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The neglect of treatment-construct validity in psychotherapy research: a systematic review of comparative RCTs of psychotherapy for Borderline Personality Disorder

Overview of attention for article published in BMC Psychology, August 2016
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Title
The neglect of treatment-construct validity in psychotherapy research: a systematic review of comparative RCTs of psychotherapy for Borderline Personality Disorder
Published in
BMC Psychology, August 2016
DOI 10.1186/s40359-016-0151-2
Pubmed ID
Authors

Lars-Gunnar Lundh, Terese Petersson, Martin Wolgast

Abstract

Randomized controlled trials (RCTs) are considered the best methodology for studying the efficacy of psychotherapy. Optimally an RCT design makes it possible to conclude that if one treatment has a better outcome than another, this is due to the treatment package (TP) as it was implemented in this particular context, rather than other factors beyond the treatment (= high internal validity). Strong internal validity does not, however, provide evidence for the treatment model (TM) that provides the theoretical basis of the TP, because the TP that is tested may differ from the comparison condition in a number of other ways that suggest alternative explanations for the effects. These alternative treatment contrasts represent threats to construct validity of the conclusions. Maximal construct validity requires (1) that the treatments are clearly contrasted on the experimental factors (treatment integrity), and (2) that alternative treatment contrasts can be eliminated. The analysis of alternative explanations is a neglected topic in psychotherapy research. To approach this problem, a methodology for the analysis of treatment contrasts is suggested and tested. Two indexes were defined: (1) a Treatment Integrity Index (TII) and (2) an Alternative Treatment Contrast Index (ATCI). This methodological approach was applied to eight comparative RCTs of treatments for Borderline Personality Disorder (BPD), which were coded for a set of treatment contrasts independently by three coders. The analysis of the RCTs of treatments for BPD showed that construct validity differed widely between the different studies but was generally low (low TII and ATCI), and that it is therefore difficult to draw causal conclusions from this research. The publication policies of scientific journals in this area seldom require the systematic data relevant to an analysis of alternative explanations of the effects, which is needed to provide evidence for a particular TM. Research on psychotherapy needs to be refocused from treatment packages (TP) to treatment models (TM). This requires an improved conceptualization of the methodological principles and skills involved, and the development of valid measures of these, but also improved reporting standards concerning treatment-construct validity in scientific journals.

Twitter Demographics

The data shown below were collected from the profiles of 2 tweeters who shared this research output. Click here to find out more about how the information was compiled.

Mendeley readers

The data shown below were compiled from readership statistics for 33 Mendeley readers of this research output. Click here to see the associated Mendeley record.

Geographical breakdown

Country Count As %
Netherlands 1 3%
Unknown 32 97%

Demographic breakdown

Readers by professional status Count As %
Researcher 7 21%
Student > Master 4 12%
Student > Doctoral Student 4 12%
Professor > Associate Professor 2 6%
Lecturer 2 6%
Other 7 21%
Unknown 7 21%
Readers by discipline Count As %
Psychology 12 36%
Medicine and Dentistry 4 12%
Social Sciences 2 6%
Computer Science 1 3%
Economics, Econometrics and Finance 1 3%
Other 3 9%
Unknown 10 30%

Attention Score in Context

This research output has an Altmetric Attention Score of 1. This is our high-level measure of the quality and quantity of online attention that it has received. This Attention Score, as well as the ranking and number of research outputs shown below, was calculated when the research output was last mentioned on 30 August 2016.
All research outputs
#11,595,159
of 15,183,934 outputs
Outputs from BMC Psychology
#318
of 358 outputs
Outputs of similar age
#174,466
of 265,268 outputs
Outputs of similar age from BMC Psychology
#1
of 1 outputs
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