Behavior therapy versus psychoanalysis: Therapeutic and social implications.

Although the specific efficacy of psychoanalytic therapy in the treatment of the neuroses has never been demonstrated, psychoanalytic theory and practices continue to dominate the field of clinical psychology. That psychoanalytic theory has not been displaced by the behavioral theory of neurosis is seen as remarkable in view of the persuasive evidence that exists for the efficacy of behavior therapy. One reason for this seems to be the persistence of widespread misperceptions of behavior therapy. It has been represented to the public as an "inhuman" treatment that routinely resorts to electric shocks and other unpleasant agents and to the profession as a therapy incognizant of the patient's feelings or thoughts and applicable only to neuroses that are "simple," such as phobias—an image regularly reinforced by "authorities" who are misinformed. This article attempts to correct these misperceptions. It also draws attention to the suffering imposed on many by years of psychoanalysis. (37 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Demonstrating therapeutic validity versus the false placebo–therapy distinction.

Discusses research problems in differentiating between effective and ineffective therapies. It is suggested that distinguishing between therapies and placebos is based on theoretical misconceptions and that research needs to focus on developing and assessing psychotherapies that show treatment effects in specific target problems. Evidence for the specificity of treatment effects and differences between outcome and process psychotherapy research are also discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Behavior therapy better than placebo treatments: Fact or artifact?

N. Brody's (see record 1990-12934-001) comment on our meta-analysis (T. G. Bowers and G. A. Clum; see record 1989-16477-001) seems to suggest that the efficacy of behavior therapy has not been established relative to placebo control conditions, especially for "neurotic conditions." The comments appear directed at defending an earlier meta-analysis (Priouleau, Murdock, & Brody, 1983) that concluded that psychotherapy was not more efficacious than a placebo control. We agree with Brody regarding the need for increased use of the heteromethod approach and longer follow-up for psychotherapy studies. However, we do not agree that the 10 studies Brody selected do not support the effectiveness of behavior therapy relative to placebo controls. Although a set of 10 studies is probably too small to allow robust conclusions, we noted a median effect size of .63 for those studies of neurotic conditions, relative to a placebo control. These results were very similar to our overall findings from 69 studies. Furthermore, available follow-up data suggest moderate effect sizes exist for those studies. We also comment on the existence of Type I and Type II errors of inference in reviews and meta-analyses. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Phenazone versus placebo: effects on post-operative course

In a double-blind crossover study essentially the same operation was performed twice in 24 patients who required surgical removal of bilateral "identically" impacted wisdom teeth. On one occasion they were given phenazone (1.0 g X 4 for 2 days, then 0.5 g X 4 for the next 2 days), on the other placebo tablets. Several objective and subjective assessments were recorded to permit paired comparison of the post-operative courses. Swelling on the 3rd day after the operation when phenazone was given averaged 82% of that when placebo was used (p > 0.10). The local temperature increase was somewhat reduced with phenazone (0.72 vs 1.10 degrees C) and there was a smaller reduction in mouth-opening ability (29 vs 41%), but there was a tendency towards a slightly greater post-operative bleeding score with the drug. Significant pain relief was obtained with phenazone according to assessment both by fixed interval scores and a visual analogue scale. Although nausea was experienced by some of the patients when given phenazone (possibly related to the rather high dose), the preference scores were clearly in favour of the drug. Compared to results previously obtained in this model, phenazone may be preferable to acetylsalicylic acid in oral surgery, but phenazone does not compare favourably with the results obtained with paracetamol.     

Comment on Critelli and Neumann's "The placebo."

Asserts that, in their article on the placebo effect, J. W. Critelli and K. F. Neumann (see record 1984-26517-001) failed to recognize that treatment cannot be of benefit if a patient knows that a treatment is a placebo. Critelli and Neumann's contention that placebo factors (the mere belief that improvement will result from treatment) could legitimately comprise all that is active in psychotherapy is criticized. It is argued that any therapy that succeeds only because of placebo effects will eventually lose credibility. (3 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Clinical versus mechanical prediction: A meta-analysis.

The process of making judgments and decisions requires a method for combining data. To compare the accuracy of clinical and mechanical (formal, statistical) data-combination techniques, we performed a meta-analysis on studies of human health and behavior. On average, mechanical-prediction techniques were about 10% more accurate than clinical predictions. Depending on the specific analysis, mechanical prediction substantially outperformed clinical prediction in 33%–47% of studies examined. Although clinical predictions were often as accurate as mechanical predictions, in only a few studies (6%–16%) were they substantially more accurate. Superiority for mechanical-prediction techniques was consistent, regardless of the judgment task, type of judges, judges' amounts of experience, or the types of data being combined. Clinical predictions performed relatively less well when predictors included clinical interview data. These data indicate that mechanical predictions of human behaviors are equal or superior to clinical prediction methods for a wide range of circumstances. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Behavior therapy: Observations and reflections.

Presents impressions based on 5 days' observation of the clinical activities of Joseph Wolpe and Arnold Lazarus at the Eastern Pennsylvania Psychiatric Institute: (1) behavior therapists now treat a wider range of patients and use a greater variety of treatment methods than before; (2) treatment is becoming longer and more complicated, with concomitant lowering of success rates; (3) clinical inference is essential in diagnosis, hierarchy selection, patient management, and ongoing evaluation; and (4) elements of suggestion in the patient-therapist reltionship may play a powerful role in treatment. Implications of these impressions for research and clinical training are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Double-blind versus deceptive administration of a placebo.

Subjects were given varying doses of a placebo, consisting of decaffeinated coffee, with double-blind or deceptive instructions. Deceptive administration simulated clinical situations in that subjects were led to believe that they were receiving an active drug. In contrast, subjects in double-blind conditions were aware that they might receive a placebo. Double-blind and deceptive administration of the placebo produced different, and in some instances, opposite effects on pulse rate, systolic blood pressure, and subjective mood. Deceptive administration produced an increase in pulse rate, whereas double-blind administration did not. A theoretically predicted curvilinear effect on systolic blood pressure, alertness, tension, and certainty of having consumed caffeine was confirmed with deceptive administration, but not with double-blind administration. Double-blind administration produced curves in the opposite direction on each of these variables. The effects of the placebo on motor performance varied as a function of subjects' beliefs about the effects of caffeine. These data challenge the validity of double-blind experimental designs and suggest that this common method of drug assessment may lead to spurious conclusions. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Comment on research in behavior therapy.

Discusses the 3 major criticisms of D. Begelman and M. Hersen (see pa, vol. 47:issue 1): (a) the measurement of awareness, (b) the parental rating scale, and (c) the exact nature of the therapeutic technique employed. Questions are raised concerning whether it is possible to clearly separate the various behavior modification techniques empirically or theoretically. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Comment on "Anxiety and Behavior Scientists' Behavior".

Comments on the article by L. Levy (see record 1962-03110-001) regarding anxiety and behavior scientists' behavior. Levy attempts to demonstrate a relationship between the publication of two instruments for the measurement of anxiety (Taylor's Manifest Anxiety scale, MA, and the Children's Form of the Manifest Anxiety scale, CMA) and a subsequent rise in published research dealing with anxiety. However, the current author argues that a casual glance at Levy's graph showing year-by-year changes in the percentage of papers listed under "anxiety" in Psychological Abstracts reveals that the trend toward greater interest in anxiety precedes the publication of Taylor's original paper in 1951. In addition a perusal of the biochemical or pharmacological literature shows this same increasing trend toward anxiety as a focus of interest anteceding the MA. The current author suggests that we should not be alarmed if the development of these two anxiety measures has indeed stimulated interest in the problem of anxiety and it would seem reasonable to hypothesize that they have to some extent. What is objected to is not Levy's hypothesis but the feast of non sequiturs he cites in support of it. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Behavior therapy: A review.

The questionable effectiveness of traditional psychodynamic psychotherapies and the development of brief new treatment techniques derived from modern learning theory have stimulated interest in applications of conditioning procedures to behavior disorders. A review of this literature revealed that behavior therapies have been applied to many neurotic and psychotic disorders, and have been most successful with disorders involving specific maladaptive behaviors. Conditioning procedures were highly effective with phobic reactions, anxiety reactions, enuresis, stuttering, and tics, but disappointing with alcoholism and some sexual disorders. Cures seemed long-lasting, with remarkably little evidence of the symptom substitution predicted by psychodynamic depth theories. Behavior therapy offers promising opportunities for the application of well-established psychological principles to the treatment of maladaptive behavior. (4 p. ref.) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Effectiveness of grief therapy: A meta-analysis.

This meta-analysis addressed the question of how effective grief therapy is and for whom, using B. J. Becker's (1988) techniques for analyzing standardized mean-change scores. Analyses were based on 35 studies (N?=?2,284), with a weighted mean effect size (ES) of δ+?=?0.43 (95% confidence interval?=?0.33 to 0.52). Clients in no-treatment control groups showed little improvement (d=?=?0.06), possibly because of the relatively long delay between loss and treatment in most studies (mean delay?=?27 months). Moderators of treatment efficacy included time since loss and relationship to the deceased. Client selection procedures, a methodological factor not originally coded in this meta-analysis, appeared to contribute strongly to variability in ESs: a small number of studies involving self-selected clients produced relatively large ESs, whereas the majority of studies involving clients recruited by the investigators produced ESs in the small to moderate range. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Positive psychology versus the medical model?: Comment.

Comments on "Positive psychology progress: Empirical validation of interventions" by Seligman, Steen, Park, and Peterson (see record 2005-08033-003). Seligman and colleagues provided a progress report on positive psychology, reviewing the impressive developments over the past five years. We wholeheartedly support the positive psychology movement and believe its success is a testimony to Seligman's vision and leadership. However, in looking back over the past five years, we are mindful of what the next five years may hold and are concerned over the future direction and development of the positive psychology movement. Positive psychology as a movement largely continues to operate within the medical model and thus to implicitly condone the "medicalization" of human experience. If positive psychology is seen only as a supplement, then a limited view is offered in which positive psychology may only be relevant as an "extra" for those who are already capable and well-functioning rather than as a useful guide for people wherever they are on the continuum of functioning. Our vision is that positive psychology should stand in contrast to the medical model and its impetus toward the medicalization of human experience. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Rational-emotive therapy, placebo, and no-treatment effects on public-speaking anxiety.

In a partial replication and refinement of an earlier study by the authors, 33 undergraduates reporting high levels of public-speaking anxiety received rational-emotive therapy (RET), attention placebo (AP), or no treatment (NT). Primary analyses of pre- to posttherapy changes as assessed with a variety of self-report and observational measures tended to support the conclusion that RET is more effective than either NT or the AP treatment used (relaxation training). Secondary analyses which included AP and NT Ss, who received RET immediately after serving in the AP and NT conditions, further support RET treatment effects. (32 ref.) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Coaching versus therapy: A perspective.

This article reports a study of current perceptions among professionals regarding therapy and coaching. Whereas therapy and counseling have been traditional fields of study and practice, coaching is not as well developed. It is helpful to examine the perceptions of practicing professionals in order to delineate the distinctions and overlaps in these modalities. A set of 7 questions was used to explore these viewpoints with a participant pool of professional coaches--therapists. Interview data and narrative summaries provide a perspective on the controversy of coaching versus therapy. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

A meta-analysis of the effectiveness of placebo manipulations in alcohol-challenge studies.

Our meta-analysis examined the impact of specific alcohol placebo procedures on two manipulation checks (participant reports of number of alcohol drinks consumed and subjective intoxication) to determine which procedures produced the smallest effect sizes in comparisons between alcohol and placebo conditions. Databases for the years 1990–2007 yielded 44 studies that met inclusion criteria. These were subjected to detailed coding of procedures pertinent to placebo effectiveness. Alcohol versus placebo condition comparisons generally produced large effect sizes for both manipulation checks, but they were moderated by double-blind procedures and by peak breath-alcohol concentration (BrAC) attained in the alcohol condition. Other procedures moderated only the estimated number of alcohol drinks consumed. Implications for selection and assessment of alcohol placebo manipulations and for interpretability of experiments using them are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Cognitive-behavioral therapy in geriatric depression: Comment on Steuer et al.

Comments on and agrees with the findings of J. L. Steuer et al (see record 1987-21146-001) that both cognitive-behavioral and psychodynamic group therapies led to significant reductions in depression in geriatric patients, as measured by the short form of the Beck Depression Inventory (BDI) and by the Hamilton Psychiatric Rating Scale, but disagrees with their conclusion that the cognitive therapy did not produce a clinically meaningful treatment superiority. For the present study, a regression equation was used to predict equivalent short-form BDI values from full-scale scores in a clinical sample of 208 adult outpatients with affective disorders. It is suggested the significant treatment superiority obtained for cognitive therapy on the BDI is accurate and meaningful. (11 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Self-changers versus therapy changers versus Schachter.

Comments that S. Schachter (see record 1982-30809-001) has tended to overstate the importance of his data. The present author questions Schachter's apparent belief concerning the adverse effects of therapy and notes that a substantial majority of patients change for the better during therapy. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Obituary: Kenneth S. Bowers (1937–1996).

Memorializes Kenneth S. Bowers, who is noted as one of the world's preeminent hypnosis researchers and an important contributor to personality and cognitive psychology. A very lucid and persuasive writer, Bowers published more than 50 journal articles, 20 book chapters, and 2 books. One of the books, Hypnosis for the Seriously Curious (1976), is still widely regarded as the best general introduction to hypnosis. Many of his research contributions involved the application of E. R. Hilgard's neodissociation theory of divided consciousness to the understanding of a wide range of hypnotic phenomena, including posthypnotic suggestions, hallucinations, analgesia, and amnesia. (PsycINFO Database Record (c) 2010 APA, all rights reserved)