are needed to counter chronification. Web-based interventions have been shown to be effective as stand-alone and add-on treatments to routine practice. Interventions designed for a wide range of mental disorders such as transdiagnostic interventions are needed to make treatment for mental disorders more accessible and thus shorten waiting times and mitigate the chronification of mental health problems. In general, interventions can be differentiated as having either a capitalization (CAP) focus-thus drawing on already existing strengths-or a compensation (COMP) focus-trying to compensate for deficits. Up to now, the effectiveness of transdiagnostic web-based interventions with either a CAP or a COMP focus has not yet been evaluated.ObjectiveThis study is the first to examine the effectiveness of two transdiagnostic web-based interventions: (1) the activation of resilience and drawing on existing strengths (CAP: Res-Up!) and (2) the improvement of emotion regulation (COMP: REMOTION), compared with care as usual (CAU) in routine outpatient psychotherapy.MethodsAdults with at least 1 mental health disorder will be recruited at 4 outpatient centers in Germany. Participants will then be randomized equally into 1 of the 2 intervention groups Res-Up! (CAP) and REMOTION (COMP) or into the control group (CAU). Assessments will be made at baseline (T0), at 6 weeks after treatment start (T1), and at 12 weeks after treatment start (T2). A primary outcome will be symptom severity (Brief Symptom Inventory-18). Secondary outcomes will focus on emotion regulation and resilience.ResultsParticipant recruitment and data collection started in April 2020 and were ongoing as of July 2022. We expect participants to benefit more from the interventions than from the CAU control on the dimensions of symptom severity, resilience, and emotion regulation. Furthermore, we expect to find possible differences between CAP and COMP. The results of the study are expected in 2023.ConclusionsThis randomized controlled trial will compare CAU with the transdiagnostic web-based interventions Res-Up! and REMOTION, and will thus inform future studies concerning the effectiveness of transdiagnostic web-based interventions in routine outpatient psychotherapy.Trial registrationClinicalTrials.gov NCT04352010; https://clinicaltrials.gov/ct2/show/NCT04352010.International registered report identifier (irrid)DERR1-10.2196/41413.

Project description:BackgroundThe decision to use patient portals can be influenced by multiple factors, including individuals' perceptions of the tool, which are based on both their personal skills and experiences. Prior experience with one type of portal may make individuals more comfortable with using newer portal technologies. Experienced outpatient portal users in particular may have confidence in their ability to use inpatient portals that have similar functionality. In practice, the use of both outpatient and inpatient portal technologies can provide patients with continuity of access to their health information across care settings, but the influence of one type of portal use on the use of other portals has not been studied.ObjectiveThis study aims to understand how patients' use of an inpatient portal is influenced by outpatient portal use.MethodsThis study included patients from an academic medical center who were provided access to an inpatient portal during their hospital stays between 2016 and 2018 (N=1571). We analyzed inpatient portal log files to investigate how inpatient portal use varied by using 3 categories of outpatient portal users: prior users, new users, and nonusers.ResultsCompared with prior users (695/1571, 44.24%) of an outpatient portal, new users (214/1571, 13.62%) had higher use of a select set of inpatient portal functions (messaging function: incidence rate ratio [IRR] 1.33, 95% CI 1.06-1.67; function that provides access to the outpatient portal through the inpatient portal: IRR 1.34, 95% CI 1.13-1.58). Nonusers (662/1571, 42.14%), compared with prior users, had lower overall inpatient portal use (all active functions: IRR 0.68, 95% CI 0.60-0.78) and lower use of specific functions, which included the function to review vitals and laboratory results (IRR 0.51, 95% CI 0.36-0.73) and the function to access the outpatient portal (IRR 0.53, 95% CI 0.45-0.62). In comparison with prior users, nonusers also had lower odds of being comprehensive users (defined as using 8 or more unique portal functions; odds ratio [OR] 0.57, 95% CI 0.45-0.73) or composite users (defined as comprehensive users who initiated a 75th or greater percentile of portal sessions) of the inpatient portal (OR 0.42, 95% CI 0.29-0.60).ConclusionsPatients' use of an inpatient portal during their hospital stay appeared to be influenced by a combination of factors, including prior outpatient portal use. For new users, hospitalization itself, a major event that can motivate behavioral changes, may have influenced portal use. In contrast, nonusers might have lower self-efficacy in their ability to use technology to manage their health, contributing to their lower portal use. Understanding the relationship between the use of outpatient and inpatient portals can help direct targeted implementation strategies that encourage individuals to use these tools to better manage their health across care settings.

Project description:BackgroundDue to the hygiene measures during the coronavirus pandemic at the beginning of 2020, psychotherapy by personal attendance was no longer possible or only possible to a limited extent in many places in Germany. In its place, psychotherapy via video conference was used as an alternative option for treatment.ObjectiveThe present study was concerned with the question of the actual use of this form of psychotherapy during the lockdown.Material and methodsTherapists in the psychotherapeutic training outpatient department of the Medical School of Hanover were questioned on their experiences and the experiences of patients with the use of the video consultation during running guideline psychotherapy. Data from 338 patents could be collated. The data contained information, for example on acceptance or rejection of the offer of a video consultation, on the reasons for rejection and on technical problems by the execution.ResultsThe presented data show that 35% of patients could not be reached by the video consultation. Approximately half of the patients from this group could not use this form of therapy due to the lack of technical equipment. The other half did not want therapy using the video consultation, although the technical requirements were available. In the group of patients who used the video consultation, the session was interrupted due to technical disturbances in 31% of the cases. In a further 10% of the cases the disturbances even led to a premature termination of the session. The presented data make it clear that the use of therapy via video consultation significantly decreases with increasing age and reduced education level.ConclusionThe results of the present study show that a considerable proportion of the patients could not be reached by the offer, despite the dissemination of the video consultation; therefore, in the case of further lockdowns special offers for this group should be considered. The authors recommend that the health insurance companies provide support for patients who do not have the technical requirements at their disposal. Patients who do not want to participate in this form of treatment need therapeutically motivating support.

Project description:BackgroundThis study evaluated two models of routine HIV testing of hospitalized children in a high HIV-prevalence resource-constrained African setting. Both models incorporated "task shifting," or the allocation of tasks to the least-costly, capable health worker.Methods and findingsTwo models were piloted for three months each within the pediatric department of a referral hospital in Lilongwe, Malawi between January 1 and June 30, 2008. Model 1 utilized lay counselors for HIV testing instead of nurses and clinicians. Model 2 further shifted program flow and advocacy responsibilities from counselors to volunteer parents of HIV-infected children, called "patient escorts." A retrospective review of data from 6318 hospitalized children offered HIV testing between January-December 2008 was conducted. The pilot quarters of Model 1 and Model 2 were compared, with Model 2 selected to continue after the pilot period. There was a 2-fold increase in patients offered HIV testing with Model 2 compared with Model 1 (43.1% vs 19.9%, p<0.001). Furthermore, patients in Model 2 were younger (17.3 vs 26.7 months, p<0.001) and tested sooner after admission (1.77 vs 2.44 days, p<0.001). There were no differences in test acceptance or enrollment rates into HIV care, and the program trends continued 6 months after the pilot period. Overall, 10244 HIV antibody tests (4779 maternal; 5465 child) and 453 DNA-PCR tests were completed, with 97.8% accepting testing. 19.6% of all mothers (n = 1112) and 8.5% of all children (n = 525) were HIV-infected. Furthermore, 6.5% of children were HIV-exposed (n = 405). Cumulatively, 72.9% (n = 678) of eligible children were evaluated in the hospital by a HIV-trained clinician, and 68.3% (n = 387) successfully enrolled into outpatient HIV care.Conclusions/significanceThe strategy presented here, task shifting from lay counselors alone to lay counselors and patient escorts, greatly improved program outcomes while only marginally increasing operational costs. The wider implementation of this strategy could accelerate pediatric HIV care access in high-prevalence settings.

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Frequencies and Predictors of Negative Effects in Routine Inpatient and Outpatient Psychotherapy: Two Observational Studies.

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Frequencies and Predictors of Negative Effects in Routine Inpatient and Outpatient Psychotherapy: Two Observational Studies.

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