Treatment Of Specific Disorders Research Articles

Do health insurers have an ethical responsibility to cover treatment of vitiligo?

In this issue, my co-authors and I examined gaps in insurance coverage for treating vitiligo and hypothesized that these have disproportionate impact on the health and well-being of children of color.1 We did not address the issue of what legal, moral, and ethical obligations health insurers have to cover care and treatment for specific disorders with disparate health impacts, such as vitiligo. Health insurers are licensed and regulated by the states in which they operate, although federal regulations, such as those spelled out in the Affordable Care Act may, in some instances, take precedence, such as the requirement to cover pre-existing conditions. To my knowledge, no regulations, federal, or state mandate coverage for this condition. Although many health care insurers have codes of ethics, several of which are available online, most are boilerplate documents on corporate compliance, conflicts of interest, and confidentiality and do not mention equity, fairness of coverage policies or decisions, or even deal with coverage-related issues. Little has been written addressing this issue. Levine et al published five principles to ensure fairness in coverage decisions: they should be transparent to all those affected by the process; participatory, involving stakeholders in a meaningful way; equitable and consistent resulting in “similar decisions under similar circumstances”; sensitive to value, “taking into account the net health outcomes of services and technologies under consideration and the resources needed to achieve these outcomes”; and compassionate, being “flexible [and] responsive to individual values and priorities and attentive to the most vulnerable individuals and those with critical needs.”2 One argument used to justify denial of coverage of certain conditions is that it is a “zero-sum game,” that is, if something is added, something must be dropped. It is a spurious argument, however. If it were truly a zero-sum game, every time a new drug or technology became covered, something would have to be dropped. Medical coverage policies are not static. Furthermore, is it fair that conditions producing permanent, disfiguring, red patches on white skin (port-wine stains) be covered while those that produce equally impactful permanent white discoloration on dark skin are not? So, are there moral and ethical grounds for covering the treatment of vitiligo? Based on the principles of consistency and fairness, even given limited resources, one would expect diseases that significantly affect quality of life to be covered. Based on the principles of equity and fairness, diseases that disproportionately affect the vulnerable and disadvantaged, or disproportionately affect one gender or certain ethnic or racial groups, deserve special consideration. There is no existing universally agreed upon set of rules or duties for health insurers regarding coverage policies or appeals. Because vitiligo is manifested by altered outward appearance rather than pain, itch or functional limitation does not in any way justify the morality of not covering its treatment. No reasonable person would consider an individual (or by extension, a corporation or public entity) who was unfair to minorities and the disadvantaged, perpetuated inequities or was inconsistent in actions and beliefs to be virtuous or ethical.

Augmented Reality Implementations in Stomatology

Augmented reality has a wide range of applications in many areas that can extend the study of real objects into the digital world, including stomatology. Real dental objects that were previously examined using their plaster casts are often replaced by their digital models or three-dimensional (3D) prints in the cyber-physical world. This paper reviews a selection of digital methods that have been applied in dentistry, including the use of intra-oral scanning technology for data acquisition and evaluation of fundamental features of dental arches. The methodology includes the use of digital filters and morphological operations for spatial objects analysis, their registration, and evaluation of changes during the treatment of specific disorders. The results include 3D models of selected dental arch objects, which allow a comparison of their shape and position during repeated observations. The proposed methods present digital alternatives to the use of plaster casts for semiautomatic evaluation of dental arch measures. This paper describes some of the advantages of 3D digital technology replacing real world elements and plaster cast dental models in many areas of classical stomatology.

Factors associated with adherence to guidelines of good clinical practice during hospital treatment of patients with the first episode of schizophrenia spectrum disorders

Background/Aim. Adherence to the guidelines of Good Clinical Practice (GCP) during the treatment of specific disorders is considered a guarantee of the implementation of a uniform, evidence-based clinical practice in psychiatry. The aim of this study was to analyze the concordance of prescribing patterns of antipsychotic drugs with the recommendations of good clinical practice in Serbia and an insight into the effects that introduction of the National Guideline for the Diagnosis and Treatment of Schizophrenia had on the prescribing practice in this area. Methods. Noninterventional, observational study was conducted at the Clinic for Mental Disorders ?Dr Laza Lazarevic? in Belgrade. It included a consecutive sample of 675 previously untreated patients, hospitalized from January 1st, 2012 to December 31st, 2015, dismissed with a discharge diagnosis of any of schizophrenia spectrum disorders. The data about demographic and clinical characteristics of patients, characteristics of prescribers and prescribed antipsychotics were obtained retrospectively, from the patients? medical records. For the analysis of primary data, the descriptive statistical methods and methods for testing statistical hypotheses were used. A method of logistic regression was used to identify the factors associated with adherence to the GCP recommendations. Results. Totaly, 446 (66.1%) of subjects were treated with antipsychotic monotherapy. After the introduction of National Guideline for the Diagnosis and Treatment of Schizophrenia prescribing of second generation antipsychotic monotherapy (78.41% vs. 63.5%, respectively; p < 0.001) increased significantly compared to the previous period. The factors independently associated with adherence to the recommendations of the GCP were the year of hospitalization, the age of the prescriber, and the age and education of the patient. Conclusion. After the introduction of the National Guide to Good Clinical Practice for the Diagnosis and Treatment of Schizophrenia there have been significant, but insufficient changes in the prescribing patterns of antipsychotics during the treatment of the first psychotic episode in Serbia.

A PROPOSAL OF AN ECOSYSTEM BASED ON INTELLIGENT ICT TOOLS TO SUPPORT THE DIAGNOSIS AND INTERVENTION OF PATIENTS WITH COMMUNICATION DISORDERS

The early intervention on People With Communication Disabilities (PWCD) is a fundamental strategy that has the aim of improving several skills related with speech, language, and swallowing. However, the existent tools are focused on the diagnosis or treatment of specific disorders, and commonly, they do not cover the different needs of people that provides rehabilitation, healthcare and educational services for patients (doctors, pathologists, and patient's relatives). On those grounds, in this paper we present a general overview of existing tools for diagnosis and intervention of PWCD, and on this basis, we propose an ecosystem that implements intelligent ICT tools and an expert system able to automatically generate therapy plans. The expert system has been previously evaluated and has reached encouraging results.

The efficacy and effectiveness of psychological treatments for mood, anxiety, and related disorders.

We provide a narrative review of the extensive evidence that supports the efficacy and effectiveness of psychological treatments, across the life span, for common mental health disorders. To this end, relying primarily on meta-analytic studies, we examine the effects of psychological treatments for depression, bipolar disorder, generalised anxiety disorder, social anxiety disorder, specific phobia, panic disorder, obsessive-compulsive disorder, and posttraumatic stress disorder. Based upon data from hundreds of studies and thousands of participants, there is substantial evidence for both the efficacy and effectiveness of specific forms of psychological intervention for these disorders. Moreover, for most disorders, the clinical impact of specific forms of psychological treatment has been found to be at least equal to that of medication. Accordingly, the research evidence strongly supports the use of a number of specific psychological treatments, most of which are cognitive-behavioural treatments, as first-line interventions for these commonly occurring mental disorders among youth, adults, and older adults.Keywords: treatment efficacy, treatment effectiveness, mood disorders, anxiety disordersResumeNous presentons une revue narrative des preuves approfondies qui confirment l'efficacite et l'utilite des traitements psychologiques, au cours des diverses etapes de la vie, pour les troubles de sante mentale courants. A cette fin, au moyen essentiellement de meta- analyses, nous examinons les effets des traitements psy- chologiques pour la depression, le trouble bipolaire, le trouble d'anxiete generalise, le trouble d'anxiete sociale, les phobies pre- cises, le trouble panique, le trouble obsessionnel-compulsif et le syndrome de stress post-traumatique. Selon les donnees tirees de centaines d'etudes regroupant des milliers de participants, il existe des preuves substantielles tant de l'efficacite que de l'utilite des interventions psychologiques precises pour ces troubles. En outre, pour la plupart, l'effet clinique de traitements psychologiques precis s'est revele au moins equivalent a celui de la medication. Ainsi, les resultats des recherches appuient fortement l'usage de certains traitements psychologiques precis, dont la plupart sont des therapies cognitivo-comportementales, en tant qu'intervention de premiere ligne pour ces troubles mentaux qui sont courants parmi les jeunes, les adultes et les aines.Mots-cles : efficacite d'un traitement, utilite d'un traitement, trou- bles de l'humeur, troubles anxieux.Based on the results of extensive research on the effects of psychological treatments, the American Psychological Association (2013) passed a resolution recognising the substantial clinical impact of psychotherapy. Although such a global statement about the positive effect of psychotherapy does reflect the general re- search findings, it glosses over the substantial variability evident in the psychological treatment research literature, including (a) not all treatments have been empirically evaluated, and (b) some treat- ments are more efficacious than others in the treatment of specific disorders (e.g., Siev & Chambless, 2007). Psychotherapies have been developed to address a broad range of mental health and health conditions, which makes it essential that consumers of the treatment literature have an awareness of the differences in the nature, strength, and scope of evidence supporting the various options available to treat a specific disorder or condition. In particular, it is critical for consumers of the research literature to be able to determine the forms of treatment that have been demon- strated to improve psychosocial functioning for those suffering from prevalent mental disorders. Such information is essential for clinicians delivering psychological treatments, for those develop- ing policies on first-line treatment options, and, of course, for those seeking treatment.In recent years, an important distinction has been emphasised in the treatment literature with respect to research focused on the outcome of psychological interventions. …

Annual research review: Child and adolescent mental health interventions: a review of progress in economic studies across different disorders.

BackgroundResources for supporting children and adolescents with psychiatric disorders continue to be scarce. Economics research can identify current patterns of expenditure, and help inform allocation of treatment and support resources between competing needs or uses.Scope and methodsThe aim was to identify the costs of supporting children and adolescents, the economic impacts of childhood psychiatric disorders in adulthood and any new evidence on the cost-effectiveness of interventions. An electronic search of databases (including PubMed, Medline and Psychinfo) identified peer-reviewed journal articles published between 2005 and 2012.FindingsSixty-seven papers provided data on support and treatment costs now or in the future, or cost-effectiveness analyses of services. Half the articles came from the United States. Most articles focussed on autism spectrum disorder (ASD; 23 articles), attention deficit hyperactivity disorder (ADHD; n = 15), conduct disorder (CD; n = 7), and anxiety or depression (n = 8).ConclusionOnly 14 studies used a cost perspective wider than health care; most included education costs (n = 11), but only five included costs to the justice system. The number of studies estimating costs to the family has increased, particularly for children with autism spectrum disorder (ASD). In the United Kingdom, support costs for children and adolescents with conduct disorder (CD) appear to be lower than for those with attention deficit hyperactivity disorder (ADHD), although for the United States, the opposite may be true. Support costs for children and adolescents with ASD may be higher than both CD and ADHD. However, there were many differences between the samples and the methods employed making comparisons between studies difficult. Outcomes in adulthood include negative impacts on (mental) health, quality of life, public sector services, employment status and income. The evidence base is improving for child and adolescent psychiatric disorders, although only one full cost-effectiveness analysis was identified since the previous review published in 2012. However, we still do not know enough about the economic implications of support and treatment for specific disorders.

Complementary and Alternative Medicine in the Treatment of Chronic Pelvic Pain in Women: What Is the Evidence?

Chronic pelvic pain (CPP) is defined as pain of at least 6 months' duration that occurs in the lower abdomen or below the umbilicus and has resulted in functional or psychological disability or required intervention and treatment. Therapeutic interventions center around the treatment of CPP as a diagnosis in and of itself, and treatment of specific disorders that may be related to CPP. A multidisciplinary approach for diagnosis and treatment seems to be most effective for symptomatic relief. This paper reviews the evidence for such interventions as psychological treatments including the use of complementary and alternative medicine techniques for CPP in women. Unfortunately, finding the best evidence in this setting is difficult as only very few randomized controlled trials are available. A combination of treatments is usually required over time for the treatment of refractory CPP. The multifactorial nature of CPP needs to be discussed with the patient and a good rapport as well as a partnership needs to be developed to plan a management program with regular followup. Promotion of a multidisciplinary approach which includes complementary and alternative medicine techniques in managing CPP in women seems to yield the best results.

You can't step into the same river twice, but you can stub your toes on the same rock: Psychotherapy outcome from a 50-year perspective.

H.H. Strupp's 1963 article, The Outcome Problem in Psychotherapy Revisited, and the exchange between Eysenck and Strupp that followed the article were reexamined to answer the question: What, if anything, has changed in the world of psychotherapy research over half a century since the article was originally published? Many of the issues that provided the impetus for the article and the focal point of the passionate debate between Strupp and Eysenck have been long put to rest. Much has been accomplished: Debates in the literature have became more civil, generic factors such as the therapy relationship have received strong empirical support, and researchers' attention has shifted from the broad question whether psychotherapy offers real benefits to patients to providing empirical support for closely prescribed treatments for specific disorders. However, some of the core issues raised in the article concerning how to measure and meaningfully appraise the benefits of psychotherapy are still a challenge today. Some possible avenues for future developments are explored.

Translating Research for Professional Development and Effective Clinical Practice With Older Adults

This paper offers a commentary on the articles in the special series on cognitive behavior therapy with older adults (Carmin, 2012-this issue), noting the commonalities found across discussions of diagnostic interviewing and cognitive-behavioral assessment and treatment for late-life insomnia, depression and suicide risk, PTSD, and OCD. These case studies demonstrate best practices in the application of cognitive-behavioral strategies for assessment and intervention with a diverse range of older adults. Clinicians can improve the effectiveness of their work with aging clients by expanding their skills in assessment and managing interprofessional relationships in integrated health-care settings. Reflected by the papers in this series, ongoing professional development and research attention are both essential as clinicians from the mental health disciplines increase provision of CBT with older adults. Treatments for specific disorders and problems will also benefit from the growing literature on successful aging, and the application of positive psychology in our future collaborations with older adults and their care partners.

Clinician's thesaurus: the guide to conducting interviews and writing psychological reports

Getting Orientated to the Clinician's Thesaurus. Part I: Conducting a Mental Health Evaluation. Beginning and Ending the Interview. Mental Status Evaluation Questions/Tasks. Questions about Signs, Symptoms, and Other Behavior Patterns. Part II: Standard Terms and Statements for Wording Psychological Reports. A. Introducing the Report. Beginning the Report: Preliminary Information. Referral Reasons. Background Information and History. B. The Person in the Evaluation. Behavioral Observations. Responses to Aspects of the Examination. Presentation of Self. Emotional/Affective Symptoms and Disorders. Cognition and Mental Status. Abnormal Signs, Symptoms, and Syndromes. Personality Patterns. C. The Person in the Environment. Activities of Daily Living. Social/Community Functioning. Couple and Family Relationships. Vocational/Academic Skills. Recreational Functioning. Other Specialized Evaluations. D. Completing the Report. Summary of Findings and Conclusions. Diagnostic Statement/Impression. Recommendations. Prognostic Statements. Closing Statements. Part III: Useful Resources. Treatment Planning and Treatment Plan Formats. Formats for Reports, Evaluations, and Summaries. Treatments for Specific Disorders and Concerns. Listing of Common Psychiatric and Psychoactive Drugs. Psychiatric Masquerade of Medical Conditions. Appendix: A. Abbreviations in Common Use. Appendix B. Annotated Readings in Assessment, Interviewing, and Report Writing.

Intellectual disability: a guide for families and professionals

Approximately 2.5 million people in the United States-one percent of the population-have an intellectual disability (previously referred to as mental retardation). These conditions range from genetic disorders such as Down syndrome to disabilities caused by infectious diseases and brain injury. Intellectual Disability: A Guide for Families and Professionals, by one of the country's foremost authorities on intellectual disability, is a comprehensive resource that will be of importance to anyone with a personal connection to a child or adult with a neurodevelopmental disorder. Emphasizing the humanity of persons with intellectual and related developmental disabilities, psychiatrist and pediatrician James Harris provides essential information on assessment and diagnosis of intellectual disability, treatments for specific disorders, and ways to take advantage of the wide array of services available today. The focus throughout is on the development of the person, the positive supports necessary for self-determination, and, to the extent possible, independent decision making. Harris also surveys historical attitudes toward intellectual disability, the medical community's current understanding of its causes and frequency, and the associated physical, behavioral, and psychiatric conditions (such as seizure disorder, depression, and autism) that often accompany particular types of intellectual disability. The book addresses legal, medical, mental health, and research-related issues as well as matters of spirituality, highlighting the ways in which individuals with intellectual disability can meaningfully participate in the spiritual lives of their families and their communities. Each chapter ends with a series of key points to remember, and the book concludes with a list of additional resources of further interest. Intellectual Disability is a must-read for parents and families of those with neurodevelopmental disorders, providing guidance and essential information to help their family members effectively, and to make a significant, positive difference in their lives now and in the future.

Endocrine and Nutritional Management of the Post-Bariatric Surgery Patient: An Endocrine Society Clinical Practice Guideline

We sought to provide guidelines for the nutritional and endocrine management of adults after bariatric surgery, including those with diabetes mellitus. The focus is on the immediate postoperative period and long-term management to prevent complications, weight regain, and progression of obesity-associated comorbidities. The treatment of specific disorders is only summarized. The Task Force was composed of a chair, five additional experts, a methodologist, and a medical writer. It received no corporate funding or remuneration. Bariatric surgery is not a guarantee of successful weight loss and maintenance. Increasingly, patients regain weight, especially those undergoing restrictive surgeries such as laparoscopic banding rather than malabsorptive surgeries such as Roux-en-Y bypass. Active nutritional patient education and clinical management to prevent and detect nutritional deficiencies are recommended for all patients undergoing bariatric surgery. Management of potential nutritional deficiencies is particularly important for patients undergoing malabsorptive procedures, and strategies should be employed to compensate for food intolerance in patients who have had a malabsorptive procedure to reduce the risk for clinically important nutritional deficiencies. To enhance the transition to life after bariatric surgery and to prevent weight regain and nutritional complications, all patients should receive care from a multidisciplinary team including an experienced primary care physician, endocrinologist, or gastroenterologist and consider enrolling postoperatively in a comprehensive program for nutrition and lifestyle management. Future research should address the effectiveness of intensive postoperative nutritional and endocrine care in reducing morbidity and mortality from obesity-associated chronic diseases.

The trouble with NHS psychiatry in England

SummaryIn ‘Wake-up call for British psychiatry’ Craddock et al explained how recent attempts to improve psychosocial care for people with mental illness focus on non-specific psychosocial support. This has been at the expense of proper diagnostic assessment and prescription of treatment by psychiatrists aimed at treatment of specific disorders and recovery. They describe a creeping devaluation of psychiatry which is caricatured as narrow, biological, reductionist, oppressive, discriminatory and stigmatising. Some trusts have implemented ‘New Ways of Working for Psychiatrists’ in a way that undermines the central importance of psychiatrists in mental healthcare. Consequently, patients may be treated in secondary care without ever being seen by a psychiatrist. We consider a number of different changes that have interacted in unforeseen ways, with unintended adverse consequences for psychiatric services in England. We aim to continue the debate here.

The promises and challenges of early intervention in psychotic disorders

The promises and challenges of early intervention in psychotic disorders

Psychiatric diagnosis - is it universal or relative to culture?

There is little consensus on the extent to which psychiatric disorders or syndromes are universal or the extent to which they differ on their core definitions and constellation of symptoms as a result of cultural or contextual factors. This controversy continues due to the lack of biological markers, imprecise measurement and the lack of a gold standard for validating most psychiatric conditions. Empirical studies were used to present evidence in favor of or against a universalist or relativistic view of child psychiatric disorders using a model developed by Robins and Guze to determine the validity of psychiatric disorders. The prevalence of some of the most common specific disorders and syndromes as well as its risk and protective factors vary across cultures, yet comorbid patterns and response to treatments vary little across cultures. Cross-cultural longitudinal data on outcomes is equivocal. The cross-cultural validity of child disorders may vary drastically depending on the disorder, but empirical evidence that attests for the cross-cultural validity of diagnostic criteria for each child disorder is lacking. There is a need for studies that investigate the extent to which gene-environment interactions are related to specific disorders across cultures. Clinicians are urged to consider culture and context in determining the way in which children's psychopathology may be manifested independent of their views. Recommendations for the upcoming classificatory system are provided so that practical or theoretical considerations are addressed about how culture and ethnic issues affect the assessment or treatment of specific disorders in children.

Management of rotator cuff disease: specific treatment for specific disorders

Disease of the rotator cuff is common. It is responsible for a high proportion of patients with shoulder pain presenting to general practice, causing work absenteeism and claims for sickness benefits. Rotator cuff disease (RCD) can often be managed in primary health care services, although some cases may require secondary referral. Both extrinsic and intrinsic factors to the cuff tendon are thought to be involved in the pathogenesis leading on to a spectrum of conditions ranging from sub-acromial bursitis to mechanical failure of the cuff tendon itself. Careful history and examination followed by pertinent investigation are essential to establish the correct diagnosis. The main aim of treatment is to improve symptoms and restore function of the affected shoulder. The majority of patients suffering from RCD can be managed by conservative means, but a shift in attitude has led to a significant number benefiting from invasive procedures ranging from decompression of the sub-acromial space to large, open procedures reconstructing the tendon itself.

Early response in psychotherapy: Further evidence for the importance of common factors rather than “placebo effects”

Evidence is presented demonstrating that placebo control groups benefit more from psychotherapy than no-treatment control groups but less than patients who receive theory-driven treatments. Through a brief review of the results of comparative outcome studies, studies which compare patient outcomes for those seen by trainees or paraprofessionals versus professional therapists and those which show an early response of a sizable portion of patients, a case is made for the powerful effects of common factors in psychotherapy. The early response phenomenon has proposed another challenge to the unique effects of specific psychotherapies and to the wisdom of emphasizing the causative effects of specific techniques in the treatment of specific disorders.

Experimental analysis of specific treatment factors: Efficacy and practice implications

Interest in the empirical demonstration of the clinical efficacy of psychosocial treatments has been rekindled by societal concerns over accountability and cost effectiveness of mental health services. The result has been the identification of specific treatments for specific disorders. The prescription of treatment content should be based on the theory of therapeutic action and/or the disorder to which it is applied. The demonstration of specific treatment efficacy requires experimental evidence showing the influence of specific procedures beyond nonspecific factors of treatment. We provide an analysis of these factors and their effects in evaluating the specific efficacy of prescriptive psychosocial treatments. Experimental procedures and designs that test the validity of specific treatments are described and applied to cognitive-behavioral treatments of generalized anxiety disorder. The empirical and professional implications of specific treatment efficacy in evidence-based practice are discussed.

The dodo-bird debate, empirically supported relationships and functional analytic psychotherapy.

Abstract The dodo-bird verdict has haunted the literature on psychotherapy outcome since its early beginnings. It is based on the counter-intuitive finding that often highly diverging treatments do not differ much in effectiveness. There is evidence that much of the common effect of different treatments can be related to unspecific factors as opposed to treatment-specific techniques. The present paper offers a short behavior analytic reflection on contemporary directions concerning effective therapeutic relationships. It suggests that the idiographic vision inherent in functional analysis may point at an alternative avenue for psychotherapy outcome research that is entirely different from those on empirically supported treatments and empirically supported relationships, and that this third direction may shed more light on the question as to what determines therapeutic change. Key-words: Dodo-bird verdict; Empirically supported therapies; Therapeutic relationship; Functional Analytic Psychotherapy. ********** Since the advent of research on the effectiveness of specific treatments for specific disorders (Eysenck, 1952; Chambless, 1996) therapy advanced tremendously and it seems it will never be the same again. As a result of this work, the well-trained therapist of today, confronting a client with this or that particular disorder will be able to choose and implement the treatment-package that will most probably be helpful. The bottom line is that a treatment that has been shown most helpful in studies for clients with a specific problem and specific characteristics, will be the most indicated treatment for a client one will meet in one's office with that same problem and those same characteristics. Critics of this development have been prolific. It has been pointed out that technique-driven protocols cannot consider the complexity of the therapeutic process and that the ecologic validity of the controlled studies is weak because the therapy settings in clinical practice vary widely (Garfield, 1996; Goldfried & Wolfe, 1996; 1998; Bohart, 2000). The Dodo-Bird Verdict Metanalyses (e.g. Smith, Glass & Miller, 1980; Wampold, et al., 1997; Luborsky et al., 2002) tend to corroborate Rozenzweig's (1936) verdict that everybody has won and must have prizes, a line taken from the Dodo-bird in Lewis Caroll's Alice's Adventures in Wonderland. That very dissimilar interventions have similar effects diminished the seeming importance of specific techniques. The Dodo-bird verdict came to evoke in specialists at least three standard types of reaction. A first type consists in pointing out that the meta-analyses don't permit disqualifying the effects of techniques and that it is more ethical to use techniques that have empirical support than to speculate about unspecific variables. Continued controlled studies are necessary to show what variables or interactions contribute to therapeutic changes (Eysenck, 1994; Chambless, 2002). A second type of reaction points at unspecific variables as holding the major promise for explaining what makes therapy work (Bohart, 2000; Messer & Wampold, 2002). The therapeutic encounter in itself can have an important effect on the client and the therapist as a person makes a difference. Characteristics of the relationship compete with specific techniques as possible explanations of why therapies work. They are often common to many different treatments, and have enough empirical support to give them a place alongside specific techniques in models about the active ingredients of therapy. Efforts to identify core relationship variables have been examined by a task force of the American Psychological Association's division 29 and reviewed in a book organized by Norcross (2002). These empirically supported relationships are aspects of the way in which client and therapist interact, that research has been able to relate favorably to treatment outcome or process. …

Specificity and Nonspecificity in Psychotherapy.

DeRubeis et al. (this issue) offer a data-based critique of two arguments frequently presented in support of the “nonspecifics” hypothesis. This commentary supports their report of superior effects for specific treatments for specific disorders and provides some additional data to support their position. We maintain, however, that current research has not adequately evaluated nonspecific effects so that theoretical conclusions can be drawn regarding the mechanisms of change of the superior treatments. DeRubeis et al. present some data to suggest that nonspecific effects, particularly the therapeutic alliance, are a result of therapy outcome rather than causal in therapeutic change. We argue, to the contrary, that adequate research remains to be done regarding nonspecific effects, and when that research is completed, what are now called nonspecific effects will be more aptly labeled previously unspecified effects.