Psychotherapy Research

Question 1

General Outcome Studies

Eysenck

Smith, Glass, Miller

Answer 1

**Eysenck: **

1. summarized 24 outcome studies
2. effects of psychotherapy are small or nonexistent
3. any positive effects may reflect nothing more than spontaneous remission.
4. SMITH et al. challenged results using META-Analysis
5. the meta analysis combined statistics from studies to calculate an effect size for common metric
6. subtract mean from control from mean of treatment group and divide difference by the SD of the control group
   
   1. number indicates difference between average patients in the treatment and control group in terms of SD units.

Smith, Glass and Miller:

• used meta-analysis to combine 475 outcome studies and got an effect size of .85
• average therapy client is better than 80% of those who need therapy but remain untreated.
• psychological treatments are generally efficacious in practical and statistical terms.!
• no one type of therapy is consistently superior to any other type across disorders
  
  • CBT is better for panic, phobias, and compulsions.
  • shared therapy factors like catharsis, positive relatioinship, bx regulations and cognitive learning and mastery seen as key, not certain technique…but what they all share!

Question 2

Effects of Treatment Length

Answer 2

Dose-Dependent Effect: Howard et al. found that 75% patients showed meansurable improement at 26 session but only 85% with 52 sessions (double the length showed only 10% increase).

Phase Model:

1. Remoralization:
   
   1. client’s feelings of h_opelessness & desperation_ respond quickly to therapy, all in a few sessions (the initial rush).
   2. evaluate well-being
2. Remediation:
   
   1. focus is on the symptoms that brought the client to therapy.
   2. Symptom relief in about 16 session.
   3. evaluate/id symptoms
3. Rehabilitation: unlearning troublesome, maladaptive, habitual bx and creating new ways to deal with aspects of life.
   
   1. Sesssion # dependent on type and severity of problem.
   2. evaluate functioning

Question 3

Efficacy vs Effectiveness

Answer 3

Efficacy (clinical trials):

1. most useful for establishing whether or not a treatment has an effect.
2. However, Seligman argues: efficacy study omits too many crucial elements of what is actually done in the field

Effectiveness (correlational or quasi-experimental)

1. strict experimental control needed by efficacy studies limits the generalizability of their results, thus effectiveness research is more indicated/valid.
2. best for assessing clinical utility, or determining a treatment’s generalizability, feasibility, and cost-effectiveness.

Question 4

Research on Psychotherapy with Members of Diverse Populations

Answer 4

Sue et al.: GAS scores post therapy showed the best improvement for Hispanics, Anglo, Asian, and AA (in order).

Utilization of MHS:

1. Blacks receive a disproportional share of MHS in the ER or psychiatric inpatient
2. Asians are mostly underrepresented in out and in patient settings.
3. Black larger treatment for alcohol, and more Whites for depression compared to blacks/hispanics

Premature Termination:

1. compared to whites, all other cultures/ethnic groups terminate more after 1 session (50% vs. 30%).
2. But for community clinics it was: blacks, white/hispanic, and asians (lowest d/o).

Effects of Therapist-Client Matching

1. mixed results if any effect correlating if ethnic matching has any benefit to retention of service.
2. factors like client’s ethnic identity, level of acculturation, gender, and trust of whites may be issue.
3. Those who benefit from client-therapist matching in terms of ethnicity, culture, or race may reduce pre-mature termination for Asians, Hispanics and Whites, but not for Blacks (so stubborn).

Question 5

Interventions with Older Adults

Answer 5

Prevalence of MH problems among older adults:

anxiety, severe cognitive impairment, and depression (in order).

1. Very heterogenious group compared to others.
2. Respond to the same degree to psychotherapies as younger adults, but more slowly.
3. Best interventions (in order):
   
   1. Behavioral and environmental interventions with older folks with dementia
   2. memory and cognitive retraining is ‘probably efficacious’ with dementia
   3. cognitive, behavioral and brief therapies also ‘probably efficacious’ with depression.
4. Best interventions for old farts are tailored to their specific needs and circumstances (slower processing, low memory, increase emotional complexity).

Question 6

Interventions for Victims of Spousal/Partner Abuse

Answer 6

1. Great abuse of woman (20% vs 7%)
2. greater abuse of younger women, heterosexual, American Indian/Alaska Native (followed by Blacks) and in families with very low SES.
3. Low SES was the best single predictor of cessation of battering (lower SES most likely to continue beating)

Intervention:

• Goals of intervention emphasize self-determination, ensure safety, increasing self-esteem, empowerment and control.
• assessments that are valid and meet their needs.
• cultrual and contextual factors assessed.
• clinicians must continually self-monitor their own feelings, attitudes and bx. Be in tune with vicarious trauma and changes in perceptions (safety).

Victim and Perpetrator conjoint therapy?!

1. Expressive Abuse ( mutual emotion followed by remorse) can be conjoint.
2. Instrumental Abuse (impulsive, goal seeking, unilateral, no remorse) therapy done separately in separate locations.

Factors to Stay in Abusive Relationship

• Woman’s commitment to the relationship, emotional level of attachment, to save it, or been in it for many years.
• economic dependence, belief that batterer will change, fear of retaliation if she leaves.

Question 7

Other Issues in Psychotherapy Practice and Research

Answer 7

Treatment Manuals

1. empirically evaluated, standardized treatments.
2. can be oversimplified and lead to misuse of therapy techniques.
3. but may also benefit from set clinical decision making guidelines, and avoid many pitfalls of individual clinical judgment.

Placebo Effect

1. means: providing participants with the nonspecific (common) factors of psychotherapy such as attenbtion and support.
2. research shows that placebo conditions have a substantial impact (.67 compared to no trtment, but .48 compared to trtment).
3. Diagnostic Overshadowing: tendency of health professionals to attribute all bx, soical, and emotional problems to MR people (everything is about the problem).
4. applies to other diagnoses and situations, and not related to professional’s orientation, expertise or experience.
5. Vocational Overshadowing: therapist overlooks vocational problems as they co-exist with personal problems (overshadowed).

_Alloplastic vs. Autoplastic Interventions: _

1. Alloplastic Intervention: goal is to make changes in the environment so that it better accommodates the person.
2. Autoplastic Intervention: goal is the change the individual so he is better able to function effectively w/in his environment.

Therapist Distress

1. Survey found that 74% of therapists had personal distress in last 3 years, w/ 36% saying decresed quality of work and 4% saying led to inadequate trtment.
2. suicidal statemtns are the most stressful type of client bx.
3. lack of therapeutic success is most stressful aspect of their work
4. confidentiality issues are most frequently ethical/legal dilemma.

Psychiatric Hospitalization

1. mental illness higher with females in each age group
2. admission to hospital is higher for men
3. but more women in outpatient services!
4. men may be more externalizers and at risk to harm, compared to anxious/depressed females.
5. commitment criteria changed from psychopathology to perceived dangerousness.!
6. Admission to hospital data
   
   1. highest for never married, middle for married/divorced, and low for widowed.
   2. whites highest frequency, but proportionally, minorities are overrepresented!
   3. whites represent 70% of admissions to both inpatient and outpatient services.
   4. largest admission is for 25-44 yo (both sexes).
   5. Schizophrenia most common admission for 18-44 yo,
   6. but 65+ yo an organic disorder is most common followed by affective dx.