07_Psychotherapy Research Flashcards by Nikos Rebetis

General Outcome Studies:

Eysenck 1952: Overview

1st efficacy studies of psychotherapy

Effects are “small or nonexistent”

Positive effects are result of spontaneous remission

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General Outcome Studies: Eysenck

Percent Improvement of Comparative Therapies

Control Group: 72% improvement within 2 years

Eclectic: 66%

Psychoanalytic: 44%

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General Outcome Studies:

Meta-Analysis

Combined results of multiple studies to calculate an effect size

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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”

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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

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General Outcome Studies:

Four Common Factors

Catharsis

Positive relationship with the therapist

Behavioral regulation

Cognitive learning and mastery

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Effects of Treatment Length: Howard (1996)

Leveling off of outcome based on treatment length

75% at 26 sessions

85% at 52 sessions

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Effects of Treatment Length: Howard (1996)

Phase Model: Three Stages

Remoralization

Remediation

Rehabilitation

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Effects of Treatment Length: Howard (1996)

Phase Model: Remoralization

Hopelessness and desperation respond quickly to therapy

Remoralization occurs within the first few sessions

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Effects of Treatment Length: Howard (1996)

Phase Model: Remediation

Focus on presenting symptoms

Symptom relief usually requires ~ 16 sessions

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Effects of Treatment Length: Howard (1996)

Phase Model: Rehabilitation

Behavior change and skill building

Number of sessions dependent on symptomatology and severity

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Efficacy Studies

Clinical trials

Determines whether or not treatment has an effect

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Effectiveness Studies

Correlational or quasi-experimental

Determines clinical utility
i.e. generalizability, feasibility, cost effectiveness

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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

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Sue (1991): Psychotherapy with Diverse Populations

Racial/Ethnic Groups with best outcomes:
High to Low

Hispanic American

Anglo

Asian

African-American

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Utilization of Mental Health Services:

African-Americans

Lower rates of general MH services than whites

Higher rates in ER and psychiatric inpatient settings

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Utilization of Mental Health Services:

Asian Americans

Underrepresented in both outpatient and inpatient settings

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Racial/ethnic group who receive most treatment for:

Depression

Whites

Followed by African-Americans and Hispanics

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Racial/ethnic group who receive most treatment for:

Illicit drug use

African-Americans

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Premature Termination Rates:

Racial/ethnic groups % dropout after first session

50%: Minority groups

30%: Whites

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Premature Termination Rates:

Community Mental Health Setting
Racial/ethnic groups dropout High to Low

African-Americans

White & Hispanics

Asian-Americans

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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