Research Spotlight: Start Of Treatment

This study explored how brief waitlist interventions impacted treatment for individuals waiting for ten-session CBT for non-underweight eating disorders (CBT-T). Participants were randomised into three groups: one received a cognitive remediation therapy session (CRT-Brief), another received supportive emails and psychoeducation (brief contact), and the control group waited as usual. While the interventions did not improve symptoms during the waitlist or treatment, they significantly increased retention: participants who received a waiting list intervention were three times more likely to complete therapy. Despite some limitations, the findings of this study suggest that even brief, non-intensive interventions can keep patients engaged in therapy – an insight that could improve their treatment outcomes.

Discussing the potential for negative effects in psychological therapies is an important but sometimes neglected conversation. In this study of Swedish clinical psychologists, 74% of clinicians informed patients about potential negative effects of therapy. Demographic factors showed no significant associations, although there did appear to be some trends. Hindrances to disclosure included lack of knowledge, fear, time constraints, and patient characteristics. The study recommends integrating discussions on negative effects into ethical guidelines and clinical training. It also highlights the importance of addressing therapist blocks and patient-specific considerations during informed consent.

What are the key dynamics of a first treatment session? This qualitative paper explored client and therapist experiences in a specialized substance use clinic. While clients struggled with ambivalence and self-presentation, therapists grappled with uncertainties around building trust and meeting clients’ needs. Both parties sought cues and feedback to establish rapport and therapeutic goals. Understanding and navigating these early relational processes is important for therapists, providing insights into alliance formation as well as potential barriers to ongoing treatment.

Do clients’ experiences of an initial assessment influence their expectations of therapy and engagement in treatment? Analysing data from over 6000 treatment-seekers and almost 150 therapists, this paper highlights the significant effects therapists have on treatment initiation and dropout. Notably, clients with higher outcome expectations are more likely to initiate treatment, underscoring the influence of therapists in fostering hope and credibility. Surprisingly, therapists who conducted initial assessments had an effect on dropout rates even when they did not go on to deliver the therapy, highlighting the enduring impact of initial therapist-patient interactions. The findings emphasize the importance of therapists’ ability to instil hope and credibility from the outset, particularly for clients who are at risk of disengaging from treatment.

This meta-analysis explores the ‘revolving door’ phenomenon in mental health, whereby individuals often experience several different mental disorders during their lifetime. While many interventions reduce the likelihood of future disorders, they do not eliminate the risk entirely, suggesting an important role of treatment history in the phenomenon. Anxiety disorders were also found to frequently precede mood and substance use disorders (the exception being panic disorder), highlighting common trajectories of mental illness. Potential recommendations from these findings include the use of transdiagnostic treatments that target shared features across disorders, broader relapse prevention strategies, and the use of stepped care treatments.