Joshua K. Swift

Inclusion and exclusion strategies for conducting meta-analyses

Abstract Some of the most important decisions that a researcher will make when conducting a meta-analysis are decisions about the search strategies and inclusion/exclusion criteria. Decisions regarding inclusion/exclusion criteria serve to define the scope of a meta-analysis and search strategy decisions can have a large impact on how well the results of a meta-analysis actually represent the existing body of literature. In this article, we provide descriptions and recommendations for performing searches and making inclusion/exclusion decisions. We also provide a review of 65 meta-analyses of psychotherapy versus pharmacotherapy in order to offer frequency data on the use of various search strategies and inclusion/exclusion decisions in the field. Clinical or methodological significance of this article: This article provides a review of and recommendations for inclusion and exclusion strategies when conducting meta-analyses. The recommendations can provide guidance for future meta-analysts. This article also provides information for consumers that may be used to judge the quality of published meta-analyses.

A meta-analysis of nonsystematic responding in delay and probability reward discounting.

Delay discounting (DD) and probability discounting (PD) are behavioral measures of choice that index sensitivity to delayed and probabilistic outcomes, which are associated with a range of negative health-related outcomes. Patterns of discounting tend to be predictable, where preferences for immediate (vs. delayed) and certain (vs. probabilistic) rewards change as a function of delay and probability. However, some participants yield nonsystematic response patterns (NSR) that cannot be accounted for by theories of choice and could have implications for the validity of discounting-related experiments. Johnson and Bickel (2008) outline an algorithm for identifying NSR patterns in discounting, but the typical frequency of and methodological predictors of NSR patterns are not yet established in the extant literature. In this meta-analytic review, we identified papers for analysis by searching Web of Science, PubMed, and PsycInfo databases until November 8, 2015 for experiments identifying nonsystematic responders using Johnson and Bickel’s algorithm. This yielded 114 experiments with nonsystematic data reported. The overall frequency of NSR across DD and PD studies was 18% and 19%, respectively. Nonmonetary outcomes (e.g., drugs, food, sex) yielded significantly more NSR patterns than did discounting for monetary outcomes. Participants recruited from a university setting had significantly more NSR patterns than did participants recruited from nonuniversity settings. Our review also indicates that researchers are inconsistent in whether or how they report NSR in discounting studies, which is relevant for a clearer understanding of the behavioral mechanisms that underlie impulsive choice. We make several recommendations regarding the assessment of NSR in discounting research.

A Collaborative Approach to Psychotherapy Termination.

Collaboration has been recognized as an important relationship variable in psychotherapy that is linked to client treatment outcomes. Although many therapists seek to build a collaborative working relationship with their clients when making treatment decisions, collaboration is also an important technique that can be used to help clients plan for a successful termination. Collaborative termination strategies can first be used in the initial session in order to address clients termination expectations. Strategies can also be used throughout treatment to help clients focus on their treatment goals. Last, collaborative termination strategies should be used in the final session to help clients take ownership of their gains and to equalize the therapeutic relationship. In this article, we provide specific recommendations for collaborating with clients in preparing for psychotherapy termination. Case examples demonstrating these strategies are also provided. (PsycINFO Database Record

Considerations of how to conduct meta-analyses in psychological interventions

Clinical or methodological significance of this article: Meta-analysis is a powerful tool for resolving conflicting conjectures or findings while also providing a critical overview of a scientific area.

Understanding the client's perspective of helpful and hindering events in psychotherapy sessions: A micro‐process approach

The purpose of this study was to bridge the methodologies of significant events and micro-process research to gain a better understanding of clients perceptions of helpful and hindering events in psychotherapy. A total of 16 clients were asked to review a recent psychotherapy session and, while watching, complete a moment-by-moment rating of helpful/hindrance using a dial rating system. They were also asked to describe the most helpful and hindering segments that were rated as such. The moment-by-moment ratings suggest that clients perceive a significant amount of variability within a single session. The qualitative results suggest that clients perceive both specific treatment and common factors techniques as being helpful. Further, some of the same therapist actions were rated as both helpful and hindering, but they differed in the timing and the clients experience of feeling heard and understood versus judged or given advice that was not perceived as relevant to them. These results have important implications for clinical practice.

Clients’ perceptions of personal psychotherapy or counselling for therapists

The purpose of this study was to examine clients’ opinions of therapists’ personal use of psychotherapy or counselling. Participants in this study, a nationwide sample of clients recruited through Amazon’s MTurk system, were asked to complete an online survey assessing their attitudes towards treatment use by therapists as well as their general attitudes towards psychological help-seeking and perceptions of stigma (social and self) with psychological treatments. In this study, we found that clients generally had positive views about therapists’ personal use of psychotherapy or counselling. Although overall positive attitudes were found, the results from repeated measures ANOVAs indicated that attitudes depended somewhat on whether the therapist had sought out treatment as part of a training requirement for self-enrichment, or for the treatment of a psychological problem. In addition, participating clients were less supportive of therapists disclosing a treatment use history with their clients. Regression analyses also indicated that attitudes towards treatment use by therapists were significantly predicted by general help-seeking attitudes and perceptions of stigma (social and self), but attitudes towards disclosure were not. The findings from this study have important implications regarding therapist treatment use and disclosure in practice.

Improving psychotherapy effectiveness by addressing the problem of premature termination: Introduction to a special section

Abstract Premature termination appears to be a consistent problem in psychotherapy, showing up across client, treatment, and therapist types. As psychotherapy researchers and practitioners, it is important that we gain a better understanding of this negative psychotherapy event and identify methods for reducing its occurrence. This article introduces a special section on premature termination in psychotherapy. In addition to briefly introducing the articles contained in the special section, this article offers suggestions for future research on the topic of premature termination.

The impact of accommodating client preference in psychotherapy: A meta-analysis: SWIFT et al.

Client preferences in psychotherapy reflect specific conditions and activities that clients desire in their treatment, with increasing evidence pointing to preference accommodation as facilitating psychotherapy outcomes. This updated meta-analysis establishes the magnitude of the effect of client preference accommodation in psychotherapy. Based on data from 53 studies and over 16,000 clients, preference accommodation was associated with fewer treatment dropouts (ORu2009=u20091.79) and more positive treatment outcomes (du2009=u20090.28) than providing client with a nonpreferred treatment or psychotherapy condition. The preference effect was moderated by study design, timing and type of outcome measurement, and client diagnosis. It was not moderated by year of publication, treatment duration, preference type, treatment options, client age, client gender, client ethnicity, or client years of education. The authors provide a case example of preference accommodation and practice recommendations for working with client preferences.

A randomized-controlled crossover trial of mindfulness for student psychotherapists.

Although research has documented a number of personal benefits for psychotherapists who practice mindfulness, the existing research examining the effects of psychotherapist mindfulness on client treatment outcomes has been mixed. The purpose of this study was to test whether a brief mindfulness training program for trainee psychotherapists could have a positive impact on psychotherapists’ ratings of their own state and trait mindfulness as well as on psychotherapy session outcomes. In this randomized-controlled crossover trial, 40 graduate student psychotherapists from 2 universities were assigned to either a mindfulness or a control group. Psychotherapists in the mindfulness group received a brief 5-week manualized mindfulness training program; those in the control group received the program after a 5-week no-contact period. Psychotherapists who received the mindfulness training showed improvements in state and trait mindfulness that were significantly greater than the changes seen in the control group. Psychotherapists also reported a significantly higher level of presence in treatment sessions after attending the training compared to the control condition; however, no differences in clients’ ratings of psychotherapist presence or session effectiveness were observed between the 2 conditions. Implications for psychotherapist training and mindfulness practice are discussed.

Utilizing Patient Hope and Outcome Expectations to Facilitate Treatment Gains

Research indicates that patients’ hope and positive outcome expectations are associated with favorable treatment outcomes. The importance of hope and expectations are discussed in relation to psychotherapy in addition to broader healthcare settings such as pain management and surgery. Five suggestions for promoting hope and positive outcome expectations for patients are provided including presenting a convincing treatment rational, sharing successful case examples and the belief that treatment will work, increasing the patient’s faith in the health care provider, making sure patients’ expectations are not overly optimistic, and allowing patients to have input into treatment decision-making.Keywords: patient; expectations; hope; patient