07_Psychotherapy Research Flashcards
General Outcome Studies:
Eysenck 1952: Overview
1st efficacy studies of psychotherapy
Effects are “small or nonexistent”
Positive effects are result of spontaneous remission
General Outcome Studies: Eysenck
Percent Improvement of Comparative Therapies
Control Group: 72% improvement within 2 years
Eclectic: 66%
Psychoanalytic: 44%
General Outcome Studies:
Meta-Analysis
Combined results of multiple studies to calculate an effect size
Smith, Glass, Miller (1980)
Meta-Analysis Results and Conclusion
Effect size = .85
Psychotherapy equal or exceed medical/educational interventions
“Efficacious in practical as well as statistical terms”
Meta-Analysis:
Therapy Efficacy
No one type of therapy to be consistently superior
Positive change due to common factors
*Not any unique or specific techniques
General Outcome Studies:
Four Common Factors
Catharsis
Positive relationship with the therapist
Behavioral regulation
Cognitive learning and mastery
Effects of Treatment Length: Howard (1996)
Leveling off of outcome based on treatment length
75% at 26 sessions
85% at 52 sessions
Effects of Treatment Length: Howard (1996)
Phase Model: Three Stages
Remoralization
Remediation
Rehabilitation
Effects of Treatment Length: Howard (1996)
Phase Model: Remoralization
Hopelessness and desperation respond quickly to therapy
Remoralization occurs within the first few sessions
Effects of Treatment Length: Howard (1996)
Phase Model: Remediation
Focus on presenting symptoms
Symptom relief usually requires ~ 16 sessions
Effects of Treatment Length: Howard (1996)
Phase Model: Rehabilitation
Behavior change and skill building
Number of sessions dependent on symptomatology and severity
Efficacy Studies
Clinical trials
Determines whether or not treatment has an effect
Effectiveness Studies
Correlational or quasi-experimental
Determines clinical utility
i.e. generalizability, feasibility, cost effectiveness
Seligman’s critique of Efficacy studies
Not applicable for empirical validation of psychotherapy
Clinical trials omit too many elements of what is actually done in the field
Sue (1991): Psychotherapy with Diverse Populations
Racial/Ethnic Groups with best outcomes:
High to Low
Hispanic American
Anglo
Asian
African-American
Utilization of Mental Health Services:
African-Americans
Lower rates of general MH services than whites
Higher rates in ER and psychiatric inpatient settings
Utilization of Mental Health Services:
Asian Americans
Underrepresented in both outpatient and inpatient settings
Racial/ethnic group who receive most treatment for:
Depression
Whites
Followed by African-Americans and Hispanics
Racial/ethnic group who receive most treatment for:
Illicit drug use
African-Americans
Premature Termination Rates:
Racial/ethnic groups % dropout after first session
50%: Minority groups
30%: Whites
Premature Termination Rates:
Community Mental Health Setting
Racial/ethnic groups dropout High to Low
African-Americans
White & Hispanics
Asian-Americans
Effects of Therapies-Client Matching:
Sue, et al. (1991)
Reduced premature termination rates for Asian, Hispanic, and Whites
*but not African-Americans
Improved treatment outcomes for Hispanics only
Effects of Therapies-Client Matching:
Individual factors
Ethnic identity
Level of acculturation
Gender
Trust of whites
Effects of Therapies-Client Matching:
Factors more important than racial/ethnic matching for members of culturally diverse groups
Therapist education
Shared values
Shared worldview
Interventions for Older Adults:
Most Common Health Problems: High to Low
Anxiety
Severe cognitive impairment
Depression
Interventions for Older Adults:
Responsiveness to Treatment
Benefit from a variety of forms of psychotherapy
Similar degree of benefit to younger adults
*However, often have a slower response to treatment
Effective Interventions for Older Adults: Dementia
Behavioral and environmental interventions
Memory and cognitive retraining
Effective Interventions for Older Adults: Depression
Cognitive
Behavioral
Brief psychodynamic
Individualization of treatment for Older Adults:
Incorporate caregivers/family members
Adapt intervention to setting
Modify therapy for age-related changes in functioning
Factors that increase likelihood Spousal/Partner Abuse:
Younger
Heterosexual
American Indian/Alaska native
African-American
Income below $10,000
Best single predictor of cessation of Spousal/Partner Abuse:
Family income
Low income families are most likely to report continued violence
Interventions for Spousal/Partner Abuse:
Main Goals
Ensuring safety
Developing and rehearsing a safety/escape plan
Self-determination, Self-esteem, Empowerment
Interventions for Spousal/Partner Abuse:
Considerations for the Clinician
Vicarious traumatization
Alterations in beliefs related to trust and safety
IPV: Expressive Abuse
Primarily expression of emotion
Mutual or reciprocal
Followed by remorse
IPV: Appropriate therapy for Expressive Abuse
Conjoint (couples) therapy
IPV: Instrumental Abuse
Committed without provocation
Goal-directed
Unilateral
Not followed by remorse
IPV: Therapy Approach to Instrumental Abuse
Main Priority = Physical Safety
Physical Separation of victim and perpetrator
Separate Services
Factors that Increase Likelihood of Staying in Abusive Relationship
Fear of retaliation against victim or children
Economic dependence
Greater length of relationship
Belief that abuser will change
Placebo Effect: Research Definition
Placebo = nonspecific/common factors Psychotherapy
Greater symptom reduction than no treatment / waitlist
Effect Size of Treatment compared to Placebo and Control Groups
.67 = compared to no treatment
.48 = compared to Placebo Control Groups
Psychotherapy Practice and Research:
Diagnostic overshadowing
Attribution of all psychiatric symptoms to intellectual disabilities
Psychotherapy Practice and Research:
Alloplastic vs. Autoplastic Intervention Focus
Allo = make changes in environment
Auto = changes in individual increases functionality in environment
Prevalence and Effects of Therapist Distress
74% = experienced personal distress in past 3 years
36% = decreased quality of work
4% = resulted in inadequate treatment
Therapist Distress:
Most stressful client behavior
Suicidal statements
Therapist Distress:
Most stressful aspect of work
Lack of therapeutic success
Most frequently encountered ethical/legal dilemma
Issues related to confidentiality
Psychiatric hospitalization: Role of Gender
Higher hospitalization of men
*Increased likelihood to exhibit threatening behaviors
Women have higher prevalence of mental illness
*anxiety and depression mostly treated outpatient
Psychiatric Hospitalization:
Perceived Dangerousness
Criterion for commitment that became greater focus than “psychopathology” starting the in the 1960’s
Increased male-to-female hospitalization ratio
Psychiatric Hospitalization:
Four Relevant Demographic Characteristics
Marital status
Race/ethnicity
Age
Diagnosis
Psychiatric Hospitalization Rates:
Marital Status, Highest to Lowest
Never married
Married or divorced/separated
Widowed
Psychiatric Hospitalization Rates:
Race/Ethnicity
Whites represent largest total number of inpatients (and outpatients)
In terms of population proportions, patients from other races are overrepresented
Psychiatric Hospitalization Rates:
Age Range with Largest Proportion of Admissions
25-44 age range for both men and women
Psychiatric Hospitalization Rates:
Most common diagnosis: 18 to 44 age range
Schizophrenia
Psychiatric Hospitalization:
Most common diagnoses: age 65 and older
Organic disorder
Affective disorder
