Evidence-Based Psychological Practice (Assessment and Evaluation of…
Evidence-Based Psychological Practice
Bridging Research and Practice
(EBT) refers to the interventions or techniques (cognitive therapy for depression, exposure therapy for anxiety) that have produced therapeutic change in controlled trials.
Condition of the research context differ from real life.
Are there satisfactory bases for concluding that treatment is effective?
A statistically significant difference, does that translate into a change in everyday life?
What should change to help bridge the gap?
Greater priority to the study of mechanisms of therapeutic change.
Study of moderators and translation to clinical care.
More qualitative research.
(EBP) refers to clinical practice that is informed by evidence about interventions, clinical expertise, and patient needs, values, and preferences and their integration in decision making about individual care.
Little empirical evidence in reliability and validity of decision making.
Issue of generalizing results in clinical practice.
Patient progress is often evaluated on the basis of clinician impressions.
What should change to help bridge the gap?
Use of systematic measures to evaluate patient progress.
A researcher-clinician collaboration that helped identify the circumstances (moderating variables) in which judgment, expertise, and context are important.
Assessment and Evaluation of Interventions
Three general strategies to assess clinical significance
Two standard deviations
No longer meeting diagnostic criteria.
Based on opinions
Has the intervention made an apparent difference?
Susceptible to bias
Social impact measures
Outcomes assessed in everyday life that are important to society at large.
In any intervention study, one or more measures of clinical significance should be included.
Outcome measures in intervention research are often narrowly focused. However, one treatment that is broad in its effects may be preferred to one that is narrow in its effects but slightly more effective in symptom reduction.
Other factors of treatment to consider
Acceptability of treatment
Pre-post and continuous assessment
Evaluating mechanisms of change
Methodology, Design, and Evaluation in Psychotherapy Research
Empirically supported treatments may be defined as treatments found to be efficacious when evaluated in
randomized clinical trials (RCTs)
with specified populations of patients.
: an intervention is applied to cases that meet criteria for a specific disorder and analyzed against a comparison condition (wait list, alternative treatment, etc.) to determine the degree or relative degree of beneficial change associated with treatments.
Selecting control conditions.
Local standard treatment
Multiple treatment comparisons.
Defining the independent variable
Checking the integrity of the independent variable
Assessing the dependent variable(s)
Use a variety of methods
Multiple domain assessment
Addressing missing data
Last observation carried forward (LOCF)
No optimal method
p < .05
Normative sample comparison
Reliable change index (RCI)
Cumulative outcome analyses
To maximize transparency in the reporting of RCTs, a set of consolidated standards of reporting trials was developed (CONSORT), consisting of a 22-item checklist of study features that can bias estimates of treatment effects, or that are critical to judging the reliability or relevance of study findings.
Three Main Approaches
The goal is to identify positive or negative developments early on in treatment and inform therapists so that they can combine science and practice.
Focus on real time improvement of the actual treatment.
The Dosage Model
Relationship between number of sessions (dose) and therapeutic effect.
Positive, but negatively accelerating, relationship.
The Phase Model
Rationally derived methods
Based on predefined judgments about progress using clinicians’ ratings based on changes in mental health functioning over sessions of psychotherapy.
Empirically derived methods
These methods define the expected treatment course based on previously treated patients with similar intake characteristics. This is done by creating curves of expected treatment response (ETR) based on large available data sets, which are then respecified for each individual client.
Feedback to practitioners on patients shown not to be on-track in their improvement progress enhances their outcomes.
Measurement and monitoring systems
Effective therapists and therapist effects
The impact of therapist effects are in the region of 5-8%.
he most effective therapists to be associated with an average recovery rate of 22.4% compared to only 10.61% for the least effective therapists.
Therapist competencies may be specific to domains or disorders rather than reflecting a core attribute or underlying skill construct.
Multiple services: effectiveness of psychological therapies in routine settings.
Based on a partnership of practitioners and researchers, and, optimally, involve collaboration on all aspects of investigation: from the generation of ideas to the design, implementation, and publication of studies.
Professional organization PRNs
PRNs based on common settings
Data collected in naturalistic settings
Evidence-Based Psychological Treatments:
An Update and a Way Forward
Enormous progress in the field of clinical science has been made over the past 50 years, with advances in our understanding of psychopathology and more sophisticated research methodology
Despite these advances, the public health impact of well-established psychological treatments is less than it should be.
Barriers to Evidence-Based Psychological Treatments
Comorbidity, temperament, and a transdiagnostic perspective
Mechanisms of action and idiographic approaches
Dissemination and implementation
Evidence-Based Treatments, General Principles, and Good Advice
Internal evidence: Patients' preferences
External evidence: Scientific evidence
Evidence-based treatment consists of three factors
The patient's values, preferences and expectations
Randomized clinical trials
Cochrane Systematic Reviews
In some cases, the therapist has to
Apply his/her clinical expertise because of the lack of scientific evidence.
Recommend a different treatment to the patient based on the existing scientific evidence, even though the therapist has experience with a different type of treatment.
Listen to the wishes of the patient, even though it goes against scientific evidence and the therapist's clinical expertise.