Medical Presentation // Public Health

1. TREATMENT EVALUATION
AND PREVENTION
STRATEGIES
Noel Christian
Group : 6

2. Introduction
› The projects researchers undertake to test the effectiveness of
particular therapies and make comparisons between different
therapies.
› The general goal is to discover the most efficient way to help
people overcome distress.
› As you will see, this research has also identified some factors that
are common to all successful therapy.
› We also consider briefly the topic of prevention: How can
psychologists intervene in people’s lives to prevent mental illness
before it occurs?

4. Evaluating Therapeutic Effectiveness
› British psychologist Hans Eysenck (1952) created a furor some
years ago by declaring that psychotherapy does not work at all!
› Spontaneous-remission effect:
The improvement of some mental patients and clients in
psychotherapy without any professional intervention; a baseline
criterion against which the effectiveness of therapies must be
assessed.
› Placebo therapy:
A therapy interdependent of any specific clinical procedures that
results in client improvement.

5. › In recent years, researchers have evaluated therapeutic
effectiveness using a statistical technique called Meta-Analysis.
› Because there are thousands of studies testing the effectiveness of
psychotherapy, and the independent and dependent variables in
the studies vary widely, the results are often combined using
a meta-analysis.
› It is a statistical technique that uses the results of existing studies
to integrate and draw conclusions about those studies.
› For example the fig. below compares results for three types of
psychotherapies and medications to placebo treatments which was
given by Hollon et al., 2002.

6. The figure displays the results from
meta-analyses of treatments for
depression. For each treatment, the
figure presents the percentage of
patients who typically respond to
each category of treatment. For
example, about 50 percent of
patients taking antidepressant
medication experience recognizable
symptom relief, whereas 50 percent
do not.
Treatment Evaluation for Depression

7. › Researchers have assessed the effectiveness of psychotherapy
alone versus psychotherapy combined with drug therapy.
› One study found that combination therapy was most able to bring
about full remission from chronic depression (Manber et al., 2008).
› Researchers are more concerned about asking why psychotherapy
works and whether any one treatment is most effective for any
particular problem and for certain types of patients (Goodheart et
al., 2006).
› Much treatment evaluation has been carried out in research
settings that afford reasonable control over patients and
procedures.

8. › Researchers need to ensure that therapies that work in research
settings also work in community settings in which patients and
therapists have more diversity of symptoms and experience
(Kazdin, 2008).
› Another important issue for evaluation research is to assess the
likelihood that individuals will complete a course of treatment.
› In almost all circumstances, some people choose to discontinue
treatments (Barrett et al., 2008). Researchers seek to understand
who leaves treatment and why—with the ultimate hope of creating
treatments to which most everyone can adhere.

9. Evidence-Based Explanation
› Evidence that various forms of psychotherapy really work has been
obtained through a large number of independent randomized
controlled trials (RCTs).
› Researcher have concluded that,“after decades of psychotherapy
research we cannot provide an evidence-based explanation for
how or why even our most well-studied interventions produce
change” (Kazdin, 2009, p. 426).
› That is, although we know that various therapies work, we still
know very little about why they work.

10. › Evidence-based practice of psychology requires practitioners to follow
psychological approaches and techniques that are based on a particular kind of
research evidence (Sackett, Straus, Richardson, Rosenberg, & Haynes, 2000).
› One such supported therapy has been defined by Chambless and Hollon (1998).
Accordingly, a therapy is considered "efficacious and specific" if there is
evidence from at least two settings that therapy is superior to a pill or
psychological placebo or another bona fide treatment.
› If there is evidence from two or more settings that the therapy is superior to no
treatment it is considered "efficacious".
› If there is support from one or more studies from just a single setting, the
therapy is considered possibly efficacious pending replication.
› Eg: Cognitive Behavior Therapy (CBT) stands out as having the most empirical
support for a wide range of symptoms in adults, adolescents, and children.

11. › There can be more evidence for some forms of psychotherapy (e.g.,
various forms of cognitive-behavior therapy) than for others (e.g.,
psychodynamic therapy) – mainly because more research has been
carried out about these kinds of treatment – there is very little
evidence that any form of psychotherapy is more effective than any
other (e.g., Wampold, 2001).
› The difficulties of demonstrating that any specific form of
psychotherapy is more effective than any other has led to the
conclusion that all active psychotherapies are equally effective, the
so-called Dodo Bird Verdict (e.g., Luborsky et al., 2002; Wampold,
2001), and to the suggestion that what really matters in
psychotherapy are “common factors”, or “non-specific” factors as
distinct from the specific factors that are explicitly formulated in
various theories of psychotherapy (Rosenzweig, 1936; Frank &
Frank, 1991).

12. Common Factors According to
Rosenzweig
The common factors hypothesis was first formulated by Rosenzweig
(1936), who also coined the term “Dodo Bird Verdict”.
Common factors are shared components that contribute to
therapeutic effectiveness (Wampold, 2001).
For successful therapies, these factors are most often present:
The client has positive expectations and hope for improvement.
The therapist is able to reinforce those expectations and cultivate
hope.

13. The therapy provides an explanation for how the client will change
and allows the client to practice behaviors that will achieve that
change.
The therapy provides a clear plan for treatment.
The client and therapist form a relationship that is characterized by
trust, warmth, and acceptance.
Among these common factors,
researchers have focused particular
attention on the relationship
between the therapist and the client.

14. Common Factors According to Frank
The title of Jerome Frank’s (1961; Frank & Frank, 1991) main work,
Persuasion and healing, captures exceedingly well the two main
aspects of his model.
According to Frank’s definition (Frank & Frank, 1991, p. 2),
psychotherapy is a special form of personal influence characterized
by
 A healing agent, typically a person trained in a socially sanctioned
method of healing believed to be effective by the sufferer and by at
least some members of his or her social group;
 A sufferer who seeks relief from the healer; and
 A healing relationship, that is, a circumscribed, more or less
structured series of contacts between the healer and the sufferer.

15. › Frank’s model also includes methods of primitive healing, religious
conversion, and even placebo effects in medicine.
› A therapeutic alliance is a mutual relationship that a client
establishes with a therapist:
The individual and the therapist collaborate to bring about relief.
Research suggests that the quality of the therapeutic alliance has
an impact on psychotherapy’s ability to bring about improved
mental health (Goldfried & Davila, 2005).

16. › In general, the more positive the therapeutic alliance, the more
relief the client obtains (Horvath et al., 2011).
› The concept of the therapeutic alliance has several components,
each of which also contributes to positive outcomes.
› For example, clients experience more improvement from
psychotherapy when they and the therapist share the same
perspective on the goals for the therapy and agree on the
processes that will achieve those goals (Tryon & Winograd, 2011).

17. The Relational-Procedural-Persuasion
(RPP) Model
The term Relational-Procedural Persuasion model (or, for short, the
RPP model) is used here as a label for a model of common factors in
psychotherapy which emphasizes three core components:
o The need for a good therapeutic relationship, but not as a goal in
itself, but
o as a means for engaging the client in a certain therapeutic
procedure and
o to persuade the client of a new explanation that gives new
perspectives and new meanings in life.

18. Prevention Strategies
› An important principle of life: Whatever the effectiveness of
treatment, it is often better to prevent a disorder than to heal it
once it arises.
› This focus is necessary because, much of the time, people are
unaware that they are at risk for psychological disorders. They
present themselves for treatment only once they have begun to
experience symptoms.
› The goal of prevention is to apply knowledge of those risk factors
to reduce the likelihood and severity of distress.

19. Prevention can be realized at several different levels.
Primary Prevention:
Seeks to prevent a condition before it begins.
Steps might be taken,
for example, to provide individuals with coping skills so
they can be more resilient or to change negative aspects
of an environment that might lead to anxiety or
depression (Boyd et al., 2006; Hudson et al., 2004).

20. Secondary Prevention:
Attempts to limit the duration and severity of a disorder
once it has begun.
This goal is realized by means of programs that allow for
early identification and prompt treatment.
For example, based on assessments of therapeutic
effectiveness, a mental health practitioner might
recommend a combination of psychotherapy and drug
therapy to optimize secondary prevention (Manber et
al.,2008).

21. Tertiary prevention
Limits the long-term impact of a psychological disorder
by seeking to prevent a relapse.
For example, individuals with schizophrenia who
discontinue drug therapy have a very high rate of relapse
(Fournier et al., 2010).
To engage in tertiary prevention, mental health
practitioners would recommend that their patients with
schizophrenia continue their courses of antipsychotic
drugs.

23. Community Psychology
› Community psychology plays a particular role in efforts to prevent
psychological illness and promote wellness (Schueller, 2009).
› Community psychologists often design interventions that address
the features of communities that put people at risk.
› For example, researchers have developed community-wide
strategies to reduce substance abuse among urban adolescents
(Diamond et al., 2009).
› These programs attempt to change community values with respect
to drugs and alcohol and they also provide adolescents with drug-
and-alcohol–free social activities.

24. › Preventing mental disorders is a complex and difficult task.
› It involves not only understanding the relevant causal factors,
but overcoming individual, institutional, and governmental
resistance to change.
› A major research effort will be needed to demonstrate the long-
range utility of prevention and the public health approach to
psychopathology.
› The ultimate goal of prevention programs is to safeguard the
mental health of all members of our society.

25. Summary
Research shows that many therapies work better than the mere
passage of time or nonspecific placebo treatment.
Evaluation projects are helping to answer the question of what
makes therapy effective.
Common factors, including the quality of the therapeutic alliance,
underlie the effectiveness of therapies.
Prevention strategies are necessary to stop psychological disorders
from occurring and minimize their effects once they have occurred.

26. References
› Alexander, F. (1946) The principle of corrective emotional experience. In F.
Alexander & T. M. French (Eds.), Psychoanalytic therapy: Principles and
applications. New York: Ronald Press.
› Andersen, S. M., & Berk, M. (1998). Transference in everyday experience:
Implications of experimental research for relevan clinical phenomena. Review of
General Psychology, 2, 81–120.
› Andersen, S. M., & Przybylinski, E. (2012). Experiments on transference in
interpersonal relations: Implications for treatment. Psychotherapy, 49, 370–383
› Freud, S. (1937). Analysis terminable and interminable. In J. Strachey (Ed.),
Standard edition of the complete works of Sigmund Freud (Vol. 23, pp. 216–
253). London: Hogarth Press.
› Goldfried, M. R. (1980). Toward the delineation of therapeutic change principles.
American Psychologist, 25, 991-999.