Abnormal Psychology

184 CHAPTER 5

1991; Martin, Garske, & Davis, 2000; Messer, 2004; Messer & Wampold,

2002; Wampold, 2001). Thus, focusing on isolated components of treatment in

an effort to enhance therapy may not be as effective as proponents had hoped.

Moreover, RCTs generally do not assess patient variables, therapist variables,

and patient-therapist interaction variables (Table 5.3), which may be important

specific factors related to successful treatment (Beutler & Karno, 1999). For

instance, those with more severe symptoms generally respond less well to treat-

ment than do those with less severe symptoms, and those who are motivated

to change make more positive change than do those less motivated (Clarkin &

Levy, 2004; Garfi eld, 1994).

• Length of treatment. RCTs use short-term therapy, which may not be comparable
  to the type of therapy provided by most therapists. Moreover, research indicates
  that patients who have problems in only one sphere of life (for example, at work)
  receive greater benefi t from brief psychotherapy than do those with problems in
  multiple spheres of life (Barkham & Shapiro, 1990; Klosko et al., 1990; Strupp &
  Binder, 1984)—perhaps in part because when a patient has problems in multiple
  spheres, fewer sessions are devoted to problems in each sphere.


• Problems with DSM diagnostic groups. We discussed some of the criticisms of
  DSM-IV-TR diagnostic groups in Chapter 3. Many of these criticisms also arise in
  the context of RCTs. For instance, it is possible that two people with the same dis-
  order (according to DSM-IV-TR criteria)—but with different sets of symptoms—
  may respond differently to different treatments (Duncan, 2002).


• Dependent variables. What are appropriate dependent variables? Different types of
  therapy might be more (or less) effective with each of the variables listed in Table 5.3.
  Some RCTs focus exclusively on symptoms that pertain to DSM-IV-TR criteria. Per-
  haps treatments (or components of treatments) that reduce symptoms are different from
  those that improve relationships or quality of life. To the extent that researchers assess
  only DSM-IV-TR symptoms, such additional information will not be discovered.


• Applying the results to individual patients. Data from groups may not apply to
  a given individual sitting in a clinician’s offi ce. Each person has a unique back-
  ground and a unique set of abilities, skills, and interests. In choosing a type of
  treatment for a given patient, clinicians often rely on their own experiences with
  similar patients (Pilkonis & Krause, 1999).

Some of the criticisms of RCTs—and therefore of empirically supported

treatments—can be summed up by noting the difference between a treatment’s

effi cacy and a treatment’s effectiveness. Effi cacy is assessed within the carefully con-

trolled confi nes of RCTs in a research clinic. Effectiveness is assessed in nonresearch

settings, the place where most clinicians treat patients, without excluding them

because of multiple diagnoses. Thus, a treatment’s effectiveness refers to the

question of its generalizability to real-world settings, with no exclusion criteria,

no set number of sessions, and usually no treatment manual (Kendall,

Holmbeck, & Verduin, 2004; Lambert & Ogles, 2004; Roth &

Fonagy, 2005). RCTs and evidence-based practices may overempha-

size differences in technique among treatments while underemphasiz-

ing other factors that affect outcomes, such as the patient-therapist

alliance and other common factors (Wampold & Bhati, 2004).

Ethical Research on Experimental Treatments

Any research on treatment conducted by a psychologist is bound by the

ethical guidelines for research and usually must be approved by an IRB,

discussed earlier in the chapter. As shown in Table 5.4, research on a

new type of treatment—anexperimentaltreatment such as your grief

box therapy—is subject to additional guidelines because the researchers

may not be aware of some of the risks and benefi ts of the new treat-

ment at the outset of the study.

Ethical Guidelines for Research

on Experimental Treatments

Ho

Fon

size

ing

alli

Eth

An

eth

disc

new

box

ma

me

Psychologists conducting research on experimental treatments

must clarify to participants at the outset of the research:

(1) the experimental nature of the treatment;

(2) the services that will or will not be available to the control

group(s) if appropriate;

(3) the means by which assignment to treatment and control

groups will be made;

(4) available treatment alternatives if an individual does not wish

to participate in the research or wishes to withdraw once a

study has begun; and

(5) compensation for or monetary costs of participating.

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Dose-response relationship
The association between more treatment
(a higher dose) and greater improvement
(a better response).