The Case for Evidence-Based Stepped Care as Part of a Reformed Delivery System

  • William T. O’Donohue
  • Crissa Draper


Healthcare is in crisis in the United States (Cummings and O’Donohue, 2008). Most view healthcare as too costly, of uneven quality, difficult to access, and inefficient. Behavioral healthcare is no different. Practitioners often charge 10–20 times the minimum wage (and sometimes argue that even this price is insufficient) and provide assessment and therapies of unknown quality or those that are obviously deficient (e.g., Rorschach, rebirthing, drum circles) (Lilienfeld et al., 2008). Waits for child psychiatrists can be from months to half a year, and services are unevenly distributed geographically.


Consumer Preference Individual Therapy Watchful Waiting Chronic Disease Management Mental Health Field 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


  1. Ackerson J, Scogin F, McKendree-Smith N, Lyman RD. Cognitive bibliotherapy for mild and moderate adolescent depressive symptomatology. J Consult Clin Psychol. 1998;66(4):685–90.CrossRefPubMedGoogle Scholar
  2. Antonuccio D, Danton W, DeNelsky G. Psychotherapy versus medication for depression: challenging the conventional wisdom with data. Prof Psychol: Res Pr. 1995;26(6):574–85.CrossRefGoogle Scholar
  3. Becker CB, Zayfert C, Anderson E. A survey of psychologists’ attitudes towards and utilization of exposure therapy for PTSD. Behav Res Therapy. 2004;42(3):277–92. doi:10.1016/S0005-7967(03)00138-4CrossRefGoogle Scholar
  4. Bischof G, Grothues JM, Reinhardt S, Meyer C, John U, Rumpf HJ. Evaluation of a telephone-based stepped care intervention for alcohol-related disorders: a randomized controlled trial. Drug Alcohol Dependence. 2008;93:244–51.CrossRefGoogle Scholar
  5. Burns D. Feeling good: the new mood therapy revised and updated. New York: HarperCollins; 1999.Google Scholar
  6. Cummings NA, O’Donohue WT. Eleven blunders that cripple psychotherapy in America: a remedial unblundering. New York: Routledge; 2008.Google Scholar
  7. Floyd M, Scogin F, McKendree-Smith NL, Floyd DL, Rokke PD. Cognitive therapy for depression: a comparison of individual psychotherapy and bibliotherapy for depressed older adults. Behav Modif. 2004;28(2):297–318.CrossRefPubMedGoogle Scholar
  8. Gould RA, Clum GA, Shapiro D. The use of bibliotherapy in the treatment of panic: a preliminary investigation. Behav Ther. 1993;24(2):241–52.CrossRefGoogle Scholar
  9. James LC, O’Donohue WT. The primary care toolkit: practical resources for the integrated behavioral care provider; 2008.Google Scholar
  10. Jamison C, Scogin F. The outcome of cognitive bibliotherapy with depressed adults. J Consult Clin Psychol. 1995;63(4):644–50.CrossRefPubMedGoogle Scholar
  11. Katon W, Korff MV, Lin E, Unützer J, Simon G, Ludman E, et al. Population-based care of depression: effective disease management strategies to decrease prevalence. Gen Hosp Psychiatry. 1997;19(3):169–78.CrossRefPubMedGoogle Scholar
  12. Lilienfeld SO, Lynn SJ, Lohr JM (Eds.). Science and pseudoscience in clinical psychology. New York: Guilford; 2008.Google Scholar
  13. O’Donohue WT, Byrd MR, Cummings N, Henderson DA. Behavioral integrative care: treatments that work in the primary care setting. 1st ed. New York, NY: Routledge; 2004.Google Scholar
  14. Paul GL. Strategy of outcome research in psychotherapy. J Consult Psychol. 1967;31(2):109–18.CrossRefPubMedGoogle Scholar
  15. Scogin F, Hamblin D, Beutler L. Bibliotherapy for depressed older adults: a self-help alternative. Gerontologist. 1987;27(3):383–7.PubMedGoogle Scholar
  16. Wylie-Rosett J, Swencionis C, Ginsberg M, Cimino C, Wassertheil-Smoller S, Caban A, et al. Computerized weight loss intervention optimizes staff time: the clinical and cost results of a controlled in a managed care setting. J Am Diet Assoc. 2001;101:1155–62.CrossRefPubMedGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2011

Authors and Affiliations

  1. 1.Department of PsychologyUniversity of Nevada-RenoRenoUSA

Personalised recommendations