Final Exam prep Flashcards
Why do we have science in psychotherapy? What questions does it address?
Because therapies that are not science-based can be harmful/dangerous
Addresses:
Whether treatment works
Are all treatments equal?
Is the field taken seriously (e.g., medical community refers to us vs. psychics, etc.)
If no support behind methods, other people (e.g., insurance companies, politicians, celebrities) would decide what treatment to use (based on popularity, low cost, etc.)
Less likely to be sued for malpractice
Directs movement towards more effective treatment, or tells us when we can stop looking (i.e., CBT used for panic disorder treatment)
Allows for therapists who don’t practice scientifically to be excluded, or not chosen as therapists
What are some examples of dangerous non-scientific practices?
E.g., “Rebirthing therapy” which resulted in a death
E.g., “repressed memories” - many patients who have now retracted their claims and know that they were false
What was Hans Eysenck’s 1952 study about? What three groups were compared?
“The Effects of Therapy, an Evaluation”
Reviewed 24 outcome studies 1920 - 1950
Compared three groups:
Psychoanalysis
Mixture of therapy
No therapy
What were the results of Hans Eysenck’s 1952 study?
What did he conclude?
Results:
44% of psychoanalysis group improved
64% of mixed therapy group improved
72% of no-therapy group improved within 2 years of symptom onset
Concluded:
The effects of therapy are small to non-existant
What are some criticisms of Hans Eysenck’s 1952 study? (5)
No randomized control trials (RCTs)
Without radomization, comparison groups weren’t equal on a number of variables (outcomes could have been because of a variety of factors)
The no-therapy group wasn’t a good control because they did receive attention, medical care and treatment, etc. (not a true no-therapy group)
Data about efficacy was “authoritatively proclaimed” or based on successful case histories (not based on good, scientific evidence) - often based on case histories
Relied on records across all patients/settings being kept the same way (assumed) but this is probably not true
What were the Smith, Glass and Miller meta-analyses of 1977 and 1980 comparing?
Combined results of 370 (1977) and 475 (1980) studies
Overal effect sizes of therapy overall and specific therapies
What was the mean effect size of therapy overall in the 1980 Smith, Glass and Miller study?
They found that the average patient is better off than __% of the people who are untreated.
What conclusion can we make from these results?
.85
80%
Clear evidence for a significant effect of therapy
What are non-specific factors of therapy?
E.g., an appointment every week, attention, care, having rituals, expectations of improvement, etc.
Dodo Bird Effect
-who coined it
-what does it suggest?
Luborsky (1975) “Everybody has won, and everybody should win a prize” (allusion to Alice in Wonderland quote)
Suggests that all therapies have the same outcome
What did Rachman & Wilson, 1980, say about the Dodo Bird effect?
If the indiscriminate distribution of prizes argument carried true conviction… we end up with the same advice for everyone – “Regardless of the nature of your problem seek any form of psychotherapy.” This is absurd. We doubt whether even the strongest advocates of the Dodo bird argument dispense this advice.
What findings seem to somewhat support the Dodo bird effect?
Some research has shown effect size differences - does not completely support Dodo bird effect (although effect sizes are somewhat similar between some therapies):
Smith & Glass, 1977:
Cognitive 2.38
CBT 1.13
Client-centered .62
Smith, Glass & Miller, 1980
Cognitive 1.31
CBT 1.24
Humanistic .63
What are the criticisms of the Smith & Glass studies which seem to support the Dodo bird effect?
no randomizations, small samples
Shapiro & Shapiro (1982)
- what were they looking at?
- what were the results?
- what does this suggest?
Researchers started looking at how different treatment types affected specific diagnoses which found that there are large effect size differences in this regard:
Anxiety and depression
Behavioural = .74
Cognitive = 1.34
Psychodynamic/humanistic = .40
Phobia
Behavioural = 1.46
Cognitive = .92
Psychodynamic/Humanistic = analysis not conducted
Findings do not support the Dodo bird effect
Reid (1997)
- what were they looking at?
- what were the results?
- what does this suggest?
42 meta-analyses of treatments for depression, insomnia, smoking cessation, and bulimia
75% of the meta-analyses showed evidence of treatment effects
Behavioural treatments (including CBT) superior to non-behavoural treatments
Findings do not support the Dodo bird effect
Wampold et al., 1997
- what were they looking at?
- what were the results?
- what does this suggest?
- what are some criticisms of this study?
Meta-analysis from studies published between 1970-1995 that compared at least two treatments
Found average effect size of only .19 (small difference between treatments)
Support for the Dodo bird effect
Criticisms: most of the studies they analyzed were based on different forms of CBT, not different orientations of treatments (so likely CBT compared with CBT would have a small effect size)
Siev & Chambless, 2007
- what were they looking at?
- what were the results?
- what does this suggest?
All published studies comparing CBT to relaxation for treatment of GAD and panic disorder
GAD: the two treatments were similar
Panic = CBT > relaxation (much better results for CBT)
Support against the Dodo bird effect:
Based on research evidence, what is our conclusion about the Dodo bird effect?
Sometimes the effect sizes can be small but other times (as in the case of panic disorder) the effect sizes can be significant. Summary: sometimes treatments are equal but in some conditions, treatments are not equal
Evidence-based practice emphasizes first using the intervention that has the greatest support, but if the intervention proves to be unsuccessful with a given patient, turning to treatments with less support is entirely appropriate
What could stand in our way of finding out if treatments work and if there are certain treatments that are better than others?
We tend to generalize (e.g., “It probably always works, or works for everyone”)
Might also bias results based on affiliation with the therapy (my school taught me this therapy so it must work)
What if a therapy DIDN’T work? Would we still see change? What are some of the reasons that we might see change for a person, even if the actual treatment didn’t work?
We may tend to think our therapy is working, based on our experience with the therapy
Passage of time, regression towards the mean (possible that simply passage of time affects change or there is regression towards the mean)
What are Empirically Supported Therapies (EST)?
Clearly specified psychological treatment shown to be efficacious in controlled research with a delineated population
APA task force suggests that good treatments must meet a specific criteria and those that meet the criteria would be labelled ESTs
What are the aspects that need to be addressed in research for it to be EST?
Efficacy
Specificity
Effectiveness
Efficiency
Other important considerations:
-Sample Description
-Treatment manual
-Reliable and valid outcome assessment measures
-Appropriate data analyses
What are the rules set out by Chambless & Hollon (1998) for a study to be considered efficacious for an EST?
Controlled research with Random Assignment - called randomized controlled trials (RCTs)
RCT = patients randomly assigned to the treatment of interest OR to one or more comparison conditions
Efficacious:
When a treatment has been found efficacious in at least 2 studies
And… when a treatment has been found efficacious by independent research teams
Possibly efficacious:
Only 1 study
Or… all research conducted by one team
What is specificity? How are studies designed to test specificity?
If the treatment is found to be superior to conditions that control for nonspecific processes, such as receiving attention for being in a treatment group, or expecting that you will change
The treatment must be successful specifically due to the elements of the treatment itself rather than other factors
Using credible sham placebos or other ESTs as a control group is how to test for and determine specificity - then we know that the change/result from treatment is due to the treatment itself and not due to other factors
What are the differences between the efficacy and the specificity of treatments/therapies?
Efficacy:
Determining if the treatment produces change compared to a control
Specificity:
Determining if the treatment itself produces the change or if other variables are producing change
Efficacy:
Has to be replicated (otherwise only possibly efficacious)
The control could be a wait-list, placebo, or another type of treatment (just has to have a control of some kind)
Specificity:
The control has to be a credible sham placebo or another treatment that has already been proven efficacious
Example of efficacy and specificity:
participants - randomly assigned to two levels of independent variable
Experimental condition: write in a journal for 15 min/day for 4 weeks about their emotions that day
Control condition: do nothing - life as usual
Measure: Beck Depression Inventory
What is the efficacy and specificity in this experiment?
Efficacy: random assignment to two conditions and there was change in the experimental condition compared with the control condition
But… was the change because they were writing about emotions or was it simply because they had something to do every day?
Specificity: the control has to be a credible sham placebo or another treatment that already has proven efficacy (e.g., write in a journal for 15/day for 4 weeks about that day or CBT for depression) – if we find that the experimental condition produces a greater change then there is specificity
What is effectiveness? What kind of designs are common in testing for this?
Does the treatment actually work in real-world clinical settings?
Studies in naturalistic settings
Quasi-experimental, uncontrolled designs are common
Can be conducted after efficacy research
What is treatment efficiency?
Cost effectiveness
Treamtents that cost the least are likely to be preferred if there is no great difference in outcome
Need to consider short-term and long-term gain (the more expensive therapy may be more effective in the long-term (cheaper in the long run))
What are some of the non-required but suggested factors concerning designation by the APA for ESTs?
Therapist training and monitoring
-need to know that the researcher was well trained and monitored
Consider investigator allegiance
-Any treatment tends to do better than other treatments when it’s conducted by people who are expert in its use
To deal with this, try and balance (e.g., if CBT is the focus of the study and IBT is the control used, have CBT experts conduct that therapy and IBT experts conduct that therapy
Comprehensive outcome
-Looking at general measures (quality of life, daily functioning) or, at least, looking at several measures (not just one specific diagnostic measure)
Follow-up studies:
-To see if gains are maintained
Clinical significance:
-Rather than only statistical significance (real-world change can be very different from statistical significance)
What are some problems/criticisms of ESTs?
RCTs are too rigid - inclusion/exclusion criteria are too strict
RCT designs place undue weight on efficacy rather than effectiveness
Selection of uncomplicated diagnostic groups fails to represent needs and responses of usual, complex, comorbid patients seen in practice
Not applicable to a diverse range of patients varying in personality, race, ethnicity, culture, etc.
Focus on brief, manuliazed treatment does not adequately or validly represent psychotherapy that is conventionally practiced
What is evidence-based practice? How is it different from ESTs? What are the benefits?
“…the integration of the best available research with clinical expertise in the context of patient characteristics, culture, and preferences.” (APA, 2006)
Going beyond the ESTs and looking at other types of research (including case studies, etc.), integrating with expertise and patient characteristics, etc.
More flexible and realistic approach than simple focus on ESTs
What is the three-legged stool? Who developed this idea? What does it relate to?
Best available research
Patient characteristics, culture, and preferences
Clinical expertise
Bauer, 2007
evidence-based practice
What are clinical practice guidelines?
a summary of scientific research (dealing with the diagnosis, assessment, and/or treatment of a disorder) designed to provide guidance to clinicians providing services to patients with the disorder.
The American Psychiatric Association, for example, has practice guidelines listed on its website that address the treatment of dementias, mood disorders, panic disorder, OCD, PTSD, borderline personality disorder, eating disorders, substance use disorders, and schizophrenia
What is the benchmarking strategy?
involves using the results of efficacy trials to form a standard (or a benchmark) against which the services provided to regular patients by regular clinicians can be compared
based on the benchmarking strategy, there is evidence from various countries that evidence-based treatments can be very effective when used in routine practice settings
11 questions to ask when critiquing the science of particular treatments
Was there a control group?
Was it an appropriate control group?
Was there random assignment to groups?
Would we be able to determine efficacy?
Is the treatment possibly efficacious or efficacious?
What would need to occur for this therapy to meet criteria for specificity?
Were the therapists trained adequately?
Who were the participants?
Were there enough study participants for the results to be meaningful?
Did the study evaluate adherence to treatment?
Did the investigators evaluate appropriate outcomes?
What is the difference between evidence-based and eminence-based practice?
Evidence-based: requires psychologists to be not only sensitive and empathic but also well informed about current research relevant to the services they provide. The effective scientist-practitioner thinks in a scientific manner and applies knowledge derived from research with care and compassion.
Eminence-based: practice based on tradition and authority; recommendations are accepted because the person delivering them is seen as an expert
What is the problem with eminence-based practice?
opinions of even recognized experts are just that—opinions—unless their views are supported by the best available empirical evidence
What are the 6 common errors in thinking in eminence-based practice?
Faulty Reasoning
False Dilemma
Golden Mean Fallacy
The Straw Person Argument
Affirming the Consequent
Appeal to Ignorance
What are:
-faulty reasoning
-false dilemma
-golden mean fallacy
-A form of argument that is inaccurate or misleading in some way. “Psychologists have provided effective services for decades without having research available on what makes treatment effective.”
-This fallacy takes the form of reducing the range of options available to just two (usually extreme) options. “Either I accept the treatment that the psychologist is suggesting, or I just give up trying to change.”
-This logical error involves assuming that the most valid conclusion to reach is a compromise of two competing positions. “I have heard that both cognitive and psychodynamic treatments can be helpful for the type of problems I have, so I really should look for a treatment that combines both cognitive and psychodynamic elements.”
What are:
-the straw person argument
-affirming the consequent
-appeal to ignorance
-This involves mischaracterizing a position in order to make it look absurd or unpalatable.
“Anyone who would prescribe a drug to treat my son’s symptoms just wants to turn active kids into zombies.”
-This logical error takes the following form: first, assume that x is a cause of y. Then, when y is observed, conclude that x must have caused it. “People who have schizophrenia always act in a bizarre manner. This person is acting bizarrely. So, obviously, this person has schizophrenia.”
-This mistake takes the form of arguing that, because there is no evidence to prove a position is wrong, the position must be correct. “There is no scientific evidence that having my patients sing and dance while they remember the trauma that they experienced harms them or is ineffective. So, of course, this new form of therapy has to be helpful.”
What is the difference between the deductive process and the inductive process in generating research ideas?
Deductive: the researcher uses a formal theory to generate a research idea
Inductive: for example, deriving an idea from repeated observations of everyday events. Even though the inductive process is not explicitly guided by theory, it is influenced by the researcher’s informal theories, including his or her theoretical orientation and general world view
What are the 5 steps to take in research after generating an idea?
First, the researcher conducts a systematic search of the published research on the phenomenon of interest.
Second, assuming that there is no research that has directly tested the idea, the researcher begins to formalize ideas so that they can be tested in a scientific manner - requires translating abstract ideas into something that can be measured (operationalizing an abstract concept)
Third, the researcher must carefully consider the extent to which the research idea may be based on cultural assumptions that may limit the applicability or relevance of the planned research
Fourth, the researcher must consider ethical issues in testing of the idea. For example, ethical considerations might make some research designs unsuitable, such as using random assignment in an experiment to determine the effects of violence
Finally, the researcher must draw together all the results of the previous steps to sketch out the study procedures. Along the way, some aspects of the planned study may need to be dropped or modified due to practical constraints (e.g., insufficient funds or a lack of appropriate measures).
What are some of the ethical considerations that must be taken in research?
participants may be vulnerable due to their psychological distress and/or may be receiving psychological services as part of the research
Psychologists are expected to apply the general principles (respect for the dignity of persons, responsible caring, integrity in relationships, and responsibility to society)
Prior to data collection, the researcher must obtain approval for conducting the research from the institution in which he or she works. In Canadian institutions, research ethics boards (REBs) ensure that the proposed research conforms to the Tri-Council Policy statement Ethical Conduct for Research Involving Humans
attention to the welfare of research participants (and animal subjects) and to honesty in the presentation of research findings
an ethical obligation to share their data with other researchers (once published)
What is the difference between internal validity and external validity?
internal: the extent to which the interpretations drawn from the results of a study can be justified and alternative interpretations can be reasonably ruled out
external: the extent to which the interpretations drawn from the results of a study can be generalized beyond the narrow boundaries of the specific study
What are 7 threats to internal validity?
History: influence of events that occur outside the context of the study
Maturation: Changes in the participants due to their psychological or physical development
Testing: Repeated testing may influence the results
Instrumentation: In longitudinal studies, changes in the definition of constructs and in their measurement
Statistical regression: Extreme scores on measures, both high and low, tend to be less extreme upon retesting
Selection biases: systematic differences in recruiting participants or assigning participants to experimental conditions
Attrition: loss of participants in a study over time
What are 5 threats to external validity?
Sample characteristics: the degree to which the characteristics of the research participants, such as their sociodemographic and psychological characteristics, map onto other samples and populations
Stimulus Characteristics and Settings: features of the study such as the institutional setting and the characteristics of those involved in the conduct of the study (e.g., therapists in a treatment study) may constrain the generalizability
Reactivity of Research Arrangements: By virtue of being in a study, participants may respond differently
Reactivity of Assessment: Participants’ awareness that their behaviours, moods, attitudes, etc. are being monitored
Timing of Measurement: The decision about when to measure variables may result in conclusions that are not true for all time points - may not be stable between measurement periods
What is useful about correlational designs and case studies?
once a research area is well developed, correlational designs are unlikely to add anything new to the scientific literature. On the other hand, in a relatively new research area, even a relatively simple case study may make a meaningful contribution to the literature
Designs such as these are often used in early research on a particular topic. As the knowledge on a topic evolves, there is a tendency for the research designs to become progressively more rigorous.
Typical case studies involve…
a detailed presentation of an individual patient, couple, or family illustrating some new or rare observation or treatment innovation
4 advantages of case studies
a valuable format for making preliminary connections between events, behaviours, and symptoms that have not been addressed in extant research
include a lot of detail (e.g., about treatment methods) making it easy to follow and replicate
can be a rich source of research hypotheses regarding the etiology or maintenance of disorders
can also be the initial testing ground for innovative assessment or intervention strategies
have heuristic value—that is, they draw the attention of other professionals to a phenomenon
3 disadvantages of case studies
do not allow for the rigorous testing of hypotheses
major weakness is that most threats to internal validity cannot be adequately addressed
alternative explanations cannot be ruled out in this simple research design
What is an A-B single case design?
A = period representing the level of symptoms prior to the intervention (also known as the baseline)
B = period representing the level of symptoms following the intervention
intervention effects are typically determined by visual inspection of graphed data
a number of statistical tests can be used to determine if statistically significant changes occurred
What is an A-B-A single case design?
similar to the A-B design except that the treatment is withdrawn after a few weeks and data continue to be collected for a second A period (i.e., a period in which no treatment occurs)
If symptoms return to pre-treatment levels, then a strong case can be made for the effectiveness of the intervention
What are the disadvantages of an A-B-A design?
it may not be possible to have the person refrain from using the treatment strategies during the second A period, especially if the strategies have been effective in reducing symptom levels for a few weeks
ethical considerations may make clinicians unwilling to remove, however briefly, a treatment strategy that appears to be working well
What are the most commonly used research designs in clinical psych?
correlational
What are some advantages of correlational designs?
can be analyzed with all types of statistics, including correlations, partial correlations, multiple regression, t-tests, or analysis of variance (ANOVA)
Come in many forms
Can be used to examine the underlying structure of a measure or a set of measures. This is known as factor analysis
Most frequently, correlational designs are employed to examine the relations among discrete variables in an effort to develop or test a conceptual model (e.g., moderator and mediator variables)
What is factor analysis? What is it used for?
a statistical procedure used to determine the conceptual dimensions or factors that underlie a set of variables, test items, or tests
can reveal which items “work” and which don’t
What are the two basic forms of factor analysis? What are they used for?
Exploratory factor analysis:
is used when the researcher has no prior hypotheses about the structure of the data
Confirmatory factor analysis:
is used to test a specific hypothesis regarding the nature of the factor structure
What is a moderator variable?
a variable that influences the strength of the relation between a predictor variable and a criterion variable
For example, the relation between the experience of stressful life events and psychological distress may be moderated by the type of coping strategies used
What is a mediator variable?
a variable that explains the mechanism by which a predictor variable influences a criterion variable
For example, the relation between parental psychopathology and child adjustment may be due, partially or entirely, to the quality of the relationship between parent and child.
What is structural equation modeling (SEM)?
What are the steps?
a comprehensive statistical procedure that involves testing all components of a theoretical model which combines elements of confirmatory factor analysis and mediator analyses
First, the researcher lays out a structural model that shows how all the variables in the model are related to each other - akin to mediator analyses
In a second step, the researcher considers how best to measure each variable in the model and selects multiple measures for each variable - akin to confirmatory factor analysis
What are the disadvantages of correlational designs?
a causal connection cannot be established, as the apparent effect of the first variable on the second could be due to the influence of an unmeasured third variable
experimental manipulation and random assignment to conditions are absent
What are the disadvantages of structural equation modeling (SEM) correlational designs?
SEM can determine only the extent to which a hypothesized causal model fits the study’s data—it cannot unequivocally demonstrate that the hypothesized causal model is true
SEM requires a relatively large sample (i.e., more than 200 participants)
What are the advantages of quasi-experimental designs?
involve some form of manipulation by the researcher (although no random assignment)
in many situations, it is simply not ethical or feasible to randomly assign participants to conditions so this design provides a compromise
The most frequently used quasi-experimental designs involve the comparison of two previously established groups of participants.
In the simplest design, one group receives the intervention, the other doesn’t. Data are collected after the intervention and then analyzed. This design is cost effective and relatively straightforward because only one wave of data collection is required.
What are the disadvantages of quasi-experimental designs?
do not involve random assignment to experimental conditions - the effect of the independent variable on the dependent variable may be confounded with extraneous influences
In the frequent design in which data are collected once after the intervention: the two groups may differ substantially before the intervention, thereby confounding the results. (pre-intervention testing can be done but is less cost effective)
What are the advantages of true experimental designs - typically known as randomized control trials (RTC)?
involve both random assignment to condition and experimental manipulation. These features allow the researcher to draw relatively unambiguous conclusions about the effects of the independent variable on the dependent variable
provide the best protection against threats to internal validity
Disadvantages of true experimental designs (RCTs)?
often more costly
As with quasi-experimental designs, the strongest design is one in which both pre-intervention and post-intervention data are collected - concerns about reactivity to testing may lead a researcher to dispense with obtaining pre-intervention data - weakens the ability to determine the initial equivalence of groups
Decisions about the strategies used to recruit participants can affect…
the validity and generalizability of a study
What is probability sampling? When is it used?
focuses on the use of numerous strategies to ensure that the research sample is representative of the population
the researcher knows the probability of selecting participants from the population of interest
required when the researcher is interested in obtaining an accurate and precise estimate of the strength, level, or frequency of some construct in the population
Typically used in:
-surveys that are frequently reported in the media on topics such as preferences for political parties or candidates
-epidemiological studies of the prevalence of mental disorders or the utilization of mental health services
What is non-probability sampling? When is it used?
it is not possible to determine the probability of obtaining participants from the pool of potential participants
may include advertising for research participants in a newspaper, on a website, or in a mental health treatment setting - or university students
psychologists more commonly rely on non-probability sampling approaches
What are the disadvantages of probability and non-probability sampling?
probability - less convenient and more costly
non-probability - unlikely to be as generalizable as data obtained from probability samples - in much psychological research, this is assumed not to be a major problem
Without a sufficient __________ of participants, a study will not have the _________________ needed to detect the very effect it was designed to examine
number
statistical power
researchers must ensure they use a measure that is both ________ and ________. The first refers to __________ and the second refers to ___________.
reliable and valid
consistency
accuracy of measurement (is it measuring what its supposed to)
What is statistical conclusion validity?
the extent to which the results of a study are accurate and valid based on the type of statistical procedures used in the research
What are the 5 common threats to statistical conclusion validity?
Low Statistical Power: If a study has low statistical power, often caused by the use of samples that are too small, the researcher may not be able to accurately conclude that group differences were found in the study.
Multiple Comparisons and Their Effects on Error Rates: consider how many analyses to conduct and the error rate to use for analyses in order to have a reasonable balance between the desire to avoid Type I errors (i.e., concluding there is an effect when no true effect exists) and Type II errors (i.e., concluding there is no effect when a true effect exists).
Procedural Variability: those conducting the research (such as interviewers, observational raters, and therapists) may differ in how they interpret or use the instructions and procedures. Increases in variability in a study decrease the ability to detect a phenomenon or experimental effect.
Participant Heterogeneity: Variability in participant characteristics may result in differential results within the sample.
Measurement Unreliability: The less reliable a measure, the more that measurement error influences the data obtained from participants.
How reliable are the findings reported in research studies? What are some of the issues here?
the findings of an initial study in a research domain are not always replicated in subsequent research - research in many areas may include substantial numbers of false-positive findings
journals are more likely to accept studies with statistically significant findings. So, the most likely explanations involve the selective use of statistical analyses and the selective reporting of outcomes in a study
researchers are likely conducting multiple statistical tests on their data without correcting the significance level for the fact that multiple tests were conducted - This is considered to be “cherry picking” the significant results
researchers sometimes report values that are significant at a larger p value than .05. For example, a result that was significant at p <.08 might be described as showing a “trend toward significance” and then discussed as a statistically significant finding
What are the solutions to solving the problem with unreliable research findings being over-published?
Ensuring that:
(a) research studies have sufficient statistical power, (b) adjustments are made for conducting multiple statistical analyses, and (c) researchers accurately report and represent major analyses of their data.
What is the difference between statistical and clinical significance?
Because many psychological measures have an arbitrary metric with limited or no real-world correspondence, it is important that researchers learn more about what the score on a measure actually means in the life of a person and just how meaningful, in real-life terms, differences in scores really are
clinical significance: in addition to the results of a study attaining statistical significance, the results are of a magnitude that there are changes in some aspects of participants’ daily functioning.
What are two methods of evaluating clinical significance? What is one thing to be cautious of here?
One commonly used approach is to evaluate, for each participant, whether the participant could be said to be in the normal range of functioning. This may involve the use of norms, cut-off scores on scales, or pre-determined criteria (such as being employed or being able to function without assistance when performing self-care tasks) to operationalize normal range functioning
A second commonly used method, developed by Neil Jacobson and colleagues and called the reliable change index, determines whether a participant’s pre-treatment to post-treatment change on a scale is statistically greater than what would be expected due to measurement error - has moved to within two standard deviations of the mean score for a non-disordered sample, then a clinically significant change is said to have occurred
different methods for calculating clinical significance may yield different conclusions
What are systematic reviews? What information is provided?
the use of a systematic and explicit set of methods to identify, select, and critically appraise research studies
Extremely detailed in the methods section
Information includes how studies were searched for and then included/discluded - this allows for replication
What is meta-analysis? What is it the standard for?
a set of statistical procedures for quantitatively summarizing the results of a research domain (developed in the 1980s)
is now the standard for making a general statement about the findings in a research field - brings scientific rigour to the process of reviewing the results of research, allowing investigators to use explicit decision rules and computations in reporting findings
What are the steps of meta-analysis?
Following the steps employed in systematic reviews, researchers attempt to obtain all relevant studies to include in their analyses.
Data are then extracted from these studies and subjected to statistical analysis - combines the results of prior research using a common metric called an effect size
What are the advantages of meta-analysis?
statistical analyses, rather than the author’s impressions, guide the conclusions drawn about a research topic
by including data from many studies, the number of research participants on whom conclusions are based is dramatically increased - greatly enhancing the researcher’s power to detect an effect
can also address the issue of publication bias—Unpublished studies (e.g., dissertations) can be included
improves the generalizability of the conclusions drawn on the basis of the literature
What is a problem with the term psychotherapy?
practised by professionals from many disciplines, including psychology, psychiatry, social work, medicine, and nursing
not licensed or restricted in any fashion, which means that anyone can advertise his or her services as a psychotherapist in most jurisdictions
the College has no authority over unregulated service providers
As a part of informed consent, patients should be informed of all…
evidence-based treatment options. This includes medication options, psychological interventions the psychologist can provide, and psychological interventions the psychologist does not have the training to provide (in which case a referral would be necessary)
What does confidentiality entail?
clients must be assured of the confidentiality of the services they receive, as well as informed of the limits to confidentiality when a person’s safety is in danger. They must also receive clear descriptions of the steps taken by the psychologist to protect their privacy.
in situations in which there is limited evidence about treatment efficacy, the client should be…
informed of this and asked to consent to treatment with full knowledge about the limited scientific basis for the treatment
Are there forms of intervention that should not be provided?
If so, what?
Yes - there is a growing awareness and research base on psychological treatments that can cause harm and even if a treatment is not directly harmful, it can interfere with patients’ efforts to deal with their problems.
Cause harm:
-“Scared straight” programs that try to frighten adolescents at risk for ongoing criminal behaviour actually increase the odds of subsequent criminal offending.
-Rebirthing therapy, in which children are wrapped in blankets and squeezed repeatedly to “simulate” the “trauma” of birth, has resulted in a number of deaths.
Indirect:
-adults with psychosis or schizophrenia not receive generic counselling, as research has not found it to be helpful (wastes time that could be spent using effective therapy)
Does it matter whether the research was conducted with people of similar age, gender, ethnicity, or socioeconomic status?
How should the therapist approach this dilemma?
Adopt - If there is a reasonable fit between client characteristics and the research samples
Adapt - If the fit is reasonable but it seems highly likely that some modification is required to respect important cultural characteristics or practices
Abandon - If other evidence-based treatment options offer a better fit to the client’s characteristics and preferences
What type of role do therapists assume in CBT?
very active role in service provision
What sorts of things do CBT therapists do in therapy?
probe the precise nature of the problem, seeking information on its intensity, frequency, and duration as well as contextual factors that are associated with variation in the problem.
collaborate with clients in establishing concrete treatment goals and in translating vague complaints into measurable outcomes toward which the client will work
provide information about the process of treatment, explaining the central role of homework assignments in gathering data, carrying out experiments, and practising new skills
take responsibility for structuring each session, setting an agenda, and teaching new skills
CBT therapists use a blend of what kind of methods and questions?
didactic teaching methods (i.e., directions and instructions)
Socratic questioning (i.e., asking questions that encourage the client to examine his or her beliefs and to be self-directed in skill acquisition)
What type of therapists engage in a process of collaborative empiricism?
What is it?
CBT
the client and therapist develop strategies to concretely test the client’s dysfunctional beliefs. By encouraging self-examination and then working with the client to test the validity of his or her beliefs, the therapist actively encourages a process of guided discovery for the client
How is CBT different from other orientations?
in contrast to many other forms of therapy, the most important changes are presumed to take place not in sessions but between sessions as the client completes and learns from homework assignments
Termination phase: The other theoretical orientations we have discussed consider termination in terms of the end of the therapeutic relationship. In CBT, the termination phase is seen as a time for consolidating skills, anticipating future challenges, and preparing the client to face inevitable slip-ups. (future oriented)
also allows for the possibility of clients requiring one or two future “booster” sessions to help them get back on track
The overall use of mental health services has been increasing in recent decades. However, much of this increase is associated with ___________________ rather than _____________________. Why is this?
the use of medication rather than psychological treatment
greater patient access to physicians than to mental health specialists,
the ease of taking medication relative to engaging in psychotherapy,
the commonly held assumption that mental disorders stem from biochemical imbalances
possible insurance coverage for meds rather than therapy
What is more efficacious between psychotropic medication and psychotherapy?
there is considerable research evidence that evidence-based psychological treatments are at least as efficacious as psychotropic medication in the treatment of depression and anxiety disorders
decades of research has found that people are three times more likely to prefer psychological treatment to medication for the treatment of mental disorders
What demographic tends to seek psychotherapy?
two-thirds of psychotherapy clients are female,
half have a college or university education,
half are married,
and the majority are young to middle-aged adults
Barriers to seeking psychotherapy (3)
economic burden
psychological challenges associated with coming to terms with the need for treatment, combined with the many practical obstacles that can interfere with actually engaging in treatment
access to all health care professionals, including psychologists, is much lower in rural settings
Studies show that the majority of people who receive psychotherapy attend fewer than __ sessions, and evidence-based treatment across orientations requires a ___________ therapist.
10
very active
about __% of clients end treatment prematurely (Swift & Greenberg, 2012) and therefore are unlikely to receive much benefit from therapy and up to __% of people fail to follow up on a referral for psychotherapy (means that almost ______________ of people who have initiated services do not follow through to the point where services could be helpful)
20
50
2/3
The Hansen, Lambert, and Forman (2002) study showed that ___% of 6000 patients improved or recovered after therapy (median sessions being 3)
The Wampold and Brown (2005) study showed that ___% of 6100 patients improved or recovered (median sessions being 8)
What are two reasons for these results?
35%
44.3%
most patients attended too few sessions, and
most therapists did not provide evidence-based treatments
What did the data summarized by Hansen et al. (2002) based on data extracted from randomized controlled trials (RCTs) of evidence-based treatments show?
What is the take-away?
Can these results be attributed directly to the treatment?
57.6% of patients meeting criteria for recovery (and 67.2% meeting criteria for improvement or recovery)
with more treatment, and treatment that is evidence based, the success rate of psychotherapy improves substantially compared with treatment as usual
yes, because of the use of untreated control groups in these studies
What is the difference between process group approaches and structured groups approaches?
process group approaches, designed to capitalize on the dynamics of the group
structured group approaches, which are extensions of treatments that are also offered in an individual format
What is a problem with group therapy? An example?
groups allow the modelling of both positive and negative behaviours (e.g., when adolescents with significant problem behaviours received peer-group interventions, they learned aggressive behaviours from one another. Thus, group treatment had an iatrogenic effect, in that youth who received the group treatment did more poorly than did youth who did not receive the treatment.)
What is self-administered treatment? How effective is it?
treatment that the client engages in with no or minimal contact with a mental health professional.
there is little evidence that many of the self-help books do much for improving the quality of the readers’ lives.
However, there are now self-help materials that have been demonstrated to have a meaningful clinical impact (based on both well-established psychological principles and treatment protocols for psychotherapies that are evidence based)
firm evidence that self-administered treatments, across this continuum, can be clinically effective in treating depression, anxiety disorders, OCD, psychosis, and substance abuse disorders in adults
How can self-help materials be used in treatment?
treatment can be entirely self-administered, with the only therapist contact being an initial assessment of patient suitability
treatment can be predominantly self-administered, with occasional therapist contact beyond an initial assessment to teach patients how to use the materials and check on their progress
minimal-contact therapy where the therapist actively aids the patient in using the self-help materials (which still remain the central focus of therapy)
in traditional, predominantly therapist-administered treatments, self-help materials can be used as an adjunct to treatment
What is telehealth? Is it efficacious?
the delivery of health care services via telephone, videoconferencing, or computer-mediated communications
growing literature on the efficacy of videoconferencing psychotherapy demonstrates that it can be successfully delivered to a wide range of clients and that the outcomes are comparable with those of face-to-face psychotherapy
most of the research on telehealth treatments has involved adapting forms of _____________, and encouraging results have been obtained for the treatment of a number of disorders, especially __________ and _____________ disorders
CBT
depression
anxiety
What is stepped care?
an approach to health care service delivery in which lower-cost interventions are offered first, with more intensive and more costly interventions being provided only to those for whom the first-line intervention was insufficient
What did the Mitchell et al. (2011) study show about stepped care?
a stepped care approach involving therapist-assisted self-help, augmented by medication and individual therapy with CBT when necessary, resulted in substantial client improvement even one year after termination of treatment
What is the focus in the initial sessions of CBT for depression?
behavioural activation tasks, such as getting the client to re-engage in some of the pleasurable activities that he or she used to do prior to the depressive episode
What is thought monitoring? How does the therapist use this tactic?
CBT task - the use of a thought record that includes a description of the situation (e.g., an event, a memory, or an attempt to do something), associated behaviours (e.g., getting into an argument and yelling at someone), associated emotions (e.g., frustration, sadness, and discouragement), and associated thoughts (e.g., What’s the point? I’m such a pushover, I’m such a total failure.).
therapist and client work together to examine how these thoughts influence decisions around behaviours - client is then coached to challenge the accuracy of these negative thoughts
What are the three broad components of CBT for PTSD?
use of relaxation skills,
imaginal exposure, and
in vivo exposure
What is the process of imaginal exposure?
used in CBT for PTSD
patients are asked to close their eyes and to recount these traumatic experiences for an extended period (typically more than 30 minutes), using the present tense and providing as much contextual details as possible (e.g., smells, sounds, their own thoughts, and physical reactions)
sessions are usually recorded, and the patient is asked to listen to the recording repeatedly between sessions in order to promote emotional processing
What is in vivo exposure?
used in CBT for PTSD
can include stimuli such as sounds (for a patient traumatized in a car accident, this could be hearing a car braking hard) and smells (for a patient who was raped, this could be the smell of the rapist’s cologne), as well as common situations such as driving a car (for the car accident victim) or walking by a body of water (for someone who almost died in a flash flood)
psychologist develops a hierarchy of feared stimuli with the patient and encourages the patient to intentionally expose himself or herself to increasingly fearful stimuli
What is the goal of psychodynamic therapy?
Addresses unresolved conflict to lead to catharsis
Problems occur if the Id drives are too intense or if our defences become too strict - develop pathologies (e.g., excessive anxiety, depression)
What are the disadvantages of classical psychoanalysis?
Time consuming (2-4 times/week for 4-6 years)
Costly
Specific type of patient needed (self-directed)
Sometimes told NOT to make major life changes while in therapy (long period)
Sometimes told to give up meds
Training - most have to undergo personal therapy themselves
Evidence - hard to quantify/operationalize concepts such as transference or consciousness
Effectiveness: Supported almost entirely by case studies
What are the differences between classical and short-term (STPP) psychodynamic therapies?
STPP:
1-2 times/week, 16-30 sessions (as opposed to 2-4 times a week for years)
More therapist-directed and more active (face-to-face is typical rather than couch)
Support medication use and continued life changes
More likely to focus on client’s current life situations, and may teach the client specific interpersonal and emotional-control skills
More flexible approach
Outcomes: APA lists this as having “modest research support”
Simpson et al (2003) = “limited evidence of improved outcome”
What is Adlerian Psychotherapy? Is it evidence-based?
Aim to understand how clients fit into their worlds, and how family and cultural background shape clients and influence their therapeutic processes and individual needs
Not listed by the APA as evidence-based - not much evidence/research base (however, the Glass study showed some treatment efficacy)
What is Interpersonal Therapy (IPT)? Is therapist active or passive? How do psych problems arise? What is therapy focused on?
Developed first for depression
Based on understanding triggers in the client’s life
Time limited therapy
Therapist is active (not passive)
Depression as an illness (no fault)
Therapy is centered on current life events (not past issues)
Problems result from and are maintained by disruptions in interpersonal relationships:
Grief
Interpersonal disputes
Role transitions
Interpersonal deficits (isolation, loneliness)
Is IPT evidence-based?
APA lists IPT as having “strong research support” for:
Binge eating disorder
Bulimia nervosa
Depression
Several clinical trials showing that it’s at least as good as other treatments and better than controls
Are humanistic/existential therapies evidence-based?
APA does not list any of these as being empirically validated but Smith, Glass meta analysis shows some efficacy
Existential - No controlled research - suggests that testing is dehumanizing and not authentic
What is the basis of existential therapy? What approach does the therapist take?
Existence is at three levels:
Nature
Social
Self
Healthy existence is being authentic at each level - authenticity is anxiety provoking so this is why it is sometimes avoided - we have to confront and survive this anxiety rather than lying about it (lying is the foundation of psychopathology)
Therapist is not very active (mostly passive)
Therapist does not need unconditional positive regard (i.e., does not hold positive regard for lying)
What type of therapy is Client-centered? What role does the therapist take?
Humanistic
Therapist is not especially active (mostly passive)
The therapist wants to create an environment for the client to engage in self-exploration and remove barriers that block their natural ability to be their personal best
In Client-centered therapy, what are the two things people need? What happens when a person doesn’t have the first of these two things? What does the therapist provide (3 things)?
Positive self regard (unconditional) - persons judges themself to be worthy
Self-actualization - motivating force to develop one’s own potential
Incongruence happens when a person doesn’t have unconditional positive self regard - then they can’t develop self-actualization - therapist helps person move towards congruence
Therapist provides three components:
Empathy
Unconditional positive regard
Genuine (open, him/herself)
What are the outcomes of client-centered therapy? Where is most effectiveness seen?
Not much strong data - how to operationalize concepts like unconditional positive regard and self-actualization?
Smith, Glass… some evidence of treatment efficacy (.63 = 74%)
Re-analysis showed effectiveness comes mainly with problems in academic settings (other studies showed that this therapy works mainly with college students with mild problems)
What is Gestalt Therapy? What does it focus on? Is it evidence-based?
Humanistic and person-centered approach developed by Frederick Perls (had anti-scientific attitude)
Mental health problems result from ignoring feelings, desires, thoughts
Therapy goal is to bring the factors into awareness for the client, so that he/she can be “whole” again
Not much research data to support (not listed by APA) but Smith, Glass… showed some treatment efficacy (but only based on 8 studies)
What is the CBT model?
In any given situation, we have thoughts, that are related to our feelings/emotions, and to our behaviours/actions… all three of these components exist, and are very much related to one another (form a triangle)
Sometimes our automatic thoughts/interpretations are accurate but often our interpretations tend to be baised, based on our own lives, our experiences, messages we’ve received, and might not be accurate
What is the CBT model for depression? How does CBT work in this case?
Emotion = sad
Behaviour = withdraw
Thoughts = I’m not interested, It’s not worth it, no point, no hope
Working on the cognitive piece (thinking patterns) and behavioural piece (activation) in order to affect the emotional piece (if one piece changes, the others will as well)
CBT is not just about _____________ thinking; it is about ___________ thinking
positive; realistic
What are the three steps of cognitive therapy?
Identify thoughts - What are my thoughts and feelings?
challenge thoughts - Are there any other possibilities about what is happening?
replace thoughts - What is the most balanced point of view?
In the spider phobia case, what was the CBT model?
Emotions:
Anxiety
Fear
Behaviours/actions:
Avoids places
Gets others to kill spiders
Runs away
Hides
Cognitive/Thoughts:
Spiders are…
Horrible
Dirty
If it crawls on me I will…
Lose control
Not be able to stand it
Have a seizure
In the spider phobia case, what was the plan?
Behavioural:
Fear hierarchy (for assessment and treatment)
Exposures
Decrease safety behaviours
Generalization Probe (other locations)
Cognitive:
Education
Guided threat reappraisal (confronting thoughts and then seeing if those things happen)
Feedback (e.g., with heart-rate monitor)
What is the Foa model? What is it called? What must happen to treat the fear?
Emotional Processing Model (Foa & Kozak, 1986)
Fear structures in memory exist
Fear structures must be activated in order to be treated
Habituation must occur in session and between sessions
Extinction can occur:
Extinction: decrease in learned response as a result of repeated presentation and the absence of reinforcement (e.g., the link between the spider–fear was no longer reinforced)
New ideas/thought/memories are formed:
Eg., spider = safe
What is the third wave of CBT? Is it evidence-based?
Mindfulness and acceptance therapies
Several listed by the APA as empirically supported treatments
ACT for OCD (modest), pain (strong), depression (modest), mixed anxiety disorders (modest), psychosis (modest)
DBT for BPD (strong)
What is the difference between CBT and acceptance-based therapy?
In traditional CBT the client works on changing their thoughts, behaviors, and emotions
Acceptance-Oriented Treatments encourage:
Flexibility (psychological)
Adaptiveness
There are circumstances where things cannot be changed
these things need to be accepted - using energy to change these things is wasted and causes more distress - also causes person to miss the other things that are happening (joy)
If we push too hard for change, clients can feel invalidated (and they can push against the change)
When to use Change vs. Acceptance:
Justified vs. unjustified responses
When a response is justified then the most effective way is to accept the response
E.g., if a client is angry but it makes sense for them to be angry (appropriate), the therapist should not try to change the anger (not practical)
When a response is unjustified then the most effective way to deal with it is to help them change
E.g., out of proportion fear to something (e.g., spider)
Changeability vs. unchangeability
E.g., blindness is not changeable
Effective vs. ineffective
Will the change be effective?
What is mindfulness?
Refocus ____________ to decrease ______________.
The _____________ itself is more important than what is being _______________ to.
What is this practice similar to?
Increased awareness of the present moment (nonjudgmentally)
A skill that can be practiced - focusing on one thing at a time
Can change your response to stimuli in the moment - refocus attention and decrease emotion
attending; attended
Gestalt practice of looking at the whole picture is slightly like mindfulness (increased awareness)
DBT combines a mixture of skills from what four orientations? What are the skills?
Behaviour techniques: skills training, exposure, contingency management
Cognitive techniques: cognitive restructuring and problem solving
Humanistic techniques: validation, reflective listening, empathy, focus on patient-therapist relationship
Mindfulness: acceptance
What role does a therapist take in DBT? what are the two major focuses?
very active
Skills to have flexibility in responding to life
A life worth living
What are the 4 primary modes of DBT?
Individual Therapy
Skills Training Group
Telephone Consultation
Therapist Consultation Team
What are the 4 major DBT skills? What is the training cycle used in group and individual therapy?
Interpersonal Effectiveness (6 wks)
Mindfulness (2 wks)
Emotion Regulation (6 wks)
Mindfulness (2 wks)
Distress Tolerance (6 wks)
Mindfulness (2 wks)
What are interpersonal effectiveness skills? What are distress tolerance skills? What are emotion regulation skills?
Interpersonal effectiveness skills:
Getting what you want while maintaining a relationship and keeping self respect
Distress tolerance / crisis intervention skills:
Distraction - in a crisis (urges to use drugs, self harm, suicide)
Rapid intervention to bring down arousal - set of strategies (e.g., paced breathing)
Emotion regulation skills:
Module of strategies developed from science of emotions and evidence-based treatment
First thing is to teach them to identify their emotions and then to regulate
What is a DBT diary card?
Patient tracks what is going on week-to-week which therapist checks
Tracks levels of emotions, self harm, lying, joy, using skills
Tracks urges (using drugs, quitting therapy, self harm)
Helps therapist track problems and gives them a place to start/focus
What is the DBT treatment hierarchy?
- this is the order in which things need to be addressed in each session:
Life-threatening behaviours (e.g., self-harm, suicide)
Therapy interfering behaviours (e.g., showing up late, not doing therapy homework)
Quality of life interfering behaviours/patterns (e.g., symptoms associated with psychological disorders)
Increasing behavioural skills (e.g., assertiveness, relationship issues, workplace stress) - integrated in the other levels as well
(Linehan et al., 2006)
What was the focus of this study?
What were the results?
101 patients with BPD aged 18-45 years
Randomized to 1 year DBT or Community Treatment by Expert (CTBE) - Allowed for treatment specificity to be determined
Looked at: suicidal behaviours, ER use, general psychological functioning
DBT< CTBE (more of the following in CTBE):
Suicide attempts (23% vs. 46%)
ER visits
Hospitalization rates
Angry behaviour
Therapist drop (25% vs. 59%)
Complete study drop outs (19% vs. 43%)
What do we know about the cost-effectiveness of DBT?
BPD patients are extremely costly to the medical system (psychiatric-related inpatient hospitalizations, medical visits) and the social system (unemployment, psychiatric disability, public assistance, incarceration)
DBT:
Cost of psychiatric-related inpatient hospitaliations one year into DBT treatment resulted in overall savings of $21,703
DBT program in Manchester, NH found overall savings of $26,786 in hospital and mental health costs for clients that participated in DBT program
Koons et al (2006) - 75% of patients in DBT program were employed at least part-time at follow-up in comparison to 50% of subjects at pre-treatment
Is DBT only useful for BPD patients?
No, also shown efficacious with other psychological problems (e.g., eating disorders)
What 3 skills does Acceptance and Commitment Therapy (ACT) focus on?
Mindfulness
Acceptance
Commitment and Values-Based Living
Is ACT evidence-based?
APA - listed as having research support for:
Depression
OCD
Chronic pain
Mixed anxiety disorders
Psychosis
What is Commitment and Values-based Living in ACT?
Are you living the life you want to live right now? Is your life focused on what is most meaningful to you?
Is your life characterized by vitality and engagement, or by the weight of your problems?
When we are caught in a struggle with psychological problems we often put life on hold, believing that our pain needs to lessen before we can really begin to live again
What if you could have your life be about what you want it to be about right now?
Values:
What do you value? -Client is asked to make a list - then asked if they are living in a way that is consistent with their top values. Living in way that is inconsistent causes stress.
Commitment:
Find the means to pursue your values
You can live them right now
Set goals
Make them happen through action
What was the Bach & Hayes (2002) study about? What were the results?
ACT
study of rehospitalization with psychotic patients (Bach & Hayes, 2002)
Randomly assigned to 4 sessions of ACT + TAU vs. TAU (N = 80)
ACT patients taught:
Noticing but not acting on thoughts
Dropping the struggle to control discomfort
Values, goals and barriers
Review
Results:
ACT patients reported more psychotic features than TAU patients:
Because they were taught to be more mindful/more aware of what was happening
ACT patients had ¼ the rate of rehospitalization than the TAU patients
What is motivational interviewing? Who developed it and how?
William Miller:
Technique is mostly written about by him
began in 1970s, was treating problem drinkers with behavioural techniques and running studies with control groups. The control groups were using self-help tools and doing surprisingly well so he examined the factors contributing to their success - developed motivational interviewing
Applies methods primarily to treatment of addictions
Enhances intrinsic motivation to change (the person’s own motivation) - uses specific steps and techniques to do this
Helps clients explore and resolve ambivalence (learn why they might not be changing)
What are the 5 stages of change?
Precontemplation:
Not really thinking about problems or about changing
Historically labeled as “resistant” or “defensive”
If they come into therapy, it is usually due to pressure from loved ones
Contemplation:
Increasingly aware that a problem exists (negative consequences)
Open to consciousness-raising methods (e.g., feedback, observations, educational info)
Not quite ready to change yet
Preparation:
On the verge of taking action
Intend to change
Need to set goals and priorities
Make firm commitments
May start to take steps towards action (delayed use, stimulus control - i.e. avoiding troublesome environments)
Develop sense of self-efficacy (belief that they can change)
Action:
Modify their behaviour, experiences, environment to overcome problem
Use techniques (such as contingency management, stimulus control)
In action stage if they have successfully altered a behaviour for 1 day to 6 months
Maintenance:
Work to prevent relapse
Consolidate gains
6 months onwards
Why is identifying the stage of change a client is at important?
Clients entering therapy will be at different stages - important because it relates to their prognosis
Stage of change can predict premature terminators (e.g., Brogan et al., 1999)
40% of dropouts were in precontemplation stage
Stage of change should be matched to treatment techniques - Intensive action-oriented approach would likely not be appropriate for people in the precontemplation or contemplation stages but might be effective in the preparation or action stages
What are the goals of motivational interviewing? What are some techniques?
Match intervention to stage of change
Get the client moving along the stages towards change
Develop discrepancies (e.g., looking at the discrepancies in a person’s life - differences between how they see themselves and their behaviours)
Empathetic listening
Minimizing resistance (instead of pushing towards change, let it go - dance with the client around change, let them argue both sides)
Amplifying ambivalence (pros and cons;
What can motivational interviewing be used for?
Addictive disorders
Anxiety
Depression
PTSD
Eating disorders
Prelude, stand-alone or combined (can be used before another treatment, by itself or with other treatments)
