(10) Research methods and evidence-based practice in clinical psychology Flashcards Preview

Abnormal Psychology > (10) Research methods and evidence-based practice in clinical psychology > Flashcards

Flashcards in (10) Research methods and evidence-based practice in clinical psychology Deck (31)
Loading flashcards...
1
Q

What is evidence based medicine? EBM

A
  • The concept is about making sure that when decisions are made they are made on the basis of the most up-to-date, solid, reliable, scientific evidence.
  • In the case of medicine or health care, these are the decisions about the care of individual patients.
2
Q

What are the aims of EBM?

A

Aim: aims to apply the best available evidence gained from the scientific method to medical decision making.
-How? By ranking evidence based on: the quality of studies, the strength of their findings

3
Q

NICE guidelines for Mental Health and example?

A
  • 23 complete guidelines
  • Example: three sets of guidelines for depression:
  • Adults
  • Children and young people
  • Depression with a chronic physical health problem
4
Q

What is the process of EBM reviews?

A
  • Search
  • Read, include & exclude studies.
  • Appraise, according to set criteria to establish quality.
  • Synthesise where possible, by pooling results across studies
5
Q

Based in appraisal (How is it assessed?)

A
  • Of published papers: Depends in quality of search And on good critical criteria
  • Laboratory tests
  • Clinical experience
6
Q

How are Randomised Controlled Trials assessed?

A
  • The gold standard
  • Randomisation: Controls for unknown bias and confounding
  • Blinding: single and double
  • Control group
7
Q

How are RCT’s often flawed?

A
  • Incomplete randomisation (drop-out, allocation bias)
  • Length of trial? (e.g. dynamic versus behaviour therapy)
  • Blinding patients? Assessor?
  • Choice of control group? (Are waiting lists ethical?)
  • Choice of outcome? (Days off work might be a primary outcome to government, but not to patients…)
8
Q

A randomized clinical trial has four elements:

A
  1. A treatment group and a control group
  2. Randomization
  3. Blinding
  4. Ethics
9
Q

What are a treatment group and control group in a radomized clinical trial?

A

A treatment groupand acontrol group.The treatment group receives an experimental treatment. The control group might be given no treatment at all, aplacebo, or “treatment-as-usual.” The idea is that the control group gives the clinician something to compare the experimental results to.

10
Q

Why is randomization used?

A

Randomizationto allocate patients to one of the two groups. This randomization is normally performed by a computer.

11
Q

Why is blinding used?

A

Blindingto prevent the patient or researcher from knowing what group they are assigned to. In a blind trial, the participants don’t know what treatment they are receiving (which may be a placebo). In a double blind trial, neither the participant nor the researcher knows which group the participant is in. Trials are often double-blinded to avoidselection biason the part of the researcher.

12
Q

RCT can be problematic when…

A
  • Clearly successful intervention (implemented already or reviewed in meta-analysis): replace with head to head or non-inferiority trials.
  • Unethical (AZT)
  • Very large subject groups needed, or when cases are very rare (Examining the effect of counselling on ‘unifying’ personality in people with split personality)
  • Arguably, when treatment cannot be standardised (think which psychological model would fare better for standardisation)
13
Q

What are cohort studies?

A
  • Cohort studiesare a type of medical research used to investigate the causes of disease, establishing links between risk factors and health outcomes.
  • Cohort studiesare usually forward-looking - that is, they are “prospective”studies, or planned in
14
Q

What is a famous cohort study?

A

Hill & Dolls’ famous ‘Doctors Study’ started in 1951, finished in 2001, and provided strong evidence the smoking was closely linked to lung cancer.

15
Q

Aspects of a cohort study

A
  • Longitudinal.
  • Baseline measures.
  • No intervention, observe follow up over time, measure outcome.
  • Inform about causality.
  • Often large, costly, and time consuming
16
Q

Example of a systematic review of prospective cohorts

A
  • Examination of GP consultations with patients with uncertain causes/ treatments
  • Split GP behaviours into affective and cognitive reassurance
  • Examines patients outcomes at follow up
17
Q

What is a case control study?

A

-A study that compares patients who have a disease or outcome of interest (cases) with patients who do not have the disease or outcome (controls), and looks back retrospectively to compare how frequently the exposure to a risk factor is present in each group to determine the relationship between the risk factor and the disease

18
Q

Key aspects of a case control study?

A
  • Retrospective. (looking back on or dealing with past events or situations)
  • Select ‘cases’ and match with control group. ‘caseness’ is the outcome.
  • Measure exposure in the past to suspected factor.
  • If Odds are significantly higher in cases, exposure factor may have contributed to developing disorder
19
Q

What is sudden infant death syndrome? SIDS

A
  • Sudden Infant Death Syndrome (SIDS)
  • Sudden, unexpected, unexplained
  • Rare: less than 1 in 1000.
  • How to investigate?…
  • Evidence now supports brain abnormalities (in some), viral infection (in some), position face down (in some…)
20
Q

What did Brown et al discover in a cohort study about schizophrenia and flu in the second trimester?

A
  • Schizophrenia and flu in second trimester
  • First identified from cohort correlation: flu epidemic curve and later incidence increase.
  • How to study???
  • Brown et al (2004) were able to analyse blood serum from expecting mothers (59 children with Schizophrenia,105 matched controls)
21
Q

What are cross sectional/correlation?

A
  • A snapshot in time: all variables measured simultaneously.
  • Statistic tests inform on the relationship between two variables: significance and grade of relationship (high, moderate, low).
22
Q

What is Causality- Bradford Hill criteria?

A
  • Time line
  • Plausibility of model
  • Research data from different designs/ samples
  • Quality of relationship (R, d’, p)
  • Dose-response
  • Reversibility
23
Q

Problems for Evidence-based Psychology

A
  • Measurements: surrogate (e.g. behaviour for cognition), self-report, validity (stress?), reliability, cut-points
  • Can’t blind
  • Often ignore / can’t measure main issue (communication)
  • Multi-faceted problems
24
Q

What issues are there with experiments?

A
  • Can’t always generalise from animals (Seligman et al, 1978)
  • Can learn about internal processes (e.g. Stroop in Spider Phobics)
  • High on reliability but what about validity?
25
Q

What are the issues with publication bias?

A
  • Replication (not original)
  • Refutation (Type II error)
  • Political (from experimenters or editors)
26
Q

What are case reports?

A
  • Individual patients (e.g. Freud)
  • Form of a story
  • Can form a case series
  • Evidence? Controversial
27
Q

Pros and cons of case studies?

A
  • Necessary for rare disorders: split personality or neuropsychology
  • But no control for bias or confounding
  • Empirical quality can be improved in single subject designs (experimental, base-line, manipulation, outcome)
28
Q

What is the hierarchy of evidence?

A
  • Systematic reviews and meta-analysis
  • Randomised Control Trials
  • Cohort studies
  • Case-control studies
  • Cross-sectional studies
  • Case reports
29
Q

Strong evidence for EBP

A

-Experiments
-Genetic research
-BUT most interventions are based on case-studies / experience:
Treatment is never the same for two individuals
-Most therapists ‘eclectic’

30
Q

Why EBP is popular…

A
  • Challenges clinical experience / authority
  • Forces clinicians to continue learning
  • Disputes value of clinical decisions based on: anecdotes, press cutting, expert opinion
31
Q

Critical Appraisal of Method: Example of an item: How Participants need to be considered

A
  • Who is the study about?
  • Recruitment
  • Is it representative? (APD in prisons)
  • Are inclusion criteria well defined? GP case notes for the tag ‘depression’, rather than diagnostic criteria
  • Exclusion: Have groups been included that could unduly sway the results? Women’s’ anxiety levels, not excluding pregnant