Effectiveness of Cognitive Behavioral Therapy in Public Mental Health: Comparison to Treatment as Usual for Treatment-Resistant Depression

Abstract

State mental health systems have been leaders in the implementation of evidence-based approaches to care for individuals with severe mental illness. Numerous case studies of the wide-scale implementation of research-supported models such as Integrated Dual Diagnosis Treatment and Assertive Community Treatment are documented. However, relatively few dissemination efforts have focused on cognitive behavioral therapy (CBT) for individuals with major depression despite evidence indicating its efficacy with this population. A multi-site effectiveness trial of CBT was conducted within the Texas public mental health system. Eighty-three adults with major depression received CBT from community clinicians trained through a workshop and regular consultation with a master clinician. Outcomes were compared to a matched sample of individuals receiving pharmacotherapy. Outcome measures used included the Quick Inventory of Depressive Symptomatology and Beck Depression Inventory. Individuals receiving CBT showed greater improvements in depression symptoms than those in the comparison group. Greater pre-treatment symptom severity predicted better treatment response, while the presence of comorbid personality disorders was associated with poorer outcomes.

Examining the Effectiveness of Integrated Behavioral and Primary Health Care Treatment

“…In 2004, Texas revamped its previous system of treatment delivery by implementing a standardized assessment to identify services that would address individuals’ needs (Cook, Toprac, & Shore, ). Often, the first line of defense is medication management and case coordination for individuals diagnosed with SMI (Lopez & Basco, ), suggesting the intent of community mental health treatment, at least for those involved in the standardized treatment protocol, is to ensure stability of clients’ symptoms while navigating the complexities associated with SMI.…”

Therapists’ Self-Efficacy for CBT Dissemination: is Supervision the Key?

“…Of course, it is possible that improved self-efficacy is with a byproduct of developing stronger CBT skills as measured by objective assessment such as ratings on the Cognitive Therapy Scale (CTS) by trained experts. Lopez and Basco (2014) [25] examined therapist competency in a similar group of therapists from the Texas community mental health system who received clinical supervision in CBT for six months following comparable didactic training. They found that those who participated in clinical supervision following didactic training achieved a moderate level of competency in CBT with average CTS ratings of 34.3 (SD = 7.8).…”

“…The dissemination effort was part of a state-wide initiative in Texas from 2005 to 2011 to redesign assessment processes in the mental health service system. Within Texas, 39 Local Mental Health Authorities (LMHA) provide public mental health services for the government [25]. Therapists from fifteen LMHAs participated in the present study.…”

An UPLC–MS/MS method for the quantitation of vortioxetine in rat plasma: Application to a pharmacokinetic study

“…Major depressive disorder (MDD) is a leading cause of disability and is associated with significant reductions in quality of life, impaired productivity, reduced overall health and substantial economic costs [1][2][3]. Vortioxetine (1-[2-(2,4-dimethyl-phenylsulfanyl)-phenyl]-piperazine hydrobromide , Fig 1.) is a novel antidepressant with a multi-modal mechanism of action approved in the USA and EU for the treatment of major depressive disorder at doses of 5, 10, 15 and 20 mg [4].…”