Symptom Reduction Without Remoralization: A Randomized, Waiting-List Controlled Study Aimed at Separating Two Beneficial Psychotherapy Outcome Effects.

OBJECTIVE: Treatment effects in psychotherapy outcome research are generally based on the reduction of symptoms. Standard inclusion of other beneficial treatment effects such as remoralization (increase of hope, self-efficacy, well-being) might lead to more elaborate findings in the field of psychotherapy. On the other hand, it is also possible that symptom reduction and remoralization always go hand in hand in the experience of patients. The present study sought to experimentally test this assumption. METHOD: A total of 78 patients suffering from panic disorder were randomly assigned to brief remoralization treatment, brief exposure treatment, or waiting list (WL). RESULTS: Both treatments increased remoralization and both reduced symptoms of panic disorder as compared to WL. CONCLUSION: It is unlikely that patients experience remoralization without symptom reduction or symptom reduction without remoralization. These findings do not favor the assumption that conclusions within psychotherapy outcome research are flawed because of its heavy reliance on measurements of symptom reduction.

Utility of measuring remoralization in addition to symptoms in efficacy research: a preliminary study.

Remoralization as an outcome measure for psychological treatments was compared with symptom reduction (agoraphobic avoidance and cognitions). Twenty-four patients with panic disorder and agoraphobia received empirically supported treatment and were monitored across multiple time points for 28 weeks. Treatment resulted in reduced symptoms and enhanced remoralization (Cohen's d=1.19-1.45). Slopes of symptoms and remoralization were obtained from latent growth model analyses. The slopes correlated highly (r=- .50 to -.55), which indicates similar patterns of change over time. The slope of remoralization also correlated with a number of aspects of health-related quality of life, while the slope of symptom reduction did not. Although strongly related to symptom reduction, the measurement of remoralization is expected to provide unique information for treatment efficacy research.