Cognitive Therapy and Research

, Volume 23, Issue 5, pp 535–548 | Cite as

Results of Randomized Controlled Trials of Cognitive Therapy for Depression Generalize to Private Practice

  • Jacqueline B. Persons
  • Alan Bostrom
  • Andrew Bertagnolli

Abstract

We compared outcomes of 45 depressed patientstreated in private practice with cognitive therapy orwith cognitive therapy plus pharmacotherapy to outcomesof patients receiving those treatments in two randomized controlled trials. Private practiceand research samples differed considerably, with privatepractice patients having more psychiatric and medicalcomorbidities and a greater range of initial depression severity. Treatment in privatepractice and research settings also differed, withprivate practice treatment conducted in a more flexiblemanner using an idiographic, formulation-drivenapproach. As predicted, private practice patients showedstatistically significant reductions in depressivesymptomatology over the course of treatment, and at posttreatment, Beck Depression Inventory (BDI) scores of patients treated in private practice andresearch settings were not statistically significantlydifferent. Clinical significance of outcomes was alsocomparable in the clinical and research samples. Of the variables measuring demographic,illness, and treatment factors, only pretreatment BDIscore predicted post treatment BDI score in the privatepractice sample.

EFFECTIVENESS STUDY RANDOMIZED CONTROLLED TRIALS COGNITIVE THERAPY FOR DEPRESSION 

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REFERENCES

  1. Agency for Health Care Policy and Research, U. S. Public Health Service. (1993). Clinical Practice Guideline Number 5. Depression in Primary Care: Volume 2. Treatment of Major Depression. Rockville, MD: Author.Google Scholar
  2. American Psychiatric Association (1987). Diagnostic and statistical manual of mental disorders (DSMIII-R). Washington, DC: Author.Google Scholar
  3. Barlow, D.H., Hayes, S. C., & Nelson, R. O. (1984). The scientist-practitioner: Research and accountability in clinical and educational settings. New York: Pergamon.Google Scholar
  4. Beck, A. T., Rush, A. J., Shaw, B. F., & Emery, G. (1979). Cognitive therapy of depression. New York: Guilford.Google Scholar
  5. Beck, A. T., Steer, R. A. & Garbin, M. G. (1988). Psychometric properties of the Beck Depression Inventory: Twenty-five years of evaluation. Clinical Psychology Review, 8, 77–100.Google Scholar
  6. Chambless, D. L., Sanderson, W. C., Shoham, V., Bennett Johnson, S., Pope, K. S., Crits-Christoph, P., Baker, M., Johnson, B., Woody, S. R., Sue, S., Beutler, L., Williams, D. A., & McCurry, S. (1996). An update on empirically validated therapies. The Clinical Psychologist, 49, 5–18.Google Scholar
  7. DeRubeis, R. J., & Crits-Christoph, P. (1998). Empirically supported individual and group psychological treatments for adult mental disorders. Journal of Consulting and Clinical Psychology, 66, 37–52.Google Scholar
  8. Eifert, G. H., Evans, I. M., & McKendrick, V. G. (1990). Matching treatments to client problems not diagnostic labels: A case for paradigmatic behavior therapy. Journal of Behavior Therapy and Experimental Psychiatry, 21, 163–172.Google Scholar
  9. Elkin, I., Shea, M. T., Watkins, J. T., Imber, S. D., Sotsky, S. M., Collins, J. F., Glass, D. R., Pilkonis, P. A., Leber, W. R., Docherty, J. P., Fiester, S. J., & Parloff, M. B. (1989). NIMH Treatment of Depression Collaborative Research Program: General effectiveness of treatments. Archives of General Psychiatry, 46, 971–982.Google Scholar
  10. Frances, A., Kahn, D., Carpenter, D., Frances, C., & Docherty, J. (1998). A new method of developing expert consensus guidelines. American Journal of Managed Care. 4, 1023–1029.Google Scholar
  11. Greene, B., & Blanchard, E. B. (1994). Cognitive therapy for irritable bowel syndrome. Journal of Consulting and Clinical Psychology, 62, 576–582.Google Scholar
  12. Haaga, D. A. F., DeRubeis, R. J., Stewart, B. L., & Beck, A. T. (1991). Relationship of intelligence with cognitive therapy outcome. Behaviour Research and Therapy, 29, 277–281.Google Scholar
  13. Jacobson, N. S., & Christensen, A. (1996). Studying the effectiveness of psychotherapy: How well can clinical trials do the job? American Psychologist, 51, 1031–1039.Google Scholar
  14. 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.Google Scholar
  15. Murphy, G. E., Simons, A. D., Wetzel, R. D., & Lustman, P. J. (1984). Cognitive therapy and pharmacotherapy. Archives of General Psychiatry, 41, 33–41.Google Scholar
  16. Ogles, B. M., Lambert, M. J., & Sawyer, J. D. (1995). Clinical significance of the National Institute of Mental Health Treatment of Depression Collaborative Research Program Data. Journal of Consulting and Clinical Psychology, 63, 321–326.Google Scholar
  17. Organista, K. C., Muñoz, R., & Gonzalez, G. (1994). Cognitive behavioral therapy for depression in low-income and minority medical outpatients: Description of a program and exploratory analyses. Cognitive Therapy and Research, 18, 241–259.Google Scholar
  18. Persons, J. B. (1989). Cognitive therapy in practice: A case formulation approach. New York: Norton.Google Scholar
  19. Persons, J. B. (1991). Psychotherapy outcome studies do not accurately represent current models of psychotherapy: A proposed remedy. American Psychologist, 46, 99–106.Google Scholar
  20. Persons, J. B. (1995). Why practicing psychologists are slow to adopt empirically-validated treatments. In S. C. Hayes, V.M. Follette, R. M. Dawes, & K. E. Grady (Eds.), Scientific standards of psychological practice: Issues and recommendations (pp. 141–157). Reno, NV: Context Press.Google Scholar
  21. Persons, J. B., Burns, D. D., & Perloff, J. M. (1988). Predictors of dropout and outcome in private practice patients treated with cognitive therapy for depression. Cognitive Therapy and Research, 12, 557–575.Google Scholar
  22. Persons, J. B., & Silberschatz, G. (1998). Are results of randomized controlled trials useful to psychotherapists? Journal of Consulting and Clinical Psychology, 66, 126–135.Google Scholar
  23. Persons, J. B., & Tompkins, M. A. (1997). Cognitive-behavioral case formulation. In T. D. Eells (Ed.), Handbook of psychotherapy case formulation. New York: Guilford.Google Scholar
  24. Sackett, D. L., Richardson, W. S., Rosenberg, W., & Haynes, R. B. (1997). Evidence-based medicine: How to practice and teach EBM. New York: Churchill Livingstone.Google Scholar
  25. Seligman, M. E. P. (1995). The effectiveness of psychotherapy: The Consumer Reports study. American Psychologist, 50, 965–974.Google Scholar
  26. Seligman, M. E. P. (1996). Science as an ally of practice. American Psychologist, 51, 1072–1079.Google Scholar
  27. Speer, D. C. (1992). Clinically significant change: Jacobson and Truax (1991) revisited. Journal of Consulting and Clinical Psychology, 60, 402–408.Google Scholar
  28. Speer, D. C. (1993). Correction to Speer. Journal of Consulting and Clinical Psychology, 61, 27.Google Scholar
  29. Wade, W. A., Treat, T. A., & Stuart, G. L. (1998). Transporting an empirically supported treatment for panic disorder to a service clinic setting: A benchmarking strategy. Journal of Consulting and Clinical Psychology, 1998, 66, 231–239.Google Scholar
  30. Weisz, J. R., Donenberg, G. R., Han, S. S., & Kauneckis, D. (1995). Child and adolescent psychotherapy outcomes in experiments versus clinics: Why the disparity? Journal of Abnormal Child Psychology, 23, 83–106.Google Scholar
  31. Wilson, G. T. (1995). Empirically-validated treatments as a basis for clinical practice: Problems and prospects. In S. C. Hayes, V. M. Folletee, R. M. Dawes, and K. E. Grady (Eds.) Scientific standards of psychological practice: Issues and recommendations (pp. 163–196). Reno, NV: Context Press.Google Scholar

Copyright information

© Plenum Publishing Corporation 1999

Authors and Affiliations

  • Jacqueline B. Persons
  • Alan Bostrom
  • Andrew Bertagnolli

There are no affiliations available

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