Skip to main content
Top
Gepubliceerd in:

29-07-2020 | Original Article

Overcoming a Poor Early Response with Cognitive Behavioral Therapy Skills

Auteurs: Samuel T. Murphy, Jennifer S. Cheavens, Daniel R. Strunk

Gepubliceerd in: Cognitive Therapy and Research | Uitgave 6/2020

Log in om toegang te krijgen
share
DELEN

Deel dit onderdeel of sectie (kopieer de link)

  • Optie A:
    Klik op de rechtermuisknop op de link en selecteer de optie “linkadres kopiëren”
  • Optie B:
    Deel de link per e-mail

Abstract

Background

Early response to treatment is a robust predictor of outcome in cognitive behavioral therapy (CBT) for depression. When clients show a poor early response, therapists may understandably be concerned. We examine how early CBT skill development might be used to help inform therapists about patients’ prognoses in such circumstances.

Methods

In a sample of 95 clients participating in CBT for depression, we examine the role of the development of CBT skills by asking whether a client’s prognosis depends not only on early response, but on its interaction with CBT skill development.

Results

We found support for the hypothesized interaction in predicting posttreatment depression and anxiety symptoms. For those who experienced modest early CBT skill improvements, early symptom improvement was strongly predictive of posttreatment outcome. However, for those who experienced more substantial early CBT skill improvements, early symptom change was not as strongly related to their posttreatment symptoms.

Conclusions

Our findings extend the literature on early response predicting outcome by showing that when clients experience more limited early symptom change, outcome depends considerably on the degree to which they are learning CBT skills. For clients with greater CBT skill improvements, a relatively positive treatment outcome is still common.
Bijlagen
Alleen toegankelijk voor geautoriseerde gebruikers
Voetnoten
1
We also evaluated our primary models while predicting regressed change from week 4 to posttreatment (with or without including intake symptoms and intake skills as covariates). In these models, our pattern of significant results was the same, with the two significant interactions remaining significant in each model variation. We also tested variations of our primary models that included the number of sessions clients attended as a covariate. Number of sessions did not predict posttreatment symptoms in any model, nor did it alter the pattern of significance of the interactions we identified.
 
2
Figure 2 appears to show some evidence that early skill change may be related to worse anxiety outcomes among patients who experienced large early change in anxiety (as shown by the estimates for those who experienced 1 SD more symptom reduction). But, the simple slope for the relation of early skill change and post-treatment anxiety for those who experienced 1 SD more symptom reduction was not significant. So, while the overall interaction was significant, the difference depicted in this portion of the figure was not.
 
3
Because clients were nested within therapists, we conducted our primary tests in a mixed model with therapist as a random effect. Significant interactions were also significant in these models.
 
Literatuur
go back to reference Barber, J. P., & DeRubeis, R. J. (1992). The ways of responding: A scale to assess compensatory skills taught in cognitive therapy. Behavioral Assessment, 14, 93–115. Barber, J. P., & DeRubeis, R. J. (1992). The ways of responding: A scale to assess compensatory skills taught in cognitive therapy. Behavioral Assessment, 14, 93–115.
go back to reference Barber, J. P., & DeRubeis, R. J. (2001). Change in compensatory skills in cognitive therapy for depression. The Journal of Psychotherapy Practice and Research, 10, 8–13.PubMedPubMedCentral Barber, J. P., & DeRubeis, R. J. (2001). Change in compensatory skills in cognitive therapy for depression. The Journal of Psychotherapy Practice and Research, 10, 8–13.PubMedPubMedCentral
go back to reference Beck, A. T., Rush, A. J., Shaw, B. F., & Emery, G. (1979). Cognitive therapy of depression. New York: Guilford. Beck, A. T., Rush, A. J., Shaw, B. F., & Emery, G. (1979). Cognitive therapy of depression. New York: Guilford.
go back to reference Benjamini, Y., & Hochberg, Y. (1995). Controlling the false discovery rate: A practical and powerful approach to multiple testing. Journal of the Royal Statistical Society: Series B, 57, 289–300. Benjamini, Y., & Hochberg, Y. (1995). Controlling the false discovery rate: A practical and powerful approach to multiple testing. Journal of the Royal Statistical Society: Series B, 57, 289–300.
go back to reference Cohen, J., Cohen, P., West, S. G., & Aiken, L. S. (2003). Applied multiple correlation/ regression analysis for the social sciences (2nd ed.). Hillsdale, NJ: Erlbaum. Cohen, J., Cohen, P., West, S. G., & Aiken, L. S. (2003). Applied multiple correlation/ regression analysis for the social sciences (2nd ed.). Hillsdale, NJ: Erlbaum.
go back to reference Crawford, J., Cayley, C., Lovibond, P. F., Wilson, P. H., & Hartley, C. (2011). Percentile norms and accompanying interval estimates from an Australian general adult population sample for self-report mood scales (BAI, BDI, CRSD, CES-D, DASS, DASS-21, STAI-X, STAI-Y, SRDS, and SRAS). Australian Psychologist, 46, 3–14. https://doi.org/10.1111/j.1742-9544.2010.00003.x.CrossRef Crawford, J., Cayley, C., Lovibond, P. F., Wilson, P. H., & Hartley, C. (2011). Percentile norms and accompanying interval estimates from an Australian general adult population sample for self-report mood scales (BAI, BDI, CRSD, CES-D, DASS, DASS-21, STAI-X, STAI-Y, SRDS, and SRAS). Australian Psychologist, 46, 3–14. https://​doi.​org/​10.​1111/​j.​1742-9544.​2010.​00003.​x.CrossRef
go back to reference Knapp, S. J., VandeCreek, L. D., & Fingerhut, R. (2017). Practical ethics for psychologists: A positive approach (3rd ed.). Washington, DC: American Psychological Association.CrossRef Knapp, S. J., VandeCreek, L. D., & Fingerhut, R. (2017). Practical ethics for psychologists: A positive approach (3rd ed.). Washington, DC: American Psychological Association.CrossRef
go back to reference Muran, J. C., & Barber, J. P. (Eds.). (2011). The therapeutic alliance: An evidence-based guide to practice. New York: Guilford. Muran, J. C., & Barber, J. P. (Eds.). (2011). The therapeutic alliance: An evidence-based guide to practice. New York: Guilford.
go back to reference Schmidt, I. D., Pfeifer, B. J., & Strunk, D. R. (2019). Putting the “cognitive” back in cognitive therapy: Sustained cognitive change as a mediator of in-session insights and depressive symptom improvement. Journal of Consulting and Clinical Psychology, 87, 446–456. https://doi.org/10.1037/ccp0000392. Schmidt, I. D., Pfeifer, B. J., & Strunk, D. R. (2019). Putting the “cognitive” back in cognitive therapy: Sustained cognitive change as a mediator of in-session insights and depressive symptom improvement. Journal of Consulting and Clinical Psychology, 87, 446–456. https://​doi.​org/​10.​1037/​ccp0000392.
go back to reference Tang, T. Z., & DeRubeis, R. J. (1999). Sudden gains and critical sessions in cognitive-behavioral therapy for depression. Journal of Consulting and Clinical Psychology, 67, 894–904.CrossRef Tang, T. Z., & DeRubeis, R. J. (1999). Sudden gains and critical sessions in cognitive-behavioral therapy for depression. Journal of Consulting and Clinical Psychology, 67, 894–904.CrossRef
Metagegevens
Titel
Overcoming a Poor Early Response with Cognitive Behavioral Therapy Skills
Auteurs
Samuel T. Murphy
Jennifer S. Cheavens
Daniel R. Strunk
Publicatiedatum
29-07-2020
Uitgeverij
Springer US
Gepubliceerd in
Cognitive Therapy and Research / Uitgave 6/2020
Print ISSN: 0147-5916
Elektronisch ISSN: 1573-2819
DOI
https://doi.org/10.1007/s10608-020-10140-1

Andere artikelen Uitgave 6/2020

Cognitive Therapy and Research 6/2020 Naar de uitgave