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Early Response to Psychotherapy Predicts 4-Month Outcome

The ability, early in treatment, to predict patients' eventual improvement would permit clinicians to alter strategies for those patients who appear not to respond initially. To investigate whether patients' early responses to treatment, as measured on standardized symptom inventories for depression or anxiety, were associated with later remission, these researchers examined data from 184 patients enrolled in 8 separate open trials of manual-based cognitive therapy (CT) or supportive-expressive psychodynamic psychotherapy (SE). Patients had at least 1 of 4 conditions: major depression (chronic subtype or with dysthymic disorder), generalized anxiety disorder, avoidant personality disorder, or obsessive-compulsive disorder.

Initial findings for depression were cross-validated by using a separate sample from the NIMH National Treatment of Depression Collaborative Research Program. For all conditions, improvement by 2 to 4 weeks with either CT or SE was highly associated with clinical remission on anxiety or depression scales at 16 weeks. Similarly, nonresponse by week 4 was strongly associated with nonresponse at the end of treatment. By week 4, investigators could predict responders and nonresponders with about 80 percent accuracy.

Comment: These findings held true across psychotherapies and across diagnoses; placebo responses might have played some role in remissions. Because many of these conditions were chronic, it is unlikely that these responses reflected the natural course of the disorders. If nonresponse to psychotherapy can be predicted early with some certainty, augmentations or switches to other psychosocial treatments, medications, or both, may be instituted earlier.

— J Yager

Published in Journal Watch Psychiatry August 7, 2001

Citation(s):

Crits-Christoph P et al. Early improvement during manual-guided cognitive and dynamic psychotherapies predicts 16-week remission status. J Psychother Pract Res 2001 Jul 10 145-154.

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