Standardized treatment manuals: Does adherence matter?

Hauke, Christina; Gloster, Andrew T.; Gerlach, Alexander L.; Richter, Jan; Kircher, Tilo; Fehm, Lydia; Stoy, Meline; Lang, Thomas; Einsle, Franziska; Deckert, Jürgen; Wittchen, Hans‐Ulrich

doi:10.7790/sa.v0i0.362

Cited by 4 publications

(2 citation statements)

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“…One study found a positive association between treatment adherence and efficiency for some but not all outcome measures (Robbins et al, ). One study found a negative association between treatment adherence and some but not all outcome measures (Hauke et al, ). Weck, Grikscheit, Jakob, Höfling, and Stangier () compared only treatment outcomes for participants that were classified as treatment failure or clear treatment, pertaining to 37% of all participants that were treated.…”

Section: Resultsmentioning

confidence: 99%

To manualize, or not to manualize: Is that still the question? A systematic review of empirical evidence for manual superiority in psychological treatment

2018

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Objective: Institutional promotion of psychotherapy manuals as a requirement for evidence-based treatments (EBTs) yields the assumption that manualized treatment is more effective than nonmanualized treatment. This systematic review examines empirical evidence for this claim. Methods: An electronic database search identified studies that directly or indirectly compared manual-based and nonmanual-based treatment. Results: Six studies directly compared manualized and nonmanualized treatment (Hypothesis 1). None support manual superiority. Eight meta-analyses indirectly assessed effect sizes of manual-based treatment and control groups (Hypothesis 2). Three support manual superiority, five do not. One meta-analysis and 15 further studies addressed manual adherence as an indirect indicator of manual efficacy (Hypothesis 3). The meta-analysis concluded that manual adherence does not affect outcome, additional studies provided inconclusive results.Conclusions: Manualized treatment is not empirically supported as more effective than nonmanualized treatment.While manual-based treatment may be attractive as a research tool, it should not be promoted as being superior to nonmanualized psychotherapy for clinical practice.

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Section: Resultsmentioning

confidence: 99%

To manualize, or not to manualize: Is that still the question? A systematic review of empirical evidence for manual superiority in psychological treatment

2018

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“…Another exception came from Emmelkamp et al (1994) At the very least, any claim that manualization is necessary to guarantee efficacy in the light of guidelines and ESTs having been derived from diagnosis-based RCTs can be dismissed, as comprehensive reviews have not supported this; nor that manual adherence is necessary (Truijens et al, 2019). In examining manual adherence, Hauke et al (2014) found that individualizing the treatment of Panic Disorder assisted in patients' motivation for exposure therapy and hence improved outcome. In the area of couple therapy, the best effects on marital distress have occurred in studies in which less structured protocols have been administered by more experienced therapists, with less pre-therapy training (Wright et al, 2007).…”

Section: The Benefits Of Formulation and Tailoringmentioning

confidence: 99%

Psychotherapy outcome research: Implications of a new clinical taxonomy

Bakker

2021

Clin Psychology and Psychoth

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Since the publication of DSM‐III in 1980, the scientist‐practitioner gap in clinical psychology has expanded, as almost all outcome research in clinical psychology has been on diagnosed mental disorders within a medical model using drug trial methodologies, whereas most practising clinicians undertake functional analyses and case formulations of clinical psychological problems (CPPs) and then apply tailored interventions within an ongoing hypothesis‐testing methodology. But comparatively reliable assessment and generalizable conclusions in psychotherapy outcome research require a comprehensive theory‐derived conception or operational definition of ‘CPPs’, standardized functional analyses, and a taxonomy of CPPs comparable to DSM's listings of mental disorders. An alternative conception and taxonomy of CPPs have recently been proposed, offering improvements in the reliability and generalizability of case formulation‐based psychotherapy outcome research. It conceives of CPPs as instances of the formation and operation of self‐sustaining problem‐maintaining circles (PMCs) of psychological‐level causal elements—that is, at the level of cognitions, behaviours, emotions, and events or situations (stimuli). The paper describes this new conception of CPPs, a subsequent nascent taxonomy of evidence‐based PMCs which standardizes the underlying mechanisms that maintain CPPs, and ensuing benefits to research (as well as to practice) in clinical psychology. These benefits include being able to encompass all treatment‐worthy CPPs, not just diagnosable mental disorders; to assess theory‐derived intervention strategies, not just arbitrary therapy bundles; and to directly feed back into psychological theories, not just expand an atheoretical list of patented “evidence supported therapies.”

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