Lecture 11_2201_LHP.pdf

PSYU2201/PSYX2201 Counselling Approaches and Principles WEEK 11 LECTURE Acknowledgement of Country Macquarie University acknowledges the traditional custodians of the Macquarie University land, the Wallumedegal clan of the Darug nation, whose cultures and customs have nurtured, and continue to nur...

PSYU2201/PSYX2201 Counselling Approaches and Principles WEEK 11 LECTURE Acknowledgement of Country Macquarie University acknowledges the traditional custodians of the Macquarie University land, the Wallumedegal clan of the Darug nation, whose cultures and customs have nurtured, and continue to nurture, this land, since the Dreamtime. I’d like to pay my respects to Elders past, present and future, and particularly to any Indigenous students in this unit. 2 Teaching & Unit Surveys • Student feedback surveys on teaching and the unit are now open on your iLearn homepage. • This data is essential for 1) continuous improvement on the unit and 2) professional development (including awards, probation, promotions). • Please take 5 mins to complete this now. 3 Objectives In this lecture we will: • introduce evidence-based practice in counselling • understand how research contributes to counselling • overview the placebo effect as a threat to internal validity 4 Making Informed Decisions • Do you recall Lecture 2, where we introduced the three core psychotherapeutic approaches i.e., psychoanalysis, person-centred therapy, and CBT? • We said there are over 400 models of psychotherapy today… how do we make decisions about which approaches to use? 5 Evidence-based practice (EBP) Evidence is everything that may be used to determine or demonstrate an assertion of truth. Evidence-based practice is the integration of: (Straus et al., 2005) 6 Purpose of EBP According to Cormack (2002), EBP aims to: • improve quality, effectiveness, and appropriateness of clinical practice • Effective treatment increases adherence, reduces drop out, promotes recovery and maintenance • reduce variations in practice patterns, which can be a result of geographical differences or gaps between current knowledge and its application to care • substantiate the care provided to clients (best use of public dollar and insurers cover what works) • share decision making with the clients • provide a framework for lifelong, self-directed learning crucial for continued provision of quality care 7 Research and EBP EBP relies on critical thinking skills and includes: • evaluating evidence • awareness of bias • ethical practice • clinical reasoning and logic Research is being conducted but evidence is not being effectively transferred into action. This may be because of: • Eminence-based practice • Pseudoscience and “self-help” 8 Eminence-based practice • Psychology, and social sciences more broadly, has a long history upending sacred theories. • Every psychotherapeutic model, in every age, has its own assumptions and metaphors to describe the phenomena within its purview. • But revolutions come, and yesterday’s truths become today's discounted myth. Someday our contemporary paradigms, too, will outlive their usefulness, and will need revising and updating! 9 Eminence-based practice • Some professionals continue to practice as they were first trained during their undergraduate studies (Turner & Whitfield, 1997) • These beliefs and habits may be based on inaccurate or outdated sources • Health-related fields seem to rely on experience and that “senior” must be “better” (Steglitz et al., 2015) but those following eminence-based practice may make mistakes and not be accountable nor attempt to repair the therapeutic relationship • The public expects that assessments and interventions will be based on up-to-date evidence, not beliefs, assumptions, and habits 10 Eminence-based practice & pseudoscience From 1800s but making a modern “comeback”: • Physiognomy: the attempt to read personality from facial features and expression, assuming, for e.g., a person with a receding chin is “weak” or one with a high forehead is “clever” (Foo et al., 2021) • Phrenology (1800s): personality traits are represented by specific areas of the brain and the size of these areas (indicated by bumps and hollows on the skull surface) determines the degree of the corresponding skill or trait (Hughes, 2022) 11 Pseudoscience & self-help The “self-help” industry is influenced by marketing = global $80 billion per year with little to no evidence to support that specific interventions work! • i.e., mobile app X “MAY” play a role in overcoming addiction DiveThru is an app that focuses on a specific part of mental health while excluding other key aspects of the healing process. It is largely a mood tracker with selfdirected exercises and educational material. The premium version unlocks access to therapists if you’re willing to pay a monthly or annual fee (Alqahtani & Orji, 2020). • In other words, such therapeutic sessions are generally one-sided. This is not ideal, especially considering how important meaningful interaction is to understanding and resolving psychological issues. 12 Pseudoscience & self-help • Social media has shown staying power in destigmatising mental illness but not every video is helpful • Social media prefers fears, cures, wacky stories… because people do! Balance is not as exciting. • If you are looking for a good, non-journal source, http://theconversation.edu.au/ is a good way to go! • Misinformation directly undermines the help that we, as experts, are trying to give to our clients and the public • People want easy/cost effective answers, when in fact health and wellness are complicated, often requiring thinking and behavioural change rather than ‘simple’ hacks • So we turn to Dr. Google or TikTok influencers for selfdiagnosis, self-treatment, etc. 13 Pseudoscience & self-help • This can be troublesome when symptoms are actually caused by medical conditions (blood sugar dysregulation vs. bipolar disorder) • Intermittent fasting has regulatory benefits for the digestive system and other bodily processes. It can increase some hormones associated with an improved mood. However, these effects are a temporary fix for a deeper issue. Fasting has been associated with harmful mental health outcomes re disordered eating attitudes and behaviours, unpredictable moods, impaired thinking and decision making, which can lead to a poor relationship with food (Berthelot et al., 2021) 14 Pseudoscience & self-help Are you feeling anxious or depressed?? Answer: The detoxification foot bath! Claim: ionic foot spa’s “bio-magnetic field will encourage release of toxins, which may cause chemical imbalances in the mind and body”, evidenced by the red-brown bubbles ―Salts added to water cause oxidation (rust) and this would occur even if you did not put your feet in there. 15 The “Practice” Part of EBP ‘Attributes of a professional’ Humphrey et al. (2007): 1. Accountability: Therapists have the highest degree of legal accountability because they hold client welfare in their hands and so must use evidence to make best practice decisions 2. Advocacy: Championing their clients, using best evidence to support their case 3. Altruism: Always seeks to do the best possible for their clients by using evidence that improves outcomes for clients 4. Autonomy: Exercising independent professional judgement to best serve their clients’ needs 16 Objectives In this lecture we will: • introduce evidence-based practice in counselling • understand how research contributes to counselling • overview the placebo effect as a threat to internal validity 17 Psychotherapeutic research In your other research unit(s), you have learnt about the ways in which good evidence is gathered by designing sound research and conducting the appropriate analyses to answer your research question. Now, we link some of this pre-existing knowledge to discuss psychotherapeutic research. 18 Research questions Intervention: Does a treatment work? Diagnosis: Does a test detect a condition? Prognosis: What is the outcome of a condition? Aetiology: What is the cause of a condition? Epidemiology: What is the trend of risk? Experiences: How do people feel about/experience a condition? 19 Qual vs. Quant Selecting a Qualitative Method If you are interested in… Understanding human experience Uncovering social processes Learning cultural patterns Capturing unique stories Phenomenological methods Grounded theory Ethnographic method Case study method What is the human experience of … What is the theoretical explanation for people’s reactions to... How does this cultural group express their pattern of … What are the details and complexities of the story of … 21 Qualitative data looks like... Interview transcript excerpt on long-lasting friendships: 22 Quant: Observational research AKA non-experimental designs: research without intervening or modifying circumstances • For when the variables cannot, or should not be manipulated, study is called Ex Post Facto Design • For example, establishing gender differences in risk for depression. • Instead, choose participants who already differ on variable of interest (gender) • Prospective studies: begin with participants that are condition-free and follow them over time to see who develops a condition versus who does not • Retrospective studies (AKA case-control studies): begin with participants who have a condition and look backward to see if can identify why these participants have the condition 23 Quant: Experimental research • Research that involves manipulation of variables prospectively • For example, is behavioural counselling an effective weight-loss intervention for clients who are obese? • Variables are controlled for i.e., the researcher controls participants’ exposure to the independent variable or not. • The randomised controlled trial (RCT) is an example of a true experimental design • At least 2 groups – treatment (experimental) and control • Participants assigned randomly • Extraneous variables are factors besides independent variables that might affect the dependent variables, and need to be controlled. 24 Quant: Experimental research (RCT) 25 Levels of evidence 26 Levels of evidence • Ahn and Kang (2018) introduce how systematic reviews (SRs) are the evaluation of the quality of different studies on the same topic • Meta-analysis (MA) is a valid, objective, and scientific method of analysing and combining different results ― Meta-analyses also allow researchers to be familiar with other’s studies i.e., presenting a composite of raw data from other studies on the same topic to draw an overall conclusion 27 Aetiological claims How do we know that chronic pain causes depression? • We cannot use experimental methods (unethical) • So, to draw causal conclusions without experimental methods, there are six criteria that need to be met: 1. A “dose-response relationship” exists between chronic pain and depression i.e., reduction of pain reduces the incidence or severity of depression and vice versa. 2. Chronic pain precedes the onset of depression 3. A cause-and-effect relationship between chronic pain and depression is physiologically plausible 4. Relevant research data consistently reveal a relationship between chronic pain and depression 5. The strength of that correlation is relatively high 6. Studies revealing that correlation are well designed 28 A well designed study • In addition to randomisation (aka random assignment), all factors (other than the independent variable) that might also affect the dependent variable, must be held constant • A good design will be able to account for extraneous variables i.e., factors that are not intended to impact on the changes in the dependent variable (temperature, mental fatigue, etc.) and will have high internal validity 29 Internal Validity • Does a study actually investigate what it claims to, or is it measuring something else? ▪ For example, a private primary school believes that regular participation in mindfulness training can increase a child’s intelligence. What would be a valid way of assessing children’s intelligence? ▪ You may suggest something like Stanford-Binet Intelligence Test, but critique that there are different types of intelligence and note inherent cultural biases in most IQ tests ▪ These critiques highlight some concern for the internal validity of the study 30 Internal Validity Other threats to internal validity include: 1. The placebo effect (this is our focus for this unit) 2. The Hawthorne Effect 3. Natural recovery or maturation 4. Bias from assessor 5. Recall bias 6. Process of treatment 7. Performance bias 8. The Rosenthal Effect 31 Objectives In this lecture we will: • introduce evidence-based practice in counselling • understand how research contributes to counselling • overview the placebo effect as a threat to internal validity 32 The placebo effect • The placebo effect is the improvement due only to experiencing an intervention or event, whether real or not • The ritual of intervention rather, than the intervention itself, may produce beneficial effects • Research has shown that the placebo improvement in most interventions is estimated to be around 30% • i.e., 1 in 3 people will get better just due to the placebo effect (but has been up to 70% in some studies). • Placebos have been shown to lead to positive health outcomes for migraine headaches, pain, depression, anxiety, insomnia, asthma, hypertension 33 The placebo effect • Placebos impact people psychologically and physically by altering neurotransmitters, hormones, and endorphins • Effect exists for nearly every type of intervention, not just pills Factors that increase the placebo effect: • Big pills work better than smaller pills • Colored pills work better than white pills • Capsules work better than tablets • Placebos labeled with brand names work better than generic labels • More expensive treatments work better than less expensive ones 34 The placebo effect • Both therapist and client expectations can increase placebo effects • Treatments are effective when the treatment is more effective than the placebo ― Need to directly compare treatment versus the placebo ― Use two groups of people: one group receives treatment, and one group receives placebo 35 Objectives In this lecture we will: • introduce evidence-based practice in counselling • understand how research contributes to counselling • overview the placebo effect as a threat to internal validity 36 Relevance to your future careers • Whether you are client facing or research-focused, you will need to be confident with making treatment claims that are evidence-based. You may be found negligent if your actions or decisions that are not supported by evidence. • This requires us to: ― Be familiar with, and make effective use of each other’s research ― Be able to critique and assess the methodological and ethical soundness of a study (including adequate cultural safety) to determine the quality of the evidence ― Keep personal biases from contaminating results and/or our acceptance/rejection of findings. ― Make claims cautiously ― Replicate studies for contextual relevance as necessary 37 References Ahn, E., & Kang, H. (2018). Introduction to systematic review and meta-analysis. Korean journal of anesthesiology, 71(2), 103-113. Alqahtani, F., & Orji, R. (2020). Insights from user reviews to improve mental health apps. Health informatics journal, 26(3), 2042-2066. APA Presidential Task Force on Evidence-Based Practice. (2006). Evidence-based practice in psychology. The American Psychologist, 61(4), 271. Berthelot, E., Etchecopar-Etchart, D., Thellier, D., Lancon, C., Boyer, L., & Fond, G. (2021). Fasting Interventions for Stress, Anxiety and Depressive Symptoms: A Systematic Review and MetaAnalysis. Nutrients, 13(11), 3947. Cormack, J. C. (2002). Evidence-Based Practice… What Is It and How Do I Do It?. Journal of Orthopaedic & Sports Physical Therapy, 32(10), 484-487. Foo, Y. Z., Sutherland, C. A. M., Burton, N. S., Nakagawa, S., & Rhodes, G. (2021). Accuracy in Facial Trustworthiness Impressions: Kernel of Truth or Modern Physiognomy? A Meta-Analysis. Personality and Social Psychology Bulletin, 01461672211048110. Hughes, W. (2022). ‘A field for quacks to fatten in’: Phrenology in the British Isles. In The dome of thought (pp. 96-143). Manchester University Press. Humphrey, H. J., Smith, K., Reddy, S., Scott, D., Madara, J. L., & Arora, V. M. (2007). Promoting an environment of professionalism: the University of Chicago “Roadmap”. Academic Medicine, 82(11), 1098-1107. Steglitz, J., Warnick, J. L., Hoffman, S. A., Johnston, W., & Spring, B. (2015). Evidence-based practice. International Encyclopedia of the Social & Behavioral Sciences, 8, 332-338. Straus, S. E., Ball, C., Balcombe, N., Sheldon, J., & McAlister, F. A. (2005). Teaching evidence-based medicine skills can change practice in a community hospital. Journal of general internal medicine, 20(4), 340-343. Turner, P. A. T., & Whitfield, T. A. (1997). Physiotherapists' use of evidence based practice: a cross‐national study. Physiotherapy Research International, 2(1), 17-29. 38 39