Authors:	Mütze, Kaline
Advisor:	Witthöft, Michael Jungmann, Stefanie M. Wessa, Michèle
Title:	On behalf of science and practice – using psychotherapy research to address clinical practice concerns
Online publication date:	4-Jan-2024
Year of first publication:	2024
Language:	english
Abstract:	The many efforts to seek common ground for psychotherapy research and practice could not yet fix the gap that exists between the two stakeholders of mental health services as it has been the case for decades. The mutual integration of research and practice is an essential ingredient in effective service delivery of psychological treatments. In this connection, practice-oriented studies that are conducted in naturalistic settings provide a context in which both parties can learn from and complement each other. With the aim of contributing to the improvement of psychological practice in terms of patient outcomes, professional well-being, and training, two research topics that are relevant to clinical practice concerns were investigated in this dissertation: the use of data-driven clinical support tools and occupational stress among psychotherapists. Study 1 investigated whether basic outcome monitoring in outpatient psychotherapy (i.e., assessment intervals of 5 to 15 sessions) can be used for personalized outcome prediction. This is significant because outcome prediction and monitoring have been proven useful to prevent stagnation, deterioration, or premature dropout from psychological treatment. However, session-by-session evaluation is rare in most clinical settings in the context of limited time and resources. In this study, individual treatment progress and dropout risk were predicted using modern statistical machine learning techniques such as the nearest neighbor method and least absolute shrinkage and selection operator regression. For the prediction of individual treatment progress, each patient’s nearest neighbors were selected based on variables that have been identified as significant predictors of symptom change (i.e., baseline distress, intrinsic treatment motivation, previous inpatient treatment, and number of suicide attempts in the past). Lower intrinsic treatment motivation, a lack of university entrance qualification, higher baseline impairment, previous inpatient treatment, and diagnosed personality or eating disorder accounted for higher dropout probability. Addressing potential obstacles in routine symptom assessment, this study points to the practical significance of evidence-based research. The findings demonstrate that innovative outcome prediction is not limited to elaborated assessment and provide a reasonable approach for successfully predicting individual patient outcomes as long as session-bysession assessment is not a valid standard. While patient symptoms and outcomes have always been the focus of investigation, therapist well-being is not sufficiently studied in psychotherapy research. High prevalences of work-related stress, that can lead to reduced professional competence and associated risks for their patients, make this topic an ethical priority in the workplace. Therefore, Study 2 investigated how potential work stressors (i.e., patient distress, working alliance, and treatment outcome) relate to occupational stress among psychotherapists. The results show that treatments with high-distress patients, poor working alliance, and non-remission are associated with higher levels of occupational stress. Furthermore, occupational stress was significantly negatively related to perceived learning opportunities and patient treatment satisfaction. When interpreting the results, particular attention was given to psychotherapy training as the potential of clinical support tools is developed in clinical training regarding their utility and implementation and because trainees experience more insecurity and stress at work compared to more experienced therapists. The conclusions of this dissertation highlight the importance of research-supported psychological treatments (e.g., the use of clinical support tools as a useful supplement to evaluation based on therapist judgment). Furthermore, approaches for the prevention of occupational stress among therapists are proposed. Both, the integration of data-driven clinical support tools into psychological practice and the risks of occupational stress burnout should be targeted in the educational context.
DDC:	150 Psychologie 150 Psychology
Institution:	Johannes Gutenberg-Universität Mainz
Department:	FB 02 Sozialwiss., Medien u. Sport
Place:	Mainz
ROR:	https://ror.org/023b0x485
DOI:	http://doi.org/10.25358/openscience-9825
URN:	urn:nbn:de:hebis:77-openscience-a11bf486-a299-4128-8e22-a540b2d837939
Version:	Original work
Publication type:	Dissertation
License:	In Copyright
Information on rights of use:	http://rightsstatements.org/vocab/InC/1.0/
Extent:	XIV, 110 Seiten ; Illustrationen, Diagramme
Appears in collections:	JGU-Publikationen