Defining early positive response to psychotherapy: An empirical comparison between clinically significant change criteria and growth mixture modeling.

Abstract

Several different approaches have been applied to identify early positive change in response to psychotherapy so as to predict later treatment outcome and length as well as use this information for outcome monitoring and treatment planning. In this study, simple methods based on clinically significant change criteria and computationally demanding growth mixture modeling (GMM) are compared with regard to their overlap and uniqueness as well as their characteristics in terms of initial impairment, therapy outcome, and treatment length. The GMM approach identified a highly specific subgroup of early improving patients. These patients were characterized by higher average intake impairments and higher pre- to-posttreatment score differences. Although being more specific for the prediction of treatment success, GMM was much less sensitive than clinically significant and reliable change criteria. There were no differences between the groups with regard to treatment length. Because each of the approaches had specific advantages, results suggest a combination of both methods for practical use in routine outcome monitoring and treatment planning.

Defining and Predicting Patterns of Early Response in a Web-Based Intervention for Depression

“…In our study, the rate of participants showing early deterioration (16.1%, 66/409) was somewhat higher than in other studies (4.6%, [23]; 2.4%, [43]), yet more studies are required before conclusions regarding the risk of deterioration during Web interventions can be drawn. Participants who deteriorate early may be facing crisis and be in need of more immediate help than can be provided by an Web intervention.…”

“…Patterns of early change in depressive symptoms, measured by the PHQ-9 over the first 4 weeks of the Web intervention, were identified using piecewise growth mixture modeling (PGMM) [43]. GMMs are considered a conservative method of identifying early change patterns in comparison with rational definitions such as reliable or clinical significant change [44].…”

“…GMMs are considered a conservative method of identifying early change patterns in comparison with rational definitions such as reliable or clinical significant change [44]. Individual variance of intercepts (intake scores) and slopes (change) are captured in terms of a latent class variable that is added to the growth model [43], which allows the identification of subpopulations of participants with similar growth curves. In contrast to conventional growth models, which assume that there is only one underlying population with a single change pattern, GMMs allow the investigation of an a priori unknown number of latent subpopulations, which can differ with regard to intercepts and slopes (in the case of a linear model) as well as class specific variations around these parameters.…”

Early response to psychological therapy as a predictor of depression and anxiety treatment outcomes: A systematic review and meta‐analysis

“…Measures of psychological distress included the Outcomes Questionnaire (OQ‐45), and the Clinical Outcomes in Routine Evaluation (CORE). Only two studies used general psychological distress measures rather than disorder‐specific measures to assess symptom change (Lutz et al, ; Rubel et al, ), while two used a combination of both (Lutz, Stulz & Köck, ; Schibbye et al, ).…”

“…As early as the 1980s, psychotherapy researchers have observed that the bulk of symptomatic improvement occurs within the 1st month of therapy, with 60% of total improvement in cognitive behavioral therapy for depression occurring by Week 4 (Rush, Kovacs, Beck, Weissenburger, & Hollon, ). Since then, numerous other studies have reported early response patterns across different mental health problems and psychological therapies (Bell, Waller, Shafran, & Delgadillo, ; Bradford et al, ; Delgadillo et al, ; Doyle, Le Grange, Loeb, Doyle, & Crosby, ; Gois et al, ; Hunnicutt‐Ferguson, Hoxha, & Gollan, ; Rubel et al, ).…”