The effectiveness of an experimental treatment when compared to care as usual depends on the type of care as usual.
UCPP cut parent-reported aggression more than family therapy but not more than usual behavior therapy, proving that "treatment as usual" is not a single thing.
01Research in Context
What this study did
Researchers tested a Dutch program called UCPP. It teaches parents and kids new coping skills.
They randomly assigned disruptive boys to three groups: UCPP, usual behavior therapy, or family therapy.
All kids were in late elementary school and had ADHD or similar diagnoses.
What they found
Parents in the UCPP group reported less overt aggression than those in family therapy.
UCPP and usual behavior therapy looked about the same on aggression scores.
The takeaway: beating "treatment as usual" depends on what that usual care is.
How this fits with other research
Matson et al. (1999) showed that doing a functional analysis steers clinicians toward reward-based plans for aggression. H et al. built on that idea by comparing one reward-heavy program against two kinds of usual care.
Eugenia Gras et al. (2003) also worked in classrooms and let teachers pick interventions after brief tests. Both studies say the same thing: test first, then match the plan to the child.
Leung et al. (2016) ran a parent-education RCT and saw medium behavior cuts, much like UCPP. The pattern repeats across countries and ages: structured parent training beats basic support.
Zachary et al. (2019) add a twist. They found parent emotion skills predict how fast behavior improves. So UCPP might have done even better if it had screened and trained parent self-control first.
Why it matters
Next time you read "our program beat treatment as usual," ask what the usual was. If the comparison is weak family therapy, gains may look big. If it is solid behavior therapy, gains may shrink. Use this insight when you review grant proposals or pitch new services to schools. Match your intervention to the true baseline in your district, not to an imaginary one.
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02At a glance
03Original abstract
In psychotherapy, effectiveness of an experimental treatment often is compared to care as usual. However, little if any attention has been paid to the heterogeneity of care as usual. The authors examined the effectiveness of manualized behavior therapy on school-aged disruptive behavior disordered (DBD) children in everyday clinical practice. A total of 77 DBD children (8-13 years) were randomly assigned to the Utrecht Coping Power Program (UCPP) condition or the care as usual condition. Care as usual consisted of family therapy (FT) or behavior therapy (BT). Decrease in parent-reported overt aggression was significantly larger in the UCPP condition than in the FT condition, but UCPP and BT did not differ significantly in this respect. The effect sizes of difference scores on other variables were more in favor of UCPP when compared to FT than to BT. The comparison of an experimental treatment to care as usual depends on the type of usual treatment.
Behavior modification, 2007 · doi:10.1177/0145445506292855