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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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“…los más habituales han sido ±1.64 y ±1.96, que son los puntos de corte que corresponden en una curva normal a niveles de confianza del 90% y del 95%, respectivamente (Jacobson et al., 1984; Jacobson et al., 1999; Jacobson y Truax, 1991). anales de psicología, 2013, vol. 29, nº 2 (mayo) Tabla 1.”
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“However, since clinical cutoff scores are one standard deviation above the mean (Jacobson et al., 1986), we used M € uller ’ s data (M € uller et al., 2010) reporting a mean score of 7.8 ( SD of 6.3), resulting in a clinical cutoff score of 14.2.”
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Assessing change in personality disorder
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Background
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Background
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Background
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“To evaluate individual change, the minimal detectable change (MDC), that is, the change beyond the error of measurement was calculated [27-30].”
Background
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EFFECT OF GUIDED IMAGERY ON CHILDREN'S SOCIAL PERFORMANCE
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Williams, L. M. (1991) · doi:10.1111/j.1752-0606.1991.tb00905.x · Cited by 10
Marital therapy outcome measured by therapist, client, and behavior change.
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“The Reliable Change Index (RCI) of Jacobson et al. (1984) was also computed as it allows to estimate when change might have arisen by unreliability of the measure alone.”
Developments in couple therapy research.
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Self-citation
Designs for Evaluating Behavior Change
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An empirical evaluation of behavioral and cognitive-behavioral group marital treatments with discordant couples.
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“Postoperative outcomes were evaluated via reliable change index (RCI), a metric used to identify whether an individual’s change in score over time is statistically significant (Jacobson et al. 1984).”
Case study assessing the feasibility of using a wearable haptic device or humanoid robot to facilitate transitions in occupational therapy sessions for children with autism spectrum disorder
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Method
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“Darüber hinaus konnten kritische Instabilitäten und Schwankungen im Erleben und Ver- Bereich Skala Aufnahme Entlassung 3-MonatsKatamnese Reliable Veränderung Klinische Signifikanz PTBS IES-R 87 44 17 ja/ja – Intrusionen 27 4 1 ja/ja – Vermeidung 25 25 13 nein/ja – Hyperarousal 35 15 3 ja/ja – Depression BDI-II 40 5 –…”
Background
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“The RCI, first proposed by Jacobson et al. (1984) and since revised (Christensen & Mendoza, 1986; Jacobson & Truax, 1991), uses a statistical formula for calculating what can be considered a clinically meaningful change.”
Method
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“…to the statistical representation of CS as a research ﬁnding, in part because CS requires a magnitude of change that substantively exceeds the parameters required for statistical signiﬁcance (Dowling et al., 2007; Greenstein, 2003; Hayat, 2010; Jacobson et al., 1984; Jacobson & Truax, 1991).”
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Result
An exploratory study of the efficacy of a Cognitive–Behavioral Treatment for hypochondriasis using different measures of change
Martínez, M. P., & Botella, C. (2005) · Psychotherapy Research · doi:10.1080/10503300500091322 · Cited by 10
“Jacobson and Truax (1991) identify the principal problems with this procedure as follows: (a) it does not provide information about the individual variations produced within the group, and (b) it does not clarify the clinical relevance of the changes produced.”
Background
Rehabilitation of schizophrenic and other long-term mentally ill patients. Results from a prospective study of a comprehensive inpatient treatment program based on cognitive therapy
Svensson, B., & Hansson, L. (1999) · European psychiatry · doi:10.1016/s0924-9338(99)00160-1 · Cited by 9
Thinking Small: Research Designs Appropriate for Clinical Practice
Streiner, D. (1998) · Canadian journal of psychiatry. Revue canadienne de psychiatrie · doi:10.1177/070674379804300709 · Cited by 9
The Brief Symptom Inventory as an Outcome Measure for Adolescentpsychiatric Inpatients
Piersma, H., Boes, J., & Reaume, W. M. (1994) · Assessment (Odessa, Fla.) · doi:10.1177/1073191194001002005 · Cited by 9
Slow progress in rational-emotive therapy outcome research: Etiology and treatment
Haaga, D. A. F., & Davison, G. C. (1989) · Cognitive Therapy and Research · doi:10.1007/bf01173908 · Cited by 24
“The approach taken by Jacobson, Follette, and Revenstorf (1984, 1986) , for example, evaluates the proportion of patients whose improvement exceeds what could likely have resulted from measurement unreliability ("improved") and whose posttreatment scores on outcome measures are more likely to derive from a nonclinical…”
Background
Depressive manifestations and differential patterns of treatment outcome in an intensive partial hospitalization treatment program.
Joyce, A., Ennis, L., O'Kelly, J. G., Ogrodniczuk, J. S., & Piper, W. (2009) · Psychological Services · doi:10.1037/a0014126 · Cited by 9
A model for conceptualizing interventions in social service agencies.
Hoge, R. D., & Andrews, D. A. (1986) · Canadian Psychology/Psychologie canadienne · doi:10.1037/h0079971 · Cited by 6
Significant individual change should be used as a lower bound for anchor based estimates of meaningful change on patient-reported outcome scores
Peipert, J., Cella, D., & Hays, R. D. (2024) · Quality of Life Research · doi:10.1007/s11136-024-03788-9 · Cited by 8
“The original version of the RCI, published in 1984, differed from the revised version cited above in that the denominator was only the SEM and did not include the √ 2 term [32].”
Practice-based research with psychologists-in-training: presentation of a supervision model and use of routine outcome monitoring (Investigación basada en la práctica con psicólogos en formación: presentación de un modelo de supervisión y uso de la monitorización rutinaria de resultados)
Valdiviezo‐Oña, J., Granja, E., Cuadros-López, A., Valdivieso-Meza, G., Evans, C., & Paz, C. (2022) · Studies in Psychology · doi:10.1080/02109395.2022.2132749 · Cited by 8
“Para evaluar el cambio confiable y clínicamente significativo se aplicaron los métodos propuestos en Jacobson et al. (1984) y en Jacobson y Truax (1991).”
BackgroundMethod
Adaptive Disclosure: Theoretical Foundations, Evidence, and Future Directions
Darnell, B. C., Vannini, M. B. N., Grunthal, B., Benfer, N., & Litz, B. T. (2022) · Current Treatment Options in Psychiatry · doi:10.1007/s40501-022-00264-4 · Cited by 8
Estimation of the minimal clinically important difference on the Aberrant Behaviour Checklist–Irritability (ABC-I) for people with intellectual disabilities who display aggressive challenging behaviour: A triangulated approach
Hassiotis, A., Melville, C. A., Jahoda, A. J., Strydom, A., Cooper, S., Taggart, L., Cooper, V., Steed, L., Ali, A., Hunter, R. M., et al. (2022) · Research in Developmental Disabilities · doi:10.1016/j.ridd.2022.104202 · Cited by 11
The Effectiveness of Cognitive Behavioral Therapy Including Updating the Early Life Experiences and Images with the Empty Chair Technique on Social Anxiety
Avşar, V., & Sevim, S. A. (2022) · International Journal of Assessment Tools in Education · doi:10.21449/ijate.1062613 · Cited by 11
Assessing recovery in treatment as usual provided by community child and adolescent mental health services
Gibbons, N., Harrison, E., & Stallard, P. (2021) · BJPsych Open · doi:10.1192/bjo.2021.44 · Cited by 8
Assessing the clinical significance of treatment outcomes for distressing voices in routine clinical practice.
Badcock, J., Graham, M., & Paulik, G. (2019) · Clinical Psychology and Psychotherapy · doi:10.1002/cpp.2410 · Cited by 8
Nocebo hyperalgesia induced by implicit conditioning
Bräscher, A., & Witthöft, M. (2019) · Journal of Behavior Therapy and Experimental Psychiatry · doi:10.1016/j.jbtep.2019.03.006 · Cited by 9
The shortened Person's Relating to Others Questionnaire (PROQ3): Comparison of the Internet-administered format with the standard-written one across four national samples.
Kalaitzaki, A., Birtchnell, J., Hammond, S., & Jong, C. L. D. (2015) · Psychological Assessment · doi:10.1037/pas0000057 · Cited by 8
Practice-Based Evidence: Patients Who Did Not Respond to Group Analysis
Lorentzen, S., Høglend, P., Martinsen, E., & Ringdal, E. (2011) · International journal of group psychotherapy · doi:10.1521/ijgp.2011.61.3.366 · Cited by 8
“Jacobson, Follette, and Revenstorf (1984) maintained that therapeutic change should be based on both statistical reliability and clinical signifi cance.”
Background
Concurrent validity of the Health of the Nation Outcome Scales compared with a patient-derived measure, the Symptom Checklist-90-Revised in out-patient clinics.
Oiesvold, T., Bakkejord, T., & Sexton, J. (2011) · Psychiatry Research · doi:10.1016/j.psychres.2010.10.023 · Cited by 8
“However, other measures based on individual level change have been developed; changes estimated to be beyond the level of measurement error (reliable change) or changes regarded as clinically significant (Jacobson et al., 1984; Jacobson and Truax, 1991; Evans et al., 1998).”
Background
Self-report of depressive symptoms in African American and white women in primary care.
Magnus, J., Shankar, A., & Broussard, D. L. (2010) · Journal of the National Medical Association · doi:10.1016/s0027-9684(15)30573-3 · Cited by 8
Clinical Significance and Remission in Treating Major Depressive Disorder: Parallels Between Related Outcome Constructs
McGlinchey, J. B., Zimmerman, M. A., & Atkins, D. C. (2008) · Harvard Review of Psychiatry · doi:10.1080/10673220701885815 · Cited by 8
Was ist klinisch bedeutsam an klinisch bedeutsamer Veränderung
Percevic, R., Bauer, S., & Kordy, H. (2004) · Zeitschrift für Klinische Psychologie und Psychotherapie · doi:10.1026/1616-3443.33.3.165 · Cited by 8
Klinische Brauchbarkeit der Konfrontationstherapie für agoraphobische Patienten
Hahlweg, K., Fiegenbaum, W., Schröder, B., Frank, M., & von Witzleben, I. (2004) · Zeitschrift für Klinische Psychologie und Psychotherapie · doi:10.1026/0084-5345.33.2.130 · Cited by 8
A Program of Research on Behavioral Marital Therapy: Hot Spots and Smoldering Embers in Marital Therapy Research
Babcock, J., & Jacobson, N. (1993) · Journal of Social and Personal Relationships · doi:10.1177/0265407593101008 · Cited by 8
Self-citation
Assessing recovery in depression: Validity of symptom inventories
Taylor, E. B., & Klein, D. (1989) · Cognitive Therapy and Research · doi:10.1007/bf01178485 · Cited by 8
“Even more important, not even the most commonly employed cutoffs have been shown to correspond to qualitative assessments of recovery (see Jacobson, Follette, & Reverstorf, 1984, for a related discussion of outcome assessment).”
Background
Disonancia cognoscitiva en la prevención de trastornos alimentarios. Significancia clínica y estadística Cognitive dissonance in eating disorders prevention. Clinical and statistical significance
García, G. P., Peresmitré, G. G., & Hernández, S. M. (2010) · doi:10.25009/pys.v20i1.622 · Cited by 8
Social Skills Training and Social Anxiety
Trower, P. (1986) · Elsevier eBooks · doi:10.1016/b978-0-08-034048-7.50010-4 · Cited by 12
Future research directions.
Beutler, L. E., & Clarkin, J. (2004) · Psychotherapy research: An international review of programmatic studies. · doi:10.1037/10092-082 · Cited by 7
“He Stole My Meds to Get High:” The Mental Health and Well-Being of Women Abused by Intimate Partners and Their Disability Status
Tutty, L. M., & Nixon, K. (2024) · Journal of Interpersonal Violence · doi:10.1177/08862605241243344 · Cited by 8
“However, since clinical cutoff scores are one standard deviation above the mean (Jacobson et al., 1984), we used Müller et al.’s data (2010) reporting a mean score of 7.8 ( SD of 6.3), resulting in a clinical cutoff score of 14.2.”
MethodInfluential
Neurofeedback Therapy for Sensory Over-Responsiveness—A Feasibility Study
Hamed, R., Mizrachi, L., Granovsky, Y., Issachar, G., Yuval‐Greenberg, S., & Bar‐Shalita, T. (2022) · Sensors · doi:10.3390/s22051845 · Cited by 8
“, the notion that a change is of everyday importance [89]), we also revealed moderate to very large effect size achieved via this treatment approach in otherwise healthy individuals with SOR.”
BackgroundResult
Intervention cost-effectiveness for pediatric anxiety and OCD: A systematic review and integrated database model
Nadai, A. S. D., Quast, T. C., Little, T. B., Westerberg, K., Patyk, K. C., Monahan, M. F., Storch, E. A., & Gregory, S. T. (2021) · Journal of Affective Disorders · doi:10.1016/j.jad.2021.10.127 · Cited by 7
Effect of a Focused Social and Communication Intervention on Preterm Children with ASD: A Pilot Study
Bejarano‐Martín, Á., Canal‐Bedia, R., Magán‐Maganto, M., Fabián, A. H., Calvarro-Castañeda, A. L., de Dios, S. M., Garcia, P., Villoria, E. D., Río, C. J., & de la Paz, M. P. (2021) · Journal of Autism and Developmental Disorders · doi:10.1007/s10803-021-05068-8 · Cited by 10
“Lastly, the Reliable Change Index (RCI, Jacobson et al., 1984) was calculated to determine whether the individual change in the different measures was reliable.”
Method
Developing Signs of Safety: A Deaf-Accessible Counseling Toolkit for Trauma and Addiction
Anderson, M. L., Glickman, N., Craig, K. S. W., Crane, A. K. S., Wilkins, A. M., & Najavits, L. (2021) · Clinical Psychology and Psychotherapy · doi:10.1002/cpp.2596 · Cited by 7
“We used the Reliable Change Index (RCI), which is computed by dividing the difference between the pretreatment and posttreatment scores by the standard error of the difference between the two scores (Jacobson et al., 1984; Ogles et al., 2001).”
Method
A process-focused case series of a school-based intervention aimed at giving young people choice and control over their attendance and their goals in therapy
Churchman, A., Mansell, W., & Tai, S. (2020) · British Journal of Guidance and Counselling · doi:10.1080/03069885.2020.1815650 · Cited by 7
“In order to understand whether the pre to post change was reliable, the reliable change index (RCI) was used (Jacobson et al., 1984).”
Method
A school-based case series to examine the feasibility and acceptability of a PCT-informed psychological intervention that combines client-led counselling (Method of levels) and a parent–child activity (Shared goals)
Churchman, A., Mansell, W., & Tai, S. (2020) · British Journal of Guidance and Counselling · doi:10.1080/03069885.2020.1757622 · Cited by 7
“In order to explore if young people achieved clinical significance change, the YP-CORE scores were used to perform a clinical significance analysis (Jacobson et al., 1984).”
Method
Evaluating change: Using the Measure of Processes of Care-Service Provider as an outcome measure for performance and confidence in family-centred care.
Gafni-Lachter, L., Josman, N., & Ben-Sasson, A. (2019) · Child: Care, Health and Development · doi:10.1111/cch.12668 · Cited by 7
Differential response to depression prevention among a sample of informal caregivers: Moderator analysis of longer-term follow-up trial data
Otero, P., Smit, F., Cuijpers, P. J., DeRubeis, R. J., Torres, Á., & Vázquez, F. L. (2015) · Psychiatry Research · doi:10.1016/j.psychres.2015.09.005 · Cited by 5
Wie kann man in der Sozialtherapie Therapieerfolg feststellen oder messen?
Wössner, G. (2014) · Forensische Psychiatrie Psychologie Kriminologie · doi:10.1007/s11757-013-0242-3 · Cited by 7
“[20], die diese Methode 1984 einführten, liegt ein klinisch signifikanter Veränderungsprozess beispielsweise dann vor, wenn sich ein Proband mehr als 2 standardabweichungen vom Mittel der „Problemgruppe“ entfernt hat oder sich nach der behandlung innerhalb von 2 standardabweichungen des Mittels der Normstichprobe bewe…”
Background

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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