title: What predicts outcome, response, and drop-out in CBT of depressive adults? a naturalistic study.
abstract: BACKGROUND
  The efficacy of CBT for unipolar depressive disorders is well established, yet not all patients improve or tolerate treatment.
  
  
  OBJECTIVE
  To identify factors associated with symptomatic outcome, response, and drop-out in depressive patients under naturalistic CBT.
  
  
  METHODS
  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.
authors.affiliation: Department of Psychology, University of Mainz, 55122 Mainz, Germany. schindam@uni-mainz.de
authors.forename: Amrei
authors.initials: A
authors.lastname: Schindler
authors.forename: Wolfgang
authors.initials: W
authors.lastname: Hiller
authors.forename: Michael
authors.initials: M
authors.lastname: Witthöft
mesh_terms: D000328:Adult; D015928:Cognitive Behavioral Therapy / Q000379:methods*; D015897:Comorbidity; D003469:Culture; D003865:Major Depressive Disorder / Q000175:diagnosis / Q000523:psychology* / Q000628:therapy*; D019263:Dysthymic Disorder / Q000175:diagnosis / Q000523:psychology* / Q000628:therapy*; D005260:Female; D005858:Germany; D006801:Humans; D008297:Male; D008875:Middle Aged; D009042:Motivation; D010043:Outcome and Process Assessment, Health Care; D010352:Patient Dropouts / Q000523:psychology*; D010554:Personality Disorders / Q000175:diagnosis / Q000523:psychology / Q000628:therapy; D011369:Professional-Patient Relations; D011379:Prognosis