Evaluating Psychotherapy and Biomedical Treatments in Psychology

Assessing the Success of Psychotherapy

• The Case of Bernice: Reflecting on a previous lesson concerning a client named Bernice, who struggled with depression and anxiety, the central question for psychology students is whether psychotherapy actually helped her and how such success can be measured scientifically. Evidence of progress would include functional improvements, such as getting out of bed, passing mid-terms without a crisis, or traveling for social activities.

• Client Perceptions: One primary method of assessment is simply asking the client about their progress.

  • Client reports are generally very positive: One study indicated that $89\%$ of individuals reported being at least "fairly well satisfied" with their treatment.
  • Subjectivity and Bias: These perceptions are inherently subjective. The therapeutic relationship can create a positive bias; if a patient remains in treatment, they likely have a rapport with their therapist, leading to a "rosy" outlook on the results.

• Clinician Perspectives: Therapists also evaluate their own success, but these views can be skewed.

  • Self-Serving Bias: A clinician may naturally want to view their intervention as successful.
  • The Relapse Blind Spot: Clinicians often do not see clients who experience future relapses or seek help elsewhere. A patient might see $10$ different therapists over time, feeling better at the conclusion of each individual treatment, but continuing to struggle long-term. In this scenario, each of the $10$ therapists might incorrectly view their specific treatment as a permanent success.

• Treatment Outcome Research: To move beyond subjective anecdotes, psychologists use systematic measurement to determine which therapies work best for specific problems.

  • Randomized Clinical Trial (RCT): Considered the "gold standard" of research. Participants are randomly selected and assigned to either a control group (receiving no treatment or a placebo) or at least one experimental group (receiving the therapeutic intervention).
  • Control Mechanisms: This design accounts for individual differences and extraneous factors, ensuring that if the experimental group improves significantly more than the control group, the intervention itself is the cause.
  • Meta-analysis: This involves gathering data from many different RCTs and measuring results across multiple trials. It allows researchers to see whether a treatment remains effective and efficacious across a variety of settings and populations.

Efficacy and Effectiveness in Treatment

• Definition of Effectiveness: This refers to whether or not a given therapy works in a "real-world setting."

• Definition of Efficacy: This refers to whether a therapy works better than a comparable intervention or a control group under controlled conditions.

• Research Consensus: Dozens of studies have confirmed that psychotherapy is both effective and efficacious. While people in control groups (those who receive no therapy) often improve on their own over time, those engaged in psychotherapy typically improve faster and face a significantly lower risk of relapse.

• Targeted Therapies for Specific Disorders:

  • Phobias: Behavior therapy is often the "clear winner" for these cases.
  • Major Depressive Disorder: Multiple approaches, including cognitive, behavioral, and psychodynamic interventions, have shown success in RCTs.

Common Factors of Effective Therapy

Despite the variety of theoretical approaches, effective therapies share common elements:

• Instilling Hope: Helping demoralized clients regain the belief that things can and will improve.

• A New Perspective: Providing a plausible explanation for the client's troubles and a new way of looking at themselves, their environment, and their future.

• The Therapeutic Alliance: Success across the board is linked to a genuine empathy within a trusting, caring relationship. Good therapists listen, understand, avoid judgement, and provide clear, positive communication.

Biomedical Treatments and Pharmacotherapy

Biomedical therapies aim to physiologically alter the brain’s electrochemical state through drugs, magnetic impulses, electrical currents, or surgery.

• Pharmacotherapy: The most widely used biomedical treatment involving the administration of psychotropic drugs. Psychotropic drugs are pharmaceuticals that affect a person's mental state.

• Four Major Categories of Psychotropic Drugs:

  • Antipsychotics: Used to treat schizophrenia and severe thought disorders. These medications typically alter the effects of the neurotransmitter dopamine by blocking its receptor sites and inhibiting its uptake. This is based on the theory that an overactive dopamine system contributes to schizophrenia. These drugs often carry severe side effects.
  • Anxiolytics (Anti-anxiety meds): These depress activity in the central nervous system. They can be dangerous when mixed with alcohol (booze) because of their additive depressant effects. They also carry a high risk of addiction as patients may become dependent on the sense of relaxation they provide.
  • Antidepressants: Used for depression and various anxiety disorders. They alter the availability of neurotransmitters like serotonin and norepinephrine.
    • SSRIs (Selective Serotonin Re-uptake Inhibitors): Examples include Zoloft, Paxil, and Prozac. They work by partially blocking the re-uptake of serotonin, making it more available to the synapses to enhance mood.
    • Placebo Debate: Meta-analyses suggest that for mild to moderate symptoms, antidepressants may be no more effective than psychotherapy or even a placebo. They are considered most effective when combined with talk therapy.
  • Mood Stabilizers: Extremely effective for the "highs and lows" of bipolar disorder. Lithium (simple salts of Lithium) was the first used and remains common. Dr. Kay Redfield Jamison described Lithium as the treatment that prevents "disastrous highs," diminishes depressions, and keeps her out of the hospital and alive.

Electrical and Magnetic Brain Stimulations

• Electroconvulsive Therapy (ECT): Formerly known as electro-shock therapy. Modern ECT involves sending a brief electrical current through the brain of an anesthetized patient. This triggers a controlled seizure lasting about $2$ minutes.

  • Effectiveness: Highly effective for severe, treatment-resistant depression.
  • Theories of Action: It may jumpstart a depressed brain by altering neurotransmitter activity, modifying stress hormone activity (linked to sleep, appetite, and mood), reactivating dormant neurons, or stimulating the growth of new ones.

• Repetitive Transcranial Magnetic Stimulation (rTMS): A gentler, non-invasive procedure involving the painless application of repeated electromagnetic pulses.

• Deep-Brain Stimulation (DBS): More invasive than rTMS; involves surgically implanting a "brain pacemaker" that sends electrical impulses to specific regions to jumpstart neural circuitry.

Lifestyle Interventions

Less severe manifestations of psychological disorders can often be improved through simple changes in lifestyle:

• Aerobic Exercise: Doing $30$ to $60$ minutes of daily aerobic exercise has been shown in research to be as effective as antidepressant medications for mild depression.
• The "Daily" and "Aerobic" Requirement: The consistency and type of exercise are critical factors for its efficacy.
• General Health: Adequate sleep, social interaction, and good nutrition are essential for managing moods.

Questions & Discussion

• What happened to Bernice? The speaker notes that Bernice is the central example and likely would have benefited from a combination of talk therapy and anxiolytic or antidepressant medications.
• Has psychotherapy helped? Generally, yes; data shows it works better and faster than no treatment, though individual results vary.
• How can we tell? Through rigorous scientific methods like RCTs and meta-analysis, combined with client functional outcomes.
• Is electroshock still a thing? Yes, as Electroconvulsive Therapy (ECT), it remains highly effective for treatment-resistant cases of depression.