Applying a novel statistical method to advance the personalized treatment of anxiety disorders: A composite moderator of comparative drop-out from CBT and ACT. (April 2017)

• Record Type: Journal Article
• Authors: Niles, Andrea N.; Wolitzky-Taylor, Kate B.; Arch, Joanna J.; Craske, Michelle G.
• Is Part Of: Behaviour research and therapy. Volume 91(2017)
• Page Start: 13
• Page End: 23
• Publication Date: 2017-04
• Subjects: Moderators -- Attrition -- Behavioral therapy -- Anxiety disorders -- Personalized medicine; Cognitive therapy -- Periodicals; Psychotherapy -- Periodicals; 616.891
• DOI: 10.1016/j.brat.2017.01.001
• Languages: English
• ISSNs: 0005-7967

Abstract

Abstract: Background: No prior studies have examined moderators of dropout between distinct treatments for anxiety disorders. This study applied a novel statistical approach for examining moderators of dropout from traditional cognitive behavioral therapy (CBT) and acceptance and commitment therapy (ACT). Method: We combined data from two randomized controlled trials ( N = 208) comparing CBT and ACT for patients with DSM-IV anxiety disorders. Adapting Kraemer's method for constructing and evaluating composite moderators (2013), 26 variables were examined for individual effect sizes. Forward-stepwise regression combined with k -fold cross validation was used to identify a model to predict treatment dropout. Results: Four baseline variables comprised the final composite moderator: self-reported degree of control over internal anxiety, current psychiatric medication use, religiosity, and endurance in a voluntary hyperventilation stressor. This composite moderator predicted differential dropout from ACT vs. CBT with a medium effect size ( r = 0.28), and had a significantly larger effect size than any individual moderator. Conclusions: Findings reveal that specific patient profiles predict differential dropout from ACT vs. CBT for anxiety disorders. In the first investigation of a composite moderator with a dichotomous outcome, findings also support the superiority of composite over individual moderators. Highlights: No research exists on moderators of attrition from therapy for anxiety disorders. We identified baseline patient characteristics moderating dropout from ACT vs CBT. We used a novel moderator approach for creating composite moderators. We combined 4 patient characteristics to form a composite moderator of attrition. Our composite moderator had a larger effect than any individual moderator.