Week 2

Question 1

Sources of evidence about which therapies help

Answer 1

Scientific research studies
-Using systematic quantitative or qualitative methods

Synthesis of research literature

• Metanalyses
• Clinical Practice Guidelines

Consumer surveys
-Aggregation of independent feedback from those using the target service (by researchers or lobby groups)

Lived experience

• Writing and advocacy of individuals
• Advocacy of consumer groups

Practice-based evidence
- Aggregating outcome data from ordinary practitioners who are trying the intervention (not opinion)

Question 2

Charman & Barkham (2005) Evidence-based practice

Answer 2

Evidence-based practice ->Top-down
Practice-based evidence -> Bottom-up

Evidence and the social gradient

Question 3

Randomised Controlled Trials (RCTs)

Answer 3

‘Gold Standard’
Which treatment and which dose are best for a particular mental disorder?
- DSM-IV or ICD-10
- Manualised treatments
- Random allocation
- outcomes include recovery and relapse rates
“It is assumed that the active ingredient is the treatment”

Question 4

Asay and Lambert (1999)

Factors accounting for patient improvements

Answer 4

Factors accounting for patient improvements
30% Theraputic relationship
40% Extratheraputic change
15% expectancy effects
15% theraputic techniques

Question 5

National Institute of Mental Health

Elkin, 1994

Answer 5

The Treatment of Depression Collaborative Research Program.

• All groups (CBT, IPT, SSRI+CM and Placebo+CM) showed improvement.
• Therapist efficacy appears more significant than treatment efficacy.

Question 6

Evidence-Based Practice three pillars

Answer 6

• Research Evidence
• Clinical Expertise
• Patient specifics

Question 7

Shadish, Clark and Steiner (2008)

Answer 7

Can Nonrandomised Experiments Yield accurate Answers? A Randomised Experiment Comparing Random and Nonrandom Assignments

Initially (N=445) they completely randomly assigned them into either a “randomly assigned” group or a “self selected group”.
They either got to choose whether to learn maths or vocab or they didn’t get to choose maths or vocab.

Question 8

Cumming (2012) video on p values

Answer 8

p values: If p reveals truth, a replication should yeild roughly the same p.
If you repeat an experiment how much will results vary?

Cannot trust p

Question 9

RCTs pros and cons

Answer 9

Pros:

• easy to replicate
• removes some bias
• very structured

Cons

• where do we have flexibility to adapt our intervention to work for the client?
• people dropping out throws off the groups and sample size

Question 10

8 Questions for critically

appraising the evidence

Answer 10

1. Is the study’s research question relevant?
2. Does the study add anything new?
3. Was the study design appropriate for the research question?
4. Did the study methods address the key
   potential sources of bias?
   - Meta-analyses – publication bias
   - RCTs – lack of allocation concealment
   - Cohort studies – identifying and measuring all important confounding factors
   - Case studies – relevance
5. Was the study performed in line with
   relevant protocols?
6. Were the statistical analyses performed
   correctly for the stated hypothesis?
7. Do the results justify the conclusions?
8. Are there any conflicts of interest?