Clinical Psychology Prevention, Consultation, and Psychotherapy Research

Question 1

Caplan’s Model is distinguished between three types______, _______, and ____

Answer 1

Primary, Secondary and Tertiary

Question 2

The goal of primary prevention is to _____the ________ of new cases of a mental or physical disorder. Primary preventions are aimed at an ___________ rather than _______, and the population or group may or may not be restricted to people who are known to be at __________ for the disorder. Examples are a ________ program about depression and suicide, a school-based program for fifth graders to prepare them for the transition to middle school, and prenatal care for low-income mothers.

Answer 2

Reduce
Occurrence
Entire population or group of individuals
Specific Individuals
Elevated risk
Public Education

Question 3

The goal of secondary prevention is to______ the _________of a mental or physical disorder in the population through _________. Secondary preventions are aimed at _________ who have been identified as being at elevated risk for the disorder. Providing _______to elementary school students who are _______ to have academic difficulties and using a _________to identify individuals at risk for depression and then providing identified individuals with counseling are secondary preventions.

Answer 3

Reduce
Prevalence
Early detection and intervention
Specific individuals
Tutoring
Beginning
Screening test

Question 4

The goal of tertiary prevention is to reduce the _______ of a mental or physical disorder. Tertiary preventions target people who have _______ a diagnosis of a mental or physical disorder and include __________ programs. _________for patients with schizophrenia, halfway houses, and ________ are tertiary preventions.

Answer 4

Severity and duration
Already received
Relapse prevention and rehabilitation
Social skills training
Alcoholics Anonymous

Question 5

Gordon’s Model distinguishes between ______, _______, and ______

Answer 5

Universal
Selective
Indicated prevention

Question 6

Universal preventions are aimed at ______that are _______to individuals who are at risk for a disorder. A ________program for all high school students in a school district is a universal prevention.

Answer 6

Entire Populations or group
Not restricted
Drug abuse prevention

Question 7

Selective preventions are aimed at ______ who have ______ as being at _______ for a disorder due to their _______________ characteristics. A drug abuse prevention program for adolescents whose parents have a substance use disorder is a selective prevention. _________ are for individuals who are known to be at ________because they have ________ of a disorder. __________ program for adolescents who have experimented with drugs is an indicated prevention.

Answer 7

Individuals
Been identified
Increased risk
Biological, Psychological or social
Indicated preventions
High risk
Early or minimal signs
Drug abuse prevention

Question 8

The Institute of Medicine (Mrazek & Haggerty, 1996) expanded Gordon’s model to create a continuum of care model that includes _______________. In this model, ________________ are restricted to people who have _____________a diagnosis of a mental or physical disorder. Treatment strategies are aimed at people who have _______a diagnosis, and _________ are for people who have _________ for a disorder and focus on preventing chronicity or relapse and/or providing rehabilitation.

Answer 8

Prevention, treatment and maintenance
Universal, selective and indicated preventions
Not received
Received
Maintenance strategies
Received treatment

Question 9

Mental Health Consultation:
Caplan (1970) distinguished between ________ of mental health consultation. Each type consists of a ______ that includes a _______, a consultee (therapist or program administrator), and a ______or program

Answer 9

Four types
Triad
Consultant
Consultee
Client

Question 10

Client-Centered Case Consultation:
This type of consultation focuses on a____________of the ________ who is having difficulty providing the client with effective services (e.g., is having trouble identifying an appropriate treatment). The consultant’s goal is to provide the consultee with a ____ that will benefit the client.

Answer 10

Particular client
Consultee
Plan

Question 11

Consultee-centered case consultation focuses on the ______ with the goal of improving ______ to work effectively with current and future __________ – e.g., clients with traumatic brain injury, clients from a specific racial/ethnic minority group. The goal of this type of consultation is to improve the consultee’s __________. Caplan identified several factors that contribute to a consultee’s _____. One of these is ________, which occurs when a consultee’s ______ and _____ beliefs interfere with his/her ability to be ________ when working with certain types of clients.

Answer 11

Consultee
His/her ability
Clients who are similar in some way
Knowledge, skills, confidence and/or objectivity
Lack of objectivity
Theme Interference
Biases
Unfounded belief
Objective

Question 12

Program-Centered Administrative Consultation
This type of consultation involves working with ________ to help them _____ and _____ they’re having with an ______ mental health program. The consultant’s goal is to provide ______ with _______ for dealing with the problems they’ve encountered in ______, ______, and/or _____ the program.

Answer 12

Program administrators
Clarify
Resolve problems
Existing
Administrators
Recommendations
Developing
Administering
Evaluating

Question 13

Consultee-Centered Administrative Consultation

Consultee-centered administrative consultation focuses on improving the ________________ so they’re better able to _____, ______, and _____mental health programs in the ____.

Answer 13

Professional functioning of program administrators
Develop
Administer
Evaluate
Future

Question 14

Mental health consultation differs from _____ in several ways. For example, a consultant has ________contact with a _______ and is ________ for the client’s outcomes. In contrast, a collaborator usually has _______ with the client and _________ for the client’s outcomes.

Answer 14

Collaboration
Little
No direct contact
Consultee’ s client
Not responsible
Direct contact
Shares responsibility

Question 15

Much of the empirical research evaluating psychotherapy outcomes can be categorized as _____ research or ________ research. Efficacy research studies are also known as _______ and maximize _______ (the ability to draw conclusions about the cause-effect relationship between therapy and outcomes) by maximizing ___________. For example, participants are _______ assigned to _____ in these studies and therapists use treatment ________ to ensure that treatment is provided in the same way to all participants.

Answer 15

Efficacy
Effectiveness
Clinical trials
Internal validity
Experimental control
Randomly
Groups
Manuals

Question 16

In contrast, ________ research studies maximize _________ (the ability to generalize the conclusions drawn from the study to other people and conditions) by providing therapy in _______ clinical settings. Both approaches have _______ and ______, and a useful strategy for ______ treatment outcomes is to first conduct an ______ study to determine a treatment’s effectiveness in well-controlled conditions, and then conduct an ______ study in “________” settings to determine its _______, ________, and _________ (Jacobson & Christensen, 1996)

Answer 16

Effectiveness
External validly
Naturalistic
Strengths
Weaknesses
Evaluating
Efficacy
Effectiveness
Real world
Generalizability, feasibility and cost -effectiveness

Question 17

Psychotherapy Outcome Research Includes studies conducted by who________

Answer 17

Frequently cited research on psychotherapy outcomes include studies conducted by Eysenck; Smith, Glass, and Miller; and Howard and his colleagues

Question 18

Hans Eysenck is probably best known for his conclusions about ______ and _______: He proposed that intelligence is due primarily to _____, with about ___% of variability in IQ scores being due to _____ factors. His personality theory also stresses the role of heredity and distinguishes between three major personality traits: ______, ______, and ________.

Answer 18

Intelligence and personality
Heredity
80%
Genetic
Personality
Extroversion, neuroticism and psychoticism

Question 19

Eysenck (1952) is also known for his controversial conclusions about the effectiveness of psychotherapy (1952), which were based on his review of ____ empirical studies that reported treatment outcomes for “_____” patients who participated in ______ or _______ psychotherapy. Because the studies did not include ________, Eysenck used other studies to estimate the ________ of neurotic patients who received custodial care in an inpatient facility or medical care from a physician.

Answer 19

24
Neurotic
Psychoanalytic or eclectic
No-treatment control groups
Spontaneous remission rates

Question 20

Based on this data, Eysenck concluded that ___% of patients who participated in psychoanalytic psychotherapy, ___% of patients who participated in eclectic psychotherapy, and ___% of patients who did not participate in psychotherapy experienced an improvement in symptoms. He proposed that these results not only showed that psychotherapy is _____ but that it may actually have ______ since the average recovery rates for psychotherapy patients were _______ than the average spontaneous remission rate for patients who did not receive psychotherapy.

Answer 20

44%
64%
72%
Ineffective
Detrimental effects
Lower

Question 21

Eysenck’s conclusions were challenged by advocates of psychotherapy who pointed out that his study had several _______. For example, Luborsky (1954) noted that the comparisons Eysenck made were questionable because patients were not _____ to groups and, consequently, initial differences in ________ could account for at least some of the differences in ________. In addition, Bergin (1971) noted that the criteria Eysenck used to determine recovery were questionable and found that use of different criteria produced a recovery rate of ___% for patients who participated in ______ psychotherapy and ___% for patients who did not receive psychotherapy.

Answer 21

Methodological flaws
Questionable
Randomly assigned
Groups
Patient characteristics
Recovery rates
83%
Psychoanalytic
30%
Did not

Question 22

Smith, Glass, and Miller

Eysenck’s article generated a great deal of research on ______, and Smith, Glass, and Miller (1980) were the first to use ________ to _____ the results of studies that compared the outcomes of patients who _____ psychotherapy to the outcomes of patients in either a ______control group or an alternative (_______) treatment group.

Answer 22

Psychotherapy outcomes
Meta-analysis
Combine
Received
No treatment
Non-therapy

Question 23

Their analysis included _____ studies and produced a mean effect size of ___, which means that the average patient who received psychotherapy was “______” than _____% of patients who did not receive psychotherapy. [An effect size indicates the mean difference between groups in terms of a standard deviation, and an effect size of ____ indicates that the mean outcome score for patients who participated in psychotherapy was ___ standard deviation _____ the mean outcome score for patients who did not receive psychotherapy. In a normal distribution, ____% of scores are below a standard deviation of 1.0, and 80% (slightly less than 84%) are below a standard deviation of .85. Note that, for the exam, you just need to remember that an effect size of .85 means that the average patient who received psychotherapy was better off than 80% of patients who didn’t receive therapy. You do not need to understand why this is so, but we’ve included the explanation for those of you who are curious about the interpretation of an effect size of .85.]

Answer 23

475
.85
Better off
80%
.85
.85
Above
84%

Question 24

Howard and Colleagues

Howard and his colleagues (1986, 1996) investigated the relationship between the duration of psychotherapy and its outcomes. Based on the results of their research, they developed two models to describe this relationship:

(a) The ______ is also known as the ______model and states that there’s a ______relationship between________ and the probability of measurable_________. Specifically, it predicts that __% of therapy clients can be expected to exhibit a clinically significant improvement in symptoms by six to eight sessions, ____% by 26 sessions, and ___% by 52 sessions.

Answer 24

Dosage
Dose-effect
Predictable
Number of therapy sessions
Improvement in symptoms
50%
Six to eight
75%
85%

Question 25

b) The _____ proposes that psychotherapy outcomes can be described in terms of ____ phases: The _______ phase occurs during the ____ sessions and is characterized by an _____ in ______. This is followed by the ______, which occurs during the next ___ sessions and involves a __________. The final _______ phase involves “unlearning troublesome, maladaptive, habitual behaviors and establishing new ways of dealing with various aspects of life (e.g., problematic relationship patterns, faulty work habits, and trouble-causing personal attitudes)” (1996, p. 1061). An implication of this model is that different outcome measures should be used during different phases of therapy – i.e., measures of subjective well-being during the remoralization phase, the severity and frequency of symptoms during the remediation phase, and life functioning during the rehabilitation phase.

Answer 25

Phase model
Three phases
Initial remoralization phase
First few sessions
Increase in hopefulness
Remediation phase
16
Reduction in symptoms
Rehabilitation

Question 26

Other Psychotherapy Research

Other issues related to psychotherapy outcome that may be asked about on the EPPP include common factors in psychotherapy, client-therapist matching, mental health care utilization, medical cost offset, and economic evaluation.

Question 27

What are the Common Factors in Psychotherapy

Answer 27

Because the research has found that different psychotherapy approaches have similar beneficial effects (APA, 2012), a number of researchers have attempted to identify elements common to the various approaches that contribute to psychotherapy outcomes. For example, based on their review of the research, Norcross and Lambert (2011) attribute 30% of variability in psychotherapy outcomes to patient contributions, 12% to the therapeutic relationship, 8% to the treatment method, 7% to therapist characteristics, 3% to other factors, and 40% to unexplained variance.

Question 28

The Working Alliance

The psychanalyst, Ralph Greenson (1967), was the first to describe the _______ as consisting of ____ components:_______, _________, and _______. Of these, the working alliance (which is also referred to as the therapeutic alliance) has been studied most extensively. As defined by Greenson, the working alliance is “the relatively non-neurotic, rational relationship between patient and analyst which makes it possible for the patient to work purposely in the analytic situation” (p. 46).

Answer 28

Therapeutic relationship
Three
Working alliance
Real relationship
Transference-countertransference

Question 29

Studies have identified the ______ as a ______ factor across all types of ________ and have found a strong working alliance to be a significant predictor of ________psychotherapy outcomes. For example, a recent meta-analysis of the research by Fluckiger, Del Re, Wampold, and Horvath (2018) confirmed that, for adult therapy clients, “the positive relation of the alliance and outcome remains across assessor perspectives, alliance and outcome measures, treatment approaches, patient (intake-) characteristics, face-to-face and Internet-mediated therapies, and countries” (p. 316).

Answer 29

Working alliance
Core common
Psychotherapy
Successful

Question 30

The results of research investigating the effects of ________ in terms of ______ and ________, depending on the outcome measure and clients’ race or ethnicity. For example, Cabral and Smith’s (2011) meta-analysis of the research produced an effect size of ____for the impact of matching on clients’ perceptions of their therapists but an effect size of only ___on measures of _______. In addition, Sue et al. (1991) found that the effects of matching on treatment outcomes _____, depending on client _________.

Answer 30

Client -therapist matching
Race
Ethnicity vary
.32
.09
Therapy outcome
Varied
Race/ethnicity

Question 31

Their study indicated that ______ matching _______ rates for ____, _____, and _____ clients but not for ________ clients and that matching was associated with ______ treatment outcomes only for _____ clients. There’s also evidence that matching in terms of factors other than race and ethnicity are ___important for therapy outcomes: Comas-Diaz (2012) report that their review of the research indicated that “clinicians’ ______, ______, and … ______ were ______ important than ethnic matching between client and clinician” (2012, p. 173).

Answer 31

racial/ethnic
Reduced premature termination
Asian
Hispanic
European America
African American
Improved
Hispanic American
More important
Cultural competence
Compassion
Worldview
More

Question 32

Utilization of Mental Health Care Services

Answer 32

The research has found that utilization rates of mental health care services vary, depending on clients’ gender, age, sexual orientation, and race/ethnicity. With regard to gender, the 2018 National Survey of Drug Use and Health (Substance Abuse and Mental Health Services Administration, 2019) found that utilization rates were higher for female adults than for male adults. In terms of age, it found that, for all adult respondents, utilization rates were highest for respondents ages 26 to 49 followed by, in order, those ages 50 and older and those ages 18 to 25, which is consistent with the results of yearly surveys conducted since 2002.

In terms of sexual orientation, the studies have generally found that sexual minority (gay/lesbian and bisexual) men and women utilize mental health care services at higher rates than sexual majority (heterosexual) men and women do. For example, data from the 2013 to 2015 National Health Interview Surveys (Platt, Wolf, & Scheitle, 2018) revealed that sexual minority men and women were two to four times more likely than heterosexual men and women to have talked with a mental health professional in the past year.

Finally, for members of different racial/ethnic minority groups, data from the 2018 National Survey of Drug Use and Health indicated that, among all adult survey respondents, the use of outpatient mental health services in the past year was highest for respondents who identified themselves as belonging to two or more racial groups and lowest for respondents who identified themselves as Asian. For inpatient mental health services, use was highest for respondents who identified themselves as American Indian or Alaska Native and lowest for respondents who identified themselves as Asian.

The research has also found that utilization rates differ for different racial/ethnic minority groups. The National Survey of Drug Use and Health (Substance Abuse and Mental Health Services Administration, 2015) collected data on the use of mental health services by individuals ages 18 and older. It found that the annual average use of outpatient mental services from 2008 to 2012 was highest for respondents reporting two or more races followed by, in order, respondents who identified themselves as White, American Indian or Alaska Native, Black or African American, Hispanic American, or Asian. For inpatient mental health services, the annual average use was highest for respondents who identified themselves as American Indian or Alaska Native followed by, in order, those who identified themselves as being Black or African American, two or more races, Hispanic American, White, or Asian.

Question 33

Psychological Interventions and Medical Costs

Answer 33

The American Psychological Association has concluded that research on psychotherapy outcomes has “demonstrated that courses of psychotherapy reduce overall medical utilization and expense” (2012, p. 2). For example, with regard to expense, Chiles, Lambert, and Hatch’s (1999) meta-analysis of research conducted between 1967 and 1997 indicated that participation in psychological interventions by patients undergoing surgery, patients with a history of medical overutilization, and patients receiving treatment for substance misuse or other psychological disorder usually resulted in a medical cost offset. They found that 90% of the studies included in their analysis reported evidence of a medical cost offset and that the average cost savings attributable to a psychological intervention was 20%.

Question 34

Economic Evaluation

Answer 34

The economic evaluation of healthcare programs involves using information about program costs and benefits to inform decision-making. Cost-benefit analysis, cost-effectiveness analysis, and cost-utility analysis are three methods of economic evaluation. Cost-benefit analysis (CBA) can be used to compare the costs and benefits of one or multiple interventions. When using CBA, costs and benefits are both expressed in monetary terms. As an example, Knapp et al. (2013) compared individual placement and support (IPS) and standard vocational rehabilitation for helping people with severe mental disorders obtain employment. When the costs of implementing the two interventions and their benefits (as measured by expected earnings) were compared, IPS produced a greater net benefit. Cost-effectiveness analysis (CEA) is used to compare the costs and benefits of two or more interventions when benefits cannot be expressed as monetary values. The Knapp et al. study used cost-effectiveness analysis to compare the costs and benefits of IPS and standard vocational rehabilitation, with benefits being measured as percent of participants who worked for at least one day during the follow-up period, percent of participants who dropped out of the program they were assigned to, and percent of participants who had to be readmitted to the hospital. IPS was found to be more effective than vocational rehabilitation for all three benefits. Finally, cost-utility analysis (CUA) is used to compare the costs of two or more interventions on quality-adjusted life-years (QALYs), which combines measures of gain in the health-related quality and the quantity (duration) of life. For instance, Sava, Yates, Lupu, Szentagotai, and David (2009) used CUA to compare the costs and benefits in terms of QALYs of three treatments for depression: cognitive therapy (CT), rational-emotive behavior therapy (REBT), and fluoxetine (Prozac). Results indicated that CT and REBT both had greater cost-utility than fluoxetine but did not differ significantly from each other.

Question 35

Effects of Age, Gender, and Socioeconomic Status on Psychotherapy Outcomes

Answer 35

Research investigating the effects of age, gender, and socioeconomic status on psychotherapy outcomes has not produced entirely consistent results, but the best overall conclusions are that they have little or no impact on outcomes and that apparent differences are due to other factors (Boswell, Constantino, & Anderson, 2016). For example, Nordberg and colleagues (2014) found that, when initial severity of symptoms was controlled, client age explained essentially none of the variance in psychotherapy outcomes. Also, while some studies have linked low socioeconomic status to premature termination, there’s evidence that this relationship is due to transportation difficulties and other factors.

Question 36

Biases in Psychological Research and Theory

Answer 36

Psychological research and theory can be affected by a number of biases, including gender biases and the WEIRD sampling bias. Gender biases can cause research results and conclusions drawn from those results to be nonrepresentative of the actual experiences and behaviors of men and/or women: Alpha bias is the tendency to exaggerate differences between men and women and can reinforce gender stereotypes and justify discriminatory practices. In contrast, beta bias is the tendency to ignore or minimize differences between men and women. It can lead to the erroneous conclusion that the results of research that included only male participants also apply to females, and vice versa. Alpha and beta biases have been linked to androcentrism, which means “male-centered” and occurs when male behaviors and traits are considered to be the norm while female behaviors and traits are viewed as deviations from the norm and often as abnormal or inferior.

As described by Henrich, Heine, and Norenzayan (2010), WEIRD is an acronym for western, educated, industrialized, rich, and democratic cultures. According to these investigators, studies published in the world’s top journals have over-relied on samples drawn from WEIRD cultures and, consequently, their results may have limited generalizability. As an example, Henrich et al. note that the Big Five personality traits have been derived primarily from research that included WEIRD samples and argue that, as a result, conclusions about the universality of the Big Five drawn from this research may not be valid. Some evidence for this claim is provided by Gurven et al. (2013), who found that the Big Five personality traits do not accurately describe the personalities of a largely illiterate indigenous population of forager-farmers in the Bolivian Amazon. (Note, however, that the universality of the Big Five continues to be debated, with studies like Gurven et al.’s being criticized on methodological grounds.)

Question 37

Routine Outcome Monitoring

Answer 37

Routine outcome monitoring (ROM) is also known as feedback-informed treatment and measurement-based care and is considered to be a transtheoretical and transdiagnostic evidence-based practice (Scott & Lewis, 2015). As described by Lewis et al. (2019), it consists of four components: “(1) a routinely administered symptom, outcome, or process measure …, ideally before each clinical encounter; (2) practitioner review of data; (3) patient review of data; and (4) collaborative reevaluation of the treatment plan informed by the data” (p. 326). ROM may involve the use of clinician rating scales but most often uses standardized patient self-report measures such as the Partners for Change Outcome Management System (PCOMS), which is used to assess a client’s progress and the quality of the therapeutic relationship (Lambert & Harmon, 2018). Studies have confirmed that ROM is more effective than less frequent feedback and is associated with several benefits including increased rates of clinically significant improvement and significant reductions in client deterioration during therapy and premature termination (e.g., Carlier & van Eeden, 2017; Fortney et al., 2017; Lambert, 2010; Lewis et al., 2019). In addition, a number of studies have found that ROM is most effective for clients who are at risk for treatment failure.

Despite evidence of its benefits, ROM is underutilized by clinicians due to client and clinician barriers (e.g., Boswell, Kraus, Miller, & Lambert, 2015; Lewis et al., 2019): Client barriers include concerns about confidentiality and the time needed to complete the measures. Clinician barriers include the belief that information provided by ROM is not more accurate than clinical judgment; a lack of training in the use of ROM; unease about the potential effects of ROM on the therapeutic relationship; concerns about the time it takes to administer, score, and interpret measures, create a report, and provide feedback to clients; and concerns about how results of ROM will be used by employers and insurance companies.

Question 38

Transdiagnostic Treatments

Answer 38

Transdiagnostic treatments are designed to address a range of diagnoses that not only share symptoms but also biological, psychological, and environmental mechanisms that increase the risk for and maintain those symptoms. “The premise underlying transdiagnostic treatments is that the commonalities across disorders outweigh the differences and that targeting the … [commonalities] may have a number of important benefits compared to diagnosis-specific approaches” (McEvoy, Nathan, & Norton, 2009, p. 21). For example, transdiagnostic treatments can reduce the cost and amount of time associated with training psychologists to deliver numerous diagnosis-specific interventions and they’re better suited than single-diagnosis treatments for addressing comorbidities. Systematic reviews and meta-analyses of the research have generally confirmed that, in terms of effectiveness, transdiagnostic psychological treatments are equivalent or superior to comparison treatments (Dalgleish, Black, Johnston, & Bevan, 2020). For example, based on the results of their meta-analysis, Newby and colleagues (2015) concluded that transdiagnostic treatments are as effective as diagnosis-specific treatments for anxiety and may be more effective for depression.

Some transdiagnostic treatments consist of evidence-based strategies that are applicable to disorders within a single diagnostic category, while others consist of strategies that are applicable to disorders from different categories. Cognitive Behavioral Therapy-Enhanced (CBT-E) is an example of the former and was designed as an intervention for anorexia nervosa, bulimia nervosa, and other eating disorders (Fairburn, Cooper, & Shafran, 2003). It is based on the assumption that these disorders share the same core psychopathology of overvaluation of body shape and weight (Fairburn et al., 2003). Examples of the latter include the following: (a) The Unified Protocol for Transdiagnostic Treatment of Emotional Disorders (UP; Barlow et al., 2011) is an emotion-focused, cognitive-behavioral intervention for anxiety, depression, and related disorders. It views neuroticism as the core characteristic shared by these disorders and focuses on mechanisms associated with neuroticism, including deficits in emotion regulation and avoidance of intense emotional experiences. (b) Emotion-Focused Therapy-Transdiagnostic (EFT-T; Timulak & Keogh, 2020) was developed as a treatment for depression, anxiety, and related disorders and targets the chronic painful emotions of loneliness/sadness, shame, and fear/terror that underlie these disorders. (c) Acceptance and Commitment Therapy (ACT) is a cognitive-behavioral intervention for a wide range of mental health and medical conditions. It is based on the assumption that “pain, grief, disappointment, illness, and anxiety are inevitable features of human life… [and its primary goal is] helping individuals adapt to these types of challenges by developing greater psychological flexibility” (Dindo, Van Liew, & Arch, 2017, p. 546). (d) Parent-Child Interaction Therapy (PCIT) was originally developed as a treatment for disruptive behavior disorders but has since been found to be an effective intervention for anxiety, mood, and trauma-related disorders and child maltreatment. It is based on the premise that emotion dysregulation is “a core process in the etiology of myriad early-onset psychopathology symptoms” (Rothenberg, Weinstein, Dandes, & Jent, 2018, p. 720), and a primary goal of therapy is improving a child’s emotion regulation.

Question 39

Telepsychology and Evidence-Based Psychotherapy

Answer 39

referred to as telehealth and telemental health and is “the provision of psychological services using telecommunication technologies … [that] include but are not limited to telephone, mobile devices, interactive videoconferencing, email, chat, text, and Internet (e.g., self-help websites, blogs, and social media)” (APA, 2013, p. 792). Interest in telepsychology has increased in recent years, especially with regard to the delivery of evidence-based psychotherapy (EBP). As noted by Wangelin, Szafranski, and Gros (2016), EBP delivered via telepsychology is associated with several benefits over EBP delivered in-person: It decreases patients’ and providers’ costs (e.g., costs related to travel and transportation); increases access to psychotherapy for individuals who have no or limited access (e.g., for members of rural and underserved populations); and reduces the stigma and embarrassment that some individuals experience when receiving psychotherapy at treatment facilities. The research has also found that, in most cases, telepsychology-delivered EBP provides roughly equivalent outcomes for members of diverse populations and a variety of disorders.

Question 40

Anxiety Disorders

Answer 40

There’s evidence that psychotherapy delivered via telepsychology is effective not only for treating individual anxiety disorders but also for treating comorbid anxiety and mood disorders. For example, Berryhill and colleagues (2019b) conducted a systematic review of studies evaluating the effectiveness of videoconference-delivered psychotherapy – most often cognitive-behavioral therapy (CBT) – for treating panic disorder with agoraphobia, generalized anxiety disorder, and social anxiety disorder. Their analysis indicated that the majority of studies found significant improvement in anxiety symptoms following participation in videoconferencing psychotherapy, with controlled studies finding no significant differences between videoconferencing and in-person therapy. In addition, Stubbings, Rees, Roberts, and Kane (2013) compared videoconferencing-delivered CBT to in-person CBT and found them to be similarly effective for reducing comorbid anxiety and depression and improving quality of life

Question 41

Posttraumatic Stress Disorder (PTSD)

Answer 41

Most studies evaluating the use of telepsychology for treating PTSD have found it to be comparable to face-to-face interventions in terms of effectiveness. For example, in their systematic review of studies evaluating telepsychology for veterans with PTSD, Turgoose, Ashwick, and Murphy (2018) found that trauma-focused therapies (e.g., exposure therapy, behavioral activation) delivered via telepsychology or in-person were similar in terms of the reduction of PTSD symptoms, attendance and dropout rates, client satisfaction, and therapist fidelity to treatment protocols. However, the studies included in their review did not provide entirely consistent results with regard to the therapeutic alliance: While therapists providing telepsychology said they didn’t have trouble developing rapport with clients, some reported barriers to developing a therapeutic alliance, such as the inability to detect nonverbal communications.

Question 42

Major Depressive Disorder

Answer 42

The research has demonstrated the effectiveness of telepsychology for treating major depressive disorder. In their systematic review of studies comparing videoconferencing and in-person psychotherapy, Berryhill and colleagues (2019a) found that most studies reported statistically significant decreases in depressive symptoms following videoconferencing psychotherapy, with no statistical differences between videoconferencing and in-person groups receiving the same intervention. There’s also evidence that telepsychology is useful for alleviating the insomnia and chronic pain that often accompany depression (Wangelin, Szafranski, & Gros, 2016). Finally, while a study evaluating the effectiveness of telephone-administered CBT found it to have a lower attrition rate than in-person CBT had, other studies have found that attrition rates for other modes of telepsychology vary, depending on the population and type of intervention (Bee et al., 2008; Mohr et al., 2012).

Question 43

Bulimia Nervosa

Answer 43

Research evaluating telepsychology-delivered treatments for bulimia nervosa (BN) has found that it has beneficial effects but is not necessarily as effective as in-person treatments. For example, Mitchell et al. (2008) compared videoconference-delivered and in-person delivered versions of manual-based CBT for BN. Overall, the results indicated that the two versions had similar attrition rates and that both produced beneficial effects on outcome measures following treatment. However, there were some differences: Patients receiving in-person CBT had non-significantly higher rates of abstinence from binge eating and purging and significantly greater reductions in eating disordered cognitions and depression. In a more recent study, Zerwas and colleagues (2017) compared a manualized version of CBT group therapy for BN delivered via an Internet chat group and the same treatment delivered via traditional face-to-face group therapy. They found that patients in both groups experienced a decrease in binge eating and purging and comorbid symptoms of depression and anxiety by the end of treatment but that there were some group differences: Immediately after treatment ended, patients receiving face-to-face group therapy had a greater decrease in abstinence rates and anxiety symptoms, but the gap between the two groups on these measures narrowed at the 12-month follow-up, indicating that the pace of recovery was slower for patients who received therapy via the Internet.

Question 44

Stepped Care

Answer 44

“ _______ is a model of healthcare delivery with two fundamental features. First, the recommended treatment within a stepped care model should be the least restrictive of those currently available, but still likely to provide significant health gain. Second, the stepped care model is self-correcting … [which means] that the results of treatments and decisions about treatment provision are monitored systematically, and changes are made (‘stepping up’) if current treatments are not achieving significant health gain” (Bower & Gilbody, 2005, p. 11). The primary goals of stepped care are to increase the efficiency of health care services and the accessibility of effective treatments through better allocation of scarce mental health resources.

There are several models of stepped care: Some apply to specific disorders, while others are non-specific and can be applied to various disorders and conditions. With regard to the former, commonly cited models for depression usually include four steps that are similar to those described by Broten, Naugle, Kalata, and Gaynor (2011):

Step 1 - Assessment and Monitoring: This step includes evaluating the patient’s symptoms and “watchful waiting” which is appropriate for patients with minor depressive symptoms and involves monitoring their symptoms.

Step 2 – Interventions Requiring Minimal Practitioner Involvement: Step 2 interventions include psychoeducation about the symptoms and course of depression, treatment options, and signs of relapse; bibliotherapy as a preventive technique for patients who are at high risk for depression or are experiencing an increase in symptoms and as an adjunct to other treatments; and computer-based interventions that track patients’ symptoms and use multimedia with interactive components designed to help patients cope with depression and anxiety.

Step 3 – Interventions Requiring More Intensive Care and Specialized Training: This step may include group therapy, individual psychotherapy, and/or medication. (Note that some models identify group psychotherapy and brief individual psychotherapy as initial choices for this step followed by longer-term psychotherapy with or without antidepressant medication for patients who do not respond adequately to group or brief individual therapy.)

Step 4 – Most Restrictive and Intensive Forms of Care: This step is for patients with severe depressive symptoms and consists of voluntary or mandated inpatient care.

Question 45

Models of Disability

Answer 45

As described in the Americans with Disabilities Act (ADA), a person with a disability has a physical or mental impairment that substantially limits a major life activity, has a record of such impairment, or is regarded as having such an impairment because of an actual or perceived physical or mental impairment. Experts distinguish between a variety of disability models, but most categorizations include the medical and social models. For example, the American Psychological Association’s (2012) Guidelines for the Assessment of and Intervention with Persons with Disabilities distinguishes between four scientific models of disability: biomedical, social, functional, and forensic. The biomedical model is also known as the medical model and views disabilities as medical conditions that deviate from the norm and disrupt a person’s physical and/or cognitive functioning. From this perspective, a disability is intrinsic to the individual and the focus of intervention is on identifying and providing treatments that will manage, alter, or cure the medical condition causing the disability. The social model views a disability as a difference rather than an abnormality or deficiency and as due primarily to aspects of society that create barriers for people with disabilities (e.g., negative attitudes, discrimination, exclusion, architectural barriers). Interventions based on this model focus on making societal and environmental changes. The functional model views a disability as the cause of a person’s inability to perform his or her function or role at work or elsewhere. It recognizes a person’s medical condition but focuses on identifying what accommodations, modifications, or assistive technology devices are needed to improve the person’s functioning (Chronister & Fitzgerald, 2018). Finally, the forensic model focuses on legal concepts and “requires objective proof of impairment and disability and determination of the honesty and motivation of individuals seeking recognition, benefits, or compensation for disability” (APA, 2012, p. 45). In other words, the primary focus of this model is on distinguishing between honest and dishonest people (e.g., malingerers) in order to identify the appropriate interventions or consequences.