Psychotherapy Research Methods

Question 1

there is no _________________ in psychotherapy

Answer 1

one size fits all

Question 2

4 components of psychotherapy research

Answer 2

what works

for whom

in what context

and why

Question 3

stages of intervention development

Answer 3

basic science

creation and preliminary testing

pure efficacy

real world efficacy

effectiveness

implementation and dissemination

Question 4

stage 0 of intervention development

Answer 4

basic science
- things to go into intervention/why the intervention will work
- identify problems that need treatment (brain, family history, etc.)
- understand treatment gap/things that are/aren’t working

Question 5

stage 1 of intervention development

Answer 5

creation and preliminary testing
- stage 1a:
- developing intervention components with clear explanation for replication
- done with patient input (focus groups to make changes/feedback)
- by the end should have materials for trials

• stage 1b
  
  • feasibility and testing
  • can we do this, get people to sign up?
  • often done in lab, goal is to see if investing is worth it

Question 6

stage 2 of intervention development

Answer 6

pure efficacy
- controlled/internal conditions
- efficacy = how well it works under perfect controlled conditions

Question 7

stage 3 of intervention development

Answer 7

real world efficacy
- trial in more external environment/real-world setting
- ex. train then closely monitor therapists

Question 8

stage 4 of intervention development

Answer 8

effectiveness
- understand what happens once you take some controls off
- less strict
- ex. train then don’t monitor therapists

Question 9

stage 5 of intervention development

Answer 9

implementation and dissemination
- how to get interventions to be used clinically?
- delay between research and implication b/c…
- people do not like change
- environment isn’t necessary for implication (where feasibility plays in)

Question 10

prospective treatment assignment

Answer 10

we have more than 1 group and assigned before condition takes place

Question 11

if there is prospective treatment assignment, we are conducting an _________ study. If there is NOT prospective treatment assignment, we are conducting an _________ study

Answer 11

experimental; observational

Question 12

key difference in experimental and observational studies

Answer 12

ex: observe cause and effect
obs: no manipulation

Question 13

observational study

Answer 13

precursor for intervention/seeing if study needs to take place

more external validity

used when experimental cannot be (studies to do with smoking, children, etc.)

cheaper and shorter time frame

Question 14

If there is a comparison group, we are conducting a(n) _______ study. If there is NOT a comparison group, we are conducting a(n) ________ study.

Answer 14

analytical; descriptive

Question 15

types of observational studies

Answer 15

descriptive
analytical

Question 16

descriptive study

Answer 16

establishing phenomenon

first study type in new research area

tells frequency, progression over time, correlations, etc.

cannot conclude cause and effect

Question 17

how results are biased in observational studies?

Answer 17

confirmation bias
- looking for one thing and only measure/record this

selection bias

Question 18

how do we determine the type of analytical study?

Answer 18

when were treatment and outcome identified/assessed?

Question 19

cohort study

Answer 19

treatment then outcome

studying effectiveness
- follow the groups forward in time to determine if they experience outcomes

no assignment takes place/no manipulation

steps: identify groups then measure outcome

Question 20

cohort study strengths

Answer 20

treatment comes before outcome (establishes temporal precedence)

less prone to recall bias (longer ago an event took place, the least likely you are to remember details)

provides estimates of incidence of outcomes overtime

Question 21

cohort study limitations

Answer 21

cost

rare outcomes are hard to observe

studies may need to be very long to observe outcomes

Question 22

case control study

Answer 22

outcome then treatment assessed

assess whether there were differences in treatment exposure retrospectively
- chart reviews
- self-report
- interviews

Question 23

case control study strengths

Answer 23

useful for rare outcomes

can save time and money

Question 24

case control study limitations

Answer 24

difficult to select an appropriate control group

recall bias

cannot tell you how prevalent the outcome or treatment is - only odds of experiencing both

Question 25

cross-sectional study

Answer 25

outcome and treatment assessed at the same time use on timepoint to assess both outcome and treatment exposure can provide estimates of frequency or prevalence of an outcome or treatment no temporal precedence and subject to recall bias

Question 26

rate

Answer 26

**frequency** of an event in the population over a **defined period of time**

Question 27

proportion

Answer 27

**frequency** of an event **without a defined time period**

Question 28

ratio

Answer 28

**number of people in one condition** relative to the **number in another**

Question 29

absolute risk

Answer 29

probability of outcome

Question 30

odds ratio

Answer 30

likelihood of membership in one group, given membership in another (also relative) ex. given membership in the treatment group (vs. nontreatment group, how likely are you to also be in the outcome group

Question 30

relative risk

Answer 30

ratio representing how often the outcome happens in the treatment group, *relative to* the untreated group

Question 31

types of experimental studies

Answer 31

randomized-control trial non-randomized-control trial

Question 32

key difference in experimental studies and why does it matter

Answer 32

if the treatment conditions are randomly assigned matters because of: - selection bias and open-label trial

Question 33

randomized-control trial

Answer 33

control for what works for who can claim cause and effect

Question 34

non-randomized control trial

Answer 34

used in early stages of a trial more exposed to bias cannot claim cause and effect

Question 35

inclusion criteria for randomized-control trials (RCTs)

Answer 35

diagnosis clinical staging prior treatment and iatrogenic comorbidity

Question 36

clinical staging for RCTs and specific stages

Answer 36

ways to grade out severity of disorder symptoms/symptoms experienced symptoms on continuum stages: 0: no symptoms 1: some symptoms that aren't specific 2: moderate-severe symptoms, meet criteria for diagnosis 3: some level of remission 4: persistent/severe, not going away or getting better

Question 37

iatrogenic comorbidity

Answer 37

had other treatments that didn't work or potentially make things worse past treatment experiences impact future reactions and so you don't repeat any treatments

Question 38

recruitment for RCTs

Answer 38

how are participants identified? is the sample representative? can become biased (socio-economically and culturally)

Question 39

control groups for RCTs

Answer 39

no treatment or waitlist minimal attention treatment as usual - standard treatment that is currently being used in field attention placebo control - rigorous, doing as much as we can to mimic the intervention other active treatment additional controls needed when pharmacotherapy is added

Question 40

designs for RCTs

Answer 40

parallel treatment - most common! groups assigned then followed simultaneously adaptive - changing course of movement throughout treatment based on how they respond, aka "stepped care" dismantling - tries to figure out active ingredients, pull apart to figure out further which produces the larger effect/most essential part of treatment

Question 41

assessments for RCTs

Answer 41

treatment allocation should be concealed from those administering assessment pre and post treatment, consider length follow up must be sensitive to change incremental validity patient-reported vs. observer-rated assess for adverse effects, not just desired effects

Question 42

demand effects

Answer 42

the more you include, the easier a patient may guess what you are studying and sway/bias their answers

Question 43

incremental validity

Answer 43

what we are measuring while adding something new

Question 44

patient-reported vs observer-rated

Answer 44

subjective or objective: who's perspective is represented in outcome? value both things: feelings and observations

Question 45

assessing for adverse effects, not just desired effects

Answer 45

focusing on people who **didn't** respond to treatment that may be affecting averages

Question 46

outcomes for RCTs

Answer 46

define a priori what level of improvement will mean the treatment worked? - remission (no longer meet criteria for diagnosis) - reduction of symptoms (still meet criteria) - longevity of change

Question 47

priori

Answer 47

established before start to gauge what a success is considered to be in an experiment

Question 48

drift

Answer 48

expect therapists to naturally drift from adhering strictly to treatment overtime because: - find things that work with patients - become less rigorous or just forget steps/get distracted

Question 49

the more ________ = the more confident one can be in the results of the study

Answer 49

rigorous

Question 50

efficacy vs. effectiveness

Answer 50

efficacy: - emphasis on internal validity - very controlled effectiveness: - less control - emphasis on external validity - comorbidities that influence treatment

Question 51

empirically-supported treatments

Answer 51

stringent criteria for study designs - active control, large sample, etc. subject to limitations of RCTs - efficacy vs. effectiveness - manualized interventions may be difficult to adapt or not applicable to a wide range of patients

Question 52

evidence-based practice has 3 components

Answer 52

best research evidence clinical expertise patient values and preferences