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August 5th, 2021

At HelloSelf it’s all about outcomes that matter…

By Dr Rumina Taylor (Chief Clinical Officer)

  • Outcomes
  • Therapy
  • Efficacy

HelloSelf’s mission is to be the most recommended place for receiving personalised psychological advice. We assess, treat and support our members online using our app and in person, at all stages of their journey towards becoming their best Self more often. Being able to measure outcomes is extremely important to us, and crucially outcomes that matter to our members, practitioners and trusted partners.

It is usual practice for psychological therapists to review how their clients are doing in therapy. This is normally based on client feedback and a clinician’s judgement. However, very few therapists working within private practice use formal outcome measures with only 37% indicating having used some sort of outcome assessment in practice (Hatfield & Ogles, 2004). This is despite it being well known that using outcome measures are incredibly helpful for the therapeutic process and for improving treatment.

At HelloSelf, we use outcomes as clinical tools for assessing and monitoring member progress and they serve as additional validation for clinical judgement. Our members also report finding the use of outcome measures a helpful way to track and quantify their progress both during treatment and afterwards to maintain their wellbeing.

Unfortunately, few private psychology clinics share their clinical outcomes, and this lack of transparency has been argued a disservice to clients (Clark et al., 2018). It does not allow people to make an informed decision about where to access help and it impacts their ability to understand themselves as well as they should. We also cannot start to look at trends and contribute to the knowledge base on the therapeutic process without data.

At HelloSelf we work collaboratively with our members to achieve their outcomes. Our model of self is centered around outcomes that matter. Our members can measure changes to their wellness, quality of life, and movement towards life goals. We also provide tools to track and maintain progress.

Initial Severity

Here we are focusing on three key outcomes which we routinely use to measure wellness: the Patient Health Questionnaire-9 (PHQ-9; Kroenke & Spitzer, 2002), the Generalized Anxiety Disorder-7 questionnaire (GAD-7; Spitzer, Kroenke, Williams, & Löwe, 2006) and the Clinical Outcomes in Routine Evaluation-10 (CORE-10; Barkham et al., 2012).

Our most recent data of more than 500 members across all three outcome measures shows that an average of 73% were scoring above the clinical cutoff when they accessed treatment with us (Figure 1). Most commonly people fell within the moderate range on all three measures indicating likely cases of anxiety, depression, and general psychological distress.

initial-severity Figure 1: Distribution of Initial Severity
Red Lines indicate Clinical Cut-off

Improvement

The overwhelming majority of our members tended to be markedly better achieving recovery at the end of treatment (Figures 2, 3) which was on average within eight sessions of therapy. We found 59%, 61%, and 70% realised enough improvements to symptoms and distress on the PHQ-9, GAD-7, and CORE-10 respectively to move them to a lower band (e.g. from ‘moderately severe’ to ‘moderate’ in terms of the PHQ-9). Most importantly these large changes in score led to clinically significant and life-changing improvements to our members as outlined in the case studies below.

change-in-outcome-measures Figure 2: Change in Outcome Measures

distribution-of-initial-and-final-severity Figure 3: Distribution of Initial and Final Severity
Red Lines indicate Clinical Cut-off

Case Studies

John’s Story
When John started therapy he described feeling depressed, with so little energy or motivation that getting out of bed and through the day was incredibly difficult. He reported feeling guilty and experienced frequent self-critical and hopeless thoughts. His outcome measures indicated he was severely anxious, depressed and distressed. After 10 sessions of treatment he is starting to feel better and this change has been shown in his outcomes. He now falls within the moderate range on all measures. His mood has lifted, he can engage with his children, now regularly completing the school run and bedtime stories. These were outcomes that mattered to him. He admits there is more work to do before he can return to work but he has realised meaningful change, reconnecting with his family, and is hopeful about the future.

Matilda’s Story
At the start of therapy Matilda was experiencing significant stress and anxiety related to her role at work. She had been recently promoted and constantly felt on edge that something would go wrong. She was convinced she would make a mistake and cause significant damage and everyone would know she was “stupid and useless”. Her outcome measures indicated she was severely anxious and distressed and moderately depressed.

Matilda has focused on her self-worth in therapy and worked on the negative predictions she makes about her performance. She has realised these are unhelpful and not based on fact but rather on the poor opinion she holds of herself. She has made significant improvements within eight sessions. Her anxiety, distress and mood are all within the non-clinical range and the frequency of her negative thoughts have reduced. Importantly, she feels confident, sees herself as worthy, and has embraced her new role. She speaks up in meetings and makes decisions without worrying about something bad happening. These were outcomes that mattered to her and she continues to do well at work and lead a more balanced life.

At HelloSelf we believe that measuring progress is a crucial part of the treatment process and outcome measures provide an objective and transparent way for both our therapists and members to do so. However, we recognise that measures of symptom change may not tell the whole story and in the future hope to share some more information about other tools we provide our members and therapists to help them achieve outcomes that truly matter to them in line with our mission to make Every Self Better.

References

Clark, D.M., Canvin, L., Green, J., Layard, R., Pilling S., & Janecka, M. (2018). Transparency about the outcomes of mental health services (IAPT approach): an analysis of public data. Lancet, 391, 679-686.

Hatfield, D.R., & Ogles, M. (2004). The use of outcome measures by psychologists in clinical practice. Professional Psychology: Research and Practice, 35(5), 485-491.

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