Enter your email address below and we will send you the reset instructions. If the address matches an existing account you will receive an email with instructions to reset your password Close. Request Username Can't sign in? Forgot your username? Enter your email address below and we will send you your username. Cyberpsychology, Behavior, and Social Networking Vol. Olatz Lopez-Fernandez , Mark D. Griffiths , Daria J.
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Volume 17 Issue 2 Feb Cyberpsychology, Behavior, and Social Networking. Feb Close Figure Viewer. With regard to symptom severity, longer treatment duration is associated with lower effect sizes, whereas regarding interpersonal problems, samples with longer treatment durations showed larger effect sizes. Generally, the relation between outcome and treatment duration is not a simple one: While dose-response-models  ,  postulate that treatment duration affects outcome higher response rates in longer treatment , the good-enough-model  implies that symptom change predicts treatment duration longer treatments in severely disturbed patients.
In this context, our findings may reflect the reality that symptom change constitutes a primary outcome of inpatient psychotherapy while change in interpersonal problems constitutes a more secondary goal. However, our data do not allow for any more detailed interpretations. To clarify these relations, further studies are required.
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The quality of included studies was not significantly associated to the treatment effect, accordingly there is no evidence that low quality studies overestimate the treatment effects in this meta-analysis. One major limitation of this meta-analysis may be seen in the lack of randomized controlled trials RCTs addressing the efficacy of psychotherapeutic hospital treatment.
This lack of RCTs may be attributed to the specialties of the German health care system and its indication standards for inpatient and outpatient psychotherapy: As inpatient psychotherapy is considered to be the indicated and available treatment option for seriously disturbed patients in Germany, an allocation to a treatment condition of lower intensity i. Therefore, any study aiming at evaluating the efficacy of psychotherapeutic hospital treatment by use of an RCT design would be disapproved by the local ethics committee.
Correspondingly, the only existing RCTs in this field compare different treatment conditions within inpatient psychotherapy  ,  or — on rare occasions — inpatient to day clinic treatment . Thus, this meta-analysis does not allow causal interpretations. Changes cannot exclusively be attributed to the psychotherapeutic treatment but may also be caused by spontaneous remission or other confounding influences. In addition, as psychotherapy is only one part of the multimodal inpatient treatment concept, the proportion of improvement caused by psychotherapeutic interventions in a narrower sense remains unclear.
Since the application of psychopharmacological treatment is rarely described, analyses on the influence of medication were not feasible in this meta-analysis. In one of the included randomized controlled trials, the combination of behavior therapy and fluvoxamine was superior to behavior therapy and placebo in patients with obsessive-compulsive disorder regarding obsessions and depressive symptoms but not superior regarding compulsions .
In another randomized trial, the application of interpersonal psychotherapy additional to pharmacotherapy showed a higher reduction of depressive symptoms compared to pharmacotherapy plus clinical management, but was not superior regarding social and interpersonal functioning . Cuijpers et al.
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Regarding these results, one can assume that the psychotherapeutic treatment itself is an effective factor in this setting - at least in some outcome areas. To date, established criteria to classify within-group e. We addressed this problem by deducting the effect sizes occurring in untreated control groups in outpatient psychotherapy studies  ,  from our calculated effect sizes before applying the critical values which have been proposed by Cohen for the interpretation of between-group effects .
However, this provisional approach certainly requires further validation. A possible imprecision of effect size calculation could as well have arisen from lacking information about pre-post-correlation in outcome measures, which did not allow the consideration of interdependence .
Methodological weakness of included studies is often criticized as one major source of bias in meta-analyses. To do justice to the complex relationship between study quality and outcome of psychotherapy, we carried out an extensive complementary project on this issue . Based on a comprehensive review of the literature and an expert rating, we selected 19 relevant quality criteria to quantify the quality of the included studies.
However, study quality varies considerably over different studies and different criteria. Especially in terms of dealing with dropouts, more detailed information in original papers is required. In spite of these limitations, there is no evidence that low quality studies distort the results of this meta-analysis since no correlation was found between study quality and outcome. Although our approach allows for a sophisticated appraisal of relevant quality criteria, especially with regard to non-randomized studies, there are no benchmarks available until now, since this is the first application of our checklist.
As the few significant results indicated overally smaller effects in smaller studies, there was no evidence for a small study bias. Some studies provided more than one publication, which complicated the process of data abstraction and data aggregation since the different publications sometimes focused on partially overlapping subgroups. We emphasized on including all relevant information without integrating data from overlapping subgroups in our calculations.
Data regarding employment status, illness duration and comorbidity were incomplete in many cases, which limited the representativeness of the overall sample description.
Heterogeneous classifications of socio-demographic variables complicated a consistent data aggregation. Fortunately, at least data on the therapeutic approach, age, sex and the main diagnoses were nearly complete. The SCL is a well-established instrument in psychotherapy research. It is able to differentiate between subjects with and without a psychiatric disorder and is qualified for measuring change in outcome studies . The SCL GSI shows a high internal consistency  ,  , while the results on the subscales are inconsistent  , .
Previous studies show that most of its subscales measure one broad dimension of general symptom distress and are not suitable to differentiate between various diagnostic groups, therefore the concept of multi-dimensionality is doubtful  — . The IIP scales are dominated by this general factor as well, but also showed high loads on three factors on interpersonal behavior and interpersonal problems identified by Tran et al.follow site
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On the one hand, it is therefore questionable whether the IIP provides relevant additional information. On the other hand, our results show different results in IIP compared to SCL, justifying the application of both measures. Even if the factorial validity of the subscales is doubtful, we reported these results to provide benchmarks for facilities applying these scales for evaluation purposes. As the high number of included studies involved an immense effort regarding the data extraction, results of this extensive meta-analysis were not available until more than four years after the end of the literature search.
Although we expect some relevant studies to be published during this period, the included studies may still be regarded as being up-to-date. Due to the large number of included studies, we do not expect that a small number of new studies would change the results significantly. However, this risk of bias can be assumed to be low as PSYNDEX comprises more than English journals and electronic search was complemented by a comprehensive hand search. In spite of all methodical limitations in this meta-analysis, there is evidence that psychotherapeutic hospital treatment shows positive outcomes regarding symptom severity as well as interpersonal problems in severely disturbed patients.
To clarify the relations between symptom severity, interpersonal problems and treatment duration, further research is required. We would like to thank Kristin Gutwirth, Nele Schmidt and Maren Spies for their support in the literature search and the data extraction as well as Jana Sommer, Maya Steinmann and three reviewers for helpful comments to an earlier version of this draft.
Performed the experiments: SL SR. Analyzed the data: SL SR. Contributed to the writing of the manuscript: SL SR. Browse Subject Areas? Click through the PLOS taxonomy to find articles in your field. Abstract Background In Germany, inpatient psychotherapy plays a unique role in the treatment of patients with common mental disorders of higher severity.
Methodology Relevant papers were identified by electronic database search and hand search. Principal Findings Sixty-seven papers representing 59 studies fulfilled inclusion criteria. Conclusions Psychotherapeutic hospital treatment may be considered an effective treatment. Introduction Inpatient psychotherapy, an intensive and multimodal treatment for patients with mental disorders, is especially common in Germany. Inclusion Criteria We included published as well as unpublished papers in German and English reporting outcomes of psychotherapeutic hospital treatment in Germany.
Table 1. Data Abstraction and Data Details Data abstraction was mainly carried out by one rater SL and supported by three trained student research assistants. Risk of Bias in Individual Studies There is a considerable lack of available checklists for the appropriate assessment of the study quality of psychotherapy outcome studies. Data Analysis and Data Synthesis We calculated standardized pre-post effect sizes as well as pre-follow-up effect sizes.
Moderator analyses To address differences between the included studies, we performed moderator analyses by calculating meta-regressions via restricted maximum likelihood, weighted by the inverse variance of the particular criterion. Risk of Bias across Studies To reduce the risk of bias, we included published as well as unpublished studies.
Results Study Selection Based on the inclusion criteria, our search resulted in 59 studies which were described in 67 different publications see Figure 1 and Table 2. Study and Publication Characteristics Except for one study conducted in Germany and Switzerland, all studies were conducted exclusively in Germany. Sample Characteristics The majority of samples were recruited from psychodynamic treatment settings.
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Quality Criteria The mean quality score ranged from 0. Outcome: Symptom Severity Treatment effects on global symptom severity GSI of the SCL had a medium size at discharge see Table 4 as well as at follow-up, although there was a slight reduction in effect size to follow-up see Table 5. Table 4. Outcome: Interpersonal Problems Regarding interpersonal problems Total Score of the IIP , an improvement of a small effect size was found at discharge see Table 4 , which slightly increased but remained a small effect size at follow-up see Table 5.
Heterogeneity Concerning pre-post effects, 12 of 19 scales i. Moderator analyses To explain the heterogeneity in treatment effects, we examined the percentage of females, mean age, diagnostic composition homogeneous vs. Discussion This study represents the first meta-analysis on the effectiveness of psychotherapeutic hospital treatment in Germany.