TY - THES
A1 - Ay-Bryson, Destina Sevde
T1 - The authenticity of simulated patients in psychotherapy training and research
T1 - Die Authentizität von Simulationspatienten in der Psychotherapieausbildung und -forschung
N2 - Mental health problems are highly prevalent worldwide. Fortunately, psychotherapy has proven highly effective in the treatment of a number of mental health issues, such as depression and anxiety disorders. In contrast, psychotherapy training as is practised currently cannot be considered evidence-based. Thus, there is much room for improvement. The integration of simulated patients (SPs) into psychotherapy training and research is on the rise. SPs originate from the medical education and have, in a number of studies, been demonstrated to contribute to effective learning environments. Nevertheless, there has been voiced criticism regarding the authenticity of SP portrayals, but few studies have examined this to date.
Based on these considerations, this dissertation explores SPs’ authenticity while portraying a mental disorder, depression. Altogether, the present cumulative dissertation consists of three empirical papers. At the time of printing, Paper I and Paper III have been accepted for publication, and Paper II is under review after a minor revision.
First, Paper I develops and validates an observer-based rating-scale to assess SP authenticity in psychotherapeutic contexts. Based on the preliminary findings, it can be concluded that the Authenticity of Patient Demonstrations scale is a reliable and valid tool that can be used for recruiting, training, and evaluating the authenticity of SPs.
Second, Paper II tests whether student SPs are perceived as more authentic after they receive an in-depth role-script compared to those SPs who only receive basic information on the patient case. To test this assumption, a randomised controlled study design was implemented and the hypothesis could be confirmed. As a consequence, when engaging SPs, an in-depth role-script with details, e.g. on nonverbal behaviour and feelings of the patient, should be provided.
Third, Paper III demonstrates that psychotherapy trainees cannot distinguish between trained SPs and real patients and therefore suggests that, with proper training, SPs are a promising training method for psychotherapy.
Altogether, the dissertation shows that SPs can be trained to portray a depressive patient authentically and thus delivers promising evidence for the further dissemination of SPs.
N2 - Psychotherapie gilt als hoch wirksame Behandlung von psychischen Störungen, wie Depressionen oder Angststörungen. Trotz verpflichtender Psychotherapieausbildung zur Befähigung psychotherapeutischer Behandlungen gibt es wenig Evidenz, welche Methoden dem effektiven Training von angehenden Psychotherapeut*innen dienen. Eine Lösung besteht im Einsatz von Simulationspatient*innen (SPs) in der Psychotherapieausbildung sowie -forschung als nachweislich effektive Lehrmethode. Dabei werden jedoch SPs für ihren Mangel an Authentizität kritisiert, wobei ungenügend Studien diesen Aspekt direkt untersuchten.
Daher war es Ziel der vorliegenden Dissertation, die Authentizität von SPs, während sie eine psychische Störung (d.h. Depression) simulieren, zu untersuchen. Die vorliegende kumulative Dissertation basiert auf drei empirischen Arbeiten. Zum Zeitpunkt der Einreichung der Dissertation wurden Paper I und Paper III nach erfolgreichem Peer-Review in Fachzeitschriften zur Veröffentlichung angenommen, Paper II befindet sich nach einer Minor Revision im Peer-Review.
In Paper I wurde die Skala Authentizität von Patientendarstellungen zur Erfassung von Authentizität von SPs, die psychische Störungen darstellen, entwickelt und validiert. Die Ratingskala weist gute psychometrische Gütekriterien auf und ist für den Einsatz in Forschung und Praxis geeignet.
In Paper II wurde mittels einer randomisiert kontrollierten Studie demonstriert, dass die Ausarbeitung von Rollenanleitungen von SPs für deren Darstellung relevant ist: Studierende, die als SPs fungierten, wurden authentischer wahrgenommen, wenn sie eine detaillierte Rollenanleitung erhielten als jene SPs, die eine einfache Rollenanleitung erhielten.
In Paper III konnte gezeigt werden, dass Psychotherapeut*innen in Ausbildung reale Patient*innen von trainierten SPs nicht unterscheiden konnten. Der Einsatz von SPs ist demzufolge eine vielversprechende Trainingsmethode der Psychotherapie.
Insgesamt stellt die vorliegende Dissertation dar, dass SPs trainiert werden können, Patient*innen mit Depressionen authentisch darzustellen. Die Arbeit liefert erfolgsversprechende Ergebnisse für die weitere Dissemination von SPs im Ausbildungskontext der Psychotherapie.
KW - Simulationspatienten
KW - Ausbildungsforschung
KW - Psychotherapieforschung
KW - Authentizität
KW - standardisierte Patienten
KW - simulated patients
KW - training research
KW - psychotherapy research
KW - authenticity
KW - standardised patients
Y1 - 2021
U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:kobv:517-opus4-533735
ER -
TY - JOUR
A1 - Ay-Bryson, Destina Sevde
A1 - Weck, Florian
A1 - Heinze, Peter Eric
A1 - Lang, Thomas
A1 - Kühne, Franziska
T1 - Can psychotherapy trainees distinguish standardized patients from real patients?
T1 - Können Psychotherapeut*innen in Ausbildung standardisierte Patient*innen von realen Patient*innen unterscheiden?
BT - a pilot study
BT - Ergebnisse einer Pilotstudie
JF - Zeitschrift für Klinische Psychologie und Psychotherapie
N2 - Background:
Under the new psychotherapy law in Germany, standardized patients (SPs) are to become a standard component inpsychotherapy training, even though little is known about their authenticity.Objective:The present pilot study explored whether, followingan exhaustive two-day SP training, psychotherapy trainees can distinguish SPs from real patients.
Methods:
Twenty-eight psychotherapytrainees (M= 28.54 years of age,SD= 3.19) participated as blind raters. They evaluated six video-recorded therapy segments of trained SPsand real patients using the Authenticity of Patient Demonstrations Scale.
Results:
The authenticity scores of real patients and SPs did notdiffer (p= .43). The descriptive results indicated that the highest score of authenticity was given to an SP. Further, the real patients did notdiffer significantly from the SPs concerning perceived impairment (p= .33) and the likelihood of being a real patient (p= .52).
Conclusions:
The current results suggest that psychotherapy trainees were unable to distinguish the SPs from real patients. We therefore stronglyrecommend incorporating training SPs before application. Limitations and future research directions are discussed.
N2 - Theoretischer Hintergrund:
Mit dem neu eingeführten Direktstudium für zukünftige Psychotherapeut_innen (PiA) wirdder Einsatz von standardisierten Patient_innen (SP) in der Lehre zunehmen, obwohl die Authentizität der Rollendarstellungen durch SPempirisch bislang kaum untersucht wurde. Ziel der vorliegenden Studie war es daher zu untersuchen, ob SP trainiert werden können, dassPsychotherapeut_innen in Ausbildung (PiA) SP von realen Patient_innen nicht unterscheiden können.
Methode:
Insgesamt nahmen 28 PiA(M= 28.54 Jahre,SD= 3.19) als verblindete Rater teil. Sie haben sechs Therapiesitzungen von trainierten SP und realen Patient_innen mitder Skala Authentizität von Patientendarstellungen bewertet.
Ergebnisse:
Die Authentizitätswerte von SP unterschieden sich nicht signifi-kant von realen Patient_innen (p= .43). Deskriptive Ergebnisse legen nahe, dass ein SP im Schnitt am authentischsten bewertet wurde.Darüber hinaus unterschieden sich SP und reale Patient_innen nicht hinsichtlich der wahrgenommenen Beeinträchtigung (p= .33) sowie derWahrscheinlichkeit, als reale/r Patient_in bewertet zu werden (p= .52).
Fazit:
Die vorliegenden Ergebnisse legen nahe, dass PiA SP vonrealen Patient_innen nicht unterscheiden konnten. Daher legen wir ein ausführliches Training der SP nahe, bevor sie für Studium und Lehreeingesetzt werden. Die Limitationen sowie zukünftige Forschungsideen werden diskutiert.
KW - evidence-based training
KW - learning
KW - simulated patients
KW - simulation-based
KW - education
KW - therapist competence
KW - evidenzbasiertes Training
KW - Lernen
KW - Simulationspatient_innen
KW - simulationsbasierte Lehre
KW - therapeutische
KW - Kompetenz
Y1 - 2020
U6 - https://doi.org/10.1026/1616-3443/a000594
SN - 1616-3443
SN - 2190-6297
VL - 49
IS - 3
SP - 182
EP - 190
PB - Hogrefe
CY - Göttingen
ER -
TY - JOUR
A1 - Ay-Bryson, Destina Sevde
A1 - Weck, Florian
A1 - Kühne, Franziska
T1 - Can simulated patient encounters appear authentic?
BT - development and pilot results of a rating instrument based on the portrayal of depressive patients
JF - Training and education in professional psychology
N2 - Public Significance Statement This study demonstrates that simulated patients (SPs) can authentically portray a depressive case. The results provide preliminary evidence of psychometrically sound properties of the rating scale that contributes to distinguishing between authentic and unauthentic SPs and may thus foster SPs' dissemination into evidence-based training.
For training purposes, simulated patients (SPs), that is, healthy people portraying a disorder, are disseminating more into clinical psychology and psychotherapy. In the current study, we developed an observer-based rating instrument for the evaluation of SP authenticity-namely, it not being possible to distinguish them from real patients-so as to foster their use in evidence-based training. We applied a multistep inductive approach to develop the Authenticity of Patient Demonstrations (APD) scale. Ninety-seven independent psychotherapy trainees, 77.32% female, mean age of 31.49 (SD = 5.17) years, evaluated the authenticity of 2 independent SPs, each of whom portrayed a depressive patient. The APD demonstrated good internal consistency (Cronbach's alpha = .83) and a strong correlation (r = .82) with an established tool for assessing SP performance in medical contexts. The APD scale distinguished significantly between an authentic and unauthentic SP (d = 2.35). Preliminary evidence for the psychometric properties of the APD indicates that the APD could be a viable tool for recruiting, training, and evaluating the authenticity of SPs. Strengths, limitations, and future directions are also discussed in detail.
KW - authenticity
KW - evidence-based training
KW - standardized patients
KW - role-play
KW - mental disorders
Y1 - 2022
U6 - https://doi.org/10.1037/tep0000349
SN - 1931-3918
SN - 1931-3926
VL - 16
IS - 1
SP - 20
EP - 27
PB - American Psychological Association
CY - Washington
ER -
TY - JOUR
A1 - Kühne, Franziska
A1 - Ay-Bryson, Destina Sevde
A1 - Marschner, Linda
A1 - Weck, Florian
T1 - The heterogeneous course of OCD
BT - a scoping review on the variety of definitions
JF - Psychiatry research : the official publication of the International Society for Neuroimaging in Psychiatry
N2 - Although effective treatments exist, obsessive-compulsive disorder (OCD) is, according to the views of patients and experts, still associated with chronicity, a term with no clear and consistent definition. To improve patient care and to foster research, a clear distinction between the various concepts of chronicity cited in the literature is crucial. The aim was thus to explicate central concepts related to courses and trajectories in OCD based on an explorative, scoping search of the existing literature. Our review revealed a considerable lack in content validity, as the concepts were operationalized inconsistently. Concepts related to symptom improvement were (complete) recovery, partial/full remission and partial/full response. Terms used in relation with symptom stability or worsening were chronic/continuous, intermittent and episodic course, waxing and waning, relapse, recurrence, deterioration and treatment-refractoriness. All concepts are explained and visualized as a result of the review. Further, based on authors' remarks, we present recommendations on how to enhance care for chronic OCD patients, namely training psychotherapists to apply CBT as intended, managing patient beliefs about disease and treatment, and adapting psychotherapy to OCD subtypes. Finally, we then propose a literature-based definition of treatment-refractory OCD.
KW - review
KW - OCD
KW - anxiety disorder
KW - prevention
KW - treatment response
KW - non-response
Y1 - 2020
U6 - https://doi.org/10.1016/j.psychres.2020.112821
SN - 0165-1781
SN - 1872-7123
VL - 285
PB - Elsevier
CY - Clare
ER -
TY - GEN
A1 - Maaß, Ulrike
A1 - Kühne, Franziska
A1 - Heinze, Peter Eric
A1 - Ay-Bryson, Destina Sevde
A1 - Weck, Florian
T1 - The concise measurement of clinical communication skills
BT - Validation of a short scale
T2 - Zweitveröffentlichungen der Universität Potsdam : Humanwissenschaftliche Reihe
N2 - Objective: There is a lack of brief rating scales for the reliable assessment of psychotherapeutic skills, which do not require intensive rater training and/or a high level of expertise. Thus, the objective is to validate a 14-item version of the Clinical Communication Skills Scale (CCSS-S).
Methods: Using a sample of N = 690 video-based ratings of role-plays with simulated patients, we calculated a confirmatory factor analysis and an exploratory structural equation modeling (ESEM), assessed convergent validities, determined inter-rater reliabilities and compared these with those who were either psychology students, advanced psychotherapy trainees, or experts.
Results: Correlations with other competence rating scales were high (rs > 0.86–0.89). The intraclass correlations ranged between moderate and good [ICC(2,2) = 0.65–0.80], with student raters yielding the lowest scores. The one-factor model only marginally replicated the data, but the internal consistencies were excellent (α = 0.91–95). The ESEM yielded a two-factor solution (Collaboration and Structuring and Exploration Skills).
Conclusion: The CCSS-S is a brief and valid rating scale that reliably assesses basic communication skills, which is particularly useful for psychotherapy training using standardized role-plays. To ensure good inter-rater reliabilities, it is still advisable to employ raters with at least some clinical experience. Future studies should further investigate the one- or two-factor structure of the instrument.
T3 - Zweitveröffentlichungen der Universität Potsdam : Humanwissenschaftliche Reihe - 820
KW - standardized patient
KW - treatment integrity
KW - measurement
KW - therapist competence
KW - role-play
KW - psychotherapy process
Y1 - 2023
U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:kobv:517-opus4-582642
SN - 1866-8364
IS - 820
ER -
TY - JOUR
A1 - Maaß, Ulrike
A1 - Kühne, Franziska
A1 - Heinze, Peter Eric
A1 - Ay-Bryson, Destina Sevde
A1 - Weck, Florian
T1 - The concise measurement of clinical communication skills
BT - Validation of a short scale
JF - Frontiers in Psychiatry
N2 - Objective: There is a lack of brief rating scales for the reliable assessment of psychotherapeutic skills, which do not require intensive rater training and/or a high level of expertise. Thus, the objective is to validate a 14-item version of the Clinical Communication Skills Scale (CCSS-S).
Methods: Using a sample of N = 690 video-based ratings of role-plays with simulated patients, we calculated a confirmatory factor analysis and an exploratory structural equation modeling (ESEM), assessed convergent validities, determined inter-rater reliabilities and compared these with those who were either psychology students, advanced psychotherapy trainees, or experts.
Results: Correlations with other competence rating scales were high (rs > 0.86–0.89). The intraclass correlations ranged between moderate and good [ICC(2,2) = 0.65–0.80], with student raters yielding the lowest scores. The one-factor model only marginally replicated the data, but the internal consistencies were excellent (α = 0.91–95). The ESEM yielded a two-factor solution (Collaboration and Structuring and Exploration Skills).
Conclusion: The CCSS-S is a brief and valid rating scale that reliably assesses basic communication skills, which is particularly useful for psychotherapy training using standardized role-plays. To ensure good inter-rater reliabilities, it is still advisable to employ raters with at least some clinical experience. Future studies should further investigate the one- or two-factor structure of the instrument.
KW - standardized patient
KW - treatment integrity
KW - measurement
KW - therapist competence
KW - role-play
KW - psychotherapy process
Y1 - 2022
U6 - https://doi.org/10.3389/fpsyt.2022.977324
SN - 1664-0640
VL - 13
PB - Frontiers
CY - Lausanne, Schweiz
ER -
TY - JOUR
A1 - Maaß, Ulrike
A1 - Kühne, Franziska
A1 - Poltz, Nadine
A1 - Lorenz, Anna
A1 - Ay-Bryson, Destina Sevde
A1 - Weck, Florian
T1 - Live supervision in psychotherapy training
BT - a systematic review
JF - Training and education in professional psychology
N2 - There is increasing interest in improving psychotherapy training using evidence-based supervision. One approach is live supervision (LS), in which the supervisor offers immediate feedback to the trainee (e.g., via microphone, text messages) during the session. This review summarizes the research on LS and its main results. The databases Web of Science Core Collection, PsycArticles, PsycBooks, PsycInfo, PSYNDEX, Psychology and Behavioral Sciences Collection, and PubMed were searched from inception to January 23, 2020 (including a backward search) and updated November 15, 2020. The inclusion criteria (i.e., main focus on LS, immediate feedback from a present supervisor, psychological setting) were met by k = 138 publications, including k = 8 randomized controlled trials (RCTs; N = 339). Two reviewers independently evaluated the RCTs' risk of bias using the revised Cochrane Risk-of-Bias Tool. Most publications had a family therapy background (59%), were categorized as nonempirical (55%), aimed primarily at describing or comparing specific LS methods (35%), and displayed positive views on LS (87%). Based on the RCTs, LS was superior to no-supervision in 78% of all comparisons, but only in 13% of the cases compared to a delayed supervision (DS) condition (i.e., regarding trainee skills, patient outcomes, or other variables). These results somewhat contradict the overall favorable views in the literature. However, the generalizability is limited due to a lack of high-quality studies and substantial heterogeneity in terms of LS methods, concepts, outcomes, and measurements. Ideas for more systematic research on LS regarding objectives and methods are proposed.
Public Significance Statement This review summarizes research on live supervision (LS). LS is a form of supervision in psychotherapy training in which the supervisor observes the trainee's therapy session and provides immediate feedback. The review concludes that LS is probably as effective as delayed supervision (DS), although more high-quality research is needed.
KW - psychotherapy
KW - feedback
KW - bug-in-the-eye
KW - training
KW - therapist competence
Y1 - 2022
U6 - https://doi.org/10.1037/tep0000390
SN - 1931-3918
SN - 1931-3926
VL - 16
IS - 2
SP - 130
EP - 142
PB - American Psychological Association
CY - Washington
ER -