Research Setting Versus Clinic Setting: Which Produces Better Outcomes in Cognitive Therapy for Depression?

Cognitive Therapy and Research - 2012
Carly R. Gibbons1, Shannon Wiltsey Stirman2,3, Robert J. DeRubeis4, Cory F. Newman4, Aaron T. Beck4
1Philadelphia, USA
2National Center for PTSD, VA Boston Healthcare System, Boston, USA
3Boston University, Boston, USA
4University of Pennsylvania, Philadelphia, USA

Tóm tắt

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 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.

Từ khóa


Tài liệu tham khảo

Beck, A. T. (2005). The current state of cognitive therapy: A 40-year retrospective. Archives of General Psychiatry, 62, 953–959. doi:10.1001/archpsyc.62.9.953.

Beck, J. S. (2011). Cognitive therapy: Basics and beyond. New York, NY: Guilford Press.

Beck, A. T., & Freeman, A. (1990). Cognitive therapy of personality disorders. New York, NY: Guilford Press.

Beck, A. T., Rush, A. J., Shaw, B. F., & Emery, G. (1979). Cognitive therapy of depression. New York, NY: Guilford Press.

Beck, A. T., Steer, R.-A., Ball, R., & Ranieri, W. F. (1996). Comparison of Beck Depression Inventories-IA and -II in psychiatric outpatients. Journal of Personality Assessment, 67(3), 588–597. doi:10.1207/s15327752jpa6703_13.

Cohen, J. (1992). A power primer. Psychological Bulletin, 112, 155–159. doi:10.1037/0033-2909.112.1.155.

DeRubeis, R. J., Hollon, S. D., Amsterdam, J. D., Shelton, R. C., Young, P. R., Salomon, R. M., et al. (2005). Cognitive therapy vs. medications in the treatment of moderate to severe depression. Archives of General Psychiatry, 62(4), 409–416. doi:10.1001/archpsyc.62.4.409.

Dozois, D., Dobson, K., & Ahnberg, J. (1998). A psychometric evaluation of the Beck Depression Inventory-II. Psychological Assessment, 10, 83–89. doi:10.1037/1040-3590.10.2.83.

Elkin, I., Shea, M. T., Watkins, J. T., Imber, S. D., Sotsky, S. M., Collins, J. F., et al. (1989). NIMH treatment of depression collaborative research program: General effectiveness of treatments. Archives of General Psychiatry, 46, 971–982. doi:10.1001/archpsyc.1989.01810110013002.

First, M. B., & Gibbon, M. (2004). The structured clinical interview for DSM-IV axis I disorders (SCID-I) and the structured clinical interview for DSM-IV axis II disorders (SCID-II). Hoboken, NJ: Wiley.

Friedman, E. S., Wright, J. H., Jarrett, R. B., & Thase, M. E. (2006). Combining cognitive therapy and medication for mood disorders. Psychiatric Annals, 36, 320–332.

Gibbons, C. J., Fournier, J. C., Stirman, S. W., DeRubeis, R. J., Crits-Christoph, P., & Beck, A. T. (2010). The clinical effectiveness of cognitive therapy for depression in an outpatient clinic. Journal of Affective Disorders, 125(1–3), 169–176. doi:10.1016/j.jad.2009.12.030.

Hamilton, M. (1960). A rating scale for depression. Journal of Neurology, Neurosurgery and Psychiatry, 23, 56–62.

Hollon, S. D., DeRubeis, R. J., Evans, M. D., Wiemer, M. J., Garvey, M. J., Grove, W. M., et al. (1992). Cognitive therapy and pharmacotherapy for depression: Singly and in combination. Archives of General Psychiatry, 49, 774–781. doi:10.1001/archpsyc.1992.01820100018004.

Hunsley, J., & Lee, C. M. (2007). Research-informed benchmarks for psychological treatments: Efficacy studies, effectiveness studies, and beyond. Professional Psychology: Research and Practice, 38(1), 21–33. doi:10.1037/0735-7028.38.1.21.

Jacobson, N. S., Roberts, L. J., Berns, S. B., & McGlinchey, J. B. (1999). Methods for defining and determining the clinical significance of treatment effects: Description, application, and alternatives. Journal of Consulting and Clinical Psychology, 67, 300–307. doi:10.1037/0022-006X.67.3.300.

Jacobson, N. S., & Truax, P. (1991). Clinical significance: A statistical approach to defining meaningful change in psychotherapy research. Journal of Consulting and Clinical Psychology, 59, 12–19. doi:10.1037/0022-006X.59.1.12.

Kazdin, A. (2008). Evidence-based treatment and practice: New opportunities to bridge clinical research and practice, enhance the knowledge base, and improve patient care. American Psychologist, 63, 146–159. doi:10.1037/0003-066X.63.3.146.

Lambert, M. (2007). Presidential address: What we have learned from a decade of research aimed at improving psychotherapy outcome in routine care. Psychotherapy Research, 17(1), 1–14. doi:10.1080/10503300601032506.

Leichsenring, F., & Leibing, E. (2003). The effectiveness of psychodynamic therapy and cognitive-behavior therapy in the treatment of personality disorders: A meta-analysis. American Journal of Psychiatry, 160, 1223–1232. doi:10.1001/archpsyc.61.12.1208.

Murphy, G. E., Simons, A. D., Wetzel, R. D., & Lustman, P. J. (1984). Cognitive therapy and pharmacotherapy. Archives of General Psychiatry, 41, 33–41.

Newman, C. F., & Beck, J. S. (2008). Selecting, training, and supervising therapists in randomized controlled trials. In A. M. Nezu & C. M. Nezu (Eds.), Evidence-based outcome research: A practical guide to conducting randomized controlled trials for psychosocial interventions (pp. 245–262). Oxford, UK: Oxford University Press.

Perepletchikova, F., Treat, T. A., & Kazdin, A. E. (2007). Treatment integrity in psychotherapy research: Analysis of the studies and examination of the associated factors. Journal of Consulting and Clinical Psychology, 75, 829–841. doi:10.1037/0022-006X.75.6.829.

Reynolds, S., Stiles, W. B., Barkham, M., Shapiro, D. A., Hardy, G. E., & Rees, A. (1996). Acceleration of changes in session impact during contrasting time-limited psychotherapies. Journal of Consulting and Clinical Psychology, 64(3), 577–586. doi:10.1037/0022-006X.64.3.577.

Shadish, W. R., Matt, G. E., Navarro, A. M., & Phillips, G. (2000). The effects of psychological therapies under clinically representative conditions: A meta-analysis. Psychological Bulletin, 126(4), 512–529. doi:10.1037/0033-2909.126.4.512.

Stewart, R. E., & Chambless, D. L. (2009). Cognitive-behavioral therapy for adult anxiety disorders in clinical practice: A meta-analysis of effectiveness studies. Journal of Consulting and Clinical Psychology, 77(4), 595–606. doi:10.1037/a0016032.

Strunk, D. R., Brotman, M. A., DeRubeis, R. J., & Hollon, S. D. (2010). Therapist competence in cognitive therapy for depression: Predicting subsequent symptom change. Journal of Consulting and Clinical Psychology, 78(3), 429–437. doi:10.1037/a0019631.

Strunk, D. R., Cooper, A. A., Ryan, E. T., DeRubeis, R. J., & Hollon, S. D. (2012). The process of change in cognitive therapy for depression when combined with antidepressant medication: Predictors of early intersession symptom gains. Journal of Consulting and Clinical Psychology,. doi:10.1037/a0029281.

Weisz, J. R., Jensen-Doss, A., & Hawley, K. M. (2006). Evidence-based youth psychotherapies versus usual clinical care: A meta-analysis of direct comparisons. American Psychologist, 61(7), 671–689. doi:10.1037/0003-066X.61.7.671.

Westbrook, D., & Kirk, J. (2005). The clinical effectiveness of cognitive behaviour therapy: Outcome for a large sample of adults treated in routine practice. Behaviour Research and Therapy, 43(10), 1243–1260. doi:10.1016/j.brat.2004.09.006.

Thông tin
Thông tin xuất bản

Cognitive Therapy and Research

Thông tin tác giả