JMIR Publications

ABSTRACT

Background:

In recent years, Routine Outcome Monitoring has been increasingly complemented by Routine Process Monitoring (RPM) in psychotherapy and other healthcare settings. Various approaches to therapy feedback exist, differing in assessment frequency, integration into the therapeutic process, and degree of personalization. In this study, we will use a procedure of high-frequency assessment through daily self-ratings, a standard process questionnaire alongside a personalized questionnaire derived from case formulation, and frequent feedback interviews using visual diagrams to mirror the ongoing therapeutic processes.

Objective:

This study aims to investigate the effectiveness of combining RPM with a version of hypno-psychotherapy (autosystemic hypnotherapy; ASH) by comparing it to ASH without process feedback in the outpatient treatment of mood disorders. It also seeks to examine process-outcome relationships and mechanisms of change through high-frequency self-assessments and session-based feedback.

Methods:

The study is a randomized controlled trial (RCT) with two arms, using within-therapist randomization (ABAB design) in outpatient psychotherapy. Participants are recruited offline via routine intake procedures. A total of 100 patients will be randomly assigned to one of the two conditions following a waiting period. Inclusion criterion is the existence of any mood disorder (Major Depressive Disorder and/or Anxiety Disorder), assessed via a standardized interview (SCID). Each therapist treats patients in both conditions. Outcomes will be measured at four time points: after diagnosis confirmation, post-waiting period, post-treatment, and a six-month follow-up. Primary and secondary outcomes, including symptom severity, will be assessed using multiple questionnaires. Data collection also includes patient and therapist session evaluations using the Bern Patient and Therapist Session Questionnaire (TSTB/PSTB), which captures therapeutic alliance, session-level outcomes, motivation for change, and other parameters. In the feedback condition, therapists conduct frequent feedback interviews using time-series data generated from daily self-assessments using the Synergetic Navigation System (SNS), including the Therapy Process Questionnaire (TPQ) and an individualized measure based on case conceptualization.

Results:

While the study is ongoing, the primary aim is to assess the effects of the feedback condition on therapeutic outcomes, including symptom reduction and patient motivation. The study will also explore how dynamic monitoring and feedback influence the therapeutic alliance and session-level improvements. It is expected that the feedback condition will lead to more pronounced improvements in symptom severity and therapeutic engagement compared to the non-feedback condition.

Conclusions:

This study combines effect and process measures within a feedback condition, compared to a non-feedback condition. It incorporates dynamic process assessment to explore change mechanisms by analyzing patterns of time-series data and session ratings by patients and therapists. The approach provides insights into how continuous feedback and tailored monitoring influence therapeutic progress and outcomes. Clinical Trial: The trial is registered at Open Science Framework (OSF). doi:10.17605/OSF.IO/Z2EFY