chapters 12, 13, 14, 15

since 2014, the Journal of Clinical Child & Adolescent Psychology has included an evidence-based update on psychological treatment of a specific child/adolescent problem area in each issue. The criteria have been modified to include a category of treatments that have been tested and found not to produce positive effects. - Five methodological criteria are used in these research reviews:

(1) a randomized controlled design is used (2) the independent variable (the treatment) is clearly defined via a manual or some equivalent method (3) the population is defined and clear inclusion criteria are specified (4) there is a psychometrically sound evaluation of outcome (5) appropriate analyses are conducted on a sample that is of sufficient size to allow detection of effects.

Main goals for EFT for couple distress is...

(a) modify emo tional responses and constricted, rigid interactional patterns (b) foster the establishment or enhancement of a secure emotional bond in the couple

What does the CBT Model emphasize?

- A collaboration in which the client participated actively in decision making throughout the treatment-> the therapist frequently provides information and lays out the options for addressing the agreed-upon targets for treatment - client is asked to monitor symptom changes throughout the treatment to determine the impact of the therapy

Emotion Focused Therapy (EFT) for couple distress

- A process-experiential treatment combining an experimental approach to affect with a systemic focus on the way in which relationship behaviours can develop into cyclical(occuring in cycles), self-perpetuating interactional patters - To bring about change in the couple, the psychologist must find ways to generate new emotional experiences and new interactional experiences for both partners

Empirically supported treatment

- A psychotherapy that has been found, in a series of randomized controlled trials or single-participant designs, to be efficacious (successful) in the treatment of a specific condition - required evidence of symptom reduction and/or improved functioning either from at least two independently conducted RCTs or from a large series of single-case studies. - a treatment could have a modest evidence base, but because no independent RCTs have been conducted on the treatment, it would not meet the original criteria to be an EST.

meta-analysis

- A set of statistical procedures for quantitatively (mathematically) summarizing the results of a research domain/multiple research studies - The use of meta-analysis to summarize research findings is now the gold standard for evaluating treatment effects and most other areas of psychological research.

effect size

- A standardized metric(measure), typically expressed in standard deviation units or correlations, that allows the results of research studies to be combined and analyzed. - allow for the meaningful integration of data across studies - when based on group difference statistics (such as t or F) effect size= expressed in standard deviation units and are called d or standardized mean difference (SMD). - For example, a between-groups effect size of d = .5 means that there is a difference of one-half standard deviation between treated and untreated groups - When correlational analyses are used to determine the strength of association between variables (e.g., r or R), the effect size is expressed as an r statistic, as one effect goes up the other goes up ex. happiness and candy

Open trial

- A type of initial exploratory treatment study in which no control group is used and typically few participant exclusion criteria are applied

Prolonged exposure therapy CBT begins with..

- An assessment of the patient's condition and the provision of psychoeducational information about the nature of PTSD and the nature of CBT approach - patients will have already described the events, situations, and memories that are most disturbing to them

randomized controlled trial

- An experiment in which research participants are randomly assigned to one of two or more treatment conditions.

Bruce Chorpita

- Anxiety and depression researcher - included in the multidisiplinary group for a class-action lawsuit on behalf of children with special needs - The settlement of the lawsuit involved an agreement by the state of Hawaii to develop a comprehensive system of care for those aged 0 to 20 years with mental health needs. The mandate (instructions) of the Hawaii task force was to identify which treatments would work in the challenging context of isolated rural areas with multi-ethnic populations.

Berke, Rozell, Hogan, Norcross, and Karpiak (2011) Evidence-based practice in psychology requires clinical psychologists to base service delivery on the best available evidence. This means psychologists must be able to access and evaluate relevant research. To what extent do psychologists do this?

- Approximately two-thirds of respondents indicated that most or all of their services were evidence based (as defined by the APA policy), with only 10% reporting little or no provision of evidence based services. - The provision of evidence-based services was highest among respondents who endorsed a cognitive-behavioural orientation

What did Hans Eysenck find?

- He reviewed data from 24 uncontrolled evaluations of psychoanalytic and eclectic therapies - He concluded that 44% of patients receiving psychoanalysis improved - 64% of those receiving eclectic treatments improved - He compared these results with two data sets in which spontaneous recovery occurred for 72% of untreated patients.

Hans Eysenck

- In 1952, published an article in which he argued that the rates of improvement among clients receiving psychodynamic or eclectic therapy were comparable to, or even worse than, rates of remission of symptoms among untreated clients.

Scott Henggeler

- Multisystemic Therapy (MST), developed by Scott Henggeler and his colleagues for seriously disordered adolescents

Coercive exchanges

- Parent-child interactions in which the parent unintentionally rewards the child for whining or aggression (by withdrawing a demand or providing attention) and the child rewards the parent for giving in to his or her complaints (by ceasing the aversive behaviour)

Parental monitoring

- Parents' awareness and tracking of the child's activities

Imaginal exposure

- Patients close their eyes and to recount these traumatic experiences for an extended period (typically more than 30 minutes), using the present tense and providing as much contextual details as possible (e.g., smells, sounds, their own thoughts, and physical reactions) - encourages the patient to begin to fully emotionally process the trauma that was experienced This allows patients to (a) revisit details of the trauma and gain new perspective on what happened and what might have occurred (b) distinguish between remembering the event (which is not inherently dangerous) and re-encountering the event (which could be dangerous) (c) develop a consistent, organized narrative of what occurred (d) learn that remembering the events can lead to an overall reduction in anxiety and other symptoms (e) develop a new appreciation for what they did to survive the trauma - sessions are usually recorded, and the patient is asked to listen to the recording repeatedly between sessions in order to promote emotional processing.

Oppositional defiant disorder (ODD)

- Reflects a pattern of persistent negativistic and hostile behaviour that is usually evident before the age of 8 years.

The final stage of CBT focuses on...

- Relapse prevention - the gains achieved by the client are reviewed, same as specific sills learned or discovered - The clinician encourages the client to imagine events that might cause self-doubt and helps the client explore the most adaptive ways (both behavioural and cognitive) to respond to such events.

General form of CBT for depression described by: Persons, Davidson, and Tompkins (2001).

- The focus of CBT for depression is on altering the behaviours, negative automatic thoughts, and dysfunctional beliefs - psychologist conducts an initial assessment to determine the client's diagnostic status (including comorbid conditions) and to obtain a sense of the client's current life circumstances - attention is paid to the client's relationships and social functioning, the client's psychological resources and strengths, recent events that may have precipitated the depressive episode, and the potential for suicidal behaviour - Early in the treatment process the client is provided basic information about the nature of depression, the evolving case formulation, and the possible treatment options for addressing the depressive symptoms.

Differences between parents and adolescence in a study in which young people receiving outpatient mental health services and their parents rated the alliance with the therapist...(Hawley & Weisz, 2005)

- The parent-therapist alliance: was related to participation in therapy, with those parents who reported a stronger alliance participating more in services and cancelling fewer sessions (the stronger alliance reported= the more participation they were doing) - The youth- therapist alliance: was related to reports of improvements in symptoms (the better the alliance= the better the symptoms got) - The results of this study illustrate that unless parents are convinced that the therapy is useful, it will be difficult for the youth to participate; however, unless the young person is collaboratively engaged with the therapist, there will be limited change in his or her symptoms.

Benchmarking strategy

- The use of data from empirical studies to provide a comparison against which the effectiveness (successfulness) of a clinical services can be measured - evaluates the impact of a treatment. - This involves using the results of efficacy(produce intended result) trials to form a standard (or a benchmark) against which the services provided to regular patients by regular clinicians can be compared (effectiveness trials/ how well it actually works)

In 1980, Smith, Glass, and Miller published a more extensive and more sophisticated meta-analysis of the psychotherapy literature...

- They reviewed 475 controlled studies of psychotherapy, including studies published in scientific journals and unpublished dissertations. Their overall finding was that psychotherapy had an average effect size of d = .85 (i.e., the average person receiving therapy was better off after therapy than 80% of people who did not receive therapy) - found the largest effect sizes (d values of 1.31 and 1.24, respectively/ people who received treatment were better off than 90% of people who didn't) for cognitive and cognitive-behavioural treatments - behavioural (.91) - psychodynamic (.78) - humanistic treatments (.63) - These effect sizes cannot be directly compared, however, as clients treated within each type of treatment were not necessarily equivalent in the type and severity of problems. - therapy was better than no therapy (treatment-outcome study)

weighted least squares method

- a more conservative way of calculating effect sizes using a statistical technique - introduced in the fourth major meta-analysis of the effects of child psychotherapy - when sampling data from a population, there is always error (i.e., deviations from the true population values) - Generally speaking, data from larger samples have less error variance and, therefore, are closer to population values - The weighted least squares method takes this into account by assigning less weight in the meta-analysis to studies with greater error variance and by more heavily weighting those with less error variance.

Example Study: a large-scale study conducted in Sweden with 908 parents of children with disruptive behaviours and ADHD examined the effects of four parenting programs delivered in clinic and community practices. Stattin and colleagues found that..

- all parents reported reductions in their children's problems - the three behavioural programs produced larger effects than the non-behavioural program

Dianne Chambless

- chaired members of a task force to show mental health care was effective Members of the original task force, chaired by Dianne Chambless came from a range of employment settings and espoused a variety of theoretical orientations. The task force's strategy was to examine treatment research for specific disorders and conditions according to a number of criteria. For a treatment to be designated as an empirically supported treatment (EST), the task force required evidence of symptom reduction and/or improved functioning either from at least two independently conducted RCTs or from a large series of single-case studies.

Mary Smith and Gene Glass (1977)

- created the first meta-analysis of the psychotherapy literature - was a landmark in efforts to review scientific literature on treatment outcome.

Huey and Polo also examined the empirical question of whether treatments demonstrate ethnic invariance or ethnic disparity + what were their results

- ethnic invariance implies that an evidence based treatment yields equivalent results for ethnic minority youth - ethnic disparity, on the other hand, implies that the treatment is not as powerful when applied to ethnic minority youth, and therefore the treatment requires adaptation - The results demonstrated ethnic disparity, but the disparity was not always in favour of the majority youth-> for three studies, stronger effects were found for ethnic minority youth than for European American youth, whereas in two studies, better outcomes were obtained for European American youth than for ethnic minority youth.

Second stage of CBT

- focuses on examining and challenging long-standing beliefs or schemas held by the client that make the client vulnerable when confronted with negative life events - assumptions are usually "there is something basically wrong with me, good things don't happen to me, I can't succeed."-> using the skill learned in the first stage of treatment clients are encourage to challenge these beliefs by engaging in personal experiments

In a survey of clinical psychologists who provide treatments for eating disorders, Mussell et al. (2000)

- found that although 70% of respondents reported using evidence-based treatment techniques - approximately 75% of these psychologists reported having received no formal training in the provision of CBT or IPT for eating disorders-> For many of these psychologists, this probably indicated a commitment on their part to learn these treatments on their own after graduation - Importantly though, more than 80% of respondents indicated a desire to obtain formal training in the approach.

thought record/ self- monitiors

- includes a description of the situation, associated behaviours, associated emotions and associated thoughts - the psychologist may help the client develop skills in areas such as assertiveness, problem-solving, or time management.

First phase of Multisystemic Therapy (MST)

- involves an explanation of the MST model. The therapist works hard to develop a collaborative relationship with the caregiver. Assessment involves identification of the risk factors that contribute to the problem, as well as strengths that can be drawn upon in every system in which the young person is involved. - establishes measurable long-term goals that can be broken down into measurable weekly goals. - selects evidence-based treatments for each goal - services to establish clear rules, to reward prosocial behaviour, and to encourage appropriate monitoring are very similar to parent training approaches. - MST therapist also targets for intervention any caregiver characteristics that significantly limit the capacity to parent effectively. - emphasis is placed on developing a supportive network so that the youth and family will be able to maintain the gains that they made when working directly with the therapist

relative risk (RR)

- is the ratio of the probability of an outcome (such as clinical meaningful improvement) in a treated group to the probability of the outcome in an untreated group.

95% confidence interval

- means that there is a 95% likelihood that the true population effect being studied falls within the confidence interval - The narrower the confidence interval, the more likely the effect size is a good estimate of the true population effect.

An odds ratio (OR)

- represents the odds that an outcome (such as clinically meaningful improvement) will happen following an intervention compared to the odds of the outcome occurring in the absence of an intervention.

A meta-analysis of 28 randomized controlled trials of the various forms of parenting programs conducted in real-world settings found that...

- they were effective in the treatment of children with disruptive behaviour disorders - Similarly, a meta analysis that focused on preschoolers with ADHD found a significant benefit of parenting interventions

In vivo exposure

- used to assist patients in reducing distress associated with encountering stimuli that remind them of the trauma ex. stimuli such as sounds (for a patient traumatized in a car accident, this could be hearing a car braking hard) and smells (for a patient who was raped, this could be the smell of the rapist's cologne), as well as common situations such as driving a car (for the car accident victim) or walking by a body of water (for someone who almost died in a flash flood). - the psychologist develops a hierarchy of feared stimuli and tells the patient to intentionally expose themselves to it - By having patients repeatedly expose themselves to these stimuli, anxiety is reduced, a sense of self-efficacy is developed, and the opportunity for engaging in a broader range of activities (instead of avoiding certain situations) is enhanced.

Persons et al. (2001) described the case of Garrett, a musician who...

- who had lost a recording contract and a series of concert bookings - Based on initial assessment information, and in order to guide treatment, a case formulation was developed that related precipitating life events (e.g., loss of the contract and concert dates) - to long-standing dysfunctional beliefs (e.g., I'm a loser) - provided a framework for understanding Garrett's affective, cognitive, and behavioural symptoms. - By spending time at home alone instead of his usual socializing, and by spending hours watching television instead of working on his music, Garrett felt increasingly depressed, discouraged, and listless.

the American Psychological Association Task Force on Evidence-Based Practice with Children and Adolescents (2008) recommended initiatives to increase training in evidence-based psychological treatments for children and adolescents. Due to the rapid flow of research in this area, updates every..

10 years are inadequate.

Time out

A parenting strategy in which the child does not have access to reinforcers for a brief period following misbehaviour

Clinical Practice Guidelines

A summary of scientific research (dealing with the diagnosis, assessment and or treatment of a disorder) designed to provide guidance to clinicians providing services to patients with the disorder - based on the best available research, are a common way in which empirical evidence is used to assist clinicians in making assessment and treatment decisions - The American Psychiatric Association, for example, has practice guidelines listed on its website that address the treatment of dementias, mood disorders, panic disorder, OCD, PTSD, borderline personality disorder, eating disorders, substance use disorders, and schizophrenia.

Ecological theory

A theory that examines a young person's functioning within the multiple contexts in which he or she lives- family, school, neighbourhood - psychosocial functioning

Nathan and Gorman (1998, 2002, 2007, 2015)

Adopted an approach to reviewing and evaluating the therapy literature that was in line with the underpinnings of evidence-based practice. Expert contributors were asked to provide indications of the methodological adequacy of outcome studies that supported the various treatments for a specific disorder - This allowed experts to extend evidence-based guidance to the treatment of conditions for which the research was limited or was in an early stage of development. - created an approach that researchers were to report which disorders their treatments worked well for

Positive Reinforcement

Any consequence that increases the likelihood of a behaviour being repeated

Bellefontaine and Lee (2014)

For example, in their meta-analysis of behavioural parenting interventions, reported that (a) published studies and grey literature studies were of comparable methodological quality, and (b) treatment effects were similar between the two categories of studies. Given the relative ease of obtaining doctoral dissertations (a major source of grey literature research), they recommended that meta-analyses routinely incorporate this research source into search strategies designed to identify relevant studies.

Example Study: Weissman et al. (2006) found that..

In a survey of accredited doctoral programs in clinical psychology, 44% of Ph.D programs and 67% if Psy. D programs did not require any training in evidence-based treatments

A subsequent meta-analysis by Weisz, Weiss, Alicke, and Klotz (1987) examined 108 controlled studies..

John Weisz and his colleagues reasoned that if a treatment uses an artificial activity (like a computer task) to train a skill (like paying attention), then it is simply not fair to use a score on that same computer activity as a measure of treatment outcome. However, if the therapy is designed to treat fear of dogs, then a behavioural approach would focus on helping the child to approach dogs, and an appropriate outcome measure would be the extent to which the child was able to comfortably interact with dogs - Using this reasoning, they excluded from analyses of outcomes any artificial or analogue activities that had been used in the treatment but retained as outcome measures any real-world activities that had been targeted in treatment. - Based on their analyses, Weisz and his colleagues reported a mean effect size of .79, with larger effects found for behavioural approaches than for non-behavioural approaches.

If evidence-based approaches seem to work better than care as usual, to be helpful to those with more serious problems and to be helpful to minority youth, why are they not used by all mental health professionals?

One obstacle to the adoption of efficacious treatments is that clinicians may simply be unaware of them. The field of clinical psychology is constantly evolving, with exciting new research being published daily. The average clinician is unable to consult the literature and synthesize new findings into meaningful recommendations on a regular basis - In addition, the average parent who is a potential consumer of psychological services can be faced with a bewildering array of contradictory messages about the most appropriate solution to the child's problem.

Example Study: in their survey of 1,291 American psychologists in independent practice, Stewart, Chambless, and Baron (2012) found that..

Psychologists interest in attending workshops providing training in evidence-based treatments was correlated with the recency of graduation and the extent to which their graduate training emphasized the results of psychotherapy research.

John Weisz

Psychotherapy researcher - reasoned that if a treatment uses an artificial activity (like a computer task) to train a skill (like paying attention), then it is simply not fair to use a score on that same computer activity as a measure of treatment outcome. - However, if the therapy is designed to treat fear of dogs, then a behavioural approach would focus on helping the child to approach dogs, and an appropriate outcome measure would be the extent to which the child was able to comfortably interact with dogs. - Using this reasoning, they excluded from analyses of outcomes any artificial or analogue activities that had been used in the treatment but retained as outcome measures any real-world activities that had been targeted in treatment.

Stepped Care Model for the Management of Depression Steps 1-4

Step 1: Recognition, Assessment and initial management: Practitioners should be alerted to symptoms of depression-> screening should be undertaken when warranted + appropriate referrals made, if urgent then make ASAP Step 2: Treatment of persistent sub threshold depressive symptoms or mild to moderate depression: provide info on sleep techniques, for those who don't want intervention or may recover w/ no further intervention, info on depression should be provided and 2 weeks another assessment, low intensity intervention options (guided self help based on CBT, computerized CBT, or structured group physical activity program), antidepressants NOT usually prescribed. Step 3: Treatment of a persistent sub threshold depressive symptoms or mild to moderate depression with inadequate response to initial interventions and also moderate to severe depression: Antidepressants may be prescribed, CBT, IPT, Behavioural activation, couples therapy-> for those who decline these then offer short term psychodynamic psychotherapy or counselling, offer a combination of meds and therapy if severe-> if not working try different options Step 4: Treatment of complex to severe depression: Involve multi-professional care, combined medication, psychosocial interventions, crisis resolution, home treatments, inpatient treatment if self harm, ECT, TMS

Nine steps in EFT

The first four steps involve assessment and deescalation of problematic interpersonal cycles: Step 1:the formation of an alliance with each partner and the development and presentation of a case conceptualization of the couple's core conflicts from an attachment perspective. Step 2: devoted to the identification of the problematic interpersonal cycle that maintains the insecure attachment and the affective distress. Step 3, 4: focus on accessing the emotions underlying each partner's position in the relationship and then presenting their core relationship conflicts as stemming from these underlying emotions and attachment needs. Steps 5: each partner is encouraged to identify and accept psychological needs that he or she disowned or suppressed and to integrate these needs into the relationship. Step 6: each partner to learn to accept the other's new approach to the relationship Step 7: focuses on facilitating this adjustment by ensuring emotional engagement in the couple Step 8: focus on developing new solutions to old relationship problems Step 9: consolidating (combining) these new solutions and the partners' new relationship positions

Huey and Polo (2008) conducted a meta-analysis of studies that had examined efficacy in samples of ethnic minority youth...

These authors found evidence that a number of treat ments are probably efficacious in the treatment of minority youth, including combined med ication and behavioural treatment for African American and Latino youth with ADHD, CBT for depressed Puerto Rican youth, Multisystemic Therapy (MST) for African American juvenile offenders, Lochman's CBT Coping Power program for aggressive African American youth, brief strategic family therapy for Latino youth with conduct problems, and multidimensional family therapy for diverse groups of ethnic minority youth -

multidimensional meta-analysis on bulimia nervosa (Thompson-Brenner et al., 2003)

These researchers found that, on average, more than 80% of patients who began the RCT completed the treatment—an important aspect to consider in understanding the potential impact of the treatments studied. When the usual effect sizes across treatments were calculated from 26 clinical trials, the average effect of therapy compared with no treatment was substantial, with d values in the range of .9 to 1.0. But how much of a difference did this make in the patients' lives? Approximately 40% of patients recovered completely, with the others continuing to experience some symptoms. Thirty-two percent of patients maintained their recovery a year after treatment.

Epidemiological studies indicate that major depressive disorder is as common in adolescence as it is in...

adulthood

Based on a meta-analysis of 150 outcome studies that had not been previously reviewed, Weisz et al. (1995) reported a similar effect size to...

all the previous meta-analyses when they used unweighted least squares methods but a lower effect size of .54 using the weighted strategy - Weisz et al. also examined data from follow-up studies and found encouraging evidence that treatment effects were evident not only at the end of services but six months later as well.

Westen and colleagues also examined variables such as..

also examined variables such as the number of patients excluded from the Randomized control trials for failure to meet inclusion criteria, recovery rates (not just symptom change), and the persistence of treatment benefits over time - By examining these types of variables, the researchers' intention was to determine (a) the clinical significance of obtained treatment results and (b) the applicability of the research results to the general population of patients receiving therapy. - in order to consider the external validity and the clinical utility of treatment studies

Smith et al. also examined the effects of psychotherapy across different disorders, some of the largest effect sizes were for...

anxiety and mood problems

In a survey of 206 clinical psychologists and other mental health professionals, Nelson and Steele (2008)..

asked respondents about the treatment factors that influenced their selection of treatments to offer clients - psychologists were influenced by the availability of research supporting a treatment - Importantly, factors associated with learning a treatment were very influential in clinicians' decisions to use a treatment - This type of finding emphasizes the critical need for access to training opportunities in evidence-based treatments.

Niemeyer, Musch, and Pietrowsky (2013)

examined the data sets used in 19 meta-analyses on the efficacy of psychotherapy for the treatment of depression in adults. They detected publication bias in many of these meta-analytic studies; however, they also found that this bias had a unimportant impact on evaluation of the effects of psychotherapies. Because of the concern about possible publication bias, many meta-analyses now include both published and unpublished research. Unpublished research is also known as "grey literature" research and can include unpublished studies provided by researchers, conference presentations, institution or agency reports, and doctoral dissertations - inclusion of grey literature studies has often been found to have little impact on the conclusions drawn in meta-analyses.

In couples with greater distress, the more withdrawn or passive partner is encouraged to....

go through the steps ahead of the other partner - It is assumed that as the more passive partner becomes engaged in the process, it will be easier for the more active or critical partner to trust that the passive partner is truly committed to the change process.

Stirman and colleagues (2003) found that the average severity of symptoms reported in RCTs of evidence-based treatments is...

greater than that found in the patients seeking routine psychotherapy services. - Moreover, it appears that even if a potential research participant might be excluded from an RCT because of the presence of a comorbid diagnosis, it is highly likely that the patient would meet commonly used inclusion criteria used in the RCTs for the comorbid diagnosis. - Thus, for example, someone excluded from an RCT for depression because of a comorbid panic disorder could be included in an RCT for panic disorder. - The implications of this are that (a) there are likely to be efficacious treatment options (based on RCTs) for most patients, even those with comorbid diagnoses; and (b) in working with patients with comorbid diagnoses, psychologists must decide which diagnosis or condition should be addressed first and which problems should be addressed only after some initial changes in functioning have occurred.

National Institute for Health and Care Excellence (NICE)

guide health care professionals and patients in making decisions about health care treatment options. - conducts extensive consultations with stakeholder organizations (both professional and consumer groups) in developing evidence-based clinical guidelines - Guidelines are reviewed and updated after several years to ensure their accuracy and completeness. - conducts extensive consultations with stakeholder organizations (both professional and consumer groups) - There are clinical guidelines for assessment and treatment services for dozens of conditions. - NICE draws upon the expertise of the National Collaborating Centre for Mental Health, which is a joint venture between the British Psychological Society and the Royal College of Psychia trists that also involves consumer groups and other professional organizations (e.g., those representing occupational therapists, nurses, pharmacists, and general medical practitioners)-> many stakeholders= more successful guidelines

Type 1 studies are

high quality random controlled trials

Type 2 studies are

imperfect random controlled trials, ex. very limited duration, incomplete patient randomization

Von Ransom, Wallace, and Stevenson (2013) interviewed 118 clinicians (including psychologists, psychiatrists, physicians, and social workers) who provided psychotherapy for eating disorders...

interviewed 118 clinicians (including psychologists, psychiatrists, physicians, and social workers) who provided psychotherapy for eating disorders - As in the Mussell et al. survey, most respondents reported using components of evidence-based treatments - However, almost 20% reported never using CBT or IPT in the treatment of bulimia nervosa or binge-eating disorder (the only evidence-based treatments listed in Exhibit 12.2) - Numerous reasons were given for not using these treatments (e.g., incompatible with my clinical style; my clinical experience indicated the treatment was ineffective), but the bottom line was that these clinicians appeared to be comfortable in routinely offering eating disorder treatments that did not have an evidence base.

Multisystemic Therapy (MST)

is an approach designed to treat seriously disturbed delinquent adolescents by intervening in an integrated way in the multiple systems in which they are involved - is consistent with research findings that delinquent behaviour is not caused simply by one factor but, rather, is multiply determined. Within this model, the caregiver (usually, but not always, a parent) plays a key role in the young person's short- and long-term adjustment. - The goals of the approach are positive and future oriented - fundamental characteristic: treatment effectiveness is evaluated continuously from the perspective of multiple stakeholders, including the youth, parents, and others in the educational, health, and justice systems - therapists work in teams of three to five people. - Treatment is time limited, lasting only three to five months. It is, however, very intense, with therapists available 24 hours a day and seven days a week to respond to crises.

Thompson-Brenner et al. were also concerned to find that..

on average, 40% of patients were excluded from the RCTs they examined. Potential participants were excluded for a variety of reasons, including the presence of psychotic disorders, substance abuse, or other major psychiatric problems. Such exclusion criteria may make good clinical sense, as it is probably important to address untreated substance abuse before beginning treatment for bulimia. However, this raises an important issue: is it possible that the RCTs routinely exclude from treatment too many patients who normally seek treatment, thereby greatly reducing the generalizability of findings?

Example Study: data from an American study of 1,420 adolescents revealed that only..

one in three (1/3) adolescents requiring services for psychopathology received them

A survey of psychologists providing PTSD treatments found that...

only one in four had received training in the use of exposure, and only 17% reported using any form of exposure in their treatments of clients with PTSD - 1/4 received training but only 17% actually used the training

children under 12 can receive psychological services...

only with the consent of a parent or legal guardian.

Type 3 studies are

open trials or pilot studies in which there are no control conditions

Initial CBT sessions focus on...

primarily on behavioural activation tasks, such as getting the client to re-engage in some of the pleasurable activities that he or she used to do prior to the depressive episode - To do this, clients are first asked to self-monitor their activities during the day this indicates if the client engages in any pleasurable activities throughout the day - clients are encouraged to actively plan to increase their daily involvement in pleasant activities (ex. exercise, go to movie w/ friend, read book)

Example study: Calhoun, Moras, Pilkonis, and Rehm (1998),

recommended that a clinical psychologist wishing to attain adequate skill in the delivery of a psychological treatment should be supervised in providing the treatment to at least three or four typical patients and a comparable number of atypical patients (i.e., those with more complex or chronic problems) - there are few structured opportunities for practising psychologists to obtain this intensity of training

Bergin (1971) demonstrated that psychodynamic and related psychotherapies worked and supported this claim (that psychotherapies work) by pointing out that

significant results in 22 out of 60 studies showed these treatments to have a moderately positive effect. In contrast, critics of these therapies claimed the opposite, noting that 38 out of 60 studies failed to demonstrate clear evidence of positive treatment effects.

Evidence-based parenting programs are grounded in....what type of theory and assumptions

social learning theory and the assumption that oppositional (resistant) child behaviour can be changed by modifying the child's social environment rather than by working directly with the child. - According to this theory, maladaptive patterns of parent-child interaction inadvertently encourage both parents and children to engage in inappropriate behaviours.

Thompson-Hollands, Edson, Tompson, and Comer (2014), for example, examined...

the impact of including family members in the treatment of adult OCD. Family member inclusion had a substantial effect on reducing Arizona State University OCD symptoms and improving overall functioning. Most importantly, the researchers found that the greatest improvement in client functioning occurred when treatment directly targeted the tendency for family members to make adjustments in their daily activities in order to accommodate the OCD symptoms.

In the APA task force report, evidence-based practice in psychology was defined as...

the integration of the best available research and clinical expertise within the context of patient characteristics, culture, values, and treatment preferences.

If Empirically supported treatment was adopted by the APA Society of Clinical Psychology

these recommendations would bring the EST work more in line with evidence-based practice initiatives. - the term evidence-based is broader and more inclusive than the term EST.

Hunsley and Lee (2007) examination of treatment completion and treatment outcome in effectiveness studies in the treatment of adult depression and anxiety disorders found that...

they found that more than 75% of patients in most effectiveness studies followed the course of services to completion, this was comparable to completion rates reported in relevant meta-analyses of efficacy treatments - that compared data from effectiveness studies to benchmarks from meta-analyses. - In terms of the outcome of treatment, most of the effectiveness studies reported results that were comparable or superior to those derived from meta-analytic estimates for each condition - Thus, based on the benchmarking strategy, there is evidence from various countries that evidence-based treatments (efficacy treatments) can be very effective when used in routine practice settings (effective treatments)

McLeod and Weisz (2004) compared 134 published studies with 121 dissertations in terms of both their methodological adequacy and their findings. Overall, they found...

they found that the unpublished dissertations were stronger methodologically but obtained lower effect sizes than did the published studies - This suggests that meta-analyses based on published studies may lead us to overestimate the effect sizes from child psychotherapy studies. McLeod and Weisz therefore recommended that future meta-analyses also include data from unpublished dissertations.

A treatment is considered "probably efficacious" when it has met all the criteria to be

to be considered well-established (been shown to produce effects that are superior to a medical placebo, psychological placebo, or another treatment in at least two trials meeting the methodological criteria conducted by different teams of researchers.) except for the one requiring two independent teams of researchers.

Parenting programs

to teach parents of children with behaviour problems to parent in the same way as parents whose children do not have problems. - Parents meet with a therapist who teaches them core skills. An essential aspect of behavioural approaches is that complex skills are broken into small steps - First, parents establish a few simple rules on which they agree and that they are willing to impose consistently - Rules for child behaviour are basic guidelines about daily living, including the child's responsibilities and chores, daytime routines, and respectful ways of interacting. Lists of rules take into account the child's developmental level, circumstances, and any special needs. - The number of sessions varies according to the child's age and the severity of the disruptive behaviour: from 4 to 8 weeks with young mildly oppositional children to 12 to 25 weeks for clinically referred youth diagnosed with CD - look at page 291

Study: Miller and Prinz (2003) found that

when treatment of childhood conduct problems did not match parents' understanding of the child's problem, parents were less likely to engage in treatment. Furthermore, even though parent motivation seems to be a necessary condition for the young person to attend psychological services, it is not sufficient for positive change to be achieved.

Why so many barriers to distribution of new evidence-based innovations in psychological interventions?

1.) One reason is that psychological interventions, unlike pharmaceutical interventions, cannot be patented. Pharmaceutical companies typically devote enormous sums of money to advertising and promoting their treatments 2.) A second reason is that there is often more to learning how to provide an efficacious psychological treatment than there is to learning how to appropriately prescribe a new medication To effectively provide psychological services, the clinician requires background preparatory work, specialized training, and closely supervised experience in providing the intervention.

Three broad components of CBT for PTSD?

1.) relaxation skills 2.) imaginal exposure 3.) in vivo exposure

Study: Casey and Berman (1985) examined data from 75 studies covering services to treat diverse clinical problems using a large range of therapeutic approaches for young people under the age of 13...

Across all techniques, they reported an effect size comparable to that reported by Smith and Glass (1977) in their review of the adult psychotherapy literature. (smith and glass found: the largest effect sizes (d values of 1.31 and 1.24, respectively/ people who received treatment were better off than 90% of people who didn't) for cognitive and cognitive-behavioural treatments)

The strongest evidence for the transportability to clinical settings of a treatment for a specific adult disorder is for...

CBT for depression.

Therefore, to maximize the availability of evidence-based treatments for clients, the training of graduate students in professional psychology programs should include both:

a.) Courses relevant to evidence based decision making and intervention and b.) clinical experiences that demonstrate how to practice in an evidence based manner

To be considered "well-established," the treatment must have..

been shown to produce effects that are superior to a medical placebo, psychological placebo, or another treatment in at least two trials meeting the methodological criteria conducted by different teams of researchers.

Gerald Patterson

behavioural parenting programs inspired by parent management training (PMT), developed and refined by Gerald and his colleagues at the Oregon Research Institute - it laid the foundation for most evidence-based parenting services

Smith et al. reported that which treatments were best in a comparative treatment outcome study

cognitive and cognitive behavioural treatments had the largest effect sizes (d values of 1.31 and 1.24, respectively), followed by behavioural (.91), psychodynamic (.78), humanistic (.63), and, finally, develop mental treatments (including vocational-personal development counselling and "undifferentiated counselling") (.42) - This evidence indicates that treatments are not equivalent.

Study: Echoing Eysenck's 1952 report, Levitt (1957, 1963) concluded that..

concluded that there was no evidence for the efficacy of child psychotherapy - During the subsequent two decades, new approaches to the treatment of disorders of childhood were developed, and numerous studies examined the efficacy of different types of child psychotherapy.

Hans and Hiller (2013) conducted a meta analysis on effectiveness studies of CBT for depression

drawing on 34 studies conducted in the United States, the United Kingdom, and several continental European countries. These studies were conducted with patients who were seeking treatment for depression, and services were provided by clinicians who differed in: (a) their background training (including both doctoral and master-level clinicians) (b) their experience in providing CBT for depression. - Found: within-group effect sizes of approximately d= 1.0 - Evidence for the transportability to clinical settings of CBT for depression - this was considered a effectiveness sample/ study

Alan Kazdin

drew attention to a troubling discrepancy between the nature of psychotherapy research and the nature of clinical practice - They found that treatment studies often relied on volunteer samples recruited through schools and treated in a group format - In contrast, surveys indicated that clinical practice more commonly involved individual treatment in outpatient clinics of referred patients - Furthermore, Kazdin and his colleagues recommended that treatment researchers pay greater attention to characteristics of the child, parent, family, or therapist that might influence treatment outcome. - these recommendations had a significant impact on the way researchers examine treatments for children so that in the decades since their review, there has been increasing attention to examining outcomes in samples of children who have been referred for treatment.

efficacy VS effectiveness

efficacy: The ability to produce a desired or intended result effectiveness: The degree to which something is successful in producing a desired result: success - so efficacy would be producing the intended result but how effective is it?/ how successful is it?

Based on a meta-analysis of 56 effectiveness studies, Stewart and Chambless (2009) found that...

evidence that CBT is effective for a range of anxiety disorders. - Treatment outcomes were comparable to results obtained in high-quality random controlled trials of these treatments

A meta-analysis of 32 studies comparing evidence-based treatments with usual clinical care found that

evidence-based care consistently outperformed usual clinical care - Furthermore, the superiority of evidence-based treatment was also evident among minority youth and among youth with the most severe problems

Drew Westen

examined how a number of methodological issues affected the results of treatment research for depression, bulimia nervosa, generalized anxiety disorder, panic disorder, PTSD, and obsessive-compulsive disorder These meta-analyses were designed to expand on previous meta-analyses by analyzing a number of other treatment-related variables in addition to treatment outcome.