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Chapter 2 The Importance of the Use of

Evidence Based Practices 

in Mental Health Professional Clinical Practice

Evidence Based Practices for Mental Health Professionals

By Jim Messina, Ph.D., CCMHC, NCC, DCMHS-T

LEARNING OBJECTIVES FOR UNDERSTANDING EVIDENCE BASED PRACTICES

After reading this section you will learn the answers to the following questions:

  1. What does Evidence Based Practices (EBP) mean?
  2. Why is it so important to know about EBPs for the common disorders treated by Mental Health Professionals?
  3. What resources are available for you to learn more about EBPs?
  4. What are some common manuals, guideline books and client workbooks for Mental Health Professionals to use to acquaint themselves better with EBPs for 12 disorders?
  5. What are some good references you can use to learn more in-depth information about the EBPs for these 12 disorders?
Video Defining Evidence Based Treatments 
Here is a short video which gives clients an overview of what is an Evidence Based Treatment:

https://www.youtube.com/watch?v=7dzkS0ioqqw&feature=youtu.be 

This overview helps to give the clients a easy to understand explanation of why you are providing a treatment for them which is considered evidence based. 

Setting the Stage for Evidence Based Practices

“John, as you know we are going to develop a plan of action which hopefully will help you to address your anxiety problems. We will be using what is called an Evidence Based Practice which will guarantee that we are using tried and true methods to alleviate your anxiety and to help you put your life back to where you want it to be.”


The movement towards evidence based practices in the practice of psychotherapy has major importance on how effectively and efficiently Mental Health Professionals provide services to their clients within an accountable and sound ethical model.

 

Benefits of Evidence Based Practices

The encouragement for Mental Health Professionals to utilize Evidence Based Practices (EBPs) with their clients is based on practitioners’ belief that there are multiple benefits to such use.

The first EBP benefit involves the clients since when the clinician informs him/her that the established treatment plan for their care is based on empirically supported treatment the clients gain confidence that they will receive some clinical benefit. Clients need to be motivated for treatment, so informing them that they will receive a “proven” treatment model helps raise their expectations for successful outcomes. It also helps to motivate them to give such treatment approaches a chance. Resistance to treatment is a major obstacle which Mental Health Professionals face in working with clients and anything which the Mental Health Professional can do to increase clients’ motivation and participation in the treatment is most welcomed.

 

The second EBP benefit involves the Mental Health Professionals. When they choose researched treatments that have demonstrated clinical benefits, this demonstrates a sense of accountability to their clients. Using EBPs also demonstrates a professionalism and ethical soundness in their approach to treatment planning since they review the latest research and findings so as to identify appropriate interventions with some promise for success with their clients. Finally, when Mental Health Professionals use EBPs, they are better able to provide a consistent rational plan of action which they can easily monitor for its implementation, management and results.  This gives Mental Health Professionals more flexibility to alter their treatment plans since EBPs offer a variety of optional interventional approaches to achieve the same clinical treatment goals. 

 

The third EBP benefit involves the opinion of other medical and mental health professions of Mental Health Practitioners since it demonstrates to both the medical and mental health community that Mental Health Professionals work hard to be as effective as possible through their use of scientifically supported treatment interventions.  

Limitations/Cautions in Using Evidence Based Practices

Particularly in the professional counseling field has been particularly reluctant to embrace EBPs. There has been a long held belief within the mental health training establishment that Counseling is developmental in nature with a primary focus on wellness and that professional counselors should not handle diagnosing and treating major mental health disorders. Most importantly, the training establishment has been unwilling to embrace EBPs given that it appears to them that EBPs are simply “cookbook-like” manualized treatment approaches which give no freedom or latitude to the professional counselor.  Unfortunately, for this reason, all too few textbooks in professional mental healthcounseling have focused on EBPs so that Mental Health Professionals in training can learn about and then put into practice these sound researched clinical interventions.

 

Barlow (2007) cautions that clinicians must be careful how they view using EBPs in their clinical practice. They need to avoid blindly using a treatment manual and rather mindlessly administering the procedures in a rote manner. Barlow (2007) went on to advocate that clinicians integrate EBPs into the treatment process based on individual client needs.

 

However, the reality is that EBPs have been effective, but have not always been universally effective, given the variety of client circumstances. Efficacy is the systematic scientific evaluation if a treatment is successful in lessening symptoms and mental health disorders. Efficacy studies use controlled studies which are not always generalizable to the real clinical world. Effectiveness, however, is concerned with whether an EBP works in less controlled, natural settings with all of its unpredictable variables. EBPs might work in controlled studies in laboratory like settings, but are they effective in the natural mental health communities in which Mental Health Professionals work? Mental Health Professionals must always be aware that when selecting EBPs they must monitor the client’s response, their own personal response in executing the EBP plan and how the EBP affects or supports the therapeutic relationship between their clients and themselves.  Mental Health Professionals need to be ready and open to adjust their treatment plans and adapt their treatment protocols to the needs, personality and make up of their specific clients to insure their treatment goals are not undermined by too strict an adherence to the EBP protocols.

 

This chapter will cover a review of the meta-analysis articles and other studies of evidenced based practices for treating 12 mental health disorders: Autism Spectrum Disorders; ADHD; Bipolar Disorders; Depressive Disorders; Anxiety Disorders; Phobias; PTSD; OCD; Eating disorders (Anorexia and Bulimia); Alcohol Use Disorders; and Substance Use Disorders.

 

This chapter will first begin with some articles which provide an overview of the history and rationale for establishing Evidenced Based Practices in Mental Health Services.

 

The last section of this chapter will offer a listing of guidebooks for Treatment Planning, EBPs for depressive disorders and anxiety disorders and other diagnoses. 

Rationale for Using Evidence Based Practices

Evidence based practices are psychological and psychotherapeutic treatments and interventions of physical and psychological pathology (Barlow, 2004). Evidence Based Practices use three concepts: 1) Empirically supported treatments (EST) which identify specific psychotherapeutic interventions with evidence for their effectiveness in treating certain diagnoses or identified problems successfully; 2) Clinical Practice Guidelines which entail assessment and treatment strategies with a recommended course of application; and 3) Evidence Based Practice which is a series of activities that would comprise evidenced based practices which enable mental health practitioners to administer the best care possible to their clients or client groups under their care (Barlow, 2007). Researchers have widely accepted that meta-analytic studies support a more nuanced view of treatment efficacy because they review a number of empirically supported treatment (EST) research efforts which have used random controlled studies (RTCs) and enables the identification of the validated and empirically supported evidence for their treatment effectiveness (Westin, Novotny and Thompson, 2004).

 

One of the major arguments that mental health practitioners have used to gain recognition as   “health” providers  who use psychological treatments for mental health disorders (typically called comorbidities) related to physical illnesses in the health care system is using Evidence Based Practices (EBPs) (Barlow, 2005). In 1995 the American Psychological Association developed a template entitled Template for Developing Guidelines: Interventions for Mental Disorders and Psychosocial Aspects of Physical Disorders to guide the optimal construction of clinical practice guidelines. Updated in 2002, the template detailed a hierarchy of evidence based on existing methodologies (Barlow, 2010). The acceptance of evidence based practice (EBP) has advanced rapidly to the point where they form core policy in most healthcare systems in the developed world, including mental health systems (Barlow, 2006). Little or no evidence existed on the effects of psychotherapy as measured by outcomes of reductions in psychopathology or improvements in functioning prior to the twenty-first century and today there is growing evidence on efficacy and effectiveness or clinical utility of treatment (Barlow, 2006). In 2010 public health authorities distributed over $2 billion to disseminate EBPs into the Veterans Association (VA) System, the National Child Traumatic Stress Network, State of Hawaii Child and Adolescent Mental Health Division and New York Office of Mental Health (McHugh and Barlow, 2010).

 

Even though the use of evidence based practices has been the norm since the start of 2000, there has been real resistance to their use by clinicians. Foa, Gillihan and Bryant, posited that there are many factors which explain the non-use of Evidence Based Treatments: “a professional culture that does not support the use of EBTs, lack of clinician training in EBTs, limited effectiveness of commonly used dissemination techniques, and the cost associated with effective dissemination models” (Foa, Gillihan & Bryant, 2013, p. 79).  These authors went on to say that:

“One shared assumption in traditional psychotherapy is that understanding the origins of one’s problems and symptoms, such as difficult childhood relationships with parents, is essential for successful therapy outcome. Thus, psychotherapy is seen as an intricate process of collaboration between the patient and the therapist, whose goal is to maximize well-being and happiness by exploring multiple aspects of the patient’s inner life and experiences and helping the patient increase insight and self-understanding” (Foa, Gillihan & Bryant, 2013, p. 80). 


It is hoped that by presenting the power of Evidence Based Practices in a Foundational Textbook such as this one, that students in various Mental Health Professional Fields will embrace a desire to learn more about EBPs and to make every effort to utilize them in their professional mental health careers.

References on EBPs

 

Barlow, D.H. (2005). Clarification on psychological treatments and psychotherapy.

American Psychologist, 60(7), 734-735. doi: 10.1037/0003-066X.60.7.

 

Barlow, D.H. (2010). Negative effects from psychological treatments. American Psychologist,

65(1), 13-20. doi: 10.1037/a0015643 

 

Barlow, D. H. (2004). Psychological treatments. American Psychologist, 59(9), 869-878. doi:

10.1037/0003-066X.59.9.869 

 

Barlow, D, H. (2006), Psychotherapy and psychological treatments: The future. Clinical

Psychology: Science and Practice, 13(3), 216-220. doi: 10.1111/j.1468-2850.2006.00027.x  

 

Barlow, D. (2007). The case of hope: Evidenced based practice (EBT) in action.Pragmatic Case

Studies in Psychotherapy, 3(4), 50-62. 

 

Foa, E.B., Gillihan, S.J. & Bryant, R.A. (2013). Challenges and success in dissemination of

evidenced-based treatements for posttraumatic stress: Lessons learned from prolonged exposure therapy for PTSD. Psychological Science in the Public Interest, 14(2), 65-111. DOI: 10.1177/1529100612468841

 

McHugh, R.K. and Barlow, D.H. (2010). The dissemination and implementation of evidenced-

based psychological treatments. American Psychologist, 65(2) 73-84, doi: 10.1037/a0018121  

 

Westen, D., Novotny, C. and Thompson-Brenner, H. (2004).  The Empirical Status of

Empirically Supported Psychotherapies: Assumptions, Findings, and Reporting in Controlled Clinical Trials. Psychological Bulletin, 130(4), 631-883.  DOI: 10.1037/0033-2909.130.4.631

WHERE DO I GO FROM HERE?

CONCERNING EVIDENCE BASED PRACTICES

Now that you have read this section, in your “My Mental Health Professional Practitioner Journal” record your answers and reactions to the following questions:

  1. How will this information help me as a Mental Health Professional?
  2. How interested am I in implementing Evidence Based Practices in my clinical practice?
  3. Why is it important that I learn more about Evidence Based Practices?
  4. What more do I need to know about Evidence Based Practices?
  5. Where can I go to obtain more information about Evidence Based Practices?
  6. Where can I go to obtain the journal articles, manuals, workbooks or guidebooks on Evidence Based Practices?