EBT Lecture 1

The flashcards below were created by user lhoyman on FreezingBlue Flashcards.

  1. faith
    belief in your theory
  2. hope
    belief that your good will, good sense and experience will win out
  3. charity
    belief that your work will be beneficial even if things seem to be going south sometimes
  4. experiment
    measured outcomes
  5. efficacy
    treatment effects compared to minimal tx or wait list control
  6. effectiveness
    • the comparative effects of txs
    • generalizability across settings
  7. efficiency
    who benefits from what tx?
  8. types of validity
    • internal
    • external
    • statistical conclusion
    • construct
  9. internal validity
    • has the tx caused a difference
    • created a change in the situation/sxs, etc?
  10. external validity
    generalizable results
  11. statistical conclusion validity
    are the statistical procedures used appropriat to demonstrate the effect?
  12. construct validity
    • is tx adequately specified and operationalized?
    • does tx truly represent the theoretical paradigm?
  13. threats to internal validity
    • temporal precedence
    • selection
    • history
    • maturation
    • regression to mean
    • attrition
    • testing and instrumentation
  14. temporal precedence-TIV
    • making sure IV(psychotherapy condition) occurs before or prior to effect/outcome
    • ex. prior experience with therapy
  15. Selection-TIV
    • presence in group participants of sig and systematic diffs prior to intro of tx
    • ex. gender, SES, age, ethnicity
  16. history-TIV
    • impact of any event within or outside of study which may influence the direction of results
    • ex. hurricanes, taking SATs
  17. maturation-TIV
    • impact of changing internal processes which may influence results
    • these processes occur over time
    • ex. age, intelligence, physical strength, motivation
  18. regression to mean-TIV
    • refers to process when individuals get an extreme score (high or low) on a test to obtain a subsequent score closer to distribution mean
    • consequently increases or descreases cannot be attributd to the IV
  19. regression to mean-remedies
    • ensure that all DV have strong test-retest reliability
    • include control group
    • use multiple measures
  20. temporal precedence-remedies
    • ex. someone already went to tx
    • remedies: exclude participants w/ prior tx experience
  21. selection-remedies
    • random assignment
    • stat analysis of systematic pre existing diffs
  22. history-remedies
    • random assignment
    • stat analysis if event occurs
  23. maturation-remedies
    • careful participant selection
    • random assignment
    • add control/contrast group
  24. attrition-TIV
    • significant or differential loss of participants over time
    • loss may be due to travel probs, lack of progress, change of job, boredom, loss of interest in study
    • ppl who leave study may be more impaired than those who stay
  25. attrition-remedies
    • foster motivation
    • make sure contrast group has adequate attention
    • avoid "no tx" control/contrast group
  26. testing and instrumentation-TIV
    • probs due to unwanted effects collecting info from participants
    • does act of testing impact the measurement?
    • is there a practice effect?
    • specific measures may change over time as well
  27. testing and instrumentation-remedies
    • choose testing protocols that have minimal impact on performance
    • include quality checks on measures
    • add good control groups
  28. threats to external validity
    • sample characteristics
    • setting characteristics
    • testing effects
  29. sample characteristics-TEV
    • capacity to generalize from sample studied to other individuals
    • subjects and research personnel should not be too unique
  30. sample characteristics-remedies
    make sure sample includes sufficient representativeness
  31. setting characteristics-TEV
    • ability to generalize from ambient conditions (physical conditions) and personnel characteristics (therapists, assessors)
    • ex. very expensive setting, dirty basement
  32. setting characteristics-remedies
    make sure settings reflect a degree of universality
  33. testing effects-TEV
    • reaction due to knowledge they are being repeatedly assessed
    • pre test sensitization-participants react to tx differently as a function of pre test
    • timing of testing
    • time lapse bw post test and FU
    • time of day
  34. testing effects-remedies
    • use measures in addition to self-reports
    • use unobstrusive measures
    • shcedule time of assessment in a clinically relevant way
  35. threats to construct validity
    • Inadequate specification of construct
    • Confounding
    • Singular definitions
    • Participant reactivity
    • Experimenter expectancies
    • Treatment diffusion
  36. inadequate specification-TCV
    • does manual contain relevant important parts?
    • does it contain elements that are not conceptually consistent w/ paradigm?
    • it is pivitol that tx is pure and undiluted so cause and effect can be determined
  37. inadequate specification-remedies
    • avoid jargon and ambiguous terms
    • make sure operational definitions clearly represent the construct
  38. confounding-TCV
    • confusing constructs
    • ex. ethnicity with SES
  39. confounding-remedies
    be clear with conceptual categories
  40. singular definitions-TCV
    • mono operation=only 1 therapist conducting tx
    • mono method=only self report measures to assess change
  41. singular definitions-remedies
    use multiple therapists and multiple measures
  42. participant reactivity-TCV
    ways in which participants react to study that are not part of tx
  43. participant reactivity-remedies
    • choose control/contrast groups that minimize the threat
    • adding good attention/placebo contrast
  44. experimenter expectancies-TCV
    • effects of experimenter's unintentional biases
    • these biases may be inadvertently communicated to the therapists in the study
  45. experimenter expectancies-remedies
    • blind research personnel
    • include tx integrity and fidelity checks
  46. treatment diffusion-TCV
    • circumstances where active components of tx are accidently provided to a control or comparison group
    • can even occur if subjects talk to each other in waiting room
  47. tx diffusion-remedies
    • use diff therapists to implement diff conditions
    • blind research personnel to hypotheses
  48. threats to statistical conclusion validity
    • Low statistical power
    • Family wise error rates
    • Unreliable measures
    • Unreliable treatment implementation
    • Heterogeneity of subjects
  49. low power-TSV
    • ability to detect an effect when it does occur
    • varies as a function of n, alpha level and effect size (min level at 0.8)
  50. low power-remedies
    • increase n
    • increase contrast by adding more robust conditions
    • varying alpha
    • use 1 tail test of sig
    • min. unwanted variability
  51. family wise error-TSV
    deals with probs with increasing Type 1 error due to multiple comparisons
  52. family wise error-remedies
    • use conservative stats
    • Bonferroni correction
  53. unreliability of measures-TSV
    if measures are unreliable, analyses are suspect
  54. unreliability of measures-remedies
    use measures with stron reliability metrics
  55. unreliability of implementation-TSV
    tx package is differentially applied as a function of participant (age, gender, ethnicity), settings, and therapists (competence, attention, boredom)
  56. unreliability of implementation-remedies
    • stringent selection of therapists
    • close supervision and in depth training of therapists
    • clear manuals
    • fidelity and tx integrity checks
  57. subject heterogeneity-TSV
    more homoegenous the subject pop, more clearly conclusions can be drawn
  58. subject heterogeneity-remedies
    • clear and stringent inclusion and exclusion criteria
    • random assignment
  59. common research designs for evaluating tx efficacy
    • No-treatment comparison design
    • Wait list comparison
    • Attention placebo
    • Relative efficacy
  60. pre-post test group comparisons
    • two group pre-post test design most common
    • key is to determine appropriate comparison group
    • same assessments are admin to participants in both conditions at same observation/measurement points
  61. advantages of pre-testing
    • ensures BG equivalence on salient variables
    • enables matching on variables and random assignment of these matche pairs to diff conditions
    • promotes responsible conclusion drawing about amount of change over course of tx
    • allows for analysis of potential moderators of tx effects
    • enables investigation of factors that predict attrition
  62. no tx comparison design-schemata
    • Exp. group O1 (pretest) X (tx) O2 O3
    • no tx group O4 (pretest) O5 O6
  63. no tx comparison design
    • random assignment-->subjects given pretest (O1, O4)
    • both groups measured ( O2, O5)
    • efficay evaluated by comparing changes from O1-->O2 to changes in those in no tx group ( O4-->O5)
    • follow assessment done at O3 and O6 to examine if gains are maintained over time
  64. wait list comparison-schemata
    • Exp group O1 X O2 O3
    • wait list comp. O4 O5 X O6
  65. wait list comparison designs
    helps account for role of hope and expectation change by providing a design where all participants get the tx but the comparison group gets it after the exp group finished

    • expectancies for change can be assessed by comparing changes O4-->O5 with O1-->O2
    • can also compare changes from O1-->O2 and O5-->O6
  66. attention/placebo comparison designs-schemata
    • Exp group O1 X1 O2 O3
    • Att/placebo O4 X2 O5 O6
  67. attention/placebo comparison designs
    • addresses variability due to possible effects of having weekly contact with a clinician and/or role of non specific factors (support)
    • X2 is placebo where they meet with clinician but do not get the specific aspects of tx hypothesized to resonsible for change
  68. relative efficacy design
    • deals with comparisons bw active txs and existing standard of care
    • X2 is another treatment protocol as usual (TAU)
  69. relative efficacy design-schemata
    • grp 1 O1 X1 O2 O3
    • grp 2= O4 X2 O5 O6
  70. treatment moderator designs
    • evaluates factors influencing tx effects
    • provides info about what works for whom under what conditions
    • moderators can be...
    • variables of convenience (age, SES, dx status)
    • theoretically derived variables (expectancies, motivation)
  71. tx moderator design-schemata
    • exp grp= O/M1 X1 O2 O3
    • comp grp=O/M4 X2 O5 O6
  72. research designs for testing mechanisms of change
    • dismantling studies
    • tx mechanism design

    • isloating active components of efficacious interventions
    • examining mechanisms of processes of change
  73. dismantling studies (component analysis)
    use BG designs to compare relative efficacy cof diff components of a tx package to see what ingredients are necessary
  74. dismantling studies-schemata
    • Exp Condition R O1 X1 O2 O3
    • Exp Condition RO4 X2 O5 O6
    • Comp Cond RO7 X3 O8 O9

    • X1=Component (Cognitive restructuring)
    • X2=Component (Exposure)
    • X3=Full treatment package (Full CBT)
  75. treatment mechanism design
    • investigates process of change
    • once mechanism or process of change is identified, interventions can be refined to include MORE of that process
    • very complex and must transcend other designs so as to allow assessment of both mechanism and outcome as freq as possible
  76. tx mechanism design-schemata
    Exp O/M1 X1 O/M2 X1 O/M3 X1 O/M4 X1 O/M5 X1 O/M6

    • Com O/M7 X2 O/M8 X2 O/M9 X2 O/M10 X2
    • O/M11 X2 O/M12
  77. dialectics of research and practice/bench to bedside
    • concerns of academic reseracher/outcome researcher
    • VS
    • concerns of clinicians
  78. using protocols and manuals as starting points
    • developing practice guidelines is an evolving practice
    • research gives clinicians directions and a starting point
    • process of applying lit to pt is a mindful one w/ deliberate info processing
  79. tolerating dialectics of research and practice
    • accept and tolerate the necessary tension
    • avoid absolutistic, all or none thinking
  80. parient level variables
    • how do they view tx?
    • what type of tx do they want?
  81. clinician level variables
    • see pts as "end users" rather than co developers who can make good decisions and are potentially creative
    • txs are designed to occur with interpersonal relationships
  82. magicians
    • possess auras or powers of change
    • dismiss skill training
    • believe change is absolutely determined by therapists' abilities
  83. technicians
    • embrace skill training in discrete areas
    • lack conceptual organizing theory
    • view theoretical discussion and investigation of change processes as irrelevant
    • see ciritical thinking/scientific reasoning as superfluous
  84. clinicians
    • combine and integrate theory, research and skill training
    • appreciate salient aspects of therapy enhancing qualities of psychotherapist and the working alliance
    • adopt a local scientist stance toward clinical work
    • advocate critical reasoning skills
  85. psychotherapy in the real world
    • recognize psychotherapy is messy and unscripted
    • trainees must balance pt's best interest and faithfulness to the approach in rapidly changing real time contexts
    • emphasizes fidelity to conceptual paradigm and flexibility within intervention
  86. good clinical skills
    • more than just being empathetic and warm
    • embrace more transcendent skills in clinical training...
    • multicultural alertness
    • apply case conceptualization and scientific mindedness to sessions
    • use of immediacy in session
    • increase tolerance of neg. emotional states
    • be flexible
  87. multicultural alertness
    • essential for good and ethical practice
    • essential part of forming authentic and highly functional working alliances
    • neglect of cultural vicissitudes tied to poor tx outcome
  88. culture affects...
    • access
    • accessibility
    • perception of symptoms
    • view of etiology
    • help seeking
    • view of psychotherapy
    • view of psychotherapist
    • response to intervention
  89. ADDRESSING model
    • Age
    • Developmental or Acquired Disabilities
    • Religiosity
    • Ethnicity
    • Socioeconomic status
    • Sexual orientation
    • Indigenous heritage
    • National origin
    • Gender
  90. mutlicultural issues
    • assimilation and accommodation to dominant culture
    • appreciate self defined identity
    • language
    • oppression, stereotyping, power and prejudice
    • engage in difficult convo
  91. multicultural alertness (2)
    • ethnic minorities are under represented in RCTs
    • causes severe threat to ext. val. (generalization)
    • lack of involvement in these trials raises access to care issues
    • foundations of historical mistrust of healthcare system
  92. clinicans, not technicians
    • learn general principles, not specific techniques
    • read primary sources rather than summaries
    • names and dates are important
    • experience is not enough-we need info/reading
    • personalize psychotherapeutic approaches
    • avoid procrustean bed
    • we treat ppl not diagoses or problems
    • one size never fits all
  93. immediacy
    • dealing with psychologically salient moments in the here and now
    • facilitates transfer of learning (generalization)
    • moves psychotherapy from being intellectual to being emotional
    • in session emotional arousal is central to propelling change
  94. welcome negative emotion
    • embrace pt's "dark Passenger"
    • communicates that this is a time and place for help
    • fosters an approach rather than avoidance orientation
    • allows genuine mastery experience-corrective emotional experience
  95. collaboration
    • avoid therapeutic narcissism-therapists think they are smarter and knows what client is really thinking
    • major impediment to change
    • takes form of telling rather than asking
  96. transparency
    • basis of genuine informed consent
    • core of collaboration
    • minimizes power differential
    • share conceptualization
    • explains interventions and rationale
    • share outcome data
  97. psychotherapy relationships are U-shaped
    • alliance starts strong then decreases as results begin to dwindle/plateau
    • if the therapist can overcome this stage, alliance again rises
  98. Rashomon effect
    • 4 ppl witness murder/rape in 4 diff ways
    • shows that ppl have diff points of views
    • ppl can convince themselves if their own private truths even if there is a flawed and inaccurate foundation
  99. remain flexible-interpretivist perspective
    • truth is shaped by ppls perceptions and worldviews
    • based on vantage points
    • trauth while relative is knowable
    • ppl build highly individualized data sets and mental filters based on their learning hx and cultural context
    • may be seen as webs of significance
Card Set:
EBT Lecture 1
2012-05-09 05:55:45
EBT Lecture

EBT Lecture 1
Show Answers: