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.

 

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The Way of Mastery is to break all the rules—but you have to know them perfectly before you can do this; otherwise you are not in a position to transcend them.

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What Clients Say

In a recent survey of our patients, 94% would recommend our practice to a friend.
Calmer in the Face of Hardship
I came to the Center for Anxiety for help in dealing with a family member who suffered from extreme anxiety. But I ended up getting a serious illness two months later and started having my own sessions. With the help of my therapist I got through my illness, learned to understand my habits that were making my major life stresses worse, learned to communicate better, taper my anger, and surprisingly I became more calmer even though my hardships in life worsened. Therapy is a lot of work and not easy, but nothing in life comes easy! I became a better and softer mom and (when I practice what I learned) and my kids and home are calmer and happier. I am still a work in progress and have more to work on, but I know I am on the right path. I wish I knew before how my communication style and anger were really impacting my life, how being softer you can accomplish way more then being harsh. I have been to other therapists in the past and I can hands down say that the Center for Anxiety’s approach is really effective. I have even referred a bunch of people to the Center and they have been really happy with the therapists and how much they really care for their patients.
I Tackled a Long List of Fears
When I first came to the Center for Anxiety, my list of anxieties/fears was long! I was scared of getting sick, getting stranded, driving, flying and more. With the help of my therapist, I immediately got to work and tackled every one of my fears. Now the world is open to me and I feel free! I can dream big and accomplish whatever I set my mind to! I am especially grateful that I was able to do all this without having to rely on medication. It was hard work – grueling at times! – but now I have the coping tools within me for life. In fact a family member recently said to me “You are awesome. You can accomplish anything you set your mind to because you don’t let fear stop you! ” Thank you Dr. Rosmarin and the Center for Anxiety staff for helping me get here. My fears no longer limit me and I love my life. Try it, it might turn your life around too!
Highly Skilled and Professional Treatment
When I sought treatment at the Center for Anxiety, the clinic was is in its incipient stages. However, by the time I successfully finished treatment, the Center for Anxiety grew and flourished into a world-class treatment center, offering cutting-edge, evidence-based treatment to countless individuals. The continued success of the Center for Anxiety comes as no surprise to me, with a team that contains such highly skilled professionals who display clinical acumen, empathy, and compassion. When I first entered treatment I was concerned that therapy would be similar to the experiences with past psychologists: a seemingly bottomless pit with no reductions in my anxiety symptoms, but was so relieved when I started to feel less anxious after only a handful of sessions. My therapist created a treatment plan that was tailored exactly to my needs and taught me practical skills to help me work through my anxiety that I still use and practice to this very day.
No More Panic
When I first came in, I was struggling with panic disorder and didn’t even know it, which only made dealing with it that much more difficult. After my first time sitting down with my therapist, however, I instantly started to gain perspective and look at the difficult situation in a different light. Our meetings helped me conquer the issue step by step and get my life back on track. I’d strongly recommend that anyone dealing with anxiety in a way that impacts their day to day life should visit the Center for Anxiety! I know it helped me tremendously.
Free of Obsessions
When I woke up one morning last June and didn’t want to get out of bed, I knew I needed help. The thought of getting through another day with all my anxieties, obsessions and rituals was just too overwhelming. After feeling stuck for years, I just couldn’t anymore. Thankfully, that’s when I found the Center for Anxiety. Dr. Rosmarin and his staff are experts at what they do, kind and professional. After just several weeks I accomplished my initial targets. The change I experienced in such a short amount of time was astounding that I stayed on for a while longer to work on more complex goals. I soon achieved those too. Now, I am free of my obsessions, know how to manage my anxiety, and love my life. My only regret: not having done this sooner. I wish I had known that you don’t have to wait to hit rock bottom to get help.
Depression Lifted
I’m 26 years old and I’ve been suffering from terrible depression for 7 years. In the throws of my sadness I literally wanted to die. Soon after starting therapy at the Center for Anxiety, my depression lifted. My suicidal thoughts began to dissipate. I remember the feeling that came over me as soon as the dark cloud above me left. It was the most liberating feeling I have ever experienced. I actually shouted to my friends, family and anyone nearby me “I’m Happy! I am Happy!” I felt free.
From EXISTING to LIVING
Over the course of four years I developed anxiety-like symptoms (tightness in chest, gut, back) that slowly but surely increased in duration and severity. The EXTREMELY uncomfortable nature of the symptoms notwithstanding, I still continued and managed to function. The effort required to do so, however, left me utterly drained. Having always been a very spiritual person I strongly felt that a course of therapy incorporating a spiritual component could potentially work well for me and decided to give the Center for Anxiety a try. Happily, I have achieved significant symptom reduction, tremendously improved emotional/mental health, and above all, Connection. Medication free. I’m no longer just existing, I’m LIVING. I’ve been given a second chance to become the unique human being that I was meant to be.
No More worries
I have wormed in healthcare for 36 years in many different settings, and I have been overwhelmingly satisfied with the Center for Anxiety. When staff says they are going to call, I get a call. From the first contact, I have been very impressed with the professionalism and efficiency. I had a situation and needed to have sessions more than once per week, and my clinicians worked out a schedule to accommodate my needs. I was astounded that they attended to me so quickly and effectively - they made my priority their priority. My clinicians were also excellent at what they do - they have a plan for me each session, and it's clear that they have thought in advance about each session, and that they are listening to what I say and observing what I do, even though our sessions have been conducted via Telehealth. Compassion is a quality that I have all too often found to be lacking in my experiences as a healthcare professional and patient, and this is not the case with the Center for Anxiety. Of all the websites I found on Google, I am so thankful that God guided my hand to yours.
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