Effectiveness of Cognitive Therapy for Depression in a Community Mental Health Center: A Benchmarking Study Kari A. Merrill and Valerie E. Tolbert Indiana University, Bloomington Wendy A. Wade Center for Behavioral Health, Bloomington, Indiana The current study examined the feasibility and effectiveness of transporting an empirically supported treatment for depression, cognitive therapy (CT), to a community mental health center setting. CT was delivered to 192 adult outpatients with major depression, and a benchmarking strategy compared results with those of 2 randomized controlled trials (RCTs). The 3 samples were largely similar in terms of initial severity of depression, and CT was as effective in reducing depressive symptoms in the current sample as in the RCTs. More favorable outcome was associated with less severe initial depression, more therapy sessions, more years of education, and absence of a comorbid personality disorder. This study demon- strates that an empirically supported treatment can be transported effectively to a clinical setting. Although randomized controlled trials (RCTs) are critical for establishing treatment efficacy, researchers and clinicians have argued that there is a need to follow these trials with studies conducted under conditions that better represent the real settings and populations for which the protocol in question is to be applied (e.g., Chambless & Hollon, 1998; Goldfried & Wolfe, 1998). Termed effectiveness studies, these investigations have the goal of increasing external validity. In clinical settings it may be difficult to use the restrictions used in controlled efficacy studies. Careful selection of clients generally may not be possible, and variables such as differential attrition and treatment drift are common (Hoag- wood, Hibbs, Brent, & Jensen, 1995). In addition, intensive ther- apist training and monitoring may not be available to clinicians outside research settings. Furthermore, it may not be feasible to withhold treatment from appropriate clients in a control condition. Thus, transporting empirically supported treatments to naturalistic clinical settings may require a shift from internal validity to favor the maximizing of generalizability. The current study investigated the effectiveness of Beck’s cog- nitive therapy for depression (CT; Beck, Rush, Shaw, & Emery, 1979) delivered in a community mental health center, the Center for Behavioral Health (CBH; Bloomington, Indiana). In addition to providing much-needed outcome data for CT on a large, community-based sample, this study provides data collected in a service-oriented setting. Our primary research question was “How effective is CT delivered to patients in an outpatient community- based clinic compared with results obtained in controlled trials?” We adopted a benchmarking strategy (McFall, 1996) used in recent studies on anxiety disorders (e.g., Wade, Treat, & Stuart, 1998) to compare our results with those of two RCTs. Two RCTs were chosen as benchmarks against which to com- pare the results from our CBH sample. The first study, by Hollon et al. (1992), involved 107 depressed patients randomly assigned to either CT alone, CT plus pharmacotherapy, or pharmacotherapy. The second is the Treatment of Depression Collaborative Research Program (TDCRP; Elkin, Parloff, Hadley, & Autry, 1985), in which 250 patients were randomly assigned to CT, interpersonal psychotherapy, antidepressant, or medication placebo (for an over- view of methods, see Elkin et al., 1985). An important consideration in treatment outcome research is not only whether the treatment is effective but also for whom it is effective. Several potential predictors of outcome have been iden- tified in previous studies, such as severity of depression, home- work compliance, and cognitive functioning (Elkin et al., 1995; Persons, Burns, & Perloff, 1988; Rude & Rehm, 1991). In the current study, potential predictors of outcome were examined first by defining outcome as the posttreatment Beck Depression Inven- tory (BDI; Beck et al., 1979) score, consistent with previous studies. Second, outcome was defined by categorizing clients according to whether they evinced clinically significant change (as defined by norms in Ogles, Lambert, & Sawyer, 1995). Method Participants Participants were 192 adults admitted for treatment through the CBH Depression Treatment Clinic (DTC) between 1994 and 1997 for whom complete assessment and treatment data were available and who consented to participate. All clients admitted to the DTC had a primary diagnosis of Kari A. Merrill and Valerie E. Tolbert, Department of Psychology, Indiana University, Bloomington; Wendy A. Wade, Center for Behavioral Health, Bloomington, Indiana. Wendy A. Wade is now at Best Buy Corporation, Eden Prarie, Minne- sota, and Valerie E. Tolbert is now at the Markey Cancer Center, Univer- sity of Kentucky, Lexington. We thank the board of directors, administration, and staff of the Center for Behavioral Health, without whom this study would not have been possible. We also thank Timothy J. Strauman and Richard M. McFall for their helpful comments on an earlier version of this article. Correspondence concerning this article should be addressed to Kari A. Merrill, who is now at the Department of Psychology, Social and Health Sciences, Duke University, Campus Box 90085, Durham, North Carolina 27708-0085. E-mail: kmerrill@duke.edu Journal of Consulting and Clinical Psychology Copyright 2003 by the American Psychological Association, Inc. 2003, Vol. 71, No. 2, 404 – 409 0022-006X/03/$12.00 DOI: 10.1037/0022-006X.71.2.404 404