3: Research methods

Question 1

What are the four principal methods to study psychotherapy?

Answer 1

Case studies
- work with specific patient cases

Naturalistic studies
- do not interfere with experience
- compare old and new psychotherapy in your practice

Quasi-experiments
- not random trials

Randomized controlled trials (RCTs)
- true experimental design
- adopted from medicine
- can infer cause and effect

Question 2

What does RCT mean?

Answer 2

Randomized controlled trial

Question 3

What are the six steps of RCTs?

Answer 3

1. Develop the protocol
2. Choose comparison to treatment of interest
3. Select participants
4. Randomly assign participants to conditions
5. Administer treatment and assess fidelity
6. Evaluate outcome at follow-up time points

Question 4

What is essential when developping the protocol to administer the treatment of interest?

Answer 4

Administration of treatment
- needs to be standardized
- development of treatment manual
- training and supervision of clinicians who will administered the treatment

Question 5

What are the three main comparison treatments used to study psychotherapy?

Answer 5

Waitlist control
- not equivalent to placebo because no that they are not taking a treatment

Supportive psychotherapy/ psychotherapy placebo
- control for interaction with therapist
- but do not give active ingredient of treatment of interest

Gold standard treatment
- CBT is often chose to be compared because best one nowadays
- just want to prove that is comparable or better to give another options to patients

Question 6

What are fidelity checks when studying psychotherapy and at which step of RCT can we find them?

Answer 6

Fidelity checks
- ongoing supervision of therapist
- session might be recorded and coded
–>during step 5: administer treatment

Question 7

What are some possible outcomes of interest when studying psychotherapy?

Answer 7

Outcome of interest→ should think about it before the experiment
- no longer meeting DSM criteria
- decrease in target symptom (but by how much)
- decrease in comorbid symptoms
- increase in functioning (occupational, social)
want people to move from 1SD of clinical group to 1SD to non clinical group→ means that switching groups

Question 8

What are the main differences between statistical significance and effect size?

Answer 8

Magnitude of effect AND sample size influence statistical significance whereas effect size is independent of sample size

Question 9

What are the possible scenarios after a follow up?

Answer 9

Different scenarios
- Relapse
- Sleeper effect→ get better over time after the study is over
—>psychological treatment is more enduring than medication

Question 10

What is a meta analysis and what does it allow?

Answer 10

Def→ gather info from body of research about a specific topic
- Statistical technique to pool effect size estimates
- strength of evidence of effect
- Can examine moderators of treatment efficacy→ ex: is it more effective in large sample than smaller one, which therapist worked better

Question 11

What did smith and glass found with their meta analysis?

Answer 11

Smith and Glass (1977)
- 375 controlled therapy studies
- results→ Typical therapy client better than 75% of untreated clients
- combined effect size= 0.68
- effect sizes for different psychotherapies were similar

Question 12

What is an EST?

Answer 12

Empirically supported treatment

Question 13

What were the Chambless and Hollon’s criteria for well established treatment?

Answer 13

Chambless & Hollon (1998)→ Criteria for well-established treatment
- At least two “good” between-group design experiments that show the treatment is better to a medication, psychotherapy placebo, or other treatment OR is equivalent to an established treatment OR
- A large series of single-case design experiments with good experimental design and comparison to another treatment AND
- Must be conducted with treatment manuals or other clear description
- Characteristics of samples must be clearly defined
- Effects must be demonstrated by at least two different investigators or team

Question 14

What were the Chambless and Hollon’s criteria for probably efficacious treatment?

Answer 14

Criteria for probably efficacious
- Two experiments show treatment is better to waitlist control OR
- One or more experiments meet criteria above but have not been replicated by independent investigators OR
- A small series of single case design experiments have been conducted

Question 15

Why are the Chambless and Hollon criteria not really used anymore?

Answer 15

—>those criteria are dated
—>nothing about mixed findings
—>no guidance on which EST to choose from list for each conditions

Question 16

What are Tolin et al new criteria for EST?

Answer 16

Tolin et al. (2015)→ new criteria
- focus more on systematic studies and meta-analyses→ two studies is not enough
- consider quality and risk of bias of individual studies
- measure functional impairment and quality of life→ better than simply symptoms reduction
- Include information on strength of treatment
- Evaluate clinical AND statistical significance

Question 17

What are the four steps of ICAT developped by Wondelrich?

Answer 17

ICAT→ Integrative cognitive-affective therapy
1. address treatment ambivalence and importance of emotions in maintaining bulimic symptoms
2. focus on adaptive coping strategies→ urge management, structured meal planning
3. address potential problems leading to negative aspects
a. self direct behaviors (excessive self control and self-neglect)
b. interpersonal problems→ submissiveness, withdrawal and blaming
c. self-discrepancy and evaluative standards
4. emphasizes healthy life style plans and relapse prevention

Question 18

What were the results of the study of Wondelrich on ICAT to treat ED?

Answer 18

Results→ similar results for both psychotherapies

Limitations
- no waitlist control→ cannot know that simply therapy was sufficient to explain changes
- overlap between CBT and ICAT