Abstract
Background: Identifying subgroups of patients that may show distinct trajectories of change during psychotherapy in realistic settings is relevant for the development of personalized therapeutic processes. Aims: The present study sought to (a) identify trajectories of change in Chilean patients; (b) explore variables that may predict the likelihood of belonging to certain trajectories; and (c) examine whether these different trajectories result in differences in treatment outcomes. Method: Growth mixture modeling (GMM) and multinomial logistic regression analysis were carried out on the data of 400 patients receiving psychotherapy at a private outpatient clinic in Chile. Results: Three trajectories of change were identified: (a) moderate initial dysfunction with slight deterioration, (b) mild initial dysfunction with favorable change, and (c) high initial dysfunction with rapid favorable change. Patient's age was found to be a significant predictor of trajectory assigned, suggesting a poorer prognosis for older patients. Moreover, the trajectories were significant predictors of treatment outcome. Conclusions: These results can be used to develop patient-specific therapeutic interventions based on the trajectories they exhibit.
References
Akaike H. (1987). Factor analysis and AIC. Psychometrika, 52(3), 317-332. https://doi.org/10.1007/BF02294359
Arnau, J. y Bono, R. (2008). Estudios longitudinales de medidas repetidas: Modelos de diseño y análisis. Escritos de PsicologÃa (Internet), 2(1), 32-41. https://doi.org/10.24310/espsiescpsi.v2i1.13356
Barkham, M., Rees, A., Stiles, W. B., Shapiro, D. A., Hardy, G. E. y Reynolds, S. (1996). Dose–effect relations in time-limited psychotherapy for depression. Journal of consulting and clinical psychology, 64(5), 927-935. https://doi.org/10.1037/0022-006X.64.5.927
Castonguay, L. G. (2011). Psychotherapy, psychopathology, research and practice: Pathways of connections and integration. Psychotherapy Research, 21(2), 125-140. https://doi.org/10.1080/10503307.2011.563250
Castonguay, L. G., Barkham, M., Lutz, W. y McAleavey, A. (2013). Practice-oriented research: Approaches and applications. En M. J. Lambert (Ed.), Bergin and Garfield's Handbook of psychotherapy and behavior change (6a ed., pp. 85–133). Wiley.
Cuijpers, P., van Straten, A., Schuurmans, J., van Oppen, P., Hollon, S. D. y Andersson, G. (2010). Psychotherapy for chronic major depression and dysthymia: a meta-analysis. Clinical Psychology Review, 30(1), 51-62. https://doi.org/10.1016/j.cpr.2009.09.003
Errázuriz, P., Opazo, S., Behn, A., Gloger, S. y Ramirez, O. S. (2017). Spanish adaptation and validation of the Outcome Questionnaire OQ-30.2. Frontiers in Psychology, 8: 673. https://doi.org/10.3389/fpsyg.2017.00673
Errázuriz, P. y Zilcha-Mano, S. (2018). In psychotherapy with severe patients discouraging news may be worse than no news: The impact of providing feedback to therapists on psychotherapy outcome, session attendance, and the alliance. Journal of consulting and clinical psychology, 86(2), 125-139. https://doi.org/10.1037/ccp0000277
Fishleder, S., Gum, A. M., King-Kallimanis, B. L. y Schonfeld, L. (2016). Trajectories of depressive symptoms in community-dwelling older adults: A six-month longitudinal study with monthly assessment. Journal of affective disorders, 198, 171-177. https://doi.org/10.1016/j.jad.2016.02.058
Hansen, N. B. y Lambert, M. J. (2003). An evaluation of the dose–response relationship in naturalistic treatment settings using survival analysis. Mental Health Services Research, 5(1), 1-12. https://doi.org/10.1023/A:1021751307358
Howard, K. I., Kopta, S. M., Krause, M. S. y Orlinsky, D. E. (1986). The dose–effect relationship in psychotherapy. American Psychologist, 41(2), 159-164. https://doi.org/10.1037/0003-066X.41.2.159
Jedidi, K., Ramaswamy, V. y DeSarbo, W. S. (1993). A maximum likelihood method for latent class regression involving a censored dependent variable. Psychometrika, 58(3), 375-394. https://doi.org/10.1007/BF02294647
Koffmann, A. (2018). Early trajectory features and the course of psychotherapy. Psychotherapy Research, 30(1), 1-12. https://doi.org/gd4wd7
Lambert, M. J. Vermeersh, D., Brown, G. C., Burlingame, G. (2004). Administration and Scoring Manual for the OQ-30.2. OQ Measures. https://www.oqmeasures.com/oq-30-2/
Lambert, M. J. (Ed.) (2013). Bergin and Garfield's handbook of psychotherapy and behavior change (6a ed.). Wiley.
Lambert, M. J. (2015). Effectiveness of Psychological Treatment. Resonanze (Krems), 3(2), 87-100. https://tinyurl.com/e52bv889
Lutz, W., Stulz, N. y Köck, K. (2009). Patterns of early change and their relationship to outcome and follow-up among patients with major depressive disorders. Journal of affective disorders, 118(1-3), 60-68. https://doi.org/10.1016/j.jad.2009.01.019
Lutz, W., Hofmann, S. G., Rubel, J., Boswell, J. F., Shear, M. K., Gorman, J. M.; Woods, S. W. y Barlow, D. H. (2014). Patterns of early change and their relationship to outcome and early treatment termination in patients with panic disorder. Journal of consulting and clinical psychology, 82(2), 287-297. https://doi.org/10.1037/a0035535
Lutz, W., Arndt, A., Rubel, J., Berger, T., Schröder, J., Späth, C., Psych, D., Meyer, B. Greiner, W., Gräfe, V. Hautzinger, M., Fuhr, K., Rose, M., Nolte, S., Löwe, B., Hohagen, F., Klein, J.P. y Moritz, S. (2017). Defining and Predicting Patterns of Early Response in a Web-Based Intervention for Depression. Journal of medical Internet research, 19(6): e206 https://doi.org/10.2196/jmir.7367
Ministerio de Salud (2017). GuÃas clÃnicas AUGE para el tratamiento de la depresión en personas mayores de 15 años: Actualización en psicoterapia. MINSAL. https://tinyurl.com/562tawj2
Muthén, B. y Muthén, L. K. (2000) Integrating personâ€centered and variableâ€centered analyses: Growth mixture modeling with latent trajectory classes. Alcohol: Clinical and experimental research, 24(6), 882-891. https://doi.org/cpbqhw
Muthén, L. K., y Muthén, B. O. (2012). Mplus: Statistical Analysis with Latent Variables; User's Guide [version 7].
Muthén, B. (2004). Latent variable analysis. En D. Kaplan (Ed.) The Sage handbook of quantitative methodology for the social sciences (pp. 345-368). Sage. http://dx.doi.org/10.4135/9781412986311.n19
Nordberg, S. S., Castonguay, L. G., Fisher, A. J., Boswell, J. F. y Kraus, D. (2014). Validating the rapid responder construct within a practice research network. Journal of Clinical Psychology, 70(9), 886-903. https://doi.org/10.1002/jclp.22077
Nylund, K. L., Asparouhov, T. y Muthén, B. O. (2007). Deciding on the number of classes in latent class analysis and growth mixture modeling: A Monte Carlo simulation study. Structural equation modeling, 14(4), 535-569. https://doi.org/fhg28s
Owen, J., Adelson, J., Budge, S., Wampold, B., Kopta, M., Minami, T. y Miller, S. (2015). Trajectories of change in psychotherapy. Journal of Clinical Psychology, 71(9), 817-827. https://doi.org/10.1002/jclp.22191
Rubel, J., Lutz, W. y Schulte, D. (2015). Patterns of change in different phases of outpatient psychotherapy: A stageâ€sequential pattern analysis of change in session reports. Clinical psychology & psychotherapy, 22(1), 1-14. https://doi.org/f6zbcn
Schwarz, G. (1978). Estimating the dimension of a model. The annals of statistics, 6(2), 461-464. https://doi.org/10.1214/aos/1176344136
Sclove, S. L. (1987). Application of model-selection criteria to some problems in multivariate analysis. Psychometrika, 52(3), 333-343. https://doi.org/fgs96q
Stulz, N. y Lutz, W. (2007). Multidimensional patterns of change in outpatient psychotherapy: The phase model revisited. Journal of clinical psychology, 63(9), 817-833. https://doi.org/10.1002/jclp.20397
Stulz, N., Lutz, W., Leach, C., Lucock, M. y Barkham, M. (2007). Shapes of early change in psychotherapy under routine outpatient conditions. Journal of Consulting and Clinical Psychology, 75(6), 864-874. https://doi.org/10.1037/0022-006X.75.6.864
Stulz, N., Thase, M. E., Klein, D. N., Manber, R. y Crits-Christoph, P. (2010). Differential effects of treatments for chronic depression: a latent growth model reanalysis. Journal of consulting and clinical psychology, 78(3), 409-419. https://doi.org/10.1037/a0019267
Tasca, G. A. y Gallop, R. (2009). Multilevel modeling of longitudinal data for psychotherapy researchers: I. The basics. Psychotherapy Research, 19(4-5), 429-437. https://doi.org/10.1080/10503300802641444
Trombello, J., South, C., Sánchez, A., Kahalnik, F., Kennard, B., y Trivedi, M. (2020). Two Trajectories of Depressive Symptom Reduction throughout Behavioral Activation Teletherapy among Underserved, Ethnically Diverse, Primary Care Patients: A VitalSign6 Report. Behavior Therapy, 51(6), 958-971. https://doi.org/jzfm
Uher, R., Muthén, B., Souery, D., Mors, O., Jaracz, J., Placentino, A., Petrovic, A., Zobel, A., Henigsberg, N., Rietschel, M., Aitchison, K. J., Farmer, A. y McGuffin, P. (2010). Trajectories of change in depression severity during treatment with antidepressants. Psychological medicine, 40(8), 1367-1377. https://doi.org/ccpdg5
Vergara, Y. (2019). Análisis costo efectividad del plan GES para depresión [Tesis de magÃster, Universidad de Chile]. Repositorio Institucional – Universidad de Chile. http://repositorio.uchile.cl/handle/2250/175028