Treatment as usual and routine care in research and clinical practice
Abstract
Treatment as usual (TAU) or routine care in the context of psychotherapy has been used both as a control condition in clinical trials of evidence-based psychotherapy (EBP) and as a primary therapeutic intervention. This article considers TAU from both perspectives in which it is used and evaluated. First, the strengths, limitations, and sources of ambiguity of using TAUs as control conditions are discussed. Second, the evidence in behalf of TAUs is evaluated. Reviews of the effectiveness of TAUs when contrasted with EBPs and when evaluated in clinical applications and benchmarked against EBPs from clinical trials suggest that both broad classes of treatments are effective and often equally effective. The effectiveness of TAUs and the often similar outcomes evident in comparison to EBPs raise research as well as clinical issues. The article discusses research priorities for the evaluation of TAUs and clinical practices that can improve both EBPs and TAUs in patient care.
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TAU is standardly used in pragmatic clinical trials.
“Although far from perfect as a control condition, TAU is standardly used in pragmatic clinical trials for these and other reasons [77,78].”
From Clinical Efficacy and Psychological Mechanisms of an App-Based Digital Therapeutic for Generalized Anxiety Disorder: Randomized Controlled Trial (2021) · cites this paper as [78]
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“Overall, the main methodological issues that arose during this review are not dissimilar to those apparent across intervention and efficacy research (Kazdin, 2015).”
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Expanding the scope, reach, and impact of evidence-based psychological treatments
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“Lastly, we acknowledge the limitations associated with the use of TAU as a control condition (Kazdin, 2015), but remain encouraged by the promising results of the current investigation.”
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- Authors
- Kazdin, A. E.
- Affiliations
- Yale University (US)
- Corresponding author
- Kazdin, Alan E.
- ORCID
- Kazdin, Alan E.
- Venue
- Clinical Psychology Review
- Publisher
- Elsevier BV
- Published
- 2015-12
- Volume
- 42
- Pages
- 168-178
- ISSN
- 0272-7358 (ISSN-L)
- OpenAlex
- W1755748266
- Cited by
- 96
- References
- 101
- Citations by year
- 2026: 11 · 2025: 7 · 2024: 10 · 2023: 10 · 2022: 14 · 2021: 10 · 2020: 7 · 2019: 7 · 2018: 8 · 2017: 5 · 2016: 6 · 2015: 1
- FWCI
- 0.96
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Clinical Psychology Review (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Social Sciences › Psychology › Clinical Psychology › Psychotherapy Techniques and Applications
- Social Sciences › Psychology › Applied Psychology › Digital Mental Health Interventions
- Health Sciences › Health Professions › General Health Professions › Health Policy Implementation Science
- Keywords
- usual care, psychotherapy, evidence-based psychotherapy, control conditions, clinical trials, treatment effectiveness, benchmarking, research priorities, clinical practice
- MeSH terms
- Humans, Psychotherapy, Research Design, Evidence-Based Practice
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