1. 1 Psychology Service 2012 Louis Stokes Cleveland VA Medical Center

2. 2 I thought you did fine, but I’m afraid you had too many patients that were no shows.

3. 3 Evidence Based Therapies in the VA Models of Therapy Engagement ● Motivational Interviewing (MI) ● Interpersonal Therapy for Depression (IPT) ● Acceptance & Commitment Therapy (ACT) ● Cognitive Behavior Therapy (Beck) (CBT) ● Family Psychoeducation (BFT, MFT) ● Cognitive Processing Therapy (CPT) ● Prolonged Exposure Therapy (PE) ● Social Skills Training (SST)

4. ♦ The effects of psychotherapy are substantial. Effect size is.85. Psychotherapy efficient, effects lasting. ♦ Contributions to Outcome Specific techniques – 15 % Relationship & common factors – 30% Patient qualities & outside factors – 40 % Expectancy & placebo – 15% Lambert. MJ. & Barley, DE (2001) Research summary on the therapeutic relationship and psychotherapy outcome. Psychotherapy: Theory / Research / Practice / Training 38 357-361. Lambert, MJ & Archer, A. (2006). In Goodheart,. CD, Kazdin, AE, & Sternberg, RJ Practice and research perspectives on the evidence for psychotherapy. Washington, D.C.: American Psychological Association. 4 Does Therapy Work?

5. What is an Evidence-Based Therapy? Best definition of EBT concept (APA): ‘…the integration of the best available outcome research evidence with clinical expertise in the context of patient characteristics, culture and’… relationship development. Definition incorporates several factors: Effect, Efficacy, Utility, Stakeholder preferences

6. A potential EBT Treatment should show results (e.g., it works) through systematic and scientific evaluation. should meet outcome criteria on multiple studies using rigorous research amenable to peer review, expert consensus, and replicability. This is seen to practically translate into standardized techniques with highly specific manual-based protocols of intervention. What makes a treatment or therapy “evidence-based??!!”

7. Research Model for Evaluating Evidence-Based Treatments* According to Researchers Best EBT studies are: Highly controlled, randomized, prospective clinical trials. comparison groups with random assignment, blinded assessments, clear presentation of exclusion and inclusion criteria, state-of-the-art diagnostic methods, adequate sample size to offer statistical power, clearly described statistical methods. * Treatments That Work, 3rd edition, Ed Peter E. Nathan and Jack M. Gorman, Oxford University Press, (2007)

8. Research Model for Evaluating Evidence-Based Treatments* “If you like sausage and admire research, do not watch either one being done.” Anonymous researcher Linear cause-effect assumptions on how therapy works not based on empiricism. Therapy is reciprocal, pills are less so. Therapist bias & experience not removable from protocol. Blind assessments are rarely totally achieved. Clear presentation of exclusion and inclusion criteria (usually results in poor external validity).

9. Research Model for Evaluating Evidence-Based Treatments* State-of-the-art diagnostic methods (most based on popularity or precedence not empiricism) Whose diagnosis are we talking about? (re: PTSD flip-flops) Where is the pure single diagnosis patient? Clearly described statistic methods (very manipulable).

10. Based on the standards of scientific rigor, the American Academy of Sciences (AAS) reviewed RCT based EBT’s for PTSD in 2007. They found…. AAS, Committee on Treatment of Posttraumatic Stress Disorder. (2007). Treatment of Posttraumatic Stress Disorder: An Assessment of the Evidence. ISBN: 0-309-10925-6, 200 pages. The free PDF may be found at: http://www.nap.edu/catalog/11955.html http://www.nap.edu/catalog/11955.html 10 Research Model for Evaluating Evidence-Based Treatments*

11. 11 Research Model for Evaluating Evidence-Based Treatments* What do EBT’s Offer for the Clinician: Structured means to deliver therapy Usually good ideas about helping people change Excitement about a new approach that can help with placebo and relationship effects

12. Q&A DISCUSSION 12