Lecture 6: Best Evidence & Practice In Mental Health Flashcards
What is the scientist practitioner model
It states that clinicians should be active consumers of research findings, evaluate their own practice, use this to produce new research and report findings to the community
What are 4 reasons why clinicians might not incorporate empirically supported treatments
- Sample might not be representative
- Treatments may not alter in response to patients needs and ignore comorbidity
- May be reluctant to use them (uncomfortable, etc.)
- Variables as life functioning, coping and quality of life are not often addressed in RCT’s but are a focus of clinical practice
What is the dodo bird verdict
The belief that all treatments are effective and differences are due to non-specific effects
Why is sole reliance on statistical significance problematic
In isolation it provides no information about the magnitude of change and it provides no description of within-group variability
What is the reliable change index (RCI)
Marking the point at which a persons score moves into the ‘normal’ distribution
Explain the dose response model
Average patient improves rapidly within the first few sessions followed by slowed but continuing improvement throughout remainder of therapy
What are the 3 phases of therapeutic gain according to the dose-response model
- Remoralization = alleviation of hopelessness + boosting of well-being
- Remediation = therapeutic relationship is established and reduction of symptoms becomes evident
- Rehabilitation = modification of patterns relating to the world/others + enhancement of life functioning
How many sessions are needed for the majority of patients at least
9
What are 3 approaches to track patients progress
- Hierarchical linear modeling = develop trajectories of expected response against which patient scores were mapped
- Nearest neighbor = each patients expected curse of treatment was calculated based on the course of similar already-treated patients
- Lambert: before each session the client fills in Outcome Questionnaire —> for clients not on track with their improvement giving feedback to the clinician on this led to increase in positive outcomes and significant reduction of deterioration
Therapist drift
The tendency to move away from the delivery of evidence-based psychological practices in which they are trained
What are the 9 important characteristics that were related to therapist drift
- Therapist knowledge
- Attitudes towards research
- Therapist anxiety
- Clinical experience (more = less)
- Therapist age —> contradictory results
- Theoretical orientations
- Critical thinking
- Personality traits (lower openness to experience = lesser use of EST’s)
- Cultural competency
What is the contextual model
Says that there are 3 pathways through which psychotherapy produces benefits and that before these can be activated an initial therapeutic relationship needs to be established
What are the 3 pathways of the contextual model
- The real relationship
- Expectations; client needs to believe in explanations/treatment for their problems and they need to agree on the goals for the therapy
- Specific ingredients; create expectations and salubrious actions
What are the 5 common factors of therapy
- Alliance
- Empathy and related constructs
- Expectations
- Cultural adaptation of evidence-based treatments
- Therapist effects
What are 3 criticisms to the importance of alliance
- early relief symptoms could cause strong alliance
- patients that come prepared to form strong alliance which leads them to have better outcome —> patient characteristics are cause
- halo-effect if patient rates both outcome and alliance
