Understanding Patterns of Change: Predictors of Response Profiles for Clients Treated in a CBT Training Clinic
Lewis, Cara C., 1981-
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Lewis, Cara C., 1981-
Empirical support for the efficacy of CBT in treating depression suggests that the majority of clients will respond to this intervention. However, the more nuanced, and clinically relevant, question of "Which clients will respond to CBT for depression?" has been difficult to answer. Research efforts have focused on two different approaches to this question. One approach focuses on trajectories of symptom change within the first weeks of treatment to identify clients who are most likely to achieve response. A second approach looks to pretreatment client variables such as hopelessness and dysfunctional attitudes to identify clients who are more likely to respond. The current study is the first to simultaneously compare these two approaches to the prediction of treatment outcome. The sample consists of 222 clients (65.32% female, 92.79% Caucasian), ages 18 through 64 (M =27.85, SD = 11.28), receiving treatment for mood and anxiety disorders (59% met criteria for comorhid disorders) in a CBT oriented psychology training clinic. Results suggest that the rate of change in depressive symptoms over the first five treatment sessions significantly and consistently predicted outcome over and above the majority of pretreatment variables, except for precontemplation stages of change scores and initial severity of depression and anxiety symptoms. Similarly, rate of change in anxiety symptoms significantly predicted outcome on two of the three measures over and above the majority of pretreatment variables, except for hopelessness and initial severity of anxiety symptoms. Post hoc analyses revealed different predictors of outcome when trajectories of change and pretreatment variables were examined separately. Both rates of change and a number of pretreatment variables predicted outcome. Finally, pretreatment predictors of rate of early symptom change such as a contemplative orientation to change and therapist experience, were identified which may suggest that therapists should target these factors to potentially maximize rapid early symptom change, and in turn outcome. The findings are discussed in terms of their implications regarding methodological approaches to treatment outcome research and treatment planning for adults with comorbidities.