Special Topics: Evidence Based Psychotherapy

Psych 5580A

 

Instructor: Jennifer Lundgren, Ph.D.

Contact Information: 4825 Troost, 108 C

lundgrenj@umkc.edu; Ph: 816-235-5384

 

Course Time: Thursday, 4:30 to 7:15 pm

Course Location: 4825 Troost, Rm 214M

Office Hours: Tuesday 10:00 to noon or by appt.

 

Required Texts:

Barlow, D.H. (2008). Clinical Handbook of Psychological Disorders: A Step-by-Step Treatment Manual. The Guilford Press: New York.

Articles/chapters listed for each topic are posted on Blackboard.

 

Recommended Texts:

Therapist guides and client workbooks from the Treatments That Work series (Oxford University Press; www.oup.com/us/ttw)

 

Purpose of the Course

Evidence Based Psychotherapy is designed to teach first and second year doctoral students in clinical psychology to evaluate critically the research base upon which EBP exists and to demonstrate skill in the use of evidence based psychotherapy for a variety of psychiatric disorders. In this context, students are also required to demonstrate appropriate ethical decision making as it is related to research and practice in psychotherapy. This is a core course in our APA approved doctoral program in clinical psychology, and is completed before or during the students' first clinical practicum.

 

Course objectives

By the end of this course you should be able to know/do the following:

-      Describe the history of the Evidence Based Psychotherapy (EBP) movement in the U.S.

-      Differentiate between efficacy and effectiveness research

-      Critically evaluate the research base upon which EBP rests

-      Demonstrate appropriate ethical decision making as it is related to psychotherapy in both research and clinical contexts

-      Develop a functional analysis of behavior to guide your treatment plan

-      Effectively demonstrate EBP skills, and apply these interventions to the wide variety of people and problems you encounter in clinical settings

-      Develop a plan to effectively monitor treatment outcome

 

Course Structure

This course will be part lecture/discussion and part student led demonstration/discussion, with the aim of blending traditional lecture, seminar, and active learning style courses. Lectures will last 1-1.5 hours, with the remaining time devoted to discussion of the course readings and/or student case conceptualizations and role play demonstrations. The text book should be used as a general reference and overview of current EBP research and techniques. The Blackboard readings should be studied in depth, as they will comprise the basis of our discussions. You should also read and familiarize yourself with the Ethical Principles of Psychologists and Code of Conduct (2002). This document is available to you via the APA website and will be handed out in class. Dr. Lundgren has copies of several of the therapist treatment guides and client workbooks—you should consult with her as your organize your mock case and role play.

 

Course Requirements

The success of this course will depend very much on the degree of your interest and participation. Active participation in discussions is therefore essential.

 

You will be evaluated based on the following criteria:

-      Each Wednesday by noon, emailing two discussion questions about the reviewed literature to me. You can focus your discussion questions on a particular reading or they can be broad questions encompassing each of the readings. Questions need not be longer than a couple of sentences. I will organize the questions and distribute them in class.

-      Full participation in class discussions and activities.

-      Functional analysis of behavior and effective demonstration of therapy technique. Starting with Part III, one or two student pairs will present a functional analysis of a mock client's behavior to the class and demonstrate a therapy skill. As a pair, you will:

 

1.     Present a functional analysis of your mock client's behavior based on the psychotherapy skill you will demonstrate.

2.     Demonstrate/role-play a core therapeutic technique that relates to your topic. For example, if your disorder is OCD and your EBP is behavior therapy; one of you will play the role of therapist and the other will play the role of client. You will present a brief case conceptualization and a detailed functional analysis of the obsessive/compulsive behavior based on the behavioral model and demonstrate exposure and ritual prevention for the class. Note: You are to demonstrate a technique, not the entire therapy session. This demonstration should be no longer than 15-20 minutes.

3.     You will create a list of assessment and treatment resources for your topic that includes key literature (articles/reference list for books, manuals), assessment questionnaires, helpful handouts and websites, and any other resources that will benefit you and your classmates when treating a client who presents to therapy with that particular disorder.

-      Midterm Examination (take home). This examination will cover the material from Parts I and II.

-      Final Examination (in class, modeling clinical comprehensive examination-type questions). This examination will primarily cover the material from Part III, but will also include conceptual and ethical issues from Parts I and II. In other words, it will require you to demonstrate effective integration of the course material in a comprehensive examination-type format.

Course Evaluation

Your grade for this course will be based on the described course requirements. In principle, everyone who regularly participates in class discussion, writes timely and thoughtful discussion questions, presents accurate and skilled class demonstrations, and performs well on the exams can earn an A. No student will get an A without actively participating in all class meetings.

 

A detailed breakdown of the course evaluation is as follows:

Discussion Questions: 5 points for each pair of questions

Class Participation: pass/fail

Case Conceptualization/Skill Demonstration: 100 points

Midterm: 100 points

Final: 100 points

 

Miscellaneous Course Information

Academic Dishonesty—I will follow the UMCK policy and procedures regarding academic dishonesty. Do not plagiarize and cite in APA style.

 

Disability Services—Please contact me if you desire an accommodation under the Americans with Disability Act; Office of Disabled Student Services: 816-235-5696.

 

Guests—Please contact me before bringing a guest to class (i.e., child, spouse, friend, etc.). Under most circumstances this is not acceptable, but accommodations can be made with advance notice and under exceptional circumstances.

 

Attendance—You are expected to be here for all scheduled classes. See me in advance if you need to be away due to an academic conference.


Date

Topic/Readings

August 21

Organizational meeting and introduction of course; Definition and history of psychotherapy

 

 

Part I: Conceptual Issues in Evidence Based Psychotherapy

August 28

Does psychotherapy work? The role of evidence-based approaches

Chambless, DL & Hollon, SD (1998). Defining empirically supported therapies. Journal of Consulting and Clinical Psychology, 66, 7-18.

Westen, D, Novotney, CM, & Thompson-Brenner, H (2004). The empirical status of empirically supported psychotherapies: Assumptions, findings, and reporting in controlled clinical trials. Psychological Bulletin, 130, 631-663.

 

Efficacy vs. Effectiveness

Nathan PE, Stuart SP, Dolan SL (2000). Research on psychotherapy efficacy and effectiveness: Between Scylla and Charybdis? Psychological Bulletin, 126, 964-981.

Seligman, M. (1995). The effectiveness of psychotherapy: The Consumer Reports study. American Psychologist, 50 (12), 965-974.

September 4

Treatment equivalence & Common factors

DeRubeis RJ, Brotman MA, & Gibbons CJ (2005). A conceptual and methodological analysis of the nonspecifics argument. Clinical Psychology: Science & Practice, 12: 174-183.

Kazdin AE (2005). Comment.

Wampold BE (2005). Comment.

Castonguay LG & Holtforth MG (2005). Comment.

Safer, DL & Huga EM (2006). Designing a control for a behavioral group therapy. Behavior Therapy, 37 (2), 120-130.

September 11

How does therapy work? Studying mechanisms of change

Doss BD (2004). Changing the way we study change in psychotherapy. Clinical Psychology: Science and Practice, 11, 368-386.

Tang T.Z, DeRubeis RJ, Beberman, & Pham (1999). Sudden gains and critical sessions in cognitive-behavioral therapy for depression. Journal of Consulting and Clinical Psychology, 67, 894-904.

Jacobson et al. (1996). A component analysis of cognitive-behavioral treatment for depression. JCCP, 64 (2), 295-304.

Mayberg, Silva, Brannan, Tekell, Mahurin, McGinnis, Jerabek (2002). The functional neuroanatomy of the placebo effect. American Journal of Psychiatry, 159, 728-737.

September 18

When interventions harm: Unsupported and iatrogenic approaches

Callahan RJ (2001). The impact of thought field therapy on heart rate variability. Journal of Clinical Psychology, 57, 1153-1170.

McNally RJ (2001). Tertullian's motto and Callahan's method. Journal of Clinical Psychology, 57, 1171-1174.

Rosa L, Rosa E, Sarner L, Barrett S (1998). A close look at therapeutic touch. Jama, 279, 1005-1010.

Devilly GJ (2002). EMDR: A chronology of its development and scientific standing. The Scientific Review of Mental Health Practice, 1, 113-138.

 

Ethics in Psychotherapy Research and Practice

Ethical Principles of Psychologists and Code of Conduct (2002)

 

 

Part II: Theoretical and Empirical Foundations of Psychotherapy

September 25

Overview of cognitive & behavioral approaches to psychotherapy

Beck, J.S. (1995). Cognitive Therapy: Basics and Beyond. The Guilford Press: New York. (Chapters 1,2, 6, 11)

Beck, A.T. (2005). The current state of cognitive therapy: A 40-year retrospective. Archives of General Psychiatry, 62, 953-959.

Fishman, D.B. & Franks, C.M. (1997) The conceptual evolution of behavior therapy. In Wachtel and Messer (Eds) Theories of Psychotherapy: Origins and Evolution. American Psychological Association, Washington, DC.

Midterm will be handed out in class

October 2

Developing a Functional Analysis of Behavior and Monitoring Treatment Progress

Sturmey, P. (1996). Functional analysis in clinical psychology. New York: John Wiley & Sons. Chapters 7 & 8

Author unknown (sorry, took from my grad class). Funtional analysis and assessment. Chapter 3 (example of anxiety disorders).

Hayes, S.C. & Follette W.C. (1992). Can functional anlysis provide a substitute for syndromal classification. Behavioral Assessment, 14, 345-365.

Hayes, S.C. & Nelson, R.O. Assessing the effects of therapeutic interventions. (Again, sorry I don't have more info—took from my grad files).

 

Midterm Due

 

 

Part III: Treatment Strategies

 

A. Anxiety Disorders

October 9

Panic Disorder, Agoraphobia

Barlow, Chapter 1

Chorpita, B.F. & Barlow, D.H. (1998). The development of anxiety: The role of control in the early environment. Journal of Consulting and Clinical Psychology, 124, 3-21.

Mitte, K.A. (2005). Meta-analysis of the efficacy of psycho-and pharmachotherapy in panic disorder with and without agoraphobia. Journal of Affective Disorders, 88, 27-45.

 

Treatment Resource or Manual:

Mastery of Your Anxiety and Panic (Craske & Barlow)

 

Techniques:

Cognitive Resturcturing, interoceptive cue exposure, breathing retraining, relaxation training

October16

Obsessive-Compulsive Disorder

Barlow, Chapter 4

Salkovskis, P.M. (1999). Understanding and treating ocd. Behavior Research and Therapy, 37 (suppl.1), S29-S52.

Whittal, M.L.,Thordarson, D.S., McLean, P.D. (2005). Treatment of obesessive-compulsive disorder: Cognitive-behavior therapy vs. exposure and response prevention. Behaviour Research and Therapy, 43, 1559-1576.

Franklin, M.E., Abramowitz, J.S., Bux, D.A., Zoellner, L.A.., & Feeny, N.C. (2002). Cognitive-behavioral therapy with and without medication in the treatment of obsessive compulsive disorder. Professional Psychology: Research and Practice, 33, 162-168.

 

Techniques:

Exposure and response/ritual prevention, flooding, cognitive restructuring, ACT (Hayes)

October 23

Acute Stress Disorder, Post-Traumatic Stress Disorder

Barlow, Chapter 2

Hickling, E.J. & Blanchard, E.B. (1997). The private practice psychologist and manual-based treatments: Post-traumatic stress disorder secondary to motor vehicle accidents. Behavior Research and Therapy, 35 (3), 191-203.

Sherman, J.J. (1998). Effects of psychotherapeutic treatments for PTSD: A meta-analysis of controlled clinical trials. Journal of Traumatic Stress, 11, 413-435.

Monson, C.M., Schnurr, P.P., Resick, P.A., Friedman, M.J., Young-Xu, Y. & Stevens, S.P. (2006). Cognitive Processing Therapy for Veterans With Military-Related Posttraumatic Stress Disorder. Journal of Consulting and Clinical Psychology, 74, 898-907.

Foa, E.B. Hembree, E.A., Cahill, S.E., Rauch, S.A., Riggs, D.S., Feeny, N.C. et al. (2005). Randomized trial of prolonged exposure for posttraumatic stress disorder with and without cognitive restructuring: Outcome at academic and community clinics. Journal of Consulting and Clinical Psychology, 73, 953-964.

 

Techniques:

Systematic desensitization, imaginal exposure, in vivo exposure, coping skills training, cognitive restructuring,

 

B. Mood Disorders

October 30

Major Depression, Dysthymia

Barlow, Chapters 6-8

DeRubeis, R.J., Hollon, SD., Amsterdam, J.D., Shelton, R.C., Young, P.R., Salomon, R.M., et al., (2005). Cognitive therapy vs. medications in the treatment of moderate to severe depression. Archives of General Psychiatry, 62, 409-416.

Jacobson & Gortner. (2000). Can depression be de-medicalized in the 21st century: scientific revolutions, counter-revolutions and the megnetic field of normal science. Behaviour Research and Therapy, 38, 103-117.

 

 

Treatment resource or manual:

Beck, J. (1995). Cognitive Therapy: Basics and Beyond. New York: Guilford Press.

Klerman, Weissman, Founsaville, & Chevron (1984). Interpersonal Psychotherapy for Depression. NY Basic.

Martell, Addis, & Jacobson. (2001). Depression in Context: Strategies for guided action. New York: Norton.

 

Techniques:

Behavioral activation, cognitive restructuring, problem solving grief, role disputes, role transition, and/or interpersonal deficits

 

C. Eating Disorders

November 6

Bulimia, Binge Eating Disorder

Barlow, Chapter 14

Wilson, G.T., Grilo, C.M., & Vitousek, K.M. (2007). Psychological treatment of eating disorders. American Psychologist, 62, 199-216.

Wilson, G.T. & Schlam, T.R. (2004). The transtheoretical model and motivational interviewing in the treatment of eating and weight disorders. Clinical Psychology Review, 24, 361-378.

Agras, W.S., Telch, c.F., Arnow, B., Eldredge, K. et al., (1995). Does interpersonal therapy help patients with binge eating disorder who fail to respond to cognitive-behavioral therapy? JCCP, 63 (3), 356-360.

 

Treatment resource or manual:

Overcoming Eating Disorders, Agras and Apple, 2007

Overcoming Binge Eating, Fairburn 1995, New York: Guilford.

Overcoming Night Eating Syndrome, Allison, Stunkard, Their, New Harbinger

Lock, J., le Grange, D. Agras, W.S., & Dare, C. (2001). Treatment manual for anorexia nervosa; A family –based approach. New York: Guilford.

 

Techniques:

Food monitoring (body checking, thought monitoring), Behavioral Chaining/Functional analysis of binge/purge, cognitive restructuring

 

D. Substance Use Disorders

November 20

Alcoholism, Addictions

Barlow, Chapter 12 & 13

Project MATCH Research Group (1998). Matching alcoholism treatment to client heterogeneity: Project MATCH three-year drinking outcomes. Alcoholism: Clinical and Experimental Research, 22, 1300-1311.

Bellack, A.S., Bennett, M.E., Gearson, J.S., Brown, C. H., & Yang, Y. (2006). A randomized clinical trial of a new behavioral treatment for drug abuse in people with severe and persistent mental illness. Archives of General Psychiatry, 63, 803-810.

 

Treatment resource or manual:

3 treatment manuals used in Project MATCH (NIAAA, $5 each)

 

Techniques:

Motivational Interviewing, functional analysis, behavior chaining, stimulus control

 

F. Serious Mental Illness

December 4

Serious Mental Illness (Schizophrenia and Bipolar Disorder)

Barlow, Chapters 10, 11

Velligan, D.I. et al., (2008). The use of individually tailored environmental supports to impreove medication adherence and outcomes in schizophrenia. Schizophrenia Bulletin, 34 (3), 483-493.

Miklowitz, D.J. (2006). A review of evidence-based psychosocial interventions for bipolar disorder. Journal of Clinical Psychiatry, 67 (Suppl. 11), 28-33

Pilling, S., Bebbington, P., Kuipers, E., Garety P., Geddes, J., Orbach, G. et al. (2002). Psychological treatment in schizophrenia: I. Meta-analysis of family interventions and cognitive behaviour therapy. Psychological Medicine, 32, 763-782.

 

Treatment Resource or Manual:

Cognitive Adaptation Training

Managing Bipolar Disorder, Otto, Reilly-Harrington, Kogan, Henin, Knauz, Sachs, 2008

December 11

Final Exam