Baseline Patient Characteristics Predicting Outcome and Attrition in Cognitive Therapy for Social Phobia: Results from a Large Multicentre Trial
Tóm tắt
We examined the role of baseline patient characteristics as predictors of outcome (end‐state functioning, response and remission) and attrition for cognitive therapy (CT) in social anxiety disorder (SAD). Beyond socio‐demographic and clinical variables such as symptom severity and comorbidity status, previously neglected patient characteristics (e.g., personality, self‐esteem, shame, interpersonal problems and attachment style) were analysed.
Data came from the CT arm of a multicentre RCT with
Up to 37% of the post‐treatment variance (LSAS) could be explained by all pre‐treatment variables combined. Symptom severity (baseline LSAS) was consistently negatively associated with end‐state functioning and remission, but not with response. Number of comorbid diagnoses was negatively associated with end‐state functioning and response, but not with remission. Self‐esteem was positively associated with higher end‐state functioning and more shame with better response. Attrition could not be significantly predicted.
The results indicate that the initial probability for treatment success mainly depends on severity of disorder and comorbid conditions while other psychological variables are of minor importance, at least on a nomothetic level. This stands in contrast with efforts to arrive at an empirical‐based foundation for differential indication and argues to search for more potent moderators of therapeutic change rather on the process level.
Personality, self‐esteem, shame, attachment style and interpersonal problems do not or only marginally moderate the effects of interventions in CT of social phobia. Symptom severity and comorbid diagnoses might affect treatment outcome negatively. Beyond these two factors, most patients share a similar likelihood of treatment success when treated according to the manual by Clark and Wells.
Từ khóa
Tài liệu tham khảo
Brown T. A., 1994, Anxiety Disorders Interview Schedule Adult Version
Clark D. M., 1995, Social phobia: Diagnosis, assessment and treatment, 69
Deusinger I. M., 1986, Die Frankfurter Selbstkonzeptskalen (FSKN)
Hautzinger M., 1995, Das Beck Depressionsinventar
Horowitz L. M., 1994, Inventar zur Erfassung Interpersoneller Probleme ‐ Deutsche Version (IIP‐D)
Stangier U., 2006, Soziale Phobie
Stangier U., 2005, Internationale Skalen für Psychiatrie, 299
Wittchen H. U., 1999, Strukturiertes Klinisches Interview für DSM‐IV (SKID‐I und SKID‐II)