PREPARED BY DR. CATHY CHOVAZ, KING’S COLLEGE, UNIVERSITY OF WESTERN ONTARIO Chapter 12 Intervention: Adults and Couples INTRODUCTION TO CLINICAL PSYCHOLOGY 2E HUNSLEY & LEE

 Does Psychotherapy work??  Evidence-Based Treatments: Initiatives and Controversies  Examples of Evidence-Based Treatments  Depression  PTSD  Couples Distress  Efficacy to Effectiveness Topics

Hans Eysenck (1952) – published a paper showing that clients in therapy were worse off than untreated individuals  44% of clients in psychoanalytic treatment improved  64% of clients in eclectic treatment improved  72% of clients not in therapy improved  Several problems with the study invalidated results – but led to push for additional research on effectiveness Does Psychotherapy Work?

 Meta-analysis: quantitatively combining several studies to measure the effect of a variable  Effect size: Numeric value that indicates size between group differences (d=.5 means ½ SD between group difference)  Can also be presented as an r statistic when correlational studies are used  First meta-analysis (1977): psychotherapy has an effect of d=.68 Does Psychotherapy Work?

 Subsequent research (e.g., Smith, Glass, & Miller, 1980) indicates d=.85.  That is, the average person in therapy is better off than 80% of people without therapy  Subsequent research validated these findings Criticisms of meta-analysis:  “garbage-in, garbage-out”  “apples and oranges” Does Psychotherapy Work?

Clinical Practice Guidelines:  Rules and guides for particular problems. Clinical Psychology has not been quick to adopt these structures Empirically Supported Treatments (ESTs):  Specific criteria must be met for a treatment to be an EST to be recommended for use.  Section on Clinical Psychology of the Canadian Psychological Association (CPA) struck a task force in 1996 to examine ESTs  Several criticisms of ESTs emerged – see Exhibit 12.2 Evidence-Based Treatments: Initiatives and Controversies

 Statistically significant differences  Differences not due to chance  Clinically significant differences  Improved quality of life, cure, recovery  Different types of clinical trials:  Type 1: High quality Randomized Controlled Trials (RCTs)  Type 2: Imperfect RCTs  Type 3: Open trials without a control condition Evidence-Based Treatments: Initiatives and Controversies

Different types of clinical trials (cont.):  Type 4: Quantitative meta-analyses  Type 5: Qualitative literature reviews  Type 6: Case studies or professional consensus statements not based on research  The EMDR debate and recent findings – concludes that eye movement does not add to treatment of trauma Evidence-Based Treatments: Initiatives and Controversies

1. Cognitive Behaviour Therapy (CBT) for Depression 2. CBT for PTSD 3. EFT for Couple Distress Examples of Evidence-Based Treatments

 Cognitive Behaviour Therapy (CBT) for Depression  Goal: Altering behaviours, negative automatic thoughts, and dysfunctional beliefs  Text: example of Garrett and losing his music contract Examples of Evidence-Based Treatments

Stages of CBT for Depression 1. Initial stage of treatment – behavioural activation  Psychoeducation about depression as well as case formulation and treatment plan 2. Targeted homework and assignments (i.e, thought records)  Testing automatic thoughts 3. Examining and challenging long-standing beliefs or schema 4. Relapse prevention CBT for Depression

2. CBT for PTSD  Some similarities to CBT for depression  Psychoeducation about PTSD and treatment  Challenge dysfunctional beliefs  Relapse prevention 1. Teaching relaxation skills 2. Imaginal exposure (bringing the trauma to mind) through recounting of memories 3. In vivo exposure with triggers of trauma Examples of Evidence-Based Treatments

3. EFT for Couple Distress  Goals: modify emotional responses to be adaptive, enhance a secure emotional bond for the couple  Help couples present their attachment needs in an adaptive, understanding (and validating) manner  Nine steps in EFT  First four involve assessment and de-escalation  Remaining steps are about changing relational pattern and developing new connections Examples of Evidence-Based Treatments

 Current research indicates that efficacy trials can be translated into real-word settings  Effectiveness studies show similar results  Benchmarking strategies: using efficacy trials as a mark for whether the translation of a treatment is working in the real world Translating Efficacy to Effectiveness

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