Cognitive Therapy and Research

, Volume 37, Issue 3, pp 605–612 | Cite as

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
Original Article


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.


Cognitive therapy Depression Effectiveness 



This research and manuscript preparation was supported by grants MH47383 (Dr. Beck), K99/R00MH080100 (Dr. Stirman) and MH50129 (R10) (Dr. DeRubeis) and MH55875 (R10) from the National Institute of Mental Health, Bethesda, MD and by grant R49/CCR316866 (Dr. Beck) by the Center for Disease Control.


  1. 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.PubMedCrossRefGoogle Scholar
  2. Beck, J. S. (2011). Cognitive therapy: Basics and beyond. New York, NY: Guilford Press.Google Scholar
  3. Beck, A. T., & Freeman, A. (1990). Cognitive therapy of personality disorders. New York, NY: Guilford Press.Google Scholar
  4. Beck, A. T., Rush, A. J., Shaw, B. F., & Emery, G. (1979). Cognitive therapy of depression. New York, NY: Guilford Press.Google Scholar
  5. 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.PubMedCrossRefGoogle Scholar
  6. Cohen, J. (1992). A power primer. Psychological Bulletin, 112, 155–159. doi: 10.1037/0033-2909.112.1.155.PubMedCrossRefGoogle Scholar
  7. 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.PubMedCrossRefGoogle Scholar
  8. 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.CrossRefGoogle Scholar
  9. 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.PubMedCrossRefGoogle Scholar
  10. 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.Google Scholar
  11. 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.Google Scholar
  12. 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.PubMedCrossRefGoogle Scholar
  13. Hamilton, M. (1960). A rating scale for depression. Journal of Neurology, Neurosurgery and Psychiatry, 23, 56–62.CrossRefGoogle Scholar
  14. 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.PubMedCrossRefGoogle Scholar
  15. 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.CrossRefGoogle Scholar
  16. 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.PubMedCrossRefGoogle Scholar
  17. 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.PubMedCrossRefGoogle Scholar
  18. 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.PubMedCrossRefGoogle Scholar
  19. 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.CrossRefGoogle Scholar
  20. 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.PubMedCrossRefGoogle Scholar
  21. Murphy, G. E., Simons, A. D., Wetzel, R. D., & Lustman, P. J. (1984). Cognitive therapy and pharmacotherapy. Archives of General Psychiatry, 41, 33–41.PubMedCrossRefGoogle Scholar
  22. 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.Google Scholar
  23. 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.PubMedCrossRefGoogle Scholar
  24. 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.PubMedCrossRefGoogle Scholar
  25. 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.PubMedCrossRefGoogle Scholar
  26. 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.PubMedCrossRefGoogle Scholar
  27. 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.PubMedCrossRefGoogle Scholar
  28. 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.PubMedGoogle Scholar
  29. 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.PubMedCrossRefGoogle Scholar
  30. 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.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media New York (outside the USA) 2012

Authors and Affiliations

  • Carly R. Gibbons
    • 1
  • Shannon Wiltsey Stirman
    • 2
    • 3
  • Robert J. DeRubeis
    • 4
  • Cory F. Newman
    • 4
  • Aaron T. Beck
    • 4
  1. 1.PhiladelphiaUSA
  2. 2.National Center for PTSDVA Boston Healthcare SystemBostonUSA
  3. 3.Boston UniversityBostonUSA
  4. 4.University of PennsylvaniaPhiladelphiaUSA

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