benefits of clinical psychology in society

Physician and other health-care professional counseling of smokers to quit United States, 1991. Berndt ER. A.I. May Someday Work Medical Miracles. For Now, It Helps Do Paperwork Certainly, other psychosocial interventions are amassing similar experimental support that provides strong business and clinical cases for funding and broad implementation. One big advantage of becoming a psychologist is that you can have a rewarding career and still have plenty of time to spend with your friends and family. The Web site offers information on training content and cost and examples of letters notifications used to document treatment, which could be helpful to new practitioners of this intervention. Revicki DA, Siddique J, Frank L, Chung JY, Green BL, Krupnick J, et al. However, even this error-impregnated index shows a strong signal of a deteriorating trend in the scientific status of graduate education in clinical psychology. Mohr DC, Hart S, Vella L. Reduction in disability in a randomized controlled trial of telephone-administered cognitivebehavioral therapy. Family-focused therapy for bipolar disorder also has been shown to be cost-effective relative to other psychosocial programs (Miklowitz & Johnson, 2006; Wolff et al., 2006). With regard to CBT for bulimia nervosa, a systematic review of 47 studies suggested that whereas both medication (fluoxetine) and CBT exerted comparable short-term effects, only CBT yielded long-term effects (Shapiro et al., 2007). Craske MG, Golinelli D, Stein MB, Roy-Byrne P, Bystritsky A, Sherbourne C. Does the addition of cognitive behavioral therapy improve panic disorder treatment outcome relative to medication alone in the primary-care setting? In 2002, the Joint Commission (formerly, JCAHO), which accredits some 15,000 hospitals and health care programs, instituted an accreditation requirement for the delivery of evidencebased tobacco dependence interventions for patientswith diagnoses of acute myocardial infarction, congestive heart failure or pneumonia (www.coreoptions.com/new_site/jcahocore.html; hospitalspecific results: www.hospitalcompare.hhs.gov). Efficacy studies are those in which an interventions effects are estimated under conditions of optimal control and standardization. Criteria for such training include (a) high admission standards for student applicants; (b) a faculty of accomplished and productive researchers, as evidenced by high-quality publications, grant support, and other research achievements; (c) objective evidence that students are trained in basic and applied science and in empirically supported therapies; and (d) evidence that students both apply and produce science during and after their graduate training. At present, there is little basis for assuming that the induction of nonspecific effects will constitute a special province of scientifically trained psychologists or constitute a central basis of psychological practice. Randomized clinical trial of cognitive behavioral stress management on human immunodeficiency virus viral load in gay men treated with highly active antiretroviral therapy. Federal government websites often end in .gov or .mil. Protocols to support fidelity of implementation also are available. Multiple randomized controlled trials (RCTs) showed that after exposure treatment lasting between 9 and 15 sessions, 40% to 87% of patients no longer qualified for the diagnosis, whereas only 5% of patients in the various no-treatment control groups had shed the PTSD diagnosis (e.g., Foa, Rothbaum, Riggs, & Murdock, 1991; Marks, Lovell, Noshirvani, Livanou, & Thrasher, 1998; Paunovic & Ost, 2001; Resick, Nishith, Weaver, Astin, & Feuer, 2002). In this sense, the system is similar to the evaluative process used in the review of federal grants submitted to the National Institutes of Health or the National Science Foundation. Incremental cost-effectiveness of a collaborative care intervention for panic disorder. Spending for mental health and substance abuse treatment, 1996. Psychological science helps educators understand how children think, process and remember helping to design effective teaching methods. Current Status and Future Prospects of Clinical Psycholog Not only are these interventions effective, but they improve quality of life in a cost-effective manner. The NICE (2004) guideline noted that alternative psychosocial interventions (e.g., interpersonal therapy) typically require 8 to 12 months to achieve comparable results, suggesting that CBT is more likely to be cost-effective. This issue also shows how far we are from building a clinical psychology that can address todays mental and behavioral health needs in an optimal manner. Indeed, Foa and Rauch (2004) found that treatment decreased such negative cognitions and that these cognitive changes predicted reduction in the severity of PTSD. Behavioral couples therapy for female substanceabusing patients: Effects on substance use and relationship adjustment. Other major concerns revolve around the importance of specific therapeutic techniques. Whereas clinical psychology has been slow to respond to this need for health economic data (Fals-Stewart, Yates, & Klostermann, 2005), other fields have not been. Indeed, there is ample evidence, much of it coming from APAs own database. Matarazzo JD. Feenstra TL, Hamberg-van Reenen HH, Hoogenveen RT, Rutten-van Molken MP. Poisal JA, Truffer C, Smith S, Sisko A, Cowan C, Keehan S, et al. In: Fairburn CG, Wilson GT, editors. Psychiatric casualties of war. Despite the noted harms caused by tobacco use, until the mid- 1990s, public health advocates and tobacco researchers had little success in winning support for tobacco interventions and in spurring physicians and other clinicians to intervene in tobacco use. Assessing reactivity to virtual reality alcohol based cues. Boberg EW, Gustafson DH, Hawkins RP, Peressini T, Chan C, Bricker E. Development, acceptance and use patterns of a computer-based education and social support system for people living with AIDS/HIV infection. In addition to finalizing and publicizing its accreditation criteria, the PCSAS is in the process of taking such steps as (a) applying for recognition by an established accreditation approval agency (e.g., the Council for Higher Education Accreditation), (b) inviting programs to apply for review and launching initial reviews, (c) pursuing acceptance of PCSAS accreditation by such entities as the Veterans Affairs and state licensing boards, and (e) securing the necessary financial support to guarantee PCSASs future viability. Partners generally attend 12- to 20-hour-long sessions over 5 to 6 months. It alsowill provide all programs with a clearer vision of the features and processes that promote scientifically principled training, and this, in turn, should enhance the quality of the science generated in scientifically oriented programs. Dixon LS, Lyles A, Fahey M, Skinner A, Shore A. Adherence to schizophrenia PORT family treatment recommendations. Does therapist guidance improve uptake, adherence and outcome from a CD-ROM based cognitivebehavioral intervention for the treatment of bulimia nervosa? The parallels are striking and illuminating. Because PCSAS accredited training programs will focus on the selection, delivery, evaluation, and dissemination of experimentally supported interventions, the availability, application, and dissemination of scientifically validated treatments should expand significantly. In effectiveness research, the intervention typically takes place in more representative clinical settings or programs, is delivered via normal clinical delivery routes (by the clinics own personnel), is delivered to relatively unselected patients with no added extrinsic motivation to comply with treatment, and so on. On the basis of strong support from multiple wellconducted randomized trials, the National Institute for Health and Clinical Excellence (NICE, 2004) guideline gave a 16- to 20-session course of CBT for bulimia nervosa their highest (A grade level) recommendation. In addition, the field too frequently has not addressed questions of central concern to health care decision makers. What is the evidence that the current system is not working? A genuine contribution to the evidence wars. Such accreditation does not discriminate programs that are focused on science from those that are not. Coverage decisions for medical technology by managed care, relationship to organizational and physician payment characteristics. 3.5. From its inception, it has given vigorous and effective support to the development of psychological clinical science. Franklin ME, Foa EB. In addition, we hope that our review of the evidence provides insight into why health care purchasers, health care systems, and other stakeholders are turning increasingly to evidence-based interventions to meet the mental and behavioral health needs of their enrolleespatients. Centers for Disease Control and Prevention. Heuzenroeder L, Donnelly M, Haby MM, Mihalopoulos C, Rossell R, Carter R, et al. lifestyle, stress, health beliefs) and social conditions (e.g. In fact, considerable evidence indicates that many, if not most, clinicians view science or research as having relatively little relevance to their practice activities and decisions (e.g., Elbogen, Mercado, Scalora, & Tomkins, 2002; Lucock, Hall, & Noble, 2006; Nunez, Poole, & Memon, 2003). Randomized trial of prolonged exposure for posttraumatic stress disorder with and without cognitive restructuring: Outcome at academic and community clinics. Bryant RA, Sackville T, Dang ST, Moulds M, Guthrie R. Treating acute stress disorder: An evaluation of cognitive behavior therapy and supportive counseling techniques. 2009; 9(2): 67103. In 1997 only 25% of managed health care plans covered any tobacco dependence treatment; this figure approached 90% by 2003 (Tobacco Cessation Leadership Network, 2006). Los 8 beneficios de la Psicologa - Estilonext Wilson GT, Grilo CM, Vitousek KM. Is the breadth and depth of training sufficient to ensure that the graduates can function as independent psychological clinical scientists? Costs of training also are reduced, undoubtedly, by the limited scope and goals of training, with little or no emphasis given to basic science training, integrating science with clinical training, or the direct production of scientific data (e.g., McFall, 2006). To achieve this kind of differentiation, we believe that a new science-centered accreditation system represents the optimal strategy. Environmental-Personal Indicators in the Course of Schizophrenia (EPICS) Research Group. Understanding Clinical Psychology Similarly, at various points in the past, we clinical psychologists have presented ourselves as having the knowledge and skills to treat conditions such as schizophrenia, bipolar illness, and autism when, in fact, we had no scientific basis for entering the fray. Castonguay LG, Constantino MJ, Holtforth MG. Evidence has shown that specific psychological interventions can be highly effective with even severe psychosis. In: Lindberg DC, editor. Other interventions, such as behavioral activation, also could be reviewed in the same light. Zuvekas SH. Kessler RC, Ustun TB. Report of the committee on education. The situation has changed dramatically over the past decade. In summary, available evidence shows that CTCBT is efficacious, effective, and cost-effective relative to competing interventions for depression. Not only did their students earn lower scores on the exams, but the programs did not provide their students with the required training and resources specified in the licensing requirementsthat is, a science-based curriculum, adequate faculty, high admission standards, and essential facilities (e.g., libraries, laboratories, and physical resources). Information demands of occupational health physicians and their attitude towards evidence-based medicine. Cognitive therapy versus fluoxetine in generalized social phobia: A randomized placebo-controlled trial. Addis ME, Hatgis C, Krasnow AD, Jacob K, Bourne L, Mansfield A. Community management of schizophrenia. These discoveries were revolutionary, but not because they rendered a significant proportion of disorders tractable. Does psychotherapy research inform treatment decisions in private practice? OConnor K, Todorov C, Robillard S, Borgeat F, Brault M. Cognitive behaviour therapy and medication in the treatment of obsessive-compulsive disorder: A controlled study. Wampold BE, Ollendick TH, King NJ. These steps might include establishment of clinical science training grants by the National Institute of Mental Health, the National Institute on Drug Abuse, the National Institute on Alcohol Abuse and Alcoholism, or other units of the National Institutes of Health; actions to encourage a greater focus on scientific issues in licensing examinations and continuing education experiences; and improved basic science education at the college, high school, and elementary school levels. Unlinking negative cognition and symptoms of depression: Evidence of a specific treatment effect for cognitive therapy. This picture stands in sharp contrast to the popularity of psychological debriefing (e.g., Critical Incident Stress Debriefing; J.T. Advances in cognitive-behavioural therapy for unipolar depression. Although some of these differences might be due to the presence of PsyD programs in the study, Cherry et al.s data suggest that university-based PhD programs vary markedly in the quality of science training offered to their students. With over 3,000 members, the Society of Clinical Psychology is the APA's second largest division. The change often is attributed to a single event: the publication of the Flexner report in 1910 (Flexner, 1910). In summary, physicians have positive views regarding experimental evidence and recognize that it constitutes the preeminent touchstone regarding practice (e.g., Farquhar et al., 2002; Schaafsma, Hulshof, van Dijk, & Verbeek, 2004). The support and use of psychosocial interventions will be determined by status on a host of dimensions that typically are not considered in debates about psychotherapy effectiveness and empirically supported therapies. Moreover, increased organization of the trauma narrative over the course of therapy predicted patient outcome (Foa et al., 1995). PTSD: Science and practiceA comprehensive handbook. Testing mediational models with longitudinal data: Questions and tips in the use of structural equation modeling. 56). However, our view is that if an EST performs well relative to other competitors for the health care dollar (e.g., pharmacotherapy), this finding retains public health and clinical significance. cultural influences, family relationships and social support). This option, a new clinical psychology accreditation system, is intended to exemplify the sort of bold steps that must be taken to salvage the field. Indeed, two of the RCTs reported above (Faloon et al., 1984; Tarrier et al., 1989) included cost-effectiveness analyses and found that family treatments versus other psychosocial approaches resulted in lower overall costs, mainly as a result of reduced inpatient and day care. Some clinicians might take solace in findings that nonspecific effects often are correlated with outcomes; they may be tempted to use such effects to justify an eclectic or nonspecific approach to therapy; one that is based on no specific techniques, hypotheses, or putative mechanisms. However, there is strong, consistent evidence from multiple trials that the effects of CTCBT are more durable than are those for antidepressant medication; that is, once treatment is discontinued, relapse rates for patients receiving CBT are about half those for patients receiving medications (DeRubeis & Crits-Christoph, 1998; Gloaguen et al., 1998; Hollon et al., 2005). A review of science and pseudoscience in clinical psychology. In: Norcross JC, Beutler LE, Levant RF, editors. International Journal of Forensic Mental Health. Just as strengthening training standards in medicine markedly enhanced the quality of health care, improved training standards in clinical psychology will enhance health and mental health care. These findings represent only a portion of those that have been produced by recent tobacco science. Psychological clinical scientists should be involved directly in the formal decision analytic modeling for health care evaluation (Fals-Stewart, Yates, & Klostermann, 2005).
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