Role of Empirically Supported Treatments in Teaching Evidence-Based Practice

1. Role of Empirically Supported Treatments in Teaching Evidence-Based Practice Sheila Woody channelling…. Dianne L. Chambless University of Pennsylvania

2. Criteria for Research Studies Used in Determining EST Status • Randomized controlled trials or single case experiments • Specification of treatment focus & sample (e.g., major depression, marital distress) • Reliable and valid assessment • Specification of treatment procedures by manual or other clear description

3. EST Review Results • 8 Largely Independent Review Groups • Findings • 108 Category I and II treatments identified for adults • 37 for children • Findings largely agree across review groups • Caveats: • Not all treatments have been reviewed • Not all treatments have been studied • Beware generic labels

4. Anxiety Depression Health Problems Obesity Sexual Dysfunction Eating Disorders Chemical Dependency Sleep Disorders Marital Discord Schizophrenia Examples of Problems Treated: Adults

5. Examples of Problems Treated: Children • ADHD • Conduct/Oppositional Defiant Disorder • Anxiety • Depression • Health Problems

6. Effects • Some didactic and applied training in ESTS now supposedly required for APA-approved applied psychology programs and internships. • APA-approved CE providers supposedly required to disclose empirical basis for treatments being taught.

7. ESTs: A Component of EBP • ESTs are not a substitute for training in building a relationship with the client. • EST evidence not the sole sort of evidence important to practice. • Effectiveness research • Acceptability research • Alliance and other process research

8. Continuum of Evidence • Case studies with data • Quasi-experiments • Experiments (randomized clinical trials or single-case experiments) _____________________________________ • Uncontrolled effectiveness studies (e.g., benchmarked) • Quasi-experimental effectiveness studies • Randomized, controlled effectiveness studies

9. Core Beliefs • Opinion based on clinical experience is an insufficient basis for practice. • Positive evidence trumps lack of evidence. • Students should learn to base treatment on the highest empirical ground possible. • Students should learn to routinely incorporate on-going assessment into practice.

10. Example of an Adult EST Course • Training in evaluation of intervention research (e.g., Chambless & Hollon, JCCP, 1998) • History of EST movement & EBP • Familiarization with the arguments for & against ESTs (e.g., Norcross, Beutler, & Levant, 2006 book)

11. EST course, continued • Readings & videotapes of specific ESTs (e.g., treatment manuals, Barlow Clinical Handbook of Psychological Disorders, commercially available or homemade tapes) • Role-plays in dyads inside or outside of class of specific procedures such as constructing a hierarchy for exposure.

12. EST course, continued • Paper assignment requiring for its completion that the student read one or more treatment manuals outside his/her area of expertise.

13. EST course, topics covered • Interpersonal therapy of depression & eating disorders • Cognitive therapy for depression & eating disorders • Motivational Interviewing for alcohol & substance abuse • Short-term psychodynamic therapy for depression

14. EST course, topics covered • Emotion-focused couples therapy • Dialectical Behavior Therapy for borderline personality disorder • Behavioral couples and family therapy • Imaginal & in vivo exposure for anxiety disorders

15. Goals for Students’ Future Clinical Practice Based on EST Training • Competence in ESTs for the sort of clients seen in one’s practice. • Knowledge of availability of ESTs for other problems to guide referrals. • Regular assessment of clients in one’s own practice to monitor progress and track success or failure.

16. Practicum Experience • Cognitive Therapy of Depression • Treatment of Anxiety Disorders (Foa, Goldstein)

17. Training Programs Should • Predoctoral level. • Expose students to a range of ESTs in didactic coursework. • Provide clinical training in one or more ESTs. • Ensure students can form an effective working alliance with their clients. • Internship level. • Train students to competence in one or more ESTs. • Provide faculty models for science-practice integration.

18. What Do We Need for Training in ESTs? • Adequate base of evidence. • Treatment manuals specifying the intervention. • Manuals may be principle-based, step-by-step session plans, or anything in between. • Research on effective methods for training therapists.