Identifying relapse prevention elements during psychological treatment of depression: Development of an observer-based rating instrument

Katja Machmutow; Martin Grosse Holtforth; Tobias Krieger; Birgit Watzke

doi:10.1016/j.jad.2017.11.009

Identifying relapse prevention elements during psychological treatment of depression: Development of an observer-based rating instrument

J Affect Disord. 2018 Feb:227:358-365. doi: 10.1016/j.jad.2017.11.009. Epub 2017 Nov 6.

Authors

Katja Machmutow¹, Martin Grosse Holtforth², Tobias Krieger³, Birgit Watzke⁴

Affiliations

¹ University of Zurich, Department of Clinical Psychology and Psychotherapy Research, Switzerland.
² University of Bern, Institute of Psychology, Clinical Psychology, Switzerland; University Hospital Insel, Bern, Psychosomatic Competence Center, Switzerland.
³ University of Bern, Institute of Psychology, Clinical Psychology, Switzerland.
⁴ University of Zurich, Department of Clinical Psychology and Psychotherapy Research, Switzerland. Electronic address: b.watzke@psychologie.uzh.ch.

PMID: 29149753
DOI: 10.1016/j.jad.2017.11.009

Abstract

Background: Although observer-rated instruments assessing therapist's adherence to relapse-preventive treatments are available, they do not adequately cover specific relapse-preventive elements that focus on implementation of strategies after terminating treatment. This study describes the development of the KERI-D (Kodierbogen zur Erfassung Rückfallprophylaktischer Interventionen bei Depression/Coding System to Assess Interventions of Relapse Prevention in Depression). The KERI-D is a new observer-based rating tool for acute or continuation/maintenance-phase sessions and assesses relapse-prevention elements including implementation into patient's daily routines.

Methods: The development of the KERI-D included iterative steps referring to theoretical, clinical and empirical sources. It consists of 19 content items within four categories (self-care, early warning signs, triggering events/situations, termination of therapy) and one global item. For empirical analyses, videotaped psychotherapy sessions of 36 psychotherapies were rated by three independent observers and analyzed for their psychometric properties.

Results: Most items showed moderate to good inter-rater reliability (median ICC = .80) and retest reliability (median ICC = .93). Principal-axis factor analysis revealed three subscales, and first evidence of content validity was demonstrated. No associations with clinical follow-up data were found.

Limitations: Analysis was limited to a relatively small sample of selected psychotherapy sessions. Evaluation of predictive validity is a desirable next step to further examine applicability and scope of the instrument.

Conclusions: The KERI-D is the first observer-based rating instrument measuring specific relapse-prevention strategies in psychotherapy for depression. It may help to identify elements that prove effective in reducing relapse/recurrence in the long-term and thereby help to optimize effect duration of depression treatment.

Keywords: Depression; Observer; Rating; Relapse prevention; Reliability; Validity.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Depression / prevention & control*
Female
Humans
Male
Psychiatric Status Rating Scales / statistics & numerical data*
Psychometrics
Psychotherapy*
Recurrence*
Reproducibility of Results
Secondary Prevention*