Abstract
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.
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Notes
While we would expect CBT-mindedness to predict outcome in clients seeking treatment for any disorder, the current study utilised a sample of adults seeking treatment for social anxiety disorder, a common and impairing anxiety disorder.
Australian and New Zealand Clinical Trials Registry [Internet]: Sydney (NSW): Centre for Emotional Health, Macquarie University (Australia); 2010—Identifier ACTRN12610000469011. Efficacy of motivational interviewing prior to cognitive behavioural treatment for social phobia; 2010 June 9; [1 page]. Available from http://www.anzctr.org.au/ACTRN12610000469011.aspx.
Mixed model analysis comparing the two treatment groups (preparatory motivational interviewing or no preparatory treat) across time on CSR and SIAS showed a significant main effect of group [F(1, 43.32 = 8.80, p = .005 and F(1, 46.18) = 5.63, p = .022) respectively], time [F(2, 39.14) = 50.91, p < .001 and F(2, 39.68) = 61.65, p < .001 respectively], and group X time interaction [F(2, 39.14) = 11.53, p < .001 and F(2, 39.68) = 3.96, p = .027 respectively]. Pairwise comparisons between the estimated means for each group at the three timepoints, using Bonferroni adjustment for multiple comparisons, showed no difference between groups at pre-treatment (CSR: p = .932, SIAS: p = .262), a trend towards significance at post-treatment (CSR: p = .082, SIAS: p = .063) and a significant reduction in scores for the CBT + preparatory group compared to CBT alone group at follow-up (CSR: p < .001, SIAS: p = .004).
This analysis is marginally significant using the imputed dataset. See the Online Appendix for results.
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Acknowledgements
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.
Funding
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).
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Lauren F. McLellan, Lexine A. Stapinski and Lorna Peters declare that they have no conflicts of interest.
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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.
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McLellan, L.F., Stapinski, L.A. & Peters, L. Pre-treatment CBT-Mindedness Predicts CBT Outcome. Cogn Ther Res 43, 303–311 (2019). https://doi.org/10.1007/s10608-018-9977-7
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DOI: https://doi.org/10.1007/s10608-018-9977-7