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Symptom courses during and after psychotherapy: models and simulations Robert Perčević June 2007

Symptom courses during and after psychotherapy: models and simulations Robert Perčević June 2007

Treatment Courses

The Random Walk Model

xt= ?

The Random Walk Model

xt=xt-1 x t

The Random Walk Model

xt=xt-1+c c<0 x t

The Random Walk Model

xt=xt-1+c+ψ c<0 V(ψ)>0, E(ψ)=0 Random Variable

The Random Walk Model with Measurement Error

xt=xt-1+c+ψ+εt-εt-1 c<0 V(ψ)>0, E(ψ)=0 V(ε)>0, E(ε)=0

Empirical Verification

Hypothesis: (a) homogeneous and (b) independent change rates Sample: Specialized psychotherapeutic hospital 1210 patients Most common diagnosis: F32, F33, F60, F50 Treatment between 2 and 77 days Up to 9 assessments per patient 4149 observations Method: HLM; (xi,t - xi,t-1) / Δt = (β1 + ai) + (β2 + bi)t + ε

Empirical Verification

0,0820 -0,3559 -0,0781 <0,01 -0,0006 <0,01 0,0002 -0,0018 SOU 0,1139 -0,3539 -0,0812 <0,01 -0,0006 <0,01 0,0004 -0,0109 ZUF 0,0867 -0,4071 0,0035 <0,01 -0,0005 <0,01 0,0003 -0,0070 KOM 0,0886 -0,6204 0,1654 <0,01 -0,0007 <0,01 0,0104 -0,0042 SOZ 0,0791 -0,6501 0,1622 <0,01 -0,0006 <0,01 0,0179 -0,0185 PSY 0,1036 -0,2983 -0,0466 0,3516 -0,0002 <0,01 0,0011 -0,0346 KOE 0,0859 -0,3473 0,0036 <0,01 -0,0008 <0,01 0,0103 -0,0201 GES res MA AR p β2 p sd(I) β1 Findings:

How to improve Outcomes?

How to improve Outcomes?

Increase treatment length Increase effectiveness Match treatment and patient Outcome monitoring Identify non-reponders Adapt treatment length to patients needs

How to improve Outcomes?

Increase treatment length Increase effectiveness Match treatment and patient Outcome monitoring Identify non-reponders Adapt treatment length to patients needs

How to improve Outcomes?

Increase treatment length Increase effectiveness Match treatment and patient Outcome monitoring Identify non-reponders Adapt treatment length to patients needs

How to improve Outcomes?

Increase treatment length Increase effectiveness Match treatment and patient Outcome monitoring Identify non-reponders Adapt treatment length to patients needs

How to improve Outcomes?

Increase treatment length Increase effectiveness Match treatment and patient Outcome monitoring Identify non-reponders Adapt treatment length to patients needs

Outcome criteria

Simulation: Treatment Length

x(1…n,0)=initial_distress_distirbution FOR patient = 1 to n FOR time = 1… max_treatment_time x(patient,time)=x(patient,time-1)+c+randomvariable IF x(patient,time)

Simulation: Treatment Length

Simulation: Treatment Length

Dose-Effect / Cost-Effect / Cost-Benefit

Simulation: Treatment Length

Dose-Effect / Cost-Effect / Cost-Benefit Efficiency: the relation between Effect and Effort

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Vortrag3robert
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Symptom courses during and after psychotherapy: models and simulations Robert Perčević June 2007
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treatment | length | patient | outcom | effect | increas | simul | model
Created: 
6/17/2007 6:03:42 PM
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