Examine issues surrounding research methodologies and empirical support for current psychotherapeutic interventions. In the early 1990’s Division 12 of the American Psychological Association, the Society of Clinical Psychology, established criteria for determining the quality and quantity of existing research supporting a particular treatment for a variety of disorders. In 1995, Division 12 categorized treatment meeting these criteria as either well-established or probably efficacious with both sets of criteria requiring replicated demonstrations of efficacy through high quality trials or case series.
For the treatment of Post-Traumatic Stress Disorder, three trauma-focused treatments and one non-trauma focused treatment are currently deemed as well-established. In addition, another non-trauma focused treatment is presently identified as probably efficacious. One other treatment is considered potentially harmful, and is without research support.
- Using this link, www.psychologicaltreatments.org, navigate to the APA Division 12 website.
- First, by perusing the website, briefly state the difference between well-established and probably efficacious.
- Then, under the Disorders tab, find PTSD and identify both the well-established treatments and the treatment regarded as probably efficacious. Provide a brief description of each treatment (either from the description provided on the website or from another source).
- Next, locate a recent (no older than five years) peer-reviewed article that both describes a treatment’s protocol and examines its efficacy for each of the five treatments (do not use the references provided on the Division website as they are generally older than five years). You may use articles that compare two or more of the treatments but you must obtain a total of five articles.
- Now, briefly provide a summary of the specific treatment provided (e.g. number of sessions, the content of the sessions, etc.) as well as a summary of the methodology of the study contained in each article including the sample, sample size, assessment measures used and the results of the study. Do this for all five articles.
- Based on your analysis of all five treatments, indicate which treatment you yourself would be most likely to use when treating someone suffering from PTSD. In your response, include the answers to these questions:
- Based on what you have learned, how important do you think it is to process the actual trauma with the client (as opposed to teaching the client current adaptive responses/coping tools)? Provide your rationale.
- Under what circumstances would you consider using a treatment that is not considered to be empirically validated (well-established or probably efficacious)?
Analysis indicated that field of research and practice in psychotherapy has been deeply influenced by two different methodologies. The first methodology is the empirically supported treatment (ESTs) movement, connected to the evidence-based medicine (EBM) perspective. The second methodology is the Common Factor approach, which is typically linked with the “Dodo Bird Verdict”(Castelnuovo, 2010). The first methodology, the list of ESTs was established since 1998 in the mental health field. Recent studies indicated that the criterions for probably and well-established efficacious treatment has increased significantly. The increase of the paradigms was attributed to the emergence of the managerial methodology and the similar systems for remunerations which included insurance companies and health providers.
For many years psychotherapy researchers have been struggling to resolve a fundamental question concerning the real effectiveness of psychotherapeutic treatments. As research methodologies become more refine, the researchers shifted their focus to the classification of specific treatments, identification and the particular examination, which have exhibited effectiveness in experimental setting for generally recognized psychopathologies away from the traditional general demonstration of the effectiveness of psychotherapy(Fonagy, 2015). In order to determine the issues surrounding research methodologies and empirical support for current psychotherapeutic interventions, the researcher needs to ask themselves about the treatment, the prescription and the circumstance under which the prescription was most effective to the specific problem.
Several studies have attempted to examine the significant outcome in psychotherapy research. Some of the researcher focused on the widespread approaches, which utilized the common factors perspective theories to validate the “Dodo Solution”. While other researchers focused on the development of the “Empirically Supported Treatment” which utilizes the evidence based medicine philosophy(Fonagy, 2015). According to Lambert (2005), common factor approach involves the dimension of the treatment such as client, therapy and therapist are not based on the any specific particular technique. Critical analysis indicated that the main idea behind the common factor was to examine the causal mechanism such as therapeutic relationship, therapist confidence and expectation for improvement connected with human wisdom, kindness, acceptance, understanding, warmth and trust.
Further analysis indicated that common factor can be expanded to include causal mechanism that are normally perceived as unique to a specific form of treatment such as assisting the clients to master the treatment through rehearsing and practicing behavior, encouraging them to take part in risk behaviors other than avoiding situation that makes the patients feel uncomfortable as well as encouraging the clients to participate in the treatment procedures that leads to exposure to anxiety-provoking stimuli(Castelnuovo, 2010). Despite the fact that specific theories of psychotherapy put more emphasis on systematic in vitro or in vivo exposure to frightening social-skills training or situations, almost all the therapies support all patients to discuss and review the situations they face and fear instead of avoiding these situations.
This means that regardless of the important role common factor contributes in the psychotherapy studies particular theories considered this approach as insignificant. Also, it is important to note that common factor approach is core to almost all psychological interventions in practice. One of the article that comprehensively used common factor approach to conduct the study is Karver et al (2005) model.
Empirically supported (evidence-based) approach
Recent studies have indicated that empirically supported treatment has proved effective based on the validation of the treatment, thus earning credibility and power due to the support from the professionals and political economic forces such as guidelines for accreditation within doctorate program in clinic psychology, protocol of the American Psychological Association (APA), developments in biological psychiatry and managed health Care. According to Schnyder (2009), the effectiveness of psychotherapy for the functional treatment of many mental disorder is empirically well documented. From the perspective of evidence-based medicine psychotherapy can be considered as one of the most effective therapeutic approach just like any other medical treatment such as pharmacology.
The corroborate the above statement, the National Institute of Mental Health (NIMH), which is the main financier of psychotherapy research advocates for the application of the methodology utilized in pharmaceutical research to examine psychotherapy, with the development of controlled and random clinical trials. Whereas many studies considered randomized controlled trials (RCTs) as the appropriate standard in the psychotherapy research, clinical practitioners have highly criticized the approach(Schnyder, 2009). In contrast to these criticism, Division 12 of the APA commonly referred to as Clinical Psychology formed a task force with the mandate of diffusing and promoting treatment protocols that have been proven experimentally to be effective.
The outcome of the task force has led to drawing up a minimum level of criterion needed to validate as effective a given psychotherapy, with a list of experimentally proven treatment which have been approved or rejected. Therefore, criteria established by the task force are not the goal to verify the clinical effectiveness of a treatment, based on the external validity of a therapy, but only the experimental effectiveness of a treatment or the validity of experimental results.
The issues of empirically supported treatment
Many studies have shown that empirically supported treatment has no significant issues in the clinical practice. For instance, few literatures have reported the incidence of minimal patients receiving empirically supported treatment regardless of the high volumes of paper, reports and documents published in support of effective treatment(Lambert, 2005). It is important to note that RCTs approach which is the major supporter is of EBM perceives that efficacy studies are more suitable in the clinical field. While psychotherapists considers value effectiveness studies to be more suitable since they are accurate and represent the reality of clinical practice.
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