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)     

Is evidence-based practice diverse enough? Philosophy of science considerations.

In its policy rationale for evidence-based practice in psychology (EBPP), the APA Presidential Task Force on Evidence-Based Practice (see record 2006-05893-001) claims to have constituted itself with "scientists and practitioners from a wide range of perspectives and traditions, reflecting the diverse perspectives within the field" (p. 273). We applaud this attention to diversity but contend that an entire perspective of the debate was omitted in the Task Force's newly approved policy and its underlying report. The failure to consider a philosophy of science perspective led the Task Force to make a number of epistemological assumptions that are not based on evidence or rationale and that thus violate the very spirit of evidence-based decision making. In this comment, we reveal a few of these assumptions and discuss their detrimental consequences. (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)     

Reestablishing clinical psychology's subjective core.

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. The Task Force is to be commended for their report valuing evidence from "clinical expertise" on a par with "research data" (p. 272) in guiding psychological practices. The current author suggests that the APA not only should make a place at psychology's policymaking table for "clinical expertise" but should prioritize clinical and subjective sources of data--the essence of the psychological--and set policies to ensure that objective data, such as behaviors and DSM diagnoses, are considered in their subjective context. The APA should also encourage researchers to devise ways to preserve as much as possible the personal "feel" of the clinical encounter in their data analysis and published conclusions. The APA also needs to assign priority to subjective emotional and relational skills on a par with academic and analytic skills in the selection and training of clinical psychology students. Reconnecting clinical psychology with its subjective evidentiary roots in ways such as these should help to bring us out from under the dominance of medicine, to the benefit of our profession and our clients. (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)     

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)     

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)     

The role of external validity in evidence-based practice for rehabilitation.

Objective: To advance a methodological convention that balances concern for rigor (i.e., internal validity) with equal concern for relevance (i.e., external validity). Method: Conceptual. Results: A rating format for relevance is derived, determined, and applied to cognitive rehabilitation. Implications: The evidentiary base for applying research to practice can be properly determined through expert analysis of multidimensional criteria. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Addressing key challenges in evidence-based practice in psychology.

With its promise of enhancing the effectiveness of services, evidence-based practice in psychology (EBPP) appears to offer much to psychologists, patients, and policymakers. The purpose of this article is to examine some of the key challenges facing psychologists who wish to provide evidence-based treatment services, including how research evidence is used in EBPP, whether the results of the treatment research literature can be generalized to typical clinical practice, and how effective evidence-based treatments are in clinical practice. On the basis of recent evidence-based initiatives and treatment research, there is a solid scientific basis for EBPP, although much more research is necessary on the treatment of relatively mild, but common, clinical conditions and on the transporting of evidence-based treatments into clinical practice. (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)     

Introduction to the special section on developing guidelines for the evidence-based assessment (EBA) of adult disorders.

The goal of this special section is to encourage greater awareness of evidence-based assessment (EBA) in the development of a scientifically supported clinical psychology. In this introductory article, the authors describe the elements that authors in this special section were asked to consider in their focused reviews (including the scope of available psychometric evidence, advancements in psychopathology research, and evidence of attention to factors such as gender, age, and ethnicity in measure validation). The authors then present central issues evident in the articles that deal with anxiety, depression, personality disorders, and couple distress and in the accompanying commentaries. The authors conclude by presenting key themes emerging from the articles in this special section, including gaps in psychometric information, limited information about the utility of assessment, the discrepancy between recommended EBAs and current training and practice, and the need for further data on the process of clinical assessment. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Evidentiary pluralism as a strategy for research and evidence-based practice in rehabilitation psychology.

Objective: This article examines the utility of evidentiary pluralism, a research strategy that selects methods in service of content questions, in the context of rehabilitation psychology. Hierarchical views that favor randomized controlled clinical trials (RCTs) over other evidence are discussed, and RCTs are considered as they intersect with issues in the field. RCTs are vital for establishing treatment efficacy, but whether they are uniformly the best evidence to inform practice is critically evaluated. Conclusions: The authors argue that because treatment is only one of several variables that influence functioning, disability, and participation over time, an expanded set of conceptual and data analytic approaches should be selected in an informed way to support an expanded research agenda in which therapeutic and extratherapeutic influences on rehabilitation processes and outcomes is investigated. The benefits of evidentiary pluralism are considered, including those that help close the gap between the narrower clinical rehabilitation model and a public health disability model. (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)     

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)     

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-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)     

Research and practice in health psychology.

The task force on research and practice in health psychology responded to three presentations on important issues. It was posited that clinical health psychology may represent the ideal specialty for scientist-practitioner training. There are exciting, important questions regarding health problems, health policy, and health treatment systems needing interdisciplinary research. Health psychologists are uniquely prepared to take a leadership role due to their training in both research and service delivery. (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)     

Research into practice/practice into research.

This article introduces a new section of this journal devoted to the interface between research and clinical practice in the family field. The purpose of this section is to provide a vehicle through which communication between clinicians and researchers can be improved, so that each can benefit most from the work of the other. This article reviews the historical antecedents of researcher/clinician alienation, discusses the specific ways clinicians can enhance research and that research can enhance clinical activity, and describes the plan for this section of the Journal of Family Psychology. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Cultural competence and evidence-based practice in mental health services: A complementary perspective.

The need for cultural competence and the need for evidence-based practice in mental health services are major issues in contemporary discourse, especially in the psychological treatment of people of color. Although these 2 paradigms are complementary in nature, there is little cross-fertilization in the psychological literature. The present article illustrates the complementary nature of these 2 paradigms. A main point of convergence is related to the development of culturally adapted interventions in the move from efficacy research to effectiveness studies. The implications of cultural adaptations of empirically supported treatments for mental health services in terms of research and practice with ethnic/racial minority populations are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)