Frontiers in Public Health (Feb 2023)
Trans-diagnostic determinants of psychotherapeutic treatment response: The pressing need and new opportunities for a more systematic way of selecting psychotherapeutic treatment in the age of virtual service delivery
Abstract
Numerous forms of psychotherapy have demonstrated effectiveness for individuals with specific mental disorders. It is, therefore, the task of the clinician to choose the most appropriate therapeutic approach for any given client to maximize effectiveness. This can prove to be a difficult task due to at least three considerations: (1) there is no treatment approach, method or model that works well on all patients, even within a particular diagnostic class; (2) several treatments are equally efficacious (i.e., more likely to be effective than no treatment at all) when considered only in terms of the patient's diagnosis; and (3) effectiveness in the real-world therapeutic setting is determined by a host of non-diagnostic factors. Typically, consideration of these latter, trans-diagnostic factors is unmethodical or altogether excluded from treatment planning – often resulting in suboptimal patient care, inappropriate clinic resource utilization, patient dissatisfaction with care, patient demoralization/hopelessness, and treatment failure. In this perspective article, we argue that a more systematic research on and clinical consideration of trans-diagnostic factors determining psychotherapeutic treatment outcome (i.e., treatment moderators) would be beneficial and – with the seismic shift toward online service delivery – is more feasible than it used to be. Such a transition toward more client-centered care – systematically considering variables such as sociodemographic characteristics, patient motivation for change, self-efficacy, illness acuity, character pathology, trauma history when making treatment choices – would result in not only decreased symptom burden and improved quality of life but also better resource utilization in mental health care and improved staff morale reducing staff burnout and turnover.
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