Abstract
Objective: Routine outcome monitoring (ROM) is a well-evidenced means of improving psychotherapy’s effectiveness. However, it is unclear how meaningful ROM is for problems that span physical and mental health, such as severe health anxiety. Physical and mental health comorbidities are common amongst severe health anxiety sufferers and cognitive behavioral therapy (CBT) is a recommended treatment. Method: Seventy-nine participants received CBT for severe health anxiety in a clinical trial. The Outcome Rating Scale (ORS: a ROM assessment of wellbeing) was completed at each session. Multilevel modeling assessed whether last-session ORS predicted health anxiety and other outcomes over 12-month follow-up. Similar models were developed using health anxiety as a comparative outcome-predictor. Outcome-improvements of treatment-responders with sudden gains were compared to those of non-sudden-gainers. Results: Last-session ORS scores predicted all outcomes up to 12 months later, with a comparable predictive effect to health anxiety. Sudden-gainers on the ORS reported significantly greater improvement in depression, functioning, and wellbeing, but no difference in health anxiety or other measures. Conclusion: The ORS may be a feasible, overall estimate of health, functioning, and quality of life in psychotherapy for severe health anxiety. Sudden gains on the ORS may be clinically meaningful with respect to some long-term outcomes.
Highlights
Extending the Use of Routine Outcome Monitoring: Predicting Long-term Outcomes in Cognitive Behavioral Therapy for Severe Health Anxiety
Predictive validity of the Outcome Rating Scale (ORS) This study used longitudinal, independent, single-blinded assessments to evaluate the predictive validity of ORS ratings on a range of health outcomes from cognitive behavioral therapy (CBT) for health anxiety
This is a significant expansion in the use of the predictive validity of a ROM assessment (the ORS) as a common Routine outcome monitoring (ROM) outcome measure, because ORS outcome studies are often clinician-assessed with short follow-up periods
Summary
Routine outcome monitoring (ROM) is a well-evidenced means of improving psychotherapy’s effectiveness. Comorbidity and ROM From this type of evidence, it is difficult to assess the independent predictive ability of ROM measures on treatment outcomes for specific disorders, which usually lack relevant assessments and are typically conducted by those with an allegiance This situation is especially problematic in mental health problems that commonly co-occur with physical health problems, as key outcomes would not be assessed by ROM measures. Demonstrating that a commonly-used ROM tool is predictive of more specific independently-assessed physical and mental health outcomes would expand our understanding of the value such ROM assessments hold It is unclear whether the most widely-used ROM measures (such as the ORS) can effectively assess the types of outcome that are important where comorbid physical and mental health problems are present. This study assessed whether sudden gains in ROM have a significant impact on long-term trajectories of health anxiety and the other outcomes
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