Philadelphia College of Osteopathic Medicine DigitalCommons@PCOM PCOM Psychology Dissertations Student Dissertations, Theses and Papers 2002 Comprehensive Profile of Adult Outpatient Psychotherapy Treatment Responders, Nonresponders, and Negative Responders in a Naturalistic Treatment Setting Anya Genieser-DeRosa Philadelphia College of Osteopathic Medicine, [email protected] Follow this and additional works at: http://digitalcommons.pcom.edu/psychology_dissertations Part of the Clinical Psychology Commons Recommended Citation Genieser-DeRosa, Anya, "Comprehensive Profile of Adult Outpatient Psychotherapy Treatment Responders, Nonresponders, and Negative Responders in a Naturalistic Treatment Setting " (2002). PCOM Psychology Dissertations. Paper 50. This Dissertation is brought to you for free and open access by the Student Dissertations, Theses and Papers at DigitalCommons@PCOM. It has been accepted for inclusion in PCOM Psychology Dissertations by an authorized administrator of DigitalCommons@PCOM. For more information, please contact [email protected]. Philadelphia College ofOsteopathic Medicine Department ofPsychology A COMPREHENSIVE PROFILE OF ADULT OUTPATIENT PSYCHOTHERAPY TREATMENT RESPONDERS, NONRESPONDERS, AND NEGATIVE RESPONDERS IN A NATURALISTIC TREATMENT SETTING By Anya Genieser-DeRosa Doctor ofPsychology May 2002 PHILADELPHIA COLLEGE OF OSTEOPATHIC MEDICINE DEPARTMENT OF PSYCHOLOGY Dissertation Approval This is to certify that the thesis presented to us by At-J.1A.. C$NtE5~~oSA. on the :;Z1.ND day of ~ANu..A,,(L1 ' 20Q2..., in partial fulfillment ofthe requirements for the degree ofDoctor ofPsychology, has been examined and is acceptable in both scho larship and literary quality. Committee Members' Signatures: Stephanie H. Felgoise, Ph.D., ABPP, Chairperson Grant R. Grissom, Ph.D. Robert A. DiTomasso, Ph.D., ABPP Arthur Freeman, Ed.D., ABPP, Chair, Department of Psychology Profile ofResponders, Nonresponders, and Negative Responders 2 Acknowledgements I would like to express my heartfelt gratitude and sincerest thanks to the many individuals who gave so generously oftheir time, energy, and talents to assist me in completing this project, including: Darren J. DeRosa, my wonderful husband and best friend, whose love, support, patience, humor, and willingness to help in any way possible made the completion of this project a reality. The late Dr. Kenneth Howard, and his kind, patient, and generous colleagues at Northwestern University - Dr. John Lyons, Dr. Zoran Martinovich, and Bruce Briscoe. Their contributions to this project have been invaluable. My dissertation committee - Dr. Stephanie Felgoise (Chair), Dr. Robert DiTomasso, and Dr. Grant Grissom. Given your patience, support, dedication, and ability to make me laugh when things looked impossibly grim to me, the dissertation process was actually - dare I say it - fun! I could not have asked for a more wonderful group of mentors. Dr. Scott Browning and Dr. Joseph Micucci, my mentors at Chestnut Hill College, whose encouragement, support, and guidance convinced me that I could successfully pursue a doctorate and who have supported me every step of the way. Dr. Eric Anderson and the Integra Board of Directors, providers of both the archival data and an initial introduction to Dr. Howard. Dr. Peter Brill, founder ofIntegra, Inc. and the primary inspiration for this study. Thank you for allowing me to complete the "final phase" ofyour vision for the Compass, and for my professional "start" at Integra, Inc. Dr. Sally Czaja, expert database assembler and on-the-fly database manager. Dr. Christopher Barbrack, Dr. Michael Lambert, and Dr. Larry Beutler, three experts who amazed me with their willingness to answer my questions, take an interest in my study, and offer their suggestions. Tera Mikula, the wonderful graduate assistant whose speedy data entry efforts allowed me to move forward at a pace I would not have imagined. The Genieser and DeRosa families, and my friends, who have patiently tolerated my physical and emotional absence over the past 5 years, and who have only occasionally asked me, "Aren't you finished yet?" Profile of Responders, Nonresponders, and Negative Responders 3 Abstract Since its inception, the effectiveness of psychotherapy as a treatment for psychological distress has been challenged vigorously. During the past 5 decades, increasingly sophisticated research studies have demonstrated psychotherapy effective in treating a variety ofpsychological disorders in the majority of individuals who avail themselves of treatment. Moreover, despite fierce competition among proponents of various psychotherapy models attempting to prove their model of choice most effective, research fmdings suggest the major models of psychotherapy are all equally effective in treating most individuals. Some have therefore shifted their research focus to determining the factors common to major psychotherapies that promote treatment success. Few, however, have examined the contributing factors involved in treatment failure. The present study investigates the factors predictive of treatment nonresponse (failure to change significantly from baseline global functioning, as a measure of overall functional psychological status) and negative response (deterioration from baseline global functioning) in a large sample of adult (ages 18-65) psychotherapy outpatients treated in naturalistic settings. Predictor variables were selected and drawn from archival questionnaire data monitoring changes in 900 patients' functioning in several specific and one global domain. The patient sample was randomly divided into two groups. Scores of Group 1 on predictors were submitted to a discriminant Profile of Responders, Nonresponders, and Negative Responders 4 function analysis, and a predictive model for treatment outcome group classification was successfully derived. The veracity ofthe model was then substantiated with the data of participants assigned to Group 2. Results indicated that the linear combination of patient's scores on specific predictor variables successfully predicted the assignment of patients to one ofthree discrete outcome groups - treatment responder, treatment nonresponder, and negative treatment responder. Findings suggest a small group of individuals is at high risk for negative treatment response. Others are highly likely to improve during treatment; however, an equal number are likely to experience no significant change during the treatment process. Further investigation into the risk factors involved in treatment nonresponse and negative response is key to a complete understanding ofthis phenomenon, to creating a method for the early identification ofthose at risk, and to developing specific interventions to increase the rate oftreatment success in those at risk of experiencing sUboptimal treatment outcome. Profile of Responders, Nonresponders, and Negative Responders 5 TABLE OF CONTENTS LIST OF TABLES 6 Chapter 1. INTRODUCTION ... 8 HISTORICAL OVERVIEW OF THE DEBATE OVER PSYCHOTHERAPY EFFECTIVENESS... 14 THE COMMON FACTORS MODEL... 59 THE TREATMENT NONRESPONSE AND NEGATIVE RESPONSE PHENOMENON... 103 INVESTIGATING THE TREATMENT NONRESPONSE AND NEGATIVE RESPONSE PHENOMENON... 176 CHAPTER 2. METHODOLOGY... 217 CHAPTER 3 RESULTS... 243 STUDY 1... 254 STUDY 2... 281 CHAPTER 4 DISCUSSION 286 REFERENCES... 293 APPENDIX 1... 344 Profile of Responders, Nonresponders. and Negative Responders 6 LIST OF TABLES Table 1 Hypothesized Direction of Variable Relationships Predicting Treatment Outcome Group Membership ... 214 Table 2 Demographic Characteristics of Total Research Sample and Two Randomly-Assigned Subsamples ... 219 Table 3 Demographic Chara«;;teristics of a Participant Sample (n= I ~938) Previously Drawn From the Same Original Population (N==23,500) ... 224 Table 4 Description of Predictor Variable Scores in Treatment Responder, Treatment Nonresponder, and Negative Treatment Responder Outcome Groups ... 249 Table 5 Results of Preliminary Standard Discriminant Function Analysis Evaluating Potential for Predictors to ClassifY Sample] Participants into Treatment Outcome Groups ... 255 Table 6 Correlation of Predictor Variables with Discriminant Functions (Function Structure Matrix) and Standardized Discriminant Function Coefficients, Preliminary Analysis, Sample] ... 256 Table 7 Classification of Treatment Response in Preliminary Analysis of Sample 1 ... 257 Table 8 Description of Eleven Predictor Variables for Treatment Outcome Group Classification, Sample 1 ... 258 Table 9 Univariate Analyses of Variance for Eleven Predictor Variables and Three Treatment Outcome Group Classifications for Sample] ... 26] Table ]0 Results of Primary Standard Discriminant Function Analysis Classifying Sample] Participants into Treatment Outcome Groups ... 268 Table] 1 Correlation of Predictor Variables with Discriminant Functions (Function Structure Matrix), Standardized and Unstandardized Discriminant Function Coefficients, Primary Analysis, Sample ] ... 269 Profile of Responders, Nonresponders, and Negative Responders 7 Table 12 Classification of Treatment Response in Primary Analysis of Sample 1... 273 Table 13 Mean Scores on Predictor Variables as a Function of Treatment Outcome Group Classification ... 277 Table 14 Validation of Classification Analysis for Treatment Outcome Group Membership ... 283 Appendix 1 Criteria for Study Exclusion and Number of Patients Excluded from Original Data Set ill = 23,500) ... 344 Profile of Responders, Nonresponders, and Negative Responders