TY - JOUR
T1 - Mechanism engagement as a potential evidence-based approach to personalized treatment termination
AU - Sauer-Zavala, Shannon
AU - Southward, Matthew W.
AU - Terrill, Doug R.
AU - Semcho, Stephen A.
AU - Stumpp, Nicole E.
N1 - Publisher Copyright:
© 2023 Society for Psychotherapy Research.
PY - 2023
Y1 - 2023
N2 - Objective: This study explores whether early change on a putative mechanism maintaining symptoms can serve as a proximal indicator of response to prompt discontinuation. Method: Patients (N = 70; M age = 33.74, 67% female, 74% white) with heterogeneous anxiety and depressive disorders completed a sequential multiple assignment randomized trial (SMART). Patients received 6 sessions of skill modules from the Unified Protocol and then underwent a second-stage randomization to either receive the remaining 6 sessions (Full duration) or discontinue treatment (Brief duration). All participants completed weekly self-report measures of anxiety and depressive symptoms and distress aversion for the full 12-week treatment window. We used structural equation modeling to test (1) if distress aversion demonstrated significant variability during the first-stage randomization and (2) if distress aversion during the first-stage randomization predicted second-stage changes in anxiety and depression. Results: Participants demonstrated significant variability in first-stage distress aversion. Latent distress aversion slopes significantly predicted latent second-stage anxiety slopes, whereas latent distress aversion intercepts significantly predicted latent second-stage depression slopes. Conclusions: These results suggest that early mechanism engagement may have potential as a trigger to prompt personalized termination. Shorter courses of care may reduce patient costs and increase the mental health service system's capacity.
AB - Objective: This study explores whether early change on a putative mechanism maintaining symptoms can serve as a proximal indicator of response to prompt discontinuation. Method: Patients (N = 70; M age = 33.74, 67% female, 74% white) with heterogeneous anxiety and depressive disorders completed a sequential multiple assignment randomized trial (SMART). Patients received 6 sessions of skill modules from the Unified Protocol and then underwent a second-stage randomization to either receive the remaining 6 sessions (Full duration) or discontinue treatment (Brief duration). All participants completed weekly self-report measures of anxiety and depressive symptoms and distress aversion for the full 12-week treatment window. We used structural equation modeling to test (1) if distress aversion demonstrated significant variability during the first-stage randomization and (2) if distress aversion during the first-stage randomization predicted second-stage changes in anxiety and depression. Results: Participants demonstrated significant variability in first-stage distress aversion. Latent distress aversion slopes significantly predicted latent second-stage anxiety slopes, whereas latent distress aversion intercepts significantly predicted latent second-stage depression slopes. Conclusions: These results suggest that early mechanism engagement may have potential as a trigger to prompt personalized termination. Shorter courses of care may reduce patient costs and increase the mental health service system's capacity.
KW - personalization
KW - SMART
KW - termination
KW - transdiagnostic
KW - Unified Protocol
UR - http://www.scopus.com/inward/record.url?scp=85147025327&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85147025327&partnerID=8YFLogxK
U2 - 10.1080/10503307.2023.2168574
DO - 10.1080/10503307.2023.2168574
M3 - Article
AN - SCOPUS:85147025327
SN - 1050-3307
JO - Psychotherapy Research
JF - Psychotherapy Research
ER -