Shapes of early change in psychotherapy under routine outpatient conditions.

Stulz, Niklaus; Lutz, Wolfgang; Leach, Chris; Lucock, Mike; Barkham, Michael

doi:10.1037/0022-006x.75.6.864

Cited by 117 publications

(119 citation statements)

References 68 publications

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“…Participants who experience improvement may feel more inclined to track their progress and to make maximum use of the limited time available (12 weeks), whereas participants who show less early improvement may be discouraged from using the intervention more intensively. While early response is often associated with shorter treatment length [51], it has also already been reported that in time-limited treatment protocols, early response participants tend to complete the protocol and are less likely to drop out of treatment [23]. …”

Section: Discussionmentioning

confidence: 99%

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

Lutz¹,

Arndt²,

Rubel³

et al. 2017

J Med Internet Res

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BackgroundWeb-based interventions for individuals with depressive disorders have been a recent focus of research and may be an effective adjunct to face-to-face psychotherapy or pharmacological treatment.ObjectiveThe aim of our study was to examine the early change patterns in Web-based interventions to identify differential effects.MethodsWe applied piecewise growth mixture modeling (PGMM) to identify different latent classes of early change in individuals with mild-to-moderate depression (n=409) who underwent a CBT-based web intervention for depression.ResultsOverall, three latent classes were identified (N=409): Two early response classes (n=158, n=185) and one early deterioration class (n=66). Latent classes differed in terms of outcome (P<.001) and adherence (P=.03) in regard to the number of modules (number of modules with a duration of at least 10 minutes) and the number of assessments (P<.001), but not in regard to the overall amount of time using the system. Class membership significantly improved outcome prediction by 24.8% over patient intake characteristics (P<.001) and significantly added to the prediction of adherence (P=.04).ConclusionsThese findings suggest that in Web-based interventions outcome and adherence can be predicted by patterns of early change, which can inform treatment decisions and potentially help optimize the allocation of scarce clinical resources.

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Section: Discussionmentioning

confidence: 99%

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

Lutz¹,

Arndt²,

Rubel³

et al. 2017

J Med Internet Res

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“…Additionally, researchers have indicated that early change in clients may be a powerful predictor of overall change, and a promising indicator of when treatment is working and when it is not (Stulz, Lutz, Leach, Lucock, & Barkham, 2007). However, achieving these converging clinical and research goals depends on reliable and valid measurement of clinical problems.…”

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confidence: 96%

Clinical validity of the Counseling Center Assessment of Psychological Symptoms-62 (CCAPS-62): Further evaluation and clinical applications.

McAleavey¹,

Nordberg²,

Hayes³

et al. 2012

Journal of Counseling Psychology

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Self-report instruments of psychological symptoms are increasingly used in counseling centers but rely on rigorous evaluation of their clinical validity. Three studies reported here (total N = 26,886) investigated the validity of the Counseling Center Assessment of Psychological Symptoms-62 (CCAPS-62; Locke et al., 2011) as an assessment and screening instrument. In Study 1, initial evidence regarding the concurrent validity of the CCAPS-62 was replicated and extended in a naturalistic clinical sample of clients from 16 counseling centers. Using this sample, convergent validity of the subscales was examined in counseling center clients, the range of sensitivity of the subscales was investigated using item-response theory, and the presence of 2nd-order factors was preliminarily examined. In Study 2, 7 of the 8 CCAPS-62 subscales statistically significantly differentiated between students in counseling and those who were not, using data collected from a large national survey, although most differences were small and the groups' distributions overlapped considerably. Cut scores based on the differences between these clinical and nonclinical populations showed limited utility due to overall similarities between these broadly defined groups. In Study 3, therapist-rated diagnoses collected from 5 university counseling centers were used to further examine the validity of subscale scores. In addition, cut points for diagnostic screening using receiver operating characteristic curves were evaluated. Overall, these studies support the use of the CCAPS-62 as an initial measure of psychological symptoms in college counseling settings, provide additional information about its psychometric performance, develop cut scores, and illustrate the potential for collaboration between practitioners and researchers on a large scale.

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“…On this basis, treatment response patterns can be detected. Specifically, growth mixture modeling (GMM) has been demonstrated to be useful for the identification of early change patterns (e.g., Cuijpers, van Lier, van Straten, & Donker, 2005;Lutz et al, 2014;Rubel, Lutz, & Schulte, 2013;Stulz, Lutz, Leach, Lucock, & Barkham, 2007). GMM is a latent variable cluster analytic method.…”

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confidence: 99%

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

Rubel¹,

Lutz²,

Kopta³

et al. 2015

Psychological Assessment

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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.

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Shapes of early change in psychotherapy under routine outpatient conditions.

Cited by 117 publications

References 68 publications

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

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

Clinical validity of the Counseling Center Assessment of Psychological Symptoms-62 (CCAPS-62): Further evaluation and clinical applications.

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

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