Category: Treatment - CBT
The dose-effect model psychotherapy outcome posits that psychotherapy produces rapid improvement in the first few sessions followed by continued, yet less robust improvement as sessions continue (Herron et al., 1994; Howard, Kopta, Krause, & Orlinsky, 1986). This model has been supported in the literature for the treatment of various psychopathologies in outpatient samples (Kopta, Howard, Lowry, & Beutler, 1994; Stulz et al., 2013) but is not consistently supported in younger samples (Salzer, Bickman, & Lambert, 1999). The purpose of the present study is to examine the outcomes of students seen for multiple school years in the Assessment, Support, and Counseling (ASC) Center, a school mental health program that provides individual CBT.
Participants (N = 66; 52.3% male) were students aged 14 to 18 (M = 16.44, SD = 0.92) referred between 2011 and 2016 to the ASC Center for multiple school years (henceforth referred to as carryover clients). Clients received an average of 18.52 sessions (SD = 12.12) with an average duration of 32.66 minutes (SD = 3.51) in year two. The Youth Outcome Questionnaire-30 (YOQ-30; Burlingame et al., 2004) was used to measure outcomes and was administered at baseline and at every other treatment session until the end of treatment.
Results indicated a significant difference in symptoms between year one baseline YOQ-30 scores (M = 38.25; SD = 17.56) and year two baseline YOQ-30 scores (M = 30.21; SD = 18.31), t(53) = 2.98, p = .004, d = 0.41. There was a significant difference between year one final YOQ-30 scores (M = 26.71, SD = 18.27) and year two final YOQ-30 scores (M = 20.84, SD = 17.32), t(51) = 2.31, p = .025, d =0.32. There was not a significant difference between year one final YOQ-30 scores (M = 26.71, SD = 18.27) and year two baseline YOQ-30 scores (M = 30.71, SD = 18.41), t(51) = -1.48, p = .144, d = -0.21. 30 carryover clients met criteria for Reliable Change Index (RCI; Jacobson & Truax, 1991) analyses for year two. Results indicated that 40% (n = 12) of carryover clients were considered “recovered,” 10% (n = 3) “improved,” 46.7% (n = 14) “unchanged,” and 3.3% (n = 1) “deteriorated.”
The results of the current study suggest improvements in symptoms at the onset and conclusion of yearly services with an observed plateauing of symptom recovery at the end of the second treatment year. Only 50% of carryover clients are recovered or improved at termination at year two, while 65% of clients, on average, achieve these outcomes at the end of their first treatment year. Explanations for these differences include the possibility that carryover clients habituate to treatment effects over consecutive treatment attempts or are generally more impaired, requiring a more intensive and sustained dosage of CBT to evidence similar outcomes.
Rachel Capps– Graduate Student, Appalachian State University, Boone, North Carolina
Morgan Brazille– Appalachian State University
Stephanie Moss– Graduate Student, Appalachian State University
JohnPaul Jameson– Associate Professor, Appalachian State University
Kurt Michael– Appalachian State University