Efficacy vs Effectiveness in CT Research

As you know, Cognitive Therapy is based on a large body of research and quite a few outcome studies show that CT is an effective treatment for a variety of problems. However, outcome research in psychotherapy has been recieving considerable criticism lately. The arguement is that "Efficacy" studies which carefully select subjects who have a single problem and provide a carefully-controlled, time-limited, manual-guided treatment protocol are quite unrealistic.

This criticism makes a fair amount of sense. After all, the clients I see in practice frequently have more than one problem, I provide individualized treatment rather than following a pre-defined treatment protocol, and the duration of treatment is flexible (if we can get authorization from managed care). Critics of efficacy research (including Marty Seligman) argue that we can't generalize the results of carefully controlled efficacy studies to real-life clinical practice and that researchers need to start doing "Effectiveness" studies which test intervention approaches under real-life conditions. Does this mean we have to abandon all of the available outcome research and start doing effectiveness studies?

No. It certainly makes sense to use caution and good judgement in drawing conclusions on the basis of carefully-controlled studies which are conducted under conditions which differ from real-life clinical practice. However, the research which has been conducted into Cognitive Therapy already includes effectiveness studies and the available effectiveness studies generally show results similar to those obtained in efficacy studies.

As time permits, I'll post summaries of some of the studies of CT under real-life conditions which I am aware of. I would also like to encourage each of you to contribute information about effectiveness studies which you are aware of.

Replies:

The Effectiveness of CT of Depression in Private Practice, by Jim Pretzer, 6/26/98 CT of Depression in Private Practice is as Effective as in Research Trials, by Jim Pretzer, 12/6/99 Effectiveness of CT of Depression for Individuals with Personality Disorders, by Jim Pretzer, 08/06/01 CBT for Panic Disorder in a CMHC Setting, by Jim Pretzer, 6/26/98 Effectiveness of Video-based Parenting Training in a Canadian CMHC, by Jim Pretzer, 6/28/98 Effectiveness of Group CBT for Depression in Military Outpatient Clinics, by Jim Pretzer, 10/14/98 CT for Panic, OCD in Private Practice Setting, by Jim Pretzer, 3/18/99 CBT Therapists More Effective than Generalists in Treating Anxiety in MBHO Setting, by Jim Pretzer, 1/4/00 Group CBT for Depression in a Community Setting, by Jim Pretzer, 3/24/99 CT in the treatment of depression in elderly primary care patients, by Jim Pretzer, 5/14/99 Predicting the Effectiveness of CBT for Insomnia, by Jim Pretzer, 03/26/01 CBT for Obsessive-Compulsive Disorder in private practice, by Jim Pretzer, 08/01/01 Long-term effectiveness of CBT for Agoraphobia, by Jim Pretzer, 08/03/01 CBT for PTSD in a Community Sample with Community Therapists, by Jim Pretzer, 12/16/02 Effectiveness of CT for Depression in CMHC Setting, by Jim Pretzer, 06/09/03

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