Bridging science and practice to improve patient care.

Replies to the comments by Tyron (see record 2009-06923-008), Silverstein and Auerbach (see record 2009-06923-009), and Raps (see record 2009-06923-010) on the authors original article (see record 2008-03389-001). I was very pleased to read these comments about the priority of bridging research and clinical practice and to have the benefit of further perspectives on how this goal might be achieved. The article to which these comments were addressed suggested changes in both clinical research and practice that might develop or strengthen such a bridge. Suggestions for clinical research included evaluating the mechanisms of change in psychotherapy so we know what is critical to include in practice, evaluating who responds to treatment in ways that can be integrated into practice, and increasing the use of qualitative research. Suggestions for practice included using systematic measures to evaluate patient progress, codifying the experiences of practitioners so they contribute to our accumulated knowledge base, and promoting direct collaborations of researchers and practitioners. The above commentaries emphasized specific points about research on mechanisms, qualitative research methods, and the challenges of providing treatments given the nature and scope of the problems that clients present. These commentaries add to the discussion in novel ways and also illustrate the obstacles that may compete with bridging. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Using qualitative research to develop culturally competent evidence-based practice.

Kazdin (see record 2008-03389-001) pointed out that the requirement for evidence-based practice (EBP) has made the long-standing gap between research and practice in clinical psychology even more salient. He offered several strategies for bridging this gap: investigating mechanisms and moderators of therapeutic change, and qualitative research. We agree that qualitative research can be useful in bridging the gap between research and clinical practice (Silverstein & Auerbach, 2007; Silverstein, Auerbach, & Levant, 2006). In this comment we discuss using qualitative research to develop EBP that is culturally competent. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

When we research “conditions–treatments,” is there a misnomer?

Kazdin (see record 2008-03389-001) is to be commended for his analysis of some current issues surrounding research and clinical practice. He described many important considerations and variables that impact the execution and usefulness of research. However, a critical conceptual issue was left unaddressed, one that is rarely addressed in these pages or elsewhere. In looking at questions of conditions and treatments, we need to pay attention to what we mean by “conditions.” How the clinician or researcher judges whether treatment has been successful depends in large part on his or her sense of the underlying condition being treated. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Missing mechanism information.

The first recommendation Kazdin (see record 2008-03389-001) made for advancing the psychotherapy research knowledge base, improving patient care, and reducing the gulf between research and practice was to study the mechanisms of therapeutic change. He noted, “The study of mechanisms of change has received the least attention even though understanding mechanisms may well be the best long-term investment for improving clinical practice and patient care” (p. 151). He clarified what he meant by mechanism by stipulating what it was and what it was not, and he provided examples. The point of this comment is to note that Kazdin (2008) omitted mention of an extensive and rapidly expanding literature on parallel distributed processing– connectionist neural network (PDP-CNN) models of cognition, affect, and behavior that provides psychologically relevant information on causal mechanisms. Kazdin’s (2008) conclusion that learning more about causal mechanisms may best provide long term benefits to the science and practice of clinical psychology, including substantially mending the research–practice schism. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Psychotherapy in long-term care: II. Evidence-based psychological treatments and other outcome research.

This article is the 2nd of 2 that together examine 3 domains important to providing high-quality, evidence-based services to long-term care (LTC) facility residents: policy and advocacy, practical considerations, and outcome research. Older adults who reside in LTC facilities have a very high rate of mental health difficulties. Psychologists have been able to provide services to this population through Medicare since the late 1980s, and empirical findings on treatment approaches are important in guiding psychotherapists to more helpful intervention. The focus of this article is outcome research in LTC settings. This article emphasizes evidence-based psychological treatments (EBTs) but also examines other scientifically supported approaches and discusses the strengths and limitations of focusing on EBTs, as well as general issues in the relation between science and practice in the provision of psychotherapy in LTC settings. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Changing paradigms from empirically supported treatment to evidence-based practice: A cultural perspective.

Psychotherapy research guidelines have a profound impact on research, training, and practice, and they also influence reimbursement decisions that can have ethical and legal consequences. Furthermore, research guidelines have implications for the treatment of culturally diverse groups. Unfortunately, these implications have often been overlooked. Therefore, this article contrasts the impact of two prominent research guidelines on the development of culturally sensitive psychotherapies: (a) empirically supported treatments (ESTs) developed in 1995 by the American Psychological Association’s (APA) Division 12 (Society of Clinical Psychology; Task Force on Promotion and Dissemination of Psychological Procedures, 1995), and (b) evidence-based practice in psychology (EBPP) developed by the APA (Task Force on Promotion and Dissemination of Psychological Procedures,2006) Presidential Task Force on Evidence-Based Practice. Although overall we believe that EBPP is more responsive to the needs and characteristics of culturally diverse groups, ESTs also have many strengths. As the cultural implications of research guidelines are better understood, researchers and clinicians will be able to more effectively advance the development of culturally sensitive evidenced-based psychological treatments. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Evidence-based therapy relationships: Research conclusions and clinical practices.

In this closing article of the special issue, we present the conclusions and recommendations of the interdivisional task force on evidence-based therapy relationships. The work was based on a series of meta-analyses conducted on the effectiveness of various relationship elements and methods of treatment adaptation. A panel of experts concluded that several relationship elements were demonstrably effective (alliance in individual psychotherapy, alliance in youth psychotherapy, alliance in family therapy, cohesion in group therapy, empathy, collecting client feedback) while others were probably effective (goal consensus, collaboration, positive regard). Three other relationship elements (congruence/genuineness, repairing alliance ruptures, and managing countertransference) were deemed promising but had insufficient evidence to conclude that they were effective. Multiple recommendations for practice, training, research, and policy are advanced. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

The future of psychotherapy integration: Closing the gap between research and practice.

Over the past several decades, the field of psychotherapy has become more receptive to the idea of integration. For the most part, efforts have been made to find commonalities and complementarities across different theoretical orientations. When the Society for the Exploration of Psychotherapy Integration (SEPI) was formed in 1983, its stated goals were for the integration of different approaches to therapy, but also for the integration of research and practice. This article comments on the long-standing gap between practice and research, and offers ways in which this gap may be closed. Moreover, in light of increasing demands for accountability, it is maintained that empirical pragmatism needs to be the integrative theme of the 21st century. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Positive emotions in psychotherapy theory, research, and practice: New kid on the block?

This article introduces the Special Section, which explores the potential importance of positive emotions in our theory, research, and practice. The authors propose that the peripheral role that psychotherapy theory, research, and practice has allotted to the variable "positive emotion" can be understood in terms of the foundational axioms of our discipline. The authors argue that psychotherapy has implicitly adopted an attitude of caution and suspicion toward the potential therapeutic value of experiencing positive emotions, an all embracing attitude toward the therapeutic value of experiencing negative emotions, and an identity focused on healing psychological wounds at the expense of promoting psychological well-being. The authors trace the adoption of these axioms to Judeo-Christian ideas of human nature and to the identity formation process of psychotherapy, and the authors speculate on the sociopolitical forces that have promoted a shift in our theorizing in the last few decades. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Evidence-based practice and the culture of adolescence.

Evidence-based practice requires attention to the client context, including client culture. We propose that the developmental period of adolescence is characterized by a unique culture that has important implications for evidence-based practice. Specifically, this paper explores three features of adolescent culture (importance of technology, centrality of peers, and the ongoing challenge of identity formation and individuation) that may be especially salient when treating adolescents. We then provide recommendations for how these features can be addressed in adapting existing evidence-based protocols and designing new interventions for adolescents, using examples from the literature to illustrate innovative applications. Overall, we argue that considering adolescent culture and thoughtfully tailoring treatment to that culture is consistent with the evidence-based practice framework and could enhance therapeutic outcomes. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

A telecommunication monitoring system for clinical and research practice.

The telephone has been used in clinical and research practice for many years. A telecommunication monitoring system (TMS) provides an automated way to track patients' and participants' symptoms, compliance, and progress as they participate in therapy and research. Data demonstrating the usefulness, strong reliability and validity, and convincing sensitivity and specificity of a TMS are provided. Future applications of this type of technology are discussed, including the ability to integrate a system with the Internet to create a more comprehensive approach to monitoring patients in therapy and participants in research studies. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Knowing the self: Building a bridge from basic research to clinical practice.

The articles under discussion give promise that basic research information about the self can be translated into useful information for the clinical practitioner. Several issues were delineated that require more careful attention and research: (a) The self needs to be more clearly defined in both basic and clinical literatures; (b) the process of self-experiencing must be studied in conjunction with the study of the acquisition, functions, and developmental trajectories of self-concepts; and (c) the complexities of identity formation in multicultural societies must be factored into future research designs. Psychotherapists need to be aware that many patients have internalized self-related ideas from several different cultures and subcultures, and puzzling out these culture-based conflicts may become a significant focus of psychotherapy. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Attending to the Omissions: A Historical Examination of Evidence-Based Practice Movements.

Evidence-based practice and empirically supported treatment movements are potent forces that affect the practice of psychology today and have the potential to mandate the types of treatments psychologists conduct. The histories of these movements reveal that certain aspects of therapy valued by psychologists have been ignored. It is shown that the evidence-based movements (a) overemphasize treatments and treatment differences and (b) ignore aspects of psychotherapy that have been shown to be related to outcome, such as variation among psychologists, the relationship, and other common factors. It is important that psychologists understand the development of these movements so that they can be critical consumers of research and can effectively influence the future course of events. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Bridging the gap between alcoholism treatment research and practice: Identifying what works and why.

Despite the proliferation of alcoholism treatment research over the past 2 decades, there is a continued gap between what has been shown to be promising in the extant literature and what is commonly practiced by clinicians in the alcohol treatment field. The present article is an effort to bridge this gap by examining findings from the broad body of alcoholism treatment outcome research to determine how these findings may optimally be used by treatment providers. To this end, the authors provide clinicians with a succinct review of the current alcoholism treatment outcome literature and identify hallmarks of the most empirically supported treatments. Clinical implications of this literature for practitioners working with client with alcohol use disorders are discussed, with a focus on factors underlying effective treatments and on how these factors can be transferred from research to practice. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Clinical practice as natural laboratory for psychotherapy research: A guide to case-based time-series analysis.

Both researchers and practitioners need to know more about how laboratory treatment protocols translate to real-world practice settings and how clinical innovations can be systematically tested and communicated to a skeptical scientific community. The single-case time-series study is well suited to opening a productive discourse between practice and laboratory. The appeal of case-based time-series studies, with multiple observations both before and after treatment, is that they enrich our design palette by providing the discipline another way to expand its empirical reach to practice settings and its subject matter to the contingencies of individual change. This article is a user's guide to conducting empirically respectable case-based time-series studies in a clinical practice or laboratory setting. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Patient-focused research: Using patient outcome data to enhance treatment effects.

A program of research aimed at improving the quality of psychological interventions is described. Data from over 10,000 patients were analyzed to understand the association between number of treatment sessions and clinically significant improvement. In addition to a potential dose-response relationship, typical recovery curves were generated for patients at varying levels of disturbance and were used to identify patients whose progress was less than expected ("signal" cases). The consequences of passing this information along to therapists were reported. Analyses of dose-response data showed that 50% of patients required 21 sessions of treatment before they met criteria for clinically significant improvement. Seventy-five percent of patients were predicted to improve only after receiving more than 40 treatment sessions in conjunction with other routine contacts, including medication in some cases. Identification of signal cases (potential treatment failures) shows promise as a decision support tool, although further research is needed to elucidate the nature of helpful feedback. Outgrowths of this research include its possible contribution to social policy decisions, reductions in the need for case management, use in supervision, and possible effects on theories of change. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Integrating evidence-based practice, cognitive–behavior therapy, and multicultural therapy: Ten steps for culturally competent practice.

During the past decade, 3 major developments in psychotherapy have been converging: the establishment of evidence-based practices in psychology (EBPP); enormous growth in cognitive–behavior therapy and research (CBT); and increasing recognition of the impact of multicultural influences, as highlighted in the field of multicultural therapy (MCT). Cognitive–behavioral research has produced many empirically supported treatments used in the establishment of the scientific research base of EBPP, and MCT research has provided a wealth of qualitative information that balances this scientific emphasis with recognition of the importance of culturally competent clinical judgment, expertise, and experience. This article describes the advantages and potential limitations involved in the integration of CBT and multicultural considerations, with limitations reframed as opportunities to improve the relevance and effectiveness of psychotherapy. Ten suggestions are provided for integrating multicultural considerations into the clinical practice of cognitive–behavior therapy. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Decision making and psychotherapy integration: Theoretical considerations, preliminary data, and implications for future research.

In recent years, a number of publications have called for investigation of how psychotherapists make treatment decisions in clinical practice. This recommendation is particularly salient for psychotherapy integration, as studies have consistently shown that a plurality of American clinicians consider themselves to be either "eclectic" or "integrative" in theoretical orientation. Yet, the research on clinician decision making in psychotherapy is in its infancy. This article examines the need for decision-making research in psychotherapy integration, as well as aspects of psychotherapy integration that are targets for research and possible theoretical frameworks for understanding decision-making processes of integrative psychotherapists. A preliminary study provides data from practicing psychotherapists to illustrate these points. Finally, implications and directions for future research are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Health care research that delivers: Introduction to the special issue on cognitive factors in health care.

Research that addresses human factors issues in health care has made good progress since the landmark 1999 Institute of Medicine report on medical error (Kohn, Corrigan, & Donaldson, 1999), yet patient safety remains a persistent challenge for the health care system. While this challenge reflects many factors, we focus on the need for research that is sufficiently comprehensive to identify threats to patient safety, yet specific enough to explain how provider and patient factors interact with task and health context to engender these threats. Such research should be theory-based, yet also problem-driven; exert experimental control over theoretically relevant variables, yet also involve participants, tasks, and contexts that represent the problems of interest. A tension exists between theory-based, experimentally controlled research on the one hand, and problem-driven research with representative situations on the other. The studies in this special issue are both informed by theory and guided by application, reflecting what Stokes (1997) referred to as “use-inspired basic research.” Collectively, these studies represent progress toward improving patient safety and the quality of health care. However, important work remains to be done to significantly improve health care by more comprehensively managing tensions between theory and application and different research methodologies. We discuss barriers to accomplishing such research in general (the challenge of testing theory in situ in rich environments), and specifically in the health care domain. Significant progress will require research programs that thoughtfully manage mixed methods across a series of converging studies. (PsycINFO Database Record (c) 2011 APA, all rights reserved)