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Evaluation ViewAttendees 10

Treatment - CBT
Symposia

Symposium 122 - Slopes, plateaus, and loop-de-loops: What can we learn about the change process from studying the trajectory of change during treatment?

Sunday, November 17, 2024
8:30 AM – 10:00 AM EST
Location: 309/310, Level 3, Downtown Marriott
CE: 1.5

Keywords: Change Process / Mechanisms, Community-Based, Clinical Decision Making
Level of Familiarity: Basic
Recommended Readings: Hayes, A. M., & Andrews, L. A. (2020). A complex systems approach to the study of change in psychotherapy. BMC Medicine, 18(1), 197. https://doi.org/10.1186/s12916-020-01662-2,  

Lutz, W., Schwartz, B., & Delgadillo, J. (2022). Measurement-based and data-Informed psychological therapy. Annual Review of Clinical Psychology, 18(1), 71–98. https://doi.org/10.1146/annurev-clinpsy-071720-014821

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Muir, H. J., Coyne, A. E., Morrison, N. R., Boswell, J. F., & Constantino, M. J. (2019). Ethical implications of routine outcomes monitoring for patients, psychotherapists, and mental health care systems. Psychotherapy, 56(4), 459. https://doi.org/10.1037/pst0000246

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Gates, V., Hsiao, M., Zieve, G. G., Courry, R., & Persons, J. B. (2021). Relationship to CBT outcome and dropout of decision support tools of the written case formulation, list of treatment goals and plot of symptom scores. Behaviour Research and Therapy, 142, 103874. https://doi.org/10.1016/j.brat.2021.103874

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A better understanding of change processes during psychotherapy can help us strengthen our treatments, broaden their appeal, and personalize the therapies to meet the needs of all, especially under-served and marginalized populations.
To shed light on change processes, this symposium features papers presented by four investigators who study the trajectory of change during treatment. Three presentations address the convention themes of community by studying patients treated in the community in routine care, and one addresses the theme of innovation by studying a digital feedback system.

A paper presented by a postdoctoral fellow from a well-established German research lab examines patterns of change in a large (N = 573) sample of patients receiving treatment in a university outpatient clinic that was guided by a digital feedback system. The paper examines outcomes and patterns of change in patients who are identified by the feedback system as being at risk of deterioration and reports considerable variability in their response.

A presentation by a graduate student working with a senior investigator in the US examines the trajectory of change in symptoms and change variables (emotion avoidance, adaptive coping skill use, and relational connection) in a large (N = 730) sample of women who received transdiagnostic residential treatment for severe eating disorders in the community. The presenter will describe results of longitudinal models examining change in these variables between admission, discharge, and 6-month followup.

A senior investigator in the US will present data from clinical trials of depression treatments to illustrate different ways of examining transient periods of apparent worsening that are associated with therapeutic improvement and will discuss the importance of differentiating disturbance associated with pattern breaking and therapeutic change from disturbance that precedes deterioration.

A postdoctoral fellow working with a senior investigator will present analyses of longitudinal data collected from 786 patients who received outpatient CBT for depression and anxiety in a private practice setting and who showed reliable symptom deterioration during treatment. Symptom deterioration during treatment was associated with worse end-of-treatment symptom severity. However, resolving a deterioration was associated with better end-of-treatment symptom severity, and the positive effect of resolving the deterioration was greater than the negative effect of the deterioration. Therapist use of a plot of progress data and a written case formulation were each associated with a higher likelihood of resolving symptom deteriorations, suggesting that when worsening occurs, if therapists use a plot of progress monitoring data to identify it and a case formulation to guide problem-solving, patients can have better outcomes than if a worsening had not occurred.

A senior investigator who has published numerous papers on the topic of sudden gains in CBT will serve as discussant.

Learning Objectives:

At the end of this session, the learner will be able to:
  1. Identify one or two patient characteristics that predict poor treatment outcome.
  2. Name one characteristic of the trajectory of symptom change that predicts treatment dropout.
  3. Name one characteristic of the trajectory of symptom change that predicts end-of-treatment symptom severity.
  4. Describe two outcomes of patients that were identified as not-on-track early in treatment.
  5. Describe the relationship between patient outcome and therapist-reported usefulness of feedback systems.

Presentations:

  • 8:30 AM – 10:00 AM EST
    (SYM 122) Patterns of Change for Not-on-track Patients in Data-informed Psychological Therapy

    Speaker: Danilo Moggia, Ph.D. (he/him/his) – University of Trier, Germany

    Co-author: Brian Schwartz, Ph.D. – University of Trier, Germany

    Co-author: Antonia Vehlen, PhD (she/her/hers) – University of Trier

    Co-author: Wolfgang Lutz, PhD – University of Trier

  • 8:30 AM – 10:00 AM EST
    (SYM 122) What Symptom Spikes and Variability Can Reveal About the Process of Change in Psychotherapy

    Speaker: Adele M. Hayes, Ph.D. (she/her/hers) – University of Delaware

    Co-author: Trevor Sanchez Stevens, B.A. (he/him/his) – University of Delaware

    Co-author: Carly Yasinski, Ph.D. – Emory University School of Medicine

    Co-author: Leigh Andrews, Ph.D. (he/him/his) – New York Cognitive

  • 8:30 AM – 10:00 AM EST
    (SYM 122) When Progress Monitoring Gives You Lemons, Make Lemonade! Symptom Deterioration and Recovery During Naturalistic Outpatient Cognitive Behavior Therapy

    Speaker: Garret G. Zieve, Ph.D. (he/him/his) – Oakland Cognitive Behavior Therapy Center

    Co-author: Jacqueline B. Persons, Ph.D. (she/her/hers) – Oakland CBT Center/UC Berkeley Department of Psychology

  • 8:30 AM – 10:00 AM EST
    (SYM 122) Processes of Change in Residential Transdiagnostic Cognitive-behavioral Therapy for Severe Eating Disorders

    Speaker: Sondra Tiab, B.A. (she/her/hers) – University at Albany, State University of New York

    Co-author: James F. Boswell, PhD – University at Albany, SUNY

    Co-author: Bethany Crawford, MA – University at Albany, SUNY

    Co-author: Shelby Ortiz, PhD – Department of Psychiatry, UNC-Chapel Hill School of Medicine

    Co-author: Molly Sanderson, MS – The Renfrew Center

    Co-author: Melanie Smith, Ph.D. – The Renfrew Center

    Co-author: Gayle Brooks, Ph.D., CEDS-S – The Renfrew Center