Exploring Resilience as a Predictor of Outcomes in Psychological Therapies

Recent research suggests that tailoring therapies to individual needs can improve treatment outcomes. Understanding which patient characteristics influence outcomes is crucial in guiding clinicians towards tailoring interventions. Research reported in this thesis investigated whether an individual’s level of resilience (their ability to bounce back from difficulties) before therapy is linked to their recovery afterwards.

Section one presents a systematic review of 19 studies assessing the association between pre-treatment resilience and therapy outcomes. Two meta-analyses were conducted to estimate the overall association. The first meta-analysis indicated that higher resilience was associated with better outcomes. However, a second meta-analysis that considered how severe people's symptoms were at the start of therapy found no clear link between resilience and outcomes. This discrepancy may be attributed to the small number of studies in the second analysis, or suggest that the resilience-outcome relationship partially depends on baseline symptom severity. Importantly, the evidence from these meta-analyses is of very low certainty and must therefore be interpreted with caution. Further research is required to clarify these associations.

Section two presents a secondary analysis of data from a randomised controlled trial evaluating the effectiveness of cognitive-behavioural therapy and person-centred experiential therapy for depression. The study investigated whether pre-treatment resilience predicted treatment outcomes in these therapies. Items from the resilience questionnaire (CD-RISC-25) used in the trial were pared down to increase sensitivity to the phenomenon. Results indicated that participants with higher resilience before therapy had better outcomes immediately after treatment when considering the full group who entered the trial (including those who did not complete therapy). However, resilience did not predict outcomes for participants who received a minimum dose of therapy. Overall, findings suggest resilience might influence the likelihood of participants engaging with therapy. Resilience did not predict 12-month outcomes. Further research is needed to better understand these associations.