Using early change to predict outcome in cognitive behaviour therapy: exploring timeframe, calculation method, and
Peter Schibbye1, Ata Ghaderi2, Brjánn Ljótsson2
1Department of Clinical Neuroscience, Division of Psychiatry, Karolinska Institutet, Stockholm, Sweden; Section of Psychiatry, Sundsvall Härnösand County Hospital, Västernorrland County Council, Sweden.
Plos One
|June 25, 2014
Summary
Early changes in cognitive behavior therapy (CBT) predict treatment success. Measuring disorder-specific symptoms at week four using a simple method offers the best prediction for psychological treatment outcomes.
Area of Science:
- Psychology
- Clinical Psychology
- Psychotherapy Research
Background:
- Early change in psychological treatment, particularly cognitive behavior therapy (CBT), is a known predictor of treatment outcomes.
- Optimal methods for defining and measuring 'early change' and comparing disorder-specific versus general mental health measures remain unclear.
Purpose of the Study:
- To investigate how early change predicts treatment outcomes based on measurement timing, calculation method, and measure type (disorder-specific vs. general).
- To compare the predictive ability of disorder-specific measures against general mental health measures (Outcome Questionnaire-45 (OQ-45) and Clinical Outcomes in Routine Evaluation-10 (CORE-10)) in internet-based CBT.
Main Methods:
- Weekly symptom ratings were collected during 10-15 weeks of internet-based CBT for depression, social anxiety disorder, and panic disorder.
- Early change was operationalized by measurement week (e.g., week four) and calculation method (regression slope vs. simple subtraction).
- Outcome was defined using disorder-specific measures, and predictive power of early change was assessed using both disorder-specific and general measures.
Main Results:
- Change at week four emerged as the optimal predictor of treatment outcome when using disorder-specific measures.
- Both regression slope and simple subtraction methods demonstrated equal predictive performance.
- Disorder-specific measures showed significantly higher predictive ability (41-43%) compared to general measures like OQ-45 (0-18%) and CORE-10 (23-29%) for predicting treatment outcomes.
Conclusions:
- A simple calculation method using disorder-specific measures at week four is a reliable predictor of outcomes in time-limited CBT.
- Disorder-specific measures are superior to general mental health measures in predicting treatment success for specific psychological disorders.
- These findings support the use of early, disorder-specific change as a key indicator for monitoring and predicting treatment response in CBT.
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