Neil S. Jacobson’s research while affiliated with University of Mary Washington and other places

This study followed treatment responders from a randomized controlled trial of adults with major depression. Patients treated with medication but withdrawn onto pill-placebo had more relapse through 1 year of follow-up compared to patients who received prior behavioral activation, prior cognitive therapy, or continued medication. Prior psychotherapy was also superior to medication withdrawal in the prevention of recurrence across the 2nd year of follow-up. Specific comparisons indicated that patients previously exposed to cognitive therapy were significantly less likely to relapse following treatment termination than patients withdrawn from medication, and patients previously exposed to behavioral activation did almost as well relative to patients withdrawn from medication, although the difference was not significantly different. Differences between behavioral activation and cognitive therapy were small in magnitude and not significantly different across the full 2-year follow-up, and each therapy was at least as efficacious as the continuation of medication. These findings suggest that behavioral activation may be nearly as enduring as cognitive therapy and that both psychotherapies are less expensive and longer lasting alternatives to medication in the treatment of depression.

The present study provides 2-year follow-up data for a comparison between a complete behavioral marital therapy treatment package (CO) and two of its major components, behavior exchange (BE) andcommunication/problem-solving training (CPT). Data are reported for 34 couples who were randomly assigned to one of these three treatments, completed the treatment to which they were assigned, and were available for the 2-year follow-up. The effects of therapy at the 2-year follow-up were evaluated using a global measure of marital satisfaction and a checklist of presenting marital problems. Statistically significant differences between the three treatments were not in evidence on any of the measures. However, couples in the CO treatment condition were most likely to be happily married and least likely to be separated or divorced. Attempts to identify variables which predicted long-term outcome were largely unsuccessful. Ananalysis based on standardized telephone interview indicated that, while neither therapist attributes nor maintenance of treatment-derived relationship skills were associated with long-term marital satisfaction, stressful life events subsequent to therapy termination were negatively related to marital satisfaction.

This paper raises and attempts to resolve some significant and controversial issues in the design of family therapy outcome studies. First, the issue of clinical relevance is addressed. Much of psychotherapy research has little relevance for practicing clinicians; this paper discusses some partial explanations and proposes some changes in the way data are reported that would have a salutary effect. Second, inter-model comparative outcome studies are critiqued. Third, the necessary preconditions for internally valid outcome studies are delineated, along with conditions in which randomization and the use of control groups can be abandoned. Fourth, there is a discussion of a research strategy which examines the generalizability of treatment effects found in research settings to conditions which come closer to resembling clinical practice. Fifth, questions regarding the selection of therapists for family therapy outcome research are addressed, including the issue of optimal level of therapist experience, and the question of whether or not “therapists” should be treated as a randomized factor in the overall design. Finally, there is a brief discussion of outcome criteria, with a fairly clear-cut and straightforward recommendation for determining whether or not a family therapy has had a desirable effect.

Antidepressant medication is considered the current standard for severe depression, and cognitive therapy is the most widely investigated psychosocial treatment for depression. However, not all patients want to take medication, and cognitive therapy has not demonstrated consistent efficacy across trials. Moreover, dismantling designs have suggested that behavioral components may account for the efficacy of cognitive therapy. The present study tested the efficacy of behavioral activation by comparing it with cognitive therapy and antidepressant medication in a randomized placebo-controlled design in adults with major depressive disorder (N = 241). In addition, it examined the importance of initial severity as a moderator of treatment outcome. Among more severely depressed patients, behavioral activation was comparable to antidepressant medication, and both significantly outperformed cognitive therapy. The implications of these findings for the evaluation of current treatment guidelines and dissemination are discussed.

Clinical significance refers to changes that are clinically meaningful for individuals as they progress through a course of treatment. Since the first method of assessing clinical significance was proposed, a number of alternatives have been suggested, each purporting to increase sensitivity for detecting meaningful change. However, few comparisons have been conducted on these methods, and there is little evidence for any method's predictive validity. This study compares classification rates of five clinical significance methods with participants treated for major depressive disorder (N = 128). It also compares the methods' accuracy in predicting relapse of depression 2 years posttreatment. Although all methods successfully predicted relapse from chance discrimination, no significant differences emerged between methods. Implications for future research are discussed.

Infidelity is a common phenomenon in marriages but is poorly understood. The current study examined variables related to extramarital sex using data from the 1991-1996 General Social Surveys. Predictor variables were entered into a logistic regression with presence of extramarital sex as the dependent variable. Results demonstrated that divorce, education, age when first married, and 2 "opportunity" variables--respondent's income and work status--significantly affected the likelihood of having engaged in infidelity. Also, there were 3 significant interactions related to infidelity: (a) between age and gender, (b) between marital satisfaction and religious behavior, and (c) between past divorce and educational level. Implications of these findings and directions for future research are discussed.

Infidelity is a common phenomenon in marriages but is poorly understood. The current study examined variables related to extramarital sex using data from the 1991-1996 General Social Surveys. Predictor variables were entered into a logistic regression with presence of extramarital sex as the dependent variable. Results demonstrated that divorce, education, age when first married, and 2 "opportunity" variables - respondent's income and work status - significantly affected the likelihood of having engaged in infidelity. Also, there were 3 significant interactions related to infidelity: (a) between age and gender, (b) between marital satisfaction and religious behavior, and (c) between past divorce and educational level. Implications of these findings and directions for future research are discussed.