Extending the use of routine outcome monitoring: Predicting long-term outcomes in cognitive behavioral therapy for severe health anxiety

Objective: Routine outcome monitoring (ROM) is a well-evidenced means of improving psychotherapy's effectiveness. However, it is unclear how meaningful ROM is for problems that span physical and mental health, such as severe health anxiety. Physical and mental health comorbidities are common amongst severe health anxiety sufferers and cognitive behavioral therapy (CBT) is a recommended treatment. Method: Seventy-nine participants received CBT for severe health anxiety in a clinical trial. The Outcome Rating Scale (ORS: a ROM assessment of wellbeing) was completed at each session. Multilevel modeling assessed whether last-session ORS predicted health anxiety and other outcomes over 12-month follow-up. Similar models were developed using health anxiety as a comparative outcome-predictor. Outcome-improvements of treatment-responders with sudden gains were compared to those of non-sudden-gainers. Results: Last-session ORS scores predicted all outcomes up to 12 months later, with a comparable predictive effect to health anxiety. Sudden-gainers on the ORS reported significantly greater improvement in depression, functioning, and wellbeing, but no difference in health anxiety or other measures. Conclusion: The ORS may be a feasible, overall estimate of health, functioning, and quality of life in psychotherapy for severe health anxiety. Sudden gains on the ORS may be clinically meaningful with respect to some long-term outcomes