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• Clinical psychology uses scientific study and empirical research to address fundamental questions.

• Research methods used by clinical psychologists overlap with those used by other psychologists and scientists.

• The goal of this chapter is to emphasize how clinical psychologists conduct research.

• Clinical psychologists do research to gain knowledge about psychological disorders.

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• Clinical psychologists conduct basic research on psychological disorders.

• Research on psychological disorders establishes a foundation for the field.

• Examples of research questions on psychological disorders:

  • Is social anxiety disorder experienced differently by men and women?

  • Do specific symptoms of PTSD predict suicidal behavior in military personnel more than others?

  • Do people with borderline personality disorder experience poor connectedness with others when they are being accepted and included?

• Clinical psychologists also conduct research to determine the effectiveness of therapies.

• Hans Eysenck's review of psychotherapy outcome served as a catalyst for additional investigations.

• Psychotherapy has been established as effective, and research now focuses on which therapies are most successful for specific disorders.

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• Clinical psychologists face fundamental questions when measuring therapy outcome.

• Questionnaires are commonly used to evaluate therapy outcome.

• Other possibilities include interviews and direct observation.

• Researchers must consider what aspects of a client to measure when assessing psychotherapy outcome.

• The timing of measuring psychotherapy outcome can vary, with evaluations occurring immediately after therapy or at follow-up intervals.

• Multiple parties may rate psychotherapy outcome, including the client, therapist, and other individuals with a vested interest.

• The reliability and validity of clients' opinions can be questionable due to biases and expectations.

• Other parties with an interest in therapy outcome include spouses, family members, employers, law enforcement, insurance companies, and society as a whole.

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Efficacy versus Effectiveness

• Efficacy refers to the success of a therapy in a controlled study with specific criteria and manualized methods.

  • Participants are selected based on strict criteria and randomly assigned to treatment or control groups.

  • Example: Cognitive-behavior therapy has demonstrated efficacy for panic disorder in controlled studies.

• Effectiveness refers to the success of a therapy in real-world clinical settings with a wider range of client problems.

  • Example: Consumer Reports survey showed positive experiences with psychotherapy in actual clinical settings.

Statistical Significance versus Clinical Significance

• Statistical tests can indicate a significant difference between groups, but it may not have a meaningful impact in real-world terms.

• Both statistical significance and clinical significance should be considered when interpreting therapy outcome studies.

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Internal versus External Validity

• Internal validity refers to the extent to which the change in the dependent variable is solely due to the change in the independent variable.

• External validity refers to the generalizability of the results to different settings and populations.

• Efficacy studies prioritize internal validity but may lack external validity.

• Effectiveness studies may have external validity but may lack internal validity.

Dissemination Strategies for Evidence-Based Therapies

• Dissemination strategies aim to promote therapies with demonstrated effectiveness to therapists.

• Therapists in clinical settings may be resistant to adopting evidence-based therapies.

• Suggestions for increasing the uptake of evidence-based therapies include direct advertising to consumers, requiring use of evidence-based therapies for licensure or payment, and changing accreditation standards for graduate programs.

Note: This note provides an overview of the concepts of efficacy and effectiveness in psychotherapy outcome studies, the importance of considering both statistical and clinical significance, the distinction between internal and external validity, and the challenges of disseminating evidence-based therapies to therapists.

Page 6: Considering Culture Treatments That Work, but for Whom?

• Researchers select clients who meet the criteria of interest for a study

  • Example: Treatment targets generalized anxiety disorder (GAD), so researchers select clients who meet the diagnostic criteria of GAD and have no other complicating factors or comorbidities

• Concerns about the generalizability of study results to diverse groups

  • Empirical basis of "what works" in psychotherapy lacks minority participants

  • Conclusions regarding efficacy may not be applicable to individuals who differ in terms of ethnicity, gender, or other variables

• Clinical trials often lack adequate samples of people of color

• Most empirically supported therapies were evaluated with samples drawn primarily from a White, middle class, English-speaking, female population

• Investigations have found that evidence-based treatments work as well with ethnic minority clients as with the majority culture, but studies are limited for certain ethnic groups such as Asian American and American Indian populations

• Cultural disparities in access to care exist, with ethnic minorities receiving less psychotherapy than those in the majority

Page 7: Assessment Methods

• Clinical psychologists conduct research to evaluate and improve assessment methods

• Studies may involve the development, validation, or expanded use of new instruments, establishment of normative data for specific populations, comparison of multiple assessment tools, and other research questions

• Examples of research in this area:

  • Comparison of an internet-based, self-administered clinical interview with an in-person interview for diagnosing ADHD in children

  • Differences in rating boys' ADHD symptoms between male and female teachers and parents

  • Differences in depressive symptom reports between self-report questionnaires and in-person interviews

• Research aims to establish cost-effective, efficient, and convenient forms of assessment

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• Psychometric comparison of the Beck Depression Inventory-II in English and Spanish

  • Reliability and validity of the Spanish version of the test comparable to the original English version

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• Study on the effectiveness of scales that detect faking in the translation of the MMPI-2 for Korean clients

• Research on diagnostic issues and categorization of psychological problems

  • Paranoid personality disorder has a dimensional, rather than categorical, underlying structure

  • Use of gender-specific norms in assessing children for ADHD or oppositional defiant disorder (ODD)

  • Relationship between eating disorders and personality disorders, specifically the overlap between anorexia nervosa and obsessive-compulsive personality disorder

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• Personality disorders are not as stable over time as often assumed

  • Longitudinal study assessed personality disorder traits in clients over a 10-year period

  • Stability of personality disorder traits comparable to some Axis I disorders

• Clinical psychologists study elements of their own profession through empirical research

  • Journals such as Professional Psychology: Research&Practice, Psychotherapy: Theory, Research, Practice, Training, and Journal of Clinical Psychology feature research on professional issues

• Ethical dilemmas and problems psychologists encounter may depend on whether they work in rural or urban communities

  • Survey found significant differences between small-town/rural psychologists and urban counterparts

  • Small-town/rural psychologists more likely to encounter multiple relationships with clients and have less access to professional resources

• Psychologists' attitudes towards integrating client religion into therapy compared to other mental health professionals

  • Study found professions generally similar in attitude, but marriage and family therapists did so more frequently

• Discussion of ethnic and racial differences with psychotherapy clients

  • Survey of licensed psychologists found discussions don't happen consistently, but when they do, they facilitate the therapy process

• Professional lives of psychologists influence their personal and family lives

  • Survey of psychologists found evidence for both positive and negative "spillover"

  • Positive spillover more common and stemmed from a sense of accomplishment at work

• Attitudes of psychologists towards gay, lesbian, and bisexual lifestyles

  • Survey found psychologists more likely to view such lifestyles as acceptable and nonpathological now than in the past

  • Female psychologists held more positive beliefs about gay, lesbian, and bisexual lifestyles and gay-affirmative therapy

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• Clinical psychologists study how to educate those entering the profession

  • Journals such as Training and Education in Professional Psychology, Teaching of Psychology, and Journal of Clinical Psychology feature research on teaching and training issues

• Teaching graduate students in assessment to write effective reports

  • Study found elementary school teachers preferred reports organized by theme and with readable language

• Training graduate students to manage potentially violent clients

  • Survey of graduate students found they encountered violent clients infrequently and felt their training was lacking

• Placement process for predoctoral internships in clinical psychology and counseling psychology programs

  • Study found clinical psychology students had a higher match rate with medical facilities, while counseling psychology students had a higher match rate with college counseling centers

• Personality assessment techniques commonly included in predoctoral and postdoctoral internship training

  • Study found objective tests like the MMPI, PAI, and MCMI more commonly taught than projective tests like the Rorschach

• Clinical psychologists adhere to the experimental method in their research efforts

  • Experimental method involves observation, hypothesis development, empirical testing, and altering the hypothesis based on results

• Experimental studies in clinical psychology often take the form of randomized clinical trials (RCTs)

  • RCTs test the outcome of a particular therapy on a specific diagnosis

  • Participants randomly assigned to experimental or control group

  • RCTs maximize internal validity but may oversimplify clinical problems and produce results that may not translate to real-world settings

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• Quasi-experimental designs are used in clinical psychology when researchers are unable to control variables or assign people randomly to certain conditions.

  • Quasi-experimental designs are less scientifically sound than experimental designs but can still yield meaningful results.

  • Example: studying the outcome of a therapy for specific phobias using a quasi-experimental design.

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• Between-group designs involve participants in different conditions receiving different treatments.

  • Control group can take different forms: no treatment, wait list for treatment, placebo, or treatment-as-usual.

  • Example: studying the relationship between physical exercise and depression using a between-group design.

• Within-group designs involve comparisons of participants in a single condition to themselves at different points in time.

  • Example: studying the relationship between physical exercise and depression using a within-group design.

• Mixed-group designs combine aspects of between-group and within-group designs.

  • Example: studying the relationship between physical exercise and depression using a mixed-group design.

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• Analogue designs are used when researchers cannot access the target population or situation adequately.

  • Involves using participants whose characteristics resemble those of the target population or asking participants to remember or imagine themselves in a certain situation.

  • Example: studying the relationship between physical exercise and depression using an analogue population.

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• Correlational methods are used when experiments or quasi-experiments are not plausible.

  • Correlational studies examine the relationship between two or more variables.

  • Correlational studies do not identify variables as independent or dependent, and causality cannot be inferred.

  • Example: studying the relationship between physical exercise and depression using a correlational study.

• Correlations can range from +1 to -1, with positive correlations indicating variables that vary together and negative correlations indicating variables that vary inversely.

• Case studies involve a detailed examination of one person or situation and include descriptive observations and interpretations.

  • Case studies can provide insights that may apply to others who are similar.

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• Case studies can stimulate more systematic research and converge on important findings

  • Dr. Victor Meyer's case studies on obsessive-compulsive disorder led to the development of exposure and response prevention as a treatment

  • Case studies can reveal unique qualities of individuals

  • Case studies can have experimental qualities, such as single-subject design studies

• Meta-analysis is a powerful tool used by clinical psychology researchers

  • It combines the results of separate studies to create an overall effect size

  • Meta-analysis provides a quantitative analysis of multiple studies on a topic

  • Meta-analysts must ensure that their method is scientifically sound

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• Meta-analysis is conceptually similar to combining movie reviews

• Meta-analyses quantitatively combine the effects of multiple studies

• Rotten Tomatoes and Metacritic are examples of websites that use a similar concept to meta-analysis

• Meta-analysts use a more sophisticated statistical process to combine the outcomes of studies

• Meta-analysis provides an overview of the effect size of a treatment or variable across multiple research settings

• Meta-analysts should follow five steps, including formulating the research question and hypotheses

Page 18: Conducting Meta-Analysis and Longitudinal Designs

• Meta-analysis in clinical psychology:

  • Obtain a representative study sample

    • Include/exclude individual studies based on criteria

    • Consider unpublished reports

  • Obtain information from individual studies

    • Consider specific methodology and reliability

  • Conduct appropriate analyses

    • Assign appropriate weights to each study

  • Reach conclusions and offer suggestions for future research

• Cross-sectional versus longitudinal designs:

  • Cross-sectional designs:

    • Assess or compare participants at one point in time

    • Easier and more efficient

    • May not provide valid approximations for changes over time

  • Longitudinal designs:

    • Emphasize changes across time

    • Make within-group comparisons

    • Require longer periods of time

    • Have the ability to study changes that evolve over time

  • Example of a longitudinal study on physical exercise and depression:

    • Extend the study to 10 years

    • Consider long-term adherence, physical injury, aging, lifestyle changes, etc.

    • Actual longitudinal studies can be much longer (e.g., 23 years, 15 years)

Page 19: Use of Technology in Clinical Psychology Research

• Use of technology in clinical psychology research:

  • Collecting data using technology:

    • Example of using smartphones and actigraphs for data collection

    • Experience sampling method for real-time behavior

    • Example of using Amazon Mechanical Turk (MTurk) to recruit participants

      • MTurk is an Internet-based crowdsourcing marketplace

      • Researchers post study descriptions and criteria for eligibility

      • MTurk workers select and complete participation online

      • MTurk population is representative of the general public

  • Studying various topics using technology:

    • Example of studying perceptions of mental disorders using MTurk

    • Example of studying the effectiveness of a smartphone app for alcohol use disorder treatment

    • Example of using technology enhancements in a parent training program for disruptive behavior disorders

    • Example of sending motivational texts to improve therapy benefits for eating disorders

Page 20: Ethical Issues in Research in Clinical Psychology

• Ethical issues in research in clinical psychology:

  • Adhering to ethical standards:

    • Informed consent from participants

    • Avoiding coercion and excessive rewards

    • Avoiding deception unless necessary

  • Other ethical issues:

    • Feedback that upsets participants

    • Responding to suicidal intentions or child abuse

  • American Psychological Association's code of ethics for clinical psychologists conducting research

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Main Ideas:

• Clinical psychologists conduct empirical research for various purposes.

• Empirical studies examine treatment outcomes, assessment methods, diagnostic issues, professional issues, and training issues.

• Different research methods are used, such as experimental, quasi-experimental, correlational, case studies, and analogue studies.

• Meta-analyses are used to combine the results of individual studies.

• Technology is increasingly incorporated into research in clinical psychology.

Supporting Details:

• Empirical studies examine the efficacy and effectiveness of treatment.

• Experimental and quasi-experimental methods measure the impact of independent variables on dependent variables.

• Correlational designs establish non-causal links between variables.

• Between-group designs compare control groups to experimental groups, while within-group designs compare the same group at different points in time.

• Case studies provide important clinical information but have limited generalizability.

• Analogue studies simulate clinical phenomena in the lab.

• Meta-analyses combine the results of individual studies to produce an overall estimate of effect size.

• Technology is used for data collection and as the subject of outcome studies in clinical psychology.

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Main Ideas:

• Various research designs and methods are used in clinical psychology research.

• Different terms and concepts related to research design are defined.

Supporting Details:

• Research designs include ABAB design, analogue design, between-group design, case studies, correlational methods, cross-sectional designs, longitudinal designs, mixed-group design, quasi-experimental design, and within-group design.

• Terms such as control group, dependent variables, experimental condition, independent variables, external validity, internal validity, idiographic approach, nomothetic approach, and treatment outcome are defined.

• Randomized clinical trials (RCTs) are mentioned as a type of research design.

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