The question of treatment effectiveness is a deceptively difficult one to answer due, principally, to the constraints imposed on treating forensic clients in general and sex offenders in particular.
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What is one reason it is always challenging to determine effectiveness?
What is one reason it is always challenging to determine treatment effectiveness in the real world? There is no way to control what happens in a person's life outside of therapy. Lindsey is a physician who specializes in the treatment of psychological disorders.
How do you assess the effectiveness of a treatment?
Another way to assess effectiveness is through careful empirical research. Research has shown that some treatments are more effective for a particular problem than a placebo or no treatment. These treatments are known as empirically validated treatments.
What is the effectiveness of psychological treatment?
Effectiveness of Treatment. Research has shown that many people with psychological disorders benefit from treatment. Effectiveness depends on the specific disorder being treated and the skill of the therapist.
Why do people feel better after being in treatment?
The placebo effect: People often feel better after being in treatment because of their expectations that they will improve. (See Chapter 1 for more information on placebo effects.)
What factors influence the effectiveness of therapy?
Other factors that contribute to successful therapy mentioned include: being collaborative, teaching skills and giving tangible assignments, consistency of the therapist, higher number of sessions, client's personality, and client's ability to feel safe.
What are the common factors that are related to all effective therapies regardless of the type of therapy )?
The most widely studied common factors include the therapeutic alliance, therapist empathy, positive regard, genuineness, and client expectations for the outcome of therapy (i.e., the extent to which clients believe therapy will be helpful in alleviating problems) (Cuijpers, Reijnders, & Huibers, 2019).
What does the research indicate about the effectiveness of psychotherapy?
Research demonstrates that psychotherapy is effective for a variety of mental and behavioral health issues and across a spectrum of population groups. The average effects of psychotherapy are larger than the effects produced by many medical treatments.
How do we know if treatment is successful?
Questions of treatment effectiveness are fundamentally questions about cause-and-effect relationships. If an effective treatment is applied, some detectable improvement in a patient's condition should occur. If the treatment is not applied, no improvement occurs or the patient gets worse.
What factors make it difficult for you to form a therapeutic relationship?
Many people harbor secret thoughts, feelings, and shame. Sharing these with a stranger, even a therapist, can be difficult....Some of the most common include:Reluctance to seek treatment. ... The client's mental health diagnosis. ... A history of bad therapy. ... Therapist anxiety and experience. ... Trauma.More items...•
What are possible common factors in psychotherapy that might account for its effectiveness and why is it important to know about them?
To understand the evidence supporting them as important therapeutic elements, the contextual model of psychotherapy is outlined. Then the evidence, primarily from meta-analyses, is presented for particular common factors, including alliance, empathy, expectations, cultural adaptation, and therapist differences.
What is the importance of evaluating the effectiveness of each treatment provided to each client?
It is important to evaluate the treatment against the consultation to identify whether the treatment achieved the desired outcomes and to what extent it was effective in doing so.
What is effectiveness in psychology?
Effectiveness means the capability of producing an effect. The word is sometimes used in a quantitative way, "being very or not much effective". However it does not inform on the direction (positive or negative) and the comparison to a standard of the given effect.
Which of the following is the most important determinant of the effectiveness of psychotherapy?
Which of the following is the most important determinant of the effectiveness of psychotherapy? trying to get the patient to identify irrational and self-defeating thoughts.
What are three factors considered to successful treatment?
The first is the use of evidence-based treatment that is deemed appropriate for your particular issue. The second important factor is the clinical expertise of the psychologist or therapist. The third factor is your own characteristics, values, preferences, and culture.
What are the methods that psychologists generally use to assess the effectiveness of their treatment?
Psychologists use outcome research, that is, studies that assess the effectiveness of medical treatments, to determine the effectiveness of different therapies.
Does therapy work for everyone?
No, therapy does not help “everyone,” but, there are all the variable to consider before deciding that therapy is for you or not. Today, we have the advantage of using medications in those serious situations where it is called for, to help make therapy more beneficial and available for those individuals who need that.
How is treatment effectiveness measured?
There are three main ways in which treatment effectiveness is measured: the patient's own impression of wellness, the therapist's impression, and some controlled research studies.
How is psychological effectiveness measured?
Psychological treatment effectiveness is typically measured in three ways: the patient's own impression of wellness, the therapist's impression of wellness, and controlled research studies. Explore how to measure treatment effectiveness, the role of attitude and empathy, and how stigmas can make people avoid treatment. Updated: 10/23/2021
What happens if a therapist acts inappropriately?
On the other hand, therapists who behave inappropriately can hinder therapeutic progress, or even do more harm than good. Therapists who act with prejudice, or without understanding of cultural differences between them and their patients, can end up making the patient distrustful of the therapist and of therapy in general. Those who, in a Freudian model, try to produce false memories of past trauma can end up setting a patient back in recovery. Finally, it should be obvious that a sexual relationship between a patient and therapist could be harmful to recovery; still, it happens, and is a serious ethical violation.
Why is it important to have a patient's impressions?
Obviously if a patient feels better, that's great. So in one sense, a patient's impressions are extremely important--the goal of therapy is, after all, to restore her to mental and emotional well-being. But for the purposes of determining which treatments are most effective in which situations, there are several problems with a patient's own impressions of her progress. The first is simply that people in distress tend to get better. This is known as regression to the mean, or average, and it's when people have a tendency to move toward an average level of functioning or happiness from whatever state they are in. If you're really happy, you're most likely to get sadder, and if you're really sad, you're most likely to get happier. People spend most of their time feeling average, so moods that are above or below average are likely to return to this average. Since people usually enter treatment because they're feeling especially bad, they're likely to get better over time not because of anything the therapist is doing, but simply because they're regressing to the mean.
Why do people with schizophrenia have lower recovery rates?
Patients least likely to get better tend to think negatively and behave hostilely. For reasons therapists don't thoroughly understand , personality disorders and psychotic disorders, like schizophrenia, tend to have lower rates of recovery in general.
Why is cognitive therapy effective?
These kinds of studies have shown that for depression and panic disorders, cognitive therapy is most effective, potentially because these disorders are in part caused by the kind of negative thinking directly addressed by cognitive therapy.
What are the shortcomings of a therapist's evaluation?
Shortcomings of Therapist's Evaluations. Therapists' evaluations of patients are subject to all of the same problems as patients' evaluations. They, too, may mistake regression to the mean for positive effects of treatment.
What is Patrick's therapist's approach to addressing his depression?
The therapist's approach is MOST representative of: cognitive therapy. Glenn suffers from depression.
What does Justin's therapist do?
While Justin's therapist listens to what he has to say without judgment, she also seeks understanding by paraphrasing as well as asking for clarification and then reflecting Justin's feelings. Justin's therapist is using a therapeutic technique known as:
How does Monica overcome her craving for chocolate?
To help Monica overcome her nearly irresistible craving for chocolate, a therapist provides her with a supply of chocolate candies that contain solidified droplets of a harmless but very bitter-tasting substance. This approach to treatment best illustrates:
What is psychodynamic therapy?
In psychodynamic therapy, the patient is viewed as responding to unconscious forces and childhood experiences. Psychodynamic therapists seek to help the patient by enhancing:
Why do therapists note supposed dream meanings and resistances?
the therapist notes supposed dream meanings and resistances in order to promote insight.
What is irrational negative thinking therapy?
This therapy seeks to make people aware of their irrational negative thinking and to replace it with new ways of thinking.
Can you enter therapy in a crisis?
people often enter therapy in crisis, and these crises often pass without professional help.
What is effectiveness study?
Effectiveness studies are intended to fill the gap between methodologically rigorous RCTs in the sense of phase III trials and naturalistic observational studies. As such, they are hybrids of the RCT methodology and naturalistic designs and are therefore termed “practical clinical trials.” 8They are intentionally designed to evaluate the effectiveness of the treatments under real-world conditions and in patient samples representative of everydayclinical practice (Table I). They can be performed as RCTs, but less demanding designs are also possible. If they use even a blind9or double-blind10RCT approach they come close to phase III trials considering design aspects, with the only difference being that patient selection is not that restrictive and that, eg, comorbidity or comedication are allowed.
Why are effectiveness studies important?
Effectiveness studies, like other types of phase IV studies, can therefore contribute to knowledge about medications and supply relevant information in addition to that gained from phase III trials. However, the less restrictive design and inherent methodological problems of phase IV studies have to be carefully considered. For example, the greater variance caused by the different kinds of confounders as well as problematic design issues, such as insensitive primary outcome criteria, unblinded treatment conditions, inclusion of chronic refractory patients, etc, can lead to wrong conclusions. Due to these methodological problems, effectiveness studies are on a principally lower level of evidence, adding only a complementary view to the results of phase III trials without falsifying their results.
What is the most effective antipsychotic study?
The most famous of effectiveness studies on antipsychotics is the CATIE study .10There is no doubt that the CATIE study is an important study when one considers, for example, the large sample size (N=1493 in 57 centers), the complex design with several parallel treatment arms, the 18-month duration of treatment of the first phase, inclusion of sequential treatment phases, etc (phase 1 of the study was published in 200510). Also, the double-blind conditions of this study and the sophisticated and comprehensive statistical analysis of the extensive database are appealing. Hie study has received a lot of publicity, particularly in the general press, where it was portrayed as showing that SGAs are for the most part not better, but much more expensive, than FGAs. This conclusion is not tenable because of the methodological failings described above and elsewhere.6,48,49However, to end on a more positive note, many other results not only from phase 1 but also phase 2 and 3 are of relevance for clinicians, eg, on different side-effect patterns of individual SGAs, on metabolic issues, on meaningful sequences of antipsychotic treatment in case of partial nonresponse, on the unique efficacy of clozapine in refractory patients, etc.46,50
What are the confounders of phase 3 trials?
The inclusion of “confounders” (from the perspective of a phase III trial) such as comorbidity or comedication increases the variance and results in a reduced signalto-noise ratio, which makes it more difficult to find differences between two groups (β error problem), even if these factors are adequately considered in the statistical analysis. It might sometimes even be difficult to judge without placebo conditions whether there is a real drug effect, especially if the pre-post difference is unexpectedly low and if there are no differences between two active comparators. Given the fact that these pragmatic trials mostly compare two active compounds, it should be accepted on the basis of the traditional methodology of clinical psychopharmacological trials that only proof of superiority in the statistical sense counts, while the failure to demonstrate a statistically significant difference cannot be interpreted as showing that both treatments are comparable.3The latter conclusion is not permissible for principal methodological reasons.
What is the purpose of randomization and blinding?
Randomization and blinding, also to reduce bias
Is equivalence/noninferiority a proof of efficacy?
Equivalence/noninferiority not suitable as proof of efficacy
Do effectiveness studies generally fulfil their claim of treating less selective samples of patients than phase III studies?
Do effectiveness studies generally fulfil their claim of treating less selective samples of patients than phase III studies? At least some apparently do not. For example, in the effectiveness study comparing olanzapine and haloperidol in the treatment of schizophrenia,44of the 4386 patients assessed for eligibility, only 309 were included in the study (7.0%). This rate is even somewhat lower than the usual rate of 10% to 15% in phase III studies:45Some effectiveness studies appear to have a different kind of selection of patients than phase III trials. Often, patients with milder and more chronic symptoms may be selected than is the case in phase III studies, thus making it more difficult per se to demonstrate drug effects and in particular differences between drug effects, because a relevant subgroup of patients might be partially unresponsive to a drug. The data from the Cost Utility of the Latest Antipsychotics in Severe Schizophrenia (CUtLASS) study serve as an example here. In this study, the pre-post changes in the Positive And Negative Symptom Scale (PANSS) positive score after 52 weeks amounted to only 2.0 in the first-generation antipsychotic (FGA) arm and 1.5 in the second generation antipsychotic (SGA) arm; these changes are extremely low, even when one takes into account that this study was not an acute treatment study but rather a switch study in partially improved/stabilized patients. Also CATIE46and STAR*D47patients seem to be more on the chronic and even partially refractory pole.
