Cited by 186Psychotherapy Techniques and ApplicationsTreatment of Major DepressionAnxiety, Depression, Psychometrics, Treatment, Cognitive Processes

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Patterns of early change and their relationship to outcome and follow-up among patients with major depressive disorders

Lutz, Wolfgang, Stulz, Niklaus, Köck, Katharina·2009·Journal of Affective Disorders

DOI 10.1016/j.jad.2009.01.019

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Abstract

Background While highlighting the efficacy of different treatments for major depressive disorders (MDD), findings of the National Institute of Mental Health (NIMH) Treatment of Depression Collaborative Research Program (TDCRP) often are interpreted as supporting the idea of treatment non-specificity for MDD. However, heterogeneity in treatment courses and outcomes might be undetected when focusing only on types of treatment in terms of sample means without taking into account early change in treatment.Method In this study, growth mixture models (GMM) were used in the completer sample of N=162 patients from the NIMH TDCRP to identify meaningful patterns of early change of depression severity that are shared by many individual patients.Results Results revealed three typical patterns of early change over the first 8 weeks of treatment irrespective of the type of treatment protocol provided: (a) moderate to severe depression with moderate early improvement, (b) moderate to severe depression with rapid early improvement, and (c) mild to moderate depression with moderate early improvement. In contrast to the type of treatment, these differential patterns of early response (together with overall pre-treatment symptom severity) predicted outcomes (i.e. depression severity) at treatment termination and over the 1.5-year follow-up period.Limitations Due to the small sample size and the controlled setting of this study the degree to which these results can be generalized to clinical practice has to be further investigated.Conclusions The findings provide further support for the assumption that early change is an important factor for the prediction of short- and long-term outcome in psychotherapy.

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“N IH -PA Author M anuscript N IH -PA Author M anuscript N IH -PA Author M anuscript In accordance with prior research on change trajectories in psychotherapy, a log-linear (base 10) transformation of the time scale was used for these analyses (Lutz et al., 2009; Stulz et al., 2007).”
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Simon, G. E., Ding, V. Y., Hubbard, R. A., Fishman, P. A., Ludman, E. J., Morales, L. S., Operskalski, B. H., & Savarino, J. E. (2011) · Administration and Policy in Mental Health and Mental Health Services Research · doi:10.1007/s10488-011-0364-x · Cited by 19
“In psychotherapy research samples, a significant number of patients experience sustained improvement in depression after one or two treatment sessions (Beckham 1989; Lutz et al. 2009; Stiles et al. 2003).”
Background
Movement-based patient-therapist attunement in psychological therapy and its association with early change
Schwartz, B., Rubel, J. A., Deisenhofer, A., & Lutz, W. (2022) · Digital Health · doi:10.1177/20552076221129098 · Cited by 20
“In a sample of depressed patients, early change predicted outcome at treatment termination as well as one and a half years after treatment.(35) Among college students treated at a university counseling center, early treatment response was associated with fewer symptoms at termination and follow-up as well as maintenan…”
BackgroundResult
Examining Differential Effects of Psychosocial Treatments for Cocaine Dependence: An Application of Latent Trajectory Analyses
Stulz, N., Gallop, R., Lutz, W., Wrenn, G., & Crits-Christoph, P. (2009) · Drug and Alcohol Dependence · doi:10.1016/j.drugalcdep.2009.08.009 · Cited by 19
Pretreatment and process predictors of nonresponse at different stages of inpatient psychotherapy
Reuter, L., Münder, T., Altmann, U., Hartmann, A., Strauss, B. M., & Scheidt, C. E. (2015) · Psychotherapy Research · doi:10.1080/10503307.2015.1030471 · Cited by 19
Personalized assessment and treatment of depression
Fisher, A. J., & Bosley, H. G. (2015) · Current Opinion in Psychology · doi:10.1016/j.copsyc.2015.03.031 · Cited by 18
“Other recent statistical innovations include latent class analysis (LCA) and growth mixture modeling (GMM), which are able to isolate clusters (classes) of responders in psychotherapy outcome data [35–37], with the assumption that understanding the predictors of class membership can generate insight into optimal inter…”
Background
The role of sampling in clinical trial design
Krause, M. S., Lutz, W., & Boehnke, J. R. (2011) · Psychotherapy Research · doi:10.1080/10503307.2010.549520 · Cited by 17
“…of treatment in the light of how the client has so far responded is the essential clinical purpose in doing multi-phase input-process-outcome studies, which cannot be done justice to here (see, e.g., Davison, 2000; Krause & Lutz, 2009b; Lambert et al., 2002; Lutz et al., 2009; Ruberg et al., 2010).”
Background
The trajectory of depressive symptoms and the association with quality of life and suicidal ideation in patients with major depressive disorder
Lai, W., Liao, Y., Zhang, H., Zhao, H., Li, Y., Chen, R., Shi, G., Liu, Y., Hao, J., Li, Z., et al. (2025) · BMC Psychiatry · doi:10.1186/s12888-025-06743-1 · Cited by 16
“Previous research has highlighted that distinct symptom trajectories are associated with different treatment outcomes [16].”
Identifying risk of deliberate self-harm through longitudinal monitoring of psychological distress in an inpatient psychiatric population
Kashyap, S., Hooke, G. R., & Page, A. C. (2015) · BMC Psychiatry · doi:10.1186/s12888-015-0464-3 · Cited by 17
“Recognition of this difficulty led to “patientfocussed” research which suggested that individuals respond to treatment at different rates [24].”
BackgroundMethodInfluential
Working along sudden gains: Responsiveness on small and subtle early changes and exceptions.
Flückiger, C., Holtforth, M. G., Re, A. C. D., & Lutz, W. (2013) · Psychotherapy · doi:10.1037/a0031940 · Cited by 21
Premature termination of the unified protocol for the transdiagnostic treatment of emotional disorders: The role of ambivalence towards change
Oliveira, J. T., Sousa, I., Ribeiro, A. P., & Gonçalves, M. M. (2021) · Clinical Psychology & Psychotherapy · doi:10.1002/cpp.2694 · Cited by 15
Course of Subtypes of Late-Life Depression Identified by Bipartite Network Analysis During Psychosocial Interventions
Solomonov, N., Lee, J., Banerjee, S., Chen, S. Z., Sirey, J. A., Gunning, F. M., Liston, C. M., Raue, P. J., Areán, P. A., & Alexopoulos, G. S. (2023) · JAMA Psychiatry · doi:10.1001/jamapsychiatry.2023.0815 · Cited by 15
Does early improvement in major depression protect against treatment emergent suicidal ideation?
Seemüller, F., Schennach-Wolff, R., Obermeier, M., Henkel, V., Möller, H. J., & Riedel, M. J. (2009) · Journal of Affective Disorders · doi:10.1016/j.jad.2009.10.010 · Cited by 15
Overcoming a Poor Early Response with Cognitive Behavioral Therapy Skills
Murphy, S. T., Cheavens, J. S., & Strunk, D. R. (2020) · Cognitive Therapy and Research · doi:10.1007/s10608-020-10140-1 · Cited by 14
“Early symptom reduction has been associated with treatment outcome across a variety of treatment modalities and patient populations (Haas et al. 2002; Lutz et al. 2014; Lutz et al. 2009).”
Background
The first session matters: Therapist responsiveness and the therapeutic alliance in the treatment of borderline personality disorder
Culina, I., Fiscalini, E., Martin-Söelch, C., & Kramer, U. (2022) · Clinical Psychology & Psychotherapy · doi:10.1002/cpp.2783 · Cited by 14
“Generally speaking, a lot happens in early sessions: numerous variables can be studied early in therapy that can be informative on later trajectories of change (e.g., Constantino et al., 2018; Lutz et al., 2020; Lutz et al., 2009).”
Background
Typical symptom change patterns and their predictors in patients with social anxiety disorder: A latent class analysis
Altmann, U., Gawlytta, R., Hoyer, J., Leichsenring, F., Leibing, E., Beutel, M. E., Willutzki, U., Herpertz, S., & Strauss, B. M. (2020) · Journal of Anxiety Disorders · doi:10.1016/j.janxdis.2020.102200 · Cited by 14
Affective impact and electrocortical correlates of a psychotherapeutic microintervention: An ERP study of cognitive restructuring
Zaunmüller, L., Lutz, W., & Strauman, T. J. (2013) · Psychotherapy Research · doi:10.1080/10503307.2013.847986 · Cited by 14
Determining prognostic variables of treatment outcome in obsessive–compulsive disorder: effectiveness and its predictors in routine clinical care
Herzog, P., Osen, B., Stierle, C. M. G., Middendorf, T., Voderholzer, U., Koch, S., Feldmann, M., Rief, W., & Brakemeier, E. (2021) · European Archives of Psychiatry and Clinical Neuroscience · doi:10.1007/s00406-021-01284-6 · Cited by 13
Experiential Dynamic Therapy: A Preliminary Investigation Into the Effectiveness and Process of the Extended Initial Session
Doorn, K. A., Macdonald, J. B., Stein, M., Cooper, A. M., & Tucker, S. (2014) · Journal of Clinical Psychology · doi:10.1002/jclp.22094 · Cited by 13
Self‐harm in nurses: prevalence and correlates
Cheung, T. C. C., & Yip, P. S. F. (2016) · Journal of Advanced Nursing · doi:10.1111/jan.12987 · Cited by 12
Three sessions of intensive short-term dynamic psychotherapy (ISTDP) for patients with dissociative seizures: a pilot study
Castillo, J. M., Beton, E., Coman, C., Howell, B., Burness, C., Martlew, J., Russell, L. A., Town, J. M., Abbass, A. A., Algorta, G. P., et al. (2022) · Psychoanalytic Psychotherapy · doi:10.1080/02668734.2021.2018623 · Cited by 12
The Illness Density Index (IDI): A longitudinal measure of treatment efficacy
Kelley, M. E., Franco, A. R., Mayberg, H. S., & Holtzheimer, P. E. (2012) · Clinical Trials · doi:10.1177/1740774512450099 · Cited by 12
“Although the comparison of slopes across groups is inherent in repeated-measures analysis of clinical trial data, the subject-level estimates have only recently been considered as possible indicators of treatment response [10,11].”
Background
Verlaufsmuster depressiver Störungen bei ambulanten psychotherapeutischen Behandlungen und deren Vorhersage/ Typical patterns of depressive disorders during outpatient psychotherapy and their prediction
Altmann, U., Steyer, R., Kramer, D., Steffanowski, A., Wittmann, W. W., von Heymann, F., Auch, E., Bruckmayer, E., Pfaffinger, I., Fembacher, A., et al. (2015) · Zeitschrift für psychosomatische Medizin und Psychotherapie · doi:10.13109/zptm.2015.61.2.156 · Cited by 12
Evaluation of the online-based self-help programme “Selfapy” in patients with unipolar depression: study protocol for a randomized, blinded parallel group dismantling study
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“These regular measurements may yield patterns that indicate the outcome of discontinuation of the treatment and allow for the follow-up period [38, 39].”
Background
The Role of Daily Steps in the Treatment of Major Depressive Disorder: Secondary Analysis of a Randomized Controlled Trial of a 6-Month Internet-Based, Mindfulness-Based Cognitive Behavioral Therapy Intervention for Youth
Dang, K., Ritvo, P., Katz, J. D., Gratzer, D., Knyahnytska, Y., Ortiz, A., Walters, C., Attia, M., Gonzalez‐Torres, C., Lustig, A., et al. (2023) · Interactive Journal of Medical Research · doi:10.2196/46419 · Cited by 12
“Moreover, it is unclear whether early changes in PA predict future outcomes, despite the clinical importance of identifying early predictors of depression treatment response [45,46], and several studies showing that early increases in behavioral activation predict later symptom improvement [47,48].”
Background
Prediction of prolonged treatment course for depressive and anxiety disorders in an outpatient setting: The Leiden routine outcome monitoring study
Boer, S., Dekkers, O. M., le Cessie, S., Carlier, I. V. E., & van Hemert, A. M. (2018) · Journal of Affective Disorders · doi:10.1016/j.jad.2018.12.035 · Cited by 12
The non-cognitive returns to vocational school tracking: South Korean evidence
Yu, B., & Kelly, S. (2019) · International Journal of Educational Research · doi:10.1016/j.ijer.2019.09.008 · Cited by 11
Response und Non-Response in der stationären Psychotherapie depressiver Patienten
Voderholzer, U., Koch, S., Hillert, A., & Schlegl, S. (2012) · Psychotherapeut (Berlin) · doi:10.1007/s00278-012-0931-y · Cited by 10
Has growth mixture modeling improved our understanding of how early change predicts psychotherapy outcome?
Koffmann, A. (2017) · Psychotherapy Research · doi:10.1080/10503307.2017.1294771 · Cited by 11
“Lutz, Stulz, and Köck (2009) analyzed data from 162 depressed American adults, who were randomized to outpatient CBT, interpersonal psychotherapy (IPT), imipramine plus clinical support, or placebo drug plus clinical support.”
Background
Evidence-Based Psychiatry
Hobbs, M. J. (2015) · Elsevier eBooks · doi:10.1016/b978-0-08-097086-8.27025-6 · Cited by 11
Latent classes of symptom trajectories during partial hospitalization for major depressive disorder and generalized anxiety disorder
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Predicting outcome of daycare cognitive behavioural therapy in a naturalistic sample of patients with PTSD: a machine learning approach
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“…in various psychiatric disorders (Henkel et al., 2009; Katz et al., 2009; Koran et al., 1995; Lewis et al., 2012; Lin et al., 2019; Lutz et al., 2009; Mulder et al., 2006; Nierenberg et al., 1995; Schindler et al., 2013; Stamm et al., 2014; Szegedi et al., 2003; Van et al., 2008).”
Latent trajectories of change for clients at a psychodynamic training clinic
Jankowski, P. J., Sandage, S. J., Bell, C. A., Rupert, D., Bronstein, M., & Stavros, G. S. (2019) · Journal of Clinical Psychology · doi:10.1002/jclp.22769 · Cited by 10
Enhancing feedback for clinical use: Creating and evaluating profiles of clients seeking counseling.
Nordberg, S. S., Castonguay, L. G., McAleavey, A. A., Locke, B. D., & Hayes, J. A. (2016) · Journal of Counseling Psychology · doi:10.1037/cou0000147 · Cited by 10
Different lens or different picture? Comparing methods of defining dramatic change in psychotherapy
Erekson, D., Horner, J., & Lambert, M. (2018) · Psychotherapy Research · doi:10.1080/10503307.2016.1247217 · Cited by 7
“These patterns may also have implications for practice, given that longitudinal outcomes of early dramatic responders have been significantly better than those who have not experienced early dramatic change (Haas, Hill, Lambert, & Morrell, 2002; Lutz et al., 2009).”
BackgroundMethod
Implementing routine outcome monitoring in public mental health services in Israel: Shared and unique challenges
Bitan, D. T., Ganor, O., Biran, L., & Bloch, Y. (2017) · Journal of Evaluation in Clinical Practice · doi:10.1111/jep.12839 · Cited by 10
“changes in symptom severity during the course of treatment in major depression disorder patients.(29)”

Authors: Lutz, W., Stulz, N., & Köck, K.
Affiliations: Universität Trier (DE)
University of Pennsylvania (US)
Corresponding author: Lutz, Wolfgang
ORCID: Lutz, Wolfgang
Stulz, Niklaus
Venue: Journal of Affective Disorders
Publisher: Elsevier BV
Published: 2009-11
Volume: 118
Issue: 1-3
Pages: 60-68
ISSN: 0165-0327 (ISSN-L)
DOI: 10.1016/j.jad.2009.01.019
OpenAlex: W2026334685
Cited by: 186
References: 70
Citations by year: 2026: 9 · 2025: 5 · 2024: 7 · 2023: 9 · 2022: 12 · 2021: 35 · 2020: 8 · 2019: 11 · 2018: 12 · 2017: 11 · 2016: 7 · 2015: 18 · 2014: 6 · 2013: 10 · 2012: 10
FWCI: 8.82
Type: journal article
Language: en
Open access: closed
Licence: www.elsevier.com/tdm/userlicense/1.0/ (tdm)
Locations: Journal of Affective Disorders (publishedVersion)
PubMed (publishedVersion)
Funders: National Institutes of Health
National Institute of Mental Health
Topics: Social Sciences › Psychology › Clinical Psychology › Psychotherapy Techniques and Applications
Health Sciences › Medicine › Pharmacology (medical) › Treatment of Major Depression
Social Sciences › Psychology › Experimental and Cognitive Psychology › Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes
Keywords: major depressive disorder, early treatment response, treatment outcome prediction, follow-up outcomes, depression severity, growth mixture modeling, psychotherapy
MeSH terms: Adult, Ambulatory Care, Antidepressive Agents, Antidepressive Agents, Tricyclic, Combined Modality Therapy, Major Depressive Disorder, Female, Follow-Up Studies, Humans, Imipramine, Male, Middle Aged, Patient Admission, Personality Inventory, Psychometrics, Psychotherapy, Cognitive Behavioral Therapy, Treatment Outcome

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Patterns of early change and their relationship to outcome and follow-up among patients with major depressive disorders

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