Abstract
Early change can predict outcome of psychological treatment, especially in cognitive behavior therapy. However, the optimal operationalization of “early change” for maximizing its predictive ability, and differences in predictive ability of disorder-specific versus general mental health measures has yet to be clarified. This study aimed to investigate how well early change predicted outcome depending on the week it was measured, the calculation method (regression slope or simple subtraction), the type of measures used, and the target disorder. During 10–15 weeks of internet-based cognitive behavior therapy for depression, social anxiety disorder, or panic disorder, weekly ratings were collected through both disorder-specific measures and general measures (Outcome Questionnaire-45 (OQ-45) and Clinical Outcomes in Routine Evaluation-10 (CORE-10)). With outcome defined as the disorder-specific measure, change at week four was the optimal predictor. Slope and subtraction methods performed equally well. The OQ-45 explained 18% of outcome for depression, 14% for social anxiety disorder, and 0% for panic disorder. Corresponding values for CORE-10 were 23%, 29%, and 25%. Specific measures explained 41%, 43%, and 34% respectively: this exceeded the ability of general measures also when they predicted themselves. We conclude that a simple calculation method with a disorder-specific measure at week four seems to provide a good choice for predicting outcome in time-limited cognitive behavior therapy.
Highlights
Cognitive behaviour therapy (CBT) has a large empirical base supporting its efficacy in the treatment of panic disorder, social anxiety disorder, and depression [1,2,3]
Among patients receiving internet-based Cognitive Behavior Therapy (ICBT) for panic disorder 32 (97%) had a baseline score on the Panic Disorder Severity Scale – Self-Report (PDSS-SR) above the clinical cutoff, i.e. 6 or higher, while 10 (31%) patients scored in the clinical range at post-treatment
The general aim of the present study was to investigate clinically relevant aspects of early improvement in CBT delivered via the Internet for panic disorder, social anxiety disorder and depression
Summary
Cognitive behaviour therapy (CBT) has a large empirical base supporting its efficacy in the treatment of panic disorder, social anxiety disorder, and depression [1,2,3]. There is a need to investigate clinically useful methods and instruments for early prediction of treatment outcome. Even though it would be desirable if patient characteristics could prospectively predict whether a treatment will be successful or not, prediction studies of CBT for panic disorder, social anxiety disorder, and depression have failed to identify stable pre-treatment patient characteristics that reliably predict treatment outcome with the exception of baseline symptom severity [11,12]. As for definition of early improvement, the studies cited above used different complex and power demanding statistical methods to predict treatment outcome. The core concern of the present study was to identify the most optimal and simple to use methods and instruments for early prediction of treatment outcome
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