Sampling from the recorded therapy interview: The problem of segment location.

To provide some evidence regarding the relative information value of different methods of sampling from the recorded individual psychotherapy interview, patient Experiencing (EXP) ratings were obtained for 5 successive 8-min. portions of 1 therapy hour for each of 24 patients (8 schizophrenics, 8 neurotics, and 8 normals). The results show a significantly different linear trend of EXP ratings over the therapy hour for the neurotic, in contrast to both the schizophrenic and normal groups. These results, suggesting greater between-group differentiation as the interview progresses, are discussed in terms of their implications for sampling procedures in psychotherapy research. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Science as an ally of practice.

Well-founded criticisms of the Consumer Reports (CR; 1995) study of psychotherapy include possible bias of the CR sample; limitations of self-report; and the limitations of cross-sectional, retrospective data. Poorly founded criticisms concern "consumer satisfaction" and the claim that the remarkably good effects of long-term therapy resulted from spontaneous remission, that psychotherapy effects were small, and that nondoctoral providers did as well as doctoral-level providers. Both the experimental method (efficacy) and the observational method with causal modeling (effectiveness) answer complementary questions, and they both do so by eliminating alternative possible causes. Efficacy studies, however, cannot test long-term psychotherapy because long-term manuals cannot be written and patients cannot be randomized into two-year-long placebo controls, so the "empirical validation" of long-term therapy will likely come from effectiveness studies. Such studies of long-term therapy, of qualifications of providers, and of clinical judgment versus case management are urgently needed as practice confronts managed care. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The effectiveness of psychotherapy: The Consumer Reports study.

Consumer Reports (1995, November) published an article which concluded that patients benefitted very substantially from psychotherapy, that long-term treatment did considerably better than short-term treatment, and that psychotherapy alone did not differ in effectiveness from medication plus psychotherapy. Furthermore, no specific modality of psychotherapy did better than any other for any disorder; psychologists, psychiatrists, and social workers did not differ in their effectiveness as treaters; and all did better than marriage counselors and long-term family doctoring. Patients whose length of therapy or choice of therapist was limited by insurance or managed care did worse. The methodological virtues and drawbacks of this large-scale survey are examined and contrasted with the more traditional efficacy study, in which patients are randomized into a manualized, fixed duration treatment or into control groups. I conclude that the Consumer Reports survey complements the efficacy method, and that the best features of these two methods can be combined into a more ideal method that will best provide empirical validation of psychotherapy. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Supervision: Its contributions to treatment efficacy.

The efficacy of supervision in training of psychotherapists is discussed in relation to (a) trainees' attitudes, beliefs, and skills, (b) trainee's performance in the therapist role, (c) interactional process events in supervision and psychotherapy, and, (d) client change. Although investigations to date suggest the potential of supervision for teaching advanced skills of psychotherapy, few studies exist that examine directly the relation of therapist performance and client change to supervision. There are virtually no studies that compare the efficacy of supervision to other training methods. If supervision is to remain an integral part of training, then standardized training manuals, analogous to those in psychotherapy, need to be developed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The scientific study of counseling and psychotherapy: A unificationist view.

Proposes 3 propositions that may underlie a unificationist view of research in counseling and clinical psychology and discusses contemporary questions concerning research in psychotherapy. The propositions are that (1) psychotherapy research is science, (2) psychotherapy research is part of a unified attempt to understand human behavior, and (3) all scientific tools are acceptable in the effort to understand the process of psychotherapy. These propositions advocate the integration of basic and applied research, theory, and practice and of laboratory-experimental and field-correlational methods. They offer potential answers to questions concerning the practical value of basic research, fact-finding research, laboratory studies, theory, and technological research. The unificationist view suggests that fuller development of the theoretical side of psychological science and the integration of theory with research and application are needed in the scientific study of counseling and psychotherapy. (53 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Evidence-based psychological treatments for late-life anxiety.

This project identified evidence-based psychotherapy treatments for anxiety disorders in older adults. The authors conducted a review of the geriatric anxiety treatment outcome literature by using specific coding criteria and identified 17 studies that met criteria for evidence-based treatments (EBTs). These studies reflected samples of adults with generalized anxiety disorder (GAD) or samples with mixed anxiety disorders or symptoms. Evidence was found for efficacy for 4 types of EBTs. Relaxation training, cognitive-behavioral therapy (CBT), and, to a lesser extent, supportive therapy and cognitive therapy have support for treating subjective anxiety symptoms and disorders. CBT for late-life GAD has garnered the most consistent support, and relaxation training represents an efficacious, relatively low-cost intervention. The authors provide a review of the strengths and limitations of this research literature, including a discussion of common assessment instruments. Continued investigation of EBTs is needed in clinical geriatric anxiety samples, given the small number of available studies. Future research should examine other therapy models and investigate the effects of psychotherapy on other anxiety disorders, such as phobias and posttraumatic stress disorder in older adults. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Grouped random effects models for Bayesian meta-analysis

Meta-analysis refers to quantitative methods to combine results from independent studies so as to draw overall conclusions. Frequently, results from dissimilar studies are inappropriately combined, resulting in suspect inferential synthesis. We present a straightforward method to identify and address this problem through the development of grouped random effect models for meta-analysis. We examine 15 comparative studies that investigate the efficacy of a new anti-epileptic drug, progabide. The flexibility of this modelling scheme is exemplified by the result that the open studies support the efficacy of progabide while the closed studies support the reverse hypothesis. Bayesian approaches for meta-analysis are preferable because of the small number of studies prevalent in meta-analysis. We specify diffuse proper prior and hyperprior distributions to assure posterior propriety. We investigate sensitivity of the posterior to choice of prior. We use Gibbs sampling and the Metropolis algorithm to generate samples from the relevant posteriors. We analyse posterior summaries and plots of model parameters to suggest solutions to questions of interest.     

The relative efficacy of psychotherapy: Reassessing the methods-based paradigm.

Because the efficacy of behavioral interventions is central to applied psychology, the relative merits of competing approaches to an intervention are important. Many comparative studies examine the differential outcomes of alternative methods of psychotherapy. This paper addresses the issue of impact differences among rival intervention methods by focusing on treatment outcome research that emphasizes the relative (or comparative) efficacy of different psychotherapies. The paper has 4 components. First, it explores the concept of relative efficacy. Second, it reviews the extensive evidence on relative efficacy, which is generally consistent with the null hypothesis. Third, it offers a 3-part explanation of the negative evidence on relative efficacy: (a) a statistical argument about how relative efficacy is bound by a modest upper limit; (b) a research design argument about how relative efficacy studies are confounded by multiple factors, which make it difficult to demonstrate differences in treatment effects; and (c) a theoretical argument about how therapists' contributions to treatment outcomes depend more on their clinical abilities than the therapy methods they implement. The final section of the paper outlines questions for future research. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Methods and mechanisms in the efficacy of psychodynamic psychotherapy.

Comments on the original article, "The efficacy of psychodynamic psychotherapy," by J. Shedler (see record 2010-02208-012). Shedler summarized a large body of research that shows psychodynamic therapy to have a substantial effect size, comparable to that for many empirically supported treatments. This is an important finding, in part refuting the concerns raised by Bornstein (2001, 2002) regarding the future of psychodynamic approaches had there been no substantial changes in how practitioners and researchers approached the science to demonstrate efficacy. Further, Shedler showed that the efficacy of psychoanalytic psychotherapy is due to therapeutic methods commonly employed in cognitive behavior therapy (CBT), one of the most frequently cited empirically supported approaches for a wide range of psychological conditions. From a methodological perspective, there are some important limitations to the claim of psychodynamic psychotherapy’s comparable efficacy to other empirically supported approaches. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The prion diseases: Creutzfeldt-Jakob, Gerstmann-Str?ussler-Scheinker, and related disorders

Conventional statistical approaches rely heavily on the properties of the central limit theorem to bridge the gap between the characteristics of a sample and some theoretical sampling distribution. Problems associated with nonrandom sampling, unknown population distributions, heterogeneous variances, small sample sizes, and missing data jeopardize the assumptions of such approaches and cast skepticism on conclusions. Conventional nonparametric alternatives offer freedom from distribution assumptions, but design limitations and loss of power can be serious drawbacks. With the data-processing capacity of today's computers, a new dimension of distribution-free statistical methods has evolved that addresses many of the limitations of conventional parametric and nonparametric methods. Computer-intensive statistical methods involve reshuffling, resampling, or simulating a data set thousands of times to empirically define a sampling distribution for a chosen test statistic. The only assumption necessary for valid results is the random assignment of experimental units to the test groups or treatments. Application to a real data set illustrates the advantages of these methods, including freedom from distribution assumptions without loss of power, complete choice over test statistics, easy adaptation to design complexities and missing data, and considerable intuitive appeal. The illustrations also reveal that computer-intensive methods can be more time consuming than conventional methods and the amount of computer code required to orchestrate reshuffling, resampling, or simulation procedures can be appreciable.     

Reconciliation of apparent nonequivalence among alternative rating methods.

Argues that past results showing nonequivalence between successive-intervals (representational) category rating (index) measures are due to oversimplified graphical methods of successive-intervals analysis employed in previous studies. The proposition was tested using 107 members of various professional and social groups (age range 26-73 yrs) and 141 attitude items. Graphical and least squares numerical analysis confirmed the hypothesis, indicating that results from category rating and successive-intervals scales may be equivalent and that the former may have more research value than previously believed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

A Meta-Analysis of Massage Therapy Research.

Massage therapy (MT) is an ancient form of treatment that is now gaining popularity as part of the complementary and alternative medical therapy movement. A meta-analysis was conducted of studies that used random assignment to test the effectiveness of MT. Mean effect sizes were calculated from 37 studies for 9 dependent variables. Single applications of MT reduced state anxiety, blood pressure, and heart rate but not negative mood, immediate assessment of pain, and cortisol level. Multiple applications reduced delayed assessment of pain. Reductions of trait anxiety and depression were MT's largest effects, with a course of treatment providing benefits similar in magnitude to those of psychotherapy. No moderators were statistically significant, though continued testing is needed. The limitations of a medical model of MT are discussed, and it is proposed that new MT theories and research use a psychotherapy perspective. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Power spectral density of unevenly sampled data by least-square analysis: performance and application to heart rate signals

This work studies the frequency behavior of a least-square method to estimate the power spectral density of unevenly sampled signals. When the uneven sampling can be modeled as uniform sampling plus a stationary random deviation, this spectrum results in a periodic repetition of the original continuous time spectrum at the mean Nyquist frequency, with a low-pass effect affecting upper frequency bands that depends on the sampling dispersion. If the dispersion is small compared with the mean sampling period, the estimation at the base band is unbiased with practically no dispersion. When uneven sampling is modeled by a deterministic sinusoidal variation respect to the uniform sampling the obtained results are in agreement with those obtained for small random deviation. This approximation is usually well satisfied in signals like heart rate (HR) series. The theoretically predicted performance has been tested and corroborated with simulated and real HR signals. The Lomb method has been compared with the classical power spectral density (PSD) estimators that include resampling to get uniform sampling. We have found that the Lomb method avoids the major problem of classical methods: the low-pass effect of the resampling. Also only frequencies up to the mean Nyquist frequency should be considered (lower than 0.5 Hz if the HR is lower than 60 bpm). We conclude that for PSD estimation of unevenly sampled signals the Lomb method is more suitable than fast Fourier transform or autoregressive estimate with linear or cubic interpolation. In extreme situations (low-HR or high-frequency components) the Lomb estimate still introduces high-frequency contamination that suggest further studies of superior performance interpolators. In the case of HR signals we have also marked the convenience of selecting a stationary heart rate period to carry out a heart rate variability analysis.     

Optimal sampling strategies for validation studies.

In selection instrument validation studies the situation occasionally arises in which there are a large number of observations on the predictor but criterion data are very expensive or difficult to obtain, thus making it necessary to sample values of the predictor. Three strategies (random, rectangular, and extreme groups) for sampling predictor values were compared with respect to accuracy and statistical power in estimating the total group validity. Comparisons were made on samples drawn from 6 large N (approximately 10,000) bivariate test score distributions known to contain some departures from linearity and homoscedasticity. It was shown that in this situation selecting values of the predictor that form a rectangular distribution gave, in all instances studied, at least equal accuracy and greater statistical power in estimating the total group validity compared with random sampling. When the predictor–criterion relationship was generally linear with only modest departures from linearity, selecting values from the extremes of the predictor distribution was optimal in terms of accuracy and statistical power and clearly superior to rectangular sampling. (14 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Psychotherapy for the treatment of depression: A comprehensive review of controlled outcome research.

Previous quantitative reviews of research on the efficacy of psychotherapy for depression have included only a subset of the available research or limited their focus to a single outcome measure. The present review offers a more comprehensive quantitative integration of this literature. Using studies that compared psychotherapy with either no treatment or another form of treatment, this article assesses (1) the overall effectiveness of psychotherapy for depressed clients, (2) its effectiveness relative to pharmacotherapy, and (3) the clinical significance of treatment outcomes. Findings from the review confirm that depressed clients benefit substantially from psychotherapy, and these gains appear comparable to those observed with pharmacotherapy. Initial analysis suggested some differences in the efficacy of various types of treatment; however, once the influence of investigator allegiance was removed, there remained no evidence for the relative superiority of any 1 approach. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

A risk-benefit assessment of pharmacotherapies for clinical depression in children and adolescents

Child and adolescent major depressive disorders are common and recurrent disorders. The prevalence of major depressive disorders is estimated to be approximately 2% in children and 4 to 8% in adolescents. Major depressive disorders in children are frequently accompanied by other psychiatric disorders, poor psychosocial outcome and a high risk of suicide and substance abuse, indicating the need for effective treatment and prevention. The use of antidepressant medications as the first line of treatment for children and adolescents with mild to moderate major depressive disorders has been questioned. However, some subgroups of patients may benefit from initial treatment with antidepressants. These subgroups may include patients who are unwilling or unable to undergo psychotherapy, have not responded to at least 8 to 12 sessions of psychotherapy, have bipolar, atypical or severe depression or have recurrent depression. Currently, the selective serotonin (5-hydroxytryptamine; 5-HT) reuptake inhibitors are the first medication choice because of their efficacy, benign adverse effect profile, ease of use and low risk of death following an overdose. Further research in continuation and maintenance treatments, treatment of comorbid conditions, subtypes of depression, e.g. bipolar, atypical, seasonal, and combinations of pharmacotherapy and psychotherapy are needed. In addition, studies of the pharmacokinetics, pharmacodynamics and long term adverse effects of antidepressant medications in children and adolescents are warranted.     

Using random telephone sampling to recruit generalizable samples for family violence studies.

Convenience sampling methods predominate in recruiting for laboratory-based studies within clinical and family psychology. The authors used random digit dialing (RDD) to determine whether they could feasibly recruit generalizable samples for 2 studies (a parenting study and an intimate partner violence study). RDD screen response rate was 42-45%; demographics matched those in the 2000 U.S. Census, with small- to medium-sized differences on race, age, and income variables. RDD respondents who qualified for, but did not participate in, the laboratory study of parents showed small differences on income, couple conflicts, and corporal punishment. Time and cost are detailed, suggesting that RDD may be a feasible, effective method by which to recruit more generalizable samples for in-laboratory studies of family violence when those studies have sufficient resources. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Varying coefficient meta-analytic methods for alpha reliability.

The conventional fixed-effects (FE) and random-effects (RE) confidence intervals that are used to assess the average alpha reliability across multiple studies have serious limitations. The FE method, which is based on a constant coefficient model, assumes equal reliability coefficients across studies and breaks down under minor violations of this assumption. The RE method, which is based on a random coefficient model, assumes that the selected studies are a random sample from a normally distributed superpopulation. The RE method performs poorly in typical meta-analytic applications where the studies have not been randomly sampled from a normally distributed superpopulation or have been randomly sampled from a nonnormal superpopulation. A new confidence interval for the average reliability coefficient of a specific measurement scale is based on a varying coefficient statistical model and is shown to perform well under realistic conditions of reliability heterogeneity and nonrandom sampling of studies. New methods are proposed for assessing reliability moderator effects. The proposed methods are especially useful in meta-analyses that involve a small number of carefully selected studies for the purpose of obtaining a more accurate reliability estimate or to detect factors that moderate the reliability of a scale. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Religion and spirituality.

We define religion and spirituality and discuss five scenarios in which they will probably emerge in psychotherapy. We review empirical research on religion and spirituality as they pertain to psychotherapy outcomes and relationships. Most research has been unsophisticated relative to the general status of psychotherapy research. Nonetheless, therapists are urged to assess for religion. and spirituality and, if possible, intervene in religiously and spiritually sensitive ways. Nine empirical studies of religiously accommodative Christian (n = 6) and Muslim (n = 3) psychotherapy have provided limited support for its efficacy, especially with depressed clients. Highly religious clients appear to desire therapy that respects (if not integrates) their religion, but research is unclear about the degree to which they can benefit from secular therapies, especially when they request religious therapy. (PsycINFO Database Record (c) 2010 APA, all rights reserved)