Abstract
Objective: Understanding how treatments work is a goal of psychotherapy research, however the strength of relationships between therapy processes and outcomes is inconsistent. DeRubeis, Cohen, et al. (2014) proposed that process-outcome relationships are moderated by patient characteristics. These "patient response patterns" (PRPs) indicate individuals' responsiveness to the active ingredients of treatment. Given the same quality of therapy, one individual may receive more benefit than another depending on their PRP. The "prognosis moderation hypothesis" states that PRPs can be defined by pretreatment prognostic indicators. Medium prognosis groups ("pliant-like") will have stronger process-outcome relationships than good ("easy-like") or poor ("challenging-like") groups.
Method: N = 190 individuals received unguided computerized CBT. They were 58% women, aged 44.7 years. Engagement with the cCBT program was the process variable. PRPs were defined by predicted scores from a prognostic regression model. Outcomes were BDI scores at 3, 6, and 12 months. "Easy-like," "pliant-like" and "challenging-like" groups were created and the engagement-outcome relationship was assessed as a function of group.
Results: Engagement-outcome correlations by PRP were: easy-like, r = -.27 (p <.05); pliant-like, r = -.36 (p <.01); and challenging-like, r =.05 (p =.70). The pliant-like group was found to be the only moderator of the engagement-outcome relationship. Results were similar at 6 months but faded at 12.
Conclusions: The engagement-outcome relationship varied as a function of prognosis, providing support for the prognosis moderation hypothesis. The "pliant-like" group appeared most sensitive to treatment procedures. Future research is needed to refine the methods for identifying PRPs.
| Original language | English |
|---|---|
| Pages (from-to) | 471-483 |
| Journal | Journal of Consulting and Clinical Psychology |
| Volume | 85 |
| Issue number | 5 |
| DOIs | |
| Publication status | Published - 2017 |
| Externally published | Yes |
Bibliographical note
Funding Information:The parent study for this research was supported by the Netherlands Organization for Health Research and Development Grant 945-04-417 awarded to Marcus J. H. Huibers. The research was further supported by a KL2 Career Development Award KL2-60044728 through the Ohio State University Center for Clinical and Translational Science awarded to Nicholas R. Forand. Portions of these results were presented at the Association for Behavioral and Cognitive Therapies annual conference in Chicago in November 2015.
Publisher Copyright:
© 2017 APA, all rights reserved.
Funding
The parent study for this research was supported by the Netherlands Organization for Health Research and Development Grant 945-04-417 awarded to Marcus J. H. Huibers. The research was further supported by a KL2 Career Development Award KL2-60044728 through the Ohio State University Center for Clinical and Translational Science awarded to Nicholas R. Forand. Portions of these results were presented at the Association for Behavioral and Cognitive Therapies annual conference in Chicago in November 2015.
Keywords
- cCBT
- moderation
- process research
- prognosis
- psychotherapy
