EBIs Flashcards
define evidence-based therapies
any therapeutic technique which has been
shown to be effective
fill in the blank
EB as a medical movement was started in early … by Canadian epidemiologist,David Sackett
1980s
what was Canadian epidemiologist,
David Sackett famously known for in terms of EB practise (2 marks)
● Encouraged clinical decision-making that was grounded in evidence
● His ideas spread throughout medicine, including psychiatry (EB movement)
why did the EBT movement in psychology adopt the FDA evidence model
● Psychiatry guidelines tended to underplay the value of psychological treatments - FDA model lent validity to the discipline
why was EB psychology developed and what did it focus on (2 marks)
● Developed to give psychological treatments greater perceived validity
● Focused on brief, focal treatments for specific disorders
>Involvement of insurance -> was perceived as cheap + effective + short-term
In 2006 APA released a policy on EB practice in psychology. What are 3 criticisms?
■ Conception + treatment of mental illnesses heavily influenced by culture.
■ Disorders constructed in different ways
■ Prescription of capitalism + West in EBT
fill in the blank
2006: APA released policy on EB practice in psychology:
“This policy emphasises integrating the best-available research with .. in the ..of the patient’s… , individual …, and personal ..”
-clinical expertise
-context
-culture
-characteristics
-preferences
best research evidence=?
data from a range of research methodology
name 5 data from a range of research methodologies
○ randomised controlled trials
○ effectiveness studies
○ process studies
○ single-case reports
○ systematic case studies
say whether the following is true or false:
● Policies about EB practice in psychologyare intended to minimize patients’ choices about treatment
false
its intended to maximize
fill in the blank
○ Globally, lifetime rates of psychiatric disorders range from …
○ SASH (Williams et al., 2008) showed 12 month prevalence rate of ..for
CMDs and a lifetime prevalence of ….(Herman et al., 2009)
-12-47%
-16%
-30%
what is estimated to be leading cause of disability worldwide by 2030
depression, Ahead of cardiovascular disease, car accidents, and HIV/AIDS
mental disorders lead to….
a greater impairment than chronic medical disorders
true or false
In SA, 23.6 days spent ‘out of role’; days when people unable to work or
carry out usual daily activities due to mental illness (Mall et al., 2014)
true, Direct + indirect costs to individuals, communities and economies are enormous.
fill in the blank
Loss of income for South Africans with CMDs is $….
THe total annual cost to SA is $…. in lost income
-$4,798
-$3.6 billion
public health expenditure of US$150
per capita serves 84% of the population, while private expenditure is ten times as much, serving only 16% of South Africans (Benatar, 2013)
what does this reflect about South Africa health care expenditure (two marks)
●South African healthcare expenditure reflects the country’s profound socioeconomic inequalities
● Overrepresented private sector -> most resources
what is the ratio of psychologists and psychiatrist to every 100 000 people in the public service
a ratio of 0.32 psychologists and 0.28 psychiatrists for every 100 000 people in public service
true or false:
Access to care is equal
Access to care is NOT equal: Treatment gap of up to 90% in LMICs.
In SA, treatment gap is 75% (SASH)
when was the global health movement established
2007
what is the Global Mental Health (GMH) movement
a movement to improve mental health services (especially in low-middle-income countries
(LMIC)
what are the Two principles that are fundamental to the mental health movement
scientific evidence + human rights.
what are the two primary goals of the mental health movement
○ address human rights issues in mental health
○ only support interventions / programmes / treatments that are based on
scientific evidence
the best research evidence=?
data from a range of research methodology
name 5 research methodology that evidence based data can come from
1.meta-analyses,
2.randomised controlled trials,
3.effectiveness studies,
4.process studies,
5. single-case reports,
MREPS
what methodology has come to represent “best” evidence (or even only evidence)
RCTs
define efficacy is when we talking about evidence based practice
the extent to which intervention produces expected results under ideal
conditions in controlled environment
fill in the blank
RCTS are condiered “evidence producers” as their evidence is derived from trials where threat to … is minimised
internal validty
what would internal validity mean in EBT
confidence that cause-and-effect relationship is not due to other factor
what is considered the gold standard in EBT
RCT
name 3 reasons why RCT`s are known as the gold standard
“Purity”,
controlled variables,
internal validity
true or false:
RCTs enable researchers to establish cause and effect
true
what has EB treatment has become synonymous with
efficacy
fill in the blank
Effectiveness = performance under ….conditions
real-world
true or false:
In real-world effectiveness studies, testing pharmacological treatments is not different from testing psychotherapy
false
it is differentas there are many extraneous variables + confounds. But this kind of study gives us a more realistic depiction
RCTs are known as what?
the Evidence Generator
are blind studies possible for therapy
not always
if u cant have a double blind study in RCTs, what can you do
Try to have groups as equal as possible
true or false
in RCTs, we always Use same instrument/measure before and after
true
in RCTs, what does TAU stand for
TAU = treatment as usual; might be effective/have an effect
why should Control and treatment groups should have similar baseline measures
so you can compare changes
in RCTs, why should sample sizes should be similar and large
to generalise
fill in the blank
RCTs Want to compare size of baseline and … measures on control and
treatment groups, but also want to compare the size of the treatment’s and control’s
…measures
-post-intervention
-post-intervention
what constitutes evidence
Evidence = empirical data; data gathered using the ‘scientific method’
○ Empirical = observable or verifiable through observation rather than theory
read the following, and answer the questions that follow
“Those psychological interventions that have been shown by means of empirical
research to reduce symptomatology and increase functioning among clients, at a rate
that is beyond what would have occurred by chance” (Kagee & Lund, 2012, p.103)
Functioning according to whom?
Capitalist + Western ideas
Symptoms are taken as universal facts. Give 2 reasons they may not be
■ Labelling + definitions are constructed
■ Symptoms constructed + viewed + experienced differently
fill in the blank
there is an assumption of healing as…
Why might this not be the case?
linear
Eg in PDT, often feel worse before you feel better and you’re bringin stuff up (one of the reasons PDT stuggles to gain “evidence” support from RCTs)
name 5 criteria of am EB Psychotherapy
○ Specific patient characteristics
- Use mutiple outcome measure
○ Random assignment
○ Using a manualised intervention
○ Statistically significant effect size
○ Outcomes can be replicated
SURUSO
*this is basically an RCT
true or false
there are over 320 EB interventions
true
○ Not just therapy, might be at a hospital, with lay-counsellors, etc
○ Some to try develop efficacious + effective interventions (think task-sharing)
why are the following criteria of EB Psychotherapies seen as unrealistic:
● Inclusion and exclusion criteria are clear
● NB to reduce in-group variability
● More than 1 diagnosis/problem often leads to exclusion
○ Intervention only shown to be effective for people with only that problem
(and no others)
what does Randomising participants do
reduces bias
what does having a control group do
allows for a suitable bias
name 4 different types of control groups
○ No-treatment
○ Treatment as usual (TAU)
○ Attention as placebo
○ Waitlist
what is a placebo effect in a control group
-> attend to them, but not giving them actual treatment
what are the critiques of placebos in control groups
■ Hard to have “placebo” in psychotherapy
■ Ethics around telling someone they’re being treated when they’re not
what is the critique of no-treatment as a control group
bar is too low (most therapies are effective)
what is the critique of TAU as a control group
no standard for TAU in psychology (unlike medicine
true or false:
Comparison studies often use under-trained therapists
true
■ May use different types of therapy (not really comparable)
■ May use trainees versus experts (not really comparing therapies, but
experience + expertise
what does fidelity mean in terms of EBT
Fidelity = staying true to the intervention; everyone gets same treatment
what are manualized interventions
● Consistency in application (fidelity) -> standardised, controlled
give 3 advantages of Manualised Interventions
● Prevents drift -> giving different, non-manual advice
● Allows for replication (clear procedures)
● Allows for task-sharing
true or false:
○ Manuals cant be obstacles to relating
false
-they can be.
- Over-focus on script rather than addressing issues that arise and following the patient
fill in the blank
technique is … despite evidence for
non-specific factors
curative
what assumptions do manual-based interventions incorrectly make
-Assumes one-approach fits all
- Based on assumptions of health
what approach do most studies use to generate data
Most studies use many outcome measures
○ Interventions may show improvements on some outcomes but not others.
complete the sentence
Outcomes measure variety of variables, which can generate a lot of ….
data
in terms of Using Multiple Outcome Measures, what deems Slanted reporting of outcomes
Often, there is a mixed set of effects across the various measures, but researchers may only report on outcomes that show improvement, to provide evidence of the intervention’s success
true or false:
there are specific guidelines regarding the selection of appropriate measures used to
assess outcomes
false
there are no guidelines, Not all measures are equally important, psychometrically sound or sensitive to change
what does psychometric validity look at
Is the instrument valid (measure what it says it measures) and reliable (achieve the same result with repeated administration)?
what are the following questions looking at
Is the change that is being measured important to participants’
lives?
Does it affect their functioning or daily living? Or does it measure some arbitrary construct that has no real bearing on patients’ lives?
importance and sensitivity to change in outcome measures
Evidence relies on ‘significant’ outcomes -> how effective it has been
name two types of significance
● Statistical significance (change didn’t occur by chance) -> does not mean big difference
● Clinical significance (effect on functioning)
○ Statistical versus real-world, lived experiences
what does the effect size look at (2 marks)
-size of the pre- and post-intervention difference
- amount of benefit
name 3 critiques to statistical significance in EBT
○ Statistical significance has little bearing on functioning (i.e. clinical significance) (yet seen as evidence)
○ Also, improvement does not mean recovery/cure
outcomes can be replicated by
● Repeating methods in other studies will produce (Following manuals faithfully will produce same outcomes)
what is the critique of replicating outcomes (3 marks)
○ Assumes a ‘cookbook’ approach to therapy- If follow the ‘recipe’ and doesn’t work, then it’s the patient’s fault
○ One-size-fits-all approach
○ Assumptions about what it means to be mentally ‘healthy’
complete the sentence
● ‘Evidence’ has come to only mean results from …
RCTs
scientific evidence is known as what
the holy grail
what is the problem with Specifying patient characteristics
○ Unrealistic and means treatments aren’t suitable for most people
manuals reduce therapy to what two things
technique and strategy
what does multiple outcomes imply
○ Evidence that doesn’t support the therapy can be excluded
Statistical significance does not equal what?
real-world benefits or recovery
what does the replication of outcomes imply
one-size-fits-all, highlights assumption of what it means to be healthy
true or false:
> Claims about efficacy are misleading
true
The problem is not with the notion of evidence-based therapy but with how and by whom ‘evidence’ is defined.
Think About
● Ethics (fairness, inclusion/exclusion)
● Constructing and going about getting evidenc
