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Effects of psychological therapies in randomized trials and practice‐based studies
Author(s) -
Barkham Michael,
Stiles William B.,
Connell Janice,
Twigg Elspeth,
Leach Chris,
Lucock Mike,
MellorClark John,
Bower Peter,
King Michael,
Shapiro David A.,
Hardy Gillian E.,
Greenberg Leslie,
Angus Lynne
Publication year - 2008
Publication title -
british journal of clinical psychology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.479
H-Index - 92
eISSN - 2044-8260
pISSN - 0144-6657
DOI - 10.1348/014466508x311713
Subject(s) - randomized controlled trial , beck depression inventory , psychology , external validity , clinical trial , clinical psychology , clinical practice , homogeneous , internal validity , physical therapy , medicine , psychiatry , anxiety , surgery , social psychology , pathology , physics , thermodynamics
Background Randomized trials of the effects of psychological therapies seek internal validity via homogeneous samples and standardized treatment protocols. In contrast, practice‐based studies aim for clinical realism and external validity via heterogeneous samples of clients treated under routine practice conditions. We compared indices of treatment effects in these two types of studies. Method Using published transformation formulas, the Beck Depression Inventory (BDI) scores from five randomized trials of depression ( N = 477 clients) were transformed into Clinical Outcomes in Routine Evaluation‐Outcome Measure (CORE‐OM) scores and compared with CORE‐OM data collected in four practice‐based studies ( N = 4,196 clients). Conversely, the practice‐based studies' CORE‐OM scores were transformed into BDI scores and compared with randomized trial data. Results Randomized trials showed a modest advantage over practice‐based studies in amount of pre–post improvement. This difference was compressed or exaggerated depending on the direction of the transformation but averaged about 12%. There was a similarly sized advantage to randomized trials in rates of reliable and clinically significant improvement (RCSI). The largest difference was yielded by comparisons of effect sizes which suggested an advantage more than twice as large, reflecting narrower pre‐treatment distributions in the randomized trials. Conclusions Outcomes of completed treatments for depression in randomized trials appeared to be modestly greater than those in routine care settings. The size of the difference may be distorted depending on the method for calculating degree of change. Transforming BDI scores into CORE‐OM scores and vice versa may be a preferable alternative to effect sizes for comparisons of studies using these measures.