In 1984, Jacobson, Follette, and Revenstorf denned clinically significant change as the extent to which therapy moves someone outside the range of the dysfunctional population or within the range of the functional population. In the present article, ways of operationalizing this definition are described, and examples are used to show how clients can be categorized on the basis of this definition. A reliable change index (RC) is also proposed to determine whether the magnitude of change for a given client is statistically reliable. The inclusion of the RC leads to a twofold criterion for clinically significant change. There has been growing recognition that traditional methods used to evaluate treatment efficacy are problematic (Barlow

Treatment effects are typically inferred on the basis of statistical comparisons between mean changes resulting from the treatments under study. This use of statistical significance tests to evaluate treatment efficacy is limited in at least two respects. First, the tests provide no information on the variability of response to treatment within the sample; yet information regarding within-treatment variability of outcome is of the utmost importance to clinicians.Second, whether a treatment effect exists in the statistical sense has little to do with the clinical significance of the effect. Statistical effects refer

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.

The purpose of this study was to provide an experimental test of the theory of change put forth by A. T. Beck, A. J. Rush, B. F. Shaw, and G. Emery (1979) to explain the efficacy of cognitive-behavioral therapy (CT) for depression. The comparison involved randomly assigning 150 outpatients with major depression to a treatment focused exclusively on the behavioral activation (BA) component of CT, a treatment that included both BA and the teaching of skills to modify automatic thoughts (AT), but excluding the components of CT focused on core schema, or the full CT treatment. Four experienced cognitive therapists conducted all treatments. Despite excellent adherence to treatment protocols by the therapists, a clear bias favoring CT, and the competent performance of CT, there was no evidence that the complete treatment produced better outcomes, at either the termination of acute treatment or the 6-month follow-up, than either component treatment. Furthermore, both BA and AT treatments were just as effective as CT at altering negative thinking as well as dysfunctional attributional styles. Finally, attributional style was highly predictive of both short- and long-term outcomes in the BA condition, but not in the CT condition.

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Manipulation checks should be used in psychotherapy trials to confirm that therapists followed the treatment manuals and performed the therapy competently. This article is a review of some strategies that have been used to document treatment integrity; also, their limitations are discussed here. Recommendations for improving these checks are presented. Specific guidelines are offered regarding when and how to assess both therapist adherence to treatment protocols and competence.

This article summarizes and scrutinizes the growth of the development of clinically relevant and psychometrically sound approaches for determining the clinical significance of treatment effects in mental health research by tracing its evolution, by examining modifications in the method, and by discussing representative applications. Future directions for this methodology are proposed.

This study examined the relationships among physiological responses during marital conflict, aggressive behavior, and violence in battering couples. As an index of physiological response, the authors used the male batterer's heart rate reactivity, assessed as the change from an eyes-closed baseline to the first 5 min of their marital conflict interaction. During marital interaction, violent husbands who lowered their heart rates below baseline levels were more verbally aggressive toward their wives. Wives responded to these men with anger, sadness, and defensiveness. The husbands were classified as Type 1 batterers. When compared to the remaining violent husbands (classified as Type 2 batterers), Type 1 men were also more violent toward others (friends, strangers, coworkers, and bosses), had more elevated scales reflecting antisocial behavior and sadistic aggression, and were lower on dependency than Type 2 men. The 2-year followup revealed a separation-divorce rate of 0 for marriages involving Type 1 men and a divorce rate of 21.5% for marriages involving Type 2 men.The domestic assault of women in the United States has become a problem of widespread proportions. For example, each year at least 1.6 million wives in the United States are severely