610 CHAPTER 15
respect, and understanding. Therapy should also offer clients a protected setting in
which to release emotions and reveal private thoughts and concerns and should help
clients understand why they feel the way they do and provide them with ways to
feel better. Other common factors in therapy effectiveness are opportunity for catharsis
(relieving pent-up emotions), learning and practice of new behaviors, and positive experi-
ences for the client (Norcross, 2005).
EVIDENCE-BASED TREATMENT An ongoing area of research in psychology is related
to identifying those treatments and other aspects of treatment that work best for spe-
cific disorders. Some treatments may not only be ineffective for certain disorders,
some treatments or alternative therapies may even prove to be dangerous or harmful.
Especially in light of managed health care and tight budgets, clients benefit through
evidence-based practice. Empirically supported or evidence-based treatment (EBT) refers
to techniques or interventions that have produced desired outcomes, or therapeutic
change in controlled studies (Barlow et al., 2013; Kazdin, 2008). Evidence-based prac-
tice includes systematic reviews of relevant and valid information that ranges from
assessment to intervention (American Psychological Association, 2005, 2013; Hunsley &
Mash, 2008; Kazdin, 2008; Nathan & Gorman, 2007). Some examples of evidence-based,
or empirically supported, treatments are exposure therapies, cognitive-behavioral, and
cognitive processing for PTSD (Ehlers et al., 2010; Hajcak & Starr, n.d.; Najavits, 2007;
Resick et al., 2008), cognitive-behavioral treatment for panic disorder with agoraphobia
(Barlow et al., 2007; Craske & Barlow, 2008), cognitive-behavioral group therapy for
social anxiety disorder (Turk et al., 2008), cognitive therapy for depression (Young et al.,
2008), antipsychotic drugs for schizophrenia (Sharif et al., 2007), and interpersonal psy-
chotherapy for depression (Bleiberg & Markowitcz, 2008). For additional information,
Division 12 of the American Psychological Association maintains an excellent resource
on research-supported treatments, https://www.div12.org/psychological-treatments/
treatments/.
NEUROIMAGING OF PSYCHOTHERAPY A growing body of research is focused on
the potential uses of neuroimaging in evaluating psychological treatments. These
studies are looking at the structural and functional changes that occur as the result
of treatment, those that occur during treatment, and the potential identification of
personalized treatment options for someone with a given disorder. While it will be
quite some time before such approaches may be feasible and broadly available for
individual consumers, if ever, it is still an exciting area of investigation and one that
will likely improve treatment options for many. Broadly speaking, there is support
for psychotherapy altering activity in brain areas associated with negative emotion,
emotion regulation, fear, and reward (Fournier & Price, 2014). Neuroimaging has
also been used to illustrate how individuals with major depressive disorder respond
to either psychological or pharmacological treatment based on pretreatment brain
activity. In one study, depressed individuals with hypometabolism in the insula
responded best with cognitive-behavioral therapy, while individuals with hyperme-
tabolism in the insula responded best to antidepressant medication (McGrath et al.,
2013).CULTURAL, ETHNIC, AND GENDER CONCERNS IN PSYCHOTHERAPY Consider the
following situation (adapted from Wedding, 2004).K. is a 24-year-old Korean American. She lived with her parents, who were both
born and reared in Korea before moving to the United States as adults. She came to
a therapist because she was depressed and unhappy with her lack of independence.
Her father was angry about her plans to marry a non-Korean. Her therapistevidence-based treatment
also called empirically supported
treatment, refers to interventions,
strategies, or techniques that have
been found to produce therapeutic
and desired changes during controlled
research studies.