Hostname: page-component-586b7cd67f-2plfb Total loading time: 0 Render date: 2024-11-27T00:06:38.889Z Has data issue: false hasContentIssue false
  • English
  • Français

Does Starting With the Behavioural Component of Cognitive Behavioural Therapy (CBT) Increase Patients’ Retention in Therapy?

Published online by Cambridge University Press:  09 January 2013

Nusrat Yasmeen Ahmed  and
Sharon Lawn
Nusrat Yasmeen Ahmed*
Affiliation:
Psychotherapist in private practice, Melbourne, VIC, Australia
Sharon Lawn
Affiliation:
Flinders Human Behaviour and Health Research Unit, Flinders University, Adelaide, SA, Australia
*
Address for correspondence: Nusrat Yasmeen Ahmed, 1/315 Jasper Road, Ormond VIC 3201, Australia. E-mail: [email protected]
Get access

Abstract

This study examined whether starting with the behavioural component of cognitive behavioural therapy (CBT) decreases the drop-out rate in outpatients with comorbid anxiety and depression. Retrospective data were collected on 60 patients with anxiety and depression. Mean values of different psychosocial assessment scales during screening, mid-session and discharge session were compared between the patients receiving and not receiving any type of behavioural interventions and among the patients receiving different types of behavioural interventions. A significant relationship was found (p < .05) between behavioural interventions and retention in therapy. Patients who did not receive any sort of behavioural intervention showed a greater rate of drop-out than those who received behavioural interventions. In the group of patients receiving different types of behavioural interventions, there was significant improvement in mental health scores between the screening and discharge sessions in those who received exposure therapy. The study findings will be helpful to retain patients with comorbid anxiety and depression in an outpatient therapy setting. If patient retention is increased, CBT can be more effectively delivered and thereby achieve better health outcomes for patients, more effective use of therapy service resources, and decrease the socioeconomic burden of anxiety and depression on the community.

Keywords

cognitive behavioural therapy (CBT)drop-outcomorbidityanxietydepressionexposure therapybehavioural activation
Type
Standard Papers
Information
Behaviour Change , Volume 29 , Issue 4 , December 2012 , pp. 238 - 257
Copyright
Copyright © The Authors 2013

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

American Psychiatric Association. (2000). Diagnostic and statistical manual of mental disorders (4th ed., text revision; DSM-IV-TR). Washington, DC: American Psychiatric Publishing, Inc.Google Scholar
Backontrack, . (n.d.). Mental Health Occupational Therapy Services. Retrieved January 5, 2012, from www.backontrackmhot.com.au/Mental-Health-Occupational-Therapy-Services.htmGoogle Scholar
Bados, A., Balaguer, G., & Saldanña, C. (2007). The efficacy of cognitive-behavioral therapy and the problem of drop-out. Journal of Clinical Psychology, 63, 585–592.CrossRefGoogle ScholarPubMed
Baekeland, F., & Lundwall, L. (1975). Dropping out of treatment: A critical review. Psychological Bulletin, 82, 738–783.Google Scholar
Barlow, D.H., Allen, L.B., & Choate, M.L. (2004). Toward a unified treatment for emotional disorders. Behavior Therapy, 35, 205–230.Google Scholar
Barlow, D.H. (2002). Anxiety and its disorders: The nature and treatment of anxiety and panic (2nd ed.). New York: Guilford Press.Google Scholar
Barrot, M., Wallace, D.L., Balanos, C.A., Graham, D.L., Perrotti, L.l., Neve, R.L., . . . Nestler, E.J. (2005). Regulation of anxiety and initiation of sexual behavior by CREB in the nucleus accumbens. Proceedings of the National Academy of Sciences of the United States of America, 102, 8357–8362.Google Scholar
Bebbington, P.E., Brugha, T.S., Meltzer, H., Jenkins, R., Ceresa, C., Farrell, M., & Lewis, G. (2000). Neurotic disorders and the receipt of psychiatric treatment. Psychological Medicine, 30, 1369–1376.Google Scholar
Beck, A.T., Rush, A.J., Shaw, B.F., & Emery, G. (1979). Cognitive therapy of depression. New York: The Guilford Press.Google Scholar
Berghofer, G., Schmidl, F., Rudas, S., Steiner, E., & Schmitz, M. (2002). Predictors of treatment discontinuity in outpatient mental health care. Social Psychiatry and Psychiatric Epidemiology, 37 (6), 276–282.Google Scholar
Bostwick, G.J. (1987). Where's Mary? A review of the group treatment dropout literature. Social Work Groups, 10 (3), 117–133.CrossRefGoogle Scholar
Coles, M.E., Turk, C.L., Jindra, L., & Heimberg, R.G. (2004). The path from initial inquiry to initiation of treatment for social anxiety disorder in an anxiety disorders specialty clinic. Journal of Anxiety Disorders, 18, 3371–3383.Google Scholar
Davidson, R.J., & Sutton, S.K. (1995). Affective neuroscience: The emergence of a discipline. Current Opinion in Neurobiology, 5, 217–224.Google Scholar
Dimidjian, S., Hollon, S.D., Dobson, K.S., Schmaling, K.B., Kohlenberg, R.J., Addis, M.E., . . . Jacobson, N.S. (2006). Randomized trial of behavioral activation, cognitive therapy, and antidepressant medication in the acute treatment of adults with major depression. Journal of Consulting and Clinical Psychology, 74, 658–670.Google Scholar
Edlund, M.J., WangP.,S. P.,S., Berglund, P.A., Katz, S.J., Lin, E., & Kessler, R.C. (2002). Dropping out of mental health treatment: patterns and predictors among epidemiological survey respondents in the United States and Ontario, American Journal of Psychiatry, 159, 845–851.Google Scholar
Ellis, H.C., Ottaway, S.A., Varner, L.J., Becker, A.S., & Moore, B.A. (1997). Emotion motivation, and text comprehension: The detection of contradictions in passages. Journal of Experimental Psychology, 126, 131–146.Google Scholar
Farmer, R.F., & Chapman, A.L. (2008). Behavioral interventions in cognitive behavior therapy. Washington, DC: American Psychological Association.Google Scholar
Ferster, C. B. (1973). A functional analysis of depression. American Psychologist, 28, 857–870.Google Scholar
Gortner, E.T., Gollan, J.K., Dobson, K.S., & Jacobson, N.S. (1998). Cognitive-behavioral treatment for depression: Relapse prevention. Journal of Consulting and Clinical Psychology, 66, 377–384.Google Scholar
Grunebaum, M., Luber, P., Callahan, M., Leon, A.C., Olfson, M., & Portera, L. (1996), Predictors of missed appointments for psychiatric consultations in a primary care clinic. Psychiatric Services, 47, 848–852.Google Scholar
Henry, J.D., & Crawford, J.R. (2005). The short-form version of the Depression Anxiety Stress Scales (DASS-21): Construct validity and normative data in a large non-clinical sample. British Journal of Clinical Psychology, 44, 227–239.Google Scholar
Higgins, E.T., Shah, J., & Friedman, R. (1997). Emotional responses to goal attainment: Strength of regulatory focus as moderator. Journal of Personality and Social Psychology, 72, 515–525.Google Scholar
Hirschfeld, R. (2001). The comorbidity of major depression and anxiety disorders: Recognition and management in primary care. Journal of Clinical Psychiatry, 3, 244–254.Google Scholar
Hopko, D.R., Lejuez, C.W., LePage, J.P., Hopko, S.D., & McNeil, D.W. (2003). A brief behavioral activation treatment for depression: A randomized pilot trial within an inpatient psychiatric hospital. Behavior Modification, 27, 458–469.Google Scholar
Issakidis, C., & Andrews, G. (2004). Pretreatment attrition and dropout in an outpatient clinic for anxiety disorders, Acta Psychiatricia Scandinavicia, 109, 426–433.Google Scholar
Izadikhah, Z., & Jackson, C.J. (2011). Investigating the moderating effect of rewarding climate on mastery approach orientation in the prediction of work performance. British Journal of Psychiatry, 102, 204–222.Google Scholar
Jacobson, N.S., Dobson, K.S., Truax, P.A., & Addis, M.E. (1996). A component analysis of cognitive-behavioral treatment for depression. Journal of Consulting and Clinical Psychology, 64, 295–304.Google Scholar
John, W.A., & Birch, D. (1978). Introduction to motivation. New York: Litton Educational Publishing.Google Scholar
Kessler, R.C., & Ustun, B. (2004). Prevalence, severity, and unmet need for treatment of mental disorders in the World Health Organization World Mental Health Surveys. Journal of the American Medical Association, 291, 2581–2590.Google Scholar
Kessler, R.C., Andrews, G., Colpe, L.J, Hiripi, E., Mroczek, D.K., Normand, S., Walters, E.E., & Zaslavsky, A.M. (2002). Short screening scales to monitor population prevalence and trends in non-specific psychological distress. Psychological Medicine, 32, 959–976.CrossRefGoogle ScholarPubMed
Kessler, R.C., Berglund, P.A., Bruce, M.L., Koch, J.R., Laska, E.M., Leaf, P.J., Manderscheid, R.W., . . . Wang, P.S. (2001). The prevalence and correlates of untreated serious mental illness. Health Services Research, 36, 987–1007.Google Scholar
Killapsy, H., Banerjee, S., King, M., & Lloyd, M. (2000). Prospective controlled study of psychiatric outpatient non-attendance: Characteristics and outcome. British Journal of Psychiatry, 176, 160–165.Google Scholar
Lewinsohn, P.M. (1974). A behavioral approach to depression. In Friedman, R.M. & Katz, M.M. (Eds.), The psychology of depression: Contemporary theory and research. New York: Wiley.Google Scholar
Lowe, B., Mundt, C., Herzog, W., Brunner, R., Backenstrass, M., Kronmüller, K., & Henningsen, P. (2008). Validity of current somatoform disorder diagnoses: Perspectives for classification in DSM-V and ICD-11, Psychopathology, 41, 4–9.Google Scholar
Macharia, W.M., Leon, G, Rowe, B.H., Stephenson, B.J., and Haynes, R.B. (1992). An overview of interventions to improve compliance with appointment keeping for medical services, JAMA, 267 (13), 1813–1817.Google Scholar
Marks, I.M., & Mathews, A.M. (1979). Brief standard self-rating for phobic patients, Behaviour Research and Therapy, 17, 263–267.Google Scholar
Morlino, M., Martucci, G., Musella, V., Bolzan, M., & De Girolamo, G. (1995). Patients dropping out of treatment in Italy. Acta Psychiatrica Scandinavica, 92, 1–6.Google Scholar
Miller, A.K., & Markman, K.D. (2007). Depression, regulatory focus, and motivation. Personality and Individual Differences, 43, 427–436.Google Scholar
Mountjoy, C.Q., & Roth, M. (1982). Studies in the relationship between depressive disorders and anxiety states: Part 1. Rating scales. Journal of Affective Disorders, 4, 127–147.Google Scholar
Mundt, J.C., Marks, I.M., Shear, M.K., & Greist, J.H. (2002). The Work and Social Adjustment Scale: A simple measure of impairment in functioning. The British Journal of Psychiatry, 180, 461–464.Google Scholar
Mueller, M., & Pekarik, G. (2000). Treatment duration prediction: Client accuracy and its relationship to dropout, outcome, and satisfaction. Psychotherapy, 2, 117–123.Google Scholar
Persons, J.B., Burns, D.D., & Perloff, J.M. (1988). Predictors of dropout and outcome in cognitive therapy for depression in a private practice setting. Cognitive Therapy and Research, 12, 557–575.Google Scholar
Rouillon, F. (1999). Anxiety with depression: a treatment need. European Neuropsychopharmacology, 9 (Suppl.), S87–S92.Google Scholar
Scott, K.M., Bruffaerts, R., Tsang, A., Ormel, J., Alonso, J., Angermeyer, M.C., . . . Korff, M.V. (2007). Depression–anxiety relationships with chronic physical conditions: Results from the World Mental Health surveys. Journal of Affective Disorders, 103, 113–120.Google Scholar
Scott, K.M., McGee, M.A., Browne, M.A.O., & Wells, J.E. (2006). Mental disorder comorbidity in Te Rau Hinengaro: The New Zealand Mental Health Survey. Australian and New Zealand Journal of Psychiatry, 40, 875–881.Google Scholar
SPSS Inc. (2008). SPSS Base 17.0 for Windows user's guide. Chicago, IL: Author.Google Scholar
Straker, M. (1968). Brief psychotherapy in an outpatient clinic: evolution and evaluation, American Journal of Psychiatry, 124, 1219–1225.CrossRefGoogle Scholar
Sasseville, M., & Grunberg, F. (1987). Unemployment and mental health, Canadian Journal of Psychiatry, 32, 798–802.Google Scholar
Tomison, A.M., & Goddard, C.R. (1999, July). Blending qualitative and quantitative approaches: Case tracking studies in child protection systems. Paper presented to the Association for Qualitative Research ‘Issues of Rigour in Qualitative Research’ International Conference, Melbourne, Australia.Google Scholar
Trepka, C. (1986). Attrition from an out-patient psychology clinic. The British Journal of Medical Psychology, 59, 181–186.Google Scholar
Wierzbicki, M., & Pekarik, G. (1993). A meta-analysis of psychotherapy dropout. Professional Psychology: Research and Practice, 24, 190–195.Google Scholar
Wittchen, H.U., & Essau, C.A. (1993). Comorbidity and mixed anxiety–depressive disorders: Is there epidemiologic evidence? Journal of Clinical Psychiatry, 54 (Suppl.), 9–15.Google Scholar
Wright, J.H., Basco, M.R., & Thase, M.E. (2006). Learning cognitive behavior therapy: An illustrated guide. Washington, DC: American Psychiatric Press.Google Scholar