Get Alert
Please Wait... Processing your request... Please Wait.
You must sign in to sign-up for alerts.

Please confirm that your email address is correct, so you can successfully receive this alert.

Letter   |    
Efficacy vs. Effectiveness in Psychiatric Research
Gerard E. Hogarty, M.S.W.
Psychiatric Services 1998; doi:
text A A A

In Reply:Drs. Summerfelt and Meltzer raise thoughtful arguments that nevertheless can be questioned.

First, attributing "external validity" to effectiveness studies but only "internal validity" to efficacy studies seems inaccurate. The external validity of any treatment is based on legitimately inferred effects that have been demonstrated in a well-defined population, an important characteristic of efficacy studies.

Second, the real "major difference" between efficacy and effectiveness research is the profound inability of effectiveness studies to draw causal treatment relationships from the uncontrolled or quasiexperimental approaches that typically confound treatment and patient selection factors. The needs of patients who have been systematically excluded from efficacy studies can and should be addressed by efficacy studies relevant to specific patient populations.

Third, while a single efficacy study might indeed have limited generalization, validation in similar (but rarely identical) samples through the use of randomized clinical trials has traditionally Increased generalization. Generalizability is constrained by an absence of replication that also applies to the effectiveness study.

Fourth, "well-planned studies [that] use random assignment procedures within naturalistic settings to produce unbiased estimates of the benefits of interventions" are studies of efficacy rather than effectiveness. If not, then the distinction is made even more obscure. Control of bias is the methodologic cornerstone of efficacy studies. That effectiveness-research settings are extolled as being "naturalistic" is an oxymoron; they typically lack the resources needed to apply and test a psychiatric treatment competently. Once the requisite resources are in place, one has an efficacy study, no matter what the setting.

Effectiveness research in psychiatry remains an empty promise. I am not aware of any effectiveness study, with or without policy change, that has been conducted on the most efficacious psychosocial treatments for schizophrenic, affective, or personality disorders. Experience to date suggests that the debate over efficacy versus effectiveness has primarily served to justify therapeutic neglect and to siphon millions of dollars from controlled clinical trials.




CME Activity

There is currently no quiz available for this resource. Please click here to go to the CME page to find another.
Submit a Comments
Please read the other comments before you post yours. Contributors must reveal any conflict of interest.
Comments are moderated and will appear on the site at the discertion of APA editorial staff.

* = Required Field
(if multiple authors, separate names by comma)
Example: John Doe

Related Content
Textbook of Psychotherapeutic Treatments > Chapter 4.  >
The American Psychiatric Publishing Textbook of Substance Abuse Treatment, 4th Edition > Chapter 38.  >
Textbook of Psychotherapeutic Treatments > Chapter 16.  >
Gabbard's Treatments of Psychiatric Disorders, 4th Edition > Chapter 20.  >
Gabbard's Treatments of Psychiatric Disorders, 4th Edition > Chapter 22.  >
Topic Collections
Psychiatric News
APA Guidelines
PubMed Articles