Term
| Efficacy and effectiveness |
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Definition
Efficacious - the research based end of things (does it work at all?)
Effectiveness - how well does it work in the real world, not in a tightly controlled setting |
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Term
| EBP, EBT, EBA, EST, ESA, EVT - whats the point? |
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Definition
Want to know WHAT we're dealing with (assessment) not just giving treatments.
Moving more to calling it evidence based PRACTICE to encompass all aspects (assmt, tx) |
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Term
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Definition
| comes all the way from the president of the APA : – “their fervor about science borders on the irrational”…requiring adherence from practicing psychologists, this is where it gets controversial – insurance companies requiring you to do certain things could be problematic but we do need to study it |
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Term
Criteria for empirically-validated treatments to be considered a
WELL ESTABLISHED TREATMENT |
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Definition
I. At least two good b/t group design experiments demonstrating efficacy in one or more of the following ways:
a) Superior (statistically significantly so) to pill or psychological placebo or to another treatment
B. Equivalent to an already established treatment in experiments with adequate sample sizes
OR
II. A large series of single-case design experiments (n>9) demonstrating efficacy. These experiments must have:
A. Used good experimental designs and
B. Compared the intervention to another treatment as in IA.
Further criteria for both I and II:
III. Experiments much be conducted with tx manuals.
IV. Characteristics of the client samples must be clearly specified.
V. Effects must have been demonstrated by at least two different investigators or investigating teams. |
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Term
Criteria for empirically-validated treatments to be considered a
PROBABLY EFFICACIOUS TREATMENT |
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Definition
I. Two experiments showing the treatment is superior (statistically significantly so) to a waiting-list control group
OR
II. One or more experiments meeting the well-established treatment criteria IA or IB, III, and IV but not V.
OR
III. A small series of single-case design experiments (N > = 3) otherwise meeting Well Established Treatment critera |
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Term
| Difference between empirically supported treatment and evidence-based treatment |
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Definition
Empirically supported generally means studies have shown some support but not necessarily a lot of support (maybe just one or two studies)
evidence based compiles from lots of studies showing effectiveness |
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Term
| Dodo verdict (Rosenzweig, 1936) |
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Definition
there are common factors to all tx that lead to their success (therapeutic relationship/alliance).
Only a small effect (d = .20) is attributable to specific intervention techniques.
Therefore all tx are equal and all deserve prizes |
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Term
| Problems with Dodo verdict |
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Definition
odd groups and comparison to get that effect (meta-analysis of studies by grouping 150 different ESTs into 5 groups including pts as varied as depression, OCD, phobia, anxiety disorders, mixed neurotics).
Actual comparisons find tx specific factors important, meaningful. When examining these partialled out into appropriate groups, relationship is only .2 and tx method is really important |
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Term
| What are the concerns with EBP? |
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Definition
- Insurance and government will regulate what therapies can be done, reimbursement, take clinical decision-making out of clinician’s hands. They decide what they are willing to reimburse or approve to be done.
- Proprietary use – copyrighting/legally restricting or repackaging therapies (EMDR) running into problems of taking portions of therapies that work and trying to make it stand alone
- Along those lines, not everything with a study is empirically supported |
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Term
| Rosen and Davison (2003) on EBT (Purple hat therapy) |
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Definition
| take something we know works (exposure) and adds another component (purple hat therapy, magnets helps during the exposure…) -> Brings up point of proprietary issues of copyrighting tx and making a profit off of it |
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Term
| Misperceptions of EBP and responses |
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Definition
1. There isn't enough evidence. We don't have a RCT for everything.
- Not true: there is a hierarchy of evidence created from case studies all the way up to the RCTS
2. An evidence based approach fails to appreciate the uniqueness of each child and takes the "art" out of clinical practice.
- Not true: manuals, guidelines, etc inform us to best practices, art is in the application. (Why is art important in the first place??)
3. Child therapy is different because a person is the instrument of change
- Not true: results from efficacy studies have been carried into effectiveness studies showing EBP can work - even as well as or better than meds
4. Doctors have always gone by the evidence anyway.
- Not true: bloodletting, childhood depression, a theory alone without empiricism has been disastrous |
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Term
| What are the steps in evidence based assessment? |
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Definition
1) Formulate relevant questions – what’s going on with client? What do I need to address and what are they here to address? Usually get a combination and doesn’t always line up.
2) Search the literature for evidence – often have to pay extra for access to research tho some basic free ways. have issues of time once youre out in practice.
3) Diagnose – how will you diagnose? Do you even need to?
a.Likelihood ratios – controversial, what is your clinic’s base rate? How certain are you they have that diagnosis? Maybe a way of combining categorical/dimensional diagnosing?
b.Good assessment/instruments – overall that’s what we need to be using.
Keep in mind, EBP is only as good as your diagnosis. want to use the diagnostic procedures used in the studies you’re basing your EBT on, want to make sure you have the right dx. Want to use the same assessment protocols
Most ESTs were based on carefully defined diagnostic groups. Don’t often deal with comorbid studies but nowadays its much more common |
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Term
| What about multiculturalism in EBP? |
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Definition
Can have completely opposite values that are appropriate for their culture.
Best advice is to simply explain and ask!
Be aware that some cultures may see you as an expert and be more comfortable in the more traditional doctor-pt or teacher-pupil relationship, so work with that |
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Term
| What does EBT matter anyway? |
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Definition
-Ethics (Ollendick & Davis, 2004)
-Patient harm or at least needless suffering
o We know some therapies don’t work (critical incident stress debriefing, scared straight, bootcamps, DARE, facilitated communications (Lilienfeld, 2007))
o We also know some tx work much more poorly than others if they work at all (play therapy)
-Competence – be the best at what youre doing. Different professions have different standards – need to make sure you stay within your area of training and competence |
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