Predicting patient outcomes from initial in-session interactions within cognitive behavioral therapy and person-centered experiential therapy for severe depression

OBJECTIVE: Cognitive behavioral therapy (CBT) and person-centered experiential therapy (PCET) are the most frequently delivered individual psychological therapies in the UK National Health Service Talking Therapies program. However, many patients do not benefit from treatment and motivational processes early in therapy may influence outcomes. This study assessed specific, in-session interaction-types at the first session of CBT and PCET for severe depression that may predict therapeutic outcomes. METHOD: Trained raters assessed active engagement in specific interactions from 103 first session transcripts of CBT (n = 40) and PCET (n = 63) for severe depression from a non-inferiority, pragmatic randomized controlled trial. Multilevel modelling and logistic regressions were used to evaluate whether initial patient-therapist interactions predicted depression change across therapy. RESULTS: In both CBT and PCET, patients' engagement with therapy-related action planning at initial sessions predicted greater improvement in depression. Conversely, where more time was taken with administrative aspects of completing measures (as opposed to discussing the implications of results) at first sessions, poorer outcomes ensued in both therapies. In CBT alone, engagement in identifying protective factors at session one predicted greater outcome improvement. In PCET alone, where more of session one was spent discussing patients' problems and contexts, greater outcome improvements followed. CONCLUSION: Specific interaction-types at first sessions of CBT and PCET for severe depression may predict outcomes, with key similarities and differences. Initial sessions cannot be considered solely information gathering and assessment processes. Identification and deliberate practice of prognostic interactions could improve therapeutic skills and outcomes from early sessions.