Conducting Psychological Research in Medical Settings: Challenges, Limitations, and Recommendations for Effectiveness Research.

Abstract

Efficacy research is insufficient and ineffective in changing practice, despite a large supporting psychotherapy efficacy literature. Concurrently, demand for supporting data and the burden on everyday practice for generating these data is increasing. The disconnect between efficacy and effectiveness is due to a lack of conceptual and methodological tools for testing efficacious procedures in real-world settings, particularly medical contexts. This article articulates the position that effectiveness studies pose more complex questions that require an alteration of conceptual and methodological frames of reference in order to make behavioral services available to the broadest patient base. Barriers to Integrated ResearchClinical-outcomes research has historically held the blinded randomized control trial (RCT) to be the methodological gold standard (Guthrie, 2000;Wells, 1999), although this type of design is never fully optimized in behavioral or psychotherapy research (Guthrie, 2000). Such methods have favored methodological design elements that promote the internal validity necessary to demonstrate the efficacy of an intervention, often at the expense of generalizability. The logic of these designs for demonstrating meaningful causal relationships between independent and dependent variables has been clearly articulated, as have the threats to that logic (Campbell & Stanley, 1963;Cooke & Campbell, 1979). The demonstration of efficacy using the RCT is a critical step in generating evidence-based clinical knowledge, and an increasingly STEVEN M. SCHWARTZ received his PhD in clinical psychology from Virginia Commonwealth University. He is the research director for Oakwood Hospital and Medical Center (Dearborn, Michigan) and adjunct faculty at the University of Michigan. His interests include psychological and behavioral risk in patients with chronic medical illness, including cardiac care. PETER C. TRASK received his PhD in clinical psychology from the University of Maine and is an assistant professor (research) in the Department of Psychiatry and Human Behavior at the Centers for Behavioral and Preventive Medicine, Miriam Hospital and Brown Medical School. His clinical and research interests have focused on distress and quality of life in cancer patients. KALPANA SHANMUGHAM earned her PhD in clinical psychology from MCP Hahnemann University in 2001. She is currently a staff consultant with RHR International (Southfield, Michigan), a management-consulting firm focused on developing the strengths of individuals, the effectiveness of teams, and the performance of organizations. Prior to joining RHR, she focused her research efforts in the areas of psycho-oncology and behavioral cardiology. CYNTHIA OSWALD TOWNSEND received her PhD in counseling psychology with a subspecialty in behavioral medicine from Virginia Commonwealth University. She is a medical psychology fellow in clinical health psychology at the Mayo Clinic in Rochester, Minnesota, where she is specializing in chronic pain rehabilitation.

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