Week 1
Literature: Evidence-based treatment and practice (Kazdin, 2008)
There is a gap between research and practice in clinical psychology
- Emphasis on evidence interventions supported by randomized controlled trials
- Concerns about adequacy, sufficiency and generalizability of research findings for
clinical practice
Evidence-Based Treatment (EBT) vs. Evidence-Based Practice (EBP)
Evidence-Based Treatment (EBT) Evidence-Based Practice (EBP)
Interventions that have produced therapeutic Clinical practice that is informed by evidence about
change in controlled trials interventions, clinical expertise, and patient needs,
● Highly controlled experimental conditions values, and preferences (patient considerations)
● Not much evidence because it is adaptive to
Concerns: the situation
➔ Generalizability: key conditions and
characteristics in treatment research depart Concerns:
from those in clinical practice ➔ Reliability and validity: not established that
➔ Focus: different clinicians would select the same
◆ In research- focus on symptoms and treatment plan when presented with same
disorders as the primary ways of case (reliability) or that it would make a
identifying participants and evaluating difference in the patient compared to other
treatment outcomes treatments (validity)
◆ In practice- emphasis on the process of ➔ Generalizability: patients with similar
coping with life instead of an eliminating complaints and personality styles will still
symptoms probably differ in other ways
➔ Methods: conclusions based on statistical ➔ Assessment: patients progress is often
differences are difficult to translate into evaluated on the basis of clinical
everyday life effects, client can change to impressions, implicating validity, reliability,
meet criteria but not change in everyday and replicability of results
life
➔ Mixed results: some show an effect while
others do not
Multiple comparisons- if many outcome variables are measured, there is a good chance that
by chance an effect is found on one of the variables
Rapprochement
The goals of research and practice are to increase our understanding of therapy and to
improve patient care⇒ refocusing their efforts on these goals could bridge the gap + direct
collaborations between researchers and practitioners
,Rapprochement: Psychotherapy research
Three shifts in emphasis in research could reduce the gap between research and practice:
1. Giving greater priority to the study mechanisms of therapeutic change
● Process within a treatment responsible for the outcome
○ By focusing on many questions about mechanisms of change,
research could improve practice by stressing factors that are most
important to effect change
● Causes vs. mechanisms
○ Causes describe what resulted in an outcome
○ Mechanisms describe how this outcome resulted from the cause
2. Study moderators of change in ways that can be better translated to practice
● Moderators: Characteristics that influence the intervention-outcome relation
(e.g. gender).
● Moderators can be difficult to translate into clinical practice because of the
ways in which they are studied and reported and because it is not clear how
the moderator works across multiple conditions or treatments
● Three changes to improve research on moderators and help bridge the gap:
1. Reporting- report findings in a way that makes them applicable to
clinical work
2. Situations: state if moderator is treatment-specific or if it influences
several or all therapies
3. Processes- state what aspect of the moderator is relevant/how the
moderator works
3. Focus on qualitative research
● Provide an understanding of individual experiences of patients
○ Can be used to test and generate conceptual models and specific
hypotheses
Rapprochement: Clinical practice
Two changes can help bridge the gap:
1. Using systematic measures to evaluate patient progress
● Evaluating patients’ progress systematically can improve the quality of
patient care and decision about continuing, alternating, or terminating
treatment, and also complement clinical judgment
2. Emphasizing that clinical practice can contribute uniquely to our knowledge
● Experiences of clinicians can be used to generate and test hypotheses
Week 2
Literature: Robinaugh et al., (2019)- The network approach to psychopathology
,The network approach to psychopathology
● Began with a simple hypothesis: symptoms may cohere as syndromes because of
causal relations among the symptoms themselves
○ Symptoms are not passive indicators of a latent ‘common cause’
○ Symptoms are agents in a causal system
Network Theory
Five areas of work that have substantially contributed to the network conceptualization of
psychopathology
1. Philosophy of psychiatry
a. Mental disorders can be conceptualized as mechanistic property
clusters→ unified by causal relations among the features of the disorder
b. Symptom networks are rooted in psychometric theory
c. Symptoms networks can be understood as a kind of MPC: one which
emphasized symptoms as features of the disorder
d. Much of the network theory literature focuses on what mental disorders
are, how they arise, and how they are treated when viewing them through
their new lens
2. Network science
a. Focus on the network’s structure (e.g. relations among symptoms) and its
effects on the network’s state (e.g. activation of symptoms)
i. When causal relations among symptoms are strong, the onset of
one symptoms will lead to the onset of others
1. Strongly interconnected symptom networks are vulnerable to a
contagion effect of spreading activation through the network
(connectivity hypothesis)
b. From a network perspective, mental disorder is characterized not only by
the state of the network (e.g. elevated symptom activation), but also by
the structure of the network: in particular, a strongly connected network in
which inter-symptom relationships are sufficient to maintain elevated
symptom activation over time
i. In other words, mental disorder is characterized by a state of harmful
equilibrium
c. In weakly connected networks, activation varies dimensionally
d. In strongly connected networks, produce sharper boundaries
e. Highly central symptoms (like those with stronger inter-symptom
connections) have stronger potential to spread symptom activation
throughout the network than do symptoms on the periphery
3. Affect dynamics and momentary experience
, a. Symptoms are aggregates of moment-to-moment experiences and they
argue that it constitutes to the true building blocks of psychopathology
i. Focus on a more granular level of experience and highlights the
importance of understanding the ‘chronometry’ of experiences,
symptoms, and disorders
4. Cognitive behavioral theory
a. Embraced network theory and proposed integrating it with cognitive
behavioral models
b. Offers a long history of theorizing about causal relations among
symptoms, empirical research investigating those relationships, and
treatment research suggesting that symptoms-level interventions are
effective treatments
5. Systems science
a. Drawn from areas of systems science beyond network science alone,
including dynamical systems theory, catastrophe theory, and
cybernetics→ these fields offer new tools for psychiatric research
Critical analysis and future directions
➔ One key advantage of such models is that they render all aspects of the theory
explicit and available for evaluations
➔ Currently operational models reveal a restrictive set of assumptions:
◆ They typically assume binary symptoms that operate on the same time scale
and interact with instantaneous and positive effects
● Models adhering to these assumptions are unrealistic for most
mental disorders- many symptoms are dimensional
Methodology
When the network approach was first proposed, there was no established method for
assessing symptom network structure
➢ Network structure
○ Defined network structure using symptom co-occurrence or correlation
○ Aims to better identify the direct inter-symptom relations posited in network
theory
➢ Network characteristics
○ Examining local and global characteristics of symptom networks, including
assessments of node centrality, node predictability, node clustering,
community structure
Critical analysis and future directions
