Treatment as usual and routine care in research and clinical practice

Treatment as usual (TAU) or routine care in the context of psychotherapy has been used both as a control condition in clinical trials of evidence-based psychotherapy (EBP) and as a primary therapeutic intervention. This article considers TAU from both perspectives in which it is used and evaluated. First, the strengths, limitations, and sources of ambiguity of using TAUs as control conditions are discussed. Second, the evidence in behalf of TAUs is evaluated. Reviews of the effectiveness of TAUs when contrasted with EBPs and when evaluated in clinical applications and benchmarked against EBPs from clinical trials suggest that both broad classes of treatments are effective and often equally effective. The effectiveness of TAUs and the often similar outcomes evident in comparison to EBPs raise research as well as clinical issues. The article discusses research priorities for the evaluation of TAUs and clinical practices that can improve both EBPs and TAUs in patient care.