Ch 12: Intervention: Adults and Couples Flashcards
Does psychotherapy work?
- Eysenck’s 1952 review found psychotherapy is worse than no-treatment (RCT did not exist yet)
- Smith and Glass 1977 found average effect size of d=.68
- Smith, Glass and Miller 1980 found effect size of d=.85 (person who received therapy is better off than 8-% of those who did not)
What are the effect sizes for different types of therapies?
- cognitive: d=1.31
- cognitive-behavioural: d=1.24
- behavioural: d=.91
- psychodynamic: d=.78
- humanistic: d=.63
- largest effect sizes for anxiety and mood problems
What are effect sizes?
- allow for meaningful integration of data across studies
- d: standardized mean difference between two groups (sample size influences)
- r: correlation, strength of association
- odds ratio and relative risk
- confidence intervals reported with effect size metric
How are meta-analyses made better?
- method has been refined as developers respond to problems
- quality depends on the methodological decisions made by meta-analyst
What are some facts about meta-analyis?
- d comparing a treatment to no treatment will almost always be larger than d comparing two treatments
- Hoffman et al. 2012: 269 meta-analyses published since 2000 on CBT
What is the problem with publication bias?
- it can be a concern but inclusion of “grey literature” (unpublished) is found to have little impact on conclusions
What are the clinical practice guidelines around evidence-based treatments?
- summary of scientific research designed to assist clinicians in making assessment and treatment decisions
- organized clinical psychology has been slow to develop compared with psychiatry or other medical professions
What are empirically supported treatments?
- evidence of symptom reduction and/or improved functioning either from at least two independent RCTs or a large series of single-case studies
- term and criteria more specific than EBT
Who identifies and promotes EBT?
- 1990’s APA Society for Clinical Psychology task force on the promotion and dissemination of psychological procedures
- Nathan & Gorman’s series of texts on their classification system (Types 1 to 6 and initiatives in Germany, Australia, NZ
What is the American task force on evidence-based practice?
- American Psychological Association 2206
- treatment should be informed by research evidence but determined on the basis of other clinical information, patient choice, and the likely costs and benefits of available treatment options
What is the Canadian task force on evidence-based practice?
- Canadian Psychological Association 2014
- emphasis on (a) published, peer reviewed research to determine treatment options and (b) use of ongoing monitoring of treatment effects
How is CBT used for depression?
- altering behaviours, negative automatic thoughts and unhelpful beliefs associated with the condition in order to reduce distressing emotions
What is phase 1 of CBT for depression?
- assessment: diagnosis and comorbidity, life circumstances, resources and strengths, and recent precipitating events and stressors
- information on depression (psychoeducation)
- case formulation
- treatment options
What is phase 2 of CBT for depression?
- behavioural activation
- altering negative automatic thoughts
- altering unhelpful core beliefs
What is behavioural acitvation?
- self-monitoring to identify patterns
- scheduling pleasant activities to reduce frequency of depressed feelings
