module 10 evidence based interventions

Question 1

explain the science practitioner model

Answer 1

The science practitioner model encourages a frame of mind where a practitioner is still adhering to scientific principles and possibly doing research. By being informed about scientific principles, graduates are able to perform research and integrate research findings, into their practice. One domain can shed understanding on the other.

Question 2

explain evidence-based practice (EBP)

Answer 2

Evidence based practice means practitioners are up-to-date with new knowledge and are able to decide which treatment has evidence of success, and how applicable it is for the current patient and what the alternatives are.
May be defined as; “the integration of the best available research with clinical expertise in the context of patient characteristics, culture, and preferences.”
Aims to improve public health outcomes.
Major issues in integrating this type of research in day-to-day practice include the relative weight to place on different research methods; the representativeness of research samples; whether research results should guide practice at the level of principles of change, intervention strategies, or specific protocols; the generalisability and transportability of treatments supported in controlled research to clinical practice settings; the extent to which judgments can be made about treatments of choice when the number and duration of treatments tested has been limited and the degree to which the results of efficacy and effectiveness research can be generalised from primarily White samples to minority and marginalised populations

Question 3

describe the three key legs of the EBP

Answer 3

1.The first leg, best available research, is often conceptualised in terms of a hierarchy of evidence with data from meta-analyses, randomised controlled trials (RCTs), and systematic within-subject designs at the apex, well conducted quasi-experimental studies in the middle, and correlational and uncontrolled case studies at the bottom.
2.In the second leg of EBP, clinical judgment and clinical experience, practitioners make use of ‘their clinical skills and past experiences to rapidly identify each patient’s unique health state and diagnosis, [and] their [sic] individual risks and benefits of potential interventions’.
3.The third leg, client preferences and values, shows that, for example, even when research evidence strongly supports the use of flooding (prolonged exposure to high intensity stimuli) for an anxiety disorder, a client may be unwilling to endure the overwhelming short-term fear necessitated by this intervention.

Question 4

describe the six root causes of resistance to EBP.

Answer 4

1.naïve realism, which can lead clinicians to conclude erroneously that client change is due to an intervention itself rather than to a host of competing explanations;
2. deep-seated misconceptions regarding human nature (e.g., mistaken beliefs regarding the causal primacy of early experiences) that can hinder the adoption of evidence-based treatments;
3. statistical misunderstandings regarding the application of group probabilities to individuals;
4. erroneous apportioning of the burden of proof on sceptics rather than proponents of untested therapies;
5. widespread mischaracterisations of what EBP entails; and
6. pragmatic, educational, and attitudinal obstacles, such as the discomfort of many practitioners with evaluating the increasingly technical psychotherapy outcome literature.

Question 5

levels of research evidence

Answer 5

(1=strongest evidence)
1. systematic review of all randomised trials
2. one properly designed randomised control trial
3-1.well designed pseudo-randomised (eg alternate allocation etc) controlled trial.
3-2.Comparative studies with concurrent controls and not randomised (cohort studies) or interrupted time series with a control group.
3-3. comparative studies with historical control, 2 or more single-arm studies or interrupted time series without a parallel control group.
4. Case series, either post test or pre & post test.

Question 6

Clinical expertise

Answer 6

The clinician is aware of all factors and selects and drives treatment for maximal effect.
factors include;
-Assessment, diagnostic judgement, systematic case formulation and treatment planning
-Clinical decision-making, treatment implementation and monitoring of patient progress
-Interpersonal expertise
-Continual self-reflection and acquisition of skills
-Appropriate evaluation and use of research evidence in both basic and applied psychological science
-Understanding the influence of individual and cultural differences in treatment
-Seeking available resources e.g. consultation, adjunctive or alternative services as needed
-Having a cogent rationale for clinical strategies.

Question 7

some INTERVENTIONS/THERAPIES:

Answer 7

1. ACCEPTANCE & COMMITMENT THERAPY
   focuses on accepting feelings completely even if they are negative and move toward behavioural changes through understanding.
   
   2. COGNITIVE BEHAVIOURAL THERAPY
      cognition affects behaviour and vice versa. Negative behaviours can be improved by working on eliminating negative cognitions and self-training. may include many aspects such as activity scheduling, relaxation, stress management, anger management, parent training, social skills training etc etc.
   3. DIALECTIVAL BEHAVIOUR THERAPY
      Aims to enhance environment, enhance capabilities, improve motivation. Delivered in modes/stages. First mode is traditional didactic relation between clinician & client, then skills training (in mindfulness, distress tolerance, emotion regulation & interpersonal effectiveness),integration of skills into real life situations, and finally team consultations (for challenging clients).
   4. EMOTION-FOCUSED THERAPY
      blend of client focussed and gestalt. Includes techniques such as 2-chair or empty chair dialogues. Aims for increased acceptance and compassion for self, and letting go of hurt and anger to others.
      5.EYE MOVEMENT DESENSITISATION AND RE-PROCESSING
      whilst re-experiencing trauma, patient’s eyes are following clinician’s finger. Connect with emotions fully but at same time more positive emotions are encouraged.
   5. FAMILY INTERVENTIONS
      improve interactions between family members. Patterns of behaviours might be problems, but not any particular person.
      7.HYPNOTHERAPY
      Patient experiences changes in perceptions/sensations with clinician’s suggestions.
   6. INTERPERSONAL PSYCHOTHERAPY
      brief, structured approach to personal issues. examines self beliefs,relationship expectations, role transitions, grief etc.
      9.MINDFULNESS BASED STRESS REDUCTION & MINDFULNESS BASED COGNITIVE THERAPY
      mindfulness-based meditation to interrupt unhealthy rumination. Experience emotions fully but as separate to self.
      10.NARRATIVE THERAPY
      Particularly used with Aboriginal/Torres Strait Islanders. Listens to how people tell their story, and how this may hold them back. Re-tell with focus on their strengths and skills.
   7. PLAY THERAPY
      Therapist plays with children in thoughtful manner to enable discussion and identifying patterns.
   8. PSYCHODYNAMIC PSYCHOTHERAPY
      short and specific. Focus on past and present interpersonal conflicts. Clinician works actively to bring about confrontation, clarification and interpretation. (unlike long term therapy where discoveries are more brought about by self exploration).
   9. PSYCHOEDUCATION
      Provision of education re dx, px, implications etc. alleviating/aggravating variables, etc. Help understand so can live more fulfilling lives.
   10. SCHEMA-FOCUSSED THERAPY
       identifying and changing maladaptive schemas and coping mechanisms. Uses blend of cbt, visual imagery and gestalt.
       15.SELF HELP (PURE OR MINIMAL THERAPIST)
       eg internet self help programs. usually a combo of cbt, exercises and readings.
   11. SOLUTION-FOCUSSED BRIEF THERAPY
       brief. uses resources and specific goal to work to clients’ strengths to enable more positive outlook.