Studying Psychotherapy I (Chapter 10) PSYC 4500: Introduction to Clinical Psychology Brett Deacon, Ph.D. October 19, 201

1. Studying Psychotherapy I(Chapter 10)PSYC 4500: Introduction to Clinical PsychologyBrett Deacon, Ph.D.October 19, 2010

2. Announcements • I noticed an error in the syllabus • I accidentally added an extra class – download the new version posted today • Changes: • No class next Tuesday October 26th • Next response paper due this Thursday • Following response paper due Thursday 10/28

3. Announcements • Remaining schedule: • Studying psychotherapy (2.5 classes) • Science and psychotherapy (1.5 classes) • Psychodynamic psychotherapy • Client-centered psychotherapy • Cognitive-behavioral therapies (3 classes) • Eye movement desensitization and reprocessing • Prescription privileges for psychologists • Exam #3: Tuesday, December 7th at 10:15 • Exam #2 returned today

4. Questions for Levant (2004) article; Response paper due this Thursday • 1. What kind of scientific evidence do you find most persuasive in establishing the effectiveness of a particular psychotherapy? • 2. What, in your opinion, is the difference between a treatment that has not been studied empirically and one that has been shown not to work? • 3. What do you think of Levant’s stance on the value of clinical expertise/judgment?

5. In the News • Newsweek article by Sharon Begley: “Ignoring the Evidence: Why do psychologists reject science?” http://www.newsweek.com/id/216506 • Summary of Baker et al. article for next week • See also: http://www.washingtonpost.com/wp-dyn/content/article/2009/11/13/AR2009111302221.html?hpid=opinionsbox1

6. In the News • From the article’s summary (Baker, McFall, & Shoham, p. 61): • “(a) By clinicians’ own admission, much of what they do is little informed by scientific evidence, • (b) many leading proponents of psychotherapy doubt whether much of the extant scientific evidence is valid or relevant, • (c) although there are specific interventions that have relatively strong research support, these are seldom used, and • (d) the factors that many practitioners point to as constituting the core of their therapeutic armamentarium (i.e., nonspecific factors) are poorly understood, may not be teachable, and almost certainly do not require extensive science-based training or highly privileged status for their delivery.” • “In summary, we are now in a situation in which many or most clinical psychologists appear strikingly unreceptive to science, incapable of taking advantage of scientific research (Tavris, 2003), and unprepared to adapt to the changing health care system.”

7. In the News • Letter to Editor in this week’s Newsweek about Sharon Begley’s “Ignoring the Evidence” column: • “The assertions by Sharon Begley that many psychologists are not trained in, nor do they use, evidence-based practices are not only untrue, but may also discourage the 57 million Americans with a mental-health disorder from seeking needed treatment. The American Psychological Association ethics code dictates that psychologists base their clinical judgments on scientific and professional knowledge. The APA's policy on evidence-based psychological practices mirrors the Institute of Medicine's definition as "the integration of best research evidence with clinical expertise and patient values." Clinical guidelines for physicians recognize the psychotherapy we provide as an effective first-line treatment for depression due to a substantial body of supporting research. These guidelines reflect what millions of Americans have experienced: psychotherapy works! “Katherine C. Nordal, Ph.D. Executive Director for Professional Practice American Psychological Association Washington, D.C.

8. Psychotherapy Research • Can we study psychotherapy? • Is it important to study psychotherapy? • Is psychotherapy research relevant to clinicians in the real world?

9. Psychotherapy Research • Can we study psychotherapy? • Is it possible to faithfully recreate the process of psychotherapy in a research context? • Problems with standardization (manualizing therapy, assessing outcomes, etc.)

10. Psychotherapy Research • Is it important to study psychotherapy? • Are all therapies equally effective? • The “Dodo Bird” verdict • The Smith & Glass (1977) meta-analysis • Strupp & Hadley (1979) college professor study • Common factors across therapies

11. Common Factors in Psychotherapy • 1. Expectations of improvement • 2. Confronting/facing the problem • 3. Receiving a compelling rationale • 4. Participation in a treatment ritual • 5. Providing an experience of mastery over problem • 6. Attributing success to internal factors • 7. Therapeutic relationship • Also: regression to the mean, passage of time, spontaneous recovery

12. Common Factors in Psychotherapy • Therapeutic relationship as a common factor • Mean correlation between therapeutic alliance and outcome = .22 (DeRubeis et al., 2005) • Directionality of this relationship?

13. Psychotherapy Research • Is psychotherapy research relevant to clinicians in the real world? • Objections to clinical trials: • Nature of patients • Nature of therapists • Nature of the therapy

14. State of the Field Today • From Baker, McFall, & Shoham article (p. 61): • “(a) By clinicians’ own admission, much of what they do is little informed by scientific evidence, • (b) many leading proponents of psychotherapy doubt whether much of the extant scientific evidence is valid or relevant, • (c) although there are specific interventions that have relatively strong research support, these are seldom used, and • (d) the factors that many practitioners point to as constituting the core of their therapeutic armamentarium (i.e., nonspecific factors) are poorly understood, may not be teachable, and almost certainly do not require extensive science-based training or highly privileged status for their delivery.” • “In summary, we are now in a situation in which many or most clinical psychologists appear strikingly unreceptive to science, incapable of taking advantage of scientific research (Tavris, 2003), and unprepared to adapt to the changing health care system.”

15. Psychotherapy Research • Goals of psychotherapy research: • 1. Understand the efficacy of various treatments for various problems (outcome research)

16. Psychotherapy Research • 2. Understand the mechanisms by which treatments work (i.e., mediators) • Examples of mediators • Cognitive change • Behavior change • Interpersonal change • Positive life events

17. Psychotherapy Research • 3. Understand the factors that influence the efficacy of specific treatments (i.e., moderators) • Examples of moderators: • Severity of symptoms • Socio-economic status • Diagnostic comorbidity • Concurrent use of medications

18. Psychotherapy Research • The example of psychotherapy research in cognitive-behavioral therapy for panic disorder • Case studies • Randomized, controlled trials • Dismantling studies • Effectiveness studies • Studies of mediators • Studies of factors that affect outcome

19. Psychotherapy Research • Single-subject and small N designs • Case studies • Single-case experiments • Multiple baseline designs • Open (uncontrolled) trials

20. Case Study: Andrea • 20-year-old woman, junior at UW, on track team • 4-year history of “seizures” during track competitions • Extensive neurological evaluation failed to identify physical cause • Referred by coach for treatment

21. Case Study: Andrea • Symptoms • Cognitions • Behaviors • Biological factors • Case Conceptualization

22. The Case of Andrea • Treatment • Results - Questionnaires Pre-Tx Post-Tx BAI 11 6 BDI 7 0 ASI-R 55 3 BVS 14.5 6.5

23. The Case of Andrea • Results – Hyperventilation Homework Practices Trial # Peak Anxiety Time 1 8 20 2 8 19 3 6 16 4 6 16 5 5 10

24. The Case of Andrea • Results – next track meet • Conclusions and implications

25. Psychotherapy Research Designs • Advantages of case study method • Disadvantages of case study method • Usefulness of this method for identifying effective treatments