Early Symptom Change Predicts Outcome of CBT

Cognitive behavioral therapy (CBT) is one of the most commonly used therapeutic approaches for the treatment of depression, anxiety, and a host of other mental health problems. However, the response rate and successful treatment outcome varies from individual to individual. Even people being treated for the same condition by the same therapist can have significantly different outcomes. The factors that predict treatment success are many, including symptom severity, treatment adherence, and willingness. Two factors that are thought to strongly influence outcome are pretreatment states and symptom changes in the initial stages of therapy. To further explore these factors with relation to CBT outcomes, Cara C. Lewis of the Department of Psychological and Brain Sciences at Indiana University led a study on 173 individuals seeking treatment for depression or anxiety.

Lewis evaluated the participants, who consisted of college students and individuals from the community, prior to the CBT. The participants ranged in age from 18 to 64 and were evaluated for treatment willingness and other pretreatment factors. Their symptom changes were assessed throughout the CBT and measured against treatment outcome. Lewis discovered that decreases in depressive symptoms in the first five sessions of treatment directly predicted overall outcome in the participants. Specifically, the individuals with the steepest decreases in sessions one through five saw the greatest improvement at the end of the CBT. This finding was distinctly different when compared to symptom reduction after intake. For instance, although the majority of participants saw a dramatic decrease in symptom severity after the first session, those who continued to have symptom declines during the following four sessions had the most positive outcomes at the end of their treatment.

Another interesting finding was the impact of willingness to change. Lewis found that the participants who paid for their therapy, the community participants, were more willing to complete the homework assignments and showed a higher level of commitment to therapy than the students who received the CBT at no cost. These findings seem to demonstrate a direct link between willingness and positive outcome. Lewis added, “Nonetheless, what is consistent about these findings is that if clients are at least thinking about changing their behaviors, they are more likely to achieve successful outcomes.” Overall, the results of this study highlight two important areas of focus for clinicians treating individuals for depression and anxiety.

Lewis, C. C., Simons, A. D., Kim, H. K. (2012). The role of early symptom trajectories and pretreatment variables in predicting treatment response to cognitive behavioral therapy. Journal of Consulting and Clinical Psychology. Advance online publication. doi: 10.1037/a0029131

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  • Phoebe


    July 10th, 2012 at 10:55 AM

    This completely makes sense to me. I would have also thought that the people who showed the greatest response to treatment sooner in the process would in fact have the most success when it cam to being more successful as an end result. They have walls that they are willing to have broken through, while those who are more resistant to treatment could have a far more difficult time making the life changes that are necessary to give themselves a complete life overhaul. I think that any time you see a response to therapy and it is in the early stages this could really bode well when it comes down to the future outcome.

  • jacquetta


    July 10th, 2012 at 3:42 PM

    I would think that the trick is to make sure that the momentum of recovery is maintained, and that the first sessions of recovery don’t stall out. You have to keep them going even if it is making smaller changes, just keeping them on the road to improvement will keep most people involved in treatment and more motivated to succeed with their treatment plan.

  • SnakQueen


    July 11th, 2012 at 4:14 AM

    My one fear about this early recovery is that once people start feeling better then they will generally stop treatment. Haven’t we all done that with a round of antibiotics before? I have and I am sure that therapy patients would be the same way.

  • Gary


    July 11th, 2012 at 8:52 AM

    All this is good research and data. We need such evaluation asap into the treatment because the best results are obtained when the problem is addressed asap and precious time could be saved.

    if some participants do not exhibit benefits early on then maybe they should try another therapy technique or just shake things up a little and see how they can attain progress.

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