(PS9-C68) Measuring Meaningful Progress During Cognitive Behavioral Therapy for Youth with Anxiety Disorders

Routine outcome monitoring (ROM) has been identified as an important element of clinical practice, yet there is little evidence-based guidance on when it is most important to measure progress during treatment. The present study examined the timepoints for measuring meaningful progress during a 16-week CBT program for youth with anxiety disorders (N = 139). Progress was assessed weekly using several measures: the Revised Child Anxiety and Depression Scales, anxiety subscale, child and parent versions (RCADS-C/P), the Coping Questionnaire, child and parent versions (CQ-C/P), and the Clinical Global Impressions Scale-Improvement (CGI-I), clinician report. To identify the timepoints for measuring meaningful progress, we first calculated the difference between each client’s baseline score and session score, at every session and for each measure (except for the CGI-I, which inherently measures improvement). If a client’s change score for a particular measure exceeded the measure’s reliable change index, the change score was considered statistically reliable (Jacobson & Truax, 1991). We then identified the sessions at which each client evidenced statistically reliable change that was then sustained for the rest of the treatment (i.e., meaningful progress). Depending on the confidence interval used to calculate the measure’s reliable change index (i.e., 95%, 90%, or 80%), post-treatment response rates were 31.52-50% for the RCADS-P, 13.89-26.85% for the RCADS-C, 36.36-59.09% for the CQ-P, 19.17-25% for the CQ-C, and 49.50% for the CGI-I. Deterioration rates at post-treatment did not exceed 3.70% for any of the measures. A majority of post-treatment responders evidenced meaningful progress by Sessions 13-14 for the RCADS-P, by Sessions 12-16 for the RCADS-C, by Sessions 12-15 for the CQ-P, by Sessions 14-15 for the CQ-C, and by Session 15 for the CGI-I. These results suggest that most treatment responders begin to demonstrate meaningful progress during the last quarter of treatment, when exposure therapy is underway. Considering the barriers to ROM (e.g., limited time), it may be less important to measure progress during earlier phases of treatment. This suggestion is particularly relevant to the delivery of CBT in under-resourced settings, where measuring progress at every session is impractical. In addition to offering guidance on when to measure progress, the present study also provides reliable change indices for the RCADS-C/P anxiety subscale and the CQ-C/P.