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Evidence-Based Practice and Empirically-Supported Treatments
Many health care fields have adopted the core principles of evidence-based practice (EBP),
an approach to patient care that encourages clinicians to consider and synthesize empirical evidence, clinical expertise, and patient values in implementing treatments.
These principles of evidence-based practice also are very relevant to clinical psychology, including the provision of psychological assessment and treatment.
Psychologists are uniquely skilled in conducting rigorous clinical research, and a large empirical base is available 1) to develop evidence-based assessment measures and treatments; and 2)
to evaluate the efficacy and effectiveness of clinical practice techniques.
This article discusses:
For an in-depth description of EBP, please read this recent article from the Behavior Therapist,
and also visit this NIH Sponsored Site.
Why is EBP Important in Clinical Psychology?
Psychologists are ethically bound to "do no harm."
When empirical evidence exists demonstrating the efficacy of a specific assessment or treatment approach for a particular clinical presentation, it is ethically irresponsible not to discuss this approach and/or provide this option to a client. Such a discussion may include a review of the applicability to this client, strengths, and limitations, of a specific assessment or treatment approach.
To date, more empirical evidence is available to support the efficacy of
cognitive and behavioral therapies
for a wide range of clinical presentations than are data available to support such a claim for any other treatment approach.
Failure to discuss EBP options with a client may have several unintended harmful consequences:
As compared to the provision of EBP (e.g., such as CBT), provision of therapy that is not based on empirical evidence presents a greater risk of treatment failure. A client's lack of progress in treatment is associated with a reduced likelihood of later efforts to seek psychological treatment throughout the lifespan.
As compared to the provision of EBP (e.g., such as CBT), provision of therapy that is not based on empirical evidence has been associated with a longer course of symptoms and/or increases in symptom severity.
In addition to protracted suffering from distressing clinical symptoms, ongoing psychopathology is associated with deteriorations in clients' life circumstances secondary to psychopathology (e.g., losing a job or a marriage).
EBP therapies are listed as 'Best Practice' Approaches for Psychological Symptom Treatment
As a form of EBP, CBT has been recommended by the American Psychiatric Association within the Practice Parameters for many psychological symptoms and disorders. The American Psychological Association has also adopted a policy statement on EBP as a preferred approach to psychological treatment.
Reimbursement for non-EBP clinical services is less likely.
Insurance companies increasingly demand evidence for the empirical basis underlying an assessment or treatment approach before reimbursing for services. This is a policy consistent within medical and psychological treatment. For instance, insurance companies are less likely to reimburse medical treatments, at least as first-line options, when there are alternatives proven to be effective. Moreover, medical practitioners who ignore current research evidence for practice are at risk of being found unethical or incompetent.
Balancing the Three-Legged Stool: Empirical Evidence, Clinical Expertise, Patient Preferences
Empirical evidence is not available to support the efficacy or effectiveness of any assessment or treatment approach in each of the complex and varied clinical presentations that are encountered by most clinicians. Until such empirical evidence is available, clinicians must provide EBP that best balances empirical evidence, clinical expertise, and patient preferences using the best information available. Achieving this balance is difficult, but essential.
EBP theories offer direction for achieving a balance in clinical decision-making. Importantly, EBP specifies that any positive evidence supporting a specific clinical approach is superior to a lack of evidence for an alternate treatment approach. In other words, the provision of services demonstrated to be efficacious or effective in any population is very often sufficient justification for the use of this approach with an untested population, and thus is preferable to the provision of untested services. EBP specifies that students should learn to base treatment on the highest empirical grounds possible.
Psychologists should recognize the limitations of clinical decision making. Considerable research across many fields suggests that people seek confirmatory evidence, fail adequately to consider evidence contrary to expectations, perceive correlations where there are none (or correlations in the opposite direction from the true association), and rely on numerous heuristics that can leave clinicians vulnerable to errors. The argument is not that clinicians are especially likely to make mistakes, but rather that clinical decision-making is extremely difficult for psychological disorders, and warrants an objective foundation.
For an in-depth description of EBP, please visit this NIH Sponsored Site.
What are Empirically Supported Treatments?
One implication of EBP is the fundamental necessity for treatment outcome research, the goal of which is to establish empirically which treatments are beneficial for specific disorders, syndromes, or symptoms. In psychology, this includes psychotherapy (and psychopathology) research, and the movement toward EBP has been accompanied by a concomitant shift toward the identification of empirically-supported treatments (ESTs), treatments whose demonstrated efficacy meets a standard of empirical investigation as gauged by various methodological criteria.
The movement toward formal identification of ESTs is at least 15 years old and has met with resistance from some quarters, a comprehensive discussion of which is beyond the scope of this primer. It is worthy of note in this context, however, that to some extent implementation of ESTs depends on the client's presenting problem. ESTs are typically designed for, and targeted to particular psychological disorders. There is no EST, for example, developed and tested specifically for individuals who are struggling with questions about self-identity and personal meaning. At the risk of stating the obvious, reliance on ESTs is sensible for decision-making about interventions and disorders for which there is a research base.
The practice of cognitive behavior therapy
(CBT) offers many advantages to clinicians interested in an evidence-based approach to their practice.
Several treatment manuals using CBT techniques are accessible from this site
, and several
slide presentations further explaining EBT and CBT also are available.
For further resources and recommended readings about EBP see
additional readings and resources as well as this related
website.
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