Article2019

Targeted prescription of cognitive–behavioral therapy versus person-centered counseling for depression using a machine learning approach.

Jaime Delgadillo · Paulina Gonzalez Salas Duhne

101 citations0/0 files storedJournal of Consulting and Clinical Psychology

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Psychotherapy Techniques and Applications Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes Mental Health Treatment and Access

Abstract

OBJECTIVE: Depression is a highly common mental disorder and a major cause of disability worldwide. Several psychological interventions are available, but there is a lack of evidence to decide which treatment works best for whom. This study aimed to identify subgroups of patients who respond differentially to cognitive-behavioral therapy (CBT) or person-centered counseling for depression (CfD). METHOD: This was a retrospective analysis of archival routine practice data for 1,435 patients who received either CBT (N = 1,104) or CfD (N = 331) in primary care. The main outcome was posttreatment reliable and clinically significant improvement (RCSI) in the PHQ-9 depression measure. A targeted prescription algorithm was developed in a training sample (N = 1,085) using a supervised machine learning approach (elastic net with optimal scaling). The clinical utility of the algorithm was examined in a statistically independent test sample (N = 350) using chi-square analysis and odds ratios. RESULTS: Cases in the test sample that received their model-indicated "optimal" treatment had a significantly higher RCSI rate (62.5%) compared to those who received the "suboptimal" treatment (41.7%); χ2(df = 1) = 4.79, p = .03, OR = 2.33 (95% CI [1.09, 5.02]). CONCLUSION: Targeted prescription has the potential to make best use of currently available evidence-based treatments, improving outcomes for patients at no additional cost to psychological services. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

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References

2001The PHQ-9 1992A power primer.2006A Brief Measure for Assessing Generalized Anxiety Disorder 2012Cognitive Therapy for Depression 1991Clinical significance: A statistical approach to defining meaningful change in psychotherapy research.2002The Work and Social Adjustment Scale: a simple measure of impairment in functioning 2015The Great Psychotherapy Debate 1978Aptitudes and Instructional Methods: A Handbook for Research on Interactions

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2020Personalized treatment selection in routine care: Integrating machine learning and statistical algorithms to recommend cognitive behavioral or psychodynamic therapy 2020Personalized Medicine and Cognitive Behavioral Therapies for Depression: Small Effects, Big Problems, and Bigger Data 2020Cross-trial prediction in psychotherapy: External validation of the Personalized Advantage Index using machine learning in two Dutch randomized trials comparing CBT versus IPT for depression 2024Predicting optimal treatment allocation for cognitive analytic‐guided self‐help versus cognitive behavioural‐guided self‐help

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