Week 4 - non CBT Flashcards
What year was Bohart, Ohara etc.?
1998
What is Bohart, Ohara all about?
Criticised development of empirically validated therapies
‘Based on medical like model’ - called disorders + ‘cured’
Therapies had to be standardised
RCTs can’t be true double blind -> medicines
No RCT research fits with philosophy + theory that non-CBT therapies such as psychodynamic + humanistic are based on -> defaiming disenfranchisement = taking away power / opportunity from a person
Criteria for ‘empirical validation’ = restrictive and scientifically unjustified
General humanistic
- goal not to alienate disorder
- psychotherapy not disorder driven
- goal = provide relationship to re-evaluate their life choices - to alleviate stress (2ndary)
What year was Elliot and Freire?
2008
What are the results of Elliot and Freire?
Like Stiles - found large mean pre-post effect (1.01)
Improvements generally well maintained over range of periods
Results empirically supported by gold standard RCT
Difference in effectiveness - no evidence to say it doesn’t work or is worse
31 RCTs = compared to control - mean pos effect of .78
63 RCTs = compared to CBT - very small difference but in favour of CBT
Also did clinically and significant equivalent to other therapies - 109 studies = no diff.
What are the weaknesses of Elliot and Friere?
Many studies uncontrolled
31 RCTs = compared to control - mean pos effect of .78
63 RCTs = compared to CBT - very small difference but in favour of CBT
What is the method of Elliot and Friere?
Meta-analysis of 191 studies (14000 = N)
Data from 4x person centred therapies including PCT
What year was Stiles?
2005
What were the results of stiles 2005
People receiving all therapies benefitted
- mean effect size of 1.36
- no huge diff between therapies
Show as good as CBT
What were the weaknesses of Stiles?
Uncontrolled - can’t assume causality Poor internal validity - offering what they said -> no independent check No random assignment to groups No control Restricted to self report
What were the results of Stiles?
1309 = N, 58 NHS sites
Outcome measure = core (clinical outcomes in routine evaluation (pre/post treatment)) - measures symp. and functioning
Effectiveness of CBT, PCT and PDT in NHS settings
What year was Shedler?
2010
What are the strengths of Shedler?
Key benefit = results improve rather than decay over time
- empirical support for psychodynamic even when CBT = NICE funded
What are the weaknesses of Shedler?
Far more empirically supported (outcome) studies for CBT - extent to limitation = debate
What are the results of Shedler?
Psychodynamic / psychoanalytic psychotherapy = range of treatments based on psychoanalytic concepts / methods
Key relationship between therapist and patient - therapeutic relationship = vehicle for change
Study: reviewed a number of meta-analyses - Abbas, Hancock etc. (06), Liechsenring + Leibing (03) and Lipsey + Wilson (93)
Non-psychodynamic therapies may be effective due to using techniques central to PDT
What year was Antesis? What was it all about?
2011
Shedler 2010 + other psychodynamic therapies have been heavily criticised
Shedler failed to report meta-analyses which indicated psychodynamic to be less effective than other treatments -> bias
Main meta-analysis - thinly spread across diagnoses -> doesn’t state compelling evidence for 1 diagnosis such as empirical evidence should do.
In Leichsing - only 3/11 studies directly compare psychodynamic + CBT
What year was Abbass, Hancock etc.? What was it all about?
2006
23 RCTs, N = 1431 -> short term PDT (>40hrs)
Common MH disorders
Compared with WLC or Tau
Large effect size of .97 for psychodynamic - increased to 1.51 at 9 months, shows people maintain improvements / improve post therapy
What year was Lipsey + Wilson? What is it all about?
1993
18 meta-analyses
Effect size of 0.85 for PDT, but compared to CBT and behaviour modification (23 meta-analyses) - effect size medium at 0.62
What year was Liechsenring and Liebing? What is it all about?
2003
Meta-analysis - 4 studies of efficacy of psychology + 11 studies for CBT for personality disorders
Mean treatment length for PDT = 37 weeks, follow up = 1.5 years vs CBT = 16 weeks, follow up = 13 weeks. Effect sizes of 1.46 (PDT) and 1.0 (CBT), both large.
what are the strengths of Elliott and Freire
Results empirically supported by gold standard RCT
Difference in effectiveness - no evidence to say it doesn’t work or is worse
what are the strengths of stiles 2005
Good ecovalidity - under routine clinical practices
showed that all as good as CBT
how many participants in stiles and how many NHS sites
58 NHS sites, N=1,309
How a=many studies and pps in Eelliot andfriere 2008
191 studies, 14,000 pps
what are the four types of humanistic therapies in Elliot and friere
PCT
supportive, non-directive therapies
emotion focussed therapy
other experimental theapies
when controlling for one type of therapy in Elliot and friere- what happened
when studies testing CBT against supportive non-directive therapy removed - there was no difference between the effectiveness of CBT and PCT
