Jeffrey S. Berman

Psychotherapy for the Treatment of Depression: A Comprehensive Review of Controlled Outcome Research

Previous quantitative reviews of research on the efficacy of psychotherapy for depression have included only a subset of the available research or limited their focus to a single outcome measure. The present review offers a more comprehensive quantitative integration of this literature. Using studies that compared psychotherapy with either no treatment or another form of treatment, this article assesses (a) the overall effectiveness of psychotherapy for depressed clients, (b) its effectiveness relative to pharmacotherapy, and (c) the clinical significance of treatment outcomes. Findings from the review confirm that depressed clients benefit substantially from psychotherapy, and these gains appear comparable to those observed with pharmacotherapy. Initial analysis suggested some differences in the efficacy of various types of treatment; however, once the influence of investigator allegiance was removed, there remained no evidence for the relative superiority of any 1 approach. In view of these results, the focus of future research should be less on differentiating among psychotherapies for depression than on identifying the factors responsible for improvement.

The Effectiveness of Psychotherapeutic Interventions for Bereaved Persons: A Comprehensive Quantitative Review.

Previous quantitative reviews of research on psychotherapeutic interventions for bereaved persons have yielded divergent findings and have not included many of the available controlled outcome studies. This meta-analysis summarizes results from 61 controlled studies to offer a more comprehensive integration of this literature. This review examined (a) the absolute effectiveness of bereavement interventions immediately following intervention and at follow-up assessments, (b) several of the clinically and theoretically relevant moderators of outcome, and (c) change over time among recipients of the interventions and individuals in no-intervention control groups. Overall, analyses showed that interventions had a small effect at posttreatment but no statistically significant benefit at follow-up. However, interventions that exclusively targeted grievers displaying marked difficulties adapting to loss had outcomes that compare favorably with psychotherapies for other difficulties. Other evidence suggested that the discouraging results for studies failing to screen for indications of distress could be attributed to a tendency among controls to improve naturally over time. The findings of the review underscore the importance of attending to the targeted population in the practice and study of psychotherapeutic interventions for bereaved persons.

Effectiveness of Psychological and Pharmacological Treatments for Nocturnal Enuresis.

This review provides a quantitative integration of research on the effectiveness of psychological and pharmacological treatments for nocturnal enuresis. With the use of experiments that compared treatments with either no treatment or another form of treatment, this article assesses (a) the overall effectiveness of psychological and pharmacological treatments, (b) the relative effectiveness of specific types of treatments, and (c) moderators of treatment effectiveness including investigator allegiance. Findings from the review confirm that enuretic children benefit substantially from treatment. However, more children improve from psychological than from pharmacological interventions. Moreover, psychological treatments involving a urine alarm are most likely to yield benefits that are maintained once treatment has ended.

Are Some Psychotherapies Much More Effective Than Others

In a previous paper we had reported on the examination of comparisons of 18 metaanalyses of active treatments with each other (Luborsky, Rosenthal, Diguer, et al., 2001). These metaanalyses gave a small and nonsignificant mean level of difference between types of treatments. The smallness of this correlation confirms Rosenzweigs (1936) expectation that because of the large overlap in effective ingredients of different psychotherapies, comparative studies of psychotherapies would show little difference. Such a comparison that includes psychoanalyses seems a long way off, but if outcomes of psychoanalyses are defined similarly to those in the other psychotherapies, the expected differences in outcomes may also be small.

The impact of counselor self-disclosure on clients: A meta-analytic review of experimental and quasi-experimental research.

In an attempt to make sense of contradictory findings, meta-analysis was used to review 53 studies that examined counselor self-disclosure (CSD) vs. nondisclosure. CSD, overall, was found to have a favorable impact on clients/participants, with clients/participants having favorable perceptions of disclosing counselors and rating themselves more likely to disclose to counselors who had self-disclosed. Specifically, CSD that (a) revealed similarity between client and counselor; (b) was of negative content valence; or (c) was related to intra- or, especially, extratherapy experiences, had favorable impacts on clients/participants compared with nondisclosure. These types of disclosure resulted in more favorable perceptions of the counselor, especially in the area of professional attractiveness. CSD that revealed similarity between client and counselor also had a favorable impact on clients/participants allegiance-specifically, on their willingness to return-to disclosing counselors. Significant moderators of the impact of CSD on clients included researcher bias for or against CSD, type of session (e.g., written transcript, interview, real session), timing of CSD (whether before or after client self-disclosure), verb tense of extratherapy CSD, experimental setting, type of control group, and the number of CSDs in the experiment. Clinical implications include that CSD may be beneficial for building rapport, strengthening alliance, and eliciting client disclosure, with similar CSD being especially beneficial.

A study of silent disengagement and distressing emotion in psychotherapy

Abstract Fifty-two psychotherapy sessions were coded for silences that reflect processes of client disengagement (e.g., withdrawal, resistance). The study examined the presence of these silences and clients reports of in-session emotion and symptom change. Results indicated that disengagement predicted poorer proximal and distal outcome as measured by the Beck Depression Inventory for Primary Care (BDI-PC) and poorer proximal outcome on the Symptom Checklist-5, but it was not significantly predictive of Outcome Questionnaire-45 scores. Interitem analyses revealed that disengagement had a significant proximal effect on depressive mood and negative self-evaluative items assessed by the BDI-PC, but across time these effects were sustained for the negative self-evaluative items only.

Investigator allegiance and the evaluation of psychotherapy outcome research

Considerable evidence has demonstrated that the beliefs of researchers can inadvertently influence research findings. The possibility of this type of bias is of special concern in studies evaluating the outcome of psychotherapy, where investigators frequently have marked allegiances to particular therapies and these allegiances have been found to correlate substantially with the pattern of results. In this article we discuss the evidence concerning investigator allegiance in psychotherapy research, emphasize the need to distinguish between this factor as a potential confound and a proved causal effect, and outline strategies that have been suggested for researchers to minimize the potential for bias both when designing future research and drawing conclusions from existing evidence.

Do Financial Literacy Classes Help? An Experimental Assessment in a Low-Income Population

ABSTRACT Although programs designed to increase financial literacy are widely promoted, there is little evidence of their impact on financial knowledge or behavior. The present study used an experimental design to examine the effectiveness of a financial literacy course for low-income individuals receiving services in a nonprofit residential program. Participants were randomly assigned either to a 4-week financial literacy course (n = 17) or a wait-list control group (n = 16). They then completed measures designed for the purposes of this study assessing financial knowledge (e.g., which loan payments should take priority), negative behaviors (e.g., overdrawing a financial account), and positive behaviors (e.g., leaving money in a savings account). Results of this randomized experiment confirmed that the course increased both financial knowledge and positive financial behaviors, thereby lending support for the continued use of such financial education programs. Attrition was high in this study, however, and future research might explore alternative formats or approaches to presenting the course material.

Evolutionary Lifestyle and Mental Health

Some have suggested that psychological distress may be lower if individuals adopt a lifestyle more similar to our evolutionary past. In this study, we assessed relationships between distress and six lifestyle elements (sleep, omega-3 consumption, exercise, rumination, sunlight exposure, and socialization). A large sample (N = 495) of college undergraduates reported levels of each lifestyle element and their distress on the Beck Depression Inventory and Hopkins Symptom Checklist. Analysis revealed a positive relationship for rumination and a curvilinear relationship for sleep. In contrast, none of the other elements correlated reliably with distress. The findings raise the possibility that relationships between these lifestyle elements and distress may not be critical for the range of exposure typically experienced in a normal, nonclinical population.

The impact of conversational acknowledgers on perceptions of psychotherapists

Abstract During conversations, individuals often signal that they are paying attention by the use of verbal and nonverbal cues. This study examined these conversational acknowledgers in psychotherapy and evaluated the effects of therapists varying levels of two specific actions—short utterances and nodding—on perceptions of the therapist. A series of brief psychotherapy videos with therapists displaying different levels of the two types of acknowledgers were presented to 320 participants recruited both online and from a university campus. Analysis indicated that when therapists used high levels of both verbal acknowledgers and nodding or when they refrained from using both types of acknowledgers, therapist empathy and therapeutic alliance were perceived as greater than when therapists engaged in one type of acknowledger but not the other.