Generic interventions “just as effective” as the brand

In the children’s services world, several branded interventions dominate the conversation on “what works,” but increasingly researchers are asking whether we need the brand to get the results we want – or whether generic components can be distilled and embedded in everyday practice.

US-based researchers explored these issues in relation to one well-known, widely implemented evidence-based intervention. Trauma-Focused Cognitive Behavior Therapy (TF-CBT) is thought of as the “intervention of choice” for psychologists treating children suffering from the symptoms of post-traumatic stress.

The evidence base for TF-CBT is strong, with positive effects demonstrated in several rigorously designed randomized controlled trials. But a new systematic review reveals that similar, non-branded versions of the popular intervention are as successful as TF-CBT itself.

Branded vs. non-branded

Colleen Cary and Curtis McMillen, researchers at the University of Chicago, explain. “We have discovered that while the branded version performs extremely well, and has the advantage of being clearly outlined in a manual and supported by trainings and learning collaboratives, clinicians may consider using highly similar alternatives with the presumption that these alternatives are likely to deliver similar results.”

In describing TF-CBT as a branded intervention, Cary and McMillen are referring to the fact that, among other things, it is manualized and supported by a well-developed training program. But, as they point out, many of the studies often cited as evidence of the TF-CBT’s positive effects do not actually use the branded package. Instead, they test very similar interventions that share some of TF-CBT’s core components. The systematic review pooled evidence across all of these studies, and examined whether the branded format offers benefits above and beyond the non-branded versions.

A systematic review of the evidence

The review was designed to scrutinize TF-CBT’s effectiveness in reducing post-traumatic stress symptoms as well as depression and behavior problems in children and adolescents.

The reviewers analyzed three things. First they looked at the effects of studies that evaluated the branded version only. Second, they looked at studies that evaluated interventions that were not branded but included all five of TF-CBT’s core components. Third, they examined studies that evaluated non-branded interventions that included only four of the five core components.

But what are the core components of TF-CBT? Cary and McMillen consulted with the program’s developers. They identified the crucial elements of the intervention as exposure, cognitive processing and reframing, stress management, parental treatment and psycho-education.

The analyses of the effects of the branded and non-branded versions of TF-CBT revealed that “enthusiasm for this intervention appears to be justified: TF-CBT effectively helps traumatized youth who experience symptoms of PTSD.” What is more, the findings were consistent across all three analyses. The pooled estimates of effect were comparable whether they analyzed only the effects of the branded intervention or the effects of interventions that were not branded but had the core features.

So it appears that, in this case, the generic is just as effective as the brand.

What now?

The study is not without its limitations. The reviewers applied strict inclusion criteria to the relevant studies and only ten made it into the review from a pool of nearly 2000 that were identified in the first literature trawl. While 10 rigorous evaluation studies might be considered a large number in the children’s services arena, it is nevertheless still a small number for a systematic review, leading Cary and McMillen to strongly advocate for further research.

“We believe that the field of child trauma would benefit from more studies that compare the effectiveness of TF-CBT with other interventions that may be chosen by clinicians over TF-CBT in the real world,” argue the Chicago researchers.

“To be clear, we are not suggesting that TF-CBT needs to continue to show its worth in more trials. We are instead suggesting that clinicians tempted to use non-TF-CBT interventions to help traumatized children deserve to know whether these other interventions stack up well with what has become the intervention of choice.”

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Reference:
Cary, C., & McMillen, J. (2012). The data behind the dissemination: A systematic review of trauma-focused cognitive behavioral therapy for use with children and youth. Children and Youth Services Review, 34, 748-757.