Chapter 12 Flashcards
Does psychotherapy work
- Effectiveness is evaluated through many different levels of expertise
- Clinical experience; case accounts; narrative reviews of uncontrolled studies (based on psych’s observations, so not objective)
- Meta-analyses of overall effects of psychotherapy (generally effective, take all data unlike literature reviews, statistical review)
- Meta-analyses of treatments for specific disorders and subgroups of clients (which therapy work best for different issues evidence wise)
Initial Evaluation - Clinical Experience & Case Examples
- Psychodynamic and eclectic therapy supporters rely on case studies
- While insightful, these lack scientific control
Initial Evaluation - Eysenck’s (1952) Review
- Analyzed uncontrolled studies and concluded therapy was less effective than no treatment
- His findings sparked major debates about psychotherapy’s validity
- However, there were key issues with his conclusions, like validity, whether the studies were rigorous enough to support his claims, and whether there was equivalence of groups pre-treatment (w/o randomization, groups may have differed before treatment, affecting outcomes)
- Sparked need for control studies
Overall Effects of Therapy Approaches - Smith & Glass (1977) Meta-Analysis
- Found an effect size (d=0.68), indicating a moderate to strong benefit
- The average person in therapy fared better than 74% of untreated individuals
Overall Effects of Therapy Approaches - Hoffman et al. (2012) Review
- Analyzed 269 meta-analyses on CBT efficacy since 2000
- Strong evidence supports on CBT as an effective treatment for various mental Health conditions
Overall Effects of Therapy Approaches - Thompson-Hollands et al. (2014) Study
- Investigated the impact of family involvement in treating adult OCD
- Found that including family can influence/enhance treatment outcomes
Criticisms of EST Initiatives - Scientific Soundness
- Some argue that Empirically supported treatments (ESTs) rely too heavily on randomized controlled trials (RCTs) (may not relate to real-world experience, instead representing lab controlled environment)
- RCTs may not fully capture the complexity of real-world therapy settings
- Certain effective therapies may be overlooked if they don’t fit strict research criteria
Criticisms of EST Initiatives - Impact on Clinicians
- Pressure to use only ESTs may limit therapist autonomy and individualized treatment options (if only able to use 3 ESTs, but you have a client with whom another treatment could work, you may not be supported in choosing another)
- Clinicians may feel restricted if a client’s needs don’t align with EST guidelines
- Risk of undervaluing clinical experience and client preferences in treatment decisions (may also limit client’s autonomy with their advocacy for what they want & like)
International Efforts on EB Psychological Services - Australia & NZ
Implemented the Quality Assurance Project to ensure psychological treatments meet high standards of evidence
International Efforts on EB Psychological Services - Germany
Focuses on providing access to EBTs, ensuring patients receive scientifically supported interventions
International Efforts on EB Psychological Services - UK
Conducted extensive research on EB psychotherapy, influencing national policies on MH services
International Efforts on EB Psychological Services - US
Reviewed psychotherapy research to establish guidelines for effective EBTs
Evidence-Based Psychological Treatments
- EBTs exist for most common disorders (ex. anxiety, depression)
- However, fewer established treatments exist for personality disorders, requiring more research
Types of EB therapies
- CBT (Highly researched, effective for many conditions)
- Interpersonal Therapy (IPT) (Addresses relationship patterns and social functioning)
- Psychodynamic Therapy (Explores unconscious processes and early experiences)
Task Forces on EBP - APA (2006)
- Defines EBP as the integration of best available research, clinical expertise, and patient values and preferences
- Emphasizes a balanced approach, ensuring treatment aligns with both science and individual needs (Client’s wants, needs & opinions)
Task Forces on EBP - CPA (2014)
Stresses that peer-reviewed research should guide treatment decisions, and ongoing monitoring of treatment effects to ensure continued effectiveness; lacks inclusion of patient’s values, in contrast to APA
Examples of EBTs - Emotionally Focused Therapy (EFT) for Couple Distress
- A structured, ST therapy based on attachment theory
- Helps couples identify (-) interaction patterns and build secure emotional bonds and attachment difficulties (helps identify (-) emotional patterns & work on mental blocks)
- Proven effective in reducing relationship distress and improving intimacy
Examples of EBTs - Prolonged Exposure (PE) for PTSD
- A trauma-focused therapy that helps individuals gradually force trauma-related memories and situations
- CBT in vivo exposure (slowly desensitizing to escalator)
- Reduces avoidance behaviours and emotional distress over time
- Considered a gold-standard treatment for PTSD with strong empirical support
Examples of EBTs - Cognitive Behavioural Therapy (CBT) for Depression
- Focuses on identifying and changing negative thought patterns
- Uses behavioural activation to increase engagement in positive activities
- One of the most widely researched treatments for depression, showing LT effectiveness
CBT for Depression: Phase 1 - Assessment
- Diagnosis and comorbidity (anything that could be related to client)
- Life circumstances: relationships & social functioning (identify any external influences)
- Resources and Strengths (What/who are your resources, what brings you comfort in these difficult times; strengths or anything that you do that helps)
- Recent precipitating events and stressors
CBT for Depression: Phase 1 - Information on depression
Information on depression and how CBT can help
CBT for Depression: Phase 1 - Case Formulation
Linking ABCs
CBT for Depression: Phase 1 - Treatment Options
Focus on addressing specific themes, choosing treatment based on all data collected in phase 1
CBT for Depression: Phase 2 - Behavioural Activation
Encouraging individuals to engage in activity to help withdraw/counteract depression symptoms (not eating, not getting out of bed, withdrawing from enjoyable activities & social life, etc.)
CBT for Depression: Phase 2 - Behavioural Activation: Self-Monitoring to Identify Patterns
- Clients track their daily activities and mood to recognize how behaviours influence emotions
- Helps identify avoidance behaviours and low-activity periods that contribute to depression
CBT for Depression: Phase 2 - Behavioural Activation: Scheduling Pleasant Activities
- Encourages deliberate engagement in enjoyable and meaningful activities
- Reinforces a positive feedback loop where action leads to improved mood
CBT for Depression: Phase 2 - Behavioural Activation: Examining Cognitions (Thought log)
- Clients record thoughts related to specific activities and emotional responses
- Helps identify negative thinking patterns that may discourage engagement
CBT for Depression: Phase 2 - Altering negative automatic thoughts
Identifying (-) thoughts, separating them from person & contribute them to person
CBT for Depression: Phase 2 - Altering dysfunctional beliefs
Addressing deep rooted thoughts that enable depression (deep dysfunctional beliefs) to help individuals have a more balanced view of themselves and the world
CBT for Depression: Phase 3 Relapse Prevention - Review Gains & New Skills
- Reflect on progress made during therapy
- Identify effective coping strategies that have helped manage depression to go forward
CBT for Depression: Phase 3 Relapse Prevention - Anticipate challenges
- Recognize situation or triggers that may increase the risk of relapse
- Develop early warning signs to detect a potential decline in MH
CBT for Depression: Phase 3 Relapse Prevention - Prepare for Future Stressors
- Create a personalized relapse prevention plan
- Encourage continued use of CBT techniques like behavioural activation and cognitive restructuring
CBT for depression: Challenging Cognitions - Gathering Data
- Clients examine evidence for and against their negative thoughts
- Encourages rational thinking by identifying cognitive distortions
CBT for depression: Challenging Cognitions - Carrying Out Experiments
- Clients test their beliefs through real-life experiences
- Examples: Someone who believes they are “not good at anything” is encouraged to try new activities and track successes
CBT for depression: Challenging Cognitions - Changing Long-Standing Beliefs
- Core Beliefs such as I am not goof at anything, I do not deserve to be in a relationship, If bad things happen to me I must deserve them, etc.
- CBT helps replace these with balanced, realistic thoughts
Effectiveness Trials - Purpose
- Assess whether EBTs work in real-world clinical settings
- Move beyond controlled research environments to measure actual impact in therapy practices
Effectiveness Trials - Evidence for CBTs Effectiveness
- Research supports CBT for depression and anxiety disorders
- Findings confirm that CBT remains effective outside of research-controlled conditions
Effectiveness Trials - Benchmark Strategy
- Involves comparing clinical service outcomes to data from empirical studies
- Helps ensure that real-world therapy aligns with research-backed effectiveness
Adoption of EBTs - Slow Integration in Training Programs
- Many clinical psychology programs have been slow to adopt EBT training (bridging gap between Research & Therapy is VERY slow usually)
- Limited exposure can affect how clinicians apply research in practice
Adoption of EBTs - Clinician Decision-Making
- Research support for a treatment influences clinician’s choices but is not always the main factor
- Other influences include personal experience, patient preferences, and accessibility of training (integrating opinions & personal experiences of clients)
Adoption of EBTs - Example of Eating Disorder Treatment
- No gold standards for ED
- Mussell et al. (2000) found that many clinicians lacked EBT training for ED
- Von Ranson et al. (2013) noted an increase in EBT use, but some clinicians still resist adopting these treatments
Efforts to Disseminate EBTs - US Department of Veterans’ Affairs (VA) Initiative
- Focuses on expanding access to EB psychological treatments for veterans
- Targets common MH conditions, particularly PTSD (Trauma-focused therapies such as Prolonged Exposure Therapy and Cognitive Processing Therapy), Insomnia (CBT for Insomnia/CBT-I to improve sleep patterns) and Depression (use of CBT and other structured therapies for mood disorders)
Efforts to Disseminate EBTs - Implementation Strategies
- Training & Supervision (Ensuring clinicians receive specialized training in EBTs)
- Monitoring (Tracking patient outcomes to ensure treatment effectiveness and fidelity)
