An Evaluation of Treatment Effectiveness
of The Sanctuary at Sedona
Coordinator/Editor/Summary Author: C. Girvani Leerer, Ph.D., Arizona Licensed Psychologist #4687, Clinical Director, The Sanctuary at Sedona
Author: Thomas Young, Ph.D., Econometric Studios, LLC/University of Utah, Independent Statistical Consultant
Principal Investigator, Interviewer: Janie Hogue, M.S., Arizona Licensed Professional Counselor #17778, Therapist/Case Manager, The Sanctuary at Sedona
This report addresses the treatment effectiveness of The Sanctuary at Sedona by looking at scores on outcome measures of 99 clients/participants admitted from February 2019 through January 2020, and discharged by end of February 2020 (n=99).
The three measurement instruments used were:
- The OQ-45.2, a 45 item scale that measures adult patient progress in treatment that is designed to be repeatedly administered during the course of treatment and at termination. The Total Score on the OQ-45.2 measures symptoms of distress including anxiety, depression, somatic problems, and stress. as well as interpersonal difficulties in social roles such as work, and in difficulties in quality of life. Higher scores indicate a greater number of symptoms and higher severity of symptoms.
- The PTSD Checklist for DSM-5 (PCL-5), a 20 item self-report measure that assesses the 20 DSM-5 symptoms of PTSD. The PCL-5 screens individuals for PTSD (Post Traumatic Stress Disorder), makes a provisional PTSD diagnosis and monitors symptom change during and after treatment. Higher scores indicate a greater number and severity of PTSD symptoms.
- The Brief Inventory of Thriving (BIT), a 10 item scale that measures a broad range of psychological well-being and offers a holistic view of positive functioning. Higher scores indicate higher psychological well-being.
All participants received these three measures upon admission, upon discharge, 30-days after discharge, and 90-days after discharge.
The methodology employed to inspect the results was Analysis of Variance for Repeated Measures (ANOVA for Repeated Measures).
OQ-45.2 Results
The first of the three measures tested was the OQ-45.2. The following Figure 1 contains the estimated marginal means for OQ-45.2. The chart indicates that the average person’s initial assessment was a score of 105.7. After going through The Sanctuary at Sedona, the average person’s score upon discharge dropped to 24.2. Some individuals participated in two further assessments 30-days after discharge and 90-days after discharge. The average scores for these assessments were 46.3 and 50.2.
Upon performing statistical testing to see if the average drop between the assessments was significant, the results were promising. With 99.2% confidence, participants lowered their overall OQ-45.2 assessment score by an average of 81.5 points. The results were also promising for the difference between the initial assessment and the post-30 day/post-90-day assessments. With 91.1% confidence, participants lowered their score by an average of 59.3 points between the first and third assessment and by 55.5 points between the first and fourth assessment (89.4% confidence).
The following Table 1 contains the statistical results. The chart shows the difference between the initial assessment (Instance 1, far left column) and the second, third, and fourth assessments (second column from the far left). As mentioned, the mean difference between the first and second assessment was 81.5 points and the significance level is 0.008 (or 99.2% confident that there is a decrease in score). The results on the difference between the initial assessment and the third and fourth assessments are somewhat less strong, but generally show a consistent drop in the overall score.
PCL-5 Results
The second measure of program effectiveness is the results on the PCL-5 assessments. The following figure shows the average scores for scores on the PCL-5 assessment for the four assessment periods. Overall, upon initial assessment, the average score was 27.3. Upon discharge, the average assessment dropped to 8.2. The average scores increased for the 30-day and 90-day post-discharge assessments, increasing to 10.2 and 13.5. It should be noted that the number of observations drops significantly for the third and fourth assessments, so much so that although there was a substantial drop in average scores, the statistical significance of that drop weakens because of the drop in the number of observations.
The following table reports the statistical results. Overall, the drop from the initial assessment to the discharge assessment is statistically significant. The average drop in score for participants was 19.167 points and a significance level of greater than 99%. Due to a drop in the number of observations, the average drop in scores of 17.167 for the 30-day post-assessment and the average drop of 13.833 points for the 90-days post-assessment was statistically insignificant. With that said, should further data be collected, it would not be surprising to see the drop in scores for the third and fourth assessments become statistically significant.
BIT Results
The third of the assessment results are the BIT results. The following figure reports the average scores by assessment. Overall, the scores trended upward after the initial assessment, increasing from 2.3 on the initial assessment to 4.6 upon discharge, and then holding values of 3.8/4.0 for the 30-day post-discharge/90-day post-discharge results.
The following table reports the statistical results. The “Mean Difference” column has the average change between the initial assessment and the second, third, or fourth assessment. On average, scores increased by 2.267 points from the initial assessment to the second assessment. This result was statistically significant with a confidence level of greater than 99%. Scores increased, on average, by 1,467 points from the initial to third assessment and by 1.667 points from the initial assessment to the fourth assessment. The difference between the first and third assessments was statistically insignificant, while the difference between the first and fourth assessment was statistically significant at greater than 99% confidence.
Summary and Limitations
While this is a small sample (n=99), particularly in regards to follow up observations at 30-day post-discharge and 90-day post-discharge, the outcome data results indicate that treatment at The Sanctuary at Sedona was effective at reducing symptoms of distress, symptoms of Post Traumatic Stress Disorder (PTSD), and increasing well-being.
There is a 99.2% confidence level of a decrease in symptoms of distress including anxiety, depression, somatic problems and stress, interpersonal difficulties in social roles such as work, and difficulties in quality of life for Participants between admission and discharge, as measured by scores on the OQ-45.2. Participants lowered their scores by an average of 81.5 points between admission and discharge, a statistical significance level of 0.008.
There is a 91.1% confidence level of decrease in symptoms between admission and 30 days post-discharge, with participants lowering their scores an average of 59.3 points, and an 89.4% confidence level of decrease in score between admission and 90-day post-discharge, with participants lowering their score an average of 55.5 points, The results on the difference between the initial admission assessment and post-discharge (third and fourth) assessments are somewhat less strong, but generally show a consistent drop in the overall score.
There is a significance level of greater than 99% in a decrease of PTSD symptoms for Participants from admission to discharge, as measured by scores on the PTSD Checklist for DSM-5 (PCL-5). Participant scores on PTSD symptoms dropped an average of 19.167 points. Due to a drop in the number of observations, the average drop in scores of 17.167 for the 30-day post-discharge assessment and the average drop of 13.833 points for the 90-days post-discharge assessment was statistically insignificant.
There is a confidence level of greater than 99% that Participants increased their well being from admission to discharge, as measured by scores on The Brief Inventory of Thriving (BIT). The increase in well being from admission to 30 days post-discharge was not significant. The increase in well being between admission and 90 days post-discharge was also statistically significant at greater than 99% confidence.
The most important limitation of this study, as noted above, is the smaller sample size, particularly in regards to follow up observations at 30-day post-discharge and 90-day post-discharge. Other study limitations include the use of all self-report measures which may be subject to either “faking good” or “faking bad” bias on the part of the participants/clients, and use of some report measures, (BIT and PCL-5) that lack reliability, validity, and/or utility. Another limitation is the lack of a measure that specifically addresses substance use although there are some questions regarding substance use on the OQ-45.2. Finally, this study did not look at the difference in treatment effectiveness by diagnostic category. Future studies should be designed to address these limitations.