Transporting an empirically supported treatment for panic disorder to a service clinic setting: A benchmarking strategy.

Abstract

This work examines the transportability of cognitive-behavioral therapy (CBT) for panic disorder to a community mental health center (CMHC) setting by comparing CMHC treatment outcome data with the results obtained in two controlled efficacy trials. Participants were 110 clients with a primary diagnosis of panic disorder with or without agoraphobia; clients were not excluded on the basis of medication use or changes, severity or frequency of panic attacks, age, or the presence of agoraphobia. Clients completed a 15-session CBT protocol. Despite differences in settings, clients, and treatment providers, the treatment outcomes for clients completing treatment in the CMHC and the efficacy studies were comparable: Of the CMHC clients who completed treatment, 87% were panic-free at the end of treatment, and clients showed significant reductions in anticipatory anxiety, agoraphobic avoidance, generalized anxiety, and symptoms of depression. The present study suggests that panic control treatment can be transported to a CMHC. Challenges facing the transportability of researchbased treatment to CMHC clients, settings, and treatment providers are discussed. Controlled treatment outcome research commonly takes place under conditions that maximize both internal validity and the specificity of conclusions about causal mechanisms. It can be argued that outcome findings from internally valid efficacy studies cannot be assumed to generalize to other settings, populations, and treatment providers (Hollon, 1996; Jacobson & Christensen, 1996; Seligman, 1996). How well do the results of empirically supported treatments (ESTs; see Jacobson & Christensen, 1996) hold up in natural settings? Generalizability studies are needed to determine the transportability of ESTs to community settings (Wilson, 1995, 1996). Some consider efficacy research overvalued because of limitations in generalizability and have proposed the "effectiveness study" as a preferable alternative (Hoagwood, Hibbs, & Brent, 1995). The effectiveness study, in which efficacious interventions are examined in real-world service settings, is offered as a viable solution to the shortcomings of the traditional, controlled conditions of efficacy research. Proponents argue that effectiveness study methodology can be used to determine treatment effectiveness without sacrificing generalizability to actual clinical settings. Unfortunately, the effectiveness study method is not without its problems. As critics have pointed out, the effectiveness ap

Effectiveness of routine psychotherapy: Method matters

“…The first studies to informally include benchmarking (e.g., Wade, Treat, & Stuart, 1998;Merrill, Tolbert, & Wade, 2003;Hunsley & Lee, 2007;Forand, Evans, Haglin, & Fishman, 2001) lacked statistical comparisons between routine care and benchmark studies: they provided the effect sizes for each, and because the two are close to each other (and in some cases the routine care actually yielded a larger effect size), the authors conclude that treatments were generally effective. Weersing and Weisz (2002)'s formal approach, which provided a statistical framework using meta-analytic methods to compare naturalistic and RCT samples, has two advantages over less formal approaches.…”

The dissemination and implementation of psychological treatments: Problems and solutions

“…This involves one staff member of a mental health organization being trained in the treatment concerned and then this staff member becoming a trainer of the remaining members of staff. 27 This strategy has been shown to be effective in training therapists to deliver CBT for panic disorder, 28 and there is also evidence that it can be used to train therapists to use guided cognitive behavioral self-help for binge eating problems. 29 The strategy remains to be evaluated in larger controlled studies.…”

Cost-benefit analysis of psychological therapy

“…The results cover social phobia, anxiety and depression, agoraphobia, panic disorder and PTSD. See Lincoln et al (2003), Persons et al (2005), Hahlweg et al (2001), Wade et al (1998) and Gillespie et al (2002). clinical trials.…”