scholarly journals Limitations of Randomized Control Designs in Psychotherapy Research

2014 ◽  
Vol 2014 ◽  
pp. 1-5 ◽  
Author(s):  
Glenn Shean

Despite the growing influence of lists of empirically supported therapies (ESTs) there are concerns about the design and conduct of this body of research. These concerns include limitations inherent in the requirements of randomized control trials (RCTs) that favor those psychotherapies that define problems and outcome in terms of uncomplicated symptoms. Additional concerns have to do with criteria for patient selection, lack of integration with research on psychotherapy process and effectiveness studies, limited outcome criteria, and lack of controls for experimenter bias. RCT designs have an important place in outcome research; however it is important to recognize that these designs also place restrictions on what and how psychotherapy can be studied. There is a need for large scale psychotherapy outcome research based on designs that allow for inclusion of process variables and the study of the effects of those idiographic approaches to therapy that do not lend themselves to RCT designs. Interpretative phenomenological analysis may provide a useful method for the evaluation of the effectiveness of idiographic approaches to psychotherapy where outcome is not understood solely in terms of symptom reduction.

Author(s):  
Oksana Shymanska

The article substantiates Elinor Ostrom’s contribution to the theory of collective management of property. The author outlines solutions to problems of the most optimal use of scarce natural resources and their economically relevant preservation in a long-term perspective. The research paper affirms the idea that it is not only the government who can solve the problem of efficient use of resources for public purposes. It is proved that collective decisions can be made in the management of resources, under which the latter are maintained in good conditions while being used for general public. The most accepted models (‘the tragedy of the commons’, ‘the prisoner’s dilemma’, ‘the logic of collective action’) are examined. The above- mentioned models are frequently used as tools to study cases of economic policy-making in allocating scarce resources for public purposes, and as a concept for analyzing problems of individuals who seek to achieve collective benefits. It is emphasized that there is a need for a balanced application of the above models as metaphors, which substitute solid foundations of the economic policy, since the limitations suggested for easing the analysis are accepted without reservation as permanent empirical requirements that remain as such until adjustments are made by the government. Special emphasis is placed on the importance of developing the theory of human organization based on realistic assessments of human possibilities and limitations that arise when a number of various situations related to using public goods are to be resolved. It is stressed that the empirically supported theories of human organization as an important component of study on economic policy are able to complement the solutions with estimates of the most likely effect of using many ways of organizing human activities. It is concluded that E. Ostrom’s experimental research in the field of natural resources management can be used to solve large-scale range of issues related to the production of public goods.


Oryx ◽  
2019 ◽  
pp. 1-10 ◽  
Author(s):  
Edwin L. Pynegar ◽  
James M. Gibbons ◽  
Nigel M. Asquith ◽  
Julia P. G. Jones

AbstractThe effectiveness of many widely used conservation interventions is poorly understood because of a lack of high-quality impact evaluations. Randomized control trials (RCTs), in which experimental units are randomly allocated to treatment or control groups, offer an intuitive way to calculate the impact of an intervention by establishing a reliable counterfactual scenario. As many conservation interventions depend on changing people's behaviour, conservation impact evaluation can learn a great deal from RCTs in fields such as development economics, where RCTs have become widely used but are controversial. We build on relevant literature from other fields to discuss how RCTs, despite their potential, are just one of a number of ways to evaluate impact, are not feasible in all circumstances, and how factors such as spillover between units and behavioural effects must be considered in their design. We offer guidance and a set of criteria for deciding when RCTs may be an appropriate approach for evaluating conservation interventions, and factors to consider to ensure an RCT is of high quality. We illustrate this with examples from one of the few concluded RCTs of a large-scale conservation intervention: an incentive-based conservation programme in the Bolivian Andes. We argue that conservation should aim to avoid a rerun of the polarized debate surrounding the use of RCTs in other fields. Randomized control trials will not be feasible or appropriate in many circumstances, but if used carefully they can be useful and could become a more widely used tool for the evaluation of conservation impact.


2017 ◽  
Vol 31 (4) ◽  
pp. 73-102 ◽  
Author(s):  
Abhijit Banerjee ◽  
Rukmini Banerji ◽  
James Berry ◽  
Esther Duflo ◽  
Harini Kannan ◽  
...  

The promise of randomized controlled trials is that evidence gathered through the evaluation of a specific program helps us—possibly after several rounds of fine-tuning and multiple replications in different contexts—to inform policy. However, critics have pointed out that a potential constraint in this agenda is that results from small “proof-of-concept” studies run by nongovernment organizations may not apply to policies that can be implemented by governments on a large scale. After discussing the potential issues, this paper describes the journey from the original concept to the design and evaluation of scalable policy. We do so by evaluating a series of strategies that aim to integrate the nongovernment organization Pratham’s “Teaching at the Right Level” methodology into elementary schools in India. The methodology consists of reorganizing instruction based on children’s actual learning levels, rather than on a prescribed syllabus, and has previously been shown to be very effective when properly implemented. We present evidence from randomized controlled trials involving some designs that failed to produce impacts within the regular schooling system but still helped shape subsequent versions of the program. As a result of this process, two versions of the programs were developed that successfully raised children’s learning levels using scalable models in government schools. We use this example to draw general lessons about using randomized control trials to design scalable policies.


2019 ◽  
Vol 27 (4) ◽  
pp. 195-208 ◽  
Author(s):  
Jennifer Schurer Coldiron ◽  
Spencer W. Hensley ◽  
Ryan M. Parigoris ◽  
Eric J. Bruns

Wraparound care coordination for youth with serious emotional and behavioral challenges has been implemented in every state and in many child-serving contexts, but evidence from rigorous effectiveness studies is scarce. We conducted a 20-month longitudinal randomized control trial of a pilot Wraparound program for youth in foster care and involved in the juvenile justice system ( n = 24), comparing outcomes with youth receiving community “treatment as usual” (TAU; n = 23). Youth in both groups experienced significantly improved outcomes, including fewer arrests and greater residential stability. Wraparound youth were less likely to be rearrested (odds ratio [OR] = 0.59, 95% confidence interval [CI] = [0.17, 2.04]), and survival analysis found they went longer before doing so than TAU youth. Wraparound youth were also more likely to be educationally on track than TAU youth by the end of the study (OR = 4.09, 95% CI = [1.89, 18.72]). Although these findings were nonsignificant at p < .05 due to small sample sizes, effect sizes were medium to large, and no such trends were found for the TAU group. Implications for Wraparound’s implementation and effectiveness, as well as the strengths and limitations of conducting a randomized control trial in “real-world” systems, are discussed.


2017 ◽  
Vol 39 (2) ◽  
pp. 104-115 ◽  
Author(s):  
Gregory T. Hatchett

Many insurance companies and professional organizations have increasingly stipulated that mental health professionals use interventions that have been classified as empirically supported therapies (ESTs). Though the EST movement aims to provide clinicians with straightforward, evidence-based interventions for making treatment planning decisions, there are several practical and scientific barriers to the wholesale implementation of ESTs by mental health counselors. These barriers will be discussed, and two alternative strategies—cultivation of the counseling relationship and routine outcomes monitoring—will be presented as evidence-based alternatives to prescriptive ESTs.


Author(s):  
Lee Hyer ◽  
Catherine A. Yeager

Our knowledge about the role of aging as a moderating or mediating influence on the expression of posttraumatic symptoms, and their remission and resolution, is nascent. This is reflected in the current state of empirically supported psychotherapies for older adults with PTSD. At this time, there are no empirically validated psychotherapeutic or psychopharmacologic treatments for this age group. This chapter highlights general issues and other factors unique to aging, such as changes in cognition, that must be taken into consideration when embarking on PTSD treatment with older adults. We review extant psychotherapy research that has applicability to this cohort: treatment studies on anxiety and depression for older adults, as well as treatment studies for younger adults with PTSD. Next, we describe promising PTSD interventions for older adults that have yet to be tested on large samples or in randomized controlled trials. The chapter culminates in the presentation of a multi-modal psychotherapy intervention designed to address factors unique to aging, and which involves a gentler version of trauma-related therapy that allows exposure to be optional.


2017 ◽  
Vol 42 (videosuppl1) ◽  
pp. V4 ◽  
Author(s):  
Chih-Chang Chang ◽  
Jau-Ching Wu ◽  
Peng-Yuan Chang ◽  
Mei-Yin Yeh ◽  
Yi-Hsuan Kuo ◽  
...  

There are many kinds of artificial discs available for cervical disc arthroplasty (CDA), with various designs of fixation and articulation mechanisms. Each of these designs has different features and theoretically fits most optimally in selected types of patients. However, there has been insufficient literature to guide individualized selection among these CDA devices. Since CDA aims to restore the joint function rather than arthrodesis, tailor-made size, shape, and mechanical properties should be taken into account for each candidate's target disc. Despite several large-scale prospective randomized control trials that have demonstrated the effectiveness and durability of CDA for up to 8 years, none of them involved more than one kind of artificial disc. In this video the authors present detailed steps and technical aspects of the newly introduced ProDisc-C Vivo (DePuy Synthes Spine), which has the same ball-and-socket design for controlled, predictable motion as the ProDisc-C. The newly derived teeth fixation provides high primary stability and multilevel capability by avoidance of previous keel-related limitations and complications (e.g., split vertebral fracture). Please note that the ProDisc-C Vivo is currently not available on the US market.The authors present the case of a 53-year-old woman who had symptoms of both radiculopathy and myelopathy caused by a large, calcified disc herniation at C4–5. There was no improvement after 4 months of medical treatment and rehabilitation. A single-level CDA was successfully performed with the ProDisc-C Vivo, and her symptoms were completely ameliorated afterward. The follow-up images demonstrated preservation of motion at the indexed level.The video can be found here: https://youtu.be/4DSES1xgvQU.


2021 ◽  
Vol 125 (3) ◽  
pp. 64-74
Author(s):  
Kseniia Solomakha

Recreational activities by the water are quite popular today. Swimming is one of the most popular ways of spending free time and sports activities, also swimming has few contraindications and, in general, is usually a good idea at any age. In our country we have a wide network of various water complexes from small spas, baths, swimming pools to large-scale water parks. At the same time, we can notice that visiting swimming pools, water parks, spa centers and other water complexes is associated with an increased risk of infectious and parasitic diseases, injuries, manifestations of allergic reactions in visitors, therefore, constant monitoring of the operation of such complexes is mandatory, as well as control at the design phase, because it`s easier to prevent some moments than to correct them in the future. Water treatment methods occupy an important place in the system of monitoring the parameters of the internal environment of the water complex and the quality of water in the pools, and these methods included filtration, disinfection, and water circulation conditions. The operation of the pool is inevitably associated with water pollution: it can be with pathogenic microorganisms, organic substances and the remains of cosmetics which enter the water with the swimmers. In this case, an insufficient level of culture of visitors, especially young children, who, due to their age, cannot control their physiological needs, also play a negative role. An important point is also the long-term use of water and not frequent sanitization of the pools (with a full drain of water). The unsatisfactory sanitary state of these complexes is also facilitated by the fact that the medical examination of visitors is rather formal, and in spa centers and water parks, which are most often visited by completely different people every day, they are not needed at all, as well as a certificate of good health; that’s why the implementation of sanitary and hygienic standards and modes of operation of pools and other water complexes is mandatory, in practice, unfortunately, in our country it completely depends on the awareness of business owners. However, the issue of safety while visiting such water complexes is important. The main purpose of our research was to analyze how visitors subjectively assess the safety of visiting water complexes, and to identify the main complaints that arise in those complexes where the main method of water disinfection is chlorination. Materials and methods: we did a cross-sectional survey among visitors of swimming pools and water parks during the period from August 2019 to December 2020 as well as the water samples were collected and analyzed. The practical significance of the obtained results was to identify the main trends, problems, and critical moments from the subjective point of view of the visitors and to be able to assess the importance of hygienic education while visiting water complexes. Conclusions: in general, we note the lack of knowledge and awareness of hygiene issues before and after visiting the swimming pool (water park), which should be noted by professionals responsible for the health of visitors of different water complexes.


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