Understanding the Differences Between Research Trials and What Treatment May Be Like for Your Loved One

Article summary provided by Kathryn Zumberg

 

THE MAIN POINT:

Treatment studies are great resources to aid you in learning more about potential treatment options for your loved one who may be struggling with social anxiety disorder; however, there are large differences between research studies examining treatment and the actual treatment that occurs in clinical practice. A brief description of some of these differences is described below.

 

THE DETAILS:

What makes treatment studies on psychotherapy different from the psychotherapy that your loved one may receive?

• Goals:
  • Research—The goal of most treatment studies is to examine whether or not a specific therapy produced meaningful and reliable change for individuals with a specific disorder. Therefore, the goal is basically to see whether or not the specific therapy works, which is called treatment efficacy (Kring, Johnson, Davision, & Neale, 2012).
  • Therapy— When your loved one goes to therapy, he or she will often work with the therapist to define specific goals based upon the kind of change he or she is seeking. Therefore, the goals of treatment will be tailored for the individual with the general aim of improving the individual’s psychological health (“Understanding psychotherapy and how it works,” n.d.).
• Problems addressed:
  • Research—Given the goals of treatment studies, the problems addressed are usually limited to one specific diagnosis. In order to target a single diagnosis, these studies tend to exclude individuals who also meet criteria for other diagnoses (e.g., Jain et al., 2007; Koszycki, Benger, Shlik, & Bradwejn, 2007).
  • Therapy—Unlike research, individual therapy does not exclude specific problems from treatment. Instead, individual therapy seeks to target many problems, such as symptoms of particular disorders, maladaptive behavioral patterns, poor coping skills, poor interpersonal relationships, and overall psychopathology (“Understanding psychotherapy and how it works,” n.d.).
• Delivery of treatment:
  • Research—Treatment studies typically use manuals, which are detailed guidebooks that specify how treatment should go in a step-by-step fashion (e.g., Jain et al., 2007; Koszycki et al., 2007). This is done so that treatment looks the same for all of the individuals in the study, which is necessary for researchers to see whether or not the treatment works (Kring et al., 2012).
  • Therapy—Therapy that your loved one may receive may also be done with a manual, but often treatment is tailored more towards the specific needs of the individual. This may result in a therapist using a manual with minor to major modifications, combining several treatments (with or without manuals), or designing therapy based upon clinical expertise (“Understanding psychotherapy and how it works,” n.d.).
• Length of treatment:
  • Research—Treatment studies limit therapy to a certain number of sessions (Goldfried & Wolfe, 1998). After the specified number of sessions has been reached, treatment is ended, regardless of how the individual is doing (e.g., Jain et al., 2007; Koszycki et al., 2007).
  • Therapy—The length of therapy varies widely in clinical practice. Sometimes, individuals may know that they will only work with a therapist for a set number of sessions, similar to research, due to limits set forth by insurance companies, but in other cases, the individual and the therapist will decide the length of treatment based upon the progress in treatment (“Understanding psychotherapy and how it works,” n.d.).
• Measurement of outcomes/success:
  • Research—Treatment studies need to be able to quantify change of individuals during treatment in a reliable way, which means that they often used standardized assessment tools, such as questionnaires and symptom counts. For example, a treatment study for social anxiety disorder will often use measures that provide an index of fear and avoidance of social situations and will count the current symptoms of social phobia (the current label for the diagnosis in DSM-IV-TR) (e.g., Jain et al., 2007; Koszycki et al., 2007). Success in treatment is then defined as significant change on these measures and/or significant change in symptoms. Additionally, studies will also examine whether or not individuals still meet criteria for a given diagnosis.
  • Therapy—In clinical practice, therapists will often incorporate standardized assessment tools into treatment, but usually treatment success is measured by both the client and therapist’s global assessment of whether or not the client has met his or her goals (“Understanding psychotherapy and how it works,” n.d.).

 

Given all these differences, how should you interpret results from treatment research?

Treatment studies essentially tell you that particular treatment works, in general, most of the time, when delivered a particular way and for a particular group of patients. In other words, these studies tell you that the treatment works, but won’t tell you whether or not the treatment will work for your loved one. Further, they don’t tell you whether or not the treatment will produce the same change for your loved one as it did for individuals in the study.

How can I learn more about treatments have been shown to work, that is, treatments that are efficacious? 

To learn more about treatments with demonstrated efficacy, you can visit the following website, which also has a nice FAQ about treatment efficacy:

http://www.div12.org/PsychologicalTreatments/index.html

How can I learn more about the differences between therapy research and therapy?

To learn more about this topic, you can read Research Designs in Clinical Psychology (Kazdin, 2003).

 

References

Goldfried, M. R., & Wolfe, B. E. (1998). Toward a more clinically valid approach to therapy research. Journal of Consulting and Clinical Psychology, 66(1), 143-150. doi: 10.1037/0022-006X.66.1.143

Jain, S., Shapiro, S. L., Swanick, S., Roesch, S. C., Mills, P. J., Bell, I., & Schwartz, G. E. R. (2007). A Randomized Controlled Trial of Mindfulness Meditation Versus Relaxation Training: Effects on Distress, Positive States of Mind, Rumination, and Distraction. Annals of Behavioral Medicine, 33(1), 11-21. doi: 10.1207/s15324796abm3301_2

Kazdin, A. E. (2003). Research design in clinical psychology (4th ed.). Boston: Allyn & Bacon.

Koszycki, D., Benger, M., Shlik, J., & Bradwejn, J. (2007). Randomized trial of a meditation-based stress reduction program and cognitive behavior therapy in generalized social anxiety disorder. Behaviour Research and Therapy, 45(10), 2518-2526. doi: 10.1016/j.brat.2007.04.011

Kring, A. M., Johnson, S. L., Davision, G., & Neale, J. (2012). Research methods in psychopathology Abnormal Psychology (Vol. 12th edition, pp. 104-130). Hoboken, NJ: John Wiley & Sons.

Understanding psychotherapy and how it works. (n.d.).   Retrieved October 14th, 2012, from http://www.apa.org/helpcenter/understanding-psychotherapy.aspx?item=10