Estimating Outcome Probabilities From Early Symptom Changes in Cognitive Therapy for Recurrent Depression

Jeffrey R. Vittengl, Lee Anna Clark, Michael E. Thase, Robin B Jarrett

Research output: Contribution to journalArticle

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.

Original languageEnglish (US)
JournalJournal of Consulting and Clinical Psychology
DOIs
StatePublished - Jan 1 2019

Fingerprint

Cognitive Therapy
Depression
Major Depressive Disorder
Informed Consent
Self Report
Outpatients
Therapeutics
Clinical Trials
Drug Therapy
Equipment and Supplies

Keywords

  • Cognitive therapy
  • Depression
  • Early symptom change
  • Remission
  • Response

ASJC Scopus subject areas

  • Clinical Psychology
  • Psychiatry and Mental health

Cite this

Estimating Outcome Probabilities From Early Symptom Changes in Cognitive Therapy for Recurrent Depression. / Vittengl, Jeffrey R.; Clark, Lee Anna; Thase, Michael E.; Jarrett, Robin B.

In: Journal of Consulting and Clinical Psychology, 01.01.2019.

Research output: Contribution to journalArticle

@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}",
year = "2019",
month = "1",
day = "1",
doi = "10.1037/ccp0000409",
language = "English (US)",
journal = "Journal of Consulting and Clinical Psychology",
issn = "0022-006X",
publisher = "American Psychological Association Inc.",

}

TY - JOUR

T1 - Estimating Outcome Probabilities From Early Symptom Changes in Cognitive Therapy for Recurrent Depression

AU - Vittengl, Jeffrey R.

AU - Clark, Lee Anna

AU - Thase, Michael E.

AU - Jarrett, Robin B

PY - 2019/1/1

Y1 - 2019/1/1

N2 - 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.

AB - 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.

KW - Cognitive therapy

KW - Depression

KW - Early symptom change

KW - Remission

KW - Response

UR - http://www.scopus.com/inward/record.url?scp=85064744543&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85064744543&partnerID=8YFLogxK

U2 - 10.1037/ccp0000409

DO - 10.1037/ccp0000409

M3 - Article

C2 - 31008632

AN - SCOPUS:85064744543

JO - Journal of Consulting and Clinical Psychology

JF - Journal of Consulting and Clinical Psychology

SN - 0022-006X

ER -