Abstract
Increased quality of life (QoL) is rated by patients as a primary factor in determining recovery from psychopathology. Cognitive behavioral therapies (CBTs) are the most well-researched psychotherapies for internalizing disorders and appear effective at reducing symptoms even when delivered by trainees. Existing research suggests that the effects of CBTs on QoL are more modest than their effects on symptoms. However, little is known about the effects of trainee-delivered CBT on life satisfaction, a subjective measure of QoL. We analyzed data from 93 clients treated by students (n = 23) in a graduate-level training clinic using an intent-to-treat approach, completers case analyses, and random forest imputation. Across methods of handling missing data, improvements in anxiety, depression, and CBT skills were more marked than improvements in QoL. Exploratory analyses suggested baseline life satisfaction was the strongest predictor of end-of-treatment life satisfaction. Future research should explore alternatives to “standard” CBT for clients with low life satisfaction.
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References
Al-Windi, A. (2005). The relations between symptoms, somatic and psychiatric conditions, life satisfaction and perceived health. A primary care based study. Health and Quality of Life Outcomes, 3(1), 28. https://doi.org/10.1186/1477-7525-3-28
Austin, P. C., & Tu, J. V. (2004). Bootstrap methods for developing predictive models. The American Statistician, 58(2), 131–137. https://doi.org/10.1198/0003130043277
Bannink, F. (2017). Positive CBT in practice. In C. Proctor (Ed.), Positive psychology interventions in practice (pp. 15–28). Springer International Publishing. https://doi.org/10.1007/978-3-319-51787-2_2
Bardhoshi, G., Duncan, K., & Erford, B. T. (2016). Psychometric meta-analysis of the english version of the Beck anxiety inventory. Journal of Counseling & Development, 94(3), 356–373. https://doi.org/10.1002/jcad.12090
Barlow, D. H., & Craske, M. G. (2006). Mastery of your anxiety and panic: Workbook. Oxford University Press, USA. https://books.google.com/books?id=eWESDAAAQBAJ
Bolier, L., Haverman, M., Westerhof, G. J., Riper, H., Smit, F., & Bohlmeijer, E. (2013). Positive psychology interventions: A meta-analysis of randomized controlled studies. BMC Public Health, 13(1), 119. https://doi.org/10.1186/1471-2458-13-119
Brenes, G. A. (2007). Anxiety, depression, and quality of life in primary care patients. Primary Care Companion to the Journal of Clinical Psychiatry, 9(6), 437–443. https://doi.org/10.4088/pcc.v09n0606
Brettschneider, C., Djadran, H., Härter, M., Löwe, B., Riedel-Heller, S., & König, H. H. (2015). Cost-utility analyses of cognitive-behavioural therapy of depression: A systematic review. Psychotherapy and Psychosomatics, 84(1), 6–21. https://doi.org/10.1159/000365150
Butler, A. C., Chapman, J. E., Forman, E. M., & Beck, A. T. (2006). The empirical status of cognitive-behavioral therapy: A review of meta-analyses. Clinical Psychology Review, 26(1), 17–31. https://doi.org/10.1016/j.cpr.2005.07.003
Chakhssi, F., Kraiss, J. T., Sommers-Spijkerman, M., & Bohlmeijer, E. T. (2018). The effect of positive psychology interventions on well-being and distress in clinical samples with psychiatric or somatic disorders: A systematic review and meta-analysis. BMC Psychiatry, 18(1), 211. https://doi.org/10.1186/s12888-018-1739-2
Chambless, D. L., & Hollon, S. D. (1998). Defining empirically supported therapies. Journal of Consulting and Clinical Psychology, 66(1), 7–18. https://doi.org/10.1037//0022-006x.66.1.7
Chaves, C., Lopez-Gomez, I., Hervas, G., & Vazquez, C. (2017). A comparative study on the efficacy of a positive psychology intervention and a cognitive behavioral therapy for clinical depression. Cognitive Therapy and Research, 41(3), 417–433. https://doi.org/10.1007/s10608-016-9778-9
Craske, M. G., Meuret, A. E., Ritz, T., Treanor, M., Dour, H., & Rosenfield, D. (2019). Positive affect treatment for depression and anxiety: A randomized clinical trial for a core feature of anhedonia. Journal of Consulting and Clinical Psychology, 87(5), 457–471. https://doi.org/10.1037/ccp0000396
Craske, M. G., Meuret, A. E., Ritz, T., Treanor, M., & Dour, H. J. (2016). Treatment for anhedonia: A neuroscience driven approach. Depression and Anxiety, 33(10), 927–938. https://doi.org/10.1002/da.22490
DeRubeis, R. J., & Lorenzo-Luaces, L. (2017). Recognizing that truth is unattainable and attending to the most informative research evidence. Psychotherapy Research, 27(1), 33–35. https://doi.org/10.1080/10503307.2016.1252072
Diener, E., Emmons, R. A., Larsen, R. J., & Griffin, S. (1985). The satisfaction with life scale. Journal of Personality Assessment, 49(1), 71–75. https://doi.org/10.1207/s15327752jpa4901_13
Dugas, M. J., & Robichaud, M. (2007). Cognitive-behavioral treatment for generalized anxiety disorder: From science to practice. Routledge. https://books.google.com/books?id=bLGqfBtyMcoC
Erford, B. T., Johnson, E., & Bardoshi, G. (2015). Meta-analysis of the English version of the Beck depression inventory–second edition. Measurement and Evaluation in Counseling and Development, 49(1), 3–33. https://doi.org/10.1177/0748175615596783
Fava, G. A. (1999). Well-being therapy: Conceptual and technical issues. Psychotherapy and Psychosomatics, 68(4), 171–179. https://doi.org/10.1159/000012329
Fava, G. A., Rafanelli, C., Cazzaro, M., Conti, S., & Grandi, S. (1998). Well-being therapy. A novel psychotherapeutic approach for residual symptoms of affective disorders. Psychological Medicine, 28(2), 475–480. https://doi.org/10.1017/S0033291797006363
Fava, G. A., Rafanelli, C., Grandi, S., Conti, S., & Belluardo, P. (1998b). Prevention of recurrent depression with cognitive behavioral therapy: Preliminary findings. Archives of General Psychiatry, 55(9), 816–820. https://doi.org/10.1001/archpsyc.55.9.816
Fernandez, E., Salem, D., Swift, J. K., & Ramtahal, N. (2015). Meta-analysis of dropout from cognitive behavioral therapy: Magnitude, timing, and moderators. Journal of Consulting and Clinical Psychology, 83(6), 1108–1122. https://doi.org/10.1037/ccp0000044
Forand, N. R., Evans, S., Haglin, D., & Fishman, B. (2011). Cognitive behavioral therapy in practice: Treatment delivered by trainees at an outpatient clinic is clinically effective. Behavior Therapy, 42(4), 612–623. https://doi.org/10.1016/j.beth.2011.02.001
Geschwind, N., Arntz, A., Bannink, F., & Peeters, F. (2019). Positive cognitive behavior therapy in the treatment of depression: A randomized order within-subject comparison with traditional cognitive behavior therapy. Behaviour Research and Therapy, 116, 119–130. https://doi.org/10.1016/j.brat.2019.03.005
Geschwind, N., Bosgraaf, E., Bannink, F., & Peeters, F. (2020). Positivity Pays off: Clients’ Perspectives on Positive Compared with Traditional Cognitive Behavioral Therapy for Depression. https://doi.org/10.1037/pst0000288
Gibbons, C. J., Fournier, J. C., Stirman, S. W., DeRubeis, R. J., Crits-Christoph, P., & Beck, A. T. (2010, 2010/09/01/). The clinical effectiveness of cognitive therapy for depression in an outpatient clinic. Journal of Affective Disorders, 125(1), 169–176. https://doi.org/10.1016/j.jad.2009.12.030
Gillis, M. M., Haaga, D. A. F., & Ford, G. T. (1995). Normative values for the Beck anxiety Inventory, Fear Questionnaire, Penn State Worry Questionnaire, and Social Phobia And Anxiety Inventory. American Psychological Association. https://doi.org/10.1037/1040-3590.7.4.450
Greenberger, D., Padesky, C. A., & Beck, A. T. (2015). Mind over mood, second edition: Change how you feel by changing the way you think. Guilford Publications. https://books.google.com/books?id=F0p2CgAAQBAJ
Hans, E., & Hiller, W. (2013). Effectiveness of and Dropout from Outpatient Cognitive Behavioral Therapy for Adult Unipolar Depression: A Meta-Analysis of Nonrandomized Effectiveness Studies. https://doi.org/10.1037/a0031080
Hedges, L. V. (1981). Distribution theory for glass’s estimator of effect size and related estimators. Journal of Educational Statistics, 6(2), 107–128. https://doi.org/10.3102/10769986006002107
Hiltunen, A. J., Kocys, E., & Perrin-Wallqvist, R. (2013). Effectiveness of cognitive behavioral therapy: An evaluation of therapies provided by trainees at a university psychotherapy training center. PsyCh Journal, 2(2), 101–112. https://doi.org/10.1002/pchj.23
Hinz, A., Conrad, I., Schroeter, M. L., Glaesmer, H., Brähler, E., Zenger, M., Kocalevent, R.-D., & Herzberg, P. Y. (2018). Psychometric properties of the satisfaction with life scale (SWLS), derived from a large German community sample. Quality of Life Research, 27(6), 1661–1670. https://doi.org/10.1007/s11136-018-1844-1
Hofmann, S. G., Wu, J. Q., & Boettcher, H. (2014). Effect of cognitive-behavioral therapy for anxiety disorders on quality of life: A meta-analysis. Journal of Consulting and Clinical Psychology, 82(3), 375–391. https://doi.org/10.1037/a0035491
Hope, D. A., Heimberg, R. G., & Turk, C. L. (2010). Managing social anxiety: A cognitive-behavioral therapy approach. Oxford University Press. https://books.google.com/books?id=Lomgcx-fvUcC
Howard, J., De Jesús-Romero, R., Peipert, A., Riley, T. N., Rutter, L. A., & Lorenzo-Luaces, L. (2021). The significance of anxiety symptoms in predicting psychosocial functioning across borderline personality traits. PLoS ONE, 16(1), e0245099. https://doi.org/10.1371/journal.pone.0245099
Jacobson, N. S., & Truax, P. (1991). Clinical significance: A statistical approach to defining meaningful change in psychotherapy research. Journal of Consulting and Clinical Psychology, 59(1), 12–19. https://doi.org/10.1037//0022-006x.59.1.12
James, S. L., Abate, D., Abate, K. H., Abay, S. M., Abbafati, C., &, et al. (2018). Global, regional, and national incidence, prevalence, and years lived with disability for 354 diseases and injuries for 195 countries and territories, 1990–2017: A systematic analysis for the Global Burden of Disease Study 2017. The Lancet, 392(10159), 1789–1858. https://doi.org/10.1016/S0140-6736(18)32279-7
Kessler, R. C., & Wang, P. S. (2008). The descriptive epidemiology of commonly occurring mental disorders in the United States. Annual Review of Public Health, 29, 115–129. https://doi.org/10.1146/annurev.publhealth.29.020907.090847
Krendl, A. C. & Lorenzo-Luaces, L. (2021). Identifying discrete drop-off points that contribute to mental health treatment noncompliance in a university training clinic. Manuscript submitted for publication.
Lake, A. J., Rodriguez-Quintana, N., Lewis, C. C., & Brothers, B. M. (in press). Adressing diversity: Clinical assessment and outcomes in a psychology training clinic. Training and Education in Professional Psychology.
Linehan, M. M. (2014). DBT skills training handouts and worksheets, second edition. Guilford Publications. https://books.google.com/books?id=-YAaBQAAQBAJ
Lorenzo-Luaces, L., Zimmerman, M., & Cuijpers, P. (2018). Are studies of psychotherapies for depression more or less generalizable than studies of antidepressants? Journal of Affective Disorders, 234, 8–13. https://doi.org/10.1016/j.jad.2018.02.066
Martell, C. R., Dimidjian, S., Herman-Dunn, R., & Lewinsohn, P. M. (2010). Behavioral activation for depression: A clinician’s guide. Guilford Publications.
Montgomery, E. C., Kunik, M. E., Wilson, N., Stanley, M. A., & Weiss, B. (2010). Can paraprofessionals deliver cognitive-behavioral therapy to treat anxiety and depressive symptoms? Bulletin of the Menninger Clinic, 74(1), 45–62. https://doi.org/10.1521/bumc.2010.74.1.45
Olatunji, B. O., Cisler, J. M., & Tolin, D. F. (2007). Quality of life in the anxiety disorders: A meta-analytic review. Clinical Psychology Review, 27(5), 572–581. https://doi.org/10.1016/j.cpr.2007.01.015
Öst, L.-G., Karlstedt, A., & Widén, S. (2012). The effects of cognitive behavior therapy delivered by students in a psychologist training program: An effectiveness study. Behavior Therapy, 43(1), 160–173. https://doi.org/10.1016/j.beth.2011.05.001
Pavot, W., & Diener, E. (1993). Review of the satisfaction with life scale. Psychological Assessment, 5(2), 164–172.
Persons, J. B. (2012). The case formulation approach to cognitive-behavior therapy. Guilford Publications. https://books.google.com/books?id=UQCjq8P02lgC
Powdthavee, N., & Wooden, M. (2015). Life satisfaction and sexual minorities: Evidence from Australia and the United Kingdom. Journal of Economic Behavior & Organization, 116, 107–126. https://doi.org/10.1016/j.jebo.2015.04.012
Rapaport, M. H., Clary, C., Fayyad, R., & Endicott, J. (2005). Quality-of-life impairment in depressive and anxiety disorders. American Journal of Psychiatry, 162(6), 1171–1178. https://doi.org/10.1176/appi.ajp.162.6.1171
Richards, D. A., Ekers, D., McMillan, D., Taylor, R. S., Byford, S., Warren, F. C., Barrett, B., Farrand, P. A., Gilbody, S., Kuyken, W., O’Mahen, H., Watkins, E. R., Wright, K. A., Hollon, S. D., Reed, N., Rhodes, S., Fletcher, E., & Finning, K. (2016). Cost and outcome of behavioural activation versus cognitive behavioural therapy for depression (COBRA): A randomised, controlled, non-inferiority trial. The Lancet, 388(10047), 871–880. https://doi.org/10.1016/S0140-6736(16)31140-0
Rodriguez, B. F., Bruce, S. E., Pagano, M. E., & Keller, M. B. (2005). Relationships among psychosocial functioning, diagnostic comorbidity, and the recurrence of generalized anxiety disorder, panic disorder, and major depression. Journal of Anxiety Disorders, 19(7), 752–766. https://doi.org/10.1016/j.janxdis.2004.10.002
Roelofs, J., van Breukelen, G., de Graaf, L. E., Beck, A. T., Arntz, A., & Huibers, M. J. H. (2013). Norms for the Beck depression inventory (BDI-II) in a large Dutch community sample. Journal of Psychopathology and Behavioral Assessment, 35(1), 93–98. https://doi.org/10.1007/s10862-012-9309-2
Ruini, C., & Fava, G. A. (2012). Role of well-being therapy in achieving a balanced and individualized path to optimal functioning. Clinical Psychology and Psychotherapy, 19(4), 291–304. https://doi.org/10.1002/cpp.1796
Schueller, S. M., & Parks, A. C. (2014). The science of self-help. European Psychologist, 19(2), 145–155. https://doi.org/10.1027/1016-9040/a000181
Sin, N. L., & Lyubomirsky, S. (2009). Enhancing well-being and alleviating depressive symptoms with positive psychology interventions: A practice-friendly meta-analysis. Journal of Clinical Psychology, 65(5), 467–487. https://doi.org/10.1002/jclp.20593
Strunk, D. R., Hollars, S. N., Adler, A. D., Goldstein, L. A., & Braun, J. D. (2014). Assessing patients’ cognitive therapy skills: Initial evaluation of the competencies of cognitive therapy scale. Cognit Ther Res, 38(5), 559–569. https://doi.org/10.1007/s10608-014-9617-9
Tang, F., & Ishwaran, H. (2017). Random forest missing data algorithms. Statistical Analysis and Data Mining: The ASA Data Science Journal, 10(6), 363–377. https://doi.org/10.1002/sam.11348
Vázquez, C., Rahona, J. J., Gómez, D., Caballero, F. F., & Hervás, G. (2015). A national representative study of the relative impact of physical and psychological problems on life satisfaction. Journal of Happiness Studies, 16(1), 135–148. https://doi.org/10.1007/s10902-014-9501-z
Vittengl, J. R., Jha, M. K., Minhajuddin, A., Thase, M. E., & Jarrett, R. B. (2021). Quality of life after response to acute-phase cognitive therapy for recurrent depression. Journal of Affective Disorders, 278, 218–225. https://doi.org/10.1016/j.jad.2020.09.059
Wells, K. B., & Sherbourne, C. D. (1999). Functioning and utility for current health of patients with depression or chronic medical conditions in managed, primary care practices. Archives of General Psychiatry, 56(10), 897–904. https://doi.org/10.1001/archpsyc.56.10.897
Westbrook, D., & Kirk, J. (2005). The clinical effectiveness of cognitive behaviour therapy: Outcome for a large sample of adults treated in routine practice. Behaviour Research and Therapy, 43(10), 1243–1261. https://doi.org/10.1016/j.brat.2004.09.006
Westen, D., & Morrison, K. (2001). A multidimensional meta-analysis of treatments for depression, panic, and generalized anxiety disorder: An empirical examination of the status of empirically supported therapies http://doi.org/https://doi.org/10.1037/0022-006X.69.6.875.
Widnall, E., Price, A., Trompetter, H., & Dunn, B. D. (2020). Routine cognitive behavioural therapy for anxiety and depression is more effective at repairing symptoms of psychopathology than enhancing wellbeing. Cognitive Therapy and Research, 44(1), 28–39. https://doi.org/10.1007/s10608-019-10041-y
Wierzbicki, M., & Pekarik, G. (1993). A meta-analysis of psychotherapy dropout. Professional Psychology: Research and Practice, 24(2), 190–195. https://doi.org/10.1037/0735-7028.24.2.190
Wiltsey Stirman, S., Gutner, A., & C., Crits-Christoph, P., Edmunds, J., Evans, A. C., & Beidas, R. S. (2015). Relationships between clinician-level attributes and fidelity-consistent and fidelity-inconsistent modifications to an evidence-based psychotherapy. Implementation Science, 10(1), 115. https://doi.org/10.1186/s13012-015-0308-z
Zimmerman, M., McGlinchey, J. B., Posternak, M. A., Friedman, M., Attiullah, N., & Boerescu, D. (2006). How should remission from depression be defined? The depressed patient’s perspective. American Journal of Psychiatry, 163(1), 148–150. https://doi.org/10.1176/appi.ajp.163.1.148
Acknowledgements
We thank Dr. Brittany Brothers and Dr. Cara Lewis for their work in the collection of these data. We also thank the patients for being willing to share their data.
Funding
This research was partially funded by the National Institute of Mental Health grant T32 MH103213-06 and grant numbers KL2TR002530 and UL1TR002529 (A. Shekhar, PI) from the National Institutes of Health, National Center for Advancing Translational Sciences, Clinical and Translational Sciences Award (PI: LL-L).
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Peipert, A., Rodriguez-Quintana, N. & Lorenzo-Luaces, L. Outcomes of Student Trainee-Delivered Cognitive Behavioral Therapy (CBT) on Internalizing Symptoms, CBT Skills, and Life Satisfaction. J Cogn Ther 15, 94–113 (2022). https://doi.org/10.1007/s41811-022-00131-3
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DOI: https://doi.org/10.1007/s41811-022-00131-3