Empirical evaluation of the assumptions in identifying evidence based treatments in mental health. Clinical Psychology Review, 25(4), 459-486

Yale University, Suite 901, 300 George Street, New Haven, CT 06511, USA.
Clinical Psychology Review (Impact Factor: 7.18). 07/2005; 25(4):459-86. DOI: 10.1016/j.cpr.2005.03.001
Source: PubMed


Extensive analyses of data from the remarkably comprehensive data set established by the Treatment of Depression Collaborative Research Program (TDCRP), initiated and conducted by the National Institute of Mental Health (NIMH), enabled us to examine the contributions of three dimensions of the treatment process (type of treatment, aspects of the therapeutic relationship, and patients' pretreatment personality characteristics) to three assessments of therapeutic change (symptom reduction, reduction of vulnerability, and development of adaptive capacities) evaluated at termination and extended follow-up. The most consistent factors predicting therapeutic gain were the quality of the therapeutic relationship and patients' pretreatment personality dimensions. The implications of these findings for clinical practice, training, and research are discussed.

1 Follower
23 Reads
  • Source
    • "There is still a lack of knowledge on predictors of outcome of psychotherapy. Blatt & Zuroff [13] found that the success of short-term outpatient treatment depended mostly on two factors: the quality of the therapeutic relationship and patients’ pretreatment personality. In particular, those patients who were perfectionistic or self-critical before treatment improved less than those with low perfectionism. "
    [Show abstract] [Hide abstract]
    ABSTRACT: Background There is a lack of psychotherapeutic trials of treatments of comorbid depression in cancer patients. Our study determines the efficacy of a manualized short-term psychodynamic psychotherapy and predictors of outcome by personality and quality of the therapeutic relationship. Methods/design Eligible breast cancer patients with comorbid depression are assigned to short-term psychodynamic psychotherapy (up to 20 + 5 sessions) or to treatment as usual (augmented by recommendation for counseling center and physician information). We plan to recruit a total of 180 patients (90 per arm) in two centers. Assessments are conducted pretreatment, after 6 (treatment termination) and 12 months (follow-up). The primary outcome measures are reduction of the depression score in the Hospital Anxiety and Depression Scale and remission of depression as assessed by means of the Structured Clinical Interview for DSM IV Disorders by independent, blinded assessors at treatment termination. Secondary outcomes refer to quality of life. Discussion We investigate the efficacy of short-term psychodynamic psychotherapy in acute care and we aim to identify predictors for acceptance and success of treatment. Trial registration ISRCTN96793588
    Full-text · Article · Dec 2012 · BMC Cancer
  • Source
    • "Tyrka, Waldron, Graber and Brooks-Gunn, 2002; Vohs, Bardone, Joiner, Abramson and Heatherton, 1999). Perfectionism also negatively affects treatment outcome in a number of ways: it interferes with an individual's ability to participate in tasks of exposure, response prevention and cognitive restructuring for obsessive-compulsive disorder (Frost, Novara and Rhéaume, 2002); it decreases response for social anxiety (Lundh and Ost, 2001); it is associated with less reduction in depressive symptoms at the end of treatment for depression and at follow-up (Blatt and Zuroff, 2005; Hawley, Ho, Zuroff and Blatt, 2006). Hence perfectionism has been represented as a transdiagnostic mechanism, a construct of interest across a range of psychopathologies (Egan et al., 2011). "
    [Show abstract] [Hide abstract]
    ABSTRACT: Background: Research indicates that psycho-education and cognitive behavioural interventions can reduce perfectionism but to date no group treatments have been examined. Aims: The current study utilized a case series design to compare psycho-education materials and subsequent eight-week group cognitive behaviour therapy (CBT) to a baseline waitlist in an outpatient community psychiatry sample (n = 21). Method: Participants were assessed on five occasions: baseline, 4 weeks later (waitlist), 4 weeks after receiving psycho-education material, post-treatment (8 weeks after receiving the group intervention), and 3-month follow-up. Results: There was a main effect of time for perfectionism and negative affect from baseline to post-group (effect sizes ranging from 1.46 to 1.91) that were maintained at 3-month follow-up. Conclusions: These results suggested that group CBT for clinical perfectionism may be beneficial, but that psycho-education alone is not effective for reducing perfectionism or negative affect.
    Full-text · Article · Aug 2012 · Behavioural and Cognitive Psychotherapy
  • Source
    • "However, the present findings clearly underscore the interpersonal nature of perfectionism, as counterargued by Hewitt, Flett, Besser, et al. (2003) in their summary of early theoretical work and Dunkley, Blankstein, et al. (2006) in their review of interpersonal processes that might explain the link between SC perfectionism and distress outcomes. It is important to briefly consider the clinical implications of these results, particularly given that SC perfectionism has been found to have a negative impact on the effective treatment of psychological symptoms (e.g., Marshall, Zuroff, McBride, & Bagby, 2008; Rector, Bagby, Segal, Joffe, & Levitt, 2000; see Blatt & Zuroff, 2005, for a review). The broad implications for intervention of the present study are as follows: (1) in addressing the psychosocial problems associated with perfectionism in treatment, clinicians should focus more closely on self-critical evaluative tendencies than on high personal standards (e.g., Dunkley, Blankstein, et al., 2006); (2) in addressing self-critical evaluative tendencies, it is important to target the dispositional and situational influences of SC perfectionism on both intraand interpersonal processes (see Dunkley, Blankstein, et al., 2006; Hewitt, Flett, Besser, et al., 2003; Zuroff et al., 2004); and (3) decreasing SC and PS perfectionists' negative affect might be accomplished by enhancing their self-esteem and, for SC perfectionists only, reducing their attachment fears of closeness with others. "
    [Show abstract] [Hide abstract]
    ABSTRACT: This study of university students (64 men, 99 women) examined the role of self-critical (SC) and personal standards (PS) higher order dimensions of perfectionism in daily self-esteem, attachment, and negative affect. Participants completed questionnaires at the end of the day for 7 consecutive days. Trait and situational influences were found in the daily reports of self-esteem, attachment, and affect. In contrast to PS perfectionism, SC perfectionism was strongly related to aggregated daily reports of low self-esteem, attachment fears (fear of closeness, fear of dependency, fear of loss), and negative affect as well as instability indexes of daily self-esteem, attachment, and negative affect. Multilevel modeling indicated that both SC and PS perfectionists were emotionally reactive to decreases in self-esteem, whereas only SC perfectionists were emotionally reactive to increases in fear of closeness with others. These results demonstrate the dispositional and moderating influences of perfectionism dimensions on daily self-esteem, attachment, and negative affect.
    Full-text · Article · Jul 2011 · Journal of Personality
Show more