Are RCT designs in psychotherapy research essential and exclusively necessary
to advance ESTs?
Within the literature westen et al. Seem to bring forth one of the more convincing papers addressing the problems with RCT designs, and advocate the use of alternative measure for psychotherapy research. Westen et al. Bring to light some serious concerns. The issues brought to light in the Westen et al, paper will be addressed as well as the response to the allegations. RCT designs in psychotherapy research are essential in psychotherapy research to advance ESTs, however, I do not believe they are exclusively necessary for their advancement. RCTs are one of the most important components in psychotherapy research but not the only component. Westen et. al., brings forth some interesting allegations regarding the use of RCTs. Some of which are widely agreed upon, others which appear to be nothing other than faulty allegations.
Westen et. al., brings forth some interesting allegations regarding the use of RCTs. Some of which are widely agreed upon, others which appear to be nothing other than faulty allegations.
Malleability (short term) -- explain what he says – and then explain how that is not true (give example)
Westen’s promotion of long-term therapies seem to ignore the issues of cost and patient compliance (Haaga, 2004). A heavy burden of cost and ability to keep patients in long term studies should beimportant considerations when comparing longer term and shorter therapies (Haaga, 2004).
- Discourage inclusion criteria, other than that a normal clinician would exclude in an everyday setting (Thompson-Brenner, 2004).
Inclusion criteria – excluded patients are more challenging that the enrolled patients (Haaga, 2004).
Isolation of personality characteristics
Problem with using DSM
By thinking categorically rather than dimensionally, one may interpret the existence of both anxiety and depression as an instance of comorbidity, rather than considering the possibility that a person’s depression results from fear-induced inhibition and passivity (Goldfried & Eubanks-Carter, 2004).
-assigning patients to treatment based solely on their DSM diagnosis – could be the issue not the RCT itself
- systematic desensitization to the treatment of public speaking anxiety. Westen et al. noted that the difficulty occurs when complex clinical problems are studied and when the intervention requires a departure from manual guidelines to use clinical
judgment—a threat to internal validity.
There is nothing in the logic of RCTs, nor in the criteria for identifying ESTs, that requires defining the relevant participant group by an Axis I condition. Indeed, my own contribution to the EST Task Force work (incorporated in Chambless et al., 1998) involved identifying ESTs for a behavior (cigarette smoking), not the related disorder (nicotine dependence). Furthermore, as long as the inclusion criteria are clear,...