Presentation on theme: "How To Be An Evidence-Based Psychologist"— Presentation transcript:
1How To Be An Evidence-Based Psychologist John Hunsley
2OVERVIEW What Is Evidence-Based Psychological Practice (EBPP) Evidence-base practice, empirically supported treatments, clinical practice guidelinesExamining the research evidenceEvidence-based treatments, therapeutic relationships, and assessmentDissemination and implementation of EBPPImplications, challenges, and opportunities
3SOME DEFINITIONSEvidence-Based Practice (and Evidence-Based Practice in Psychology)Empirically Supported TreatmentsPractice GuidelinesRandomized Controlled Trials (RCTs)Efficacy Studies & Effectiveness StudiesTreatment As Usual (TAU)
4EVIDENCE-BASED PRACTICE The use of systematically collected data, clinical expertise, and patient preferences by decision-makers (including clinicians, administrators, and policy makers) when considering service options.Sackett, D. L., Rosenberg, W. M. C., Gray, J. A. M., Haynes, R. B., & Richardson, W. S. (1996). Evidence based medicine: What it is and what it isn’t. British Medical Journal, 312,Institute of Medicine. (2001). Crossing the quality chasm: A new health system for the 21st century. Washington, DC: National Academy Press.American Psychological Association Presidential Task Force on Evidence-Based Practice. (2006). Evidence-based practice in psychology. American Psychologist, 61,
5EVIDENCE-BASED PRACTICE Providing the right health care services—services that have been demonstrated to work—for each client’s needsServices are based on empirical evidence but are individually tailored to take into account client characteristics, needs, and resourcesServices may also need to be adjusted in order to fit the demands and constraints of real world clinical practice
6IMPLEMENTATION OF EVIDENCE-BASED SCURVY PREVENTION PROGRAMS: AN EXAMPLE WE DO NOT WANT TO REPEAT 1497 Vasco da Gama sailed around Cape of Good Hope:100 of 160 sailors died of scurvy (due to deficiency of vitamin C)1601 James Lancaster RCT (4 ships England to India, 1 on which sailors received 3 tsps of lemon juice each day):Halfway, 110/278 died of scurvy on 3 ships; 0 on the “lemon” ship1747 James Lind RCT of 6 treatments (including citrus juice) replicates Lancaster findingJames Cook (early adopter), 3 voyages, required sauerkraut in the rationsOnly 3 sailors died of scurvy1795 British Navy required citrus fruit as part of diet (limey)1865 British Board of Trade required citrus fruit as part of dietBerwick. (2003). Disseminating innovations in health care. Journal of the American Medical Association
7Best Available Evidence Client/Patient Preferences THE EBP MODELBest Available EvidenceEBPClient/Patient PreferencesClinical Expertise7
9EVIDENCE-BASED PSYCHOLOGICAL PRACTICE Influenced by multiple factors in North AmericaEvidence-Based MedicineScientist-Practitioner ModelAccountability/Quality AssuranceEmpirically Supported Treatments
10EBP IN PSYCHOLOGY: THE CONTROVERSY Concerns:loss of professional autonomytakeover of professional psychology by specific interest groupsdehumanization of psychological servicesinadequacy of the research baseimpossibility of basing care on research evidenceSimilar concerns raised in other health professions
11APA DIVISION 12 EMPIRICALLY SUPPORTED TREATMENTS: CRITERIA FOR WELL-ESTABLISHED TREATMENTS I. At least 2 good between group design experiments demonstrating efficacy in one or more of the following ways:A. Superior (stat. sign.) to pill or psychological placebo or to another treatmentB. Equivalent to an already established treatment in experiments with adequate sample sizesORII. A large series of single case design experiments (n > 9) demonstrating efficacy. These experiments must have:A. Used good experimental designs andB. Compared the intervention to another treatment.--highlight experiments—RCT as the gold standard--if a large series of studies with mixed findings, go with the preponderance of findings
12CRITERIA FOR WELL-ESTABLISHED TREATMENTS FURTHER CRITERIA FOR BOTH I AND II:III. Experiments must be conducted with treatment manuals or equivalent clear descriptions of treatmentIV. Characteristics of the client samples must be clearly specifiedV. Effects must have been demonstrated by at least 2 different investigators or teams
13CAUTION: ESTs ≠ EBTDifference between (a) research on a treatment meeting a pre-established set of criteria and (b) determining which treatments have strongest support for a specific conditionDespite this, terms are now being used almost interchangeablycan be confusing, especially as trend in professional psychology has been to use lists rather than encourage the use of practice guidelines or having individual clinicians conducting their own literature searches
14EBTs FOR CHILDREN & ADOLESCENTS (Multiple Single Case Designs or Higher) Autistic DisorderAttention-Deficit/Hyperactivity DisorderAnxiety DisordersChronic PainConduct Problems & Oppositional Defiant DisorderMajor Depressive DisorderEating DisordersElimination DisordersObesityTic Disorders
15EBTs FOR ADULTS Anxiety Disorders Specific Phobias Social Phobia Panic Disorder (with/without Agoraphobia)GADOCDPTSDMajor Depressive DisorderBipolar Disorder
17EBTs FOR ADULTS Tic Disorders Sexual Disorders Schizophrenia Marital/Couple ConflictPersonality DisordersAvoidant PDBorderline PDSomatoform DisordersPain DisordersBody Dysmorphic DisorderHypochondriasis
18SOME ADDITIONAL EBTs Anger Management Anxiety/fear associated with medical/dental proceduresAssertiveness SkillsParent TrainingSocial SkillsStress ManagementMany also available for specific illnesses/chronic health conditions (e.g., Chronic Fatigue Syndrome, Irritable Bowel Syndrome)Psychometrically strong assessment measures available for assessing outcomes from all EBTs
19CLINICAL PRACTICE GUIDELINES Common in many health professions; in professional psychology, they are almost totally absent (but coming soon from APA)In general, they are consensus statements from experts/professional organizations/healthcare organizations that present best clinical practices (screening, assessment, consultation, treatment, referral, etc.)Not the same as guidelines for reimbursement or other administrative purposesUsually encourage appropriate initial assessment, without any further guidance on how to do this (more on this later)
20CLINICAL PRACTICE GUIDELINES National Institute for Health and Clinical Excellence (NICE) sponsored by National Health Service in England and WalesUse of explicit evidence hierarchyExtensive consultations undertaken with stakeholder organizations (both consumer and professional groups)Each guideline has a limited “life,” ensuring review in near future
21CLINICAL PRACTICE GUIDELINES: NICE RECOMMENDATIONS Some current guidelines recommending use of a psychological interventionADHDAnxiety Disorders (Panic Disorder, Agoraphobia, Generalized Anxiety Disorder)Bipolar DisorderChronic Fatigue SyndromeConduct DisorderDepression (child, adolescent, & adult)Eating DisordersObsessive-Compulsive Disorder & Body Dysmorphic DisorderPersonality Disorders (Antisocial, Borderline)Posttraumatic Stress DisorderSchizophrenia
22BUT AREN’T ALL THERAPIES EQUIVALENT? Most meta-analyses suggest that this is not the case for most disorders/conditionsWampold et al. (1997) meta-analysis of bona fide comparative treatment studiesMean effect size = .19Wampold, B. E., Mondin, G. W., Moody, M., Stich, F., Benson, K., & Ahn, H. (1997). A meta-analysis of outcome studies comparing bona fide psychotherapies: Empirically, “All must have prizes.” Psychological Bulletin, 122,But, over ¾ of comparisons within types of CBTNNT was 9 (for comparison, interferon vs. placebo to slow progression of multiple sclerosis has NNT of 9)For depression, marital conflict, PTSD, & bipolar disorder, however, there do appear to be multiple treatments with similar results
23EBT COMPARED WITH TAUMeta-analysis of 32 studies of youth interventions found majority of EBTs yielded outcomes superior to TAU (most studies focused on externalizing disorders)Mean effect size for EBT versus TAU was 0.30This indicates that the average “EBT” youth was better off after treatment than 62% of “TAU” youthAlternatively, this can be represented as a NNT of 6 (similar NNT for average effects of adding radiation treatment to chemotherapy for a range of cancers)Weisz, Jensen-Doss, & Hawley (2006). Psychological Bulletin.
24EBT COMPARED WITH TAUData on treatment outcome for adults, in real world clinics:Of over 6000 clients, 35% rate of improvement/recovery (Hansen, Lambert, & Forman, 2002, Clinical Psychology: Science and Practice, 9, )Of over 6100 clients, 29% rate of improvement/recovery (Wampold & Brown, 2005, Journal of Consulting and Clinical Psychology, 73, )Data on treatment outcome for adults, in RCTs with EBTsOf over 2100 clients, 67% rate of improvement/recovery (Hansen, Lambert, & Forman, 2002, Clinical Psychology: Science and Practice, 9, )
25BUT ARE EBTs CLINICALLY RELEVANT? Are the participants in treatment studies similar enough to patients routinely seen in practice settings to warrant generalizing research results to clinical practice?Is the research literature on psychological treatments sufficiently developed to be applicable to the broad range of conditions encountered in practice?
26BUT ARE EBTs CLINICALLY RELEVANT? Participants in RCTs/efficacy trials are unlike “real” clients because ………..They are only the “worried well”They are only “pure” cases
27BUT ARE EBTs CLINICALLY RELEVANT? Patients included in RCTs for cocaine dependence had symptoms comparable to, but more severe than, those found reported by patients receiving outpatient servicesCarroll et al. (1999, Drug and Alcohol Dependence)Compared patient files from a managed behavioral health care network to the inclusion and exclusion criteria used in numerous RCTs for adults with mental disordersOver ½ of patients would have been ineligible for RCTs because symptoms were not severe enough to warrant inclusion (in most cases, due to patient diagnosis of adjustment disorder)Stirman et al. (2003, Journal of Consulting and Clinical Psychology)
28BUT ARE EBTs CLINICALLY RELEVANT? For youth RCTs, approx. half used no exclusion criteria related to comorbidityWeisz et al. (2004, Child and Adolescent Psychiatric Clinics of North America)In adult disorder efficacy RCTs, only “clinical appropriate” exclusion criteria used for many years nowCan see this even almost 20 years ago in US NIMH Collaborative Depression Treatment study, with approximately ¾ having personality disorders
29BUT ARE EBTs CLINICALLY RELEVANT? Single RCTs, or more, available for most DSM IV Axis I and Axis II disorders, and many nondiagnosable conditionsHawaii study of 2,200 youth receiving services89% had a primary diagnosis for which an EBT was availableIn terms of treatment targets, 90% had 1 or more problems for which an EBT was availableOn the other hand, for only 3% were there EBTs for all treatment targetsSchiffman et al. (2006). Evidence-based services in a statewide public mental health system: Do the services fit the problems? Journal of Clinical Child and Adolescent Psychology, 35,
30EFFECTIVENESS RESEARCH Reviewed EBT effectiveness studies published prior to April 200621 studies of adult treatment and 13 of child/adolescent treatment met criteria (including at least 2 effectiveness trials)Compared results to benchmarks from reviews of efficacy studies (mainly meta-analysis)Hunsley & Lee (2007). Research-informed benchmarks for psychological treatments: Efficacy studies, effectiveness studies, and beyond. Professional Psychology: Research and Practice, 38,
31EFFECTIVENESS RESEARCH Completion rates higher than usually reported in studies of “real world” psychotherapyFor both adult and youth disorders, the average improvement rates were similar to efficacy benchmarksSome examples:Adult Depression: 74% completed, 51% improvedAdult OCD: 88% completed, 64% improvedYouth Anxiety Disorders: 87% completed, 63% improved
32EFFECTIVENESS RESEARCH PTSD TreatmentsOmagh BombingGillespie et al. (2002). Behaviour Research and Therapy, 40,9/11 World Trade CenterLevitt et al. (2007). Behaviour Research and Therapy, 45,Vast majority completed treatment, with results very similar to efficacy RCTsUp to sessions; most clinicians had limited CBT background, received training over several days, weekly/monthly supervision
33EBTs: CONCLUSIONS Does treatment research generalize to practice? Compelling evidence that it does, but always need to exercise caution in applying results to a particular individualMuch more research on “mild” conditions and Axis II conditions neededHow effective are evidence-based treatments (EBT) in clinical practice?More evidence needed, but EBTs are usually as effective as in efficacy trialsHunsley, J. (2007). Addressing key challenges in evidence-based practice in psychology. Professional Psychology: Research and Practice, 39,Hunsley, J. (2007). Training psychologists for evidence-based practice. Canadian Psychology, 47,
34EBPP: “FLEXIBILITY WITHIN FIDELITY” Treatment manuals now focus attention on key elements of treatments, not just session by session list of activities/strategiesIncreased recognition of importance of tailoring treatment to clients, especially aspects related to cultural diversity and presence of multiple disorders/problems componentsCall for attention to principles of change and commonly used techniques/strategies, not “trademarked” therapiesSome examples:David Barlow: Unified treatment for mood and anxiety disordersBruce Chorpita: Modular CBT for youth disorders
35EBPP: INCLUDING CLINICAL EXPERTISE Evidence-Based Therapy RelationshipsNorcross, J. C. (Ed.). (2011). Psychotherapy relationships that work: Evidence-based responsiveness (2nd ed.). New York: Oxford University Press.There is more to EBT than RCTsClient expectationsTherapist empathyTherapeutic allianceRepairing therapeutic rupturesCulturally adapted treatments
36EVIDENCE-BASED ASSESSMENT (EBA) Use of research and theory to guide:The selection of constructs to be assessed for a specific assessment purposeThe methods and measures to be used in the assessmentThe manner in which the assessment process unfolds (including integration and interpretation of assessment data)Hunsley, J., & Mash, E. J. (2007). Evidence-based assessment. Annual Review of Clinical Psychology, 3,
37WHY IS EBA NEEDED?“…blanket recommendations to use reliable and valid measures when evaluating treatments are tantamount to writing a recipe for baking hippopotamus cookies that begins with the instruction “use one hippopotamus,” without directions for securing the main ingredient.”Mash, E. J., & Hunsley, J. (2005). Evidence-based assessment of child and adolescent disorders: Issues and challenges. Journal of Clinical Child and Adolescent Psychology, 34,
38WHY IS EBA NEEDED?Almost no overlap among the psychological measures found in surveys (USA, UK) to be commonly used by psychologists (and those commonly taught to clinical graduate students) and the measures necessary toimplement and monitor EBTsadapt treatments based on the consideration of Evidence-Based Therapy Relationship (EBTR) elementsHow can we use EBT and EBTR information without using appropriate assessment tools in practice?
39A GUIDE TO ASSESSMENTS THAT WORK Hunsley and Mash (2008) “good enough” criteria for use of instrumentsMust balance psychometric ideals with clinical realitiesMust keep in mind issues such as age, gender, ethnicity in determining relevance of instruments and supporting dataPresented criteria used in rating norms, reliability indices (internal consistency, inter-rater reliability, test-retest reliability), validity indices (content validity, construct validity, validity generalization, treatment sensitivity), and clinical utility
40A GUIDE TO ASSESSMENTS THAT WORK Youth: ADHD, Conduct Problems, Depression, Self-Injurious Thoughts and Behaviors, Anxiety Disorders, PainAdults: Depression, Bipolar Disorder, Self-Injurious Thoughts and Behaviors, Anxiety Disorders, Substance Abuse Disorders, Alcohol Use Disorders, Gambling Disorders, Schizophrenia, Personality Disorders, Couple Distress, Sexual Dysfunction, Paraphilias, Eating Disorders, Sleep Disorders, PainHunsley, J., & Mash, E. J. (Eds.). (2008). A guide to assessments that work. New York: Oxford University Press.
41WHY IS EBA NEEDED?When asked to rate 3 most important problems to address in treatment, 77% of child-parent-therapist triads failed to agree on a single problemCorrelations between clinician and youth symptom and self-esteem measures <.23Hawley, K. M., & Weisz, J. R. (2003). Child, parent, and therapist (dis)agreement on target problems in outpatient therapy: The therapist’s dilemma and its implications. Journal of Consulting and Clinical Psychology, 71,Love et al. (2007). Meeting the challenges of evidence-based practice: Can mental health therapists evaluate their practice? Brief Treatment and Crisis Intervention, 7,.
42WHY IS EBA NEEDED?In a population-based study of Canadian adults who received psychotherapy in past year, 43% terminated services because they felt betterBut, 14% terminated because they felt therapy was not helping, and 7% were not comfortable with the therapist’s approachClinicians identified <50% of treatment successes (as rated by patients) and failed to identify the 10% of patients who terminated because they felt treatment was worsening their problemsWestmacott & Hunsley. (2010). Reasons for terminating psychotherapy: A general population study. Journal ofClinical Psychology, 66,Hunsley et al. (1999). Comparing therapist and client perspectives on reasons for psychotherapy termination Psychotherapy, 36,.
43WHY IS EBA NEEDED?Limited evidence of clinical utility for commonly used instrumentsMMPI-2 completed by all clients prior to treatmentHalf of clinicians (randomly assigned) received test results; half did notAll clients received an appropriate EBT (based on diagnosis)Having MMPI-2 information had no impact onthe number of sessions patients attendedwhether therapy ended prematurelyoverall patient improvement in functioning assessed in the end of treatment.Lima et al. (2005). The incremental validity of the MMPI-2: When does therapist access not enhance treatment outcome? Psychological Assessment, 17,
44A GUIDE TO ASSESSMENTS THAT WORK Focus on specific assessment purposes directly pertinent to clinical interventions:diagnosis (including screening issues and the importance of addressing comorbidity)case conceptualization and treatment planningtreatment monitoring and treatment evaluation
45DIAGNOSISDiagnostic information allows access to relevant research on psychopathology, epidemiology, prognosis, and treatmentClient characteristics (common comorbid conditions, likely health concerns) and social/interpersonal characteristics (common problems or limitations associated with social networks and intimate relationships, work functioning, and healthcare utilization) that are likely to merit further evaluation or consideration in treatment planninge.g., clients meeting criteria for a substance abuse disorder are likely to abuse additional substances, and those who abuse multiple substances are least likely to benefit from treatmentRohsenow, D. (2008). Substance use disorders. In J. Hunsley & E. J. Mash (Eds.), A guide to assessments that work (pp ). New York: Oxford University Press.
46DIAGNOSIS Diagnosis has utility for EBTs i.e., points in the direction of treatment options based on research evidence (e.g., NICE guidelines)Can give directions for treatment planning with respect to comorbiditye.g., presence of depression among people with OCD can diminish the effectiveness of exposure and response preventionAbramowitz, J. S., Franklin, M. E., Kozak, M. J., Street, G. P., & Foa, E. B. (2000). The effects of pre-treatment depression on cognitive-behavioral treatment outcome in OCD clinic patients. Behavior Therapy, 31,
47DIAGNOSIS Symptom profile can be used to guide treatment selection e.g., bipolar disorder treatments to reduce manic symptoms should address medication adherence and recognition of mood changes; treatments focusing on cognitive and interpersonal coping strategies reduce depressive symptomsMiklowitz, D. J. (2008). Adjunctive psychotherapy for bipolar disorder: State of the evidence. American Journal of Psychiatry, 165,Symptom profile can also lead to emphases in treatment strategies or addition of treatment strategiesChorpita’s modular treatment approachChorpita, B. F. (2006). Modular cognitive– behavioral therapy for childhood anxiety disorders. New York: Guilford Press.Chorpita, B. F., & Daleiden, E. L. (2009). Mapping evidence-based treatments for children and adolescents: Application of the distillation and matching model to 615 treatments for 322 randomized trials. Journal of Consulting and Clinical Psychology, 77,
48DIAGNOSIS Study of community based services for adolescents Disagreement between clinician-generated and research-based diagnoses were associated with a host of treatment implementation problems including:Increased number of client “no-shows”Cancelled treatment appointmentsTreatment drop-outsInaccurate clinician-generated diagnoses were also associated with smaller treatment gainsJensen-Doss, A., & Weisz, J. R. (2008). Diagnostic agreement predicts treatment process and outcomes in youth mental health clinics. Journal of Consulting and Clinical Psychology, 76,
49TREATMENT MONITORING AND EVALUATION What do all RCTs, used as evidence for EBTs, have in common?Routine collection of monitoring data, typically reviewed by clinicians during the supervision of services being providedHypothesis: The fact that treatment is repeatedly monitored, and information provided to clinicians, is one of the most important contributors to successful treatment outcome in EBTsCollection of assessment data as treatment unfolds allows for making any needed adjustments as requiredDoes this apply to routine practice?
50TREATMENT MONITORING AND EVALUATION The potential benefits of treatment monitoringOutcome Questionnaire – 45Over 2,500 clients from a range of clinicsAll completed OQ weekly, half of clinicians received feedback, namely RED, YELLOW, & GREEN dotsNo feedback: 21% improved, 21% worsenedFeedback: 35% improved (i.e., 66% increase), 13% worsened (i.e., 33% decrease)Lambert et al. (2003). Is it time to track patient outcome on a routine basis? A meta-analysis. Clinical Psychology: Science and Practice, 10,
51TREATMENT MONITORING AND EVALUATION Most recent meta-analysesLambert & Shimokawa. (2011), Collecting client feedback. In Norcross (Ed.). Psychotherapy relationships that work (2nd ed.).Outcome Questionnaire (4 studies, over 6100 clients)2.6X greater likelihood of improvementLess than half the likelihood of deteriorationPartners for Change Outcome Management System (3 studies, over 550 clients)3.5X greater likelihood of improvement
52TREATMENT MONITORING AND EVALUATION Three specific categories of client and treatment variables that should be given particular consideration:Treatment targets and goals (intermediate and ultimate)Causal mechanisms believed to be maintaining client problemsTherapeutic context or process variables are particularly relevant to enhancing treatment servicesIn all instances, validity evidence for sensitivity to treatment change is particularly relevant in selecting measures
53TREATMENT MONITORING AND EVALUATION To practice in an evidence-based manner, it is inappropriate to claim that the treatment that a client is receiving is effective simply because it is an EBT—to determine the impact of any treatment, including an EBT, it is essential that data are collected in order to accurately determine its effects for individual clientsBickman, L. (2008). A measurement feedback system (MFS) is necessary to improve mental health outcomes. Journal of the American Academy of Child & Adolescent Psychiatry, 47,
54INTEGRATION AND INTERPRETATION OF ASSESSMENT DATA Clear evidence that clinicians (like people in general) are not very accurate in self-assessment, have limited awareness of biases, and are influenced by numerous heuristics in the decisions they makeÆgisdóttir et al. (2006). The meta-analysis of clinical judgment project: Fifty-six years of accumulated research on clinical versus statistical prediction. The Counseling Psychologist, 34,Davis et al. (2006). Accuracy of physician self-assessment compared with observed measures of competence: A systematic review. Journal of the American Medical Association, 296,Garb, H. (2005). Clinical judgment and decision making. Annual Review of Clinical Psychology, 1,
55INTEGRATION AND INTERPRETATION OF ASSESSMENT DATA Use decision aids (such as decision trees in DSM-IV-TR, research based data, norms, practice guidelines)Use standardized, psychometrically strong instruments to collect dataCollect data from multiple sources (remembering that different informants have differing experiences, perspectives, & attributions)Ensure all aspects of assessment processes are sensitive to diversity factorsContinue to evaluate and adjust hypotheses based on dataTreat all formulations as tentativeRemember heuristics (e.g., primacy effect, availability heuristic) and biases (e.g., attributional biases, orientation influence) and actively address them
56EBA INITIATIVESAntony, M. M., Orsillo, S. M., & Roemer, L. (Eds.). (2001). Practitioner's guide to empirically based measures of anxiety. New York: Plenum.Nezu, A. M., Ronan, G. F., Meadows, E. A., & McClure, K. S. (Eds.). (2000). Practitioner’s guide to empirically based measures of depression. New York: Kluwer Academic.Journal of Clinical Child and Adolescent Psychology (2005) special sectionPsychological Assessment (2005) special sectionJournal of Pediatric Psychology (2008) special issueA Guide to Assessments That Work (2008) Hunsley & MashHandbook of Child and Adolescent Diagnostic and Behavioral Assessment (in press) McLeod, Jensen-Doss, & Ollendick
57THE PROFESSIONAL CHALLENGES OF EBPP Critical self-evaluation of knowledge and skillsCritically evaluate limits of competenceTime constraints for learning and skill developmentWhat is sufficient training (peer supervision/consultation)Competence + Frequency = ↑ Positive Outcomesimplications for specialist vs. generalist?Possible impact on income/job requirements (referring to others vs. time for training vs. client hours)Balancing the ethical/professional issue of competence with reality of availability of appropriately trained mental health professionals
58EBPP: KEEPING UP TO DATE Example of CPA Code of Ethics (2000)II.9 (Psychologists) Keep themselves up to date with a broad range of relevant knowledge, research methods, and techniques, and their impact on persons and society, through the reading of relevant literature, peer consultation, and continuing education activities, in order that their service or research activities and conclusions will benefit and not harm others.Information overload: Primary care physicians need 21 hours/day to read all relevant articles that are published!Alper et al. (2004). Journal of the Medical Library Association.Clearly some strategies and summaries are necessary
60EBPP RESOURCESAntony & Barlow (Eds.), (2010). Handbook of Assessment and Treatment Planning for Psychological Disorders (2nd ed.). Guilford Press.Clinician’s Research Digest“Clinicians don't have to read all the journals publishing research of interest to them—the Editor and staff of Clinician's Research Digest do it for them. CRD reviews over 100 journals each month and highlights the most relevant articles in this 6-page monthly newsletter.”Evidence-Based Mental Health“Evidence-Based Mental Health journal surveys a wide range of international medical journals applying strict criteria for the quality and validity of research. Practising clinicians assess the clinical relevance of the best studies. The key details of these essential studies are presented in a succinct, informative abstract with an expert commentary on its clinical application.”
61TREATMENTS THAT WORK SERIES Some examples:Stress ManagementHoardingCoping with Chronic IllnessSocial AnxietyAdult ADHDFears and PhobiasPanicWorryEating DisordersPathological GamblingInsomniaSchool Refusal
62ADVANCES IN PSYCHOTHERAPY: EVIDENCE-BASED PRACTICE SERIES Some examples:Bipolar DisorderHeart DiseaseObsessive-Compulsive DisorderChildhood MaltreatmentSchizophreniaTreating Victims of Mass Disaster and TerrorismAttention-Deficit/Hyperactivity Disorder in Children and AdultsProblem and Pathological GamblingChronic Illness in Children and AdolescentsAlcohol Use DisordersBorderline DisorderProstate CancerDiabetes
63EBPP RESOURCES: WEB SITES The Cochrane CollaborationThe Cochrane Library“The Cochrane Library contains high-quality, independent evidence to inform healthcare decision-making. It includes reliable evidence from Cochrane and other systematic reviews, clinical trials, and more. Cochrane reviews bring you the combined results of the world’s best medical research studies, and are recognised as the gold standard in evidence-based health care.”
64EBPP RESOURCES: WEB SITES TRIP Database“Welcome to the TRIP Database, the Internet's leading resources for Evidence-Based Medicine. Allowing users to rapidly identify the highest quality clinical evidence for clinical practice.”Enter a term (e.g., adolescent anxiety, postpartum depression, psychosis) and search engine will list systematic reviews, evidence based synopses, guidelines (international), e-textbooks, etc.
65EBPP RESOURCES: WEB SITES National Registry of Evidence-Based Programs and Practices“Welcome to the National Registry of Evidence-based Programs and Practices (NREPP), a service of the Substance Abuse and Mental Health Services Administration (SAMHSA). NREPP is a searchable database of interventions for the prevention and treatment of mental and substance use disorders. SAMHSA has developed this resource to help people, agencies, and organizations implement programs and practices in their communities.”
66EBPP RESOURCES: WEB SITES Society of Clinical Psychology (APA Division 12)“The purpose of this website is to provide information about effective treatments for psychological disorders. The website is meant for a wide audience, including the general public, practitioners, researchers, and students. Basic descriptions are provided for each psychological disorder and treatment. In addition, for each treatment, the website lists key references, clinical resources, and training opportunities.The American Psychological Association has identified "best research evidence" as a major component of evidence-based practice (APA Presidential Task Force on Evidence-Based Practice, 2006). This website describes the research evidence for psychological treatments, which will necessarily be combined with clinician expertise and patient values and characteristics in determining optimum approaches to treatment.”
67EBPP RESOURCES: WEB SITES Evidence-Based Mental Health Treatment for Children and Adolescents“The information on this website is offered as a completely free service to families and mental health professionals to help ensure that children and adolescents benefit from the most up-to-date information about mental health treatment. We request absolutely no information from visitors to this site, and hope this service will help all learn more about important differences in mental health treatments. Families want their children to get the best possible treatment, and this site maintains an updated list of treatments with strong scientific support.”
68HOW TO BE AN EVIDENCE-BASED PSYCHOLOGIST Accurately assess and diagnose clients, paying close attention to:ComorbidityDominant client concernsCultural factorsCollaborate with clients to develop treatment goals, paying close attention to client expectations and barriers to treatment involvementProvide the most appropriate evidence-based treatment possible, flexibly tailoring to client circumstances
69HOW TO BE AN EVIDENCE-BASED PSYCHOLOGIST Work to ensure a strong therapeutic relationship, and move quickly to repair any relationship difficulties that ariseMonitor treatment progress, both in terms of symptoms/problems and the therapeutic relationshipRegularly review treatment progress with clients, modifying treatment as neededIf treatment progress is suboptimal, be prepared to provide a different EBT or refer to another professional who can offer a different EBT
70HOW TO BE AN EVIDENCE-BASED PSYCHOLOGIST Questions or comments?For copies of the presentation, contact