Dodo Bird Verdict Research Articles

MAGIC: a Proposed Model Based on Common Factors.

The author offers an initial formulation of what an approach integrating common factors and the processes of change would look like. The dodo-verdict has been extant in the psychology literature for almost 100years, and it is time to acknowledge the veracity of the dodo-bird verdict as we move toward therapeutic approaches focusing on factors the empirical approaches have in common. Although we now have hundreds of different theoretical models, no one model appears to be superior to any other. However, certain presenting conditions may be more suited to certain interventions. The MAGIC approach introduced here incorporates client motivation, the therapeutic alliance, goal-setting, implementation, and commitment. This gives us a basic structure of commonalities around which we will be able to build comprehensive psychotherapeutic strategies drawing on intervention techniques from many different models. After a brief consideration of historical factors, I will present one idea for an integrated approach followed by a discussion of some assumptive processes which are at work in the therapeutic cadre as well as a consideration of cultural diversities.

Towards a Person-Oriented Approach to Psychotherapy Research.

Common conclusions from traditional psychotherapy research are that we still do not know how or why even our most well-studied interventions produce change, and that there is little evidence that any form of psychotherapy is generally more effective than any other. This has led some researchers to the so-called Dodo Bird Verdict, that all forms of psychotherapy are equally effective, and to the conclusion that what is at work are “common factors” that have little to do with treatment method. An alternative explanation, however, is that the traditional research paradigm is insufficiently sensitive to provide us with the required kind of knowledge. First, the outcome in typical RCTs is averaged across individuals, and at best complemented by a search for predictors in the form of stable individual differences. This means that this research stays at a group level of analysis and is insensitive to variation and change in individual patients. Second, the independent variable in RCTs does not consist in any well-controlled psychological intervention, but in large-scale treatment packages that contain a large number of interventions over a considerable time period. In other words, this research is insensitive to the effects of specific treatment interventions. Third, traditional psychotherapy research is insensitive to the therapist and patient as individual persons, and their specific interaction. It is argued that a person-oriented approach to psychotherapy, which is idiographic, holistic and interactional, may be able to overcome some of these problems by being more sensitive to (1) the treatment course of individual patients, and patterns during that course; (2) the effects of the specific interventions that are implemented over time, and (3) the personal characteristics of patient and therapist, and nuances of their interaction.

Placebo Effects in Psychotherapy: A Framework.

The issue of placebo response and the extent of its effect on psychotherapy is complex for two specific reasons: i) Current standards for drug trials, e.g., true placebo interventions, double-blinding, cannot be applied to most psychotherapy techniques, and ii) some of the “nonspecific effects” in drug therapy have very specific effects in psychotherapy, such as the frequency and intensity of patient–therapist interaction. In addition, different psychotherapy approaches share many such specific effects (the “dodo bird verdict”) and lack specificity with respect to therapy outcome. Here, we discuss the placebo effect in psychotherapy under four aspects: a) nonspecific factors shared with drug therapy (context factors); b) nonspecific factors shared among all psychotherapy traditions (common factors); c) specific placebo-controlled options with different psychotherapy modalities; and d) nonspecific control options for the specific placebo effect in psychotherapy. The resulting framework proposes that the exploration and enumeration of context factors, common factors, and specific factors contributes to the placebo effects in psychotherapy.

Innovation in Psychotherapy, Challenges, and Opportunities: An Opinion Paper.

Psychotherapy as a field tends toward conservativism, and the rate of innovation and development of new evidence-based effective treatments has been slow. The paper explores important barriers to innovation like the dodo bird verdict and the habit of starting the development of therapeutic methods from techniques. The paper looks at the opportunities for translating basic science in psychology into psychotherapeutic techniques. Metacognitive therapy stands out from other psychotherapies by its development from basic science. The paper describes the development of the techniques detached mindfulness and attention training, how they were derived from basic science and tested for their suitability in the therapy of patients with anxiety disorders. By this process, metacognitive therapy may be an important model for the innovation process in psychotherapy.

The misleading Dodo Bird verdict. How much of the outcome variance is explained by common and specific factors?

The literature on psychotherapy research makes use of the so-called "Dodo Bird Verdict" to show that therapeutic change owes more to common factors than to specific techniques. According to the bulk of the empirical literature, common factors explain 30–70% of therapy outcome variance, while specific factors account for between 5% and 15%. This formulation is based on the assumption that common and specific factors are independent of each other. The present study uses a systematic review of the literature to empirically demonstrate that common and specific factors of change are actually correlated. In other words, the prevalent practice in the literature of using correlated common and specific factors as independent predictors in classical ANOVA models is both statistically unsound and conceptually distorted. We offer several alternative proposals for a sensible re-evaluation of the Dodo Bird verdict.

Is EBM an Appropriate Model for Research into the Effectiveness of Psychotherapy?

EBM, and the hierarchy of evidence it prescribes, is a controversial model when it comes to research into the effectiveness of psychotherapeutic treatments. This is due in part to the so-called ‘Dodo Bird verdict’, which claims that all psychotherapies are equally effective, and that their effectiveness is largely due to the placebo effect. In response to this controversy, I argue that EBM can nevertheless be made to fit research into the effectiveness of psychotherapy, once a piecemeal approach to conducting RCTs is taken. Such an approach involves studying the contributions made by individual treatment components.

From efficacy to pragmatic trials: does the dodo bird verdict apply?

From efficacy to pragmatic trials: does the dodo bird verdict apply?

Debatt: Divergent perspectives on the Dodo bird? A comment to Mullen, Shuluk and Soydan

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On the present situation in psychotherapy and its implications - A critical analysis of the facts

The currently dominating research paradigm in evidence-based medicine is expounded and discussed regarding the problems deduced from so-called empirically supported treatments (EST) in psychology and psychotherapy. Prevalent political and economic as well as ideological backgrounds influence the present dominance of the medical model in psychotherapy by implementing the randomized-controlled research design as the standard in the field. It has been demonstrated that randomized controlled trials (RCTs) are inadequate in psychotherapy research, not the least because of the high complexity of the psychotherapy and the relatively weak role of the treatment concept in the change process itself. All major meta-analyses show that the Dodo bird verdict is still alive, thereby demonstrating that the medical model in psychotherapy with its RCT paradigm cannot explain the equivalence paradox. The medical model is inappropriate, so that the contextual model is proposed as an alternative. Extensive process-outcome research is suggested as the only viable and reasonable way to identify highly complex interactions between the many factors regularly involved in change processes in psychotherapy.

Where is the forest?

The consistent finding that there are no or only small differences in outcome between bona-fide treatment interventions in the addiction field (and also in other neighbouring fields such as psychotherapy in general) is gaining increasing support in the international literature. The paper by Miller & Moyers 1 represents an elaborate and well-articulated piece in that genre. However, while the support for the outcome equivalence paradox (or the Dodo bird verdict) seems to develop into a consensus, the same is not true concerning what the consequences of this situation should entail for the organization of future research on addiction treatment. Babor suggests, with reference to his experiences as one of the leading researchers within Project MATCH 2, that the failure ‘to explain treatment effects also suggest that we focus attention of how to best motivate people to enter treatment, regardless of the therapeutic modality employed’ 3. The rejection of a continued focus on establishing differences in treatment outcome is turned upside-down in a proposal for more elaborated specificity put forward by Magill & Longabaugh 4, when they write: ‘to the extent that future RCT yield results of no difference the need for specificity as to how the treatment works becomes more compelling’ (p. 876). Miller & Moyers, on their part, state that it seems unlikely that treatment outcome will be improved by searching for better specific ingredients and that future research should focus on therapist, relational and client variables. Although this position seems to be congruent with the ‘common factor ‘ approach 5, such an interpretation is hard to maintain due to the fact that Miller & Moyers also claim that terms such as ‘common’ and ‘non-specific’ factors are misnomers. They claim that it is a mistake to refer to an important treatment factor as ‘non-specific’, and that to the extent that such factors are present we should specify them and develop an understanding of how they the work as well as of how they can be measured and incorporated into therapist training. Here it appears that Miller & Moyers assert that any factor that is important is also a specific factor; in my view, that is at least one step too far. Specific factors are factors that are characteristic and theoretically central to a given treatment intervention. In contrast, common factors are factors that seem to be present among a majority of treatment interventions, and for this reason they are designated as common or contextual factors. By definition, common factors are incidental to treatment intervention theory, a fact that does not hinder that a given common factor may be highly important for treatment outcome at the same time as it is not unique. The most well-studied common factor, which for many decades has been a part of the ‘gold standard’ design in the medical field, is the placebo, present in the randomized double-blind placebo-controlled effect study. A treatment intervention is considered to be a placebo if its content is incidental, as opposed to characteristic in relation to the therapeutic theory studied (i.e. the sugar pill is incidental in a study of the effects of a given antibiotic). The rationale that underlies this design is that comparison conditions should be impossible to identify as different compared to the experimental condition, i.e. the contextual framing should be common to both. For these reasons I find it hard to agree with the suggestion of Miller & Moyers 1 that it is mistake to talk about common and non-specific factors. None.

Specificity of CBT for Depression: A Contribution from Multiple Treatments Meta-analyses

The “Dodo bird verdict,” which claims that all psychotherapies are equally effective, has been a source of bewilderment and intense controversy among psychiatrists and psychologists. To examine this issue, we focused on cognitive-behavior therapy (CBT) and applied the newly developed review method known as multiple treatments meta-analysis (MTM). We identified randomized controlled trials comparing CBT against a psychological placebo (PP) and/or no treatment (NT) controls during the acute phase treatment of adults with depression. A random-effects MTM was conducted within a Bayesian framework. All the analyses were performed on an intention-to-treat basis. The MTM of the evidence network from 18 studies (39 treatment arms, 1,153 participants) revealed that CBT was significantly more likely to yield a response than NT (OR 2.24, 1.32–3.88) and that CBT was nominally, but not significantly, superior to PP (OR 1.30, 0.53–2.94), which in turn was superior to NT (OR 1.73, 0.67–4.84). The intervention effects in MTM were associated with the number of sessions, and the specificity of CBT increased as the number of sessions increased. The specific component of CBT was estimated to constitute 50.4 % (19.7–85.0) when CBT was given for ten or more sessions. Despite the quantitatively and qualitatively limited body of randomized evidence examining this issue, the present study strongly suggested a non-null specific component of CBT when given for an adequate length.

The Search for Common Factors in Psychotherapy: Two Theoretical Models with Different Empirical Implications

The difficulties of demonstrating that any specific form of psychotherapy is more effective than any other has led to the formulation of the so-called Dodo Bird Verdict (that all forms of therapy are equally effective) and to the suggestion that what really matters for therapeutic efficiency are factors that are common to different forms of therapy. The term “common factors”, however, is seldom defined in an unambiguous way. In this paper, two different models of “common factors” are differentiated, and their implications are compared. The first model is referred to as the Relational-Procedural Persuasion (RPP) model and is primarily based on the writings of Frank and Wampold; according to this model effective psychotherapy requires a good therapeutic relationship, a specified therapeutic procedure, and a rhetorically skilful psychotherapist who persuades the client of a new explanation that provides new perspectives and meanings in life. The contents of these procedures and perspectives, however, are less important – according to this model, the treatment procedures are beneficial to the client because of the meaning attributed to these procedures rather than because of the specific nature of the procedures. The other model, the Methodological Principles and Skills (MPS) model, is based on the assumption that effective psychotherapy relies on common methodological principles that are instantiated in various ways in different forms of psychotherapy, and on the therapist’s capacity of applying these principles in a skillful way. According to this model, method matters, and it is possible to improve existing methods. Whereas the MPS model carries a hope for the improvement of psychotherapy, the RPP model implies a more pessimistic view of psychotherapy as forever bound by the limits of the Dodo Bird Verdict. It is concluded that psychotherapy research may benefit from using the MPS model as a working hypothesis, but that a comprehensive model of common factors in psychotherapy also needs to integrate important insights from the RPP model, as well as an understanding of the structural characteristics that psychotherapy shares with other kinds of social interaction.

Competing perspectives on erasing the stigma of illness: What says the dodo bird?

The dodo bird is an Alice in Wonderland character who, at the end of a race, concludes “Everybody has won and all must have prizes”. The dodo bird effect has been used to describe a conundrum resulting from behavior change research that fails to distinguish superiority among discrete strategies for psychotherapeutic change. Research on stigma change may find itself at this point. Advocates have developed and implemented multiple approaches to changing stigma; some of these might be shown to have more beneficial impact than others. The mental health community has been especially active in tackling stigma, so many of the examples herein come from the corresponding body of research. We divide the multiple approaches to stigma change into sets of competing or complementary perspectives and examine both the benefits and the negative unintended consequences of examples. We consider the effects of education versus contact on stigmatizers (public stigma), the stigmatized (self-stigma), and the social sphere in which the two groups engage (structural stigma). Stigma impact varies by targets and outcomes so we examine impact on knowledge versus attitudes at the population versus grassroots levels. Overall, we found that effects of contact seem greater than education for stigmatizers. For the stigmatized, approaches that target eliminating self-stigma may be less beneficial than interventions designed to promote disclosure. Targeting grassroots may yield greater impact than population-based approaches. Increasing knowledge and pity may yield unintended consequences which may undermine life opportunities of people with the illness. Our review highlighted the benefits of competing perspectives in advancing our understanding of stigma change and crafting of more effective anti-stigma interventions.

What works in helping people and why?

Randomized controlled trials (RCTs) are the most rigorous test of effectiveness for any intervention. This article considers RCTs as policy projects, and outlines the key elements of effective delivery of interventions within an RCT. It is argued that conceptualizing RCTs as practice delivery projects provides insights of relevance for effective leadership in social work or other helping professions. Three elements of effective RCT delivery are suggested to be crucial: (a) a theory about the nature of the issues being worked with and how people can be helped by professionals; (b) a detailed description of practice that flows from this and (c) skills development and monitoring methods for ensuring practitioners are delivering practice in this way. These are argued to be key components required for effective leadership in social work. Finally, it is suggested that while there is increasing focus on the common elements within specific interventions there has been a neglect of the common features associated with their delivery. Attention to these might help explain the ‘Dodo bird effect’, in which different interventions often prove to be equally effective, and thereby enrich our appreciation of what works, for whom and why.

What works in helping people and why?

Randomized controlled trials (RCTs) are the most rigorous test of effectiveness for any intervention. This article considers RCTs as policy projects, and outlines the key elements of effective delivery of interventions within an RCT. It is argued that conceptualizing RCTs as practice delivery projects provides insights of relevance for effective leadership in social work or other helping professions. Three elements of effective RCT delivery are suggested to be crucial: (a) a theory about the nature of the issues being worked with and how people can be helped by professionals; (b) a detailed description of practice that flows from this and (c) skills development and monitoring methods for ensuring practitioners are delivering practice in this way. These are argued to be key components required for effective leadership in social work. Finally, it is suggested that while there is increasing focus on the common elements within specific interventions there has been a neglect of the common features associated with their delivery. Attention to these might help explain the ‘Dodo bird effect’, in which different interventions often prove to be equally effective, and thereby enrich our appreciation of what works, for whom and why.

The dodo bird verdict and the elephant in the room: A service user-led investigation of crisis resolution and home treatment

Recent years have seen an international move towards home treatment of acute mental health difficulties. This has been based upon trial data which do little to develop understanding of how or why this approach is as effective as it seems to be. In order to explore this question the study interviewed patients who had recently used the services of a crisis resolution home treatment (CRHT) team in the English East Midlands. Triangulated parallel qualitative analyses of 33 semi-structured interviews conducted by service users trained in research techniques demonstrated that successful CRHT reflected practitioners’ ability to provide clients with a sense of feeling safe, accepted and understood. Unhelpful outcomes followed when participants did not experience such unconditionally supportive relationships. These findings further endorse the primacy of relational factors in mental health practice. They are discussed in relation to the Dodo Bird verdict upon psychological therapies and systemic difficulties acknowledging an inconvenient truth.

Psychotherapy for Depression With Executive Dysfunction

Psychotherapy for Depression With Executive Dysfunction

Cognitive behaviour therapy (CBT) for the treatment of co‐occurring depression and substance use: Current evidence and directions for future research

ISSUES AND APPROACH: The high rates of co-occurring depression and substance use, and the negative impact of this on illness course and outcomes have been well established. Despite this, few clinical trials have examined the efficacy of cognitive behaviour therapy (CBT). This paper systematically reviews these clinical trials, with an aim of providing recommendations for how future research can develop a more robust evidence base for the treatment of these common comorbidities. Leading electronic databases, including PubMed (ISI) and PsychINFO (CSA), were searched for peer-reviewed journal articles using CBT for the treatment of co-occurring depression and substance use. Of the 55 articles identified, 12 met inclusion criteria and were included in the review. There is only a limited evidence for the effectiveness of CBT either alone or in combination with antidepressant medication for the treatment of co-occurring depression and substance use. While there is support for the efficacy of CBT over no treatment control conditions, there is little evidence that CBT is more efficacious than other psychotherapies. There is, however, consistent evidence of improvements in both depression and substance use outcomes, regardless of the type of treatment provided and there is growing evidence that that the effects of CBT are durable and increase over time during follow up. Rather than declaring the 'dodo bird verdict' that CBT and all other psychotherapies are equally efficacious, it would be more beneficial to develop more potent forms of CBT by identifying variables that mediate treatment outcomes.

Empirically supported treatments in psychotherapy: towards an evidence-based or evidence-biased psychology in clinical settings?

The field of research and practice in psychotherapy has been deeply influenced by two different approaches: the empirically supported treatments (ESTs) movement, linked with the evidence-based medicine (EBM) perspective and the “Common Factors” approach, typically connected with the “Dodo Bird Verdict”. About the first perspective, since 1998 a list of ESTs has been established in mental health field. Criterions for “well-established” and “probably efficacious” treatments have arisen. The development of these kinds of paradigms was motivated by the emergence of a “managerial” approach and related systems for remuneration also for mental health providers and for insurance companies. In this article ESTs will be presented underlining also some possible criticisms. Finally complementary approaches, that could add different evidence in the psychotherapy research in comparison with traditional EBM approach, are presented.

PERHAPS IT IS THE DODO BIRD VERDICT THAT SHOULD BE EXTINCT

Dr. Sellman’s excellent synthesis and common sense conclusions regarding the addiction treatment field will doubtless become required reading in many addiction training centres, and deservedly so [1]. However, Professor Sellman makes one point that appears to us to misrepresent some of the evidence and reflects a line of thinking, which if broadly accepted, has some potential to reverse some of the important, and very hard-won, progress we’ve made in improving the quality of addiction treatment. The premise that “Different psychotherapies appear to produce similar results”, reminiscent of the “Dodo Bird verdict” (2), overlooks some of the recent evidence and results in some misconceptions. Following Professor Sellman’s lead, we’ll limit ourselves to 10 points: