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Background: Oxytocin, popularly known as the "social hormone", has wide implications for the regulation of socially relevant cognitions, emotions and behaviors. Individual differences in oxytocin may be relevant to mental health treatment outcomes, given the centrality of the therapeutic relationship in psychotherapy., Methods: This systematic review aimed to synthesize findings from psychotherapy studies that examined oxytocin measurement and augmentation methods and their association with treatment outcomes. The methodology was preregistered in the Open Science Framework (https://osf.io/xtyvc/?view_only=2bc37dc0b2cd41f8939e2964bd8b884f). Five databases were searched on 30th of March 2023 (PubMed, SCOPUS, Web of Science, Medline, PsycINFO). Eligible studies were assessed for risk of bias and findings were summarized using narrative synthesis and vote counting methods., Results: Overall, 24 studies (n=881 participants) including experimental and observational designs and covering various diagnostic groups were reviewed. Findings from 9 studies (n=406) indicate that oxytocin measures were associated with psychotherapy treatment outcomes for depression, and oxytocin-augmentation improved depression outcomes. Results regarding other mental disorders were mixed and inconclusive., Discussion: Current evidence indicates that oxytocin-augmented psychotherapy for depression warrants further research. Currently there is not sufficient evidence to draw firm conclusions regarding the clinical relevance of oxytocin in the context of other disorders. Key limitations are the lack of meta-analytic synthesis and small sample sizes for primary studies., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Background: Relapse of depression is common and contributes to the overall associated morbidity and burden. We lack evidence-based tools to estimate an individual's risk of relapse after treatment in primary care, which may help us more effectively target relapse prevention., Objective: The objective was to develop and validate a prognostic model to predict risk of relapse of depression in primary care., Methods: Multilevel logistic regression models were developed, using individual participant data from seven primary care-based studies (n=1244), to predict relapse of depression. The model was internally validated using bootstrapping, and generalisability was explored using internal-external cross-validation., Findings: Residual depressive symptoms (OR: 1.13 (95% CI: 1.07 to 1.20), p<0.001) and baseline depression severity (OR: 1.07 (1.04 to 1.11), p<0.001) were associated with relapse. The validated model had low discrimination (C-statistic 0.60 (0.55-0.65)) and miscalibration concerns (calibration slope 0.81 (0.31-1.31)). On secondary analysis, being in a relationship was associated with reduced risk of relapse (OR: 0.43 (0.28-0.67), p<0.001); this remained statistically significant after correction for multiple significance testing., Conclusions: We could not predict risk of depression relapse with sufficient accuracy in primary care data, using routinely recorded measures. Relationship status warrants further research to explore its role as a prognostic factor for relapse., Clinical Implications: Until we can accurately stratify patients according to risk of relapse, a universal approach to relapse prevention may be most beneficial, either during acute-phase treatment or post remission. Where possible, this could be guided by the presence or absence of known prognostic factors (eg, residual depressive symptoms) and targeted towards these., Trial Registration Number: NCT04666662., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY-NC. Published by BMJ.)

Objective: We used longitudinal youth- and caregiver-reports of adolescent psychological symptoms from three samples of youth receiving mental health services in routine treatment settings to derive expected change trajectories and identify cases at risk for treatment failure., Method: Participants were 1906 youth (1053 caregivers) receiving treatment in community mental health settings, merged across three samples. The Symptoms and Functioning Severity Scale (SFSS) was used as an indicator of weekly clinical change. Multilevel modeling methods were used to develop expected change trajectories and identify cases at risk for treatment failure (not on track; NOT). Logistic regression was used to predict client improvement as a function of NOT status., Results: The SFSS was a reliable indicator of therapeutic change according to youth-reported symptoms. Caregiver reports were not as robust. Whereas predictive accuracy of NOT status yielded moderately high sensitivity in detecting improvement according to youth report, caregiver reports were not as predictive., Conclusions: The youth-reported version of the SFSS-based algorithm seems appropriate for implementation in clinical care. Future studies should search for similarly predictive measures for caregivers.

Objective: To test the predictive accuracy and generalisability of a personalised advantage index (PAI) model designed to support treatment selection for Post-Traumatic Stress Disorder (PTSD)., Method: A PAI model developed by Deisenhofer et al. (2018) was used to predict treatment outcomes in a statistically independent dataset including archival records for N  = 152 patients with PSTD who accessed either trauma-focussed cognitive behavioural therapy or eye movement desensitisation and reprocessing in routine care. Outcomes were compared between patients who received their PAI-indicated optimal treatment versus those who received their suboptimal treatment., Results: The model did not yield treatment specific predictions and patients who had received their PAI-indicated optimal treatment did not have better treatment outcomes in this external validation sample., Conclusion: This PAI model did not generalise to an external validation sample.

Sexually hyperactive bucks are more efficient than sexually hypoactive bucks in stimulating testosterone secretion and sexual behaviour in other bucks in seasonal sexual rest by the phenomenon that we called the "buck-to-buck effect". Here, we determined whether physical separation and reduction of the duration of contact with the sexually hyperactive bucks would modify those parameters in sexually hypoactive bucks exposed to the "buck-to-buck effect". Bucks were subjected to natural day length throughout the study; this was the sexually hypoactive group. Other bucks were subjected to artificial long days (16 h of light per day) from 15 November to 15 January followed by exposure to natural day length to stimulate their sexual activity during the rest season; this was the sexually hyperactive group. In Experiment 1, we determined testosterone concentrations and sexual behaviour of six sexually hypoactive bucks separated 1.5 m from six sexually hyperactive bucks for 60 days by a metal open work fence, while a control group of six sexually hypoactive bucks was in permanent contact with six sexually hyperactive bucks. In Experiment 2, the duration of contact with sexually hyperactive males was reduced from 31 days (contact group, six bucks) to 10 days (withdraw group, seven bucks). In experiments 1 and 2, there was an effect of time (P < 0.01) and an interaction between time and groups (P < 0.05). In Experiment 1, testosterone plasma concentrations were greater in bucks in contact with sexually hyperactive bucks than in those separated from bucks at 20 and 30 days after the introduction of sexually hyperactive bucks (P < 0.01). The bucks from the contact group also displayed more nudging than bucks from the separated group from 0 to 30 days (P < 0.001). In Experiment 2, testosterone concentrations were greater in the contact group than in those from the withdraw group from 19 to 31 days after the introduction of sexually hyperactive bucks (P < 0.05). Bucks from the withdraw group displayed more nudging than the contact group 7 days after the introduction of the sexually hyperactive bucks (P < 0.05). Afterwards, bucks from the contact group displayed more nudging than the withdraw group 14, 21 and 28 days after the introduction of the sexually hyperactive bucks. We concluded that physical separation and reduction of the duration of contact with the sexually hyperactive bucks decrease testosterone concentrations and sexual behaviour of bucks in sexual rest exposed to the "buck-to-buck effect"., (Copyright © 2024 The Author(s). Published by Elsevier B.V. All rights reserved.)

Background: Depression is one of the most prevalent mental health conditions in the world. However, the heterogeneity of depression has presented obstacles for research concerning disease mechanisms, treatment indication, and personalization. The current study used network analysis to analyze and compare profiles of depressive symptoms present in community samples, considering the relationship between symptoms., Methods: Cross-sectional measures of depression using the Patient Health Questionnaire - 9 items (PHQ-9) were collected from community samples using data from participants scoring above a clinical threshold of ≥10 points (N = 2,023; 73.9% female; mean age 49.87, SD = 17.40). Data analysis followed three steps. First, a profiling algorithm was implemented to identify all possible symptom profiles by dichotomizing each PHQ-9 item. Second, the most prevalent symptom profiles were identified in the sample. Third, network analysis for the most prevalent symptom profiles was carried out to identify the centrality and covariance of symptoms., Results: Of 382 theoretically possible depression profiles, only 167 were present in the sample. Furthermore, 55.6% of the symptom profiles present in the sample were represented by only eight profiles. Network analysis showed that the network and symptoms' relationship varied across the profiles., Conclusions: Findings indicate that the vast number of theoretical possible ways to meet the criteria for major depressive disorder (MDD) is significantly reduced in empirical samples and that the most common profiles of symptoms have different networks and connectivity patterns. Scientific and clinical consequences of these findings are discussed in the context of the limitations of this study.

We face increasing demand for greater access to effective routine mental health services, including telehealth. However, treatment outcomes in routine clinical practice are only about half the size of those reported in controlled trials. Progress feedback, defined as the ongoing monitoring of patients' treatment response with standardized measures, is an evidence-based practice that continues to be under-utilized in routine care. The aim of the current review is to provide a summary of the current evidence base for the use of progress feedback, its mechanisms of action and considerations for successful implementation. We reviewed ten available meta-analyses, which report small to medium overall effect sizes. The results suggest that adding feedback to a wide range of psychological and psychiatric interventions (ranging from primary care to hospitalization and crisis care) tends to enhance the effectiveness of these interventions. The strongest evidence is for patients with common mental health problems compared to those with very severe disorders. Effect sizes for not-on-track cases, a subgroup of cases that are not progressing well, are found to be somewhat stronger, especially when clinical support tools are added to the feedback. Systematic reviews and recent studies suggest potential mechanisms of action for progress feedback include focusing the clinician's attention, altering clinician expectations, providing new information, and enhancing patient-centered communication. Promising approaches to strengthen progress feedback interventions include advanced systems with signaling technology, clinical problem-solving tools, and a broader spectrum of outcome and progress measures. An overview of methodological and implementation challenges is provided, as well as suggestions for addressing these issues in future studies. We conclude that while feedback has modest effects, it is a small and affordable intervention that can potentially improve outcomes in psychological interventions. Further research into mechanisms of action and effective implementation strategies is needed., (© 2024. The Author(s).)

There has been a growing emphasis on dissemination of empirically supported treatments. Dissemination, however, should not be restricted to treatment. It can and, in the spirit of the scientific-practitioner model, should also involve research. Because it focuses on the investigation of clinical routine as it takes place in local settings and because it can involve the collaboration of several stakeholders, practice-oriented research (POR) can be viewed as an optimal research method to be disseminated. POR has the potential of addressing particularly relevant gaps of knowledge and action when implemented in regions of the world that have limited resources for or experiences with empirical research, and/or in clinical settings that are serving clinical populations who are not typically receiving optimal mental care services - specifically, individuals in rural and inner cities that have limited economic and social resources. The establishment and maintenance of POR in such regions and/or settings, however, come with specific obstacles and challenges. Integrating the experiences acquired from research conducted in various continents (Africa, Europe, Latin America, and North America), the goal of this paper is to describe some of these challenges, strategies that have been implemented to address them, as well as new possible directions to facilitate the creation and growth of POR. It also describes how these challenges and ways to deal with them can provide helpful lessons for already existing POR infrastructures., (© 2023. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)

Background: Some patients return for further psychological treatment in routine services, although it is unclear how common this is, as scarce research is available on this topic., Aims: To estimate the treatment return rate and describe the clinical characteristics of patients who return for anxiety and depression treatment., Method: A large dataset ( N =21,029) of routinely collected clinical data (2010-2015) from an English psychological therapy service was analysed using descriptive statistics., Results: The return rate for at least one additional treatment episode within 1-5 years was 13.7%. Furthermore, 14.5% of the total sessions provided by the service were delivered to treatment-returning patients. Of those who returned, 58.0% continued to show clinically significant depression and/or anxiety symptoms at the end of their first treatment, while 32.0% had experienced a demonstrable relapse before their second treatment., Conclusions: This study estimates that approximately one in seven patients return to the same service for additional psychological treatment within 1-5 years. Multiple factors may influence the need for additional treatment, and this may have a major impact on service activity. Future research needs to further explore and better determine the characteristics of treatment returners, prioritise enhancement of first treatment recovery, and evaluate relapse prevention interventions.

Objective: Conduct a systematic review and meta-analysis of randomized controlled trials (RCTs) evaluating the efficacy of individual humanistic-experiential therapies (HEPs) for depression., Method: Database searches (Scopus, Medline, and PsycINFO) identified RCTs comparing any HEP intervention with a treatment-as-usual (TAU) control or active alternative intervention for the treatment of depression. Included studies were assessed using the Risk of Bias 2 tool and narratively synthesized. Post-treatment and follow-up effect sizes were aggregated using random-effects meta-analysis and moderators of treatment effect were explored (PROSPERO: CRD42021240485)., Results: Seventeen RCTs, synthesized across four meta-analyzes, indicated HEP depression outcomes were significantly better than TAU controls at post-treatment ( g  = 0.41, 95% CI [0.18, 0.65], n  = 735), but not significantly different at follow-up ( g  = 0.14, 95% CI [-0.30, 0.58], n  = 631). HEP depression outcomes were comparable to active treatments at post-treatment ( g  = -0.09, 95% CI [-0.26, 0.08], n  = 2131), but significantly favored non-HEP alternative interventions at follow-up ( g  = -0.21, 95% CI [-0.35, -0.07], n  = 1196)., Conclusion: Relative to usual care, HEPs are effective in the short-term and comparable to non-HEP alternative interventions at post-treatment, but not at follow-up. However, imprecision, inconsistency, and risk of bias concerns were identified as limitations of the evidence included. Future large-scale trials of HEPs with equipoise between comparator conditions are required.

Background: Sudden gains occur in a range of disorders and treatments and are of clinical and theoretical significance if they can shed light on therapeutic change processes. This study investigated the relationship between sudden gains in panic symptoms and preceding cognitive change during cognitive behavioural therapy (CBT) for panic disorder., Method: Participants with panic disorder completed in session measures of panic symptoms and catastrophic cognitions. Independent samples t -tests were used to compare the post-treatment score of those who met criteria for one or more sudden gain during treatment with those who did not, and to compare within-session cognitive change between pre-sudden gain sessions and the previous (control) session., Results: Twenty-two (42%) of 53 participants experienced a sudden gain during treatment. Participants demonstrating a sudden gain showed more improvement in panic symptoms from pre- to post-treatment than those without a sudden gain. The within-session cognitive change score in the pre-gain session was significantly greater than in the control session., Conclusions: Sudden gains occurred in individual CBT for panic disorder and within-session cognitive change was associated with sudden gains. This is consistent with the cognitive model of panic disorder and highlights how sudden gains can help to identify key change processes.

Feedback-informed treatment (FIT) has been shown to reduce the gap between more and less effective therapists. This study aimed to examine therapists' professional characteristics as potential moderators of the effect of feedback on treatment outcomes., The IAPT-FIT Trial was a clinical trial where therapists were randomly assigned to a FIT group or a usual care control group. Treatment response was monitored using measures of depression (PHQ-9), anxiety (GAD-7) and functional impairment (WSAS). In a secondary analysis of this trial ( n  = 1,835 patients; t  = 67 therapists), we used multilevel modelling to examine interactions between therapists' professional characteristics (e.g., attitude towards and self-efficacy regarding feedback utilization, decision-making style, job satisfaction, burnout, difficulties in practice, coping styles, caseload size) with random allocation (FIT vs. controls) to identify moderators of the effects of feedback., Between 9.6% and 10.8% of variability in treatment outcomes was attributable to therapist effects. Therapist-level caseload sizes and external feedback propensity (EFP) moderated the effect of feedback on depression outcomes. No statistically significant main effects were found for any of the included therapist characteristics., FIT reduced variability in outcomes between therapists and was particularly effective for therapists with high EFP and larger caseloads.

Background: Long-term sickness costs businesses in the United Kingdom (UK) approximately £7 billion per annum. Most long-term sickness absences are attributed to common mental health conditions, which are also highly prevalent in people with acute or musculoskeletal health conditions. This study will pilot the IGLOo (Individual, Group, Leaders, Organisation, overarching context) intervention which aims to support workers in returning to and remaining in work following long-term sickness absence. The potential impact of the intervention is a timely return to work (main trial primary outcome) and prevention of a further episode of long-term sick leave. The intervention will be piloted in a randomised controlled trial (RCT) to examine the feasibility of the intervention (pilot trial primary outcome) and to inform a fully powered definitive trial to evaluate sustainable return to work (RTW) in people with primary or secondary mental ill-health who go on long-term sick leave., Methods and Design: A two-arm feasibility randomised controlled trial (with a 30-month study period including 12-month follow-up) of the IGLOo intervention will be conducted in large organisations (≥ 600 workers) from the Yorkshire and Humberside regions, in the UK. Eight consenting organisations will be recruited and randomised to the intervention or control arms of the study (1:1 ratio), with a minimum recruitment target of 13 workers eligible to participate from each. Organisations assigned to the control group will continue with their usual practice. Feasibility data will include data collected on recruitment, retention and attrition of participants; completion of research outcome measures; and intervention compliance. Measurements of mental health, RTW, work outcomes, quality-of-life, workplace support and communication and other demographic data will be taken at baseline, 3, 6, 9 and 12 months in all participants. Qualitative interviews and survey data with all participants will explore the experiences of participants, acceptability of the intervention components and evaluation measures. Exploratory economic evaluation will be conducted to further inform a definitive trial., Discussion: The findings from this pilot study will help to inform the development of a definitive cluster RCT designed to examine the efficacy of this intervention on health and work-related outcomes in UK workers on long-term sick leave., Trial Registration: ISRCTN11788559 (prospectively registered, date registered 6 October 2022)., (© 2024. The Author(s).)

Objective: This study investigated if patients' experience of an initial assessment may be associated with outcome expectations, and with subsequent treatment attendance., Method: The sample comprised n  = 6051 patients with depression/anxiety disorders, nested within k  = 148 assessing therapists. Multilevel modelling (MLM) was used to examine therapist effects on treatment initiation and subsequent dropout, adjusting for patient-level characteristics. We tested associations between early outcome expectancy measured at an initial assessment with attendance at a first therapy session, and with dropout after initiation. Variability in mean expectancy ratings in the caseloads of assessing therapists was examined using the intracluster correlation coefficient (ICC)., Results: Therapist effects partly explained the variance in treatment initiation and dropout. Pre-treatment outcome expectations significantly predicted treatment initiation but not dropout for the subgroup of patients who started treatment. Approximately 16% of variability in mean expectancy ratings was explained by therapist effects (ICC = 0.159) after controlling for patient-level covariates., Conclusions: Patients assessed by some therapists are more likely to have higher outcome expectations, which influences their decision to initiate treatment thereafter. Once patients start therapy, early expectancy measured at assessment no longer influences their attendance, but the "first impression" from an initial assessment does influence their subsequent likelihood of dropout.

Seasonality of reproductive activity in rams and bucks is the major constraint in temperate and subtropical zones. Rapid alternation between 1 month of short days and 1 month of long days (LD) over three years in lightproof buildings eliminates this seasonality. We examined if this would also work in open barns, using only supplementary light. Over two years, one group of bucks (n = 7) was subjected to alternate 1 month of LD and 1 month of permanent light (LD-LL) and another group (n = 7) to alternate 1 month of LD and 1 month of natural light (LD-NL). A simultaneous control group, used for both experiments (CG1, n = 6; CG2, n = 6), remained under natural photoperiod. BW, testis weight (TW), plasma testosterone (T) and cortisol (C) were evaluated in all bucks. CG1 and CG2 bucks showed identical dramatic seasonal variations in BW (stable or decreasing in summer), TW (from 85 ± 12 g in February to 127 ± 7 g in July) and T (from 2.7 ± 1.2 ng/mL in January-April to 24.3 ± 3.2 ng/mL in June-October). By contrast, BW of LD-LL and LD-NL bucks increased regularly during the experiment. From 5 and 9 months after the experiment onset, LD-LL and LD-NL bucks, respectively, maintained constant TW of 115 ± 5 g until the experiment end. After the first 3 months <5 ng/mL, T of LD-LL bucks remained constant (5-10 ng/mL) until the experiment end. By contrast, T of LD-NL bucks showed four periods of low (<5 ng/mL) and two periods of high concentrations (18.1 ± 2.6 and 11.9 ± 3.4 ng/mL). Plasma C remained low (5-8 ng/mL) and did not change with group or light treatment. These results show for the first time in any seasonal photoperiodic species that it is possible to maintain the sexual activity of males all year round in open buildings using alternating periods of LD and LL. By contrast, return to NL instead of LL every other month does not prevent seasonality in T concentration. These results raise interesting questions about the photoperiodic control of neuroendocrine regulation of seasonal sexual activity and suggest that these treatments can be used to manage males in open barns in farms and in artificial insemination centres. (Spanish and French versions of the full text are available as Supplementary Materials S1 and S2)., (Copyright © 2023 The Authors. Published by Elsevier B.V. All rights reserved.)

Competing Interests: Declaration of competing interest Michael Barkham has co-produced outcome measures used in routine outcome monitoring and also jointly published a text on routine outcome monitoring but receives no financial payment for these activities. Christopher G. Beevers has received funding for his research from the National Institutes of Health, Brain and Behavior Foundation, Aiberry Inc., and other private, not-for-profit foundations. He has received income from the Association for Psychological Science for his editorial work and from Orexo, Inc. for serving on a Scientific Advisory Board related to digital therapeutics. Dr. Beevers' financial disclosures have been reviewed and approved by the University of Texas at Austin in accordance with its conflict-of-interest policies. Tim Dalgleish has received payment for consultancy work with Princeton Biopartners, Boehringer Ingelheim and Felix Inc. He delivers paid workshops on psychological therapies. He receives royalties for books on affect and psychological disorders. Nicholas C. Jacobson declares the following conflicts of interest. He has edited a book that includes discussion of this topic from which he receives royalties. Additionally, he has accepted paid speaking invitations from various organizations. Dr. Jacobson confirms that these interests do not influence the research, interpretation, or conclusions presented in this manuscript. Daniel R. Karlin is an employee, officer, and shareholder of MindMed; shareholder and director at Sonara Health; trustee at Trudeau Institute; shareholder and consultant to NightWare; consultant to Otsuka, Tempus, Limitless Ventures, Recovery Delivered, and 4YouandMe. Cheri A. Levinson has a financial interest in BeWell and Awaken Digital Solutions. Lorenzo Lorenzo-Luaces has received consulting fees from Syra Health who had no involvement in the current research. Stephen M. Schueller serves on the Scientific Advisory Board for Headspace for which he receives compensation and has received consulting payments from Boehringer Ingelheim, K Health (Trusst), and Otsuka Pharmaceuticals for unrelated work. Greg J. Siegle receives royalty payments on a patent regarding a vibroacoustic intervention for psychiatric conditions, licensed to Apollo Neurosciences. Wolfgang Lutz and Eva-Lotta Brakemeier initiated and chair the Interest Group "Evidence-Based Personalized Psychotherapy Research (ePePsy)" of the German Psychological Association.

This study aimed to develop and test algorithms to determine the individual relevance of two psychotherapeutic change processes (i.e., mastery and clarification) for outcome prediction. We measured process and outcome variables in a naturalistic outpatient sample treated with an integrative treatment for a variety of diagnoses ( n = 608) during the first 10 sessions. We estimated individual within-patient effects of each therapist-evaluated process of change on patient-evaluated subsequent outcomes on a session-by-session basis. Using patients' baseline characteristics, we trained machine learning algorithms on a randomly selected subsample ( n = 407) to predict the effects of patients' process variables on outcome. We subsequently tested the predictive capacity of the best algorithm for each process on a holdout subsample ( n = 201). We found significant within-patient effects of therapist perceived mastery and clarification on subsequent outcome. In the holdout subsample, the best-performing algorithms resulted in significant but small-to-medium correlations between the predicted and observed relevance of therapist perceived mastery ( r = .18) and clarification ( r = .16). Using the algorithms to create criteria for individual recommendations, in the holdout sample, we identified patients for whom mastery (14%) or clarification (18%) were indicated. In the mastery-indicated group, a greater focus on mastery was moderately associated with better outcome ( r = .33, d = .70), while in the clarification-indicated group, the focus was not related to outcome ( r = -.05, d = .10). Results support the feasibility of performing individual predictions regarding mastery process relevance that can be useful for therapist feedback and treatment recommendations. However, results will need to be replicated with prospective experimental designs. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Blood, tissue and cell establishments (BTCs) stand out in the management of donor selection, procurement and processing of all types of substances of human origin (SoHO). In the last decades, the framework created around BTCs, including hospitals and national health system networks, and their links to research, development and innovation organizations and agencies have spurred their involvement in the study of groundbreaking advanced therapy medicinal products (ATMP). To further improve strategic synergies in the development of ATMPs, it will be required to promote intra- and inter-European collaborations by creating an international network involving BTCs and major stakeholders (i.e., research organizations, hospitals, universities, patient associations, public agencies). This vision is already shared with the European Blood Alliance, the association of non-profit blood establishments, with 26 member states throughout the European Union and European Free Trade Association states. Herein we present and analyze the "BTC for ATMP Development And Manufacture" (BADAM) model, an ethically responsible business model based on the values and missions of BTCs and their commitment to health equity, patient access and education (based on voluntary donation of SoHO to address unmet clinical needs, while contributing to training professionals and scientific literacy of our Society)., Competing Interests: Declaration of Competing Interest All authors are employees of either non-profit Blood, Tissue and Cell Establishments or academic hospitals, whose role in the development, manufacturing and distribution of advanced therapies are the main topic of this manuscript. AW is member of the European Blood Alliance Donor Studies working group., (Copyright © 2023 International Society for Cell & Gene Therapy. Published by Elsevier Inc. All rights reserved.)

Objective: To provide a research review of the components and outcomes of routine outcome monitoring (ROM) and recommendations for research and therapeutic practice., Method: A narrative review of the three phases of ROM - data collection, feeding back data, and adapting therapy - and an overview of patient outcomes from 11 meta-analytic studies., Results: Patients support ROM when its purpose is clear and integrated within therapy. Greater frequency of data collection is more important for shorter-term therapies, and use of graphs, greater specificity of feedback, and alerts are helpful. Overall effects on patient outcomes are statistically significant ( g ≈ 0.15) and increase when clinical support tools (CSTs) are used for not-on-track cases ( g ≈ 0.36-0.53). Effects are additive to standard effects of psychological therapies. Organizational, personnel, and resource issues remain the greatest obstacles to the successful adoption of ROM., Conclusion: ROM offers a low-cost method for enhancing patient outcomes, on average resulting in an ≈ 8% advantage (success rate difference; SRD) over standard care. CSTs are particularly effective for not-on-track patients (SRD between ≈ 20% and 29%), but ROM does not work for all patients and successful implementation is a major challenge, along with securing appropriate cultural adaptations.

Background: Guided self-help (GSH) for anxiety is widely implemented in primary care services because of service efficiency gains, but there is also evidence of poor acceptability, low effectiveness and relapse., Aims: The aim was to compare preferences for, acceptability and efficacy of cognitive-behavioural guided self-help (CBT-GSH) versus cognitive-analytic guided self-help (CAT-GSH)., Method: This was a pragmatic, randomised, patient preference trial (Clinical trials identifier: NCT03730532). The Beck Anxiety Inventory (BAI) was the primary outcome at 8- and 24-week follow-up. Interventions were delivered competently on the telephone via structured workbooks over 6-8 (30-35 min) sessions by trained practitioners., Results: A total of 271 eligible participants were included, of whom 19 (7%) accepted being randomised and 252 (93%) chose their treatment. In the preference cohort, 181 (72%) chose CAT-GSH and 71 (28%) preferred CBT-GSH. BAI outcomes in the preference and randomised cohorts did not differ at 8 weeks (-0.80, 95% confidence interval (CI) -4.52 to 2.92) or 24 weeks (0.85, 95% CI -2.87 to 4.57). After controlling for allocation method and baseline covariates, there were no differences between CAT-GSH and CBT-GSH at 8 weeks (F(1, 263) = 0.22, P = 0.639) or at 24 weeks ( F (1, 263) = 0.22, P = 0.639). Mean BAI change from baseline was a reduction of 9.28 for CAT-GSH and 9.78 for CBT-GSH at 8 weeks and 12.90 for CAT-GSH and 12.43 for CBT-GSH at 24 weeks., Conclusions: Patients accessing routine primary care talking treatments prefer to choose the intervention they receive. CAT-GSH expands the treatment offer in primary care for patients with anxiety seeking a brief but analytically informed GSH solution.

Background: Occupational burnout is highly prevalent in the mental healthcare workforce and associated with poorer job satisfaction, performance and outcomes., Aims: To evaluate the effects of the Mind Management Skills for Life Programme on burnout and wellbeing., Methods: N  = 173 mental health nurses were recruited from the English National Health Service during the acute phase of the COVID-19 crisis. Participants were allocated to an immediate intervention or a delayed intervention control group, using a stepped wedge randomized controlled trial design. Measures of burnout (OLBI) and wellbeing (WEMWBS) were completed at four time-points: [1] baseline; [2] after the first group finished the intervention; [3] after the second group finished the intervention; and [4] six-months follow-up., Results: Between-group differences were compared at each time-point using ANCOVA adjusting for baseline severity. Statistically significant effects on burnout ( d  = 0.60) and wellbeing ( d = -0.62) were found at time-point 2, favouring the intervention relative to waitlist control. No significant differences were found at subsequent time-points, indicating that both groups improved and maintained their gains after the intervention., Conclusions: This intervention led to moderate improvements in burnout and wellbeing, despite the adverse circumstances of the COVID-19 pandemic at the time of the study.

Objective: The occurrence of dropout from psychological interventions is associated with poor treatment outcome and high health, societal and economic costs. Recently, machine learning (ML) algorithms have been tested in psychotherapy outcome research. Dropout predictions are usually limited by imbalanced datasets and the size of the sample. This paper aims to improve dropout prediction by comparing ML algorithms, sample sizes and resampling methods. Method: Twenty ML algorithms were examined in twelve subsamples (drawn from a sample of N  = 49,602) using four resampling methods in comparison to the absence of resampling and to each other. Prediction accuracy was evaluated in an independent holdout dataset using the F 1 -Measure. Results: Resampling methods improved the performance of ML algorithms and down-sampling can be recommended, as it was the fastest method and as accurate as the other methods. For the highest mean F 1 -Score of .51 a minimum sample size of N  = 300 was necessary. No specific algorithm or algorithm group can be recommended. Conclusion: Resampling methods could improve the accuracy of predicting dropout in psychological interventions. Down-sampling is recommended as it is the least computationally taxing method. The training sample should contain at least 300 cases.

Background: The manner in which heuristics and biases influence clinical decision-making has not been fully investigated and the methods previously used have been rudimentary., Aims: Two studies were conducted to design and test a trial-based methodology to assess the influence of heuristics and biases; specifically, with a focus on how practitioners make decisions about suitability for therapy, treatment fidelity and treatment continuation in psychological services., Method: Study 1 ( N =12) used a qualitative design to develop two clinical vignette-based tasks that had the aim of triggering heuristics and biases during clinical decision making. Study 2 ( N =133) then used a randomized crossover experimental design and involved psychological wellbeing practitioners (PWPs) working in the Improving Access to Psychological Therapies (IAPT) programme in England. Vignettes evoked heuristics (anchoring and halo effects) and biased responses away from normative decisions. Participants completed validated measures of decision-making style. The two decision-making tasks from the vignettes yielded a clinical decision score (CDS; higher scores being more consistent with normative/unbiased decisions)., Results: Experimental manipulations used to evoke heuristics did not significantly bias CDS. Decision-making style was not consistently associated with CDS. Clinical decisions were generally normative, although with some variability., Conclusions: Clinical decision-making can be 'noisy' (i.e. variable across practitioners and occasions), but there was little evidence that this variability was systematically influenced by anchoring and halo effects in a stepped-care context.

Objective: To evaluate the efficacy of different approaches to personalization in psychological therapy., Method: This was a systematic review and meta-analysis of randomized controlled trials that compared the mental health outcomes of personalized treatment with standardized treatment and other control groups. Eligible studies were identified through three databases (Scopus, APA PsycInfo, and Web of Science). We conducted a narrative synthesis and random effects meta-analysis of available outcomes date, including subgroup analyses to investigate sources of effect size heterogeneity. The review protocol was preregistered in the Open Science Framework., Results: Seventeen studies ( N = 7,617) met inclusion criteria for the review, nine of which ( N = 5,134) provided sufficient data for inclusion in meta-analysis. Eight studies were classed as having high risk of bias, eight had moderate risk, and one had low risk. There was no significant evidence of publication bias. A statistically significant effect size was found in favor of personalized treatment relative to standardized treatment ( d = 0.22, 95% CI [0.05, 0.39], p = .011). When studies with a high risk of bias were removed, this effect size was smaller but remained statistically significant ( d = 0.14, 95% CI [0.08, 0.20], p < .001)., Conclusion: Current evidence indicates that personalization is an effective strategy to improve outcomes from psychological therapy, and the seemingly small effect size advantage of personalization could have an important impact at a clinical population level. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Background: Approximately 1.5 million referrals are made to Improving Access to Psychological Therapy (IAPT) services annually. However, treatment is received in less than half of cases due to ineligibility or non-attendance. The aim was to explore risk factors for non-attendance at the initial two IAPT appointments following referral., Methods: An exploratory, retrospective analysis of referral and attendance data from five IAPT services in the North of England. Participants were 97,020 referrals received 2010-2014. Main outcome was attendance at the first two offered appointments (assessment and initial treatment)., Results: Based on data from two services, 66% of referrals resulted in assessment attendance. Across all five services 57% of patients who attended for assessment subsequently attended the first treatment appointment. The odds of attending an assessment appointment were more than 3 times higher for self-referrals than for GP referrals (OR 3.46, 95% CI 3.27-3.66, p  < 0.001). Factors important to treatment appointment attendance following assessment were the service, referral source, presenting problem, and anxiety severity., Conclusion: Initial appointment non-attendance is a consistent problem for IAPT services. Specific factors that may support IAPT services to improve non-attendance rates are identified. IAPT indicators of success should take account of non-attendance at initial appointments.

Objectives: The literature regarding the effectiveness of long-term psychological interventions delivered in tertiary care is scarce. This study sought to quantify and evaluate outcomes delivered in a UK tertiary care psychotherapy service against equivalent service benchmarks., Design: A retrospective analysis of outcomes on the Outcome Questionnaire-45 (OQ-45) over a 10-year period in a tertiary care psychotherapy service. The modalities evaluated were cognitive-behavioural, cognitive-analytic, and psychoanalytic psychotherapies., Methods: Effectiveness was calculated at the service level and for each modality using pre-post-effect sizes and recovery rates. Benchmarking included a random-effects meta-analysis. Trajectories of change for each modality were examined using growth curve models., Results: Baseline distress on the OQ-45 was higher than comparative norms (M = 102.57, SD = 22.79, N = 364). The average number of sessions was 48.68 (SD = 42.14, range = 5-335). There was a moderate pre-post-treatment effect (d = .46, 95% CI = .37-.55) which was lower than available benchmarks. The modalities differed in duration but were largely equivalent in terms of outcome. The reliable improvement rate was 29.95%, and the recovery rate was 10.16%, and change over time was best explained using a nonlinear (cubic) time trend., Conclusions: The elevated distress at baseline appears to create the conditions for relatively lengthy interventions and attenuated clinical outcomes. Suggestions are made regarding the clinical role, function, and evaluation of tertiary care psychotherapy services., (© 2023 The Authors. British Journal of Clinical Psychology published by John Wiley & Sons Ltd on behalf of British Psychological Society.)

Aim: Few published studies comprehensively describe the characteristics of patients with pancreatic cancer and their treatment in clinical practice. This study aimed to describe the current clinical practice for treating pancreatic cancer in Catalonia, along with the associated survival and treatment costs., Methods: A retrospective observational cohort study in patients diagnosed with pancreatic cancer from 2014 to 2018, using data from the healthcare records of the Public Health System of Catalonia, was conducted. Treatment patterns and costs were described by age groups from 2014 to 2018, with survival reported until December 2021., Results: The proportion of patients receiving surgery with curative intent was low, especially in older patients (23% of patients <60 years and 9% of patients ≥80 years). The percentage of patients treated with drugs for unresectable disease also decreased with age (45% of patients <60 years and 8% of patients ≥80 years). Although age was associated with significant differences in survival after curative surgery, no differences attributable to age were observed in patients who received pharmacological treatment for unresectable disease. In patients under 60 years of age, the mean cost of the first year of treatment was EUR 17,730 (standard deviation [SD] 5754) in those receiving surgery and EUR 5398 (SD 9581) in those on pharmacological treatment for unresectable disease. In patients over 80, the mean costs were EUR 15,339 (SD 2634) and EUR 1845 (SD 3413), respectively., Conclusions: Half of the patients diagnosed with pancreatic cancer did not receive specific treatment. Surgery with curative intent was associated with longer survival, but only 18% of (mostly younger) patients received this treatment. Chemotherapy was also used less frequently in patients of advanced age, though survival in treated patients was comparable across all age groups, so careful oncogeriatric assessment is advisable to ensure the most appropriate indication for eligibility in older patients. In general, earlier diagnosis and more effective pharmacological treatments are necessary to treat frail patients with high comorbidity, a common profile in older patients.

Background: The aim of this study was to investigate and model the interactions between a range of risk and protective factors for suicidal ideation using general population data collected during the critical phase of the COVID-19 pandemic., Methods: Bayesian network analyses were applied to cross-sectional data collected 1 month after the COVID-19 lockdown measures were implemented in Austria and the United Kingdom. In nationally representative samples ( n = 1,005 Austria; n = 1,006 UK), sociodemographic features and a multi-domain battery of health, wellbeing and quality of life (QOL) measures were completed. Predictive accuracy was examined using the area under the curve (AUC) within-sample (country) and out-of-sample., Results: The AUC of the Bayesian network models were ≥ 0.84 within-sample and ≥0.79 out-of-sample, explaining close to 50% of variability in suicidal ideation. In total, 15 interrelated risk and protective factors were identified. Seven of these factors were replicated in both countries: depressive symptoms, loneliness, anxiety symptoms, self-efficacy, resilience, QOL physical health, and QOL living environment., Conclusions: Bayesian network models had high predictive accuracy. Several psychosocial risk and protective factors have complex interrelationships that influence suicidal ideation. It is possible to predict suicidal risk with high accuracy using this information., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2023 Delgadillo, Budimir, Barkham, Humer, Pieh and Probst.)

On September 1, 2022, CDC recommended an updated (bivalent) COVID-19 vaccine booster to help restore waning protection conferred by previous vaccination and broaden protection against emerging variants for persons aged ≥12 years (subsequently extended to persons aged ≥6 months).* To assess the impact of original (monovalent) COVID-19 vaccines and bivalent boosters, case and mortality rate ratios (RRs) were estimated comparing unvaccinated and vaccinated persons aged ≥12 years by overall receipt of and by time since booster vaccination (monovalent or bivalent) during Delta variant and Omicron sublineage (BA.1, BA.2, early BA.4/BA.5, and late BA.4/BA.5) predominance. † During the late BA.4/BA.5 period, unvaccinated persons had higher COVID-19 mortality and infection rates than persons receiving bivalent doses (mortality RR = 14.1 and infection RR = 2.8) and to a lesser extent persons vaccinated with only monovalent doses (mortality RR = 5.4 and infection RR = 2.5). Among older adults, mortality rates among unvaccinated persons were significantly higher than among those who had received a bivalent booster (65-79 years; RR = 23.7 and ≥80 years; 10.3) or a monovalent booster (65-79 years; 8.3 and ≥80 years; 4.2). In a second analysis stratified by time since booster vaccination, there was a progressive decline from the Delta period (RR = 50.7) to the early BA.4/BA.5 period (7.4) in relative COVID-19 mortality rates among unvaccinated persons compared with persons receiving who had received a monovalent booster within 2 weeks-2 months. During the early BA.4/BA.5 period, declines in relative mortality rates were observed at 6-8 (RR = 4.6), 9-11 (4.5), and ≥12 (2.5) months after receiving a monovalent booster. In contrast, bivalent boosters received during the preceding 2 weeks-2 months improved protection against death (RR = 15.2) during the late BA.4/BA.5 period. In both analyses, when compared with unvaccinated persons, persons who had received bivalent boosters were provided additional protection against death over monovalent doses or monovalent boosters. Restored protection was highest in older adults. All persons should stay up to date with COVID-19 vaccination, including receipt of a bivalent booster by eligible persons, to reduce the risk for severe COVID-19., Competing Interests: All authors have completed and submitted the International Committee of Medical Journal Editors form for disclosure of potential conflicts of interest. Kathryn A. Turner reports an uncompensated position as the secretary/treasurer of the Board of the Council of State and Territorial Epidemiologists. No other potential conflicts of interest were disclosed.

Objective: Treatment outcomes are known to vary according to therapist and clinic/organization (therapist effect, clinic effect). Outcomes may also vary according to the neighborhood where a person lives (neighborhood effect), but this has not previously been formally quantified. Evidence suggests that deprivation may contribute to explaining such cluster effects. This study aimed to (a) simultaneously quantify neighborhood, clinic, and therapist effects on intervention effectiveness and (b) determine the extent to which deprivation variables explain neighborhood and clinic effects., Method: The study used a retrospective, observational cohort design with a high intensity psychological intervention sample (N = 617,375), and a low intensity (LI) psychological intervention sample (N = 773,675). Samples each included 55 clinics, 9,000-10,000 therapists/practitioners, and over 18,000 neighborhoods in England. Outcomes were postintervention depression and anxiety scores and clinical recovery. Deprivation variables included individual employment status, domains of neighborhood deprivation, and clinic-level mean deprivation. Data were analyzed using cross-classified multilevel models., Results: Unadjusted neighborhood effects of 1%-2% and unadjusted clinic effects of 2%-5% were detected, with proportionally larger effects for LI interventions. After controlling for predictors, adjusted neighborhood effects of 0.0%-0.1% and clinic effects of 1%-2% remained. Deprivation variables were able to explain a significant proportion of the neighborhood effect (80%-90% of neighborhood variance) but not clinic effect. The majority of neighborhood variance could only be explained by a shared effect of baseline severity and socioeconomic deprivation variables., Conclusions: People in different neighborhoods respond differently to psychological intervention, and this clustering effect was mainly explained by socioeconomic factors. People also respond differently according to the clinic they access, but this could not be completely explained by deprivation in the present study. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Background Aims: To describe and analyze whether a hub-and-spoke organizational model could efficiently provide access to chimeric antigen receptor (CAR) T-cell therapy within a network of academic hospitals and address the growing demands of this complex and specialized activity., Methods: The authors performed a retrospective evaluation of activity within the Catalan Blood and Tissue Bank network, which was established for hematopoietic stem cell transplantation to serve six CAR T-cell programs in academic hospitals of the Catalan Health Service. Procedures at six hospitals were followed from 2016 to 2021. Collection shipments of starting materials, CAR T-cell returns for storage and infusions for either clinical trials or commercial use were evaluated., Results: A total of 348 leukocytapheresis procedures were performed, 39% of which were delivered fresh and 61% of which were cryopreserved. The network was linked to seven advanced therapy medicinal product manufacturers. After production, 313 CAR T-cell products were shipped back to the central cryogenic medicine warehouse located in the hub. Of the units received, 90% were eventually administered to patients. A total of 281 patients were treated during this period, 45% in clinical trials and the rest with commercially available CAR T-cell therapies., Conclusions: A hub-and-spoke organizational model based on an existing hematopoietic stem cell transplantation program is efficient in incorporating CAR T-cell therapy into a public health hospital network. Rapid access and support of growing activity enabled 281 patients to receive CAR T cells during the study period., Competing Interests: Declaration of Competing Interest JF and SQ have served on an advisory board for Novartis., (Copyright © 2022 International Society for Cell & Gene Therapy. Published by Elsevier Inc. All rights reserved.)

This review presents a comprehensive evaluation of the effectiveness of routinely delivered psychological therapies across inpatient, outpatient and University-based clinics. This was a pre-registered systematic-review of studies meeting pre-specified inclusion criteria (CRD42020175235). Eligible studies were searched in three databases: MEDLINE, CINAHL and PsycInfo. Pre-post treatment (uncontrolled) effect sizes were calculated and pooled using random effects meta-analysis to generate effectiveness benchmarks. Moderator analyses were used to examine sources of heterogeneity in effect sizes. Overall, 252 studies (k = 298 samples) were identified, of which 223 (k = 263 samples) provided sufficient data for inclusion in meta-analysis. Results showed large pre-post treatment effects for depression [d = 0.96, (CI 0.88-1.04), p ≤ 0.001, k = 122], anxiety [d = 0.8 (CI 0.71-0.9), p ≤ 0.001, k = 69], and other outcomes [d = 1.01 (CI 0.93-1.09), p ≤ 0.001, k = 158]. This review provides support for the effectiveness of routinely delivered psychological therapy. Effectiveness benchmarks are supplied to support service evaluations across multiple settings., (© 2022. The Author(s).)

Background: Early dropout hinders the effective adoption of brief psychological interventions and is associated with poor treatment outcomes. This study examined if attendance and depression treatment outcomes could be improved by matching patients to either face-to-face or computerized low-intensity psychological interventions., Methods: Archival clinical records were analysed for 85,664 patients who accessed face-to-face or computerized guided self-help (GSH). The primary outcome was early dropout (attending ≤3 sessions). Supervised machine learning analyses were applied in a training sample (n = 55,529). The trained algorithm was cross-validated in an independent test sample (n = 30,135). The clinical utility of the model was evaluated using logistic regression, chi-square tests, and sensitivity analyses in a balanced subsample., Results: Patients who received their model-indicated treatment modality were 12% more likely to receive an adequate dose of treatment OR = 1.12 (95% CI = 1.02 to 1.24), p = .02, and the strength of this effect was larger in the balanced subsample (OR = 2.10, 95% CI = 1.65 to 2.68, p < .001). Patients had better treatment outcomes when matched to their model-indicated treatment modality., Conclusions: Machine learning approaches may enable services to optimally match patients to the treatment modality that maximizes attendance., Competing Interests: Declaration of competing interest None., (Copyright © 2022 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Objective: Few published studies have described multidisciplinary therapeutic strategies for lung cancer. This study aims to describe the different approaches used for treating lung cancer in Catalonia in 2014 and 2018 and to assess the associated cost and impact on patient survival., Methods: A retrospective observational cohort study using data of patients with lung cancer from health care registries in Catalonia was carried out. We analyzed change in treatment patterns, costs and survival according to the year of treatment initiation (2014 vs. 2018). The Kaplan-Meier method was used to estimate survival, with the follow-up until 2021., Results: From 2014 to 2018, the proportion of patients undergoing surgery increased and treatments for unresectable tumors decreased, mainly in younger patients. Immunotherapy increased by up to 9% by 2018. No differences in patient survival were observed within treatment patterns. The mean cost per patient in the first year of treatment increased from EUR 14,123 (standard deviation [SD] 4327) to EUR 14,550 (SD 3880) in surgical patients, from EUR 4655 (SD 3540) to EUR 5873 (SD 6455) in patients receiving curative radiotherapy and from EUR 4723 (SD 7003) to EUR 6458 (SD 10,116) in those treated for unresectable disease., Conclusions: From 2014 to 2018, surgical approaches increased in younger patients. The mean cost of treating patients increased, especially in pharmaceutical expenditure, mainly related to the use of several biomarker-targeted treatments. While no differences in overall patient survival were observed, it seems reasonable to expect improvements in this outcome in upcoming years as more patients receive innovative treatments., Competing Interests: The authors reported no conflict of interest.

Aim: Immune pathogenesis of nephrotic syndrome (NS) is not completely understood. We aimed to evaluate the expression of B-cell activating factor (BAFF) and its receptors in renal samples from pediatric NS patients and its relationship with renal function survival., Materials and Methods: We conducted an ambispective study on 33 patients with pediatric NS. Immunohistochemistry for BAFF, TACI, BCMA and BR3 was performed. Markers were evaluated on podocytes and interstitial inflammatory infiltrates (III). We performed Kaplan-Meier curves to describe renal function survival according to markers' expression., Results: Thirty-three NS patients were included. Minimal change disease was seen in 21 (63.6%) patients, and focal segmental glomerulosclerosis in 12 (36.4%). BAFF was found in podocytes (18.2% of samples) and III (36.4% of samples), BAFF-R in one sample, TACI in 4 (podocytes and III), and BCMA in 5 samples of podocytes and 7 of III. BAFF on podocytes and III was associated with worst renal function at follow-up; those patients had 25% probability of having GFR >90 mL/min/1.73m2, versus 84.9% when absent (p = 0.0067). Patients with BAFF in III had 42.9% probability of having GFR>90 mL/min/1.73 m2, versus 94.1% when absent (p = 0.0063)., Conclusion: BAFF expression in renal biopsies could be a prognostic factor for renal function., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2022 Forero-Delgadillo et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Currently, no reports exist on the phenomenon of early response in humanistic-experiential therapies. This study investigated the prognostic value of early response on posttreatment outcomes in person-centered experiential therapy (PCET) for depression within the English Improving Access to Psychological Therapies program. The design of the study was a retrospective observational cohort study. Routine clinical data were drawn from N = 3,321 patients with depression symptoms. The primary outcome was reliable and clinically significant improvement (RCSI) on the Patient Health Questionnaire-9 (PHQ-9) self-report depression measure at the end of treatment. Early response was operationalized as reliable improvement, defined as a PHQ-9 change score ≥ 6 from baseline to Session 4. Early response was examined as a predictor of RCSI using logistic regression controlling for baseline depression severity. In sensitivity analyses, therapist effects were controlled using multilevel modeling. A total of 38.7% of patients met the criterion for early response. Patients who experienced an early response to treatment were six times more likely to recover at the end of treatment compared to patients who did not have an early response. The early response effect was still evident after accounting for individual variability between therapists. However, a quarter of patients displayed a pattern of eventual response, reaching recovery at end of treatment despite not experiencing an initial improvement early in therapy. Early response to PCET is a reliable predictor of treatment outcome. Different response patterns evidenced in this study indicate that identifying subgroups of patients associated with early and eventual response could support clinical decision-making. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Male goats rendered sexually active by exposure to a photoperiodic treatment are more efficient than untreated goats in stimulating LH secretion and ovulation in seasonally anestrous goats. This phenomenon is called the "male effect." Here, we determined whether sexually active bucks are able to stimulate the endocrine and sexual activities of other bucks in seasonal sexual rest through the phenomenon that we called the "buck-to-buck effect." We used bucks rendered sexually active (SA) during sexual rest by exposure to 2.5 mo of artificial long days (16 h of light per d) and untreated, sexually inactive (SI) bucks. In Experiment 1, we determined the short-term (21 d) LH and testosterone responses of sexually inactive bucks joined with a SA or SI buck. In Experiment 2, we determined the long-term (60 d) testosterone and sexual behavior responses of sexually inactive bucks joined with 2 SA or SI bucks. In Experiment 3, we determined the efficacy of bucks initially exposed to the buck-to-buck effect, the SABB bucks, to thereafter induce a "classical" male effect in seasonally anestrous goats. In Experiments 1 and 2, there was an interaction between time and groups in LH and testosterone plasma concentrations (P < 0.01). In Experiment 1, plasma LH concentrations were greater in bucks joined with a SA buck than in those joined with an SI buck (P < 0.05). In Experiments 1 and 2, testosterone concentrations were greater in bucks joined with SA bucks than in those joined with SI bucks (P < 0.05). In addition, in Experiment 2, the sexually inactive bucks joined with SA bucks displayed more nudging than those joined with SI bucks (P < 0.001). In Experiment 3, kidding rates did not differ between females joined with SA (34 of 40: 85%) or SABB bucks (32 of 40: 80%; P > 0.05). We concluded that the endocrine and sexual activities of bucks during sexual rest can be stimulated by SA bucks. In addition, SABB bucks are able to stimulate the reproductive activity of seasonally anestrous goats., Competing Interests: Declaration of interest None., (Copyright © 2022. Published by Elsevier Inc.)

Background: Cognitive therapy and behavioural activation are both widely applied and effective psychotherapies for depression, but it is unclear which works best for whom. Individual participant data (IPD) meta-analysis allows for examining moderators at the participant level and can provide more precise effect estimates than conventional meta-analysis, which is based on study-level data., Aims: This article describes the protocol for a systematic review and IPD meta-analysis that aims to compare the efficacy of cognitive therapy and behavioural activation for adults with depression, and to explore moderators of treatment effect. (PROSPERO: CRD42022341602)., Method: Systematic literature searches will be conducted in PubMed, PsycINFO, EMBASE and the Cochrane Library, to identify randomised clinical trials comparing cognitive therapy and behavioural activation for adult acute-phase depression. Investigators of these trials will be invited to share their participant-level data. One-stage IPD meta-analyses will be conducted with mixed-effects models to assess treatment effects and to examine various available demographic, clinical and psychological participant characteristics as potential moderators. The primary outcome measure will be depressive symptom level at treatment completion. Secondary outcomes will include post-treatment anxiety, interpersonal functioning and quality of life, as well as follow-up outcomes., Conclusions: To the best of our knowledge, this will be the first IPD meta-analysis concerning cognitive therapy versus behavioural activation for adult depression. This study has the potential to enhance our knowledge of depression treatment by using state-of-the-art statistical techniques to compare the efficacy of two widely used psychotherapies, and by shedding more light on which of these treatments might work best for whom.

Background: One in two patients seeking help for substance use disorders (SUDs) has clinically significant depression symptoms. This co-occurrence impairs treatment outcomes, but limited evaluation of the implementation of evidence-based interventions has taken place., Methods: This pilot randomized controlled trial (RCT) assessed the feasibility and potential efficacy of a brief, protocol-driven behavioral activation (BA) intervention delivered by drug and alcohol workers in a community drug and alcohol treatment (CDAT) service. Eligible participants (n = 34) were randomly allocated to either BA (n = 17) or treatment as usual (n = 17) and assessed at baseline and 6-, 12-, and 24-week follow-up. Feasibility outcomes were participant engagement and worker protocol adherence. The primary pilot outcome was severity of depression symptoms (PHQ-9) at 12-week follow-up. Secondary outcomes included percent days abstinent (PDA) in the past month, severity of dependence (SDS), anxiety symptoms (GAD-7), and valued living (VQ) at all follow-up points., Results: Fifty-nine percent of BA participants attended at least one session and there was 95% adherence to the treatment protocol. BA was associated with significantly reduced depression at 12-week follow-up (PHQ-9 mean difference - 5.69, 95% CI -10.07 to -1.31). BA participants had significantly greater improvements in PDA (mean difference 17.9, 95% CI 0.99 to 34.82) and VQ-Progress (mean difference 5.34, 95% CI 1.47 to 9.22) at 6-week follow-up and PDA (mean difference 27.69, 95% CI 4.44 o 50.95) at 12-week follow-up. The study found no significant between-group differences at 24-week follow-up., Conclusion: BA implemented by drug and alcohol treatment workers in CDAT appears feasible and may add clinical benefit to usual care for SUD patients with elevated depressive symptoms accessing CDAT. Fully powered RCTs are warranted to better investigate the replicability of these preliminary findings. Methodological limitations are discussed and suggestions for future research are provided., (Copyright © 2022 Elsevier Inc. All rights reserved.)

Objective: Some psychotherapists are more effective than others, which means that patients' treatment outcomes partly depend on therapist effects (TEs). This study investigated whether the use of progress feedback influences TE., Method: Data from N = 4,549 participants and 131 therapists across six clinical trials of progress feedback were analyzed. All trials used the Outcome-Questionnaire-45 (OQ-45) outcome measure and assigned psychotherapy patients to a usual psychological care condition or feedback condition. We examined whether feedback utilization moderated TE using multilevel modeling and random-effects meta-analysis., Results: TE explained a small proportion (intracluster correlation coefficient [ICC] = .011) of variability in posttreatment OQ-45 scores in the pooled multistudy sample, after controlling for intake severity. Feedback utilization was associated with a statistically significant reduction of the magnitude of the TE (ICC = .009) by approximately 18.2%. Secondary analyses of OQ-45 subscales indicated that TEs were statistically significant in relation to symptom distress, but not interpersonal relations or social role. Feedback was associated with better treatment outcomes and narrower variability between therapists., Conclusions: Feedback-informed treatment reduces the gap between more and less effective therapists, leading to more equitable and effective psychological care. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Background: Prior research indicates that patients' personality traits are associated with psychotherapy processes and outcomes. However, the potential relevance of therapists' personality traits is less understood., Methods: This is a scoping review of studies investigating associations between therapists' personality traits with treatment processes and outcomes. Three databases (Scopus, PsycINFO, and Web of Science) were searched, identifying 27 eligible studies synthesized using a narrative review of key findings., Results: The influence of therapists' personality traits was studied in relation to therapeutic orientation, interpersonal skills, therapist competence and skill, model fidelity, treatment outcomes, therapeutic alliance, and therapist well-being. Findings indicate that therapists' personality traits are associated with the choice of therapeutic orientation and with interpersonal skills, but there is mixed evidence about associations with clinical outcomes., Conclusion: Therapists' personality traits are associated with therapeutic orientation and interpersonal skills. However, it remains unclear whether therapists' personality traits influence other aspects of therapeutic processes or outcomes., (© 2022 Wiley Periodicals LLC.)

Objectives: To investigate associations between alcohol use, psychological treatment attendance, and clinical outcomes., Methods: We analysed electronic health records for N = 7,986 patients accessing psychological treatment for common mental disorders. Data were collected for pre-treatment alcohol use (average units per week) and severity of dependence (SDS), number of therapy contacts attended, pre- and post-treatment anxiety (GAD-7), and depression (PHQ-9) symptom severity. Hierarchical regression was used to examine associations between alcohol use/dependence and post-treatment symptom severity controlling for intake severity and relevant confounders., Results: After controlling for confounders, alcohol use had significant nonlinear associations with pre-treatment depression severity (R 2  = .54, p < .01, cubic trend), and post-treatment anxiety (R 2  = .23, p < .01, quadratic trend). Alcohol use was not significantly associated with intake anxiety, post-treatment depression or treatment duration. SDS was not significantly associated with depression severity, alcohol severity, or total contacts after controlling for confounders., Conclusion: Alcohol users are just as likely to engage in and benefit from evidence-based psychological treatments for depression in primary care. A nonlinear association between alcohol use and anxiety treatment outcomes indicates that light-to-moderate drinkers have some shared characteristic that favours treatment response., Practitioner Points: Depression and anxiety problems often co-occur with alcohol use and dependence. Conventional wisdom in the field suggests that heavy alcohol users may not engage well or benefit from psychological therapies for depression and anxiety. We found no empirical support for the above assumptions in a large clinical sample. Alcohol consumption was not significantly associated with treatment attendance or depression treatment outcomes. A nonlinear association between alcohol use and anxiety outcomes suggests that moderate drinkers may have some shared characteristic that favours treatment response., (© 2021 The British Psychological Society.)

Outcome measurement in the field of psychotherapy has developed considerably in the last decade. This review discusses key issues related to outcome measurement, modeling, and implementation of data-informed and measurement-based psychological therapy. First, an overview is provided, covering the rationale of outcome measurement by acknowledging some of the limitations of clinical judgment. Second, different models of outcome measurement are discussed, including pre-post, session-by-session, and higher-resolution intensive outcome assessments. Third, important concepts related to modeling patterns of change are addressed, including early response, dose-response, and nonlinear change. Furthermore, rational and empirical decision tools are discussed as the foundation for measurement-based therapy. Fourth, examples of clinical applications are presented, which show great promise to support the personalization of therapy and to prevent treatment failure. Finally, we build on continuous outcome measurement as the basis for a broader understanding of clinical concepts and data-driven clinical practice in the future.

Dropout during psychological intervention is a significant problem. Previous evidence for associations with socioeconomic deprivation is mixed. This study aimed to review the evidence for associations between deprivation and dropout from contemporary adult psychological interventions for common mental disorders (CMDs). Systematic review, narrative synthesis and random effects meta-analysis of peer-reviewed English language journal articles published June 2010-June 2020 was conducted. Data sources included medline, PsycInfo, databases indexed by web of science, ProQuest social science database and sociology collection, and the Cochrane Library, supplemented by forward and backward citation searching. Five studies were eligible for inclusion (mean N = 170, 68% female, 60% White Caucasian, 32% dropout rate, predominantly cognitive behaviour therapy/cognitive processing therapy). Narrative synthesis indicated an overall non-significant effect of deprivation on dropout. Meta-analytic significance of controlled (k = 3) and uncontrolled (k = 4) effects depended on the measure of deprivation included for those studies using more than one measure (controlled OR 1.21-1.32, p = 0.019-0.172, uncontrolled OR 1.28-1.76, p = 0.024-0.423). The low number of included studies meant sub-group comparisons were limited, despite some tentative indications of potential differential effects. A comparator set of excluded studies showed similar uncertainty. There was limited evidence that did not overall suggest a clear significant effect of deprivation on dropout from contemporary individual CMD interventions. However, more contemporary research is needed, as effects may vary according to clinical and methodological factors, and for dropout versus non-initiation., (© 2021. The Author(s).)

Objective: To provide a comprehensive assessment of the association between psychological treatment adherence/competence/integrity (ACI) and clinical outcomes., Method: The review protocol was preregistered (CRD42020193889). Studies that assessed ACI-outcome relationships for adult psychotherapy were searched across three databases (Scopus, PsycINFO, MEDLINE). Random effects meta-analyses were conducted on adherence-outcome, competence-outcome, and integrity-outcome relationships. Separate analyses were performed for studies with hierarchical (i.e., patients nested within therapist) versus nonhierarchical study designs. Moderator analyses were performed according to predefined clinical and methodological features. GRADE assessments rated the quality of each meta-analytic comparison., Results: The review identified 62 studies suitable for inclusion (45 adherence-outcome, 39 competence-outcome, and seven integrity-outcome effect sizes; N = 8,210 across all analyses). No significant adherence-outcome association was found. A small significant positive association was found only in nonhierarchical studies between competence and outcome, r = 0.17, 95% CI [0.07-0.26], p < .001, ∼d = .34, GRADE = moderate. Small-to-moderate significant positive associations between integrity and outcome were found for both nonhierarchical, r = 0.15, 95% CI [0.06-0.23], p < .001, ∼d = .30, GRADE = high, and hierarchical study designs, r = 0.23, 95% CI [0.01, 0.43], p < .044, ∼d = .47, GRADE = low. Diagnosis, treatment modality and year of publication significantly moderated the strength of ACI-outcome correlations., Conclusions: Competence and integrity are significantly associated with clinical outcome, with a magnitude comparable to wider common factors. Further research is required to study these process-outcome associations with greater precision in routine-care settings and to understand the role of moderating variables. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Objectives: Publications assessing health and economic outcomes of risk-sharing arrangements (RSAs) are limited. Better knowledge of these outcomes would shed light on the pertinence of such arrangements, informing design improvements for the future. The aim of the study is to describe the different types of RSAs implemented in Catalonia and their health and economic outcomes., Methods: Retrospective descriptive analysis of RSAs implemented from January 2016 to December 2019 in the Catalan Health Service, CatSalut. Individual RSAs were reviewed and categorized according to standard RSA guidelines. Relevant health and economic outcomes pertaining to the RSAs were analyzed using aggregate data recorded in Catalan central registries., Results: A total of 15 RSAs were implemented over the study period (10 of which are still ongoing). A total of 8 consisted of performance-linked reimbursements (PLRs) and 7 of cost-sharing arrangements (CSAs). The arrangements were implemented in the oncohematology (n = 11), rare disease (n = 3), and neurology (n = 1) areas. A total of 951 patients were included in PLR and 73% achieved the target health outcomes. Total medication costs were €9 295 755 of which 11% were refunded to CatSalut. CSAs involved 2066 patients and resulted in overall refunds of €1 349 564 (2.61%) for CatSalut., Conclusions: Both PLRs and CSAs were used to manage the different uncertainties related to accessing innovative medicines in Catalonia. The data generated provide relevant information to inform decision-making, allowing an adaptation of the initial recommendation for use and access. Additional efforts are required to increase the RSA assessments and their publication., (Copyright © 2021. Published by Elsevier Inc.)