Newest Data on Shame and Drinking Published at Western Psychological Association Conference

Newest Data on Shame and Drinking Published at Western Psychological Association Conference

Last Friday, Portland Psychotherapy research assistants Monica Bahan, Megan Cheslock, and Jackie Potter presented a research poster at the annual Western Psychological Association convention, which took place in Portland. Their poster detailed findings from one of our ongoing studies exploring the relationship between shame, guilt, and drinking behavior. The findings were based on the first 88 participants in the study, all volunteers from the Portland area.

Congratulations to Monica, Megan, and Jackie on their first presentation!

Jason Luoma, Ph.D.

Author: Jason Luoma, Ph.D.

Jason is a psychologist who researches ways to help people with chronic shame and stigma and also works clinically with people struggling with those same problems.

Marketing For the Evidence-Based Therapist

Marketing For the Evidence-Based Therapist

As a large body of therapies have been identified that are demonstrably effective, the field has shifted toward dissemination and implementation. For those who are out in practice, a main way we get evidence-based therapies to clients is through effective marketing. As the director of a growing clinic who has worn pretty much every hat (e.g., entrepreneur, biller, therapist, manager, bookkeeper, receptionist, accountant, janitor), I’ve had to learn a lot about marketing over the last several years. In particular, I’ve found that online marketing has been especially fruitful for our business.

In the process of doing some of our online marketing, a colleague asked me to make some recommendations for key books relating to marketing a private practice. I realized that I had no one book that covered most of the material that I had learned, but instead had learned through a variety of resources over the years, many of them online. Below lies a smattering of links and resources on online marketing that I’ve found useful over the years as well as some general comments about the important elements of a building a business as a therapist.

Search engine optimization (SEO)

Once you build a website, you need to hire someone to help you optimize your site and drive traffic to it. Just building a website is near useless if you don’t figure out how to get people to visit it. You should be able to get someone who can help you drive traffic to your website for $400 a month or less. You need to spend money on marketing in order to grow your business (or even to have a business usually). Marketing works, that’s why we have so much of it around us. It changes behavior and will bring people to your doorstep. SEO professionals know how to bring more clients to your door. This is money well spent, once you have a website already up.

Some links to get you started on what SEO is and how to do it:

http://www.seomoz.org/blog/the-beginners-checklist-for-small-business-seo

Private practice marketing

If you need some help with business strategies overall, most areas of the country have a small business development center. Look up your local center. They often provide very affordable and expert training that is perfect for mental health professionals trying to expand their business knowledge. I’ve learned a lot from my local SBDC. http://www.sba.gov/content/small-business-development-centers-sbdc

Some good articles can be found here: http://www.uncommonpractices.com/articles.html

This is my favorite book about running a private practice in terms of recommendations on how to do marketing: Getting Started in Private Practice: The Complete Guide to Building Your Mental Health Practice

Website design

Three tips:

1) Put a contact form on the front page of your website and the contact page, rather than relying on people to call you. You’ll get a lot more contacts that way.

2) Learn how to use WordPress to set up your site. It’s simple and easy to use once you’ve learned how to set it up.

3) Get your site noticed and convert visitors to clients:

Business blogging and writing good content

Here’s a basic primer on writing good blog posts by a leading blog developer: http://www.davidrisley.com/blog-writing/

One of the oldest and most prolific blogs about blogging: http://www.copyblogger.com/blog/

General online marketing

Here’s a graphic to help you see all the possibilities for online marketing and organize your thinking: http://assets.unbounce.com/s/images/noob-guide-to-marketing-infographic-1800.png

Some basics on online marketing: http://counsellingresource.com/lib/practice/internet-marketing/

Some webinars if you like to watch those: http://www.hallme.com/archived-webinars.php

Social Media Marketing

Some tips on how to embrace social media and the latest changes in Google to your advantage: http://www.psychotherapynetworker.org/magazine/recentissues/2012-mayjune/item/1708-in-consultation

A psychotherapist’s guide to Facebook and Twitter: Why clinicians should give a tweet – http://www.psychotherapy.net/article/psychotherapists-guide-social-media

Dr. Keely Kolmes’ private practice social media policy – http://www.drkkolmes.com/docs/socmed.pdf

Online business models

You might want to write a business plan. Here’s a template:

http://www.copyblogger.com/smart-people-business-plan/

I don’t know of anyone better at it and who produces better content on running a business online than Pat at Smart Passive Income. His podcast is super-popular, interesting, and very relevant: http://www.smartpassiveincome.com/

Pay-per-click advertising (PPC)

 

Really the only place you need to advertise is with google adwords. It’s not too hard to set up a basic account, set a budget and try it out. Here are some ideas on how to do that: http://adwords.google.com/select/Login

Adwords for therapists: http://www.uncommonpractices.com/adwords.html

Optimizing quality score: http://www.redflymarketing.com/blog/how-to-improve-quality-score-the-ultimate-guide/

Newsletters

Before putting your efforts into blogging, first create a following with an email list to directly connect with local, potential clients in a more direct way

http://uncommonpractices.wordpress.com/2009/04/22/why-blogging-is-a-waste-of-time-for-private-practitioners/

http://www.smartpassiveincome.com/email-list-strategies/

I like Mailchimp because the interface is very simplified and you are able to get a feel for creating and using newsletters for marketing your business without having to invest right from the start.  Your account is free as long as you have less than 2,000 subscribers and you send less than 12,000 emails per month.

http://mailchimp.com/

Other popular services include:

http://www.aweber.com/

http://www.constantcontact.com/

Face-to-face networking

My favorite book on this topic is: Never Eat Alone

And if you are looking to improve your social skills, speaking abilities, and ability to just interact with others and make conversation, I don’t know a better place than Toastmasters, which I have been a member of for years. To find a meeting near you: http://reports.toastmasters.org/findaclub/

See if there is a meetup group in your area either of therapists or other professionals in your area of interest.

Finding your passion

And Don’t do any of these things if it doesn’t align with your passion: http://zenhabits.net/the-short-but-powerful-guide-to-finding-your-passion/

Team Up

Check with your state’s psychological association to see if they have any events scheduled to learn more about marketing.

See if you can find a “practice buddy” — another local mental health practitioner who has similar goals and who can meet with you to brainstorm ideas regarding seminars, networking groups to attend, accessing each other’s networks, and setting goals for putting these tips to work.

Do you have favorites? Send me a message about those and I’ll check them out. Who knows, maybe they’ll make it onto the list.

Defending behavioral science

Defending behavioral science

A couple weeks ago, the New York Times posted an opinion piece which presented a very pessimistic and narrow view of the behavioral sciences. While I agreed with some of the points of the author, particularly the need for more randomized controlled trials of psychosocial interventions, I also think he “threw the baby out with the bathwater.” While we haven’t solved all the problems of humanity through behavioral science research, we have managed to discover a range of interventions that have been shown to work.

In response to the NY Times article, a local colleague and friend at Oregon Research Institute, Tony Biglan, wrote an excellent response. In his post, he outlines some of the research-based intervention that have been shown to work.

In a time of decreasing funding for research and particulary for behavioral research, it’s important that we advocate for the importance of science-based psychotherapy and related psychosocial interventions. If you like this piece, consider passing it on, blogging about it, or tweeting it. There are buttons right at the bottom of this page that make it easy to pass along.

Reducing Shame in Addictions: Slow and Steady Wins the Race

Reducing Shame in Addictions: Slow and Steady Wins the Race

I’m pretty excited about publishing the 51st randomized clinical trial on Acceptance and Commitment Therapy (in The Journal of Consulting and Clinical Psychology). Our study is the first randomized trial ever published to test the effectiveness of an intervention targeting shame in substance use disorders. Authors have been writing about the importance of shame in addiction for decades, but no one has spent the time and money to actually test an intervention. It’s pretty cool to be the first.

This study adds to the rapidly growing database on ACT

The number of randomized clinical trials on ACT is growing rapidly, with most studies published in just the last four years (see graph below of the number of published randomized clinical trials on ACT, by year, courtesy of Steve Hayes  – the graph is missing the five most recently published randomized trials).

 

Those who follow this blog are going to get a sneak peak at what will be in the manuscript. Below, I’ll snip out a few findings and the abstract. I’m pretty excited about this work and where our research on shame and self-stigma is leading. Keep tuned to this blog for more about where this work goes. You can find past publications on the topic on our Portland Psychotherapy publications page.

 

First, the abstract:

Objective: Shame has long been seen as relevant to substance use disorders, but interventions have not been tested in randomized trials. This study examined a group-based intervention for shame based on the principles of Acceptance and Commitment Therapy (ACT) in patients (N = 133; 61% female; M = 34 years old; 86% Caucasian) in a 28-day residential addictions treatment program. Method: Consecutive cohort pairs were assigned in a pair-wise random fashion to receive treatment as usual (TAU) or the ACT intervention in place of six hours of treatment that would have occurred at that same time. The ACT intervention consisted of three, two-hour group sessions scheduled during asingle week. Results: Intent-to-treat analyses demonstrated that the ACT intervention resulted in smaller immediate gains in shame, but larger reductions at four month follow up. Those attending the ACT group also evidenced fewer days of substance use and higher treatment attendance at follow up. Effects of the ACT intervention on treatment utilization at follow up were statistically mediated by post treatment levels of shame, in that those evidencing higher levels of shame at post treatment were more likely to be attending treatment at follow up. Intervention effects on substance use at follow up were mediated by treatment utilization at follow up, suggesting that the intervention may have had its effects, at least in part, through improving treatment attendance. Conclusions: These results demonstrate that an approach to shame based on mindfulness and acceptance appears to produce better treatment attendance and reduced substance use. 

 

And the overall summary of the findings from the discussion:

A six-hour group using an ACT approach to shame as a small part of a 28-day residential program led to slower immediate gains in shame, but better long term progress….Results indicated that reductions in shame during active treatment predicted higher levels of substance use at follow up. Mediational analyses suggested that the more gradual reductions in shame found in the ACT group protected against the pattern seen in TAU for shame reductions to be associated with subsequent higher levels of substance use. As predicted, the ACT intervention led to higher levels of outpatient treatment attendance during follow up, which in turn was functionally related to lower levels of substance use. Across the board, participants in the ACT condition showed a pattern of continuous treatment gains, especially on psychosocial measures, rather than the boom and bust cycles seen in treatment as usual.

 Our explanation for this pattern of results:

… something in the six hours spent in the ACT group changed the overall effect of this residential program. Unhealthy suppression of shame may be involved in the “treatment high” sometimes seen in early recovery in which sobriety can lead to unrealistic treatment gains, only to be followed by urges to use, relapse, or depression … It seems plausible that these six hours [of the intervention] kept participants from interacting with the overall treatment program in a way that produced illusory short term gains, perhaps by helping them experience shame in a more open and  mindful fashion, thereby allowing the emotion to perform its regulatory function of warning against or punishing violations of personal values or social norms and of helping to repair strained social roles. The resulting improvement in functioning and reintegration into healthy social networks, such as those found in a recovery community, led to less shame over time.

At the end of our article we summed up our hopes for how this research might help people with addiction:

Many people with substance use disorders experience shame as a result of the stigma of substance abuse, failure to control their substance use, and failures in role functioning. Understandably, people are motivated to avoid or reduce this extremely painful affect. Unfortunately, when the emotion of shame itself becomes the target of avoidance, this may exacerbate shame in the long run, even though it may provide some relief in the short-term. In a similar way, while negative self-conceptions are painful, direct change efforts can paradoxically increase the frequency and regulatory power of negative self-conceptions. Results of this study suggest that acceptance and mindfulness based interventions may help people to step out of a cycle of avoidance and shame and move toward a path of successful recovery that leads to more stable reductions in shame and to more functional ways of living. 

 

Citation:

Luoma, J. B., & Kohlenberg, B.S., Hayes, S. C., & Fletcher, L. (in press). Slow and Steady Wins the Race: A Randomized Clinical Trial of Acceptance and Commitment Therapy Targeting Shame in Substance Use Disorders. Journal of Consulting and Clinical Psychology.

The full study should be available shortly on the journal’s website.

“Evidence-Based Psychotherapy” versus “Scientifically Oriented Psychotherapy”

“Evidence-Based Psychotherapy” versus “Scientifically Oriented Psychotherapy”

I just stumbled across a new paper by David and Montgomery (2011), who provide a novel system for categorizing psychotherapies in terms of their quality of evidence. One reason we named this blog Science-Based Psychotherapy, is to highlight some of the flaws in the current methods of evaluating evidence-based practice. I hope that some of the recommendations of David and Montgomery (2011) get adopted, because their guidelines would be a huge advance over the current state of affairs. As stated in the article:

…all the current systems of evaluating evidence-based psychotherapies have a significant weakness; they restrict their focus on evidence to data supporting (psycho)therapeutic packages while ignoring whether any evidence exists to support the proposed theoretical underpinnings of these techniques. (i.e., theory about psychological mechanisms of change; p. 90)

Evidence-based therapy lists ignore basic science and theory

One big problem of the current methods of evaluating evidence is the lack of attention to basic science and theory. The result is that therapy packages that are based on theories that have been clearly invalidated can still appear to be scientifically credible:

By ignoring the theory, the evaluative frameworks of various health-related interventions (including psychotherapy), technically (a) allow pseudoscientific (i.e., ‘‘junk-science’’) interventions to enter into the classification schemes and or (b) bias the scientific research in a dangerous direction (p. 90).

The danger of these kinds of incentives is that they push researchers to focus solely on outcome research at the expense of testing and refining the scientific theories that will allow for future advances in therapy.

…a consequence of current classification schemes (which consistently do not address underlying theories about mechanisms of change) is that as long as there are randomized trial data, the validity of the underlying theory is less relevant (p. 90).

The current evaluative systems focus on only one kind of evidence: outcome evidence based on the performance of particular therapy packages. This evidence is typically in the form of randomized controlled trials (RCTs). What David et al. add is a second factor that focuses on evidence for the underlying theory.

They propose that each of these two factors are evaluated on three levels

a) empirically well supported;

(b) equivocal no clear data, which includes–not yet evaluated, preliminary data, or mixed data

(c) strong contradictory evidence (SCE; i.e., invalidating evidence).

Here’s their diagram showing how this breaks down:

One of the cool things about this framework is that it allows distinctions between therapies with both types of evidence and therapies that only have one form of evidence. They call those therapies with the highest levels of evidence “Scientifically Oriented Psychotherapies.”

Scientically oriented psychotherapies (SOPs) are those which do not have clear SCE for theory and package; the highest level of validation of a SOP is that in which both the theory about psychological mechanisms of change and the therapeutic package are well validated (i.e., Category I). A SOP seeks to investigate empirically both the therapeutic package in question and the underlying theory guiding the design and implementation of the therapeutic package (i.e., theory about mechanisms of change; p. 91).

A definition of pseudoscience

This allows for a pretty solid definition of a therapy based on pseudoscience.

Pseudoscientically oriented psychotherapies (POPs) are those that claim to be scientific, or that are made to appear scientific, but that do not adhere to an appropriate scientific methodology (e.g., there is an overreliance on anecdotal evidence and testimonial rather than empirical evidence collected in controlled studies; Lilienfeld, Lynn, & Lohr, 2003)…. We define POPs as therapies used and promoted in the clinical field as if they were scientifically based, despite strong contrary evidence related to at least one of their two components (i.e., therapeutic package and theory; p. 92).

One consequence of this approach is that it allows for the identification of therapies that have accumulated evidence of effectiveness, but where the theory on which they are based has been invalidated. If these therapies are promulgated based on the invalidated theory, they are classified as pseudoscientifically oriented psychotherapies (POP). Here’s an example from their article of a commonly utilized approach, neurolinguistic programming, that is based on a disproven theory:

An interesting shift from SOPs to POPs is illustrated by neurolinguistic programming. Once an interesting system (e.g., Category IV of SOPs, according to our classification), it is now seen largely as a POP (Category VII) because although its theory was invalidated by a series of studies (for details, see Heap, 1988; Lilienfeld et al., 2003), it continues to be promoted in practice based on the same theory, as if it were valid (p. 95).

Let’s break this down a little bit. While there is a general lack of evidence for the effectiveness of NLP, there is a greater consensus that the underlying theory contradicts basic research in neuroscience or psychology. NLP uses many scientific sounding but empty terms such as pragmagraphics, surface structure, non-accessing movement, metamodeling, metaprogramming, and submodalities. While these terms form the theoretical foundation for much of the  NLP techniques and sound scientific, they have not stood up to scientific scrutiny and thus the term pseudoscientific applies to this therapy.

Science cannot be stagnant. It is ever evolving and needs to be modifiable based on what the data suggest. In order for science to progress and produce effective treatments over time, good theory is needed. Theory is what allows scientists to make sense of the findings that are observed and guides new research. Brute force empiricism, without theory, leads to a lot of blind paths and wasted energy. I’m heartened to see a leading journal discussing alternate schemes for evaluating the scientific credibility of therapies that focus on mechanisms of action, theory, and incorporates understanding derived from basic science.

Reference:

David, D., & Montgomery, G. H. (2011). The Scientific Status of Psychotherapies: A New Evaluative Framework for Evidence-Based Psychosocial Interventions. Clinical Psychology: Science and Practice. Volume 18, Issue 2, pages 89–99.

UPCOMING TRAINING EVENTS

April 17 and 18, 2020, 9:15 am – 5:00 pm · Portland, OR · Details

Do you ever “get stuck” as a therapist? Do some of your clients press your “hot buttons”? Do you ever find yourself struggling and thinking about “what do I do next” or feeling anxious, scared or stressed in therapy? In this workshop we will work on clarifying your therapist values and defining what is “difficult” about “difficult” clients. Through discussions, demonstrations and roleplays we will then work on these difficult clients and look at the processes from a compassionate ACT perspective. Read more