The third way: Single-case research, training, and practice in clinical psychology

The Combination of Cognitive-Behavioural Therapy with Virtual Reality for the Treatment of Postnatal Depression in a Brief Intervention Context: A Single-Case Study Trial

Postnatal depression (PND) is a mood disorder with potentially devastating effects to the individual on many levels. It can affect cognitive functioning, motivation, and self-esteem. The person can socially withdraw from their immediate familial or social circle. It can affect bonding and quality time between the mother and baby. There are many effective therapeutic treatments used for the treatment of PND such as cognitive-behavioural therapy (CBT) and interpersonal psychotherapy (IPT). This study using a single-case study trial with 15 participants investigates the clinical usefulness of combining CBT with virtual reality (VR). Results show that the combination of CBT with VR is an effective treatment for PND. In addition, VR can enhance awareness, decision-making, and self-appreciation within the individual and can also have real-life applications. This study also shows that the combination of VR and CBT is feasible, while the use of such a technology is well accepted.

A summary of reporting guidelines and evaluation domains for using single-case experimental designs and recommendations for the study of eating disorders

The insights and activities that regularly occur in clinical settings are an underutilized wellspring of potential scientific advances. Single-case experimental designs (SCEDs) include a collection of methods for testing hypotheses in one individual (or a small number of individuals) at a time that are particularly well suited to clinical settings. Their strengths include their potential for maximizing both internal and external validity by way of tight experimental control over threats to internal validity and flexibility in application and inclusion criteria. Despite these advantages, the eating disorder field has not made use of SCEDs to a similar extent as other research areas, providing an opportunity for expansion. Recent advances in organizing SCED standards have resulted in the publication of two sets of reporting guidelines relevant to eating disorders research. These guidelines are integrated and summarized alongside descriptions of domains for evaluating their methodological rigor. Example research questions of potential interest to the eating disorder field are illustrated with SCEDs, and several issues to consider when using SCEDs in eating disorders research are described. It is recommended that researchers aiming to use SCEDs refer to this paper and the resources cited herein when designing and reporting their work. Finally, it is hoped that individuals with access to clinical samples use this paper as a source of inspiration for testing their unique clinical insights.

Single-Case Research Methods: History and Suitability for a Psychological Science in Need of Alternatives

This paper presents a historical and conceptual analysis of a group of research strategies known as the Single-Case Methods (SCMs). First, we present an overview of the SCMs, their history, and their major proponents. We will argue that the philosophical roots of SCMs can be found in the ideas of authors who recognized the importance of understanding both the generality and individuality of psychological functioning. Second, we will discuss the influence that the natural sciences' attitude toward measurement and experimentation has had on SCMs. Although this influence can be traced back to the early days of experimental psychology, during which incipient forms of SCMs appeared, SCMs reached full development during the subsequent advent of Behavior Analysis (BA). Third, we will show that despite the success of SCMs in BA and other (mainly applied) disciplines, these designs are currently not prominent in psychology. More importantly, they have been neglected as a possible alternative to one of the mainstream approaches in psychology, the Null Hypothesis Significance Testing (NHST), despite serious controversies about the limitations of this prevailing method. Our thesis throughout this section will be that SCMs should be considered as an alternative to NHST because many of the recommendations for improving the use of significance testing (Wilkinson & the TFSI, 1999) are main characteristics of SCMs. The paper finishes with a discussion of a number of the possible reasons why SCMs have been neglected.

Some Problems with Randomized Controlled Trials and Some Viable Alternatives

Randomized controlled trials (RCTs) are currently the dominant methodology for evaluating psychological treatments. They are widely regarded as the gold standard, and in the current climate, it is unlikely that any particular psychotherapy would be considered evidence-based unless it had been subjected to at least one, and usually more, RCTs. Despite the esteem within which they are held, RCTs have serious shortcomings. They are the methodology of choice for answering some questions but are not well suited for answering others. In particular, they seem poorly suited for answering questions related to why therapies work in some situations and not in others and how therapies work in general. Ironically, the questions that RCTs cannot answer are the questions that are of most interest to clinicians and of most benefit to patients. In this paper, we review some of the shortcomings of RCTs and suggest a number of other approaches. With a more nuanced understanding of the strengths and weaknesses of RCTs and a greater awareness of other research strategies, we might begin to develop a more realistic and precise understanding of which treatment options would be most effective for particular clients with different problems and in different circumstances. Copyright © 2015 John Wiley & Sons, Ltd.

KEY PRACTITIONER MESSAGE

Practitioners can think more critically about evidence provided by RCTs and can contribute to progress in psychotherapy by conducting research using different methodologies.

Training in Emotion Regulation as a Treatment for Binge Eating: A Preliminary Study

Binge eating within Binge Eating Disorder (BED) may represent ineffective management of, and inappropriate escape from, strong, dysphoric emotions, but treatments have been slow to incorporate an emotion regulation focus. Eleven women meeting criteria for BED participated in 11 sessions (2 hours per week) of a psychoeducational group program providing training in emotion recognition and management, problem-solving, assertion training, relaxation and stress management. Outcome was evaluated using a multiple-baseline design replicated across groups. Binges were self-monitored daily, and self-report questionnaires assessed wellbeing and emotion regulation at pretreatment, posttreatment and follow-up. Cognitive changes from pre to posttreatment were evaluated by Articulated Thoughts in Simulated Situations. The program was effective in reducing binge eating, alexithymia, stress and depression, and it improved coping and positive cognitions. No participant met criteria for BED at follow-up. The findings provide support for the inclusion of training in emotion recognition and regulation in treatments for BED and for affect regulation models of binge eating.

On the Decline of n = 1 Research in Behaviour Change: The Rise of the Evidence-Based Practice Movement as One Explanation for the Trend

Paradoxically, the rise of the evidence-based practice (EBP) movement with its growing reliance on the execution of randomised controlled trials (RCTs) has been associated with a fall in the conduct of single-case research. Sharpley, among others, is concerned with this trend because it ignores the complementarity of single-case and group experimentation. We argue that the view that EBP should be founded predominantly on group data is untenable on both scientific and practical grounds.

Exposure and reorganization: the what and how of effective psychotherapy

Even though the effectiveness of psychotherapy is generally acknowledged, researchers are yet to agree on a plausible explanation for this effectiveness or on possible mechanisms of change that are activated by psychotherapy. To enhance developments in these areas some researchers have called for a focus on treatment principles rather than treatment techniques. In this respect, the technique of exposure is instructive. Despite its common use with anxiety disorders and the successful outcomes it produces, it has only recently been considered as a treatment for other disorders. By focussing on the underlying principles of exposure it is possible to consider exposure as a transdiagnostic component of successful psychotherapies. Understanding exposure from the perspective of Perceptual Control Theory (PCT) enables the identification of a functional, rather than a conceptual or statistical, mechanism of change. Functionally, exposure can be understood as an essential precursor to the internal reorganization that is necessary for the amelioration of psychological distress. PCT suggests a more considered and widespread use of exposure in psychotherapy as a way of improving both the efficiency and the effectiveness of the treatments offered. Despite the proliferation of psychotherapies in recent years there has not been a commensurate growth in our understanding of the effective ingredients of treatment. It seems unlikely that there are multitudes of different mechanisms and processes through which psychological distress is resolved and that each of these different psychotherapies utilises a distinct item from the collection. In fact, the spawning of hundreds of different psychotherapies is perhaps the most telling sign that there may still be much work to do before the important principles of treatment are described and fundamental mechanisms of change are identified. Could a technique as mundane as exposure hold the key to effective psychotherapy? For psychotherapy, is there just one road leading to Rome but a plethora of ways to travel that road?