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Science and Psychotherapy II PSYC 4500: Introduction to Clinical Psychology Brett Deacon, Ph.D. November 8, 2012

Science and Psychotherapy II PSYC 4500: Introduction to Clinical Psychology Brett Deacon, Ph.D. November 8, 2012. What We’ve Discussed. What is the role of science in informing psychotherapy? Can we study psychotherapy? Is it important to study psychotherapy?

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Science and Psychotherapy II PSYC 4500: Introduction to Clinical Psychology Brett Deacon, Ph.D. November 8, 2012

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  1. Science and Psychotherapy IIPSYC 4500: Introduction to Clinical PsychologyBrett Deacon, Ph.D.November 8, 2012

  2. What We’ve Discussed • What is the role of science in informing psychotherapy? • Can we study psychotherapy? • Is it important to study psychotherapy? • Is psychotherapy research relevant to clinicians in the real world? • Does psychotherapy work? Can psychotherapy cause harm? Are all psychotherapies equally effective? Do all therapies work via the same common factors?

  3. What We’ve Discussed • What efforts have clinical scientists made to disseminate effective psychotherapies? How successful have these efforts been? • What is the current state of the field with respect to science-based practice? • What are the barriers to the dissemination of science-based practice?

  4. Why This Matters: A Case Example • Phone call I received yesterday • http://www.anxietysolution.com/index.html • http://www.bu.edu/card/get-help/pda-intensive/

  5. What We’ve Discussed • Therapist-level barriers according to Scott Lilienfeld • Split between romantics and empiricists • Romantics endorse clinical intuition, empiricists endorse science http://www.psychologytoday.com/blog/feeling-relating-existing/201206/scientism-in-psychotherapy/comments • Examples of clinical vs. statistical judgment • Selecting psychological tests • Selecting psychotherapies • Graduate school admissions • Sports (baseball, fantasy football)

  6. What We’ve Discussed • Another examples of clinical vs. statistical/actuarial judgment • Can you think of a recent high-profile prediction task in which people were free to use the statistical or clinical method? http://campaignstops.blogs.nytimes.com/2012/11/06/e-day/#Beeson • Outcomes for romanticists vs. empiricists?

  7. What We’ve Discussed • Misconceptions about science-based therapies • Unnatural nature of scientific thinking • Confirmation bias • Naïve realism • Failure to appreciate causes of spurious therapeutic effectiveness • Illusory correlation • Inadequate scientific training

  8. Remainder of Dr. Lilienfeld’s Talk

  9. Biomedical Model as Additional Barrier to Dissemination of Science-Based Practice (Deacon, in press) • Core tenets of the biomedical model • Mental disorders are caused by biological abnormalities principally located in the brain • There is no meaningful distinction between mental disorders and physical diseases • Biological treatment is emphasized

  10. Biomedical Model: Our Vocabulary Mental Illness Neurobiological Disorder Brain Disorder Chemical Imbalance Pathophysiology Cure Comorbidity Psychopathology Antidepressant Antipsychotic Mood stabilizer Side Effect

  11. The Biomedical Model and Psychotherapy Research • Adoption of drug trial methodology (RCT) • Feasibility demonstrated in Treatment of Depression Collaborative Research Program (Elkin, 1994) • NIMH funding = RCT of manualized treatment for DSM-defined mental disorder

  12. Biomedical Approach to Psychotherapy Research: Benefits • Enhanced internal validity of psychotherapy research • Empirically supported treatments (ESTs) for specific DSM-defined mental disorders • Clinical scientists have attempted to disseminate science-based psychotherapy principally by disseminating ESTs

  13. Disorder-Specific EST Approach

  14. Biomedical Approach to Psychotherapy Research: Costs • RCTs widely perceived as irrelevant to real-world practice • Reification of invalid DSM diagnoses • Treatment of disorders, not problems • Analogue research marginalized

  15. Biomedical Approach to Psychotherapy Research: Costs • Science-based psychotherapy = treatment manuals • Treatment manuals widely perceived as clinically inapplicable • Treatment process/mechanisms ignored

  16. Biomedical Approach to Psychotherapy Research: Costs • Multi-component treatment packages vs. empirically supported principles of change • Dissemination of disorder-specific EST manuals in piecemeal fashion • Polarization of clinical psychology

  17. Promising Developments in Psychotherapy Research • Ecologically valid RCTs • Attention to process and mechanisms • Transdiagnostic theories and treatments • Improvement beyond symptom reduction • Current status of dissemination efforts

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