Meta-analysis: On the road to synthesis of knowledge?

The future of meta-analysis is considered following an overview of its methodological procedures and the trends in their application to the psychotherapy outcome literature. Methodological issues, such as quality selection and the potential moderating effects of methods on outcomes, are addressed. Proposals for future meta-analysis reports are offered. The need for normative comparisons and the assessment and quantification of the quality of therapy are specifically recommended.     

Limitations,liabilities, and obstacles in reviews of the literature: The current status of meta-analysis

In the 7 years since the publication of Smith and Glass' initial results of their psychotherapy outcome meta-analysis the topic of quantitatively-based literature reviews has been one of the most controversial in clinical psychology. The debate has made apparent a wide variety of problems with the typical manner in which research domains are reviewed in general, and with the application of statistical procedures to those reviews in particular. This article summarizes the current state of affairs in the conduct of a meta-analysis, and outlines the broad range of problems and limitations likely to be encountered. An attempt is made to distinguish the problems that are general to all reviews and those endemic to meta-analysis. These distinctions should aid future development and refinement of the review process in general, and make meta-analysis a more applicable and less controversial mode of inquiry.     

心理治疗效果的元分析研究综述

目的探讨元分析在心理治疗领域的研究现状和发展趋势。方法利用文献法对国外的相关研究追行整合。结果大多数元分析研究所得到的平均效果量大于0．5，这意味着心理治疗的效果是比较显着的。结论影响心理治疗效果的因素众多，追一步的研究不应只局限于单一变量的研究，而要更多了解多重变量之间的关系以及对治疗效果的影响。     

国内心理治疗效果的文献计量学分析

目的探讨国内心理治疗的整体效果及影响因素。方法利用文献计量学分析的方法,对我国自1990年至2003年6月间发表的有关心理治疗效果的103篇研究结果的重要变项进行登录,计算效果量,用SPSS进行整合分析。结果国内心理治疗研究的平均效果是正向的;治疗效果量在发表年代、治疗方式、治疗场所、个案性别、个案具有的不适应行为以及效果量统计来源等研究变项上达显著性差异,而在治疗取向和实验设计等研究变项上的差异不显著。结论国内心理治疗均具有大约中等程度的疗效,许多研究变项会影响心理治疗的效果。     

Attrition in maintenance therapy for recurrent depression. A preliminary report

All maintenance treatment programs are complicated by the issue of patient noncompliance. This report investigates factors contributing to noncompliance during a 2-year study designed to evaluate the efficacy of long-term antidepressant medication in patients with recurrent unipolar depression. Only 21 of 51 patients (49%) who entered maintenance treatment successfully completed this phase of the study. Fifteen patients (8 completers and 7 dropouts) were randomly selected for an interview which focused on their previous psychiatric treatment history and attitudes towards the maintenance treatment program. In addition, these patients also completed a comprehensive personality battery. Results indicate that, while both groups had similar attitudes about the treatment program, they differed significantly along personality and psychiatric treatment history variables. Dropouts scored higher than completers on a measure of hysterical personality style. They were also more likely to have received psychotherapy in previous treatment experiences and to rate it as beneficial, while completers consistently rated prior treatment, which did not include antidepressant medication, as being of no benefit whatsoever. In order to enhance patient compliance, it is important to obtain information early in treatment about patients' treatment histories and their expectations about effective treatment for depression.     

Eustachian tube function: physiology,pathophysiology, and role of allergy in pathogenesis of otitis media

Otitis media may be the result of Eustachian tube dysfunction or inflammation of the middle ear, or both. The Eustachian tube may be either abnormally patent (patulous or semipatulous) or, more commonly, obstructed. Functional obstruction is most likely due to either lack of tubal stiffness or an abnormal active opening mechanism, e.g., inefficient tensor veli palatini muscle. Mechanical obstruction may be secondary to extrinsic causes such as a nasopharyngeal tumor or possibly an adenoid mass. Intrinsic obstruction can result from an upper respiratory tract infection. Even though proof that allergy is causally related to otitis media is lacking, recent studies indicate that the Eustachian tube can become partially obstructed when upper respiratory allergy is present. In addition, there is now some evidence that in a small percentage of children with upper respiratory allergy, the middle ear may be a “shock organ.” Future studies are needed to define the role of allergy in the pathophysiology of the Eustachian tube and the pathogenesis of otitis media. Randomized clinical trials will be required to determine the efficacy of the currently popular forms of immunotherapy and allergy control in the prevention of otitis media.     

On the relationship between therapist experience and psychotherapy outcome

The question of whether a relationship exists between the therapists' level of experience or training and psychotherapy outcome has numerous implications for clinical training and practice. A comprehensive examination and meta-analysis of available research suggests that answers to this question are complex and problematic. The present review considers the question of the relationship between experience and outcome as it relates to a number of therapist, client, treatment, and methodological variables. This paper also considers past attempts by reviewers to summarize studies that sought to address this issue. In addition, it examines variables that helped predict whether a study's results favored (to varying degrees) experienced clinicians versus less-trained persons. A discussion of prominent methodological problems and recommendations for future research is also offered.     

Cognitive-behavior modification: A conceptual review

Conceptual issues regarding cognitive-behavior modification are presented, beginning with an analysis of the basic terms of cognition, behavior modification, and behaviorism. Five controversies in the relevant literature that stimulated increased interest in cognitive factors among behavior therapists are reviewed: (a) symbolic control in classical and operant conditioning; (b) Breger and McGaugh's (1965) critique of behavior therapy; (c) cognitive factors in systematic desensitization; (d) the debate regarding cognition in the first issue of Behavior Therapy (1970); and (e) Ledwidge's (1978) Psychological Bulletin critique of cognitive-behavior modification. An analysis of several conceptual issues emerging from the literature results in the following conclusions: cognitive-behavior modification is a “revolutionary” development only insofar as it extends beyond mediational behaviorism to a truly cognitive view that includes internal cognitive structures; cognitions are not behaviors, but can be studied in their effects on behaviors as is done with drugs and genetics; a unifiedinteractive approach that incorporates cognition, behavior, and affect represents the logical future development in psychotherapy research and practice.     

Convergence in counseling and psychotherapy: A current look

Increasing concern with the influence of therapist values and beliefs in psychotherapy underscores the importance of determining whether a patient's personality and personal belief systems become more like those of their therapist and facilitate improvement in the course of therapy. A review of literature suggests that convergence of patient and therapist belief systems and personalities is associated with improvement and that initial discrepancy among belief systems facilitates convergence. However, the relationship between convergence and improvement is sufficiently complex to disallow firm conclusions at this point. The importance of considering personal belief systems in psychotherapy is underlined by the fact that patients seem to adopt the personal beliefs of their therapists during successful treatment.     

Synthesis of IgE by the human conceptus

The capability of the human conceptus in synthesizing IgE was investigated in this study. Embryonic and fetal tissues obtained from spontaneously or therapeutically aborted conceptuses were cultured in the presence of ¹⁴C-labeled amino acids, and the culture fluids were then analyzed by radioimmunoelectrophoresis for the presence of radioactive IgE and IgG. Synthesis of IgE was noted as early as 11 weeks in fetal lung and liver, and by 21 weeks in fetal spleen. Interestingly, synthesis of IgG was also found as early as 11 weeks of gestation. The data indicate: (1) that the conceptus has the potential, in terms of IgE synthesis, for developing reaginmediated sensitivity in utero; and (2) that each of the immunoglobulin classes of man may be synthesized by separate lymphoid cell lines rather than from a single cell line that develops immunoglobulin synthesis sequentially.     

Use of an integrative interview to manage somatization

Although somatizing patients may be aided by psychotherapy, they usually are very resistant to any therapeutic engagement. We have found a biopsychosocial integrative interview to be helpful for involving severely somatizing inpatients in psychotherapy. Two case examples clarify four elements central to successful use of the interview: (1) the psychiatrist becomes involved early; (2) the interview occurs in the context of an inpatient medical work-up, at the conclusion of diagnostic testing, and after the psychiatrist has spent some time with the patient; (3) a multifactorial, integrated perspective is discussed with the patient; and (4) substantial empathy is achieved.     

Psychotherapy for chronic major depression and dysthymia: A meta-analysis

Although several studies have examined the effects of psychotherapy on chronic depression and dysthymia, no meta-analysis has been conducted to integrate results of these studies. We conducted a meta-analysis of 16 randomized trials examining the effects of psychotherapy on chronic depression and dysthymia. We found that psychotherapy had a small but significant effect (d = 0.23) on depression when compared to control groups. Psychotherapy was significantly less effective than pharmacotherapy in direct comparisons (d = − 0.31), especially SSRIs, but that this finding was wholly attributable to dysthymic patients (the studies examining dysthymia patients were the same studies that examined SSRIs). Combined treatment was more effective than pharmacotherapy alone (d = 0.23) but even more so with respect to psychotherapy alone (d = 0.45), although again this difference may have reflected the greater proportion of dysthymic samples in the latter. No significant differences were found in drop-out rates between psychotherapy and the other conditions. We found indications that at least 18 treatment sessions are needed to realize optimal effects of psychotherapy. We conclude that psychotherapy is effective in the treatment of chronic depression and dysthymia but probably not as effective as pharmacotherapy (particularly the SSRIs).     

心理治疗临床督导理论模型综述

心理咨询和治疗督导与临床工作之间关系密切，最早的临床督导是自心理治疗理论外推而来的，主要涉及从精神分析模型、以人为中心模型、认知行为模型、系统模型、结构模型等而衍生形成的几种督导模型。近年来的特殊督导模式的发展则是独立于心理治疗之外，代表性的有发展模型和社会角色督导模型。本文简要总结了该领域的各种理论模型．为心理咨询和治疗督导提供一个文献索引和概念框架。     

Is rational-emotive therapy a truly unified interactive approach?: A reply to Ellis

Ellis (1984) has noted that a unified-interactive approach (Schwartz, 1982) to clinical problems is not a new idea, but one that is contained in RET, and that he is therefore incorrectly classified as a cognitive primacy theorist. While these claims are partially correct, the present response holds that: (a) the unified-interactive approach is not a new idea, but an articulation of trends in psychology, adding a special emphasis which distinguishes it from RET; (b) while Ellis (1979a) in principle acknowledges an interactive position, the majority of his tenets (1979c) justifies viewing him as a cognitive primacy theorist; (c) RET would be a truly unified-interactive theory only if, following Eschenroeder (1982), it placed the interaction hypothesis at the core of the theory; (d) a unified-interactive approach would facilitate constructive dialogue between researchers studying the various components of the interaction by addressing them within a singular perspective, with the expectation that “primacy” will vary depending on the specific nature of the psychological event being studied.     

佛教思想对心理治疗观的影响

心理治疗的主要目的是减轻人们的心理痛苦。佛教如同任何宗教一样都有帮助人们减轻精神痛苦的作用。心理治疗源自西方的相对科学的体系,其理念重在以不同的方式帮助人们更好地适应环境,或更好地满足自己的需要。佛教中的理念引导人们应对心理痛苦的方式是接受放下,是一种人生态度。在心理治疗中渗入这一理念,会更有效地帮助来访者,至少在受佛教思想影响的中国文化背景下。本文将以心理治疗实践中的案例为例具体阐述佛教思想对心理治疗观的影响,并与心理动力学治疗和其他的心理治疗方法的一些理念进行比较。     

Life events assessment: Current practices, emerging trends

The study of stressful life events and disorder has become a prolific area of research in the past two decades, While a large literature suggests the importance and viability of this approach for studying basic stress and disease relationships, many important assessment issues require reevaluation. In particular, current assessment procedures are characterized by a wide range of varied practices. Given the lack of standardized procedures, combined with the inadequate psychometric properties of the life events instruments themselves, assessment issues may be most important for advancing knowledge of event-illness associations. Alternative approaches to assessing events, particularly taking into consideration the complex associations between events themselves, are outlined in the present paper as examples of assessment strategies that may more accurately reflect the importance of life events. Finally, the implications of such considerations for both theoretical and clinical issues are addressed.     

Stages of change

The transtheoretical model, in general, and the stages of change, in particular, have proven useful in adapting or tailoring treatment to the individual. We define the stages and processes of change and then review previous meta-analyses on their interrelationship. We report an original meta-analysis of 39 studies, encompassing 8,238 psychotherapy patients, to assess the ability of stages of change and related readiness measures to predict psychotherapy outcomes. Clinically significant effect sizes were found for the association between stage of change and psychotherapy outcomes (d = .46); the amount of progress clients make during treatment tends to be a function of their pretreatment stage of change. We examine potential moderators in effect size by study outcome, patient characteristics, treatment features, and diagnosis. We also review the large volume of behavioral health research, but scant psychotherapy research, that demonstrates the efficacy of matching treatment to the patient's stage of change. Limitations of the extant research are noted, and practice recommendations are advanced.     

Researching psychotherapy effectiveness in mental health service agencies

The results of psychotherapy outcome research to date are briefly reviewed and the reasons why this research has not had greater impact on the practice of psychotherapy in mental health service agencies are presented. Sources of pressure to conduct evaluation research are enumerated. Involving mental health practitioners in field research is proposed as a means of increasing the relevance of psychotherapy outcome research to service personnel. Difficulties frequently encountered in the planning, data gathering, and implementation of results phases of evaluation projects are discussed and recommendations are made for ameliorating these problems. An improvement-oriented feedback model of program evaluation is presented and the value of individualized measurement, repeated-measures designs, and experimental case studies in maximizing the utilization of research results are discussed.     

Pharmacotherapy with the mentally retarded: Implications for clinical psychologists

The present review was prepared to facilitate clinical psychologists' knowledge of possible therapeutic and contratherapeutic effects of pharmacotherapeutic agents used with the mentally retarded. Six classes of drugs regularly used with the mentally retarded are discussed: neuroleptics, anxiolytics, antidepressants, antimonics, stimulants, and antiepileptics. The conditions for which these drugs are prescribed, their prevalence of use, pharmacological properties, side effects, and effectiveness are considered, along with the availability of other treatments. Beyond this, the methodological issues involved in assessing drug effects and current litigation and legislation with the mentally retarded are summarized.