Clinically Significant Change in Treatments for Depression

Abstract

The assessment of change has been a problematic issue in psychotherapy research and has become increasingly important in up rise of evidence-based practices. In the present paper, the clinical significance of the change of 243 patients who received one of nine treatments for depression was analyzed using the Reliable Change Index (Jacobson, Follette, & Revenstorf, 1984) and normative comparisons (Equivalency Testing; Kendall, Marrs-Garcia, Nath, & Sheldrick, 1999). 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 (8 psychotherapies e 1 drug treatment) were compared in terms of their reliability and clinical significance. Traditional statistical tests in treatment outcome studies were also conducted. Findings support the importance of analysing the clinical significance of change during treatment. 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. Implications of the use of clinical significance testing in the exploration of empirical support for treatments of depression 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.