Long-Term Effectiveness of Cognitive Behavioral Therapy in Routine Outpatient Care: A 5- to 20-Year Follow-Up Study

Abstract

<b><i>Objective:</i></b> Long-term follow-ups several years after receiving cognitive behavioral therapy (CBT) are scarce and most of the existing literature describes follow-up data of randomized-controlled trials. Thus, very little is known about the long-term effects of CBT in routine care. <b><i>Methods:</i></b> We investigated psychological functioning in a sample of 263 former outpatients who had received CBT for a variety of mental disorders such as depression, anxiety-, eating- or somatoform disorders 8.06 (SD 5.08) years after treatment termination. All participants completed a diagnostic interview as well as the Brief-Symptom Inventory (BSI) and the Beck Depression Inventory (BDI). Effect sizes and response rates according to Jacobson and Truax [J Consult Clin Psychol 1991;59:12–9] were calculated from pre- to posttreatment and from pretreatment to follow-up assessment. <b><i>Results:</i></b> Pre- to posttreatment effect sizes ranged between 0.75 (BDI) and 0.63 (BSI) and pretreatment to follow-up effect sizes were 0.92 (BDI) and 0.75 (BSI). Of all patients, 29% (BDI) and 17% (BSI) experienced clinically significant change at posttreatment and 42% (BDI) and 24% (BSI) at follow-up. <b><i>Conclusion:</i></b> The results point to the long-term effectiveness of CBT under routine conditions for a wide array of problems, especially when compared to the long-term effects of medical treatment. It is noteworthy that the results at follow-up were even better than at posttreatment, indicating further improvement. However, about a quarter of the patients did not respond sufficiently to therapy, neither concerning short-term nor long-term effects.

Allostatic Load and Its Impact on Health: A Systematic Review

“…Promoting lifestyle modifications and pursuit of psychological wellbeing, whose importance is increas ingly recognized in clinical medicine [316] and psychiatry [317], may provide more enduring effects. Psychothera peutic strategies aimed at improving coping with stressful situations [304,[318][319][320] may also be of value. The clinical diagnosis of allostatic overload may be helpful in a com prehensive approach that seeks to understand how the in teractions among genetics, mind, body, behavior and the environment affect both the risk of disease and the re sponse to treatment [321].…”

The Effect of Patient’s Choice of Cognitive Behavioural or Psychodynamic Therapy on Outcomes for Panic Disorder: A Doubly Randomised Controlled Preference Trial

“…The present trial involved the choice between PCT and PFPP, as representatives of CBT and PDT, because CBT and PDT are the 2 most widely used approaches in routine care facilities throughout Sweden, and because they draw upon distinct theories of change and ways of working. A different set of findings may have emerged had we chosen 2 other forms of psychotherapy, or indeed different forms of CBT [36] and PDT (however, there are no other panic-specific forms of PDT). It is also important to point out that the findings from this paper are based on mean scores for groups and there are likely important variations in outcomes for individuals.…”

Cognitive behavioral group therapy for panic disorder in a general clinical setting: a prospective cohort study with 12 to 31-years follow-up

“…Some have found that good results can also be achieved following group CBT [6], and this format may be more cost effective and feasible in the clinical setting. Nevertheless, the number of studies, especially long-term studies (> 2 years), on CBT in groups is scarce [5,[7][8][9][10][11][12][13][14]. Long term outcome following CBT varies across studies.…”