17: Treatment of Psychological Disorders - Evaluating Psychotherapies Flashcards
Evaluating Psychotherapies
Specificity question – Which types of therapy, administered by which kinds of therapists to which kinds of clients having which kinds of problems, produce which kinds of effects?
Psychotherapy Research Methods
Hans Eysenck countered the assumption that without therapy, patients would not improve
- Concluded that rate of spontaneous remission (symptom reduction in absence of treatment) was as high as success rates reported by psychotherapists
- Came to conclusion that troubled people are equally likely to improve, with or without therapy
- APA has now found effective therapies for specific disorders
Psychotherapy Research Methods
What is a Good Psychotherapy Research Design
- randomized clinical trials - research design that involves random assignment of clients with specific problems to an experimental group or control condition so as to draw sound conclusions about the therapy’s efficacy
- Placebo control group – gets an intervention that is not expected to work, but controls for client expectation of improvement
- Standardization of Treatment - manual containing procedures that the therapists have to follow exactly, and that therapists’ compliance with these procedures be evaluated by observing them or taping their sessions
Psychotherapy Research Methods
Meta-Analysis: A look at the Big Picture
statistical procedure for combining results of different studies that examine the same topic
Psychotherapy Research Methods
Meta-Analysis: A look at the Big Picture
Effect Size Statistic
measure of treatment effectiveness that indicates percentage of treated clients that improve more than average untreated client
Psychotherapy Research Methods
Meta-Analysis: A look at the Big Picture
Dodo Bird Effect
effect that widely differing therapies all are effective
Psychotherapy Research Methods
Meta-Analysis: A look at the Big Picture
Clinical Significance
requires that for a treatment to be successful, a patient can no longer fall within the range of having a psychological disorder
- Ex: even if a deeply depressed person becomes significantly less depressed over the course of treatment, but still falls in the range of depression, the treatment is not considered successful
Factors Affecting the Outcome of Therapy
Client Variables:
Three Factors Influencing the outcome
- Openness – clients’ willingness to invest themselves in therapy and take risks required to change
- Self-relatedness – ability to experience and understand internal states such as thoughts and emotions, to be attuned to processes in relationship with their therapist, and ability to apply what they learn in therapy to lives outside of treatment
- Nature of the problem – how appropriate the therapy is to treat the disorder
Factors Affecting the Outcome of Therapy
Therapist Variables
Quality of relationship between therapist and client is important determinant of outcome
- Hostile interchanges between client and therapist can lead to deterioration effect
Factors Affecting the Outcome of Therapy
Techniques
- Dose-response effect – relation between amount of treatment received and quality of outcome
- Most patients do not remain in therapy long enough to realize potential benefits (average of 5 sessions with 20% improvement)
Factors Affecting the Outcome of Therapy
Common Factors that Contribute to Therapy Success
- Faith in therapist and belief on client’s part that they are receiving help
- Plausible explanation for their problems, and alternative way of looking at themselves with their problems
- Protective setting in which clients can experience and express deepest feelings
- Opportunity to practice new behaviours
- Increased optimism and self-efficacy
A Study of Therapeutic Outcome
- Paul (1966)
- 96 undergraduates severely anxious about public speaking
- Were randomly placed into 1 of 4 therapy groups
- Each experimental group received 5 therapy sessions
A Study of Therapeutic Outcome
Insight Therapy
Subjects received 5 sessions during which the therapist established unconditional positive regard for the students and attempted to help them understand their fears and present feelings
A Study of Therapeutic Outcome
Desensitization Therapy
Subjects received 5 sessions in which they worked through hierarchically arranged speech-related anxiety situations
A Study of Therapeutic Outcome
Placebo Control
- Subjects in this condition were also given 5 sessions
- In each session they were given a simple bicarbonate of soda capsule which they were led to believe was a potent tranquilizer
- They then performed a very boring discrimination task which they were told was, under normal conditions, very stressful
- They were also told that after repeated sessions they would be able to be free of anxiety
A Study of Therapeutic Outcome
No-Treatment Group
And Results
- This group received no treatment and were only measured at the outset of the study and again after all other subjects had completed their 5 sessions
- Were measured for trembling hands, quivering voices, sweating, pulse rate and self-evaluation
