Psychosocial Interventions for Mental and Substance Use Disorders A Framework for Establishing Evidence-Based Standards (2015) / Chapter Skim
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3 The Elements of Therapeutic Change
3 The Elements of Therapeutic Change
Pages 57-72
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From page 57... ...
AN ELEMENTS APPROACH TO EVIDENCE BASED PSYCHOSOCIAL INTERVENTIONS Specific and Nonspecific Elements Some debate exists as to the relative importance of specific and nonspecific elements. A common factors model for psychosocial interventions suggests that nonspecific elements are the most critical to outcomes (Laska et al., 2014)
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From page 58... ...
BOX 3-1 Nonspecific and Specific Elements of Cognitive Behavioral Therapy for Adult Anxiety and Depression Nonspecific Elements Specific Elements • nowledge and understanding K • xposure techniques E of mental health problems • pplied relaxation and applied A • Knowledge of and ability to tension operate within professional and • ctivity monitoring and scheduling A ethical guidelines • sing thought records U • Knowledge of a model of • dentifying and working with safety I therapy and the ability to behaviors understand and employ the • Detecting and reality testing model in practice automatic thoughts • Ability to engage client • liciting key cognitions E • bility to foster and maintain A • Identifying core beliefs a good therapeutic alliance • Employing imagery techniques • bility to grasp the client's A • Planning and conducting perspective and world view behavioral experiments • bility to deal with emotional A content of sessions • bility to manage endings A • bility to undertake generic A assessment • Ability to make use of supervision SOURCE: Roth and Pilling, 2008.
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From page 59... ...
Social skills training for schizophrenia includes such elements as behaviorally based instruction, role modeling, rehearsal, corrective feedback, positive reinforcement, and strategies for ensuring adequate practice in applying skills in an individual's day-to-day environment. Cognitive-behavioral therapy for substance use disorders includes elements of exploring the positive and negative consequences of continued drug use, self-monitoring to recognize cravings early and identify situations that might put one at risk for use, and developing strategies for coping with cravings and avoiding those high-risk situations (e.g., Carroll and Onken, 2005)
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From page 60... ...
At the same time, some specific elements differentiate among manualized psychosocial interventions or are unique to a given manual. For example, the element of "the dialectic between acceptance and change" is
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From page 61... ...
fantasy life) Manualized Psychosocial Manualized Psychosocial Manualized Psychosocial Intervention I Intervention II Intervention III Cognitive Processing Prolonged Imaginal Brief Psychodynamic Therapy for PTSD Exposure for PTSD Therapy Cognitive-Behavioral Therapy Psychodynamic Theory Shared Specific Elements (e.g., explore attempts to avoid distressing thoughts or feelings)
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From page 62... ...
ADVANTAGES OF AN ELEMENTS APPROACH A common terminology for listing elements may offer several advantages for evidence-based psychosocial interventions. A commonly agreedupon terminology for classifying specific and nonspecific elements would permit researchers to use the same terms so that data could be pooled from different research groups.
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From page 63... ...
. Psychosocial interventions comprising multiple specific elements can be problematic when one is studying moderation, because a complex intervention may include elements that are both more or less effective for a given individual.
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From page 64... ...
Similarly, the mechanism of social cognition in schizophrenia may be linked more closely to the element of "social skills training" than to the effects of broader intervention packages such as assertive community treatment or supported employment. Knowledge of mechanisms can be used to hone psychosocial interventions to be optimally effective (Kazdin, 2014)
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From page 65... ...
Furthermore, many training programs for evidence-based psychosocial interventions already use an elements framework, although currently these frameworks are tied to specific theoretical models and approaches. For example, the comprehensive program for Improving Access to Psychotherapies (IAPT)
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From page 66... ...
, an elements approach could encourage practitioners to select nonspecific elements as the foundation of their intervention, and to select specific elements from among those occurring most frequently that have an evidence base for their population (i.e., a personalized approach)
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From page 67... ...
In a randomized controlled trial, the elements approach was found to outperform usual care and standard evidence-based psychosocial treatment
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From page 68... ...
DISADVANTAGES OF AN ELEMENTS APPROACH The elements approach is more closely aligned with psychological therapies than with other community-based psychosocial interventions. In addition, different levels of abstraction may characterize elements from different theoretical models (e.g., structural elements in assertive community treatment versus content elements in cognitive-behavioral therapy)
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From page 69... ...
The committee also recognizes that evidence-based psychosocial interventions comprise therapeutic strategies, activities, and techniques (i.e., elements) that are nonspecific to most if not all interventions, as well as those that are specific to a particular theoretical model and approach to intervention.
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From page 70... ...
. The development and implementation of a research agenda is needed for • developing a common terminology for describing and classify ing the elements of evidence-based psychosocial interventions; • evaluating the sequencing, dosing, moderators, mediators, and mechanisms of action of the elements of evidence-based psy chosocial interventions; and • continually updating the evidence base for elements and their efficacy.
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From page 71... ...
2012. A model of therapist competencies for the empirically supported interpersonal psychotherapy for adolescent depression.
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