Clinical Psychology Prevention, Consultation, and Psychotherapy Research Flashcards

Question

b) The _____ proposes that psychotherapy outcomes can be described in terms of ____ phases: The _______ phase occurs during the ____ sessions and is characterized by an _____ in ______. This is followed by the ______, which occurs during the next ___ sessions and involves a __________. The final _______ phase involves “unlearning troublesome, maladaptive, habitual behaviors and establishing new ways of dealing with various aspects of life (e.g., problematic relationship patterns, faulty work habits, and trouble-causing personal attitudes)” (1996, p. 1061). An implication of this model is that different outcome measures should be used during different phases of therapy – i.e., measures of subjective well-being during the remoralization phase, the severity and frequency of symptoms during the remediation phase, and life functioning during the rehabilitation phase.

Answer 1

Phase model Three phases Initial remoralization phase First few sessions Increase in hopefulness Remediation phase 16 Reduction in symptoms Rehabilitation

Answer 2

Because the research has found that different psychotherapy approaches have similar beneficial effects (APA, 2012), a number of researchers have attempted to identify elements common to the various approaches that contribute to psychotherapy outcomes. For example, based on their review of the research, Norcross and Lambert (2011) attribute 30% of variability in psychotherapy outcomes to patient contributions, 12% to the therapeutic relationship, 8% to the treatment method, 7% to therapist characteristics, 3% to other factors, and 40% to unexplained variance.

Answer 3

Therapeutic relationship Three Working alliance Real relationship Transference-countertransference

Answer 4

Working alliance Core common Psychotherapy Successful

Answer 5

Client -therapist matching Race Ethnicity vary .32 .09 Therapy outcome Varied Race/ethnicity

Answer 6

racial/ethnic Reduced premature termination Asian Hispanic European America African American Improved Hispanic American More important Cultural competence Compassion Worldview More

Answer 7

The research has found that utilization rates of mental health care services vary, depending on clients’ gender, age, sexual orientation, and race/ethnicity. With regard to gender, the 2018 National Survey of Drug Use and Health (Substance Abuse and Mental Health Services Administration, 2019) found that utilization rates were higher for female adults than for male adults. In terms of age, it found that, for all adult respondents, utilization rates were highest for respondents ages 26 to 49 followed by, in order, those ages 50 and older and those ages 18 to 25, which is consistent with the results of yearly surveys conducted since 2002. In terms of sexual orientation, the studies have generally found that sexual minority (gay/lesbian and bisexual) men and women utilize mental health care services at higher rates than sexual majority (heterosexual) men and women do. For example, data from the 2013 to 2015 National Health Interview Surveys (Platt, Wolf, & Scheitle, 2018) revealed that sexual minority men and women were two to four times more likely than heterosexual men and women to have talked with a mental health professional in the past year. Finally, for members of different racial/ethnic minority groups, data from the 2018 National Survey of Drug Use and Health indicated that, among all adult survey respondents, the use of outpatient mental health services in the past year was highest for respondents who identified themselves as belonging to two or more racial groups and lowest for respondents who identified themselves as Asian. For inpatient mental health services, use was highest for respondents who identified themselves as American Indian or Alaska Native and lowest for respondents who identified themselves as Asian. The research has also found that utilization rates differ for different racial/ethnic minority groups. The National Survey of Drug Use and Health (Substance Abuse and Mental Health Services Administration, 2015) collected data on the use of mental health services by individuals ages 18 and older. It found that the annual average use of outpatient mental services from 2008 to 2012 was highest for respondents reporting two or more races followed by, in order, respondents who identified themselves as White, American Indian or Alaska Native, Black or African American, Hispanic American, or Asian. For inpatient mental health services, the annual average use was highest for respondents who identified themselves as American Indian or Alaska Native followed by, in order, those who identified themselves as being Black or African American, two or more races, Hispanic American, White, or Asian.

Answer 8

The American Psychological Association has concluded that research on psychotherapy outcomes has “demonstrated that courses of psychotherapy reduce overall medical utilization and expense” (2012, p. 2). For example, with regard to expense, Chiles, Lambert, and Hatch’s (1999) meta-analysis of research conducted between 1967 and 1997 indicated that participation in psychological interventions by patients undergoing surgery, patients with a history of medical overutilization, and patients receiving treatment for substance misuse or other psychological disorder usually resulted in a medical cost offset. They found that 90% of the studies included in their analysis reported evidence of a medical cost offset and that the average cost savings attributable to a psychological intervention was 20%.

Answer 9

The economic evaluation of healthcare programs involves using information about program costs and benefits to inform decision-making. Cost-benefit analysis, cost-effectiveness analysis, and cost-utility analysis are three methods of economic evaluation. Cost-benefit analysis (CBA) can be used to compare the costs and benefits of one or multiple interventions. When using CBA, costs and benefits are both expressed in monetary terms. As an example, Knapp et al. (2013) compared individual placement and support (IPS) and standard vocational rehabilitation for helping people with severe mental disorders obtain employment. When the costs of implementing the two interventions and their benefits (as measured by expected earnings) were compared, IPS produced a greater net benefit. Cost-effectiveness analysis (CEA) is used to compare the costs and benefits of two or more interventions when benefits cannot be expressed as monetary values. The Knapp et al. study used cost-effectiveness analysis to compare the costs and benefits of IPS and standard vocational rehabilitation, with benefits being measured as percent of participants who worked for at least one day during the follow-up period, percent of participants who dropped out of the program they were assigned to, and percent of participants who had to be readmitted to the hospital. IPS was found to be more effective than vocational rehabilitation for all three benefits. Finally, cost-utility analysis (CUA) is used to compare the costs of two or more interventions on quality-adjusted life-years (QALYs), which combines measures of gain in the health-related quality and the quantity (duration) of life. For instance, Sava, Yates, Lupu, Szentagotai, and David (2009) used CUA to compare the costs and benefits in terms of QALYs of three treatments for depression: cognitive therapy (CT), rational-emotive behavior therapy (REBT), and fluoxetine (Prozac). Results indicated that CT and REBT both had greater cost-utility than fluoxetine but did not differ significantly from each other.

Answer 10

Research investigating the effects of age, gender, and socioeconomic status on psychotherapy outcomes has not produced entirely consistent results, but the best overall conclusions are that they have little or no impact on outcomes and that apparent differences are due to other factors (Boswell, Constantino, & Anderson, 2016). For example, Nordberg and colleagues (2014) found that, when initial severity of symptoms was controlled, client age explained essentially none of the variance in psychotherapy outcomes. Also, while some studies have linked low socioeconomic status to premature termination, there’s evidence that this relationship is due to transportation difficulties and other factors.

Answer 11

Psychological research and theory can be affected by a number of biases, including gender biases and the WEIRD sampling bias. Gender biases can cause research results and conclusions drawn from those results to be nonrepresentative of the actual experiences and behaviors of men and/or women: Alpha bias is the tendency to exaggerate differences between men and women and can reinforce gender stereotypes and justify discriminatory practices. In contrast, beta bias is the tendency to ignore or minimize differences between men and women. It can lead to the erroneous conclusion that the results of research that included only male participants also apply to females, and vice versa. Alpha and beta biases have been linked to androcentrism, which means “male-centered” and occurs when male behaviors and traits are considered to be the norm while female behaviors and traits are viewed as deviations from the norm and often as abnormal or inferior. As described by Henrich, Heine, and Norenzayan (2010), WEIRD is an acronym for western, educated, industrialized, rich, and democratic cultures. According to these investigators, studies published in the world’s top journals have over-relied on samples drawn from WEIRD cultures and, consequently, their results may have limited generalizability. As an example, Henrich et al. note that the Big Five personality traits have been derived primarily from research that included WEIRD samples and argue that, as a result, conclusions about the universality of the Big Five drawn from this research may not be valid. Some evidence for this claim is provided by Gurven et al. (2013), who found that the Big Five personality traits do not accurately describe the personalities of a largely illiterate indigenous population of forager-farmers in the Bolivian Amazon. (Note, however, that the universality of the Big Five continues to be debated, with studies like Gurven et al.’s being criticized on methodological grounds.)

Answer 12

Routine outcome monitoring (ROM) is also known as feedback-informed treatment and measurement-based care and is considered to be a transtheoretical and transdiagnostic evidence-based practice (Scott & Lewis, 2015). As described by Lewis et al. (2019), it consists of four components: “(1) a routinely administered symptom, outcome, or process measure …, ideally before each clinical encounter; (2) practitioner review of data; (3) patient review of data; and (4) collaborative reevaluation of the treatment plan informed by the data” (p. 326). ROM may involve the use of clinician rating scales but most often uses standardized patient self-report measures such as the Partners for Change Outcome Management System (PCOMS), which is used to assess a client’s progress and the quality of the therapeutic relationship (Lambert & Harmon, 2018). Studies have confirmed that ROM is more effective than less frequent feedback and is associated with several benefits including increased rates of clinically significant improvement and significant reductions in client deterioration during therapy and premature termination (e.g., Carlier & van Eeden, 2017; Fortney et al., 2017; Lambert, 2010; Lewis et al., 2019). In addition, a number of studies have found that ROM is most effective for clients who are at risk for treatment failure. Despite evidence of its benefits, ROM is underutilized by clinicians due to client and clinician barriers (e.g., Boswell, Kraus, Miller, & Lambert, 2015; Lewis et al., 2019): Client barriers include concerns about confidentiality and the time needed to complete the measures. Clinician barriers include the belief that information provided by ROM is not more accurate than clinical judgment; a lack of training in the use of ROM; unease about the potential effects of ROM on the therapeutic relationship; concerns about the time it takes to administer, score, and interpret measures, create a report, and provide feedback to clients; and concerns about how results of ROM will be used by employers and insurance companies.

Answer 13

Transdiagnostic treatments are designed to address a range of diagnoses that not only share symptoms but also biological, psychological, and environmental mechanisms that increase the risk for and maintain those symptoms. “The premise underlying transdiagnostic treatments is that the commonalities across disorders outweigh the differences and that targeting the … [commonalities] may have a number of important benefits compared to diagnosis-specific approaches” (McEvoy, Nathan, & Norton, 2009, p. 21). For example, transdiagnostic treatments can reduce the cost and amount of time associated with training psychologists to deliver numerous diagnosis-specific interventions and they’re better suited than single-diagnosis treatments for addressing comorbidities. Systematic reviews and meta-analyses of the research have generally confirmed that, in terms of effectiveness, transdiagnostic psychological treatments are equivalent or superior to comparison treatments (Dalgleish, Black, Johnston, & Bevan, 2020). For example, based on the results of their meta-analysis, Newby and colleagues (2015) concluded that transdiagnostic treatments are as effective as diagnosis-specific treatments for anxiety and may be more effective for depression. Some transdiagnostic treatments consist of evidence-based strategies that are applicable to disorders within a single diagnostic category, while others consist of strategies that are applicable to disorders from different categories. Cognitive Behavioral Therapy-Enhanced (CBT-E) is an example of the former and was designed as an intervention for anorexia nervosa, bulimia nervosa, and other eating disorders (Fairburn, Cooper, & Shafran, 2003). It is based on the assumption that these disorders share the same core psychopathology of overvaluation of body shape and weight (Fairburn et al., 2003). Examples of the latter include the following: (a) The Unified Protocol for Transdiagnostic Treatment of Emotional Disorders (UP; Barlow et al., 2011) is an emotion-focused, cognitive-behavioral intervention for anxiety, depression, and related disorders. It views neuroticism as the core characteristic shared by these disorders and focuses on mechanisms associated with neuroticism, including deficits in emotion regulation and avoidance of intense emotional experiences. (b) Emotion-Focused Therapy-Transdiagnostic (EFT-T; Timulak & Keogh, 2020) was developed as a treatment for depression, anxiety, and related disorders and targets the chronic painful emotions of loneliness/sadness, shame, and fear/terror that underlie these disorders. (c) Acceptance and Commitment Therapy (ACT) is a cognitive-behavioral intervention for a wide range of mental health and medical conditions. It is based on the assumption that “pain, grief, disappointment, illness, and anxiety are inevitable features of human life… [and its primary goal is] helping individuals adapt to these types of challenges by developing greater psychological flexibility” (Dindo, Van Liew, & Arch, 2017, p. 546). (d) Parent-Child Interaction Therapy (PCIT) was originally developed as a treatment for disruptive behavior disorders but has since been found to be an effective intervention for anxiety, mood, and trauma-related disorders and child maltreatment. It is based on the premise that emotion dysregulation is “a core process in the etiology of myriad early-onset psychopathology symptoms” (Rothenberg, Weinstein, Dandes, & Jent, 2018, p. 720), and a primary goal of therapy is improving a child’s emotion regulation.

Answer 14

referred to as telehealth and telemental health and is “the provision of psychological services using telecommunication technologies ... [that] include but are not limited to telephone, mobile devices, interactive videoconferencing, email, chat, text, and Internet (e.g., self-help websites, blogs, and social media)” (APA, 2013, p. 792). Interest in telepsychology has increased in recent years, especially with regard to the delivery of evidence-based psychotherapy (EBP). As noted by Wangelin, Szafranski, and Gros (2016), EBP delivered via telepsychology is associated with several benefits over EBP delivered in-person: It decreases patients’ and providers’ costs (e.g., costs related to travel and transportation); increases access to psychotherapy for individuals who have no or limited access (e.g., for members of rural and underserved populations); and reduces the stigma and embarrassment that some individuals experience when receiving psychotherapy at treatment facilities. The research has also found that, in most cases, telepsychology-delivered EBP provides roughly equivalent outcomes for members of diverse populations and a variety of disorders.

Answer 15

There’s evidence that psychotherapy delivered via telepsychology is effective not only for treating individual anxiety disorders but also for treating comorbid anxiety and mood disorders. For example, Berryhill and colleagues (2019b) conducted a systematic review of studies evaluating the effectiveness of videoconference-delivered psychotherapy – most often cognitive-behavioral therapy (CBT) – for treating panic disorder with agoraphobia, generalized anxiety disorder, and social anxiety disorder. Their analysis indicated that the majority of studies found significant improvement in anxiety symptoms following participation in videoconferencing psychotherapy, with controlled studies finding no significant differences between videoconferencing and in-person therapy. In addition, Stubbings, Rees, Roberts, and Kane (2013) compared videoconferencing-delivered CBT to in-person CBT and found them to be similarly effective for reducing comorbid anxiety and depression and improving quality of life

Answer 16

Most studies evaluating the use of telepsychology for treating PTSD have found it to be comparable to face-to-face interventions in terms of effectiveness. For example, in their systematic review of studies evaluating telepsychology for veterans with PTSD, Turgoose, Ashwick, and Murphy (2018) found that trauma-focused therapies (e.g., exposure therapy, behavioral activation) delivered via telepsychology or in-person were similar in terms of the reduction of PTSD symptoms, attendance and dropout rates, client satisfaction, and therapist fidelity to treatment protocols. However, the studies included in their review did not provide entirely consistent results with regard to the therapeutic alliance: While therapists providing telepsychology said they didn’t have trouble developing rapport with clients, some reported barriers to developing a therapeutic alliance, such as the inability to detect nonverbal communications.

Answer 17

The research has demonstrated the effectiveness of telepsychology for treating major depressive disorder. In their systematic review of studies comparing videoconferencing and in-person psychotherapy, Berryhill and colleagues (2019a) found that most studies reported statistically significant decreases in depressive symptoms following videoconferencing psychotherapy, with no statistical differences between videoconferencing and in-person groups receiving the same intervention. There’s also evidence that telepsychology is useful for alleviating the insomnia and chronic pain that often accompany depression (Wangelin, Szafranski, & Gros, 2016). Finally, while a study evaluating the effectiveness of telephone-administered CBT found it to have a lower attrition rate than in-person CBT had, other studies have found that attrition rates for other modes of telepsychology vary, depending on the population and type of intervention (Bee et al., 2008; Mohr et al., 2012).

Answer 18

Research evaluating telepsychology-delivered treatments for bulimia nervosa (BN) has found that it has beneficial effects but is not necessarily as effective as in-person treatments. For example, Mitchell et al. (2008) compared videoconference-delivered and in-person delivered versions of manual-based CBT for BN. Overall, the results indicated that the two versions had similar attrition rates and that both produced beneficial effects on outcome measures following treatment. However, there were some differences: Patients receiving in-person CBT had non-significantly higher rates of abstinence from binge eating and purging and significantly greater reductions in eating disordered cognitions and depression. In a more recent study, Zerwas and colleagues (2017) compared a manualized version of CBT group therapy for BN delivered via an Internet chat group and the same treatment delivered via traditional face-to-face group therapy. They found that patients in both groups experienced a decrease in binge eating and purging and comorbid symptoms of depression and anxiety by the end of treatment but that there were some group differences: Immediately after treatment ended, patients receiving face-to-face group therapy had a greater decrease in abstinence rates and anxiety symptoms, but the gap between the two groups on these measures narrowed at the 12-month follow-up, indicating that the pace of recovery was slower for patients who received therapy via the Internet.

Answer 19

“ _______ is a model of healthcare delivery with two fundamental features. First, the recommended treatment within a stepped care model should be the least restrictive of those currently available, but still likely to provide significant health gain. Second, the stepped care model is self-correcting … [which means] that the results of treatments and decisions about treatment provision are monitored systematically, and changes are made (‘stepping up’) if current treatments are not achieving significant health gain” (Bower & Gilbody, 2005, p. 11). The primary goals of stepped care are to increase the efficiency of health care services and the accessibility of effective treatments through better allocation of scarce mental health resources. There are several models of stepped care: Some apply to specific disorders, while others are non-specific and can be applied to various disorders and conditions. With regard to the former, commonly cited models for depression usually include four steps that are similar to those described by Broten, Naugle, Kalata, and Gaynor (2011): Step 1 - Assessment and Monitoring: This step includes evaluating the patient’s symptoms and “watchful waiting” which is appropriate for patients with minor depressive symptoms and involves monitoring their symptoms. Step 2 – Interventions Requiring Minimal Practitioner Involvement: Step 2 interventions include psychoeducation about the symptoms and course of depression, treatment options, and signs of relapse; bibliotherapy as a preventive technique for patients who are at high risk for depression or are experiencing an increase in symptoms and as an adjunct to other treatments; and computer-based interventions that track patients’ symptoms and use multimedia with interactive components designed to help patients cope with depression and anxiety. Step 3 – Interventions Requiring More Intensive Care and Specialized Training: This step may include group therapy, individual psychotherapy, and/or medication. (Note that some models identify group psychotherapy and brief individual psychotherapy as initial choices for this step followed by longer-term psychotherapy with or without antidepressant medication for patients who do not respond adequately to group or brief individual therapy.) Step 4 – Most Restrictive and Intensive Forms of Care: This step is for patients with severe depressive symptoms and consists of voluntary or mandated inpatient care.

Answer 20

As described in the Americans with Disabilities Act (ADA), a person with a disability has a physical or mental impairment that substantially limits a major life activity, has a record of such impairment, or is regarded as having such an impairment because of an actual or perceived physical or mental impairment. Experts distinguish between a variety of disability models, but most categorizations include the medical and social models. For example, the American Psychological Association’s (2012) Guidelines for the Assessment of and Intervention with Persons with Disabilities distinguishes between four scientific models of disability: biomedical, social, functional, and forensic. The biomedical model is also known as the medical model and views disabilities as medical conditions that deviate from the norm and disrupt a person’s physical and/or cognitive functioning. From this perspective, a disability is intrinsic to the individual and the focus of intervention is on identifying and providing treatments that will manage, alter, or cure the medical condition causing the disability. The social model views a disability as a difference rather than an abnormality or deficiency and as due primarily to aspects of society that create barriers for people with disabilities (e.g., negative attitudes, discrimination, exclusion, architectural barriers). Interventions based on this model focus on making societal and environmental changes. The functional model views a disability as the cause of a person’s inability to perform his or her function or role at work or elsewhere. It recognizes a person’s medical condition but focuses on identifying what accommodations, modifications, or assistive technology devices are needed to improve the person’s functioning (Chronister & Fitzgerald, 2018). Finally, the forensic model focuses on legal concepts and “requires objective proof of impairment and disability and determination of the honesty and motivation of individuals seeking recognition, benefits, or compensation for disability” (APA, 2012, p. 45). In other words, the primary focus of this model is on distinguishing between honest and dishonest people (e.g., malingerers) in order to identify the appropriate interventions or consequences.

Clinical Psychology Prevention, Consultation, and Psychotherapy Research Flashcards

(45 cards)