Therapist-rated Engagement and Compliance as Proxies for Treatment Success: A Bayesian Mediation Analysis of Exposure and Stress Management for Adults with Misophonia
Previous research has found that treatment engagement and compliance predict better outcomes for a number of mental health symptoms. These common factors may contribute over and above the particular effects of specific psychotherapeutic interventions. This study assessed whether therapist-rated engagement and treatment compliance mediated outcome in a randomized controlled trial (RCT) of exposure and stress management for adults with misophonia (selective sound aversion). A theoretical pathway was proposed in which engagement and treatment compliance would increase inhibitory learning, foster distress tolerance and reduce anxiety sensitivity, and mediate clinical outcome. Participants (n = 18) received six sessions of exposure and six session of stress management over six weeks. Study therapists rated engagement and treatment compliance after sessions 2, 4, 6, 8, 10 and 12. Bayesian mediation analysis was conducted on misophonia symptoms, behaviors, and severity ratings, as well as secondary outcome measures. None of the initial models converged. However, employing a sample simulated from the models’ correlation matrix (n = 100), posterior probabilities were computed for path alpha, beta, tau, and full mediation. Bayesian credible intervals suggested that engagement and treatment compliance were not significant mediators. Further, Bayes factors (< 0.33) supported the null hypothesis for primary outcomes. This could suggest that technical aspects of cognitive-behavioral therapy were sufficient to produce change in our sample. However, there were several limitations including sample size, a lack of psychometric evidence, and the potential for rater error. In addition, there was some evidence for a nonlinear mediational pathway. Future studies should be conducted on this topic with larger samples.^
Frank, Brandon, "Therapist-rated Engagement and Compliance as Proxies for Treatment Success: A Bayesian Mediation Analysis of Exposure and Stress Management for Adults with Misophonia" (2017). ETD Collection for Fordham University. AAI10617067.