RICERCA EFFICIENTE E SOSTENIBILE SULL'EFFICACIA DELLE PSICOTERAPIE PSICODINAMICHE: L'ESPERIENZA DELL'ANALISI TRANSAZIONALE - Enrico Benelli
←
→
Page content transcription
If your browser does not render page correctly, please read the page content below
RICERCA EFFICIENTE E SOSTENIBILE SULL’EFFICACIA
DELLE PSICOTERAPIE PSICODINAMICHE:
L’ESPERIENZA DELL’ANALISI TRANSAZIONALE
Enrico Benelli
FISPPA
Dipartimento di Filosofia,
Sociologia, Pedagogia e
Psicologia ApplicataL’analisi transazionale nella
comunità scientifica della ricerca
in psicoterapia
FISPPA
Dipartimento di Filosofia,
Sociologia, Pedagogia e
Psicologia ApplicataAnalisi Transazionale • Modello diffuso in tutto il mondo • Piu di 7,000 clinici associati in Europa • Ha ispirato diversi modelli di psicoterapia empiricamente supportati (senza essere citata, e.g. Schema therapy) • Supportata da una ampia letteratura clinica (TAJ, IJTARP) • Non ancora pienamente riconosciuta come Empirically Supported Treatment per i Common Mental Disorders (e.g. Depression, Anxiety)
Scientific evidence base for transactional analysis
in the year 2010
© 2010 Thomas Ohlsson
Abstract that the studies likely were conducted and/or approved
by trained PhD level researchers, that TA was a major
The International Journal of Transactional Analysis research focus, and that the studies were published. It wasOhlsson, 2010
• Khalil (2007) conduce una review sull’efficacia dell’AT e identifica 97
studi.
• Khalil, E., Callaghan, P., James, N. (2007). Transactional analysis: A scoping
exercise for evidence of outcome. Report prepared for the Berne Institute. The
University of Nottingham, School of Nursing.
• Khalil (p. 20) concluse che per la psicoterapia AT “the evidence-base
remains scant and of relatively poor quality”Come è percepita l’AT nella comunità
scientifica della ricerca in psicoterapia?
Professional Psychology: Research and Practice © 2013 American Psychological Association
2013, Vol. 44, No. 5, 363–370 0735-7028/13/$12.00 DOI: 10.1037/a0034633
Psychotherapy in 2022: A Delphi Poll on Its Future
John C. Norcross and Rory A. Pfund James O. Prochaska
University of Scranton University of Rhode Island
Repeating and expanding Delphi polls conducted during the past 30 years, the authors empaneled 70
psychotherapy experts to forecast psychotherapy trends in the next decade. Mindfulness, cognitive–
behavioral, integrative, and multicultural theories were predicted to increase the most, whereas Jungian
therapy, classical psychoanalysis, and transactional analysis were expected to decline the most. Tech-
nological, self-change, skill-building, and relationship-fostering interventions were judged to be in the
ascendancy. Internet programs, telephone therapy, and master’s-level professionals were expected to
flourish. Forecast scenarios with the highest likelihood centered on expansion of telepsychology,
evidence-based practice, pharmacotherapy, and masters-degree practitioners flooding the job market.
Four themes seem to be driving these changes: technology, economy, evidence, and ideas.
Keywords: psychotherapy, future of psychology, Delphi poll, psychologists, theoretical orientations,Figure 1. Predicted changes in theoretical orientations in rank order. 1 ! great decrease, 4 ! remain the same, 7 ! great increase. EMDR ! eye movement desensitization and reprocessing.
Council conclusions on 'The European Pact for Mental Health
and Well-being: results and future action'
• EU Council (6 giugno 2011) 3095th EMPLOYMENT, SOCIAL POLICY, HEALTH
and CONSUMER AFFAIRS
• Council conclusions on “The European Pact for Mental Health and Well-
being: results and future action”.
• Retrieved from http://www.consilium.europa.eu/uedocs/cms_data/docs/
pressdata/en/lsa/122389.pdf
• Articolo 22: “...to identify evidence based best policy approaches and
practices and analyse activities in particular in the following areas:
• Tackling mental disorders through health and social systems;
• Taking evidence based measures against depression;Come è riconosciuta l’AT nei SSN europei? • Svezia: esclusa dalla lista dei trattamenti riconosciuti negli anni 90 • Gran Bretagna: non contemplata dalle NICE Guidelines per la depressione • Germania: non ha ottenuto per la seconda volta il riconoscimento ministeriale • Svizzera: il paradigma non è stato riconosciuto e le scuole di AT sono state chiuse nel 2018 • Spagna: nel 2019 è stata equiparata alle pseudoscienze come l’omeopatia ed è stata avviata una procedura di valutazione delle prove di efficacia
Livelli di evidenza richiesti dal SSN svizzero:
Leichsenring & Rueger Criteria
Level of Question 1: Efficacy studies Question 2: Effectiveness studies
evidence (laboratory, experimental) (fields, observational)
Level 1 1. Prospective studies of a 1. Naturalistic, quasi-experimental prospective studies;
randomized-controlled type; 2. non-randomized control group (e.g., matching,
2. Randomized control group; stratification);
3. Blind rating; clear inclusion 3. Blind rating; clear inclusion and exclusion criteria; Current
and exclusion criteria; diagnostic methods;
Current diagnostic methods; 4. adequate sample size with respect to the test reliability;
4. adequate sample size with 5. statistical methods clearly described;
respect to the test 6. Guarantee of internal validity (e.g., additional design
reliability; elements, prediction of complex patterns at the results
5. statistical methods clearly level);
described 7. Clinically representative and defined treatments;
8. Patient with defined disorders
Level 2 Clinical studies missing some Clinical studies miss a control group but meet the essential
level 1 characteristics (e.g., criteria of Level 1 studies
without double blinding or
without randomization)(Leichsenring & Rueger, 2004)
Level of Question 1: Efficacy studies Question 2: Effectiveness
evidence
Level 3 Open pilot study or case control Clinical studies missing several characteristics of the level 1
studies in which the outcome (e.g., without: pre-inquiry, comparison group, blind rating)
was collected after the
treatment
Level 4 Reviews with secondary data Reviews with secondary data analysis
analysis
Level 5 Reviews without secondary data Reviews without secondary data analysis
analysis
Level 6 Case studies, essays, opinion Case studies, essays, opinion articles
articlesEmpirically Supported Treatment:
come essere riconosciuti
FISPPA
Dipartimento di Filosofia,
Sociologia, Pedagogia e
Psicologia ApplicataCosa significa “empirical support”?
To become an EST we need...
“only when a treatment has been found efficacious in at least two
studies by two independent research teams do we consider its
efficacy to have been established and label it an efficacious
treatment.
If there is only one study supporting a treatment's efficacy, or if all
of the research has been conducted by one team, we consider the
findings promising but would label such treatments as possibly
efficacious, pending replication. “
(Chambless & Hollon, 1998, p8)
FISPPA
Dipartimento di Filosofia,
Sociologia, Pedagogia e
Psicologia ApplicataDiventare EST: solo RCT?
“efficacy is best demonstrated in randomized clinical trials (RCTs),
group designs in which patients are randomly assigned to the
treatment of interest or one or more comparison conditions...
...or carefully controlled single case experiments (i.e., SCED) and their
group analogues (i.e., multiple baseline series across patients)”
FISPPA Clinica e Ricerca nelle
Dipartimento di Filosofia, Associazione Italiana Psicoterapie
Sociologia, Pedagogia e Analisi Transazionale Psicodinamiche
Psicologia Applicata Padova, 5 Maggio 2018Diventare EST con la ricerca single case
“We consider a treatment to be possibly efficacious if it has proved
beneficial to at least three participants in research by one group.
Multiple replications (at least three each) by two (then three) or more
independent research groups are required before we consider a
treatment's efficacy as established (each in the absence of conflicting
data).”
FISPPA Clinica e Ricerca nelle
Dipartimento di Filosofia, Associazione Italiana Psicoterapie
Sociologia, Pedagogia e Analisi Transazionale Psicodinamiche
Psicologia Applicata Padova, 5 Maggio 2018Chambless and Hollon criteria per diventare
Empirically Supported Treatment
Between groups design Within subject design
RCT - Randomized SCED - Single Case
Clinical Trials Experimental Design
Efficacious 2 RCTs conducted by 6(9) SCEDs by
2 research groups 2(3) research groups
(3 each)
Probably efficacious 1 RCT or 3 or more SCEDs
more RCTs conducted by conducted by 1 group
1 research groupPsychological Bulletin Copyright 2004 by the American Psychological Association
2004, Vol. 130, No. 4, 631– 663 0033-2909/04/$12.00 DOI: 10.1037/0033-2909.130.4.631
The Empirical Status of Empirically Supported Psychotherapies:
Assumptions, Findings, and Reporting in Controlled Clinical Trials
Drew Westen Catherine M. Novotny
Emory University Veterans Affairs Medical Center, San Francisco, California
Heather Thompson-Brenner
Boston University
This article provides a critical review of the assumptions and findings of studies used to establish
psychotherapies as empirically supported. The attempt to identify empirically supported therapies (ESTs)
imposes particular assumptions on the use of randomized controlled trial (RCT) methodology that appear
to be valid for some disorders and treatments (notably exposure-based treatments of specific anxiety
symptoms) but substantially violated for others. Meta-analytic studies support a more nuanced view of
treatment efficacy than implied by a dichotomous judgment of supported versus unsupported. The
authors recommend changes in reporting practices to maximize the clinical utility of RCTs, describe
alternative methodologies that may be useful when the assumptions underlying EST methodology areRCT e validità interna • I trattamenti sono disegnati per un singolo disturbo • I pazienti sono selezionati per massimizzare l’omogeneità della diagnosi (no comorbidità) • I trattamenti sono manualizzati e di breve e/o fissa durata durata per minimizzare la varianza • La valutazione dell’esito è basata sulla riduzione del sintomo
Assunzioni sottostanti gli RCT • La psicopatologia è altamente malleabile • I pazienti possono essere trattati per un singolo sintomo • I disturbi psichiatrici possono essere trattati in modo indipendente dalla personalità • Il metodo sperimentale è il miglior standard per identificare le psicoterapie utili
Single Case Experimental Design (SCED) • Multiple baseline (69%) • Alternating/simultaneous design (6%) – Across behaviours, settings or patients – Two or more treatments – Concurrent and nonconcurrent • Changing criterion (4%) • Reversal design (17%) – Stepwise change and criterion shift – ABAB phases • Mixed Design (10%)
SCED – reversal design
• Withdrawal is not applicable in psychotherapy
• Phase A: No treatment - Baseline
• Phase B: Treatment
• Phase A: No treatment - Follow up
ABA design
12
10
8
SCORE
6 Clinical cut off
4 patient A
2
0
pre 1 pre 2 pre 3 session session session session session session session session session session Follow Follow Follow
1 2 3 4 5 6 7 8 9 10 up 1 up 2 up 3SCED: multiple baseline across patients
Multiple concurrent Baseline
10
9
8
7
6
Clinical cut off
SCORE
5
patient lag 3
4 patient lag 6
3 patient lag 9
2
1
0
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16
WeeksSCED: multiple baseline across patients
Multiple nonconcurrent Baseline
10
9
8
7
6
Clinical cut off
SCORE
5
patient lag 3
4 patient lag 6
3 patient lag 9
2
1
0
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22
WeeksDagli SCED agli HSCED
FISPPA
Dipartimento di Filosofia,
Sociologia, Pedagogia e
Psicologia ApplicataSingle Case Experimental Design e
Hermeneutic Single Case Efficacy Design
• Hermeneutic Single Case Efficacy Design (HSCED) is considered one of
the most advanced research design for systematic collection of
evidence on efficacy and effectiveness of psychotherapies
(McLeod, 2010)From SCED to HSCED
Caratteristiche degli HSCED
– Time series analysis di variabili quantitative di esito, come gli SCED
– Analisi incrociate dei dati quantitativi con i dati qualitativi ricavati da fonti
multiple (patient, therapist, supervisor, researcher)
– Diversi valutatori coinvolti nell’analisi del caso, sia nelle analisi ermeneutiche,
sia nel giudizio finale sull’efficacia del trattamento.
– Maggiore sensibilità a cambiamenti causali complessi
– Permette l’analisi e lo sviluppo della teoria (theory building case study)
– Coinvolge l’interesse dei cliniciMarginalized and Emerging
Psychotherapies (MEPs)
FISPPA
Dipartimento di Filosofia,
Sociologia, Pedagogia e
Psicologia ApplicataIl problema dell’attuale sistema basato sugli RCT come Golden Standard • I sostenitori di tutti gli approcci di psicoterapia sono pressati a condurre sempre più e sempre migliori RCTs • Approcci senza supporto di RCT sono marginalizzati e disincentivati • Questa ideologia favorisce lo sviluppo di trattamenti più facili da studiare, con poche sedute, manualizzabili, con obiettivi più semplici e misurabili • La lista degli EST diventa autoperpetuante
RCT criticità • RCTs sono costosi e richiedono molto tempo e spesso non sono utilizzabili per supportare: 1) Modelli emergenti di psicoterapia; 2) Applicazione di modelli ben validati e riconosciuti a nuove patologie; 3) Modelli di psicoterapia tradizionali, che tuttavia non sono empiricamente supportati e perciò marginalizzati in alcuni Stati • Emerging and Marginalized Psychotherapies non possono affrontare gli RCT
Il percorso proposto da Stiles, Hill & Elliott,
2015
• “A four step pathway to bring Marginalized and Emerging
Psychotherapies toward recognition”
• 1. condurre una serie di studi sistematici sul caso singolo
• Sensibilizzare la comunità clinica
• 2. Costruire un Practitioner Research Network
• Raccolta di dati Online a basso costo, direttamente dalla pratica clinica, che possono
essere aggragati e pubblicati come open clinical trials
• Comparazione degli outcome degli studi pre-post con i benchmarks presenti in
letteratura per stimare l’efficacia dei trattamenti MEPThe pathway proposed by Stiles, Hill and
Elliott
• 3. I PRC possono condurre piccoli-medi RCT comparando il MEP con altri
trattamenti
• Diffusione di manuali di trattamento e misure dell’aderenza
• Practice based randomized studies (pragmatic trials)
• 4. Politiche di rete per il riconoscimento e l’inclusione nelle linee guidaVerso il riconoscimento dell’AT come un EST
• a series of mixed methods systematic case studies
– HSCED (Elliott, 2002)
– Significance is based on measures Reliable and Clinically Significant Change
(RCSC) (Jacobson & Truax, 1991)
• Reliable Change
• Movement to the functional population
– BenchmarkingStatistical and clinical significance
• Statistical significance
– Provides no information on the impact of the therapy
– or meaningfulness of change
• Reliable and Clinically Significant Change (RCSC)
– Allow to compare proportion of change in case series
outcome research, against normative values or benchmarks
from Randomized Clinical Trials
Change CORE (Italian normative scores)
Reliable improvement - 5.1
Reliable deterioration +5.1
Moving from population ≤ 10.9 (M) / ≤ 12.2 (F)
Clinical significant (RCSI) Both reliable improvement and functional populationCase Study Research for policy makers (McLeod, 2011) • Authoritative policy-making groups have accepted, within their guidelines, that case studies do have a valuable contribution to make • At the present time, it is not possible to identify any model of psychotherapy officially approved on the basis of case study evidence • Because there does not exist sufficient good-quality evidence that can be put forward • This situation can be contrasted with other fields, such as management studies, education, where case study evidence has often had a decisive impact on policy and practice
Practice-Oriented Research (POR) and Practioner Researcher Network (PRN)
• Practice-Oriented Research (POR) allows gathering Practice-Based Evidences (PBEs) that are complementary to the indications of the Evidence Base Practice (EBP). • Practitioner Research Networks (PRN) allow collaboration between clinicians and researchers
AT verso il riconoscimento EST • Transactional Analysis Practitioner Research Networks – 7 Istituti di training in AT, associazioni, scuole di formazione, singoli ricercatori – un caso all’anno • Replicazione sistematica delle evidenze raccolte in UK
Effect Sizes degli studi finora pubblicati per il
trattamento AT della depressione
N Study Depressive Symptoms (PHQ9/BDI-II) General Distress (CORE-OM)
1 Peter -1,689702716 -1,967335147
2 Denise -1,802349564 -3,152207452
3 Tom -2,47823065 -3,576972995
4 Linda (9 sessions) -2,140290107 -3,129851371
5 Alastair -2,665845369 -3,308700021
6 Sara -2,665845369 -2,705085828
7 Penelope 0 -0,067068244
8 Luisa -3,838817332 -3,129851371
9 Anna -1,066338148 -1,050735817
10 Caterina -1,412898046 -2,481525016
11 Deborah -2,399260832 missing
GROUP EFFECT SIZE -2,00 -2,45Single Case Meta-Analysis
FISPPA
Dipartimento di Filosofia,
Sociologia, Pedagogia e
Psicologia ApplicataStandardized Mean Difference (SMD) statistic
• una d-statistic per studi singoli come gli SCED e gli HSCED
• Shadish et al, 2014
• I vantaggi dell’uso della statistica SMD:
• Ha la stessa metrica delle d-statistic usate nei between-subjects designs
(RCTs)
• Ha uno sviluppo statistico formale
• Permette una appropriata power analiysisLa d statistic permette la comparazione tra disegni HSCED e RCT • Single Case Designs (SCD) possono contribuire al dibattito nel movimento Evidence-Based Practice (EBP) • Per contribuire al dibattito è utile avere una misura dell’effetto nella stessa metrica usata nei Between-Subject Design (BSD), come gli RCT
Effect Size with d statistic
• Effect size is important for different reasons:
1. Many review of EBP consider evidences from both SCD and BSD, both
combining and separately reporting the results. EBP community often use
standardized effect size estimates as the common denominator for comparing
studies, thus it is essential to represent evidence from SCDs on the same scale
used in BSDs, because a common effect size measure for SCD and BSD would
provide comparability in the reporting and synthetizing of evidence
2. Rational planning of SCD should depend on power calculation to ensure
adequate design sensitivity, just as it does in BSDs. Methods for statistical
power analysis that depend on a standardized effect size metric would allow
SCD researchers to rationally plan and justify in grant proposals their deigns
in terms of the same effect size parameters used by BSD researchersEffect Size with d statistic
3. There is a growing interest in meta-analysis of SCDs, but most effect
sizes proposed for SCD lack a formal statistical development. Without
plausible distribution theory, (e.g., knowledge of the sampling
variance of an effect size statistic) these effect sizes cannot be used
with common meta-analytic tools, such as forest plots, diagnostic
plots (radial and residual), cumulative meta-analysis, regression tests,
publication bias analysis
4. APA prompt that results from BSDs are summarized using effect sizes
and accompanying confidence intervals
FISPPA Clinica e Ricerca nelle
Dipartimento di Filosofia, Associazione Italiana Psicoterapie
Sociologia, Pedagogia e Analisi Transazionale Psicodinamiche
Psicologia Applicata Padova, 5 Maggio 2018Effect Size with d statistic
5. It is of both intellectual and practical interest to compare the size of treatment
effects from SCD with the effects from other methodologies: non randomized
experiments can approximate the results from randomized experiments.
SCD are a form of time series analysis, but there is little empirical evidence
that address how their results compare to results from randomized
experiments.
6. Practically, both practitioners and policy makers cannot always carry out
randomized experiments to examine every causal question, and are
interested in what they can get from alternative designs. These comparisons
cannot be made without statistics in the same metrics for all desings.
FISPPA Clinica e Ricerca nelle
Dipartimento di Filosofia, Associazione Italiana Psicoterapie
Sociologia, Pedagogia e Analisi Transazionale Psicodinamiche
Psicologia Applicata Padova, 5 Maggio 2018Conclusion
• This d may prove useful for both the analysis and meta-analysis of
data from Single Case Design such as Single Case Experimental Design
and Hermeneutic Single Case Efficacy Design
FISPPA Clinica e Ricerca nelle
Dipartimento di Filosofia, Associazione Italiana Psicoterapie
Sociologia, Pedagogia e Analisi Transazionale Psicodinamiche
Psicologia Applicata Padova, 5 Maggio 2018Single case meta-analysis di HSCED pubblicati sull’efficacia del trattamento AT della depressione
Meta-analisi di studi randomizzati
sull’efficacia della psicoterapia psicodinamica
ES ES
Autore Anno Rivista Studi RCT N Popolazione Intervento Controllo Outcome
End Follow Up
Miglioramento
1.51 (>9m)
Sintomatologi .97
co Generale
Abbass,
CMD Psicoterapia Sintomi 2.21 (>9m)
Hancock, Cochcrane Lista d’attesa, .81
2006 23 1431 Common Mental Psicodinamica somatici
Henderson et Library TAU
Disorders Breve (9m)
Ansia 1.08
.98 (>9m)
Depressione .59
Leichsenring, Archives of Psicoterapia 1.17 (controlli)
Sintomatologi
Rabung, 2004 General 17 CMD psicodinamica TAU 1.39 (pre-post) 1.57 (13m)
a generale
Leibing Psychiatry Breve (M=21)
1) Sintomi
.69
psichiatrici
Abbas, Kisely, Psychotherapy Condizioni
2009 23 1870 generali.
Kroencke Psychosomatic somatiche
2) Sintomi
.59
somatici
American
Leichsenring, 14 Psicodin. Disturbi di Dinamica M=37 1.46 (18m)
2003 Journal of
Leibing 11 CBT Personalità CBT M=16 1.0 (13w)
PsychiatryBenchmarking
FISPPA
Dipartimento di Filosofia,
Sociologia, Pedagogia e
Psicologia ApplicataBenchmarking • Domanda cruciale: i pazienti curati in contesti clinici hanno i benefici attesi e dimostrati nei trial clinici? • Spesso è impossibile comparare il trattamento con un non trattamento, placebo o lista di attesa nei contesti clinici • Il Benchmarking permette di comparare l’esito dei trattamenti nei contesti clinici con gli standard di esito osservati nei trial clinici
Benchmarking • Benchmarking permette di comparare l’effect size di un caso singolo o di una serie di casi ai valori di alta e bassa performance ottenuti dalle meta- analisi di RCT pubblicati. • Single Case Meta-Analysis (SCMA) fornisce un ES nella stessa metrica degli RCT e permette di confrontare l’efficacia con le soglie di bassa ed alta efficacia ricavate dagli RCT e da ampi studi ecologici • I Benchmarks sono soglie di riferimento che possono essere usate per interpretare i dati • Permettono di comparare il caso singolo con I valori normativi ricavati da altri studi • Non possono verificare la causalità poichè non prevedono il controllo interno
Benchmarking rules
• Reactivity and specificity of the outcome measures (e.g., PHQ9) used
in the meta-analysis of clinical trials, should match the reactivity and
specificity of the outcome measures used in clinical studies
Reactivity: Who measure the outcome?
Low Reactivity High Reactivity
(self report) (proxy rated)
Low Sensitivity SCL-90/Global Severity Index GAF/DSM-IV-TR Axis V
address the
Sensitivity:
measure?
(general disease, e.g. global distress) CORE-OM
outcome
High Sensitivity Beck Depression Inventory Hamilton Rating Scale for
What
(specific symptoms, e.g. depression) PHQ-9 DepressionJournal of Consulting and Clinical Psychology Copyright 2007 by the American Psychological Association
2007, Vol. 75, No. 2, 232–243 0022-006X/07/$12.00 DOI: 10.1037/0022-006X.75.2.232
Benchmarks for Psychotherapy Efficacy in Adult Major Depression
Takuya Minami Bruce E. Wampold and Ronald C. Serlin
University of Utah University of Wisconsin—Madison
John C. Kircher George S. (Jeb) Brown
University of Utah Center for Clinical Informatics
This study estimates pretreatment–posttreatment effect size benchmarks for the treatment of major
depression in adults that may be useful in evaluating psychotherapy effectiveness in clinical practice.
Treatment efficacy benchmarks for major depression were derived for 3 different types of outcome
measures: the Hamilton Rating Scale for Depression (M. A. Hamilton, 1960, 1967), the Beck Depression
Inventory (A. T. Beck, 1978; A. T. Beck & R. A. Steer, 1987), and an aggregation of low reactivity–low
specificity measures. These benchmarks were further refined for 3 conditions: treatment completers,
intent-to-treat samples, and natural history (wait-list) conditions. The study confirmed significant effects
of outcome measure reactivity and specificity on the pretreatment–posttreatment effect sizes. The authors
provide practical guidance in using these benchmarks to assess treatment effectiveness in clinical
settings.Benchmarks for Low Reactivity/High
240 Sensitivity
MINAMI, WAMPOLD, SERLIN, outcome
KIRCHER, AND BROWN measures for depression240 MINAMI, WAMPOLD, SERLIN, KIRCHER, AND BROWN
TA single case meta analysisBehavioural and Cognitive Psychotherapy, 2014, 42, 16–30
First published online 24 October 2012 doi:10.1017/S135246581200080X
Benchmarking Routine Psychological Services:
A Discussion of Challenges and Methods
Jaime Delgadillo
Leeds Community Healthcare NHS Trust, UK
Dean McMillan
University of York, UKTA single case meta analysis
R28 n=641 d=0.95 (0.86, 1.04)
R4 n=956 d=0.95 (0.87, 1.02)
R6 n=1552 d=0.91 (0.85, 0.96)
R14 n=1529 d=0.88 (0.82, 0.94)
R22 n=118 d=0.85 (0.64, 1.05)
R24 n=135 d=0.85 (0.65, 1.04)
R17 n=724 d=0.84 (0.75, 0.92)
R36 n=1058 d=0.79 (0.72, 0.86)
R7 n=1139 d=0.79 (0.72, 0.85)
R16 n=829 d=0.77 (0.70, 0.85)
Benchmarking routine psychological services
R3 n=324 d=0.75 (0.63, 0.87)
R23 n=1712 d=0.75 (0.70, 0.80)
R11 n=692 d=0.74 (0.66, 0.82)
R5 n=1001 d=0.74 (0.67, 0.81)
R33 n=1480 d=0.73 (0.68, 0.79)
R31 n=1736 d=0.73 (0.68, 0.78)
R27 n=1111 d=0.70 (0.64, 0.77)
R25 n=1274 d=0.70 (0.64, 0.76)
R13 n=148 d=0.69 (0.52, 0.87)
R19 n=266 d=0.69 (0.56, 0.82)
R26 n=275 d=0.68 (0.55, 0.81)
R8 n=739 d=0.65 (0.57, 0.72)
R9 n=477 d=0.63 (0.53, 0.72)
R10 n=449 d=0.62 (0.52, 0.72)
R15 n=424 d=0.61 (0.51, 0.71)
R12 n=366 d=0.58 (0.47, 0.69)
R21 n=820 d=0.50 (0.43, 0.57)
R18 n=60 d=0.48 (0.22, 0.73)
R20 n=1059 d=0.42 (0.36, 0.48)
R30 n=69 d=0.42 (0.18, 0.65)
Leeds n=2890 d=0.81 (0.77,0.86)
0.0 0.4 0.8 1.2
Depression effect sizes (PHQ-9)
Notes: Solid line = average benchmark (0.73); do!ed lines = low (0.46) and high (0.91) performance benchmarks
25
Figure 1. Forest plot of PHQ-9 effect sizes (and 95% CI) for IAPT roll-out sites (R), and Leeds siteBenchmarking TA single case meta analysis • Il Benchmarking non è adatto ad essere utilizzato con campioni inferiori a N=100 • Gli Outcome ricavati da piccoli setting clinici possono comparare il loro effect size con i benchmarks, • Ma il risultato è valido solo per quella osservazione e non può essere generalizzato
Conclusioni: • Per i pazienti inclusi in queste serie di casi, il trattamento AT per la depressione risulta più efficace che il miglior centro IAPT • Ovviamente…. More research needing….
enrico.benelli@unipd.it
You can also read
