Category: Professional Development

Beyond Clinical Judgment: Using Progress Monitoring to Guide Treatment and Improve Outcomes

By Tonya Swartzendruber

A recent article in The Atlantic featured a topic near and dear to us at the Center for Anxiety: Using data to inform evidence based treatment. The author, Tony Rosmaniere, argues that the field of psychotherapy, and our clients, benefit greatly when therapists are willing to routinely look at progress through data generated from patient self-report assessments.

We know that assessing progress in treatment is essential. Evidence suggests that tracking progress in treatment through patient report increases therapist’s capacity to identify those patients benefiting (or not) from the treatment process and adjust their treatment plan accordingly. Just imagine if an oncologist or cardiologist or surgeon didn’t consider data when performing their clinical duties!

However, most therapists use a blend of experience, knowledge and intuition to determine how well treatment is addressing the problems of their patient. While general clinical judgment based on these factors is very useful, it is not always sufficient when dealing with the complexity of human experience and psychology. In evidence-based practice, established treatment methods, such as a Cognitive Behavioral Therapy, go a long way in organizing a treatment plan in the face of this complexity. Using progress monitoring in addition to evidence-based principles can make treatment even more flexible and responsive to individual and contextual factors that we know have a huge impact on treatment outcomes.

So, what is progress monitoring, and how should we use it? Progress monitoring is the ongoing use of data generated from the assessment of indicators that reflect progress in treatment: Quality of life, functioning, severity of symptoms and aspects of the therapeutic relationship. At it’s best, the patient and the therapist use reported information collaboratively to guide the treatment process and when necessary, address and prevent potential early termination of treatment and worsening of symptoms.

Progress and outcome monitoring increase accountability in the mental health profession, because it becomes clear when patients are and are not getting better. Accountability for therapists addressing mental health problems is extremely important. Other professional fields, such as medicine, demonstrate competence through good outcomes. The field of mental health should be no different. Using outcome monitoring helps ensure that mental health clinicians are aware of how their intervention is impacting their patients in an objective way.

Interestingly, just measuring outcomes can improve the effects of care. In a series of studies, Harmon, Slade, Whipple, Hawkins (2005), found objective feedback to therapists on patient response to treatment produced better patient clinical outcomes. That is, when patients had an opportunity to communicate indirectly with their therapists about how they were doing, they got better more often and more quickly. Of particular importance, when given information about when patients were worsening or the patient therapist alliance needed improvement therapists are able to adjust treatment as needed to prevent drop out or deterioration.

The Center for Anxiety has a rigorous progress-monitoring system in place. Using Mentegram software, patients complete a set of brief questionnaires assessing current symptoms related to mood and anxiety both prior to treatment and at each session. In addition to these routine questions, we regularly assess for risk items and if a patient reports a severe change in symptoms, their therapist and our patient care manager is notified immediately by email. The data generated from these questionnaires are routinely reviewed by therapists and can be viewed with the patient as well.

Center for Anxiety clinicians use this data for a wide range of purposes: To review data with clients on a regular basis; to discuss treatment termination when appropriate by pointing to progress; to encourage more engagement in therapy by showing that progress is slower than it could be; to demonstrate that a valued life can be created even when experiencing symptoms; to more accurately identify stressors and their relationship to increase or decrease in symptoms; and perhaps most importantly, to address any increase in symptoms through a possible change of the treatment plan.

In summary, progress and outcome monitoring is an essential and effective way to increase accountability, improve outcomes, augment clinical judgment when making decisions in treatment and more flexibly respond to the changing and dynamic needs of our patients.