Science Is Not a Trial (But It Can Sometimes Be a Tribulation) Irene Elkin School of Social Service Administration University of Chicago Robert D. Gibbons Department of Psychiatry and Biometry University of Illinois at Chicagoo M. Tracie Shea Department of Psychiatry and Human Behavior Brown University and Veterans Affairs Medical Center Brian F. Shaw The Toronto Hospital University of Toronto ABSTRACT This article addresses a few of the most important issues raised by N. S. Jacobson and S. D. Hollon and by D. F. Klein about the findings of the National Institute of Mental Health Treatment of Depression Collaborative Research Program (TDCRP). Questions addressed include the following: (a) What was the relative effectiveness of the treatments in the TDCRP for patients with severe depressive symptomatology? (b) Were there Treatment × Research Site interactions within the more severely depressed subsamples? (c) Was there adequate implementation of cognitive—behavior therapy (CBT) and other treatment conditions in the TDCRP? and (d) How do the relapse rates in the TDCRP compare with those in other studies? Current conclusions regarding all of these issues are presented. For the future, it is recommended that, rather than revisiting these issues again, researchers apply their energies to investigating new questions using the valuable TDCRP database. The National Institute of Mental Health (NIMH) Treatment of Depression Collaborative Research Program (TDCRP) is a multisite program initiated and sponsored by the Psychosocial Treatments Research Branch, Division of Extramural Research Programs (later part of the Mood, Anxiety, and Personality Disorders Research Branch, Division of Clinical Research), NIMH, Rockville, Maryland. The principal NIMH collaborators were Irene Elkin, Coordinator (University of Chicago); M. Tracie Shea, Associate Coordinator (Brown University); John P. Docherty (New York Hospital–Cornell University, White Plains, New York), and Morris B. Parloff (independent practice, Bethesda, Maryland). The principal investigators and project coordinators at the three participating research sites were as follows: Stuart M. Sotsky and David Glass, George Washington University; Stanley D. Imber and Paul A. Pilkonis, University of Pittsburgh; John T. Watkins, (now at the Atlanta Center for Cognitive Therapy) and William Leber, University of Oklahoma. The principal investigators and project coordinators at the three sites responsible for training therapists were as follows: Myrna Weissman (now at Columbia University), Eve Chevron, and Bruce J. Rounsaville, Yale University; Brian F. Shaw (now at Toronto Hospital, University of Toronto) and T. Michael Vallis (now at Dalhousie University), Clarke Institute of Psychiatry; and Jan A. Fawcett and Phillip Epstein, Rush Presbyterian–St Luke's Medical Center. Collaborators in the data management and data analysis aspects of the program were as follows: C. James Klett, Joseph F. Collins, and Roderic Gillis of the Veterans Affairs Cooperative Studies Program, Perry Point, Maryland. The program was funded by Cooperative Agreements to the following six participating sites: George Washington University (MH 33762), University of Pittsburgh (MH 33753), University of Oklahoma, Oklahoma City (MH 33760), Yale University (MH 33827), Clarke Institute of Psychiatry, Toronto, Journal of Consulting and Clinical Psychology © 1996 by the American Psychological Association February 1996 Vol. 64, No. 1, 92-103 For personal use only--not for distribution. Page 1 of 1712/13/2000http://spider.apa.org/ftdocs/ccp/1996/february/ccp64192.htmlOntario, Canada (MH 38231), and Rush Presbyterian–St. Luke's Medical Center, Chicago, Illinois (MH 35017). The analyses for this article were funded in part by a grant from the John D. and Catherine T. MacArthur Foundation and by Grants R01 MH 4426-01 and K05 MH 01254 from the Services Research Branch of NIMH. We thank Jane Yamaguchi, for her assistance in the preparation of the manuscript. We also thank Myrna Weissman, for providing interpersonal psychotherapy competence ratings and Steven Hollon for providing data from his outcome study. Correspondence may be addressed to Irene Elkin, School of Social Service Administration, University of Chicago, 969 East Sixtieth Street, Chicago, Illinois, 60637. Received: June 29, 1995 Revised: September 12, 1995 Accepted: September 12, 1995 N. S. Jacobson and S. D. Hollon, as well as D. F. Klein, have once again posed some interesting questions about the findings of the National Institute of Mental Health (NIMH) Treatment of Depression Collaborative Research Program (TDCRP). In this article, we address what we consider a few of the most important issues raised about the TDCRP. Because of page limitations, we do not address here some of the broader issues raised about psychotherapy research and psychotherapy—drug comparisons; nor do we address questions raised about the 1986 New York Times article ( Boffey, 1986 ) 1 or about the treatment of depression guidelines issued by the American Psychiatric Association (1993) or by the Agency for Health Care Policy and Research ( Depression Guideline Panel, 1993 ); we were not responsible for these. We agree, in fact, with Jacobson and Hollon that a recommendation in such guidelines should never be based on a single study. The major questions that were raised and that are addressed in this article include the following: (a) What was the relative effectiveness of the treatments in the TDCRP for patients with severe depressive symptomatology? (b) Were there Treatment × Research Site interactions within the more severely depressed subsamples? (c) Was there adequate implementation of cognitive—behavior therapy (CBT) and other treatment conditions in the TDCRP? and (d) How do the relapse rates in the TDCRP compare with those in other studies? 2 Before addressing these issues, we provide a brief description of the TDCRP and the initial findings most relevant to the present discussion. For further details, the reader may refer elsewhere ( Elkin, 1994 ; Elkin et al., 1985 , 1989 ; a list of 34 publications based on TDCRP data that involved research site, training site, and/or NIMH collaborators can also be obtained from Irene Elkin.) The TDCRP was a collaborative clinical trial, in which investigators at three research sites (George Washington University, the University of Pittsburgh, and the University of Oklahoma) carried
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