New research suggests CBT depression treatment is more effective if we focus on strengths rather than weaknesses (2nd post)
Last updated on 20th May 2015
I wrote an initial post on "New research suggests ... focus on strengths rather than weaknesses" a couple of days ago. I discussed various reasons for thinking that better matching of patients to more personalized treatments could be helpful (although difficult) and looked as well at several research studies that have explored possible benefits of focusing treatment - particularly early in the course of therapy - on patient strengths rather than their weaknesses.
It does make a lot of sense to try to get therapy "off to a flying start". The classic paper "Early improvement during manual-guided cognitive and dynamic psychotherapies predicts 16-week remission status" "examined the extent to which improvement from baseline to weeks 2, 3, and 4 on the Beck Depression Inventory and Beck Anxiety Inventory predict week 16 clinical remission for patients with major depressive disorder, generalized anxiety disorder, and/or obsessive-compulsive or avoidant personality disorders who were receiving manual-based psychotherapies. Logistic regression and receiver-operator characteristic analyses revealed relatively accurate identification of remitters and nonremitters based on improvement from baseline to sessions 2 to 4 in both original and cross-validation samples. Predictive success did not vary as a function of diagnosis, treatment type (cognitive or dynamic), or treatment status (short-term or long-term)." Haas et al in their paper "Do early responders to psychotherapy maintain treatment gains?" reported similar findings, stating clearly that in their study too "early positive response to therapy was associated with fewer psychological symptoms at therapy termination and follow-up and maintenance of therapy gains."
And in a more nuanced & recent study published this year - "Is the relation between early post-session reports and treatment outcome an epiphenomenon of intake distress and early response? A multi-predictor analysis in outpatient psychotherapy" - the authors wrote "The early phase of psychotherapy has been regarded as a sensitive period in the unfolding of psychotherapy leading to positive outcomes. However, there is disagreement about the degree to which early (especially relationship-related) session experiences predict outcome over and above initial levels of distress and early response to treatment. The goal of the present study was to simultaneously examine outcome at post treatment as a function of (a) intake symptom and interpersonal distress as well as early change in well-being and symptoms, (b) the patient's early session-experiences, (c) the therapist's early session-experiences/interventions, and (d) their interactions. The data of 430 psychotherapy completers treated by 151 therapists were analyzed using hierarchical linear models. Results indicate that early positive intra- and interpersonal session experiences as reported by patients and therapists after the sessions explained 58% of variance of a composite outcome measure, taking intake distress and early response into account."
OK, so trying our best to get therapy "off to a flying start" makes good sense and this may well link with positive intra- and interpersonal early session experiences. I suspect this may well be an important part of the reason for the positive results reported by the recent Cheavens et al paper - "The compensation and capitalization models: A test of two approaches to individualizing the treatment of depression" - with its abstract reporting "Despite long-standing calls for the individualization of treatments for depression, modest progress has been made in this effort. The primary objective of this study was to test two competing approaches to personalizing cognitive-behavioral treatment of depression (viz., capitalization and compensation). Thirty-four adults meeting criteria for Major Depressive Disorder (59% female, 85% Caucasian) were randomized to 16-weeks of cognitive-behavioral treatment in which strategies used were selected based on either the capitalization approach (treatment matched to relative strengths) or the compensation approach (treatment matched to relative deficits). Outcome was assessed with a composite measure of both self-report (i.e., Beck Depression Inventory) and observer-rated (i.e., Hamilton Rating Scale for Depression) depressive symptoms. Hierarchical linear modeling revealed a significant treatment approach by time interaction indicating a faster rate of symptom change for the capitalization approach compared to the compensation approach (d=.69, p=.03). Personalizing treatment to patients' relative strengths led to better outcome than treatment personalized to patients' relative deficits. If replicated, these findings would suggest a significant change in thinking about how therapists might best adapt cognitive-behavioral interventions for depression for particular patients."
So how did Cheavens & colleagues go about focusing on patient strengths? This is the topic of the third and last post in this sequence on the potential value of "capitalizing" on what's likely to go well in treatment for a particular patient rather than "compensating" for what's likely to be a struggle.