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Do empirically Supported Treatments Generalize to Private Practice?

Do Empirically Supported Treatments Generalize to Private Practice?

Holly Gerard

PSY 400 Abnormal Psychology

Dr. Ken Elliott

University of Maine Augusta

May 2016
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Gaston, J. E., Abbott, M. J., Rapee, R. M., & Neary, S. A. (2006). Do empirically
supported
treatments generalize to private practice? A benchmark study of a
cognitive-behavioural group treatment programme for social
phobia. The British Journal of Clinical Psychology / the British
Psychological Society.

Introduction

This article was chosen to critique for its personal and practical value.
Social anxiety

disorder is defined as having significant anxiety and discomfort about being


embarrassed,

humiliated, rejected, or looked down on in social interactions. I had been


living with social

anxiety disorder in my youth but had success in diminishing it with cognitive-


behavioral

therapy (CBT). Curiosity peaked when I found an article examining how a


randomized

controlled trial (RCT) of CBT translate to private therapy sessions. Not only
are the

findings of this study of interest to me, this information could be important to


those who

plan on administering treatment.

Although each case is individually based, efficacy studies of treatment


outside of

trials may change what is considered the best approach. Few studies
benchmarking

private practice settings for anxiety disorders have been conducted. Only
two studies were

cited as examining treatment generalization: Huag et al. and Lincoln et al.


Both of which,
Do empirically Supported Treatments Generalize to Private Practice? 3

the authors of the journal article criticize as, being limited. Given the high
prevalence and

interference of social anxiety disorder, and the potential significance of


private practice as

a point of specialized delivery treatment, it may be important to determine


whether the

same clinical outcomes can be achieved in private practice that result from
randomized

controlled trials. The following will provide a summary and discussion of the
journal

article titled Do Empirically Supported Treatments Generalize to Private


Practice? A

Benchmark Study of a Cognitive-Behavioral Group Treatment Program for


Social Anxiety

Disorder authored by J.E. Gaston and colleagues.

Summary

The objective of the study was to examine how an empirically


supported CBT group

program for social anxiety disorder can translate into a private practice
setting, as well as,

to compare outcomes from the university based clinical trial of origin and the
private

practice population. A benchmark strategy was used in evaluating


participants who met

the diagnostic criteria for social anxiety disorder completed the 10-session
group program.

Symptom severity was measured at three points: pre-treatment, post-


treatment, and three
Do empirically Supported Treatments Generalize to Private Practice? 4

months after treatment.

The result of the study showed that both the clinical program and the
program in

private practice had similar results. The treatment for both groups proved
successful for

both groups at the three-month check-in. The findings of the study suggest
that treatments

developed for randomized controlled trials are potentially transferrable to


private practice

settings.

Discussion

While meta-analytic studies are generally compared with private


practice

outcomes, this study took a specific treatment method from an RCT and
tested it in the

private practice setting. The study shows the ability to test the effect of
sample

characteristics on treatment generalizability more directly (Gaston et al.,


p.43). Although

knowing generalizability may aid in a practitioners choice of best evidence-


based practice,

therapy is individual-based and the practitioner may need to customize a


treatment plan

specific to the client.

The diagnostic procedure differed in the RCT and the private practice
setting. In the

RCT group, graduate students used the anxiety disorders interview schedule
for DSM-IV

(ADIS-IV; DiNardo, Brown, & Barlow, 1994). The private practice group was
diagnosed
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used a semi-structured clinical interview by clinical psychologists


experienced with

assessing anxiety disorders. Although the diagnostic methods varied, the


studys method of

measuring the patients social anxiety at the three marked points of


treatment seem

adequate. The authors utilized the Social Interaction Scale (SIAS; Mattick &
Clarke, 1998),

the Social Phobia Scale (SPS; Mattick & Clarke, 1998), and the Fear of
Negative Evaluation

Scale (BFNE; Leary, 1983). SIAS and SPS have proven to be both reliable and
valid. Despite

adherence to measuring treatment results strictly, treatment protocol was


not measured

in any standardized fashion to test for differences between therapist


treatment delivery

(Gaston et al., 2006).

Participants in each group had slight variations that may have affected
outcome. The

research unit participants seemed to be worse off than those in the private
practice setting.

More of the private practice participants were married. This suggests that
they may have a

better support system. The private practice sample had a greater number of
individuals

with an undergraduate degree and held managerial/professional jobs than


the research

unit. They also had lower rates of avoidant personality disorder, dysthymia,
major
Do empirically Supported Treatments Generalize to Private Practice? 6

depressive disorder, and alcohol abuse/dependence. Generalized anxiety for


the private

practice was only 1.9% higher than the research unit. Statistical analysis
comparing Axis I

and Axis II comorbidity rates between the two groups were not conducted
(40).

Although there is no evidence that the private practice sample doesnt


represent the

naturalistic setting, only one private practice setting was chosen with a
small group of

participants. The efficacy of only one mode of treatment, cognitive


behavioral therapy,

was tested. The study also only examines treatment administered in the
private practice

setting. It does not explore generalizability in community health or hospital


settings (44).

Conclusion

The breadth of the study is not sufficient to answer whether empirically


supported

treatments generalize to private practices. Several more studies should be


conducted

to determine whether RCTs generalize to private practice settings. I have


found one study

done in 2010, The Effectiveness of Routinely Delivered Cognitive Behavioral


Therapy for

Obsessive-Compulsive Disorder: A Benchmarking Study by Houghton et. al.,


that explores

generalizability of RCTs to other settings. These studies are good starts, but
both the same

mode of therapy on a small number of clients.


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Although the authors of study had a rebuttal to the criticisms


aforementioned, they

seemed to be suggestions rather than hard facts. When the modest size of
the groupings

was addressed, blame was cast upon the disorder itself. The reasoning was
cited from

Fedoroff & Taylor but I have difficulty believe that a larger sample could not
be found.

Also, given that the introduction was so long, I was surprised that the reason
behind the

objective was not explained in greater length. The private practice setting
was deemed as a

special delivery point but no facts were given to prove this idea. A more in-
depth and

detailed study is necessary to make this article relevant.

References

Gaston, J. E., Abbott, M. J., Rapee, R. M., & Neary, S. A. (2006). Do empirically
supported treatments generalize to private practice? A benchmark
study of a cognitive-behavioural group treatment programme for
social phobia. The British Journal of Clinical Psychology / the British
Psychological Society,45(Pt 1), 33.

Houghton, Simon, Saxton, David, Bradburn, Mike, Ricketts, Tom, Hardy,


Gillian. (2010). The effectiveness of routinely delivered cognitive
behavioural therapy for obsessive-compulsive disorder: a
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benchmarking study. The British Journal of Clinical Psychology / the


British Psychological Society, 49(Pt 4), 473.