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Clinical significance: A statistical approach to defining meaningful change in psychotherapy research.
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In the citing paper
“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 & Truax, 1991
In the citing paper
“The brief version of the World Health Organization Disability Assessment Schedule (WHODAS-II) 47,48 is a 12-item self-report measure that has evidence of reliability and validity for assessing various aspects of psychosocial and physical disability.”
From Acceptance-based Behavior Therapy for Depression With Psychosis (2015) · cites this paper as [48]
In the citing paper
“we examined if the changes in distress tolerance were clinically significant (as indexed by the reliable change index (RCI; Jacobson and Truax, 1991)).”
From Initial RCT of a distress tolerance treatment for individuals with substance use disorders (2012) · cites this paper as Jacobson and Truax, 1991
In the citing paper
“Formative indicators of working memory, inhibitory control, and set shifting were derived, and these participant-level component scores were subjected to reliable change analyses (Jacobson & Truax, 1991) that explicitly account for measurement error to objectively define impairment (Kofler et al., 2016; Sarver et al., 2015).”
From Executive Functioning Heterogeneity in Pediatric ADHD (2019) · cites this paper as Jacobson & Truax, 1991
In the citing paper
“Clinical significance at post-intervention was operationalized by the recommended reliable change index and cut-off points (Jacobson and Truax 1991; Vollestad et la. 2011)”
From CALM Pregnancy: results of a pilot study of mindfulness-based cognitive therapy for perinatal anxiety (2014) · cites this paper as Jacobson and Truax 1991
In the citing paper
“The reliable change index (RCI) (Jacobson & Truax, 1991) was used as a means of calculating clinical significance of the changes on the TFI.”
From Internet-based cognitive behavioural therapy for tinnitus in Spanish: a global feasibility trial. (2022) · cites this paper as Jacobson & Truax, 1991
In the citing paper
“Patient safety was measured via adverse event monitoring on three indices (1) crisis/home treatment team involvement during the intervention (present/absent and number of treatment days); (2) inpatient hospitalization days during the intervention (present/absent and number of inpatient days); and (3) a reliable deterioration on the CORE-OM (see below) as defined by Jacobson and Truax (1991).”
From Acceptance and Commitment Therapy for perinatal mood and anxiety disorders: A feasibility and proof of concept study. (2020) · cites this paper as Jacobson and Truax (1991)
In the citing paper
“Using Jacobson criteria for defining recovery, 80% of the MCT group were recovered at post-treatment and 12 month follow-up as measured by the Penn State Worry Questionnaire, compared with 10% of patients who had received relaxation.”
From Metacognitive Theory and Therapy for Worry and Generalized Anxiety Disorder: Review and Status (2010) · cites this paper as Jacobson & Truax (1991)
In the citing paper
“Jacobson & Truax (1991) criteria for defining reliable improvement and recovery demonstrated that 87% of patients were recovered at post treatment as assessed by trait-anxiety and 75% remained recovered at 6 and 12 month follow-up.”
From Metacognitive Theory and Therapy for Worry and Generalized Anxiety Disorder: Review and Status (2010) · cites this paper as Jacobson & Truax (1991)
In the citing paper
“Reliable change indices 18 provided fi ner grained detail with a minimum of 15 (44%) inperson participants achieving reliable improvement on at least one measure (CPAQ)”
From A service evaluation to examine the effectiveness of chronic pain management programmes delivered using video conferencing technology compared to in-person (2023) · cites this paper as [18]
In the citing paper
“Caseness data were unavailable for the CompACT-8; therefore, Jacobson and Truax’s “criterion a” was used to tentatively estimate thresholds (Jacobson & Truax, 1991).”
From “I don’t want to take buprenorphine for the rest of my life”: Acceptance and Commitment Therapy for a Client Struggling to Reduce Low-Dose Buprenorphine (a Hermeneutic Single-Case Efficacy Design) (2023) · cites this paper as Jacobson & Truax, 1991
In the citing paper
“The RCI is considered a reliable indicator to test the efficacy of a particular therapy or program and can show whether an individual improves or deteriorates in comparison to pretreatment.”
From THE EFFICACY OF A COMPASSION, ACCEPTANCE AND MINDFULNESS-BASED PILOT INTERVENTION FOR ADOLESCENTS’ TEST ANXIETY: A CASE STUDY USING THE ACADEMIC PROGRAM (2023) · cites this paper as Jacobson & Truax, 1991
In the citing paper
“To determine whether the detected change is in fact reliable, the RCI also considers normative data and the measurement error of the scale (Jacobson & Truax, 1991).”
From THE EFFICACY OF A COMPASSION, ACCEPTANCE AND MINDFULNESS-BASED PILOT INTERVENTION FOR ADOLESCENTS’ TEST ANXIETY: A CASE STUDY USING THE ACADEMIC PROGRAM (2023) · cites this paper as Jacobson & Truax, 1991
In the citing paper
“It was based on the Jacobson and Truax model for clinical significance [27].”
From Virtual reality exposure therapy for fear of spiders: an open trial and feasibility study of a new treatment for arachnophobia (2024) · cites this paper as [27]
In the citing paper
“Reliability of change was calculated based on the reliable change index (RCI) according to Jacobson and Truax (24).”
From Acceptance and commitment therapy in a psychiatric day hospital—A longitudinal naturalistic effectiveness trial (2023) · cites this paper as [24]
In the citing paper
“The SDC and LOA provide indices determining whether the change in scores in a scale can be considered true change or not (Shimoi, 2011) and play similar roles to the reliable change index (Jacobson & Truax, 1991).”
From Reliability and validity of the Japanese version of the experiential avoidance in caregiving questionnaire (EACQ) (2023) · cites this paper as Jacobson & Truax, 1991
In the citing paper
“The patients' psychological inflexibility clinically reduced; that is, most moved from the dysfunctional to the functional group according to the AAQ-II scores (Jacobson & Truax, 1991).”
From Acceptance and commitment therapy for chronic pain: a quasiexperimental study (2023) · cites this paper as Jacobson & Truax, 1991
In the citing paper
“RCIs lower than -1.96 indicate reliable symptom improvement [33].”
In the citing paper
“When the calculated RC score is >1.96, it is unlikely that the change that occurred during the treatment does not reflect real change (46).”
From Metacognitive Short-Term Intervention in Patients With Mental Disorders Following Cardiovascular Events (2022) · cites this paper as [46]
In the citing paper
“Clinically significant change was defined as the posttreatment score falling below two standard deviations from the mean pretreatment score, i.e.M pre -2 × SD pre (Jacobson & Truax, 1991), in this study 21 points on the PSWQ-C.”
From Intolerance of Uncertainty–Focused Treatment for Adolescents With Excessive Worry: A Pilot Feasibility Study (2020) · cites this paper as Jacobson & Truax, 1991
In the citing paper
“Each RCI calculation (see Table 1) indicated that a reliable change had indeed occurred at the data collection points in August, September, and December for all four measures, with only one exception: Toby’s scores on the PHLMS awareness subscale did not change reliably from June to August.”
From Piloting a New Model for Treating Music Performance Anxiety: Training a Singing Teacher to Use Acceptance and Commitment Coaching With a Student (2020) · cites this paper as Jacobson and Truax, 1991
In the citing paper
“The observed shift in mean depression scores from the moderate level to the mild level represents not only a significant reduction in depressive symptoms from pre- to post-intervention, but also a clinically significant change according to Jacobson and Truax [37] whereby post-treatment scores fall within two standard deviations of the normal population mean score [39].”
From A pilot evaluation of a smartphone application for workplace depression (2020) · cites this paper as Jacobson and Truax [37]
In the citing paper
“This framework is stricter than the most used method advocated by Jacobson and Truax (1991) and does not rely on the conceptual problems of p-values.”
From A Multiple-Baseline Evaluation of Acceptance and Commitment Therapy Focused on Repetitive Negative Thinking for Comorbid Generalized Anxiety Disorder and Depression (2020) · cites this paper as Jacobson and Truax, 1991
In the citing paper
“We did not assess reliable change (Jacobson & Truax, 1991), because, due to our inclusive entry criteria, this would have necessitated post-intervention scores at or above ceiling level for several participants.”
From A pilot case series of a brief acceptance and commitment therapy (ACT)-based guided self-help intervention for improving quality of life and mood in muscle disorders (2017) · cites this paper as Jacobson & Truax, 1991
In the citing paper
“Statistically reliable improvements in score were used to define minimal clinicallyimportant change, in the same way they are used in the national Improving Access to Psychological Therapies programme. 31”
From Cognitive behaviour therapy for long-term frequent attenders in primary care: A feasibility case series and treatment development study (2016) · cites this paper as [31]
In the citing paper
“Figure 1. The equation for calculating Reliable Change Index”
From Acceptance and Commitment Therapy for depression following psychosis: An examination of clinically significant change (2015) · cites this paper as Jacobson, N. S. & Truax, P. (1991)
In the citing paper
“is associated with a large burden of disease and generates considerable economic costs to society. 3-5”
From Early intervention in panic: Pragmatic randomised controlled trial (2010) · cites this paper as [5]
In the citing paper
“is associated with a large burden of disease and generates considerable economic costs to society. 3-5”
From Early intervention in panic: Pragmatic randomised controlled trial (2010) · cites this paper as [5]
In the citing paper
“As cautioned by Jacobson and Truax 21 cutoff scores can be arbitrary and may not capture all improvements (e.g., from one end of a range to another).”
From The Effectiveness of an Acceptance and Commitment Therapy Self-help Intervention for Chronic Pain. (2010) · cites this paper as [21]
In the citing paper
“In order to provide consistency in discussing clinically significant change, and as recommended by Jacobson and Truax 21 , overall improvement (shift toward mean of general population) was reported.”
From The Effectiveness of an Acceptance and Commitment Therapy Self-help Intervention for Chronic Pain. (2010) · cites this paper as [21]
In the citing paper
“Evidence of such “reliable change” is one of the 2 criteria for clinically significant change suggested by Jacobson and colleagues.24,25”
In the citing paper
“In a post-hoc analysis of EESC data sets based on the Jacobson and Truax method (Jacobson and Truax 1991), ≥99% of participants did not show emotional control impairments and method-defined, reliable change in emotional expression during LDX treatment (Katic et al. 2012).”
From Treatment Outcomes with Lisdexamfetamine Dimesylate in Children Who Have Attention-Deficit/Hyperactivity Disorder with Emotional Control Impairments (2013) · cites this paper as Jacobson and Truax 1991
In the citing paper
“Deterioration was measured using the criteria for clinically significant deterioration by Jacobson and Truax (1991) in 11 studies, while 7 studies used another definition (such as moving to another symptom category or scoring a number of points lower on a depression scale).”
From Negative effects of psychotherapies for adult depression: A meta-analysis of deterioration rates (2018) · cites this paper as Jacobson and Truax (1991)
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“Reliable change index (RCI) scores were also calculated to assess whether the magnitude of individual-level change on continuous study measures from T1 to T2 exceeded the margin of measurement error [45].”
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“Finally, Reliable Change Index (RCI) scores [52] were calculated in order to examine whether any changes in outcome measures across time were reliable (i.”
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“Reliable improvement was defined as a reduction ≥ 6 on the PHQ-9 and ≥ 4 on the GAD-7 [32,33].”
Katic, A., Dirks, B., Babcock, T., Scheckner, B., Adeyi, B., Richards, C., & Findling, R. L. (2013) · Journal of Child and Adolescent Psychopharmacology · doi:10.1089/cap.2012.0104 · Cited by 10
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“Treatment response was assessed with the reliable change index [46], which was calculated using the internal consistency [47] of the PSWQ and the sample SD of this measure at pretreatment.”
MethodUniversity of Coimbra, P., PIRES, C. P., HOFMANN, S. G., Philipps-University Marburg, G., PUTWAIN, D. W., Liverpool John Moores University, U., DO CÉU SALVADOR, M., & University of Coimbra, P. (2023) · Journal of Evidence-Based Psychotherapies · doi:10.24193/jebp.2023.1.3 · Cited by 9
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“…(RC) were calculated for the outcomes that showed significant effects, the pre–post treatment score difference of the individual participant was divided by the standard error of the differences between the two scores, [2(SE) 2 ], where SE = [1 − r xx ] 1/2 (Jacobson & Truax, 1991; Speer, 1992).”
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“Individual changes on the AAQoL and ASRS are determined using the Reliable Change Index (Jacobson and Truax, 1992; Maassen, 2004), i.e., yes/no, for improvement, deterioration, and non-response.”
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“Clinically significant changes We replicated the analysis conducted by Belloch et al,(52) who used the criteria proposed by Jacobson and Truax.(39) Patient improvement”
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“The clinically significant change was evaluated from pre-measurement to 6 months and from pre-measurement to 12 months using the Reliable Change Index (RCI) with twofold criteria, as proposed by Jacobson and Truax [30].”
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“Statistical significance in changes were determined by comparing his baseline and termination scores to means reported by general and clinical populations (Jacobson & Truax, 1991).”
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“For the clinical outcome measures, RCSC rates were calculated using the assessment and treatment termination session outcomes, via the reliable change index (RCI; Jacobson & Truax, 1991).”
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Ludlow, C., Wardle, B., & Nedeljkovic, M. (2024) · Australian Psychologist · doi:10.1080/00050067.2023.2257864 · Cited by 4
Gould, R. L., Wetherell, J. L., Serfaty, M. A., Kimona, K., Lawrence, V., Jones, R., Livingston, G., Wilkinson, P., Walters, K., Novere, M. L., et al. (2021) · Health Technology Assessment · doi:10.3310/hta25540 · Cited by 4
Konanur, S., & Muller, R. T. (2024) · Child Abuse & Neglect · doi:10.1016/j.chiabu.2024.106921 · Cited by 4
Lamarche, J., Grenier, J., Lafontaine, M.-F., Greenman, P. S., Gosselin, J., Joanisse, M., Chomienne, M.-H., Maheu, C., & Lebel, S. (2019) · Psycho-Oncologie · doi:10.3166/pson-2019-0106 · Cited by 4
Bowers, E. M., Levin, M. E., Ong, C. W., & Twohig, M. P. (2025) · Behaviour Research and Therapy · doi:10.1016/j.brat.2025.104806 · Cited by 5
Thienot, E., Provencher, M. D., & St-Amand, J. (2013) · Journal de Therapie Comportementale et Cognitive · doi:10.1016/j.jtcc.2012.11.003 · Cited by 4
Carrier, M.-H., & Côté, G. (2010) · European Review of Applied Psychology · doi:10.1016/j.erap.2009.06.002 · Cited by 3
McLay, L., Emerson, L. M., Waddington, H., van Deurs, J., Hunter, J., Blampied, N., Hapuku, A., Macfarlane, S., Bowden, N., van Noorden, L., et al. (2023) · BMJ Open · doi:10.1136/bmjopen-2022-071235 · Cited by 3
“Where descriptive examination suggests that one or more groups may differ substan-tively from the others, the statistical significance of such differences will be tested by independent sample t-tests and χ 2 with alpha set at p 0.05.”
MethodInfluentialGebhardt, P., Caldarone, F., Westhoff-Bleck, M., Olsson, K. M., Hoeper, M. M., Park, D.-H., Stapel, B., Breitner, M. H., Werth, O., Heitland, I., et al. (2022) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2022.812807 · Cited by 3
Widmann, M., Apondi, B., Musau, A., Warsame, A. H., Isse, M., Mutiso, V., Veltrup, C., Schalinski, I., Ndetei, D., & Odenwald, M. (2022) · BMC Public Health · doi:10.1186/s12889-022-14681-w · Cited by 3
Shepherd, K., Pritty, B., Tickle, A., & Moghaddam, N. (2023) · International Journal of Mental Health and Addiction · doi:10.1007/s11469-021-00729-2 · Cited by 6
“Reliable change (RC) computations were applied to examine the statistical reliability of quantitative changes (Jacobson & Truax, 1991).”
MethodMaras, D., Balfour, L., Lefebvre, M., & Tasca, G. (2022) · Research in Psychotherapy: Psychopathology, Process and Outcome · doi:10.4081/ripppo.2022.634 · Cited by 3
“Cut-off scores were calculated for the FACTG and GSES as per the recommended methods described by Jacobson and Truax (Jacobson & Truax, 1991).”
BackgroundMethodInfluentialAlves, F., Figueiredo, D. V., & Vagos, P. (2023) · Clinical Case Studies · doi:10.1177/15346501221144069 · Cited by 3
Taylor, H., Kingston, J., & Taylor, M. D. (2024) · Journal of Contextual Behavioral Science · doi:10.1016/j.jcbs.2024.100849 · Cited by 3
Shields, C., Murrell, S. A., & Salsman, N. (2006) · Clinical Case Studies · doi:10.1177/1534650103261222 · Cited by 2
Joy, D., & Caddle, A. (2023) · British Journal of Pain · doi:10.1177/20494637221135125 · Cited by 2
Johns, E. K., Kokokyi, S., Neufeld, D., Krysanski, V., & Meek, B. P. (2024) · Journal of Contextual Behavioral Science · doi:10.1016/j.jcbs.2024.100812 · Cited by 2
Ooi, J., & Steverson, T. (2023) · The Cognitive Behaviour Therapist · doi:10.1017/s1754470x23000260 · Cited by 2
Hirsig, A., Häfeli, X. A., & Schmidt, S. J. (2024) · Trials · doi:10.1186/s13063-024-08241-3 · Cited by 2
“The Reliable Change Index [179] will be used to assess symp - tom deterioration according to the primary outcome (i.e., SDQ-s).”
MethodPatterson, V. C., Tibbo, P. G., Stewart, S. H., Town, J., Crocker, C. E., Ursuliak, Z., Lee, S., Morrison, J., Abidi, S., Dempster, K., et al. (2024) · BMC Psychiatry · doi:10.1186/s12888-024-06050-1 · Cited by 1
“We used the Reliable Change Index (RCI) [39] to assess change from baseline— all metrics used to establish the degree of required change can be found at clinicaltrials.gov (NCT04546178).”
MethodHoogerwerf, E., Greeven, A., Goekoop, R., & Spinhoven, P. (2024) · Trials · doi:10.1186/s13063-023-07780-5 · Cited by 1
“Effect sizes and clinical significant change according to the Jacobson and Truax criteria will be calculated to estimate respectively the magnitude of the treatment effect and the significance of the results for clinical practice [49].”
MethodConceptualization and Management of Chronic Pain in an Over 65 Using an ACT Lens—A Single Case Study
Campbell, R., Prasadarao, P. S. D. V., & Morris, M. (2021) · Clinical Case Studies · doi:10.1177/1534650120978299 · Cited by 1
Lobato, D., Flujas-Contreras, J. M., Montesinos, F., & Montoya-Rodríguez, M. M. (2026) · Behavioral Sciences · doi:10.3390/bs16010082 · Cited by 1
Barrett, M. E., & Welsh, D. P. (2025) · Clinical Case Studies · doi:10.1177/15346501251368809 · Cited by 1
Acceptance and commitment therapy for chronic pain: a quasiexperimental study
Miyazaki, E. S., Banaco, R. A., Domingos, N. A. M., Martins, G. B., & Miyazaki, M. C. D. O. S. (2023) · Estudos de Psicologia (Campinas) · doi:10.1590/1982-0275202340e210067
Miller‐Mendes, M., Castilho, P., Clara, M. I., Clemente, V., & Gomes, A. A. (2026) · British Journal of Clinical Psychology · doi:10.1111/bjc.70077
Metadata
- Authors
- Jacobson, N. S., & Truax, P.
- ORCID
- Jacobson, Neil S.
- Venue
- Journal of Consulting and Clinical Psychology
- Published
- 1991
- Volume
- 59
- Issue
- 1
- Pages
- 12-19
- ISSN
- 0022-006X (ISSN-L)
- 1939-2117
- OpenAlex
- W4235813114
- Cited by
- 7,770
- References
- 0
- Citations by year
- 2026: 323 · 2025: 310 · 2024: 326 · 2023: 363 · 2022: 411 · 2021: 472 · 2020: 484 · 2019: 457 · 2018: 452 · 2017: 395 · 2016: 385 · 2015: 399 · 2014: 373 · 2013: 350 · 2012: 304
- FWCI
- 20.99
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Journal of Consulting and Clinical Psychology (publishedVersion)
- Topics
- Social Sciences › Psychology › Clinical Psychology › Psychotherapy Techniques and Applications
- Social Sciences › Decision Sciences › Management Science and Operations Research › Psychometric Methodologies and Testing
- Social Sciences › Decision Sciences › Statistics, Probability and Uncertainty › Meta-analysis and systematic reviews
- Keywords
- meaningful change, clinical significance, psychotherapy outcome assessment, statistical significance, effect size
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