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Cited by 15Psychotherapy Techniques and ApplicationsAnxiety, Depression, Psychometrics, Treatment, Cognitive ProcessesPsychological Treatments and Assessments

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

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Gibbons, Carly R., Wiltsey Stirman, Shannon, DeRubeis, Robert J., Newman, Cory F., Beck, Aaron T.·2013·Cognitive Therapy and Research
DOI 10.1007/s10608-012-9499-7PMC PMC3661278
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Abstract

Objective To compare the outcomes of cognitive therapy for depression under controlled and clinically representative conditions, while holding several therapist and clinical assessment factors constant. Method 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. Results 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. Conclusions 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.

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Crossref · 10.1007/s10608-012-9499-7

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  • Patients in real-world settings present with greater symptom severity, complexity and diversity than is often observed among patients in early phase randomized controlled trials.

    “Evaluations in such real‐world settings are, however, essential because patients are known to present with greater symptom severity, complexity and diversity than is often observed among patients in early phase RCTs (Gibbons et al., 2013).”

    From Five-year observational study of Internet-delivered cognitive behavioural pain management when offered as routine care by an online therapy clinic (2022) · cites this paper as Gibbons et al., 2013

    The Results report more Axis II comorbidity in the clinic sample (74% versus 39%), supporting greater complexity in that comparison. They do not support greater symptom severity: mean intake depression scores did not differ significantly and were numerically higher in the RCT sample. The paper also does not establish the broader claim about patient diversity across real-world settings and early-phase RCTs. (LLM, conf=0.90)

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  • Therapist drift occurs less in the context of a closely monitored intervention.

    “However, such drift occurs less in the context of a closely monitored intervention, as shown by Gibbons et al . (2013).”

    From Supervisor practice when guiding therapists working with depression: The impact of supervisor and patient characteristics (2018) · cites this paper as Gibbons et al ., 2013

    The Discussion suggests that therapists may have been less adherent to cognitive therapy protocols when they were not closely supervised or monitored. But it says the clinic collected no fidelity data, so the study could not determine whether adherence differed. The claim presents a plausible explanation as a demonstrated finding. (LLM, conf=0.88)

    Experimental — accuracy not yet measured

  • Patient complexity does not fully explain differences in outcome between RCTs and routine practice.

    “However, this is not a complete explanation, as patient complexity does not fully explain differences in outcome between RCTs and routine practice (e.g. Gibbons et al ., 2013; Weisz et al ., 2006).”

    From Supervisor practice when guiding therapists working with depression: The impact of supervisor and patient characteristics (2018) · cites this paper as Gibbons et al ., 2013

    The Discussion (page not provided) reports that controlling for Axis II comorbidity did not appear to account for the outcome differences between the research and clinic samples. That supports the claim's central point, but the paper treats the explanation as tentative and limits its comparison to one research sample, one outpatient sample, and one disorder; the citing sentence states the conclusion more generally and definitively. (LLM, conf=0.84)

    Experimental — accuracy not yet measured

  • RCT supervision seems to differ from supervision in clinical practice.

    “Although supervision in RCT settings has not been directly compared with supervision in clinical settings, RCT supervision seems to differ from supervision in clinical practice.”

    From Supervisor practice when guiding therapists working with depression: The impact of supervisor and patient characteristics (2018) · cites this paper as Gibbons et al ., 2013

  • Clinical improvement and recovery rates for patients with depression in routine clinical settings are not always as high as in RCTs.

    “Unfortunately, clinical improvement and recovery rates for patients with depression in routine clinical settings are not always as high as in RCTs.”

    From Supervisor practice when guiding therapists working with depression: The impact of supervisor and patient characteristics (2018) · cites this paper as Gibbons et al ., 2013

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Authors
Gibbons, C. R., Wiltsey Stirman, S., DeRubeis, R. J., Newman, C. F., & Beck, A. T.
Affiliations
University of Pennsylvania (US)
ORCID
Venue
Cognitive Therapy and Research
Publisher
Springer Science and Business Media LLC
Published
2012-11-13
Volume
37
Issue
3
Pages
605-612
ISSN
  • 0147-5916 (ISSN-L)
  • 1573-2819
DOI
10.1007/s10608-012-9499-7
PMC
PMC3661278
OpenAlex
W2001316200
Cited by
15
References
40
Citations by year
2024: 2 · 2022: 2 · 2021: 2 · 2020: 1 · 2018: 1 · 2017: 1 · 2015: 6
FWCI
2.18
Type
journal article
Language
en
Open access
Licence
www.springer.com/tdm (tdm)
Locations
  • Cognitive Therapy and Research (publishedVersion)
  • PubMed (publishedVersion)
  • Europe PMC (PubMed Central) (acceptedVersion)
  • PubMed Central (acceptedVersion)
Funders
National Institute of Mental Health (R00MH080100, R37MH047383, R10MH055875, R25MH080916)
Topics
  • Social Sciences › Psychology › Clinical Psychology › Psychotherapy Techniques and Applications
  • Social Sciences › Psychology › Experimental and Cognitive Psychology › Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes
  • Social Sciences › Psychology › Clinical Psychology › Psychological Treatments and Assessments
Keywords
cognitive therapy, depression, major depressive disorder, outpatient clinics, treatment outcomes, randomized controlled trials, therapist experience, fidelity monitoring, treatment expectations, treatment motivation

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