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What Predicts Outcome, Response, and Drop-out in CBT of Depressive Adults? A Naturalistic Study

  • Amrei Schindler (a1), Wolfgang Hiller (a1) and Michael Witthöft (a1)

Background: The efficacy of CBT for unipolar depressive disorders is well established, yet not all patients improve or tolerate treatment. Aims: To identify factors associated with symptomatic outcome, response, and drop-out in depressive patients under naturalistic CBT. Method: 193 patients with major depression or dysthymia were tested. Sociodemographic and clinical variables were entered as predictors in hierarchical regression analyses. Results: A higher degree of pretreatment depression, early improvement, and completion of therapy were identified as predictors for symptomatic change and response. Drop-out was predicted by concurrent personality disorder, less positive outcome expectancies, and by failure to improve early in treatment. Conclusions: Our results highlight the importance of early response to predict improvement in routine CBT. Attempts to refine the quality of treatment programs should focus on avoiding premature termination (drop-out) and consider motivational factors in more depth. Routinely administered standardized assessments would enhance symptom monitoring and help to identify persons at risk of not improving under therapy.

Corresponding author
Reprint requests to Amrei Schindler, Department of Psychology, University of Mainz, Wallstraße 3, 55122 Mainz, Germany. E-mail address:
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Hautzinger, M., Bailer, M., Worall, H. and Keller, F. (1994). Das Beck Depressionsinventar (BDI) [The Beck Depression Inventory (BDI)]. Bern: Huber.
Hollon, S. D. and Beck, A. T. (2004). Cognitive and cognitive behavioral therapies. In Lambert, M. J. (Ed.), Bergin and Garfield's Handbook of Psychotherapy and Behavior Change (5th ed., pp. 447492). New York: Wiley.
Jacobson, N. S. and Truax, P. (1991). Clinical significance: a statistical approach to defining meaningful change in psychotherapy research. Journal of Consulting and Clinical Psychology, 59, 1219.
Persons, J. B., Burns, D. D. and Perloff, J. M. (1988). Predictors of dropout and outcome in cognitive therapy for depression in a private practice setting. Cognitive Therapy and Research, 12, 557575.
Schindler, A., Hiller, W. and Witthöft, M. (2011). Benchmarking of cognitive-behavioral therapy for depression in efficacy and effectiveness studies: how do exclusion criteria affect treatment outcome? Psychotherapy Research, 21, 644657.
Seggar, L. B., Lambert, M. J. and Hansen, N. B. (2002). Assessing clinical significance: application to the Beck Depression Inventory. Behavior Therapy, 33, 253269.
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Behavioural and Cognitive Psychotherapy
  • ISSN: 1352-4658
  • EISSN: 1469-1833
  • URL: /core/journals/behavioural-and-cognitive-psychotherapy
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