Abnormal Psychology: Effectiveness of Treatment and the role of Culture

Challenges in assessing the effectiveness of treatment

-severity of the disorder

-which treatment outcome to use

-how to identify the exact mechanism that is causing change

- how to account for the placebo effect

Way to assess the effectiveness of treatment

- randomized control trails (RCTs)

- qualitative research studies

- meta-analysis

How do you study "the exact mechanism of change" in CBT?

dismantling design

conclusion of Jacobson et al., 1996

-No evidence was found to support that full cognitive treatment is more effective

Possible explanations: presence of non specific factors

What are "modes of referral for help"?

How individuals seek help

- refer themselves

-referred by relatives

-referred by primary care physician (medical doctor)

participants in Naem et al., 2012

patients in a psychiatric outpatient clinic in Pakistan

What themes were established based on the research conducted by Naem et al., 2012?

- perceptions of depression (focused on mental illness, but described physical symptoms)

- model of causes focused on stress and problem sin the environment, but did not mention specific disorders

- most individuals believed that they could be cured

conclusion of Griner and Smith, 2006

cultural adaptations carried out for specific sub-groups may be more effective than just making treatments more culturally flexible

How does acculturation impact treatment?

-older patients were more responsive to culturally adapted therapy

-why? older participants may be less accultured

Acculturation

the modification of the social patterns, traits, or structures of one group or society by contact with those of another

what is a common threat to the validity of meta-analysis?

publication bias

Construct validity:

When comparing therapies it is difficult to know whether all members of each group suffer from the same type of depression. The construct of depression is quite broad and may make comparison difficult.

predictive validity

likelihood that an individual would benefit from the treatment and the likelihood of relapse.

Correlational data

Many studies are correlational in nature and thus do not establish a cause-and-effect relations

File drawer effect:

Many therapies are assessed by clinics, pharmaceutical companies or theorists. Often when there is no significant data, that information is not published. Thus, meta-analyses may be biased because they usually only include published studies. Also known as publishing bias.

Social desirability effect:

When clients self-report their progress, they may be very positive so that neither they nor the therapist looks bad.

Spontaneous remission:

This is the criticism that a disorder may have gone away on its own and that the therapy was actually only incidental, not playing a significant role. This argument is unfalsifiable.

Marian & Neisser (2000)

It may be easier for patients to recall events from their past in their native language than in their new language, regardless of their level of language proficiency.

key barriers for community.

Cognitive, Affective, Socioculural

emic approach

believes that many factors come into play when diagnosing and treating a client, especially in regard to their culture. Some factors can include cultural values, morals, and lifestyle.

Etic approach

believe that mental disorders are universal and all clients should and can be treated and diagnosed in the same manner.

indigenous psychotherapy

These therapies are embedded within a culture and do not include anyone from outside the culture.

Cross-cultural psychotherapy

Also known as "intercultural counseling" or "multicultural therapy." This is when the therapist is from a different culture from the patient.

Smith and Glass (1977)

The researchers concluded that all types of therapy are to some extent effective and that it may not be the specific kind of therapy that makes a difference.

Elkin et al. (1989)

The drug treatment produced faster results, but the study showed no overall difference in the effectiveness of CBT, IPT, and drug treatment. In other words, it did not matter which treatment patients received, all the treatments had positive results.

File-drawer Effect (Publication Bias)

Studies that do not support the hypothesis are less likely to get published than studies that do

wait-list control group

in a therapy outcome study, group of people that functions as a control group while an experimental group receives an intervention and then receives the intervention itself after a waiting period

Kirsch et al"s (2008)

There was no significant difference in improvement between placebo and SSRI treatment groups, except in the most severely depressed