Evidence-Based Practice in Psychology
https://www.apa.org/pubs/journals/features/evidence-based-
statement.pdf?fbclid=IwAR1kuh4gx0_c9KTMkXs5w4kPh_Xou2pv6bIIZmdcRabHsLNABv
__9aBlDok
Page 271:
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.
Applied Psychology and Evidence-Based Practice:
• Lightner Witmer: First articulated applied psychology, established first
psychological clinic in 1896.
• Evidence-Based Approach: Psychologists linked with evidence-based patient care
from the beginning.
• Witmer's insight: Progress of pure and applied sciences is interconnected.
• APA Policy (1947): Psychologists should be trained as scientists and practitioners.
• Frederick C. Thorne: Early practitioner, emphasized integrating science into practice
through an experimental approach.
• Psychologists pioneering evidence-based practice development for decades.
Evidence-Based Practice in Psychology and Medicine:
• Consistency with evidence-based medicine's principles.
• Goal: Enhance patient outcomes by incorporating relevant research.
• Sackett et al. (1996): Defined evidence-based medicine as conscientious, judicious
use of current best evidence in patient care decisions.
Psychologists' Role in Evidence-Based Practice:
• Psychologists' training based on empirical methods.
• Vital role in advancing evidence-based practice for better patient care.
Guidelines for Best Practice Implementation:
• Implementation strategy: Developing guidelines for best practice.
• APA's Role: Recognized need for comprehensive guideline approach.
• Risk: Misuse of guidelines by commercial healthcare entities lacking scientific
understanding.
• APA's Initiative (1992): Formed joint task force for guideline development.
,This text emphasizes the historical development of evidence-based practice in psychology, its
alignment with evidence-based medicine, psychologists' significance in this process, and the
importance of guidelines for best practice implementation.
Page 272:
Guideline Development and Evaluation in Psychology:
• APA Council Approval: Template for Developing Guidelines approved in 1995.
• Template's Focus: Outlined evidence considerations, cautioned systematic weighing
of research and clinical expertise.
• Guidelines construction reliant on adequate scientific and clinical evidence.
• Panels' Role: Weigh available evidence following accepted scientific merit standards.
Efficacy and Clinical Utility Evaluation:
• Guidelines' evidence base evaluated through two dimensions:
• efficacy and clinical utility.
• Efficacy: Evaluates strength of evidence for causal relationships between
interventions and treated disorders.
• Clinical Utility: Considers research, consensus, generalizability, feasibility, costs, and
benefits of interventions.
Variation in Guideline Quality:
• Template assessed mental health treatment guidelines.
• Wide variation in quality observed: coverage, scientific basis, specificity,
generalizability.
• Even well-designed, interdisciplinary guidelines struggled to accurately translate
evidence into treatment protocols.
Psychologists' Concerns and Efforts:
• Concerns about guidelines favoring medications over psychological interventions
without support.
• Division 12 Task Force (1995): Criteria for empirically validated treatments
published to promote psychological procedures.
• Identified 18 treatments with strong empirical support via randomized
controlled trials (RCTs) and treatment manuals.
• Division 29 and Division 17 Efforts: Task forces formed to identify empirically
supported therapy relationships and counseling psychology treatments.
• Other groups offered frameworks for integrating research evidence.
Evidence-Based Practice Movement and Health Care:
• Evidence-based practice movement crucial in health care systems and policies.
• State and federal initiatives promoting evidence-based mental health practices.
• Focus on specific treatments within state Medicaid programs and state mental health
systems.
This text discusses the development, evaluation, and concerns about guidelines in psychology,
the efforts of psychologists to promote evidence-based treatments, and the wider adoption of
evidence-based practices in health care systems and policies.
Page 273:
Goals of Evidence-Based Practice Initiatives:
, • Improve quality and cost-effectiveness in psychology.
• Enhance accountability within the field.
• Limited empirical evidence of systemwide improvements post-implementation.
Concerns and Context:
• Psychological community supports evidence-based practice but fears misuse.
• Appointed APA Presidential Task Force on Evidence-Based Practice in 2005.
• Task Force represents diverse perspectives in psychology.
Definition of Evidence-Based Practice in Psychology (EBPP):
• Integration of best available research and clinical expertise.
• Considers patient characteristics, culture, and preferences.
• Aligns with Institute of Medicine's definition with deeper focus on expertise and
broader consideration of patients.
Purpose of EBPP:
• Promote effective psychological practice and public health.
• Apply empirically supported principles in assessment, case formulation, therapeutic
relationship, and intervention.
Scope of Psychological Practice:
• Interventions across various settings for different populations.
• Term "patient" used broadly, acknowledging alternatives like client, consumer, or
person.
• Targets diverse problems, including mental health, academic, vocational, relational,
and community issues.
EBPP vs. Empirically Supported Treatments (ESTs):
• ESTs focus on specific treatments' efficacy for particular disorders.
• EBPP emphasizes patient-centered approach, integrating research evidence into best
outcomes.
• EBPP covers a wider range of clinical activities beyond specific treatments.
Components of EBPP Definition:
• Best Available Research: Integration of research evidence, including RCTs.
• Clinical Expertise: Psychologists' professional knowledge and skills.
• Patient Characteristics: Incorporating individual traits, culture, and preferences.
• Integration of these components forms the basis of EBPP.
Page 274:
Best Available Research Evidence:
• Scientific evidence supports effectiveness of psychological practices.
• Psychological interventions effective for children, adults, older adults across various
issues.
• Psychological treatments often enduring and cost-effective.
• Psychologists excel in research design and interpretation.
Integration of Research in Practice:
• Psychology combines scientific commitment with human relationships and individual
differences.
, • Psychology contributes to research base for evidence-based practice.
• Challenges: Weight of research methods, representativeness of samples, level of
practice guidance, generalizability of treatments, effectiveness across populations.
Consensus for EBPP Principles:
• Meta-analyses show therapeutic practices widely used are effective.
• Psychological interventions' effect sizes comparable to medical treatments.
• Untested interventions shouldn't be assumed ineffective, but timely testing is essential.
• Need rigorous evaluation of established and innovative practices.
Multiple Types of Research Evidence:
• Clinical observation and basic psychological science: Innovations and hypotheses.
• Qualitative research: Describing subjective experiences.
• Systematic case studies: Aggregated comparisons for similar characteristics.
• Single-case experimental designs: Establishing causal relationships for individuals.
• Public health and ethnographic research: Tracking treatment availability,
utilization, acceptance.
• Process–outcome studies: Identifying mechanisms of change.
• Studies of interventions in naturalistic settings: Assessing treatment ecological
validity.
• Randomized controlled trials (RCTs): Standard for causal inference.
• Meta-analysis: Synthesizing results, testing hypotheses, estimating effect sizes.
Page 275:
Evaluating Research on Interventions:
• APA policy highlights two dimensions for evaluating interventions.
• Treatment efficacy: Scientific evaluation of treatment effectiveness.
• Clinical utility: Applicability, feasibility, usefulness, generalizability of
intervention.
Types of Research Evidence:
• Ascending order of contribution to efficacy conclusions:
• Clinical opinion, observation, consensus among experts.
• Systematized clinical observation.
• Sophisticated empirical methodologies (quasi-experiments, RCTs).
• RCTs most stringent for evaluating efficacy.
Importance of Clinical Utility:
• Consideration of generality of effects across diverse factors.
• Robustness of treatments, feasibility in real-world settings, costs.
Recognizing Strengths and Limitations:
• Different research types offer distinct evidence.
• Treatment method, psychologist, treatment relationship, and patient are crucial factors
in psychological practice success.
• Comprehensive evidence-based practice considers these factors.
Psychological Practice Complexity:
• Clinical and research attention needed for treatment effectiveness.
• Clinicians use clinical judgment and research evidence for coherent strategies.
https://www.apa.org/pubs/journals/features/evidence-based-
statement.pdf?fbclid=IwAR1kuh4gx0_c9KTMkXs5w4kPh_Xou2pv6bIIZmdcRabHsLNABv
__9aBlDok
Page 271:
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.
Applied Psychology and Evidence-Based Practice:
• Lightner Witmer: First articulated applied psychology, established first
psychological clinic in 1896.
• Evidence-Based Approach: Psychologists linked with evidence-based patient care
from the beginning.
• Witmer's insight: Progress of pure and applied sciences is interconnected.
• APA Policy (1947): Psychologists should be trained as scientists and practitioners.
• Frederick C. Thorne: Early practitioner, emphasized integrating science into practice
through an experimental approach.
• Psychologists pioneering evidence-based practice development for decades.
Evidence-Based Practice in Psychology and Medicine:
• Consistency with evidence-based medicine's principles.
• Goal: Enhance patient outcomes by incorporating relevant research.
• Sackett et al. (1996): Defined evidence-based medicine as conscientious, judicious
use of current best evidence in patient care decisions.
Psychologists' Role in Evidence-Based Practice:
• Psychologists' training based on empirical methods.
• Vital role in advancing evidence-based practice for better patient care.
Guidelines for Best Practice Implementation:
• Implementation strategy: Developing guidelines for best practice.
• APA's Role: Recognized need for comprehensive guideline approach.
• Risk: Misuse of guidelines by commercial healthcare entities lacking scientific
understanding.
• APA's Initiative (1992): Formed joint task force for guideline development.
,This text emphasizes the historical development of evidence-based practice in psychology, its
alignment with evidence-based medicine, psychologists' significance in this process, and the
importance of guidelines for best practice implementation.
Page 272:
Guideline Development and Evaluation in Psychology:
• APA Council Approval: Template for Developing Guidelines approved in 1995.
• Template's Focus: Outlined evidence considerations, cautioned systematic weighing
of research and clinical expertise.
• Guidelines construction reliant on adequate scientific and clinical evidence.
• Panels' Role: Weigh available evidence following accepted scientific merit standards.
Efficacy and Clinical Utility Evaluation:
• Guidelines' evidence base evaluated through two dimensions:
• efficacy and clinical utility.
• Efficacy: Evaluates strength of evidence for causal relationships between
interventions and treated disorders.
• Clinical Utility: Considers research, consensus, generalizability, feasibility, costs, and
benefits of interventions.
Variation in Guideline Quality:
• Template assessed mental health treatment guidelines.
• Wide variation in quality observed: coverage, scientific basis, specificity,
generalizability.
• Even well-designed, interdisciplinary guidelines struggled to accurately translate
evidence into treatment protocols.
Psychologists' Concerns and Efforts:
• Concerns about guidelines favoring medications over psychological interventions
without support.
• Division 12 Task Force (1995): Criteria for empirically validated treatments
published to promote psychological procedures.
• Identified 18 treatments with strong empirical support via randomized
controlled trials (RCTs) and treatment manuals.
• Division 29 and Division 17 Efforts: Task forces formed to identify empirically
supported therapy relationships and counseling psychology treatments.
• Other groups offered frameworks for integrating research evidence.
Evidence-Based Practice Movement and Health Care:
• Evidence-based practice movement crucial in health care systems and policies.
• State and federal initiatives promoting evidence-based mental health practices.
• Focus on specific treatments within state Medicaid programs and state mental health
systems.
This text discusses the development, evaluation, and concerns about guidelines in psychology,
the efforts of psychologists to promote evidence-based treatments, and the wider adoption of
evidence-based practices in health care systems and policies.
Page 273:
Goals of Evidence-Based Practice Initiatives:
, • Improve quality and cost-effectiveness in psychology.
• Enhance accountability within the field.
• Limited empirical evidence of systemwide improvements post-implementation.
Concerns and Context:
• Psychological community supports evidence-based practice but fears misuse.
• Appointed APA Presidential Task Force on Evidence-Based Practice in 2005.
• Task Force represents diverse perspectives in psychology.
Definition of Evidence-Based Practice in Psychology (EBPP):
• Integration of best available research and clinical expertise.
• Considers patient characteristics, culture, and preferences.
• Aligns with Institute of Medicine's definition with deeper focus on expertise and
broader consideration of patients.
Purpose of EBPP:
• Promote effective psychological practice and public health.
• Apply empirically supported principles in assessment, case formulation, therapeutic
relationship, and intervention.
Scope of Psychological Practice:
• Interventions across various settings for different populations.
• Term "patient" used broadly, acknowledging alternatives like client, consumer, or
person.
• Targets diverse problems, including mental health, academic, vocational, relational,
and community issues.
EBPP vs. Empirically Supported Treatments (ESTs):
• ESTs focus on specific treatments' efficacy for particular disorders.
• EBPP emphasizes patient-centered approach, integrating research evidence into best
outcomes.
• EBPP covers a wider range of clinical activities beyond specific treatments.
Components of EBPP Definition:
• Best Available Research: Integration of research evidence, including RCTs.
• Clinical Expertise: Psychologists' professional knowledge and skills.
• Patient Characteristics: Incorporating individual traits, culture, and preferences.
• Integration of these components forms the basis of EBPP.
Page 274:
Best Available Research Evidence:
• Scientific evidence supports effectiveness of psychological practices.
• Psychological interventions effective for children, adults, older adults across various
issues.
• Psychological treatments often enduring and cost-effective.
• Psychologists excel in research design and interpretation.
Integration of Research in Practice:
• Psychology combines scientific commitment with human relationships and individual
differences.
, • Psychology contributes to research base for evidence-based practice.
• Challenges: Weight of research methods, representativeness of samples, level of
practice guidance, generalizability of treatments, effectiveness across populations.
Consensus for EBPP Principles:
• Meta-analyses show therapeutic practices widely used are effective.
• Psychological interventions' effect sizes comparable to medical treatments.
• Untested interventions shouldn't be assumed ineffective, but timely testing is essential.
• Need rigorous evaluation of established and innovative practices.
Multiple Types of Research Evidence:
• Clinical observation and basic psychological science: Innovations and hypotheses.
• Qualitative research: Describing subjective experiences.
• Systematic case studies: Aggregated comparisons for similar characteristics.
• Single-case experimental designs: Establishing causal relationships for individuals.
• Public health and ethnographic research: Tracking treatment availability,
utilization, acceptance.
• Process–outcome studies: Identifying mechanisms of change.
• Studies of interventions in naturalistic settings: Assessing treatment ecological
validity.
• Randomized controlled trials (RCTs): Standard for causal inference.
• Meta-analysis: Synthesizing results, testing hypotheses, estimating effect sizes.
Page 275:
Evaluating Research on Interventions:
• APA policy highlights two dimensions for evaluating interventions.
• Treatment efficacy: Scientific evaluation of treatment effectiveness.
• Clinical utility: Applicability, feasibility, usefulness, generalizability of
intervention.
Types of Research Evidence:
• Ascending order of contribution to efficacy conclusions:
• Clinical opinion, observation, consensus among experts.
• Systematized clinical observation.
• Sophisticated empirical methodologies (quasi-experiments, RCTs).
• RCTs most stringent for evaluating efficacy.
Importance of Clinical Utility:
• Consideration of generality of effects across diverse factors.
• Robustness of treatments, feasibility in real-world settings, costs.
Recognizing Strengths and Limitations:
• Different research types offer distinct evidence.
• Treatment method, psychologist, treatment relationship, and patient are crucial factors
in psychological practice success.
• Comprehensive evidence-based practice considers these factors.
Psychological Practice Complexity:
• Clinical and research attention needed for treatment effectiveness.
• Clinicians use clinical judgment and research evidence for coherent strategies.
