Overcoming a Poor Early Response with Cognitive Behavioral Therapy Skills
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ORIGINAL ARTICLE
Overcoming a Poor Early Response with Cognitive Behavioral Therapy Skills Samuel T. Murphy1 · Jennifer S. Cheavens1 · Daniel R. Strunk1
© Springer Science+Business Media, LLC, part of Springer Nature 2020
Abstract Background Early response to treatment is a robust predictor of outcome in cognitive behavioral therapy (CBT) for depression. When clients show a poor early response, therapists may understandably be concerned. We examine how early CBT skill development might be used to help inform therapists about patients’ prognoses in such circumstances. Methods In a sample of 95 clients participating in CBT for depression, we examine the role of the development of CBT skills by asking whether a client’s prognosis depends not only on early response, but on its interaction with CBT skill development. Results We found support for the hypothesized interaction in predicting posttreatment depression and anxiety symptoms. For those who experienced modest early CBT skill improvements, early symptom improvement was strongly predictive of posttreatment outcome. However, for those who experienced more substantial early CBT skill improvements, early symptom change was not as strongly related to their posttreatment symptoms. Conclusions Our findings extend the literature on early response predicting outcome by showing that when clients experience more limited early symptom change, outcome depends considerably on the degree to which they are learning CBT skills. For clients with greater CBT skill improvements, a relatively positive treatment outcome is still common. Keywords Cognitive behavioral therapy · Depression · Skills · Early response · Therapeutic outcomes Early symptom reduction has been associated with treatment outcome across a variety of treatment modalities and patient populations (Haas et al. 2002; Lutz et al. 2014; Lutz et al. 2009). The importance of early symptom change in CBT for depression specifically has garnered attention for over 25 years, with researchers engaged in a lively debate over what this research means for how CBT achieves its effects (Ilardi and Craighead 1994; Lewis et al. 2012; Schlagert and Hiller 2017; Tang and DeRubeis 1999). Despite considerable research effort including studies focused on early change, an understanding of what clients learn in CBT that explains its therapeutic benefits has yet to emerge (Cuijpers et al. 2019). The available evidence provides some support Electronic supplementary material The online version of this article (https://doi.org/10.1007/s10608-020-10140-1) contains supplementary material, which is available to authorized users. * Daniel R. Strunk [email protected] 1
Department of Psychology, The Ohio State University, 1835 Neil Avenue, Columbus, OH 43220, USA
for several putative mechanisms in CBT, including cognitive change, behavioral activation, and the therapeutic alliance (Manos et al. 2010; Muran and Barber 2011; Schmidt et al. 2019). Another hypothesized mechanism is the development of CBT skills, the strategies that client
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