5: Evidence based practice

Question 1

What does nomotheticn and idiographic mean in the context of evidence based practice?

Answer 1

• research is nomothetic→ on average for the general population
• BUT therapy is idiographic→ one on one relationship

Question 2

What are the three legs of the stool for EBP?

Answer 2

Three legs
- Best scientific evidence
- Clinical experience
- Patient preference

Question 3

What type of research should be address when looking at EBP?

Answer 3

• treatment outcome research
• treatment process research→ best way to incorporate this therapy for it to work
• basic and applied psychological research

Question 4

What is the hierarchy of good sources to inform EBP?

Answer 4

expert opinion­ < case reports< case-control studies< cohort studies< RCT< systematic reviews

Question 5

What are some sources of evidence for a EBP?

Answer 5

• treatment efficacy
  
  • Strength of evidence pertaining to causal relationship between intervention and disorder
  • rigorously designed studies in research settings
  • would it work in the best conditions
• Treatment effectiveness/clinical utility
  
  • real world settings
  • ex→ Generalizability, feasibility, costs and benefits of intervention
• Basic psychological processes relevant to treatment
  
  • ex→ memory, attention, problem-solving, emotion, personality

Question 6

What should research studies consider more when studying EBP?

Answer 6

• Patient diversity
• Mode of delivery→ ex: group treatment more cost effective but do they benefit people
• Feasibility of delivery in real world settings
• Treatment costs
• Therapeutic relationships

Question 7

What is included in clinical expertise?

Answer 7

• Clinical case conceptualization/formulation→ make sense of the case, importante before planning an intervention
• Treatment planning
• Treatment implementation
• Interpersonal expertise
• Self-reflection
• Knowledge and use of research literature
• Understanding influence of diversity and culture on treatment
• Seeking consultation and resources
  —>Research evidence not available to dictate every decision in a therapy session
  —>sometimes need clinical judgment and past experience
  —>BUT should always start and be grounded with research evidence

Question 8

What is a patient moderator of treatment effect?

Answer 8

variable that influences strength and direction of effects between two variables
- ex→ culture, racial minority, comorbidity, past experience in therapy

Question 9

What was added in the CPA report compared to the APA one for executive summary for EBP?

Answer 9

Differences with APA
- Focus on treatment process research→ focus on common factors
- Add the use of guidelines
- importance of measuring patient’s improvement over the session to see if treatment is being effective

Question 10

What are some advantages of EBP?

Answer 10

Advantages
- Improve quality and cost effectiveness of treatment
- Enhance accountability→ let the patient knows the treatments that are recommended for each disorder

Question 11

What are some criticisms of EBP?

Answer 11

Criticisms
- Treatments easier to research are more likely to be included
- Inappropriately restrict access to certain treatments

Question 12

What is the difference between unvalidated and invalidated treatments?

Answer 12

Unvalidated treatments VS invalidated treatments
- Unvalidated = not examined sufficiently in controlled study but does not mean that it does not work
- Invalidated treatment = shown not to work
—> should make list of invalidated treatments to make it clear what not to do (even for patient)

Question 13

How should studies clealry show the relationship between guiding theoretical base and treatment outcome?

Answer 13

• First, proposed mechanisms of change should be validated in basic research
• Second, proposed mechanisms of change should be related to proposed mechanisms of disorder
• Third, change in proposed mechanisms should relate to change in symptoms in treatment studies