Patients who were matched to therapists with proven effectiveness in addressing the patients’ top areas of concern experienced greater improvements following treatment than those paired with therapists randomly, according to a study published today in JAMA Psychiatry.
“Mental illness is a major public health problem, and even among people who engage mental health care, more than 60% do not benefit meaningfully from care received,” wrote Michael Constantino, Ph.D., of the University of Massachusetts, Amherst, and colleagues. “These results suggest that measurement-based therapist report cards can help redirect [mental health care] toward therapists’ strengths.”
Constantino and colleagues conducted a trial across six clinics in Cleveland, Ohio, that included 48 therapists and 218 patients. To be included, the therapists had to provide outcome data from at least 15 cases, which were used to establish their performance profiles. Using 12 symptomatic or functional domains determined by the Treatment Outcome Package (TOP), the therapists were classified as effective (on average, their patients’ symptoms reliably improved), neutral (on average, their patients’ symptoms neither improved nor deteriorated), or ineffective (on average, their patients’ symptoms reliably deteriorated) within each of the domains. The TOP measures how much a patient has experienced 12 specific concerns in the past two weeks, including depression, quality of life, social conflict, substance misuse, suicidality, violence, and work functioning, among others. The TOP also measured patients’ impairment.
The patients in the 16-week trial completed the TOP to determine what interventions they needed. They were then randomly assigned to the matched group or the care-as-usual group. Those in the matched group were assigned to therapists who had proven effective in addressing the patients’ top three elevated domains as determined by their TOP results. Patients in the care-as-usual group were assigned to therapists through typical procedures, such as the therapist’s availability. The patients completed the TOP and the Symptom Checklist-10 (to measure psychological distress) at baseline and bi-weekly throughout the trial or the end of their treatment.
Patients in the matched group experienced greater reductions in their overall impairment compared with patients in the care-as-usual group. Though the matched group started treatment with higher impairment scores, on average, than the care-as-usual group, they ended the trial in the nonclinical range with an average score of about zero, which is the mean score for the general population. Impairment scores for patients in the care-as-usual group improved, but they still ended treatment in the clinically impaired range. Similarly, patients in the matched group experienced greater weekly reductions in psychological distress compared with patients in the care-as-usual group.
“Notably, the good fit in this study came not from changing what the therapists did in their treatment, but rather who they treated,” the authors wrote. “Capitalizing on whatever it is that a therapist historically does well when treating patients with certain mental health problems, the current data indicate that our match system can improve the effectiveness of that care, even with neither therapist nor patient being aware of their match status.”
For related information, see the American Journal of Psychotherapy article “Patient Choice in Depression Psychotherapy: Outcomes of Patient-Preferred Therapy Versus Randomly Allocated Therapy.”
