UC Berkeley

Patient treatment engagement is a construct composed of two parts: attitudinal engagement and behavioral engagement. Although previous studies have started to demonstrate a relation between treatment engagement and treatment outcome, such research typically has limited long- term follow-up, often focuses on only one treatment or patient population, utilizes varied measures of engagement, and often measures attitudinal or behavioral engagement (but not both). The present study seeks to address these gaps by evaluating treatment engagement across three different interventions and three different patient populations: adults with interepisode bipolar disorder and insomnia (N = 58), adults with depression (N = 48), and adolescents with sleep and circadian problems (N = 176). The first aim was to examine whether attitudinal engagement with treatment—measured as higher credibility/expectancy scores—predicts treatment outcome. The second was to examine whether behavioral engagement with treatment—measured as ratings of adherence by providers—predicts treatment outcome. Results from Study 1 and Study 3 indicate that attitudinal engagement is associated with select measures of treatment outcome. Results from Study 2 suggest that attitudinal engagement is associated with an improvement in symptoms whereas behavioral engagement is associated with improvement in functioning. Overall, results underscore the impact of attitudinal engagement on treatment outcome and highlight important areas for future research.