Convergence and divergence in the delivery of cognitive therapy in two randomized clinical trial

Webb, C.A., DeRubeis, R.J., Hollon, S.D., Dimidjian, S., Amsterdam, J.D., Shelton, R.C. Convergence and divergence in the delivery of cognitive therapy in two randomized clinical trial. Behavior Research & Therapy 51:493-498, 2013.


Shelton is was one of the investigators on two large-scale clinical trials of cognitive behavioral therapy for depression. This paper reports an analysis of the psychotherapy delivered in one of those studies showing that the quality of the cognitive therapy delivered varied considerably between therapists and sites. These results raise questions about how cognitive therapy is delivered, both in trials and clinical practice.

It raises significant questions about the variability of how cognitive behavior therapy is delivered in research and practice and how it might negatively impact treatment outcome.

One of the major objectives of this paper is to alert providers about variability in practice and to reduce the variation in CBT techniques to achieve better outcomes.