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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Training Programs Should Predoctoral level. 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. Internship level. –Train students to competence in one or more ESTs. Provide faculty models for science-practice integration. Provide faculty models for science-practice integration.

What Do We Need for Training in ESTs? Adequate base of evidence. Adequate base of evidence. Treatment manuals specifying the intervention. 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. Research on effective methods for training therapists.