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Early general change mechanisms (GCMs) have been shown to be associated with psychotherapy outcome but it remains unclear which specific patients benefit from which GCM. This study explored whether the patients' characteristic motivational incongruence moderates the effect of GCMs in the early treatment phase on the outcome. Three early GCMs (interpersonal experiences, intrapersonal experiences, and problem actuation) were evaluated after five therapy-preparing sessions by patients and therapists. On the basis of previous work, we assumed that the association between intrapersonal experiences and outcome is moderated by incongruence. A total of 524 patients completing outpatient cognitive behavioural therapy (CBT) were investigated. The patient-reported outcome measure was psychological symptom severity. The patients' motivational incongruence was assessed with the incongruence questionnaire short form at baseline. Results showed that therapists' ratings of all three early GCMs and patients' ratings of early problem actuation were not associated with CBT outcome. By contrast, positive patients' ratings of early interpersonal and early intrapersonal experiences were beneficial for CBT outcome (both p

General change mechanisms (GCMs) have been shown to predict treatment outcome in cognitive behavioral therapy (CBT). Early changes in GCMs (early-change-GCMs) and in symptom severity were also linked to treatment outcome, but evidence is still limited. We investigated whether early-change-GCMs from patients' and therapists' perspectives in addition to early changes in symptom severity predict treatment outcome. Data from a university-based outpatient clinic was analyzed (

Dropping out of psychotherapeutic treatment (i.e., the patient ending treatment unilaterally) poses a problem for patients, therapists, and the health care sector. Previous research showed that changes in symptom severity and general change mechanisms (GCMs), such as interpersonal experiences, intrapersonal experiences, and problem actuation, might be related to drop-out. We investigated the relationship of these predictors and drop-out in a sample of 724 patients (21.1% drop-out) receiving cognitive-behavioral therapy in routine care from a German outpatient clinic. Survival analysis was used to account for the longitudinal nature of the data created by routine outcome monitoring and to deal with the time varying predictors, GCMs, and changes in symptom severity. As outcome, we predicted the risk of dropping out. Results showed that patient- and therapist-rated interpersonal experiences, which include alliance, significantly predicted the risk for drop-out. Contrary to previous research, intrapersonal experiences and symptom severity change did not predict drop-out. Overall, GCMs and symptom severity change accounted for 3.8% of explained variance in the outcome. These results entail that it is important to monitor interpersonal experiences over the course of treatment to identify patients at risk for drop-out. (PsycInfo Database Record (c) 2020 APA, all rights reserved).