Objective: To examine whether and how different patterns of psychotherapy history (no prior therapy, successful therapy experience, and unsuccessful therapy experience) affect the outcome of future treatment among patients undergoing cognitive-behavioural group therapy for social anxiety disorder.
Method: Fifty-seven patients with varying histories of psychotherapy participating in cognitive-behavioural group treatment for social anxiety disorder were included in the study. Symptom severity (including anxiety, depression, self-efficacy, and global symptom severity) was assessed at pre- and posttreatment. A therapist-rated measure of patient therapy engagement was included as a process variable.
Results: First-time therapy patients showed more favourable pre-treatment variables and achieved greater benefit from group therapy. Among patients with unsuccessful therapy experience, substantial gains were attained by those who were able to actively engage in the therapy process. Patients rating previous therapies as successful could benefit the least and tended to stagnate. Possible explanations for group differences and clinical implications are discussed.
Conclusions: Prior psychotherapy experience affects the course of cognitive-behavioural group therapy in patients with social phobias. While patients with negative therapy experience may need extensive support in being and remaining actively engaged, those rating previous therapies as successful should be assessed very carefully and may benefit from a major focus on relational aspects.
Can J Psychiatry 2008;53(8):509-516
* Differentiating between patients with successful and unsuccessful psychotherapy histories can be of crucial importance for clinicians.
* Patients with prior unsuccessful therapy experience can achieve satisfying gains but need to be supported in their efforts to actively engage in therapy.
* Not only unsuccessful therapies but also successful treatments in the past should be discussed before starting a new psychotherapy. In particular, clinicians should explore the reasons why patients rate prior therapies as successful, why they seek a new treatment, and what they expect from future therapy.
* The study sample did not include patients deciding against starting a new therapy.
* The findings on patients rating prior therapies as successful may be accentuated in the study sample (social anxiety disorder), compared with other psychiatric patients.
* Generalization to other diagnostic groups, therapeutic orientations, and therapy settings needs to be confirmed by future studies.
Key Words: psychotherapy history, psychotherapy experience, prior psychotherapy, therapy success, cognitive-behavioural therapy, group therapy, social anxiety disorder, social phobia
Abbreviations used in this article
BAI Beck Anxiety Inventory
BDI Beck Depression Inventory
DSM-IV Diagnostic and Statistical Manual of Mental Disorders-Fourth Edition
ICC intra-class correlation coefficient
LSAS Liebowitz Social Anxiety Scale
SCL symptom checklist
SE Schwarzer Self-Efficacy Scale
An important portion of psychotherapy patients have a prior history of in- or outpatient treatment. Substance abusers, for instance, often undertake more than one treatment attempt. Among patients suffering from eating disorders, repeated psychotherapy experiences are more often a rule than an exception.1 Psychotherapy history, together with a diagnosis of obsessive-compulsive disorder, predicted high-intensive use of mental health services among anxious patients.2 Comorbidity and concomitant personality disorders are known factors related to more extensive histories of psychiatric treatment.3
Further, previous psychotherapy experience can affect attitudes toward future treatments. In a sample of elderly patients suffering from depression, the degree of satisfaction with prior psychotherapy was associated with current preference for psychotherapy over pharmacological treatment. …