Zijn de resultaten van randomized clinical trials (RCT’s) naar de effectiviteit van cognitieve gedragstherapie generaliseerbaar naar de klinische praktijk?

Paul Emmelkamp

Jaargang 2011 - Nummer 4 - dinsdag 4 november 2025

Samenvatting

Cognitieve gedragstherapie is de eerste keus behandeling voor veel stoornissen. Deze richtlijnen zijn in belangrijke mate gebaseerd op de resultaten van randomised clinical trials (RCT's). Hoewel RCT's als de gouden standaard beschouwd worden, gaat het bij RCT's vaak om efficacy trials in plaats van effectiveness trials. In dit artikel wordt besproken in hoeverre de resultaten uit gerandomiseerde efficacy studies generaliseerbaar zijn naar de klinische praktijk. Resultaten van effectiviteitsonderzoek in de klinische praktijk (‘Benchmark studies') laten over het algemeen positieve resultaten voor psychologische behandelingen zien, maar de effecten zijn doorgaans iets minder gunstig dan in efficacy trials. Een overzicht van recente RCT's in Behaviour Research & Therapy en Behavior Therapy laat zien dat in de meeste RCT's patiënten worden behandeld die vaak gekenmerkt worden door comorbide stoornissen. Ook het beeld dat therapeuten in RCT's hoogopgeleide en streng gesuperviseerde behandelaars zijn dient op grond van dit overzicht bijgesteld te worden. De modale therapeut in de meeste RCTs heeft zeker niet meer ervaring dan de gemiddelde behandelaar in de GGZ.

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