Mon, 26 Aug 2024 20:34:41 GMT

🚨 New preprint (accepted at Psychotherapy)

Which items in weekly outcome assessments have similar rates of change over time?

Using weekly assessments of the Outcome Questionnaire-45 (OQ-45) in a large and clinically diverse (N = 12075) sample of outpatients with an average of 11 (SD = 10.7) sessions, we conducted a dynamic exploratory graph analysis (DynEGA), as implemented by @hudsongolino.bsky.social. Instead of correlating item values, this technique uses the first-order derivative, i.e., their rates of change over time. Main findings:

1️⃣ DynEGA showed that the originally proposed three-scale structure of the OQ-45 (symptoms, interpersonal problems, role functioning) did not explain the data as well as the empirically detected five-community structure. Items with similar rates of change over time can be grouped into:

• Anxiety, including items describing problems with fear, anxiety and related physical perceptions,

• Hopelessness, which includes (but is not limited to) depressive symptoms and other problem descriptions that describe acute, severe distress.

• Interpersonal problems, including conflicts with partners, colleagues, etc.

• Well-being, including positive statements about relationships, work, hobbies, and general satisfaction with life

• Work impairment, including items describing problems at work or college

This is important because monitoring psychotherapy outcomes relies on constructs with a homogenous rate of change over time. This is a basic prerequisite for being able to make valid comparisons between expected and observed treatment courses and to interpret these comparisons in a meaningful way.

2️⃣ We also estimated a between-subjects network that does not consider change, but only average item values. While similar to the change network in many aspects, we found some interesting differences.

Reductions of feeling blue, irritated, lonely, getting into frequent arguments, and noticing a decline in working/studying capabilities are more likely to be accompanied by reductions in other problem areas. These items were highly central in the change network, but less so in the between-subjects network.

Conversely, getting along well with others, work satisfaction, and having good relationships could be more general protective factors. These items were more central in the between-subjects network. Persons scoring high on these items, on average, report fewer problems in other areas.

3️⃣ We found that items from the "hopelessness" community decreased more quickly than interpersonal problems and anxiety. This provides some support for Howard's assumption of a "remoralization" phase in psychotherapy: initial feelings of hopelessness diminish rather quickly, which is accompanied by increases in subjective well-being.

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