Procedures for identifying evidence-based psychological treatments for older adults

The authors describe the methods used to identify evidence-based psychological treatments for older adults in this contribution to the special section. Coding teams were assembled to review the literature on several problems relevant to mental health and aging. These teams used the manual developed by the Committee on Science and Practice of the Society for Clinical Psychology (Division 12) of the American Psychological Association that provided definitions of key constructs used in coding. The authors provide an overview of the process followed by the review teams and of some of the issues that emerged to illustrate the steps involved in the coding procedure. Identifying evidence-based treatments is a fundamental aspect of promoting evidence-based practice with older adults; such practice is advocated by most health care disciplines, including psychology.     

Arbitrary metrics in psychology

Many psychological tests have arbitrary metrics but are appropriate for testing psychological theories. Metric arbitrariness is a concern, however, when researchers wish to draw inferences about the true, absolute standing of a group or individual on the latent psychological dimension being measured. The authors illustrate this in the context of 2 case studies in which psychologists need to develop inventories with nonarbitrary metrics. One example comes from social psychology, where researchers have begun using the Implicit Association Test to provide the lay public with feedback about their "hidden biases" via popular Internet Web pages. The other example comes from clinical psychology, where researchers often wish to evaluate the real-world importance of interventions. As the authors show, both pursuits require researchers to conduct formal research that makes their metrics nonarbitrary by linking test scores to meaningful real-world events.     

Commentary on evidence-based psychological treatments for older adults

This article comments on the articles in the Special Section on Evidence-Based Psychological Treatments for Older Adults. The articles apply criteria developed by the Society of Clinical Psychology to evaluate treatments for late-life anxiety, insomnia, behavior disturbances in dementia, and caregiver distress. The articles document that there are evidence-based psychological treatments that can help older adults. However, there are 2 substantial hurdles: evidence and access. Gaps in the evidence, as mentioned by the authors of the articles in the special section, result from disproportionate research attention to some psychotherapies and some mental disorders, with corresponding lack of research about other treatments and disorders. The challenge for access is to ensure that older adults with treatable mental disorders will get connected to psychologists trained in these evidence-based therapies.     

Neurorobiology and evidence-based biological treatments for substance abuse disorders

Behavioral patterns of addiction include compulsive drug-seeking, persistent abuse of substances despite the often dire consequences on social functioning and physical health, and the high probability of relapse even after prolonged drug-free periods. The recent focus on the biological basis of addiction has provided evidence to support the hypothesis that behavioral manifestations for addiction are influenced by biological factors, and biological factors often produce behavioral changes that can further increase risk. The current understanding of the role of the dopaminergic, glutamatergic, Upsilon-aminobutyric acidergic, and opioid receptor systems in the pathophysiology of addiction as well as the clinical implications of these systems for new and emerging treatments will be discussed. This article will also review the pharmacologic agents used in the treatment of substance abuse disorders and presents evidence-based data for their safety, efficacy, and feasibility of use in different patient populations.     

Guidelines for classifying evidence-based treatments in couple and family therapy

Guidelines for Evidence-Based Treatments in Family Therapy are intended to help guide clinicians, researchers, and policy makers in identifying specific clinical interventions and treatment programs for couples and families that have scientifically based evidence to support their efficacy. In contrast to criteria, which simply identify treatments that "work" and have been employed in the evaluation of other psychotherapies, these guidelines propose a three-tiered levels-of-evidence-based model that moves from "evidence-informed," to "evidence-based," to "evidence-based and ready for dissemination and transportation within diverse community settings." Each level reflects an interaction between the specificity of the intervention, the strength and readth of the outcomes, and the quality of the studies that form the evidence. These guidelines uniquely promote a clinically based "matrix" approach in which the empirical support is evaluated according to various dimensions including strength of the outcomes, the applicability across cultural contexts, and demonstration of specific change mechanisms. The guidelines are offered not only as a basis for understanding the evidence for diverse clinical approaches in couple and family therapy within the systemic tradition of the field, but also as an alternative aspirational model for evaluating all psychotherapies.     

Disseminating evidence-based treatments for PTSD in organizational settings: A high priority focus area

Dissemination of evidence-based treatments for PTSD has become an important focus of activity in the aftermath of recent terrorist attacks (e.g., London underground and U.S. 9/11 attacks), natural disasters (e.g., Indian Ocean tsunami and Hurricane Katrina), and wars (e.g., in Iraq and Afghanistan). This has become a high priority need for all mental health training and service delivery organizations. Researchers and educators have begun to examine clinician and client perceptions and preferences regarding PTSD treatment processes, and health care systems are organizing more comprehensive efforts at training and system change. As this evolution of services moves forward, effective dissemination should be a major focus of health policy research for the next decade or more.This review critically evaluates the PTSD-related research and emerging theory related to four major sets of variables that affect dissemination: (1) Practitioner factors, (2) Training methods, (3) The practice innovation(s) being disseminated; and (4) Organization or system factors. We evaluate findings from recent studies in light of emerging models of dissemination, and in the final section of the paper, we consider five broad topics with particular implications for dissemination of PTSD-specific treatments. They are: (1) The content of dissemination (i.e., which treatment protocols or intervention methods should be prioritized); (2) Strict adherence versus flexibility in the use of treatment manuals and the role of fidelity assessment; (3) The need for collaboration with user audiences; (4) The potential role of web-based technologies in increasing the effectiveness and efficiency of dissemination; and (5) Development of dissemination infrastructures within organizations.     

Developing evidence-based guidance – implications for systemic interventions

This article provides a brief review of the history and current approaches to the development of clinical guidelines, particularly as applied to systemic and more generally psychological therapies. Some commonly identified problems associated with guideline development in mental health are reviewed and their implications for guideline development considered. The challenges this work presents for systemic therapies are considered, along with likely future development in clinical guidelines.     

Taste-aversion retention: An animal experiment with implications for consummatory-aversion alcoholism treatments

Inquiries into the longevity of illness-induced aversions (TAs) in animals are relevant to consummatory-aversion (CA) treatments of human alcoholism. The range of nausea reactions that accompanied the relapses of some alcoholics who had acquired alcohol aversions during covertsensitization (verbal aversion) alcoholism treatment has implicated CA forgetting as one probable contributor to recidivism. CA forgetting is operationalized as aversion diminution during postconditioning periods in which Ss abstain from contact with the target substance. TAs of varying strengths were induced in groups of Sprague-Dawley rats that received low, medium or high doses of the illness-inducing drug cyclophosphamide following saccharin-solution ingestion. TA retention was assessed following saccharin-free intervals of 2–40 days. Each Ss' retention interval was followed by 30 days of two-bottle preference testing, thereby additionally permitting an assessment of TA extinction following differing degrees of TA forgetting. Low-dose Ss displayed moderate strength TAs that were forgotten within 20 days and that had little resistance to extinction when testing began shortly after conditioning. Medium-dose Ss displayed stronger TAs having greater resistance to both forgetting and extinction. Unlike these low- and medium-dose TAs, high-dose TAs were impervious to aversion degradation as a result of forgetting. This finding is interpreted as supporting the attempted induction of intense nausea during covert-sensitization and chemical aversion (emetic therapy) alcoholism treatment. Other related conditioning procedures that may contribute to effective treatment are also discussed.     

Meta-analyses and systematic reviews of psychological treatments for chronic pain: relevance to an evidence-based practice.

As evidence-based practitioners become more reliant on systematic reviews to inform treatment, it becomes important to systematize reporting details as well as improve the quality of the primary studies that will later be incorporated into this secondary literature. In this article, the authors consider several specific factors that can serve this function in the area of chronic pain: (a) adhering to a standardized set of reporting standards; (b) measuring a standardized set of short- and long-term outcome variables; (c) providing information about individual differences; and (d) providing detailed, easily accessible documentation of the treatment program (or progams). The article also highlights ways that practitioners and researchers can collaborate on treatment outcome research, thereby improving the ability to discover and disseminate effective treatments for patients who suffer from chronic pain.     

Publication bias in psychological science: prevalence, methods for identifying and controlling, and implications for the use of meta-analyses

The issue of publication bias in psychological science is one that has remained difficult to address despite decades of discussion and debate. The current article examines a sample of 91 recent meta-analyses published in American Psychological Association and Association for Psychological Science journals and the methods used in these analyses to identify and control for publication bias. Of the 91 studies analyzed, 64 (70%) made some effort to analyze publication bias, and 26 (41%) reported finding evidence of bias. Approaches to controlling publication bias were heterogeneous among studies. Of these studies, 57 (63%) attempted to find unpublished studies to control for publication bias. Nonetheless, those studies that included unpublished studies were just as likely to find evidence for publication bias as those that did not. Furthermore, authors of meta-analyses themselves were overrepresented in unpublished studies acquired, as compared with published studies, suggesting that searches for unpublished studies may increase rather than decrease some sources of bias. A subset of 48 meta-analyses for which study sample sizes and effect sizes were available was further analyzed with a conservative and newly developed tandem procedure of assessing publication bias. Results indicated that publication bias was worrisome in about 25% of meta-analyses. Meta-analyses that included unpublished studies were more likely to show bias than those that did not, likely due to selection bias in unpublished literature searches. Sources of publication bias and implications for the use of meta-analysis are discussed.     

Telehealth for underserved families: An evidence-based parenting program

Families with a child diagnosed with attention-deficit hyperactivity disorder completed an 8-session parenting program, the Group Triple P Positive Parenting Program, provided by videoconferencing technology. Families reported improved child behavior (effect size of d = -1.23) and decreased parent distress (d = -0.34). Parent training implemented with videoconferencing technology can be an effective way of delivering evidence-based services to families with specialized needs. (PsycINFO Database Record (c) 2012 APA, all rights reserved).     

Visual metrics: discriminative power through flexibility

An important stage in visual processing is the quantification of optical attributes of the outside world. We argue that the metrics used for this quantification are flexible, and that this flexibility is exploited to optimise the discriminative power of the metrics. We derive mathematical expressions for such optimal metrics and show that they exhibit properties resembling well-known visual phenomena. To conclude, we discuss some of the implications of flexible metrics for visual identification.     

Combinatorial Bitstring Semantics for Arbitrary Logical Fragments

Logical geometry systematically studies Aristotelian diagrams, such as the classical square of oppositions and its extensions. These investigations rely heavily on the use of bitstrings, which are compact combinatorial representations of formulas that allow us to quickly determine their Aristotelian relations. However, because of their general nature, bitstrings can be applied to a wide variety of topics in philosophical logic beyond those of logical geometry. Hence, the main aim of this paper is to present a systematic technique for assigning bitstrings to arbitrary finite fragments of formulas in arbitrary logical systems, and to study the logical and combinatorial properties of this technique. It is based on the partition of logical space that is induced by a given fragment, and sheds new light on a number of interesting issues, such as the logic-dependence of the Aristotelian relations and the subtle interplay between the Aristotelian and Boolean structure of logical fragments. Finally, the bitstring technique also allows us to systematically analyze fragments from contemporary logical systems, such as public announcement logic, which could not be done before.     

Confronting ambiguity: identifying options for infants with trisomy 18

Identifying ethically allowable options for infants with trisomy 18 has become more challenging as medical standards of practice shift, based on emerging scientific data and changing societal perceptions of disability. Lack of a stable professional standard of practice ought not prevent ethicists from facilitating a consensus; rather, these "unsettled cases" require an individualized, narrative approach that allows the values of the family and the particularities of each case to provide the necessary additional moral grounding.     

Crime prevention: more evidence-based analysis

This paper introduces a new section of Psicothema dedicated to the evidence-based approach to crime prevention. Along with an original sexual-offender-treatment programme implemented in Spain, this section presents four systematic reviews of important subjects in the criminological arena, such as sexual offender treatment, the well-known programme, the effectiveness of custodial versus non-custodial sanctions in reoffending and the fight against terrorism. We also highlight some of the focal points that scientists, practitioners and governments should take into account in order to support this evidence-based viewpoint of crime prevention.