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Predictors of Symptomatic Change and Adherence in Internet-Based Cognitive Behaviour Therapy for Social Anxiety Disorder in Routine Psychiatric Care.

El Alaoui S, Ljótsson B, Hedman E, Kaldo V, Andersson E, Rück C, Andersson G, Lindefors N - PLoS ONE (2015)

Bottom Line: Treatment credibility was the strongest predictor of greater adherence.Having a family history of SAD-like symptoms was also associated with greater adherence, whereas Attention-Deficit/Hyperactivity Disorder (ADHD)-like symptoms, male gender, and family history of minor depression predicted lower adherence.Also, the amount of therapist time spent per treatment module was negatively associated with adherence.

View Article: PubMed Central - PubMed

Affiliation: Department of Clinical Neuroscience, Division of Psychiatry, Karolinska Institutet, Stockholm, Sweden.

ABSTRACT

Objective: A central goal of health care is to improve patient outcomes. Although several studies have demonstrated the effectiveness of therapist guided internet-based cognitive behaviour therapy (ICBT) for social anxiety disorder (SAD), a significant proportion of patients do not respond to treatment. Consequently, the aim of this study was to identify individual characteristics and treatment program related factors that could help clinicians predict treatment outcomes and adherence for individuals with SAD.

Method: The sample comprised longitudinal data collected during a 4-year period of adult individuals (N = 764) treated for SAD at a public service psychiatric clinic. Weekly self-rated Liebowitz Social Anxiety Scale (LSAS-SR) scores were provided. Rates of symptomatic change during treatment and adherence levels were analysed using multilevel modelling. The following domains of prognostic variables were examined: (a) socio-demographic variables; (b) clinical characteristics; (c) family history of mental illness; and (d) treatment-related factors.

Results: Higher treatment credibility and adherence predicted a faster rate of improvement during treatment, whereas higher overall functioning level evidenced a slower rate of improvement. Treatment credibility was the strongest predictor of greater adherence. Having a family history of SAD-like symptoms was also associated with greater adherence, whereas Attention-Deficit/Hyperactivity Disorder (ADHD)-like symptoms, male gender, and family history of minor depression predicted lower adherence. Also, the amount of therapist time spent per treatment module was negatively associated with adherence.

Conclusions: Results from a large clinical sample indicate that the credibility of ICBT is the strongest prognostic factor explaining individual differences in both adherence level and symptomatic improvement. Early screening of ADHD-like symptoms may help clinicians identify patients who might need extra support or an adjusted treatment. Therapist behaviours that promote adherence may be important for treatment response, although more research is needed in order to determine what type of support would be most beneficial.

No MeSH data available.


Related in: MedlinePlus

Predicted symptomatic improvement based on individual differences in treatment adherence.For illustrative purposes, a categorization was performed to depict predicted growth curves for patients with high and low adherence. High adherence was operationalized as 1 standard deviation above the mean activated number of treatment modules and low adherence as 1 standard deviation below the mean number of modules. Mean adherence was 7.72 (SD = 3.36). Error bars are displayed with 95% confidence intervals.
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pone.0124258.g002: Predicted symptomatic improvement based on individual differences in treatment adherence.For illustrative purposes, a categorization was performed to depict predicted growth curves for patients with high and low adherence. High adherence was operationalized as 1 standard deviation above the mean activated number of treatment modules and low adherence as 1 standard deviation below the mean number of modules. Mean adherence was 7.72 (SD = 3.36). Error bars are displayed with 95% confidence intervals.

Mentions: The results of the longitudinal growth model predicting symptomatic improvement are presented in Table 6 and in Figs 1, 2 and 3. For illustrative purposes, a categorization was performed to depict predicted growth curves for patients scoring high and low on each predictor variable, where a “high” score was operationalized as one standard deviation above the mean and a “low” score as one standard deviation below the mean. According to the final model, age and employment status did not have an effect on improvement when controlling for patients’ overall functioning level, treatment credibility ratings and adherence levels. Specifically, a high level of perceived treatment credibility was associated with a faster rate of improvement and lower social anxiety after treatment (see Fig 1). Also, a high level of adherence was associated with a greater improvement rate and lower post-treatment LSAS-SR scores (see Fig 2). Patients with a higher overall functioning level also evidenced lower post-treatment LSAS-SR scores, although these individuals had a slower rate of improvement (see Fig 3).


Predictors of Symptomatic Change and Adherence in Internet-Based Cognitive Behaviour Therapy for Social Anxiety Disorder in Routine Psychiatric Care.

El Alaoui S, Ljótsson B, Hedman E, Kaldo V, Andersson E, Rück C, Andersson G, Lindefors N - PLoS ONE (2015)

Predicted symptomatic improvement based on individual differences in treatment adherence.For illustrative purposes, a categorization was performed to depict predicted growth curves for patients with high and low adherence. High adherence was operationalized as 1 standard deviation above the mean activated number of treatment modules and low adherence as 1 standard deviation below the mean number of modules. Mean adherence was 7.72 (SD = 3.36). Error bars are displayed with 95% confidence intervals.
© Copyright Policy
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4404057&req=5

pone.0124258.g002: Predicted symptomatic improvement based on individual differences in treatment adherence.For illustrative purposes, a categorization was performed to depict predicted growth curves for patients with high and low adherence. High adherence was operationalized as 1 standard deviation above the mean activated number of treatment modules and low adherence as 1 standard deviation below the mean number of modules. Mean adherence was 7.72 (SD = 3.36). Error bars are displayed with 95% confidence intervals.
Mentions: The results of the longitudinal growth model predicting symptomatic improvement are presented in Table 6 and in Figs 1, 2 and 3. For illustrative purposes, a categorization was performed to depict predicted growth curves for patients scoring high and low on each predictor variable, where a “high” score was operationalized as one standard deviation above the mean and a “low” score as one standard deviation below the mean. According to the final model, age and employment status did not have an effect on improvement when controlling for patients’ overall functioning level, treatment credibility ratings and adherence levels. Specifically, a high level of perceived treatment credibility was associated with a faster rate of improvement and lower social anxiety after treatment (see Fig 1). Also, a high level of adherence was associated with a greater improvement rate and lower post-treatment LSAS-SR scores (see Fig 2). Patients with a higher overall functioning level also evidenced lower post-treatment LSAS-SR scores, although these individuals had a slower rate of improvement (see Fig 3).

Bottom Line: Treatment credibility was the strongest predictor of greater adherence.Having a family history of SAD-like symptoms was also associated with greater adherence, whereas Attention-Deficit/Hyperactivity Disorder (ADHD)-like symptoms, male gender, and family history of minor depression predicted lower adherence.Also, the amount of therapist time spent per treatment module was negatively associated with adherence.

View Article: PubMed Central - PubMed

Affiliation: Department of Clinical Neuroscience, Division of Psychiatry, Karolinska Institutet, Stockholm, Sweden.

ABSTRACT

Objective: A central goal of health care is to improve patient outcomes. Although several studies have demonstrated the effectiveness of therapist guided internet-based cognitive behaviour therapy (ICBT) for social anxiety disorder (SAD), a significant proportion of patients do not respond to treatment. Consequently, the aim of this study was to identify individual characteristics and treatment program related factors that could help clinicians predict treatment outcomes and adherence for individuals with SAD.

Method: The sample comprised longitudinal data collected during a 4-year period of adult individuals (N = 764) treated for SAD at a public service psychiatric clinic. Weekly self-rated Liebowitz Social Anxiety Scale (LSAS-SR) scores were provided. Rates of symptomatic change during treatment and adherence levels were analysed using multilevel modelling. The following domains of prognostic variables were examined: (a) socio-demographic variables; (b) clinical characteristics; (c) family history of mental illness; and (d) treatment-related factors.

Results: Higher treatment credibility and adherence predicted a faster rate of improvement during treatment, whereas higher overall functioning level evidenced a slower rate of improvement. Treatment credibility was the strongest predictor of greater adherence. Having a family history of SAD-like symptoms was also associated with greater adherence, whereas Attention-Deficit/Hyperactivity Disorder (ADHD)-like symptoms, male gender, and family history of minor depression predicted lower adherence. Also, the amount of therapist time spent per treatment module was negatively associated with adherence.

Conclusions: Results from a large clinical sample indicate that the credibility of ICBT is the strongest prognostic factor explaining individual differences in both adherence level and symptomatic improvement. Early screening of ADHD-like symptoms may help clinicians identify patients who might need extra support or an adjusted treatment. Therapist behaviours that promote adherence may be important for treatment response, although more research is needed in order to determine what type of support would be most beneficial.

No MeSH data available.


Related in: MedlinePlus