An Exploration of Intervention Augmentation in a Single Case.
Plot weekly mood scores; if flat for two sessions, drop in a brief relaxation block and watch the line fall.
01Research in Context
What this study did
One therapist watched a client’s weekly anxiety and mood scores. When the scores stayed flat for two visits, she added a short relaxation module to the usual CBT plan.
The team tracked the client’s GAD-7 and PHQ-9 every week. They used simple line graphs to see if the extra breathing and muscle work helped.
What they found
After the add-on, the lines went steadily down. Both anxiety and depression dropped each week.
The client kept using the skills at home. The therapist never changed the medicine or the main CBT plan.
How this fits with other research
Tallant et al. (1989) ran a group class that mixed CBT with relaxation. Their big study showed the same good results, but for many people at once.
Rojahn et al. (1994) also tweaked CBT for one client. They added in-the-moment coaching instead of relaxation. Both single-case papers show you can bend CBT without breaking it.
Munno et al. (2023) let college students pick their own step goals. Like Boswell et al. (2023), they used daily data to decide when to change the plan.
Why it matters
You already track behavior data. Add a quick GAD-7 or PHQ-9 at check-in. If the numbers stall for two sessions, plug in a five-minute relaxation drill and keep plotting. One client got better without a full re-write of the program.
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02At a glance
03Original abstract
Recent work has highlighted that process-outcome relationships are likely to vary depending on the client, yet much work remains to be done in the area of tailoring interventions to a given client. This naturalistic single-case analysis provides an example of augmenting a treatment protocol with "off protocol" relaxation methods, based on routinely collected outcome information to guide shared decision making. Intensive case study analyses were applied to one client with principal generalized anxiety disorder and comorbid major depressive disorder receiving transdiagnostic cognitive-behavioral therapy. The client completed two routine anxiety and depression symptom and functioning scales prior to each session of naturalistic treatment. Time series analyses were applied to the two symptom measures. Among the results, (a) significant linear decreases in anxiety and depression from baseline to posttreatment were observed; and (b) the introduction of relaxation methods had a significant impact on the course of anxiety symptom change. In conclusion, routine outcome assessment can be used to inform intervention augmentation with individual clients. Furthermore, regular assessment is needed to determine if a client may benefit from an alternative set of specific intervention strategies.
Behavior modification, 2023 · doi:10.1177/0145445518796202