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Landin-Romero R, Moreno-Alcazar A, Pagani M, Amann BL. How Does Eye Movement Desensitization and Reprocessing Therapy Work? A Systematic Review on Suggested Mechanisms of Action. Front Psychol 2018; 9:1395. [PMID: 30166975 PMCID: PMC6106867 DOI: 10.3389/fpsyg.2018.01395] [Citation(s) in RCA: 70] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2017] [Accepted: 07/18/2018] [Indexed: 12/15/2022] Open
Abstract
Background: Eye movement desensitization and reprocessing [EMDR] is an innovative, evidence-based and effective psychotherapy for post-traumatic stress disorder [PTSD]. As with other psychotherapies, the effectiveness of EMDR contrasts with a limited knowledge of its underlying mechanism of action. In its relatively short life as a therapeutic option, EMDR has not been without controversy, in particular regarding the role of the bilateral stimulation as an active component of the therapy. The high prevalence of EMDR in clinical practice and the dramatic increase in EMDR research in recent years, with more than 26 randomized controlled trials published to date, highlight the need for a better understanding of its mechanism of action. Methods: We conducted a thorough systematic search of studies published until January 2018, using PubMed, ScienceDirect, Web of Knowledge and Scopus databases that examined the mechanism of action of EMDR or provided conclusions within the framework of current theoretical models of EMDR functioning. Results: Eighty-seven studies were selected for review and classified into three overarching models; (i) psychological models (ii) psychophysiological models and (iii) neurobiological models. The evidence available from each study was analyzed and discussed. Results demonstrated a reasonable empirical support for the working memory hypothesis and for the physiological changes associated with successful EMDR therapy. Recently, more sophisticated structural and functional neuroimaging studies using high resolution structural and temporal techniques are starting to provide preliminary evidence into the neuronal correlates before, during and after EMDR therapy. Discussion: Despite the increasing number of studies that published in recent years, the research into the mechanisms underlying EMDR therapy is still in its infancy. Studies in well-defined clinical and non-clinical populations, larger sample sizes and tighter methodological control are further needed in order to establish firm conclusions.
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Affiliation(s)
- Ramon Landin-Romero
- Brain and Mind Centre and School of Psychology, The University of Sydney, Sydney, NSW, Australia.,ARC Centre of Excellence in Cognition and its Disorders, Sydney, NSW, Australia
| | - Ana Moreno-Alcazar
- Institut de Neuropsiquiatria i Addiccions, Centre Fòrum Research Unit, Parc de Salut Mar, Barcelona, Spain.,IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain.,Centro de Investigación Biomedica en Red de Salud Mental (CIBERSAM), Madrid, Spain
| | - Marco Pagani
- Institute of Cognitive Sciences and Technologies, CNR, Rome, Italy
| | - Benedikt L Amann
- Institut de Neuropsiquiatria i Addiccions, Centre Fòrum Research Unit, Parc de Salut Mar, Barcelona, Spain.,IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain.,Centro de Investigación Biomedica en Red de Salud Mental (CIBERSAM), Madrid, Spain.,Department of Psychiatry, Autonomous University of Barcelona, Barcelona, Spain
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Gorin SS, Haggstrom D, Han PKJ, Fairfield KM, Krebs P, Clauser SB. Cancer Care Coordination: a Systematic Review and Meta-Analysis of Over 30 Years of Empirical Studies. Ann Behav Med 2017; 51:532-546. [DOI: 10.1007/s12160-017-9876-2] [Citation(s) in RCA: 126] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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Stevens SE, Hynan MT, Allen M, Braun MM, McCart MR. Are Complex Psychotherapies More Effective than Biofeedback, Progressive Muscle Relaxation, or Both? A Meta-Analysis. Psychol Rep 2016; 100:303-24. [PMID: 17451038 DOI: 10.2466/pr0.100.1.303-324] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
A meta-analysis of 26 studies was conducted to assess whether more complex forms of psychotherapy would be superior to control treatments of either biofeedback, progressive muscle relaxation, or both. Consistent with hypotheses, more complex treatments provided a small, significant improvement over biofeedback and progressive muscle relaxation ( r = .09). A subset of the more complex behavioral treatments accounted for most of this small incremental effectiveness of more complex treatments ( r = .15). Possible sources of this incremental effectiveness are discussed.
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Affiliation(s)
- Sean E Stevens
- Department of Psychology, University of Wisconsin-Milwaukee, P.O. Box 413, Milwaukee, WI 53201, USA
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Guitar B, Kazenski D, Howard A, Cousins SF, Fader E, Haskell P. Predicting Treatment Time and Long-Term Outcome of the Lidcombe Program: A Replication and Reanalysis. AMERICAN JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2015; 24:533-544. [PMID: 26125134 DOI: 10.1044/2015_ajslp-13-0156] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/29/2013] [Accepted: 06/23/2015] [Indexed: 06/04/2023]
Abstract
PURPOSE The present study presents treatment duration and outcome data on 14 children who stutter (CWS) recently treated by the Lidcombe Program (LP). These data were then combined with data from a previous LP treatment study (Miller & Guitar, 2009) to examine predictor variables for treatment duration and outcome. The present study also provides evidence of the effectiveness of LP from researchers who are independent of the developers of the program. METHOD Fourteen preschool CWS were assessed on stuttering severity variables and participant characteristics prior to treatment, given LP treatment, and reassessed 2 years after the children achieved stable fluency. These children's data were added to the data of 15 previously treated CWS to examine predictors of treatment duration and long-term outcome. Preliminary analysis lead to the identification of two predictors that were tested in a generalized linear model. RESULTS For the new group of 14 CWS, median treatment duration was 15 clinic visits and resulted in near-zero stuttering long term for most of the children and substantial reductions in stuttering for all of the children. For the combined group of 29 children, pretreatment stuttering frequency and severity were the best predictors of treatment duration in both clinic visits and weeks. CONCLUSIONS Children with more frequent and more severe stuttering may take longer in LP treatment. Long-term outcome may best be predicted by pretreatment stuttering and sex.
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Herbert JD, Gaudiano BA, Forman EM. The importance of theory in cognitive behavior therapy: a perspective of contextual behavioral science. Behav Ther 2013; 44:580-91. [PMID: 24094783 DOI: 10.1016/j.beth.2013.03.001] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2012] [Revised: 02/23/2013] [Accepted: 03/01/2013] [Indexed: 12/19/2022]
Abstract
For the past 30 years, generations of scholars of cognitive behavior therapy (CBT) have expressed concern that clinical practice has abandoned the close links with theory that characterized the earliest days of the field. There is also a widespread assumption that a greater working knowledge of theory will lead to better clinical outcomes, although there is currently very little hard evidence to support this claim. We suggest that the rise of so-called "third generation" models of CBT over the past decade, along with the dissemination of statistical innovations among psychotherapy researchers, have given new life to this old issue. We argue that theory likely does matter to clinical outcomes, and we outline the future research that would be needed to address this conjecture.
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Crombie IK, Falconer DW, Irvine L, Williams B, Ricketts IW, Humphris G, Norrie J, Rice P, Slane PW. Reducing alcohol-related harm in disadvantaged men: development and feasibility assessment of a brief intervention delivered by mobile telephone. PUBLIC HEALTH RESEARCH 2013. [DOI: 10.3310/phr01030] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
AbstractBackgroundSocially disadvantaged men suffer substantial harm from heavy drinking. Brief alcohol interventions are effective in reducing consumption when delivered via health care. There is a need for tailored brief interventions for disadvantaged men who seldom attend health care.Objectives(1) To investigate the best ways to recruit and retain disadvantaged men in a study aimed at reducing the frequency of heavy drinking. (2) To identify the type of content and timing of the delivery that is most likely to engage disadvantaged young to middle-aged men in an intervention delivered by text messages. (3) To determine whether or not the intervention is likely to be an acceptable way to influence the frequency of heavy drinking.DesignA three-phase study involving the development of the recruitment strategy and the intervention, an assessment of the feasibility of a randomised controlled trial, and a post-study evaluation.SettingCommunity-based study, conducted in Dundee, UK.ParticipantsDisadvantaged men aged 25–44 years who had two or more episodes of heavy drinking (≥ 8 units in a single session) in the preceding month. Two recruitment strategies were employed: recruitment through general practice (GP) registers and recruitment through a community outreach strategy.InterventionsFocus groups explored drinking motives and behaviours of the target group. The intervention also drew on reviews of the literature on: alcohol brief interventions, text message studies, communication theory and behaviour change theories and techniques. The intervention group received 36 text messages with images sent over a 28-day period.Main outcome measuresThe outcome measures evaluated the likely success of a full trial: recruitment of the participants; construction and delivery of a theoretically and empirically based intervention that successfully engages disadvantaged men; potential for the intervention to influence binge drinking.ResultsThe focus group analyses identified that personal experience and knowledge of the harmful effects of alcohol was widespread. Furthermore, there was a discrepancy between frequent binge drinking and perceived social expectations and duties. This could usefully be targeted in the intervention. Theoretically and empirically based behaviour change strategies were successfully rendered in attractive, colourful, brief text messages. Both recruitment strategies (GP registers and community outreach) proved successful and a total of 67 men were recruited, exceeding the target of 60. The participants were at high risk of harm because of frequent episodes of heavy binge drinking. Baseline interviews established that those recruited through community outreach drank substantially more and had more frequent binge drinking sessions than those recruited through GP registers. Retention at follow-up was 96%. Extensive process evaluation was conducted. The evaluation showed that 95% of text messages were successfully delivered to participants' telephones. Furthermore, there was a high level of engagement with text messages which sought responses. Most men replied to these texts, often giving carefully structured personal responses. Analyses of the responses indicated a high level of engagement with key components of the behaviour change strategy. Post-trial evaluation showed high levels of satisfaction with the intervention.ConclusionsThis study has shown that disadvantaged men can be recruited and retained in an alcohol intervention trial. A theoretically and empirically based intervention was successfully delivered by text message. Furthermore, the messages were well received and elicited the types of response intended. A full trial of the intervention, incorporating a cost-effectiveness study, should be carried out.Study registrationThis study is registered as ISRCTN10515845.FundingThe National Institute for Health Research Public Health Research programme.
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Affiliation(s)
- IK Crombie
- School of Medicine, University of Dundee, Dundee, UK
| | - DW Falconer
- School of Medicine, University of Dundee, Dundee, UK
| | - L Irvine
- School of Medicine, University of Dundee, Dundee, UK
| | - B Williams
- Nursing, Midwifery and Allied Health Professions (NMAHP) Research Unit, University of Stirling, Stirling, UK
| | - IW Ricketts
- School of Computing, University of Dundee, Dundee, UK
| | - G Humphris
- School of Medicine, University of St Andrews, St Andrews, UK
| | - J Norrie
- Centre for Health Care Randomised Trials, University of Aberdeen, Aberdeen, UK
| | - P Rice
- NHS Substance Abuse Services, Stracathro Hospital, Brechin, UK
| | - PW Slane
- The Erskine Practice, Arthurstone Medical Centre, Dundee, UK
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Magill M, Longabaugh R. Efficacy combined with specified ingredients: a new direction for empirically supported addiction treatment. Addiction 2013; 108:874-81. [PMID: 23072622 PMCID: PMC3566277 DOI: 10.1111/add.12013] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2012] [Revised: 07/16/2012] [Accepted: 10/10/2012] [Indexed: 11/28/2022]
Abstract
AIMS With the increased need for sanctioning behavioral addiction treatments to guide key stakeholders, focus has shifted to developing and applying criteria for establishing empirically supported treatments (EST). Among the many criteria offered, demonstration of incremental efficacy over a placebo or comparison in at least two independent randomized clinical trials (RCTs) has been the gold standard. While necessary, the present EST criteria are not sufficient. The present work: (i) argues for empirically supported specificity in behavioral addiction treatment, (ii) explores the limitations of empirical support for EST efficacy without evidence of specificity and (iii) discusses implications and recommendations for ultimately raising the bar for status as an EST. METHODS The authors review relevant literature on ESTs, evidence-based practice and clinical trial design in the addictions and related disciplines. RESULTS We clarify that the additional bar of specificity does not denote uniqueness in causal processes and we argue that specificity should not be inferred only via the nature of the experimental contrast. Rather, a treatment has specificity if its active ingredients are identified and validated empirically as predictors of subsequent treatment-related outcomes. Within this new definition, there are implications for clinical research and other key stakeholders. CONCLUSIONS A heightened centrality of empirically supported addiction treatment ingredients moving forward will advance clinical knowledge and evaluation methodology at a far greater pace.
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Affiliation(s)
- Molly Magill
- Center for Alcohol and Addiction Studies, Brown University, Providence, RI, USA
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Lohr JM, Lilienfeld SO, Rosen GM. Anxiety and its treatment: promoting science-based practice. J Anxiety Disord 2012; 26:719-27. [PMID: 22858898 DOI: 10.1016/j.janxdis.2012.06.007] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2012] [Revised: 06/13/2012] [Accepted: 06/25/2012] [Indexed: 01/14/2023]
Abstract
In this article we analyze ways that psychological science can inform the treatment of anxiety disorders. We focus on experimental psychopathology research to describe the structure of anxiety and the functions of danger, safety, predictability and controllability in contributing to disorder. We then address science-based practice in terms of principles of change and the benefits from the self-corrective nature of science, contrasting this form of practice with treatments that are not grounded in basic learning theory. Models for dissemination and implementation of science-based practices are described and related to practitioner attitudes regarding scientific evidence. Finally, we consider practice implications when treatments are, and are not, based on the informative role of clinical psychological science.
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Affiliation(s)
- Jeffrey M Lohr
- Department of Psychology, University of Arkansas, Fayetteville, AR 727201, United States.
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Schüz N, Eid M. Beyond the usual suspects: target group- and behavior-specific factors add to a theory-based sun protection intervention for teenagers. J Behav Med 2012; 36:508-19. [DOI: 10.1007/s10865-012-9445-x] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2012] [Accepted: 06/28/2012] [Indexed: 10/28/2022]
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Sheinfeld Gorin S, Krebs P, Badr H, Janke EA, Jim HS, Spring B, Mohr DC, Berendsen MA, Jacobsen PB. Meta-analysis of psychosocial interventions to reduce pain in patients with cancer. J Clin Oncol 2012; 30:539-47. [PMID: 22253460 PMCID: PMC6815997 DOI: 10.1200/jco.2011.37.0437] [Citation(s) in RCA: 191] [Impact Index Per Article: 15.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2011] [Accepted: 11/08/2011] [Indexed: 01/09/2023] Open
Abstract
PURPOSE Pain is one of the most common, burdensome, and feared symptoms experienced by patients with cancer. American Pain Society standards for pain management in cancer recommend both pharmacologic and psychosocial approaches. To obtain a current, stable, and comprehensive estimate of the effect of psychosocial interventions on pain-an important clinical topic-we conducted a meta-analysis of randomized controlled studies among adult patients with cancer published between 1966 and 2010. METHODS Three pairs of raters independently reviewed 1,681 abstracts, with a systematic process for reconciling disagreement, yielding 42 papers, of which 37 had sufficient data for meta-analysis. Studies were assessed for quality using a modified seven-item Physiotherapy Evidence Database (PEDro) coding scheme. Pain severity and interference were primary outcome measures. RESULTS Study participants (N = 4,199) were primarily women (66%) and white (72%). The weighted averaged effect size across studies for pain severity (38 comparisons) was 0.34 (95% CI, 0.23 to 0.46; P < .001), and the effect size for pain interference (four comparisons) was 0.40 (95% CI, 0.21 to 0.60; P < .001). Studies that monitored whether treatment was delivered as intended had larger effects than those that did not (P = .04). CONCLUSION Psychosocial interventions had medium-size effects on both pain severity and interference. These robust findings support the systematic implementation of quality-controlled psychosocial interventions as part of a multimodal approach to the management of pain in patients with cancer.
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Affiliation(s)
- Sherri Sheinfeld Gorin
- Sherri Sheinfeld Gorin, Herbert Irving Comprehensive Cancer Center, Columbia University; Paul Krebs, New York University School of Medicine; Hoda Badr, Mount Sinai School of Medicine, New York, NY; Elizabeth Amy Janke, University of the Sciences, Philadelphia, PA; Heather S.L. Jim and Paul B. Jacobsen, H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL; Bonnie Spring and Mark A. Berendsen, Northwestern University; and David C. Mohr, Northwestern University, Feinberg School of Medicine, Chicago, IL
| | - Paul Krebs
- Sherri Sheinfeld Gorin, Herbert Irving Comprehensive Cancer Center, Columbia University; Paul Krebs, New York University School of Medicine; Hoda Badr, Mount Sinai School of Medicine, New York, NY; Elizabeth Amy Janke, University of the Sciences, Philadelphia, PA; Heather S.L. Jim and Paul B. Jacobsen, H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL; Bonnie Spring and Mark A. Berendsen, Northwestern University; and David C. Mohr, Northwestern University, Feinberg School of Medicine, Chicago, IL
| | - Hoda Badr
- Sherri Sheinfeld Gorin, Herbert Irving Comprehensive Cancer Center, Columbia University; Paul Krebs, New York University School of Medicine; Hoda Badr, Mount Sinai School of Medicine, New York, NY; Elizabeth Amy Janke, University of the Sciences, Philadelphia, PA; Heather S.L. Jim and Paul B. Jacobsen, H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL; Bonnie Spring and Mark A. Berendsen, Northwestern University; and David C. Mohr, Northwestern University, Feinberg School of Medicine, Chicago, IL
| | - Elizabeth Amy Janke
- Sherri Sheinfeld Gorin, Herbert Irving Comprehensive Cancer Center, Columbia University; Paul Krebs, New York University School of Medicine; Hoda Badr, Mount Sinai School of Medicine, New York, NY; Elizabeth Amy Janke, University of the Sciences, Philadelphia, PA; Heather S.L. Jim and Paul B. Jacobsen, H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL; Bonnie Spring and Mark A. Berendsen, Northwestern University; and David C. Mohr, Northwestern University, Feinberg School of Medicine, Chicago, IL
| | - Heather S.L. Jim
- Sherri Sheinfeld Gorin, Herbert Irving Comprehensive Cancer Center, Columbia University; Paul Krebs, New York University School of Medicine; Hoda Badr, Mount Sinai School of Medicine, New York, NY; Elizabeth Amy Janke, University of the Sciences, Philadelphia, PA; Heather S.L. Jim and Paul B. Jacobsen, H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL; Bonnie Spring and Mark A. Berendsen, Northwestern University; and David C. Mohr, Northwestern University, Feinberg School of Medicine, Chicago, IL
| | - Bonnie Spring
- Sherri Sheinfeld Gorin, Herbert Irving Comprehensive Cancer Center, Columbia University; Paul Krebs, New York University School of Medicine; Hoda Badr, Mount Sinai School of Medicine, New York, NY; Elizabeth Amy Janke, University of the Sciences, Philadelphia, PA; Heather S.L. Jim and Paul B. Jacobsen, H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL; Bonnie Spring and Mark A. Berendsen, Northwestern University; and David C. Mohr, Northwestern University, Feinberg School of Medicine, Chicago, IL
| | - David C. Mohr
- Sherri Sheinfeld Gorin, Herbert Irving Comprehensive Cancer Center, Columbia University; Paul Krebs, New York University School of Medicine; Hoda Badr, Mount Sinai School of Medicine, New York, NY; Elizabeth Amy Janke, University of the Sciences, Philadelphia, PA; Heather S.L. Jim and Paul B. Jacobsen, H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL; Bonnie Spring and Mark A. Berendsen, Northwestern University; and David C. Mohr, Northwestern University, Feinberg School of Medicine, Chicago, IL
| | - Mark A. Berendsen
- Sherri Sheinfeld Gorin, Herbert Irving Comprehensive Cancer Center, Columbia University; Paul Krebs, New York University School of Medicine; Hoda Badr, Mount Sinai School of Medicine, New York, NY; Elizabeth Amy Janke, University of the Sciences, Philadelphia, PA; Heather S.L. Jim and Paul B. Jacobsen, H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL; Bonnie Spring and Mark A. Berendsen, Northwestern University; and David C. Mohr, Northwestern University, Feinberg School of Medicine, Chicago, IL
| | - Paul B. Jacobsen
- Sherri Sheinfeld Gorin, Herbert Irving Comprehensive Cancer Center, Columbia University; Paul Krebs, New York University School of Medicine; Hoda Badr, Mount Sinai School of Medicine, New York, NY; Elizabeth Amy Janke, University of the Sciences, Philadelphia, PA; Heather S.L. Jim and Paul B. Jacobsen, H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL; Bonnie Spring and Mark A. Berendsen, Northwestern University; and David C. Mohr, Northwestern University, Feinberg School of Medicine, Chicago, IL
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Olatunji BO, Cisler JM, Deacon BJ. Efficacy of cognitive behavioral therapy for anxiety disorders: a review of meta-analytic findings. Psychiatr Clin North Am 2010; 33:557-77. [PMID: 20599133 DOI: 10.1016/j.psc.2010.04.002] [Citation(s) in RCA: 245] [Impact Index Per Article: 17.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Numerous clinical trials have supported the efficacy of cognitive behavioral therapy (CBT) for the treatment of anxiety disorders. Accordingly, CBT has been formally recognized as an empirically supported treatment for anxiety-related conditions. This article reviews the evidence supporting the efficacy of CBT for anxiety disorders. Specifically, contemporary meta-analytic studies on the treatment of anxiety disorders are reviewed and the efficacy of CBT is examined. Although the specific components of CBT differ depending on the study design and the anxiety disorder treated, meta-analyses suggest that CBT procedures (particularly exposure-based approaches) are highly efficacious. CBT generally outperforms wait-list and placebo controls. Thus, CBT provides incremental efficacy above and beyond nonspecific factors. For some anxiety disorders, CBT also tends to outperform other psychosocial treatment modalities. The implications of available meta-analytic findings in further delineating the efficacy and dissemination of CBT for anxiety disorders are discussed.
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Affiliation(s)
- Bunmi O Olatunji
- Department of Psychology, Vanderbilt University, 301 Wilson Hall, 111 21st Avenue South, Nashville, TN 37203, USA.
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Gaudiano BA. Ost's (2008) methodological comparison of clinical trials of acceptance and commitment therapy versus cognitive behavior therapy: Matching apples with oranges? Behav Res Ther 2009; 47:1066-70. [PMID: 19679300 PMCID: PMC2786237 DOI: 10.1016/j.brat.2009.07.020] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2009] [Revised: 06/10/2009] [Accepted: 07/30/2009] [Indexed: 10/20/2022]
Abstract
Ost (2008) recently compared the methodological rigor of studies of acceptance and commitment therapy (ACT) and traditional cognitive behavior therapy (CBT). He concluded that the ACT studies had more methodological deficiencies, and thus the treatment did not qualify as an "empirically supported treatment." Although Ost noted several important limitations that should be carefully considered when evaluating early ACT research, his attempt to devise an empirical matching strategy by creating a comparison sample of CBT studies to bolster his conclusions was itself problematic. The samples were clearly mismatched in terms of the populations being treated, leading to differences in study design and methodology. Furthermore, reanalysis showed clear differences in grant support favoring CBT compared with ACT studies that were not reported in the original article. Given the actual mismatch between the samples, Ost's methodological ratings are difficult to interpret and provide little useful information beyond what could already be gathered by a qualitative review of ACT study limitations. Such limitations are characteristic of the earlier randomized controlled trials of any emerging psychotherapeutic approach.
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Affiliation(s)
- Brandon A Gaudiano
- Department of Psychiatry & Human Behavior, Alpert Medical School of Brown University, USA.
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Ayala ES, Meuret AE, Ritz T. Treatments for blood-injury-injection phobia: a critical review of current evidence. J Psychiatr Res 2009; 43:1235-42. [PMID: 19464700 DOI: 10.1016/j.jpsychires.2009.04.008] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2008] [Revised: 03/20/2009] [Accepted: 04/17/2009] [Indexed: 10/20/2022]
Abstract
Blood-injury-injection (BII) phobia presents with a unique anxiety response that often involves blood pressure drops and pronounced bradycardia, which can culminate in fainting. The current recommended treatment for BII phobia is Applied Tension (AT), a tension technique that includes in vivo exposure. However, surprisingly little empirical evidence is available on the additive efficacy of tension beyond exposure alone. Our literature search yielded five controlled treatment studies for BII phobia, all from one research group. Beyond AT, these studies also tested Exposure only (E), Tension only, Applied Relaxation (AR), or a combination of AR and AT. Based on self-reported levels of anxiety, in-session avoidance and fainting, AT was superior over other conditions; however, when considering pre- to post-treatment effect sizes on BII-related questionnaires, E outperformed all other treatments. In addition, AT did not yield better results on physiological measures, and individuals with BII fears improved similarly within studies across treatment groups, regardless of fainting status. Heterogeneity in patient populations (e.g. extent of fainting-proneness), differential targeting of BII phobia manifestations, and small sample sizes may explain some of the variability in findings. Further research is needed to determine the efficacy of treatment techniques for BII phobia patients with and without fainting history.
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Affiliation(s)
- Erica S Ayala
- Department of Psychology, Southern Methodist University,Dallas, TX 75206, USA.
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Faris AS, Cavell TA, Fishburne JW, Britton PC. Examining motivational interviewing from a client agency perspective. J Clin Psychol 2009; 65:955-70. [PMID: 19459196 DOI: 10.1002/jclp.20599] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Rutherford BR, Roose SP, Sneed J. Mind over medicine: the influence of expectations on antidepressant response. J Am Psychoanal Assoc 2009; 57:456-60. [PMID: 19516067 DOI: 10.1177/00030651090570020909] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Bret R Rutherford
- Columbia University Center for Psychoanalytic Training and Research.
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Rutherford BR, Sneed JR, Roose SP. Does study design influence outcome? The effects of placebo control and treatment duration in antidepressant trials. PSYCHOTHERAPY AND PSYCHOSOMATICS 2009; 78:172-81. [PMID: 19321970 PMCID: PMC3785090 DOI: 10.1159/000209348] [Citation(s) in RCA: 119] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/27/2008] [Indexed: 11/19/2022]
Abstract
BACKGROUND Clinicians and researchers synthesize data from randomized controlled trials (RCTs) of antidepressants to make conclusions about the efficacy of medications for depression. All treatments include nonspecific factors in addition to the specific effects of drugs, and study design may influence patient outcomes via nonspecific factors. This study investigated whether placebo control and treatment duration affect the outcome in antidepressant RCTs. METHODS Medline and the Cochrane Database were searched to identify RCTs of antidepressants for major depression approved by the Food and Drug Administration. Included studies enrolled outpatient participants aged 18-65, lasted 6-12 weeks, compared an antidepressant to placebo or another antidepressant and were published in English after 1985. Excluded trials enrolled inpatients, pregnant women and subjects with psychosis or mania. Mixed-effects logistic regression models including study type (placebo-controlled or comparator) and study duration (6, 8 or 12 weeks) as fixed effects determined whether these factors affected response and remission rates. RESULTS In the 90 trials analyzed, the odds of depression response (OR = 1.79, 95% CI = 1.45-2.17, p < 0.001) and remission (OR 1.53, 95% CI = 1.11-2.11, p < 0.001) were significantly higher in comparator relative to placebo-controlled trials. Trials lasting 8 (OR = 1.37, CI = 1.14-1.64, p = 0.001) and 12 (OR = 1.52, CI = 1.12-2.07, p = 0.008) weeks had significantly greater response rates than 6-week trials without differing themselves. CONCLUSIONS Response and remission rates to antidepressants are significantly affected by study type and duration. Clinicians and researchers must consider the study design when interpreting and designing RCTs of antidepressant medications.
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Affiliation(s)
- Bret R Rutherford
- Department of Psychiatry, Columbia University and the New York State Psychiatric Institute, 1051 Riverside Drive, New York, NY 10032, USA.
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Gillam RB, Loeb DF, Hoffman LM, Bohman T, Champlin CA, Thibodeau L, Widen J, Brandel J, Friel-Patti S. The efficacy of Fast ForWord Language intervention in school-age children with language impairment: a randomized controlled trial. JOURNAL OF SPEECH, LANGUAGE, AND HEARING RESEARCH : JSLHR 2008; 51:97-119. [PMID: 18230858 PMCID: PMC2361096 DOI: 10.1044/1092-4388(2008/007)] [Citation(s) in RCA: 83] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/14/2023]
Abstract
PURPOSE A randomized controlled trial was conducted to compare the language and auditory processing outcomes of children assigned to receive the Fast ForWord Language intervention (FFW-L) with the outcomes of children assigned to nonspecific or specific language intervention comparison treatments that did not contain modified speech. METHOD Two hundred sixteen children between the ages of 6 and 9 years with language impairments were randomly assigned to 1 of 4 conditions: (a) Fast ForWord Language (FFW-L), (b) academic enrichment (AE), (c) computer-assisted language intervention (CALI), or (d) individualized language intervention (ILI) provided by a speech-language pathologist. All children received 1 hr and 40 min of treatment, 5 days per week, for 6 weeks. Language and auditory processing measures were administered to the children by blinded examiners before treatment, immediately after treatment, 3 months after treatment, and 6 months after treatment. RESULTS The children in all 4 conditions improved significantly on a global language test and a test of backward masking. Children with poor backward masking scores who were randomized to the FFW-L condition did not present greater improvement on the language measures than children with poor backward masking scores who were randomized to the other 3 conditions. Effect sizes, analyses of standard error of measurement, and normalization percentages supported the clinical significance of the improvements on the Comprehensive Assessment of Spoken Language (E. Carrow-Woolfolk, 1999). There was a treatment effect for the Blending Words subtest of the Comprehensive Test of Phonological Processing (R. K. Wagner, J. K. Torgesen, & C. A. Rashotte, 1999). Participants in the FFW-L and CALI conditions earned higher phonological awareness scores than children in the ILI and AE conditions at the 6-month follow-up testing. CONCLUSION Fast ForWord Language, the intervention that provided modified speech to address a hypothesized underlying auditory processing deficit, was not more effective at improving general language skills or temporal processing skills than a nonspecific comparison treatment (AE) or specific language intervention comparison treatments (CALI and ILI) that did not contain modified speech stimuli. These findings call into question the temporal processing hypothesis of language impairment and the hypothesized benefits of using acoustically modified speech to improve language skills. The finding that children in the 3 treatment conditions and the active comparison condition made clinically relevant gains on measures of language and temporal auditory processing informs our understanding of the variety of intervention activities that can facilitate development.
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Conrad A, Isaac L, Roth WT. The psychophysiology of generalized anxiety disorder: 2. Effects of applied relaxation. Psychophysiology 2008; 45:377-88. [PMID: 18221441 DOI: 10.1111/j.1469-8986.2007.00644.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Muscle relaxation therapy assumes that generalized anxiety disorder (GAD) patients lack the ability to relax but can learn this in therapy. We tested this by randomizing 49 GAD patients to 12 weeks of Applied Relaxation (AR) or waiting. Before, during, and after treatment participants underwent relaxation tests. Before treatment, GAD patients were more worried than healthy controls (n=21) and had higher heart rates and lower end-tidal pCO2, but not higher muscle tension (A. Conrad, L. Isaac, & W.T. Roth, 2008). AR resulted in greater symptomatic improvement than waiting. However, 28% of the AR group dropped out of treatment and some patients relapsed at the 6-week follow-up. There was little evidence that AR participants learned to relax in therapy or that a reduction in anxiety was associated with a decrease in activation. We conclude that the clinical effects of AR in improving GAD symptoms are moderate at most and cannot be attributed to reducing muscle tension or autonomic activation.
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Affiliation(s)
- Ansgar Conrad
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, and the Veterans Affairs Health Care System, Palo Alto, California, USA
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Ratner NB. Evidence-based practice: an examination of its ramifications for the practice of speech-language pathology. Lang Speech Hear Serv Sch 2007; 37:257-67. [PMID: 17041074 DOI: 10.1044/0161-1461(2006/029)] [Citation(s) in RCA: 65] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
PURPOSE The purpose of this article is to consider some of the ramifications that arise when a discipline newly endorses evidence-based practice (EBP) as a primary guiding principle. Although EBP may appear straightforward, events experienced by peer disciplines that have preceded us in the implementation of EBP raise questions about defining acceptable forms of evidence for treatment effectiveness and efficacy, the potential roles of nonspecific or common factors, therapist quality in achieving therapy outcomes, and eventual applications of EBP that may overly confine which treatments are considered acceptable and reimbursable. METHOD Through narrative review of the literature, the article examines valuable as well as controversial features of EBP in addition to obstacles that may impede the transition of evidence (research findings) to clinical practice. CONCLUSION EBP is a valuable construct in ensuring quality of care. However, bridging between research evidence and clinical practice may require us to confront potentially difficult issues and establish thoughtful dialogue about best practices in fostering EBP itself.
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Affiliation(s)
- Nan Bernstein Ratner
- Department of Hearing and Speech Sciences, 0100 Lefrak Hall, The University of Maryland, College Park, MD 20742, USA.
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Abstract
To evaluate whether the specific techniques of a newly developed behavioral therapy exceed the effects of its common factors (e.g., therapeutic alliance), an ideal comparison control must omit the unique ingredients of the active treatment while possessing the common factors in equal measure. Reviews of the controlled-trial psychotherapy research literature show that such systematic matching is not a common practice. Addressing this gap between theory and practice, we delineate 7 steps for designing a credible control for a recently developed behavioral therapy adapted for binge eating disorder--dialectical behavior therapy (DBT). Our detailed description of matching the common factors to the extent possible and specifically measuring these offers a useful research design template for investigators of controlled behavioral treatment trials.
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Weiner JS, Arnold RM, Curtis JR, Back AL, Rounsaville B, Tulsky JA. Manualized Communication Interventions to Enhance Palliative Care Research and Training: Rigorous, Testable Approaches. J Palliat Med 2006; 9:371-81. [PMID: 16629567 DOI: 10.1089/jpm.2006.9.371] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Palliative care practice requires excellent communication between the patient, family, and clinical team. Experts in the field have proposed a variety of communication interventions that can be used in the palliative care setting. However, these interventions are at a high level of generality: the specifics of each intervention are not well codified; the individual steps in each intervention are not easily reproducible and thus not comparable between practitioners; the methods to measure adherence to these communication protocols have not been established; and there is little detail on how to adapt these general interventions to the individual patient and family. Therefore, we lack good evidence for the efficacy of these recommendations. This paper makes the case for development of structured, testable approaches to communication that will inform clinical practice and communication training. To do so, palliative care communication should be conceived as a formal medical and psychosocial intervention-a potential treatment with risks and benefits to be systematically researched and operationalized in the same manner as medication interventions. As we illustrate, psychotherapy research has faced the same challenges in the past and has utilized manualized treatments to meet its goals. Through such approaches, we can begin to address the most basic intervention questions such as protocol efficacy, dose-response, side effects, and the optimal process and content of communication with the patient and family. The advantages of manualized communication approaches; some concepts underlying manual construction; and challenges to extending manualized communication to the palliative care domain are discussed.
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Affiliation(s)
- Joseph S Weiner
- Long Island Jewish Medical Center, Department of Medicine, New Hyde Park, NY 11040, USA.
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Gaudiano BA, Herbert JD. Methodological issues in clinical trials of antidepressant medications: perspectives from psychotherapy outcome research. PSYCHOTHERAPY AND PSYCHOSOMATICS 2005; 74:17-25. [PMID: 15627852 DOI: 10.1159/000082022] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Despite their widespread use, the specific efficacy of antidepressant medications has been a source of debate in recent years. Examination of the literature reveals that a significant proportion of the benefit produced in antidepressant trials is duplicated in pill placebo conditions. Furthermore, early trials utilizing active placebos, or medications that mimic the common side effects of antidepressants, showed even smaller differences as compared with active medications. We examine issues surrounding the use of placebo control conditions in antidepressant trials, including the pros and cons of active placebos. We conclude that similar challenges are faced by psychotherapy outcome researchers who have focused more on the separation of specific from nonspecific treatment factors and on the effects of researcher allegiance and patient expectancy on outcome. Within this context, recommendations for improving future antidepressant research are discussed.
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Affiliation(s)
- Brandon A Gaudiano
- Department of Psychiatry and Human Behavior, Brown University School of Medicine and Butler Hospital, Providence, RI 02906, USA.
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Gaudiano BA. Cognitive Behavior Therapies for Psychotic Disorders: Current Empirical Status and Future Directions. ACTA ACUST UNITED AC 2005. [DOI: 10.1093/clipsy.bpi004] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Bernstein Ratner N. Evidence-based practice in stuttering: Some questions to consider. JOURNAL OF FLUENCY DISORDERS 2005; 30:163-88. [PMID: 15961152 DOI: 10.1016/j.jfludis.2005.04.002] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/30/2004] [Revised: 04/19/2005] [Accepted: 04/22/2005] [Indexed: 05/03/2023]
Abstract
UNLABELLED A recent forum in JFD (28/3, 2003) evaluated the status of evidence-based practice in fluency disorders, and offered recommendations for improvement. This article re-evaluates the level of support available for some popular approaches to stuttering therapy and questions the relative value placed on some types of programs endorsed by the forum. Evidence-based practice is discussed within the context of emerging concerns over its application to non-medical interventions and suggestions are made for grounding fluency interventions by reference to empirically supported principles of change. A popular, evidence-based intervention for stuttering in young children (the Lidcombe program) is evaluated within the suggested parameters. EDUCATIONAL OBJECTIVES After reading this article, the reader will be able to: (1) evaluate the status of evidence-based practice in fluency disorders; (2) list concerns about the impact of narrow interpretation of EBP on research and practice in the field of fluency disorders and other non-medical domains; (3) articulate the role of theory and basic research in selecting among and evaluating therapy approach options.
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Affiliation(s)
- Nan Bernstein Ratner
- Department of Hearing and Speech Sciences, The University of Maryland, 0100 Lefrak Hall, College Park, MD 20742, USA.
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Wampold BE, Minami T, Tierney SC, Baskin TW, Bhati KS. The placebo is powerful: Estimating placebo effects in medicine and psychotherapy from randomized clinical trials. J Clin Psychol 2005; 61:835-54. [PMID: 15827993 DOI: 10.1002/jclp.20129] [Citation(s) in RCA: 157] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
The logic of the randomized double-blind placebo control group design is presented, and problems with using the design in psychotherapy are discussed. Placebo effects are estimated by examining clinical trials in medicine and psychotherapy. In medicine, a recent meta-analysis of clinical trials with treatment, placebo, and no treatment arms was conducted (Hróbjartsson & Gøtzsche, 2001), and it was concluded that placebos have small or no effects. A re-analysis of those studies, presented here, shows that when disorders are amenable to placebos and the design is adequate to detect the effects, the placebo effect is robust and approaches the treatment effect. For psychological disorders, particularly depression, it has been shown that pill placebos are nearly as effective as active medications whereas psychotherapies are more effective than psychological placebos. However, it is shown that when properly designed, psychological placebos are as effective as accepted psychotherapies.
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Affiliation(s)
- Bruce E Wampold
- Department of Counseling Psychology, University of Wisconsin-Madison, WI 53706, USA.
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Herbert JD, Gaudiano BA. Moving from empirically supported treatment lists to practice guidelines in psychotherapy: The role of the placebo concept. J Clin Psychol 2005; 61:893-908. [PMID: 15827997 DOI: 10.1002/jclp.20133] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
The use of placebos is the "gold standard" in studies of investigational drugs, and of other medical procedures as well. Several recent trends have suggested the use of placebos in studies of psychotherapy to isolate effective treatment components, and as a basis for establishing lists of empirically supported treatments. Unlike within the domain of medicine, in which the logic of placebos is relatively straightforward, the concept of placebo as applied to psychotherapy is fraught with both conceptual and practical problems. The evidence-based practice of psychotherapy can best be promoted through the development of practice guidelines, for which psychotherapy placebos are unnecessary. Moreover, even if problems associated with psychological placebos could be overcome, they are not necessary in psychotherapy research.
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Affiliation(s)
- James D Herbert
- Department of Psychology, Drexel University, Philadelphia, PA 19102-1192, USA.
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Olatunji BO, Tolin DF, Lohr JM. Irritable bowel syndrome: associated features and the efficacy of psychosocial treatments. ACTA ACUST UNITED AC 2004. [DOI: 10.1016/j.appsy.2004.09.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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