Clinical Psychology E-Book
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- Herausgeber: John Wiley & Sons
- Kategorie: Fachliteratur
- Sprache: Englisch
The first book to offer a truly global perspective on the theory and practice of clinical psychology
While clinical psychology is practiced the world over, up to now there has been no text devoted to examining it within a global context. The first book of its kind, Clinical Psychology: A Global Perspective brings together contributions from clinicians and scholars around the world to share their insights and observations on the theory and practice of clinical psychology.
Due partly to language barriers and entrenched cultural biases, there is little cultural cross-pollination within the field of clinical psychology. In fact, most of the popular texts were written for English-speaking European and Anglo-American audiences and translated for other countries. As a result, most psychologists are unaware of how their profession is conceptualized and practiced in different regions, or how their own practices can be enriched by knowledge of the theories and modalities predominant among colleagues in other parts of the world. This book represents an important first step toward rectifying that state of affairs.
- Explores key differences and similarities in how clinical psychology is conceptualized and practiced with children, adolescents and adults across different countries and cultures
- Addresses essential research methods, clinical interviews, psychometric testing, neuropsychological assessments, and dominant treatment modalities
- Follows a consistent format with each chapter focusing on a specific area of the practice of clinical psychology while integrating cultural issues within the discussion
- Includes coverage of how to adapt one’s practice to the differing cultures of individual clients, and how to work in multidisciplinary teams within a global context
Clinical Psychology: A Global Perspective is a valuable resource for students, trainees, and practicing psychologists, especially those who work with ethnic minority groups or with interpreters. It is also a must-read for practitioners who are considering working internationally.
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Veröffentlichungsjahr: 2017
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Table of Contents
Cover
Title Page
Notes on Contributors
Preface
1 Research Methods
Introduction
Research on the Frequency, Cause, and Prevention of Psychological Problems, and Disorders
Evaluating Clinical Interventions and Treatments
Summary
References
2 Classification Systems across the Globe
Introduction
Classification Systems in Western Cultures
The
International Classification of Diseases, Injuries and Causes of Death
(
ICD
)
Classification Systems in Non‐Western Cultures
Specific Classification Systems
References
3 Clinical Interviewing with Adults
Introduction
Goals of the Clinical Interview
Elements of the Clinical Interview
Interviewing Techniques
Reliability and Validity of Interviews
Integrating Cultural Context in Interviews
Actuarial Judgment
Functional Analysis
Differential Diagnosis
Summary
References
4 Clinical Interviews with Children and Adolescents
Introduction
Clinical Interviews with Children and Adolescents
Implementation of Clinical Interviews
Difficulties in Daily Practice
Everything Perfect? How Often are Structured Interviews used in Clinical Practice?
Summary
References
Note
5 Psychological Tests
Introduction
Principles and Properties of Psychological Tests
Types of Psychological Tests
Objective Personality Tests
Projective Clinical Assessment Instruments
Computer Test Interpretation
Recent Challenges
References
6 A Global Perspective on Neuropsychological Assessment
Introduction
Purposes of Neuropsychological Assessment
Classification of Behavior and Cognition in Neuropsychological Assessment
Neuropsychological Assessment: Approaches and Methods
Critical Considerations for Neuropsychological Assessment in a Global Society
Interpretation of Neuropsychological Assessment Results
Feedback and Recommendations
Future Directions for Neuropsychological Assessment: A Global Perspective
References
7 Culturally Informed Neuropsychological Assessment
Introduction
The Field of Clinical Neuropsychology
Clinical Neuropsychology Assessment
Crosscultural Considerations in Clinical Neuropsychology
Are Nonverbal Tests Culture Free?
Bilingualism
Translating Tests
Literacy
Norming by Race or Country
Acculturation
Interaction of Different Subject Characteristics
Child Neuropsychology
Reading Disorder: A Lens through which to View Crosscultural Issues
Clinical Case Study
Summary
References
8 Evidence‐Based Treatments
Introduction
Defining Evidence‐Based Treatments
Evidence‐Based Treatments: The Debate
Conclusions
References
9 Childhood and Adolescent Disorders
Neurodevelopmental Disorders
Disruptive, Impulse‐Control, and Conduct Disorders
Summary
References
Note
10 Mood Disorders
Symptomatology and Classification of Mood Disorders
Epidemiology
Assessment
Treatment
Conclusions
References
11 Anxiety and Obsessive‐Compulsive Related Disorders
Treatment of Anxiety and Obsessive‐Compulsive Related Disorders
Overview of Anxiety and OC‐related Disorders
Treatment of Anxiety and OC‐Related Disorders
Cultural Considerations in Treatment
Summary
References
12 Posttraumatic Stress Disorder
Definition
Prevalence of PTSD
The Course of PTSD
Comorbidity
Theoretical Models of PTSD
Risk Factors
Treating PTSD
Early Intervention for PTSD
Complex PTSD
Conclusions
References
13 Eating Disorders
Psychopathology of Eating Disorders
Assessment
Development, First Onset and Maintenance Factors
Treatment
Efficacy of Cognitive Behavioral Therapy (CBT)
References
14 Sexual Dysfunctions
Introduction
Classification of Sexual Dysfunctions
Prevalence of Sexual Dysfunctions
Risk Factors for Sexual Dysfunction
Psychological Factors and Sexual Dysfunction
Psychological Models of Sexual Dysfunction
Treatments for Sexual Dysfunction
Brief Summary
References
15 Couple Distress
Introduction
What are the Processes that Differentiate Functional Couples from Dysfunctional Ones?
Assessment of the Couples
Goal Setting in Couple Therapy
Couple Therapy: Strategies and Techniques
Difficulties with Promoting Change: Difficulties Encountered during Couple Therapy Practice
Treatment Issues: Couple Therapy
Treatment Approaches for Intervention
Cognitive‐Behavioral Couple Therapy (CBCT) Approaches
Integrative Behavioral Couple Therapy (IBCT)
Behavioral Systems Approach to Couple Problems
Emotionally Focused Couple Therapy (EFCT)
Strategic Approaches and Brief Strategic Couple Therapy (BSCT)
Solution‐Focused Approaches and Brief Solution‐Focused Therapy (BSFT)
Psychoanalytical Approaches
References
16 Somatic Symptom Disorders
Introduction
Classifying and Diagnosing SSRD
Classifying Specific Functional Somatic Syndromes
Specific Cultural Syndromes of Distress
Empirically Supported Psychological Interventions for SSRD
Other Psychological Interventions for SSRD
Empirical Evidence for Psychological Interventions in SSRD
Transcultural Aspects in Psychological Interventions for SSRD
Summary and Conclusion
References
17 Psychotic Disorders
Introduction
Description of the Disorder
Etiology
Assessment
Pharmacological Treatment
Psychological Interventions
Family Behavioral Interventions
Other Psychological Approaches and their Effectiveness
Summary and Outlook
References
18 Neurobiology and Pharmacological Treatment of Mental Disorders
Introduction
Mood Disorders
Psychotic Disorders
Anxiety Disorders
Obsessive‐Compulsive Disorder (OCD)
Posttraumatic Stress Disorder (PTSD)
Somatic Symptom Disorders
Substance‐Related Disorders
Eating Disorders
Personality Disorders
Dementia
Sleep Disorders
Attention‐Deficit / Hyperactivity Disorder (ADHD)
Summary
References
19 Mindfulness‐Based Interventions
Popular Mindfulness‐Based Interventions
Application of Mindfulness in Mental Health Care
Effects of Mindfulness‐based Interventions on Psychological Disorders
Discussion
Acknowledgments
References
20 Internet‐Based Treatments
Introduction
Are Internet Treatments Effective?
The “How” Question
A Research Agenda for the World?
Challenges for the Future
Summary
References
21 Virtual Reality
Introduction
Virtual Reality for the Treatment of Different Psychological Disorders and Health Problems
Virtual Reality as an Ecological Context for Assessing Human Behavior
Virtual Reality as a Realistic Laboratory Setting for Psychopathology
Virual Reality Developments for the Treatment of Different Mental and Health Conditions
Future Perspectives and Ethical Implications of VR
Summary
References
22 Working Alliance
Measurement
Evidence for Relations with Outcome
Impact of Alliance Rater and Time of Assessment
Adapting Working Alliance Based on Patient Characteristics
The Therapeutic Relationship is More Than the Working Alliance: The Case of Cognitive Behavior Therapy
Conclusion
References
23 Culture in Clinical Psychology: Adapting Treatments
Why do we Need Culturally Adapted Treatments?
How to Adapt: Develop New Treatments or Modify what Works?
Evidence for Efficacy of Cultural Adaptation: What to Adapt
A Model of Anxiety Generation across Cultural Contexts
How to Culturally Adapt Treatment?
Summary
References
Index
End User License Agreement
List of Tables
Chapter 1
Table 1.1 Different control groups and potential corresponding study conclusions.
Table 1.2 Basic differences between naturalistic / quasi experimental and experimental clinical studies.
Chapter 4
Table 4.1 Advantages (+) and disadvantages (−) of different approaches to assess mental disorders in children and adolescents
Table 4.2 Clinical interviews.
Table 4.3 Clinical interviews for preschool children.
Chapter 5
Table 5.1 Types of test validity.
Table 5.2 Millon's Personality Taxonomy Classification of Normal, Subclinical and Clinical Disorder Types brief definitions (varying in severity).
Table 5.3 Millon's Typology of Personality Styles and Disorders.
Chapter 6
Table 6.1 Sample approach to hypothesis‐testing in the context of a neuropsychological evaluation for a fictitious client, “Julian.”
Chapter 9
Table 9.1 Criterion A of the Communication Disorders Included in
DSM‐5
(APA, 2013).
Chapter 10
Table 10.1
DSM‐5
depressive disorders.
Table 10.2
DSM‐5
bipolar and related disorders.
Table 10.3 Instruments to assess symptoms of depression and symptoms of mania / hypomania.
Table 10.4 Example for a behavioral experiment protocol of a depressed patient.
Chapter 11
Table 11.1
DSM‐5
anxiety disorders.
Table 11.2
DSM‐5
obsessive compulsive (OC) and related disorders.
Chapter 13
Table 13.1 Comparison of AN, BN and BED with respect to
DSM‐5
criteria (adapted from Tuschen‐Caffier & Hilbert, 2016).
Table 13.2 Extract from the Marburger eating diary (Tuschen‐Caffier & Florin, 2012).
Table 13.3 Development, first onset and maintenance of eating disorders (adapted from Tuschen‐Caffier & Hilbert, 2016).
Chapter 14
Table 14.1 DSM‐5 sexual dysfunction diagnoses and specifiers.
Chapter 16
Table 16.1 Diagnoses of somatic symptom and related disorders in
DSM‐IV
,
DSM‐5
, and
ICD‐10
.
Table 16.2 Examples of cultural concepts of distress associated with somatic symptoms (American Psychiatric Association, 2013; Kohrt et al., 2014).
Chapter 18
Table 18.1 Major mental disorders: Heritability, putative dysfunctional neurobiological system; standard pharmacological treatment recommended by guidelines
Table 18.2 Common adverse effects of psychopharmacological drugs.
List of Illustrations
Chapter 2
Figure 2.1
AMDP
decision tree (based on
AMDP
, 2007, p. 23).
Chapter 6
Figure 6.1 Skulls showing trephination.
Figure 6.2 Intraoperative placement of intracranial electrodes over the right frontotemporal areas.
Figure 6.3 Müller‐Lyer illusion. Both vertical lines are the same length, but the image on the left appears longer to most Americans.
Figure 6.4 When presented with this picture, Chinese participants spend more time gazing back and forth between the airplane and the mountains or the tiger and the forest, whereas Americans spend more time looking primarily at the airplane or the tiger.
Chapter 10
Figure 10.1 Schematic course of major depression, persistent depressive disorder, bipolar I, bipolar II and cyclothymic disorder.
Figure 10.2 Cognitive model of depression according to Beck's theory.
Chapter 14
Figure 14.1 Cognitive‐emotional model for sexual dysfunction
Chapter 16
Figure 16.1 Etiological model of somatoform disorders by Kirmayer and Taillefer (1997) transferred to the case example.
Figure 16.2 The vicious circle of somatosensory amplification,
Chapter 17
Figure 17.1 Model of persecutory delusions.
Figure 17.2 Vicious circles of voices.
Chapter 18
Figure 18.1 Mechanism of action at the serotonin synapse. Serotonin is released from vesicles in the presynaptic cell into the synaptic cleft. When it binds to the receptors at the postsynaptic, the signal is transmitted. Then, the serotonin molecules re‐enter the presynaptic cell. An antidepressant blocks the reuptake of serotonin, thus leaving more serotonin in the cleft, which can bind to the receptors.
Chapter 23
Figure 23.1 A culturally informed model of how psychopathology is generated (Hinton & La Roche, 2013).
Guide
Cover
Table of Contents
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Clinical Psychology
A Global Perspective
Edited by Stefan G. Hofmann
This edition first published 2018
© 2018 John Wiley & Sons Ltd
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Library of Congress Cataloging-in-Publication Data
Names: Hofmann, Stefan G., author.
Title: Clinical psychology : a global perspective / by Stefan G. Hofmann, Boston University, Department of Psychological and Brain Sciences, US.
Description: First edition. | Hoboken, NJ : Wiley, 2018. | Includes bibliographical references. |
Identifiers: LCCN 2017015385 (print) | LCCN 2017019086 (ebook) | ISBN 9781118960004 (pdf) | ISBN 9781118960011 (epub) | ISBN 9781118959961 (hardback) | ISBN 9781118959886 (paperback)
Subjects: LCSH: Clinical psychology.
Classification: LCC RC467 (ebook) | LCC RC467 .H63 2017 (print) | DDC 616.89—dc23
LC record available at https://lccn.loc.gov/2017015385
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Notes on Contributors
Gerhard Andersson is full professor of clinical psychology at Linköping University in the Department of Behavioural Sciences and Learning, and an affiliated researcher at Karoliniska Institutet, Stockholm. He is clinically active as psychologist at the local hearing clinic. Andersson has a PhD in psychology and one in medicine and is trained as CBT therapist and supervisor. He is also interested in religion and atheism and has a BSc in theology. Professor Andersson is an internationally recognized leader in the field of cognitive‐behavior therapy delivered through information and communication technology as evidenced by his over 500 peer‐reviewed publications. His research spans somatic and psychiatric conditions; he is a leading researcher in the field of tinnitus and has published extensively on depression and anxiety disorders. Andersson is also the editor‐in‐chief for the journal Internet Interventions. In 2014 he was awarded the Nordic Prize in Medicine. For more information see www.gerhardandersson.se (retrieved April 3, 2017).
Martin M. Antony, PhD, is professor in the department of psychology at Ryerson University, in Toronto Canada. He has published more than 275 books, articles, and chapters, mostly in the area of anxiety and related disorders. He is a fellow of the Royal Society of Canada, the American and Canadian Psychological Associations, the Association for Psychological Science, and several other professional associations.
Elisabeth A. Arens received her PhD in clinical psychology from Heidelberg University in 2013. She currently holds a position as a postdoctoral researcher in the Department of Clinical Psychology and Psychotherapy at the Goethe University of Frankfurt. Dr. Arens has a special research expertise in depressive disorders, with a particular focus on the assessment of emotion regulation deficits. Her clinical practice (cognitive behavioral therapy) includes a special consulting service for individuals with depressive disorders.
Borwin Bandelow, born in Göttingen, Germany, is Professor at the Department of Psychiatry and Psychotherapy at the University of Göttingen. As a specialist in psychiatry and neurology, a psychologist, and a psychotherapist, Dr. Bandelow specializes mainly in anxiety disorders, but also in schizophrenia, depression, psychotherapy, and psychopharmacology. He is currently the Deputy Director of the Department of Psychiatry and Psychotherapy of Göttingen.
Rosa M. Baños is full professor in psychopathology at the Universitat de Valencia, Spain, and has been a Senior lecturer at Universitat Jaume I, in Spain. She is the director of the Master in Multidisciplinary Intervention in Eating Disorders, Personality Disorders and Emotional Disorders course at the University of Valencia. Her research activity has focused in the study of psychopathology and the treatment of various psychological disorders (emotional disorders, anxiety disorders, eating disorders, etc.). She has also been working in recent years on the application of new technologies to clinical psychology for the understanding and treatment of mental disorders and the promotion of wellbeing.
Thomas Berger holds a Swiss National Science Foundation Professorship in Clinical Psychology and Psychotherapy at the University of Bern, Switzerland and leads the research group investigating Internet interventions. He earned his PhD degree in clinical psychology and psychotherapy in 2005 from the University of Freiburg, Germany. Since then he has received several grants and awards such as the Outstanding Early Achievement Award of the Society for Psychotherapy Research.
Susan M. Bögels is clinical psychologist, psychotherapist and mindfulness trainer, professor in developmental psychopathology at the University of Amsterdam, and director of academic treatment center for children and parents UvA minds. Her research interests concern the intergenerational transmission of psychopathology, with a specific focus on the role of the father, and the effects of mindfulness‐based and cognitive‐behavioral family interventions on child and parental psychopathology. She was a member of the anxiety disorder workgroup preparing the DSM‐5.
Cristina Botella is full professor of clinical psychology at Universitat Jaume I (UJI), Spain, director of Labpsitec (www.labpsitec.es, retrieved April 3, 2017), and director of the doctorate program in psychology. She has been principal investigator in more than 40 research projects and has published over 200 papers. Her main line of research is the treatment of psychological disorders, and the use of information and communication technology (virtual reality, augmented reality, the Internet, and mobile apps) to promote health and wellbeing.
Michelle L. Bourgeois received her BA with Honors in psychology from Wellesley College and is currently a doctoral candidate in clinical psychology at Boston University (BU), where she works as a graduate student researcher and clinician at the BU Center for Anxiety and Related Disorders. Under the mentorship of Timothy A. Brown Psy.D. she studies the classification, time course, and transdiagnostic treatment of emotional disorders.
Timothy A. Brown is a professor in the Department of Psychology at Boston University, and director of research at Boston University's Center for Anxiety and Related Disorders. He has published extensively in the areas of the classification of anxiety and mood disorders, vulnerability to emotional disorders, psychometrics, and methodological advances in social sciences research. In addition to conducting his own grant‐supported research, Dr. Brown serves as a statistical investigator or consultant on numerous federally funded research projects. He has been on the editorial boards of several scientific journals, including a longstanding appointment as associate editor for the Journal of Abnormal Psychology.
Richard A. Bryant, DSc, is a Scientia Professor of Psychology at the University of New South Wales, Sydney. He is also an NHMRC senior principal research fellow and director of the UNSW Traumatic Stress Clinic. He has conducted extensive research into assessment, mechanisms, and treatment of acute stress disorder and posttraumatic stress disorder, and has conducted research trials in diverse settings across Africa, Asia, and the Middle East.
Matthew Calamia, PhD, is an assistant professor in the Department of Psychology at Louisiana State University. He earned his doctorate in clinical psychology at the University of Iowa and completed his predoctoral psychology internship at the University of Illinois at Chicago Department of Psychiatry. His research interests include neuropsychological assessment and psychometrics.
Rachel N. Casas is an assistant professor of graduate psychology at California Lutheran University, and a licensed clinical neuropsychologist with expertise in cognitive assessment of ethnic and linguistic minority populations. Her research focuses on understanding how cultural factors influence brain functioning and behavior, and her work has been funded by the National Science Foundation (NSF), the American Psychological Association, and the Foundation for Psychocultural Research (FPR).
Brad Cini, BPsych (Hons), completed a research thesis at the Cognitive Behavior Therapy Research Unit, Monash University, Australia (http://www.med.monash.edu.au/psych/cbtru/, retrieved April 3, 2017) under the supervision of Dr. Nikolaos Kazantzis, on change processes in psychological therapy. Specifically, his research focused on the effects of collaboration between therapist and client on symptom reduction in cognitive behavior therapy. He has a keen interest in cognitive behavioral therapy and is currently pursuing a career in clinical practice.
Christopher C. Conway graduated with a B.S. in psychology from Duke University, and he earned his PhD in clinical psychology from UCLA in 2013. He went on to hold postdoctoral fellowships at the UCLA Anxiety Disorders Research Center and the Boston University Center for Anxiety and Related Disorders. He joined the William & Mary faculty as an assistant professor in 2015. Along with his team, he studies the onset, time course, and classification of emotional disorders.
Robert J. Craig, PhD, ABPP, is a licensed and board certified clinical psychologist who attained fellow status in the American Psychological Association and in the Society for Personality Assessment, where he was the recipient of the Martin Mayman award for “distinguished contributions to the literature of personality assessment.” He has published 10 academic books, contributed over a hundred scientific papers in peer‐reviewed journals and served as consulting editor for the Journal of Personality Assessment as well as for journals in psychology, psychiatry and substance abuse. He served as the director of the drug abuse treatment program at the VA Medical Center, Chicago.
Jan Christopher Cwik is postdoctoral researcher and licensed psychotherapist (cognitive behavior therapy) at the Mental Health Research and Treatment Center of the Ruhr‐Universität Bochum (Germany). He received a postgraduate grant from the Bergische Universität Wuppertal while completing his PhD. His research focuses on diagnostics in clinical psychology, diagnostic decisions and processes, and psychophysiological processes of mental disorders. He is member of the American Psychological Association and the Association for Psychological Science.
Cecilia A. Essau, PhD, is full professor in developmental psychopathology and director of the Centre for Applied Research and Assessment in Child and Adolescent Wellbeing at the University of Roehampton, United Kingdom. Her research focuses on understanding the interacting factors that can lead children and adolescents to have serious emotional and behavioral problems. She uses this research to enhance the assessment of childhood and adolescent psychopathology, and design more effective interventions to prevent and treat such problems.
Nicole Everitt, BA (Hons), is a doctor of clinical psychology student at Deakin University, Australia. She completed a prior research thesis at the Cognitive Behavior Therapy Research Unit (http://www.med.monash.edu.au/psych/cbtru/, retrieved April 3, 2017) under the supervision of Dr. Nikolaos Kazantzis, on process‐outcome relationships in the treatment of depression. Specifically, she examined the moderating effect of client characteristics on alliance‐outcome and collaboration‐outcome relationships in cognitive behavior therapy for depression. Recently, she presented this research at the World Congress of Behavioural and Cognitive Therapies.
Azucena García‐Palacios is professor of abnormal psychology and member of Labpsitec research team at Universitat Jaume I, Spain. Her main research field is the study of the psychopathology and improvement of psychological treatments, mainly for emotional disorders, personality disorders, and chronic pain, using information and communication technologies. She has participated in more than 20 research projects funded by national institutions and the European Union, and she is the author of more than 90 scientific papers.
Amie E. Grills, PhD, is an associate professor at Boston University, United States. Dr. Grills is a licensed clinical psychologist whose work focuses on internalizing disorders and trauma, particularly among children and young adults. Dr. Grills' research includes investigations of risk and resiliency factors that influence the development of psychopathology, as well as on designing and evaluating cognitive‐behavioral assessments and interventions, including those conducted using novel delivery systems (e.g., web‐based designs, school‐based services).
Devon E. Hinton, MD, PhD, is an anthropologist and psychiatrist, and an associate clinical professor of psychiatry at Massachusetts General Hospital, Harvard Medical School. He is the author of over a hundred articles, and is the co‐editor of three volumes: Culture and panic disorder (Stanford University Press, 2009); Culture and PTSD: Trauma in global and historical perspective (University of Penn Press, 2015); and Genocide and mass violence: Memory, symptom, and recovery (Cambridge University Press, 2015).
Stefan G. Hofmann, PhD, is professor of psychology in the Department of Psychological and Brain Sciences at Boston University, where he directs the Psychotherapy and Emotion Research Laboratory. His main research focuses on the mechanism of treatment change, translating discoveries from neuroscience into clinical applications, emotion regulation strategies, and cultural expressions of psychopathology. He is the author of more than three hundred scientific publications and twenty books. He is a Highly Cited Researcher by Thomson Reuters, and has many other awards. For more information see http://www.bostonanxiety.org/.
Melissa K. Holt, PhD, is an assistant professor at Boston University's School of Education. She is a counseling psychologist whose clinical work with adolescents and adults has focused on trauma and disordered eating. Dr. Holt studies how multiple victimization forms affect children and adolescents, with attention to their influence on psychological and academic functioning. Within this body of research, she has conducted numerous studies on bullying, and tied findings to implications for prevention and intervention.
Nikolaos Kazantzis, PhD, is associate professor of clinical psychology and program director for clinical psychology at Monash University. He is an expert on cognitive behavior therapy. His scientific work has been supported by grants from the NIMH and various private foundations. His research focuses on change processes in treatment and the effects of therapeutic relationship elements on symptom reduction. He has published more than a hundred scholarly publications, including six books. For more information visit http://www.med.monash.edu.au/psych/cbtru/ (retrieved April 3, 2017).
Maria Kleinstäuber, assistant professor, Department of Clinical Psychology and Psychotherapy, Philipps University of Marburg, Germany. Dr. Kleinstäuber is a licensed cognitive behavior therapist, specializing in therapy efficacy as well as pathomechanisms in the area of behavioral medicine. In 2014 she worked as postdoctoral research fellow under supervision of Prof. Dr. Michael J. Lambert at the Psychology Department of Brigham Young University, Provo, United States. Since 2015 she has been Secretary of the International Society of Behavioral Medicine and Research Fellow of the Department of Health Psychology, KU Leuven, Belgium. In 2013 she received the National Institute for Health Research (NIHR) Cochrane Review Incentive Scheme and in 2016 the ICMB Early Career Award.
Kirstyn L. Krause is a doctoral student in clinical psychology at Ryerson University in Toronto, Canada. Her research interests include (a) the relationship between anxiety disorders and related constructs (e.g., perfectionism), and (b) mechanisms of fear reduction (e.g., expectancy violation) during exposure‐based practice. Her research has been presented at a number of national and international meetings.
Tania Lincoln studied psychology in Marburg, Germany. She completed her PhD in 2003 and her training as a clinical psychologist in 2004. From 2003 to 2005 she worked in a forensic mental health setting, where she became increasingly interested in psychological therapy for psychosis. From 2005 to 2011 she was the principal investigator in a randomized controlled trial on CBT for psychosis at the University of Marburg. Since 2011 she has been professor of clinical psychology and psychotherapy in Hamburg. Her research focuses on understanding the psychological mechanisms of how psychotic symptoms arise and on improving interventions for psychosis.
Wolfgang Lutz, PhD, full professor, is head of the Department of Clinical Psychology and Psychotherapy and the Director of the Outpatient Clinic and Postgraduate Clinic Training at the University of Trier, Germany. He is one of the pioneers of patient‐focused and feedback research and worked in this area in several countries using service research data from the United States, the United Kingdom, Switzerland, and Germany.
Jürgen Margraf, after a research scholarship at Stanford University, held professorships in Berlin, Dresden, Basel, and Bochum. In 2009 he was awarded an Alexander von Humboldt professorship, Germany´s most highly endowed scientific award, for his work on mental health. He is past president of the European Association for Behavioural and Cognitive Therapies (EABCT) and the German Society of Psychology and member/fellow of the German National Academy of Science (Leopoldina), the Academia Europaea, and the Association for Psychological Science.
Anne Marie Meijer is a cognitive behavioral and family therapist. She worked as associate professor at the University of Amsterdam. She conducted studies in the field of childhood chronic illness, parental chronic illness and sleep problems of children and adolescents. The projects concerning sleep are focused on the influence of sleep and chronic sleep reduction on problem behavior and academic performance. In addition, efficacy of melatonin, light therapy and face‐to‐face and online CBTi on children's sleep problems are investigated.
Eva Charlotte Merten earned her M.Sc. in clinical psychology at Ruhr‐Universität Bochum and is currently a PhD. student at the Department of Clinical Child and Adolescent Psychology of the Ruhr‐Universität Bochum, researching diagnostics in children and adolescents, especially self‐evaluations in preschool children with externalizing disorders and consequences of discrepancies in self‐ and parent‐evaluations of child symptoms. (Department of Clinical Child and Adolescent Psychology of the Faculty of Psychology, Ruhr‐Universität Bochum, Massenbergstraße 9‐13, 44787 Bochum, Germany; eva.merten@ruhr‐uni‐bochum.de).
Peter Muris, PhD, is full professor in Clinical Psychology and Developmental Psychopathology at Maastricht University, the Netherlands, and part‐time working as a clinician at Virenze Maastricht, an outpatient treatment facility for children and adolescents with mental health problems. His clinical and research interests focus on various types of childhood psychopathology, but in particular on anxiety disorders. He is also the present chair of the Dutch‐Flemish research school on Experimental Psychopathology.
Pedro J. Nobre has a PhD in clinical psychology, and is director of the Laboratory for Research in Human Sexuality (SexLab) at Porto University, Portugal, and research fellow at the Kinsey Institute (United States). He is PI in various research projects on sexual health, has published over 70 papers in international journals, and serves in the editorial board of sex research and clinical psychology journals. He is past president of the Portuguese Society of Sexology (2008–2011) and is currently chair of the Scientific Committee of the World Association for Sexual Health (2013–2017).
Thomas H. Ollendick, PhD, is University Distinguished Professor in Clinical Psychology at Virginia Tech. He is the author of numerous research publications, book chapters, and books, and the past president of AABT (1995) and the Society for the Science of Clinical Psychology (2010). His clinical and research interests range from the study of diverse forms of child psychopathology to the assessment, treatment, and prevention of these disorders from a social cognitive theory and evidence‐based perspective.
Brian D. Ostafin is an associate professor in the experimental psychopathology and clinical psychology program at the University of Groningen, the Netherlands. He received his doctorate in clinical psychology from Boston University in 2004. His research focuses on the role of implicit processes in psychopathology (with an emphasis on addictive behaviors) and the usefulness of mindfulness interventions to overcome such processes. This work has been funded by the NIH and other agencies.
Anushka Patel is a clinical psychology doctoral student at the University of Tulsa. She studies the diagnosis and treatment of trauma‐related sequelae in global settings. During her graduate career, Anushka has examined psychological outcomes of trauma related to gender‐based violence among women from Indian slums using mixed methods. She plans to spend her career developing, testing, and refining culturally adapted treatments for populations in low‐ and middle‐income countries.
Soledad Quero is professor of clinical psychology at Universitat Jaume I, Spain. Her main research interest is the application of information and communication technologies to improve psychological treatments for emotional disorders. She has been principal investigator in five research projects, has participated in at least 20 projects funded by national and local institutions, and seven European projects. She has published over 70 papers in national and international journals and is co‐author of at least 30 book chapters.
Winfried Rief is a professor of clinical psychology and psychotherapy, Philipps University of Marburg, Germany. Head of the Clinic for Psychological Interventions. He holds a license for psychotherapy and supervision. Dr. Rief worked for many years in hospital settings (e.g., Roseneck Hospital for Psychosomatic Medicine, Prien a. Ch.). He specializes in placebo and nocebo effects, perception and coping with somatic symptoms, and optimization of clinical studies and interventions. He was guest professor at Harvard Medical School, Boston (2004/2005), University of Auckland Medical School (2002), and University of California San Diego (2009/2010). He was also nominated for the expert committee of WHO/APA for the revision of the classification of mental disorders according to DSM‐5, and he is co‐chairing the WHO working group on chronic pain diagnoses in ICD‐11. Dr. Rief is elected coordinator for grant applications to the German Research Foundation and he is spokesperson of the DFG‐research unit on placebo and nocebo mechanisms. His publication record summarizes more than 400 articles, in particular in the field of behavioral medicine and somatoform disorders. He received the Distinguished Researchers award in behavioral medicine in 2014.
Julian A. Rubel, PhD, is a research fellow at the Department of Clinical Psychology and Psychotherapy at the University of Trier, Germany. His research focuses on the development and implementation of decision rules that support the personalized selection of treatment alternatives and their adaptation in the course of the treatment.
Elske Salemink is an assistant professor at the department of developmental psychology of the University of Amsterdam. Her research focuses on the role of implicit processes in anxiety, depression, and addiction, and on changing these processes by means of computerized training. She is also a licensed behavioral and cognitive therapist (member of the Association of Behavioral and Cognitive Therapy).
Silvia Schneider, PhD, is Dean of the Faculty of Psychology and Professor of Clinical Child and Adolescent Psychology at the Ruhr‐Universität Bochum and Head of the Mental Health Research and Treatment Center in Bochum, Germany. She conducts research on the etiology of anxiety disorders in children, familial transmission of anxiety disorders, stress and emotion/self‐regulation in infancy, and diagnostics of mental disorders. (Clinical Child and Adolescent Psychology, Ruhr‐Universität Bochum, Massenbergstraße 9–13, 44787 Bochum, Germany; [email protected].)
Ulrich Stangier, PhD, is a professor of clinical psychology and psychotherapy at the Goethe University of Frankfurt. He is also director of the Behavior Clinic and of the clinical training program at the department. He has conducted research trials in social anxiety disorder, chronic and recurrent depression, and body dysmorphic disorder. An additional focus of research is on therapy process and therapists' competence and adherence in cognitive therapy.
Mehmet Zihni Sungur is a professor of psychiatry at the Psychiatry Department of Marmara University, Istanbul, Turkey. He received training in cognitive behavior therapy, and sexual and marital therapies at the Institute of Psychiatry, London. He is certified as a cognitive therapist and supervisor by the Academy of Cognitive Therapy (ACT). He is president elect of the International Association for Cognitive Psychotherapy (IACP). He is also a past presidents of the European Association for Behavioural and Cognitive Therapy (EABCT), and is a board member of the European Federation of Sexology (EFS).
Jennifer Svaldi works as a full professor at the Department of Clinical Psychology and Psychotherapy at the University of Tübingen. Her research themes focus on mechanisms that cause and maintain pathological eating behavior and body‐image disturbances in at‐risk populations, overweight individuals, and individuals with eating disorders. To this end, a variety of designs and methods are used, ranging from fundamental studies (eye tracking, EEG, reaction‐time tasks, fMRI) to laboratory‐based behavioral studies, ecological momentary assessment (EMA) studies and applied clinical studies (treatment processes and treatment effects).
Rosemary Toomey completed her doctorate in clinical psychology from the University of Montana, and her clinical internship, neuropsychology fellowship, and research fellowship from Harvard Medical School (HMS), Psychiatry Department at Massachusetts Mental Health Center, where she was also assistant professor. She previously worked at the Brockton VAMC and the Brookline Mental Health Center. She is currently research associate professor in the Department of Psychological and Brain Sciences at Boston University, where she is Director of Neuropsychological Assessment at the Psychological Services Center.
Daniel Tranel graduated from the University of Notre Dame in 1979, and then earned a PhD in clinical psychology at the University of Iowa in 1982. He completed postdoctoral training at Iowa under Drs. Arthur Benton and Antonio Damasio, and joined the faculty in the Department of Neurology in 1986, where he has been ever since. Tranel currently holds joint appointments as a professor in the Department of Neurology and the Department of Psychological and Brain Sciences. He heads the Benton Neuropsychology Laboratory, and he is Director of the Neuroscience PhD Program at Iowa. He has also served as the associate dean of graduate and postdoctoral studies at the Carver College of Medicine. Dr. Tranel studies the neural basis of higher order cognition and behavior, using the lesion method and functional neuroimaging in human participants. His clinical and research work has provided new insights into the diagnosis and treatment of traumatic brain injury, Alzheimer's disease, and mental health disorders.
Brunna Tuschen‐Caffier has been a full professor for clinical psychology and psychotherapy at the University of Freiburg, Department of Psychology, Germany since 2007. Before she moved to the University of Freiburg she had a professorship at the Universities of Bielefeld (2003–2007) and Siegen (2000–2003), both in Germany. Her research focuses on mechanisms of maintenance and change in mental disorders, especially eating disorders and anxiety disorders. Thus, she combines a variety of methods (e.g., psychophysiological and behavioral methods) to analyze patterns of psychopathology pre and post psychotherapy. Moreover, she developed and evaluated manuals for the psychotherapy of patients with eating disorders as well as anxiety disorders (social anxiety disorder).
Bram Van Bockstaele is a postdoctoral researcher of the YIELD research priority area at the University of Amsterdam. His main research interests are adaptive and maladaptive emotion regulation, and interventions aiming to improve emotion regulation skills (e.g., mindfulness, attention training).
Preface
Clinical psychology is an international discipline with many international societies, journals, and training workshops. Although the geographical, sociological, cultural, and even political contexts are important variables that need to be considered for the understanding of the subject, existing clinical psychology textbooks have not attempted to capture this diversity.
In fact, most of the popular existing clinical psychology texts were written for English‐speaking European or Anglo‐American audiences and translated for other countries. There is no text that takes a global perspective of the field of clinical psychology. This text is an attempt to fill this gap. Written by experts from around the world, this book is unique in its breadth and depth. It is aimed at undergraduate and graduate students and serves as a modern and international alternative to existing clinical psychology textbooks. All chapters of this book cover the basic areas of clinical psychology, but integrate cultural issues into the discussion of the various topics.
The book begins with a review of research methods used in clinical psychology (Chapter 1 by Julian A. Rubel and Wolfgang Lutz) and classification systems across the globe (Chapter 2 by Jan Christoph Cwik and Jürgen Margraf). This is followed by an overview of clinical interviewing of adults (Chapter 3 by Christopher C. Conway, Michelle L. Bourgeois, and Timothy A. Brown) and of children and adolescents (Chapter 4 by Eva Charlotte Merten and Silvia Schneider). The most important psychological tests are described in Chapter 5 by Robert J. Craig. Neuropsychological tests are covered in Chapter 6 by Rachel N. Casas, Matthew Calamia, and Daniel Tranel (with a particular emphasis on clinical neuropsychology) and by Rosemary Toomey in Chapter 7, providing a complementary discussion on this subject.
Chapter 8 by Thomas H. Ollendick, Peter Murris, and Cecilia A. Essau provides an update on the discussion on evidence‐based treatments. Chapter 9 by Amie E. Grills and Melissa K. Holt covers some of the most common childhood and adolescent disorders. The subsequent chapters then discuss various disorders during adulthood, including mood disorders (Chapter 10 by Ulrich Stangier and Elisabeth A. Arens), anxiety and obsessive‐compulsive disorders (Chapter 11 by Kristyn L. Krause and Martin M. Antony), posttraumatic stress disorder (Chapter 12 by Richard A. Bryant), eating disorders (Chapter 13 by Brunna Tuschen‐Caffier and Jennifer Svaldi), sexual dysfunctions (Chapter 14 by Pedro J. Nobre), couple distress (Chapter 15 by Mehmet Zihni Sungur), somatic symptom disorders (Chapter 16 by Maria Kleinstäuber and Winfried Rief), and psychotic disorders (Chapter 17 by Tania Lincoln). These chapters primarily review the psychological treatments of these problems. A separate chapter specifically reviewing the neurobiology and pharmacological treatments of mental disorders is provided by Borwin Bandelow (Chapter 18).
More recent, less traditional, but increasingly popular approaches for dealing with psychological problems include mindfulness‐based interventions (Chapter 19 by Bram van Bockstaele, Elske Salemink, Brian D. Ostafin, Anne Marie Meijer, and Susan Bögels), Internet‐based treatments (Chapter 20 by Gerhard Andersson and Thomas Berger), and virtual reality (Chapter 21 by Cristina Botella, Rosa Banos, Azucena Garcia‐Palacios, and Soledad Quero). Finally, the chapter by Nicole Everitt, Brad Cini, and Nikolaos Kazantzis (Chapter 22) highlights the importance of working alliance in psychological treatments, and Chapter 23 by Anushka Patel and Devon Hinton concludes with a summary of the importance of adapting treatments to the person’s culture.
Thanks to the diverse background of the authors, who are some of the world’s leaders in their respective fields, this text provides an international perspective on clinical psychology. My hope is that this book has the potential to become the leader of clinical psychology textbooks.
Stefan G. Hofmann, PhDProfessor of Psychology, Boston UniversityBoston, Massachusetts.
1Research Methods
Julian A. Rubel and Wolfgang Lutz
Introduction
In most areas of psychology, chapters on research methods are predominantly concerned with the description of well‐controlled conditions of laboratory studies and their proper analysis. However, the scope of clinical psychology is much broader than that of basic psychological science and laboratory studies. The variety of topics ranges from foundational issues to applied contexts. As clinical psychology is a far‐reaching field of applied psychology, much research is concerned with phenomena that could not easily be studied in the lab or under controlled conditions. As a consequence, research methods within clinical psychology need to include designs and evaluation strategies ranging from laboratory studies to clinical interventions as they are delivered in the field. However, instead of making considerations about research methodology less important, this broader focus increases the importance of a knowledge of methodological issues to allow the appropriate analysis and interpretation of study results (Kazdin, 2013). Increased sophistication of applied research methods helped clinical psychology to establish itself as a profession. Regardless of their future occupation, a firm understanding of research methods is pivotal to every scholar in clinical psychology. Clinical scientists must not only be acquainted with research design considerations and statistical concepts, they also need to have expertise in this area to be able to provide a treatment that is based on scientific evidence.
The present chapter provides a nontechnical overview of the most important concepts of research methods in clinical psychology. In the first section of this chapter, central concepts pertaining to the study of the frequency, development and prevention of psychological problems are described briefly. Since most research in clinical psychology is on interventions, the second part of this chapter deals with the evaluation of these treatments. In this section, we present methods that are concerned with the following three overarching questions: (a) Does the intervention work? (b) Is the intervention effective for a specific patient? (c) How, for whom, and under which conditions does the intervention work?
Research on the Frequency, Cause, and Prevention of Psychological Problems, and Disorders
Epidemiology
Much research within clinical psychology attempts to answer questions such as: Who has a psychological problem or disorder? How is a disorder distributed in a specific population? Which factors lead to or increase the risk of psychological disorders? How does an untreated disorder develop? Who is seeking treatment and who needs it? The field of epidemiology deals with these questions (e.g., Rockett, 1999). Descriptive epidemiology deals with the distribution (occurrence, spatial, temporal) of these phenomena, and analytic epidemiology deals with the determinants (causes) of psychological disorders. Important concepts in epidemiological research are described below.
Prevalence
Prevalence indicates the frequency of a psychological disorder, generally or in a specific population. The prevalence rate is the proportion of people with a specific disorder in relation to the population of interest. Prevalence must be specified with regard to a particular time period and the examined population: For example, 12‐month prevalence refers to the rate of occurrence within a period of 12 months. In comparison, lifetime prevalence refers to the entire lifespan. Instead of a time period, prevalence can also refer to a specific time point (point prevalence). An additional important figure is treatment prevalence, which is not concerned with the frequency of occurrence of a disorder but the frequency with which persons seek treatment for a specific disorder.
Incidence
Incidence refers to the number of persons in a given time period and population that newly develop a disorder. Thus, the incidence rate is the proportion of persons in a given population that have a disorder but did not have that disorder in the past. In accordance with this definition, two measurement points would be necessary for a valid incidence estimate: The first time point provides the base‐rate of people in a population who do not suffer from the disorder. The second time point determines the number of patients who were not ill at the first time point but are ill now. Like prevalence, incidence depends on the investigated period, and the population. If, for example, the second measurement point is one year after the first measurement point, the incidence rate is specific for this 1‐year period.
Risk Measures
Generally, two types of risk measures can be differentiated: unconditional risks and conditional risks. Unconditional risks address the likelihood of developing a specific disorder in a given period. These risks can be calculated with the respective prevalence and incidence estimates described above. Conditional risks address whether certain variables increase (risk factor) or decrease (protective factor) the probability of developing a disorder. As such, whether the prevalence and/or incidence rates differ is investigated depends on the variable in question (e.g., sex). Many psychological disorders occur more frequently in women than in men. Consequently, being female is a risk factor for the development of these disorders.
Etiology and Analytical Epidemiology
When investigating the causes of psychological disorders, multidimensional models are usually assumed. That is to say, psychopathology is too complex to be explained by a single cause. Rather, many different influence factors from multiple dimensions are thought to interact, and eventually result in a psychological disorder. Etiology and analytical epidemiology address the questions of who develops a disorder and under which circumstances, taking into account behavioral, biological, emotional, social, and developmental influences. To observe the relative influence of each of the different factors, similar methods are applied, as described below (also see the section on the control‐group experiment). The basic idea is to investigate groups that differ with regard to certain influence factors and are identical with regard to others. The examination of the effects of genes, for example, is often done within so called “twin studies.” Twins are identical with regard to their genetic code but might be exposed to other very different influence factors, especially if they were raised apart from each other. Those characteristics, which are shared by twins after many years within different environmental conditions, are highly likely to have strong genetic influences.
For the design of examinations that seek to establish causal influence factors, it is important to show that the potential influence factor was present before the disorder. Therefore, the repeated assessment of the same individuals over time is needed (longitudinal designs). Cross‐sectional designs, in which data is collected from different age groups at the same time, can also hint at causal associations. However, this design assumes that the age groups are comparable with regard to other, not measured characteristics. If there are systematic differences between the different age groups (cohort effects) these can hamper the interpretation of cross‐sectional studies.
Prevention
Besides the treatment of psychological disorders, the prevention of their onset is crucial for clinical psychology. Prevention research within clinical psychology investigates interventions or programs that help to reduce the risk of developing a psychological disorder. While primary prevention programs aim at risk reduction on a global level (e.g., for all inhabitants of a country), secondary prevention focuses on individuals who already show an increased risk of developing a disorder or already report subclinical problems. As such, prevention research is based on etiology and epidemiology, as knowledge on the potential causes of psychological disorders is needed to create effective programs. The evaluation of these programs uses the same methods as those presented below for the evaluation of other clinical interventions.
Evaluating Clinical Interventions and Treatments
Central to clinical psychology is the question of the effectiveness of specific clinical interventions as well as complete psychological treatments (e.g., cognitive behavioral treatments, psychodynamic treatments). The first step in the process of evaluating psychological interventions and treatments is an appropriate definition of the program or intervention, and the identification of criteria that differentiate success from failure. In psychotherapy research, for example, it is agreed that assessments of outcomes should not be limited to a single dimension (e.g., depressive symptoms), even if the focus of the study is a specific disorder (e.g., depression). While symptoms should be one of the primary outcomes, most studies collect data along multiple dimensions (e.g., work/social adjustment, interpersonal problems etc.), and include different perspectives (e.g., patient ratings, therapist ratings, third‐party ratings). While psychophysiological and neurocognitive procedures have recently emerged as a new way of measuring change, questionnaires are still the predominant method of choice (e.g., Ogles, 2013).
In clinical studies, these outcome criteria are used as dependent variables (DV), which are assumed (hypothesized) to differ between persons depending on one or more manipulated or observed independent variables (IV). The most common IV in clinical research are interventions. If a researcher hypothesizes that 6 weeks of an intervention A are more effective in reducing symptoms of depression than just waiting 6 weeks, patients would be assigned into two groups: One group would receive intervention A, the other would not. Thus, these groups differ with regard to the IV treatment (intervention A versus waiting). If, after the 6 weeks, patients who underwent the intervention show less depressive symptoms (DV) than those in the waiting group, the researcher's hypothesis is confirmed. However, it must be ensured that there are no alternative explanations for the differences in the DV other than the difference in the IV (intervention versus waiting). For potential threats to this causal interpretation and means of ruling out competing explanations, see the sections on internal and external validity.
In clinical psychology, the aim is often the amelioration of relevant symptoms. A crucial task in clinical research is therefore the measurement of change. “Measuring” denotes the determination of patients' characteristics regarding specific attributes. With regard to the measurement of change, two types can be differentiated: Retrospective and repeated assessments change measurement. Retrospective change measurement uses retrospective ratings of the amount of change induced by an intervention. This can be realized via global success ratings at the end of the treatment or by questionnaires specifically developed for this purpose. Repeated assessments change measurement uses differences in the scores from ratings at the beginning and the end of the intervention. Both approaches have specific advantages and disadvantages. Retrospective measurements allow an immediate and economic assessment of change. However, this approach enables no objective comparison with the state at the beginning of the treatment. Retrospective estimates are prone to several biases, which are typical of retrospective ratings. Repeated assessments rely on the principles of classical test theory (CTT). Since CTT struggles with an appropriate conceptualization of change measurement, related issues apply to repeated assessments (e.g., the problem of regression to the mean, the reliability of difference scores and the stability of the construct over time; for an in‐depth discussion of these issues refer to Crocker & Algina, 1986). In clinical studies, multiple assessments have become standard.
Having defined appropriate criteria for the description of a course of change, the question arises of when these criteria should be assessed and after what amount of time an intervention can be considered successful. In order to test the stability of effects, the observed change must remain stable after termination of the intervention. Thus, conducting the last assessment at the end of an intervention cannot be enough to confirm its effectiveness. Instead, in order to be able to assess the stability of effects, the evaluation design must include measurements that are timed several weeks, months or even years after the end of treatment (follow up).
Does the Intervention Work?
To establish the effectivity of an intervention, it is crucial that the observed change can be attributed to the intervention with certainty. That is to say, alternative explanations of this change must be eliminated. To rule out as many alternative explanations for the observed change as possible, the control‐group experiment has been considered the “gold standard” in clinical research. In control‐group experiments, patients are randomly assigned to the intervention or a control condition. The objective of random assignment is the complete interchangeability of the groups before the start of the experiment. If this is achieved, every difference between the groups that is observed after the experiment can be attributed to the difference between the intervention and the control condition (manipulated IV). To be able to draw very specific conclusions, the difference between the intervention and the control condition should be limited to the specific factor that is hypothesized to cause the effect of the intervention. All other factors should be kept constant. These kind of studies are called “randomized control(led) trials” (RCTs). Depending on the respective control condition, different conclusions can be drawn (see Table 1.1).
Table 1.1 Different control groups and potential corresponding study conclusions.
Control condition
Potential conclusion
Waitlist control
(participants receive no intervention and are just assessed before and after the experiment; after the experiment these participants receive treatment)
Intervention A is more effective than no intervention
Alternative intervention A—without effective ingredients
(participants receive a placebo treatment)
The effects of intervention A are not only due to a placebo response
Alternative intervention B—with other effective ingredients
(participants receive a different intervention, which is assumed or has been shown to be effective)
Intervention A is more effective than intervention B
Internal Validity
Randomized controlled trials aim to test hypotheses deductively, for example with respect to the effectivity of a newly developed intervention in comparison to an established intervention. Thus, aspects of internal validity are emphasized. Internal validity describes the certainty with which the observed differences between the experimental conditions can be attributed to the manipulations in the experiment (i.e. the clinical‐psychological intervention). As described above, ruling out alternative explanations is key to this approach. In clinical psychology, the following measures are often taken to secure internal validity:
random assignment to the conditions
to secure the comparability of the groups and rule out person characteristics as alternative explanations;
homogeneous samples (i.e. clearly specified diagnostic groups)
to draw specific conclusions for specific populations;
a strict standardization of the intervention (e.g., by manualization of the intervention)
to ensure that the intervention is conducted as intended for every participant
—
this regularly includes post hoc assessments of protocol adherence and the competence with which the protocol was implemented;
training of those who conduct the intervention
to ensure a comparable competence of the therapists.
