Week 10: Evidence-based Interventions

Question 1

What is evidence-based practice?

Answer 1

combining best research with clinical expertise in the context of patient characteristics, culture and references

Question 2

What are the 3 legs of the EBP stool?

Answer 2

1: Best available research
2: Clinical judgement and clinical expertise
3: Client preferences and values

Question 3

What is considered the best available research (in terms of hierarchy?

Answer 3

Meta-analyses of RCT’s
RCT’s
Systematic within-subject designs (pseudo RCT)
Comparative studies with controls (cohort studies)
Comparitive studies with historical control
Case studies (post, or pre and post test)

Question 4

What makes psychology distinctive?

Answer 4

Combines science, human relationships and individual differences

Question 5

What are major issues around integrating/transferring research findings in day to day clinical practice?

Answer 5

weight: how much weight does one place on different research methods

Research samples: How representative are they

WEIRD: whether findings can be generalised to minority groups

Level of change: which level should research results guide change

Clinical vs. real world: How well results that have occurred in standardized, clinical contexts can be generalised to clinical practice settings

Question 6

What is considered the most robust form of experimental study?

And why?

Answer 6

Randomised Control Trials

The structure helps to control potential confounding variables.

Question 7

What is a pseudorandomised control trial?

Answer 7

When group allocation is not done randomly.

Instead uses methods including day of week, odd-even study numbers.

Question 8

What is a comparative study?

Answer 8

When at least two groups are being compared and doesn’t include randomisation or a control group.

Question 9

What is a case series?

Answer 9

Where all participants receive the intervention, and effectiveness is based on comparing measures taken at baseline.

Question 10

What is naive realism?

Answer 10

When a practitioner concludes client change is due to an intervention, rather than a range of other factors.

Prioritises their own clinical intuition over systematic research.

“Seeing is believing”

Question 11

What do advocates of EBP tend to do about colleagues who are sceptical of EBP?

Answer 11

Dismiss or ignore their skepticism and put it down to ignorance and anti-intellectualism

Question 12

What does the ‘best available research’ leg of the EBP stool cover?

Answer 12

Focuses on research which covers if and why a treatment works.

Conceptualised based on a hierarchy of evidence.

Covers therapeutic efficacy and therapeutic evidence as well as basic psychological processes

Question 13

What does the ‘clinical expertise’ leg of the EBP stool cover?

Answer 13

Comprised of clinical judgement and clinical expertise.

Clinicians must rely on their professional judgement and data, where possible.

More often than not, there isn’t data to guide decisions.

Question 14

What does the ‘client preferences and values’ leg of the EBP stool cover?

Answer 14

The client may resist certain inventions, despite there being strong evidence around effectiveness.

Thus, the clinician will need to go with less effective options which the client is happy to work with.

Question 15

Lillenfeld argues that best available research should be the top priority over clinical expertise and client preferences.

Why?

Answer 15

Because clinical experience is highly subjective, each will have their own preferences and experiences.

They should only revert to decisions based on clinical experience when there is an apparent reason. (e.g. the client failed to respond to Therapy X when properly administered).

Question 16

What is one of the reasons why there is tension between research and resistance from therapists about EBP?

Answer 16

Science by its nature highlights that some therapies have more support than others; all are not created equal.

It, therefore, asks that therapists drop certain longstanding practices in favour of others.

Question 17

Which practitioners tend to harbour greater resistance to EBP?

Answer 17

Older practiticioners

They are wedded to their way of doing things and less accustomed to the greater demands for accountability in mental health practice.

Question 18

What is the scientific impotence excuse?

Answer 18

When findings contradict our deeply held views, we tend to state the findings from the research are flawed.

Question 19

What thinking style was associated with more negative attitudes towards EBP?

Answer 19

Intuitive thinking style

Question 20

Why is naive realism flawed?

Answer 20

Because the world is not as we perceive it. Our perception of reality is based on our own biases, flaws and misconceptions.

Question 21

How does naive realism impact the ability to see change effectively in terms of interventions?

Answer 21

Change following therapy does not equate to change as a result of therapy.

Question 22

What are ‘causes of spurious therapeutic effectiveness’?

Answer 22

Myriad of reasons that therapies can appear to be effective, when they’re not

Question 23

Why is there an issue around the effective of memory and memory recovery techniques?

Answer 23

Because many therapists have questionable beliefs about interventions such as hypnosis and recovered memories, which do not have any evidence to support them.

Ethical issues include false memories.

Question 24

What are nomothetic approaches to understanding human behaviour?

Answer 24

Extracting universal, generalised laws which can apply to most or all of the population.

Question 25

What are idiographic approaches to understanding human behaviour?

Answer 25

Dealing with unique cases of individual behaviour.

Question 26

What is the misconception between the nomothetic and idiographic realms when dealing with individual clients?

Answer 26

That you cannot bridge the two, instead believing that ‘every individual is unique’ and ignoring the EBP approach.

Question 27

What element helps to bridge the gap between nomothetic and demographic approaches to treatment decisions?

And why?

Answer 27

Meta-analyses

As they highlight which subsets of individuals respond differently to interventions.

Question 28

What is the ad ignorantium fallacy?

Answer 28

The error of concluding that if a claim has not been proven wrong, then it must be correct or have some merit.

Question 29

What underlies the resistance around onus of proof requirement?

Answer 29

That whilst many therapies that are invalidated (not tested) might actually work, and should not be treated as invalidated (don’t work).

Researchers should keep an open mind to interventions that are yet to be tested, if their effectiveness is at least plausible.

Question 30

What are some of the key misunderstandings of what EBP is and isn’t?

Answer 30

1. stifles innovation of new treatments
2. focuses on cookie cutter approach
3. excludes nonspecific influences in therapy
4. doesn’t generalise to individuals which haven’t been examined in RCT’s
5. EBP neglects all evidence outside of RCTs
6. EBP is unnecessary because all interventions are equally efficacious
7. EBP is limited because therapeutic changes cannot be quantifiable
8. EBP is problematic because human nature cannot be predicted

Question 31

What are some of the key misunderstandings of what EBP is and isn’t?

Answer 31

1. stifles innovation of new treatments
2. focuses on cookie-cutter approach
3. excludes nonspecific influences in therapy
4. doesn’t generalise to individuals which haven’t been examined in RCT’s
5. EBP neglects all evidence outside of RCTs
6. EBP is unnecessary because all interventions are equally efficacious
7. EBP is limited because therapeutic changes cannot be quantifiable
8. EBP is problematic because human nature cannot be predicted

Question 32

What obstacles impede openness to EBP?

Answer 32

Lack of time
Knowledge about training materials
Steep learning curve
Statistical complexity
Ivory Tower mentality

Question 33

What are ways that could address resistance towards EBP?

Answer 33

Training of future clinical psychologists in naive realism and causes of spurious therapy effectiveness (CSTEs)

Awareness of biases which impact ability to measure therapeutic change.

Highlight inaccurate information as much as accurate information.

Focus on a rationale based approach over a protocol based approach.

Question 34

What are the myths and misconceptions regarding human nature?

Answer 34

That things such as memory retrieval will result in the retrieval of actual memory rather than the creation of them.

Culturally prevalent beliefs around certain therapies mean that therapists may use interventions which have very little scientific support and could cause major issues with clients.