Evaluating Psychological Interventions: Outcomes, Issues, and Limitations, Slides of Psychology

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Outcomes and Issues in

Psychological Intervention

Ch 17

Therapy Evaluation

• Evaluation of therapy assumes that one can determine

the specific procedures that are used in the therapy

• How therapy is conducted in practice can be different than what is specified in a therapy manual
• Randomized controlled trials (RCTs) vs. idiographic analysis of a single clinical case, or replicated cases
• Efficacy refers to how well a therapy does in a

controlled clinical trial (i.e., an RCT)

• Effectiveness refers to how well a therapy does in the

real world of practice

Ch 17.

Limitations of Clinical Trials

• Volunteer participants are likely different from

general public.

• Will results from clinical trials based on these participants generalize to other groups of patients?
• Use of DSM diagnostic categories to create

homogeneous groups may blur differences between

participants in groups.

• Is there room for idiographic analysis of individuals in clinical trials?

The Challenge of Managed Care

• Managed care organizations (contracting with employers) demand accountability from providers (MD and non-MD clinicians)
• Evaluations of psychotherapy outcomes are not merely of academic research interest, but have practical implications for people in their daily lives.
• Providers are concerned about the potential for abuse of

patients’ privacy and denial of needed treatments

• Stepped Care: Beginning with the least intrusive, least expensive level of care, and moving up only when necessary. (Question: Does this increase drop out risk compared to the initial use of the most powerful intervention? B&N, 9th edition, pp. 568-569)

 Seligman (1995):

 Treatment Worked

 87% Improved

 Long Term Treatment

Better than Short-Term

 Therapy vs. Therapy

Plus Meds Were Similar

 Limit Care = Poor

Outcome 180

190

200

210

220

230

240

250

Improvement Score

1 Mos 1-2 Mos3-6 Mos 7-11 Mos

1-2 Yrs>2 Yrs

Duration of Therapy

Consumer

Reports Magazine

Consumer Reports, 2004 Survey

Evaluation of Psychodynamic

Therapies

• Classical Psychoanalytic treatment has been evaluated in only 4 studies - These studies are limited by lack of a control group
• General findings:
  • Patients with anxiety disorders do better in psychoanalysis than do schizophrenic patients
  • Better educated clients do better in therapy
  • Interpretation by the therapist may not be helpful for the therapy process
• Outcome research has demonstrated that brief interpersonal therapy (IPT) is as effective as CBT for depression and bulimia nervosa
• Process research in brief therapy has emphasized the importance of the therapeutic working alliance

Ch 17.

Evaluation of Client-Centered

Therapy

• Humanistic psychotherapy assumes that people must

be understood from their own point of view

• Psychological disorders arise when people fail to appreciate their own internal worlds
• Therapist role is to be accepting of the client and to be non- judgmental
• Positive outcomes are not always related to therapist

empathy

Ch 17.

Evaluation of Counterconditioning /

Exposure Methods

• Counterconditioning involves imaginal and/or real-life

exposure to threat stimuli

• Systematic desensitization involves having a deeply

relaxed person imagine a series of fear-inducing

situations

• Systematic desensitization / exposure methods are

effective for the treatment of anxiety-related problems

• Simple phobias, agoraphobia
• PTSD
• Obsessive-compulsive disorder
• Panic disorder

Ch 17.

Evaluation of Operant Methods

• Operant methods involve the systematic rewarding of

desirable behaviors and extinguishing undesirable

behaviors

• Operant methods are effective for a wide range of

behavioral problems, particularly in children

• Caveat: The problem behavior must be an operant (i.e.

under the control of a contingent reinforcer)

Ch 17.

Evaluation of Beck’s Cognitive

Therapy

• People in emotional distress operate under cognitive

schemas that are disabling

• The goal of Beck’s cognitive-behavioral therapy (CBT) is to challenge these schemas
• CBT has been shown to
• Improve depression and to prevent future depression episodes
• Be comparable to drug therapy in overall effectiveness for the treatment of depression
• See pp. 581-582, for comparison with Ellis’ REBT

Ch 17.

Generalization/Maintenance of

Treatment Effects

• Generalization seeks to identify the factors that allow clients to maintain treatment-related gains while in the real world - Using intermittent and natural reinforcers is helpful - Eliminating secondary gain (through use of paradox) - Reducing the likelihood of relapse by encouraging clients to attribute their slips to external, unstable, specific and controllable factors - Attribution of treatment gains to oneself may be useful for the person(e.g., self-control strategies)
• Some basic issues in cognitive and behavioral therapy
  • Internal behavior and cognition
  • Importance of relationship factors (the therapeutic alliance)

Ch 17.

Review of Community Psychology

• The focus of community psychology is prevention of

disorder

• Community psychology has been useful in
  • Prevention of cigarette smoking
  • Prevention of HIV infection
  • Reducing the risk of cardiovascular disease
• Community psychology efforts do not work when the

disorder of interest is not subject to

social/environmental change

Ch 17.

Psychotherapy Integration

• Integration seeks to determine the common ground

among the various therapy schools

• Technical eclecticism refers to a situation in which a therapist uses techniques from other disciplines, without adopting the theories that spawned them
• Common factorism seeks strategies that are common to all therapy schools
• Theoretical integration attempts to synthesize both theory and technique across schools

Ch 17.