Journal article
Clinical effectiveness of cognitive behavioral therapy for depression in routine care: A propensity score based comparison between randomized controlled trials and clinical practice.
- Lutz W Clinical Psychology and Psychotherapy, Department of Psychology, University of Trier, D-54296 Trier, Germany. Electronic address: wolfgang.lutz@uni-trier.de.
- Schiefele AK Clinical Psychology and Psychotherapy, Department of Psychology, University of Trier, D-54296 Trier, Germany. Electronic address: schiefele@uni-trier.de.
- Wucherpfennig F Clinical Psychology and Psychotherapy, Department of Psychology, University of Trier, D-54296 Trier, Germany. Electronic address: wucherpfennig@uni-trier.de.
- Rubel J Clinical Psychology and Psychotherapy, Department of Psychology, University of Trier, D-54296 Trier, Germany. Electronic address: rubel@uni-trier.de.
- Stulz N Department of Psychology, University of Berne, Fabrikstrasse 8, CH-3012 Berne, Switzerland. Electronic address: niklaus.stulz@psy.unibe.ch.
- 2015-10-05
Published in:
- Journal of affective disorders. - 2016
Clinical practice
Cognitive behavioral therapy
Depressive disorders
Propensity score matching
Randomized controlled trial
Treatment effects
Adult
Cognitive Behavioral Therapy
Depression
Female
Humans
Male
Propensity Score
Treatment Outcome
United States
English
BACKGROUND
The efficacy of cognitive behavioral therapy (CBT) for the treatment of depressive disorders has been demonstrated in many randomized controlled trials (RCTs). This study investigated whether for CBT similar effects can be expected under routine care conditions when the patients are comparable to those examined in RCTs.
METHOD
N=574 CBT patients from an outpatient clinic were stepwise matched to the patients undergoing CBT in the National Institute of Mental Health Treatment of Depression Collaborative Research Program (TDCRP). First, the exclusion criteria of the RCT were applied to the naturalistic sample of the outpatient clinic. Second, propensity score matching (PSM) was used to adjust the remaining naturalistic sample on the basis of baseline covariate distributions. Matched samples were then compared regarding treatment effects using effect sizes, average treatment effect on the treated (ATT) and recovery rates.
RESULTS
CBT in the adjusted naturalistic subsample was as effective as in the RCT. However, treatments lasted significantly longer under routine care conditions.
LIMITATIONS
The samples included only a limited amount of common predictor variables and stemmed from different countries. There might be additional covariates, which could potentially further improve the matching between the samples.
CONCLUSIONS
CBT for depression in clinical practice might be equally effective as manual-based treatments in RCTs when they are applied to comparable patients. The fact that similar effects under routine conditions were reached with more sessions, however, points to the potential to optimize treatments in clinical practice with respect to their efficiency.
The efficacy of cognitive behavioral therapy (CBT) for the treatment of depressive disorders has been demonstrated in many randomized controlled trials (RCTs). This study investigated whether for CBT similar effects can be expected under routine care conditions when the patients are comparable to those examined in RCTs.
METHOD
N=574 CBT patients from an outpatient clinic were stepwise matched to the patients undergoing CBT in the National Institute of Mental Health Treatment of Depression Collaborative Research Program (TDCRP). First, the exclusion criteria of the RCT were applied to the naturalistic sample of the outpatient clinic. Second, propensity score matching (PSM) was used to adjust the remaining naturalistic sample on the basis of baseline covariate distributions. Matched samples were then compared regarding treatment effects using effect sizes, average treatment effect on the treated (ATT) and recovery rates.
RESULTS
CBT in the adjusted naturalistic subsample was as effective as in the RCT. However, treatments lasted significantly longer under routine care conditions.
LIMITATIONS
The samples included only a limited amount of common predictor variables and stemmed from different countries. There might be additional covariates, which could potentially further improve the matching between the samples.
CONCLUSIONS
CBT for depression in clinical practice might be equally effective as manual-based treatments in RCTs when they are applied to comparable patients. The fact that similar effects under routine conditions were reached with more sessions, however, points to the potential to optimize treatments in clinical practice with respect to their efficiency.
- Language
-
- English
- Open access status
- closed
- Identifiers
-
- DOI 10.1016/j.jad.2015.08.072
- PMID 26433763
- Persistent URL
- https://sonar.ch/global/documents/178376
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