PSYC36H3 Lecture Notes - Lecture 2: Attribution Bias, Systematic Review, Generalized Anxiety Disorder

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22 Dec 2017
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Week 2 Lecture #2: Tuesday January 12, 2016
Evaluating Treatment Effectiveness
Overview
•Basics of Clinical Research
•Treatment efficacy
•Treatment effectiveness
•Issues in Evaluating Treatments
•Evidence Based Practices
Reading Comprehension - Luborsky (2002)
What is • the Dodo bird verdict?
How does this relate to psychotherapy?
Based on the idea that all the treatments available don't vary in effectiveness.
Different modalities produce results, not uniqueness.
• What does the stated focus on "the relative efficacy" of different psychotherapies tell us?
Focus on very specific kind of treatment studies.
• What were the main findings of this meta-analysis?
Showed small and non-significant differences; supports the Dodo effect.
Allegiance effects: if someone uses a treatment frequently, the usually show bias
for this treatment.
• Why would different psychotherapies have small, nonsignificant differences?
Common factors are believed to account for most of the outcomes of treatments.
Basics of Clinical Research
The Scientific Method
1. Defining a problem
2. Specifying a testable hypothesis (educated guess)
3. Choosing and implementing a research method
- usually have diff aims (arms?)
4. Analyzing data, drawing appropriate conclusions, and communicating the findings
Aspects of Clinical Research
•Independent vs. Dependent Variables
- Independent: could be the experimental manipulation or predictor variables
- Dependent: outcome
•Internal Validity
- important for efficacy studies; makes sure that the results are due to the variables and
not external variables.
Control Groups
Randomization
•Reliability of Results
- important for allegiance bias (replication)
•External Validity
- how well the results generalize to the general population; if you can replicate
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across a variety of studies.
Measures of Treatment Success
1. Compare mean outcomes across groups
- d= (sum of 1)-(sum of 2) / s
2. % of patients who “improve” (i.e., response rate)
- have a definition of this; have a preset prediction of what response is
3. Complete recovery
- is it someone who shows improvement or who fully recovers
4. % of patients who seek additional treatment
- might be a strength to actively seek more treatment
Reading Comprehension - Dozois (2013)
How might psychotherapy be more cost effective • than medication?
When people are treated with CBT or medication they might show the same
results initially, but research shows the CBT shows longterm effects; people who
stop medication don't learn the techniques to cope with their stress.
Reduces disability problems (lower insurance costs).
• What is the difference between efficacy and effectiveness?
Efficacy: highly controlled lab studies (internal validity).
Effectiveness: can be replicable in outside environments (external validity).
How is Treatment Efficacy Evaluated?
Klerman (1986)
“We must come to view psychotherapy as we do aspirin. That is, each form of psychotherapy
must have known ingredients, we must know what these ingredients are, they must be trainable
and replicable across therapists, and they must be administered in a uniform and consistent way
within a given study.”
Efficacy Research
•Tightly controlled experimental trials
- usually due to strict criteria
•High internal validity
treatment is considered effective if the treatment shows higher results than the
placebo
Randomized controlled trials (RCTs)
Example RCT
- efficacy
•Treatments of depression
•3 treatment conditions:
1. Antidepressant medication (ADM)
2. Interpersonal therapy (IPT)
3. Cognitive behavioral therapy (CBT)
Eligibility Criteria:
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•Met 5 of 9 DSM-IV criteria for depressive episode
symptoms had to be current, at least one that is depressive or andendonia (?)
•18-to-65 years old
•Fluent in English, able to provide informed consent
•Excluded if:
- excluding comorbidity reduces the generalization of the sample
Comorbid diagnoses (e.g., bipolar disorder, schizophrenia)
Active psychotic symptoms, suicidal or self-harm behaviors
- due to setting of the study
Organic brain syndromes and injuries
- hyperthyroid can look like symptoms of depression
Concurrent active medical illnesses
•Randomized patients received 16-20 tx sessions
•Tx administration followed published guidelines (Greenberger & Padesky, 1995; Kennedy et
al., 2001; Weissmanet al., 2000) “Mind over Mood”
–CBT & IPT was “manualized”
How is Treatment Effectiveness Evaluated?
Sternberg, Roediger, & Halpern (2007)
“An effectiveness study is one that considers the outcome of psychological treatment, as it is
delivered in real-world settings. Effectiveness studies can be methodologically rigorous in the
sense that careful procedures are employed to identify the nature of the client’s problems and to
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Document Summary

Week 2 lecture #2: tuesday january 12, 2016. Overview: basics of clinical research, treatment efficacy, treatment effectiveness, issues in evaluating treatments, evidence based practices. The scientific method: defining a problem, specifying a testable hypothesis (educated guess, choosing and implementing a research method, analyzing data, drawing appropriate conclusions, and communicating the findings. Important for efficacy studies; makes sure that the results are due to the variables and not external variables. Independent: could be the experimental manipulation or predictor variables. How well the results generalize to the general population; if you can replicate. Have a definition of this; have a preset prediction of what response is across a variety of studies. D= (sum of 1)-(sum of 2) / s. Is it someone who shows improvement or who fully recovers. Might be a strength to actively seek more treatment: efficacy: highly controlled lab studies (internal validity), effectiveness: can be replicable in outside environments (external validity).

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