Data-Informed Case Formulation with the Trier Treatment Navigator
DOI:
https://doi.org/10.33898/rdp.v33i123.35971Keywords:
clinical decision support systems, measurement-based care, routine outcome monitoring, feedback system, practice-based evidenceAbstract
The current article presents a way of practising case formulation using technology augmentation in the context of data-informed psychotherapy. First, we explain how case formulation guides the decision-making processes in psychotherapy and how decisions made under an intuitive clinical judgement can be biased. The use of actuarial methods is pointed out as a way of addressing these biases, mainly through clinical decision support systems based on statistical tools and machine learning algorithms. We present the Trier Treatment Navigator (TTN), a clinical decision support system developed in a University research-based clinical training programme. We show how the TTN can contribute to an initial case formulation and its dynamic adaptations during treatment with a clinical case. Finally, we discuss how case formulation and data-informed psychotherapy are aimed at the same goal: treatment personalisation. We argue that case formulation and data-informed psychotherapy enrich and feedback on each other.
Downloads
References
Aston, R. (2009). A literature review exploring the efficacy of case formulations in clinical practice. What are the themes and pertinent issues? The Cognitive Behaviour Therapist, 2(2), 63–74. https://doi.org/10.1017/S1754470X09000178
Barkham, M., Hardy, G. E., & Startup, M. (1996). The IIP-32: A short version of the inventory of interpersonal problems. British Journal of Clinical Psychology, 35(1), 21–35. https://doi.org/10.1111/j.2044-8260.1996.tb01159.x
Barkham, M., & Lambert, M. J. (2021). The efficacy and effectiveness of psychological therapies. In M. Barkham, W. Lutz, & L. G. Castonguay (Eds.), Bergin and Garfield’s handbook of psychotherapy and behavior change: 50th anniversary edition (7th ed., pp. 135–189). Wiley.
Beesdo-Baum, K., & Zaudig, M. (2019). SCID-5-CV strukturiertes klinisches interview für DSM-5-störungen–klinische version: Deutsche Bearbeitung des Structured Clinical Interview for DSM-5 disorders–clinician bersion von Michael B. First, Janet BW. Williams, Rhonda S. Karg, Robert L. Spitzer [SCID-5-CV Structured clinical interview for DSM-5 disorders - clinical version: German adaptation of the structured clinical interview for DSM-5 disorders - clinician version by Michael B. First, Janet BW. Williams, Rhonda S. Karg, Robert L. Sharpener]. Hogrefe.
Bickman, L., Lyon, A. R., & Wolpert, M. (2016). Achieving precision mental health through effective assessment, monitoring, and feedback processes: Introduction to the special issue. Administration and Policy in Mental Health and Mental Health Services Research, 43(3), 271–276. https://doi.org/10.1007/s10488-016-0718-5
Bieling, P. J., & Kuyken, W. (2003). Is cognitive case formulation science or science fiction? Clinical Psychology: Science and Practice, 10(1), 52–69. https://doi.org/10.1093/clipsy.10.1.52
Boswell, J. F., Kraus, D. R., Miller, S. D., & Lambert, M. J. (2015). Implementing routine outcome monitoring in clinical practice: Benefits, challenges, and solutions. Psychotherapy Research, 25(1), 6–19. https://doi.org/10.1080/10503307.2013.817696
British Psychological Society. (2011). Good practice guidelines on the use of psychological formulation. British Psychological Society.
Caspar, F. (2022). Optimizing psychotherapy with plan analysis. In T. D. Eells (Ed.), Handbook of psychotherapy case formulation (3rd ed., pp. 209–258). Guilford Press,.
Castonguay, L. G., Barkham, M., Youn, S. J., & Page, A. (2021). Practice-based evidence—Findings from routine clinical settings. In M. Barkham, W. Lutz, & L. G. Castonguay (Eds.), Bergin and Garfield’s handbook of psychotherapy and behavior change: 50th anniversary edition (7th ed., pp. 121–222). Wiley.
Cohen, Z. D., Delgadillo, J., & DeRubeis, R. (2021). Personalized Treatment Approaches. In M. Barkham, W. Lutz, & L. G. Castonguay (Eds.), Bergin and Garfield’s handbook of psychotherapy and behavior change: 50th anniversary edition (7th ed., pp. 673–704). Wiley.
Cohen, Z. D., & DeRubeis, R. J. (2018). Treatment selection in depression. Annual Review of Clinical Psychology, 14(1), 209–236. https://doi.org/10.1146/annurev-clinpsy-050817-084746
Constantino, M. J., Boswell, J. F., Coyne, A. E., Swales, T. P., & Kraus, D. R. (2021). Effect of matching therapists to patients vs assignment as usual on adult psychotherapy outcomes: A randomized clinical trial. JAMA Psychiatry, 78(9), 960. https://doi.org/10.1001/jamapsychiatry.2021.1221
de Jong, K. (2016). Challenges in the implementation of measurement feedback systems. Administration and Policy in Mental Health and Mental Health Services Research, 43(3), 467–470. https://doi.org/10.1007/s10488-015-0697-y
de Jong, K., Conijn, J. M., Gallagher, R. A. V., Reshetnikova, A. S., Heij, M., & Lutz, M. C. (2021). Using progress feedback to improve outcomes and reduce drop-out, treatment duration, and deterioration: A multilevel meta-analysis. Clinical Psychology Review, 85, 102002. https://doi.org/10.1016/j.cpr.2021.102002
de Jong, K., & de Goede, M. (2015). Why do some therapists not deal with outcome monitoring feedback? A feasibility study on the effect of regulatory focus and person–organization fit on attitude and outcome. Psychotherapy Research, 25(6), 661–668. https://doi.org/10.1080/10503307.2015.1076198
Delgadillo, J., de Jong, K., Lucock, M., Lutz, W., Rubel, J., Gilbody, S., Ali, S., Aguirre, E., Appleton, M., Nevin, J., O’Hayon, H., Patel, U., Sainty, A., Spencer, P., & McMillan, D. (2018). Feedback-informed treatment versus usual psychological treatment for depression and anxiety: A multisite, open-label, cluster randomised controlled trial. The Lancet Psychiatry, 5(7), 564–572. https://doi.org/10.1016/S2215-0366(18)30162-7
Derogatis, L. R. (1994). SCL-90-R: symptom checklist-90-R: administration, scoring & procedures manual. National Computer Systems.
Derogatis, L. R., & Melisaratos, N. (1983). The brief symptom inventory: An introductory report. Psychological Medicine, 13(3), 595–605. https://doi.org/10.1017/S0033291700048017
Douglas, S., Button, S., & Casey, S. E. (2016). Implementing for sustainability: Promoting use of a measurement feedback system for innovation and quality improvement. Administration and Policy in Mental Health and Mental Health Services Research, 43(3), 286–291. https://doi.org/10.1007/s10488-014-0607-8
Dumont, F. (1993). Inferential heuristics in clinical problem formulation: Selective review of their strengths and weaknesses. Professional Psychology: Research and Practice, 24(2), 196–205. https://doi.org/10.1037/0735-7028.24.2.196
Eells, T. D. (2015). Psychotherapy case formulation. American Psychological Association. https://doi.org/10.1037/14667-000
Eells, T. D. (2022). History and current status of psychotherapy case formulation. In T. D. Eells (Ed.), Handbook of psychotherapy case formulation (3rd ed., pp. 1–35). The Guildford Press.
Elliott, R. (Ed.). (2004). Learning emotion-focused therapy: The process-experiential approach to change (1st ed.). American Psychological Association.
Emmelkamp, P. M. G., Bouman, T. K., & Blaauw, E. (1994). Individualized versus standardized therapy: A comparative evaluation with obsessive-compulsive patients. Clinical Psychology & Psychotherapy, 1(2), 95–100. https://doi.org/10.1002/cpp.5640010206
Eubanks, C. F., & Goldfried, M. R. (2019). A principle-based approach to psychotherapy integration. In J. C. Norcross, & M. R. Goldfried (Eds.), Handbook of Psychotherapy Integration (pp. 88–104). Oxford University Press. https://doi.org/10.1093/med-psych/9780190690465.003.0004
Eubanks, C. F., Samstag, L. W., & Muran, J. C. (2023). Rupture and repair in psychotherapy: A critical process for change. American Psychological Association.
Flinn, L., Braham, L., & das Nair, R. (2015). How reliable are case formulations? A systematic literature review. British Journal of Clinical Psychology, 54(3), 266–290. https://doi.org/10.1111/bjc.12073
Frank, E., & Levenson, J. C. (2011). Interpersonal psychotherapy (1st ed.). American Psychological Association.
Franke, G. H. (2000). Brief symptom inventory (BSI) Deutsche version. Beltz Test GmbH.
Friedlander, M. L., Heatherington, L., & Diamond, G. D. (2021). Systemic and conjoint couple and family therapies: recent advances and future promise. In M. Barkham, W. Lutz, & L. G. Castonguay (Eds.), Bergin and Garfield’s handbook of psychotherapy and behavior change: 50th anniversary edition (7th ed., pp. 539–582). Wiley.
Garb, H. N. (1998). Studying the clinician: Judgment research and psychological assessment. American Psychological Association.
Gilbody, S. M., House, A. O., & Sheldon, T. A. (2002). Psychiatrists in the UK do not use outcomes measures: National survey. British Journal of Psychiatry, 180(2), 101–103. https://doi.org/10.1192/bjp.180.2.101
Grawe, K. (1997). Research-informed psychotherapy. Psychotherapy Research, 7(1), 1–19. https://doi.org/10.1080/10503309712331331843
Grawe, K. (2002). Psychological therapy. Hogrefe & Huber Publishers.
Harper, D., & Moss, D. (2003). A different kind of chemistry? Reformulating ‘formulation’. Clinical Psychology, 23, 6–10.
Hayes, S. C., & Hofmann, S. G. (2018). Process-based CBT: The science and core clinical competencies of cognitive behavioral therapy. New Harbinger Publications.
Health & Care Professions Council. (2015). Standards of proficiency – Practitioner psychologists. Health & Care Professions Council.
Hehlmann, M. I., Schwartz, B., Lutz, T., Gómez Penedo, J. M., Rubel, J. A., & Lutz, W. (2021). The use of digitally assessed stress levels to model change processes in CBT - A feasibility study on seven case examples. Frontiers in Psychiatry, 12, 613085. https://doi.org/10.3389/fpsyt.2021.613085
Horowitz, L. M., Rosenberg, S. E., Baer, B. A., Ureño, G., & Villaseñor, V. S. (1988). Inventory of interpersonal problems: Psychometric properties and clinical applications. Journal of Consulting and Clinical Psychology, 56(6), 885–892. https://doi.org/10.1037/0022-006X.56.6.885
Jacobson, N. S., Schmaling, K. B., Holtzworth-Munroe, A., Katt, J. L., Wood, L. F., & Follette, V. M. (1989). Research-structured vs clinically flexible versions of social learning-based marital therapy. Behaviour Research and Therapy, 27(2), 173–180. https://doi.org/10.1016/0005-7967(89)90076-4
Johnstone, L., & Dallos, R. (2014). Formulation in psychology and psychotherapy: Making sense of people’s problems (2nd ed.). Routledge.
Kahneman, D. (2013). Thinking, fast and slow (1st ed.). Farrar, Straus, and Giroux.
Kroenke, K., Spitzer, R. L., & Williams, J. B. W. (2001). The PHQ-9: Validity of a brief depression severity measure. Journal of General Internal Medicine, 16(9), 606–613. https://doi.org/10.1046/j.1525-1497.2001.016009606.x
Lambert, M. J., Whipple, J. L., Hawkins, E. J., Vermeersch, D. A., Nielsen, S. L., & Smart, D. W. (2003). Is it time for clinicians to routinely track patient outcome? A meta-analysis. Clinical Psychology: Science and Practice, 10(3), 288–301. https://doi.org/10.1093/clipsy.bpg025
Leary, T. (1957). Interpersonal Diagnosis of Personality. Ronald.
Löwe, B., Spitzer, R. L., Zipfel, S., & Herzog, W. (2002). PRIME MD Patient Health Questionnaire (PHQ)—German version manual and materials (2nd ed.). Pfizer.
Lutz, W. (2022). Data-Informed Advances and Technology Augmentation. Cognitive and Behavioral Practice, 29(3), 591-597. https://doi.org/10.1016/j.cbpra.2022.02.008
Lutz, W., de Jong, Ki., Rubel, J. A., & Delgadillo, J. (2021a). Measuring, Predicting, and Tracking Change in Psychotherapy. In M. Barkham, W. Lutz, & L. G. Castonguay (Eds.), Bergin and Garfield’s handbook of psychotherapy and behavior change: 50th anniversary edition (7th ed., pp. 89–134). Wiley.
Lutz, W., Deisenhofer, A.-K., Rubel, J., Bennemann, B., Giesemann, J., Poster, K., & Schwartz, B. (2021b). Prospective evaluation of a clinical decision support system in psychological therapy. Journal of Consulting and Clinical Psychology, 90(1), 90-106. https://doi.org/10.1037/ccp0000642
Lutz, W., Deisenhofer, A.-K., Weinmann-Lutz, B., & Barkham, M. (in press). Data-informed Clinical Training and Practice. In L. G. Castonguay, & C. E. Hill (Eds.), Training in psychotherapy: Learning, improving, and supervising therapeutic skills. American Psychological Association.
Lutz, W., Rubel, J. A., Schwartz, B., Schilling, V., & Deisenhofer, A.-K. (2019). Towards integrating personalized feedback research into clinical practice: Development of the Trier Treatment Navigator (TTN). Behaviour Research and Therapy, 120, 103438. https://doi.org/10.1016/j.brat.2019.103438
Lutz, W., Rubel, J., Deisenhofer, A., & Moggia, D. (2022a). Continuous outcome measurement in modern data‐informed psychotherapies. World Psychiatry, 21(2), 215–216. https://doi.org/10.1002/wps.20988
Lutz, W., & Schwartz, B. (2021). Trans‐theoretical clinical models and the implementation of precision mental health care. World Psychiatry, 20(3), 380–381. https://doi.org/10.1002/wps.20888
Lutz, W., Schwartz, B., & Delgadillo, J. (2022b). Measurement-Based and Data-Informed Psychological Therapy. Annual Review of Clinical Psychology, 18(1), annurev-clinpsy-071720-014821. https://doi.org/10.1146/annurev-clinpsy-071720-014821
Lutz, W., Schwartz, B., Martín Gómez Penedo, J., Boyle, K., & Deisenhofer, A.-K. (2020). Working Towards the Development and Implementation of Precision Mental Healthcare: An Example. Administration and Policy in Mental Health and Mental Health Services Research, 47(5), 856–861. https://doi.org/10.1007/s10488-020-01053-y
McAleavey, A. A., Nordberg, S. S., & Moltu, C. (2021). Initial quantitative development of the Norse Feedback system: A novel clinical feedback system for routine mental healthcare. Quality of Life Research, 30(11), 3097–3115. https://doi.org/10.1007/s11136-021-02825-1
Meehl, P. E. (1973). Why I do not attend case conferences. In P. E. Meehl (Ed.), Psychodiagnosis: Selected Papers (pp. 225–302). University of Minneapolis Press.
Miller, S. D., Duncan, B. L., Sorrell, R., & Brown, G. S. (2005). The partners for change outcome management system. Journal of Clinical Psychology, 61(2), 199–208. https://doi.org/10.1002/jclp.20111
Miller, W. R., & Rollnick, S. (2013). Motivational interviewing: Helping people change (3rd ed.). Guilford Press.
Moggia, D. (2017). El modelo constructivista integrativo: Una nueva propuesta [The constructivist integrative model: A new proposal]. Revista de Psicoterapia, 28(108), 125–147. https://doi.org/10.33898/rdp.v28i108.205
Moggia, D., Niño-Robles, N., Miller, S. D., & Feixas, G. (2021). Psychometric properties of the session rating scale 3.0 in a Spanish clinical sample. British Journal of Guidance & Counselling, 49(5), 648–659. https://doi.org/10.1080/03069885.2020.1778635
Müller, V. N. L. S., Boyle, K., Zimmerman, D., Weinmann-Lutz, B., Rubel, J. A., & Lutz, W. (2018). What is individually tailored mental health care? Revista Argentina de Clinica Psicológica, 27(2), 157-169.
Mütze, K., Witthöft, M., Lutz, W., & Bräscher, A.-K. (2022). Matching research and practice: Prediction of individual patient progress and dropout risk for basic routine outcome monitoring. Psychotherapy Research, 32(3), 358–371. https://doi.org/10.1080/10503307.2021.1930244
Nelson-Gray, R. O. (2003). Treatment utility of psychological assessment. Psychological Assessment, 15(4), 521–531. https://doi.org/10.1037/1040-3590.15.4.521
Papayianni, F., & Cooper, M. (2018). Metatherapeutic communication: An exploratory analysis of therapist-reported moments of dialogue regarding the nature of the therapeutic work. British Journal of Guidance & Counselling, 46(2), 173–184. https://doi.org/10.1080/03069885.2017.1305098
Persons, J. B., & Hong, J. J. (2016). Case formulation and the outcome of cognitive behavior therapy. In N. Tarrier, & J. Johnson (Eds.), Case formulation in cognitive behaviour therapy (2nd ed., pp. 14–37). Routledge.
Schaffrath, J., Weinmann‐Lutz, B., & Lutz, W. (2022). The trier treatment navigator (TTN) in action: Clinical case study on data‐informed psychological therapy. Journal of Clinical Psychology, 78(10), 2016–2028. https://doi.org/10.1002/jclp.23362
Scholten, S., Lischetzke, T., & Glombiewski, J. A. (2022). Integrating theory-based and data-driven methods to case conceptualization: A functional analysis approach with ecological momentary assessment. Psychotherapy Research, 32(1), 52–64. https://doi.org/10.1080/10503307.2021.1916639
Schulte, D., Künzel, R., Pepping, G., & Schulte-Bahrenberg, T. (1992). Tailor-made versus standardized therapy of phobic patients. Advances in Behaviour Research and Therapy, 14(2), 67–92. https://doi.org/10.1016/0146-6402(92)90001-5
Stanovich, K. E. (2009). What intelligence tests miss: The psychology of rational thought. Yale Univ. Press.
Sutton, R. T., Pincock, D., Baumgart, D. C., Sadowski, D. C., Fedorak, R. N., & Kroeker, K. I. (2020). An overview of clinical decision support systems: Benefits, risks, and strategies for success. Npj Digital Medicine, 3(1), 17. https://doi.org/10.1038/s41746-020-0221-y
Thomas, A., Brähler, E., & Strauß, B. (2011). IIP-32: Entwicklung, validierung und normierung einer kurzform des inventars zur erfassung interpersonaler probleme [IP-32: Development, validation and standardization of a short form of the inventory for recording interpersonal problems]. Diagnostica, 57(2), 68–83. https://doi.org/10.1026/0012-1924/a000034
Downloads
Published
How to Cite
Issue
Section
License
Copyright (c) 2022 Revista de Psicoterapia
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
