The effect of feedback-informed cognitive behavioral therapy on treatment outcome: A randomized controlled trial.

Abstract

Objective: Previous studies have shown that feedback-informed treatment can improve outcomes of psychological treatments. This randomized controlled effectiveness trial evaluated the effect of progress feedback on treatment duration, symptom reduction, and dropout in individual cognitive behavioral therapies (CBTs). A control condition where CBT was combined with low-intensive monitoring of progress was compared to an experimental condition where CBT was combined with a high-intensive form of feedback. Method: Data of 368 outpatients (57.9% female, mean age 41.4 years, SD = 12.2) in secondary care were analyzed using multilevel analyses. Treatment duration was assessed with the number of sessions clients received. Symptom reduction was measured with the Symptom Checklist Revised. Possible moderators of the effect of intensive progress feedback on outcome were explored. Results: Clients achieved the same amount of symptom reduction in significantly fewer sessions in the high-intensive feedback condition. Additionally, dropout was significantly lower in the high-intensive feedback condition. Post hoc analyses assessing clients’ diagnoses as a possible moderator showed that clients with personality disorders (mainly Cluster C) achieved more symptom reduction in fewer sessions when high-intensity feedback was provided. Also, a high degree of implementation within the experimental condition was associated with fewer treatment sessions. Conclusion: In sum, the use of high-intensive client feedback reduced treatment duration and reduced dropout of CBT. Thus, feedback-informed CBTs seem to be a promising adaptation of conventional CBT.

Relationship to CBT outcome and dropout of decision support tools of the written case formulation, list of treatment goals and plot of symptom scores

“…Of the three tools we studied in our sample, the one that most aligned with our predictions was the plot of symptom scores, which predicted reduced end-of-treatment Beck Depression Inventory score, marginally predicted reduced end-of-treatment Burns Anxiety Inventory score (p = .09), and predicted lower rates of both types of dropout. This observation is consistent with a growing body of studies showing that measurement-based care and routine outcome monitoring are associated with improved outcome (see reviews by Carlier et al, 2012;Goodman et al, 2013;Lewis et al, 2018) and reduced dropout (Janse et al, 2020;meta-analysis by de Jong et al, 2012).…”

The need for a measurement-based care professional practice guideline.

“…For example, in the United Kingdom, Delgadillo et al (2018) observed a statistically and clinically significant feedback effect relative to treatment as usual in a sample of 2,223 routinely presenting patients. In the Netherlands, Janse et al (2020) conducted a trial that randomized patients to a cognitive behavioral therapy condition that involved low-intensity feedback (completion of a symptom measure every fifth session) or to a cognitive behavioral therapy condition that involved high-intensity feedback (use of the PCOMS at each session). They found that patients achieved the same amount of symptom reduction in fewer sessions in the high-intensity feedback condition.…”

Choice, voice and collaboration: using preference accommodation and feedback in trauma therapy

“…Dozens of RCTs have been conducted across feedback approaches, demonstrating positive outcomes across measures such as drop out, symptom reduction, identifying not on track cases, deterioration and less session needed. (Brattland et al, 2018;Delgadillo et al, 2018;Janse et al, 2020a;Janse et al, 2020b). Several meta-analysis and Cochrane reviews demonstrate small to moderate effect sizes for feedback (Bergman et al, 2018;Kendrick et al, 2016;Knaup et al, 2009;Lambert et al, 2018;Østerga ˚rd et al, 2020;Shimokawa et al, 2010;Tam and Ronan, 2017).…”