Evidence-based working in clincial practice
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Voorbij het oordeel van de dodo - samenvatting van een artikel van Huiberts (2015)
Voorbij het oordeel van de dodo
Huibers (2015)
Tijdschrift voor Psychotherapie
DOI: 10.1007/s12485-015-0027-6
Inleiding
Om de effectiviteit van psychotherapie te verhogen zijn er drie routes. Dit zijn: 1) Het bedenken van nieuwe therapieën 2) Inzicht vinden in de onderliggende werkingsmechanismen 3) Onderzoek doen naar het profiel van patiënten die baad hebben van therapie.
The great psychotherapy debate
Over de werkingsmechanismen van psychotherapie is weinig bekend.
Mechanismen en mediatie in onderzoek
Een mediator is de term voor het werkingsmechanisme of het veranderproces waarmee we het effect van de therapie willen verklaren.
De temporele relatie is wat er vooraf gaat aan het andere. Om dit te kunnen bepalen moeten we tijdens de behandeling vaak zowel de mediator als de uitkomstvariabele meten. Zo kun je ontdekken welke eraan vooraf gaat. Indien de mediator aan de uitkomstvariabele vooraf gaat, weet je nog niet zeker of de mediator werkelijk het veranderingsmechanisme is. De verandering op de mediator kan op zijn beurt weer worden veroorzaakt door een andere factor.
In onderzoek naar werkingsmechanismen zijn twee elementen belangrijk. Dit zijn: 1) Statistische mediatie, het effect van de behandeling op de uitkomst loopt via de mediator 2) Temporele relatie, de verandering van de mediator moet eerder optreden dan de verandering in uitkomstvariabele.
Welke therapie werkt voor welke patiënt?
Een moderator wijst op verschillende uitkomsten in verschillende behadelingen. Het is een interessante factor om te bepalen voor welke mensen een bepaalde soort therapie werkt. bn
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