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Psychotherapy outcome research: Methods for reporting variability and evaluating clinical significance

Jacobson, Neil S., Follette, William C., Revenstorf, Dirk·1984·Behavior Therapy

DOI 10.1016/s0005-7894(84)80002-7

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SOCIAL VALIDITY: THE CASE FOR SUBJECTIVE MEASUREMENT or HOW APPLIED BEHAVIOR ANALYSIS IS FINDING ITS HEART 1
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Hayes, 1981, Time series methodology and empirical clinical practice, Journal of Consulting and Clinical Psychology, 49, 193, 10.1037/0022-006X.49.2.193 · DOI
Hugdahl, 1981, On the difference between statistical and clinical significance, Behavioral Assessment, 3, 289

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“Jacobson and Truax also present a reliable change index (RCI) to account for overlap in functional and dysfunctional distributions (Jacobson & Truax, 1991 ; Jacobson, Follette, & Revenstorf, 1984 ); in other words, the RCI is designed to ensure that a posttest score that crosses the “functional” cutoff point is indeed…”
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“[25] is an enhancement in precision by a closer approximation of the underlying true scores.”
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“The clinical significance of change scores was established using Type C cut-off points, as recommended by Jacobson et al. (1984) for situations in which the functional and dysfunctional population distributions ovelap.”
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“[1995], die die Kriterien nach Jacobson et al. [1984] verwendeten, weist die Expositionsbehandlung von Zwangspatienten einen Prozentsatz von 31% klinisch signifikanten Verbesserungen auf, gemessen mit dem PI-R (Padua Inventory-Revised) auf.”
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“The original method proposed by Jacobson, Follette, and Revenstorf (1984) established four categories that participants may fall into: recovered (reliable improvement and passed the predetermined cutoff), improved (reliable improvement but did not pass the cutoff), unchanged (neither criteria met),…”
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“To determine the clinical significance by considering the RCI, the pre-and post-test scores are compared with the cutoff point of the variable (Jacobson et al., 1984).”
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“Reliable change is change that is statistically significant, where the change is not likely to have occurred by chance, measurement error or normal fluctuations of symptoms (Jacobson et al., 1984; Jacobson & Truax, 1991).”
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“…difference, which we refer to as clinical relevance, to be a change considered meaningful or worthwhile by the patient, such that the patient would consider repeating the intervention if given the choice (for a more thorough discussion, see Jacobson et al., 1984 and Jaeschke et al., 1989).”
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“Change scores suggest that seven participants in the control group and eight in the experimental group met criteria for Jacobson et al., (1984) reliable change.”
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Method
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Background
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Background
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“No imputation was performed because linear mixed-effects models estimated with restricted maximum likelihood provided unbiased estimates under the missing at random assumption [35].”
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Background
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“Therefore, an alternative is to use statistics to determine the significance of change within a group of clients (Bolton, 2004; Jacobson et al., 1984); namely whether the post-intervention measurement is different from the baseline measurement at some level of statistical significance.”
Method
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“Green = reliable improvement; blue = no change; red = reliable deterioration; X = reliable and clinically significant improvement; * superscript letters after measure names depict criterion used to evaluate clinically significant change [39]: B = criterion B, C = criterion C; E = external criterion; N = insufficient r…”
BackgroundMethod
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Background
Memory changes in patients with hippocampal sclerosis submitted to surgery to treat mesial temporal lobe epilepsy.
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“Given measurement error inherent in self-reported outcomes, the reliable change index was generated for the EPDS scores using the reliability and standard deviation of the scores at baseline (Christensen, 1986; Jacobson et al., 1984; Jacobson & Truax, 1991).”
Method
Compliant patients with borderline personality disorder non-responsive to one-year dialectical behavior therapy: Outcomes of a second year
Salamin, V., Kratzel, A., Gothuey, I., & Guenot, F. (2021) · Journal of Behavioral and Cognitive Therapy · doi:10.1016/j.jbct.2021.01.001 · Cited by 4
Cognitive behavioural therapy for anxiety in psychosis: a systematic review and meta-analysis
Heavens, D., Odgers, K., & Hodgekins, J. (2019) · Psychosis · doi:10.1080/17522439.2019.1618380 · Cited by 4
The Role of Executive Function in Predicting Children’s Outcomes in a Cognitive Behavioral Treatment for Trauma-Related Nightmares and Secondary Sleep Disturbances
Rischard, M. E., & Cromer, L. D. (2019) · Journal of Child & Adolescent Trauma · doi:10.1007/s40653-019-00252-6 · Cited by 4
Lateral visual occlusion does not change walking trajectories
Dunn, M. J., & Rushton, S. (2018) · Journal of Vision · doi:10.1167/18.9.11 · Cited by 4
Use of the Counseling Center Assessment of Psychological Symptoms 62 (CCAPS-62) as a Repeated Measure
Ghosh, A., Bennett, S. R., & Martin, J. K. (2017) · Journal of College Student Psychotherapy · doi:10.1080/87568225.2017.1367630 · Cited by 6
“…of whether clients change in symptomology while in treatment as measured by the CCAPS-62, the RCI was calculated utilizing the following formula (Jacobson et al., 1984): RC ¼ X2 X1 Sdiff In this, X1 represents the individual’s pretest score, X2 represents the same individual’s posttest scores,…”
Method
Therapist-Specific Factors and Psychotherapy Outcomes of Adult and Youth Clients Seen in a Psychology Training Clinic
Prout, K., & Deberard, M. S. (2017) · Administration and Policy in Mental Health and Mental Health Services Research · doi:10.1007/s10488-017-0798-x · Cited by 4
“Per Jacobson and Truax (1991), CS change is said to occur when a client’s assessment score at intake is in the dysfunctional range (above the clinical cutoff) and when the client’s score has improved to meet the threshold for reliable change as well as falls in the functional range (below the clinical cutoff) (Jacobso…”
Background
Internal Memory Rehabilitation Strategies in the Context of Post-acute Brain Injury: A Pilot Study
Perna, R., & Perkey, H. (2016) · International Journal of Neurorehabilitation · doi:10.4172/2376-0281.1000199 · Cited by 4
“Thus, RCI indicates whether the change in scores from pre-intervention to postintervention occurred due to a meaningful change rather than chance score variability [30,31].”
BackgroundMethod
Assessing clinical significance using robust normative comparisons
Mangardich, H., & Cribbie, R. A. (2014) · Psychotherapy Research · doi:10.1080/10503307.2014.889329 · Cited by 6
“The first method proposed for assessing clinical significance (Jacobson et al., 1984), with slight modifications by Jacobson and Truax (1991), suggested a two-step criterion to assess clinically significant change (also see Jacobson, Roberts, Berns, &.”
Does Change in Hostility Predict Sexual Recidivism?
Pettersen, C., Nunes, K., Woods, M., Maimone, S., Hermann, C. A., Looman, J., & Spape, J. (2014) · International journal of offender therapy and comparative criminology · doi:10.1177/0306624x14547033 · Cited by 4
“Following convention (e.g., Jacobson et al., 1984), the RCI was used to classify offenders as recovered, improved, unchanged, or deteriorated.”
BackgroundMethod
A Program Intervention for Pediatric Bipolar Disorder: Preliminary Results
McTate, E., Brack, A. S. B., Handal, P., & Burke, R. (2013) · Child & Family Behavior Therapy · doi:10.1080/07317107.2013.846194 · Cited by 4
“Clinically Significant Change Clinically significant change as defined by Jacobson, Follette, and Revenstorf (1984) requires satisfying two criteria.”
Background
Within-Treatment Change: Finding the Individual in Group Outcomes
Bowen, E. (2012) · Advances in program evaluation · doi:10.1108/s1474-7863(2012)0000013011 · Cited by 4
FIABILIDAD EN EL TEST GESTÁLTICO DE BENDER - II, EN UNA MUESTRA INDEPENDIENTE DE CALIFICADORES
Soto, C. M. (2011) · Revista de Investigación Educativa · doi:10.6018/rie.30.1.117541 · Cited by 4
What is Psychotherapy for? A Plausible Alternative to Empirically Supported Therapies, Therapy Relationships, and Practice Guidelines
Mahrer, A. (2005) · Journal of Contemporary Psychotherapy · doi:10.1007/s10879-005-0806-4 · Cited by 4
Physiotherapy and low back pain - Part II: Outcomes research utilising the biopsychosocial model: Biological outcomes
Bardin, L. (2002) · South African Journal of Physiotherapy · doi:10.4102/sajp.v58i4.225 · Cited by 4
Countering perfectionism in research on clinical practice I: Surveying rationality changes after a single intensive ret intervention
Ellis, A., Sichel, J. L., Leaf, R., & Mass, R. (1989) · Journal of Rational-Emotive & Cognitive-Behavior Therapy · doi:10.1007/bf01073808 · Cited by 4
Long-Term Forensic Psychiatric Care
Völlm, B., & Braun, P. (2019) · Cambridge International Law Journal · doi:10.1007/978-3-030-12594-3 · Cited by 4
Exploring Mechanisms of Change in the Rehabilitation of High-Risk Offenders
Yesberg, J. A. (2015) · doi:10.26686/wgtn.17009639 · Cited by 4
Feasibility of Telephone Support Groups for Spouses of Returning Iraq and Afghanistan Service Members
Nichols, L., Martindale-Adams, J., Graney, M., Zuber, J. K., Miller, P. E., & Brown, D. (2014) · Springer eBooks · doi:10.1007/978-1-4614-8712-8_4 · Cited by 4
A practitioner's guide to developing critical appraisal skills
Abt, E., & Pihlstrom, B. L. (2012) · The Journal of the American Dental Association · doi:10.14219/jada.archive.2012.0019 · Cited by 4
Just what do we mean by clinical significance.
Fonn, D. (2010) · Eye & contact lens · doi:10.1097/icl.0b013e3181ccaeb3 · Cited by 4
Propiedades psicométricas de un cuestionario específico de calidad de vida en trasplante hepático
Estraviz, B., Quintana, J., Valdivieso, A., Bilbao, A., de Urbina, J. O., & Sarabia, S. (2007) · Revista Española de Enfermedades Digestivas · doi:10.4321/s1130-01082007000100004 · Cited by 4
“El MCD representa el mínimo cambio en la puntuación que refleja un cambio clínico real y no un cambio por error de medida (22).”
BackgroundInfluential
Evaluating the co-designed “kalmer” relaxation intervention for people with aphasia: a feasibility case series
El-Helou, R., Ryan, B., Hilari, K., & Kneebone, I. (2024) · Aphasiology · doi:10.1080/02687038.2024.2437784 · Cited by 3
“If RCI value is greater than 1.96, then the difference is considered reliable (Jacobson & Truax, 1992; Jacobson et al., 1984).”
Influential
“It Was one of the Most Revealing Experiences of My Life:” Women's Views on Group Counseling for Survivors of Intimate Partner Violence
Tutty, L. (2024) · Violence against Women · doi:10.1177/10778012241259712 · Cited by 3
“However, since clinical cut-off scores are one standard deviation above the mean (Jacobson et al. 1984), we used Müller ’ s data (Mu ̈ ller et al., 2010) reporting a mean score of 7.8 ( SD of 6.3), resulting in a clinical cut-off score of 14.2.”
Influential
Parenting support: The added value of an enhanced program on child behavior
Filion, F., Gagné, M., Drapeau, S., & Paradis, H. (2023) · Children and Youth Services Review · doi:10.1016/j.childyouth.2023.107202 · Cited by 5
Empirical examination of long-term and intensive psychodynamic psychotherapy for severely disturbed patients
Shefler, G., Abargil, M., Yonatan‐Leus, R., Finkenberg, R., & Amir, I. (2023) · Psychotherapy Research · doi:10.1080/10503307.2023.2263810 · Cited by 3
“In the absence of a norm, we calculated the size of the required change in the GSI of the SCL90 from Cronbach ’ s alpha and the standard deviation of the current sample as 0.3 fol-lowings Christensen and Mendoza (1986) correction to Jacobson et al. (1984) formulation.”
Influential
Modified metacognitive therapy for anorexia nervosa: An open trial in an outpatient setting
Lawson, R., Carter, J. D., Britt, E., Knowles, K., Then, R., Vallance, J. K., Jenkins, L., & Tauamiti, R. (2022) · International Journal of Eating Disorders · doi:10.1002/eat.23749 · Cited by 4
One in five, not one in 17, youth patients deteriorate during psychotherapy for depression
McAleavey, A. (2022) · European Child and Adolescent Psychiatry · doi:10.1007/s00787-022-01943-6 · Cited by 3
“It only pertains to clinical significance when it is paired with some clinical criterion, which was the original suggestion of Jacobson and Truax [4] and Jacobson, Follette, and Revenstorf [3] when they developed the RCI.”
Background
Robustness of Adaptive Measurement of Change to Item Parameter Estimation Error
Cooperman, A. W., Weiss, D. J., & Wang, C. (2021) · Educational and Psychological Measurement · doi:10.1177/00131644211033902 · Cited by 3
“For example, proposed change statistics like the reliable change index (Jacobson et al., 1984; Jacobson & Truax, 1991) generally depend upon the sample composition and reliability, and are thus unable to adequately identify significant intra-individual change between test administrations that is…”
Method
Differential effects from cognitive rehabilitation and high-definition tDCS in posterior cortical atrophy: A single-case experimental design
Dugas, C., Keltner-Dorman, E., & Hart, J. (2021) · Neuropsychological Rehabilitation · doi:10.1080/09602011.2021.1927761 · Cited by 3
“*Clinically significant change at > = 2 SD or within normal limits (Jacobson et al., 1984); Primary outcome measures highlighted within box.”
Background
Self-help guided by trained lay providers for generalized anxiety disorder in older adults: study protocol for a randomized controlled trial
Landreville, P., Gosselin, P., Grenier, S., & Carmichael, P. (2021) · BMC Geriatrics · doi:10.1186/s12877-021-02221-x · Cited by 3
Songwriting intervention for cognitively-impaired children with life-limiting conditions: Study protocol
Akard, T. F., Davis, K. A., Hills, T., Lense, M. D., Kim, D., Webber, R., Dietrich, M. S., & Gilmer, M. J. (2021) · Contemporary Clinical Trials Communications · doi:10.1016/j.conctc.2021.100765 · Cited by 3

Authors: Jacobson, N. S., Follette, W. C., & Revenstorf, D.
Affiliations: University of Washington (US)
University of Tübingen (DE)
Corresponding author: Jacobson, Neil S.
ORCID: Jacobson, Neil S.
Venue: Behavior Therapy
Publisher: Elsevier BV
Published: 1984-09
Volume: 15
Issue: 4
Pages: 336-352
ISSN: 0005-7894 (ISSN-L)
DOI: 10.1016/s0005-7894(84)80002-7
OpenAlex: W2086791094
Cited by: 1,294
References: 0
Citations by year: 2026: 15 · 2025: 20 · 2024: 29 · 2023: 26 · 2022: 33 · 2021: 46 · 2020: 34 · 2019: 40 · 2018: 39 · 2017: 39 · 2016: 42 · 2015: 52 · 2014: 45 · 2013: 51 · 2012: 48
FWCI: 19.53
Type: journal article
Language: en
Open access: closed
Licence: www.elsevier.com/tdm/userlicense/1.0/ (tdm)
Locations: Behavior Therapy (publishedVersion)
Topics: Social Sciences › Psychology › Clinical Psychology › Psychotherapy Techniques and Applications
Social Sciences › Decision Sciences › Statistics, Probability and Uncertainty › Meta-analysis and systematic reviews
Social Sciences › Psychology › Experimental and Cognitive Psychology › Psychology Research and Bibliometrics
Keywords: psychotherapy outcome research, clinical significance, statistical significance, treatment response classification, statistical reliability, treatment outcome assessment

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Psychotherapy outcome research: Methods for reporting variability and evaluating clinical significance

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