Closing the Efficacy-Effectiveness Gap: Translating Both the What and the How From Randomized Controlled Trials to Clinical Practice

Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, USA.
The Journal of Clinical Psychiatry (Impact Factor: 5.5). 05/2009; 70(4):446-9. DOI: 10.4088/JCP.08com04901
Source: PubMed
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    • "Several problems contribute to the fact that new interventions are often not provided for patients seeking help in routine care (Depp & Lebowitz, 2007; Weiss, Guidi, & Fava, 2009). One of these is the continuing focus of scientists on small efficacy studies and a lack of effectiveness trials (Weiss et al., 2009; Weisz, Donenberg, Han, & Weiss, 1995). Efficacy refers to the effects of psychotherapy in randomized controlled trials (RCTs) usually conducted under optimal conditions, involving recruited and wellselected patients, well-prepared therapists, highly structured treatment manuals, and a free-of charge treatment for a narrow problem focus. "
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    ABSTRACT: Randomized controlled trials have attested the efficacy of cognitive behavioral therapy (CBT) in reducing psychotic symptoms. Now, studies are needed to investigate its effectiveness in routine clinical practice settings. Eighty patients with schizophrenia spectrum disorders who were seeking outpatient treatment were randomized to a specialized cognitive behavioral intervention for psychosis (CBTp; n = 40) or a wait list (n = 40). The CBTp group was assessed at baseline, posttreatment, and 1-year follow-up. The wait list group was assessed at baseline, after a 4-month waiting period, at posttreatment, and after 1 year. The primary outcome measure was the Positive and Negative Syndrome Scale (PANSS). The CBTp group showed significant improvement over the wait list group for the total PANSS score at posttreatment-postwaiting. CBTp was also superior to the wait list group in regard to the secondary outcomes positive symptoms, general psychopathology, depression, and functioning, but not in regard to negative symptoms. The number of dropouts during the treatment phases was low (11.3%). Participants perceived the treatment as helpful (98%) and considered themselves improved (92%). Significant pre- and posttreatment effect sizes varied between 0.77 for general psychopathology and 0.38 for delusional conviction. The positive effects of treatment could be maintained at 1-year follow-up, although the number of patients who had deteriorated was higher than at postassessment. Large proportions of patients in clinical practice settings benefit from CBTp. The efficacy of CBTp can be generalized to clinical practice despite the differences in patients, therapists, and deliverance.
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