3. empirically supported tx: research methods + evidence based

Question 1

what are the 4 methods of evaluating psychotherapies

Answer 1

1. case studies
2. naturalistic studies
3. quasi-experiments
4. RCTs

Question 2

in what context would it be best to use a case study?

Answer 2

best when studying completely new therapies

Question 3

what are naturalistic studies? pros? cons?

Answer 3

• over long period of time
• usually with same patient
• con: usually the same people

Question 4

what is quasi-experiment, and what is it usually used for?

Answer 4

• not a complete experiment
• comparing 2 experiments or tx

Question 5

what does RCT stand for, what are their origins, what’s it used for?

Answer 5

• randomized controlled trials
• adopted from medicine
• used to determine cause and effect

Question 6

name the 7 steps of RCT testing

Answer 6

1. develop protocol
2. choose comparison to tx of interest
3. select participants of interest
4. random assign participants to conditions
5. administer tx and assess fidelity
6. evaluate outcomes at end of tx
7. evaluate outcomes at follow up time points

Question 7

developing the protocol…

what are the 2 questions you need to ask yourself when developing the protocol?

Answer 7

1. what is the tx? (what’s the model? what’s the tx technique?)
2. how will it be administered? (is it standardized?)

Question 8

what are the 3 types of comparison txs?

Answer 8

1. waitlist
2. supportive psychotherapy
3. CBT (gold standard)

Question 9

what is the difference between CBT and supportive psychotherapy?

Answer 9

support implies building a relationship w the patient as a baseline. usually includes just conversational therapy. CBT is the tested therapy in which there’s a little sprinkle sprinkle

Question 10

what are the 2 things you need to consider when selecting participants?

Answer 10

1. balancing concerns with internal and external validity
2. finding participants that are representative of the population to which it’ll be generalized

Question 11

what is internal validity?

Answer 11

quality of experimental design and control for extraneous factors

Question 12

what is external validity?

Answer 12

will the results be generalizable?

Question 13

what are the 2 factors that usually prevent researchers to have representative samples when selecting participants?

Answer 13

1. demographic factors (usually causasion undergrads)
2. comorbid dx (usually ask for non-comorbid)

Question 14

why do we need random assignment?

Answer 14

minimizes pre-existing differences between groups that could affect the outcome

Question 15

difference between single blind and double blind

Answer 15

double blind: both part and exp don’t know who gets what
single blind: part doesn’t know if they’re getting tx, exp knows

Question 16

explain how to administer double blind experiment in the context of psychotherapy

Answer 16

… u can’t. lol.

Question 17

what is a fidelity check? what is it used for?

Answer 17

fidelity checking is to make sure that the tx is administered adequately. researchers will use recordings and rate how well it’s being administered

Question 18

what’s the biggest influence that could alter how a tx is being administered in the context of psychotherapy?

Answer 18

individual therapist factors

Question 19

what kind of validity is being ruptured if the therapists aren’t administering the tx as outlined?

Answer 19

internal validity

Question 20

how do you evaluate the outcome of a tx? on a px

there are 4 ways

Answer 20

1. no longer meeting the DSM dx criteria
2. decrease in target sx (not necessarily a full recovery)
3. decrease in comorbid sx
4. increase in functioning

Question 21

what are 4 ways to evaluate the success of your tx?

Answer 21

1. statistical significance
2. effect size
3. therapist and site effects
4. people who drop out

Question 22

what 2 things influence statistical significance?

Answer 22

• magnitude of effect
• sample size

Question 23

what is an effect size?

Answer 23

magnitude of difference, independent of sample size

Question 24

what’s the formula for Cohen’s d?

Answer 24

d = (x1-x2)/Sp

d = cohen’s d
x1 = mean exp
x2 = mean contr
Sp = SD of control group

Question 25

Cohen’s d: what is a small, medium, large effect?

Answer 25

small: 0.2
medium: 0.5
big: 0.8

it can go over 1

Question 26

how much change is needed for clinical significance?

Answer 26

relative to what we’re studying

ex: if it’s suicide attempts? anything. lol.

Question 27

what are site effects?

Answer 27

results can be different based on location in which tx is administered

Question 28

what do we do if people drop out? what are some assumptions we can have? what do we do, statistically?

Answer 28

perform intention-to-treat analyses

did they get better before the end? did it not help?

Question 29

two things that can happen once tx stops?

Answer 29

1. relapse
2. sleeper effect

Question 30

what’s the sleeper effect?

Answer 30

during tx, might not see any improvements. after tx, continue to do better (concept of consolidation during sleep)

Question 31

according to the DeRubeis et al study, what was the conclusion drawn about psychological tx and medication?

Answer 31

psychological tx was more enduring than meds

Question 32

why might some people relapse after tx?

Answer 32

during tx, you’re continuously held accountable, learning new skills, practicing said skills. after, all the accountability stops.

Question 33

what’s one element that needs to be in the report of an RCT?

i usually skip these when skimming research articles lol

Answer 33

CONSORT flow diagram

Question 34

what’s in the flow diagram?

4 questions

Answer 34

• who’s in the study
• what happened to them
• how well was it designed
• is something wrong with the design

the last two are the same tho so cut urself some slack

Question 35

what did the first ever meta-analysis conclude?

Smith + Glass 1977

Answer 35

typical therapy client was better than untreated clients

Question 36

what does EST stand for?

Answer 36

empirically supported tx

Question 37

what were the criteria that the chambless & hollon article imposed for well established tx?

Answer 37

minimum 2 “good” between group designs that show tx better than meds, psychotherapy, or other tx
OR
equivalent to established tx
OR

bunch of single case designs with good exp design and comparison to other tx AND
conducted with tx manuals or other clear descriptions
characteristics of sample must be clearly defined
effects must be demonstrated by min 2 different investigators or teams

Question 38

according to chambless & hollon

what’s a probably efficacious tx?

Answer 38

• 2 exp show tx is better to waitlist control
  OR
• 1 or more exp meet criteria but have not been replicated by independent investigators
  OR
• small series of single case design experiements have been conducted

Question 39

what were tolin’s critiques of chambless & hollon?

Answer 39

1. eval based on 2 studies is too low of a bar
2. focus is on sx reduction
3. no guidance on which EST to choose

Question 40

which is better:

meta-analysis or single case study?

Answer 40

meta-analysis

Question 41

which is better:

RCT or single case study?

Answer 41

RCT

Question 42

what’s the difference between a strong and a modest tx?

Answer 42

strong: well established
modest: probably efficacious