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A huge number of clinical studies and meta-analyses have shown that psychotherapy is effective on average. However, not every patient profits from psychotherapy and some patients even deteriorate in treatment. Due to this result and the restricted generalization of clinical studies to clinical practice, a more patient-focused research strategy has emerged. The question whether a particular treatment works for an individual case is the focus of this paradigm. The use of repeated assessments and the feedback of this information to therapists is a major ingredient of patient-focused research. Improving patient outcomes and reducing dropout rates by the use of psychometric feedback seems to be a promising path. Therapists seem to differ in the degree to which they make use of and profit from such feedback systems. This dissertation aims to better understand therapist differences in the context of patient-focused research and the impact of therapists on psychotherapy. Three different studies are included, which focus on different aspects within the field:
Study I (Chapter 5) investigated how therapists use psychometric feedback in their work with patients and how much therapists differ in their usage. Data from 72 therapists treating 648 patients were analyzed. It could be shown that therapists used the psychometric feedback for most of their patients. Substantial variance in the use of feedback (between 27% and 52%) was attributable to therapists. Therapists were more likely to use feedback when they reported being satisfied with the graphical information they received. The results therefore indicated that not only patient characteristics or treatment progress affected the use of feedback.
Study II (Chapter 6) picked up on the idea of analyzing systematic differences in therapists and applied it to the criterion of premature treatment termination (dropout). To answer the question whether therapist effects occur in terms of patients’ dropout rates, data from 707 patients treated by 66 therapists were investigated. It was shown that approximately six percent of variance in dropout rates could be attributed to therapists, even when initial impairment was controlled for. Other predictors of dropout were initial impairment, sex, education, personality styles, and treatment expectations.
Study III (Chapter 7) extends the dissertation by investigating the impact of a transfer from one therapist to another within ongoing treatments. Data from 124 patients who agreed to and experienced a transfer during their treatment were analyzed. A significant drop in patient-rated as well as therapist-rated alliance levels could be observed after a transfer. On average, there seemed to be no difficulties establishing a good therapeutic alliance with the new therapist, although differences between patients were observed. There was no increase in symptom severity due to therapy transfer. Various predictors of alliance and symptom development after transfer were investigated. Impacts on clinical practice were discussed.
Results of the three studies are discussed and general conclusions are drawn. Implications for future research as well as their utility for clinical practice and decision-making are presented.
For grape canopy pixels captured by an unmanned aerial vehicle (UAV) tilt-mounted RedEdge-M multispectral sensor in a sloped vineyard, an in situ Walthall model can be established with purely image-based methods. This was derived from RedEdge-M directional reflectance and a vineyard 3D surface model generated from the same imagery. The model was used to correct the angular effects in the reflectance images to form normalized difference vegetation index (NDVI)orthomosaics of different view angles. The results showed that the effect could be corrected to a certain scope, but not completely. There are three drawbacks that might restrict a successful angular model construction and correction: (1) the observable micro shadow variation on the canopy enabled by the high resolution; (2) the complexity of vine canopies that causes an inconsistency between reflectance and canopy geometry, including effects such as micro shadows and near-infrared (NIR) additive effects; and (3) the resolution limit of a 3D model to represent the accurate real-world optical geometry. The conclusion is that grape canopies might be too inhomogeneous for the tested method to perform the angular correction in high quality.
A satellite-based climatology of wind-induced surface temperature anomalies for the Antarctic
(2019)
It is well-known that katabatic winds can be detected as warm signatures in the surface temperature over the slopes of the Antarctic ice sheets. For appropriate synoptic forcing and/or topographic channeling, katabatic surges occur, which result in warm signatures also over adjacent ice shelves. Moderate Resolution Imaging Spectroradiometer (MODIS) ice surface temperature (IST) data are used to detect warm signatures over the Antarctic for the winter periods 2002–2017. In addition, high-resolution (5 km) regional climate model data is used for the years of 2002 to 2016. We present a case study and a climatology of wind-induced IST anomalies for the Ross Ice Shelf and the eastern Weddell Sea. The IST anomaly distributions show maxima around 10–15K for the slopes, but values of more than 25K are also found. Katabatic surges represent a strong climatological signal with a mean warm anomaly of more than 5K on more than 120 days per winter for the Byrd Glacier and the Nimrod Glacier on the Ross Ice Shelf. The mean anomaly for the Brunt Ice Shelf is weaker, and exceeds 5K on about 70 days per winter. Model simulations of the IST are compared to the MODIS IST, and show a very good agreement. The model data show that the near-surface stability is a better measure for the response to the wind than the IST itself.