A new direction in psychological treatment research, pulling from the medical field, is called “personalized medicine”1,2. This is the study of how to tailor treatments for specific diagnoses to the individuals based on the clients’ specific characteristics. The goal is to be able to select the treatment most likely to be effective for that person. This type of research involves examining:
- how treatments work (what are the most important components of the treatment?)
- for whom they work for (what are the characteristics of people who respond well to treatment? What are the characteristics of those who do not?)
- what factors can predict differential responding to different types of psychological treatments (are there any characteristics that can be identified before treatment begins that predict the different levels of response to the treatment?).
By identifying these factors, also known as “moderators” of treatment, healthcare providers can assess their clients, and then work with the client to identify the type of treatment that will likely be the most effective for them based on those moderating factors, traits, or characteristics1. In addition, with this information, clients can also ask their healthcare providers about this: how likely is this suggested treatment to work for me, as someone with these characteristics?
Every one is different
Evidence-based psychological treatments are not a one-size fits all type of product or process. People are extremely diverse, and so are the unique constellations of psychological problems people experience, even within particular diagnostic categories. One client’s symptoms of PTSD or Social Anxiety may look very different from another client’s. Therefore, while certain types of psychological treatments may be deemed effective, they likely do not work equally well for all individuals, and that is why personalization is particularly important.
One example of this recent research is by Michelle Newman and colleagues. They examined interpersonal style as a moderator of treatment response, and more specifically, how it may predict the way people suffering from generalized anxiety disorder (GAD) respond to three different types of evidence-based treatments3. They wanted to understand if people diagnosed with GAD who report higher levels of domineering and intrusive interpersonal styles do better in more behaviorally oriented treatment, compared to CBT or cognitive therapy.
Problems presented with GAD
Prior research into GAD and interpersonal problems has highlighted that people diagnosed with GAD experience higher levels of interpersonal problems and sensitivity than people without the diagnosis of GAD4,5, and are more likely to have higher marital conflict leading to divorce or separation6. In addition, people diagnosed with GAD who reported high levels of interpersonal problems related to being domineering, intrusive, or vindictive, have been found to respond less well to cognitive behavioral treatment, cognitive therapy, or behavioral therapy7, suggesting that interpersonal problems can impede treatment progress for GAD.
Researchers examined this in a sample of 47 participants diagnosed with GAD seeking treatment. Researchers measured all participants’ interpersonal style and interpersonal problems at the pre-treatment time-point, and then randomly assigned participants to either behavioral therapy (BT), cognitive therapy (CT), or combined cognitive behavior therapy (CBT), all of which were 14 sessions long. In addition, each treatment included psycho-education about anxiety, self-monitoring of anxiety, practice identifying early cues of anxiety, and out of session practice. However, the participants in the BT condition were taught applied relaxation and diaphragmatic breathing skills, and meditational relaxation. In comparison, participants in the CT condition were taught to explicitly challenge their anxious thoughts by analyzing the evidence for thoughts, and the probabilities that thoughts may come true, in addition to recognizing logical thinking errors, and practice generating alternative, more helpful and balanced thoughts. The CBT condition combined both CT and BT components.
Results indicated that, in support of the researchers’ hypothesis, participants who reported both higher domineering interpersonal style and problems, and participants who reported higher intrusive interpersonal style and problems, fared better in the BT condition, compared to CBT or CT. It is important to note this study includes a small sample size. Further, the sample was highly educated and not racially or ethnically diverse (participants were 89.4% White). Therefore, it is unclear if these findings are generalizable, or will replicate in a larger sample.
However, this study does suggest, that for people who may identify with a more domineering and/or intrusive personality suffering from GAD, and find themselves often struggling in interpersonal relationships for control, seeking out treatment providers who practice from a more hands-on, experiential, concrete, and action-oriented behavioral perspective may be better suited than a more intellectually oriented therapy that involves interrogating one’s own thoughts and identifying logical errors, such as in cognitive therapy.
This is an exciting new direction in psychological treatment research, and hopefully more research will continue to clarify which types of treatments are best suited for particular clients experiencing different types of psychological problems, based on meaningful characteristics, like personality, cultural identity and values, developmental stage, or traits or characteristics.
1. Simon, G. E., & Perlis, R. H. (2010). Personalized medicine for depression: Can we match patients with treatments? American Journal of Psychiatry, 167, 1445–1455. http://dx.doi.org/ 10.1176/appi.ajp.2010.09111680
2. Paul, G. L. (1967). Strategy of outcome research in psycho- therapy. Journal of Consulting Psychology, 31, 109–118. http://dx.doi.org/10.1037/h0024436
3. Newman, M. G., Jacobson, N. C., Erickson, T. M., & Fisher, A. J. (2017). Interpersonal problems predict differential response to cognitive versus behavioral treatment in a randomized controlled trial. Behavior Therapy, 48(1), 56-68. doi:10.1016/j.beth.2016.05.005
4. Gamez, W., Watson, D., & Doebbeling, B. N. (2007). Abnormal personality and the mood and anxiety disorders: Implications for structural models of anxiety and depres- sion. Journal of Anxiety Disorders, 21, 526–539. http://dx. doi.org/10.1016/j.janxdis.2006.08.003
5. Afifi, T. O., Cox, B. J., & Enns, M. W. (2006). Mental health profiles among married, never-married, and separated/ divorced mothers in a nationally representative sample. Social Psychiatry and Psychiatric Epidemiology, 41, 122–129. http://dx.doi.org/10.1007/s00127-005-0005-3
6. Gasperini, M., Battaglia, M., Diaferia, G., & Bellodi, L. (1990). Personality features related to generalized anxiety disorder. Comprehensive Psychiatry, 31, 363–368. http://dx.doi.org/ 10.1016/0010-440X(90)90044-S
7. Borkovec, T. D., Newman, M. G., Pincus, A. L., & Lytle, R. (2002). A component analysis of cognitive-behavioral therapy for generalized anxiety disorder and the role of interpersonal problems. Journal of Consulting and Clinical Psychology, 70, 288–298. http://dx.doi.org/10.1037/0022-006X .70.2.288
Sarah Krill Williston is a PhD Candidate at the University of Massachusetts Boston, working in the Roemer lab. Her research centers on boosting mental health literacy and reducing stigma to encourage evidence-based care-seeking for anxiety and trauma-related disorders. Sarah specializes in offering evidence-based treatments like CBT and ABBT to individuals, particularly military families, active duty service members, and veterans with mood, anxiety, and trauma-related disorders.