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

Abstract

Many patients who receive cognitive behavior therapy (CBT) for mood and anxiety disorders fail to respond or drop out of treatment. We tested the hypotheses that therapist use of each of three decision support tools, a written case formulation, a list of treatment goals, and a plot of symptom scores, was associated with improved outcome and reduced dropout in naturalistic CBT provided to 845 patients in a private practice setting. We conducted regression analyses to test the hypotheses that the presence of each tool in the clinical record was associated with lower end-of-treatment scores on the Beck Depression Inventory (BDI) and the Burns Anxiety Inventory (BurnsAI), and lower rates of premature and uncollaborative dropout. We found that the presence of a written case formulation in the clinical record was associated with lower rates of both types of dropout. A list of treatment goals was associated with lower end-of-treatment scores on the BDI and the BurnsAI, and a lower rate of uncollaborative but a higher rate of premature dropout. A plot of symptom scores was associated with lower end-of-treatment scores on the BDI, and lower rates of both types of dropout. Results suggest that therapist use of a written case formulation, list of treatment goals, and a plot of symptom scores can contribute to improved outcome and reduced dropout in CBT.

Keywords: Case formulation; Decision support; Dropout; Measurement-based care; Outcome; Private practice.