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Predicting Treatment Failure in Regular Care Internet-Delivered Cognitive Behavior Therapy for Depression and Anxiety Using Only Weekly Symptom Measures
Karolinska Institutet, Sweden;Stockholm County Council, Sweden.ORCID iD: 0000-0001-8236-4323
Karolinska Institutet, Sweden;Stockholm County Council, Sweden.ORCID iD: 0000-0002-5749-5310
Karolinska Institutet, Sweden;Stockholm County Council, Sweden.ORCID iD: 0000-0002-6681-0554
Karolinska Institutet, Sweden;Stockholm County Council, Sweden.ORCID iD: 0000-0002-0633-8104
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2020 (English)In: Journal of Consulting and Clinical Psychology, ISSN 0022-006X, E-ISSN 1939-2117, Vol. 88, no 4, p. 311-321Article in journal (Refereed) Published
Abstract [en]

Objective: Therapist guided Internet-Delivered Cognitive Behavior Therapy (ICBT) is effective, but as in traditional CBT, not all patients improve, and clinicians generally fail to identify them early enough. We predict treatment failure in 12-week regular care ICBT for Depression, Panic disorder and Social anxiety disorder, using only patients' weekly symptom ratings to identify when the accuracy of predictions exceed 2 benchmarks: (a) chance, and (b) empirically derived clinician preferences for actionable predictions. Method: Screening, pretreatment and weekly symptom ratings from 4310 regular care ICBT-patients from the Internet Psychiatry Clinic in Stockholm, Sweden was analyzed in a series of regression models each adding 1 more week of data. Final score was predicted in a holdout test sample, which was then categorized into Success or Failure (failure defined as the absence of both remitter and responder status). Classification analyses with Balanced Accuracy and 95% Confidence intervals was then compared to predefined benchmarks. Results: Benchmark 1 (better than chance) was reached 1 week into all treatments. Social anxiety disorder reached Benchmark 2 (>65%) at week 5, whereas Depression and Panic Disorder reached it at week 6. Conclusions: For depression, social anxiety and panic disorder, prediction with only patient-rated symptom scores can detect treatment failure 6 weeks into ICBT, with enough accuracy for a clinician to take action. Early identification of failing treatment attempts may be a viable way to increase the overall success rate of existing psychological treatments by providing extra clinical resources to at-risk patients, within a so-called Adaptive Treatment Strategy.

Place, publisher, year, edition, pages
American Psychological Association (APA), 2020. Vol. 88, no 4, p. 311-321
Keywords [en]
cognitive behavior therapy, ehealth, Internet interventions, treatment failure, prediction
National Category
Psychology
Research subject
Social Sciences, Psychology
Identifiers
URN: urn:nbn:se:lnu:diva-93127DOI: 10.1037/ccp0000462ISI: 000518804400003PubMedID: 31829635Scopus ID: 2-s2.0-85076437637OAI: oai:DiVA.org:lnu-93127DiVA, id: diva2:1416984
Available from: 2020-03-26 Created: 2020-03-26 Last updated: 2021-05-07Bibliographically approved

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Kaldo, Viktor

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Forsell, ErikIsacsson, NilsBlom, KerstinJernelov, SusannaKaldo, Viktor
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