1. Strength of Evidence; Empirically Supported Treatments

3. The Evidence Pyramid for Treatment Effectiveness Questions

4. Clinical Trials – Phases of Development
Phase I: Researchers test a new drug or treatment in a small group of people for the first time to evaluate its safety, determine a safe dosage range, and identify side effects.
Phase II: The drug or treatment is given to a larger group of people to see if it is effective and to further evaluate its safety.
Phase III: The drug or treatment is given to large groups of people to confirm its effectiveness, monitor side effects, compare it to commonly used treatments, and collect information that will allow the drug or treatment to be used safely.
Phase IV: Studies are done after the drug or treatment has been marketed to gather information on the drug's effect in various populations and any side effects associated with long-term use.

5. Strength of Evidence
Strength of research design: SR of homogeneous studies at the highest level; combines individual studies using a summary metric
RCT strongest single research design capable of demonstrating causation
Other key dimensions
Consistency of evidence
Specificity
Dose-response
Biological or psychological plausability
Common sense

6. RCT Example - NRT

7. RCT Example – Buproprion v. Placebo

8. Case Series and Case Reports
A group or series of case reports involving patients who were given similar treatment. Reports of case series usually contain detailed information about the individual patients. This includes demographic information (for example, age, gender, ethnic origin) and information on diagnosis, treatment, response to treatment, and follow-up after treatment.

9. Cohort Studies
Definition ||Advantages ||Disadvantages  A Cohort Study is a study in which subjects who presently have a certain condition and/or receive a particular treatment are followed over time and compared with another group who are not affected by the condition under investigation. For research purposes, a cohort is any group of individuals who are linked in some way or who have experienced the same significant life event within a given period. There are many kinds of cohorts, including birth (for example, all those who born between 1970 and 1975) disease, education, employment, family formation, etc. Any study in which there are measures of some characteristic of one or more cohorts at two or more points in time is cohort analysis.
In some cases, cohort studies are preferred to randomized experimental design. For instance, since a randomized controlled study to test the effect of smoking on health would be unethical, a reasonable alternative would be a study that identifies two groups, a group of people who smoke and a group of people who do not, and follows them forward through time to see what health problems they develop.
In general, Cohort analysis attempts to identify cohorts effects: Are changes in the dependent variable (health problems in this example) due to aging, or are they present because the sample members belongs to the same cohort (smoking vs. non smoking)? In other words, cohort studies are about the life histories of sections of populations and the individuals who comprise them. They can tell us what circumstances in early life are associated with the population's characteristics in later life - what encourages the development in particular directions and what appears to impede it. We can study such developmental changes across any stage of life in any life domain: education, employment, housing, family formation, citizenship and health

10. The main advantages of case control studies are:
  They can be done quickly. By asking patients about their past history, researchers can quickly discover effects that otherwise would take many years to show themselves. Researchers don't need special methods, control groups, etc. They just take the people who show up at their institution with a particular condition and ask them a few questions. The first study to suggest a new medical conclusion will often be a case control study, perhaps designed to check on a hypothesis suggested by a case series. If possible, researchers will generally try to confirm the results with a randomized controlled trial or a cohort study.

11. Empirically Supported Treatments in Psychology
Let’s take a look at the Division 12 website:

12. Historical Aspects of EST
TASK FORCE ON PROMOTION AND DISSEMINATION OF PSYCHOLOGICAL PROCEDURES A Report Adopted by the Division 12 Board - October 1993
Categories of support:
I: supported by at least two RCT’s showing superiority to a palcebo or other bonafide treatment
II: supported by at least one RCT showing superiority to a placebo or other bonafide treatment, or some other reasonably well-controlled situation
III: heterogeneous with low levels of evidence
Current state of website:
Criticisms of EST

13. EST Criticisms EST’s used inappropriately in managed care
Malpractice for failure to follow guidelines
Practice restriction/restraint of trade
EST data is flawed
RCTism
Rejects qualitative approach
Favors CBT
Manualization restricts generalization
Limits application to specific cases
Not the way it happens in real life
Limited effectiveness data (as opposed to efficacy)