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Session Title: Quantifying the Evidence for Psychotherapy: The German Way to Quality Control
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Panel Session 459 to be held in Panzacola Section H2 on Friday, Nov 13, 9:15 AM to 10:45 AM
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Sponsored by the Quantitative Methods: Theory and Design TIG
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| Chair(s): |
| Lee Sechrest, University of Arizona, sechrest@u.arizona.edu
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| Discussant(s):
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| Fred L Newman, Florida International University, newmanf@fiu.edu
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| Abstract:
Psychotherapy in Germany either ambulatory or stationary was under the scrutiny of quality control. Our Mannheim research group was directly involved in delivering the evaluation plans and to report about the outcomes for three different large-scale projects. The first one was a meta-analysis of stationary psychotherapy for psychosomatic patients, the second a place randomized trial for evaluating a computerized feedback tool mapping the progress of individual patient financed by a health care insurance company and the third one a similar system sponsored by the Bavarian Association of Compulsory Health Insurance Physicians (KVB). The panel intends to demonstrate the quantitative methodological tools our group implemented in these different projects and what benefits result in applying them.
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Quality Assurance in Ambulatory Psychotherapy: Designs, Tools and First Results
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| Andrés Steffanowski, University of Mannheim, andres@steffanowski.de
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| Werner W Wittman, University of Mannheim, wittmann@tnt.psychologie.uni-mannheim.de
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Client and therapist document the therapy process using handheld computers by answering questions about symptom severity (e.g. depression, anxiety and stress), life satisfaction, therapeutic relationship and problem domains. The encrypted data is sent to the University of Mannheim via Internet, where the data is analyzed by specific software. The KVB provides the documentation software and handheld computers for a sample of 200 psychotherapists. Up to present, more than 1.500 patients participate in the prospective naturalistic study and more than 250 patients have completed their therapy so far. As from now the first 1-year-follow-up measures are done. For outcome evaluation, an overall index of outcome quality is computed, aggregating single pre-post-measures to a multiple outcome criterion. 77% of the 1.500 patients at intake are female; the age mean is 40 years (SD = 12). About 47% suffer from depressive disorders, followed by anxiety disorders (19%). Outcome results for short-term therapies completed so far (N=250), demonstrate impressive effect sizes (Cohen's d>1,0) on a multiple outcome criterion. Electronic documentation is well accepted by most of the participating therapists. The encrypted computer based documentation is a secure and comfortable approach to improve transparency for therapists and patients. It provides useful information for therapy process optimization and outcome documentation of therapy results.
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Monitoring Quality in Ambulatory Psychotherapy Using a Place Randomized Trial: The TK project
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| Manuel Voelkle, Max Planck Institute of Human Development, voelkle@mpib-berlin.mpg.de
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| Andrés Steffanowski, University of Mannheim, andres@steffanowski.de
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| Werner W Wittmann, University of Mannheim, wittmann@tnt.psychologie.uni-mannheim.de
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Design and goals of this project had already been presented at AEA 2008 Denver.
This time we will give more details and information about the first results and the consequences one has to consider given that the intraclass coefficients have substantially changed from the beginning to the end of therapy. It seems that the psychotherapy not only lead to mean changes in outcome assessments, but also to higher similarities of patient derived data within a psychotherapy unit. Whether this phenomenon is an artifact or a positive therapy result, i.e. that the patients take over parts of the worldview of the therapist will be discussed.
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Meta-analysis of Stationary Psychotherapy (MESTA) for Psychosomatic Patients: How to Fool Yourself in Not Considering Opportunity Costs
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| Werner W Wittmann, University of Mannheim, wittmann@tnt.psychologie.uni-mannheim.de
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| Andrés Steffanowski, University of Mannheim, andres@steffanowski.de
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This meta-analysis encompassed 65 different studies where over 25000 patients had been treated in the German rehabilitation system. The effect sizes were computed immediately after the end of the treatment and also one year after. The effect sizes varied between different diagnosis groups. Patients with a primary diagnosis of depression had the largest effect sizes (Cohen d=. 76 one year after). The studies were done in the last 30 years. After financial problems in the health system the dosage in terms of numbers of days treated was substantially reduced. The dosage level turned out to be the most important moderator of the effect sizes, lower dosage leading to lower effects. I can be demonstrated that the smaller effect sizes lead to substantial opportunity costs. The money saved via reduction of treatment dosage was substantially smaller than the money lost due to smaller effects. Without the evidence given by this meta-analysis the opportunity costs would not have become visible.
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