Procedures for identifying evidence-based psychological treatments for older adults.

The authors describe the methods used to identify evidence-based psychological treatments for older adults in this contribution to the special section. Coding teams were assembled to review the literature on several problems relevant to mental health and aging. These teams used the manual developed by the Committee on Science and Practice of the Society for Clinical Psychology (Division 12) of the American Psychological Association that provided definitions of key constructs used in coding. The authors provide an overview of the process followed by the review teams and of some of the issues that emerged to illustrate the steps involved in the coding procedure. Identifying evidence-based treatments is a fundamental aspect of promoting evidence-based practice with older adults; such practice is advocated by most health care disciplines, including psychology. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Evidence-based psychological treatments for insomnia in older adults.

The review describes evidence-based psychological treatments (EBTs) for insomnia in older adults. Following coding procedures developed by the American Psychological Association's Committee on Science and Practice of the Society for Clinical Psychology, two treatments were found to meet EBT criteria: sleep restriction-sleep compression therapy and multicomponent cognitive-behavioral therapy. One additional treatment (stimulus control therapy) partially met criteria, but further corroborating studies are needed. At the present time, there is insufficient evidence to consider other psychological treatments, including cognitive therapy, relaxation, and sleep hygiene education, as stand-alone interventions beneficial for treating insomnia in older adults. Additional research is also needed to examine the efficacy of alternative-complementary therapies, such as bright light therapy, exercise, and massage. This review highlights potential problems with using coding procedures proposed in the EBT coding manual when reviewing the existing insomnia literature. In particular, the classification of older adults as persons age 60 and older and the lack of rigorous consideration of medical comorbidities warrant discussion in the future. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Commentary on evidence-based psychological treatments for older adults.

This article comments on the articles in the Special Section on Evidence-Based Psychological Treatments for Older Adults (see records 2007-03358-002, 2007-03358-003, 2007-03358-004, 2007-03358-005, and 2007-03358-006). The articles apply criteria developed by the Society of Clinical Psychology to evaluate treatments for late-life anxiety, insomnia, behavior disturbances in dementia, and caregiver distress. The articles document that there are evidence-based psychological treatments that can help older adults. However, there are 2 substantial hurdles: evidence and access. Gaps in the evidence, as mentioned by the authors of the articles in the special section, result from disproportionate research attention to some psychotherapies and some mental disorders, with corresponding lack of research about other treatments and disorders. The challenge for access is to ensure that older adults with treatable mental disorders will get connected to psychologists trained in these evidence-based therapies. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Evidence-based psychological treatments for distress in family caregivers of older adults.

This review identifies evidence-based psychological treatments (EBTs) for reducing distress, and improving well-being, of family members caring for an older relative with significant cognitive and/or physical impairment. Three categories of psychologically derived treatments met EBT criteria: psychoeducational programs (N = 14 studies), psychotherapy (N = 3 studies), and multicomponent interventions (N = 2 studies). Specifically, support within the psychoeducational category was found for skill-training programs focused on behavior management, depression management, and anger management and for the progressively lowered threshold model. Within the psychotherapy category, cognitive-behavioral therapy enjoys strong empirical support. Within the multicomponent category, programs using a combination of at least 2 distinct theoretical approaches (e.g., individual counseling and support group attendance) were also found to be effective. Suggestions for future research include the development of more well-integrated multicomponent approaches, greater inclusion of ethnically diverse family caregivers in research protocols, and greater incorporation of new technologies for treatment delivery. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Meta-analyses and systematic reviews of psychological treatments for chronic pain: Relevance to an evidence-based practice.

As evidence-based practitioners become more reliant on systematic reviews to inform treatment, it becomes important to systematize reporting details as well as improve the quality of the primary studies that will later be incorporated into this secondary literature. In this article, the authors consider several specific factors that can serve this function in the area of chronic pain: (a) adhering to a standardized set of reporting standards; (b) measuring a standardized set of short- and long-term outcome variables; (c) providing information about individual differences; and (d) providing detailed, easily accessible documentation of the treatment program (or progams). The article also highlights ways that practitioners and researchers can collaborate on treatment outcome research, thereby improving the ability to discover and disseminate effective treatments for patients who suffer from chronic pain. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Public policy and the provision of psychological services to older adults.

Public policy shapes who delivers health care, how care is delivered, and how much providers are paid. The impact of public policy will become even more important to psychologists who serve older adults as 76 million members of the so called “baby boom” generation enter their later years. Armed with basic public policy facts, psychologists can better maneuver the systems created by public policy and even change policy. This article reviews how Medicare works since it is the primary payer of mental health services for older adults. The article then turns to the question of how many health care professionals (including psychologists) will be required to meet the needs of a rapidly growing older population and concurrent challenges of training and building that work force. Finally, different policy visions for a better mental health care system for older adults are summarized since they may be roadmaps to what the future of mental health care will look like. The article closes with practical recommendations on how psychologists can influence mental health and aging public policy. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The dissemination and implementation of evidence-based psychological treatments: A review of current efforts.

Recognizing an urgent need for increased access to evidenced-based psychological treatments, public health authorities have recently allocated over $2 billion to better disseminate these interventions. In response, implementation of these programs has begun, some of it on a very large scale, with substantial implications for the science and profession of psychology. But methods to transport treatments to service delivery settings have developed independently without strong evidence for, or even a consensus on, best practices for accomplishing this task or for measuring successful outcomes of training. This article reviews current leading efforts at the national, state, and individual treatment developer levels to integrate evidence-based interventions into service delivery settings. Programs are reviewed in the context of the accumulated wisdom of dissemination and implementation science and of methods for assessment of outcomes for training efforts. Recommendations for future implementation strategies will derive from evaluating outcomes of training procedures and developing a consensus on necessary training elements to be used in these efforts. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Introduction to the special section on developing guidelines for the evidence-based assessment (EBA) of adult disorders.

The goal of this special section is to encourage greater awareness of evidence-based assessment (EBA) in the development of a scientifically supported clinical psychology. In this introductory article, the authors describe the elements that authors in this special section were asked to consider in their focused reviews (including the scope of available psychometric evidence, advancements in psychopathology research, and evidence of attention to factors such as gender, age, and ethnicity in measure validation). The authors then present central issues evident in the articles that deal with anxiety, depression, personality disorders, and couple distress and in the accompanying commentaries. The authors conclude by presenting key themes emerging from the articles in this special section, including gaps in psychometric information, limited information about the utility of assessment, the discrepancy between recommended EBAs and current training and practice, and the need for further data on the process of clinical assessment. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Evidence-based treatments and delivery of psychological services: Shifting our emphases to increase impact.

Evidence-based psychological treatments (EBTs) have made enormous gains in the range of techniques that are available and the scope of problems to which they can be applied. Debates about the advances focus on issues related to applicability of the evidence to clinical work, limits of highly controlled studies, and decision making in clinical practice. Less often discussed is arguably the more salient issue, namely, that most people in need of psychological treatment do not receive services, whether evidence based or not. This article discusses EBTs as currently studied in relation to an overarching goal of our interventions, namely, to reduce the burden of mental illness and the full range of social, emotional, and behavioral problems leading to impairment. The diversity of clients, the range of settings in which treatments must be delivered, and the models of delivery ought to receive greater attention in developing evidence-based interventions. In the context of treatment of children and adolescents, this article discusses service needs and how EBTs can better align with these needs to exert broad impact. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Psychotherapy in long-term care: II. Evidence-based psychological treatments and other outcome research.

This article is the 2nd of 2 that together examine 3 domains important to providing high-quality, evidence-based services to long-term care (LTC) facility residents: policy and advocacy, practical considerations, and outcome research. Older adults who reside in LTC facilities have a very high rate of mental health difficulties. Psychologists have been able to provide services to this population through Medicare since the late 1980s, and empirical findings on treatment approaches are important in guiding psychotherapists to more helpful intervention. The focus of this article is outcome research in LTC settings. This article emphasizes evidence-based psychological treatments (EBTs) but also examines other scientifically supported approaches and discusses the strengths and limitations of focusing on EBTs, as well as general issues in the relation between science and practice in the provision of psychotherapy in LTC settings. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Addressing key challenges in evidence-based practice in psychology.

With its promise of enhancing the effectiveness of services, evidence-based practice in psychology (EBPP) appears to offer much to psychologists, patients, and policymakers. The purpose of this article is to examine some of the key challenges facing psychologists who wish to provide evidence-based treatment services, including how research evidence is used in EBPP, whether the results of the treatment research literature can be generalized to typical clinical practice, and how effective evidence-based treatments are in clinical practice. On the basis of recent evidence-based initiatives and treatment research, there is a solid scientific basis for EBPP, although much more research is necessary on the treatment of relatively mild, but common, clinical conditions and on the transporting of evidence-based treatments into clinical practice. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Introduction to the special section on cognitive science and psychological assessment.

This introduction to the Special Section on Cognitive Science and Psychological Assessment begins with a brief overview of cognitive science and its interface with the clinical assessment of cognitive functioning. Concepts and themes permeating the articles in this section are then taken up. Included are cognitive-model architectures and model parameters, differential emphasis on efficiency versus content of cognition, and implementation of stochastic and dynamical aspects of cognitive processes. Selected distinguishing attributes of the respective contributions are highlighted. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Introduction to the special section on chaos theory and psychological assessment.

The premise of the articles in this special section is that the goals of psychological assessment, and the explanations and predictions made on the basis of it, can be advanced by assimilating several concepts from nonlinear dynamical modeling and chaos theory—concepts and mathematical models that have been discussed most frequently in economics, ecology, biology, and physics. The concepts presented in the two articles by Heiby (1995a, 1995b, in this issue) and the article by Haynes, Blaine, and Meyer (1995, in this issue) are brief introductions to a small set of ideas from much larger domains (e.g., Burton, 1994). More extensive discussions of nonlinear dynamics and chaos can be found in several recently published books (Baker & Gollub, 1990; ?ambel, 1993; Haynes, 1992; Vallacher & Nowak, 1994; von Eye, 1990; Wei, 1990). These three articles borrow ideas that have been useful in other disciplines to address several phenomena that have been problematic in psychological assessment: (a) Behavior and causal variables often change rapidly in magnitude, rate, and form over time—they are dynamic; (b) these changes are often unpredictable, nonlinear, and discontinuous; and (c) it is often difficult to establish causal relationships for behavior change. The articles suggest several measurement strategies to increase our abilities to predict and explain the dynamical, nonstationary, and nonlinear phenomena that are often the targets of psychological assessment. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Introduction to the special section: Providing psychological test feedback to clients.

This article introduces the special section on providing psychological test feedback to clients. This Special Section has three main objectives. First, we will explore the ethical issues involved in discussing test results with clients. Next, we will illustrate the test feedback process with an often complex clinical assessment situation: neuropsychological evaluation. Finally, the process of incorporating test feedback into the treatment context has not been extensively researched and not much is known about whether clients effectively use information they are provided. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Introduction to the special section: The neglected psychological–physical interface.

Provides an introduction to the special section on neglected psychological-physical interface. This special section was undertaken to stimulate research on the interface between physical disorders and psychological problems and to aid in the development of new conceptual models in this area. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

New approaches to missing data in psychological research: Introduction to the special section.

Traditional approaches to missing data (e.g., listwise deletion) can lead to less than optimal results in terms of bias, statistical power, or both. This article introduces the 3 articles in the special section of Psychological Methods, which consider multiple imputation and maximum-likelihood methods, new approaches to missing data that can often yield improved results. Computer software is now available to implement these new methods. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Introduction to the special section on assessment in psychological treatment: A necessary step for effective intervention.

Great changes are taking place in mental health treatment, because health care providers are placing constraints on therapists. Yet psychologists have been slow to react to these demands and have not incorporated personality measurement in treatment planning to address therapeutic effectiveness. Many therapists initiate therapy without obtaining a personality assessment in the early stages of therapy. Psychological assessment can, however, provide an effective means of detecting problems and motivation for therapy and can, if therapist test feedback is provided, serve to bring about desired behavior change more effectively than if assessment is not used. This Special Section is devoted to the potentially fruitful role psychological assessment can play in treatment planning. The contributors who were invited to write articles were chosen for their expertise in using psychological procedures in treatment planning. Their contributions provide important insights into methods for facilitating psychological therapy. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Introduction to special issue.

Recent years have witnessed the emergence of two powerful, and seemingly contradictory, visions of what most fundamentally causes change in psychotherapy. One of these visions emphasizes the primacy of therapist technique. According to this viewpoint, it is the specific methods used by the psychotherapist that account for, by far, most of the variance in treatment outcome. This viewpoint is seen most notably in what have been termed the empirically supported treatments (EST) and evidence-based practices (EBP) movements. The second vision instead focuses on the patient-therapist relationship and so-called therapist-offered relationship qualities as the sine qua non of therapeutic effectiveness. Advocates of this viewpoint underscore research on the importance of relational qualities such as the therapeutic working alliance (or cohesion in groups) and therapist-offered conditions. While acknowledging the value of both visions noted above, this special issue of Psychotherapy is based on the notion that what matters most in psychotherapeutic treatments is the interplay of the two, of techniques and the therapeutic relationship. Technical factors and relational factors are indelible elements in each and every psychotherapy encounter, and the articles in this special issue explore and seek to uncover why this is so. The articles, in addition, seek to describe the complex ways in which technique and relationship interact with one another in different treatments, at different points in treatment, and in conjunction with still other variables. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The treatment of depression in older adults in the primary care setting: An evidence-based review.

The objective of this study was to conduct an evidence-based review of treatments for depression in older adults in the primary care setting. A literature search was conducted using PsycINFO and Medline to identify relevant, English language studies published from January 1994 to April 2004 with samples aged 55 and older. Studies were required to be randomized controlled trials that compared psychosocial interventions conducted within the primary care setting with "usual care" conditions. Eight studies with older adult samples met inclusion criteria and were included in the review. Two treatment models were evident: Geriatric Evaluation Management (GEM) clinics and an approach labeled integrated health care models. Support was found for each model, with improvement in depressive symptoms and better outcomes than usual care; however, findings varied by depression severity, and interventions were difficult to compare. Further efforts to improve research and clinical care of depression in the primary care setting for older adults are needed. The authors recommend the use of interdisciplinary teams and more implementation of psychosocial treatments shown to be effective for older adults. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Cultural adaptation of treatments: A resource for considering culture in evidence-based practice.

There is a growing interest in whether and how to adapt psychotherapies to take into account the cultural, linguistic, and socioeconomic context of diverse ethnocultural groups. At the root of the debate is the issue of whether evidence-based treatments (EBTs) developed within a particular linguistic and cultural context are appropriate for ethnocultural groups that do not share the same language, cultural values, or both. There is considerable evidence that culture and context influence almost every aspect of the diagnostic and treatment process. Yet, there are concerns about fidelity of interventions, and some have questioned whether tinkering with well-established EBTs is warranted. We present arguments in favor of the cultural compatibility and universalistic hypotheses. Next, we review the available published frameworks for cultural adaptations of EBTs and offer examples from the literature on the process and outcome of different approaches used. Conceptual models for adapting existing interventions and emerging evidence that adapted intervention leads to positive outcomes suggest that there are tools for engaging in evidence-based psychological practices with ethnocultural youth. Recommendations for future directions are provided. (PsycINFO Database Record (c) 2010 APA, all rights reserved)