A demonstration of a multi-method variable selection approach for treatment selection: Recommending cognitive–behavioral versus psychodynamic therapy for mild to moderate adult depression

Zachary D. Cohen*, Thomas T. Kim, Henricus L. Van, Jack J.M. Dekker, Ellen Driessen

*Corresponding author for this work

Research output: Contribution to JournalArticleAcademicpeer-review

Abstract

Objective: We use a new variable selection procedure for treatment selection which generates treatment recommendations based on pre-treatment characteristics for adults with mild-to-moderate depression deciding between cognitive behavioral (CBT) versus psychodynamic therapy (PDT). Method: Data are drawn from a randomized comparison of CBT versus PDT for depression (N = 167, 71% female, mean-age = 39.6). The approach combines four different statistical techniques to identify patient characteristics associated consistently with differential treatment response. Variables are combined to generate predictions indicating each individual’s optimal-treatment. The average outcomes for patients who received their indicated treatment versus those who did not were compared retrospectively to estimate model utility. Results: Of 49 predictors examined, depression severity, anxiety sensitivity, extraversion, and psychological treatment-needs were included in the final model. The average post-treatment Hamilton-Depression-Rating-Scale score was 1.6 points lower (95%CI = [0.5:2.8]; d = 0.21) for those who received their indicated-treatment compared to non-indicated. Among the 60% of patients with the strongest treatment recommendations, that advantage grew to 2.6 (95%CI = [1.4:3.7]; d = 0.37). Conclusions: Variable selection procedures differ in their characterization of the importance of predictive variables. Attending to consistently-indicated predictors may be sensible when constructing treatment selection models. The small N and lack of separate validation sample indicate a need for prospective tests before this model is used.

Original languageEnglish
Pages (from-to)137-150
Number of pages14
JournalPsychotherapy Research
Volume30
Issue number2
Early online date11 Jan 2019
DOIs
Publication statusPublished - 17 Feb 2020

Keywords

  • cognitive behavioral therapy
  • depression
  • precision medicine
  • psychodynamic therapy
  • treatment selection
  • variable selection

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