Baseline Patient Characteristics Predicting Outcome and Attrition in Cognitive Therapy for Social Phobia: Results from a Large Multicentre Trial

Clinical Psychology and Psychotherapy - Tập 23 Số 1 - Trang 35-46 - 2016
Jürgen Hoyer1, Joerg Wiltink2, Wolfgang Hiller3, Robert Miller1, Simone Salzer4, Stephan Sarnowsky1, Ulrich Stangier5, Bernhard Strauß6, Ulrike Willutzki7, Eric Leibing4
1Clinical Psychology and Psychotherapy Technische Universitaet Dresden Dresden Germany
2Department of Psychosomatic Medicine and Psychotherapy, University Medical Center, Johannes Gutenberg University Mainz, Mainz, Germany
3Clinical Psychology and Psychotherapy, Johannes Gutenberg University Mainz, Mainz, Germany
4Department of Psychosomatic Medicine and Psychotherapy, University Medicine; Georg-August University Goettingen; Goettingen Germany
5Clinical Psychology and Psychotherapy, Goethe University Frankfurt, Frankfurt, Germany.
6Institute of Psychosocial Medicine and Psychotherapy, Jena University Hospital, Jena, Germany
7Clinical Psychology and Psychotherapy, Ruhr University Bochum, Bochum, Germany.

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.MethodData came from the CT arm of a multicentre RCT with n = 244 patients having DSM‐IV SAD. CT was conducted according to the manual by Clark and Wells. Severity of SAD was assessed at baseline and end of treatment with the Liebowitz Social Anxiety Scale (LSAS). Multiple linear regression analyses and logistic regression analyses were applied.ResultsUp 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.ConclusionsThe 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.Key Practitioner Message 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. Copyright © 2014 John Wiley & Sons, Ltd.

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Clinical Psychology and Psychotherapy

Tập 23 Số 1

35-46

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