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Announcements

Studying Psychotherapy IV (Chapter 10) PSYC 4500: Introduction to Clinical Psychology Brett Deacon, Ph.D. October 31 , 2013. Announcements. Deacon response paper due next Tuesday , 11/5. Questions for Deacon (2013) article; Response paper due next Tuesday 11/5.

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Announcements

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  1. Studying Psychotherapy IV(Chapter 10)PSYC 4500: Introduction to Clinical PsychologyBrett Deacon, Ph.D.October 31, 2013

  2. Announcements • Deacon response paper due next Tuesday, 11/5

  3. Questions for Deacon (2013) article; Response paper due next Tuesday 11/5 • Describe what you believe to be the three most significant effects (good or bad) of clinical psychology’s adoption of the biomedical model of psychotherapy research.

  4. From Last Class • Summary of take-home messages from Lilienfeld’s presentation and article • Psychologically harmful treatments • Empirically supported treatment movement • Evidence-based practice in psychology • Baker article: state of the field, challenges, and possible solutions

  5. Question • What does science-based psychotherapy look like? • What form does it take? • How should we be training therapists to practice like scientists?

  6. Questions • What is an empirically supported treatment? • http://www.div12.org/PsychologicalTreatments/treatments.html

  7. Questions • What is evidence-based practice? http://www.abct.org/Public/?m=mPublic&fa=WhatIsEBPpublic • What are EBPs ?EBPs are treatments that are based directly on scientific evidence suggesting that strongest contributors and risk factors for psychological symptoms. Most EBPs have been studied in several large-scale clinical trials, involving thousands of patients and careful comparison of the effects of EBPs vs. other types of psychological treatments. Dozens of multi-year studies have shown that EBPs can reduce symptoms significantly for many years following the end of psychological treatment - similar evidence for other types of therapies is not available to date.

  8. Questions • Do ESTs = EBP? • “Evidence-based practice in psychology (EBPP) is the integration of the best available research with clinical expertise in the context of patient characteristics, culture, and preferences.” • What’s the difference? Bruce Thyer’s slides…

  9. Biomedical Model as Additional Barrier to Dissemination of Science-Based Practice (Deacon, 2013) • 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: Tenets • Mental disorders are medical diseases caused by biological abnormalities principally located in the brain • There is no meaningful distinction between mental disorders and physical diseases • Biological treatment is emphasized Andreasen(1985)

  11. Biomedical Model: Our Field • Does psychology operate independently of the biomedical model? • Do we represent an alternative approach?

  12. 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

  13. The Biomedical Model and Psychotherapy Research • Randomized, controlled trials became the “gold standard” method of studying psychotherapy • Required for research funding and publication in top journals • Emphasis on standardized (manualized) treatments for targeting DSM-defined disorders

  14. 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

  15. Disorder-Specific EST Approach

  16. DSM-III: Effects on Psychotherapy Research and Dissemination • How successful have efforts been to disseminate DSM-disorder-specific empirically supported treatment manuals?

  17. DSM-III: Effects on Psychotherapy • Disorder-specific ESTs are rarely used • Why?

  18. Biomedical Approach to Psychotherapy Research: Costs • RCTs widely perceived as irrelevant to real-world practice • Patients, therapists, therapy • Negative beliefs about treatment manuals • Reification of invalid DSM diagnoses • Treatment of disorders, not problems • Analogue research marginalized

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

  20. Biomedical Approach to Psychotherapy Research: Costs • Reificationof invalid DSM diagnoses • Treatment of disorders, not problems • Analogue research marginalized

  21. Biomedical Psychotherapy Research: Costs • Treatment process/mechanisms ignored • Treatment packages for DSM-disorders • Efficacy studies vs. component analyses • May include unnecessary ingredients • Lack of emphasis on how treatments can be made to work better

  22. Biomedical Psychotherapy Research: Costs • No ESTs for many client problems • EST-focused clinical training • Referral of clients with non-EST problems • Less severe problems more difficult to treat

  23. Biomedical Psychotherapy Research: Costs • Specific disorders studied and treated in isolation from similar clinical problems • EST dissemination in piecemeal fashion • PE for PTSD in VA system • Increased polarization of clinical psychology

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