Department of Clinical Psychology and Psychotherapy, University of Freiburg.
Department of Clinical Psychological Science, Maastricht University.
J Consult Clin Psychol. 2022 Jan;90(1):5-17. doi: 10.1037/ccp0000658.
The Personalized Advantage Index (PAI) is a method to guide treatment selection by investigating which of two or more treatments is optimal for a given individual. Recently, it was shown that, on average, twice-weekly sessions of psychotherapy for depression lead to better outcomes compared to once-weekly sessions. The present study applied the PAI method to assess if subgroups of patients may have a differential response to psychotherapy frequency.
Data came from a clinical trial (n = 200) randomizing depressed patients into different session frequencies: weekly sessions versus twice-weekly sessions. Machine-learning techniques were used to select pretreatment variables and develop a multivariable prediction model that calculated each patient's PAI. Differences in observed depression post-treatment scores (Beck Depression Inventory-II [BDI-II]) were tested between patients that received their PAI-indicated versus non-indicated session frequency. Between-group effect sizes (Cohen's d) were reported.
We identified prognostic indicators generally associated with lower post-treatment BDI-II regardless of treatment assignment. In addition, we identified specific demographic and psychometric features associated with differential response to weekly- versus twice-weekly therapy sessions. Observed post-treatment BDI-II scores were significantly different between individuals receiving the PAI-indicated versus non-indicated session frequency (d = .37).
Although a higher session frequency is more effective on average, different session frequencies seem beneficial for different patients. Future studies should externally validate these findings before they can be generalized to other settings. (PsycInfo Database Record (c) 2022 APA, all rights reserved).
个性化优势指数（PAI）是一种通过研究两种或两种以上治疗方法中哪种对特定个体最有效来指导治疗选择的方法。最近的研究表明，与每周一次的治疗相比，每周两次的心理治疗对抑郁症的疗效更好。本研究应用 PAI 方法评估是否存在对治疗频率有不同反应的亚组患者。
数据来自一项临床试验（n=200），将抑郁患者随机分为不同的治疗频率：每周一次和每周两次。使用机器学习技术选择治疗前变量，并开发一个多变量预测模型，计算每个患者的 PAI。测试接受 PAI 指示与非指示治疗频率的患者之间治疗后观察到的抑郁评分（贝克抑郁量表第二版[BDI-II]）的差异。报告了组间效应大小（Cohen's d）。
我们确定了一般与治疗后 BDI-II 评分降低相关的预后指标，而与治疗分配无关。此外，我们还确定了与每周治疗与每周两次治疗的反应差异相关的特定人口统计学和心理测量特征。接受 PAI 指示与非指示治疗频率的个体治疗后 BDI-II 评分存在显著差异（d=0.37）。
尽管更高的治疗频率平均更有效，但不同的治疗频率对不同的患者似乎是有益的。未来的研究应在这些发现可以推广到其他环境之前对其进行外部验证。
