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
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- "Assessing treatment progress and outcome in acute treatment settings (e.g., inpatient, residential , or partial hospitals) is just as critical as other settings and warrants its own empirically-based evidence given the unique characteristics of these settings (e.g., very limited time to provide treatment in a population with high levels of symptom severity, comorbidity, functional impairment, and suicide risk). Although the clinical benefits of using evidence based assessments to monitor treatment outcome are clear (e.g., Duffy et al. 2008; Slade et al. 2006), they remain underutilized in psychiatric settings (Weiss et al. 2009; Zimmerman and McGlinchey 2008; Gilbody et al. 2002). This is in part due to a lack of recognition of the clinical benefits, as well as practical barriers such as time (Zimmerman and McGlinchey 2008). "
ABSTRACT: The CES-D-10, QIDS-SR, and DASS-21-DEP are brief self-report instruments for depression that have demonstrated strong psychometric properties in clinical and community samples. However, it is unclear whether any of the three instruments is superior for assessing depression and treatment response in an acute, diagnostically heterogeneous, treatment-seeking psychiatric population. The present study examined the relative psychometric properties of these instruments in order to inform selection of an optimal depression measure in 377 patients enrolled in a psychiatric partial hospital program. Results indicated that the three measures demonstrated good to excellent internal consistency and strong convergent validity. They also demonstrated fair to good diagnostic utility, although diagnostic cut-off scores were generally higher than in previous samples. The three measures also evidenced high sensitivity to change in depressive symptoms over treatment, with the QIDS-SR showing the strongest effect. The results of this study indicate that any of the three depression measures may satisfactorily assess depressive symptoms in an acute psychiatric population. Thus, selection of a specific assessment tool should be guided by the identified purpose of the assessment. In a partial hospital setting, the QIDS-SR may confer some advantages, such as correspondence with DSM criteria, greater sensitivity to change, and assessment of suicidality.
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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. "
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.