Evaluating reporting and abstracts of clinical trials.
Explore the source record for details and available documents.
Abstracting and Indexing↗
Biomedical subjects
P Crits-Christoph
Publications and source records attributed to P Crits-Christoph.
Predictors of dropout from psychosocial treatment of cocaine dependence.
The current study assessed demographic, drug and psychiatric predictors of dropout in the pilot/training phase of a large, multi-site psychotherapy outcome study for patients with cocaine dependence. The different predictors of dropout were assessed throughout the phases of the study: screening, intake, stabilization and assessment phase, and following randomization to treatment. Results showed that (1) younger patients were less likely to keep their intake appointment. (2) Of the patients who had an intake visit, those who did not complete high school and with more days of cocaine use in the previous month were less likely to complete an initial stabilization and assessment phase requiring 1 week of abstinence from all drugs. A survival analysis was used to examine time to dropout for the 286 patients randomized to individual treatment. (3) Again, younger age was associated with dropout after randomization. (4) Drug use variables did not predict time to dropout. (5) Presence of any current Axis I disorder was associated with later dropout from treatment. Minority treatment information seekers and treatment initiators were less likely to go on to complete the full treatment program.
Adult↗
Empirically supported individual and group psychological treatments for adult mental disorders.
The experimental literature on individual and group psychological treatments for adult disorders is reviewed. For each of the 11 disorders or problems covered, treatments that fall into the following categories, as defined by D.L. Chambless and S. D. Hollon (1998), are identified: efficacious and specific, efficacious, and possibly efficacious. Behavioral and cognitive-behavioral treatments dominate the lists, especially in the anxiety disorders, with notable exceptions. Reasons for the hegemony of the behavioral and cognitive modalities are discussed, and some limitations of the empirically supported treatment concept are addressed. Continued research is recommended on Aptitude x Treatment interactions, cost-benefit ratios, and generalization of treatments to a variety of patient populations, therapists, and treatment settings.
Adult↗
Training in cognitive, supportive-expressive, and drug counseling therapies for cocaine dependence.
This study assessed the effects of training on the performance of 65 therapists in delivering manual-guided therapies to 202 cocaine-dependent patients. Changes in ratings of therapists' adherence and competence was assessed in 3 treatment modalities: supportive-expressive dynamic therapy (SE), cognitive therapy (CT), and individual drug counseling. Effects of manual-guided training on the therapeutic alliance were also assessed. Training effects were examined through a hierarchical linear modeling approach that examined changes both within cases and across training cases. A large effect across cases was detected for training in CT. Supportive-expressive therapists and individual drug counselors demonstrated statistically significant learning trends over sessions but not over training cases. Training in SE and CT did not have a negative impact on the therapeutic alliance, although alliance scores for trainees in drug counseling initially decreased but then rebounded to initial levels.
Adult↗
Cocaine dependence with and without PTSD among subjects in the National Institute on Drug Abuse Collaborative Cocaine Treatment Study.
OBJECTIVE: This study examined the prevalence of lifetime traumatic events and current symptoms of posttraumatic stress disorder (PTSD) among treatment-seeking cocaine-dependent outpatients and compared patients with and without PTSD on current substance use, psychopathology, and sociodemographic characteristics. METHOD: The subjects were 122 adult cocaine-dependent outpatients participating in a treatment outcome study of psychosocial therapy. In addition to standard self-report and interview measures of psychopathology and substance use, the subjects completed the Trauma History Questionnaire and the PTSD Checklist before entering treatment. RESULTS: These patients experienced a large number of lifetime traumatic events (mean = 5.7); men experienced more general disasters and crime-related traumas than women, and women experienced more physical and sexual abuse than men. According to self-report measures, 20.5% of the subjects currently met the DSM-III-R criteria for PTSD; the rate of PTSD was 30.2% among women and 15.2% among men. Patients with PTSD had significantly higher rates of co-occurring axis I and axis II disorders, interpersonal problems, medical problems, resistance to treatment, and psychopathology symptoms than patients without PTSD. Psychopathology symptoms represented the most consistent difference between the two groups and provided the best prediction of PTSD status in a logistic regression. However, the groups did not differ significantly in current substance use or sociodemographic characteristics. CONCLUSIONS: These findings underscore the value of screening substance abusers for PTSD, because it can identify a small but substantial number who might require additional treatment. Further studies of the relationship between PTSD and substance abuse appear warranted.
Adult↗
Therapist interventions in early sessions of brief supportive-expressive psychotherapy for depression.
Although psychotherapy manuals provide treatment guidelines, detailed descriptions of therapist interventions in manual-guided therapies are lacking. The purpose of the present investigation was to evaluate the types of therapist interventions in Supportive-Expressive (SE) psychotherapy for depression by using a molecular method of assessment and then to compare the results with those attained with a molar method. Four percent of therapist statements per session early in treatment were interpretations, which most often focused on the patient's parents, significant others, and self in the present time frame. This molecular method for assessing therapist interventions did converge with the molar adherence/competence method.
Adult↗
The National Institute on Drug Abuse Collaborative Cocaine Treatment Study. Rationale and methods.
The National Institute on Drug Abuse Collaborative Cocaine Treatment Study is a large, multisite psychotherapy clinical trial for outpatients who meet the DSM-IV criteria for cocaine dependence. For 480 randomized patients, the outcomes of 4 treatments are compared for an 18-month period. All treatments include group drug counseling. One treatment also adds cognitive therapy, one adds supportive-expressive psychodynamic therapy, and one adds individual drug counseling; one consists of group drug counseling alone. In addition, 2 specific interaction hypotheses, one involving psychiatric severity and the other involving degree of antisocial personality characteristics, are being tested. This article describes the main aims of the project, the background and rationale for the study design, the rationale for the choice of treatments and patient population, and a brief description of the research plan.
Ambulatory Care↗
Evidence that therapy works in clinically representative conditions.
This article reports a secondary analysis of past therapy outcome meta-analysis. Fifteen meta-analysis provided effect sizes from 56 studies in previous reviews that met 1 of 3 increasingly stringent levels of criteria for clinical representativeness. The effect sizes were synthesized and compared with results from the original meta-analyses. Effect sizes from more clinically representative studies are the same size at all 3 criteria levels as in past meta-analyses. Almost no studies exist that meet the most stringent level of criteria. Results are interpreted cautiously because of controversy about what criteria best capture the notion of clinical representativeness, because so few experiments have tested therapy in clinical conditions, and because other models for exploring the generalizability of therapy outcome research to clinical conditions might yield different results.
Humans↗
The role of psychotherapy in the treatment of depression: review of two practice guidelines.
We review two recent practice guidelines' assessments of the role of psychotherapy in the treatment of major depression in adults. We examine the practice guideline published by the American Psychiatric Association (APA) and that published by the Depression Guideline Panel of the Agency for Health Care Policy and Research. We focus on the guidelines' evaluations of psychotherapies, their statements about the role of psychotherapy in first-line treatment of depression, and the procedures they recommend for choosing among psychotherapies. We argue that the APA guideline understates the value of cognitive, behavioral, brief psychodynamic, and group therapies. Both guidelines understate the value of psychotherapy alone in the treatment of more severely depressed outpatients. The APA guideline overvalues the role of combined psychotherapy-pharmacotherapy regimens, particularly in view of the greater cost of this strategy. The APA guideline also makes recommendations about choosing among psychotherapies that are not well supported by empirical evidence. We conclude with some guidelines for guideline development.
Adult↗
Psychosocial treatment for drug abuse. Selected review and recommendations for national health care.
Substance abuse and dependence remains an important public health concern because of health-related and other costs to our society. We review selected articles that address questions about the psychosocial treatment of substance abuse disorders; these articles could aid in setting the parameters of a national health care insurance. Data from major program evaluation studies of existing substance abuse treatment programs are presented, followed by reviews of controlled studies of opiate, cocaine, and marijuana abuse and dependence; particular attention is given to studies that have standardized treatment through the use of treatment manuals. Articles about the treatment of substance abuse in adolescents are also reviewed. The existing data suggest that substance abuse treatment should be intensive and should probably involve multiple modalities targeted to various problems encountered in patients with substance use disorders, including comorbid psychiatric problems. However, only a few well-controlled studies have been performed to date; therefore, substantial research is needed before a system truly informed by research can be designed. Suggestions for future research directions are provided.
Adolescent↗
Effects of therapist adherence and competence on patient outcome in brief dynamic therapy.
The authors examined the relation between therapist process variables (adherence and competence) and subsequent symptomatic change in patients. Twenty-nine depressed patients were seen in 16 sessions of weekly supportive expressive (SE) dynamic psychotherapy. Change in depression from intake to Session 3 predicted higher ratings of adherence to expressive (interpretative) techniques during Session 3 but not their competent delivery. Partialling pretreatment psychiatric severity, therapists' adherence to use of expressive techniques, and previous symptomatic improvement, relatively competent delivery of SE-specific expressive techniques predicted subsequent improvement in depression. Secondary analyses addressing alternative explanations (such as the role of either therapeutic alliance or general therapeutic skills) did not change the results.
Depressive Disorder↗
Varieties of transference patterns in psychotherapy.
This investigation explored the nature of transference of interpersonal patterns in patients' psychotherapy narratives. The relation between interpersonal patterns with significant others in a patient's life and the pattern with the therapist early in treatment was examined. Cluster analysis was used to categorize similar relationships for each of 35 patients. Many patients revealed multiple interpersonal themes in their relationship narratives. Furthermore, these interpersonal themes correlated significantly with the interpersonal pattern extracted from narratives told about the therapist for many of the patients who discussed the therapeutic relationship during therapy. However, the interpersonal pattern evident in the relationship with the therapist was not necessarily the most pervasive pattern exhibited in the narratives about significant others.
Humans↗
A comparison of core conflictual relationship themes before psychotherapy and during early sessions.
This report shows (a) that the Core Conflictual Relationship Theme (CCRT) can be rated reliably either from therapy sessions or from a special pretreatment interview in a group of depressed patients, and (b) that the CCRTs obtained before treatment are similar to the CCRTs extracted from the early sessions of brief dynamic psychotherapy. The data suggest that, at least in the early sessions of treatment, the therapist's influence did not significantly alter the patients' CCRTs.
Adult↗
Consistency of interpersonal themes for patients in psychotherapy.
In this study the extent to which patients in psychotherapy display similar interpersonal themes across multiple narratives of their interactions with others was investigated. Interpersonal themes were measured using a new instrument entitled the Quantitative Assessment of Interpersonal Themes (QUAINT) method, which assesses the wishes, responses from others, and responses of self that occur in narratives about interactions with others. For 60 patients in psychotherapy, evidence for repetitiveness of themes was found; the effect was relatively small but was highly statistically significant. Individual differences in the degree of repetitiveness of themes were not related to type of treatment (dynamic vs. cognitive), but they were related to length of time in treatment. The limitations of the study are reviewed and future research directions are outlined.
Adolescent↗
Advances in measures of psychodynamic formulations.
Recently published methods are reviewed to assess dynamic formulations derived from psychodynamic case material, especially those methods that emphasize central maladaptive interpersonal patterns. These methods are divided into those that yield psychometric data based on samples that are at least of moderate size and those in which the measures are derived from case studies. The psychometric properties of the first group of measures are reviewed, including interjudge reliability, internal consistency, and content, predictive, and concurrent validity. This article then examines how the measures have addressed and could address the question of construct validity. Also discussed are issues involving the comparison of the methods, particularly their importance for examining specific hypotheses in psychodynamic psychotherapy. Concrete suggestions are made for future research.
Conflict, Psychological↗
Therapist techniques used during the cognitive therapy of opiate-dependent patients.
A review of current substance abuse literature indicates that although clinicians espouse cognitive and behavioral methods in the treatment of drug-dependent patients, little is known about the process of cognitive-behavioral therapy with these individuals. Our objective is to examine the specific techniques used by manual-guided cognitive-behavioral therapists during the treatment of opiate-dependent patients. Ratings of audiotaped sessions using the Collaborative Study Psychotherapy Rating Scale indicate that the cognitive-behavioral therapists did not rely on behavioral methods early in treatment as predicted by both theory and the clinical literature. Cognitive techniques and techniques oriented toward establishing a collaborative structure predominated and increased from early- to late-in-treatment sessions. We discuss the implications of the results in terms of treatment manual revisions and directions for future research.
Adolescent↗
The first empirical demonstration of transference in psychotherapy.
This study investigates the similarity between patients' relationships with their therapists and patients' relationships with others in their life. We examined the in-session narratives about the therapist and compared them with the patient's general relationship pattern as determined by a previously tested method, the Core Conflictual Relationship Theme (CCRT) method. The source for both narratives and CCRT patterns were transcripts of therapy sessions from 35 consenting outpatients in a university clinic. We found significant similarity between the patterns of relationship with the therapist and with others. One aspect of the relationship pattern, the patient's response to the therapist and to others, was consistently similar. We offer objective evidence in support of an age-old and central tenet of psychodynamic therapy, the transference concept.
Ambulatory Care↗