Class 11 - Intervention Research

How many brand name psychotherapies are there?

> 600

When does ANXIETY developmentally emerge?

Around age 5

When do EATING DISORDERS developmentally emerge?

Late Teens

When does SCHIZOPHRENIA developmentally emerge?

Early 20s

3 Goals of Therapy Research

• Efficacy

• Effectiveness

• Active Components

Efficacy

Does it work in controlled study settings? Can it actually improve someone’s symptoms of problems?

Effectiveness

Does it work in the real world of clinical delivery?

Active Components

What part of the therapy works?

Between-Subjects Design

every participant experiences only one condition, and you compare group differences between participants in various conditions

Within-Subjects Design

every participant experiences every condition

True or False: Randomized control trials are in between within and between designs

True

What are common control conditions?

• Waitlist Control

• Treatment as Usual

Waitlist Control (Intent to Treat)

• Essentially no treatment, but you know it’s coming

• Takes into account the phenomenon that many psychiatric symptoms often improve on their own without treatment

Treatment as Usual

• Most rigorous test of a new therapy

• Control treatment should be:

  • of long-standing use

  • designed to treat the problem being studied

  • supported by large body of evidence

Attention Control/Psychological Placebo

• approaches specific v. common factor issue

• deliver the same nose of interpersonal interaction (common factors) but no other intervention elements

• Takes into account the many benefits of psychological attention

True or False: The control we use can change our effect estimates.

True

Response to Treatment"

at least 50% reduction in depressive symptoms

Waitlist “less effective” than No Treatment?

• Participants on non-treatment and waitlist are free to seek other treatments while being monitored

• waitlisters more likely to wait for active treatment, while non-treatment may be more likely to seek help somewhere else

• waitlist can also increase state of helplessness during the waiting period, while increasing expectations for upcoming intervention

What is the weakest control condition?

waitlsit

What are other designs that exist to determine components of psychotherapies?

• Dismantling Design

• Additive Design

Dismantling Design

Break the treatment into all its components and give them individually (separately)

• help identify active components/streamline therapies

Additive Design

Break the treatment into all its components and give them individually (one on top of the other)

• help identify active components/streamline therapies

Why is it important to identify active components and streamline therapies?

We tend to build therapies to “get the job done,” meaning we throw everything we can at the problem.

True or False: Shorter therapies are more accessible, more tolerable, and can reach more people.

True

Is therapy effective?

Since the 1970s, yes!

How effective is therapy?

1977 - Smith & Glass Meta-Analysis of 400 treatment studies

• “The average person who receives psychotherapy is better off than 80& of untreated individuals”

• effect size of 0.85 SD; big shift to the right

How can we check if therapy is effective?

Client Satisfaction Surveys - non-random, post-treatment clients asked to rate helpfulness of their therapy ~90% say that it helped them, regardless of type of treatment

Is therapy well tolerated?

Clients often drop out of therapy!

What is the average drop-out rate?

• 30% (high-income countries)

• 45% (low/middle income)

When is dropout more likely?

• In general medical (60%) rather than in specialist settings (20%)

• For mild and moderate, rather than for severe presentations

When do most drop-outs occur?

Within the first 2 sessions

Clients are more likely to drop out with:

• lower education levels

• lower income

• poor social support

True or False: You can expect around 1 in 5 of your patients to drop out

True

Meta-Analysis Findings suggest…

• Estimate of therapy effectiveness range from medium to highly effective

• Generally behavioral and cognitive-behavioral therapies do the best

What is the gold standard/most effective treatment (regardless of disorder)?

Cognitive-Behavioral Therapy

Empirically-Supported Treatments

APA has determined whether specific treatments are efficacious for certain disorders based on the empirical evidence (meta-analyses of RCTs)

Terms that are used Synonymously

• Empirical-validated treatments

• Evidence-based treatments

• Empirically-supported treatments

Evidence-based practice (EBP)

delivers an empirically supported treatment (EST) selected via evidence, clinical judgement, and patient values