How Ready Are You Now?: A dynamic and experimental approach to predicting anxiety treatment outcomes

Abstract

Anxiety disorders are among the most common psychological disorders. Although Cognitive Behavioral Therapy (CBT) is the recommended evidence-based treatment, approximately 50% of patients undergoing CBT do not benefit. Therefore, it is important to identify predictors that, at the start of treatment, can provide an indication of who will benefit from CBT for anxiety disorders. Such information can help clinicians offer patients a more effective treatment trajectory. However, to date, no consistent predictors of treatment outcome have been identified. This dissertation proposes a novel approach, employing an experimental psychopathology framework to investigate “speed of return to baseline” as a dynamic predictor of treatment outcome in anxiety. Specifically, it is proposed to intentionally introduce a perturbation that temporarily induces a positive shift in an anxiety-related process. Repeated assessments following this experimental perturbation can then be used to measure the speed of return to baseline. It was hypothesized that individuals with an anxiety disorder who show a slower return to baseline, thus those who maintain a positive change for a longer time following the perturbation, would benefit more from treatment compared to individuals who return to baseline more quickly. Across two separate studies, we found that indeed, benefitting longer from a reduction in negative interpretations and negative beliefs about worry predicted better treatment outcomes. However, this effect was not observed in a study in which the likelihood of a feared outcome was experimentally manipulated. Currently, no firm conclusions can be drawn regarding the utility of a dynamic predictor of treatment outcome in anxiety, given the limited number of studies that have tested this predictor. Nevertheless, the findings presented in this dissertation demonstrate the potential of a dynamic predictor, and future research is needed to examine the conditions under which speed of return to baseline following an (experimental) perturbation may predict treatment outcomes in anxiety.