The empirical status of empirically supported psychotherapies: assumptions, findings, and reporting in controlled clinical trials

This article provides a critical review of the assumptions and findings of studies used to establish psychotherapies as empirically supported. The attempt to identify empirically supported therapies (ESTs) imposes particular assumptions on the use of randomized controlled trial (RCT) methodology that appear to be valid for some disorders and treatments (notably exposure-based treatments of specific anxiety symptoms) but substantially violated for others. Meta-analytic studies support a more nuanced view of treatment efficacy than implied by a dichotomous judgment of supported versus unsupported. The authors recommend changes in reporting practices to maximize the clinical utility of RCTs, describe alternative methodologies that may be useful when the assumptions underlying EST methodology are violated, and suggest a shift from validating treatment packages to testing intervention strategies and theories of change that clinicians can integrate into empirically informed therapies.     

A healthy dose of criticism for randomized trials: comment on Westen, Novotny, and Thompson-Brenner (2004)

D. Westen, C. M. Novotny, and H. Thompson-Brenner identified many important concerns in their critique of methods typically used in randomized controlled trials (RCTs) of psychotherapy outcome and by extension in methods of identifying empirically supported therapies (ESTs). Some of the concerns would be mitigated if empirical support of treatments were assessed multidimensionally (separating favorability of results from definitiveness of research methods used) and continuously rather than categorically. Other concerns can and should be addressed within the existing framework of RCTs and ESTs, including consideration of inclusion criteria other than a single Axis I condition, experimental evaluation of some of the procedural assumptions codified in psychotherapy manuals, and far more detailed reporting of RCT results.     

Empirically supported psychotherapies: comment on Westen, Novotny, and Thompson-Brenner (2004)

D. Westen, C. M. Novotny, and H. Thompson-Brenner (2004; see record 2004-15935-005) suggested that efforts to identify empirically supported treatments are misguided because they are based on assumptions that are not appropriate for some types of treatment and patients. The authors of this comment argue that Westen and colleagues are simply incorrect when they assert that empirically supported treatments require that psychopathology must be highly malleable, that treatments must be brief, or that the samples studied are unrepresentative of the kinds of patients typically encountered in clinical practice--comorbidity is common in many clinical trials. Randomized controlled trials remain the most powerful way to test notions of causal agency.     

Comparative validity of the Shedler and Westen Assessment Procedure-200

A predominant dimensional model of general personality structure is the five-factor model (FFM). Quite a number of alternative instruments have been developed to assess the domains of the FFM. The current study compares the validity of 2 alternative versions of the Shedler and Westen Assessment Procedure (SWAP-200) FFM scales, 1 that was developed on the basis of items identified by J. Shedler and D. Westen (2004) and 1 that used items identified by R. R. McCrae, C. E. Lokenhoff, and P. T. Costa (2005). The comparative validity of both measures was examined in a sample of persons who evidenced personality-related problems in living (N = 94). The McCrae et al. Neuroticism, Agreeableness, and Openness scales were superior to their respective Shedler and Westen scales. Both research teams developed comparably valid Extraversion and Conscientiousness scales. Implications of the results for future SWAP-200 research are discussed.     

Best Practices: A Critical Yet Inclusive Vision for the Counseling Profession

Substantial controversy has surrounded the concept of best practices (BPs) in counseling; in particular, the consequences of deriving practice guidelines from empirically supported treatments (ESTs). Criticisms of EST methodology, assumptions, and findings are summarized, and implications for core counseling values, including multiculturalism, are discussed. The authors further elaborate an inclusive view of BP that can facilitate the use of research to inform and enhance counseling services while rectifying problems associated with methodological and theoretical bias.     

A misleading review of response bias: comment on McGrath, Mitchell, Kim, and Hough (2010)

In the May 2010 issue of Psychological Bulletin, R. E. McGrath, M. Mitchell, B. H. Kim, and L. Hough published an article entitled "Evidence for Response Bias as a Source of Error Variance in Applied Assessment" (pp. 450-470). They argued that response bias indicators used in a variety of settings typically have insufficient data to support such use in everyday clinical practice. Furthermore, they claimed that despite 100 years of research into the use of response bias indicators, "a sufficient justification for [their] use… in applied settings remains elusive" (p. 450). We disagree with McGrath et al.'s conclusions. In fact, we assert that the relevant and voluminous literature that has addressed the issues of response bias substantiates validity of these indicators. In addition, we believe that response bias measures should be used in clinical and research settings on a regular basis. Finally, the empirical evidence for the use of response bias measures is strongest in clinical neuropsychology. We argue that McGrath et al.'s erroneous perspective on response bias measures is a result of 3 errors in their research methodology: (a) inclusion criteria for relevant studies that are too narrow; (b) errors in interpreting results of the empirical research they did include; (c) evidence of a confirmatory bias in selectively citing the literature, as evidence of moderation appears to have been overlooked. Finally, their acknowledging experts in the field who might have highlighted these errors prior to publication may have prevented critiques during the review process.     

Flexible Applications of the Coping Cat Program for Anxious Youth

The current article offers suggestions for ways to adapt empirically supported treatments (ESTs). A specific manualized EST (Coping Cat; Kendall & Hedtke, 2006a) is used to illustrate the concept of "flexibility within fidelity" (Kendall & Beidas, 2007; Kendall, Gosch, Furr, & Sood, 2008). Flexibility within fidelity stresses the importance of using ESTs while considering and taking into account individual client presentations. In this discussion, recommendations are offered for the use of the Coping Cat with younger youth, adolescents, and youth with secondary comorbidities (i.e., social skills deficits, inattentive symptoms, and depressive symptoms).     

Assessing the belief bias effect with ROCs: reply to Dube, Rotello, and Heit (2010)

Dube, Rotello, and Heit (2010) argued (a) that the so-called receiver operating characteristic is nonlinear for data on belief bias in syllogistic reasoning; (b) that their data are inconsistent with Klauer, Musch, and Naumer's (see record 2000-02818-008) model of belief bias; (c) that their data are inconsistent with any of the existing accounts of belief bias and only consistent with a theory provided by signal detection theory; and (d) that in fact, belief bias is a response bias effect. In this reply, we present reanalyses of Dube et al.'s data and of old data suggesting (a) that the receiver operating characteristic is linear for binary "valid" versus "invalid" responses, as employed by the bulk of research in this field; (b) that Klauer et al.'s model describes the old data significantly better than does Dube et al.'s model and that it describes Dube et al.'s data somewhat better than does Dube et al.'s model; (c) that Dube et al.'s data are consistent with the account of belief bias by misinterpreted necessity, whereas Dube et al.'s signal detection model does not fit their data; and (d) that belief bias is more than a response bias effect.     

A Model of Therapist Competencies for the Empirically Supported Cognitive Behavioral Treatment of Child and Adolescent Anxiety and Depressive Disorders

While a plethora of cognitive behavioral empirically supported treatments (ESTs) are available for treating child and adolescent anxiety and depressive disorders, research has shown that these are not as effective when implemented in routine practice settings. Research is now indicating that is partly due to ineffective EST training methods, resulting in a lack of therapist competence. However, at present, the specific competencies that are required for the effective implementation of ESTs for this population are unknown, making the development of more effective EST training difficult. This study therefore aimed to develop a model of therapist competencies for the empirically supported cognitive behavioral treatment of child and adolescent anxiety and depressive disorders using a version of the well-established Delphi technique. In doing so, the authors: (1) identified and reviewed cognitive behavioral ESTs for child and adolescent anxiety and depressive disorders, (2) extracted therapist competencies required to implement each treatment effectively, (3) validated these competency lists with EST authors, (4) consulted with a panel of relevant local experts to generate an overall model of therapist competence for the empirically supported cognitive behavioral treatment of child and adolescent anxiety and depressive disorders, and (5) validated the overall model with EST manual authors and relevant international experts. The resultant model offers an empirically derived set of competencies necessary for effectively treating children and adolescents with anxiety and depressive disorders and has wide implications for the development of therapist training, competence assessment measures, and evidence-based practice guidelines for working with this population. This model thus brings us one step closer to bridging the gap between science and practice when treating child and adolescent anxiety and depression.     

The growing significance of hot intelligences

Comments on the original article, "Intelligence: New findings and theoretical developments," by R. E. Nisbett, J. Aronson, C. Blair, W. Dickens, J. Flynn, D. F. Halpern, and E. Turkheimer (see record 2011-30298-001). The present authors note that Nisbett et al's review focuses on intelligences that have been topics of research through the 20th century. Since then, however, attention to a new group of intelligences that the present authors refer to as "hot intelligences" has been growing (Mayer, Salovey, & Caruso, 2004). Although Nisbett et al (2012) mentioned potential newcomers to the group of intelligences, such as practical intelligence, the present authors feel that future reviews should consider the burgeoning research in new conceptions of intelligence. Here the authors express a rationale for including a consideration of these newly described intelligences. (PsycINFO Database Record (c) 2012 APA, all rights reserved).     

年幼儿童的尺寸匹配误差现象

近十年来,尺寸匹配误差作为年幼儿童生活中的一种常见的尺寸误用现象逐渐受到了一些研究者的关注。现有研究主要集中在尺寸匹配误差的特点、出现频率和产生原因等方面。抑制控制的失败、神经通路的协调失败、“计划-控制”模型和“感觉-行动”模型、功能性推理偏好以及身体意识发展的不成熟等观点能够对某些类型的尺寸匹配误差现象做出解释。未来的研究应从进一步深入探讨尺寸匹配误差与假装的区别、完善研究方法以及跨文化研究的开展几方面进行。     

A Qualitative Investigation of Practicing Psychologists' Attitudes Toward Research-Informed Practice: Implications for Dissemination Strategies

This article presents the results of a qualitative analysis of interviews with 25 psychologists in independent practice, investigating everyday treatment decisions and attitudes about treatment outcome research and empirically supported treatments (ESTs). Clinicians noted positive aspects about treatment outcome research, such as being interested in what works. However, they had misgivings about the application of controlled research findings to their practices, were skeptical about using manualized protocols, and expressed concern that nonpsychologists would use EST lists to dictate practice. Clinicians reported practicing in an eclectic framework, and many reported including cognitive-behavioral elements in their practice. To improve their practice, they reported valuing clinical experience, peer networks, practitioner-oriented books, and continuing education when it was not too basic. Time and financial barriers concerned nearly all participants. Clinicians suggested they might be interested in ESTs if they could integrate them into their current frameworks, and if resources for learning ESTs were improved.     

Evidence-Based Psychotherapy Means Evidence-Informed,Not Evidence-Driven

Some advocates of empirically-supported treatments (ESTs) argue that practitioners who do not use them are practicing unethically. I argue that it is unethical to try to impose EST criteria on the field of psychotherapy practice when (a) there is considerable controversy over these criteria, (b) there are alternative ways to construe evidence-based practice, and (c) by other criteria many approaches are evidence-based. I consider views of the relationship of science to practice, and other bases for practice such as practical knowledge and ethics. I conclude with a case history of client-centered therapy.     

Patterns of Religious Coping among Bereaved College Students

Contemporary research has suggested that bereavement is a paramount issue in college populations, a group which has historically been underrepresented in grief research (Balk. in Death studies 25:67–84, 2001; Balk et al. in Death Studies 34:459–468, 2010). Indeed, there has been a call to generate new research on grief with specific populations and age groups (Center for the Advancement of Health. in Death Studies 28:568–575, 2004). Religion is often described as a primary way that individuals cope with bereavement in particular (Frantz et al. in Pastor Psychol 44(3):151–163, 1996) and has been shown to effect college student reactions to stress in general (Merrill et al. in Mental Health, Religion & Culture 12(5):501–511, 2009). The RCOPE (Pargament et al. in J Clin Psychol 56(4):519–543, 2000, J Health Psychol 9:713–730, 2004) is a frequently used measure of religious coping, but has not been evaluated with a bereaved undergraduate population. Given that emerging adulthood is a critical developmental phase of religious identity (Fowler. in New Directions for Child Development 3(52):27–45, 1991), the current study examined the factor structure of the RCOPE within a sample of bereaved college students. An exploratory factor analysis was performed, which approximated the factor structure proposed by Pargament et al. (J Clin Psychol 56(4):519–543, 2000). However, a high correlation between the positive and negative religious coping subscales (r = 0.71) detracted from the predictive utility of Pargament et al.′s (2000) two overarching subscales. Therefore, an exploratory factor analysis with an orthogonal rotation was used to identify two uncorrelated subscales (adaptive religious coping and maladaptive religious coping). This new two-factor, 39-item version of the RCOPE was found to demonstrate good internal consistency (α > 0.8) as well as convergent and discriminant validity. The interaction between religious coping strategies and core beliefs about the predictability of the world is explored, and directions for future research and clinical practice are suggested.     

Living with Gratitude: Spouse’s Gratitude on One’s Depression

Research has shown that gratitude makes people happier (McCullough and Tsang in Psychol Gratitude, Oxford University Press, pp 123–141, 2004; Wood et al. in Clin Psychol Rev 30(7):890–905, 2010), healthier (McCullough et al. in J Pers Soc Psychol, 86(2):295–309, 2004), more considerate (Bartlett and DeSteno in Psychol Sci 17(4):319–325, 2006), and better evaluated (Gordon et al. in Pers Individ Differ 50(3):339–343, 2011), enabling more stable relationships (Algoe et al. in Pers Relationsh 17(2):217–233, 2010; Algoe et al. in Emotion 8(3):425–429, 2008; Lambert et al. in Psychol Sci 21(4):574–580, 2010). However, no study has extended research beyond individual persons to investigate the impact of one’s gratitude on the mental well-being of those who surround her or him. Thus, we tested this possibility and found in Study 1 that within marriage, husbands’ depositional gratitude negatively correlated with their wives’ depressive emotion. The results of Study 2 validated Study 1 by showing that a wife’s depression would be relatively palliated if her husband was assigned to express appreciation to her and not share daily hassles. While a causal relationship was demonstrated as hypothesized, a difference between genders also emerged. We discuss in particular the latter in terms of its mechanism, limitations, and practical implications for marriage.     

Imperfection,Indecision, and Hoarding

Hoarding disorder is a new DSM-5 disorder that causes functional impairment and affects 2 to 6% of the population (Frost and Steketee 2014). The current study evaluated a multiple mediation model with 243 undergraduate women in which indecisiveness (VOCI; Thordarson et al. Behaviour Research and Therapy, 42(11), 1289-1314, 2004) and decisional procrastination (DPS; Mann 1982) mediated the relationship between dimensions of perfectionism (F-MPS-B; Burgess et al. 2016a) and hoarding behavior (SI-R; Frost et al. Behaviour Research And Therapy, 42(10), 1163–1182, 2004) and excessive acquiring (CAS; Frost et al. Annual Review of Clinical Psychology, 8, 219–242, 2012). Multiple mediational analyses indicated a significant indirect effect for decisional procrastination, but not indecisiveness, in mediating evaluative concerns (but not striving) to SI-R Total, SI-R Clutter, SIR Excessive Acquisition, and both CAS subscales. Both mediators were significant pathways between evaluative concerns and SI-R Difficulty Discarding. These findings support a cognitive behavioral model of hoarding, suggesting that evaluative concerns produces problems in decision-making that influence acquisition, discarding, and clutter.     

Diagnosis and repair of negative polarity constructions in the light of symbolic resonance analysis

In a post hoc analysis, we investigate differences in event-related potentials of two studies (Drenhaus et al., 2004, Drenhaus et al., to appear, Saddy et al., 2004a and Saddy et al., 2004b) by using the symbolic resonance analysis (Beim Graben & Kurths, 2003). The studies under discussion, examined the failure to license a negative polarity item (NPI) in German: Saddy et al. (2004a) reported an N400 component when the NPI was not accurately licensed by negation; Drenhaus et al., 2004 and Drenhaus et al., to appear considered additionally the influence of constituency of the licensor in NPI constructions. A biphasic N400-P600 response was found for the two induced violations (the lack of licensor and the inaccessibility of negation in a relative clause). The symbolic resonance analysis (SRA) revealed an effect in the P600 time window for the data in Saddy et al., which was not found by using the averaging technique. The SRA of the ERPs in Drenhaus et al., showed that the P600 components are distinguishable concerning the amplitude and latency. It was smaller and earlier in the condition where the licensor is inaccessible, compared to the condition without negation in the string. Our findings suggest that the failure in licensing NPIs is not exclusively related to semantic integration costs (N400). The elicited P600 components reflect differences in syntactic processing. Our results confirm and replicate the effects of the traditional voltage average analysis and show that the SRA is a useful tool to reveal and pull apart ERP differences which are not evident using the traditional voltage average analysis.     

Object recognition memory and the rodent hippocampus

In rodents, the novel object recognition task (NOR) has become a benchmark task for assessing recognition memory. Yet, despite its widespread use, a consensus has not developed about which brain structures are important for task performance. We assessed both the anterograde and retrograde effects of hippocampal lesions on performance in the NOR task. Rats received 12 5-min exposures to two identical objects and then received either bilateral lesions of the hippocampus or sham surgery 1 d, 4 wk, or 8 wk after the final exposure. On a retention test 2 wk after surgery, the 1-d and 4-wk hippocampal lesion groups exhibited impaired object recognition memory. In contrast, the 8-wk hippocampal lesion group performed similarly to controls, and both groups exhibited a preference for the novel object. These same rats were then given four postoperative tests using unique object pairs and a 3-h delay between the exposure phase and the test phase. Hippocampal lesions produced moderate and reliable memory impairment. The results suggest that the hippocampus is important for object recognition memory.Recognition memory refers to the ability to judge a previously encountered item as familiar and depends on the integrity of the medial temporal lobe (Squire et al. 2007). Tasks that assess recognition memory (and object recognition memory in particular) have become increasingly useful tools for basic and preclinical research investigating the neural basis of memory (Winters et al. 2008). Perhaps the best known of these tasks is the novel object recognition task (NOR) (also known as the visual paired-comparison task in studies with humans and monkeys).Studies of the NOR task in humans with hippocampal damage (McKee and Squire 1993; Pascalis et al. 2004) and in monkeys with selective damage to the hippocampus (Pascalis and Bachevalier 1999; Zola et al. 2000; Nemanic et al. 2004) have resulted in clear and consistent findings. Damage limited to the hippocampus is sufficient to produce impaired recognition memory (Squire et al. 2007, Box 1). In rats and mice, the NOR task has become particularly popular and is currently a benchmark task for assessing recognition memory. Yet despite its widespread use in rodents, the findings are rather mixed. For example, in the rat, although there is agreement that the perirhinal cortex is critically important for normal NOR performance, there is less agreement about the hippocampus (for review, see Winters et al. 2008). Although some of the discrepancies between studies may be attributed to differences in lesion size and in the length of the retention delay (Broadbent et al. 2004), these factors cannot account for all the findings (Squire et al. 2007).Whereas most studies have investigated the effects of hippocampal lesions on postoperative NOR performance, there is also interest in the effects of hippocampal lesions on memory for previously encountered objects. For a number of tasks, hippocampal lesions produce temporally graded retrograde amnesia, such that memory acquired recently is impaired and memory acquired more remotely is spared (for review, see Squire et al. 2004; Frankland and Bontempi 2005). In the case of the single study of retrograde memory that has involved the NOR task, recognition memory was impaired when a 5-wk interval intervened between training and hippocampal surgery (Gaskin et al. 2003). It remains possible that memory might be spared if a longer delay was imposed between training and surgery.The aim of the present study was to assess both the anterograde and retrograde effects of hippocampal lesions on recognition memory using the NOR task. To thoroughly assess the effects of hippocampal lesions we used (1) large groups of animals, (2) multiple tests of NOR memory, (3) a scoring method that allowed object preference to be determined on a second-by-second basis during the recognition tests, and (4) a novel training protocol that permitted the evaluation of recognition memory even after a retention interval as long as 10 wk.     

Working memory capacity and fluid intelligence are strongly related constructs: comment on Ackerman, Beier, and Boyle (2005)

The authors agree with P. L. Ackerman, M. E. Beier, and M. O. Boyle (2005; see record 2004-22408-002) that working memory capacity (WMC) is not isomorphic with general fluid intelligence (Gf) or reasoning ability. However, the WMC and Gf/reasoning constructs are more strongly associated than Ackerman et al. (2005) indicate, particularly when considering the outcomes of latent-variable studies. The authors' reanalysis of 14 such data sets from 10 published studies, representing more than 3,100 young-adult subjects, suggests a strong correlation between WMC and Gf/reasoning factors (median r=.72), indicating that the WMC and Gf constructs share approximately 50% of their variance. This comment also clarifies the authors' "executive attention" view of WMC, it demonstrates that WMC has greater discriminant validity than Ackerman et al. (2005) implied, and it suggests some future directions and challenges for the scientific study of the convergence of WMC, attention control, and intelligence.