Do psychotherapies have specific effects?

Development and Validation of the Psychotherapeutic Effectiveness Attribution Questionnaire (PEAQ-12) in a Spanish Population

In recent decades, the study of psychotherapy effectiveness has been one of the pillars of clinical research because of its implication for therapeutic cure. However, although many studies have focused their interest on the patient's perception, there are no instruments oriented to the study of psychotherapists' attributions of effectiveness: to what factors psychotherapists attribute responsibility for the cure of the therapies they provide. The present study aimed to develop and validate an instrument for assessing the attribution of the effectiveness of psychotherapy in a population of 69 psychotherapists of different theoretical orientations. After an initial process of inter-judge content validation, 12 items were selected for validation in the targeted population, adequately fulfilling the quality requirements in the validity-reliability tests, and grouped into four factors after principal component analysis. These factors were as follows: (1) therapeutic alliance enhancers; (2) psychotherapist emotional characteristics; (3) therapy-specific variables; and (4) facilitators of patient engagement with therapy. This four-factor structure also showed a good fit for the fit indices checked in confirmatory factor analysis. In summary, we can conclude that the Psychotherapeutic Effectiveness Attribution Questionnaire (PEAQ-12) developed in our research can be helpful if tested on a larger number of individuals. The results can be replicated in other populations of psychotherapists.

Treatment fidelity: its importance and reported frequency in aphasia treatment studies

PURPOSE

Treatment fidelity is a measure of the reliability of the administration of an intervention in a treatment study. It is an important aspect of the validity of a research study, and it has implications for the ultimate implementation of evidence-supported interventions in typical clinical settings.

METHOD

Aphasia treatment studies published in the last 10 years in 3 journals were reviewed using coding techniques that were adapted from Gresham, Gansle, Noell, Cohen, and Rosenblum (1993). The following items were noted: identifying information, study design, description of both the dependent and independent variables, and whether a measure of treatment fidelity was explicitly included.

RESULTS

Of the aphasia treatment studies published in the last 10 years, 14% explicitly reported treatment fidelity. Most studies reporting treatment fidelity used checking of videotaped sessions by independent raters. Of the reviewed studies, 45% provided sufficient treatment description to support replication.

CONCLUSION

Treatment fidelity is widely acknowledged as being critical to research validity and is a foundation for the implementation of evidence-based practices, but only a small percentage of aphasia treatment studies published in the last 10 years explicitly reported treatment fidelity. Recommendations for research practices include increased attention to matters of treatment fidelity in the peer review process and explicit incorporation of 3 levels of treatment fidelity in treatment research.

Clinical trials in neurorehabilitation

The clinical trial is essential to testing efficacy and effectiveness of therapeutic interventions. Neurorehabilitation presents unique challenges in the execution of clinical trials due to the complexity of both human interface with complex interventions and clinical/research staff interaction. Attention to key elements, recruitment, retention, treatment fidelity, and control intervention selection, contributes to successful conduct of a trial. Alternatives to the randomized controlled trial and outcome measure selection are important considerations contributing to the merit of the trial. While clinical trial outcomes contribute to the scientific evidence, their true value and impact comes in the next step, translation to clinical practice and the improvement of patient outcomes and qualify of life. Translation of evidence into practice may best be achieved via partnerships of scientists, clinicians, and administrators resulting in a dynamic interface between science and practice, the laboratory, and the clinic.