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We evaluated the effectiveness and acceptability of metacognitive interventions for mental disorders. We searched electronic databases and included randomized and nonrandomized controlled trials comparing metacognitive interventions with other treatments in adults with mental disorders. Primary effectiveness and acceptability outcomes were symptom severity and dropout, respectively. We performed random-effects meta-analyses. We identified Metacognitive Training (MCTrain), Metacognitive Therapy (MCTherap), and Metacognition Reflection and Insight Therapy (MERIT). We included 49 trials with 2,609 patients. In patients with schizophrenia, MCTrain was more effective than a psychological treatment (cognitive remediation, SMD = -0.39). It bordered significance when compared with standard or other psychological treatments. In a post hoc analysis, across all studies, the pooled effect was significant (SMD = -0.31). MCTrain was more effective than standard treatment in patients with obsessive-compulsive disorder (SMD = -0.40). MCTherap was more effective than a waitlist in patients with depression (SMD = -2.80), posttraumatic stress disorder (SMD = -2.36), and psychological treatments (cognitive-behavioural) in patients with anxiety (SMD = -0.46). In patients with depression, MCTherap was not superior to psychological treatment (cognitive-behavioural). For MERIT, the database was too small to allow solid conclusions. Acceptability of metacognitive interventions among patients was high on average. Methodological quality was mostly unclear or moderate. Metacognitive interventions are likely to be effective in alleviating symptom severity in mental disorders. Although their add-on value against existing psychological interventions awaits to be established, potential advantages are their low threshold and economy.
While metacognitive interventions are gaining attention in the treatment of various mental disorders, a review of the literature showed that the term is often defined poorly and used for a variety of psychotherapeutic approaches that do not necessarily pursue the same goal. We give a summary of three metacognitive interventions which were developed within a sound theoretical framework-metacognitive therapy, metacognitive training, and metacognitively-oriented integrative psychotherapies-and discuss their similarities and distinctive features. We then offer an integrative operational definition of metacognitive interventions as goal-oriented treatments that target metacognitive content, which is characterized by the awareness and understanding of one's own thoughts and feelings as well as the thoughts and feelings of others. They aim to alleviate disorder-specific and individual symptoms by gaining more flexibility in cognitive processing.
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. <br /> 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.
This study examined the effectiveness of psychological interventions for severe health anxiety (SHA) regarding somatic symptoms (SS) and health anxiety (HA). The databases Web of Science, EBSCO, and CENTRAL were searched on May 15, 2019, May 16, 2019, and August 5, 2019, respectively. Eighteen randomized controlled trials (N = 2,050) met the inclusion criteria (i.e., hypochondriasis, illness anxiety disorder or somatic symptom disorder with elevated HA being assessed with validated interviews: use of standardized outcome measures). Two reviewers independently evaluated the studies' risk of bias using the Revised Cochrane Risk-of-Bias Tool for randomized trials (RoB-2) tool. Overall, psychological interventions were significantly more effective than waitlist, treatment-as-usual, or placebo post-treatment (g(SS) = 0.70, g(HA) = 1.11) and at follow-up (g(SS) = 0.33, g(HA)= 0.70). CBT outperformed other psychological interventions or pharmacotherapy for HA post- treatment (Hedge's g(HA) = 0.81). The number of sessions did not significantly predict the effect sizes. In sum, psychological interventions were effective for SHA, but the generalizability of the results for SS is limited, because only two high-quatity trials contributed to the comparison.
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.
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.
Background
Despite the prevalence of obsessive-compulsive disorder (OCD), its precise identification remains challenging. With the Zohar-Fineberg Obsessive-Compulsive Screen (ZF-OCS; 5 or 6 items), a brief instrument is widely available mainly in English. As there is a lack of empirical studies on the ZF-OCS, the aim of the present study was to translate the items into German and investigate the instrument in a nonclinical sample.
Methods
In two consecutive online surveys, n = 304 and n = 51 students participated. Besides the ZF-OCS, they answered established measures on OCD, depression, health anxiety, general anxiety and health-related well-being.
Results
Whereas internal consistency was low (α = .53–.72; ω = .55–.69), retest reliability (rt1,t2 = .89) at two weeks was high. As expected, we found high correlations with other OCD instruments (r > .61; convergent validity), and significantly weaker correlations with measures of depression (r = .39), health anxiety (r = .29), and health-related well-being (r = −.28, divergent validity). Nonetheless, the correlations with general anxiety were somewhere in between (r = .52).
Conclusions
Due to heterogeneous OCD subtypes, the ZF-OCS asks diverse questions which probably resulted in the present internal consistency. Nevertheless, the results on retest reliability and validity were promising. As for other OCD instruments, divergent validity regarding general anxiety seems problematic to establish. Even so, the ZF-OCS seems valuable for screening purposes, as it is short and easy to administer, and may facilitate initiating subsequent clinical assessment. Further studies should determine the instrument’s diagnostic accuracy.
Background
Despite the prevalence of obsessive-compulsive disorder (OCD), its precise identification remains challenging. With the Zohar-Fineberg Obsessive-Compulsive Screen (ZF-OCS; 5 or 6 items), a brief instrument is widely available mainly in English. As there is a lack of empirical studies on the ZF-OCS, the aim of the present study was to translate the items into German and investigate the instrument in a nonclinical sample.
Methods
In two consecutive online surveys, n = 304 and n = 51 students participated. Besides the ZF-OCS, they answered established measures on OCD, depression, health anxiety, general anxiety and health-related well-being.
Results
Whereas internal consistency was low (α = .53–.72; ω = .55–.69), retest reliability (rt1,t2 = .89) at two weeks was high. As expected, we found high correlations with other OCD instruments (r > .61; convergent validity), and significantly weaker correlations with measures of depression (r = .39), health anxiety (r = .29), and health-related well-being (r = −.28, divergent validity). Nonetheless, the correlations with general anxiety were somewhere in between (r = .52).
Conclusions
Due to heterogeneous OCD subtypes, the ZF-OCS asks diverse questions which probably resulted in the present internal consistency. Nevertheless, the results on retest reliability and validity were promising. As for other OCD instruments, divergent validity regarding general anxiety seems problematic to establish. Even so, the ZF-OCS seems valuable for screening purposes, as it is short and easy to administer, and may facilitate initiating subsequent clinical assessment. Further studies should determine the instrument’s diagnostic accuracy.
Assessments of psychotherapeutic competencies play a crucial role in research and training. However, research on the reliability and validity of such assessments is sparse. This study aimed to provide an overview of the current evidence and to provide an average interrater reliability (IRR) of psychotherapeutic competence ratings. A systematic review was conducted, and 20 studies reported in 32 publications were collected. These 20 studies were included in a narrative synthesis, and 20 coefficients were entered into the meta-analysis. Most primary studies referred to cognitive-behavioral therapies and the treatment of depression, used the Cognitive Therapy Scale, based ratings on videos, and trained the raters. Our meta-analysis revealed a pooled ICC of 0.82, but at the same time severe heterogeneity. The evidence map highlighted a variety of variables related to competence assessments. Further aspects influencing the reliability of competence ratings and regarding the considerable heterogeneity are discussed in detail throughout the manuscript.
Background: Although clinical supervision is considered to be a major component of the development and maintenance of psychotherapeutic competencies, and despite an increase in supervision research, the empirical evidence on the topic remains sparse.
Methods: Because most previous reviews lack methodological rigor, we aimed to review the status and quality of the empirical literature on clinical supervision, and to provide suggestions for future research. MEDLINE, PsycInfo and the Web of Science Core Collection were searched and the review was conducted according to current guidelines. From the review results, we derived suggestions for future research on clinical supervision.
Results: The systematic literature search identified 19 publications from 15 empirical studies. Taking into account the review results, the following suggestions for further research emerged: Supervision research would benefit from proper descriptions of how studies are conducted according to current guidelines, more methodologically rigorous empirical studies, the investigation of active supervision interventions, from taking diverse outcome domains into account, and from investigating supervision from a meta-theoretical perspective.
Conclusions: In all, the systematic review supported the notion that supervision research often lags behind psychotherapy research in general. Still, the results offer detailed starting points for further supervision research.