Mechanism engagement as a potential evidence-based approach to personalized treatment termination

Shannon Sauer-Zavala, Matthew W. Southward, Doug R. Terrill, Stephen A. Semcho, Nicole E. Stumpp

Research output: Contribution to journalArticlepeer-review

2 Scopus citations


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.

Original languageEnglish
JournalPsychotherapy Research
StateAccepted/In press - 2023

Bibliographical note

Publisher Copyright:
© 2023 Society for Psychotherapy Research.


  • personalization
  • termination
  • transdiagnostic
  • Unified Protocol

ASJC Scopus subject areas

  • Clinical Psychology


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