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- PublicationHow do we find out what works for whom? Evaluating the efficacy and effectiveness of psychotherapyControlled randomized clinical trials of psychotherapy have traditionally been used to test the efficacy of specific forms of psychotherapy for specific problems. The value of findings from such efficacy studies for practicing psychotherapists has been questioned because these studies involve clients and therapy procedures that are radically different from those typically used in routine clinical practice. Opponents of efficacy research have proposed health service-based effectiveness research as a more valuable alternative to efficacy research. Arguments for and against rigorously controlled efficacy research on the one hand, and 'real-world' effectiveness research on the other are explored in this paper.
- PublicationDifferential outcomes to a pain management programme based on coping styleThe study objectives were to investigate whether a heterogeneous sample of Irish chronic pain patients could be classified into subgroups using the Multidimensional Pain Inventory to profile the subgroups’ experiences of pain and distress, and to compare their responses to a multidisciplinary pain management programme. Ninety chronic pain patients completed the Multidimensional Pain Inventory (MPI), the McGill Pain Questionnaire (MPQ), and the Hospital Anxiety and Depression Scale (HADS) before and after a multidisciplinary pain management programme and at 6–23 months follow-up. Eighty-eight percent of patients were classified as Dysfunctional (DYS), Interpersonally Distressed (ID), or Adaptive Coper (AC) on the basis of their responses to the MPI. The proportions of patients classified into the three MPI groups were similar to those found in previous studies: 21% were AC, 20% were ID, and 47% were DYS. The three groups differed significantly in their levels of pre-treatment pain and distress. Compared with the AC group, the DYS group had greater pain and both the DYS and ID groups had greater distress. For measures of pain intensity and interference, from pre- to post-treatment, the DYS group improved significantly more than the AC group, but for pain intensity, the DYS group had relapsed at follow-up and the AC group’s interference scores had significantly improved. All patients who participated in the programme showed significant improvement in depression and the sense of control they had over their lives; this improvement was partially maintained at follow-up; and participants expressed a high level of satisfaction with all aspects of the programme. In conclusion, Irish chronic pain patients are not a homogeneous group and may be classified into subgroups based on psychological factors. Treatment response may be related to subgroup membership. Future research should evaluate whether tailoring treatments to patient characteristics will improve treatment outcome.
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