when it comes to the use of scientifically valid psychological treatments, what can we assume?

Chapter 14. Treating Psychological Disorders

14.4 Evaluating Treatment and Prevention: What Works?

Learning Objectives

1. Summarize the ways that scientists evaluate the effectiveness of psychological, behavioural, and community service approaches to preventing and reducing disorders.
2. Summarize which types of therapy are most effective for which disorders.

We have seen that psychologists and other practitioners employ a variety of treatments in their attempts to reduce the negative outcomes of psychological disorders. But nosotros have not yet considered the of import question of whether these treatments are effective, and if they are, which approaches are most effective for which people and for which disorders. Accurate empirical answers to these questions are important as they help practitioners focus their efforts on the techniques that take been proven to be near promising and will guide societies as they make decisions about how to spend public money to amend the quality of life of their citizens (Hunsley & Di Giulio, 2002).

Psychologists use outcome research, that is, studies that assess the effectiveness of medical treatments, to determine the effectiveness of dissimilar therapies. As you can see in Figure 14.7, "Outcome Research," in these studies the independent variable is the type of the treatment — for instance, whether it was psychological or biological in orientation or how long it lasted. In most cases characteristics of the client (e.g., his or her gender, historic period, disease severity, and prior psychological histories) are besides nerveless as control variables. The dependent mensurate is an assessment of the benefit received past the client. In some cases nosotros might simply ask the client if he or she feels better, and in other cases we may directly measure out behaviour: Can the client at present get in the airplane and take a flying? Has the client remained out of juvenile detention?

Figure 14.7 Outcome Inquiry. The blueprint of an outcome study includes a dependent measure of do good received by the customer, as predicted by independent variables including blazon of handling and characteristics of the individual. [Long Description]

In every instance the scientists evaluating the therapy must proceed in mind the potential that other effects rather than the treatment itself might be important, that some treatments that seem effective might not be, and that some treatments might really be harmful, at to the lowest degree in the sense that coin and time are spent on programs or drugs that do not work.

Ane threat to the validity of outcome research studies is natural improvement—the possibility that people might get better over time, even without handling. People who begin therapy or bring together a self-help grouping do and so considering they are feeling bad or engaging in unhealthy behaviours. After being in a plan over a menstruation of time, people frequently feel that they are getting better. But information technology is possible that they would accept improved even if they had not attended the program, and that the program is non actually making a divergence. To demonstrate that the treatment is constructive, the people who participate in information technology must exist compared with another group of people who do not get treatment.

Another possibility is that therapy works, but that information technology doesn't really affair which blazon of therapy it is. Nonspecific handling effects occur when the patient gets ameliorate over time simply by coming to therapy, even though it doesn't affair what actually happens at the therapy sessions. The idea is that therapy works, in the sense that information technology is better than doing nothing, just that all therapies are pretty much equal in what they are able to attain. Finally, placebo furnishings are improvements that occur as a result of the expectation that one volition get ameliorate rather than from the actual effects of a treatment.

Effectiveness of Psychological Therapy

Thousands of studies have been conducted to test the effectiveness of psychotherapy, and mostly they find bear witness that it works. Some outcome studies compare a grouping that gets treatment with some other (control) group that gets no treatment. For instance, Ruwaard, Broeksteeg, Schrieken, Emmelkamp, and Lange (2010) establish that patients who interacted with a therapist over a website showed more reduction in symptoms of panic disorder than did a similar grouping of patients who were on a waiting list but did non become therapy. Although studies such every bit this one command for the possibility of natural improvement (the treatment group improved more than the command group, which would non accept happened if both groups had only been improving naturally over time), they do not control for either nonspecific treatment effects or for placebo effects. The people in the treatment group might have improved only by beingness in the therapy (nonspecific effects), or they may have improved considering they expected the treatment to help them (placebo effects).

An culling is to compare a group that gets real therapy with a group that gets only a placebo. For instance, Keller et al. (2001) had adolescents who were experiencing feet disorders have pills that they thought would reduce anxiety for 8 weeks. However, one-half of the patients were randomly assigned to really receive the antianxiety drug Paxil, while the other half received a placebo drug that did not accept whatsoever medical properties. The researchers ruled out the possibility that merely placebo effects were occurring because they found that both groups improved over the 8 weeks, simply the group that received Paxil improved significantly more than the placebo group did.

Studies that use a control grouping that gets no treatment or a group that gets just a placebo are informative, but they also enhance ethical questions. If the researchers believe that their handling is going to piece of work, why would they deprive some of their participants, who are in need of help, of the possibility for improvement past putting them in a control grouping?

Another type of outcome study compares different approaches with each other. For instance, Herbert et al. (2005) tested whether social skills preparation could boost the results received for the handling of social anxiety disorder with cognitive behavioural therapy (CBT) lonely. Every bit y'all tin can see in Figure 14.8, they institute that people in both groups improved, but CBT coupled with social skills training showed significantly greater gains than CBT alone.

Figure 14.viii CBT Enquiry. Herbert and colleagues compared the effectiveness of CBT lone with CBT along with social skills training. Both groups improved, but the group that received both therapies had significantly greater gains than the group that received CBT lone. [Long Description]

Other studies (Crits-Christoph, 1992; Crits-Christoph et al., 2004) have compared cursory sessions of psychoanalysis with longer-term psychoanalysis in the treatment of anxiety disorder, humanistic therapy with psychodynamic therapy in treating depression, and cognitive therapy with drug therapy in treating anxiety (Dalgleish, 2004; Hollon, Thase, & Markowitz, 2002). These studies are advantageous because they compare the specific effects of one type of handling with another, while allowing all patients to become treatment.

Research Focus: Meta-Analyzing Clinical Outcomes

Because there are thousands of studies testing the effectiveness of psychotherapy, and the independent and dependent variables in the studies vary widely, the results are frequently combined using a meta-analysis. A meta-analysis is a statistical technique that uses the results of existing studies to integrate and draw conclusions about those studies. In i important meta-analysis analyzing the effect of psychotherapy, Smith, Glass, and Miller (1980) summarized studies that compared unlike types of therapy or that compared the effectiveness of therapy against a command grouping. To find the studies, the researchers systematically searched computer databases and the reference sections of previous research reports to locate every study that met the inclusion criteria. Over 475 studies were located, and these studies used over x,000 research participants.

The results of each of these studies were systematically coded, and a mensurate of the effectiveness of treatment known as the upshot size was created for each study. Smith and her colleagues establish that the average event size for the influence of therapy was 0.85, indicating that psychotherapy had a relatively big positive outcome on recovery. What this means is that, overall, receiving psychotherapy for behavioural problems is substantially ameliorate for the individual than non receiving therapy (Figure 14.nine, "Normal Curves of Those Who Do and Do Not Get Treatment"). Although they did non measure information technology, psychotherapy presumably has large societal benefits every bit well — the cost of the therapy is likely more than made up for by the increased productivity of those who receive it.

Figure 14.ix Normal Curves of Those Who Exercise and Do Non Get Treatment. Meta-analyses of the outcomes of psychotherapy have found that, on average, the distribution for people who get treatment is higher than for those who practise not get treatment.

Other meta-analyses accept as well constitute substantial support for the effectiveness of specific therapies, including cognitive therapy, CBT (Butler, Chapman, Forman, & Beck, 2006; Deacon & Abramowitz, 2004), couples and family therapy (Shadish & Baldwin, 2002), and psychoanalysis (Shedler, 2010). On the footing of these and other meta-analyses, a list of empirically supported therapies— that is, therapies that are known to exist effective — has been developed (Chambless & Hollon, 1998; Hollon, Stewart, & Strunk (2006). These therapies include cerebral therapy and behaviour therapy for depression; cerebral therapy, exposure therapy, and stress inoculation training for feet; CBT for bulimia; and behaviour modification for bed-wetting.

Smith, Drinking glass, and Miller (1980) did non notice much evidence that whatsoever one type of therapy was more than effective than any other type, and more recent meta-analyses have not tended to find many differences either (Cuijpers, van Straten, Andersson, & van Oppen, 2008). What this means is that a adept part of the outcome of therapy is nonspecific, in the sense that simply coming to whatsoever type of therapy is helpful in comparing to not coming. This is true partly because there are fewer distinctions amidst the ways that dissimilar therapies are practised than the theoretical differences among them would suggest. What a practiced therapist practising psychodynamic approaches does in therapy is often not much dissimilar from what a humanist or a cognitive-behavioural therapist does, and so no 1 arroyo is actually likely to be improve than the other.

What all adept therapies have in common is that they give people hope; aid them call back more than carefully about themselves and about their relationships with others; and provide a positive, empathic, and trusting relationship with the therapist — the therapeutic alliance (Ahn & Wampold, 2001). This is why many self-help groups are also likely to be constructive and maybe why having a psychiatric service dog may besides make us experience better.

Effectiveness of Biomedical Therapies

Although there are fewer of them because fewer studies accept been conducted, meta-analyses also support the effectiveness of drug therapies for psychological disorder. For instance, the use of psychostimulants to reduce the symptoms of attending-deficit/hyperactivity disorder (ADHD) is well known to exist successful, and many studies detect that the positive and negative symptoms of schizophrenia are substantially reduced by the apply of antipsychotic medications (Lieberman et al., 2005).

People who take antidepressants for mood disorders or antianxiety medications for anxiety disorders most ever report feeling ameliorate, although drugs are less helpful for phobic disorder and obsessive-compulsive disorder. Some of these improvements are almost certainly the result of placebo effects (Cardeña & Kirsch, 2000), but the medications do piece of work, at least in the curt term. An analysis of the Health Canada database plant a success rate of 26% for Prozac and Zoloft, 24% for Celexa, and 31% for Lexapro and Cymbalta (Deshauer et al., 2008). The overall average success rate for antidepressant medications canonical by Health Canada and the FDA between 1987 and 2004 was 30% (Deshauer et al., 2008; Turner, Matthews, Linardatos, Tell, & Rosenthal, 2008).

One trouble with drug therapies is that although they provide temporary relief, they don't care for the underlying cause of the disorder. One time the patient stops taking the drug, the symptoms often return in full force. In addition many drugs have negative side effects, and some also accept the potential for habit and abuse. Different people have different reactions, and all drugs conduct alert labels. As a result, although these drugs are frequently prescribed, doctors attempt to prescribe the lowest doses possible for the shortest possible periods of time.

Older patients face special difficulties when they take medications for mental illness. Older people are more than sensitive to drugs, and drug interactions are more likely because older patients tend to accept a multifariousness of unlike drugs every day. They are more than probable to forget to take their pills, to take also many or likewise few, or to mix them up due to poor eyesight or faulty memory.

Like all types of drugs, medications used in the treatment of mental illnesses can carry risks to an unborn infant. Tranquilizers should not be taken past women who are significant or expecting to become meaning, because they may cause birth defects or other infant problems, specially if taken during the first trimester. Some selective serotonin reuptake inhibitors (SSRIs) may also increase risks to the fetus (Louik, Lin, Werler, Hernandez, & Mitchell, 2007; U.Due south. Food and Drug Administration, 2004), equally do antipsychotics (Diav-Citrin et al., 2005).

Decisions on medication should be carefully weighed and based on each person's needs and circumstances. Medications should be selected based on available scientific research, and they should be prescribed at the lowest possible dose. All people must be monitored closely while they are on medications.

Effectiveness of Social-Community Approaches

Measuring the effectiveness of community action approaches to mental health is hard because they occur in community settings and affect a wide multifariousness of people, and it is difficult to find and appraise valid issue measures. Nevertheless, research has constitute that a variety of customs interventions can be effective in preventing a diversity of psychological disorders (Price, Cowen, Lorion, & Ramos-McKay,1988). Information suggest that prevention programs that provide supplemental foods, health-intendance referral, and nutrition pedagogy for low-income families are successful in leading to higher birth weight babies and lower infant mortality (Ripple & Zigler, 2003).

Although some of the many community-based programs designed to reduce alcohol, tobacco, and drug abuse; violence and malversation; and mental disease have been successful, the changes brought about by even the all-time of these programs are, on average, modest (Wandersman & Florin, 2003; Wilson, Gottfredson, & Najaka, 2001). This does not necessarily mean that the programs are not useful. What is important is that community members go on to work with researchers to assist make up one's mind which aspects of which programs are most effective, and to concentrate efforts on the nigh productive approaches (Weissberg, Kumpfer, & Seligman, 2003). The almost beneficial preventive interventions for young people involve coordinated, systemic efforts to enhance their social and emotional competence and health. Many psychologists continue to work to promote policies that support community prevention every bit a model of preventing disorder.

Key Takeaways

• Outcome inquiry is designed to differentiate the effects of a treatment from natural improvement, nonspecific treatment effects, and placebo effects.
• Meta-analysis is used to integrate and draw conclusions about studies.
• Enquiry shows that getting psychological therapy is better at reducing disorder than not getting it, but many of the results are due to nonspecific effects. All good therapies give people hope and help them call back more carefully well-nigh themselves and nigh their relationships with others.
• Biomedical treatments are effective, at least in the short term, but overall they are less effective than psychotherapy.
• One problem with drug therapies is that although they provide temporary relief, they exercise not treat the underlying crusade of the disorder.
• Federally funded customs mental health service programs are effective, but their preventive furnishings may in many cases be small-scale.

Exercises and Critical Thinking

1. Revisit the chapter opener that focuses on the utilise of psychiatric service dogs. What factors might pb you to believe that such therapy would or would not be effective? How would you propose to empirically test the effectiveness of the therapy?
2. Given your knowledge almost the effectiveness of therapies, what approaches would you take if y'all were making recommendations for a person who is seeking handling for severe depression?

References

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Butler A. C., Chapman, J. E., Forman, E. M., Beck, A. T. (2006). The empirical condition of cerebral-behavioral therapy: A review of meta-analyses.Clinical Psychology Review, 26(1), 17–31.

Cardeña, E., & Kirsch, I. (2000). True or false: The placebo effect as seen in drug studies is definitive proof that the mind can bring about clinically relevant changes in the body: What is so special about the placebo effect?Advances in Mind-Trunk Medicine, 16(1), 16–18.

Chambless, D. 50., & Hollon, Southward. D. (1998). Defining empirically supported therapies.Journal of Consulting and Clinical Psychology, 66(1), 7–xviii.

Crits-Christoph, P. (1992). The efficacy of brief dynamic psychotherapy: A meta-analysis.American Periodical of Psychiatry, 149, 151–158.

Crits-Christoph, P., Gibbons, G. B., Losardo, D., Narducci, J., Schamberger, M., & Gallop, R. (2004). Who benefits from brief psychodynamic therapy for generalized anxiety disorder?Canadian Periodical of Psychoanalysis, 12, 301–324.

Cuijpers, P., van Straten, A., Andersson, G., & van Oppen, P. (2008). Psychotherapy for depression in adults: A meta-assay of comparative issue studies.Journal of Consulting and Clinical Psychology, 76(six), 909–922.

Dalgleish, T. (2004). Cerebral approaches to posttraumatic stress disorder: The development of multirepresentational theorizing.Psychological Bulletin, 130, 228–260.

Deacon, B. J., & Abramowitz, J. Due south. (2004). Cognitive and behavioral treatments for feet disorders: A review of meta-analytic findings.Journal of Clinical Psychology, 60(4), 429–441.

Deshauer, D., Moher, D., Fergusson, D., Moher, E., Sampson, Thou., & Grimshaw, J. (2008). Selective serotonin reuptake inhibitors for unipolar low: A systematic review of classic long-term randomized controlled trials.Canadian Medical Association Journal, 178(10), 1293–301.

Diav-Citrin, O., Shechtman, Southward., Ornoy, S., Arnon, J., Schaefer, C., Garbis, H.,…Ornoy, A. (2005). Safety of haloperidol and penfluridol in pregnancy: A multicenter, prospective, controlled report.Journal of Clinical Psychiatry, 66, 317–322.

Herbert, J. D., Gaudiano, B. A., Rheingold, A. A., Myers, V. H., Dalrymple, Grand., & Nolan, E. M. (2005). Social skills training augments the effectiveness of cerebral behavioral grouping therapy for social anxiety disorder.Behavior Therapy, 36(2), 125–138.

Hollon, S. D., Thase, M. East., & Markowitz, J. C. (2002). Treatment and prevention of depression.Psychological Science in the Public Interest, 3, 39–77.

Hollon, S., Stewart, M., & Strunk, D. (2006). Indelible effects for cognitive therapy in the treatment of depression and feet.Annual Review of Psychology, 57, 285–316.

Hunsley, J., & Di Giulio, G. (2002). Dodo bird, phoenix, or urban fable? The question of psychotherapy equivalence.The Scientific Review of Mental Wellness Practice: Objective Investigations of Controversial and Unorthodox Claims in Clinical Psychology, Psychiatry, and Social Work, 1(1), 11–22.

Keller, One thousand. B., Ryan, North. D., Strober, One thousand., Klein, R. G., Kutcher, Southward. P., Birmaher, B.,…McCafferty, J. P. (2001). Efficacy of paroxetine in the treatment of adolescent major depression: A randomized, controlled trial.Journal of the American Academy of Child & Adolescent Psychiatry, 40(seven), 762–772.

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Louik, C., Lin, A. E., Werler M. M., Hernandez, Due south., & Mitchell, A. A. (2007). Starting time-trimester apply of selective serotonin-reuptake inhibitors and the adventure of birth defects.New England Journal of Medicine, 356, 2675–2683.

Price, R. H., Cowen, E. L., Lorion, R. P., & Ramos-McKay, J. (Eds.). (1988).Fourteen ounces of prevention: A casebook for practitioners. Washington, DC: American Psychological Clan.

Ripple, C. H., & Zigler, E. (2003). Research, policy, and the federal role in prevention initiatives for children.American Psychologist, 58(six–seven), 482–490.

Ruwaard, J., Broeksteeg, J., Schrieken, B., Emmelkamp, P., & Lange, A. (2010). Spider web-based therapist-assisted cerebral behavioral handling of panic symptoms: A randomized controlled trial with a three-year follow-up.Journal of Anxiety Disorders, 24(4), 387–396.

Shadish, W. R., & Baldwin, Southward. A. (2002). Meta-analysis of MFT interventions. In D. H. Sprenkle (Ed.),Effectiveness research in marriage and family therapy (pp. 339–370). Alexandria, VA: American Association for Spousal relationship and Family Therapy.

Shedler, J. (2010). The efficacy of psychodynamic psychotherapy.American Psychologist, 65(2), 98–109.

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U.S. Food and Drug Administration. (2004). FDA Medwatch drug alert on Effexor and SSRIs. Retrieved from http://www.fda.gov/medwatch/condom/2004/safety04.htm#effexor

Wandersman, A., & Florin, P. (2003). Customs interventions and effective prevention.American Psychologist, 58(6–vii), 441–448.

Weissberg, R. P., Kumpfer, Grand. L., & Seligman, M. E. P. (2003). Prevention that works for children and youth: An introduction.American Psychologist, 58(6–7), 425–432.

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Image Attributions

Figure fourteen.eight: Adapted from Herbert et al., 2005.

Long Descriptions

Figure 14.7 long description: In issue enquiry, individual characteristics like severity of the disorder, sexual activity, socio-economic status, and race are controlled for. The treatment grouping receives therapy while the control group receives no therapy. Past comparing the ii groups, the researcher can decide the outcome benefits of the therapy. [Return to Figure 14.7]

Figure 14.8 long description: Effectiveness of CBT combined with social skills training.

	Percentage of patients who improved with CBT alone	Pct of patients who improved with CBT and social skills preparation
Immediately subsequently handling	57%	83%
three calendar month follow-upwardly	38%	lxx%

[Return to Figure 14.8]

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