Week 1 Helen Flashcards
What year was Clark, Kingston, James… etc.?
2014
What are the strengths of Clark etc.?
Conducted in a clinic in Poole - high external validity
Implications
What are the weaknesses of Clark etc.?
Lacks generalisability - 45 pps but not generally used
What are the results of Clark etc.?
Both groups showed reduced symptoms immediately after intervention - improvements more sustained in ACT 6 months after
So RCT’s should look at group and individual means - clinical and statistical difference
What year was Parry?
2000
What are the strengths of Parry?
Patients have the right to know if therapies are effective
More systematic review - better need for good research as gaps in methods and evidence being identified
What are the weaknesses of Parry?
Psychotherapy harder to ‘set standard’ than drug - negative results could be down to poor delivery of intervention
Randomisation - systematic between group difference when people have strong preferences for therapy -> attrition and small groups
Researchers enthusiasm - allegiance effects
What are the results of Parry?
Still debate about applying - as research evidence to change psychotherapy practise may be unreliable / misleading and as such prematurely applied
What year is Dimidijan et al.?
2006
What are the strengths of Dimidijan?
Findings question assumptions that cognition is a vital, active ingredient in CBT - controversial???
What are the weaknesses of Dimidijan?
Doesn’t support CBT theory
If therapist can only offer few sessions - focus???
Conducted as Washington Uni where BA model was developed - allegiance effects
Attrition rates in study of PPs using ADM - larger than other trials, may deteriorate
What are the results of Dimidijan?
Example of CBT / Behav and dismantling study
Low severity dep - no difference in effec for all active conditions
High severity - BA + ADM equivalent, both more effective than CBT
What year was Pearson and Sulber Shatz?
1998
How did Pearson and silberschatz argue that RCT results are useful to psychotherapies
Ethics - responsible to inform and supply RCT treatment
Scientifically designed to show what’s most effective - best at doing so
Should rely on individualised case formation to guide therapy
Standardised - less bias and valid
How did Pearson and silberschatz argue that RCTs aren’t useful to psychotherapies
About the ‘average’ case
Only single not multiple disorders
No evidence of non. compliance
Compromise of validity
What are the results of Pearson and Sulber Shatz?
The findings are useful to provide top quality care (pyschotherapies), but there are many alternative research methods
What year is Kuyken et al.?
2010
What are the strengths of Kuyken?
PPs still at risk of relapse - mindfulness based CT attempts to try and treat this
RCT showed that MCBT = significant fewer dep. symptoms at follow up than ADM
What are the results of Kuyken?
Looking at mech of change - collected outcome data + data and changes in psych processes MCBT designed to impact (mindful and self-compassion)
Changes in mind and self compassion during MCBT, significant mediated effect of MCBT at 15 month follow up.
Mediators are ‘casual stepping stones’
What year was Chambless and Hollon?
1998
What were the strengths of Chambless and Hollon?
Prior to paper, we barely tested - he laid out rules
What are the weaknesses of Chambless and Hollon?
In reality need:
Good quality RCT
Specific pop.
Findings replicated by independent research group (removes unconscious bias)
What are the results of Chambless and Hollon?
Draws conclusions from 23 RCTs
Describes what empirically supported psychotherapies are
Said ‘comparison with control/ treatment/ placebo’ -
In a RCT/controlled single case
experiment/time samples design
Do statistically better than comparison at relieving symptoms - statistical power to detect difference
Efficacious - superior of the EST in 2 independent research settings
What are the other key sources to quote?
David and Montgomery (2011), Baker (2014) and Clay (2010)
What is David and Montgomery all about?
We should now evaluate (for efficacy) therapies and theory based on
E.g. due to ‘bad air’ - malaria
They encouraged mediation studies / process research
What is Baker all about?
Systemic reviews are top level quality info - empirical
What is Clay all about?
RCTs = gold standard
Some RCT limitations - represent population ( -> change criteria), not random (lack external validity), control list (ethics)
in reality what do we need for a good quality RCT
a good quality RCT in favour of the intervention
for a specific population
with the findings replicated by an independent research group
why should we find out the active ingredients of a therapy
- Why? Poor theories lead to pseudoscience+ potentially damaging interventions/ therapeutic ‘blind alleys’ Example of the ‘bad air’ theory of malaria
thinking has moved on now seen as important to evaluate therapies and the theories they are based on (David & Montgomery, 2011)
what are the 2 levels of analysis according to david and Montgomery
two levels in the analysis of evidence supporting psychological treatments.
o Psychological theory of therapeutic change should be scientifically evaluated
o The therapeutic package (psychological treatment) is derived from the theory about the mechanisms of change and is scientifically evaluated.”
describe RCTs
- Originally used in medical research: e.g. testing medication
- Double blind RCT design not possible with psychotherapy research
o Therapist knows what giving, and patient can look it up ( biases)
o Also pps know when reciving no active treatment - Stats: mixed ANOVAs
Rct pp experiences - If an nhs patient offered to put into intervention or control OR wait months for treatment
Can see why lack of signup
what are the strengths of RCTs
- Currently= ‘gold-standard’ method of evaluating psychotherapy interventions.
o (See Persons & Silberschatz, 1998; Clay, 2010) - High Internal Validity: high confidence the intervention caused the changes that participants report
- Very clear guidelines on how to conduct and report RCTs
what are the key design features of RCTs
randomisation and controlconditions
whatis the limitations of using randomisation in RCTs
o Single blindness= claim pps doesn’t know about therapy but can google/ find out
Leads to bad expectations
o Creates uncertaintys going into RCTs which leads to issues as no people= no way to test
whatarethe strengths of usingRCTs
- Participants have an equal chance of being allocated to any of the study conditions
- Minimises the risk of biases (systematic differences) between the different groups in the study
o E.g. Age, gender, pre-treatment symptomology levels etc. - So, the therapy being tested should be the only significant difference between the different participant groups
howcan weimprovethelimitations of RCTs through betterdesign
- Some limitations might be improved through better design
o E.g. Participants do not represent patient population -> change inclusion/exclusion criteria
what issues can wenotsolve as they are inherent to RCTs
- But some limitations are inherent in the RCT design
o Participants randomised to treatment condition
o In normal life not randomly put in treatments therapist suggests it
Looses external validity as randomization doesn’t normally happen – no discussion - This is an example of a threat to external, ecological validity
what study shows that we can improve the inherent issues of RCTs through better design
Clarke,kingston ,james , bolderston and Remington 2014
If you wanted to show how reposting clinical as well as individual not group means impacts research, which study would you use?
Clarke, Kingston, james, bolderston and Remington 2014
If you wanted to show how mediation studies work and why we use them which study would you use and what’s the mechanism of change
Kuyken 2010- mech of change = changes mindfullnessband self compassion- this mediated the effect of MCBT
If you wanted to show a dismantling study what would you use
Dimijian 2006
What did Pearson and silberschatz argue
Whether RVT results are useful to psychotherapies
