Diagnostic and Statistical Manual of Mental Disorders
Running head: ASSIGNMENT 1: QUANTITATIVE JAR 1
ASSIGNMENT 1: QUANTITATIVE JAR 2
Assignment 1: Quantitative Journal Article Review and Topic Declaration
Abstract
This assignment is comprised of a Journal Article Review (JAR) related to the topic chosen for the Final Paper: Factors contributing to the success of Cognitive-Behavioural Therapy (CBT) in treating Panic Disorder. The article under review, The Effects of Treatment Compliance on Outcome in Cognitive-Behavioral Therapy for Panic Disorder: Quality Versus Quantity, employs a quasi-experimental design and is relevant to the topic for the Final Paper because it demonstrates the effectiveness of group CBT in the treatment of panic disorder, particularly when there is quality compliance with group exercises related to target outcomes, and that quality of work when compared to quantity of work, better predicts therapy outcome. The authors argue these findings are important for therapists to consider when designing good quality work and training patients to complete high quality assignments. Such considerations can contribute to the success of CBT in treating panic disorder.
Keywords: cognitive-behavioral therapy, CBT, panic disorder, anxiety
Table of Contents
Abstract ……………………………………………………………………………………………………….2
JAR: Quantitative Review…………………………………………………………………………………….4
References…………………………………………………………………………………………………….?
Assignment 1: Quantitative Journal Article Review and Topic Declaration
Introduction
Statement of Problem
This research aims to fill a gap in the literature on addressing quality versus quantity of assignments completed by patients receiving cognitive-behavioral therapy (CBT) for treatment of panic disorder (PD). The researchers evaluate the relationship between homework quality and outcome as they argue, based on clinical experience, that quality of homework completed is more important to recovery.
Literature Review
The authors review the literature evaluating the effectiveness of homework compliance on outcome of CBT. They argue a collaborative-empiricist approach to treatment requires treatment compliance for therapeutic change. The authors cite literature which supports clinical improvement for homework compliance (Edelman & Chambless, 1993; Barlow, O’Brien, & Last, 1984; Michelson, Mavissakalian, Marchione, Dancu, & Greenwald, 1986) and research by Mavissakalian and Michelson (1983) which does not support this relationship. Primakoff, Epstein, and Covi (1986) noted the gap in the literature on assessing quality versus quantity of homework, which has influenced the present study.
Hypotheses To Be Tested
The hypotheses to be tested are: 1. The overall quantity of the work completed by patients will be positively associated with treatment outcome; and 2. The relative quality of homework will better predict outcome.
Method
Smith and Woolaway-Bickel (2000) employ a quasi-experimental one-group pretest-posttest design. To control for within-group differences and increase internal validity, researchers placed stability requirements on medication use and accepted participants who were not suicidal or abusing substances, and had no history of schizophrenia, bipolar disorder, or organic mental disorder.
Participants
The sample consisted of 48 patients, mostly White (86%), female (66%), married (63%), and employed (52%) who met the Diagnostic and Statistical Manual of Mental Disorders, 4th edition (DSM-IV) criteria for PD with or without agoraphobia. Most patients (52%) were medicated. The participants were recruited by convenience sampling.
Materials
Participants were assessed pre- and post-treatment for clinical dimensions of PD. If panic frequency, anxiety, and phobic avoidance scores fell within the normal range post-treatment, participants were classified as recovered. Panic attack symptoms ratings by patients had adequate test-retest reliability throughout treatment and were significantly associated with corresponding self-report measures and clinic ratings (Schmidt & Woolaway-Bickel, 2000, p. 14). Videotaped interviews were randomly selected for viewing to establish interrater agreement on DSM-IV Axis I diagnoses. Interval scale measures such as The Multicenter Panic Anxiety Scale (MC-PAS), Sheehan Patient-Rated Anxiety Scale (SPRAS), Mobility Inventory for Agoraphobia (MI-Alone; MI-Accompanied), Sheehan Disability Scale, and Beck Depression Inventory (BDI) were administered pre- and post-treatment to measure self-rated disability and clinician-rated impairment. Researchers monitored participants’ panic symptoms and compliance through the Uniformed Services University of the Health Sciences (USUHS) Weekly Monitoring System.
Procedure
Patients received 12 sessions over 12 weeks of group CBT for panic disorder. Homework was assigned based on session exercises and individually-tailored to type of panic experienced by participants. Treatments were structured, manualized, well-defined, and administered by an experienced psychologist. Participants were assessed weekly on their subjective sense of time spent on homework and compliance. A quality ideal was operationally defined for therapists and participants. Participant quality compliance was measured with a 6-point Likert scale (0 = poor to 5 = excellent). To control for therapist bias on compliance ratings, an independent rater completed weekly quality and quantity ratings, thus increasing inter-rater reliability and internal validity. Inter-rater reliability for quantity and quality were high.
Statistics
Descriptive statistics, including measures of central tendency, frequency, and variation were used to describe data. Additionally, inferential statistics such as Pearson’s r and paired t-test values were calculated, and a stepwise multiple regression analysis was performed.
Results
Overall, patients completed 60% of home assignments, as rated by the therapist, with good quality (mean 2.8; SD – 0.9; range = 0.3 – 4.8). Quantity remained consistent while quality increased over time. Patient and therapist rating correlations were significant at r = .28, ps < .05. Researchers found that older and unemployed patients submitted higher quality work; thus, “age and employment status were covaried for subsequent analysis with the quality ratings” (p. 15). Paired t tests showed significant improvement to panic disorder based on treatment protocol, with high recovery from panic attacks (94%), anxiety (83%), and phobic avoidance (71%). Importantly, the authors demonstrated that, consistent with pervious research, group-administered CBT is “highly effective for panic disorder” (p. 15). Therapist ratings indicated that quality ratings are “somewhat better predictors of outcome” (p. 16); whereas, researchers found they significantly predicted outcome in .
Stepwise multiple regression analyses indicated that clients ratings of compliance were not correlated with outcome, but therapist ratings were and that quality ratings are “somewhat better predictors of outcome” ; independent evaluator ratings and outcomes mimicked those of the therapist, though were “less strongly predictive.” In six of the sessions, compliance was significantly associated with “some outcome variable” and “compliance with particular skills is associated with changes in a related symptom variable” Found that “compliance exerts incremental effects on symptomatology that is best evidence over the entire course of treatment” (p. 17). Researchers found “compliance with particular skills is associated with canges in related symptom variable” Researchers observed that impacts of compliance were not immediate but were noted over time.
Implications
Implications for Counselors, Clients, and Counselling
As noted by the authors, quality of work and training of patients in quality of assignment completion are important factors in CBT success. Also, group CBT therapy is an effective way to employ CBT for panic disorder. Counsellors should understand that immediate effects of CBT may not be immediately evident and may incrementally improve over time. It is important that counsellor and client agree on meaning of quality work. This study is a great example of applied research as findings monitoring of quality and quantity or work between counsellor and client, developing a common understanding “The goal of CBT is to get patients actively involved in their treatment plan” (https://www.psychologytoday.com/ca/therapy-types/cognitive-behavioral-therapy-0 ). Having clients assess their own compliance and understand and be trained in quality completion can enhance treatment success. Support your assertions with citations, using the text and additional references where possible.]
Discussion
Summary
Group CBT is highly effective in treating panic disorder. Homework assignments administered to patients based on clinical status can build skills necessary to reduce panic symptoms. Note that these findings are important in that more attention could be given to quality of individualized homework over quantity. Strengths of this research include control of: ( …..) plus inter-rate reliability which lends internal validity. However, there are limitations to this study to consider: Weaknesses = no random assignment, hard to control for extraneous variables, but medication and mental health controlled for; variation in treatment makes it difficult to directly compare, small sample size; [Summarize the main results with reference to the original hypotheses. To what extent were the hypotheses supported by the findings?] Threats to internal validity: history (repeat applicants); maturation (better as study progresses); test and homework fatigue, statistical conclusion validity? Power? Variable types of homework administered to patients. Control for researcher and participant bias (psychologist) with independent rater.
Interpretation
[Are the conclusions made by the author(s) warranted? What are the possible alternative explanations of the results? What are the strengths of the study? What was done well? What are the weaknesses/limitations of the study? Identify the specific design and describe the salient features (it must be a quantitative design for JAR 1; if you have chosen an experiment for JAR 1, explain whether it is a true experiment or a quasi-experimental design and why). Incorporate your knowledge of course-related concepts in your discussion of these questions (e.g., ethical considerations, reliability/validity of measures, ability to draw causal conclusions, threats to the internal/external validity of the study, generalizability of the study, confounding variables and sources of bias). Support your claims with material from the text and other scholarly references, as appropriate.] power was noted to be compromised due to independent rater examining a subset of participants (p. 16) Researchers found no significant different in “demographics, symptom severity at pretreatment, or average level of compliance during completed portions of the treatment (ps > .05)” between attritors (n = 10) and completers (n – 38)
For Further Study
It would be interesting to perform this study with a control group receiving individual CBT to those receiving group CBT to monitor how individuals may or may not be motivated to complete homework based on group dynamic. Motivation to complete these assignments could have come a Hawthorne effect, participant bias, being observed by other individuals.
References
Surname, Initial., Surname, Initial., & Surname, Initial. (Year). Title of journal article with no caps. Title of Journal, Volume number (issue number), page numbers.
Surname, Initial. (Year). Book title: No caps except after colon or if the capitalization is for proper nouns like names of assessment tools. City, State or Province written as 2 letter abbreviation, such as ON: Publisher Name.