Development of a PatientReport Measure of Psychot

Authors: Jeanne Miranda Kimberly A Hepner Francisca Azocar Greg Greenwood Victoria Ngo M Audrey Burnam

Publish Date: 2009/09/12

Volume: 37, Issue: 3, Pages: 245-253

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Abstract

Despite clear indications of need to improve depression treatment practical tools that efficiently measure psychotherapy are not available We developed a patientreport measure of psychotherapy for depression that assesses Cognitive Behavioral CBT Interpersonal IPT and Psychodynamic therapies 420 patients with depression from a large managed behavioral health care organization completed the measure The three subscales measuring CBT IPT and Psychodynamic Therapy showed good internal consistency appropriate itemtotal correlations and were supported by a 3factor structure Our results suggest that a patient questionnaire is a promising approach for assessing psychotherapy in quality improvement interventionsMental health care provided in most practice settings uses procedures that are different from the treatments found to be effective in research settings Institute of Medicine 2001 Quality improvement interventions are effective at increasing rates of evidencebased depression care Katon et al 1995 1996 Wells et al 2000 Unfortunately managed behavioral health care settings are unlikely to be able to engage in large scale quality improvement interventions for psychotherapy because no efficient easily administered measures of the extent to which psychotherapy procedures provided are evidencebased are available In this study we present initial findings on the development of a patientreport measure of the extent to which therapists use procedures of Cognitive Behavioral Therapy CBT Interpersonal Therapy IPT or Psychodynamic TherapyPsychotherapy for depression is an appropriate area to begin development of a patientreport measure of psychotherapy procedures Depression has a high prevalence and early age of onset making depressive disorders a leading cause of disability worldwide Murray and Lopez 1996 Lopez et al 2006 Two forms of welldefined psychotherapy for depression CBT and IPT have been wellestablished as effective interventions for depression USDHHS 1999 Yet many depressed patients do not receive evidencebased psychotherapy Wang et al 2000 Young et al 2001 Quality improvements efforts greatly improve the outcomes for depression Gilbody et al 2003 yet are not feasible for psychotherapy without ways to measure quality care An efficient measure of the extent to which psychotherapy procedures consistent with CBT or IPT are used could enable managed behavioral health organization to document the impact of quality improvement interventions for psychotherapy for depressionCurrent methods to determine if psychotherapy is evidence based are not feasible for quality improvement efforts Trained observers code audio or videotapes of sessions to determine adherence to a particular psychotherapy Although not a measure of psychotherapy caregiver reported adherence to principles of MST have proven to be reliable and valid predictors of child outcome in randomized trials as well as usual care settings Schoenwald 2008 In fact caregiver reports of adherence to principles of MST have proved better predictors than therapist reports of adherence Schoenwald 2008 In this study we reviewed existing rating scales and psychotherapy literature to develop a patient selfreport measure of Cognitive Behavioral Interpersonal and Psychodynamic Therapies that could easily be administered as part of a quality improvement effort We include Cognitive Behavioral and Interpersonal Therapies because they are well validated forms of care We include Psychodynamic Therapy because 25 of therapists in practice use this approach Norcross et al 2002 The goals of our study were to present preliminary evidence of the psychometric characteristics of our patientreport measure of psychotherapy for depressionWe sought to develop a patientreport instrument to describe three psychotherapy approaches used in the treatment of depression The goals of the analyses presented here were to evaluate the a psychometric properties of the measure b preliminary data on validity of the scale and c propose a revision of the measure based on these initial evaluationsThe instrument the Psychotherapy Practice Scale—Patient Depression Care Version PPS Patient was designed to provide a tool to describe the psychotherapeutic techniques used in the treatment of depression from the patient perspective The instrument focuses on three therapeutic approaches CBT IPT and Psychodynamic Therapy CBT and IPT techniques were included because these approaches have strong empirical support for the treatment of major depression Butler et al 2006 Chambless et al 1998 Chambless and Ollendick 2001 Frank and Spanier 2006 Psychodynamic Therapy has limited empirical support but was included given the prominence of this orientation in clinical training and practiceContent and item development was guided by review of clinical literature on efficacy and essential therapy components and existing observation coding tools of adherence and competence including rating scales used in the NIMH Treatment of Depression Collaborative Research Program Generated items were reviewed in consultation with at least two clinical experts in each of the three therapeutic approaches to ensure inclusion of key therapeutic techniques essential to each type of therapy Items were further refined by conducting cognitive interviews with 12 current psychotherapy patients who completed the measure

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