Improving professional psychological practice through an increased repertoire of research methodologies: Illustrated by the development of MOL.

Abstract

Mental health problems present an increasing global disease burden making the development of effective and efficient psychological treatments an urgent public health priority. Despite the continued proliferation of treatments and large numbers of randomized controlled trials (RCTs), evidence suggests that pre-post effect sizes have been decreasing over time not increasing. Promoting RCTs as a gold standard of evidence has not been a useful strategy for advancing progress in the development of increasingly effective and efficient psychological treatments and has, in fact, created a divide between research and practice in professional psychology. To close this divide, other methodologies are needed that can assist in the rigorous development and evaluation of treatments in routine clinical practice. We outline some of the problems with using RCTs as the sole means of generating evidence for treatment effectiveness and efficiency and we use the development and evaluation of a transdiagnostic cognitive therapy to illustrate an alternative way of accumulating evidence through a much closer connection between research and practice. Ultimately, including other methodologies alongside RCTs that combine research and practice more seamlessly, will produce treatments of greater effectiveness and efficiency and help to reduce the global burden of mental health problems.

Identifying Functional Mechanisms in Psychotherapy: A Scoping Systematic Review

“…It might be the case that were Kazdin's recommendations for mechanistic research implemented rigorously-something that is not happening at present-it might result in the identification of plausible mechanisms (1). Recently, however, there have been calls for changes to evaluation practices to help improve the effectiveness and efficiency of psychological interventions, and to increase progress toward identifying plausible mechanisms of psychotherapeutic change (27,39,40). These changes would involve the adoption of a different approach to research practices to the one proposed by Kazdin (1).…”

Why Do We Need Computational Models of Psychological Change and Recovery, and How Should They Be Designed and Tested?

“…A case has been made regarding the limitations of randomized controlled trials of therapies in being able to understand how a given psychological intervention has its effects (1)(2)(3)(4). Psychological interventions are typically complex, multifaceted treatments, and so in a typical controlled trial, it is not clear which of the various active components of the treatment could account for any differences.…”

“…A series of articles have begun to make the case that a PCT explanation of psychological change is supported by existing computational models (2,34,35). These accounts rely on three additional principles within PCT that help to model how psychological change occurs in therapy.…”

“…It is well recognized that randomized controlled trials, in isolation, cannot identify the mechanism of action of a psychological therapy (1)(2)(3). Most commonly, tests of mechanism involve prospective studies or experimental designs (3,4).…”

Future of Rural, Remote, and very Remote Mental Health

“…It is especially important in RRvR locations where it is extremely unlikely that there would exist specialist eating disorder, obsessive-compulsive disorder, or mood disorder clinics that mental health professionals, to be effective, learn to work a-diagnostically. It is well established that comorbidity is extremely common in routine clinical practice (Carey et al 2017) which makes the delivery of disorder-specific models of treatment less than straightforward. If a middle-aged man in a rural farming community visits a mental health professional displaying symptoms of both anxiety and depression, which treatment protocol should be delivered?…”