A comparison of outcomes of cognitive therapy for depression in randomized controlled trials to outcomes in an outpatient clinic

In recent years, the field of psychotherapy has seen a movement towards more evidence-based practice and the randomized controlled trial (RCT) has emerged as the gold standard for establishing efficacy. One concern raised has been that RCTs often eliminated more troubled and difficult-to-treat patients (Westen & Morrison, 2001, p.880). Participant samples from six RCTs for depression were compared to a large outpatient sample (N = 408, Center for Cognitive Therapy - CCT). With the exception of one of the prognostic indicators examined (recurrent depression), there was no consistent pattern of differences between the research and outpatient samples. Another concern is whether the treatment effects demonstrated within RCTs are generalizable to clinicians employing such treatments in the real world. Treatment outcomes from five RCTs for depression were compared to those of depressed patients treated at CCT (n = 217). Patients in RCTs had similar or better treatment outcomes than patients at CCT. When one RCT (DeRubeis et al., 2005) was compared to CCT, patients with more symptoms at intake demonstrated greater improvement when treated within the RCT than when treated at CCT