PREPARED BY DR. CATHY CHOVAZ, KING’S COLLEGE, UNIVERSITY OF WESTERN ONTARIO Chapter 12...
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Transcript of PREPARED BY DR. CATHY CHOVAZ, KING’S COLLEGE, UNIVERSITY OF WESTERN ONTARIO Chapter 12...
PREPARED BY DR. CATHY CHOVAZ, KING’S COLLEGE,
UNIVERSITY OF WESTERN ONTARIO
Chapter 12Intervention: Adults and Couples
INTRODUCTION TO CLINICAL PSYCHOLOGY 2EHUNSLEY & LEE
Does Psychotherapy work?? Evidence-Based Treatments: Initiatives and
Controversies Examples of Evidence-Based Treatments
Depression PTSD Couples Distress
Efficacy to Effectiveness
Topics
Hans Eysenck (1952) – published a paper showing that clients in therapy were worse off than untreated individuals 44% of clients in psychoanalytic treatment
improved 64% of clients in eclectic treatment improved 72% of clients not in therapy improved
Several problems with the study invalidated results – but led to push for additional research on effectiveness
Does Psychotherapy Work?
Meta-analysis: quantitatively combining several studies to measure the effect of a variable
Effect size: Numeric value that indicates size
between group differences (d=.5 means ½ SD between group difference)
Can also be presented as an r statistic when correlational studies are used
First meta-analysis (1977): psychotherapy has an effect of d=.68
Does Psychotherapy Work?
Subsequent research (e.g., Smith, Glass, & Miller, 1980) indicates d=.85. That is, the average person in therapy is better off
than 80% of people without therapy Subsequent research validated these findings
Criticisms of meta-analysis: “garbage-in, garbage-out” “apples and oranges”
Does Psychotherapy Work?
Clinical Practice Guidelines: Rules and guides for particular problems. Clinical
Psychology has not been quick to adopt these structures
Empirically Supported Treatments (ESTs): Specific criteria must be met for a treatment to be an
EST to be recommended for use. Section on Clinical Psychology of the Canadian
Psychological Association (CPA) struck a task force in 1996 to examine ESTs
Several criticisms of ESTs emerged – see Exhibit 12.2
Evidence-Based Treatments: Initiatives and Controversies
Statistically significant differences Differences not due to chance
Clinically significant differences Improved quality of life, cure, recovery
Different types of clinical trials: Type 1: High quality Randomized Controlled Trials
(RCTs) Type 2: Imperfect RCTs Type 3: Open trials without a control condition
Evidence-Based Treatments: Initiatives and Controversies
Different types of clinical trials (cont.): Type 4: Quantitative meta-analyses Type 5: Qualitative literature reviews Type 6: Case studies or professional consensus
statements not based on research
The EMDR debate and recent findings – concludes that eye movement does not add to treatment of trauma
Evidence-Based Treatments: Initiatives and Controversies
1.Cognitive Behaviour Therapy (CBT) for Depression
2.CBT for PTSD
3.EFT for Couple Distress
Examples of Evidence-Based Treatments
Cognitive Behaviour Therapy (CBT) for Depression Goal: Altering behaviours, negative automatic
thoughts, and dysfunctional beliefs Text: example of Garrett and losing his music
contract
Examples of Evidence-Based Treatments
Stages of CBT for Depression
1. Initial stage of treatment – behavioural activation Psychoeducation about depression as well as case formulation
and treatment plan
2. Targeted homework and assignments (i.e, thought records) Testing automatic thoughts
3. Examining and challenging long-standing beliefs or schema4. Relapse prevention
CBT for Depression
2. CBT for PTSD Some similarities to CBT for depression Psychoeducation about PTSD and treatment Challenge dysfunctional beliefs Relapse prevention
1. Teaching relaxation skills2. Imaginal exposure (bringing the trauma to mind)
through recounting of memories3. In vivo exposure with triggers of trauma
Examples of Evidence-Based Treatments
3. EFT for Couple Distress Goals: modify emotional responses to be adaptive,
enhance a secure emotional bond for the couple
Help couples present their attachment needs in an adaptive, understanding (and validating) manner
Nine steps in EFT First four involve assessment and de-escalation Remaining steps are about changing relational pattern
and developing new connections
Examples of Evidence-Based Treatments
Current research indicates that efficacy trials can be translated into real-word settings
Effectiveness studies show similar results
Benchmarking strategies: using efficacy trials as a mark for whether the translation of a treatment is working in the real world
Translating Efficacy to Effectiveness
Copyright © 2010 John Wiley & Sons Canada, Ltd. All rights reserved. Reproduction or translation of this work beyond that permitted by Access Copyright (The Canadian Copyright Licensing Agency) is unlawful. Requests for further information should be addressed to the Permissions Department, John Wiley & Sons Canada, Ltd. The purchaser may make back-up copies for his or her own use only and not for distribution or resale. The author and the publisher assume no responsibility for errors, omissions, or damages caused by the use of these programs or from the use of the information contained herein.
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