The presentations in this panel explore two perspectives on the question which constructs could "matter" when measuring outcomes during and at the end of psychological therapies: (i) using conceptual as well as empirical approaches to identify content that captures relevant variation among patients; and (ii) by engaging with stakeholders (including and foremost patients) to identify which constructs provide meaningful or valued information in a given setting. The first presentation reports on a project that uses empirical methods to develop an ontology for depression measurement. An ontology is a formalised representation of domain knowledge, supporting the comparison and integration of the content of measurement tools. The second presentation focuses on using idiographic methods to identify core elements that matter quantitatively for individual PTSD patients and their trajectories, assimilating principles of clinical case formulations and theoretical models into empirical assessment. The third presentation switches the panel toward the question of meaningful measures. It discusses theoretical frameworks to assess psychotherapy outcomes beyond symptoms, and methods to find agreement on such outcomes. The final talk will present qualitative analyses based on the process evaluation embedded in a multi-centre trial, focusing on the context, mechanisms, and outcomes of the trialled intervention that are relevant for patients. All presentations are concerned with how we identify and measure outcomes that matter and they stress that this requires considering different voices, values, and evidence. Since the presentations cover different methodologies and application contexts, the panel encourages attendees to discuss what we perceive as "valid" assessments from this perspective.
The panel included the following presentations and was discussed by Michael Barkham (University of Sheffield, UK):
Constructing a measurement ontology of depression and depression related constructs. Gary Brown, Royal Holloway University of London, George Holliday, Northamptonshire Healthcare NHS Foundation Trust Background: The present study seeks to establish a set of essential measures of depression and depression-related constructs. Methods: The PHQ-8, along with measures of well-being, quality of life, life satisfaction, personal meaning, hopelessness, self-concept , and depressogenic attitudes were administered to a sample of UK respondents on the Testable Minds platform. Results: Using the tools included in the Exploratory Graph Analysis R package (EGA; Christensen, A. P., & Golino, H. (2024, November 12). Exploratory Graph Model. https://doi.org/10.31234/osf.io/zkdr4) the resulting 157-item battery is being analysed in a stepwise manner starting with the core standard measure of depression (the PHQ) and systematically identifying and removing redundant items with EGA unique variable analysis, starting with the symptom core and moving outward to more peripheral constructs. Item stability analysis will then be used to assign items to underlying clusters, with unstable items removed. The remaining dimensions will then be refined further to ensure each is maximally unidimensional. Discussion: The resulting refined battery is intended to reflect an ontology of depression related constructs aimed at clarifying measurement in this area. In planned subsequent research, the battery will be further developed through co-production with individuals with lived experience. The eventual goal is a broadened standard for measuring depression based on a portfolio of linked scales that better reflect what matters to these individuals in contrast to the conventional medical model approach.
Formulation-Guided Mapping of PTSD: An Idiographic Approach Informed by Ehlers and Clark’s Cognitive Model. Nimrod Hertz, University of Cambridge, UK, Elizabeth Blomfield, Royal Holloway University of London, UK, Gary Brown, Royal Holloway University of London, Tim Dalgleish, University of Cambridge, UK, Anna Bevan, University of Cambridge, UK Aim: The integration of Ecological Momentary Assessments (EMA) with idiographic network analysis shows promise as an analogue to clinical case formulation, offering insights into patients' presentations and treatment planning. Yet, data-driven methods often overlook causal mechanisms and essential components beyond symptoms. We propose a formulation-guided approach to EMA for Posttraumatic Stress Disorder (PTSD), comparing it with clinically derived formulations using the Ehlers and Clark Cognitive Model. Methods: Five PTSD patients and their clinicians developed tailored EMA questionnaires, administered five times daily for 14 days (N=348 observations). Individual items were collapsed and analyzed as components of the cognitive model and compared with clinician and patient formulations and theoretical predictions. Two network algorithms, Mixed Graphical Model (MGM) and Graphical Vector Auto-Regression (GVAR), were evaluated against traditional formulations. Results: Data-driven networks highlighted trauma memories and their association with triggers and current threat. Empirical formulations differed from clinician and patient formulations, with MGM networks being more stable than GVAR, with larger effects. Some theoretical predictions were supported, while others were not. Discussion: We stress the value of theoretical models and clinical conceptualization in enhancing EMA data and network models to empirically support case formulations, and use them as valid tools for treatment planning and assessment. We discuss the limitations of data-driven methods to derive causality.
Going beyond measuring symptoms: Constructs and approaches. Jan Boehnke, University of Dundee Aim: The evaluation and practice of psychological therapies is underpinned by well-developed frameworks supporting different epistemological claims, with efficacy, effectiveness, process, patient-oriented research, and measurement-based care as key examples for the topics discussed in this panel. While their reliance on the availability of (mostly) quantitative tools has sparked a proliferation of measures, value-based discussions about what should be measured, in which contexts, and why, are limited, especially when considering engagement beyond providers and assessment content beyond symptoms. Methods: The presentation will discuss frameworks with relevance to research and practice of psychological therapies, and embed these in research into what patients and other stakeholders identify as meaningful outcomes. A focus of the presentation will be consensus processes to identify which outcomes to measure, drawing on the experience of developing two core outcome sets. Results: Research and the concrete examples of the core outcome sets support that different stakeholders have often different and not always compatible perspectives on what is important to measure as an outcome. Stakeholders’ views are driven by several factors, e.g., their epistemological goals (especially from a research and service perspective) or the social context of their lives (especially from a patient perspective). Discussion: It is not a done deal that symptom burden matters most when evaluating outcomes of psychological therapies, but alternatives may depend on the context and stakeholders involved in a particular application. Consensus processes can bring stakeholders together and develop solutions that transparently present the decisions and values that underpin the selection of outcomes.
Exploring the Implementation of a Digital Mobile Mental Health intervention with ESM-based monitoring, reporting, and feedback from the perspective of service users in Germany. Jessica Gugel, Central Institute of Mental Health, Mannheim, Simon Hammes, Central Institute of Mental Health, Mannheim, Germany, Jens Notheis, Central Institute of Mental Health, Mannheim, Germany, Christian Rauschenberg, Central Institute of Mental Health, Mannheim, Germany, Isabell Paetzold, Central Institute of Mental Health, Mannheim, Germany, Anita Schick, Central Institute of Mental Health, Mannheim, Germany, Julia Schulte-Strathaus, Central Institute of Mental Health, Mannheim, Germany, Marta Nemcikova, Pavol Jozef Safárik University, Kosice, Slovakia, Iveta Nagyova, Pavol Jozef Safárik University, Kosice, Slovakia, Lotte Uyttebroek, KU Leuven, Leuven, Belgium, Adam Kurilla, Comenius University, Bratislava, Slovakia, Theresa Ikegwuonu, University of Edinburgh, Edinburgh, UK, Matthias Schwannauer, University of Edinburgh, Edinburgh, UK, Michel Wensing, Heidelberg University Hospital, Heidelberg, Germany, Ulrich Reininghaus, Central Institute of Mental Health, Mannheim, Germany Background: Given mental health tools’ potential of enabling timely, personalized, and innovative interventions, they may foster a more person-centred mental health care. Experience Sampling Methodology (ESM) exemplifies this potential by capturing mental states as they occur in individuals’ everyday lives, possibly yielding feedback on emerging patterns. However, a gap exists between innovations researched in mental health care and their uptake into routine practice. The Implementing Mobile Mental hEalth Recording Strategy for Europe (IMMERSE) consortium attempts to address this by implementing an ESM-based Digital Mobile Mental Health intervention into routine mental health care in four European countries. A customizable App allows service users to monitor their momentary mental states, combined with an interactive dashboard that provides feedback to their respective clinicians. The current study examines the outcomes achieved by this intervention for German service users and the contexts and mechanisms they deem essential for attaining them. Methods: We use interview data from a subsample of N=10 German service users from the IMMERSE hybrid effectiveness-implementation study that consists of a multi-centre, parallel-group cluster randomized controlled trial combined with a process and economic evaluation. Our qualitative analyses will follow a realist evaluation approach. Discussion: Results of this study will help us understand what matters to service users regarding ESM-based monitoring, reporting, and feedback in Germany. Integrating service users’ real-life experience provides critical insights into what should be measured to evaluate mental health interventions, ensuring that they are tailored to the needs of their target population.
| Period | 28 Jun 2025 |
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| Event title | 56th International Meeting of the Society for Psychotherapy Research: Psychotherapy Research-Practice Integration: Who are the voices we need to hear? |
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| Event type | Conference |
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| Location | Krakow, PolandShow on map |
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