Evidence-based Practice is a Verb not a Noun

April 8, 2013 By scottdm 1 Comment

Evidence-based practice (EBP). What is it? Take a look at the graphic above. According to American Psychological Association and the Institute of Medicine, there are three components: (1) the best evidence; in combination with (2) individual clinical expertise; and consistent with (3) patient values and expectations. Said another way, EBP is a verb. Why then do so many treat it as a noun, continually linking the expression to the use of specific treatment approaches? As just one example, check out guidelines published for the treatment of people with PTSD by the National Institute for Clinical Excellence (NICE)–the U.K.’s equivalent to the U.S. Substance Abuse and Mental Health Services Administration (SAMHSA). Despite the above noted definition, and the lack of evidence favoring one treatment over another, the NICE equates EBP with the use of specific treatment approaches and boldly recommends certain methods over others.

The main point here is that clinicians need not be afraid of EBP. Instead, they need to insist that leaders and officials stick to the stated definition–a definition I’m perfectly content to live with as are most practitioners I meet. To wit, know what the evidence says “works,” use my expertise to translate such findings into practices that fit with the values, preferences, and expectations of the individual consumers I treat.

Click here to read the meta-analysis that started it all. Don’t stop there, however, make sure and read the response to that study written by proponents of the NICE guideliness. You’ll be completely up-to-date if you finish with our response to that critique.

The Revolution in Swedish Mental Health Services: UPDATE on the CBT Monopoly

April 5, 2013 By scottdm Leave a Comment

No blogpost I’ve ever published received the amount of attention as one back in 2012 detailing changes to Swedish Mental Health practice. At the time, I reported about research results showing that the massive investment of resources in training therapists in CBT had not translated into improved outcomes or efficiency in the treatment of people with depression and anxiety. In short, the public experiment of limiting training and treatment to so called, “evidence-based methods” had failed to produce tangible results. The findings generated publications in Swedish journals as merited commentary in Swedish newspapers and on the radio.

I promised to keep people updated if and when research became available in languages other than Swedish. This week, the journal Psychotherapy, published an article comparing outcomes of three different treatment approaches, including CBT, psychodynamic, and integrative-eclectic psychotherapy. Spanning a three year period, the results gathered at 13 outpatient clinics, found that psychotherapy was remarkably effective regardless of the type of treatment offered! Read the study yourself and then ask yourself: when will a simpler, less expensive, and more client-centered approach to insuring effective and efficient behavioral health services be adopted? Routinely seeking feedback from consumers regarding the process and outcome of care provides such an alternative. The failure to find evidence that adopting specific models for specific disorders improves outcomes indicates the time has come. You can learn more about feedback-informed treatment (FIT), a practice recently deemed “evidence-based” by the Substance Abuse and Mental Health Services Administration (SAMHSA), by visiting the International Center for Clinical Excellence website.

You can learn more about what happened in Sweden by reading:

Everyday evidence outcomes of psychotherapies in swedish public health services (psychotherapy werbart et al 2013)

Here’s one additional reference for those of you who read Swedish. It’s the official summary of the results from the study that started this entire thread:

Delrapport ii slutversion

What to Pay Attention to in Therapy?

March 15, 2013 By scottdm Leave a Comment

A week or so ago, I received an email from my friend, colleague, and mentor Joe Yeager. He runs a small listserve that sends out interesting and often provocative information. The email contained pictures from a new and, dare I say, ingenious advertising campaign for Colgate brand dental floss. Before I give you any of further details, however, take a look at the images yourself:

All right. So what caught your attention? If you’re like most people–including me–you probably found yourself staring at the food stuck in the teeth of the men in all three images. If so, the ad achieved its purpose. Take a look at the pictures one more time. In the first, the woman has one too many fingers on her left hand. The second image has a “phamtom arm” around the man’s shoulder. Can you see the issue in the third?

The anomalies in the photos are far from minor! And yet, most of us, captured by the what initially catches our eye, miss them.

Looking beyond the obvious is what Feedback Informed Treatment (FIT) is all about. Truth is, much of the time therapy works. What we do pay attention to gets results–except when it doesn’t! At those times, two things must happen: (1) we have to know when what we usually do isn’t working with a given person; and (2) look beyond the obvious and see a bigger picture. Doing this takes effort and support. What can you do?

1. Download two free, brief, simple to use tools for tracking outcome and engagement in care (the ORS and SRS) and begin using them in your work;

2. Join the International Center for Clinical Excellence, a free, online, non-denominational organization of behavioral health professionals;

3. Read the FIT Treatment and Training manual