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Evidens-baseret praksis (Evidence-Based Psychological Treatments: An…

- - - - Specifikke teknikker: 15% outcome tilskrives dette
      - Forventninger (placebo): 15% af outcome tilskrives dette
      - Fælles-faktorer: 30% af outcome tilskrives dette
      - Ekstraterapeutisk forandring (noget der sker udenfor terapien): 40% af outcome tilskrives dette
    - - Effekt afhænger ikke af specifikke teknikker; fælles faktorer synes at have størst betydning for forandring
      - Tilgange lige effektive i: individual ambulant terapi, gruppeterapi, individuel behandling med dagspatienter, individuel terapi med indlagte patienter
    - - Nærmer samme niveau som behandlingseffekter: placebo stiger, måske skyldes det kulturelle faktorer
      - Patientens forventninger omkring respons spiller en rolle ift. respons på behandling: start med at give håb
      - Placebo afhænger af at føle sig forstået og valideret af en som opfattes som en autoritet
    - - Alliance: Bordin (1979), emotionelt bånd (enighed, samarbejde om opgaver, enighed om mål) - vedligeholdelse af stærk arbejdsalliance, terapeutens evne til at forstå, støtte og oplevelsen af at terapeuten bekymrer dig, enighed om mål
      - Interventioner vil også bidrage til alliance: relation kan påvirke alliance - prædiktor (5-7% i outcome), alliance kan fluktuere gennem behandlingsforløb, alliance prædikterer symptombedring (reciprok kausalitet)
    - - Stærk evidens for at terapeuten har stor betydning: forbedring i patienter upåvirket af terapeutens erfaring, køn, type af træning, orientering
      - Nogen får det dårligere
        
        Terapeuter overkompensere for patienternes dårlige outcome ved at yde mere komplekse interventioner
        
        Højere kompleksitet resulterer ikke i bedre outcome
        
        Terapeuter der yder overkomplekse interventioner skaber dårligere outcome idet interventioner ikke tilpasses patienten og kan potientielt skade
  - - - Ikke velvalgt behandling: debriefing ved stress i forbindelse med kritiske oplevelser, sorg-behandling ved normal sorg-reaktion, psykodynamisk terapi for skizofreni
      - Sub-optimal terapi: par-terapi der kun tilgodeser den ene part (og skader den anden)
      - Dårligt udført terapi: manglende adækvat behandling, arbejde med 'teknikker' når alliancen er dårlig
      - Fejl: interventionsfejl
- - - - 'Controlled' treatment evaluation: comparable persons are randomly placed into either treatment condition composed of those who receive the interventions control condition
      - No-treatment control condition: comparison participants are given the assessment on repeated occasions, separated by an interval ofttimes equal in duration
      - Wait-list condition: expect that after a certain period of time they will receive treatment and may anticipate changes due to this treatment (symptom changes are evaluated at uniform intervals across the experimental and wait-listed conditions)
      - Ethical considerations: same duration, differential attrition, induce differential feelings, repeated measures, follow-up evaluations
      - Attention-placebo (instill positive expectations in participants), local standard treatment (evaluation of experimental treatment relative to intervention that is currently available locally and being applied)
    - - Use between-groups designs with more than one active treatment condition to determine comparative efficacy of therapeutic interventions - larger effect sizes maybe expected in evaluations comparing an active treatment inactive treatment, smaller differences are to be expected when distinguishing among multiple active treatments
      - Research aiming to identify reliable differences in response between two active treatment will need to evaluate larger sample of participants than research comparing an active condition to an inactive treatment
      - In actual practice therapist comparability can never be truly achieved - clinical researchers may aim for therapist equivalence across (a) training, (b) experience, (c) intervention expertise, (d) treatment allegiance, (e) expectation that interventions will be effective - stratified blocking
      - For proper evaluation, intervention procedures across treatments must bequeathed for key variables such as (a) duration, (b) length, intensity, and frequency of contacts with clients, (c) credibility of the treatment rationale, (d) treatment setting, (e) degree of involvement for persons significant to the client
  - - - Manuals enhance internal validity and treatment integrity, and afford comparison of treatments across contexts and formats while at the same time reducing confounds - goal is flexibility within fidelity
    - - Not sure that the independent variable has been implemented as intended: evaluating the quality of treatment provided is also of interest
      - Also of interest to investigate potential variations in treatment outcome that may be associated with differences in the quality the treatment provided - client diversity
      - Sample selection
        
        Community subthreshold sample: non-treatment-seeking sample of participants who may benefit from treatment but who may otherwise only approximate clinically disordered individuals
        
        Genuine clinical sample: sample of treatment-seeking clients diagnoses via structured interviews
        
        Analogue sample: sample that report sub-clinical disorder
        
        Highly select sample
        
        A simple rule is that the research sample should reflect the population to which study results will be generalised
      - Study setting
        
        The question of whether the treatment can be transport to other settings requires independent evaluation
  - - - Multi-informant strategy: variables of interest are collected from multiple reporters can be important
      - Multimodul strategy: multiple modes of assessment to evaluate underlying construct of interest
    - - It is often of interest to identify (a) conditions that dictate when a treatment isomer or less effective, and (b) processes through which a treatment produces change (necessitates the specification of moderator and mediator variables)
      - Moderators: identify on whom and under what circumstances which treatments have different effects
      - Mediators: variable that serves to explain the process by which treatment impacts on an outcome - identify how and why treatments have effects