Advances in Individualized Psychotherapy Treatment of Young People with Mental Disorders - European Network for Individualized Youth Psychotherapy
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Advances in Individualized
Psychotherapy Treatment of Young
People with Mental Disorders
European Network for
Individualized Youth Psychotherapy
Overview: Structured discussion
Introduction WG1
TREATme & Treatment
STSMs markers
WG 2 WG 3
Mecha- Age-
nisms of customized
change assessments
WG 4 WG 5
Age- Dissemi-
customized nation
designs
www.treat-me.eu
European Network for
Individualized Youth Psychotherapy
What is ?
Individualized
Youth
Psychotherapy
SPR Klagenfurt, Austria www.cost.eu
Randi Ulberg
Adolescent & Adult Psychiatrist
Associate Professor
University of Oslo Norway
Why ?
1. Developmental Changes: physical, hormonal, cognitive, emotional, social –
brain maturation rate paralleled only to that of the very first years of life
2. Youth Developmental Tasks: individuation, identity formation,
education, entering the work force, forming relationships
beyond the family
3. Mental Illness: 50% of lifetime mental disorders
manifest by age 15, 75% by age 25
4. Adverse Outcomes: Mental disorders are associated with
distress (individual, family, friends); high healthcare
costs; barriers to employment; economic deprivation;
social exclusion
Critical Intervention Window: The developmental period of
adolescence and young adulthood (14 – 30) constitutes a critical
window of opportunity for mental health treatment interventions.
Why ? 1. Scattered knowledge on individualized psychotherapy for young people 2. Lack of understanding between different therapeutic schools 3. Lack of sufficient assessment tools and adequate study designs 4. Existing research groups Europe lack visibility so that many researchers are not aware of each other’s work
What are the aims of ?
Establish a Network!
A sustainable, multidisciplinary European Network of
researchers, focusing on individualized psychotherapy for
young people
1. Integrate and Share Knowledge: Integrate
and share the so far scattered knowledge
on individualized youth psychotherapy
research
2. Create Synergies: Collaborate across
Europe, design research projects, make 29 Countries
effective and collective use of EU
research funding options
How does work?
WG1: Specific Treatment Markers
WG2: Mechanisms of Change
WG3: Age Customized Assessment Tools
WG4: Age Customized Study Designs
WG5: Dissemination of Results
Year 1 Year 2 Year 3 Year 4
WORKING GROUP 1 Specific Markers
OBJECTIVES
Focus on the empirical,
qualitative and Share knowledge on age
theoretical literature, specific markers that
and describe the-state- influence therapeutic
of-the-art on specific outcome, in order to
markers interacting with help develop effective
psychotherapy for individualized
adolescents and young treatments
adultsDeliverables
Identify putative age specific
Develop systematic reviews markers; e.g. diagnoses, Organize TS on specific
and meta-analyses on gender and other patient markers during the first year
existing knowledge. characteristics, cultural of the Action.
aspects, etc.
Suggest putative specific Disseminate information
markers for treatment of Publish reports from WG through the Action’s website
young people that should be meetings. on putative age specific
further investigated. markers.
Together with WG 2
overseen by MC, organize
the Action’s first
International conference.What have we achieved so far..?
Training School in Athens
Initial pubmed searches
Tentative Inclusion/exclusion criteria
PICO String group Search strings
Participants 1) Disorder String (Depressive Disorder[MeSH Terms] OR Depression[MeSH Terms] OR depression[All Fields] OR "affective disorder"[All Fields] OR "affective disorders"[All
Fields] OR "mood disorder"[All Fields] OR "mood disorders"[All Fields] OR “depressive disorder”[All Fields]) OR “seasonal affective disorder”[All Fields] OR
“dysthymia”[All Fields] OR “persistent depressive disorder”[All Fields]) OR “postpartum depression”[All Fields] OR “perinatal depression”[All Fields] OR “major
depressive disorder”[All Fields] OR “treatment-resistant depressive disorder”[All Fields] OR "dysthymic disorder”[All Fields] OR “premenstrual dysphoric
disorder”[All Fields] OR “seasonal affective disorder”[All Fields])
2) Age "humans"[MeSH Terms] AND English[lang] AND ("adult"[MeSH Terms:noexp] OR "adolescent"[MeSH Terms]))
Intervention 1) General ("psychotherapy"[MeSH Terms] OR "psychotherapy"[All Fields] OR "psychotherapies"[All Fields]) OR ("counselling"[All Fields] OR "counseling"[MeSH Terms]
psychotherapy OR "counseling"[All Fields]) OR "counselling"[All Fields] OR "psychological treatment"[All Fields] OR "psychological intervention"[All Fields] OR
psychoeducation[All Fields] OR "group therapy"[All Fields] OR "family therapy"[All Fields] OR "psychosocial intervention"[All Fields] OR "psychosocial
treatment"[All Fields] OR "Mind-Body Therapies"[MeSH Terms] OR "Art Therapy"[MeSH Terms] OR "Dance Therapy"[MeSH Terms] OR "Music Therapy"[MeSH
Terms] OR "Play Therapy"[MeSH Terms]) OR "supportive psychotherapy"[All Fields]
2) Specific OR cbt[All Fields] OR "cognitive therapy"[All Fields] OR "behavior therapies"[All Fields] OR "behavior therapy"[All Fields] OR "behavioural treatment"[All
treatments Fields] OR "behavioral treatment"[All Fields] OR "behavioral activation"[All Fields] OR "exposure and response prevention"[All Fields] OR "exposure with
response prevention"[All Fields] OR (exposure[All Fields] AND "response prevention"[All Fields]) OR REBT[All Fields] OR "problem solving therapy"[All Fields]
OR "interpersonal therapy"[All Fields] OR "mindfulness"[All Fields] OR psychodynamic[All Fields] OR "psychodynamic therapy"[All Fields] OR
"psychoanalysis"[MeSH Terms] OR "psychoanalytic"[All Fields] OR "mentalization based therapy"[All Fields] OR "mentalization based treatment"[All Fields] OR
"MBT"[All Fields] OR “transference focused therapy”[All Fields] OR ("transference focused psychotherapy"[All Fields] OR “metacognitive therapy"[All Fields]
OR "metacognitive treatment"[All Fields] OR "Acceptance and Commitment Therapy"[All Fields] OR "ACT"[All Fields] OR "dialectical behavior therapy"[All
Fields] OR "dialectical behaviour therapy"[All Fields] OR DBT[All Fields] OR "Schema Therapy"[All Fields] OR "Schema-focused Therapy"[All Fields] OR
"Systematic Desensitization"[All Fields] OR "Exposure therapy"[All Fields] OR ("relaxation"[MeSH Terms] OR "relaxation"[All Fields]) OR ("biofeedback,
psychology"[MeSH Terms] OR ("biofeedback"[All Fields] AND "psychology"[All Fields]) OR "psychology biofeedback"[All Fields] OR "biofeedback"[All Fields])
OR ("hypnosis"[MeSH Terms] OR "hypnosis"[All Fields]) OR "Attention bias-modification"[All Fields])
Step 1: Step 2: Step 3:
Title Abstract Full TextChallenges
Search Results
Inclusiveness
Anxiety
Disorders 20724
Depressive
Disorders 20162
Psychoses 17863
Feasiblility
Eating 18492
Bipolar
Disorders 25833Moving forward...
August 15th
• Search committee to finalize
searches
• Finalize Inclusion/exclusion Criteria
• Diagnosis Teams to retrieve relevant
articles using PRISMA guidelines
September 13th Cyprus
Meeting
• Decide on scope of articles
• Decide on research
methodology (only RCTs vs.
more extensive research
designs)
• Upload a protocol in PROSPERO 14Questions and Suggestions • Stig Poulsen (chair): stig.poulsen@psy.ku.dk • Eleni Vousoura (vice chair): evousoura@acg.edu
WORKING GROUP 2 Mechanisms of change
24 members
What do we do? • Identify the potential pathways and mechanisms of therapeutic change • = what happens between start of treatment and outcome • Task 1: Exchange knowledge and research experience, and collaborate with clinicians in order to identify putative mechanisms of change. • Task 2: Identify what is missing in the evidence base. • Task 3: Suggest what kind of research on mechanisms of change is needed to further knowledge.
Why do we do it? • Theoretical coherence • Understanding the relationships between what we do and what is the outcome • To more effectively implement treatments (for different people and age groups)
How do we do it? • Define and operationalize mediator in pragmatic ways • Set up a standardized procedure for all searches
Next steps • Carry out reviews (and meta-analyses) of found literature • Exchange information with working groups on moderators, measurement issues, and research designs • Disseminate information (with other working groups) to relevant research and clinical settings
Questions and suggestions • Svenja Taubner (chair): Svenja.Taubner@med.uni-heidelberg.de • Erkki Heinonen (vice chair): erkki.heinonen@helsinki.fi
WORKING GROUP 3 Age-customized
assessmentsAge customized measurement
• Adolescence/young adulthood a period of transition
psychologically, socially, and biologically
• Mental health problems increasing
• Identity vs role confusion (Erikson, Marcia, McAdams)
• Formal operations stage (abstract thought, metacognition
etc; Piaget, Elkind)
• These issues may affect measurement
a) Reliability – i.e. we can not assume that a measure that
works for adults works for adolescents
b) What we want to measure? Different
processes/outcomes may be important for adolescents
compared to adultsDomains of measurement • Process measures • Outcome measures • Dropout rates/reasons for dropout • Therapist measures (e.g. training, experience, personality) • Therapeutic modality • Adherence/competence measures
Outcome domains a) Symptoms b) Functioning c) Quality of life d) Relationships (family, friends, love relationships) e) Physical health f) Sexuality g) Education/work problems h) Self-harm i) Personality structure j) Narrative coherence k) Identity
How do we measure? • Self reports (intern-based vs pen & paper) • Parent/parental figures/legal guardian reports • Teacher reports • Peer report • Clinician ratings • Independent observer ratings • Psychological or physical test results • Individualised measures • Qualitative interviews
WORKING GROUP 4 Age-customized
designsWG 4
Julian Edbrooke-Childs UK Lead
Nick Midgley UK MC member
MC member:
Luis-Joaquin Garcia-Lopez Spain Spanish
representative
Catarina Pinheiro Mota Portugal Researcher
Camellia Hancheva Bulgaria vice-leader
Nick Morgan UK MC member
Célia Sales Portugal vice-leader
Sonia Sousa Estonia Member
Vivek Furtado UK Member
4/15/2019What do we do?
1. Identify age customized research designs
2. Propose guidelines for process & outcome
research of psychotherapy with adolescents
and YP
3. Facilitate collaborative European Research
Special focus on digital psychotherapy and
participatory research designsWhy do we do it? • Fast development of psychotherapy into digital formats • Adolescents and YP are “native digital” (and researchers & psychotherapists are not…) • Benefits of involving patients and the public in designing research: more appropriate studies, better recruitment rates, and increased public confidence in research findings • Research designed with patients and the public is increasingly recognised as good practice (e.g., in funding applications) • Researchers are unclear about how best to involve patients and the public in designing research • Involving children and young people in psychotherapy research design has additional challenges (e.g., capacity and consent)
How do we do it? A. Three systematic reviews of literature In collaboration with TEAM
How do we do it?
1. Liverpool et al. (in preparation). A systematic review to
examine approaches used for engaging children and
young people in digital psychotherapy interventions.
• Protocol registered in Prospero
• Aim to complete review by end of January 2019
1. What existing approaches to involving young people in
designing psychotherapy research are used?
• Aim to draft and finalise protocol between September-
December 2018
• Aim to complete review by December 2019How do we do it?
3. How have existing studies on moderators and
mediators of psychotherapy research customized
research designs to make them appropriate for
young people?
• Secondary analysis of studies identified and included by
the reviews of WG1 and WG2
• Aim to complete review between April 2019-September
2020How do we do it?
B. Consultations with clinicians, researchers
and young people: How to effectively
involve young people in psychotherapy
research design?
• Included in the Systematic Reviews (1-3) to inform
the development and interpretation of findings
C. Training School: Customizing psychotherapy
research design for young people
• Year 4How do we do it?
D. Framework of age customized research
designs and approaches to involving young
people in the design of psychotherapy
research
• Based on the findings of activities A-C
• Aim to develop this framework Oct 2020-April
2021
• Aim to be disseminated for instance at
www.allaboutux.comWORKING GROUP 5 Dissemination
What do we do? • TREATME intends to reach a broad audience across Europe, near neighbor countries (NNCs) and international partner countries (IPCs). • TREATme will include a broad range of stakeholders including researchers, clinicians, psychotherapy training institutions, NGOs, policy makers, national decision makers, private institutions, and the general public/youth. • Three main methods for dissemination: 1) electronic communication 2) publications, 3) face-to-face contact
Why do we do it? • Lack of knowledge about mental health problems in youth and families low levels of help-seeking, long duration of untreated illness and negative course parameters • Significant drop of efficacy if evidence-based interventions for youth were implemented in clinical practice • Support policy makers to allocate resources and design appropriate treatment strategies for young people suffering from mental disorders
How do we do it? Updates and materials (e.g. of Training Schools) are provided on Facebook (http://www.facebook.com/pg/TreatMeEU) and Twitter (@TreatMeEU).
How do we do it? Development of our own website: www.treat-me.eu
How do we do it? • Regular newsletter with updates from WGs and recent publication in child/adolescent psychotherapy • Organization of symposia at conferences • Involvement of youth in the dissemination process adequate techniques/tools (e.g. interviews)
Next steps • Formation of a Youth Advisory Board to discuss techniques and modes to disseminate knowledge in youth • Collection of information on relevant stakeholders (i.e. mental health institutions/organizations, clinicians, politicians, NGOs, psychotherapy training institutions,…) • Organization of stakeholder-workshops in 2019/20 to disseminate knowledge generated from WGs 1-4
Questions and suggestions • Michael Kaess (chair): michael.kaess@upd.ch • Hanne-Sofie Johnsen Dahl (vice chair): h.s.dahl@medisin.uio.no • Stefanie J. Schmidt (vice-chair): stefanie.schmidt@psy.unibe.ch
Short Term Scientific Missions
and
ITC conference grantsSTSMs AIM TO • facilitate the mobility of ECIs and offer an opportunity to interact with more advanced researchers TARGET RESEARCHERS • are Early Career Investigators (ECIs, up to 8 years after PhD), female researchers, from Inclusiveness Target Country researchers (ITCs) EXPECTED OUTPUT • to disseminate knowledge on moderators, mediators, assessment tools and research designs on individualized psychotherapy for young people
ITC Conference Grants
AIM TO
• supporting PhD students and ECI researchers from Participating ITC to
attend international science and technology related conferences
ELIGIBIILITY
1. exclusively reserved for PhD students and ECI’s with a primary
affiliation in an institution located in an ITC
2. oral/poster presentation at the conference, listed in the official
event/conference programme
3. subject of the oral presentation / poster must be on the topic of the
Action and must acknowledge COST (see Section 9)
4. Participation must be pre-approved by the Action MC
5. European conferences are preferredSTSMs for 2nd grant period • 7 applications have been received • 4 STSMs to be funded • Average cost 2,500 € per STSM • STSM activity will carried out until February 28th 2019
STSMs-
opportunities
• 9 new STSM opportunities are offered in 8 countries
• Countries: Spain, former Yugoslav Republic of Macedonia, Switzerland,
Portugal, Estonia, Germany…
Experts in the field of
• Family and systemic psychotherapy
• Neuro- and Biofeedback
• RCTs in school settings
• Mentalization-based interventions
• CBT
• Psychodrama
• …STSM- selection criteria
Formal criteria
• Early career researcher
• Gender balance
• ITC country
Scientific criteria
1. Motivation and research match TreatMe aims & host institution
2. Scientifc quality of working plan: research questions, methodology,
timeline
• Ratings:
• 1 = very low motivation, no research question, low quality
methodology
• 10 = very high motivation, specific, relevant research question, well-
designed methodSTSM- review committee • HANCHEVA Camellia (Bulgaria) • BARKAUSKIENE Rasa (Lithuania) • MARKOVSKA-SIMOSKA Silvana (fyrMacedonia) • VOLKERT Jana (Germany) • Evaluation will be completed by July, 1st 2018
ITC Conference Grants
in 2nd grant period
• 5 Conference grants have been awarded
• Maximum cost 2,500 € per applicant
• are be carried out between May 1st 2018 and February 28th
2019ITC conference grant-
Formal criteria
selection criteria
• Early career researcher
• Gender balance
• ITC country
Scientific criteria
1. Motivation and research match TreatMe aims & conference
2. Scientifc quality of conference contribution: research questions,
methodology, timeline
• Ratings:
• 1 = very low motivation, no research question, low quality
methodology
• 10 = very high motivation, specific, relevant research question, well-
designed methodList of ITC countries Bosnia-Herzegovina, Bulgaria, Cyprus, Czech Republic, Estonia, Croatia, Hungary, Lithuania, Latvia, Luxembourg, Malta, Montenegro, Poland, Portugal, Romania, Slovenia, Slovakia, the former Yugoslav Republic of Macedonia, Republic of Serbia and Turkey. http://www.cost.eu/about_cost/strategy/excellence-inclusiveness
ITC conference grants-
selection committee
• TULBURE Bogdan Tudor (Romania)
• RANGEL HENRIQUES Margarida (Portugal)
• STEPISNIK Tjasa (Slovenia)ITC conference grant
awardees
• Vera Coehlo (Portugal): Early Sig 5
Conference on Future Challenges for
Early Childhood Education & Care in
Berlin in August 2018
• Tamara Prevendar (Croatia), João
Francisco Barreto (Portugal) and
Ioana Podina (Romania): SPR in
Amsterdam in June 2018
• Monica Costa (Portugal): Conference
of the European Association for
Research on Adolescence (EARA) in
Ghent in September 2018New calls for STSMs and ITC conference grants in February/ March 2019
Further information
www.treat-me.eu
http://www.cost.eu/COST_Actions/ca/CA16102
or contact
jana.volkert@med.uni-heidelberg.deThank you very much for your
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