A meta-analysis of the association between patients’ early perception of treatment credibility and their posttreatment outcomes.

Abstract

Patients' perception of treatment credibility represents their belief about a treatment's personal logicality, suitability, and efficaciousness. Although long considered an important common factor bearing on clinical outcome, there have been no systematic reviews of the credibility-outcome association. The present study represents a meta-analysis of the association between patients' credibility perception and their posttreatment outcomes. To be included, articles published through August, 2017 had to (a) include a clinical sample, (b) include a therapist-delivered treatment of at least 3 sessions, (c) include a measure of patients' own early treatment credibility perception, (d) include at least 1 posttreatment mental health outcome not explicitly referenced as a follow-up occasion, and (e) report a statistical test of the credibility-outcome association. The meta-analysis was conducted on 24 independent samples (extracted from 19 references) with 1,504 patients. The overall weighted effect size was r ϭ .12, p Ͻ .001, or d ϭ .24, with high heterogeneity (I 2 ϭ 57%) and no evidence of publication bias. There were no significant moderating effects on the credibility-outcome association for any of the potential moderators that we evaluated. The meta-analytic findings are discussed in light of methodological limitations and with regard to their practice implications. Clinical Impact StatementQuestion: This article examined the association between patients' perception of treatment credibility and their outcomes after treatment ends. Findings: Patients' treatment credibility belief is an empirically supported correlate of treatment outcome that therapists would do well to assess throughout treatment, attempt to heighten at treatment's outset, attempt to responsively match to intervention style, and respond to sensitively if/when it wanes. Meaning: The treatment credibilityimprovement correlation increases the scientific credibility of formerly ill-named "nonspecific" belief factors; thus, there is sufficient information to incorporate persuasive, credibility-enhancing strategies into treatment rationale delivery, ongoing clinical exchange, and training. Next Steps: Future research needs to (a) improve credibility measurement, (b) test strategies that causally enhance patients' perceptions of treatment and therapist credibility to improve treatment efficacy, and (c) illuminate both patient and therapist contributions to such credibility beliefs to help tailor clinical practice and training.

Whose anxiety are we treating, anyway?

“…Despite the important role ESTs play in reducing patient distress about symptoms and the demanding work of psychotherapy, there is growing evidence that patients value and benefit from a range of other factors. Patient beliefs and expectations about treatment have a significant impact on the development of early treatment alliance and the ultimate outcome of therapy (Constantino, Coyne, Boswell, Iles, & Vîslă, ). We can better integrate research evidence into clinical practice if the wishes of the patient are taken into account (Swift et al, ).…”

Love in Action: An Integrative Approach to Last Chance Couple Therapy

“…Furthermore, findings about the broader issue of predictors of treatment outcome also provide support for the approach. A recent meta‐analysis demonstrates that patients’ perceptions of the credibility of the treatment proffered to them have an impact on treatment outcomes (Constantino, Coyne, Boswell, Iles, & Visla, ). When patients perceive a treatment to be logical, suitable, and efficacious (Constantino et al., , p. 487; see also Devilly & Borkovec, ), treatment outcomes are better than when they perceive the treatment as not making sense for them, or a poor match for the issues they present.…”

“…A recent meta‐analysis demonstrates that patients’ perceptions of the credibility of the treatment proffered to them have an impact on treatment outcomes (Constantino, Coyne, Boswell, Iles, & Visla, ). When patients perceive a treatment to be logical, suitable, and efficacious (Constantino et al., , p. 487; see also Devilly & Borkovec, ), treatment outcomes are better than when they perceive the treatment as not making sense for them, or a poor match for the issues they present. As noted above, given that last chance couples typically come to therapy in crisis and hope that the therapist can relieve their suffering rapidly, often explicitly ask for “techniques” or “tools” that promote change, and frequently state hesitance about engaging in long‐term therapy that will primarily examine each partner's psychodynamics and family history, a therapy that starts with action‐based interventions seems more likely to be viewed as credible than an approach that suggests the initial need for extensive exploration of each partner's respective family of origin, or repeated, open‐ended, and unstructured recitation of the prior week's specific conflicts.…”

“…Constantino et al. () note, “Patients’ treatment credibility belief is an empirically supported correlate of treatment outcome that therapists would do well to assess throughout treatment …” (p. 486, italics added). Research on treatment credibility needs to test this hypothesis about the importance of sequencing action‐oriented interventions early (in a first session) and of following these interventions with a focus on insight‐oriented work, and then back again to action‐oriented work in a virtuous spiral that maintains clients’ sense of treatment credibility.…”

“…The present author has frequently heard, in initial phone calls prior to the first session, this mixed feeling about insight-oriented work: On the one hand, prospective clients generally state they want action-oriented techniques, but become nervous about completely abandoning a focus on insight, such that the therapist needs to reassure them that both sorts of work will be done. Constantino et al (2018) note, "Patients' treatment credibility belief is an empirically supported correlate of treatment outcome that therapists would do well to assess throughout treatment. .…”