Samenvatting
Summary Evidence-based Clinical Practice, Research Methods/CP UvA Year 3
- Instelling
- Universiteit Van Amsterdam (UvA)
Summary of Evidence-based Clinical Practice, Research Methods/CP UvA Year 3
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Voorbeeld 4 van de 43 pagina's
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Voorbeeld van de inhoud
WEEK 1ARTICLE BY EHRING ET AL. (2022) – (WHEN AND HOW) DOES BASIC
RESEARCH IN CLINICAL PSYCHOLOGY LEAD TO MORE EFFECTIVE
PSYCHOLOGICAL TREATMENT FOR MENTAL DISORDERS?
Basic research in clinical psychology: Any type of psychological research investigating
processes that are involved in the development and/or maintenance of psychopathology across
any level of explanation
Psychological treatment for mental disorders: Any intervention that has been developed to
treat mental disorders, is based on a psychological theory, and uses psychological methods to
modify individuals’ behaviours, cognitions, emotions and/or other personal characteristics
More effective: The development of new evidence-based treatments and/or the substantial
further development and improvement of existing evidence-based treatments based on the
results of basic research in clinical psychology
The aims of the article are:
1. Critically examining evidence for basic research leading to more effective
psychological treatments for mental disorders
2. Reviewing obstacles for the translation of basic research findings into clinical
innovation
3. Discussing possible solutions to the translational gap
The review uses two key sources to identify evidence-based psychological treatments for
mental disorders that have been shown to be effective:
1. The list of empirically supported treatments published by the APA Division 12
2. Clinical guidelines from the UK’s National Institute for Health and Care Excellence
(NICE)
Focusing on the five disorders with the highest disease burden (i.e. depression, anxiety, drug
use disorders, alcohol use disorders, and schizophrenia), the authors of the article first
identified treatments with strong or moderate support from the APA Division 12 list, after
which they assessed how much these treatments were influenced by basic research, rating the
connection from ‘very strong’ to ‘weak’ – In a second step, they reviewed treatments
recommended by NICE guidelines for the same disorders and evaluated them similarly
- Very strong: Systematic testing of underlying theory conducted prior to treatment
development and treatment principles or interventions developed or refined in basic
research before application
- Strong: One of the two criteria for ‘very strong’ is present and conducted prior to
development of intervention
- Moderate: Some testing of theoretical model or intervention principles prior to or
parallel to treatment development, but not in a systematic or extensive way
- Weak: No basic research directly underlying treatment
Results:
- The most effective treatments fall into two categories:
, 1. CBT-based interventions rooted in basic research from 40+ years ago → These
treatments have strong research support and a strong link to basic research,
though the research is older
2. Treatments only moderately or weakly tied to basic research → These
treatments have been proven effective, but their development is not as closely
tied to foundational basic research
- Only 23% of treatments had a very strong link to basic research, with 20% showing a
strong connection
Translational gap → The separation and lack of integration between basic and applied
research in clinical psychology – Basic research focuses on understanding psychopathology
processes, while applied research tests psychological interventions through clinical trials
↓
Steps to guide the process of translating basic research findings into effective clinical
interventions:
1. Identifying processes involved in the development and maintenance of
psychopathology
2. Experimental Psychopathology (EPP) Research: Research that aims to establish
causality by experimentally manipulating a psychological process in order to
investigate its effect on symptoms – Aims to elucidate whether, how, when and why
specific processes result in psychopathological symptoms
- Type-I EPP research: A design to test the causal role of a defined process for
the development of defined symptoms – Explores the role of a process in
causing symptoms
- Type-II EPP research: A design that gives an indication of the modulation of
already existing symptoms – Explores how a process affects existing
symptoms → Ex-juvantibus argument: Assuming that the effects of a cure for
a certain condition (E.g.: aspirin for headaches) would tell something about the
cause of the condition (E.g.: a lack of aspirin causing headaches), which is a
logical fallacy
3. Developing and refining intervention strategies aimed at modifying the processes
4. Developing and testing new or improved interventions based on theoretical ideas
regarding mechanisms and principles of change, as well as on clinical expertise
- Step 4.1: Testing the efficacy of novel or improved interventions
- Step 4.2: Finding which processes mediate treatment effects, including those
that can be considered mechanisms of change
- Step 4.3: Identifying which treatment works best for a specific group of
patients (i.e. moderation), how treatment non-response can be predicted, what
predictors of dropout are and whether the intervention’s results seen in
controlled research settings can be replicated in routine clinical practice
5. Summarising and translating the results from efficacious and effective interventions
identified into clinical guidelines and recommendations
6. Taking the disseminated guidelines and empirically-supported interventions and
ensuring they are adopted and used widely in clinical practice
,Specific challenges in bridging the translational gap and their possible solutions:
- Studies bridging the gap require considerable expertise in both basic research as well
as know-how on clinical intervention principles
- Integrated approaches
- Bi-directional translation: Where basic research findings on important
treatment targets and/or intervention principles inform the development of
novel interventions; and, on the other hand, data on the efficacy and working
mechanisms of these interventions in a clinical context then in turn feed back
into further theoretical development and advanced additional basic research
- Language gap between basic research focusing on precise models, and clinical
application favouring concepts that are often broad but technically imprecise
- Mutual interest model: Where basic researchers, clinically-oriented researchers
and practitioners collaborate and communicate in areas of overlapping interests
- Limited resources and funding
- Lack of stability and replicability of basic research findings
- Stronger focus on reliability of measurements
- Increasing research transparency and collaboration (E.g.: preregistration; data
sharing)
- Strong emphasis on replication
- Improved statistical tools (E.g.: refined power analyses; Bayesian statistics)
- Incentivise good scientific practice and open science
- Lack of basic studies establishing causality before moving from step 1 to step 4
- Unclear external validity of basic and translational research
- Fat-handed interventions: When an intervention is broad and impacts several aspects
of an individual’s internal processes or external environment at once, making it
difficult to determine which specific factor is responsible for any observed changes
- Focus on robust empirical findings
- Searching for multiple sources of evidence
- Improving theory building, and focusing on construct validity
- An exclusive focus on RCTs → May neglect other important research questions
, - Lack of research on mediators and mechanisms of change → The need for a deeper
understanding of not just whether psychological treatments are effective, but also how
and why they work
- Kazdin: Formulated eight criteria for establishing mechanisms of change
- Lack of research on moderators
- Larger sample sizes for analyses on moderation
Why clinical guidelines may not effectively capture innovations in psychological treatments:
1. Guidelines are centred on treatments for DSM criteria, which often overlook
interventions that target specific subgroups or key processes within a disorder
2. Guidelines group similar treatments, hiding variations in efficacy
3. Guidelines simplify recommendations by offering broad categories
4. There is a delay between new research findings and their inclusion in guidelines
CHAPTER 9 (FIELD) – THE LINEAR MODEL (REGRESSION)
Simple linear regression: A linear approach for modelling the relationship between a response
and one predictor variable
↓
outcome ( y )=b 0+ b1 x 1 i +ε i
- Regression coefficients:
- b 0 = y-intercept (i.e. the value of y when the predictor variable is 0) – Starting
point of the line on the y-axis
- b 1= Slope (i.e. the rate at which y changes with respect to changes in x) – Rate
at which the dependent variable (y) changes for a one-unit change in the
independent variable (x) – If a is positive, it indicates a positive relationship,
and if it is negative, it indicates a negative relationship
- ε i = Error term (i.e. the discrepancy between the observed y and the value predicted by
the linear model)
- x 1 i = Observed value of the independent variable
Multiple regression: A statistical technique used to analyse the relationship between a
response variable and two or more predictor variables
↓
outcome ( y )=b0 + b1 x 1 i+ b2 x2 i +ε i
Regression plane: A three-dimensional plane that represents the relationship between the
dependent variable and two predictors
Estimating the model:
- Method of least squares: The fit of a model can be assessed by looking at the
deviations (= residuals) between the model and the data collected
↓
Sum of squared residuals ( S S R ): A gauge of how well a linear model fits the data – If
the squared differences are large, the model is not representative of the data; if the
squared differences are small, the line is representative
↓
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