Response rates for CBT for anxiety disorders: Need for standardized criteria

Loerinc, Amanda G.; Meuret, Alicia E.; Twohig, Michael P.; Rosenfield, David; Bluett, Ellen J.; Craske, Michelle G.

doi:10.1016/j.cpr.2015.08.004

Cited by 423 publications

(239 citation statements)

References 107 publications

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“…Although the response rate we obtained (71%) was comparable to the average rate of 60% found in a systematic review (Loerinc et al, 2015), as well as to the response rates of studies with patient populations comparable to ours based on trauma characteristics (Bohus et al, 2013; Cloitre et al, 2010; Schnurr et al, 2007), not all participants improved to the same degree. Our cluster analyses revealed four distinct trajectories based on change patterns: Fast, Slow, Partial, and Non-responders.…”

Section: Discussionsupporting

confidence: 86%

“…Still, a systematic review of response in anxiety related disorders showed that the average response rate for PTSD is approximately 60% (Loerinc et al, 2015), although it needs to be noted that definitions of treatment response varied greatly across studies. In addition to this suboptimal response, dropout rates in regular TFT programmes are high.…”

Section: Introductionmentioning

confidence: 99%

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Intensive prolonged exposure therapy for chronic PTSD patients following multiple trauma and multiple treatment attempts

Hendriks

Kleine

Broekman³

et al. 2018

European Journal of Psychotraumatology

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Background: Suboptimal response and high dropout rates leave room for improvement of trauma-focused treatment (TFT) effectiveness in ameliorating posttraumatic stress disorder (PTSD) symptoms. Objective: To explore the effectiveness and safety of intensive prolonged exposure (iPE) targeting chronic PTSD patients with a likely diagnosis of ICD-11 Complex PTSD following multiple interpersonal trauma and a history of multiple treatment attempts. Method: Participants (N = 73) received iPE in 12 × 90-minute sessions over four days (intensive phase) followed by four weekly 90-minute booster prolonged exposure (PE) sessions (booster phase). The primary outcomes, clinician-rated severity of PTSD symptoms, and diagnostic status (Clinician-Administered PTSD Scale; CAPS-IV) were assessed at baseline, post-treatment, and at three and six months. Treatment response trajectories were identified and predictors of these trajectories explored. Results: Mixed model repeated measures analysis of CAPS-IV scores showed a baseline-to-posttreatment decrease in PTSD symptom severity (p < .001) that persisted during the three- and six-month follow-ups with large effect sizes (Cohen’s d > 1.2); 71% of the participants responded. None of the participants dropped out during the intensive phase and only 5% during the booster phase. Adverse events were extremely low and only a minority showed symptom exacerbation. Cluster analysis demonstrated four treatment response trajectories: Fast responders (13%), Slow responders (26%), Partial responders (32%), and Non-responders (29%). Living condition and between-session fear habituation were found to predict outcome. Participants living alone were more likely to belong to the Partial responders than to the Non-responders cluster, and participants showing more between-session fear habituation were more likely to belong to the Fast responders than to the Non-responders cluster. Conclusions: The results of this open study suggest that iPE can be effective in PTSD patients with multiple interpersonal trauma and after multiple previous treatment attempts. In addition, in this chronic PTSD population iPE was safe.

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Section: Discussionsupporting

confidence: 86%

Section: Introductionmentioning

confidence: 99%

Intensive prolonged exposure therapy for chronic PTSD patients following multiple trauma and multiple treatment attempts

Hendriks

Kleine

Broekman³

et al. 2018

European Journal of Psychotraumatology

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“…Other behavioral treatments, such as Acceptance and Commitment therapy (ACT; Hayes, Strosahl, & Wilson, 1999) are garnering support as well (Arch et al, 2012; Craske et al, 2013; Meuret, Twohig, Rosenfield, Hayes, & Craske, 2012). However, many patients do not respond to behavioral treatments, drop out of treatment or show a return of symptoms at follow-up (Loerinc, Meuret, Twohig, Rosenfield, & Craske, 2013). The National Institute of Mental Health has called for a focus on personalized medicine to identify which treatment under what conditions will be most effective (National Institute of Mental Health, 2010).…”

mentioning

confidence: 99%

Attentional bias and emotional reactivity as predictors and moderators of behavioral treatment for social phobia

Niles

Mesri

Burklund

et al. 2013

Behaviour Research and Therapy

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Cognitive behavioral therapy (CBT) is a well-established treatment for anxiety disorders, and evidence is accruing for the effectiveness of acceptance and commitment therapy (ACT). Little is known about factors that relate to treatment outcome overall (predictors), or who will thrive in each treatment (moderators). The goal of the current project was to test attentional bias and negative emotional reactivity as moderators and predictors of treatment outcome in a randomized controlled trial comparing CBT and ACT for social phobia. Forty-six patients received 12 sessions of CBT or ACT and were assessed for self-reported and clinician-rated symptoms at baseline, post treatment, 6, and 12 months. Attentional bias significantly moderated the relationship between treatment group and outcome with patients slow to disengage from threatening stimuli showing greater clinician-rated symptom reduction in CBT than in ACT. Negative emotional reactivity, but not positive emotional reactivity, was a significant overall predictor with patients high in negative emotional reactivity showing the greatest self-reported symptom reduction.

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“…Assessing the severity of anxiety disorders can be performed using different rating scales, with varying characteristics. No consensus regarding the best means of measuring response to CBT exists (Loerinc et al 2015). In this study, the CGI-S was used as a measure of clinical concern across treatment groups, allowing a single measure to be used to assess general functioning.…”

Section: J U S T a C C E P T E Dmentioning

confidence: 99%

“…They identify the cognitive and behavioural processes underlying their anxious response, and develop strategies to mitigate against these negative schema and to cope with their anxiety (Otto et al 2004). Rates of response (in terms of a reduction in symptom severity) and of remission (no longer meeting diagnostic criteria) vary between specific disorders and studies, but are invariably less than 100% (Ballenger 1999;Hofmann et al 2012;Loerinc et al 2015;Olatunji et al 2010).…”

Section: Introductionmentioning

confidence: 99%

Separate and combined effects of genetic variants and pre-treatment whole blood gene expression on response to exposure-based cognitive behavioural therapy for anxiety disorders

Coleman

Lester

Roberts

et al. 2016

The World Journal of Biological Psychiatry

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(2016) Separate and combined effects of genetic variants and pre-treatment whole blood gene expression on response to exposure-based cognitive behavioural therapy for anxiety disorders. World Journal of Biological Psychiatry, 18 (3). pp. 215-226. ISSN 1562215-226. ISSN -2975 This version is available from Sussex Research Online: http://sro.sussex.ac.uk/62023/ This document is made available in accordance with publisher policies and may differ from the published version or from the version of record. If you wish to cite this item you are advised to consult the publisher's version. Please see the URL above for details on accessing the published version. Copyright and reuse:Sussex Research Online is a digital repository of the research output of the University.Copyright and all moral rights to the version of the paper presented here belong to the individual author(s) and/or other copyright owners. To the extent reasonable and practicable, the material made available in SRO has been checked for eligibility before being made available.Copies of full text items generally can be reproduced, displayed or performed and given to third parties in any format or medium for personal research or study, educational, or not-for-profit purposes without prior permission or charge, provided that the authors, title and full bibliographic details are credited, a hyperlink and/or URL is given for the original metadata page and the content is not changed in any way. Associations with treatment response were assessed using expression data from 3,233 probes, and expression profiles clustered in a data-driven and literature-driven manner.3,343,497 genetic variants were used to predict treatment response alone and combined in polygenic risk scores.Genotype and expression data were combined in expression quantitative trait loci (eQTL)analyses. ResultsExpression levels were not associated with either treatment phenotype in any analysis.1,492 eQTLs were identified with q<0.05, but interactions between genetic variants and treatment response did not affect expression levels significantly. Genetic variants did not significantly predict treatment response alone or in polygenic risk scores. ConclusionsWe assessed gene expression alone and alongside genetic variants. No associations with treatment outcome were identified. Future studies require larger sample sizes to discover associations.

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Response rates for CBT for anxiety disorders: Need for standardized criteria

Cited by 423 publications

References 107 publications

Intensive prolonged exposure therapy for chronic PTSD patients following multiple trauma and multiple treatment attempts

Intensive prolonged exposure therapy for chronic PTSD patients following multiple trauma and multiple treatment attempts

Attentional bias and emotional reactivity as predictors and moderators of behavioral treatment for social phobia

Separate and combined effects of genetic variants and pre-treatment whole blood gene expression on response to exposure-based cognitive behavioural therapy for anxiety disorders

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