Practicing psychologists’ reflections on evidence-based practice in psychology.

An American Psychological Association (APA) policy definition of evidence-based practice in psychology (EBPP) states that practice based on evidence must consider the best available research, use clinical expertise, and consider client contextual variables (APA Presidential Task Force, 2006). The researchers qualitatively examined clinical and counseling psychologists’ attitudes toward EBPP using grounded theory. The study explored the extent to which the official view of EBPP reflects current psychological practice as well as whether EBPP is an idealistic definition to work toward. An examination of themes from this research yielded evidence that the framework for EBPP is in place, although many participants initially confused EBPP with research. Psychologists will benefit from an open-minded review of the official APA policy definition and from considering how the policy may affect their practice and interactions with managed care providers. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Clarification and elaboration on evidence-based practice in psychology.

Responds to comments by D. C. Wendt and B. D. Slife (see record 2007-13085-019), P. H. Hunsberger (see record 2007-13085-020), and R. B. Stuart and S. O. Lilienfeld (see record 2007-13085-021) regarding the report by the APA Presidential Task Force on Evidence-Based Practice (see record 2006-05893-001) entitled Evidence-based practice in psychology. The goal of the task force was to create a scheme that would suggest how evidence should be used to design and offer services that will benefit patients and to assure the public and the health care system that psychologists are providing evidence-based services. There were and will continue to be many scientific and philosophical issues inherent in any such enterprise, and agreement by all psychologists with every aspect of EBPP may not be possible. Nevertheless, the APA's EBPP policy and the report that accompanied it are remarkably inclusive of various perspectives while remaining unambiguous about the need to use evidence in a way that leads to effective services. What is needed at this point are clinically relevant evidence and investigations of how such evidence can be used to best benefit those served by psychological interventions. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Evidence-based practice in psychology.

The evidence-based practice movement has become an important feature of health care systems and health care policy. Within this context, the APA 2005 Presidential Task Force on Evidence-Based Practice defines and discusses evidence-based practice in psychology (EBPP). In an integration of science and practice, the Task Force's report describes psychology's fundamental commitment to sophisticated EBPP and takes into account the full range of evidence psychologists and policymakers must consider. Research, clinical expertise, and patient characteristics are all supported as relevant to good outcomes. EBPP promotes effective psychological practice and enhances public health by applying empirically supported principles of psychological assessment, case formulation, therapeutic relationship, and intervention. The report provides a rationale for and expanded discussion of the EBPP policy statement that was developed by the Task Force and adopted as association policy by the APA Council of Representatives in August 2005. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The evidence missing from evidence-based practice.

Comments on the report by the APA Presidential Task Force on Evidence-Based Practice (see record 2006-05893-001) entitled Evidence-based practice in psychology. Regrettably, the task force report was largely silent on three critical issues. As a consequence, it omitted much of the evidence necessary for a complete picture of evidence-based practice. First, the task force report did not operationalize "evidence." Second, the task force report did not address the crucial problem of iatrogenic treatments. Third, the task force report said little about the necessity for ongoing objective evaluation of clinical cases, which is critical to ethically responsible services. Current debate centers on how research findings should be factored into interventions, not on whether it is necessary to do so. Rather than waiting for the resolution of competing views on the matter, psychologists bear an ethical obligation to offer evidence-informed services. Three critical steps that were largely neglected by the task force report can go far toward helping psychologists honor that commitment: (a) providing a clearer operationalization of scientific evidence, (b) using current research to rule out the use of potentially harmful methods, and (c) using objective criteria to evaluate all of their cases on an ongoing basis. These steps, in turn, clarify the menu of options available to therapists, help protect clients from harm, and offer the advantage of allowing clinicians to contribute to the growing body of knowledge about what does and does not work in psychotherapy. (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)     

Training psychologists for evidence-based practice.

Evidence-base practice (EBP) is now commonplace in many health care services and, in recent years, there has been a healthy debate about the role of EBP in psychology. In this article, I provide information on the nature of EBP and how it is consistent with professional training models and standards in psychology. In discussing some of the concerns that have been raised about the value of EBP in psychology, I present research findings on the relevance and potential impact of evidence-based assessment and treatment practices. Finally, after highlighting the promise of EBP, I offer some recommendations for how training efforts in professional psychology should be refocused in order to optimally prepare current and future psychologists to practice in an evidence-based manner. (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)     

Advancing the implementation of evidence-based practices into clinical practice: How do we get there from here?

How does an individual practitioner, agency, or treatment system get from making a decision or being mandated to adopt an evidence-based practice (EBP) to successfully implementing and using the EBP? Research and theory on factors that help or hinder putting new treatments into practice focus on individual, organizational, and external levels. Although several factors have been identified that affect implementation, the level and specificity of evidence do not warrant the term evidence-based implementation strategies. Yet steps must be taken now to start using EBPs. This article includes a review of research and theory on implementation, a case example of statewide implementation, and recommendations for psychologists across multiple roles to assist in advancing the implementation of EBPs into clinical practice. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Evidence searching for evidence-based psychology practice.

There is an increased awareness of evidence-based methodology among psychologists, but little exists in the literature about how to access the research. Moreover, the prohibitive cost of this information and limited time are barriers to the identification of evidence to answer clinical questions. This article presents an example of a question worked though in an evidence-based way. Methods are highlighted, including distinguishing background and foreground questions, breaking down questions into searchable statements, and adapting statements to suit both the question being asked and the resource being searched. A number of free, evidence-based resources are listed. Knowing how and where to access this information will enable practitioners to more easily use an evidence-based approach to their practice. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Evidence-based treatment and practice: New opportunities to bridge clinical research and practice, enhance the knowledge base, and improve patient care.

The long-standing divide between research and practice in clinical psychology has received increased attention in view of the development of evidence-based interventions and practice and public interest, oversight, and management of psychological services. The gap has been reflected in concerns from those in practice about the applicability of findings from psychotherapy research as a guide to clinical work and concerns from those in research about how clinical work is conducted. Research and practice are united in their commitment to providing the best of psychological knowledge and methods to improve the quality of patient care. This article highlights issues in the research- practice debate as a backdrop for rapprochement. Suggestions are made for changes and shifts in emphases in psychotherapy research and clinical practice. The changes are designed to ensure that both research and practice contribute to our knowledge base and provide information that can be used more readily to improve patient care and, in the process, reduce the perceived and real hiatus between research and practice. (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)     

Implementation of an evidence-based practice in a clinical setting: What happens when you get there?

Great strides have been made in creating and testing evidence-based practices (EBPs). However, without adequate dissemination and implementation in clinical settings, this progress is of limited value. This article describes the implementation of an EBP (e.g., cognitive–behavioral therapy for depression and anxiety) in a large-group practice mental health services delivery system, focusing on both the role of psychologists and on the training model developed for implementation. The experience in implementation of an EBP is reviewed, with an emphasis on the role and direction psychologists might take in engaging and developing EBP training programs for other mental health services delivery systems. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

From clinical trials to professional training: A graduate course in evidence-based interventions for children, youth, and families.

In preparing students to become competent professional psychologists, graduate coursework must lay the foundation for the development of competence in the ethical delivery of evidence-based interventions. This paper describes a graduate course designed to introduce students to evidence-based treatments with children and youth. The course is designed to enhance critical thinking in translating research into practice as well as to develop core competencies in intervention planning, implementation, and evaluation. Activities to enhance interaction and to promote problem-based learning include student presentations of a workshop on an effective practice element, as well as a case assignment requiring treatment planning. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Evidence-Based Practice: Beyond Empirically Supported Treatments.

Must the clinician choose between a practice that is strictly objective and data based and one that is purely subjective and experience based? Optimally, practitioners need to follow a model of evidence-based psychotherapy practice, such as the disciplined inquiry or local clinical scientist model, that encompasses a theoretical formulation, empirically supported treatments (ESTs), empirically supported therapy relationships, clinicians' accumulated practical experience, and their clinical judgment about the case at hand. Some shortcomings of ESTs are reviewed, and a form of evidence for psychotherapy practice is presented that entails the accumulation of systematic case studies published online. Practitioners can contribute to such a database and be guided in their practice by those cases most relevant to their clients' problems. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Preparing psychologists for evidence-based school practice: Lessons learned and challenges ahead.

The evidence-based practice (EBP) movement has the potential to significantly advance the quality of psychological and educational services provided by psychologists working in schools. Training psychologists in EBP has challenged the profession and caused faculty in graduate programs to reevaluate and retool professional training curricula and instructional practices. Four domains of challenges in graduate training are identified: (a) integrating the EBP knowledge base into the curriculum, (b) expanding models of research training, (c) expanding training in prevention science, and (d) expanding training in problem-solving consultation and school contextual issues. For each of these, the author discusses the range and scope of the challenge and possible solutions for advancing graduate training in psychology relevant to school practice. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Beyond “ESTs”: Problematic assumptions in the pursuit of evidence-based practice.

There has been much confusion in the literature of psychotherapy between the broad concept of evidence-based practice and the narrower set of criteria that have been employed in designating certain treatments as “empirically validated” or “empirically supported.” In contrast to the appropriate concern with examining the evidence for the efficacy of various approaches to therapy and for the theoretical assumptions that underlie them, the “empirically supported treatments” movement has been characterized more by ideology and faulty assumptions than by good science. This paper examines in detail the scientific and logical limitations of the “EST” movement and aims to place the empirical investigation of theory and practice in psychotherapy on a sounder basis. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

What Works in Psychotherapy and How Do We Know?: What Evidence-Based Practice Has to Offer.

Evidence-based practice may be insufficiently understood by dynamically oriented therapists and analysts. It includes the integration of the best available research evidence, clinical expertise, and considered attention to a patient's personal attributes, sociocultural characteristics, and unique dynamics. These 3 streams of knowledge inform clinical practice. Advocates of a manual approach to treatment have challenged clinicians to rethink the importance of what they consider salient in their therapeutic endeavors. This article demonstrates the relevance of an evidence-based practice perspective for dynamically oriented clinicians. An American Psychological Association task force has been established to develop and elaborate the view of current clinical practice so that it can be disseminated to clinicians and to the public as a policy statement that governs clinicians' thinking and work. The goal is to provide knowledgeable, reasonable, and responsible high-quality health care to those who need it based on these developed practice principles. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The power of multiple methods and evidence sources: Raising the profile of Canadian counselling psychology research.

In counselling psychology, research and practice are viewed as mutually informative, and Canadian counselling psychologists conduct research in a wide range of areas, utilizing a wide range of research methods. However, there are few Canadian publications that give prominence to counselling psychology scholarly work. Over the past decade, two trends have become more prominent in the practice of counselling psychology: evidence-based practice and outcome-focused intervention. Traditionally, empirical evidence for the efficacy of practice interventions has come from randomized controlled trials. This fails to reflect the diversity of methods and practice that Canadian counselling psychologists utilize. To address this discrepancy, in this article we provide some alternate ways for obtaining empirical support for the predictive efficacy of counselling interventions. We conclude by addressing some challenges currently facing counselling psychologists in Canada (i.e., publication venues, funding for research, the connection between research and practice, preparation of students) and describing some ways for raising the profile of counselling psychology research and practice in Canada. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

Evidence-based treatments and delivery of psychological services: Shifting our emphases to increase impact.

Evidence-based psychological treatments (EBTs) have made enormous gains in the range of techniques that are available and the scope of problems to which they can be applied. Debates about the advances focus on issues related to applicability of the evidence to clinical work, limits of highly controlled studies, and decision making in clinical practice. Less often discussed is arguably the more salient issue, namely, that most people in need of psychological treatment do not receive services, whether evidence based or not. This article discusses EBTs as currently studied in relation to an overarching goal of our interventions, namely, to reduce the burden of mental illness and the full range of social, emotional, and behavioral problems leading to impairment. The diversity of clients, the range of settings in which treatments must be delivered, and the models of delivery ought to receive greater attention in developing evidence-based interventions. In the context of treatment of children and adolescents, this article discusses service needs and how EBTs can better align with these needs to exert broad impact. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Smoothing the trail for dissemination of evidence-based practices for youth: Flexibility within fidelity.

The role and implementation of evidence-based practice and empirically supported treatments has been hotly contested among researchers and practitioners. Using examples of and from various empirically supported treatments the authors offer suggestions for smoothing the pathway for dissemination of evidence-based practice with children and adolescents. The authors underscore that mediational analyses, treatment process studies, and the continued creation of flexible treatment manuals are important components of successful dissemination. Flexibility within fidelity is proposed as the preferred perspective that eases the transition and dissemination of empirically supported treatments from research clinics to service clinics. (PsycINFO Database Record (c) 2010 APA, all rights reserved)