Using a shared parameter mixture model to estimate change during treatment when termination is related to recovery speed
Gottfredson, N. C., Bauer, D. J., Baldwin, S. A., & Okiishi, J. C. (2014). Using a shared parameter mixture model to estimate change during treatment when termination is related to recovery speed. Journal of Consulting and Clinical Psychology, 82(5), 813-827. https://doi.org/10.1037/a0034831
Objective: This study demonstrates how to use a shared parameter mixture model (SPMM) in longitudinal psychotherapy studies to accommodate missingness that is due to a correlation between rate of improvement and termination of therapy. Traditional growth models assume that such a relationship does not exist (i.e., assume that data are missing at random) and produce biased results if this assumption is incorrect. Method: We used longitudinal data from 4,676 patients enrolled in a naturalistic study of psychotherapy to compare results from a latent growth model and an SPMM. Results: In this data set, estimates of the rate of improvement during therapy differed by 6.50%-6.66% across the two models, indicating that participants with steeper trajectories left psychotherapy earliest, thereby potentially biasing inference for the slope in the latent growth model. Conclusion: We conclude that reported estimates of change during therapy may be underestimated in naturalistic studies of therapy in which participants and their therapists determine the end of treatment. Because non-randomly missing data can also occur in randomized controlled trials or in observational studies of development, the utility of the SPMM extends beyond naturalistic psychotherapy data.