Researchers, Dr. Femke Truijens and colleagues in Europe, found that manualized psychotherapy is no more superior to psychotherapy delivered without a manual. “Manualized treatment is not empirically supported as more effective than non-manualized treatment.
What are the problems with manualized treatment?
What is the purpose of manualization in clinical trials?
Is manualized psychotherapy effective?
In addition to their now required use in controlled outcome studies, treatment manuals offer important advantages for clinical practice. Manual-based treatments are often empirically-validated, more focused, and more disseminable. They are useful in the training and supervision of therapists. Criticisms of manual-based treatments center on five ...
What are the advantages of using a treatment manual?
Dec 11, 2018 · “Manualized treatment is not empirically supported as more effective than non-manualized treatment. While manual‐based treatment may be attractive as a research tool, it should not be promoted as being superior to non-manualized psychotherapy for clinical practice.”
What Manualized treatment?
What is manual-based treatment?
What is evidence based treatment in psychology?
Why are treatment manuals important?
What is manual-based CBT?
What is the greatest benefit of evidence-based therapy and why?
Two of the main goals behind evidence-based practice are: increased quality of treatment, and. increased accountability.Mar 29, 2022
What is the difference between evidence-based practice and evidence-based treatment?
Why are evidence-based therapies important?
Why are treatment manuals important?
In addition to their now required use in controlled outcome studies, treatment manuals offer important advantages for clinical practice . Manual-based treatments are often empirically-validated, more focused, and more disseminable. They are useful in the training and supervision of therapists. Criticisms of manual-based treatments center on five main themes: they are conceptually at odds with fundamental principles of cognitive-behavioral therapy; they preclude idiographic case formulation; they undermine therapists' clinical artistry; they apply primarily to research samples which differ from the patients practitioners treat; and they promote particular 'schools' of psychological therapy. This paper emphasizes the inherent limitations of idiographic case formulation. It is argued that treatment manuals are consistent with an actuarial approach to assessment and therapy, which, on average, is superior to individual clinical judgment. Available data suggest that standardized treatment is no less effective than individualized therapy. Manual-based treatment demands therapist skill in its implementation. In suitably chosen therapists these skills are more a function of training than amount of clinical experience. Treatment manuals are likely to encourage a pragmatic approach to therapy and should not discourage clinical innovations.
What is manual based treatment?
Manual-based treatments: the clinical application of research findings
What is a psychotherapy treatment manual?
Psychotherapy treatment manuals are intended to direct therapists in the application of their approach. Manualized treatments specify a theoretical basis, the number and sequencing of treatment sessions, the content and objectives of each session, and the procedures required to achieve the objective of each session. The use of manuals have been embraced, and at times required, by overseeing institutions such as the American Psychological Association (APA) and the National Institute for Health and Care Excellence (NICE).
Can psychology make claims about effectiveness?
I have always found it astounding that psychology can make claims about the effectiveness of this or that approach or technique when there are so many variables such as the nature of the relationship between “therapist” and “client” that remain unaccounted for in their research. In any event, I do not believe that there are many psychologists, except for the insecure, mini-me wannabe psychiatrists ones , that would try and help people with a cookbook approach.
Is manual therapy a pushback?
They note that in clinical practice, there has been pushback to manualized approaches and the utility of manuals has been critiqued. Scholars and psychotherapists have expressed concerns that manuals inhibit flexible application of approaches, and impedes on one’s ability to tailor therapy to individual needs or adapt interventions to multiple, or “comorbid” presentations of distress.
Does adherence to the manual affect outcomes?
One meta-analysis found that the degree of therapist adherence to the manual did not affect outcomes. The remaining 15 studies provided unclear results. Truijens and team comment on these findings:
Is therapy okay for mental illness?
Most of these studies serve as last-ditch attempt to legitimize “therapy” as okay while so many people are damning psychiatry. Therapy is psychiatry’s little sister. For many patients, if not almost all, therapy is the Gateway to the Endless Pit of the Mental Illness System, never to return. You want a diagnosis, drugs, more diagnoses, increased level of care needed, repeat offender, chronicity? Please go to a therapist. It might be a slower, more insidious route than showing up at an ER, but it’ll work just as well to silence you, put you out of work, ghettoize you, and kill you off early.
Is manualized psychotherapy better than non-manualized psychotherapy?
Researchers, Dr. Femke Truijens and colleagues in Europe, found that manualized psychotherapy is no more superior to psychotherapy delivered without a manual.
What is manualized therapy for PTSD?
Manualized Therapy for PTSD: Flexing the Structure of Cognitive Processing Therapy
What are the most common missing items in a therapy session?
The most common missing item was completion of the homework check-in log during session (35% of missing items). Significant differences were observed between therapists. Specifically, adherence rates ranged from 73–97% across therapists, χ2(3, N= 451) = 51.90, p< .0001, with one therapist accounting for 64% of missed adherence items. Differences were also observed for competence, such that satisfactory ratings ranged from 74-97% across therapists, χ2(3, N= 415) = 20.72, p< .0001. Although there were differences in overall adherence and competence amongst therapists, all means fell between “satisfactory” and “excellent”. There was no difference between therapists on dropout rate (range 17.6–35.7%), χ2(3, N= 64) = 1.70, p= .636, and no significant difference on average number of sessions between therapists (M= 10.45–11.56; SD= 2.70–5.32), F(3, 45) = .11, p= .954.
How many participants completed SMDT?
Following completion of the SMDT condition, SMDT participants were invited to cross over to the MCPT condition. Thirty-seven participants completed SMDT. Twelve of the 37 participants did not cross over to MCPT. Of these 12, 2 no longer met criteria for PTSD and did not wish to pursue treatment, 1 reported no longer being interested in the program, and the remaining 9 participants were either no longer able to participate due to relocation or changes in schedule (n = 2) or for unknown reasons (n = 7). Twenty-five total participants crossed over to MCPT from SMDT (3 were removed, including 2 participants who no longer met criteria for PTSD but wanted to participate in therapy and one participant who was exposed to a criterion A event between SMDT and commencement of MCPT and needed to be treated out of protocol, 5 dropped out of treatment, and 17 completed). Thus the Combined MCPT treatment sampleconsisted of 69 participants who we intended to treat with MCPT (22 crossovers and 47 original MCPT). A total of 50 individuals completed MCPT.
How many sessions of CPT for PTSD?
Additionally, in an effort to independently assess symptom severity and PTSD diagnostic status, an independent rater conducted a CAPS (following session 12) for those participants who required more therapy. Thus the primary modification of the CPT protocol consisted of varying the possible course of therapy, as dictated specifically by participant recovery, resulting in a range of 4-18 sessions of CPT.
How is modified cognitive processing therapy tested?
A randomized, controlled, repeated measures, semi-crossover design was utilized to test the relative efficacy of Modified Cognitive Processing Therapy (MCPT) compared to a Symptom-Monitoring Delayed Treatment (SMDT) condition. Using a semi-crossover design, the SMDT participants were crossed over to the MCPT condition following 10 weeks of symptom monitoring. The use of the SMDT condition allowed us to control for the passage of time, the therapeutic benefits of symptom monitoring, and minimal therapist contact. The semi-crossover design also ensured that all participants were offered the active treatment and provided increased statistical power to assess the efficiency of response to MCPT. Upon completion of a phone screen to determine eligibility, participants were invited for an initial assessment to read and sign the informed consent. There were no adverse events and the single-site study was conducted with University of Missouri - St. Louis Institutional Review Board approval.
What are the objections to EBP?
Objections to the integration of EBPs may stem from general dissonance around the application of the seemingly rigid “cookbook approach” of manualized therapies to the perceived complexity of distress observed in many clients seeking services in community care settings. The debate over EBP guidelines began almost immediately following the APA Task Force on Promotion and Dissemination of Psychological Procedures’ (1995)recommendations. A host of criticism for the implausibility of the APA’s recommended use of empirically supported treatments in clinical practice resounded through both clinical and academic circles resulting in a special issue of Journal of Consulting and Clinical Psychology (1998). Some of the strongest criticisms against the proclaimed empirical support of the cited interventions included the lack of flexibility of treatment manuals in RCTs (Beutler & Howard, 1998), the focus on outcome rather than processes of therapy (Barlow, 1996), the fixed number of sessions contained in protocols (Jacobsen & Christensen, 1996), the use of highly trained, expert clinicians to administer the intervention (Chambless & Hollon, 1998), the focus on diagnostic outcome rather than client level of functioning, and lack of overall ecological validity (Persons & Silberschatz, 1998). More recently, participant attrition and non-response rates reported in RCTs have also been cited as evidence that no given psychotherapy has generated sufficient empirical support to be labeled as an EBP for the treatment of PTSD (Schottenbauer, Glass, Arnkoff, Tendick, & Gray, 2008). RCTs for manualized PTSD treatments indicate that approximately one-third of the participants remain refractory to treatment and approximately one-quarter of the samples drop out prematurely (Bradley, Greene, Russ, Dultra, & Westen, 2005; Schottenbauer, Glass, Arnkoff, Tendick, & Gray, 2008). Although continued empirical support and significant advances have accumulated since the beginning of this debate in the 1990s, the integration of EBPs into community care remains challenging at best (Kazdin, 2008). Specifically, with respect to utilizing EBPs in the treatment of PTSD, Cook, Schnurr, and Foa (2004)suggest that researchers actively attend to clinicians’ concerns and challenges regarding the use of manual-based treatment. The current study sought to evaluate modifications to an existing evidence-based protocol (CPT) in an effort to more closely mimic practice by community clinicians and empirically address perceived barriers to implementation of evidence-based practice.
Does CPT affect the efficacy of stressor therapy?
The insertion of stressor sessions did not alter the efficacy of the therapy.
How to treat Henry's social anxiety?
Cognitive-behavioral treatment for SAD, as outlined in Hope and colleagues’ manual (2006, 2010), involves a combination of exposure and cognitive restructuring techniques. As detailed elsewhere (i.e., Turk, Heimberg, & Magee, 2008), exposure gives individuals with social anxiety an opportunity to examine and test their dysfunctional beliefs and experience natural reductions in anxiety that come when one stays in a situation they perceive as fearful (i.e., habituation). Cognitive restructuring allows individuals with SAD to examine their thoughts and determine whether there is other, more helpful and realistic ways of examining social situations. Cognitive restructuring can also help SAD patients reduce self-focused attention and devote more resources toward social situations and improve their social capabilities (Turk et al., 2008).
How did Henry use his exposures?
For example, Henry reported that between sessions he went to a local mall on a crowded night, sat on a bench in the middle of the mall, and removed his shoes. He felt that by removing his shoes he would draw more attention to himself, which would allow him a greater opportunity to practice the rational responses he developed and to challenge his dysfunctional beliefs (e.g., “people will think I am weird”). Henry also used his college courses as opportunities to engage in exposures, such as by preparing questions to ask teachers in front of the entire class and by asking classmates if they would like to study and read his hand-written notes for completeness. During each of these between session exposures, Henry reported that he was able to successfully use the coping skills he had learned during treatment in order to reduce his anxiety to a manageable level.
How does attention affect SAD?
That is, individuals with SAD often have excessive self-focused attention, which may be in an attempt to prevent one from embarrassing or humiliating themselves in social situations (Wells et al., 1995). However, this cognitive process also interferes with one’s ability to process additional information that may provide evidence against one’s beliefs that they will be evaluated negatively (Hoffman & Barlow, 2002). Consistent with this line of reasoning, Henry reported an excessive focus on himself during social situations, constantly evaluating whether he was engaging in behaviors that others would view as negative and, thus, embarrassing or humiliating.
Did Henry have any psychotropic medications?
There were no apparent complicating factors in the treatment of Henry. He was not taking any prescription medications during treatment and had never taken any psychotropic medications. He had no comorbid psychological disorders. Henry only cancelled one scheduled session, which was cancelled prior to the 24-hour cancelation notice policy of the treatment clinic. Henry presented as highly motivated throughout the entire course of treatment and demonstrated a strong desire to gain control over his social anxiety.
Is cognitive behavioral therapy effective for SAD?
Due to the cognitive, behavioral, and physiological components of SAD, numerous studies have investigated the efficacy of cognitive-behavioral therapy (CBT) on SAD. In fact, CBT is the most widely used and researched treatment for SAD (Feeney, 2004). Research has consistently shown CBT to be an efficacious treatment for SAD when administered either individually or in a group format (Fedoroff, & Taylor, 2001; Gould, Buckminster, Pollack, Otto, & Yap, 1997; Heimberg & Becker, 2002). Recently a manualized CBT treatment for SAD, Managing Social Anxiety: A Cognitive-Behavioral Therapy Approach(Hope et al., 2006; 2010), has been developed for the individual treatment of SAD. Although treatment following this manual has been shown to be efficacious, researchers have called for continued empirical examination of this treatment (Ledley et al., 2009). The following case study is an example of this manualized CBT treatment for SAD.
