Let us move ahead together: Commentary on "Empirically supported treatments in psychology: Implications for Canadian professional psychology."

The impact on Canadian professional psychological treatment practices of the American Psychological Association (APA) Division 12 (Clinical Psychology) Task Force on the Promotion and Dissemination of Psychological Procedures' development of criteria and listings for empirically supported psychological treatments, along with other industrial efforts to standardize the identification of treatments with established efficacy is described in the article by J. Hunsley et al (see record 1999-01869-001). P. A. Pilkonis comments here on these efforts with an eye towards both producing additional information in support of the new practice criteria and establishing grounds for future progress and collaboration, especially in the research arena. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Empirically supported treatments: Implications for training.

This article discusses the role of empirically supported treatments (ESTs) in the training of clinical psychologists. Training in ESTs can be integrated in ways that vary depending on the level of training and setting. Predoctoral programs, internships, postdoctoral programs, and continuing education are discussed in regard to special challenges and sequencing of training. A preliminary set of guidelines for training in ESTs is suggested. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

"Canadian professional psychology and empirically supported treatments": Commentary.

The impact on Canadian professional psychological treatment practices of the American Psychological Association's Division 12 (Clinical Psychology) Task Force's development of criteria and listings for empirically supported psychological treatments, along with other industrial efforts to standardize the identification of treatments with established efficacy is described in the article by J. Hunsley et al (see record 1999-01869-001). D. L. Chambless comments on the importance of having empirically supported treatments (ESTs) because many clients will not have the specific problems for which ESTs have been developed. In such cases, clinicians need to decide whether they are warranted in generalizing from the samples on which an EST is based, or whether they need to devise a novel approach. Also of importance is the therapeutic relationship or working alliance: a focus on ESTs should not be taken to mean that foundational issues such as the alliance can be forgotten. Training therapists should first learn basic therapeutic skills before learning more specialized ESTs. Other comments concern traditional training in Canada and a US trend of rejecting ESTs until more efficacy studies are completed of research-to-treatment generalizability. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Empirically supported comprehensive treatments for young children with autism

Aplastic anemia can be either acquired or congenital. The paradigm for the congenital form is Fanconi's anemia (FA). FA is an autosomal recessive, genetic syndrome characterized by progressive bone marrow failure, developmental abnormalities, and a predisposition to malignancy. The clinical manifestations of FA are heterogeneous, but one common outcome in the majority of patients is the development of life-threatening hematologic disease. FA is thought to affect the hematopoietic stem cell, and the hematologic consequences of FA can be effectively treated by complete replacement of patient stem cells by those from a histocompatible donor. Unfortunately, allogeneic stem cell transplantation is currently limited to patients with an unaffected matched sibling donor. Transplantation from alternative donors, while successful in selected cases, is associated with a high risk of graft failure and must be carefully considered in terms of risk and benefit for each individual. For FA patients lacking an appropriate donor, new therapies need to be devised. This review summarizes both the scientific rationale and the progress of gene therapy strategies aimed at correcting the hematopoietic defect of FA.     

Empirically supported treatments and comorbid psychopathology: Spelunking Plato's cave.

Presents two case examples of diagnostic ambiguity and examines the empirical literature to identify appropriate empirically supported treatments (ESTs). The author contends that the examples outlined show the discontinuity between clients with comorbid psychopathology and ESTs. He suggests two agendas for future research and practice: (1) the inevitable limitations of efficacy studies do not excuse clinicians from ignoring scientific evidence. The expensive tradeoff of client heterogeneity for experimental control and statistical power is the cost of keeping the discipline grounded in science and (2) to practice maximally affect practice, researchers need to incorporate more comorbid psychopathology. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Empirically supported individual and group psychological treatments for adult mental disorders.

The experimental literature on individual and group psychological treatments for adult disorders is reviewed. For each of the 11 disorders or problems covered, treatments that fall into the following categories, as defined by D. L. Chambless and S. D. Hollon (1998), are identified: efficacious and specific, efficacious, and possibly efficacious. Behavioral and cognitive–behavioral treatments dominate the lists, especially in the anxiety disorders, with notable exceptions. Reasons for the hegemony of the behavioral and cognitive modalities are discussed, and some limitations of the empirically supported treatment concept are addressed. Continued research is recommended on Aptitude?×?Treatment interactions, cost–benefit ratios, and generalization of treatments to a variety of patient populations, therapists, and treatment settings. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Empirically supported treatments: Too little, too late: A commentary.

The impact on Canadian professional psychological treatment practices of the American Psychological Association's Division 12 (Clinical Psychology) Task Force's development of criteria and listings for empirically supported psychological treatments, along with other industrial efforts to standardize the identification of treatments with established efficacy is described in the article by J. Hunsley et al (see record 1999-01869-001). D. R. Evans proposes that the evidence-based movement is too little, in that considerably more, and much more complex evidence for what professional psychologists do is required. It is too late, in that both in Canada and the US professional psychologists have suffered considerable setbacks in both the economic and popularity domains. There is a broad range of treatment proposals professional psychologists make to their clients daily, which are fraught with a lack of research backing. There is a vicious circle in that unless evidence-based practices become the norm, and, hence, the stuff of media, it is difficult to convince new and even some old practitioners to adopt them. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The exchangeability of IQs: Implications for professional psychology.

IQs are important measures in the practice of psychology. Psychologists may frequently expect that IQs from different test batteries are reasonably exchangeable as measures of general intelligence. Results presented in this article provide evidence that different test batteries produce less similar IQs for samples of school-age children and undergraduate students than may have been expected. In fact, psychologists can anticipate that 1 in 4 individuals taking an intelligence test battery will receive an IQ more than 10 points higher or lower when taking another battery. Resulting suggestions for practice include carefully choosing batteries that provide representative sampling of specific abilities, differential weighting, or both; attending to unreliability in measurement; closely monitoring behaviors that undermine assessment of general intelligence; and considering the benefits of obtaining multiple IQs when such scores are used to make high-stakes diagnostic or eligibility decisions. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Psychological test usage: Implications in professional psychology.

Do psychological assessments require more time than third parties and managed care are willing to reimburse? A survey of clinical psychologists and neuropsychologists was conducted to evaluate the current uses of psychological assessment instruments. Respondents reported their use of tests for 8 different areas of assessment, the average time spent in performing various assessment services and other assessment practices. Results suggested that a majority of neuropsychologists devote a substantial portion of their time to assessment, but only 12% of clinical psychologists reported spending more than 10 hr in assessment-related practice each week. The authors describe the typical time required to administer, score, and interpret various tests and assessments; factors that affect the time required to conduct assessments; and provide a current ranking of the most frequently used assessments in clinical and neuropsychology. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Empirically supported treatments for panic disorder: Costs, benefits, and stepped care.

Treatment outcome findings suggest that cognitive-behavioral therapy (CBT) and pharmacotherapy offer similar short-term treatment gains for panic disorder and that CBT may afford more optimal maintenance of treatment gains without the need for ongoing treatment. However, efficacy is not the only consideration for patients, and because of limited health care resources, evaluation of the cost-benefit ratio of these treatments is important. In this article, the authors review estimates of the relative efficacy, acceptability, tolerability, and costs of these treatments; empirically examine the costs and outcome of cognitive-behavioral and pharmacologic interventions as they are delivered in an outpatient clinic specializing in these treatments; and comment on how these data inform a stepped care model of treatment. Analysis of the "services" data indicated that CBT was at least equal to pharmacotherapy in terms of pretreatment severity and acute treatment outcome and that CBT is an especially cost-effective treatment option. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Empirically supported treatments for children with phobic and anxiety disorders: current status

Although interactions of proteins with glycosaminoglycans (GAGs), such as heparin and heparan sulphate, are of great biological importance, structural requirements for protein-GAG binding have not been well-characterised. Ionic interactions are important in promoting protein-GAG binding. Polyelectrolyte theory suggests that much of the free energy of binding comes from entropically favourable release of cations from GAG chains. Despite their identical charges, arginine residues bind more tightly to GAGs than lysine residues. The spacing of these residues may determine protein-GAG affinity and specificity. Consensus sequences such as XBBBXXBX, XBBXBX and a critical 20 A spacing of basic residues are found in some protein sites that bind GAG. A new consensus sequence TXXBXXTBXXXTBB is described, where turns bring basic interacting amino acid residues into proximity. Clearly, protein-GAG interactions play a prominent role in cell-cell interaction and cell growth. Pathogens including virus particles might target GAG-binding sites in envelope proteins leading to infection.     

Ten interdisciplinary principles for professional practice in telehealth: Implications for psychology.

Emerging telecommunications technology is changing psychological practice by enabling the provision of services across time and distance, yet there are significant concerns about these applications. In response to developments in telehealth—the term used for health services provided through these technologies—an interdisciplinary group developed a series of principles to inform health care practice. In this article, the authors review these principles and their implications for psychological telehealth, emphasizing that psychologists' ethical and professional requirements do not change with the introduction of a new tool. The principles provide a framework of critical ethical and professional issues that psychologists must consider in undertaking telehealth practice. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Historically grounding the practice of psychology: Implications for professional training.

The author explores 3 ways the history of psychology can be made relevant to professional training in clinical psychology. Focusing on the practitioner-scholar model of clinical professional training, he argues that 3 central facets of historical understanding can be wedded to existing goals of professional training: (a) providing an interdisciplinary context for psychology, (b) addressing concerns about humans in the field, and (c) mediating theory-practice tensions that often exist in professional training. Suggestions are also made for encouraging historical understanding as essential to fostering critical self-reflection among students preparing for careers in professional psychology. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Empirically supported psychological therapies.

This article introduces the special section of the Journal of Consulting and Clinical Psychology on empirically supported psychological therapies. After a discussion of the rationale for the selection of the specific terms in the label, several justifications are considered for conducting and learning from empirical evaluations of psychological therapies. Finally, the process that guided the special section is described. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

An exploratory survey on empirically supported treatments: Implications for internship training.

Is training in empirically supported treatments (ESTs) necessary for internship? Are all internship sites embracing EST training equally? An exploratory survey reports training practices and attitudes toward use of ESTs in internship sites accredited by the American Psychological Association. Training practices during an internship year varied across type of setting, but only 28% reported offering more than 15 hr of training. Lack of managed care demands, flexibility in session limits, and perceived mismatch between client needs and treatment options were reasons endorsed for not doing more training and supervision with ESTs. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Empirically supported treatments or type I errors? Problems with the analysis of data from group-administered treatments.

When treatments are administered in groups, clients interact in ways that lead to violations of a key assumption of most statistical analyses-the assumption of independence of observations. The resulting dependencies, when not properly accounted for, can increase Type I errors dramatically. Of the 33 studies of group-administered treatment on the empirically supported treatments list, none appropriately analyzed their data. The current authors provide corrections that can be applied to improper analyses. After the corrections, only 12.4% to 68.2% of tests that were originally reported as significant remained significant, depending on what assumptions were made about how large the dependencies among observations really are. Of the 33 studies, 6-19 studies no longer had any significant results after correction. The authors end by providing recommendations for researchers planning group-administered treatment research. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The governance of psychological practice: Implications of American developments for Canadian psychology.

Describes 5 means of maintaining standards for psychological practice that are currently used in the US: (1) general and criminal law, (2) peer control, (3) federal regulations, (4) state boards of examiners in psychology, and (5) civil malpractice litigation. Their relevance to the Canadian context is discussed, especially with respect to the more restricted role of the Canadian federal government in professional affairs, the lower profile for civil rights, and the lower incidence of civil litigation in Canada. Recommendations made to ensure the exemplary practice of psychology include the increased use of peer control through peer review committees, increased organization of professional practice at the national level, and a closer liaison between professional associations and governing boards at the provincial level. (7 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Early intervention: Implications of Public Law 99-457 for professional child psychology.

We review components of Public Law (PL) 99-457 and discuss several concerns related to the practice of psychology and early intervention. PL 99-457 establishes a new national blueprint for expanding the opportunities and benefits of early intervention and preschool services to children and families. We examined implications of the new law in terms of the following broad categories: assessment and diagnosis, intervention, planning and case management, program evaluation, and interagency collaboration. On the basis of practice needs in these areas, we propose several areas of needed training for child practitioners. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Professional issues in Canadian counselling psychology: Identity, education, and professional practice.

The past decade has seen significant growth in counselling psychology's professional identity, increased visibility of the specialization within applied psychology, and advances in doctoral training and accreditation by the Canadian Psychological Association. The current article details professional issues associated with the recent evolution of the field, including the establishment of a strong professional identity for the profession, developments and challenges associated with graduate training (e.g., the limited availability of predoctoral internships), and the implications of the dynamic, changing workplace environment for graduates affiliated with counselling psychology. Recommendations are offered for continued development of the specialization in its Canadian context. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

Prescribing and primary care psychology: Complementary paths for professional psychology.

Two paths have been suggested for the future evolution of professional psychology. Prescribing psychology has already been legally authorized in two states, the military, and the Indian Health Service. Primary care psychology does not require legal recognition and has been slowly growing as a career option for psychologists across the nation. Both paths have their obstacles and limitations, but both are also associated with great potential. This article provides a brief summary of the strengths and weaknesses of each path and suggests an integrated perspective for planning the future of the profession. Each is seen as complementary to the other and providing a basis for pursuing the other. (PsycINFO Database Record (c) 2011 APA, all rights reserved)