INTERVENTION: Subdomain 2 -- Psychotherapy Outcome Research Flashcards
SUBDOMAIN 2: Psychotherapy outcome Research
SUBDOMAIN 2: Psychotherapy outcome Research
What is the difference between efficacy and effectiveness?
(Lambert, 2013)
- Efficacy –> Determined with randomized control trials (RCTs) with variables controlled
- Effectiveness –> implementation in a clinical setting outside of the research lab
What are the benefits of psychotherapy?
(Smith & Glass, 1980; Lipsey & Wilson, 1993)
- 30% of clients spontaneously remit vs. 70% get better with therapy
- Psychotherapy is equal to or better than some medical practices
- Clinically meaningful change (measured by the OQ Reliable Change Index [RCI])
- Many maintain gains after termination
——* (Sampling bias alert –> we don’t measure those who drop out!) - Relapse rate lower for therapy than for medication
What factors relate to rates of relapse?
(Lambert, 2013)
1. Number of episodes
2. Initial severity
3. Response to acute treatment
4. Residual symptoms after termination
5. Comorbidity
6. Family hx
7. Treatment type/duration
8. Treatment adherence
9. Therapeutic alliance
What are the positive responses to therapy?
(Lambert, 2013)
- Half clients who begin considered dysfunctional = clinically significant change in 20 sessions
——* 50 sessions necessary for full recovery - 1/2 of clients respond by 8th session; 75% by 14th session
- 30% of clients make sudden gains after 3 sessions (positive indicators for total change)
- People with personality disorders and significant interpersonal problems –> slow to respond to therapy
What are negative results of therapy?
(Lambert, 2013)
- Some clients get worse in therapy
- Caused by:
—* Inept treatment
—* Negative attitudes
—* Poor combination of treatment technique and patient problem
—* 5–10% of adults deteriorate in therapy
(Warren et al., 2010)
* 14–24% of children deteriorate in treatment
(Hatfield, 2010)
* Clinicians not good at noticing can assess progress using Outcome Questionnaire (OQ-45) to monitor
Why do efficacy and effectiveness rates not match?
(Lambert, 2013)
- Efficacy often generalizes to applied settings
—* Dependent on how similar settings are though
—* Mismatch:
——* Therapists not abiding closely to manuals
——* Comorbidity may be a big reason they don’t match (comorbidity used as an exclusion criteria for many) - Best outcomes seen early in therapy
What is the common factors concept?
(Wampold, 1997)
- Meta-analysis of 300 studies
- Dodo Bird Argument –> All bona fide treatments are equally efficacious
- common factors viewed as the real reason tx works
- The common factors concept in therapy refers to the idea that different psychotherapy approaches share fundamental elements that contribute to their effectiveness, regardless of their specific theoretical orientations or techniques.
What are the arguments supporting Wampold’s idea?
(Lambert, 2013)
1. Literature for specific EBTs are biased
—* The creators of the treatments are the one’s testing them
2. Placebo literature
—* placebos do better than waitlist
——* Could be the result of common factors
3. Comparative outcome literature (Wampold)
4. Component analysis
—* When you take out “essential” components of treatments it has no effect on effectiveness of treatment
What is the counter perspective from those in favor of EBT?
(Crist-Cristoph, 1997)
- Critical review of Wampold
- Many studies were comparing different types of CBT (not totally different therapies)
- In remaining studies they did find differences between therapies
(Chambless & Hollon, 1998)
——* Some therapies better for certain disorders
(Lilienfeld, 2007)
——* Some therapies can cause harm with certain disorders
What are the problems with meta-analysis?
(Lambert, 2013)
- They’re super important to efficacy research BUT:
—1. File-drawer problem –> studies with no effect never published
—2. Garbage in, garbage out problem (GIGO) –> mixing of poor quality and high-quality studies
—3. Apples and Oranges problem –> combining studies of different phenomena
What additional considerations does insurance cause?
(Lambert, 2013)
- Need to reimburse therapy more than medication
- Relapse rates higher among medication users
- Chronic/severe clients benefit from medication
- Long run: insurance pays less when therapy included BUT need to cover enough sessions to get better
What should you remember about the idea of exceptional therapists?
(Lambert, 2013)
- Lake Wobegon effect –> We all think we are above average.
- 90% believed they were above average
- Experience does not equal better (except in some cases)
(Wampold, 2017) - The most successful psychotherapists average 50% better outcomes and 50% fewer dropouts than do psychotherapists in general
SUBDOMAIN 2 CITATIONS
SUBDOMAIN 2 CITATIONS
Lambert, 2013
Lambert, 2013
- What is the difference between efficacy and effectiveness?
- What factors relate to rates of relapse?
- What are the positive responses to therapy?
- What are the negative responses to therapy?
———(also Warren et al., 2010) - Why do efficacy and effectiveness rates not match?
- What are the arguments supporting Wampold’s idea? (i.e., the Dodo bird verdict, that common factors are key)
- What are the problems with meta-analysis?
- What additional considerations does insurance cause?
- What should you remember about the idea of exceptional therapists?
