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Barriers To The Dissemination of Empirically Supported Treatments: Matching Messages To The Evidence (Wampold, Imel & Miller, 2009)
Barriers To The Dissemination of Empirically Supported Treatments: Matching Messages To The Evidence (Wampold, Imel & Miller, 2009)
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Research Forum
Bruce E. Wampold, Zac E. Imel, and Scott D. Miller
W with the following:
You pay good
money for a suit or dress, take
it home, look at it, and hang it
Barriers to the Dissemination of Empirically Supported in the closet. Years go by, you
Treatments: Matching Messages to the Evidence • 144 take it out and look at it and
say, “It’s not me—I’ll wear something else.” You
Book Review can’t seem to throw it out although you really
know you won’t wear it again. You say, “I can’t
Reviewed by Chad E. Drake throw it out. It’s hardly been used. I paid good
Roemer & Orsillo (2009), Mindfulness- and Acceptance-Based money for it.” Or, more significantly, you have
Behavioral Therapy in Practice • 156 been stuck in a dead-end relationship that has
dragged on for years. You know—“ratio-
Multimedia Journal nally”—it makes sense to get out, but you can’t.
Your friends urge you to look at the costs and
Maureen Whittal benefits of staying versus getting out. You know
Looking to the Future of Cognitive and Behavioral Practice • 157 rationally they are right, but you can’t pull the
plug. In both cases, you are “honoring” the sunk
Letter to the Editor costs of prior decisions. You can’t abandon the
sunk cost because you believe you have to justify
Patti Lou Watkins and George A. Clum why you have stayed in so long. You say, “If I left
Empirically Evaluated Self-Help Therapies • 157 it would mean I wasted all that time”; “I can’t
stand the feeling of loss”; “If I left it would prove
At ABCT I am a failure”; or “You don’t understand. There
really are good things there. I just have to wait
Kristene A. Doyle for things to turn around.” In fact, your reasons
To Lead or Not to Lead? • 159 for staying may continue to change—because
Virginia Rutter you are highly motivated to prove that you are
Three Recipients of the Neil S. Jacobson Research Award
not wrong in staying in the first place. Your deci-
sion is “backward-looking,” attempting to jus-
for Outstanding and Innovative Clinical Research • 160
tify what you have done in the past. Ironically,
CALL for AWARD NOMINATIONS • 161 the longer you stay in, the greater the sunk cost
and the greater the need to justify your decision
WELCOME, NEW MEMBERS • 162 to stay. You are making decisions looking back-
138
ward to past investments and not making make the trap more familiar (Leahy, 2000). References
decisions based on future utility. Third, you can divide (or bifurcate) the deci-
Arkes, H. R. (1996). The psychology of waste.
Rational decision-making models argue sion: “If you had never gotten into this be- Journal of Behavioral Decision Making, 9, 213-
that we make choices based on future util- havior, would you make a decision to get 224.
ity, but evidence for sunk costs suggests that into it now?” Fourth, the patient can exam- Arkes, H. R., & Ayton, P. (1999). The sunk cost
we are often trapped by past commitments ine the justifications and challenges to these and Concorde effects: Are humans less ratio-
and investments. Indeed, the greater the rationalizations: “I have too much invested nal than lower animals? Psychological Bulletin,
sunk cost, the greater the escalation of com- 125, 591-600.
to walk away”; “I now have a responsibility
mitment. There are endless examples of Arkes, H. R., & Blumer, C. (1985). The psychol-
sunk costs. Along with your out-of-style to make it work out”; or “I’m not frivo-
lous—I don’t walk away from my commit- ogy of sunk cost. Organizational Behavior &
jacket or dress, there are sunk costs in rela- Human Decision Processes, 35, 124-140.
tionships, careers, purchases, and even in ments.” These assumptions may be
Festinger, L. (1957). A theory of cognitive disso-
foreign policy. The Vietnam War is a much- examined utilizing cognitive therapy tech-
nance. Palo Alto, CA: Stanford University
agreed-on sunk cost, but when the United niques: “What if you looked at your prior Press.
States was engaged in that war a significant investments as lost costs that you can never Festinger, L. (1961). The psychological effects of
majority of Americans supported the war. recover? How would putting more of your- insufficient rewards. American Psychologist,
An entire nation at times was committed to self into this help you achieve your ultimate 16, 1-11.
honoring sunk costs. President Johnson in goals?” Fifth, you can externalize the deci- Gilovich, T., & Medvec, V. H. (1994). The tem-
fact made the bold sunk-cost justification sion by asking, “What if your friends had to poral pattern to the experience of regret.
for staying, claiming that we couldn’t give make the decision for you? What would Journal of Personality & Social Psychology, 67,
up because we had lost so many men. Sunk they decide?” This helps decouple the decider 357-365.
costs are common in behavioral finance from the decision. Sixth, you can identify the Gilovich, T., Medvec, V. H., & Chen, S. (1995).
where investors double-up on a losing in- Commission, omission, and dissonance re-
fear of “wasting,” which often underlies the duction: Coping with regret in the “Monty
vestment to “get their money back.” We
often “ride a loser.” fear that walking away from the sunk cost is Hall” problem. Personality & Social Psychology
Humans are the only animals who honor an admission of having wasted time and re- Bulletin, 21, 182-190.
sunk costs (Arkes & Ayton, 1999). sources. This fear can be addressed by rec- Jones, E. E., & Davis, K. E. (1965). From acts to
Laboratory rats may show a burst of activity ognizing that losses (or wasting) are always dispositions: The attribution process in per-
as they face extinction trials when reinforce- involved in decision making, but the self-in- son perception. In L. Berkowitz (Ed.),
ments have been eliminated, but they terest strategy would be not to throw good Advances in experimental social psychology (Vol.
2, pp. 219-266). New York: Academic Press.
quickly learn to look somewhere else for re- money after bad. Seventh, many people
wards. Why are rats “smarter” than hu- stay in sunk costs because of the fear of hu- Kahneman, D., & Tversky, A. (1979). Prospect
theory: An analysis of decision under risk.
mans? Or are we too smart for our own miliation: “I would be telling everyone that Econometrica, 47, 263-291.
good? Unlike the “rational” rat, humans I was wrong and they were right.” This con- Kiesler, C. A., Nisbett, R. E., & Zanna, M. P.
appear condemned to continually reflect on cern can be addressed by recognizing that (1969). On inferring one’s beliefs from one’s
their past decisions, attempting to make most friends will be happy to have you behavior. Journal of Personality & Social
“sense” of them and to justify their future agree with them and happy that you are out Psychology, 11, 321-327.
decisions by reference to the past. Honoring
of your misery but, in the event that they Leahy, R. L. (2000). Sunk costs and resistance to
sunk costs can be explained by loss aversion change. Journal of Cognitive Psychotherapy: an
use this as a reason for criticism, it may be a
(Wilson, Arvai, & Arkes, 2008), commit- International Quarterly, 14, 355-371.
ment theory (Kiesler, Nisbett, & Zanna, price worth paying to cut your losses.
Eighth, some people fear the flood of nega- Leahy, R. L. (2004). Decision making processes
1969), cognitive-dissonance theory and psychopathology. In R. L. Leahy (Ed.),
(Festinger, 1957, 1961), prospect theory tive feelings following abandoning a sunk
Contemporary cognitive therapy: Theory, research,
and loss frames (Kahneman & Tversky, cost. This can be addressed by an analogy of and practice (pp. 116-138). New York:
1979), fear of wasting (Arkes, 1996; Arkes pulling a splint from a toe. It hurts until it Guilford Press.
& Blumer, 1985), attribution processes (for stops hurting and then it is followed by re- Wilson, R. S., Arvai, J. L., & Arkes, H. R. (2008).
example, Jones & Davis, 1965), and inac- lief. Being stuck in a sunk cost is the ulti- My loss is your loss...sometimes: Loss aver-
tion inertia (Gilovich & Medvec, 1994; mate helplessness and is a guarantee for sion and the effect of motivational biases.
Gilovich, Medvec, & Chen, 1995). In each depression, anger, and hopelessness (Leahy, Risk Analysis, 28, 929-938.
case it is the absence of reward that makes 2000, 2004).
this puzzling until we recognize that it is the . . .
We often get trapped by our need to jus-
“interpretation” of change and the “need to tify the decisions that have continued our
explain” the past that keeps us trapped. misery—looking backward to the past for Correspondence to Robert L. Leahy, Ph.D.,
How can we liberate ourselves from the American Institute for Cognitive Therapy, 136
justification, rather than committing to ac-
sunk cost trap? First, standard cognitive E. 57th St., Suite 1101, New York, NY
therapy inquiries can be used, but may lead tions for future utility. Focusing on valued
10022; Leahy@CognitiveTherapyNYC.com
nowhere. For example, one can ask about goals rather than valuing our past can help
the costs and benefits of continuing in the liberate us from commitments whose pay-
course of action. Patients often say, “I know offs have turned into deficits. Our “rational-
it’s irrational, but I can’t get out.” Second, ity” may be less logical than we think and
educating the patient about sunk costs (the more determined by rationalizing the past
jacket in the closet) immediately helps to rather than pursuing a better future.
Michael J. Asher, Ph.D., ABPP Debra G. Salzman, Ph.D. Mark Cooperberg, Ph.D.
Board Certified in Cognitive Clinical Psychologist Clinical Psychologist
and Behavioral Psychology NJ Lic. #3160 NJ Lic. #4365, PA #15827
Clinical Psychologist
NJ Lic. #2792
Postdoctoral Fellows
Rory Panter, Psy.D.
Lisa Spano, Psy.D., BCBA
CLASSIFIED
Q
T FA POSTDOCTORAL FELLOWSHIP IN
C What are the registration hours
AB ALCOHOL RESEARCH AT THE
at the ABCT Annual Meeting in NYC? UNIVERSITY OF WASHINGTON.
The fellowship will provide training for
individuals who wish to pursue a career in
• Thursday preregistration pick-up: 11:00 A.M. – 8:00 P.M.
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j
ABCT Annual Convention
ISSN 1077-7229
Looking to the Future of Empirically
Maureen Whittal
Cognitive and
Editor
to manuscripts, the video components will he June 2009 issue of the Behavior
C
ommunicating the complexity of
treatment strategies can be difficult
using the written word. However,
technology today offers us the opportunity
also undergo review. This review will be
handled by the action editor upon accep-
tance of your manuscript.
T Therapist announced the advent of a
“Seal of Merit” system to be applied
to self-help books “that are consistent with
to enhance our learning experiences To introduce the use of this technology, a CBT principles and that incorporate scien-
through the use of multimedia platforms video component is available and accompa- tifically tested strategies for overcoming
such as video. The addition of video pro- nies the electronic version of this manu- these difficulties” (p. 110). In line with the
vides the advantage of an alternate avenue script at www.sciencedirect.com. If you are overarching theme of the June 2009 issue,
to learn, similar to attending a training interested in submitting a manuscript that this system seems designed to promote im-
workshop without leaving your office or includes video clips, look for detailed in- proved dissemination of empirically vali-
home. Imagine being able to access video structions in the “Guide for Authors” sec- dated self-help programs to practitioners
segments that illustrate how to roll with re- tion on the C&BP web pages at Elsevier, and the general public alike. As researchers
sistance, setting up and debriefing behav- www.elsevier.com/locate/cabp. I believe in this field, we laud ABCT’s move to edu-
ioral experiments, or how to respond to that C&BP is the first psychology journal to cate consumers and promote the use of self-
ruptures in the therapeutic alliance. Given make use of multimedia. It is my hope that help materials with demonstrated efficacy,
the potential advantages, I am pleased to it will enhance the visibility and utility of especially given the plethora of self-help
introduce the opportunity to augment this unique journal. products of dubious quality (Rosen,
C&BP manuscripts with video components. In closing, I would like to thank you for Barrera, & Glasgow, 2008; Watkins,
The first two issues of Volume 17 in your continued interest in the journal. I en- 2008). We would also like to bring atten-
2010 will contain invited contributions to courage you to continue submitting manu- tion to another resource that aims to spur
illustrate the various ways in which this new scripts (with or without videos) and reading critical thinking about available self-help
application can be utilized. Similar to mak- the work of your colleagues. If you have approaches and facilitate the dissemination
ing reference to Tables and Figures in the feedback regarding the journal, be it posi- of approaches that have scientifically
body of a manuscript, authors will now tive or negative, we are always happy to demonstrated effectiveness: Handbook of
have the opportunity to embed video clips hear it. Or ultimate goal remains the same: Self-Help Therapies (Watkins & Clum,
at key points in the paper. In the first issue to be an enduring resource for scientist- 2008).
of 2010, the C&BP editorial team, includ- practitioners interested in empirically sup- As stated in the first chapter, which pro-
ing myself, Associate Editors Steve Safren ported approaches. With the imminent vides an overview of definitions, history, ad-
and Joaquin Borrego Jr., and Book Editor availability of multimedia manuscripts, we vantages, and limitations of self-help, “The
Sabine Wilhelm, along with our colleagues hope to stay on the cutting edge, for at least lack of empirical evaluation of self-help ma-
will be presenting manuscripts that include a little while! terials is, in fact, the impetus for this text”
the use of video. In the second issue, outgo- (Watkins, 2008, p. 15). Following initial
ing Publications Coordinator Phil Kendall . . . chapters describing various considerations
and Jack Rachman and their colleagues will in using self-help therapies as well as the
be presenting their recent work, aug- Correspondence to Maureen Whittal, theoretical underpinnings of this modality,
mented with video components. Ph.D., Vancouver CBT Centre, 708-777 W. the Handbook of Self-Help Therapies contains
The purpose of these video components Broadway, Vancouver BC V5Z 4J7 Canada 11 chapters, each detailing the empirical
is to concretize a concept or to illustrate the whittal@interchange.ubc.ca. evidence for self-help methods to treat psy-
specifics of a treatment strategy. The focus chiatric disorders such as depression and
of the video should be the clinician and not sexual dysfunctions as well as behavioral
the patient. Secondary to confidentiality, we health problems such as cigarette smoking
ask that real patients not be used. As you and weight management. In fact, over half
will see in the invited manuscripts, the of the inaugural titles that have received
videos are shot with actors or manuscript ABCT’s “Self-Help Seal of Merit” are dis-
collaborators. The number of clips will be cussed and referenced in these chapters.
up to the author, but the length of each The text also contains a chapter specifically
video should not exceed 7 minutes. Similar addressing the integration of self-help ther-
On Our Website
http://www.abct.org
DEADLINE for submissions: February 1, 2010
NOMINATE the Next Candidates for ABCT Office 2010 Call for Nominations
I nominate the following individuals Every nomination counts! Encourage colleagues to run
for office or consider running yourself. Nominate as many
for the positions indicated: full members as you like for each office. The results will be
tallied and the names of those individuals who receive the
P R E S I D E N T- E L E C T ( 2 0 1 0 – 2 0 1 1 )
most nominations will appear on the election ballot next
April. Only those nomination forms bearing a signature
and postmark on or before February 1, 2010, will be
counted.
R E P R E S E N TAT I V E - AT- L A R G E ( 2 0 1 0 – 2 0 1 3 )
Nomination acknowledges an individual's leadership
abilities and dedication to behavior therapy and/or cogni-
tive therapy, empirically supported science, and to ABCT.
When completing the nomination form, please take into
consideration that these individuals will be entrusted to
represent the interests of ABCT members in important pol-
NAME (printed) icy decisions in the coming years. Contact the Leadership
and Elections Chair for more information about serving
ABCT or to get more information on the positions.
Please complete, sign, and send this nomination form
S I G N AT U R E ( r e q u i r e d ) to Kristene Doyle, Ph.D., Leadership & Elections Chair,
ABCT, 305 Seventh Ave., New York, NY 10001.
Aw a r d
for
Nominations
The ABCT Awards and Recognition Committee, chaired by Shelley Robbins of Holy Family
University, is pleased to announce the 2010 awards program. Nominations are requested in
all categories listed below. Please see the specific nomination instructions in each category.
Please note that award nominations may not be submitted by current members of
the ABCT Board of Directors.
Outstanding Contribution by an Individual of your submission to ABCT, Student Dissertation Awards, 305
for for Research Activities Seventh Ave., New York, NY 10001.
Eligible candidates for this award should be members of ABCT in
good standing who have provided significant contributions to the Distinguished Friend to Behavior Therapy
literature advancing our knowledge of behavior therapy. Past Eligible candidates for this award should NOT be members of
recipients of this award include Alan E. Kazdin in 1998, David H. ABCT, but are individuals who have promoted the mission of cog-
Barlow in 2001, Terence M. Keane in 2004, and Thomas nitive and/or behavioral work outside of our organization.
Borkovec in 2007. Please complete an on-line nomination form Applications should include a letter of nomination, three letters of
at www.abct.org. Then, e-mail the completed forms to srob- support, and a curriculum vitae of the nominee. Past recipients of
bins@holyfamily.edu. Also, mail a hard copy of your submission this award include Jon Kabat-Zinn, Nora Volkow, John Allen,
to ABCT, Outstanding Researcher, 305 Seventh Ave., New York, Anne Fletcher, Jack Gorman, Art Dykstra, and Michael Davis.
NY 10001. Please complete an on-line nomination form at www.abct.org.
Then, e-mail the completed forms to srobbins@holyfamily.edu.
Also, mail a hard copy of your submission to ABCT, Distinguished
Outstanding Mentor Friend to BT Award, 305 Seventh Ave., New York, NY 10001.
This year we are seeking eligible candidates for the Outstanding
Mentor award who are members of ABCT in good standing who Career/Lifetime Achievement
have encouraged the clinical and/or academic and professional Eligible candidates for this award should be members of ABCT in
excellence of psychology graduate students, interns, postdocs, good standing who have made significant contributions over a
and/or residents. Outstanding mentors are considered those who number of years to cognitive and/or behavior therapy.
have provided exceptional guidance to students through leader- Applications should include a letter of nomination, three letters of
ship, advisement, and activities aimed at providing opportunities support, and a curriculum vitae of the nominee. Past recipients of
for professional development, networking, and future growth. this award include Albert Ellis, Leonard Ullman, Leonard Krasner,
Appropriate nominators are current or past students of the men- Steve Hayes, and David H. Barlow. Please complete an on-line
tor. The first recipient of this award was Richard Heimberg in nomination form at www.abct.org. Then, e-mail the completed
2006, followed by G. Terence Wilson in 2008. Please complete forms to srobbins@holyfamily.edu. Also, mail a hard copy of your
an on-line nomination form at www.abct.org. Then, e-mail the submission to ABCT, Career/Lifetime Achievement Award, 305
completed forms to srobbins@holyfamily.edu. Also, mail a hard Seventh Ave., New York, NY 10001.
copy of your submission to ABCT, Outstanding Mentor, 305
Seventh Avenue, NY, NY 10001. NOMINATIONS FOR THE FOLLOWING AWARD ARE SOLICITED
FROM MEMBERS OF THE ABCT GOVERNANCE :
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INTERNSHIP PANEL
Internship Training Site Overview | Jeanette Hsu & Justin Nash
Friday, Nov. 20, Manhattan Ballroom, 8:45 a.m.
POSTGRADUATE PANEL
Postdoctoral Paths for Professional Development | Richard Seime & Antonette Zeisss
Friday, Nov. 20, Marquis B & C, 10:30 a.m.