Jochems 2015.

Study characteristics
Methods	12‐month trial with 2 arms Motivation feedback Standard treatment or treatment‐as‐usual (TAU) Duration of trial: 12 months Country: The Netherlands Setting: Outpatient
Participants	Method of recruitment of participants: “Subsequently, clinicians were asked to provide their caseload to the PI, who randomly selected ten eligible patients for participation (or if fewer than ten eligible patients were available, all the eligible patients were selected). Clinicians explained to the selected patients the contents and procedure of the study and asked for participation. To enhance the likelihood of participation, patients were given an incentive of €15 for participating.“ (quote, p 3053) Sample size: subsample = 42 Diagnosis of borderline personality disorder: Diagnostic and Statistical Manual of Mental Disorders, 4th Edition (DSM‐IV) Means of assessment: “As diagnosed by the psychiatrist of the team using the Diagnostic and Statistical Manual of Mental Disorders‐Text Revision [fourth edition] criteria and obtained from the medical record” (quote, p 3050‐51) Mean age: no data on subsample. Full sample: motivation feedback = 45.47 years (standard deviation = 10,4), TAU = 42.5 years (standard deviation = 10) Sex: not stated Comorbidity: no data on subsample; “Our sample largely represents a broad population of outpatients with diagnoses of psychotic and personality disorders with a variety of comorbid psychiatric disorders”. (quote, p 3061) Inclusion criteria As diagnosed by the psychiatrist of the team using DSM‐IV‐TR (text revision) criteria and obtained from medical records Aged between 18 and 65 years Received individual outpatient treatment for their mental disorder Exclusion criteria Insufficient command of the Dutch language (which was estimated by the clinician who was most frequently involved with the patient) A documented diagnosis of dementia or chronic toxic encephalopathy
Interventions	Experimental group Treatment name: motivation feedback Number randomised to group: subsample = 16 Duration: 12 months Control/comparison group Comparison name: treatment‐as‐usual Number randomised to group: subsample = 26 Duration: 12 months Both groups Concomitant psychotherapy: outpatient care Concomitant pharmacotherapy: no data on subsample Proportions of participants taking standing psychotropic medication during trial observation period: unclear
Outcomes	Primary Mental health status, assessed by the Dutch version of the Health of the Nations Outcome Scales (HoNOS)
Notes	Sample size calculation: yes Ethics approval: “This study was approved by the Medical Ethical Committee for Mental Health Care Institutions (MotivaTe‐IT; trial number NTR2968, Netherlands Trial Register, http://www.trialregister.nl/trialreg/admin/rctview.asp?TC=2968) as well as by the scientific committees of the Western North Brabant Mental Health Center and Breburg Mental Health Center, the specialty mental health institutions where the data were collected.” (quote, p 3050) Comments from review authors: To enhance the likelihood of participation, patients were given an incentive of €15 for participating (p 3053). We received subsample data on the patient with a BPD diagnosis by email from Dr Jochems on 2 July 2018.
Risk of bias
Bias	Authors' judgement	Support for judgement
Random sequence generation (selection bias)	Low risk	Quote: "a computer‐generated list of random numbers was used to randomly assign each team to a treatment condition, such that all clinicians and patients in the same team were randomized to a similar treatment". (p. 3053). "The randomization sequence was created using software from www.randomization.org with a 1:1 allocation ratio using random block sizes of 1, 2, and 3". (p. 3053)
Allocation concealment (selection bias)	Low risk	Quote: "the random allocation sequence was performed by authors ECJ and HJD prior to approaching treatment teams, such that treatment teams and their members were still unknown and were numbered blindly before entering team numbers into the computer program". (p. 3053)
Blinding of outcome assessment (detection bias) All outcomes	Low risk	Quote: “At baseline, patients were unaware (blind) as to which treatment condition they had been randomized to. Clinicians had to be made aware of treatment condition as those randomized to MF needed to receive the necessary training prior to baseline assessments such that MF could start immediately thereafter. This blinding procedure is common in psychiatric intervention research. At the 12‐month assessment, clinicians and patients were not blind to treatment condition while filling in questionnaires, whereas independent research assistants who looked up information from the medical record and performed interviews with patients were blind to treatment allocation.” (p.3053)
Incomplete outcome data (attrition bias) All outcomes	Unclear risk	Comment: skewed dropout population of non‐ethnic Dutch participants in full sample. Only observer data used. Unclear handling of data on subsample data
Selective reporting (reporting bias)	Low risk	Comment: a protocol was available and the details matched those presented in the report.
Other bias	Unclear risk	Adherence bias: Adherence to treatment: Patients and clinicians in the MF intervention group were asked to fill in a Short Motivation Feedback List (SMFL) every month up to 12 months after baseline assessment. (p. 3051). Clinicians were free to decide for themselves how they would structure this conversation with the patient, such as discussing only one item or several, or discussing differences between patient’s and clinician’s vision, and they were free to decide how long this would take. The duration and frequency of SMFL assessments were monitored by the research team. (p. 3051) During the course of the study, clinicians were regularly contacted by the PI to monitor the MF intervention and to discuss progress and experiences together with other colleagues who also participated in the MF intervention. These evaluation sessions took place four times over the course of the study. (p.3051) We did not seek for uniformity in TAU as such diversity reflects reality. (p.3051); although we performed evaluation sessions with clinicians about MF alongside the trial, we have limited insight into what happened during MF sessions as these were neither recorded nor supervised. (p 3061). Attention bias: There was no control on the amount of treatment received in the TAU group, but that was intended from the authors to test the real life setting of psychotherapy. Allegiance bias: no evidence of allegiance bias found