Consultations Interactions Coding Scheme: Predictive validity with session-by-session outcome and sudden gains

Early interaction-style and –type can affect outcomes
in cognitive behavioural therapy (CBT) for anxiety disorders. However, it is
unclear specifically what interactions are helpful or hindering in CBT for
severe health anxiety (SHA). This study aimed to identify interaction-styles
and types that predict session-by-session outcomes and sudden gains in CBT for SHA.
Each interaction in the first and second sessions of 49 recipients of CBT for
SHA was categorised and rated on the basis of patient activation: an
individual’s confidence and perceived ability to manage their own health.
Multilevel modelling was used to assess early interactions’ predictive validity
with session-by-session self-reported wellbeing. The 11 participants experiencing
sudden gains had each interaction in the session directly prior to the gain
similarly categorised and rated. The results were then compared to ratings of the
preceding session. The greater the proportion of first and second sessions
taken up with problem description interactions the smaller the improvement in
wellbeing over treatment course. Furthermore, there was a significant reduction
in problem description interactions at sessions directly prior to sudden gains,
as compared to preceding control sessions. Problem descriptions are needed
early in CBT for SHA, but they can reduce effectiveness if they dominate initial
discussions.