On the Road to Personalized Psychotherapy: A Research Agenda Based on Cognitive Behavior Therapy for Depression

Abstract

In this conceptual paper, we outline the many challenges on the road to personalized psychotherapy, using the example of cognitive behavior therapy (CBT) for depression. To optimize psychotherapy for the individual patient, we need to find out how therapy works (identification of mechanisms of change) and for whom it works (identification of moderators). To date, psychotherapy research has not resulted in compelling evidence for or against common or specific factors that have been proposed as mechanisms of change. Our central proposition is that we need to combine the “how does it work?”-question with the “for whom does it work?”-question in order to advance the field. We introduce the personalized causal pathway hypothesis that emphasizes the links and distinction between individual patient differences, therapeutic procedures and therapy processes as a paradigm to facilitate und understand the concept of personalized psychotherapy. We review the mechanism of change literature for CBT for depression to see what we have learned so far, and describe preliminary observational evidence supporting the personalized causal pathway hypothesis. We then propose a research agenda to push the ball forward: exploratory studies into the links between individual differences, therapeutic procedures, therapy processes and outcome that constitute a potential causal pathway, making use of experience sampling, network theory, observer ratings of therapy sessions, and moderated mediation analysis; testing and isolation of CBT procedures in experiments; and testing identified causal pathways of change as part of a personalized CBT package against regular CBT, in order to advance the application of personalized psychotherapy.

Comparing skill enhanced and standard cognitive behavioral therapy for depression: a protocol for a randomized trial

“…41,42 In describing how such research could be used to inform treatment, Huibers and colleagues give a hypothetical example of a research finding that a focused cognitive intervention was particularly effective for women with high levels of anxiety and noted that this finding might lead researchers to propose using a personalized form of CBT using greater cognitive restructuring with these patients. 43 This process involves a disconnect between the finding that informed the intervention and the personalized treatment. When researchers find moderation in these studies, the findings are taken to suggest that therapists should use an intervention approach more with clients who appeared to benefit more strongly from it.…”

Moving beyond a ‘one-size-fits-all’ rationale in global mental health: prospects of a precision psychology paradigm

“…Accurate prediction of which persons will benefit the most from which intervention would be possible even in the field of clinical psychology, where a theoretical framework is being developed for mental health conditions as depression (Huibers et al ., 2021 ).…”

CBT for Childhood Anxiety: Reviewing the State of Personalised Intervention Research

“…Additionally, predictors fail to identify those who will benefit most from a given treatment and provide no recommendations for modification to treatment to optimise response (Kraemer, 2013) nor do they lend themselves to identifying processes that may serve as mechanisms for treatment outcome (Kraemer et al, 2002). Therefore, researching moderators and mediators of treatment outcome alongside predictors of outcome is paramount to improving the effectiveness of CBT by being able to personalise treatment (Huibers et al, 2021).…”

“…Questions remain regarding the effect of CBT on affective and physiological outcomes for children with anxiety, such as fear and physiological indicators of fear (Herres et al, 2015). The limited and unconvincing mediator findings have also been ascribed to the challenging nature of mediator research and insufficient methodologies, such as not demonstrating temporal precedence of the mediator (Huibers et al, 2021). Therefore, research with strong study designs to assess variables at multiple time points are required to delineate mechanisms of change (Luo and McAloon, 2021).…”

“…Considering the barriers, benefits and future directions of the childhood anxiety research, the field requires a strategic program of research that will bridge the gap between our current understanding of differential CBT response and the optimisation of treatment for young people at risk of poor outcome. Similar to a recently proposed agenda for personalising CBT for depression (Huibers et al, 2021), next steps should include the following: continued search for evidence of predictors, moderators and mediators and how they interact to affect change using large data sets and rigorous study methodologies, a considered research effort into the identification of treatment ingredients beyond common factors and their impact on therapeutic change (Norris and Kendall, 2021) and continued development and testing of modified CBT interventions in RCTs with strong control conditions. This mini-review provides an evaluation of recent literature on current research methodologies, as well as approaches to the personalisation of CBT for childhood anxiety.…”