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The use of feedback to patients in therapy

The use of feedback to patients in therapy. Professor Janet Treasure Kings College London South London & Maudsley NHS Trust. Contents. Models of feedback Process/ mechanisms of feedback Evidence for efficacy of feedback in psychotherapy

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The use of feedback to patients in therapy

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  1. The use of feedback to patients in therapy Professor Janet Treasure Kings College London South London & Maudsley NHS Trust

  2. Contents • Models of feedback • Process/ mechanisms of feedback • Evidence for efficacy of feedback in psychotherapy • Can feedback be used as part of quality management?

  3. Feedback-types • Risk Laboratory variables, Demographics etc • Change variables Stage of change, Self efficacy, Decisional balance, Process of change, symptom level/change, formulation

  4. Mechanisms of Action of feedback • Informational/educational • Motivational/inspirational • Changing attitudes and beliefs • Provide support & a helpful relationship • Offering social norms and comparisons • Increasing engagement in the information • Providing critical risk, skill and protective factors

  5. What is the evidence that feedback to clients in psychotherapy research has an effect?

  6. Bien et al., 1993Behavioural & Cognitive Psychotherapy, 21:347-356 • Design Randomized clinical trial • Population Outpatient alcohol (VA) • Nation US (Albuquerque, NM) • N 32 adults • MI 1 session MET (+ TAU) • Comparison TAU • Follow-up 6 months post discharge

  7. Bien et al., 1993 p<.05

  8. Bien et al., 1993

  9. Monti et al., 1999Journal of Consulting and Clinical Psychology, 67:989-994 • Design Randomized clinical trial • Population Emergency room • Nation US (Providence, RI) • N 94 adolescents (18-19) • MI 1 session (35-40 min) • Comparison Standard care • Follow-up 6 months

  10. Monti et al • MI plus personalised problem focused feedback • Standard Care condition: handout drink/drive & list local treatment resources

  11. Monti et al., 1999 p<.05 p<.05 p<.01

  12. Project MATCH, 1997Journal of Studies on Alcohol, 58:7-29 • Design Randomized clinical trial • Population Outpatient and aftercare • Nation US (9 sites) • N 1,726 adults • MI 4 session MET • Comparison 12 session CBT or TSF • Follow-up 15 months post-treatment

  13. Content Feedback MET • Comprehensive personalised feedback: problem/risk and current status with written explanation including , normative comparisons drinking rates, typical blood alcohol levels, personal risk factors – family history, tolerance, negative consequences drinks, LFTs , neuropsychological assessment

  14. Project MATCH, 1997 p<.04 p<.003

  15. Project MATCH, 1998Alcoholism: Clinical and Experimental Research, 22:1300-1311 p<.007 On percent days abstinent, MET = TSF > CBT

  16. What about giving feedback in general Psychiatric settings?

  17. Swanson et al., 1999Journal of Nervous & Mental Disease, 187:630-635 • Design Randomized clinical trial • Population Psychiatric inpatients • Nation US (New York) • N 121 inpatients • MI 2 sessions (15, 60 min) + TAU • Comparison TAU • Follow-up Transition to aftercare

  18. Intervention • 15 min session of feedback on their URICA scores at beginning of hospitalization • Description of instrument • Results in terms of profiles in previous research • Interpretation of results based on stage of change model • Discussion of patients views of results and how they may influence commitment to adhere to treatment recommendations • Later one hour review of problem and level of commitment to treatment (review feedback)

  19. Swanson et al., 1999 p<.01

  20. The effect of feedback to patients on management of bulimia nervosa • Design Randomized clinical trial • Population DSMIV Bulimia Nervosa • Nation UK (London) • N 62 • MI Letter, AQUASI + TAU • Comparison TAU • Follow-up BN symptoms

  21. The effect of feedback on BN symptoms at 6/12 follow up * * * *

  22. Summary of the evidence • Personalised feedback has the potential for increasing the effectiveness of interventions. • Normative comparisons and details of risk and problem dimensions has been found to be as good as more extensive interventions in terms of engagement and outcome

  23. Can/ should we use feedback to patients as part of quality management?And encourage them to give feedback to us?

  24. Sue’s Feedback • Over the years I have had & recovered from an eating disorder, both anorexia & bulimia.  By taking part in the research questionnaire I was able to reflect on the BIG improvements I had made in my life and give myself a pat on the back . Recently I gave up smoking, I felt the time was right, the eating disorder was under control and I had just completed some research questionnaires so felt very positive.  About 6- 7 weeks after giving up smoking I received another research paper, at this point I had started to gain weight & feel quite bad.  Although my responses this time where not as positive, doing the paper allowed me to reflect again, and reinforce the positive aspects of not abusing food, me and my body.

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