Personality and Psychotherapy Outcome

1. Personality and Psychotherapy Outcome

2. Does Psychotherapy Work? • efficacy study • contrasts some kind of therapy to a comparison group under well controlled conditions • high internal validity (degree of confidence that IV caused change in DV) • effectiveness study • how patients fare under the actual conditions of treatment in the field • high external validity (ability to generalize)

3. Model Efficacy Study • patients are randomly assigned to treatment • existence of a control group • non treatment-seekers • wait list • placebo pill • clinical case management: controls for expectation of benefit, rapport, and sympathetic attention • treatments are manualized • highly scripted, fidelity is assessed using videotapes

4. Model Efficacy Study (continued) • patients are seen for a fixed number of sessions • target outcomes (dependent variables) are well operationalized • self report • therapist report • independent evaluator report • significant other/peer report • multiple indicators are best

5. Model Efficacy Study (continued) • raters and diagnosticians are blind to which group patient comes from • patients meet criteria for only one disorder • long-term follow-up • patients are followed for some fixed period of time after treatment ends

6. Some Efficacy Study Findings: • depression • cognitive therapy, interpersonal therapy, and medications all provide moderate relief • psychotherapy more effective than meds at preventing relapse • obsessive-compulsive disorder • exposure with response prevention and medications both relieve symptoms • exposure with response prevention more effective than meds at preventing relapse

7. Some Efficacy Study Findings: • panic disorder • cognitive therapy plus exposure to cues that trigger panic work well • psychotherapy more effective at preventing relapse than meds • phobia • exposure to feared stimulus plus response prevention works well • sexual offenses • aversion therapy produces only marginal improvements

8. Some Efficacy Study Findings: • bulimia • cognitive therapy provides significant relief and outperforms medications

9. Meta-analysis • Combines results across multiple studies • Strengths • Can detect average effect size • Can examine some variables systematically (e.g., duration of treatment, experience of therapist) • Potential problems • Apples and oranges • Garbage in; garbage out

10. Smith, Glass, & Miller (1980) • Patients in treatment groups improved more than controls • Variables that didn’t affect outcome • duration of therapy • training/experience of therapist • type of therapy (dodo bird problem)

11. Some Qualifications • Failure of some well-designed studies to show effects • NIMH collaborative study on tx of depression • CBT, IPT, drug, clinical management (placebo drug & support) • At end of tx, 3 active txs only marginally better than clinical management • At 6-mos f/u, no diffs

12. Effectiveness Studies • investigates how patients fare under the actual conditions of treatment in the field • psychotherapy in the field • is often “eclectic” • is not of fixed duration • is self-correcting • patients get there by active shopping • patients have multiple problems

13. An Example • Consumer Reports included survey about psychotherapy and drugs in its 1994 annual questionnaire • 22,000 responded to survey • 7,000 had experienced stress or emotional problem for which they had sought help in past 3 years • 4,100 saw mental health professional, family doctor, or support group

14. Major Findings • Most people reported getting better • among 426 people who were feeling “very poor” when they began therapy, 87% were feeling very good, good, or at least so-so. • among 786 people who were feeing “fairly poor” at beginning of therapy, 92% were feeling very good, good, or at least so-so.

15. Major Findings (continued) • the longer people were in therapy, the more improvement they reported • there was no difference between psychotherapy alone and psychotherapy plus medication for any disorder • psychologists, psychiatrists, and social workers • did equally well • did better than marriage counselors and family doctors

16. Major Findings (continued) • active shoppers did better than passive recipients • no specific type of psychotherapy did better than any other • respondents whose choice of therapist or duration of care was limited by their insurance coverage did worse

17. A Few Caveats • Consumer Reports study found that • only 1/2 of the respondents thought that therapy “made things a lot better” regarding their presenting problem • only 1/3 of the respondents thought that therapy “made things a lot better” regarding overall functioning • Many other studies find that, even with treatment, the relapse rate for many disorders is high

18. Seligman’s (1993) theory • What You Can Change and What You Can’t • responsiveness of a problem to therapy depends on the depth of the problem • biological: • to the extent that a psychological condition has biological underpinnings because it is evolutionarily prepared or heritable, it will be harder to change

19. Seligman’s (1993) theory • evidence: • the easier a belief underlying a problem is to confirm, and the harder it is to disconfirm, the harder it will be to change • power • a theory has high power when it is general and explains many facts about the world • to the extent that a belief underlying a problem has high power, the harder it will be to change

20. Some Examples • specific phobia • somewhat prepared: have been evolutionarily prepared to learn to fear some things more easily than others • easy to disconfirm: if you expose yourself to spiders • low power: belief that spiders are dangerous applies only to spiders

21. sexual orientation • highly prepared: probably influenced by biological factors such as hormonal levels during gestation • hard to disconfirm: you enjoy sexual activity with one gender, but not the other • powerful: sexual orientation affects many spheres of life (political beliefs, religious beliefs, social circles)

22. Problems ranked from easiest to most difficult to change • panic: curable • specific phobia: almost curable • sexual dysfunction: marked relief • social phobia: moderate relief • agoraphobia: moderate relief • depression: moderate relief • obsessive-compulsive disorder: moderate/mild relief

23. Problems ranked from easiest to most difficult to change • paraphilia: moderate/mild relief • anger: mild/moderate relief • everyday anxiety: mild/moderate relief • alcoholism: mild relief • overweight: temporary change • posttraumatic stress disorder: marginal relief • sexual orientation: probably unchangeable