"it's just not evidence based"

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baa
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Re: "it's just not evidence based"

Post by baa » Sun Aug 07, 2011 9:06 pm

eponymous85 wrote:hmm I guess so, even brief approaches seem to be around 40 sessions. But then I'm not aware of a huge amount of evidence for briefer CBT, which was always originally supposed to be around 40 sessions (and what the original studies are based on). Didn't they just go "ooh, CBT looks good. Let's do it, but halve the number of sessions"?
I'm pretty sure most of the trials that the disorder-specific protocols are based on are 20 sessions or fewer. So the <20 sessions are evidence based, rather than just chopped in half ;)
At least I'm not as mad as that one!

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Re: "it's just not evidence based"

Post by Ruthie » Sun Aug 07, 2011 9:29 pm

russ wrote:You're wasting your time if you think you'll ever 'prove' things like an unconscious or transference :)
I think we need to separate out evidence for the model and evidence for the therapy. The concepts in psychodynamic model are difficult to define and operationalise and therefore they have not been submitted to the kind of scrutiny that the concepts in the cognitive models have been. Indeed there are those within the psychoanalytic school who actively resist this. CBT has made a commitment from the beginning (because Beck was nigh on obsessional about it - and it got him excluded from the psychodynamic school at the time because they deemed his commitment to evidence as a sign that he was not sufficiently analysed) to developing the evidence base for it's models and developing the models in line with the evidence base. I think Anke Ehlers and David Clarke have been star players here in developing the evidence base for models of PTSD and social anxiety disorders. Interestingly, as the models have developed, so too have the effect sizes in the treatment trials.

The equivalence argument is well established in depression where basically everything works but not all that well. CBT effectiveness for some of the anxiety disorders (particularly PTSD) has improved. It will be interesting to see how the evidence base develops for CBT for more complex disorders such as personality disorders and psychosis. DBTs effectiveness in reducing self-harm is well established but Kate Davidson's team on the BOSCOT trial and Arnoud Arntz's team on the schema therapy trials are getting excellent results of late.There are so few head to head trials that it really is impossible to say for sure whether one therapy is more effective than the other although I don't think we can ignore Geisen-Bloo et al. by any means.

Ruthie
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Scottybottybanana
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Re: "it's just not evidence based"

Post by Scottybottybanana » Thu Aug 11, 2011 12:42 pm

eponymous85 wrote:
alsmithee wrote: ME: Actually, meta-analyses consistently show that psychodynamic-oriented psychotherapy has equivalent outcomes compared to other types of therapy and better outcomes compared to medication. It also consistently shows further improvement at longitudinal follow-up.
Is this not the dodo-bird conjecture? Meta-analysis proves that too
http://www.personal.kent.edu/~dfresco/C ... 1997_1.pdf

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Toria
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Re: "it's just not evidence based"

Post by Toria » Thu Aug 11, 2011 12:49 pm

Scottybottybanana wrote:
eponymous85 wrote:ME: Actually, meta-analyses consistently show that psychodynamic-oriented psychotherapy has equivalent outcomes compared to other types of therapy and better outcomes compared to medication. It also consistently shows further improvement at longitudinal follow-up.
Is this not the dodo-bird conjecture?
As eponymous says, is there not evidence that psychodynamic therapy shows greater long-term improvement compared to other orientations? If so, that doesn't seem like dodo bird equivalence to me...
You can't stop the waves, but you can learn to surf - Jon Kabat-Zinn

urmaserendipity85
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Re: "it's just not evidence based"

Post by urmaserendipity85 » Wed Aug 17, 2011 11:54 am

Oops just seen all the replies, should really check this forum more often! I'm definitely happy to share parts of my essay, and references etc if people would find that useful. How do I go about this?

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eponymous85
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Re: "it's just not evidence based"

Post by eponymous85 » Wed Aug 17, 2011 1:58 pm

Well you can either edit it into a digestible little nugget if you have the time, otherwise just copy and paste here m'dear ;) I can collate replies in to a wiki at a later stage.
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Mal
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Re: "it's just not evidence based"

Post by Mal » Thu Aug 18, 2011 3:12 pm

The Heart And Soul Of Change by Duncan et al is a useful book about research on this theme. The second edition has Rosenzweig's original Do-Do bird paper in it. You can also take a look at: Developing and Delivering Practice Based Evidence by Barkham, Haryd and Mellor-Clark. Wampold's 'The great psychotherapy debate' is the cheapest (I think) but regarded as the classic study into the misuse of RCTs and how research that attempts to compare therapies by standardising their delivery brings other complications because the confounding variables get ignored: a great book.

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russ
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Re: "it's just not evidence based"

Post by russ » Thu Aug 18, 2011 5:42 pm

"The Problem with Psychoanalytic Psychotherapy" by Kirsty Hall (a psychoanalyst) et al, is quite good for a heads-up on this.
metrotherapy: personal and professional development for psychologists at all stages in their career

PETRAN
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Re: "it's just not evidence based"

Post by PETRAN » Sat Nov 05, 2011 4:41 am

eponymous85 wrote:hmm I guess so, even brief approaches seem to be around 40 sessions. But then I'm not aware of a huge amount of evidence for briefer CBT, which was always originally supposed to be around 40 sessions (and what the original studies are based on). Didn't they just go "ooh, CBT looks good. Let's do it, but halve the number of sessions"?


This is an old thread, but the paper by Shedler is one heavily criticised paper with lots of methodological mistakes. It is not an "awesome paper" at all. Cherry-picking of studies, problems with the computations of meta-analyses, comparison of psychodynamic therapy to "short-term therapy" (meaning supportive-type therapies) rather than actual CBT or DBT among others. After various corrections, psychodynamic was not proven to be "better" than the so-called "evidence-based therapies" (such as CBT) as Shedler calls them.


Shedler's response to the critics? A personal attack on the researchers because of presenting themselves as "authoritative and objective" (perhaps having some type of complex?) :P


http://psycnet.apa.org/journals/amp/66/2/152/

Sorry, but the psychiatrist was right :P

alsmithee
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Re: "it's just not evidence based"

Post by alsmithee » Sat Nov 05, 2011 10:51 am

"Cherry-picking of studies, problems with the computations of meta-analyses, comparison of psychodynamic therapy to "short-term therapy" (meaning supportive-type therapies) rather than actual CBT or DBT among others. After various corrections, psychodynamic was not proven to be "better" than the so-called "evidence-based therapies" (such as CBT) as Shedler calls them."

Sounds exactly like CBT research! Go figure!

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Tiggerman
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Re: "it's just not evidence based"

Post by Tiggerman » Sun Mar 18, 2012 1:55 am

alsmithee wrote:You can look up Jonathan Shedler's paper on the efficacy of psychodynamic therapy, which can be found here: http://nvpp.nl/JonathanShedlerStudy20100202.pdf
Man I am so happy I found this article, thank you! Helps put everything into perspective! :lol:
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Baneen03
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Re: "it's just not evidence based"

Post by Baneen03 » Thu Mar 29, 2012 4:31 pm

Shedler...now that rings a bell. Think he popped up in a critique I wrote of CBT. He really doesn't seem to like it LoL!

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Will
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Re: "it's just not evidence based"

Post by Will » Thu Mar 29, 2012 5:54 pm

Baneen03 wrote:Shedler...now that rings a bell.
Had we been talking about classical conditioning that would've been the best accidental joke ever.
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Baneen03
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Re: "it's just not evidence based"

Post by Baneen03 » Fri Mar 30, 2012 10:05 am

Ha, yes Will! How about...

Who's the fella who did the reknowned conformity experiments? I'm not sure but everyone here is saying Asch, so I'll just go with that...

pepper24
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Re: "it's just not evidence based"

Post by pepper24 » Fri Mar 30, 2012 12:04 pm

Baneen03 wrote:Ha, yes Will! How about...

Who's the fella who did the reknowned conformity experiments? I'm not sure but everyone here is saying Asch, so I'll just go with that...
Milgram did experiments with conforming to authority figures, if that helps?

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