title: Benchmarking of cognitive-behavioral therapy for depression in efficacy and effectiveness studies--how do exclusion criteria affect treatment outcome?
abstract: OBJECTIVE
  Little is known about how exclusion criteria applied in randomized controlled trials (RCTs) affect the transfer of psychotherapy outcome research to naturalistic settings. This study evaluated the effects of naturalistic depression therapies and benchmarked them with published RCTs.
  
  
  METHODS
  Commonly used exclusion criteria were applied to n=338 depressive patients receiving cognitive-behavioral therapy. Outcomes of the resulting subsample eligible for RCTs were compared to those reported in RCTs.
  
  
  RESULTS
  Treatment outcomes of the total sample (d=1.16) and the subsample eligible for RCTs (d=1.15) were highly similar. Therapy outcome was worse than in high-quality RCTs (d=1.39).
  
  
  CONCLUSIONS
  No systematic bias was demonstrated due to patient selection criteria that are typically applied in RCTs. The comparability of psychotherapies conducted in RCTs and in real-world settings might be underestimated. Conclusions concerning the improvement of therapies in naturalistic settings are discussed.
authors.affiliation: Department of Psychology, Johannes Gutenberg University of Mainz, Germany. schindam@uni-mainz.de
authors.forename: Amrei C
authors.initials: AC
authors.lastname: Schindler
authors.forename: Wolfgang
authors.initials: W
authors.lastname: Hiller
authors.forename: Michael
authors.initials: M
authors.lastname: Witthöft
mesh_terms: D000328:Adult; D019985:Benchmarking / Q000379:methods; D015928:Cognitive Behavioral Therapy / Q000592:standards*; D003866:Depressive Disorder / Q000628:therapy*; D019263:Dysthymic Disorder / Q000628:therapy*; D005260:Female; D006801:Humans; D008297:Male; D018579:Patient Selection; D016032:Randomized Controlled Trials as Topic / Q000379:methods* / Q000592:standards; D016896:Treatment Outcome