Div12 Research-Supported Psychological Treatments

A working paper for Authors and Reviewers of

Energy Psychology: Theory, Research, and Treatment

Introduction:? In 1995, Division 12 of the American Psychological Association (The Society of Clinical Psychology) published a list of ?empirically-supported treatments,? which it continually updates.

Criteria for deciding whether a psychological treatment is empirically supported were developed in a series of papers by Chambless et al. and are the basis of the determinations on Division 12?s website on Research-Supported Psychological Treatments.

Of these papers, a seminal 1996 piece titled Defining Empirically Supported Therapies and a 1998 Update on Empirically-Validated Therapies are still considered authoritative.

While treatment outcomes are influenced by factors other than those associated with specific treatments?such as therapist and client variables and the therapeutic alliance?the guidelines in use by Division 12 on research-supported psychological treatments are of immense value for practitioners, researchers, health care administrators, and the general public.

This working paper provides an overview for authors and reviewers of Energy Psychology of the seven essential criteria for evidenced-based treatments as presented in the two Chambless et al. papers cited above, as well as criteria that are desirable or highly desirable but not described by Chambless et al. as essential.

It involves interpretation and has not been approved by Division 12, but is a carefully-considered overview.

While it is not a requirement that a study submitted to the journal meet the Chambless/Division 12 criteria for adding empirical support to a psychological treatment, it is a consideration in determining which papers will be selected for publication.

Basic Requirements for Studies that Lend Empirical Support to a Therapy

For a therapy to be considered a ?well-established treatment?:

I. Two strong studies by independent investigators or teams comparing groups receiving the treatment of interest and at least one other treatment condition must have demonstrated that the treatment of interest is:

A. Statistically superior to a pill, a placebo, or another treatment [or]

B. Statistically equivalent to an already established treatment.[1]

For a therapy to be considered a ?probably efficacious treatment?:

I. One strong study comparing groups receiving the treatment of interest and at least one other treatment condition must have demonstrated that the treatment is:

A. Statistically superior to a pill, a placebo, or another treatment [or]

B. Statistically equivalent to an already established treatment.[2]? Or:

II. Two strong studies showed the treatment to be statistically superior to a waiting list control group.

Additional Requirements

Overall Research Design

Essential Criterion 1:[3]? Randomized Controlled Trials (RCTs)?subjects were randomly assigned to the treatment of interest condition or to one or more comparison conditions.

Essential Criterion 2:? Adequate sample size to detect statistically significant (p < .05 or better) differences between the treatment of interest and the comparison condition(s) were used.

Highly Desirable: A sample size of at least 25 to 30 in each treatment condition.

Sample Description

Essential Criterion 3:? The population for which the treatment was designed and tested must be clearly defined either through the use of diagnosis by qualified clinicians, or through cutoff scores on questionnaires that are reliable and valid, or through interviews identifying the focus of the study?s interest, or through some combination of these.

Highly Desirable: ?Use of a structured diagnostic interview to assign diagnoses.

Highly Desirable: ?Use of standardized diagnostic procedures for assessing difficult diagnoses.

Desirable: ?Evaluation of other characteristics of the population that might affect the generalizability of the findings.

Outcome Assessment

Essential Criterion 4:? Assessment tools must have demonstrated reliability and validity in previous research.

Essential Criterion 5:? Any interview assessments were made by interviewers who were blind to group assignment.

Highly Desirable:? Researchers did not rely solely on self-reports.

Highly Desirable: Multiple methods of assessment were used.

Highly Desirable: Follow-up to assess the long-term effects of the treatment was conducted.

Desirable: Possible negative effects of the treatment were considered.

Desirable😕 Assessments that go beyond symptoms, examining the effects of the treatment on more general measures of functioning and quality of life were used.

Desirable😕 The clinical significance of the treatment was assessed?not just that the treatment produced a change but whether that change is of significant magnitude to be of value clinically.

Treatment Implementation

Essential Criterion 6:? Treatment manuals that make clear the nature of the treatment being tested was used.? If the treatment was relatively simple, it could be described in the procedure section of the journal article presenting the experiment in lieu of a treatment manual.

Highly Desirable:? Fidelity to the manualized procedures was enforced and assessed.

Desirable: Potential influences of the therapist?s or the investigator?s allegiance to the treatment being studied were assessed.

Data Analysis

Essential Criterion 7: The paper reporting the study provided enough data that the study?s conclusions can be reviewed for appropriateness, including sample sizes, use of instruments that detect changes targeted by the study?s design, and magnitude of statistical significance.

Highly Desirable:? ?In instances where drop-out rates differ substantially among treatment conditions, intention-to-treat analyses were conducted for all individuals who had been randomized to treatments.

Desirable:? Analysis was conducted of site effects, investigator effects, and/or therapist effects, such as the impact of the therapist?s training (or inexperience) with a particular modality or of the investigator?s allegiance to the treatment of interest.

Desirable:? The clinical significance of the findings in terms of the differences between functional and dysfunctional populations was described.

Desirable:Studies ideally involve multiple therapists and sites, and the investigators should determine whether sites and therapists are deferentially effective.

Additional Considerations

(See Chambless et al., 1996)

Combination treatments involving multiple components (p. 9).

Resolution of conflicting results (p. 13).

Limitations of efficacy (p. 14).

Effectiveness in the clinical setting as contrasted with efficacy in a controlled experiment (p. 14).

Generalizability across populations, therapists, and settings (p. 15).

Patience acceptance and compliance (p. 15).

Ease of dissemination (p. 15).

Cost effectiveness (p. 16).

 


[1] A series of single case design experiments may also qualify. See Chambless et al., 1996.

[2] A series of single case design experiments may also qualify. See Chambless et al., 1996.

[3] ?Essential? criteria are necessary for the study to establish a treatment as evidence-based; ?Highly Desirable? criteria are judgment calls that the Division 12 evaluators make based on various factors; ?Desirable? criteria do not necessarily need to be met to establish efficacy.