MEASURING OUTCOME Advanced Psychotherapy CognitiveBehavioral Therapy Only about

MEASURING OUTCOME Advanced Psychotherapy: Cognitive-Behavioral Therapy

Only about 1/3 mental health clinicians routinely measure outcomes Due to: Lack of curriculum in training Worries about therapeutic relationship

REASONS TO MEASURE OUTCOME Some insurance companies require it for reimbursement Ethical and responsible practice Research shows it improves outcomes Providing feedback to therapists about poor progress improves outcomes

CONCEPTUALIZING OUTCOME MEASURES Content What it measures Multiple constructs vs single construct Most measure one or more intrapersonal constructs: Cognitions Behavior Affect Interpersonal and social domains

SOURCE Who provides the information? Best practice = multiple sources of data How is this helpful? Always have patient provide outcome data Consider who else could provide additional data when possible Why not always possible?

METHOD OF CHANGE MEASURES General vs specific measures The more specific the measure, the less likely you are to see large amounts of change Most measures are face valid Patient knows what is being measured Rater observation measures are difficult to manipulate

TIME ORIENTATION Traits vs States Traits = enduring characteristics States = temporary characteristics Don’t measure traits frequently because they take longer to change (e. g. , pre and post test) Measure states frequently because they can change quickly

CRITERIA FOR SELECTING AN OUTCOME MEASURE Psychometrically Strong Applicable Practical

PSYCHOMETRICALLY STRONG Reliable Measures consistence Test-retest Internal consistency Valid Measures what it says it measures Sensitive to Change Can detect when change occurs Treated patients should improve more than untreated patients

APPLICABLE Measures characteristics relevant to your treatment group Measure most common symptoms Specific measures Panic Disorder Severity Scale (PDSS) PHQ-9 PTSD checklist (PCL-5) General Measures Measure multiple domains For example: anxiety and depression

PRACTICAL How much does it cost? How long does it take the patient to complete? How long does it take to score and interpret? Global measures are easiest for general outpatient population

EXAMPLES OF GLOBAL MEASURES Behavior and Symptoms Identification Scale (BASIS-32) 5 -point likert scale Measures: Relation to self/others, depression/anxiety, daily living/role functioning, impulsive/addictive behavior, and Psychosis. Sensitive to change from intake to end of treatment. Brief and flexible Interview or self-report

EXAMPLES OF GLOBAL MEASURES Depression Anxiety Stress Scale (DASS-21) 0 -3 Likert scale Provides severity ratings for depression, anxiety and stress Free Brief and flexible

EXAMPLES OF GLOBAL MEASURES Brief Symptom Inventory (BSI) 53 total items 9 subscales: somatization, obsessive-compulsive, interpersonal, depression, anxiety, hostility, phobic anxiety, paranoid ideation, psychoticism. 3 global indexes: global severity index, positive distress symptom distress, positive symptom total index Norms for college, outpatient, psychiatric groups, plus multiple age groups Cost: $1 per administration

EXAMPLES OF GLOBAL MEASURES The Outcome Questionnaire – 45 (OQ-45) 45 items 3 areas: symptom distress, interpersonal relations, social role functioning Sensitive to change Pay for license

TIMING AND FREQUENCY Administer at intake Measure repeatedly throughout treatment – each session if possible Complete prior to the session Review measure with patient or refer to it to show importance

USE MEASURES TO INFORM TREATMENT Initial assessment: determine severity of symptoms, length and intensity of treatment Look for critical items: suicide, substance use Strengths and weaknesses Throughout treatment Plot progress on graph Discuss with patient