Evidence-based practice in psychology.
TL;DR: 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.
Abstract: 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.
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TL;DR: Recommendations are provided for improving the study of outcomes associated with mental health interventions adapted to the cultural context of the client, indicating a moderately strong benefit of culturally adapted interventions.
Abstract: There is a pressing need to enhance the availability and quality of mental health services provided to persons from historically disadvantaged racial and ethnic groups. Many previous authors have advocated that traditional mental health treatments be modified to better match clients' cultural contexts. Numerous studies evaluating culturally adapted interventions have appeared, and the present study used meta-analytic methodology to summarize these data. Across 76 studies the resulting random effects weighted average effect size was d = .45, indicating a moderately strong benefit of culturally adapted interventions. Interventions targeted to a specific cultural group were four times more effective than interventions provided to groups consisting of clients from a variety of cultural backgrounds. Interventions conducted in clients' native language (if other than English) were twice as effective as interventions conducted in English. Recommendations are provided for improving the study of outcomes associated with mental health interventions adapted to the cultural context of the client. (PsycINFO Database Record (c) 2010 APA, all rights reserved).
1,000 citations
TL;DR: Various models of delivery are illustrated to convey opportunities provided by technology, special settings and nontraditional service providers, self-help interventions, and the media for reducing the burden of mental illness.
Abstract: Psychological interventions to treat mental health issues have developed remarkably in the past few decades. Yet this progress often neglects a central goal-namely, to reduce the burden of mental illness and related conditions. The need for psychological services is enormous, and only a small proportion of individuals in need actually receive treatment. Individual psychotherapy, the dominant model of treatment delivery, is not likely to be able to meet this need. Despite advances, mental health professionals are not likely to reduce the prevalence, incidence, and burden of mental illness without a major shift in intervention research and clinical practice. A portfolio of models of delivery will be needed. We illustrate various models of delivery to convey opportunities provided by technology, special settings and nontraditional service providers, self-help interventions, and the media. Decreasing the burden of mental illness also will depend on integrating prevention and treatment, developing assessment and a national database for monitoring mental illness and its burdens, considering contextual issues that influence delivery of treatment, and addressing potential tensions within the mental health professions. Finally, opportunities for multidisciplinary collaborations are discussed as key considerations for reducing the burden of mental illness.
995 citations
TL;DR: Suggestions are made for changes and shifts in emphases in psychotherapy research and clinical practice to ensure that both research and practice contribute to the 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 betweenResearch and practice.
Abstract: 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.
992 citations
TL;DR: The concepts of evidence-based public health (EBPH), on which formal discourse originated about a decade ago, hold promise to better bridge evidence and practice.
Abstract: Despite the many accomplishments of public health, a greater attention to evidence-based approaches is warranted. This article reviews the concepts of evidence-based public health (EBPH), on which formal discourse originated about a decade ago. Key components of EBPH include making decisions on the basis of the best available scientific evidence, using data and information systems systematically, applying program-planning frameworks, engaging the community in decision making, conducting sound evaluation, and disseminating what is learned. Three types of evidence have been presented on the causes of diseases and the magnitude of risk factors, the relative impact of specific interventions, and how and under which contextual conditions interventions were implemented. Analytic tools (e.g., systematic reviews, economic evaluation) can be useful in accelerating the uptake of EBPH. Challenges and opportunities (e.g., political issues, training needs) for disseminating EBPH are reviewed. The concepts of EBPH outlined in this article hold promise to better bridge evidence and practice.
869 citations
TL;DR: The history of EBPP is explored, the definition and present uses of the term are elaborate, and information relevant to the skill set regarding a practice consistent with the evidence-based approach is provided.
Abstract: Evidence-based practice is a growing topic of interest in the field of psychology. In 2006, the American Psychological Association (APA) developed a formal policy statement on evidence-based practice in psychology (EBPP). It is now important for the profession to come to a better understanding about what EBPP is (and is not), and to develop a skill set associated with EBPP. The next seven articles explore the history of EBPP, elaborate the definition and present uses of the term, and provide information relevant to the skill set regarding a practice consistent with the evidence-based approach. Many of the articles were derived from the 2007 midwinter meeting of the Council of University Directors of Clinical Psychology, where the program topic was "Evidence-based Practice: What it is, Why It's Important, and What you Need to Know."
841 citations
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TL;DR: It is proposed that motivation may affect reasoning through reliance on a biased set of cognitive processes--that is, strategies for accessing, constructing, and evaluating beliefs--that are considered most likely to yield the desired conclusion.
Abstract: It is proposed that motivation may affect reasoning through reliance on a biased set of cognitive processes—that is, strategies for accessing, constructing, and evaluating beliefs. The motivation to be accurate enhances use of those beliefs and strategies that are considered most appropriate, whereas the motivation to arrive at particular conclusions enhances use of those that are considered most likely to yield the desired conclusion. There is considerable evidence that people are more likely to arrive at conclusions that they want to arrive at, but their ability to do so is constrained by their ability to construct seemingly reasonable justifications for these conclusions. These ideas can account for a wide variety of research concerned with motivated reasoning. The notion that goals or motives affect reasoning has a long and controversial history in social psychology. The propositions that motives may affect perceptions (Erdelyi, 1974), attitudes (Festinger, 1957), and attributions (Heider, 1958) have been put forth by some psychologists and challenged by others. Although early researchers and theorists took it for granted that motivation may cause people to make self-serving attributions and permit them to believe what they want to believe because they want to believe it, this view, and the research used to uphold it, came under concentrated criticism in the 1970s. The major and most damaging criticism of the motivational view was that all research purported to demonstrate motivated reasoning could be reinterpreted in entirely cognitive, nonmotivational terms (Miller & Ross, 1975; Nisbett & Ross, 1980). Thus people could draw self-serving conclusions not because they wanted to but because these conclusions seemed more plausible, given their prior beliefs and expectancies. Because both cognitive and motivational accounts could be generated for any empirical study, some theorists argued that the hot versus cold cognition controversy could not be solved, at least in the attribution paradigm (Ross & Fletcher, 1985; Tetlock & Levi, 1982). One reason for the persistence of this controversy lies in the failure of researchers to explore the mechanisms underlying motivated reasoning. Recently, several authors have attempted to rectify this neglect (Kruglanski & Freund, 1983; Kunda, 1987; Pyszczynski & Greenberg, 1987; Sorrentino & Higgins, 1986). All these authors share a view of motivation as having its effects through cognitive processes: People rely on cognitive processes and representations to arrive at their desired conclusions, but motivation plays a role in determining which of these will be used on a given occasion.
6,643 citations
TL;DR: The results of the meta-analysis indicate that the overall relation of therapeutic alliance with outcome is moderate, but consistent, regardless of many of the variables that have been posited to influence this relationship.
Abstract: To identify underlying patterns in the alliance literature, an empirical review of the many existing studies that relate alliance to outcome was conducted. After an exhaustive literature review, the data from 79 studies (58 published, 21 unpublished) were aggregated using meta-analytic procedures. The results of the meta-analysis indicate that the overall relation of therapeutic alliance with outcome is moderate, but consistent, regardless of many of the variables that have been posited to influence this relationship. For patient, therapist, and observer ratings, the various alliance scales have adequate reliability. Across most alliance scales, there seems to be no difference in the ability of raters to predict outcome. Moreover, the relation of alliance and outcome does not appear to be influenced by other moderator variables, such as the type of outcome measure used in the study, the type of outcome rater, the time of alliance assessment, the type of alliance rater, the type of treatment provided, or the publication status of the study.
3,127 citations
TL;DR: Results of nearly 400 controlled evalua- tions of psychotherapy and counseling were coded and integrated statistically and provide convincing evidence of the efficacy of psych therapy.
Abstract: Results of nearly 400 controlled evalua- tions of psychotherapy and counseling were coded and integrated statistically. The findings provide convincing evidence of the efficacy of psychotherapy. On the average, the typical therapy client is better off than 75% of untreated individuals. Few important differ- ences in effectiveness could be established among many quite different types of psychotherapy . More generally, virtually no difference in effectiveness was observed be- tween the class of all behavioral therapies (systematic desensitization, behavior modification) and the nonbe- havioral therapies (Rogerian, psychodynamic, rational- emotive, transactional analysis, etc.).
2,091 citations
TL;DR: A meta-analysis on studies of human health and behavior indicates that mechanical predictions of human behaviors are equal or superior to clinical prediction methods for a wide range of circumstances.
Abstract: The process of making judgments and decisions requires a method for combining data. To compare the accuracy of clinical and mechanical (formal, statistical) data-combination techniques, we performed a meta-analysis on studies of human health and behavior. On average, mechanical-prediction techniques were about 10% more accurate than clinical predictions. Depending on the specific analysis, mechanical prediction substantially outperformed clinical prediction in 33%-47% of studies examined. Although clinical predictions were often as accurate as mechanical predictions, in only a few studies (6%-16%) were they substantially more accurate. Superiority for mechanical-prediction techniques was consistent, regardless of the judgment task, type of judges, judges' amounts of experience, or the types of data being combined. Clinical predictions performed relatively less well when predictors included clinical interview data. These data indicate that mechanical predictions of human behaviors are equal or superior to clinical prediction methods for a wide range of circumstances.
1,481 citations
TL;DR: A critical review of the assumptions and findings of studies used to establish psychotherapies as empirically supported suggests a shift from validating treatment packages to testing intervention strategies and theories of change that clinicians can integrate into empirically informed therapies.
Abstract: This article provides a critical review of the assumptions and findings of studies used to establish psychotherapies as empirically supported. The attempt to identify empirically supported therapies (ESTs) imposes particular assumptions on the use of randomized controlled trial (RCT) methodology that appear to be valid for some disorders and treatments (notably exposure-based treatments of specific anxiety symptoms) but substantially violated for others. Meta-analytic studies support a more nuanced view of treatment efficacy than implied by a dichotomous judgment of supported versus unsupported. The authors recommend changes in reporting practices to maximize the clinical utility of RCTs, describe alternative methodologies that may be useful when the assumptions underlying EST methodology are violated, and suggest a shift from validating treatment packages to testing intervention strategies and theories of change that clinicians can integrate into empirically informed therapies.
1,083 citations