Several controlled treatment-outcome studies have demonstrated the clinical efficacy of group behavioral and cognitive behavioral treatments for depression. However, there is a significant lack of evidence on mental health outcome evaluation studies for depression conducted in nonresearch clinical settings. Subjects in research settings may represent only about 20% of the clinical population because of stringent inclusion criteria, requirements to accept random assignment to conditions, etc. The present study is a clinical replication series of the effectiveness of group cognitive behavior therapy for depression administered in a nonresearch community setting. The subjects included 138 adult patients referred by mental health clinic providers for participation in a six-session (12-hour) depression management group. Outcome measures using the Beck Depression Inventory indicated that the level of depression was decreased for 84% of the participants, the average reduction in depression as measured by the BDI was 38%, and 43% of the patients had a greater than 50% reduction in their BDI score. The results indicated that group cognitive behavior therapy can be effectively applied in a clinical setting with a heterogeneous patient population, although the magnitude of the treatment effect was somewhat less than found in research settings (38% reduction on the BDI as compared to 57%). Group cognitive behavior therapy is a cost-effective treatment approach and the potential for benefits significantly outweighs the cost. In this era of managed care initiatives, group cognitive behavior therapy for depression should be considered as a first-line treatment intervention for many patients with depression as part of a stepped-care treatment approach to provide "the best treatment at the best value.".
