Comparison of empirically‐derived and rationally‐derived methods for identifying patients at risk for treatment failure

Abstract

Several systems have been developed to monitor and feedback information about a patient's responses to psychotherapy as a method of enhancing patient outcome. Feedback is generated from decision rules based on a patient's expected level of progress. Those patients who do not make expected levels of progress or whose progress in therapy is less than adequate are referred to as signal-alarm cases. Research has shown that feedback based on rationally-derived identification procedures increased the duration of treatment and improved outcomes for patients identified as potential treatment failures (signal-alarms). This paper compared two identification methods: a rationally-derived method based on clinical judgments about poor progress, and an empirical method based on statisticallyderived expected recovery curves. The concordance of these two methods was examined with regards to detecting signal-alarm cases. Results suggested that the empirically-derived method was more accurate in identifying patients who actually deteriorated. It was able to identify 100% of the cases that had deteriorated at termination, with 85% being identified by the time they had had three treatment sessions. However, the rationally-derived method was faster at identifying signal cases and more likely to identify the most seriously disturbed cases as potential treatment failures. Future directions for research in quality management were identified.

Maximizing Psychotherapy Outcome beyond Evidence-Based Medicine

“…Finch et al [13] developed and tested the accuracy of predicting deterioration in adults. These and related signal alarm systems have been evaluated in a number of empirical investigations [14,15,16,17]. This research shows that 85-100% of patients who deteriorate in treatment can be accurately identified prior to departing from treatment and often after the first few sessions of treatment.…”

Improving the effects of psychotherapy: The use of early identification of treatment and problem-solving strategies in routine practice.

“…The exact cutoff scores for determining how much change and by which session of therapy, and taking into account the initial OQ-45 score, were based on expert judgments and information on dose-response analysis, survival analysis, and hierarchical linear modeling (Lambert, Hansen, & Finch, 2001). These cutoff scores were established by Lambert, Whipple, Bishop, et al (2002) independently and before the current study.…”

“…The decision rules were based on a client's intake score (initial level of disturbance), number of treatment sessions completed, and amount of change noted at the most recent session compared with the initial score. For a full description of the development and implementation of the decision rules, refer to Lambert, Whipple, Bishop, et al (2002). The exact cutoff scores for determining how much change and by which session of therapy, and taking into account the initial OQ-45 score, were based on expert judgments and information on dose-response analysis, survival analysis, and hierarchical linear modeling (Lambert, Hansen, & Finch, 2001).…”

A comparison of rational versus empirical methods in the prediction of psychotherapy outcome

“…The prior study analyzing differential accuracy of a rational versus an empirical method in predicting psychotherapy outcome (Lambert et al, 2002a) also utilized this instrument as a dependent measure.…”