Patterns of change in anxiety with routine clinical practice and potential cognitive predictors : a three-part study

• Main Author: Easter, Kate
• Published: Royal Holloway, University of London 2011
• Subjects: 616.8522
• Online Access: http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.588601

Research exploring how people change across treatment has identified subpopulations of individuals that follow similar patterns of change across time. Empirical findings indicate that early change might be key in overall treatment benefit. One particular pattern of early change, Sudden Gains (SG), has received much attention in the depression literature in recent years. However, few studies have investigated SG in anxiety disorders or indeed in routine clinical practice. Furthermore, two key cognitive constructs have been suggested as relevant in the experience of SG, attributional style, and level of efficacy expectancy, yet no empirical research to date has investigated them together in predicting SG. The objectives of this project were three-fold: 1) to explore patterns of anxiety change in routine clinical practice using a relatively new statistical approach; 2) to identify if SG occur in anxiety in routine practice and if so, to explore the contributing role of attributional style and efficacy expectancy; and 3) to explore if these two constructs fluctuate across treatment and if specific treatment strategies were associated with this. To address these objectives this project used a prospective and retrospective longitudinal design and a singe case experimental design. In line with the hypotheses SG were identified in the sample, these were characterised by high levels of reversal of gains, similar to other routine practice research in this area. The cognitive variables were not found to predict SG. Four different patterns of change were identified that differed in response to treatment. Results indicated that exploring patterns of change in routine practice might have specific clinical implications in exploring effectiveness of treatments for different subpopulations of individuals. In addition the finding of a non-changing cluster pattern highlighted the importance of future research to inform clinical understanding of individuals who do not respond to treatment.