Evidence-based Treatment and Practice

Question 1

difference evidence-based treatment and evidence-based practice

Answer 1

• Evidence-based treatment (EBT) = interventions that have produced therapeutic change in controlled trials.
• Evidence-based practice (EBP) = clinical practice that is informed by evidence about interventions, clinical expertise, and patient needs, values, and preferences (patient considerations).

Question 2

EBTs =

Answer 2

1) generalizability = key conditions and characteristics in research are different from those in clinical practice (less severe disorders, selecting patients differently)
2) focus on symptoms and disorders as the primary ways of identifying participants, in clinical practice there is more emphasis on the process of coping with life
3) methods are questioned:
- conclusions based on statistical differences are difficult to translate into everyday life effects
- outcome measures in studies are arbitrary: they do not translate easily to changes in everyday life
- a client can meet change in clinical significance but may still not change in everyday life
4) mixed results of clinical trials

Question 3

concerns about clinical practice

Answer 3

1. reliability and validity (do different clinicians select the same treatment plan when presented with the same case (reliability) or if it would make a difference compared to another treatment (validity))
2. generalizability (two patients can differ)
3. assessment (clinician impressions are not the truth)

Question 4

3 shifts could reduce the gap between research and practice

Answer 4

giving greater priority to
(1) the study of mechanisms of therapeutic change,
(2) the study of moderators of change in ways that can be better translated to clinical practice, and
(3) qualitative research

Question 5

how do causes and mechanisms differ

Answer 5

Causes and mechanisms are different in the sense that causes describe what resulted in an outcome, while mechanisms describe how this outcome resulted from the cause

Question 6

why is it important to focus on mechanisms of change

Answer 6

By focusing more on questions about mechanisms of change, which now get the least attention, research could improve clinical practice and patient care by stressing the factors that are most important to effect change.

Question 7

moderator=

Answer 7

influences the relationship between the intervention and outcome

Question 8

3 changes would improve the research on moderators and in turn help bridge the gap:

Answer 8

• Reporting: report the findings in a way that makes them applicable to clinical work (we need more information than just stating that a variable is a mediator).
• Situations: state if the moderator is treatment specific or if it influences several or all therapies.
• Processes: state what facet of the moderator is relevant or how the moderator works in general.

Question 9

2 changes in clinical practice that could be helpful

Answer 9

1) systemic measures to evaluate patient progress (could complement clinical judgment)
2) contributing to the knowledge base (right now, research is seen as contributing to the knowledge base, while clinical practice is the
application of that base. We can bridge the gap by acknowledging that clinical work can contribute directly to the knowledge base too. The experiences of clinicians can be used to generate and test hypotheses, if they are codified)