Overcoming a Poor Early Response with Cognitive Behavioral Therapy Skills

Background Early response to treatment is a robust predictor of outcome in cognitive behavioral therapy (CBT) for depression. When clients show a poor early response, therapists may understandably be concerned. We examine how early CBT skill development might be used to help inform therapists about patients' prognoses in such circumstances. Methods In a sample of 95 clients participating in CBT for depression, we examine the role of the development of CBT skills by asking whether a client's prognosis depends not only on early response, but on its interaction with CBT skill development. Results We found support for the hypothesized interaction in predicting posttreatment depression and anxiety symptoms. For those who experienced modest early CBT skill improvements, early symptom improvement was strongly predictive of posttreatment outcome. However, for those who experienced more substantial early CBT skill improvements, early symptom change was not as strongly related to their posttreatment symptoms. Conclusions Our findings extend the literature on early response predicting outcome by showing that when clients experience more limited early symptom change, outcome depends considerably on the degree to which they are learning CBT skills. For clients with greater CBT skill improvements, a relatively positive treatment outcome is still common.