Psychological Therapies of Depression Flashcards
If there is a big difference between the therapies, there needs to be a ____ sample size (Active therapy vs a wait list control)
Small
If there is a small difference between the therapies, there needs to be a _____ sample size (Two active therapies)
Large
ES =
Pre-therapy score minus post-therapy score divided by the pooled SD
What does the ES state?
The magnitude of the difference between conditions A and B
Is ES affected by sample size?
No
What is reliable improvement?
Improvement that is reliably greater than measurement error or chance
What is clinically-significant improvement?
Measurement score moves from a clinical to a non-clinical population
Smith and Glass (1977)
Treatment > placebo > no treatment
ES for treatment vs no treatment studies = .80 - large effect size according to Cohen
Average treated patient is better off than ____ of people receiving no treatment
79%
Wampold (2015)
Psychological therapies are superior to medical interventions
Robinson et al. (1990) - therapy vs no-treatment
ES = 0.73 (N = 37) significant
Robinson et al. (1990) - therapy vs wait list
ES = 0.84 (N = 29) significant
Robinson et al. (1990) - therapy vs placebo
ES = 0.28 (N = 9) not significant
Elkin et al. (1989) - method
250 patients randomised to one of 4 conditions
- CBT
- Interpersonal therapy (IPT)
- Imipramine + clinical management
- Control (Placebo and clinical management)
Elkin et al. (1989) - results
Imipramine does best for severe depression
IPT out-performs CBT
CBT out-performs control condition by only a small amount
Shapiro et al. ( ) - method
117 patients Diagnosis of depression Randomly assigned to - 8-session CBT - 8-session Psychodynamic interpersonal therapy (PIT) - 16-session CBT - 15-session PIT
Shapiro et al. ( ) - outcome measure
Beck Depression Inventory
Shapiro et al. ( ) - results
CB and PI were equally effective, irrespective of depression severity or duration of treatment.
No overall advantage to 16-session treatment over 8-session
But patients with relatively severe depression improved substantially more after 16 than 8 sessions
Stiles et al. (2008) - method
32 NHS primary care services
5613 patients
399 therapists
Routine NHS data
Not a trial, so no randomisation
Stiles et al. (2008) - results
Reliable and clinically significant improvement of those who competed the treatment was 55-60%
No reliable change happened in 20%
Cuijpers et al. (2008)
Meta-analysis of 53 outcome studies for depression
No difference between CBT and the other therapies
Cuijpers et al. (2017)
40 years of research summary
Not much difference between different therapies
Data is not strong enough to recommend the superiority of one therapy over another for depression
IAPT (Layard, 2006; Clark, 2011)
Stepped care model (low and high intensity treatments)
Rolled out in 2008
Primarily CBT
More recently Counselling for Depression
CBT and CfD annual recovery rates for depression are equivalent
Norcross (2014)
Psychotherapeutic factors which affect outcomes
Individual therapist (7%) Treatment method (8%) Therapy relationship (12%) Patient contribution (30%) Unexplained variance (40%) Other factors (3%)
Treatment method accounts for very little, we don’t know a lot about what affects it (unexplained variance)
Contextual model
The real relationship
Expectations
Specific ingredients
Rogers (1951) - active components in the therapeutic relationship
Empathy
Congruence
Unconditional regard
Genuineness
(collectively termed the necessary and sufficient conditions for therapeutic change)
Luborsky (1976) - types of alliance
Type 1 - early phases of therapy, based on the patient’s perception of the therapist as supportive
Type 2 - typical of later phases in therapy, represented by the collaborative relationship between patient and therapist to overcome the patient’s problems (a sharing of responsibility to achieve the goals of therapy and a sense of communion)
Bordin’s model (Bordin, 1979)
Agreement on goals
Agreement on tasks
Bond
Saxon and Barkham ( )
Above average therapist group is almost 2x as effective as below average group
Some therapists are 4x as effective as others
Saxon et al. (2017)
More effective therapists’ patients continually improve
Average therapists’ patients improve and then plateau
Less effective therapists’ patients improve and then decline with sustained contact after around 9 sessions
