Psychotherapy for Chronic In- and Outpatients with Common Mental Disorders: The "Choose Change" Effectiveness Trial

Andrew T Gloster; Elisa Haller; Jeanette Villanueva; Victoria Block; Charles Benoy; Andrea H Meyer; Sandra Brogli; Veronika Kuhweide; Maria Karekla; Klaus Bader; Marc Walter; Undine Lang

doi:10.1159/000529411

Psychotherapy for Chronic In- and Outpatients with Common Mental Disorders: The "Choose Change" Effectiveness Trial

Psychother Psychosom. 2023;92(2):124-132. doi: 10.1159/000529411. Epub 2023 Apr 6.

Authors

Andrew T Gloster¹, Elisa Haller¹, Jeanette Villanueva^{1

2}, Victoria Block¹, Charles Benoy^{1

3}, Andrea H Meyer⁴, Sandra Brogli², Veronika Kuhweide², Maria Karekla⁵, Klaus Bader², Marc Walter^{2

6}, Undine Lang²

Affiliations

¹ Department of Psychology, Division of Clinical Psychology & Intervention Science, University of Basel, Basel, Switzerland.
² Center for Psychosomatics and Psychotherapy, University Psychiatric Clinics Basel, Basel, Switzerland.
³ Centre Hospitalier Neuro-Psychiatrique, Ettelbrück, Luxembourg.
⁴ Department of Psychology, Division of Clinical Psychology and Epidemiology, University of Basel, Basel, Switzerland.
⁵ Department of Psychology, University of Cyprus, Nicosia, Cyprus.
⁶ Psychiatrische Dienste Aargau AG, Windisch, Switzerland.

PMID: 37023742
DOI: 10.1159/000529411

Abstract

Introduction: Treatment non-response occurs regularly, but psychotherapy is seldom examined for such patients. Existing studies targeted single diagnoses, were relatively small, and paid little attention to treatment under real-world conditions.

Objective: The Choose Change trial tested whether psychotherapy was effective in treating chronic patients with treatment non-response in a transdiagnostic sample of common mental disorders across two variants of treatment delivery (inpatient and outpatient).

Methods: The controlled nonrandomized effectiveness trial was conducted between May 2016 and May 2021. The study took place in two psychiatric clinics with N = 200 patients (n = 108 inpatients and n = 92 outpatients). Treatment variants were integrated inpatient care versus outpatient care based on acceptance and commitment therapy (ACT) for approximately 12 weeks. Therapists delivered individualized and non-manualized ACT. Main outcome measures were symptoms (Brief Symptom Checklist [BSCL]); well-being (Mental Health Continuum-Short Form [MHC-SF]), and functioning (WHO Disability Assessment Schedule [WHO-DAS]).

Results: Both inpatients and outpatients showed decreases in symptomatology (i.e., BSCL: d = 0.68) and increases in well-being and functioning (MHC-SF: d = 0.60 and WHO-DAS: d = 0.70), with more improvement in the inpatients during treatment. Both groups maintained gains 1 year following treatment, and the groups did not significantly differ from each other at this timepoint. Psychological flexibility moderated impact of stress on outcomes.

Conclusions: Psychotherapy as practiced under routine conditions is effective for a sample of patients with common mental disorders, a long history of treatment experience and burden of disease, in both inpatient and outpatient settings.

Trial registration: This study was registered in the ISRCTN registry on May 20, 2016, with the registration number ISRCTN11209732.

Keywords: Anxiety and depression; Effectiveness; Routine care; Transdiagnostic; Treatment non-response.

Publication types

Controlled Clinical Trial

MeSH terms

Acceptance and Commitment Therapy*
Ambulatory Care
Humans
Mental Disorders* / therapy
Outpatients
Psychotherapy
Treatment Outcome