The Norway Couple Feedback Study
After a year of contemplating and debating the best possible design and methodology for an RCT in a naturalistic setting, 2 years of intensive data collection, and a year and a half of data analysis, writing, and rewriting, the Norway Couple Feedback Study (Anker, Duncan, & Sparks, in press) has received final acceptance from what I consider to be one of the top (if not the top) psychotherapy research journals on the planet, the Journal of Consulting and Clinical Psychology. Hoorah! I want to publicly thank and congratulate my colleagues and very good friends, Morten Anker and Jackie Sparks not only for their dedicated efforts on the largest RCT ever done with couples, the first feedback study to address couples, and the first RCT published using the ORS and the SRS, but also for their spirit of collaboration and teamwork—that often not experienced stuff that really makes each person bring out their best and propel such a project to fruition.
While we cannot disseminate the article, I can now let you know more about the results.
As most of you know, the study tested the effects of feedback in couples therapy compared with couples receiving treatment as usual (TAU) in a naturalistic setting (n=410). Consistent with our hypothesis, the feedback condition emerged as significantly superior to TAU. A moderate to large ES (0.50) was found for the feedback condition. The predicted score adjusted for severity of an average client in the feedback group was 4.89 points higher than an average client in the TAU group. The difference was, in effect, the difference required for reliable change. Said another way, the average post score for persons in the feedback condition (26.35) was nearly 5 points greater than the average post score for those in the TAU group (21.69). The difference between the groups, in other words, nearly constituted both a reliable change and transcended the clinical cut off. The proportion of clients responding to treatment in the TAU group was 41.7% (both in couple, 22.6%) and in the feedback group was 64.6% (both in couple, 50.5%). The strong effect of feedback seems particularly noteworthy given the relative simplicity of the intervention and in light of the comparison group being an active treatment.
In addition, the significant superiority of feedback over TAU was maintained at follow up. Moreover, the TAU group had a 34.2% separation/divorce rate v. 18.4% rate for the feedback condition. In the feedback group, 40.8% (both in couple) scored 25 or above and 5 or more points in change compared with 10.8% of non-feedback couples, a difference of nearly four times. Six month follow-up revealed that feedback maintained nearly a three-fold advantage in proportion of clinically significant change (35.7% v. 12.5%).
Another finding really blew us away—about therapist effects and feedback. The effect of feedback varied significantly across therapists, and was not due to outliers (extreme scores). The correlation between the variability in the effectiveness of a therapist with no feedback and variability in the effect of feedback was unusually high, r = -.99. Although the small number of therapists significantly limits any conclusions that can be drawn, it does suggest that the less effective therapists (those who had the worst outcomes without feedback) benefited more from feedback that the most effective therapists. Feedback, therefore, seems to act as a “leveler” among therapists, raising the effectiveness of lower or average therapists to that of their more successful colleagues. In fact, check this out: the therapist with the WORST results without feedback became the therapist with the BEST results with feedback! These preliminary findings based on but ten therapists warrant further investigation and replication. Nine of ten therapists benefited from the effects of feedback.
With this study in the bank, Jackie is writing a grant for replication with kids and families, and with Barry W. in Louisville, we are hoping to replicate in an inpatient setting.
Bottom Line: Add feedback to your work and watch your effectiveness soar!
Barry
While we cannot disseminate the article, I can now let you know more about the results.
As most of you know, the study tested the effects of feedback in couples therapy compared with couples receiving treatment as usual (TAU) in a naturalistic setting (n=410). Consistent with our hypothesis, the feedback condition emerged as significantly superior to TAU. A moderate to large ES (0.50) was found for the feedback condition. The predicted score adjusted for severity of an average client in the feedback group was 4.89 points higher than an average client in the TAU group. The difference was, in effect, the difference required for reliable change. Said another way, the average post score for persons in the feedback condition (26.35) was nearly 5 points greater than the average post score for those in the TAU group (21.69). The difference between the groups, in other words, nearly constituted both a reliable change and transcended the clinical cut off. The proportion of clients responding to treatment in the TAU group was 41.7% (both in couple, 22.6%) and in the feedback group was 64.6% (both in couple, 50.5%). The strong effect of feedback seems particularly noteworthy given the relative simplicity of the intervention and in light of the comparison group being an active treatment.
In addition, the significant superiority of feedback over TAU was maintained at follow up. Moreover, the TAU group had a 34.2% separation/divorce rate v. 18.4% rate for the feedback condition. In the feedback group, 40.8% (both in couple) scored 25 or above and 5 or more points in change compared with 10.8% of non-feedback couples, a difference of nearly four times. Six month follow-up revealed that feedback maintained nearly a three-fold advantage in proportion of clinically significant change (35.7% v. 12.5%).
Another finding really blew us away—about therapist effects and feedback. The effect of feedback varied significantly across therapists, and was not due to outliers (extreme scores). The correlation between the variability in the effectiveness of a therapist with no feedback and variability in the effect of feedback was unusually high, r = -.99. Although the small number of therapists significantly limits any conclusions that can be drawn, it does suggest that the less effective therapists (those who had the worst outcomes without feedback) benefited more from feedback that the most effective therapists. Feedback, therefore, seems to act as a “leveler” among therapists, raising the effectiveness of lower or average therapists to that of their more successful colleagues. In fact, check this out: the therapist with the WORST results without feedback became the therapist with the BEST results with feedback! These preliminary findings based on but ten therapists warrant further investigation and replication. Nine of ten therapists benefited from the effects of feedback.
With this study in the bank, Jackie is writing a grant for replication with kids and families, and with Barry W. in Louisville, we are hoping to replicate in an inpatient setting.
Bottom Line: Add feedback to your work and watch your effectiveness soar!
Barry
posted by Barry at
11:48 AM
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