Notes to the lectures given for the course Evidence-Based Interventions (PSMKB-1) during the Master's in Clinical Psychology at the University of Groningen.
Lecture notes Evidence-based interventions (PSMKB-1)
Learning goals of course;
1. can articulate the basic principles of evidence based mental health and can articulate the
research methodology for validating psychological treatments
2. can search literature for evidence-based-treatments when confronted with a clinical case
3. can articulate what a clinical guideline is and how it is used in individual treatment
4. can articulate what a treatment protocol is and how these are used in clinical practice
5. can provide arguments to convince practitioners to implement a specific evidence-based
treatment in their setting
Lecture 1: Introduction and finding evidence: sources
Learning objectives for today;
- Learning how to search for scientific evidence
- Learning how to formulate a clinical question
- Learning how to appraise the quality of scientific evidence and
methods for improving quality
- Knowing about possible biases in published evidence
Evidence based medicine: “integrating individual clinical expertise with
the best available external clinical evidence from systematic research.”
Searching for scientific evidence;
- Scientific data bases
University library: PsychInfo and PsychArticles (including APA journals) & Medline –
Pubmed (option: clinical queries)
Cochrane library: Systematic reviews and meta-analyses
Search within databases: PICO framework
- Systematic search protocol
- To formulate a well-focused clinical question
- To retrieve a higher % of relevant citations
PICO (TT) framework;
- Patient/Population (who/what)
- Intervention (diagnostic test/
treatment/prognostic factor)
- Comparison (what is the main alternative)
, - Outcome (what are you trying to accomplish/measure/improve/effect)
- (T)ype of question (therapy/diagnosis)
- (T)ype of study (the design that is best for the question)
Example: Does psychodynamic therapy (I) help depressed individuals (P) experience reductions in
depression on the Hamilton depression scale (a clinician-administered measure) (O), that are at least
as strong as those of cognitive behavioral therapy (C)?
Evidence: operationalization
- Summary scores for RCT are helpful, but also ask…
Effect size: moderate = a few patients with large changes? many patients with smaller
changes?
Percent improved: of completers or all who entered?
Percent recovered
Sustained efficacy: what timeline was used
Control groups and what it means to say “treatment ‘x’ works”
- Types of control
No treatment
Wait-list
Treatment as usual (TAU) (=very often
substandard care)
Active control
- No treatment, wait-list, TAU
Control for passage of time
Do NOT control for common factors
(therapeutic alliance)
Do NOT control for expectation/placebo
RCT methods
- Unlike pharmacological RCTs, double-blinding is difficult
Depressed patient enrolled in a study is likely to know whether s/he is receiving the real
treatment (expectancy, placebo, hope)
Active control: expectancy very rarely assessed
Intervention provider is likely to know whether s/he is providing the real treatment
Confirmation bias= tendency to favor information that confirms our theory (beliefs, hypotheses).
Researcher allegiance= the researcher’s ‘belief in the superiority of a treatment and in the superior
validity of the theory of change that is associated with the treatment’.
1. Methods and importance of systematic reviews and meta-analyses
2. Publication bias
Systematic review and meta-analyses;
, - Collate all evidence that fits pre-specified eligibility criteria in order to answer research
question
- Minimize bias using explicit, systematic methods
- Meta-analysis= use of statistical methods to summarize the results
- Different from a traditional narrative review;
No systematically collected evidence
(possibly) not objective
No statistical summary of association
Systematic reviews are less biased than a normal review.
A disadvantage of a systematic review is that it takes a lot of time.
Two systematic reviews can have the same subject but very different conclusions due to;
- Other search terms
- Different inclusion and exclusion criteria
Why systematic reviews;
- Many studies, different results
- Overview
- Small effects
- Subgroup
- Reporting bias
- Step 1: Research questions (PICO)
- Step 2-4: Searching (come up with search terms, searching for research)
- Step 5: Selecting studies
- Step 6: Collecting data
- Step 7: Assessing risk of bias
- Step 8: Analyzing data and meta-analysis
- Step 9: Reporting bias
Quality assessment (risk of bias); look at the individual studies included to assess the quality of the
studies.
Define research question with PICO
- Population
- Intervention/influence
- Control group/comparison
The benefits of buying summaries with Stuvia:
Guaranteed quality through customer reviews
Stuvia customers have reviewed more than 700,000 summaries. This how you know that you are buying the best documents.
Quick and easy check-out
You can quickly pay through credit card or Stuvia-credit for the summaries. There is no membership needed.
Focus on what matters
Your fellow students write the study notes themselves, which is why the documents are always reliable and up-to-date. This ensures you quickly get to the core!
Frequently asked questions
What do I get when I buy this document?
You get a PDF, available immediately after your purchase. The purchased document is accessible anytime, anywhere and indefinitely through your profile.
Satisfaction guarantee: how does it work?
Our satisfaction guarantee ensures that you always find a study document that suits you well. You fill out a form, and our customer service team takes care of the rest.
Who am I buying these notes from?
Stuvia is a marketplace, so you are not buying this document from us, but from seller isabelvdb. Stuvia facilitates payment to the seller.
Will I be stuck with a subscription?
No, you only buy these notes for $3.24. You're not tied to anything after your purchase.
