Cognitive Therapy and Research

, Volume 43, Issue 2, pp 303–311 | Cite as

Pre-treatment CBT-Mindedness Predicts CBT Outcome

  • Lauren F. McLellanEmail author
  • Lexine A. Stapinski
  • Lorna Peters
Original Article


While CBT is considered efficacious for a range of mental health conditions, identifying pre-treatment predictors of differential response to CBT is an important direction for research. This study investigated whether pre-treatment attitudes aligned with cognitive behaviour therapy (CBT) (termed CBT-mindedness) predicts CBT outcome within a clinical sample of adults diagnosed with social phobia (N = 50). Pre-treatment CBT-mindedness, measured by the CBT Suitability Scale, was found to predict treatment outcome immediately and 3 months following treatment. Higher CBT-mindedness was associated with lower clinician-rated diagnostic severity and client self-reported social anxiety symptoms following CBT. CBT-mindedness predicted self-reported, but not clinician-reported severity, even when controlling for existing client-factors that predict outcome (expectancy for symptom change and treatment credibility). However, CBT-mindedness was not associated with therapy session attendance. Results suggest that pre-treatment CBT-mindedness is a promising predictor of CBT outcome. Clinical implications for this predictor of CBT response are discussed.


Cognitive behaviour therapy Treatment outcome Predictor of outcome Client characteristics Social anxiety disorder 



We would like to thank Professor Ron Rapee and Mr Alan Taylor for their support in this research. Thanks also to the therapists and research assistants who coordinated and ran sessions, and finally the clients who participated in the trial.


This study was funded by Dr McLellan’s PhD scholarship (Australian Postgraduate Award) and funding from Macquarie University for the clinical trial (to Dr Peters, 2010, MQ Safety Nets Grant Scheme).

Compliance with Ethical Standards

Conflict of Interest

Lauren F. McLellan, Lexine A. Stapinski and Lorna Peters declare that they have no conflicts of interest.

Ethical Approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed Consent

Informed consent was obtained from all individual participants included in the study.

Animal Rights

No animal studies were carried out by the authors for this article.

Supplementary material

10608_2018_9977_MOESM1_ESM.doc (154 kb)
Supplementary material 1 (DOC 154 KB)


  1. American Psychiatric Association. (2000). Diagnostic and statistical manual of mental disorders (4th ed. text rev.). Washington, DC: Author.Google Scholar
  2. Bados, A., Balaguer, G., & Saldana, C. (2007). The efficacy of cognitive-behavioral therapy and the problem of drop-out. Journal of Clinical Psychology, 63, 585–592. Scholar
  3. Baker, K. D., & Neimeyer, R. A. (2003). Therapist training and client characteristics as predictors of treatment response to group therapy for depression. Psychotherapy Research, 13, 135–151. Scholar
  4. Beutler, L. E., Harwood, T. M., Kimpara, S., Verdirame, D., & Blau, K. (2011). Coping style. Journal of Clinical Psychology: In Session, 67, 176–183. Scholar
  5. Butler, A. C., Chapman, J. E., Forman, E. M., & Beck, A. T. (2006). The empirical status of cognitive-behavioral therapy: A review of meta-analyses. Clinical Psychology Review, 26, 17–31. Scholar
  6. Devilly, G. J., & Borkovec, T. D. (2000). Psychometric properties of the credibility/expectancy questionnaire. Journal of Behavior Therapy and Experimental Psychiatry, 31, 73–86. Scholar
  7. Di Nardo, P., Brown, T., & Barlow, D. (1994). Anxiety disorders interview schedule for DSM-IV—Lifetime version. Albany: Graywind Publications.Google Scholar
  8. Dozois, D. A. J., & Westra, H. A. (2005). Development of the Anxiety Change Expectancy Scale (ACES) and validation in college, community, and clinical samples. Behaviour Research and Therapy, 43, 1655–1672. Scholar
  9. Elkin, I., Yamaguchi, J., Arnkoff, D., Glass, C., Sotsky, S., & Krupnick, J. (1999). “Patient-treatment fit” and early engagement in therapy. Psychotherapy Research, 9, 437–451. Scholar
  10. Eskildsen, A., Hougaard, E., & Rosenberg, N. K. (2010). Pre-treatment patient variables as predictors of drop-out and treatment outcome in cognitive behavioral therapy for social phobia: A systematic review. Nordic Journal of Psychiatry, 64, 94–105. Scholar
  11. Heimberg, R. G., Mueller, G. P., Holt, C. S., Hope, D. A., & Liebowitz, M. R. (1992). Assessment of anxiety in social interaction and being observed by others: The Social Interaction Anxiety Scale and the Social Phobia Scale. Behavior Therapy, 23, 53–73. Scholar
  12. Kampman, M., Keijsers, G. P. J., Hoogduin, C. A. L., & Hendriks, G. (2008). Outcome prediction of cognitive behaviour therapy for panic disorder: Initial symptom severity is predictive for treatment outcome, comorbid anxiety or depressive disorder, cluster c personality disorders and initial motivation are not. Behavioural and Cognitive Psychotherapy, 36, 99–112. Scholar
  13. Keeley, M. L., Storch, E. A., Merlo, L. J., & Geffken, G. R. (2008). Clinical predictors of response to cognitive-behavioral therapy for obsessive-compulsive disorder. Clinical Psychology Review, 28, 118–130. Scholar
  14. Kocsis, J. H., Leon, A. C., Markowitz, J. C., Manber, R., Arnow, B., Klein, D. N., & Thase, M. E. (2009). Patient preference as a moderator of outcome for chronic forms of major depressive disorder treated with Nefazodone, cognitive behavioral analysis system of psychotherapy, or their combination. Journal of Clinical Psychiatry, 70, 354–361. Scholar
  15. Lincoln, T. M., Rief, W., Hahlweg, K., Frank, M., von Witzleben, I., Schroeder, B., et al. (2005). Who comes, who stays, who profits? Predicting refusal, dropout, success, and relapse in a short intervention for social phobia. Psychotherapy Research, 15, 210–225. Scholar
  16. Mattick, R. P., & Clarke, J. C. (1998). Development and validation of measures of social phobia scrutiny fear and social interaction anxiety. Behaviour Research and Therapy, 36, 455–470. Scholar
  17. McLellan, L., Peters, L., & Rapee, R. (2016). Measuring suitability for cognitive behaviour therapy: A self-report measure. Cognitive Therapy and Research. Scholar
  18. Mululo, S. C. C., de Menezes, G. B., Vigne, P., & Fontenelle, L. F. (2012). A review on predictors of treatment outcome in social anxiety disorder. Revista Brasileira de Psiquiatria, 34, 92–100. Scholar
  19. Myhr, G., Russell, J. J., Saint-Laurent, M., Tagalakis, V., Belisle, D., Khodary, F., et al. (2013). Assessing suitability for short-term cognitive-behavioral therapy in psychiatric outpatients with psychosis: Comparison with depressed and anxious outpatients. Journal of Psychiatric Practice, 19, 29–41. Scholar
  20. Myhr, G., Talbot, J., Annable, L., & Pinard, G. (2007). Suitability for short-term cognitive behavioral therapy. Journal of Cognitive Psychotherapy, 21, 334–345. Scholar
  21. Norton, P. J., & Price, E. C. (2007). A meta-analytic review of adult cognitive-behavioral treatment outcome across the anxiety disorders. The Journal of Nervous and Mental Disease, 195, 521–531. Scholar
  22. Ong, J. C., Kuo, T. F., & Manber, R. (2008). Who is at risk for dropout from group cognitive-behavior therapy for insomnia. Journal of Psychosomatic Research, 64, 419–425. Scholar
  23. Rapee, R. M., Gaston, J. E., & Abbott, M. J. (2009). Testing the efficacy of theoretically derived improvements in the treatment of social phobia. Journal of Consulting and Clinical Psychology, 77, 317–327. Scholar
  24. Renaud, J., Russell, J. J., & Myhr, G. (2014). Predicting who benefits most from cognitive-behavioral therapy for anxiety and depression. Journal of Clinical Psychology, 70, 923–932. Scholar
  25. Rodebaugh, T., Holoway, R. M., & Heimberg, R. G. (2004). The treatment of social anxiety disorder. Clinical Psychology Review, 24, 883–908. Scholar
  26. Safran, J. D., Segal, Z. V., Vallis, T., Shaw, B. F., & Samstag, L. W. (1993). Assessing patient suitability for short-term cognitive therapy with an interpersonal focus. Cognitive Therapy and Research, 17, 23–38.CrossRefGoogle Scholar
  27. Schafer, J. L., & Graham, J. W. (2002). Missing data: Our view of the state of the art. Psychological Methods, 7, 147–177. Scholar
  28. van Doorn, K., McManus, F., & Yiend, J. (2012). An analysis of matching cognitive-behavior therapy techniques to learning styles. Journal of Behavior Therapy and Experimental Psychiatry, 43, 1039–1044. Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Centre for Emotional Health, Department of PsychologyMacquarie UniversityNorth RydeAustralia
  2. 2.NHMRC Centre of Research Excellence in Mental Health and Substance Use, National Drug & Alcohol Research CentreUniversity of New South WalesKensingtonAustralia

Personalised recommendations