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Psychotherapy outcome research: Methods for reporting variability and evaluating clinical significance
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“A change of 6.39 on the Y-BOCS was considered reliable.”
From A randomized clinical trial of acceptance and commitment therapy versus progressive relaxation training for obsessive-compulsive disorder (2010) · cites this paper as Jacobson, Follette, & Revenstorf, 1984
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“For the fifth analysis, the reliable change index (Jacobson et al., 1984) was computed as RC = X2 – X1/S1 √1 – Rxx, where X1 = T1-value and X2 = T4value, S1 = standard deviation and Rxx = test–retest reliability.”
MethodReliable Change Estimates for Assessing Recovery From Concussion Using the ANAM4 TBI-MIL
Haran, F. J., Alphonso, A. L., Creason, A. H., Campbell, J., Johnson, D. E., Young, E., & Tsao, J. W. (2016) · The journal of head trauma rehabilitation · doi:10.1097/htr.0000000000000172 · Cited by 18
Functional Task Constraints Foster Enhanced Postural Control in Children With Cerebral Palsy
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“To evaluate this, Jacobson, Foilette and Revenstorf ( 1984 ) proposed a reliable change index (RCI) that each participant has to pass in order to demonstrate that his or her change is not simply due to measurement error.”
MethodKinder mit Lese- und Rechtschreibstörungen: Selbstwertgefühl und Integrative Lerntherapie
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“, PDA, DDD, HRSD, BDI, DrInC) based on the difference score from baseline to 24 weeks divided by the standard error of the difference score (63).”
MethodVorhersage individueller Psychotherapieverläufe
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Long Term Outcome of Anorexia Nervosa
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Psychometric evaluation of the Nurses Observation Scale for Inpatient Evaluation in the Netherlands
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“Without such information on the variability of therapeutic outcome, there is no way to determine the proportion of patients who really benefit or deteriorate from treatment (25).”
BackgroundDie Evaluation von Psychotherapie und das Konzept der „Klinisch bedeutsamen Veränderungen“
Kordy, H., & Hannöver, W. (2000) · doi:10.1007/978-3-7091-6767-0_32 · Cited by 17
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“RCIs±1.96 were considered to represent a reliable change (Jacobson et al., 1984).”
BackgroundInfluentialMarkell, H. M., Newman, M. G., Gallop, R., Gibbons, M. B. C., Rickels, K., & Crits-Christoph, P. (2014) · Behavior Therapy · doi:10.1016/j.beth.2014.02.008 · Cited by 16
Dealing with Fear of Blushing: A Psychoeducational Group Intervention for Fear of Blushing
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Reductions in behavioural and emotional difficulties from a specialist, trauma-informed school
Diggins, J. (2021) · The Educational and Developmental Psychologist · doi:10.1080/20590776.2021.1923131 · Cited by 18
“The RCI method was developed to determine whether ‘the difference in score from pre-to-post-treatment is meaningful or due to random error’ (Ferguson et al., 2002, p. 510; Jacobson et al., 1984).”
BackgroundMethodBo, S., BATEMAN, A. W., & Kongerslev, M. (2019) · Journal of Infant Child and Adolescent Psychotherapy · doi:10.1080/15289168.2019.1625655 · Cited by 22
“In addition, we used Jacobson, Follette, and Revenstorf (1984) “responder” definitions of clinically significant change to assess whether any changes could be perceived as clinically relevant.”
BackgroundMethodClinical significance of assertive community treatment among adolescents
Mantzouranis, G., Baier, V., Holzer, L., Urben, S., & Villard, E. (2018) · Social Psychiatry and Psychiatric Epidemiology · doi:10.1007/s00127-018-1613-z · Cited by 16
Evolução dos modelos de pesquisa em psicoterapia
de Brum, E. H. M., Frizzo, G. B., Gomes, A. G., Silva, M. D. R., de Souza, D. D., & Piccinini, C. (2012) · Estudos de Psicologia (Campinas) · doi:10.1590/s0103-166x2012000200012 · Cited by 16
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Bushman, B. B., & Peacock, G. (2010) · Child & Family Behavior Therapy · doi:10.1080/07317101003776449 · Cited by 16
The psychophysiology of generalized anxiety disorder: 2. Effects of applied relaxation
Conrad, A., Isaac, L., & Roth, W. T. (2008) · Psychophysiology · doi:10.1111/j.1469-8986.2007.00644.x · Cited by 20
Zeitliche und sequenzielle Muster von nonlinearen Veränderungen im Therapieverlauf
Lutz, W., Bachmann, F., Tschitsaz, A., Smart, D. W., & Lambert, M. J. (2007) · Zeitschrift für Klinische Psychologie und Psychotherapie · doi:10.1026/1616-3443.36.4.261 · Cited by 17
Group Treatment for Aggressive Women: An Initial Evaluation
Tutty, L., Babins-Wagner, R., & Rothery, M. (2006) · Journal of Family Violence · doi:10.1007/s10896-006-9030-6 · Cited by 16
“Jacobson, Follette, and Revenstorf (1984) have suggested that another way of examining improvements is looking for movement from the clinical into the normal range, especially in conjunction with statistical significance.”
BackgroundThe Evolution of Clinical Significance
Follette, W., & Callaghan, G. M. (2006) · Clinical Psychology Science and Practice · doi:10.1093/clipsy.8.4.431 · Cited by 16
Self-citationA naturalistic comparison of the effectiveness of trainee and qualified clinical psychologists.
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Maassen, G. (2005) · British Journal of Sports Medicine · doi:10.1136/bjsm.2004.015594 · Cited by 16
Patient experiences and outcome of treatment in psychiatric occupational therapy – three cases
Eklund, M. (1996) · Occupational Therapy International · doi:10.1002/oti.38 · Cited by 16
PSYCHOTHERAPY WITH DEPRESSED INCARCERATED FELONS: A COMPARATIVE EVALUATION OF TREATMENTS
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How to Measure Progress in Forensic Care
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[Relationship experiences and therapeutic outcome in inpatient psychotherapy].
Sammet, I., Staats, H., & Schauenburg, H. (2004) · Zeitschrift für psychosomatische Medizin und Psychotherapie · doi:10.13109/zptm.2004.50.4.376 · Cited by 16
Singh, N. N., Lancioni, G. E., Medvedev, O. N., Hwang, Y., & Myers, R. E. (2021) · Advances in Neurodevelopmental Disorders · doi:10.1007/s41252-021-00192-z · Cited by 20
Responsivity to Problem-Solving Skills Training in Mothers of Children With Cancer
Dolgin, M. J., Devine, K. A., Tzur-Bitan, D., Askins, M. A., Fairclough, D. L., Katz, E. R., Noll, R. B., Phipps, S., & Sahler, O. J. Z. (2020) · Journal of Pediatric Psychology · doi:10.1093/jpepsy/jsaa117 · Cited by 16
Comparing outcomes: The Clinical Outcome in Routine Evaluation from an international point of view
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“…that the group may demonstrate evidence of possible benefit, measured using the Intolerance of Uncertainty Scale (Freeston, Rhéaume, Letarte, Dugas, & Ladouceur, 1994) and analysed using reliable change scores informed by Jacobson and Truax (1991), and Jacobson, Follette, and Revenstorf (1984).”
MethodDiedrich, A., Schlegl, S., Greetfeld, M., Fumi, M., & Voderholzer, U. (2016) · Psychotherapy Research · doi:10.1080/10503307.2016.1210834 · Cited by 16
Thibaudeau, É., Cellard, C., Reeder, C., Wykes, T., Ivers, H., Maziade, M., Lavoie, M.-A., Pothier, W., & Achim, A. M. (2017) · Schizophrenia Research and Treatment · doi:10.1155/2017/7203871 · Cited by 20
“They correspond to the difference between two measures of the same individual, divided by the standard error of the difference of the test [54, 55]:”
BackgroundGehlert, N. C., Schmidt, C. D., Giegerich, V., & Luquet, W. (2017) · Journal of Couple & Relationship Therapy · doi:10.1080/15332691.2016.1253518 · Cited by 19
“We used a reliable change index (RC), which was developed by Jacobson, Follette, and Revenstorf (1984) and later amended by Christensen and Mendoza (1986): RC = X2 − X1 Sdi f f where X1 represents the participant’s pretreatment score, X2 represents the posttreatment score, and Sdiff is the standard…”
MethodAshworth, S., Mooney, P., & Tully, R. J. (2017) · Journal of Forensic Psychology Research and Practice · doi:10.1080/15228932.2017.1251098 · Cited by 15
“This can be interpreted negatively as it can be perceived as a shift toward a more dysfunctional population (Jacobson et al., 1984).”
BackgroundInfluentialPretreatment 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
Bowersox, N. W., Saunders, S., & Wojcik, J. (2009) · Alcoholism Treatment Quarterly · doi:10.1080/07347320802591700 · Cited by 15
Long‐term reliable change of pain scores in individual myogenous TMD patients
Grootel, R. J., Bilt, A., & Glas, H. W. (2007) · European Journal of Pain · doi:10.1016/j.ejpain.2006.10.003 · Cited by 15
“A clinically relevant treatment effect within a patient is characterized by: (i) a change in score that is statisti-1090-3801 cally ‘reliable’ and (ii) a change that a patient considers as being beneficial (Jacobson et al., 1984; Kropmans et al., 1999a).”
Stability and Change of Sociotropy and Autonomy Subscales in Cognitive Therapy of Depression
Bieling, P., Beck, A., & Brown, G. K. (2004) · Journal of Cognitive Psychotherapy · doi:10.1891/jcop.18.2.135.65962 · Cited by 15
Sharp, D., & Power, K. (1998) · Behavioural and Cognitive Psychotherapy · doi:10.1017/s1352465898000034 · Cited by 15
Beutler, L. (1993) · doi:10.1177/088626093008003008 · Cited by 15
Geiser, F., Imbierowicz, K., Conrad, R., Wermter, F., & Liedtke, R. (2004) · Zeitschrift für psychosomatische Medizin und Psychotherapie · doi:10.13109/zptm.2004.50.1.53 · Cited by 15
An Evaluation of After-Treatment Couples' Groups for Wife Abuse
Johannson, M., & Tutty, L. (1998) · doi:10.2307/584848 · Cited by 15
Wolf, S., Seiffer, B., Zeibig, J., Welkerling, J., Bauer, L. L., Frei, A. K., Studnitz, T., Rosenstiel, S., Fiedler, D. V., Helmhold, F., et al. (2021) · BMC Psychiatry · doi:10.1186/s12888-021-03541-3 · Cited by 15
“Jacobson and Truax suggest combining the RCI with an estimation of a cut-off point between a functional (non-patient) and dysfunctional (patient) population, describing a clinically significant change [96, 98].”
BackgroundCassel, A., McDonald, S., & Kelly, M. (2020) · Brain Injury · doi:10.1080/02699052.2020.1831072 · Cited by 21
Vázquez, F. L., López, L., Torres, Á., Otero, P., Blanco, V., Fernández, O. D., & Páramo, M. (2020) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph17062067 · Cited by 14
Examining Clinical Meaningfulness in Randomized Controlled Trials: Revisiting the Well Elderly II
Schelly, D., & Ohl, A. (2019) · American Journal of Occupational Therapy · doi:10.5014/ajot.2019.030874 · Cited by 14
“Jacobson et al. (1984) were not the first to argue that the focus should not be on group means but on people who may benefit from a treatment.”
Pfund, R., Peter, S. C., Whelan, J., & Meyers, A. (2018) · Journal of Gambling Studies · doi:10.1007/s10899-017-9733-z · Cited by 14
“The RCI reflects a change in scores on a standardized outcome measure (for a detailed discussion of reliable improvement, see Jacobson et al. 1984; Jacobson and Truax 1991).”
BackgroundMethodKratzer, L., Heinz, P., Schennach, R., Schiepek, G., Padberg, F., & Jobst, A. (2018) · PPmP. Psychotherapie, Psychosomatik, medizinische Psychologie · doi:10.1055/a-0591-3962 · Cited by 14
“Response wurde gemäß des Reliable Change Index (RCI) [45] als unter Berücksichtigung des Messfehlers reliable Symptomredukti-on (p 0,05) operationalisiert.”
Temple, J., Salmon, P., Smith, C. T., Huntley, C. D., & Fisher, P. (2018) · Journal of Psychosomatic Research · doi:10.1016/j.jpsychores.2018.02.013 · Cited by 13
Tutty, L. M., Babins‐Wagner, R., & Rothery, M. A. (2017) · Journal of Family Violence · doi:10.1007/s10896-017-9927-2 · Cited by 15
“An additional method to interpret statistically significant improvements (Jacobson et al. (1984) is identifying movement from the clinical into the normal range.”
MethodBabchishin, K., Curry, S. D., Fedoroff, J. P., Bradford, J. M. W., & Seto, M. C. (2017) · Archives of Sexual Behavior · doi:10.1007/s10508-017-0952-2 · Cited by 14
“Ofcourse, theclinically significant change approach (Jacobson et al., 1984) used in thecurrentstudyisonlyasaccurateasthereliabilityestimatefrom which the calculations are based.”
BackgroundMethodBusse, R. T., Elliott, S., & Kratochwill, T. (2010) · doi:10.1080/15377901003712728 · Cited by 14
“For example, a Reliable Change Index (RCI; eg, Jacobsen, Follette, & Revenstorf, 1984 ) can be calculated by subtracting pre- and postintervention data and dividing by a measure of standard error to provide an outcome index.”
MethodChronischer Tinnitus: Für wen ist eine ambulante Kurzzeitpsychotherapie indiziert?
Heinecke, K., Weise, C., & Rief, W. (2009) · PPmP. Psychotherapie, Psychosomatik, medizinische Psychologie · doi:10.1055/s-0029-1225334 · Cited by 14
Moritz, S., Iverson, G., & Woodward, T. (2003) · Applied Neuropsychology · doi:10.1207/s15324826an1002_07 · Cited by 14
de Beurs, E., van Dyck, R., van Balkom, A. V., Lange, A., & Koele, P. (1994) · Behavior Therapy · doi:10.1016/s0005-7894(05)80150-9 · Cited by 14
A delay discounting model of psychotherapy termination.
Swift, J. K., & Callahan, J. L. (2010) · International Journal of Behavioral Consultation and Therapy · doi:10.1037/h0100889 · Cited by 12
White, R. G., Gumley, A. I., McTaggart, J., Rattrie, L., McConville, D., Cleare, S., McLeod, H. J., & Mitchell, G. (2015) · Journal of Contextual Behavioral Science · doi:10.1016/j.jcbs.2015.06.004 · Cited by 13
The placebo and nocebo effects in functional urology
Mostafaei, H., Jilch, S., Carlin, G. L., Mori, K., Quhal, F., Pradère, B., Laukhtina, E., Schuettfort, V. M., Aydh, A., Motlagh, R. S., et al. (2021) · Nature Reviews Urology · doi:10.1038/s41585-021-00545-2 · Cited by 14
Lekkas, D., Price, G. D., McFadden, J. R., & Jacobson, N. C. (2021) · Mindfulness · doi:10.1007/s12671-021-01723-4 · Cited by 13
“The RCI is a psychometric criterion which accounts for the measurement reliability.”
MethodInfluentialSelf-citationTutty, L. M., & Nixon, K. (2020) · Children and Youth Services Review · doi:10.1016/j.childyouth.2020.105090 · Cited by 17
A routine outcome measure for youth mental health: Clinically interpreting MyLifeTracker
Kwan, B., & Rickwood, D. (2020) · Early Intervention in Psychiatry · doi:10.1111/eip.13016 · Cited by 13
Kobel, F., Morawa, E., & Erim, Y. (2020) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2020.00542 · Cited by 15
A Study of Clinical Change in Individual Career Counseling
Milot-Lapointe, F., le Corff, Y., & Savard, R. (2019) · The Career Development Quarterly · doi:10.1002/cdq.12204 · Cited by 13
Zhong, X.-M., Ning, Y.-P., Gu, Y., Wu, Z.-Y., Ouyang, C., Liang, W., Chen, B., Peng, Q., Mai, N., Wu, Y., et al. (2018) · Journal of Affective Disorders · doi:10.1016/j.jad.2018.07.052 · Cited by 13
Hessler, J., Diedrich, A., Greetfeld, M., Schlegl, S., Schwartz, C., & Voderholzer, U. (2018) · European eating disorders review · doi:10.1002/erv.2573 · Cited by 13
Facets of Object Representation: Process and Outcome Over the Course of Psychodynamic Psychotherapy
Mullin, A. S. J., Hilsenroth, M. J., Gold, J. R., & Farber, B. A. (2016) · Journal of Personality Assessment · doi:10.1080/00223891.2016.1215320 · Cited by 13
“RCI was determined using the method outlined in Jacobson, Follette, and Revenstrof (1984) and in Jacobson, Roberts, Berns, and McGlinchey (1999): RCID X1¡X2 S diff where X1 D pretest score; X2 D posttest score; Sdiff D x2 (SE2); SE D s1 x(1 – rxx); s1 D the standard deviation of Note.”
Methodde Beurs, E., Barendregt, M., Rogmans, B., Robbers, S., van Geffen, M., van Aggelen-Gerrits, M., & Houben, H. (2015) · European Child and Adolescent Psychiatry · doi:10.1007/s00787-014-0609-9 · Cited by 13
“Therefore, Jacobson and colleagues [17, 18] introduced an additional requirement: the Reliable Change Index (RCI).”
BackgroundDams, A., Schommer, N., Roepke, S., Heuser, I., & Lammers, C. (2007) · PPmP - Psychotherapie · Psychosomatik · Medizinische Psychologie · doi:10.1055/s-2006-951908 · Cited by 13
Reconviction of sexual offenders in England and Wales: an overview of research
Friendship, C., & Beech, A. (2005) · Journal of Sexual Aggression · doi:10.1080/13552600500063690 · Cited by 13
“It is argued by Jacobson, Follette and Ravenstorf ( 1984 ) that it is not the magnitude of the change that is important but the level of functioning attained at the end of treatment.”
BackgroundGresham, F. M. (2005) · Behavioral Disorders · doi:10.1177/019874290503000302 · Cited by 11
Research and Representation: A Conundrum for Behavior Analysts
Bolling, M. Y. (2002) · Behavior and Social Issues · doi:10.5210/bsi.v12i1.76 · Cited by 13
Drug Treatment Effectiveness: An Examination of Conceptual and Policy Issues
Prendergast, M., & Podus, D. (2000) · Substance Use & Misuse · doi:10.3109/10826080009148235 · Cited by 13
Introduction to the special section on seeking new clinical research methods.
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Predictores del cambio clínicamente significativo en una intervención de prevención de la depresión.
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“As a method of statistical reliability, the RCI “ tells us whether change reflects more than the fluctuations of an imprecise measuring instrument ” (Jacobson et al., 1984, p. 344; Jacobson & Truax, 1991, p. 14).”
A randomized clinical trial of a gamified app for the treatment of perfectionism
Amitai Abramovitch, A., Uwadiale, A. Y., & Robinson, A. D. (2023) · British Journal of Clinical Psychology · doi:10.1111/bjc.12444 · Cited by 15
“To examine whether the change in the primary outcome measure could be considered reliable and not a consequence of an error in measurement, we calculated the Reliable Change Index (RCI; Jacobson et al., 1984; Jacobson & Truax, 1991).”
MethodTutty, L., & Nixon, K. L. (2021) · Violence against Women · doi:10.1177/10778012211032699 · Cited by 12
“However, since clinical cut-off scores are one standard deviation above the mean (Jacobson et al., 1984), we used Müller’s data (2010) reporting a mean score of 7.8 (SD of 6.3), resulting in a clinical cut-off score of 14.2.”
MethodInfluential
Metadata
- 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)
- 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
- 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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