Important Dimensions of Therapy Outcome Measures
Anxiety and Depression
Outline:
Important Dimensions of Therapy Outcome Measures
Dimensions
Focus of measures Emotions
Thoughts
Behaviors
Possible processes Evaluation
Description
Observation
Possible sources of data Self-report
Therapist rating
Relevant-other rating
Trained observation by others
Trained self-monitoring
Instrumental behavior
The three dimensions may be combined in many ways, but
all combinations may not yield similar results.
Single-subject research differs in an important respect
from the traditional case study. Although case studies
may provide insights about treatment, they generally
rely on anecdotal information and impressions, which
may be misleading. In single-subject studies, on the
other hand, behavior is observed directly, either in the
actual problem situation or in a simulated laboratory environment.
The behavior is also measured continuously,
before, during, and in some cases after treatment.
Immediate information about whether the
treatment is having the desired effects can be obtained.
This allows the therapist to make decisions about the
treatment while it is going on.
The most common test of the effect of a clinical procedure
with a single client involves the A-B-A-B research
design. This design is used most often to determine
whether operant-conditioning procedures are
effective in bringing about behavioral change. lt consists
of obtaining a baseline measure of the target behavior
(A), instituting reinforcement-contingency procedures
(B), removing the contingency so that the
conditions that were present during the baseline period
are reinstated (A), and reintroducing the phase-B contingency
(B). This repeated-measures design is a very
powerful method for isolating the conditions that control
1 behavior.
An A-B-A-B design was used in operant therapy with
a 19-year-old man who had been admitted to a hospital
with complaints of pain in the lower back, hips, and
both legs, and great difficulty in walking, sitting, and
standing. An exhaustive medical study determined 'hat
his symptoms were unrelated to physical causes, and
the case was diagnosed as a psychological disorder.
The operant therapy consisted of visits by a youfl9
assistant to the patient's room three times daily. During
these visits the assistant spent approximately 10 minutes
talking to the patient about topics unrelated to his
psychiatric disorder.' During an initial 3-day period she
encouraged him to walk but provided him ·with no reinforcement
for doing so. 'During the next 3-day sequence
she instructed the patient to walk and reinforced
him when this happened. Reinforcement
consisted of comments such as "Good," "That's great,"
and "You're doing fine," accompanied by attention,
friendliness, and smiling. Reinforcements were not
given during the following 3~day period, but they were
reinstituted during the final 3 days of the experimental
therapeutic program.
In another piece I summarizes the results of the program.
During the instruction period there was no increase in
walking~ The addition of reinforcement resulted in increased
walking. When reinforcing contingencies are
discontinued, there is usually a decrement in the target
behavior. In this case, contrary to what might be expected,
improvement continued during the period when
no reinforcement was given. Uncontrolled and unscheduled
reinforcement by other patients may have
contributed to this continued improvement.
The great Days of a cure in anxiety and depression are now a reality.
Important Dimensions of Therapy Outcome Measures
Dimensions
Focus of measures Emotions
Thoughts
Behaviors
Possible processes Evaluation
Description
Observation
Possible sources of data Self-report
Therapist rating
Relevant-other rating
Trained observation by others
Trained self-monitoring
Instrumental behavior
The three dimensions may be combined in many ways, but
all combinations may not yield similar results.
Single-subject research differs in an important respect
from the traditional case study. Although case studies
may provide insights about treatment, they generally
rely on anecdotal information and impressions, which
may be misleading. In single-subject studies, on the
other hand, behavior is observed directly, either in the
actual problem situation or in a simulated laboratory environment.
The behavior is also measured continuously,
before, during, and in some cases after treatment.
Immediate information about whether the
treatment is having the desired effects can be obtained.
This allows the therapist to make decisions about the
treatment while it is going on.
The most common test of the effect of a clinical procedure
with a single client involves the A-B-A-B research
design. This design is used most often to determine
whether operant-conditioning procedures are
effective in bringing about behavioral change. lt consists
of obtaining a baseline measure of the target behavior
(A), instituting reinforcement-contingency procedures
(B), removing the contingency so that the
conditions that were present during the baseline period
are reinstated (A), and reintroducing the phase-B contingency
(B). This repeated-measures design is a very
powerful method for isolating the conditions that control
1 behavior.
An A-B-A-B design was used in operant therapy with
a 19-year-old man who had been admitted to a hospital
with complaints of pain in the lower back, hips, and
both legs, and great difficulty in walking, sitting, and
standing. An exhaustive medical study determined 'hat
his symptoms were unrelated to physical causes, and
the case was diagnosed as a psychological disorder.
The operant therapy consisted of visits by a youfl9
assistant to the patient's room three times daily. During
these visits the assistant spent approximately 10 minutes
talking to the patient about topics unrelated to his
psychiatric disorder.' During an initial 3-day period she
encouraged him to walk but provided him ·with no reinforcement
for doing so. 'During the next 3-day sequence
she instructed the patient to walk and reinforced
him when this happened. Reinforcement
consisted of comments such as "Good," "That's great,"
and "You're doing fine," accompanied by attention,
friendliness, and smiling. Reinforcements were not
given during the following 3~day period, but they were
reinstituted during the final 3 days of the experimental
therapeutic program.
In another piece I summarizes the results of the program.
During the instruction period there was no increase in
walking~ The addition of reinforcement resulted in increased
walking. When reinforcing contingencies are
discontinued, there is usually a decrement in the target
behavior. In this case, contrary to what might be expected,
improvement continued during the period when
no reinforcement was given. Uncontrolled and unscheduled
reinforcement by other patients may have
contributed to this continued improvement.
The great Days of a cure in anxiety and depression are now a reality.