Concerns regarding the traditional paradigm for causal research: The unified paradigm and causal research in scientific psychology.

The traditional paradigm refers to the assumption held by most methodologists and researchers that causal research must be defined in terms of the causal powers evident in a closed system. The traditional paradigm does not concord, however, with the nature of scientific theories often cited in the methodological and research literature. The unified paradigm is introduced and causal research defined in terms of the causal powers evident in an open system. Notable implications of the unified paradigm are that experimental methods do not provide a better opportunity than modeling methods to conduct a causal analysis and that the nomenclature often used to describe the validity of causal conclusions must be amended. Additional implications of the unified paradigm are discussed and includes a comparison of the traditional paradigm and the unified paradigm when applied to treatment-outcome research. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Integrating outcome research and clinical reasoning in psychotherapy planning.

This article reviews the strengths and weaknesses of outcome research and clinical reasoning as bases of treatment planning and presents a synthesis in which these two types of information complement each other. The author proposes that therapy planning should begin with a review of the relevant outcome literature and also that divergence from research-based guidelines might be warranted under several conditions, including (a) when the client is demographically or culturally dissimilar to the study samples, (b) when assessment suggests a mismatch between the etiologies of the client's disturbance and the processes addressed by empirically supported treatments, and (c) when use of such treatments is followed by a lack of progress that signals the advisability of midcourse correction. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Beyond the illusion of structural change: A process priming approach to psychotherapy outcome research.

Psychoanalytically oriented psychotherapy outcome research has yet to differentiate between a psychological structure that is present but temporarily inactive and genuine change in that underlying structure. Thus, a decrease in maladaptive responding following treatment may sometimes reflect illusory structural change, with the patient remaining vulnerable to relapse in situations that activate the underlying pathogenic structure. Genuine structural change would be better assessed by deliberately seeking and failing to find evidence of the enduring presence of a pathogenic structure under conditions that typically activate that structure, using both implicit (e.g., free response) and explicit (self-report) outcome measures. Because implicit and explicit measures are differentially affected by situational variables (e.g., mood, mindset priming), rigorous psychotherapy research must use experimental techniques and multimodal assessments to assess outcome under the conditions most likely to evoke a pathological reaction in a seemingly recovered individual. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

Psychotherapy outcome and quality improvement: Introduction to the special section on patient-focused research.

This article introduces the special section of the Journal of Consulting and Clinical Psychology on patient-focused research for improving the outcome of psychological therapies. After a discussion of the context, promise, and problems associated with this research domain, an overview of the contributions is offered. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The role of method in treatment effectiveness research: Evidence from meta-analysis.

A synthesis of 319 meta-analyses of psychological, behavioral, and educational treatment research was conducted to assess the influence of study method on observed effect sizes relative to that of substantive features of the interventions. An index was used to estimate the proportion of effect size variance associated with various study features. Study methods accounted for nearly as much variability in study outcomes as characteristics of the interventions. Type of research design and operationalization of the dependent variable were the method features associated with the largest proportion of variance. The variance as a result of sampling error was about as large as that associated with the features of the interventions studied. These results underscore the difficulty of detecting treatment outcomes, the importance of cautiously interpreting findings from a single study, and the importance of meta-analysis in summarizing results across studies. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The outcome of psychotherapy: A selected analysis of research findings.

A selective review of outcome studies of psychotherapy with emphasis on the major methodological issues of spontaneous recovery and methods of experimental control. The results of 9 studies which used experimental controls were assessed in terms of their limitations and merits in demonstrating the effectiveness of psychotherapy. It is concluded that outcome research with available techniques could be fruitful even though conclusions based on present research must be carefully qualified. (30 ref.) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Comparative outcome evaluations of psychotherapies: Guidelines for addressing eight limitations of the gold standard of causal inference.

Although randomized experiments represent the gold standard in causal research, their limitations are easily overlooked, especially in field experiments. Although discussions of the limitations of field experiments typically detail problems of design implementation, field experiments have limitations even if their randomized designs are successfully implemented. This is particularly true of comparative evaluations of psychotherapy programs. Accordingly, this article focuses on eight limitations that pervade such comparative treatment research: (a) Direct and indirect effects are conflated; (b) the investigation of interactions is limited; (c) attention is diverted from background conditions; (d) temporal factors complicate causal inferences; (e) the stable-unit-treatment-value assumption is easily violated; (f) therapist effects can confound therapy method effects; (g) differential effects of treatment methods are small; and (h) generalizability of treatment research findings is indeterminate. In addition to explaining each limitation, the author proposes research strategies for addressing it. The author concludes that attention to these 8 limitations and to the various strategies for overcoming them can increase increase the causal contribution of experimental evaluations of psychotherapies. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The effects of manual-based training on treatment fidelity and outcome: A review of the literature on adult individual psychotherapy.

The authors examine training issues related to the use of treatment manuals in psychotherapy outcome research. In particular, they examine methodological considerations such as the operationalization of manual-based training, trainer effects, therapist variables that mediate training, issues related to experimental design, and the choice and definition of appropriate dependent variables. The research literature indicates that manual-based training can produce technical adherence. Improvements in treatment competence were seen within, as opposed to across, cases. Researchers have been unable to draw strong links between treatment fidelity and patient outcomes. The review concludes that the limited focus on training studies in the manual-based treatment field compromises conclusions drawn from psychotherapy outcome research that relies on manuals to ensure a uniform delivery of the experimental variable. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The generalization of expectancies.

To test the proposition that generalization of expectancy changes occurs along a dimension of learned-goal similarity, a level-of-aspiration paradigm was utilized. The results were dealt with in terms of proportion of Ss who changed their expectancies on three generalization tasks (which varied in goal-relatedness to a control task by decreasing amounts) after experiencing success or failure on the control task. The data supported the hypothesis and indicated that the three tasks were significantly different from each other in relative position along the dimension of goal similarity. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The special status of actions in causal reasoning in rats.

A. P. Blaisdell, K. Sawa, K. J. Leising, and M. R. Waldmann (2006) reported evidence for causal reasoning in rats. After learning through Pavlovian observation that Event A (a light) was a common cause of Events X (an auditory stimulus) and F (food), rats predicted F in the test phase when they observed Event X as a cue but not when they generated X by a lever press. Whereas associative accounts predict associations between X and F regardless of whether X is observed or generated by an action, causal-model theory predicts that the intervention at test should lead to discounting of A, the regular cause of X. The authors report further tests of causal-model theory. One key prediction is that full discounting should be observed only when the alternative cause is viewed as deterministic and independent of other events, 2 hallmark features of actions but not necessarily of arbitrary events. Consequently, the authors observed discounting with only interventions but not other observable events (Experiments 1 and 2). Moreover, rats were capable of flexibly switching between observational and interventional predictions (Experiment 3). Finally, discounting occurred on the very first test trial (Meta-Analysis). These results confirm causal-model theory but refute associative accounts. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

How causal knowledge affects classification: A generative theory of categorization.

Several theories have been proposed regarding how causal relations among features of objects affect how those objects are classified. The assumptions of these theories were tested in 3 experiments that manipulated the causal knowledge associated with novel categories. There were 3 results. The 1st was a multiple cause effect in which a feature's importance increases with its number of causes. The 2nd was a coherence effect in which good category members are those whose features jointly corroborate the category's causal knowledge. These 2 effects can be accounted for by assuming that good category members are those likely to be generated by a category's causal laws. The 3rd result was a primary cause effect, in which primary causes are more important to category membership. This effect can also be explained by a generative account with an additional assumption: that categories often are perceived to have hidden generative causes. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Therapist adherence/competence and treatment outcome: A meta-analytic review.

Objective: The authors conducted a meta-analytic review of adherence–outcome and competence–outcome findings, and examined plausible moderators of these relations. Method: A computerized search of the PsycINFO database was conducted. In addition, the reference sections of all obtained studies were examined for any additional relevant articles or review chapters. The literature search identified 36 studies that met the inclusion criteria. Results: R-type effect size estimates were derived from 32 adherence–outcome and 17 competence–outcome findings. Neither the mean weighted adherence–outcome (r = .02) nor competence–outcome (r = .07) effect size estimates were found to be significantly different from zero. Significant heterogeneity was observed across both the adherence–outcome and competence–outcome effect size estimates, suggesting that the individual studies were not all drawn from the same population. Moderator analyses revealed that larger competence–outcome effect size estimates were associated with studies that either targeted depression or did not control for the influence of the therapeutic alliance. Conclusions: One explanation for these results is that, among the treatment modalities represented in this review, therapist adherence and competence play little role in determining symptom change. However, given the significant heterogeneity observed across findings, mean effect sizes must be interpreted with caution. Factors that may account for the nonsignificant adherence–outcome and competence–outcome findings reported within many of the studies reviewed are addressed. Finally, the implication of these results and directions for future process research are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Propensity score techniques and the assessment of measured covariate balance to test causal associations in psychological research.

There is considerable interest in using propensity score (PS) statistical techniques to address questions of causal inference in psychological research. Many PS techniques exist, yet few guidelines are available to aid applied researchers in their understanding, use, and evaluation. In this study, the authors give an overview of available techniques for PS estimation and PS application. They also provide a way to help compare PS techniques, using the resulting measured covariate balance as the criterion for selecting between techniques. The empirical example for this study involves the potential causal relationship linking early-onset cannabis problems and subsequent negative mental health outcomes and uses data from a prospective cohort study. PS techniques are described and evaluated on the basis of their ability to balance the distributions of measured potentially confounding covariates for individuals with and without early-onset cannabis problems. This article identifies the PS techniques that yield good statistical balance of the chosen measured covariates within the context of this particular research question and cohort. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Does the alliance cause good outcome? Recommendations for future research on the alliance.

Research has consistently documented that the quality of the therapeutic alliance is related to the outcome of diverse psychotherapies. Insufficient attention, however, has been directed at identifying the nature and magnitude of the causal relationship between the alliance and outcome. In this commentary, we discuss the major threats to causal interpretation of alliance-outcome correlations and provide suggestions for future research that would help clarify the extent to which the alliance causes positive outcomes. Assuming the alliance is a causal factor in relation to outcome, we provide recommendations for research on the alliance that would attempt to improve patient care by enhancing the alliance. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Treatment integrity in psychotherapy research: Analysis of the studies and examination of the associated factors.

Treatment integrity refers to the degree to which an intervention is delivered as intended. Two studies evaluated the adequacy of treatment integrity procedures (including establishing, assessing, evaluating, and reporting integrity; therapist treatment adherence; and therapist competence) implemented in psychotherapy research, as well as predictors of their implementation. Randomized controlled trials of psychosocial interventions published in 6 influential psychological and psychiatric journals were reviewed and coded for treatment integrity implementation. Results indicate that investigations that systematically addressed treatment integrity procedures are virtually absent in the literature. Treatment integrity was adequately addressed for only 3.50% of the evaluated psychosocial interventions. Journal of publication and treatment approach predicted integrity implementation. Skill-building treatments (e.g., cognitive-behavioral) as compared with non-skill-building interventions (e.g., psychodynamic, nondirective counseling) were implemented with higher attention to integrity procedures. Guidelines for implementation of treatment integrity procedures need to be reevaluated. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The social psychological nature of stress: A framework for causal inquiry.

A theoretical formulation exemplified by 8 propositions is offered, which attempts an understanding of the consequence of social-psychological stress upon the individual. This formulation is based on the paradigm established by Hans Selye and the effect of stress upon the physiopsychological condition of the organism. From Psyc Abstracts 36:04:4CA94D. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Patient-focused research: Using patient outcome data to enhance treatment effects.

A program of research aimed at improving the quality of psychological interventions is described. Data from over 10,000 patients were analyzed to understand the association between number of treatment sessions and clinically significant improvement. In addition to a potential dose-response relationship, typical recovery curves were generated for patients at varying levels of disturbance and were used to identify patients whose progress was less than expected ("signal" cases). The consequences of passing this information along to therapists were reported. Analyses of dose-response data showed that 50% of patients required 21 sessions of treatment before they met criteria for clinically significant improvement. Seventy-five percent of patients were predicted to improve only after receiving more than 40 treatment sessions in conjunction with other routine contacts, including medication in some cases. Identification of signal cases (potential treatment failures) shows promise as a decision support tool, although further research is needed to elucidate the nature of helpful feedback. Outgrowths of this research include its possible contribution to social policy decisions, reductions in the need for case management, use in supervision, and possible effects on theories of change. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Semantic generalization of classically conditioned responses: A review.

25 experiments on semantic generalization of classically conditioned responses are reviewed. Several major methodological inadequacies are discussed. These included frequent failure to convincingly demonstrate conditioning, failure to distinguish between generalization effects and extinction effects, and failure to control for simultaneous conditioning to the generalization stimuli. 2 alternative inferred mechanisms of generalization are discussed. While mediation by common responses is not strongly supported by evidence, there is suggestive evidence of the importance of Ss' categorizing generalization stimuli as similar to the conditioned stimuli, as evidenced by Ss' reported expectation of reinforcement. (50 ref.) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Relationship between patient-doctor compatibility, mutual perception, and outcome of treatment.

An investigation was designed to study the effects of patient-doctor Fundamental Interpersonal Relations Orientation Behavior (FIRO-B) scale compatibility upon outcome of hospital treatment and upon perceptions developed of each other in the dyadic relationship. The latter variable was measured by administration of a Semantic Differential Scale under differing instructonal "sets." A total of 25 voluntarily hospitalized female patients and 3 psychiatric residents participated. The degree of compatibility existing between patient and doctor was found to have been positively correlated with outcome of treatment. This effect upon outcome of treatment appeared to have occurred through the differential effect the compatibility variable had upon the way the resident was perceived by the patient. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Predicting cocaine group treatment outcome in cocaine-abusing methadone patients.

The authors examined predictors of cocaine group treatment outcome in methadone maintenance treatment (MMT) patients, including cocaine urinalysis at intake and demographic variables. Clinic policy is that patients identified as using cocaine must attend a weekly cocaine-focused, cognitive–behavioral therapy (CBT) group. Cocaine treatment is based on a behavioral (escape) contingency model whereby completers must attend group-counseling sessions and produce cocaine-negative urinalysis results. Among the 113 patients enrolled in the cocaine group, 43 (38%) were treatment completers (who attended 6 consecutive weeks of group and produced 6 consecutive weeks of cocaine-free urine tests) and 70 (62%) were treatment noncompleters. Treatment completion (i.e., cocaine abstinence) was significantly associated with baseline cocaine-free urinalysis and higher methadone dose. (PsycINFO Database Record (c) 2010 APA, all rights reserved)