Predictors of dropout and outcome in cognitive therapy for depression in a private practice setting

The efficacy of cognitive therapy was examined for 70 depressed private practice patients. Although these patients had a broader range of psychopathology than patients in controlled outcome studies of cognitive therapy, they had comparably large reductions in Beck Depression Inventory (BDI) scores. Patients who completed treatment had an average reduction in BDI scores of 65.5%. Initial BDI scores, endogenous symptoms, compliance with homework, and the interaction between homework and initial BDI scores were statistically significant predictors of end-of-treatment BDI scores. The squared correlation between the observed end-of-treatment BDI scores and the estimated expected value was .81. Controlling for other factors, patients who did homework improved three times as much as those who did not. The effect of homework was substantially larger for patients with high initial BDI scores; thus, studies that include only patients with high initial BDI scores may overstate the importance of homework on a general population. In spite of significant improvement, 50% of patients terminated treatment prematurely, premature termination was most likely in patients with personality disorders, high initial BDI scores, and no endogeneous symptoms.We thank our patients for their contributions. Manuel Barrera, Jeanne Miranda, Ricardo Muñoz, and George Murphy made helpful comments on an earlier draft. This paper was presented at the meetings of the Society for Psychotherapy Research, Evanston, Illinois, June 20, 1985.     

Does learned resourcefulness predict the response to cognitive behavioral therapy for depression?

We attempted to replicate findings that depressed patients with high learned resourcefulness, as measured by the Self-Control Schedule (SCS), respond better to cognitive behavioral therapy (CBT) in a pooled sample of 112 depressed patients, including 53 patients participating in a controlled research investigation and 59 private practice patients participating in a naturalistic research study. As predicted, patients with high learned resourcefulness at intake improved the most during the first 12 weeks of treatment in the combined sample. However, the size of the effect was quite small and did not emerge when the two groups were analyzed separately. The relationship between learned resourcefulness and recovery was moderated by the severity of initial depression: SCS scores predicted improvement only among subjects who were more severely depressed at intake. These results may help to explain previous inconsistencies in reports regarding the ability of the SCS to predict the degree of response to CBT for depression.     

A comparison of hospital-based and private outpatient physical therapy practices

A paucity of data exists about the delivery of contemporary adult outpatient physical therapy services in the United States. Although many debates about this issue have taken place within the physical therapy profession, assumptions about practice patterns have generally not been studied. This article reports some of the first-year findings from a 3-year survey research effort begun in September 1988 by Mathematica Policy Research Inc for the American Physical Therapy Association. Analyses are based on survey data from national probability samples of physical therapy facilities and discharged patients from 155 hospital-based and 166 private outpatient practices. The primary goal was to compare outpatient physical therapy practice patterns in the hospital-based and private practice settings. Findings reveal considerable homogeneity in private and hospital-based outpatient physical therapy practices. Hospital-based and private practices serve predominantly young, white adults who have private health insurance and a prevalence of orthopedic impairments. In both settings, direct access to outpatient physical therapy services was the exception and not the rule. Even in states in which direct access without a physician's referral was permitted by law, the majority of outpatient physical therapy was provided with a physician's referral. Most respondents in direct-access states indicated that reimbursement requirements were the major reason for needing a physician's referral to provide outpatient physical therapy.     

Research Setting Versus Clinic Setting: Which Produces Better Outcomes in Cognitive Therapy for Depression?

To compare the outcomes of cognitive therapy for depression under controlled and clinically representative conditions, while holding several therapist and clinical assessment factors constant. Treatment outcomes for a sample of 23 adults with a primary diagnosis of Major Depressive Disorder who received cognitive therapy in an outpatient clinic were compared with outcomes of 18 clients who were treated in the cognitive therapy condition of a large, multi-site randomized clinical trial of treatments for depression. All participants had been treated by one of two therapists who served as clinicians in both settings. Individuals in the two samples were diagnostically and demographically similar (approximately 50 % Female, 83 % White). A variety of client characteristics, assessed prior to treatment, as well as the outcomes of treatment, were examined. Significantly superior treatment outcomes were observed in the individuals treated in the research study, relative to clients in the outpatient clinic, and the difference was not accounted for by intake characteristics. Individuals treated by the therapists in the RCT experienced almost three times as much improvement in depressive symptoms as clients seen in the outpatient setting. If replicated, the findings suggest that differences exist between treatment outcomes in research and outpatient settings and that these differences may not simply be due to therapist experience and training, or differences in patient populations. Future research should further examine the impact of fidelity monitoring, treatment expectation and motivation, and the duration and timing of treatment protocols on clinical outcomes.     

Treatment intensity in everyday clinical management of speech sound disorders in Hong Kong

Abstract

Much evidence supports the efficacy of different treatment approaches for speech sound disorders (SSD) in children. Minimal research in the field has been conducted using treatment intensity as a research variable. This study examined the current practice of speech-language pathologists (SLPs) in Hong Kong regarding the treatment intensity prescribed to children with SSD and potential factors that were associated with the intensity. Participants were 102 SLPs working in different settings in Hong Kong who completed an online questionnaire. SLPs who had a heavier caseload offered significantly less frequent and shorter treatment duration to clients with SSD. Public and private settings differed significantly in treatment duration. Treatment approaches and clinicians’ consideration about a client's conditions did not affect treatment intensity. SLPs in Hong Kong do not plan treatment duration and frequency in an evidence-based direction because of their heavy workloads and the dearth of research evidence on treatment intensity to guide their clinical practice.     

Treatment intensity in everyday clinical management of speech sound disorders in Hong Kong

Abstract Much evidence supports the efficacy of different treatment approaches for speech sound disorders (SSD) in children. Minimal research in the field has been conducted using treatment intensity as a research variable. This study examined the current practice of speech-language pathologists (SLPs) in Hong Kong regarding the treatment intensity prescribed to children with SSD and potential factors that were associated with the intensity. Participants were 102 SLPs working in different settings in Hong Kong who completed an online questionnaire. SLPs who had a heavier caseload offered significantly less frequent and shorter treatment duration to clients with SSD. Public and private settings differed significantly in treatment duration. Treatment approaches and clinicians' consideration about a client's conditions did not affect treatment intensity. SLPs in Hong Kong do not plan treatment duration and frequency in an evidence-based direction because of their heavy workloads and the dearth of research evidence on treatment intensity to guide their clinical practice.     

The Hopelessness Theory of Depression: Clinical Utility and Generalizability

To date, “basic” research has dominated the empirical literature on hopelessness theory. The next logical step in this area of research is to determine if the theory can be used to help people. We conducted three studies to determine if the cognitive vulnerability factor featured in hopelessness theory could be reliably measured in diverse samples in a treatment context and if it could predict depressive therapeutic outcomes. Study 1 used a sample of male juvenile detainees (n?=?296; 70% from underrepresented groups) and found that cognitive vulnerability moderated the effectiveness of a social problem solving training intervention. Study 2 used a clinical sample of U.S. Veterans (n?=?16; 56% from underrepresented groups) enrolled in a cognitive behavioral therapy group for depression and found that cognitive vulnerability predicted post-therapy depressive outcomes. In both Study 1 and Study 2, higher levels of cognitive vulnerability resulted in poorer treatment outcomes (i.e., greater post-treatment levels of depressive symptoms). Study 3 used a clinical sample of U.S. Veterans (n?=?76; 67% from underrepresented groups) enrolled in a behavior activation group and found no effect of cognitive vulnerability on post-therapy depressive outcomes. The results of the three studies indicate that hopelessness theory’s cognitive vulnerability construct can be reliably measured in diverse samples in real world clinical contexts and that it has the potential to be a useful predictor of clinical outcomes in the context of cognitively focused treatments.     

The Beck Depression Inventory II and the Beck Anxiety Inventory in People with Intellectual Disabilities: Factor Analyses and Group Data

Background There have been several developments in research on emotional disorders in people with intellectual disability (ID). Although a large amount of work has been completed in mainstream clinical fields on the Beck Anxiety Inventory (BAI) and the Beck Depression Inventory– 2^nd Edition (BDI‐II), to date there has been little work completed on people with ID. Design This paper presents several analyses that provide information on the psychometric properties of the BAI and the BDI‐II. Data on subsamples of the total cohort are also presented. Method Both assessments were appropriately revised for use with persons with ID and individually administered. A sample of 108 participants from inpatient and community settings completed the assessments. In supplementary analyses, several subsamples of anxiety referrals, depression referrals, sex offenders, other types of offenders, men and women are also presented. Results The joint factor analyses of the BAI and BDI‐II revealed a two factor solution corresponding closely to a depression and anxiety factor. Results from further factor analyses independently demonstrated that the BAI had three factors corresponding to cognitive–subjective anxiety, somatic temperature and somatic balance symptoms. The BDI‐II exhibited a three factor structure: cognitive self, cognitive‐affective/loss of functioning and somatic symptoms. In the supplementary analyses anxiety referrals had significantly higher scores on the BAI, depression referrals higher scores on the BDI, sex offenders are significantly lower scores on both the BAI and BDI than other groups. Conclusion The factor structure of the BAI and BDI conforms specifically to those found in research with the general population. Result suggests that both assessments can be used reliably with individuals who have ID.     

重症抑郁症病人认知功能与焦虑的关系

目的 :探讨重症抑郁症病人的认知功能性失调与焦虑障碍的关系。方法 :对24例伴有严重焦虑障碍和21例不伴有严重焦虑障碍的重症抑郁症病人在入院治疗前及常规药物治疗后 ,分别同时应用功能失调状况评定量表“DAS”、HAMD抑郁量表及Beck抑郁自评量表“BDI”进行测评与对照研究。结果 :常规药物治疗后两组患者抑郁症状严重程度(HAMD总分)明显减轻或消失 ,疗效显著(P<0.01)。但是认知功能改善存在较大差异。不伴焦虑的抑郁症在药物治疗后其认知障碍的严重程度随着抑郁症状的减少也明显减轻 ,而伴有焦虑的抑郁症病人在药物治疗后 ,尽管抑郁症状已明显减少或消失 ,但其认知障碍依然存在。结论 :伴有焦虑的抑郁症病人 ,认知障碍更突出、顽固。因而在治疗过程中 ,必须将药物和认知行为治疗相结合 ,这样才能获得长期的疗效并能预防复发。     

Evaluation of a knowledge translation initiative for physical therapists treating patients with work disability

Purpose. We evaluated a knowledge translation and exchange (KTE) initiative aimed at providing physical therapists with best practice information regarding work disability prevention.

Method. The KTE initiative involved dissemination of a best practice resource guide for work disability prevention, creation of a network of peer-selected educationally influential clinicians, province-wide seminars for practicing clinicians, and use of the resources in an academic training curriculum. Evaluation included email surveys of clinician practice patterns and exposure to the KTE initiative. We also evaluated the impact of the KTE on community physical therapy workers' compensation outcomes.

Results. 241 and 164 clinicians responded to the baseline and follow-up email surveys, respectively. Clinicians reported a wide range of years in practice (0–30+ years) and practice settings although the majority worked in private clinics (～61%). Approximately 80% of the follow-up sample reported some exposure to the KTE initiative. Few differences were observed in reported practice patterns between survey periods. Compensation outcomes improved slightly after KTE (68 versus 70% off benefits) however, this effect was confounded by proportion of claimants with sprain/strain injury.

Conclusions. Implementation of a KTE initiative appears to have had little impact on the clinical practice or outcomes. Future interventions for rehabilitation professionals should consider the organisational culture of the settings in which they practice, which may be a barrier or facilitator of research uptake.