What is Treatment as Usual (TAU)?
Treatment as usual (TAU) refers to the standard care that patients receive in routine clinical practice settings, which typically includes pharmacotherapy and/or psychotherapy delivered according to local or national guidelines, but without the systematic monitoring, structured protocols, or specific interventions being tested in research studies. 1
Core Definition in Clinical Research
TAU represents commonly employed practice patterns where treatment adjustments are based on shared decision-making, but typically without systematic monitoring of disease activity using validated measures to reach a predefined target. 1
In psychiatric research, TAU encompasses standard outpatient care including psychotherapy and pharmacotherapy services, but lacks the structured, protocol-driven elements of evidence-based interventions being studied. 1
TAU serves as the most frequently used control condition in randomized controlled trials, particularly when comparing novel interventions against existing standard care. 2, 3
Critical Problem: TAU is Highly Variable
TAU is "anything but usual"—there is significant heterogeneity in what constitutes TAU across different studies, settings, and geographic locations, making it difficult to interpret research findings and compare across trials. 4, 3
The content of TAU ranges from basic care (minimal intervention) to moderate care (following local guidelines) to advanced care (comprehensive assessment, psychological treatment, medication, and somatic examination). 4
Only 3 out of 32 studies in primary care research provided advanced descriptions of TAU, while 18 provided only basic descriptions lacking detailed accounts or reference to guidelines. 4
TAU in Different Clinical Contexts
Psychiatric Care
In depression and anxiety treatment, TAU typically includes care coordinators providing physical health awareness training plus health promotion materials, but without structured psychotherapy protocols. 1
TAU for bipolar disorder in adolescents consists of standard outpatient psychotherapy and pharmacotherapy, distinct from enhanced TAU (ETAU) which provides services from study clinics. 1
Rheumatology
- In rheumatoid arthritis management, usual care refers to treatment adjustment based on shared decision-making without systematic monitoring of disease activity using validated measures to reach predefined targets. 1
TAU Effectiveness Compared to Evidence-Based Treatments
Both TAU and evidence-based psychotherapies (EBPs) are effective, and often produce equally effective outcomes when evaluated in clinical applications. 5
Psychotherapy shows medium effect sizes over TAU for both anxiety (g=0.69) and depression (g=0.70), but the magnitude depends heavily on the intensity and nature of the TAU condition. 3
Higher intensity TAU produces smaller differences from active treatment (SMD=0.324) compared to lower intensity TAU (SMD=0.628), which does not differ significantly from waitlist controls. 2
Critical Pitfall: TAU vs. Waitlist Confusion
Lower intensity TAU produces effects similar to waitlist controls, meaning some "TAU" conditions provide minimal active treatment. 2
The greatest separation between active treatment and control occurs when TAU is the comparator (Hedges' g=1.17) versus no-treatment controls (g=0.84) or attention-matched controls (g=0.47). 1
What Should Be Documented About TAU
When describing TAU in clinical research or practice, specify the "who, what, how many, and any additional treatments": 3
- Who provides the care (psychiatrist, primary care physician, care coordinator, therapist credentials)
- What treatments are offered (specific medications, type of psychotherapy, frequency of visits)
- How many sessions/contacts occur over what time period
- Any additional treatments available (case management, crisis services, referrals)
TAU in Real-World Effectiveness
At a large academic medical center, TAU for depression (psychotherapy, pharmacotherapy, or combined treatment) produced significant improvement with effect sizes surpassing no-treatment benchmarks, with no significant differences between treatment modalities. 6
All three TAU approaches (psychotherapy alone, medication alone, combined) showed similar rates of reliable improvement in routine clinical care. 6