PREPARED BY DR. CATHY CHOVAZ, KING’S COLLEGE, UNIVERSITY OF WESTERN ONTARIO Chapter 12 Intervention: Adults and Couples INTRODUCTION TO CLINICAL PSYCHOLOGY.

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

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