What is evidence-based practice and why is it important?

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The term “evidence-based practice” seems to be everywhere lately. We hear about it in relation to everything from medicine to education to personal training, but what does it mean?

In order to explain what evidence-based practice is and why it's important, imagine:

Picture somebody you really care about. Now imagine that that person is sick with a rare disease, or is having trouble learning in school, or struggling with a serious mental health problem.

Can you imagine how you would feel? Maybe you’ve already had this experience. If you’re like most people, finding a “good” doctor/learning specialist/therapist to solve the problem for your loved one would be the biggest priority. But how do you know what qualifies someone as “good” in this situation?

Perhaps you try the first professional and find they’re basing their intervention decisions on “their gut” rather than the research literature. Or, you discover they have a long track record of doing the same intervention over and over, whether it’s been shown to be helpful or not.

For any given problem there are often many different treatment options, only some of which have been researched and shown to be effective.  The professional has to choose the right one for the situation.

If only there was a way to figure out who was likely to use the most up-to-date scientific methods, while still thoughtfully considering the circumstances of the individual needing help. That is exactly what evidence-based practice is.

A Three-Legged Stool

An evidence-based approach means that the doctor/teacher/therapist has used the following three criteria in deciding what therapeutic technique(s) to use:

1) What the research literature says is helpful for this problem

2) The clinician’s own training and judgment

3) The values, culture, and preferences of the person needing help

These three factors comprise what is called the “three-legged stool” of care—if one of the “legs” is missing, the stool falls over. They’re all crucial.

The research leg

In mental health care, this leg is essential. Because many mental health interventions have been studied for decades, there is actually a ton of information out there about what works, and for whom. This leg of the stool incorporates that knowledge base into decisions about which treatment to use, so therapists don’t have to trust “their gut,” rely on traditions that might be outdated or incompatible, or reinvent the wheel with each new patient.

Because many mental health interventions have been studied for decades, there is actually a ton of information out there about what works, and for whom.

In the case of claustrophobia (fear of confined spaces), decades of research shows that something called “exposure therapy” can be really helpful.  Exposure therapy involves a person taking small steps toward spending time in an enclosed space, even when they’re really afraid, until they eventually lose their fear.  It’s all done with the help of a therapist, a little bit at a time, until the fear is gone.

It should be noted that there are many different ways a therapist might choose to help somebody with claustrophobia, including talking about their thoughts and feelings about being in enclosed spaces, or examining factors from childhood that might have contributed to the phobia’s development. However, many of these methods have never been studied around claustrophobia, or haven’t been shown to reliably help people with claustrophobia. So finding a therapist who is knowledgeable about the research on exposure therapy would be important if you were seeking help for claustrophobia.

The clinical expertise leg

While clinical expertise is often not enough by itself, clinician training and experience is actually very helpful in knowing what the problem might be, and which treatments should be considered. Additionally, therapists need to know how to deliver treatments effectively.

Let’s look at claustrophobia again. Clinical expertise is necessary to determine whether exposure therapy would be a good idea any given case. Let’s say a person has lots of other mental health problems in addition to being afraid of enclosed spaces.  This might be a factor in whether or not to select exposure therapy as the first treatment, or whether to select it at all.  Also, the therapist would have to be trained in exposure therapy, which isn’t always the case. Despite the strength of the research behind exposure therapy, not all therapists know how to provide it.

The patient preferences/values leg

This leg of the stool is obvious: If the intervention doesn’t match the preferences of the person who needs help, it’s very unlikely to be successful. Simply basing an intervention on what research studies have shown to be effective when the needs of the patient are not considered is a doomed endeavor. Also doomed is the one-size-fits-all approach to problems. Considering a person’s age, gender, race, culture, and identity are often critical for customizing an intervention to fit in just the right way.

In the example of claustrophobia, this can be a really important. It wouldn’t matter if exposure therapy was the most effective treatment in the world if the patient wasn’t willing to go near an enclosed space. In fact, we know that exposure therapy is not a fit for everybody, and many patients won’t try it or would drop out of it, even if it might be helpful for them.  

Finding an Evidence-Based Practitioner

When you are meeting with a mental health practitioner for the first time, or talking with them on the phone to set up an appointment, I encourage you to ask about evidence-based practice. Here are some questions you might consider:

·      Do you have training in evidence-based therapies for my problem?

·      What sort of therapy do you provide? And what’s the evidence to support it?

·      Are there effective evidence-based alternatives to the therapy you are offering?

With these questions in hand, you’ll be more prepared to have a conversation about what works for your problem, and whether the provider can offer you that.

 

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DISCLAIMER: The content of this blog is not intended to be a substitute for professional medical advice, diagnosis, or treatment.

ABOUT THE AUTHOR
Jennifer Gregg, Ph.D. is an Associate Professor at San Jose State University and a clinical psychologist who researches, delivers, and trains acceptance and commitment therapy (ACT) and other evidence-based mindfulness interventions with difficult populations.  She is co-author of The Diabetes Lifestyle Book.