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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

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.

vorige artikel Memory-Related Emotion Regulation and its Relation to Internalizing Symptoms

volgende artikel Emotion Malleability Beliefs and Emotion Experience and Regulation in the Daily Lives of People with High Trait Social Anxiety

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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.

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.

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.

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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

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Abstract

Background

Methods

Results

Conclusions

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