New directions and resources in group psychotherapy: introduction to the issue

Establishing an evidence-based practice (EBP) is a central byproduct of the ever-increasing emphasis on accountability in mental health services. Though much has been written and developed for individual psychotherapists who wish to develop EBPs, there are far fewer resources for group psychotherapists. This article introduces a series of articles designed to provide EBPs and resources for group psychotherapists. We discuss how therapists can develop and apply the following aspects of EBPs: research-supported treatments (RSTs), practice guidelines, practice-based evidence, and multicultural competence.     

Overcoming our resistances to "doing" evidence-based group practice: a commentary

This commentary focuses on how the articles in the group therapy issue of the Journal of Clinical Psychology: In Session can address the resistances that many group practitioners exhibit to "doing" evidence-based practice (EBP). The articles attempt to overcome the resistances to practicing evidence-based group therapy through a process of education and skills training. A major issue cutting across the articles is the narrow focus of incorporating empirical findings only from studies specifically examining psychotherapy groups. The author argues that incorporating research from the whole field of group dynamics research can increase the empirical basis for evidence-based practice.     

Why many clinical psychologists are resistant to evidence-based practice: Root causes and constructive remedies

Psychotherapists are taught that when a client expresses resistance repeatedly, they must understand and address its underlying sources. Yet proponents of evidence-based practice (EBP) have routinely ignored the root causes of many clinical psychologists' reservations concerning the use of scientific evidence to inform clinical practice. As a consequence, much of the resistance to EBP persists, potentially widening the already large scientist–practitioner gap. Following a review of survey data on psychologists' attitudes toward EBP, we examine six sources underpinning resistance toward EBP in clinical psychology and allied domains: (a) naïve realism, which can lead clinicians to conclude erroneously that client change is due to an intervention itself rather than to a host of competing explanations; (b) deep-seated misconceptions regarding human nature (e.g., mistaken beliefs regarding the causal primacy of early experiences) that can hinder the adoption of evidence-based treatments; (c) statistical misunderstandings regarding the application of group probabilities to individuals; (d) erroneous apportioning of the burden of proof on skeptics rather than proponents of untested therapies; (e) widespread mischaracterizations of what EBP entails; and (f) pragmatic, educational, and attitudinal obstacles, such as the discomfort of many practitioners with evaluating the increasingly technical psychotherapy outcome literature. We advance educational proposals for articulating the importance of EBP to the forthcoming generation of clinical practitioners and researchers, and constructive remedies for addressing clinical psychologists' objections to EBP.     

Treating chronic migraine headaches: an evidence-based practice approach

Psychologists and other mental health care professionals are generally trained to incorporate empirical evidence into clinical practice, but few have been taught formal techniques for doing so. Given the rapidity of progress in the clinical sciences, there is a growing need among practitioners to access current, clinically relevant research and have strategies for integrating these research findings into the clinic. In the field of medicine, evidence-based medicine took hold in the early 1990s to provide a framework and skill set for translating research into practice. This method is now widely known as evidence-based practice (EBP) to reflect its applicability to multiple disciplines. In this article, we present a general overview of EBP, illustrate how we used this approach to develop a treatment plan for a patient who had chronic migraine headaches, and discuss some of the opportunities and challenges EBP presents to mental health professionals.     

Assessing competency in Evidence Based Practice: strengths and limitations of current tools in practice

Background  

Evidence Based Practice (EBP) involves making clinical decisions informed by the most relevant and valid evidence available. Competence can broadly be defined as a concept that incorporates a variety of domains including knowledge, skills and attitudes. Adopting an evidence-based approach to practice requires differing competencies across various domains including literature searching, critical appraisal and communication. This paper examines the current tools available to assess EBP competence and compares their applicability to existing assessment techniques used in medicine, nursing and health sciences.     

A modified evidence-based practice- knowledge,attitudes, behaviour and decisions/outcomes questionnaire is valid across multiple professions involved in pain management

Background

A validated and reliable instrument was developed to knowledge, attitudes and behaviours with respect to evidence-based practice (EBB-KABQ) in medical trainees but requires further adaptation and validation to be applied across different health professionals.

Methods

A modified 33-item evidence-based practice scale (EBP-KABQ) was developed to evaluate EBP perceptions and behaviors in clinicians. An international sample of 673 clinicians interested in treatment of pain (mean age?=?45 years, 48% occupational therapists/physical therapists, 25% had more than 5 years of clinical training) completed an online English version of the questionnaire and demographics. Scaling properties (internal consistency, floor/ceiling effects) and construct validity (association with EBP activities, comparator constructs) were examined. A confirmatory factor analysis was used to assess the 4-domain structure EBP knowledge, attitudes, behavior, outcomes/decisions).

Results

The EBP-KABQ scale demonstrated high internal consistency (Cronbach’s alpha?=?0.85), no evident floor/ceiling effects, and support for a priori construct validation hypotheses. A 4-factor structure provided the best fit statistics (CFI =0.89, TLI =0.86, and RMSEA?=?0.06).

Conclusions

The EBP-KABQ scale demonstrates promising psychometric properties in this sample. Areas for improvement are described.

     

Initial Test of a Principle-Guided Approach to Transdiagnostic Psychotherapy With Children and Adolescents

To address implementation challenges faced by some evidence-based youth psychotherapies, we developed an efficient transdiagnostic approach—a potential “first course” in evidence-based treatment (EBP)—guided by five empirically supported principles of therapeutic change. An open trial of the resulting FIRST protocol was conducted in community clinics. Following a 2-day training, staff practitioners treated 24 clinically referred youths ages 7–15, 50% male, 87% White and 13% Latino, all with the Schedule for Affective Disorders and Schizophrenia for School-Age Children Diagnostic and Statistical Manual of Mental Disorders (4th ed.) anxiety, depressive, or conduct-related disorders, and averaging 2.21 disorders. We evaluated the protocol’s (a) feasibility for use in everyday clinical practice (examining therapy process, client engagement, and therapist adherence and competence in using the protocol), (b) acceptability (examining therapeutic alliance and treatment satisfaction by youths, caregivers, and therapists), and (c) potential for clinical benefit (examining treatment outcomes across multiple measures and time points). FIRST scored well on measures of feasibility, acceptability to clients and clinicians, and clinical outcomes, matching or exceeding the corresponding scores in most benchmarking comparisons. Observational coding of sessions showed high levels of protocol adherence (86.6%) and good therapist competence in the evidence-based skills. Weekly assessments throughout treatment showed effect sizes for clinical improvement ranging from .41 to 2.66 on weekly total problems and problems deemed “most important” by caregivers and youths. The FIRST protocol showed evidence of feasibility, acceptability, and clinical benefit when used by practitioners with referred youths treated in community clinics. The findings suggest sufficient potential to justify a full randomized controlled trial of FIRST.     

Advancing the Scientific Foundation for Evidence-Based Practice in Clinical Child and Adolescent Psychology

Evidence-based practice (EBP) has become a central focus in clinical child and adolescent psychology. As originally defined, EBP in psychology is the integration of the best available research evidence, patient characteristics, and clinical expertise. Although evidence-based perspectives have garnered widespread acceptance in recent years, there has also been some confusion and disagreement about the 3-part definition of EBP, particularly the role of research. In this article, we first provide a brief review of the development of EBP in clinical child and adolescent psychology. Next, we outline the following 4 points to help clarify the understanding of EBP: (a) knowledge should not be confused with epistemic processes, (b) research on clinician and client factors is needed for EBP, (c) research on assessment is needed for EBP, and (d) the 3-part conceptualization of EBP can serve as a useful framework to guide research. Based on these principles, we put forth a slightly revised conceptualization of EBP, in which the role of research is expanded and more clearly operationalized. Finally, based on our review of the literature, we offer illustrative examples of specific directions for future research to advance the evidence base for EBP in clinical child and adolescent psychology.     

Overcoming barriers to implementation of evidence-based practice concepts in athletic training education: perceptions of select educators

Context:

The need to include evidence-based practice (EBP) concepts in entry-level athletic training education is evident as the profession transitions toward using evidence to inform clinical decision making.

Objective:

To evaluate athletic training educators'' experience with implementation of EBP concepts in Commission on Accreditation of Athletic Training Education (CAATE)-accredited entry-level athletic training education programs in reference to educational barriers and strategies for overcoming these barriers.

Design:

Qualitative interviews of emergent design with grounded theory.

Setting:

Undergraduate CAATE-accredited athletic training education programs.

Patients or Other Participants:

Eleven educators (3 men, 8 women). The average number of years teaching was 14.73 ± 7.06.

Data Collection and Analysis:

Interviews were conducted to evaluate perceived barriers and strategies for overcoming these barriers to implementation of evidence-based concepts in the curriculum. Interviews were explored qualitatively through open and axial coding. Established themes and categories were triangulated and member checked to determine trustworthiness.

Results:

Educators identified 3 categories of need for EBP instruction: respect for the athletic training profession, use of EBP as part of the decision-making toolbox, and third-party reimbursement. Barriers to incorporating EBP concepts included time, role strain, knowledge, and the gap between clinical and educational practices. Suggested strategies for surmounting barriers included identifying a starting point for inclusion and approaching inclusion from a faculty perspective.

Conclusions:

Educators must transition toward instruction of EBP, regardless of barriers present in their academic programs, in order to maintain progress with other health professions'' clinical practices and educational standards. Because today''s students are tomorrow''s clinicians, we need to include EBP concepts in entry-level education to promote critical thinking, inspire potential research interest, and further develop the available body of knowledge in our growing clinical practice.     

Examination of the analytic quality of behavioral health randomized clinical trials

Adoption of evidence-based practice (EBP) policy has implications for clinicians and researchers alike. In fields that have already adopted EBP, evidence-based practice guidelines derive from systematic reviews of research evidence. Ultimately, such guidelines serve as tools used by practitioners. Systematic reviews of treatment efficacy and effectiveness reserve their strongest endorsements for treatments that are supported by high-quality randomized clinical trials (RCTs). It is unknown how well RCTs reported in behavioral science journals fare compared to quality standards set forth in fields that pioneered the evidence-based movement. We compared analytic quality features of all behavioral health RCTs (n = 73) published in three leading behavioral journals and two leading medical journals between January 2000 and July 2003. A behavioral health trial was operationalized as one employing a behavioral treatment modality to prevent or treat an acute or chronic physical disease or condition. Findings revealed areas of weakness in analytic aspects of the behavioral health RCTs reported in both sets of journals. Weaknesses were more pronounced in behavioral journals. The authors offer recommendations for improving the analytic quality of behavioral health RCTs to ensure that evidence about behavioral treatments is highly weighted in systematic reviews.     

Recognizing the True Norm: Commentary on “Toward Defining,Measuring, and Evaluating LGBT Cultural Competence for Psychologists”

In this commentary, the author discusses the difference between aspirational guidelines and enforceable standards of professional practice and argues that the 28 recommendations proposed by Boroughs, Bedoya, O’Cleirigh, and Safren (Clinical Psychology: Science and Practice, 22, 2015) contain both. The ultimate goal of developing cultural competence training and evaluating cultural competence is to create a professional psychology workforce of people committed to the lifelong practice of self‐evaluation when it comes to the inevitable biases engrained through learning and development within the limitations of our own cultures. The damage of decades of marginalization of sexual and gender minority communities can be ameliorated by improvements in multicultural training and by establishing an expectation that adequate representation of sexual and gender minority participants be included in research on therapeutic practices that will be recognized as treatments with empirical support. The development of criteria for instruction in cultural competence at all levels of psychological training will improve our research and clinical training to be inclusive of sexual minority and gender identity minority individuals, rather than continuing considerations of this population as an out‐group.     

Evidence-based practice in psychology: implications for research and research training

In this article, the author discusses the implications of evidence-based practice (EBP) for research and research training in clinical psychology. It is argued that EBP provides a useful framework for addressing some heretofore ignored problems in clinical research. Advancing evidence-based psychological practice will require educators to inject significant new content into research, design, and methodology courses and to further integrate research and practicum training. The author believes this to be an exciting opportunity for the field, not only because it will further psychologists' integration into the interdisciplinary health care and research environment, but also because it will provide new tools to educate students for capable, not just competent professional activity.     

Evidence-based practice in clinical psychology: what it is, why it matters; what you need to know

The history and meaning of evidence-based practice (EBP) in the health disciplines was described to the Council of University Directors of Clinical Psychology (CUDCP) training programs. Evidence-based practice designates a process of clinical decision-making that integrates research evidence, clinical expertise, and patient preferences and characteristics. Evidence-based practice is a transdisciplinary, idiographic approach that promotes lifelong learning. Empirically supported treatments (ESTs) are an important component of EBP, but EBP cannot be reduced to ESTs. Psychologists need additional skills to act as creators, synthesizers, and consumers of research evidence, who act within their scope of clinical expertise and engage patients in shared decision-making. Training needs are identified in the areas of clinical trial methodology and reporting, systematic reviews, search strategies, measuring patient preferences, and acquisition of clinical skills to perform ESTs.     

Barriers to Dissemination of Evidence-Based Practices: Addressing Practitioners' Concerns About Manual-Based Psychotherapies

The last several years have seen much debate over the appropriateness and viability of empirically supported manual-based psychotherapies for clinical practice. While the majority of discussions have focused on the strengths or weaknesses of evidence-based treatments, and the differences between research and clinical practice, scant attention has been paid to addressing the actual concerns of practitioners in clinical settings. Based on the available research, and our experiences with training and supervision in manual-based treatments, we discuss practitioners' most common concerns, including (a) effects on the therapeutic relationship, (b) unmet client needs, (c) competence and job satisfaction, (d) treatment credibility, (e) restriction of clinical innovation, and (f) feasibility of manual-based treatments. Rather than arguing that these concerns are unwarranted, we suggest future directions the field must take if evidence-based treatments are to be viable and effective in clinical practice. Starting with the assumption that these treatments have much (but not everything) to offer practitioners in clinical settings leads to qualitative and quantitative research questions involving all parties with an interest in evidence-based practice.     

Integrating information technology into the evidence-based practice of psychology

Information technology (IT) is increasingly being used to facilitate, complement, and support the implementation of evidence-based practices (EBP) in psychology. This article reviews recent randomised trials that evaluate the integration of IT applications into the process of delivering EBP. More specifically, we review 11 studies that illustrate how IT has been successfully integrated into traditional clinician-delivered psychotherapy to promote the adoption of EBP. Advantages and disadvantages of this approach are discussed. The paper concludes with practical recommendations for clinicians who are interested in integrating IT into their practice.     

Teaching evidence-based practice: implications for psychology

A movement advocating the use of evidence-based practice (EBP) is increasingly influencing health care and the practice of psychology. Thus, teaching evidence-based practice in psychology (EBPP) is critical to the preparation of future health service psychologists. In this article, the authors address common myths associated with EBP, propose core components involved in teaching EBPP, and describe an example of how such training can be incorporated into a professional psychology education and training curriculum.     

Autism Spectrum Disorder and Evidence‐Based Practice in Psychology

The article discusses current empirical evidence, also identifying gaps and areas for future research, for the three critical elements of evidence‐based practice in psychology (EBPP) (evidence‐based practice; client characteristics, preferences, and culture; and clinical expertise) as applied to autism spectrum disorder (ASD). We contrast EBPP to a pure EBP approach, outline issues in specifying criteria and sources for defining EBP, and identify gaps in the evidence base (e.g., treatments for adults with ASD). We review the impact on treatment of specific client characteristics (client age, ASD severity, intellectual and language ability, diagnostic comorbidity, cultural/family factors) and outline critical issues affecting clinical expertise and decision making when choosing and adapting treatments. Implications for policy, training, and research are discussed.     

Well prepared for work? Junior doctors' self-assessment after medical education

Background

Training in the five steps of evidence-based practice (EBP) has been recommended for inclusion in entry-level health professional training. The effectiveness of EBP education has been explored predominantly in the medical and nursing professions and more commonly in post-graduate than entry-level students. Few studies have investigated longitudinal changes in EBP attitudes and behaviours. This study aimed to assess the changes in EBP knowledge, attitudes and behaviours in entry-level physiotherapy students transitioning into the workforce.

Methods

A prospective, observational, longitudinal design was used, with two cohorts. From 2008, 29 participants were tested in their final year in a physiotherapy program, and after the first and second workforce years. From 2009, 76 participants were tested in their final entry-level and first workforce years. Participants completed an Evidence-Based Practice Profile questionnaire (EBP²), which includes self-report EBP domains [Relevance, Terminology (knowledge of EBP concepts), Confidence, Practice (EBP implementation), Sympathy (disposition towards EBP)]. Mixed model analysis with sequential Bonferroni adjustment was used to analyse the matched data. Effect sizes (ES) (95% CI) were calculated for all changes.

Results

Effect sizes of the changes in EBP domains were small (ES range 0.02 to 0.42). While most changes were not significant there was a consistent pattern of decline in scores for Relevance in the first workforce year (ES -0.42 to -0.29) followed by an improvement in the second year (ES +0.27). Scores in Terminology improved (ES +0.19 to +0.26) in each of the first two workforce years, while Practice scores declined (ES -0.23 to -0.19) in the first year and improved minimally in the second year (ES +0.04). Confidence scores improved during the second workforce year (ES +0.27). Scores for Sympathy showed little change.

Conclusions

During the first two years in the workforce, there was a transitory decline in the self-reported practice and sense of relevance of EBP, despite increases in confidence and knowledge. The pattern of progression of EBP skills beyond these early professional working years is unknown.