Presentation on theme: "Empirically Supported Psychological Treatment C. Ervin Davis III, Ph.D. Assistant Professor Department of Psychology East Carolina University"— Presentation transcript:
Empirically Supported Psychological Treatment C. Ervin Davis III, Ph.D. Assistant Professor Department of Psychology East Carolina University
Outline of Session Part I. The Research METHODS –Definitions & Concepts (What is psychotherapy research?) empirical, theory, hypotheses, psychotherapy, efficacy vs. effectiveness –The Methods (How to do research?) Part II. The Research RESULTS –A History Lesson –In answer to your question… –Going Beyond
Part I. The Research METHODS
What is Empirically Supported Treatment? (EST) For psychotherapy, does EST mean anything? Or, have we been played for a Fool? Medical Model Science & Art
What is Psychotherapy Research? First – some definitions –Empirical –Psychotherapy –Theory –Hypothesis –Empirical Support –Efficacy & Effectiveness Second – Methods of research
Empirical 1 : originating in or based on observation or experience 2 : relying on experience or observation alone often without due regard for system and theory 3 : capable of being verified or disproved by observation or experiment 4 : of or relating to empiricismempiricism Source: Merriam-Webster Online Dictionary
Psychotherapy – What is it?..a formal process of interaction between two parties … may be two or more … for the purpose of amelioration of distress … in the following areas of disability or malfunction: cognitive functions …affective functions …or behavioral functions …with the therapist having some theory of personalitys origins, development, maintenance and change along with some method of treatment related to the theory … Source: Corsini in Corsini & Wedding (2005)
Psychotherapy – The Important Points Its -- interaction talk Involves cognition, affect, behavior Has a personality theory (philosophy) Has a theory of change Has a set of techniques
Theory & Hypotheses Theory: set of ideas, principles to explain & predict Hypotheses: tentative, statements based on theory that can be tested empirically Theory Hypothesis
Empirical Support Data in accord with hypothesis Gives support to hypotheses & theory Does not contradict, falsify theory Gradual building Natural laws govern behavior, mind –objectivism, materialism The word empiricism comes from the Greek word εμπειρισμός, a noun meaning a "test" or "trial"
Efficacy or Effectiveness Efficacy – In the Lab – Analog Therapy – Not real therapists, Not real patients, Not real world Effectiveness – In the real world Vs. Most of the research on psychotherapy has been of efficacy. Lab Reality
Methods of Research Experiments or Non-experiments –Randomized Controlled Trials –Quasi-experiments –Naturalistic Study –Case Study Effects of therapy and not expectancy, time, attention, repeated assessment, regression Sample Selection –analog –select –genuine clinical
Randomized Control Trial --try to remove pre-existing differences Random assignment to Treatment Group Control group Gets the therapy. Gets an alternative. Waitlist, contact/attention placebo, no-treatment Standard treatment (TAU)) Blinding?
Research Methods Samples –Analog –Highly select –Genuine clinical Assessment (to measure condition or outcome) Meta analysis-- cumulative outcome-- effect sizes Alternatives (to compare with treatment) –Wait list –Contact or attention placebo (non-Therapy) –No treatment (Assess Only) –Standard treatment (TAU/Another Treatment) OK, sorry…just forget I asked for a double blind, placebo control
Effect Size Cohen (1988) Cohens d, effect sizes as "small, d = 0-.2," "medium, d =.3-.5," and "large, d =.8-1,0Cohen (1988) Corresponds to correlation coefficient r=.1, r=.24, r=.37 g = M 1 - M 2 / where (between 2 conditions) = [ (X - M)² / N] (standard deviation) –where X is the raw score, M is the mean, and N is the number of cases. How much did these groups (means) differ?
The Research problem Client Problems (diagnosis) X Client Personal Characteristics X Therapy Approaches X Therapist Characteristics X Situation/ Circumstances 10 x 10 x 10 x 10 x 10 = 100,000 combinations! How big is this question about psychotherapy research? Shes BIG problem quicksdraw Big cube
Part II. The Research RESULTS
Outline Part II. The Research RESULTS –A History Lesson –In answer to your question: Questions about what the research says: e.g. Does therapy work? Which is better? How long? (Highlights of the most significant research findings) –Going Beyond (Some important topics for future research)
History Psychotherapy Research See your Timeline Whered that therapist go?
History s-1930s Early research on psychodynamic and behavioral therapy 1936 Rozensweigs Common Factors 1952 Eysenck No evidence for psychotherapy effectiveness 1958 Wolpe – Reciprocal Inhibition 1960 Psychotherapies proliferate
History Bergin & Garfield 1 st Edition 1976 Beck Cognitive Therapy 1977, 1980 Glass meta analysis 1994 Consumer Reports Survey 1995, 1998 APA Task force 1990s – current -- Many Meta analyses 1990s – managed care
Results Does Psychotherapy Work? Are some therapies better than another? Does therapist experience matter? Is psychotherapy better than drugs? Is longer or shorter therapy better? Are specific ingredients/factors therapeutic? Are improvements maintained? A large body of research has addressed the following questions: Remember the fool and the 100,000 combinations.
Does Psychotherapy Work? Smith & Glass, 1977 – Meta- analysis of 475 studies, overall effect size of 0.85 – mean treated better than 80% of untreated Table 5.1 Summarized Meta- Analytic reviews, from Lambert, 2004 Seligman, 1995 – Consumer Reports Survey (Generalizability, Effectiveness Issue)
Lambert, 2004 in Bergin & Garfields Handbook of Psychotherapy & Behavior Change.
Seligman, 1995 – Consumer Reports Survey
Are Some Therapies Better than Others? Luborsky, Singer, & Luborsky, 1975 Do-Do Bird: All must have prizes APA Task Force on Promotion & Dissemination of Psychological Procedures, 1995 – The List Wampold, 1997 Meta analysis – Test of Do-Do hypothesis
27 effect sizes.05 – 4.34 Lambert, 2004
59 effects, -.19 to 3.45
APA Task Force Report 2 group studies >Placebo or other Tx. Adequate power Or large series single case manualized Samples defined 2 group studies >Waiting-list Sample heterogeneous Or small series single case Or 2 by same lab or 1 good
Does therapist experience matter? Strupp & Hadley, 1979 Therapists vs. College Professors Stein & Lambert, 1995 Meta Analysis, 33 studies- -more training correlated with lower dropout, more satisfaction & better outcome M.A. M.S.W. PsyD R.N M.D. Ph.D.
Is psychotherapy better than drugs? NIMH Depression Collaborative Research program -- (Elkin, Gibbons, Shea, Sotsky, & et al., 1995) equally efficacious for less severe depression Thase, 1997 Depression Single & Combined Txt, Depends on Severity Gloaguen et al., 1998 CBT>Rx, d=.38 –CBT 1-yr relapse 29%, Rx 60% Reynolds et al., 1999 Recurrence after successful treatment
NIMH Depression Collaborative Research Program -- (Elkin, Gibbons, Shea, Sotsky, & et al., 1995) Figure 1. Estimated Hamilton Rating Scale for Depression (HRSD) scores in cognitivebehavior therapy (CBT), interpersonal psychotherapy (IPT), imipramine plus clinical management (IMI-CM), and placebo plus clinical management (PLA-CM) for high initial severity based on HRSD. Figure 2. Estimated Hamilton Rating Scale for Depression (HRSD) scores in cognitive behavior therapy (CBT), interpersonal psychotherapy (IPT), imipramine plus clinical management (IMI-CM), and placebo plus clinical management (PLA-CM) conditions for high initial severity patients based on the Global Assessment Scale. Lower is better PLA-CM, CBT IMI-CM IPT IMI-CM CBT PLA-CM More severely depressed patients
Thase, 1997 Meta analysis In 6 studies No sig Diff. Sig. Diff. Therapy alone or combined with medication
(Reynolds et al., 1999) 107 pts fully recovered from depression at BL, Age > 59 Figure 2. Recurrence Rates of Major Depressive Episodes. Survival function of 4 treatment groups (log-rank statistic=34.31; df=3; P=.001). On pairwise analysis, each of the 3 active treatment groups was significantly better than placebo. IPT indicates interpersonal psychotherapy.
Is longer or shorter therapy better? Lambert, Hansen, & Finch, 2001 dose- response curve –data from 6,072 patients –therapy as usual, with a wide variety of treatment methods
Are specific ingredients therapeutic? (Ahn & Wampold, 2001) –Meta Analysis of 27 studies comparing a treatment and a treatment without a therapeutically important component
Ahn & Wampold, 2001
Aggregate effect size not significantly different from zero.
Common Factors From Lambert (2004)
Are improvements maintained? (Nicholson & Berman, 1983) – 67 studies information obtained at follow-up often added little to that obtained at the end of treatment. Findings highlight the general durability of gains achieved during psychotherapy, suggesting that costly follow-up procedures may be used more selectively Bakker et al., 1998 Anxiety & Panic Follow-up Meta analysis, 68 studies, Gains maintained for variety of treatments (Jarrett et al., 2001) Maintenance Cognitive Therapy for Depression vs. control (evaluation only)
Jarrett et al., 2001
Different Strokes for Different Folks? Or What works for whom? (Chambless & Ollendick, 2001) Reviews the results of Task Forces in the US and UK – List of Treatments by Disorder and category of support
Going beyond Treatment Matching Access to Treatment 3 rd Party payment Integrated Treatment Effectiveness Weiten 2001, Adapted from Mental Health: A Report of the Surgeon General, U.S. Department of Health and Human Services, 1999