Evidence-Based Psychotherapy E-Book

• Herausgeber: John Wiley & Sons
• Kategorie: Fachliteratur
• Sprache: Englisch

Seitenzahl: 1230

Veröffentlichungsjahr: 2018

Beschreibung

A Comprehensive, Systematic Evaluation of Treatment Effectiveness for Major Psychological Disorders With over 500 types of psychotherapy being practiced in the field today, navigating the maze of possible treatments can be daunting for clinicians and researchers, as well as for consumers who seek help in obtaining psychological services. Evidence-Based Psychotherapy: The State of Science and Practice offers a roadmap to identifying the most appropriate and efficacious interventions, and provides the most comprehensive review to date of treatments for psychological disorders most often encountered in clinical practice. Each chapter applies a rigorous assessment framework to evaluate psychotherapeutic interventions for a specific disorder. The authors include the reader in the evaluation scheme by describing both effective and potentially non-effective treatments. Assessments are based upon the extant research evidence regarding both clinical efficacy and support of underyling theory. Ultimately, the book seeks to inform treatment planning and enhance therapeutic outcomes. Evidence-Based Psychotherapy: The State of Science and Practice: * Presents the available scientific research for evidence-based psychotherapies commonly practiced today * Systematically evaluates theory and intervention efficacy based on the David and Montgomery nine-category evaluative framework * Covers essential modes of treatment for major disorders, including bipolar disorder, generalized anxiety disorder, PTSD, eating disorders, alcohol use disorder, major depressive disorder, phobias, and more * Includes insightful discussion of clinical practice written by leading experts * Clarifies "evidence-based practice" versus "evidence-based science" and offers historical context for the development of the treatments under discussion Evidence-Based Psychotherapy: The State of Science and Practice is designed to inform treatment choices as well as strengthen critical evaluation. In doing so, it provides an invaluable resource for both researchers and clinicians.

Leseprobe

Evidence-Based Psychotherapy

The State of the Science and Practice

Edited by

Daniel David, Steven Jay Lynn, and Guy H. Montgomery

This edition first published 2018 © 2018 John Wiley & Sons, Inc

All rights reserved. No part of this publication may be reproduced, stored in a retrieval system, or transmitted, in any form or by any means, electronic, mechanical, photocopying, recording or otherwise, except as permitted by law. Advice on how to obtain permission to reuse material from this title is available at http://www.wiley.com/go/permissions.

The right of Daniel David, Steven Jay Lynn, and Guy H. Montgomery to be identified as the authors of the editorial material in this work has been asserted in accordance with law.

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Library of Congress Cataloging-in-Publication Data

Names: David, Daniel, 1972– editor. | Lynn, Steven J., editor. | Montgomery, Guy, 1967– editor.

Title: Evidence-based psychotherapy: the state of the science and practice / edited by Daniel David, Steven Jay Lynn, Guy Montgomery.

Other titles: Evidence-based psychotherapy (David)

Description: First edition. | Hoboken, NJ, USA: Wiley, 2018. | Includes bibliographical references and index. | Identifiers: LCCN 2017037695 (print) | LCCN 2017038625 (ebook) | ISBN 9781118625538 (pdf) | ISBN 9781118625583 (epub) | ISBN 9781118625521 (cloth)

Subjects: | MESH: Mental Disorders–therapy | Psychotherapy | Evidence-Based Practice

Classification: LCC RC480 (ebook) | LCC RC480 (print) | NLM WM 420 | DDC 616.89/14–dc23

LC record available at https://lccn.loc.gov/2017037695

Cover Design: Wiley Cover Image: © monsitj/Gettyimages

CONTENTS

List of Contributors

1: An Introduction to the Science and Practice of Evidence-Based Psychotherapy: A Framework for Evaluation and a Way Forward

1.1 Evidence-Based Psychotherapies and Clinical Practice

1.2 Classifying Psychotherapies: Tricky Business

1.3 A New Evaluation Scheme for Psychotherapy: Efficacy and Mechanisms

1.4 What We Aim to Accomplish

1.5 Conclusions

References

2: Varieties of Psychotherapy for Major Depressive Disorder in Adults: An Evidence-Based Evaluation

2.1 Description of the Disorder

2.2 Classification of Psychotherapies According to David and Montgomery's (2011) Evaluative Framework

2.3 Conclusions and Discussion

References

3: Evidence-Based Psychological Interventions for Bipolar Disorder

3.1 Overview of Bipolar Disorder

3.2 Evidence-Based Interventions for Bipolar Disorder

3.3 Conclusions and Future Directions

References

4: The Treatment of Panic Disorder and Phobias

4.1 Panic Disorder

4.2 Social Anxiety Disorder

4.3 Specific Phobia

4.4 Implications for Research

4.5 Implications for Practice

4.6 Conclusions

References

5: The Psychological Treatment of Generalized Anxiety Disorder

5.1 Features and Prevalence of Generalized Anxiety Disorder

5.2 Review of Theory and Evidence Supporting GAD Psychotherapies

5.3 Implications for Research

5.4 Implications for Practice

5.5 Conclusions

Notes

References

6: The Treatment of Obsessive–Compulsive Disorder

6.1 Exposure and Ritual Prevention

6.2 Cognitive Therapy

6.3 Cognitive–Behavioral Therapy

6.4 Acceptance and Commitment Therapy

6.5 Metacognitive Therapy

6.6 Attention Bias Modification Training

6.7 Interpretation Bias Modification Training

6.8 Eye Movement Desensitization and Reprocessing Therapy

6.9 Implications for Research

6.10 Implications for Practice

6.11 Conclusions

Note

References

7: Evidence-Based Practice for Posttraumatic Stress Disorder

7.1 Overview

7.2 Etiological Pathways and Causal Mechanisms

7.3 Evidence-Based Practices

7.4 Conclusions

References

8: Evidence-Based Psychological Interventions for Eating Disorders

8.1 Description of the Disorders

8.2 David and Montgomery's (2011) Evaluative Framework

8.3 Classification of Psychological Interventions for Anorexia Nervosa

8.4 Classification of Psychological Interventions for Binge Eating Disorder

8.5 Classification of Psychological Interventions for Bulimia Nervosa

8.6 Discussion and Conclusions

References

9: Evidence-Based Treatment for Alcohol Use Disorders: A Review Through the Lens of the Theory × Efficacy Matrix

9.1 A Brief History of Alcohol Use Disorder Treatment

9.2 Treatment Reviews

9.3 Implications for Research and Practice

9.4 Conclusions

Acknowledgments

Note

References

10: Psychotherapeutic Treatments for Male and Female Sexual Dysfunction Disorders

10.1 Treatments for Sexual Dysfunction

10.2 Category I

10.3 Category III

10.4 Category IV

10.5 Category VIII

10.6 Other Therapies

10.7 Implications for Research

10.8 Implications for Practice

10.9 Conclusions

References

11: The Psychological Treatment of Psychopathy: Theory and Research

11.1 Conceptualizing and Measuring Psychopathy

11.2 Is Psychopathy Treatable? A History of Negative Opinion

11.3 Methodological Issues in Treatment Investigations

11.4 Evaluation of Psychopathy Treatments

11.5 Implications for Research

11.6 Implications for Clinical Practice

11.7 Conclusions

References

12: The Treatment of Borderline Personality Disorder

12.1 Treatments for Borderline Personality Disorder

12.2 Category II

12.3 Category IV

12.4 Other Therapies

12.5 Implications for Research

12.6 Implications for Practice

12.7 Conclusions

References

13: The Treatment of Dissociation: An Evaluation of Effectiveness and Potential Mechanisms

13.1 A Review of the DSM-5 Dissociative Disorders

13.2 Treatments for Depersonalization/Derealization Disorder

13.3 Treatments for Dissociative Identity Disorder

13.4 Treatments for Dissociative Fugue and Dissociative Amnesia

13.5 Innovative Treatments for Dissociation

13.6 Conclusions

References

14: Psychotherapy for Schizophrenia-Spectrum Disorders

14.1 Treatment for Schizophrenia

14.2 Category II

14.3 Category IV

14.4 Other Therapies

14.5 Implications for Research

14.6 Implications for Clinical Practice

14.7 Conclusion

References

15: Psychotherapy and Autism Spectrum Disorder: Conceptual and Pragmatic Challenges

15.1 History of the Diagnosis of Autism

15.2 Heterogeneity

15.3 Core Characteristics

15.4 Prevalence

15.5 Etiology and Theoretical Approach: The Context of Etiological Complexity

15.6 Defining Psychotherapy in the Context of Autism Spectrum Disorder

15.7 Evidence-Based Treatment Review

15.8 Discussion

15.9 Conclusion

Notes

References

16: Varieties of Psychotherapy for Attention-Deficit Hyperactivity Disorder: An Evidence-Based Evaluation

16.1 Description of the Disorder

16.2 Classification of Psychotherapies

16.3 Conclusions and Discussion

References

17: The Treatment of Insomnia

17.1 Description of the Disorder

17.2 Psychological Theories and Mechanisms of Change

17.3 Therapeutic Packages

17.4 Implications for Research and Practice

17.5 Conclusions

References

18: The Scientific Status of Evidence-Based Psychotherapies: Concluding Thoughts

References

Index

EULA

List of Tables

Chapter 1

Table 1.1

Chapter 2

Table 2.1

Chapter 3

Table 3.1

Chapter 5

Table 5.1

Chapter 8

Table 8.1

Table 8.2

Table 8.3

Chapter 9

Table 9.1

Table 9.2

Table 9.3

Chapter 14

Table 14.1

Table 14.2

Table 14.3

Chapter 15

Table 15.1

Table 15.2

Table 15.3

Table 15.4

Table 15.5

Chapter 16

Table 16.1

Chapter 17

Table 17.1

Table 17.2

Guide

Cover

Table of Contents

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List of Contributors

Leigh A. Andrews is a doctoral student at the University of Delaware. He graduated cum laude from Bowdoin College in 2015 and worked for 2 years as a research coordinator in the Psychotherapy and Emotion Research Laboratory under Dr. Stefan G. Hofmann. He is interested in mechanisms of treatment in emotional disorders, particularly in novel forms of treatment. He is particularly interested in studying how some transdiagnostic factors, such as negative affect, emotional reactivity, and coping strategies including suppression, interact with treatment mechanisms.

Martin M. Antony is Professor of Psychology at Ryerson University in Toronto. He also holds faculty appointments in the Department of Psychiatry at the University of Toronto and the Department of Psychiatry and Behavioural Neurosciences at McMaster University. His expertise is in the area of anxiety and related disorders (e.g., panic disorder, social anxiety disorder, phobias, obsessive–compulsive disorder) as well as perfectionism.

Isabelle Avildsen is an expert in the field of sexual disorder at the Graduate Center, City University of New York, approaching the disorders in an evidence-based paradigm.

Aaron T. Beck is a Professor Emeritus in the Department of Psychiatry at the University of Pennsylvania. He is the father of cognitive therapy and the grandfather of cognitive–behavioral therapy. Professor Beck is considered one of the “Americans in history who shaped the face of American psychiatry” and one of the most influential psychotherapists of all time (e.g., by American Psychologist, 1998). Professor Beck is a key world expert in the in the theory, research, and treatment of depression.

Deborah C. Beidel is Trustee Chair and Pegasus Professor of Psychology and Medical Education at the University of Central Florida (UCF), where she is also Director of UCF RESTORES, a clinical research center dedicated to anxiety, stress, and trauma. Her recent work focuses on developing effective treatments for PTSD for veterans, active duty personnel, and first responders, using technology to enhance effective treatments for use in standard clinical practice.

Laura B. Bragdon is a graduate student in the Coles lab at the Department of Psychology, Binghamton University. She received her BS in psychology, with a minor in studio arts/art history, from Trinity College in 2008, and holds an MA in psychology from Columbia University. Before joining the Coles lab, she worked at the Anxiety Disorders Center at Hartford Hospital's Institute of Living as a full-time research assistant. Her areas of research interest focus on anxiety disorders and obsessive–compulsive disorder, specifically the varying mechanisms underlying the motivational domains of incompleteness and harm avoidance, the mediators and moderators involved in the treatment of anxiety disorders, and dissemination of evidence-based treatments for anxiety disorders more broadly.

Diana M. Cȃndea is an Assistant Professor in the Department of Clinical Psychology and Psychotherapy, Babeş-Bolyai University, and a member of the International Institute for the Advanced Studies of Psychotherapy and Applied Mental Health (Cluj-Napoca, Romania). Her expertise is related to self-conscious emotions, emotion regulation, and evidence-based psychotherapies.

Rachel N. S. Cavalari is Director of Services of the Children's Unit for Treatment and Evaluation at the Institute for Child Development and adjunct Assistant Professor in the Department of Psychology at Binghamton University. Her expertise is related to assessment, diagnosis, and treatment approaches for autism spectrum disorders, child safety and caregiver supervision, and staff supervision practices.

Meredith E. Coles is Professor of Psychology at Binghamton University and has served as the director of the Binghamton Anxiety Clinic since 2004. She is a fellow of the Association for the Advancement of Behavioral Therapy. Her expertise is in the nature and treatment of obsessive–compulsive disorder and anxiety disorders in both children and adults. Dr. Coles’ work spans basic mechanisms (e.g., information-processing biases, circadian rhythms) to treatment utilization (e.g., mental health literacy).

Lindsey M. Collins is a graduate student in the Coles lab in the Department of Psychology, Binghamton University. Her current areas of interest include the etiology of obsessive–compulsive disorder (OCD), cognitive control deficits in OCD, and mechanisms of cognitive–behavioral therapy (CBT) for anxiety. Lindsey is currently involved in research projects investigating the development of OCD-related beliefs in children and the relation between electroencephalography indices, cognitive control, and OCD symptoms. Lindsey's clinical interests include CBT for child anxiety and behavior disorders. She is currently a clinician in the Binghamton Anxiety Clinic and the Binghamton Psychological Clinic. She interns twice a week at the Children's Home of Wyoming Conference.

Colleen M. Cowperthwait is a Clinical Associate and Fellow in the Clinical Psychology Fellowship Program in the Department of Psychiatry and Behavioral Sciences at Duke University Medical Center. She has clinical and research experience in cognitive–behavioral therapy and dialectical behavioral therapy, and studies how to adapt and implement evidence-based treatment programs. She is especially dedicated to adaptations of dialectical behavioral therapy for teens, college students, and young adults.

Ioana A. Cristea is Associate Professor in the Department of Clinical Psychology and Psychotherapy, Babeş-Bolyai University. Her research focuses on critically appraising the efficacy of psychological and pharmacological interventions for mental disorders, as well as issues related to transparency and rigor in clinical research.

Daniel David is Professor of Clinical Cognitive Sciences at Babeş-Bolyai University, Director for Research at the Albert Ellis Institute, Adjunct Professor at the Icahn School of Medicine at Mount Sinai, and Director of the International Institute for the Advanced Studies of Psychotherapy and Applied Mental Health. His expertise is related to clinical cognitive neurogenetic sciences and evidence-based psychotherapies.

Barbara Depreeuw is based at the Department of Psychological and Brain Sciences, Boston University, and is an internationally trained clinical psychologist with wide clinical experience. She has worked at various universities and in clinical settings in the United States (University of California, Los Angeles; Boston University), the Netherlands, and Belgium (The Human Link; University of Leuven). She has over 10 years of experience in primary care, clinic, and corporate settings. Her main expertise is related to cognitive–behavioral therapy for anxiety disorders, work-related stress, and traumatic stress.

Anca Dobrean is Professor in the Department of Clinical Psychology and Psychotherapy at Babeş-Bolyai University. Her main research interests are related to evidence-based assessment and treatment of children's and adolescents’ emotional and behavioral problems.

Manfred Döpfner is Professor of Psychotherapy in the Department of Child and Adolescent Psychiatry and Psychotherapy, Medical Faculty of the University of Cologne, Germany. He is a supervisor in behavior therapy and Director of the School of Child and Adolescent Cognitive Behavior Therapy at the University of Cologne and of the Institute of Clinical Child Psychology of the Christoph-Dornier-Foundation for Clinical Psychology at the University of Cologne. He received the German Psychology Prize for his scientific work in 2005.

Sharon Eldar is based at the Department of Psychological and Brain Sciences, Boston University, and is a clinical psychologist with vast experience as a clinical therapist, specializing in anxiety disorders. She received her PhD from Tel-Aviv University and was a postdoctoral fellow at Boston University. Her research is focused on the development of new therapeutic methods to treat anxiety and related disorders. These methods include attention bias modification, and enhancement of existing cognitive–behavioral therapy via positive affect training. In her clinical work, she works with all age groups and uses integrative methods in treating a wide range of mental disorders.

Jon D. Elhai is Professor in the Department of Psychology and in the Department of Psychiatry at the University of Toledo in Toledo, Ohio. His areas of research include posttraumatic stress disorder and cyberpsychology.

Stacy Ellenberg is a clinical psychology graduate student in the Department of Psychology at Binghamton University. Her research interests include technology-based interventions and psychosis.

Jessica C. Emanu is based at Long Island University and is an expert in the field of sexual disorders, approaching them from an evidence-based paradigm.

Katie Fracalanza is a clinical instructor in the Department of Psychiatry and Behavioral Neurosciences at Stanford University. Her areas of expertise include cognitive–behavioral therapy, exposure and response prevention, and other empirically supported treatments for adults with mood and anxiety disorders. She is actively involved in research and in teaching psychotherapy to graduate students and psychiatry residents.

B. Christopher Frueh is Professor in the Department of Psychology at the University of Hawaii. His areas of research include posttraumatic stress disorder among combat veterans, and he also works extensively with retired and active duty members of the military special operations community.

Jennifer M. Gillis is Associate Professor and a member of the Clinical Psychology Faculty at Binghamton University. She is Codirector of the Institute for Child Development and Adjunct Assistant Professor of Psychiatry at SUNY Upstate Medical University. Her expertise is related to evidence-based treatment approaches for autism spectrum disorders throughout the lifespan, applied behavior analysis, and organizational behavior management.

Anouk L. Grubaugh is Professor in the Department of Psychiatry at the Medical University of South Carolina and a staff psychologist at the Veterans Affairs Medical Center in Charleston, South Carolina, USA. Her areas of research include posttraumatic stress disorder among combat veterans and people with severe mental illnesses.

Lisa K. Hecht is a doctoral student in clinical neuropsychology in the Department of Psychology at Georgia State University. Her research interests focus on the relationship between executive functioning, social cognition, and psychopathy.

Elisabeth Hertenstein is a psychologist and Research Associate at the University Medical Center Freiburg and member of the workgroup “Sleep, Insomnia and Mental Disorders.” She is a cognitive–behavioral therapist in training and currently works as a clinical psychologist at the sleep laboratory of the University Medical Center Freiburg.

Stefan G. Hofmann is Professor of Psychology in the Department of Psychological and Brain Sciences at Boston University. He has been the president of numerous national and international cognitive–behavioral therapy associations and has been the editor of various professional journals, including Cognitive Therapy and Research. His research focuses on the mechanism of treatment change, translating discoveries from neuroscience into clinical applications, emotion regulation, and cultural expressions of psychopathology.

Robert D. Latzman is an Associate Professor and Associate Director of Clinical Training in the Department of Psychology at Georgia State University. His research focuses on characterizing neurobehavioral mechanisms that underlie the development and persistence of psychopathological behaviors in both human and nonhuman primates, particularly externalizing-related behaviors (e.g., aggression, substance use, psychopathy).

Scott O. Lilienfeld is Samuel Candler Dobbs Professor of Psychology at Emory University and Visiting Professor at the University of Melbourne. His research focuses on personality disorders (especially psychopathy), dissociative disorders, psychiatric classification, pseudoscience in psychology, evidence-based practice, and the application of scientific thinking to psychology.

Noriel E. Lim is Assistant Professor of Psychiatry and Behavioral Sciences at Emory University School of Medicine, where he directs Emory's Child, Adolescent, and Young Adult Pre-doctoral Internship Training Program as well as the children's anxiety treatment program. He also serves on the Board of Convention Affairs for the American Psychological Association and on the Board of Directors for the Asian American Psychological Association.

Steven Jay Lynn is a Distinguished Professor of Psychology at Binghamton University, a licensed clinical psychologist, and the editor of Psychology of Consciousness: Theory, Research, and Practice. He has published extensively in the areas of psychopathology, psychotherapy, memory, hypnosis and consciousness, and trauma.

James MacKillop is the Peter Boris Chair in Addictions Research, Director of the Peter Boris Centre for Addictions Research, and Professor of Psychiatry and Behavioural Neurosciences at McMaster University/St. Joseph's Healthcare Hamilton. Dr. MacKillop is also a Senior Scientist at Homewood Research Institute.

Alok Madan is an Associate Professor in the Menninger Department of Psychiatry and Behavioral Sciences at the Baylor College of Medicine, and McNair Scholar and Senior Psychologist at the Menninger Clinic. His clinical and research interests include mental health quality and outcomes, psychosomatic and behavioral medicine, and minimally invasive neuromodulation for neuropsychiatric disorders.

Reed Maxwell is based at the Psychiatry Department, Weil-Cornell Medical College, and is an expert in clinical, health, and positive psychology, working in the framework of the evidence-based paradigm.

Hanna McCabe-Bennett is a graduate student at Ryerson University in Toronto. She is currently completing her predoctoral internship at St. Joseph's Healthcare Hamilton with rotations in anxiety disorders, dialectical behavior therapy, and neuropsychology. Her expertise is in the area of anxiety and related disorders and hoarding.

Harald Merckelbach is Professor of Psychology and Law in the Departments of Forensic Psychology and Clinical Psychological Science, Faculty of Psychology and Neuroscience, Maastricht University. His expertise is related to clinical psychology and law and he has been awarded the “Nobel Prize for Psychology.”

Guy H. Montgomery is an Associate Professor and Director of the Center for Behavioral Oncology at the Icahn School of Medicine at Mount Sinai. Dr. Montgomery is also a licensed clinical psychologist, specializing in behavioral medicine. He has published more than 100 peer-reviewed empirical articles and has received research funding from the National Cancer Institute and the American Cancer Society.

Sandra M. Neer is a clinical psychologist on the faculty of the Psychology Department at the University of Central Florida (UCF). She is Director of Clinical Services at UCF RESTORES, a clinical research center for trauma. Her research focuses on the outcome of evidence-based treatments for posttraumatic stress disorder in combat veterans and first responders.

Christian J. Nelson is a clinical psychologist in the Department of Psychiatry and Behavioral Sciences at Memorial Sloan Kettering Cancer Center. He specializes in the treatment of patients with genitourinary malignancies and older patients with cancer. As the psychological liaison to the genitourinary and sexual medicine services, he helps men experiencing treatment-related sexual dysfunction, and their partners, optimize intimacy before, during, and after treatment. He also works with the geriatric disease management team in the hospital, providing psychological support for patients aged 65 and over coping with the combined issues of cancer and aging.

Max M. Owens is a doctoral candidate in the Department of Psychology at the University of Georgia.

Costina R. Păsărelu is Assistant Professor at Babeş-Bolyai University in the Department of Clinical Psychology and Psychotherapy and a member of the International Institute for the Advanced Studies of Psychotherapy and Applied Mental Health. Her expertise is related to evidence-based assessment and interventions for children and adolescents. Her main research interests are transdiagnostic treatments delivered via technology for youth populations and parents.

Dieter Riemann has been tenured Professor of Clinical Psychophysiology at the University Medical Centre Freiburg since 1993. He is also head of the Department of Clinical Psychology at the Centre for Mental Disorders, and since 2015 he has been a Visiting Professor at the University of Oxford (Nuffield Department of Clinical Neurosciences). He served as a member of a DSM-5 workgroup for the American Psychiatric Association and is Editor in Chief of the Journal of Sleep Research. His research interests encompass the etiology, pathophysiology, and treatment of insomnia as well as neurophysiological and behavioral correlates of sleep and mental disorders.

Lorie A. Ritschel is Clinical Assistant Professor in the Department of Psychiatry at the University of North Carolina Chapel Hill School of Medicine. She is a consultant and trainer in dialectical behavior therapy (DBT) with Behavioral Tech, LLC, and she directs the adolescent DBT program at her private practice in Durham, North Carolina. Her areas of expertise are borderline personality disorder, emotion dysregulation, suicide and self-harm behavior, and a variety of empirically supported psychotherapies.

Raymond G. Romanczyk is a SUNY Distinguished Service Professor and a member of the clinical psychology faculty at Binghamton University. He is Codirector of the Institute for Child Development and Adjunct Professor of Psychiatry at SUNY Upstate Medical University. His expertise is related to evidence-based treatment approaches for autism spectrum disorders, large-scale service delivery, and information-processing for clinical decision-making.

Lindsay M. Stewart is Assistant Professor within the Department of Psychiatry and Behavioral Sciences at Emory University. She specializes in the assessment and treatment of mood and anxiety disorders.

Monika Stojek is based at the Department of Psychology, University of Georgia and Medical College of Georgia, Georgia Regents University. She is also a Postdoctoral Research Fellow at Eunice Kennedy Shriver National Institute of Child Health and Human Development.

Gregory P. Strauss is Assistant Professor at the Department of Psychology, University of Georgia, and is an expert in the fields of psychosis and emotions. He takes a translational approach to studying various aspects of schizophrenia, relying on theoretical frameworks and methods from the field of affective neuroscience (e.g., functional magnetic resonance imaging, electroencephalography, event-related potentials, eye tracking, electrocardiography, electrodermal activity, and electromyography).

Aurora Szentágotai-Tătar is Professor of Clinical Psychology and Psychotherapy at Babeş-Bolyai University, a fellow of the Albert Ellis Institute, and a member of the International Institute for the Advanced Studies of Psychotherapy and Applied Mental Health. Her expertise is related to emotion regulation and evidence-based psychotherapies.

Lauren VanderBroek-Stice is a doctoral candidate in the Department of Psychology at the University of Georgia.

Bogdan Voinescu is a clinical research fellow at the Institute of Psychiatry, Psychology and Neuroscience, King's College London, and a lecturer in Psychiatry at the Department of Clinical Psychology and Psychotherapy, Babeş-Bolyai University. His research interests have mainly been related to insomnia and circadian rhythms in various psychiatric and somatic conditions.

1An Introduction to the Science and Practice of Evidence-Based Psychotherapy: A Framework for Evaluation and a Way Forward

Daniel David,1 Steven Jay Lynn,2 and Guy H. Montgomery3

1 Department of Clinical Psychology and Psychotherapy, Babeş-Bolyai University, Cluj-Napoca, Romania

2 Psychology Department, Binghamton University, Binghamton, USA

3 Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, USA

The terrain of contemporary psychotherapy is vast. In fact, patients can choose from more than 500 brands of psychotherapy. The challenges in navigating this bewildering landscape of psychotherapeutic interventions can be daunting (Lilienfeld, 2007). In this volume, we guide consumers of psychotherapy, clinicians, researchers, and students in the task of ascertaining the psychological treatments that are most rigorously evaluated, the treatment mechanisms that are best established, and the interventions that are most likely to be associated with positive outcomes for an array of disorders.

1.1 Evidence-Based Psychotherapies and Clinical Practice

Many psychotherapies in vogue today have never been subjected to rigorous scientific scrutiny, and there is no guarantee that a consumer of psychotherapy will receive an effective, evidence-based treatment. Although researchers have demonstrated that some psychotherapeutic interventions are successful, many individuals with major mental disorders still fail to receive treatments grounded in rigorous research (see Lynn & Lilienfeld, 2017). As Lilienfeld (2007) points out, surveys of clinical practitioners reveal that “substantial pluralities or even majorities do not treat patients with empirically supported methods” (p. 63). One such survey (Kessler et al., 2003) revealed that only about a fifth of individuals with clinical depression received adequate, empirically based clinical treatment in the year in which they were interviewed (see also Wang, Berglund, & Kessler, 2000, reporting similar findings for anxiety disorders). A more recent representative community household survey from 21 countries found that, among respondents who received treatment for depression, only 41% received treatment that met even minimal standards (Thornicroft et al., 2017). Most people with depression receive no psychological treatment, grossly suboptimal treatment, or ineffective treatment (Kessler et al., 2003; Shim, Baltrus, Ye, & Rust, 2011). Much the same can be said for anxious individuals. In a study of 582 patients with anxiety disorders treated in community mental health settings, only 13.2% received cognitive–behavioral therapy, an empirically based treatment for anxiety (Sorsdahl et al., 2013; Wolitzky-Taylor, Zimmerman, Arch, De Guzman, & Lagomasino, 2015).

There is reason for equal, if not more, pessimism regarding treatment of disorders other than anxiety and depression. About one-third of individuals with autism receive nonvalidated interventions (Romanczyk, Turner, Sevlever, & Gillis, 2015); the majority of therapists who treat posttraumatic stress disorder fail to implement exposure and response prevention, one of the consensus treatments of choice for this condition (Freiheit, Vye, Swan, & Cady, 2004; Lilienfeld, 2007; Russell & Silver, 2007; see also Chapter 7); most therapists who treat eating disorders fail to capitalize on scientifically based treatments (Lilienfeld, Ritschel, Lynn, Brown et al., 2013); and as many as three-quarters of licensed social workers deliver one or more interventions with no research grounding whatsoever (Pignotti & Thyer, 2009).

Other interventions (e.g., attachment therapies, memory recovery techniques, critical incident stress debriefing, grief counseling for normal bereavement) not only lack empirical support but are also potentially harmful. Several produce “deterioration effects” in as many as 3% to 10% of patients, in which patients become worse after psychotherapy (see Lilienfeld, 2007). Moreover, a quarter or more of therapists report they use highly suggestive techniques (such as guided imagery or repeated prompting of memories) that are known to increase the risk of false memories of abuse (see Lynn, Krackow, Loftus, Locke, & Lilienfeld, 2015). Thomas Insel, the director of the National Institute of Mental Health, framed the situation this way: “Mental health care in America is ailing” (Insel & Fenton, 2009).

Unfortunately, many mental health professionals administer scientifically questionable or pseudoscientific techniques (see Lilienfeld, Lynn, & Lohr, 2015). For example, a large national survey by Kessler and associates (2001) revealed that substantial numbers of clinically depressed and anxious individuals receive such interventions as “energy therapy,” massage therapy, aromatherapy, acupuncture, and even laughter therapy (see also Lee & Hunsley, 2015; Lilienfeld et al., 2015; Lilienfeld, Ruscio, & Lynn, 2008). Even if treatments such as equine assisted therapy (i.e., animal-assisted therapy), which lack rigorous empirical support (Anestis, Anestis, Zawilinski, Hopkins, & Lilienfeld, 2014), do little or no harm, mental health consumers who engage in them may forego effective interventions. Economists term this little-appreciated adverse effect an “opportunity cost.” Such unsupported techniques also deprive mental health consumers of valuable time, money, and energy, sometimes leaving them with precious little of all three (see Lynn & Lilienfeld, 2017; Lynn, Malakataris, Condon, Maxwell, & Cleere, 2012). Nonscientific practices can also tarnish the reputation and credibility of mental health professionals, rendering members of the general public more reluctant to turn to them for greatly needed psychological help (Lynn & Lilienfeld, 2017).

In the main, psychotherapy is helpful. Scientists have established that many interventions—those that focus on directly changing people's thoughts, feelings, behaviors, and interpersonal relationships—are superior to no therapy, and often work as well as, or even better than, medications for common psychological conditions such as depression and anxiety (Barlow, Gorman, Shear, & Woods, 2000; Butler, Chapman, Forman, & Beck, 2006; Dimidjian et al., 2006; Lemmens et al., 2015; Stewart & Chambless, 2009; Weitz et al., 2015). Moreover, psychotherapy combined with medication produces better outcomes in the treatment of depression than medication alone (Cuijpers, De Wit, Weitz, Andersson, & Huibers, 2015).

Still, implementing interventions, maximizing their outcomes, and getting them to patients in need are by no means without challenges. Although evidence-based therapies are available for a diversity of clinical conditions, there exists a pressing need to more widely disseminate (by teaching, training, and practice) and increase the accessibility of such services (Barnett, Rosenberg, Rosenberg, Osofsky, & Wolford, 2014; Karlin & Cross, 2014; Stewart et al., 2014). For example, as many as 70% of individuals with anxiety and mood disorders do not use or have access to psychological services (Kazdin & Rabbitt, 2013; Lilienfeld, Lynn, & Namy, 2018). Moreover, there is much room for improvements in evidence-based therapies, as many patients with clinical conditions do not respond satisfactorily to treatment, and, even when they do respond, they often relapse months to years after treatment (Steinert, Hofmann, Kruse, & Leichsenring, 2014).

1.2 Classifying Psychotherapies: Tricky Business

As David and Montgomery (2011) argued, the meaning of the term “evidence-based psychotherapy” is a moving target that varies considerably among (a) researchers, (b) classification schemes that identify therapies as “empirically supported,” and (c) international organizations. A particular therapy may be considered empirically supported vis-à-vis one classification system, yet not be listed as supported in another classification system. Indeed, multiple evaluative frameworks for evidence-based psychotherapies have generated conflicting views and diverging standards regarding the status of individual psychological interventions. For example, the National Institute for Health and Care Excellence's guidelines (http://www.nice.org.uk) are not always consistent with those stipulated by Division 12 (the Society of Clinical Psychology) of the American Psychological Association (https://www.div12.org/psychological-treatments) or the American Psychiatric Association (http://www.psych.org), or with the conclusions of typically comprehensive Cochrane Reviews (http://www.cochrane.org). This lack of consistency instills confusion among professionals and patients alike, both of whom are seeking to select empirically validated treatments, and strongly supports the need for a unified, more scientifically oriented system for categorizing psychological treatments.

Most of the abovementioned classification systems are limited to a focus on the empirical status of the therapy package. Typically, the schemes evaluate the intervention package by comparing it with various control conditions (e.g., no intervention, waitlist, placebo/attention control, treatment as usual, active treatment, evidence-based treatment). Nevertheless, a treatment package is typically allied with a hypothesized underlying theory/mechanism of change, which should, we contend, impact the evidence-based status of the treatment delivered. Unfortunately, as David and Montgomery (2011) have argued, the current evaluative psychotherapy frameworks ignore the support, or lack thereof, for underlying theory and mechanism of change. Conceivably, a technique based on voodoo practices could be classified as “probably efficacious” in current evaluative frameworks of psychotherapy, based on a clinical trial comparing voodoo therapy with a waitlist control condition.

The lack of a concerted focus on mechanisms of change is not surprising given that science (Kuhn, 1962), and the science of psychotherapy in particular, can be described as evolving in loosely demarcated stages or phases. Acknowledgment of the need to consider potential mechanisms that moderate or mediate treatment success is only of recent origin. DiGiuseppe, David, and Venezia (2016) have argued that the psychotherapy field can be described in terms of the following phases: (1) a preparadigmatic phase (e.g., schools of psychotherapy proliferated, often based on who would “shout the loudest” to attract attention, rather than based on rigorous controlled studies); (2) a paradigmatic phase (e.g., the first science-based paradigm was arguably behavior therapy); (3) crisis (e.g., behavior therapy was strongly challenged by new learning theories that emphasized cognitive processes); (4) new paradigms (e.g., cognitive therapies emerged as contenders to behavior therapy); (5) paradigm clashes (e.g., behavior and cognitive paradigms competed for ascendancy); and (6) normal science (e.g., the integration of cognitive and behavioral paradigms yielded the cognitive–behavioral paradigm), which is being challenged again by emerging (so-called third-wave) approaches such as acceptance and commitment therapy (which are in the process of a new integration into the cognitive–behavioral family).

In the early phases of the evolution of psychotherapy, a psychotherapy school was often successful because a charismatic or highly influential founder (e.g., Freud, Rogers) forcefully promoted its practice and the hypothesized underlying theory as useful and even scientific, as viewed through the lens of prevailing scientific standards. In this period of “grand psychotherapy systems” (e.g., psychoanalysis, humanistic–existential), most of the evidence invoked by a particular school was based on examples derived from successful cases. During this period, advocates of a particular system often did not place a premium on careful evaluation of treatment efficacy or effectiveness, and rarely, if at all, on empirical evaluation of mechanisms presumed to be associated with treatment gains.

A notable, contrasting, and welcome development, then, was the emergence of the relatively recent movement toward evidence-based practice (Lilienfeld, Ritschel, Lynn, Cautin, & Latzman, 2013). The scientific community increasingly acknowledged that a practice cannot be said to be “supported” in the context of a verification framework alone (e.g., identifying successful examples based on more or less anecdotal reports) and that a framework of falsification (e.g., searching for counterexamples or alternative explanations) should also be implemented in the evaluation process. Not surprisingly, the randomized clinical trial (RCT) became the gold standard for establishing an evidence-based psychological treatment. Probably the first large-scale RCTs involving psychotherapy, as compared with pharmacotherapy, were related to cognitive psychotherapy for depression (Rush, Beck, Kovacs, & Hollon, 1977). No matter how useful this approach, it nevertheless ignored, or gave short shrift to, evaluation of the underlying theory of the practice.

It seems fair to say that psychotherapy continues to evolve, as exemplified by recent efforts to identify and assess mechanisms of successful treatment outcomes within and across interventions. Yet, to this day, clinical practice continues to be based largely on personal experiences with a particular therapy, expert consensus, and reports of successful clinical applications (see Lilienfeld, Ritschel, Lynn, Cautin, & Latzman, 2013). Still, in recent years, researchers and clinicians have gradually, and some might say grudgingly, come to appreciate the value of testing theories and mechanisms associated with diverse interventions.

1.3 A New Evaluation Scheme for Psychotherapy: Efficacy and Mechanisms

The evaluation of treatment mechanisms is particularly important because any number of explanations or variables may account for why a psychotherapy appears to be efficacious or effective, albeit not for the reasons stipulated by the innovators or promoters of the intervention. Causes of spurious therapeutic efficacy or effectiveness include spontaneous recovery, demand characteristics and nonspecific factors, natural fluctuations in symptoms, and a tendency to remember one's pretreatment functioning as worse than it was (see Lilienfeld, Ritschel, Lynn, Cautin, & Latzman, 2014, for a list of 26 such reasons). To address the need to consider treatment mechanisms in extant evaluative frameworks of psychotherapy, David and Montgomery (2011) proposed a scheme that takes into account both the efficacy and the effectiveness of the intervention package as well as its underlying theory regarding mechanism of change (see Table 1.1).

Table 1.1 A new evaluative framework of psychotherapy (reproduced after David and Montgomery, 2011).

Therapeutic Package

Theory

Well Supported

a

Equivocal: No, Preliminary, or Mixed Data

b

Strong Contradictory Evidence

c

Well Supported

d

Category I

Category II

Category V

Equivocal: No, Preliminary, or Mixed Data

b

Category III

Category IV

Category VII

Strong Contradictory Evidence

c

Category VI

Category VIII

Category IX

aWell-supported theories are defined as those with evidence based on (1) experimental studies (and sometimes additional/adjunctive correlational studies) and/or (2) component analyses, patient–treatment interactions, and/or mediation/moderation analyses in complex clinical trials (CCTs). Thus, the theory can be tested independent of its therapeutic package (e.g., in experimental studies and sometimes their additional/adjunctive correlational studies) and/or during a CCT. “Well supported” within this framework means that a theory has been empirically supported in at least two rigorous studies, by two different investigators or investigating teams.

bEquivocal evidence for therapeutic package and/or theory means no data (data not yet collected), preliminary data (there are data collected, be it supporting or contradictory, but it does not fit the minimum standards), or mixed data (there is both supporting and contradictory evidence).

cStrong contradictory evidence for therapeutic package and/or theory means that it has not been empirically supported in at least two rigorous studies, by two different investigators or investigating teams.

dWell-supported therapeutic packages are defined as those with randomized clinical trial (or equivalent) evidence of their efficacy (absolute, relative, and/or specific) and/or effectiveness. “Well supported” in this framework means that a package has been empirically supported in at least two rigorous studies, by two different investigators or investigating teams.

The darker backgrounds (Categories V–IX) signify pseudoscientifically oriented psychotherapies (POPs); the core of the POPs is Category IX. The lighter backgrounds (Categories I–IV) signify scientifically oriented psychotherapies (SOPs); the core of the SOPs is Category I. Depending on the progress of research, a psychotherapy could move from one category to another.

1.4 What We Aim to Accomplish

Our book presents the most systematic evaluation of psychotherapies for a variety of psychological disorders. The structure relies heavily on the David and Montgomery (2011) framework for evaluating the state of the science of psychotherapy interventions. More specifically, we have engaged eminent experts to evaluate the scientific status of psychotherapy for each disorder presented in the pages that follow. The new framework is used as a springboard to consider both theory (i.e., mechanisms of psychological change) and the therapeutic package. Contributors evaluate therapies in terms of the extent to which interventions and theoretical mechanisms are supported by empirical evidence ranging from empirically well-supported to contradictory evidence. Although the framework uses categories, with well described criteria for placement in each category (e.g., minimum number of positive trials), to describe the empirical status of studies pertinent to different disorders, the chapter authors do consider the entire body of evidence related to the therapies they describe and address the strengths and weaknesses of the research base in doing so (e.g., through the use of the “mixed data” status). This scheme affords researchers, clinicians, patients, and students the opportunity to assess the empirical status of treatments for disorders likely to be encountered in clinical practice and to separate science-based treatments from primarily pseudoscientific interventions.

To facilitate comparisons across disorders and therapies, and to move the field of psychotherapy forward, we invited experts to present (1) a description of the disorder (e.g., diagnostic features, prevalence); (2) a review of empirical support for the intervention and the supporting theory; and (3) implications for research and practice. The chapters encompass adult and child treatments and family and couples interventions. Our aim was to catalogue studies that support or fail to support treatment efficacy and effectiveness and to assess whether the psychological mechanisms presumed to be associated with therapeutic change are, in fact, supported by empirical studies. Typically, the term “efficacy” refers to studies with maximum internal validity (e.g., an RCT with a well-described treatment protocol and highly trained therapists), whereas the term “effectiveness” refers to studies that evaluate how well an intervention works in the real world or everyday practice. Nevertheless, in this volume, the terms are often used interchangeably by the authors so the exact meaning should be determined in each context. Taking into account our classification scheme, which is based on randomized trials, typically the focus is on efficacy studies, without ignoring existing effectiveness studies.

1.5 Conclusions

In conclusion, the authors of the chapters in this book evaluate the evidentiary status of treatments for a specific disorder or condition in terms of a well-delineated framework. By providing an up-to-date snapshot of the field of psychotherapy and pinpointing gaps in our knowledge of the efficacy and effectiveness of diverse interventions, each chapter provides researchers with potential directions for future studies.

Surveys consistently reveal that many clinicians do not embrace empirically supported psychotherapies, despite clear indications of their superiority over interventions that might be appealing on face yet have little or no scientific standing (Lilienfeld, Ritschel, Lynn, Cautin, & Latzman, 2013). Accordingly, an overarching goal of this book is to tout the promise of empirically based methods and to increase the accessibility of the very best practices available for psychological disorders and conditions (ranging from insomnia to schizophrenia) and broadly promote their dissemination.

Readers will come to appreciate that the empirical support for theory and treatment protocols varies greatly, and that some treatments are considerably more efficacious or effective than others within and across the psychological disorders and conditions reviewed. We hope that our book will serve as an invaluable resource for the broad range of consumers (or potential consumers) of psychological services who wish to make informed choices regarding the most efficacious treatments for their problems in living and the psychological challenges their loved ones face.

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2Varieties of Psychotherapy for Major Depressive Disorder in Adults: An Evidence-Based Evaluation

Daniel David,1 Ioana A. Cristea,1 and Aaron T. Beck2

1 Department of Clinical Psychology and Psychotherapy, Babeş-Bolyai University, Cluj-Napoca, Romania

2 Department of Psychiatry, University of Pennsylvania, Philadelphia, USA

2.1 Description of the Disorder

According to the Diagnostic and Statistical Manual of Mental Disorders, major depressive disorder (MDD) is characterized by persistent low mood and/or loss of interest or pleasure in most activities (American Psychiatric Association, 2013). For a person to qualify for a diagnosis, at least five of nine symptoms must be present, including significant changes in appetite or weight loss, insomnia or hypersomnia, fatigue and loss of energy, noticeable physical agitation or slow-down, feelings of worthlessness or excessive guilt, reduced concentration or persistent indecision, and recurrent thoughts of death or suicide (American Psychiatric Association, 2013). Symptoms have to be present for at least 2 weeks, for most of the day.