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A C Del Re

VA, HSR&D, Research Health Scientist

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I received a PhD from the University of Wisconsin-Madison followed by a postdoctoral research fellowship with the Center for Health Care Evaluation, VA Palo Alto Healthcare System and Stanford University School of Medicine. I am currently a Research Health Scientist with the Center for Innovation to Implementation.My research interests are broad and diverse: health services, mental health/psychotherapy, pharmacotherapy, mindfulness, obesity management, and high-cost psychiatric patients. I also have an interest in statistical methods and in developing open source software to assist researchers in utilizing recommended meta-analytic statistical procedures.
Address: Palo Alto, California, United States

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George MacDonald

University of South Florida

Patrice Rasmussen

Patrice Rasmussen [email protected]

University of Florida

Elizabeth Frolova

University of Stirling

Alirio Rodrigo Bastidas Goyes

Universidad Militar Nueva Granada

Florida State University

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Papers by A C Del Re

compute.es: Compute Effect Sizes

Description This package contains several functions for calculating and converting various statis... more Description This package contains several functions for calculating and converting various statistics, such as a t-test or p-value and sample size, to effect size estimates of d (mean difference), g (unbiased estimate of d), r (correlation coefficient), z (Fisher's z), and log odds ratio. The variance of these estimates are also computed. These calculation/conversion functions are a particularly useful resource during the preliminary stages of a meta-analytic project when deriving effect sizes from reported data. This package uses recommended formulas as described in The

A Practical Tutorial on Conducting Meta-Analysis in R

Meta-analysis is a set of statistical procedures used for providing transparent, objective, and r... more Meta-analysis is a set of statistical procedures used for providing transparent, objective, and replicable summaries of research findings. This tutorial demonstrates the most common procedures on conducting a meta-analysis using the R statistical software program. It begins with an introduction to meta-analysis along with detailing the preliminary steps involved in completing a research synthesis. Then, a step-by-step tutorial for each of the quantitative components involved for meta-analysis is provided using a fictional set of psychotherapy treatment-control studies as a running example.

Flückiger, Kommentar

Flückiger, JCR, 2014.2

Bedeutung der Arbeitsallianz in der Psychotherapie

Psychotherapeut, 2015

ABSTRACT Die Arbeitsallianz ist das am meisten untersuchte therapiebezogene Prozessmerkmal weltwe... more ABSTRACT Die Arbeitsallianz ist das am meisten untersuchte therapiebezogene Prozessmerkmal weltweit. Zwischen 2000 und 2014 sind dazu jährlich um die 300 Fachpublikationen veröf- fentlicht worden. Die Gründe für die Popularität des Konzepts liegen möglicherweise in der intuitiven Erfahrung vieler Psychotherapeuten, dass eine insgesamt „positive“ Arbeitskollaboration zwischen Therapeut und Patient ein nützlicher (wenn vielleicht auch nicht hinreichender) Indikator für das Fortschreiten der Therapie darstellt. Inwieweit lässt sich dieser subjektive Eindruck empirisch bestätigen?

Corrigendum to: “The effectiveness of evidence-based treatments for personality disorders when comparing treatment-as-usual and bona fide treatments” [Clin. Psychol. Rev. 33 (2013) 1057–1066]

Clinical Psychology Review, 2014

The therapeutic alliance in the context of empirically supported treatments: A longitudinal meta-analysis

L’ alleanza nella psycoterapiy individuale

The alliance in adult psychotherapy

The working alliance in individual therapy

Exploration von Resilienzen und Ressourcen bei Veränderungssprüngen

MAc: Meta-Analysis with Correlations

This is an integrated meta-analysis package for conducting a correlational research synthesis. On... more This is an integrated meta-analysis package for conducting a correlational research synthesis. One of the unique features of this package is in its integration of user-friendly functions to facilitate statistical analyses at each stage in a meta-analysis with correlations. It uses recommended procedures as described in The Handbook of Research Synthesis and Meta-Analysis (Cooper, Hedges, & Valentine, 2009).

MAd: Meta-Analysis with Mean Differences

This is an integrated meta-analysis package for conducting a research synthesis with mean differe... more This is an integrated meta-analysis package for conducting a research synthesis with mean differences data. One of the unique features of this package is in its integration of user-friendly functions to facilitate statistical analyses at each stage in a meta-analysis with mean differences. It uses recommended procedures as described in The Handbook of Research Synthesis and Meta-Analysis (Cooper, Hedges, & Valentine, 2009).

A meta-analysis of topiramate's effects for individuals with alcohol use disorders

Alcoholism, clinical and experimental research, 2014

Influenced by several trials and reviews highlighting positive outcomes, topiramate is increasing... more Influenced by several trials and reviews highlighting positive outcomes, topiramate is increasingly prescribed as a treatment for alcohol use disorders (AUDs). The only previously published meta-analysis of topiramate for AUDs was limited by a sample of only 3 randomized, placebo-controlled trials (RCTs). A systematic search identified 7 RCTs (including a total of 1,125 participants) that compared topiramate to placebo for the treatment for AUDs. This meta-analysis estimated the overall effects of topiramate on abstinence, heavy drinking, craving, and γ-glutamyltranspeptidase (GGT) outcomes and included several sensitivity analyses to account for the small sample of studies. Overall, the small to moderate effects favored topiramate, although the effect on craving was not quite significantly different from 0. The largest effect was found on abstinence (g = 0.468, p < 0.01), followed by heavy drinking (g = 0.406, p < 0.01), GGT (g = 0.324, p = 0.02), and craving (g = 0.312, p = ...

Enduring effects of evidence-based psychotherapies in acute depression and anxiety disorders versus treatment as usual at follow-up - A longitudinal meta-analysis

Moderate superiority of evidence based psychotherapies (EBP) in comparison to TAU • No growth of ... more

Intention-to-treat analyses and missing data approaches in pharmacotherapy trials for alcohol use disorders

BMJ Open, 2013

Objectives: Intention to treat (ITT) is an analytic strategy for reducing potential bias in treat... more Objectives: Intention to treat (ITT) is an analytic strategy for reducing potential bias in treatment effects arising from missing data in randomised controlled trials (RCTs). Currently, no universally accepted definition of ITT exists, although many researchers consider it to require either no attrition or a strategy to handle missing data. Using the reports of a large pool of RCTs, we examined discrepancies between the types of analyses that alcohol pharmacotherapy researchers stated they used versus those they actually used. We also examined the linkage between analytic strategy (ie, ITT or not) and how missing data on outcomes were handled (if at all), and whether data analytic and missing data strategies have changed over time.

Extended Release Naltrexone for Alcohol Use Disorders: Quasi-Experimental Effects on Mortality and Subsequent Detoxification Episodes

Alcoholism: Clinical and Experimental Research, 2015

Utilization of extended release naltrexone (XRN) for alcohol use disorders (AUDs) in the U.S. Vet... more Utilization of extended release naltrexone (XRN) for alcohol use disorders (AUDs) in the U.S. Veterans Health Administration (VHA) has been limited, perhaps due to high cost, lack of established superiority over less expensive alternatives including oral naltrexone, and related formulary restrictions. Despite these barriers, pockets of higher utilization exist in VHA, allowing for the quasi-experimental examination of the effects of XRN on 1-year mortality and number of subsequent detoxification episodes among patients with high rates of psychiatric comorbidities and previous psychosocial and pharmacological addiction treatment. Using propensity score-weighted mixed-effects logistic regression, 1-year mortality was compared between patients with AUDs who received XRN in fiscal year 2010 (n = 387) and a random sample of patients with AUDs who did not receive XRN (n = 3,759). Among the subgroup of patients who had at least 1 detoxification episode in the previous year, 1-year mortality and number of subsequent detoxification episodes were compared between those who did and did not receive XRN. Overall, 1-year mortality for the patients receiving XRN was significantly lower than for the comparison group who did not receive XRN (odds ratio [OR] = 0.30; p &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.001). Among patients with a detoxification episode in the previous year, those receiving XRN had, on average, 0.80 fewer subsequent detoxification episodes (p &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.001) and significantly lower mortality (OR = 0.78, p &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.001) in the postindex year. Among patients with AUDs, those receiving XRN had lower 1-year mortality and fewer detoxifications compared to similar patients not receiving XRN. These results, although observational, support the use of XRN, especially among patients with high rates of psychiatric comorbidities and previous addiction treatment who are still struggling with AUDs and/or facing a period of vulnerability to relapse.

Working along sudden gains: Responsiveness on small and subtle early changes and exceptions

Psychotherapy, 2013

When mental health is monitored over the course of treatment, many clients report strong and stab... more When mental health is monitored over the course of treatment, many clients report strong and stable changes, particularly early in psychotherapy. Such changes can occur both in singular events, such as sudden gains in particular symptoms, and more comprehensive ways across the World Health Organization definition of health (WHO, 1948), which includes well-being and psychosocial functioning. The present practical guideline illustrates a systematized sequence of tasks that explore rapid changes and sudden gains at a very early stage of therapy, as well as how such changes can be used in future therapeutic work. These tasks include (1) exploration of the change situation, (2) reinforcement of generalized self-efficacy and hope bonding, and (3) benefit for therapy.

Alliance in individual psychotherapy

Psychotherapy, 2011

This article reports on a research synthesis of the relation between alliance and the outcomes of... more This article reports on a research synthesis of the relation between alliance and the outcomes of individual psychotherapy. Included were over 200 research reports based on 190 independent data sources, covering more than 14,000 treatments. Research involving 5 or more adult participants receiving genuine (as opposed to analogue) treatments, where the author(s) referred to one of the independent variables as "alliance," "therapeutic alliance," "helping alliance," or "working alliance" were the inclusion criteria. All analyses were done using the assumptions of a random model. The overall aggregate relation between the alliance and treatment outcome (adjusted for sample size and non independence of outcome measures) was r ϭ .275 (k ϭ 190); the 95% confidence interval for this value was .25-.30. The statistical probability associated with the aggregated relation between alliance and outcome is p Ͻ .0001. The data collected for this meta-analysis were quite variable (heterogeneous). Potential variables such as assessment perspectives (client, therapist, observer), publication source, types of assessment methods and time of assessment were explored.

Apolipoprotein-E genotype and human immunodeficiency virus-associated neurocognitive disorder: the modulating effects of older age and disease severity

Neurobehavioral HIV Medicine, 2013

The apolipoprotein-E (APOE) ε4 allele is a risk factor for vascular dementia and Alzheimer&am... more The apolipoprotein-E (APOE) ε4 allele is a risk factor for vascular dementia and Alzheimer&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;s disease. Recent studies are equivocal with regards to whether or not the ε4 allele confers increased risk for the development of human immunodeficiency virus (HIV)-associated neurocognitive disorder (HAND), but suggest that age and/or disease severity may be modulating factors. The aim of this study was to assess the interactions and contributions of APOE genotype, age, and HIV disease severity as risk factors for HAND in HIV-infected adults. Participants were 259 HIV-positive individuals who underwent APOE genotyping, a standardized neurological evaluation, a comprehensive neuropsychological evaluation, and laboratory testing. Older ε4 carriers showed a higher frequency of HAND compared with age-matched non-ε4 carriers. Analysis by discrete neurocognitive domain revealed that advanced age modulated the effect of the ε4 allele, such that older ε4 allele carriers showed reduced executive functioning and information processing speed. Exploratory analyses assessing the relationship between ε4 and disease severity in the overall sample revealed that disease severity modulated the effect of the ε4 allele on cognition. Lower absolute CD4+ cell count among ε4 allele carriers was associated with poorer working memory ability. Advancing age and degree of immunosuppression may influence the association between APOE ε4 allele status and HAND. These two factors need to be taken into account in future research.

compute.es: Compute Effect Sizes

Description This package contains several functions for calculating and converting various statis... more Description This package contains several functions for calculating and converting various statistics, such as a t-test or p-value and sample size, to effect size estimates of d (mean difference), g (unbiased estimate of d), r (correlation coefficient), z (Fisher's z), and log odds ratio. The variance of these estimates are also computed. These calculation/conversion functions are a particularly useful resource during the preliminary stages of a meta-analytic project when deriving effect sizes from reported data. This package uses recommended formulas as described in The

A Practical Tutorial on Conducting Meta-Analysis in R

Meta-analysis is a set of statistical procedures used for providing transparent, objective, and r... more Meta-analysis is a set of statistical procedures used for providing transparent, objective, and replicable summaries of research findings. This tutorial demonstrates the most common procedures on conducting a meta-analysis using the R statistical software program. It begins with an introduction to meta-analysis along with detailing the preliminary steps involved in completing a research synthesis. Then, a step-by-step tutorial for each of the quantitative components involved for meta-analysis is provided using a fictional set of psychotherapy treatment-control studies as a running example.

Flückiger, Kommentar

Flückiger, JCR, 2014.2

Bedeutung der Arbeitsallianz in der Psychotherapie

Psychotherapeut, 2015

ABSTRACT Die Arbeitsallianz ist das am meisten untersuchte therapiebezogene Prozessmerkmal weltwe... more ABSTRACT Die Arbeitsallianz ist das am meisten untersuchte therapiebezogene Prozessmerkmal weltweit. Zwischen 2000 und 2014 sind dazu jährlich um die 300 Fachpublikationen veröf- fentlicht worden. Die Gründe für die Popularität des Konzepts liegen möglicherweise in der intuitiven Erfahrung vieler Psychotherapeuten, dass eine insgesamt „positive“ Arbeitskollaboration zwischen Therapeut und Patient ein nützlicher (wenn vielleicht auch nicht hinreichender) Indikator für das Fortschreiten der Therapie darstellt. Inwieweit lässt sich dieser subjektive Eindruck empirisch bestätigen?

Corrigendum to: “The effectiveness of evidence-based treatments for personality disorders when comparing treatment-as-usual and bona fide treatments” [Clin. Psychol. Rev. 33 (2013) 1057–1066]

Clinical Psychology Review, 2014

The therapeutic alliance in the context of empirically supported treatments: A longitudinal meta-analysis

L’ alleanza nella psycoterapiy individuale

The alliance in adult psychotherapy

The working alliance in individual therapy

Exploration von Resilienzen und Ressourcen bei Veränderungssprüngen

MAc: Meta-Analysis with Correlations

This is an integrated meta-analysis package for conducting a correlational research synthesis. On... more This is an integrated meta-analysis package for conducting a correlational research synthesis. One of the unique features of this package is in its integration of user-friendly functions to facilitate statistical analyses at each stage in a meta-analysis with correlations. It uses recommended procedures as described in The Handbook of Research Synthesis and Meta-Analysis (Cooper, Hedges, & Valentine, 2009).

MAd: Meta-Analysis with Mean Differences

This is an integrated meta-analysis package for conducting a research synthesis with mean differe... more This is an integrated meta-analysis package for conducting a research synthesis with mean differences data. One of the unique features of this package is in its integration of user-friendly functions to facilitate statistical analyses at each stage in a meta-analysis with mean differences. It uses recommended procedures as described in The Handbook of Research Synthesis and Meta-Analysis (Cooper, Hedges, & Valentine, 2009).

A meta-analysis of topiramate's effects for individuals with alcohol use disorders

Alcoholism, clinical and experimental research, 2014

Influenced by several trials and reviews highlighting positive outcomes, topiramate is increasing... more Influenced by several trials and reviews highlighting positive outcomes, topiramate is increasingly prescribed as a treatment for alcohol use disorders (AUDs). The only previously published meta-analysis of topiramate for AUDs was limited by a sample of only 3 randomized, placebo-controlled trials (RCTs). A systematic search identified 7 RCTs (including a total of 1,125 participants) that compared topiramate to placebo for the treatment for AUDs. This meta-analysis estimated the overall effects of topiramate on abstinence, heavy drinking, craving, and γ-glutamyltranspeptidase (GGT) outcomes and included several sensitivity analyses to account for the small sample of studies. Overall, the small to moderate effects favored topiramate, although the effect on craving was not quite significantly different from 0. The largest effect was found on abstinence (g = 0.468, p < 0.01), followed by heavy drinking (g = 0.406, p < 0.01), GGT (g = 0.324, p = 0.02), and craving (g = 0.312, p = ...

Enduring effects of evidence-based psychotherapies in acute depression and anxiety disorders versus treatment as usual at follow-up - A longitudinal meta-analysis

Moderate superiority of evidence based psychotherapies (EBP) in comparison to TAU • No growth of ... more

Intention-to-treat analyses and missing data approaches in pharmacotherapy trials for alcohol use disorders

BMJ Open, 2013

Objectives: Intention to treat (ITT) is an analytic strategy for reducing potential bias in treat... more Objectives: Intention to treat (ITT) is an analytic strategy for reducing potential bias in treatment effects arising from missing data in randomised controlled trials (RCTs). Currently, no universally accepted definition of ITT exists, although many researchers consider it to require either no attrition or a strategy to handle missing data. Using the reports of a large pool of RCTs, we examined discrepancies between the types of analyses that alcohol pharmacotherapy researchers stated they used versus those they actually used. We also examined the linkage between analytic strategy (ie, ITT or not) and how missing data on outcomes were handled (if at all), and whether data analytic and missing data strategies have changed over time.

Extended Release Naltrexone for Alcohol Use Disorders: Quasi-Experimental Effects on Mortality and Subsequent Detoxification Episodes

Alcoholism: Clinical and Experimental Research, 2015

Utilization of extended release naltrexone (XRN) for alcohol use disorders (AUDs) in the U.S. Vet... more Utilization of extended release naltrexone (XRN) for alcohol use disorders (AUDs) in the U.S. Veterans Health Administration (VHA) has been limited, perhaps due to high cost, lack of established superiority over less expensive alternatives including oral naltrexone, and related formulary restrictions. Despite these barriers, pockets of higher utilization exist in VHA, allowing for the quasi-experimental examination of the effects of XRN on 1-year mortality and number of subsequent detoxification episodes among patients with high rates of psychiatric comorbidities and previous psychosocial and pharmacological addiction treatment. Using propensity score-weighted mixed-effects logistic regression, 1-year mortality was compared between patients with AUDs who received XRN in fiscal year 2010 (n = 387) and a random sample of patients with AUDs who did not receive XRN (n = 3,759). Among the subgroup of patients who had at least 1 detoxification episode in the previous year, 1-year mortality and number of subsequent detoxification episodes were compared between those who did and did not receive XRN. Overall, 1-year mortality for the patients receiving XRN was significantly lower than for the comparison group who did not receive XRN (odds ratio [OR] = 0.30; p &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.001). Among patients with a detoxification episode in the previous year, those receiving XRN had, on average, 0.80 fewer subsequent detoxification episodes (p &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.001) and significantly lower mortality (OR = 0.78, p &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.001) in the postindex year. Among patients with AUDs, those receiving XRN had lower 1-year mortality and fewer detoxifications compared to similar patients not receiving XRN. These results, although observational, support the use of XRN, especially among patients with high rates of psychiatric comorbidities and previous addiction treatment who are still struggling with AUDs and/or facing a period of vulnerability to relapse.

Working along sudden gains: Responsiveness on small and subtle early changes and exceptions

Psychotherapy, 2013

When mental health is monitored over the course of treatment, many clients report strong and stab... more When mental health is monitored over the course of treatment, many clients report strong and stable changes, particularly early in psychotherapy. Such changes can occur both in singular events, such as sudden gains in particular symptoms, and more comprehensive ways across the World Health Organization definition of health (WHO, 1948), which includes well-being and psychosocial functioning. The present practical guideline illustrates a systematized sequence of tasks that explore rapid changes and sudden gains at a very early stage of therapy, as well as how such changes can be used in future therapeutic work. These tasks include (1) exploration of the change situation, (2) reinforcement of generalized self-efficacy and hope bonding, and (3) benefit for therapy.

Alliance in individual psychotherapy

Psychotherapy, 2011

This article reports on a research synthesis of the relation between alliance and the outcomes of... more This article reports on a research synthesis of the relation between alliance and the outcomes of individual psychotherapy. Included were over 200 research reports based on 190 independent data sources, covering more than 14,000 treatments. Research involving 5 or more adult participants receiving genuine (as opposed to analogue) treatments, where the author(s) referred to one of the independent variables as "alliance," "therapeutic alliance," "helping alliance," or "working alliance" were the inclusion criteria. All analyses were done using the assumptions of a random model. The overall aggregate relation between the alliance and treatment outcome (adjusted for sample size and non independence of outcome measures) was r ϭ .275 (k ϭ 190); the 95% confidence interval for this value was .25-.30. The statistical probability associated with the aggregated relation between alliance and outcome is p Ͻ .0001. The data collected for this meta-analysis were quite variable (heterogeneous). Potential variables such as assessment perspectives (client, therapist, observer), publication source, types of assessment methods and time of assessment were explored.

Apolipoprotein-E genotype and human immunodeficiency virus-associated neurocognitive disorder: the modulating effects of older age and disease severity

Neurobehavioral HIV Medicine, 2013

The apolipoprotein-E (APOE) ε4 allele is a risk factor for vascular dementia and Alzheimer&am... more The apolipoprotein-E (APOE) ε4 allele is a risk factor for vascular dementia and Alzheimer&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;s disease. Recent studies are equivocal with regards to whether or not the ε4 allele confers increased risk for the development of human immunodeficiency virus (HIV)-associated neurocognitive disorder (HAND), but suggest that age and/or disease severity may be modulating factors. The aim of this study was to assess the interactions and contributions of APOE genotype, age, and HIV disease severity as risk factors for HAND in HIV-infected adults. Participants were 259 HIV-positive individuals who underwent APOE genotyping, a standardized neurological evaluation, a comprehensive neuropsychological evaluation, and laboratory testing. Older ε4 carriers showed a higher frequency of HAND compared with age-matched non-ε4 carriers. Analysis by discrete neurocognitive domain revealed that advanced age modulated the effect of the ε4 allele, such that older ε4 allele carriers showed reduced executive functioning and information processing speed. Exploratory analyses assessing the relationship between ε4 and disease severity in the overall sample revealed that disease severity modulated the effect of the ε4 allele on cognition. Lower absolute CD4+ cell count among ε4 allele carriers was associated with poorer working memory ability. Advancing age and degree of immunosuppression may influence the association between APOE ε4 allele status and HAND. These two factors need to be taken into account in future research.