Attachment--and loss.

Cognitive behavioral therapy (CBT) refers to a popular therapeutic approach that has been applied to a variety of problems. The goal of this review was to provide a comprehensive survey of meta-analyses examining the efficacy of CBT. We identified 269 meta-analytic studies and reviewed of those a representative sample of 106 meta-analyses examining CBT for the following problems: substance use disorder, schizophrenia and other psychotic disorders, depression and dysthymia, bipolar disorder, anxiety disorders, somatoform disorders, eating disorders, insomnia, personality disorders, anger and aggression, criminal behaviors, general stress, distress due to general medical conditions, chronic pain and fatigue, distress related to pregnancy complications and female hormonal conditions. Additional meta-analytic reviews examined the efficacy of CBT for various problems in children and elderly adults. The strongest support exists for CBT of anxiety disorders, somatoform disorders, bulimia, anger control problems, and general stress. Eleven studies compared response rates between CBT and other treatments or control conditions. CBT showed higher response rates than the comparison conditions in seven of these reviews and only one review reported that CBT had lower response rates than comparison treatments. In general, the evidence-base of CBT is very strong. However, additional research is needed to examine the efficacy of CBT for randomized-controlled studies. Moreover, except for children and elderly populations, no meta-analytic studies of CBT have been reported on specific subgroups, such as ethnic minorities and low income samples.

/pdf/the-efficacy-of-cognitive-behavioral-therapy-a-review-of-txe8rqmfum.pdf

The Efficacy of Cognitive Behavioral Therapy: A Review of Meta-analyses

Meta-analytic procedures for social research

This article provides a critical review of the assumptions and findings of studies used to establish psychotherapies as empirically supported. The attempt to identify empirically supported therapies (ESTs) imposes particular assumptions on the use of randomized controlled trial (RCT) methodology that appear to be valid for some disorders and treatments (notably exposure-based treatments of specific anxiety symptoms) but substantially violated for others. Meta-analytic studies support a more nuanced view of treatment efficacy than implied by a dichotomous judgment of supported versus unsupported. The authors recommend changes in reporting practices to maximize the clinical utility of RCTs, describe alternative methodologies that may be useful when the assumptions underlying EST methodology are violated, and suggest a shift from validating treatment packages to testing intervention strategies and theories of change that clinicians can integrate into empirically informed therapies.

/pdf/the-empirical-status-of-empirically-supported-2nkuyl6oot.pdf

The empirical status of empirically supported psychotherapies: assumptions, findings, and reporting in controlled clinical trials.

Background: The suboptimal compliance to vaccinations continues to be a major public health problem.

Factors associated with

Objective: The authors present a multidimensional meta-analysis of studies published between 1980 and 2003 on psychotherapy for PTSD. Method: Data on variables not previously meta-analyzed such as inclusion and exclusion criteria and rates, recovery and improvement rates, and follow-up data were examined. Results: Results suggest that psychotherapy for PTSD leads to a large initial improvement from baseline. More than half of patients who complete treatment with various forms of cognitive behavior therapy or eye movement desensitization and reprocessing improve. Reporting of metrics other than effect size provides a somewhat more nuanced account of outcome and generalizability. Conclusions: The majority of patients treated with psychotherapy for PTSD in randomized trials recover or improve, rendering these approaches some of the most effective psychosocial treatments devised to date. Several caveats, however, are important in applying these findings to patients treated in the community. Exclusion criteria and failure to address polysymptomatic presentations render generalizability to the population of PTSD patients indeterminate. The majority of patients posttreatment continue to have substantial residual symptoms, and follow-up data beyond very brief intervals have been largely absent. Future research intended to generalize to patients in practice should avoid exclusion criteria other than those a sensible clinician would impose in practice (e.g., schizophrenia), should avoid wait-list and other relatively inert control conditions, and should follow patients through at least 2 years.

/pdf/a-multidimensional-meta-analysis-of-psychotherapy-for-ptsd-1q55lal5th.pdf

A Multidimensional Meta-Analysis of Psychotherapy for PTSD.

http://coping.us/images/Eddy_et_al_2004_Compare_therapy_meds_OCD.pdf

A multidimensional meta-analysis of psychotherapy and pharmacotherapy for obsessive-compulsive disorder.

From Infant Attachment Disorganization to Adult Dissociation: Relational Adaptations or Traumatic Experiences?

Kihlstrom (2005) has recently called attention to the need for prospective longitudinal studies of dissociation. The present study assesses quality of early care and childhood trauma as predictors of dissociation in a sample of 56 low-income young adults followed from infancy to age 19. Dissociation was assessed with the Dissociative Experiences Scale; quality of early care was assessed by observer ratings of mother-infant interaction at home and in the laboratory; and childhood trauma was indexed by state-documented maltreatment, self-report, and interviewer ratings of participants' narratives. Regression analysis indicated that dissociation in young adulthood was significantly predicted by observed lack of parental responsiveness in infancy, while childhood verbal abuse was the only type of trauma that added to the prediction of dissociation. Implications are discussed in the context of previous prospective work also pointing to the important contribution of parental emotional unresponsiveness in the development of dissociation.

/pdf/quality-of-early-care-and-childhood-trauma-a-prospective-r3cxe56mkz.pdf

Quality of Early Care and Childhood Trauma: A Prospective Study of Developmental Pathways to Dissociation

The aim of this study was to assess the reliability and validity of the Child Behavior Checklist (CBCL) as completed by doctoral-level clinicians in the treatment of adolescents. We asked 294 randomly selected, experienced psychiatrists and psychologists to describe a patient aged 14 to 18 in treatment for personality pathology. Clinicians completed the CBCL (parent-report version) and measures of adaptive functioning, personality pathology, and family and developmental history, which served as criterion variables to test the validity of the CBCL as completed by clinicians. Most CBCL scales demonstrated acceptable reliability. Validity estimates were impressive, and the data revealed clinically meaningful associations between specific CBCL scale scores and developmental and family history variables. Confirmatory factor analysis showed that the factorial structure of the clinician-report CBCL resembled that of the parent-report CBCL, with the exception of a substantially lower correlation between higher order internalizing and externalizing factors. The data suggest that clinical judgment can be both reliable and valid when quantified using psychometrically sound instruments.

Quantifying clinical judgment in the assessment of adolescent psychopathology: Reliability, validity, and factor structure of the Child Behavior Checklist for clinician report.

Lissa Dutra

Papers

A Multidimensional Meta-Analysis of Psychotherapy for PTSD.

A multidimensional meta-analysis of psychotherapy and pharmacotherapy for obsessive-compulsive disorder.

From Infant Attachment Disorganization to Adult Dissociation: Relational Adaptations or Traumatic Experiences?

Quality of Early Care and Childhood Trauma: A Prospective Study of Developmental Pathways to Dissociation

Quantifying clinical judgment in the assessment of adolescent psychopathology: Reliability, validity, and factor structure of the Child Behavior Checklist for clinician report.