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Unread December 14th, 2006, 10:59 PM
James Pretzer James Pretzer is offline
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Join Date: Jun 2004
Posts: 283
Default I think you missed my point

You wrote:

If you are holding out CBT to be superior (more effective) and as having a scientific basis supporting this (this is my interpretation of your stance) then in my view some things must be addressed to maintain that position.

I am definitely not arguing that CBT is more effective than other treatment approaches. I've been arguing that we have reason to believe that empirically-supported therapies are effective, at least for the conditions they've been tested on. With therapeutic approaches that have not been tested, we do not have grounds for assuming that they are effective treatments. They may eventually prove to be effective, they may not.

You assert that most of the common therapies have been researched and have been found effective. If this is true, then all of the common therapies would be empirically supported. However, I see a lot of therapists using treatment approaches that have little or no empirical support (as well as alot of therapists who use empirically-supported approaches).

CBT is by no means the only empirically-supported therapy. I'm aware of a large body of research supporting behavior therapy for a range of problems, a fair amount of support for short-term psychodynamic therapies, support for Acceptance and Commitment Therapy, etc. Given a choice, I think there are important advantages to using treatment approaches that have been found to be effective under real-life conditions.
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Unread December 18th, 2006, 10:02 PM
James Pretzer James Pretzer is offline
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Join Date: Jun 2004
Posts: 283
Default Some of the reasons I think that Empirically-Supported Treatments make a difference

I haven't had time to read Wampold's book or to look into the controversy over empirically-supported treatments in detail. However, one of the reasons that I'm sceptical about studies that reportedly find that all therapies are equally effective is that I keep seeing studies that show that some treatment approaches work better than others. Here are a few that I've encountered recently:

Weisz, J. R., Jensen-Doss, A. & Hawley, K. M. (2006). Evidence-based youth psychotherapies versus usual clinical care: A meta-analysis of direct comparisons. American Psychologist, 61, pp. 671-689.

Abstract In the debate over evidence-based treatments (EBTs) for youth, one question is central: Do EBTs produce better outcomes than the usual interventions employed in clinical care? The authors addressed this question through a meta-analysis of 32 randomized trials that directly compared EBTs with usual care. EBTs outperformed usual care. Effects fell within the small to medium range at posttreatment, increasing somewhat at follow-up. EBT superiority was not reduced by high levels of youth severity or by inclusion of minority youths. The findings underscore a need for improved study designs and detailed treatment descriptions. In the future, the EBT versus usual care genre can inform the search for the most effective interventions and guide treatment selection in clinical care. (While the abstract doesn't mention it, some EBTs produced larger effect-sizes than others. Multi systemic therapy, parent management training, problem-solving skills training, and cognitive self-instruction training did particularly well.)

Cukrowicz, K. C., White, B. A. & Reitzel, L. R. (2005). Improved Treatment Outcome Associated With the Shift to Empirically Supported Treatments in a Graduate Training Clinic. Professional Psychology:
Research and Practice
, 36, pp. 330-337.

Abstract: There has been an increase in recent years in the use of empirically supported treatments (ESTs) for a variety of mental disorders. This study was an investigation of the impact of standardized use of ESTs in an outpatient community clinic. Clients treated prior to and those treated after the implementation of this policy were compared. The results indicate significant group differences, with the improvement ratings of the group receiving ESTs surpassing those of the group receiving unsupported treatment. Support for the use of ESTs indicates that patients may be best served if therapists rely primarily on these treatments.

Linehan, M. M., Comtois, K. A. et al. (2006). Two-year randomized controlled trial and follow-up of dialectical behavior therapy vs therapy by experts for suicidal behaviors and borderline personality disorder. Archives of General Psychiatry, 63, 757-766.

(from a summary in Clinician's Research Digest) In an attempt to control for many of the factors thought to be associated with therapeutic outcome, 101 women who met criteria for BPD and current or past suicidal behavior were randomly assigned to one year of DBT or community treatment by experts (CTBE) and were matched on several prognostic variables. The CTBE therapists were chosen for their expertice in treating difficult clients and were free to provide the type and frequency of treatment they deemed appropriate. The CTBE group did not include any CBT therapists. Relative to the CTBE group, DBT participants had half the rate of suicide attempts (23% vs 46%) and were less likely to use crisis services, to visit the emergency room for psychiatric problems, or to be hospitalized for psychiatric reasons. DBT participants also were less likely to drop out of treatment.
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