Daily affect dynamics predict early response in CBT: Feasibility and predictive validity of EMA for outpatient psychotherapy

K. Husen, E. Rafaeli, J. A. Rubel, E. Bar-Kalifa, W. Lutz

Research output: Contribution to journalArticlepeer-review

32 Scopus citations


Background Previous studies have shown that individual differences in affect dynamics during depressed patients’ everyday lives allow the prediction of treatment outcome and of symptom reoccurrence in remitted patients. In this study, we analyze whether understanding patients’ affective states and their fluctuation patterns helps predict early treatment response (until session 5). Methods Ecological Momentary Assessment (EMA) strategies allow in-depth analyses of real-time affective states and of their dynamics. Repeated assessments were made four times a day during a two-week period to capture real-life affective states (positive affect, PA and negative affect, NA) and dynamics (fluctuations in NA and PA) before the start of outpatient treatment of 39 patients. Due to the nested structure of the data, hierarchical linear models were conducted. Results PA/NA ratios, as well as fluctuations in NA predicted early treatment response, even when adjusting for initial impairment. In contrast, mean levels of NA or PA, as well as fluctuations in PA did not predict treatment response. Limitations The time between the EMA assessment and treatment onset varied between patients. However, this variation was not associated with early change. Conclusions The results suggest that pre-treatment affect dynamics could provide valuable information for predicting treatment response independent of initial impairment levels. Better predictions of early treatment response help to improve treatment choices early in the treatment progress.

Original languageEnglish
Pages (from-to)305-314
Number of pages10
JournalJournal of Affective Disorders
StatePublished - 1 Dec 2016
Externally publishedYes


  • Early response
  • Ecological momentary assessment
  • Emotion/affect dynamics
  • Patient-focused psychotherapy research

ASJC Scopus subject areas

  • Clinical Psychology
  • Psychiatry and Mental health


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