Evidence-based practice in psychology: Implications for research and research training

Caregiver training: Evidence of its effectiveness for cognitive and functional improvement in older adults

AIMS AND OBJECTIVES

The objectives of this study were to assess the benefits of a caregiver training programme on the cognitive and functional status of older adults, and to compare the effects of this programme according to type of caregiver (professional vs. family caregiver).

BACKGROUND

Due to demographic changes that have resulted in an aging population, the role of caregiver of an older adult has become very important in recent years.

DESIGN AND METHODS

The sample was composed of 160 older adults: (a) 100 received care from caregivers who had taken the three-month training programme (treatment group), of which 60 were professional caregivers and 40 were family caregivers, and (b) 60 received care from caregivers who had not taken the programme (control group). In order to evaluate programme effects on cognitive and functional status, we used both direct measures answered by the older adults (MMSE, CAPE and EuroQol) and caregiver reports (Barthel and RMPBC). We used a quasi-experimental, pre-post design. We followed SQUIRE 2.0 guidelines for reporting.

RESULTS

The results showed that older adults who were cared for by caregivers that had participated in the training programme showed gains in quality of life and cognitive ability and maintenance of functional ability. Within the treatment group, although everyone significantly improved their scores, the older adults cared for by family caregivers improved in more of the cognitive sub-items than did their peers in the professional caregiver group.

CONCLUSIONS

The data obtained show that a caregiver training programme based on cognitive stimulation produces cognitive, functional and health-related quality-of-life benefits in older adults. Furthermore, the caregivers reported increased satisfaction with their work.

RELEVANCE TO CLINICAL PRACTICE

The improvements obtained in the older adults and in caregivers show the relevance of this type of intervention when working in the clinical field of caregiving.

Constructive Biases in Clinical Judgment

With a pair of oppositely valenced stimuli, rating the first one sometimes leads to a more extreme evaluation for the second (e.g., if the second is negatively valenced, rating the first stimulus would lead to a more negative rating for the second). We considered an evaluation bias in the case of clinical diagnosis relating to eating disorders. A population sample which included experienced clinical psychologists and psychiatrists showed partial evidence of an evaluation bias, when judging descriptions of individuals designed to be consistent with eating disorders or not. Quantum probability theory, the probability rules from quantum mechanics without any of the physics, is particularly well-suited to modeling the evaluation bias (and constructive influences generally), because a measurement (or judgment) can change the state of the system. We applied a previous quantum model to the present result, an extension of the model embodying noisy processes, and belief adjustment model. We discuss how model fits inform an examination of rationality in the observed behavior.

Perceived Statistical Knowledge Level and Self-Reported Statistical Practice Among Academic Psychologists

Introduction: Publications arguing against the null hypothesis significance testing (NHST) procedure and in favor of good statistical practices have increased. The most frequently mentioned alternatives to NHST are effect size statistics (ES), confidence intervals (CIs), and meta-analyses. A recent survey conducted in Spain found that academic psychologists have poor knowledge about effect size statistics, confidence intervals, and graphic displays for meta-analyses, which might lead to a misinterpretation of the results. In addition, it also found that, although the use of ES is becoming generalized, the same thing is not true for CIs. Finally, academics with greater knowledge about ES statistics presented a profile closer to good statistical practice and research design. Our main purpose was to analyze the extension of these results to a different geographical area through a replication study.

Methods: For this purpose, we elaborated an on-line survey that included the same items as the original research, and we asked academic psychologists to indicate their level of knowledge about ES, their CIs, and meta-analyses, and how they use them. The sample consisted of 159 Italian academic psychologists (54.09% women, mean age of 47.65 years). The mean number of years in the position of professor was 12.90 (SD = 10.21).

Results: As in the original research, the results showed that, although the use of effect size estimates is becoming generalized, an under-reporting of CIs for ES persists. The most frequent ES statistics mentioned were Cohen's d and R²/η², which can have outliers or show non-normality or violate statistical assumptions. In addition, academics showed poor knowledge about meta-analytic displays (e.g., forest plot and funnel plot) and quality checklists for studies. Finally, academics with higher-level knowledge about ES statistics seem to have a profile closer to good statistical practices.

Conclusions: Changing statistical practice is not easy.This change requires statistical training programs for academics, both graduate and undergraduate.

Efficacy of ICT-Based Neurocognitive Rehabilitation Programs for Acquired Brain Injury

Abstract. This systematic review aims to analyze the methods used in the assessment of the efficacy of Neurocognitive Rehabilitation Programs (NRP) based on Information and Communication Technologies in patients with Acquired Brain Injury, namely platforms and online rehabilitation programs. Studies with the main purpose of evaluating the efficacy of those programs were retrieved from multiple literature databases, accordingly to inclusion and exclusion criteria. The inclusion and analysis of the studies followed preferred reporting items for systematic review and meta-analysis protocols (PRISMA-P) and Cochrane Collaboration Guidelines. Thirty-one studies were included in this review. Results showed that most studies used a pre-post methodological design, with few studies performing assessment moments during intervention or follow-up. Attention, memory, and executive functions were the cognitive variables considered by a larger number of studies at the assessment of NRP efficacy. Despite that, there is a growing evidence on the inclusion of variables related to everyday functioning in this process, increasing its ecological validity. Concerning the instruments used, the studies presented a large heterogeneity of the instruments and methods used, even for the same assessment purpose, highlighting a lack of consensus regarding assessment protocol. Psychophysiological and neuroimaging techniques are seldom used on this field. This review identifies the main characteristics of the methodology used at the assessment of NRP and potential limitations, providing useful information to guide the practice of the health care professionals in rehabilitation of Acquired Brain Injury. It also suggests new directions for future studies.

Psychodynamic Group Psychotherapy: A Behavior Science Perspective

As the current mental health climate places greater emphasis on evidence-based practice, it is important to consider the basic science underlying treatment. This article examines the psychodynamic group psychotherapy process from a behavior science perspective, linking basic research results to clinical practice. Clinical interventions and the change process are explained in the context of operant behavior theory. A special class of operant behavior, cultural behavior, is described and connected to therapeutic resistance and its resolution. Emotional difficulties and their amelioration are explained using respondent conditioning principles. In keeping with the American Psychological Association (2005) position regarding research evidence, these behavior science explanations serve to connect the group psychotherapeutic process to relevant results of basic research in psychology, further endorsing this treatment modality.

An opportunity to bridge the gap between clinical research and clinical practice: implications for clinical training

Clinical researchers and clinical practitioners share a goal of increasing the integration of research and clinical practice, which is reflected in an evidence-based practice (EBP) approach to psychology. The EBP framework involves the integration of research findings with clinical expertise and client characteristics, values, and preferences, and consequently provides an important foundation for conducting clinically relevant research, as well as empirically based and clinically sensitive practice. Given the critical role that early training can play in the integration of science and practice and in promoting the future of the field, the present article addresses predoctoral training programs as a context for adopting an EBP approach to clinical work. We address training in the three components of EBP and provide suggestions for curriculum development and practicum training that we hope will contribute to bridging the gap between research and practice.

Evidence-based practice problems: form and focus

Health care reform poses major challenges for psychiatric mental health care. Foremost among the challenges is a mandate for reimbursement based on performance-based outcomes. Clinicians can increase the efficiency of evidence-based practice searches by using the correct form of PICOT (population, intervention, comparator, outcome, time frame) question to focus the search, based on (a) diagnosis, (b) treatment, (c) prognosis, (d) etiology, (e) prevention, and (f) meaning. The correct form of a PICOT question focuses the literature search by requiring a minimum of sorting to find relevant studies. Quickly and effectively locating the critical evidence will help meet the performance standard mandates required by new health care reform legislation.

Evidence-based practice in psychology

Evidence-based practice is a growing topic of interest in the field of psychology. In 2006, the American Psychological Association (APA) developed a formal policy statement on evidence-based practice in psychology (EBPP). It is now important for the profession to come to a better understanding about what EBPP is (and is not), and to develop a skill set associated with EBPP. The next seven articles explore the history of EBPP, elaborate the definition and present uses of the term, and provide information relevant to the skill set regarding a practice consistent with the evidence-based approach. Many of the articles were derived from the 2007 midwinter meeting of the Council of University Directors of Clinical Psychology, where the program topic was "Evidence-based Practice: What it is, Why It's Important, and What you Need to Know."