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Class 13 and 14

Class 13 and 14. Jacobson et al (1996) APA (2006)Evidence Based Practice in Psychology. Experimental Between Group Designs. Post-Test Only Control Pre-Test -- Post-Test Control Solomon Four Group (combination of 1 and 2 above) Factorial Design

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Class 13 and 14

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  1. Class 13 and 14 Jacobson et al (1996) APA (2006)Evidence Based Practice in Psychology

  2. Experimental Between Group Designs Post-Test Only Control Pre-Test -- Post-Test Control Solomon Four Group (combination of 1 and 2 above) Factorial Design more than one independent variable; interactions gender x treatment Dependent Sample Design (Matching) 2

  3. Experimental Between Group Designs Post-Test Only Control Pre-Test -- Post-Test Control Solomon Four Group Factorial Design (Treatment X Therapist) Dependent Sample Design(Matching) # of previous episodes and severity depression, presence of dysthimia, gender, marital stauts 3

  4. Types Outcome Studies Kazdin (chap 18) • Treatment Package Strategy • Dismantling Strategy • Constructive Strategy • Parametric Strategy (structural components) • Common factors Control Group • Comparative Outcome Strategy • Client and Therapist Variation Strategy Moderation Designs

  5. Types Outcome Studies Kazdin (chap 18) • Treatment Package Strategy • Dismantling Strategy What are the active ingredients ? • Constructive Strategy • Parametric Strategy (structural components) • Common factors Control Group • Comparative Outcome Strategy • Client and Therapist Variation Strategy Moderation Designs

  6. Research Focus • How treatment effects change: identify change mechanisms VS. • How well treatment works

  7. Change Mechanisms • Activation Hypotheses ( BA) (activation) • Change behaviors- become active and access sources of reinforcement- occurs early in therapy • Coping Skills Hypotheses (AT) • Learn effective cognitive coping strategies (coping + activation) • Beck Hypotheses (CT) • Change cognitive structures or core schemas (coping + activation + cognitive schemas)

  8. Treatment Groups BA Condition: Behavioral Activation Hypotheses: Behavioral Activation AT Condition: Coping Skills Hypotheses Behavioral Activation Coping Skills - Automatic Thoughts CT Condition: Cognitive Therapy Hypotheses Behavioral Activation Automatic Thoughts Core Schemas Chapter 7 8

  9. Mechanisms of ChangeConstruct Measure How did the authors examine if the mechanisms of change worked in therapy as predicted by theory? Behavioral Activation Dysfunctional Thinking Cognitive Schemas Pleasant Events Schedule Automatic Thoughts Q. Expanded Attributional Styles Chapter 7 9

  10. How Treatment Effects Change • To what extent treatment groups differed in post-test measures of each change mechanism Measure Ttreat. G • Behavioral activation – Pleasant Event SCdBA • Coping skills- - AT (Dist Thinking) AT • Core schemas - ExpAttrb Style CT • To what extent was there change from pre-to post- treatment in each change mechanism

  11. How Well Treatments Work • Which of the three treatment conditions yielded better outcomes regarding Depressionat termination and at 6 month follow up? • HRSD • BDI • Recovered • Improved Rates

  12. How Well Treatments Work • Which of the three treatment conditions yielded better Depression outcomes at termination and at 6 month follow up? 3 X 4 MANCOVA IVS 3 Treatments (CT, AT, BA) 4 Therapists Treatment X Therapist (Interaction) DVs - Depression HRSD – Clinician BDI - Self- Report

  13. Which group to use in outcome analyses

  14. Results MANCOVAsTreatment Outcome: Post- Test Depression • Main Effect Treatment ? • Main Effect Therapist ? • Treatment X Therapist Interaction ? Results p. 300 -- ANOVAs Table 3

  15. Results MANCOVAs Treatment Outcome: Post- Test BID & HRSDTreatment Group N= 149 129 137 • Main Effect Treatment NS NSNS • Main Effect Therapist NS NSNS • Treatment X Therapist NS NSNS Results p. 300-- ANOVAs Table 3

  16. Table 3 -- ANCOVAS ??

  17. ANCOVA Post-TestMain Effects for Therapists 20

  18. ANCOVA - Post-Test EffectsTherapist X Treatment Interaction 21

  19. Outcome: Follow-up 6 months • Overall Impact of Therapy • ANCOVAS • IV:Treatments • DVs: Follow-Up HRSD BDI • Covariate: Pretest Score • Changes in Follow-up Time • ANCOVAS • IV: Treatments • DVs: Follow-UpHRSD BDI • Covariate: ???

  20. Outcome: Follow-up 6 months • Overall Impact of Therapy • ANCOVAS • IV:Treatments • DVs: Follow-Up HRSD BDI • Covariate: Pretest Score • Changes in Follow-up Time • ANCOVAS • IV: Treatments • DVs: Follow-UpHRSD BDI • Covariate: ???

  21. Outcome: Follow-up 6 months • Overall Impact of Therapy • ANCOVAS • IV:Treatments • DVs: Follow-Up HRSD BDI • Covariate: Pretest residualized change score • Changes in Follow-up Time • ANCOVAS • IV: Treatments • DVs: Follow-UpHRSD BDI • Covariate: Pre-test score

  22. Clinical Significance: Termination • Improved • No major depression at post-test: • LIFE Interview: psychiatric rating • Recovered • No major depression and BDI<8

  23. Clinical Significance: Mean Improvement/Recovered Rates across Treatments – Post -Test (p.299 text)

  24. Conclusion

  25. Conclusion • 12 to 20 therapy sessions of either Behavioral Activation (BA), Automatic Thoughts (AT) and BA or Schema Restructuring and BA and AT results in similar outcome in treating depression for adult clients who meet exclusionary criteria and were treated by highly trained and monitored therapists. • Regarding the mechanisms of change in CBT??

  26. Mechanisms of ChangeConstruct Measure How did the authors examine to what extent the mechanisms of change worked in therapy as predicted by theory? Behavioral Activation Dysfunctional Thinking Cognitive Schemas Pleasant Events Schedule Automatic Thoughts Q. Expanded Attributional Styles Chapter 7 31

  27. How Treatment Effects Change • To what extent treatment groups differed in post-test measures of each change mechanism Measure Ttreat. Grps • Behavioral activation – Pleasant Event SCdBA • Coping skills- - AT (Dist Thinking) AT • Core schemas - ExpAttrb Style CT • To what extent was there change from pre-to post- treatment in each change mechanism

  28. Paired T Tests: Pre-test/Post-test Change

  29. Residual change score (RCS) in Mechanism of Change from Pre-to Mid-T and RCS in Depression from Mid-T to Post-T (p.301)

  30. Empirically Supported Therapies - EST • 1993 APA Division 12 • Identify Efficacious treatments for specific disorders • FDA Criteria: Specificity • Specific ingredients vs. placebo effects • Randomized double-blind, placebo control design

  31. What components of treatment are responsible for therapy effects? • Specific Ingredients • unique to each therapy approach • Common Factors --- Placebo • underlie most approaches

  32. Scientific advances that lead to theRandomized Placebo Control Group Design • Germany: 1850 Wundt’s experimental method in psychology – 1st psychology lab • Britain:1800 Galton & Pearson – use of normal curve in assessment of distribution mental abilities • France: Physicians start comparing treatments across groups of patients: treatment groups

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