Lecture 8 - Clinical Psychology - EBP part 1 Flashcards
What is the main point of evidence based practice?
To do your best to a help a person.
Psychology was not always a science. It was a philosophy in around end of 1800s and early 1900s.
What is Evidence Based Practice when it comes to clinical psychology?
The idea that psychological practice should be based on evidence as opposed to intuition. This helps to ensure that treatments being used are actually helping clients, or are likely to help clients.
What is one of the definitions of EBP given in the lecture?
The integration the best evidence with clinical expertise and patient values and circumstances.
What is the three-legged stool analogy for EBP?
If one leg is taken away the stool will collapse.
Three legs are:
Current best evidence.
Clinical expertise.
Patient characteristics, culture, and preferences.
What is the current best-practice of scientific enquiry?
Randomised Controlled Trial.
When engaging in EBP one of the legs of the stool is the current best evidence, such as using empirically supported treatments.
Is this all there is to EBP?
No. Understwanding what empircically supported treatments are available is one aspect of EBP, however, having clinicl expertise, as well as taking into account the client’s values, preferences, and culture are also key to EBP.
What is Clinical Expertise?
Understanding which evidence is relevant to a given patient, and knowing how to integrate this information into clinical decisions.
Staying up-to-date with current research and literature.
Some examples of clinical expertise:
Knowing about the given mental health condition.
Matching individual client to an appropriate psychological treatment, as well as risk factors associated with a presenting mental health condition and treatments.
Knowing how to properly assess risks, such as risk of suicide.
What are the 5 A’s for applying evidence in psychological treatment?
Ask - ask the question of what is going on/what does the client want/need?
Acquire - acquire the appropriate and relevant evidence about treatment options relevant to the individual.
Appraise - assess whether the evidence is of good quality and is relevant.
Apply - engage the client, with their consent, in the relevant psychological treatment.
Assess - check in to see whether there has actually been improvement or change?
What is meant by the Patient preferences, culture, and characteristics?
What are the patient’s goals?
Does the research apply to the client? Is the client represented in the research?
What culture are they from and are the psychological treatments available culturally sensitive, or do they run the risk of pathologising a cultural norm?
What can the client afford?
What risks does the client face?
EBP aims to be a contra paternalistic model. What does this mean?
EBP aims to involve the client at every step of the way. They are kept informed of what and why certain psychological treatments are being used.
There is no ‘behind the back’ of the client.
Case study.
Current best-evidence.
Does CBT normally show meaningful improvement in 6 sessions?
What other psychological treatments have good evidence for helping those with major depressive disorder?
What has evidence shown about Major Depressive Disorder in young women?
Clinical Expertise.
What could be some of the reasons the 6-sessions have not been helpful?
Why was CBT chosen in the first place?
Have the sessions been well handled by the practitioner (was the practitioner proficient at delivering the treatment)?
What has or has not been working?
Was the original diagnosis correct?
Is there good rapport with client?
Is there comorbidity of other conditions?
Client characteristics, preferences, and culture.
What is the client’s culture?
What are the client’s goals?
What cant the client afford?
What are the client’s values?
Is the client happy doing CBT?
What low-cost options do they have?
What change would we expect to see after 6 sessions? Does the client show change in any way?
The Canadian Psychological Association recommends that the ‘Current Best Evidence’ leg of the EBP should carry more weight than clinician intuition.
Is it true that the more clinical experience you have the more clinical expertise you have?
Not always.
How are our cognitive biases influencing your opinion about your experiences with clients.
What are some limitations to having more clinical experience?
Clinicians can become over-confident when they have more experience. They may use treatments when not appropriate because they have had success with these treatments in the past, but are not considering the circumstances of the individual they are currently working with.
