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Fichier Détails
| Cartes-fiches | 298 |
|---|---|
| Langue | Deutsch |
| Catégorie | Devinettes |
| Niveau | Université |
| Crée / Actualisé | 28.02.2023 / 12.09.2023 |
| Lien de web |
https://card2brain.ch/box/20230228_evaluation_of_psychotherapeutic_interventions_
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Meta-analysis of Howick et al. (2013) Effects of Parmacological Treatments; welche gründe kanns geben, dass ne placebo gruppe bessere ergebnisse im vergleich zu ner wait list group erzielen kann?
placebo vs no treatment comparisons cannot be blinded:
• untreated patients know they are not being treated
• caregivers and observers are unblinded
Social desirability:
• Polite patients taking placebo could report improvement to please investigators, although no benefit
was felt
Meta-analysis of Howick et al. (2013) Effects of Parmacological Treatments; welche gründe kanns geben, dass ne placebo gruppe schlechtere ergebnisse im vergleich zu ner wait list group erzielen kann?
‘untreated’ groups often involve contact with therapists, maintenance of therapy, or other forms of
standard care
▪ Hawthorne and context effects
• Systematic review (Krogsboll et al., 2009) found 24% improvement compared with baseline in untreated
groups
• Change is unlikely to be wholly due to natural history or regression to the mean
Meta-analysis of Howick et al. (2013) Effects of Parmacological Treatments; welche gründe kanns geben, dass ne experimental gruppe bessere ergebnisse im vergleich zu placebo group erzielen kann?
blinding bei rcts of ned wirksam, weil patients side effects erfahren, und scientist an blood samples sehen, dass sich die werte der experimentalteilnehmer verändern
f a trial is unsuccessfully blinded, patients who know they are in the placebo group may drop out, or fail
to report recovery.
• Patients with pain or depression could develop negative feelings about having been given a placebo and
actually experience a worsening of their symptoms.
• Patients who know they are receiving the experimental treatment may exaggerate reports of benefits or
actually experience improvements
Negative results for treatment benefit are less likely to be published--> support publication bias hypothesis
woraus setzt sich treatment integrety im rahmen der psychotherapieforschung zusammen?
-treatment manual, that contains the typical techniques and therapist behaviors relevant for the approach--> Flexibility within fidelity; stadandardiued implemention of therapy, while using a personalized case formulation
-careful training of therapists
-frequent supervision
-recording of video / audio tapes of each session
-independent raters analyze videos to check --> whater prescribed intervetions were applied correctly + wheter therapists abstained of nontypical treatmant approaches
Validity of controlled clinical trials of psychotherapy: Findings from the NIMH Treatment of Depression Collaborative Research Program; worums gings in der studie?
eigentlich sollte ne therapie so ablaufen: Therapists adhere to manuals
− use only techniques specified in manual
− but abstain from other techniques
oft läuft die dann aber so ab:
Many therapist behaviors are not school specific
− E.g. correction of wrong cognitions und irrational beliefs in
psychodynamic therapy
• Similar therapist behaviors in different approaches (common
factors)
− E.g. establishing a positive client patient-relationship--> des heisßt auch wen therapeuten ne andere schule vertretn, machen die trotzdem oft das gleiche zeugs
deswegen ziel der studie rauszufinden,...
Whether and how theories of IPT and CBT were translated
into practice
• Could particular principals and techniques of IPT or CBT be
observed in therapist behavior and therapist-patient
interaction?
Validity of controlled clinical trials of psychotherapy: Findings from the NIMH Treatment of Depression Collaborative Research Program; welche forschungshypothesen wurden aufgstellt?
H1: techniques and processes in manualized IPT and CBT
psychotherapies studied in an RCT overlap
▪ H2: Intervention strategies common to IPT and CBT
promote improvement
Validity of controlled clinical trials of psychotherapy: Findings from the NIMH Treatment of Depression Collaborative Research Program; wie wurden protoypen of the ideal treatment in der ipt repesctively cbt generiert?
Identifying proto-typs of ideal treatments:
• leading theoreticians and practitioners:
CBT (N = 10), IPT (N = 11)
• described ideal treatment for CBT and IPT with
Psychotherapy Process Q-Set
▪ Interrater-reliability of expert ratings was high
(Cronbach’s Alphas => .95)
Validity of controlled clinical trials of psychotherapy: Findings from the NIMH Treatment of Depression Collaborative Research Program; wie ist der psychotherapy process q-set aufgebaut?
100 Items to describe therapist-patient-interaction on
a behavioral level
▪ Unit of observation: 1 session
▪ Rating from:
1 = “least characteristic / negatively salient” to
9 = “most characteristic / salient”
5 = “neutral or irrelevant”
▪ PT-theory independent
▪ Developed to compare PT-processes of different PTs
Validity of controlled clinical trials of psychotherapy: Findings from the NIMH Treatment of Depression Collaborative Research Program; was sind typische ipt interventionen, welche im rahmen des psychotherapy process q-set identifiziert wurden?
-patients interpersonal relationships are a major theme
-therapist emphazises patients feelings about being close to or needing someone
-love or romatic relationships are a topic of discussion
-therapist explains rationale behind technique or approach to treatment
Validity of controlled clinical trials of psychotherapy: Findings from the NIMH Treatment of Depression Collaborative Research Program; was sind typische cbt interventionen, welche im rahmen des psychotherapy process q-set identifiziert wurden?
-there is a discussion of specific activities or tasks for the patient to attempt outside of the session
-discussions centers on cognitive themes i.e(this is) about ideas or belief systems
-patients treatment goals are discussed
-therapist encourages patients to try new ways of behaving with others
Validity of controlled clinical trials of psychotherapy: Findings from the NIMH Treatment of Depression Collaborative Research Program; was war die Average similarity of CBT sessions with
CBT and IPT prototypes?
cbt sessions with cbt =.65
cbt sessions with ipt =.20
Validity of controlled clinical trials of psychotherapy: Findings from the NIMH Treatment of Depression Collaborative Research Program; was war die Average similarity of IPT sessions with
CBT and IPT prototypes?
ipt sessions with itp stereotypes: .40
ipt sessions with cbt stereotypes: . 60
Surprisingly, therapists’ behavior in IPT sessions agreed much higher with the CBT ideal than with the IPT ideal
Techniques and processes in manualized
IPT and CBT psychotherapies studied in
an RCT overlap
Validity of controlled clinical trials of psychotherapy: Findings from the NIMH Treatment of Depression Collaborative Research Program; cbt-therapeuten; waren eher die therapeuten erfolgreich, welch viele cbt interventionen angewendet haben, oder die welche eher mehr ipt interventionen anwenden?
--> beide sorgen für signi verbsseerungen wenn sie sich an skripts halten, die wo ich an cbt interventionen gehalten haben waren n bissl besser aber kein signi unterschied
Validity of controlled clinical trials of psychotherapy: Findings from the NIMH Treatment of Depression Collaborative Research Program; ipt-therapeuten; waren eher die therapeuten erfolgreich, welch viele cbt interventionen angewendet haben, oder die welche eher mehr ipt interventionen anwenden?
es waren die erfolgreicher, welche eher cbt interventionen angewendet haben
Validity of controlled clinical trials of psychotherapy: Findings from the NIMH Treatment of Depression Collaborative Research Program; ipt-therapeuten; welche relevanten facts kann man aus der studie festhalten?
Result: Both CBT and IPT therapist behaviors correlated higher with ideal
prototype of CBT than with ideal prototype of IPT
Process of IPT was quite similar to CBT in actual practice
▪ -> “challenging the presumption of large differences across these two
brand names of therapy
PT and CBT have a degree of overlap, “particularly in what experts
described as cognitive behavior therapy processes
Clinicians from different orientations may use very different terminology to
describe psychological constructs and processes that are actually quite similar
Conclusion of the authors: “What was shared between the two forms of therapy [...] was
more salient and defining of the treatments than what was different.
A Component Analysis of Cognitive- Behavioral Treatment for Depression Jacobson and colleagues; worum gings denn hier bzw. was waren die forschungsfragen?
Which of the three treatment variants (behavioral activation, correcting automatic thinking, modification of cognitive sturctures(ABC-Model Beck) is most efficacious?
• Is BA sufficient
Is it necessary to change cognitive schema as proposed by
Beck’s cognitive model
how do treatments produce change?
• Do treatments operate through different mechanisms?
• Do treatments differentially effect the processes that they are
supposed to effect?
A Component Analysis of Cognitive- Behavioral Treatment for Depression Jacobson and colleagues; grundlagen; nach welchen faktoren sollte ne cbt eigentlich wirken?
a) Activation-hypothesis: Change through activation
• Instigation to become active and put in contact with available sources of reinforcement -> experience pleasure
• Plays a major role in early stages of CT
b) Coping skills hypothesis
• Clients learn to cope with depressing events and
Automatic thinkings associated with these events during therapy
c) Cognitive restructuring hypothesis
• Cognitive structures (core schemas) produce ATs
-> Structural changes in cognitive structures
(core schemas) are necessary for improvemen
welcher der 3 komponenten der cbt sollte die höchste efficacy beinhalten?
beahavioral activation<attacking automatic thinking<cognitive restructuring
A Component Analysis of Cognitive- Behavioral Treatment for Depression Jacobson and colleagues;; was waren inclusion, was waren exclusion criteria?
inclusion criteria:
• Depression according to DSM-III-R
• Beck Depression Inventory (BDI): ≥ 20
• Hamilton Rating Scale for Depression (HRSD): ≥ 14
Exclusion criteria:
• Other mental disorders
• Other psychotherapeutic or medical treatments
• Hospitalization (suicidal tendency, psychosis
A Component Analysis of Cognitive- Behavioral Treatment for Depression Jacobson and colleagues; wie wurde die bahavioral activation dargestellt?
Aims of BA:
• identify behavior problems and
• activate people in their natural environment
Interventions:
• Monitoring daily activities and assessing the pleasure and mastery involved.
• Assigning new daily activities to increase pleasure and mastery.
• Imaginal rehearsal of activities before they are undertaken.
− participants imagine themselves engaging in various activities to find obstacles to
the imagined pleasure or mastery expected from those events
• Discussion of specific problems (e.g., difficulty in falling asleep) and prescription of
behavior therapy techniques to deal with them
• Assertiveness- and communication training to address social skills deficits such as.
▪ Proscription:
• work on automatic dysfunctional thoughts and
• work on underlying core beliefs or schemas
A Component Analysis of Cognitive- Behavioral Treatment for Depression Jacobson and colleagues; wie wurde die modification of dysfunctional thoughts dargestellt?
im of AT
• Identify and modify automatic dysfunctional thoughts
▪ Techniques:
• Identifying automatic thoughts arising in session
• Use of Daily Thought Records
• Examining evidence for and against automatic thoughts
• Examining attributional biases in the way participants assess their
successes and failures
• Homework assignments in which participants assess the validity of
their negative interpretations
▪ All interventions from BA condition were possible
▪ Proscription: work on underlying core beliefs or schemas
A Component Analysis of Cognitive- Behavioral Treatment for Depression Jacobson and colleagues; wie wurde die cognitive therapy in its whole form dargestellt?
Aim of CT
• Identification and modification of more general patterns
of thought that are stable and presumably causes of
cognitive distortions and negative feelings
Techniques:
• “Downward arrow“: client explains problems ->
therapist hypothesizes general concerns and core beliefs
• Explicit identification of underlying assumptions and core beliefs
• Developing alternative assumptions or core beliefs
• Discussion of advantages and disadvantages of holding assumptions or core beliefs
• Homework to determine assumptions or core beliefs and apply other assumptions
to circumstances
• Application of techniques to modify dysfunctional thinking to core beliefs rather
than situation-specific dysfunctional thinking
-->ABC
A Component Analysis of Cognitive- Behavioral Treatment for Depression Jacobson and colleagues; wie wurde treatment adherence gewährleistet und was kam bei raus?
Protocol adherence
• Sessions were audiotaped
• Random selection of 9 clients for each condition
− 3 tapes: early middle late session
• Blind judges listened to audio tapes of therapy sessions and
rated behaviors of therapists on 45 items
Ergebnis: keine signi abweichung vom protokoll
− prohibited or prescribed
− measuring particular intervention focused on BA, AT, CT
A Component Analysis of Cognitive- Behavioral Treatment for Depression Jacobson and colleagues; welche tests wurden zum assesement der wirksamkeit der 3 verschied. komponenten genommen und in welchem zeitl. rahmen wurden assesements durchgeführt?
BDI; HRSD; LIFE = Longitudinal Interval Follow-Up Evaluation to assess depression according to DSM-III-R
Pre, Post, 6, 12, 18, 24 months follow up
A Component Analysis of Cognitive- Behavioral Treatment for Depression Jacobson and colleagues; was waren prä vs. post unterschiede zw. den gruppen bzgl. BDI, HRSD? zusaätzlich gabs bei der BDI erhebung nen unterschied, wie viele leute post unter dem cutoffwert von 8 geblieben sind(recovered) und Unterschiede bei den Leuten die post die DSM-III criteria für ne MD nicht mehr erfüllt haben(improved)
BDI: signi abnahme in allen gruppen, kein signi unterschied auch bei intent to treat
HRSD: BA prä signi geringere schwere, post alle signi besser, keine signi unterschiede
rund 50 % BDI unter cutoff, kein signi unterschied; rund 60% haben MD criteria nicht mehr erfüllt, kein signi Unterschied
A Component Analysis of Cognitive- Behavioral Treatment for Depression Jacobson and colleagues; welche treatments of change konnten identifiziert werden?
Clients in all conditions significantly
• increased frequency and enjoyability of pleasant events (PES =
Pleasant Events Schedule)
• decreased their negative thinking (DAS = Dysfunctional Attitudes
Scale)
• decreased tendencies to attribute negative events to internal, stable,
and global factors (EASQ = Expanded Attributional Style
Questionnaire)
--> allerdings keine signi unterschiede zw. den treatment conditions
--> treatments zeigen ned spezi wirkungen in den domänen in welchen sie eig. wirken sollten
A Component Analysis of Cognitive- Behavioral Treatment for Depression Jacobson and colleagues; change of attribution style bzw. change in frequency of pleasent events und deren later change in the depression; mit welchen der 3 komponenten der cbt wird dies assoziert und was ist wirklich rausgekommen?
Only in BA early
change in attribution
styles was associated
with later change in
depression, but not in CT
• Early change in
frequency of pleasant
events was associated
with a smaller later
change in depression
in CT but not in BA.
A Component Analysis of Cognitive- Behavioral Treatment for Depression Jacobson and colleagues; was war die generelle discussion der ergebnisse?
No sig. differences between treatment conditions in any of the outcome measures!
üarticipants with depression who received BA alone did as well as those who were additionally
taught coping skills to counter depressive thinking. Furthermore, both component groups
improved as much as those who received interventions aimed at modifying cognitive structures,
specifically underlying assumptions, and core schema
konträr zu becks getätigter aussage, dass direct efforts aimed at modifying
negative schema are necessary to maximize treatment outcome and prevent relapse.
A Component Analysis of Cognitive- Behavioral Treatment for Depression Jacobson and colleagues; welche discussion gab es bzgl. tong term effects?
bout 60% of patients were recovered directly after treatment
• After 1 year: 80% of recovered patients had no relapse
• After 2 years: 50% of recovered patients had no relapse
− Comparable to results of Treatment of Depression Collaborative Research
Program (only about 25% of patients stayed healthy)
-> Depression = chronic disease
-> Relapse is likely for most patients
Maintenance therapy and booster sessions are required
Randomized trial of behavioral activation, cognitive therapy, and antidepressant medication in the treatment of adults with major depression. Dimidjian et al. (2006); Dobson et al. (2008); was waren hier die großen research questionsund welche hypothesen hatten die researchers zu aufgestellt?
How efficacious is Behavioral Activation (BA) for the
treatment of major depression compared to
• Cognitive Therapy (CT)
• Antidepressant medications (ADM)
• Placebo
▪ Are psychosocial treatments an alternative to ADM in the
treatment of moderate to severe depression?
▪ How enduring are effects?
H-1: For severely depressed patients
− Antidepressant medications (ADM) > placebo
− No differences between active treatments (ADM = BA = CT)
• H-2: For less severely depressed participants
− No differences between treatments and placebo
(ADM = BA = CT = placebo)
Randomized trial of behavioral activation, cognitive therapy, and antidepressant medication in the treatment of adults with major depression. Dimidjian et al. (2006); Dobson et al. (2008); was wurde hier spez. in der cognitive activation gruppe getan?
-Promote engagement with activities and contexts that are
Reinforcing and consistent with an individual’s long-term goals
• Change patterns of avoidance and withdrawal that prevent contact with potential
reinforcers
Monitoring daily activities and assessing the pleasure and mastery involved.
• Exploration of alternative behaviors related to achieving goals
• Role-playing to address specific behavioral deficits
Randomized trial of behavioral activation, cognitive therapy, and antidepressant medication in the treatment of adults with major depression. Dimidjian et al. (2006); Dobson et al. (2008); welches medi wurde in der antidepressant medication gegeben?
paroxetine --> SSRI zudem wöchentlich clinical management wo n HRSD erhoben wurde; Develop therapeutic relationships characterized by support, reassurance, and
optimism about the treatment regimen to maximize participant adherence
Randomized trial of behavioral activation, cognitive therapy, and antidepressant medication in the treatment of adults with major depression. Dimidjian et al. (2006); Dobson et al. (2008); wie sahs hier mit der ranomisierung aus; was wurde mit den placebo leuten gemacht?
-Triple-blind (participants, pharmacotherapists, evaluators) in the beginning
− at 8 weeks, blind was broken
− Placebo participants were offered their choice of treatment
Randomized trial of behavioral activation, cognitive therapy, and antidepressant medication in the treatment of adults with major depression. Dimidjian et al. (2006); Dobson et al. (2008); wie lang lief die studie in den verschied. conditions und wie viele assesements gabs?
treatment pahse 16 weeks, für placebo leute nur 8 weeks; jede 2. woche assesement, im anschluss follow up assesements nach 3, 6, 12, 13, 14, 18, 24 months
Randomized trial of behavioral activation, cognitive therapy, and antidepressant medication in the treatment of adults with major depression. Dimidjian et al. (2006); Dobson et al. (2008); warum war das sample bei den ssri leuten so viel größer as bei placebo
zum einen ethical reasons, zum anderen braucht man bei ner größeren sample size nen größeren effekt damit der signi wird, und genau das wollte man zeigen, dass ssri auf jedne fall besser sind als placebo
Randomized trial of behavioral activation, cognitive therapy, and antidepressant medication in the treatment of adults with major depression. Dimidjian et al. (2006); Dobson et al. (2008); in welcher gruppe gabs die signi höchste attrition rate?
antidepressant mediaction
Randomized trial of behavioral activation, cognitive therapy, and antidepressant medication in the treatment of adults with major depression. Dimidjian et al. (2006); Dobson et al. (2008);; midly depressed patients, was war das ergebnis nach 8 wochen (ohne intent to treat)und wie steht das im einklang im der forschungshypothese? ACHTunG: bzgl . HRSD
alle signi besser, keine gruppe unterscheidet sich signi von ner anderen; forschungshypothese wurde erfüllt
Randomized trial of behavioral activation, cognitive therapy, and antidepressant medication in the treatment of adults with major depression. Dimidjian et al. (2006); Dobson et al. (2008); was war das ergebnis nach 8 wochen für die leute mit ner severe depression(ohne intent to treat + steht das im einklang zur forschungshypothese?ACHTunG: bzgl . HRSD
verbesserungen geringer als bei leuten mit mild dpression, am wenigsten bei placebo was der forschungshypothese entspricht, allerdings verbot signi aussagen zu machen weil kien signifikanztest gemacht wurde(zu hohes alpha durch viele tests sollte verhindert werden)
Randomized trial of behavioral activation, cognitive therapy, and antidepressant medication in the treatment of adults with major depression. Dimidjian et al. (2006); Dobson et al. (2008); welche ergebnisse gabs bzgl. den leuten mit high/los severity? bzgl. dem BDI und stand das im Einklang zur den Forschungshypothsen?
mildly: alle gleich gut abgeschnitten(BA; CT; ADM(Medi), Placebo)--> konform zur Hypothese
severe: CT hat schlechter abgeschnitten als BA und ADM--> hätte man nicht gedacht
Randomized trial of behavioral activation, cognitive therapy, and antidepressant medication in the treatment of adults with major depression. Dimidjian et al. (2006); Dobson et al. (2008); welche ergebnisse gabs bzgl. den leuten mit high/los severity? bzgl. dem HRSD im Verlauf und diesemal mit intent to treat und stand das im Einklang zur den Forschungshypothsen?
mildly: alle gleich--> kompatibel zur Hypothese
severe: CT wieder schlechter als ADM (medi) und BA--> nicht kompatibel zur hypothese
--> gleiches muster wie im BDI
