Research Setting Versus Clinic Setting: Which Produces Better Outcomes in Cognitive Therapy for Depression?
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ORIGINAL ARTICLE
Research Setting Versus Clinic Setting: Which Produces Better Outcomes in Cognitive Therapy for Depression? Carly R. Gibbons • Shannon Wiltsey Stirman Robert J. DeRubeis • Cory F. Newman • Aaron T. Beck
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Published online: 13 November 2012 Ó Springer Science+Business Media New York (outside the USA) 2012
Abstract To compare the outcomes of cognitive therapy for depression under controlled and clinically representative conditions, while holding several therapist and clinical assessment factors constant. Treatment outcomes for a sample of 23 adults with a primary diagnosis of Major Depressive Disorder who received cognitive therapy in an outpatient clinic were compared with outcomes of 18 clients who were treated in the cognitive therapy condition of a large, multi-site randomized clinical trial of treatments for depression. All participants had been treated by one of two therapists who served as clinicians in both settings. Individuals in the two samples were diagnostically and demographically similar (approximately 50 % Female, 83 % White). A variety of client characteristics, assessed prior to treatment, as well as the outcomes of treatment, were examined. Significantly superior treatment outcomes were observed in the individuals treated in the research study, relative to clients in the outpatient clinic, and the difference was not accounted for by intake characteristics. Individuals treated by the therapists in the RCT experienced almost three times as much improvement in depressive symptoms as clients seen in the outpatient setting. If replicated, the findings suggest that differences C. R. Gibbons Philadelphia, PA, USA S. Wiltsey Stirman (&) National Center for PTSD, VA Boston Healthcare System, Boston, MA, USA e-mail: [email protected] S. Wiltsey Stirman Boston University, Boston, MA, USA R. J. DeRubeis C. F. Newman A. T. Beck University of Pennsylvania, Philadelphia, PA, USA
exist between treatment outcomes in research and outpatient settings and that these differences may not simply be due to therapist experience and training, or differences in patient populations. Future research should further examine the impact of fidelity monitoring, treatment expectation and motivation, and the duration and timing of treatment protocols on clinical outcomes. Keywords Cognitive therapy Depression Effectiveness
Introduction The establishment of a set of evidence-based treatments (EBTs; see Kazdin 2008) has depended heavily on findings from randomized clinical trials (RCTs). The maximization of internal validity in RCTs are seen as great advantages by developers of treatment guidelines, but lead some to question the relevance of RCT findings to clinical practice (Kazdin 2008). Features of RCTs include stringent inclusion and exclusion criteria, treatment manuals, and careful selection, training, and supervision of therapists. Such factors may lead to differences in treatment delivery and outcomes in RCTs compared to routine care settings. The effectiveness and efficacy of cognitive therapy (CT) have b
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