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 psychological treatments: A natural extension of the scientist–practitioner paradigm.

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). C. M. Morin voices comments on some aspects of the article which may need further thought. The reasons for, and utility of such a movement toward empirically supported treatment (ESTs) is investigated. The defining characteristics of an EST (from the Task Force's perspective) are subject for debate. Why have only 2 categories of ESTs (well established empirical support vs probably efficacious)? The implications of the adoption of EST-based systems will reverberate throughout training, practice, and public health policies. (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)     

Defining empirically supported therapies.

A scheme is proposed for determining when a psychological treatment for a specific problem or disorder may be considered to be established in efficacy or to be possibly efficacious. The importance of independent replication before a treatment is established in efficacy is emphasized, and a number of factors are elaborated that should be weighed in evaluating whether studies supporting a treatment's efficacy are sound. It is suggested that, in evaluating the benefits of a given treatment, the greatest weight should be given to efficacy trials but that these trials should be followed by research on effectiveness in clinical settings and with various populations and by cost-effectiveness research. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

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 treatments in psychology: Implications for Canadian professional psychology.

Examines several interconnected efforts to develop evidence-based practice in professional psychology. We first review 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. Next, we present related efforts to develop procedures to identify treatments that have established efficacy and to develop practice guidelines. The possible impact of these initiatives on Canadian professional psychology in the domains of training, credentialing, practice, and research are then examined. Finally, we present recommendations for steps that should be taken by Canadian psychology organizations to respond to these initiatives in order to ensure that psychological practice in Canada is optimally supported by scientific evidence. (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: 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)     

Toward specific psychological therapies for specific conditions.

Comparative psychotherapy research has traditionally failed to find that one treatment is uniformly more beneficial than another. The lack of methodological and conceptual consistency among researchers, however, may have masked significant effects. This article presents a speculative model for predicting differential rates of therapeutic change. Through a review of 52 comparative psychotherapy studies, an effort was made to assess certain hypothesized relationships between the characteristics constituting the model and a variety of psychological treatment procedures. The use of the model for generating and guiding research is discussed. (69 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Empirically supported therapy relationships: Conclusions and recommendations fo the Division 29 Task Force.

Discusses the conclusions and reccomendations of the Division 29 Task Force regarding emperical evidence supporting therapy relationships. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Empirically supported interventions and school psychology: Conceptual and practice issues—Part II.

In Part II of this 2-part article (Part I, see record 2000-03347-005), the authors present some conceptual and practice issues on the use of empirically supported interventions in school and community settings. Conceptual issues discussed include the foci of effective intervention studies, specification of interventions, and intervention manuals and procedural guidelines. The authors conclude with a discussion of essential practice issues, given a dual goal of advancing research in empirically supported interventions and of producing a knowledge base that has a direct meaning and application to school and community settings. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Empirically supported interventions and school psychology: Rationale and methodological issues—Part I.

In Part 1 of this 2-part article, the authors present historical, contextual, and methodological perspectives on the use of empirically supported interventions in school and community settings. Historical advances in this area are reviewed within the context of the scientist-practitioner model, psychotherapy outcome research, meta-analysis, and the development of criteria and practice guidelines for empirically supported interventions. The rationale for empirically supported interventions in school psychology practice encompasses schooling issues, including school restructuring, special education, and the research-practice gap. Methodological challenges discussed include issues surrounding the terminology used in the area of empirically supported interventions, criteria for classification interventions as supported, methods of summarizing the literature, and publications of negative results. (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 couple and family interventions for marital distress and adult mental health problems.

This article evaluates the efficacy, effectiveness, and clinical significance of empirically supported couple and family interventions for treating marital distress and individual adult disorders, including anxiety disorders, depression, sexual dysfunctions, alcoholism and problem drinking, and schizophrenia. In addition to consideration of different theoretical approaches to treating these disorders, different ways of including a partner or family in treatment are highlighted: (a) partner–family-assisted interventions, (b) disorder-specific partner–family interventions, and (c) more general couple–family therapy. Findings across diagnostic groups and issues involved in applying efficacy criteria to these populations are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Empirically supported interventions: Announcing a new standing section of School Psychology Quarterly.

We are delighted to introduce a new standing section of School Psychology Quarterly entitled "Empirically Supported Interventions" (ESI). This section will be devoted to publishing (a) reviews of the empirical literature on prevention and intervention; (b) reports of original empirical work that enhance our knowledge of empirically supported programs; (c) empirically supported practice parameters or best practices guidelines aimed at improving the clinical behavior of school psychologists and related professionals; (d) methodological approaches or technologies for advancing empirically supported interventions; and (e) scholarly analyses of criteria used to identify empirically supported interventions. The inauguration of the ESI section of School Psychology Quarterly represents a new era in research for our profession that we hope will usher in advancements for both the science and practice of school psychology. The former will be addressed by applying rigorous empirical standards to evaluate intervention research. For the latter, we hope to provide research data that are directly relevant to the application of psychology in school and community settings, thus strengthening the ties between science and practice. (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.     

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 effects of psychological therapies under clinically representative conditions: A meta-analysis.

Recently, concern has arisen that meta-analyses overestimate the effects of psychological therapies and that those therapies may not work under clinically representative conditions. This meta-analysis of 90 studies found that therapies are effective over a range of clinical representativeness. The projected effects of an ideal study of clinically representative therapy are similar to effect sizes in past meta-analyses. Effects increase with larger dose and when outcome measures are specific to treatment. Some clinically representative studies used self-selected treatment clients who were more distressed than available controls, and these quasi-experiments underestimated therapy effects. This study illustrates the joint use of fixed and random effects models, use of pretest effect sizes to study selection bias in quasi-experiments, and use of regression analysis to project results to an ideal study in the spirit of response surface modeling. (PsycINFO Database Record (c) 2010 APA, all rights reserved)