Journal of Affective Disorders
Volume 115, Issue 1 , Pages 220-224, May 2009

Clinically significant change in psychotherapy for depressive disorders☆☆☆

  • Carla Moleiro

      Affiliations

    • ISCTE, Lisbon University Institute, Portugal
    • Corresponding Author InformationCorresponding author. Psychology Department, ISCTE, Lisbon University Institute, Av. das Forças Armadas, 1649-026 Lisbon, Portugal. Tel.: +351 21 790 3022, +351 21 790 3001; fax: +351 21 790 3002.
    • ,
  • Larry E. Beutler

      Affiliations

    • Pacific Graduate School of Psychology, Palo Alto, CA, United States

Received 15 February 2008; received in revised form 9 September 2008; accepted 11 September 2008.

Abstract 

Background

The assessment of change has been a problematic issue in psychotherapy research and has become increasingly important in the up rise of evidence-based practices.

Methods

In the present paper, the clinical significance of the change of 243 patients who received one of nine treatments for depression was analysed using the Reliable Change Index [Jacobson, N.S., Follette, W.C., Revenstorf, D., 1984. Psychotherapy outcome research: Methods for reporting variability and evaluating clinical significance. Behav. Ther. 15, 336–352.] and normative comparisons (Equivalency Testing; [Kendall, P.C., Marrs-Garcia, A., Nath, S.R., Sheldrick, R.C., 1999. Normative comparisons for the evaluation of clinical significance. J. Consult. Clin. Psychol. 67, 285–299.]). While the first method addresses the question of whether or not the change that occurred was large enough to be attributable to treatment rather than to measurement error, the second method addresses the issue of comparing the level of functioning of treated individuals with non-clinical population. Hence, the nine treatments of depression were compared in terms of their reliability and clinical significance. Traditional statistical tests in treatment outcome studies were also conducted.

Results

Findings support the importance of analysing the clinical significance of change during psychotherapy. While all but one treatment led to statistical significant changes in depressive symptoms, differences among treatments were found in terms of their reliability and clinical significance.

Limitations

Small sample sizes and representativeness of each treatment warrant further replication of these results.

Conclusions

Implications of the use of clinical significance testing in the exploration of empirical support for psychotherapy treatments in conjunction with traditional statistical analyses are discussed, which will be more readily useful and meaningful to clinicians who wish to embark in evidence-based practices.

Keywords: Depression, Clinical significance, Treatment outcomes, Normative comparisons, Reliable change

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☆ The reported work was carried out at the University of California at Santa Barbara, Education Department, Santa Barbara, CA 93106, USA.

☆☆ An earlier version of this paper was presented at the 33rd Annual Conference of the Society for Psychotherapy Research, in Santa Barbara, California.

PII: S0165-0327(08)00366-2

doi:10.1016/j.jad.2008.09.009

Journal of Affective Disorders
Volume 115, Issue 1 , Pages 220-224, May 2009

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