@article{16fb8c42d94147958f3553b0274e8e41,
title = "Estimating outcome probabilities from early symptom changes in cognitive therapy for recurrent depression",
abstract = "Objective: Acute-phase cognitive therapy (CT) is an efficacious treatment for major depressive disorder (MDD) producing benefits comparable to pharmacotherapy, but not all patients respond or remit. The purpose of the current analyses was to estimate CT patients' probability of nonresponse and remission from symptom improvement early in treatment. Method: Data from 2 clinical trials of acute-phase CT for recurrent depression were pooled for analysis (N = 679). Adult outpatients received 16- or 20-session CT protocols. Symptoms were measured repeatedly with the clinician-report Hamilton Rating Scale for Depression (HRSD) and Inventory of Depressive Symptomatology-Self-Report (IDS-SR). Outcomes at exit from CT were nonresponse (<50% reduction in HRSD scores) and remission (no MDD and HRSD score ≤6). Results: The nonresponse rate was 45.7%, and the remission rate was 33.4%. In logistic regression models, improvements on the HRSD or IDS-SR from intake to CT Sessions 3, 5, 7, 9, or 11 significantly predicted both outcomes, with prediction gaining in accuracy in later sessions. Clinician and self-report assessments yielded similar results. Prediction of outcomes replicated across data sets. Patients with no symptom improvement by CT Session 9 (Week 5) had ≤10% probability of remission and >75% probability of nonresponse. Conclusions: Outcomes of CT for depression are predictable from early symptom changes. Clinicians may find nonresponse and remission probability estimates useful in the informed consent process and in choosing whether to continue, augment, or switch treatments for CT patients with recurrent MDD.",
keywords = "Cognitive therapy, Depression, Early symptom change, Remission, Response",
author = "Vittengl, {Jeffrey R.} and Clark, {Lee Anna} and Thase, {Michael E.} and Jarrett, {Robin B.}",
note = "Funding Information: This report was supported by Grants R01 MH38238, K02 MH01571, K24 MH001571, R01 MH58397, R01 MH69619 (to Robin B. Jarrett) and R01 MH58356 and R01 MH69618 (to Michael E. Thase) from the National Institute of Mental Health (NIMH). The content is solely the responsibility of the authors and does not necessarily represent the official views of the NIMH or the National Institutes of Health. Vittengl is a paid reviewer for UpToDate. Clark has no financial interest or conflict of interest in the research. Thase has no conflicts of interest pertaining to this paper. He reports the following relationships with companies that develop treatments for depression or provide associated education: Thase has consulted with and/or served on advisory boards for Alkermes, Allergan (includes Forest Laboratories), AstraZeneca, Cerecor, Johnson & Johnson (includes Jans- sen), Lundbeck, MedAvante, Merck, Moksha8, Otsuka, Pfizer Pharmaceuticals, Shire, Sunovion, and Takeda; he has received grant support from Akili Inc., Alkermes, Allergan (includes Forest Laboratories), Assurerx, Axome, Johnson & Johnson, NeoSync, Otsuka, and Takeda, as well as the Agency for Healthcare Research and Quality, Patient Centered Outcomes Research Institute, and the NIMH. He has received royalties from American Psychiatric Publishing, Inc. (APPI), Guilford Publications, Herald House, W.W. Norton & Company, Inc., and UpToDate. Thase{\textquoteright}s spouse is an employee of Peloton Advantage, which does business with several pharmaceutical companies. Jarrett{\textquoteright}s medical center collects the payments from the cognitive therapy she provides to patients. Jarrett is a paid consultant to the National Institutes of Health and is a paid reviewer for UpToDate. Publisher Copyright: {\textcopyright} 2019 American Psychological Association.",
year = "2019",
month = jun,
doi = "10.1037/ccp0000409",
language = "English (US)",
volume = "87",
pages = "510--520",
journal = "Journal of Consulting and Clinical Psychology",
issn = "0022-006X",
publisher = "American Psychological Association Inc.",
number = "6",
}