Early change as a predictor of outcome in a routine UK psychological therapies service

Aim. The importance of developing reliable models and predictors of change in psychotherapy has been highlighted in recent years. These models have the potential to inform feedback of progress during therapy to improve outcomes. This study analyses sessional data from a routine NHS psychological therapies service in order to investigate how a simple measure of early reliable improvement or deterioration at session 4 predicts final outcome.
Methods. 272 Consecutive patients receiving a range of psychological therapies within a UK psychological therapies service completed the CORE-SF every session. Patients who experienced significant improvement or deterioration of 5 points or more at session 4, indicating a reliable change, were identified. Comparisons were then made with outcomes at the end of treatment. These findings were compared to a more robust definition of sudden improvements and deterioration (Stiles et al, 2003).
Results. Overall, 42% of clients showed a significant overall improvement at the end of therapy, with 12% showing a significant deterioration. Chi squared analysis showed a very significant relationship between presence of significant improvement at session 4 with final outcomes, with 79% of clients with significant improvement at session 4 maintaining those gains by the last session, but only 3% of those showing a significant deterioration at the last session. In contrast, for those showing a significant deterioration at session 4, only 17% showed a significant improvement and 34% significantly improved at the last session.
Discussion. These findings support the idea that early response to therapy, both improvement and deterioration, are significant predictors of therapeutic outcome. It also suggests this relatively simple measure of significant change at session 4 does provide useful information to therapists which may improve outcomes. Simple indicators of early change may be preferable to more sophisticated approaches because they are easily understood and therefore more readily accepted by therapists.