What is Evidence-Based Practice (EBP)?
- A decision making approach based on 3 pillars
- Central for providing effective, ethical & individualised care
- Ensures psychological interventions are grounded in scientific research
3 pillars of EBP
| Best Available Research Evidence | Clinical Expertise | Client Preferences & Values |
| Use up to date scientific studies to guide psychological interventions | Draw on practitioner’s skills, knowledge & experience to interpret evidence and tailor for client’s needs | Take into account the client’s unique needs and profile when planning care |
EBP & Ethics
| Respect for Persons | Respect client’s autonomy, dignity and right to make informed choices about their care. Clients must be involved in decision making. |
| Beneficence | Acting in the best interest of the client by maximising benefits and minimising harm. |
| Justice | Ensure fair access to psychological services by trying to eliminate bias. |
| Fidelity & Responsibility | Maintain trust, accountability & professional standards. Practitioners should be honest about evidence behind their interventions. |
Steps to apply EBP
1. Identify Client Needs & Context
- Be curious about their concerns, background & goals
2. Consult Current Best Evidence
- Look for recent research related to client’s issues
- Be critical about the quality of the research
3. Integrate Clinical Expertise
- Use professional knowledge to interpret evidence according to client’s context
4. Consider Client Preferences & Values
- Discuss decisions with client
- Take into account their values, preferences & culture
Levels Of Evidence
Expert Opinion
Definition: Insights or recommendations from recognized authorities in the field, often published as commentaries or guidelines.
Example: A leading psychologist publishes an editorial on a new therapy approach.
Strengths: Useful for generating ideas and summarizing experience.
Limitations: High risk of bias; lowest level of evidence.
Case Study
Definition: In-depth analysis of a single individual or case, often used to explore rare or novel situations.
Example: The famous case of Phineas Gage in neuroscience and psychology.
Strengths: Provides detailed insights; useful for hypothesis generation.
Limitations: Not generalizable; subject to bias.
Case Series
Definition: Observational studies tracking multiple cases with similar characteristics over time.
Example: A report on several patients receiving a new intervention for anxiety.
Strengths: Identifies patterns; more data than a single case.
Limitations: No control group; limited ability to infer causality.
Case- Control Study
Definition: Compares individuals with a condition (cases) to those without (controls) to identify potential causes or risk factors.
Example: Studying factors linked to depression by comparing affected and unaffected groups.
Strengths: Useful for studying rare conditions; relatively quick.
Limitations: Prone to recall bias; cannot prove causation.
Cohort Study
Definition: Follows a group of people over time to observe how exposures affect outcomes.
Example: Tracking a cohort of adolescents to study the impact of social media on mental health.
Strengths: Can establish temporal relationships; stronger than case-control.
Limitations: Time-consuming; may be affected by confounding variables.
Non-Randomised Controlled Trial
Definition: Compares outcomes between groups receiving different interventions, but without random assignment.
Example: Comparing two therapy groups where participants choose their treatment.
Strengths: Practical in real-world settings.
Limitations: Greater risk of bias than randomized trials.
Randomised Controlled Trial (RCT)
Definition: Participants are randomly assigned to intervention or control groups to test effectiveness.
Example: Testing a new cognitive-behavioural therapy for depression versus a placebo.
Strengths: Gold standard for determining causality; minimizes bias.
Limitations: Can be expensive and complex; not always ethical or feasible.
Systematic Review
Definition: Comprehensive, structured review of all relevant studies on a topic, critically evaluating their quality.
Example: Reviewing all RCTs on mindfulness interventions for anxiety.
Strengths: Synthesizes large bodies of evidence; reduces bias.
Limitations: Quality depends on included studies; time-intensive.
Meta Analysis
Definition: Statistical technique that combines data from multiple studies to produce a more precise estimate of effects.
Example: Pooling results from several studies on therapy outcomes to determine overall effectiveness.
Strengths: Increases statistical power; generalizes findings.
Limitations: Dependent on study quality; complex to interpret.
Barriers to EBP
Limited Resources
Barrier: Psychologists may lack access to the latest research on mental health interventions or funding for implementing new programs.
Example: A psychologist working in a rural area struggles to access subscription-based journals for evidence-based therapy techniques.
Possible Strategy: Utilize open-access journals, collaborate with academic institutions, or join professional organizations that provide resource-sharing opportunities.
Time Constraints
Barrier: Heavy caseloads and administrative duties leave little time for psychologists to stay updated on emerging research.
Example: A clinical psychologist with back-to-back client sessions finds it challenging to review new studies on mindfulness-based stress reduction.
Possible Strategy: Subscribe to research digests, attend brief webinars, or allocate specific time slots weekly for professional reading and development.
Resistance to Change
Barrier: Some psychologists or organizations may be hesitant to adopt new therapeutic approaches or interventions.
Example: A counseling center resists integrating teletherapy despite evidence of its effectiveness in improving access to care.
Possible Strategy: Share case studies demonstrating successful implementation, provide training sessions, and encourage open discussions about the benefits of adopting new methods.
Sub-Optimal Training
Barrier: Psychologists may lack adequate training in evaluating or applying research findings to their practice.
Example: A school psychologist feels unprepared to assess the validity of studies on behavioral interventions for children with ADHD.
Possible Strategy: Attend workshops on evidence-based practices, seek mentorship from experienced colleagues, and participate in continuing education programs.
Cultural & Organisational Factors
Barrier: Workplace culture or societal norms may not prioritize evidence-based practices in psychological services.
Example: A mental health clinic prioritizes traditional talk therapy over newer, evidence-based approaches like cognitive-behavioral therapy (CBT).
Possible Strategy: Advocate for policy changes, engage leadership in discussions about the value of evidence-based practices, and connect with professional networks that support innovation in psychology.
Psychotherapeutic Approaches
What is psychotherapy?
- Interpersonal, evidence-informed process
- Therapist works with client toward meaningful change for improved wellbeing
- Draws on strong therapeutic alliance
History of Psychotherapy
1890s – Birth of Psychoanalysis
- Freud introduces psychoanalysis
- Focus on the unconscious & early childhood on psychological distress
Early 1900s
- Rise of behaviourism (Watson & Skinner)
- Observable behaviour
- Environmental interactions
1950s – 1960s
- Humanistic & Existential Therapies (Rogers & Maslow)
- Personal growth, authenticity
- Emphasis on therapeutic relationship
1960s- 1970s
- CBT (Beck & Ellis)
- Integration of cognitive & behavioural principles to create evidence based interventions
1980s- present
- Therapists combine approaches and use evidence based practices
Humanistic & Existential Therapy
Core Features
- Unconditional Positive Regard
- Empathy
- Genuiness
- Self-Actualisation
- Therapeutic Relationship
Psychoanalytic Therapy
Core Features
- Unconscious mind
- Analytic Techniques (Free associations, dream analysis projective tests)
- Defense Mechanisms
- Therapist = neutral interpreter facilitating clients to access their subconscious mind
- Transference
- Goal is to explore to unconscious roots of distress
Behavioural & Cognitive-Behavioural Therapies
Behavioursim
- Behaviour learned from interacting with environment
- Watson & Skinner
- Conditioning shapes responses
- Reinforcement, punishment, exposure therapy
Cognitive Therapy
- Aaron Beck & Albert Ellis
- Identifying & challenging maladaptive thought patterns
- ABC model (Activating event, Belief, Consequence)
- Cognitive distortions
- The cognitive triad & depressions
- Therapies draw upon Socratic questioning
CBT
- Integration of cognitive & behavioural principles
- Interaction between thoughts, feelings, behaviours, physiological responses
- Strong focus on goal setting
- Therapist works with clients to identify problematic patterns and learn new skills
- Self-monitoring
- Behavioural Activation
Third Wave Approaches
- Builds on CBT by including values based action
- Acceptance & Commitment Therapy (ACT)
- Dialectical Behaviour Therapy (DBT)
- Mindfulness
Therapeutic Relationship Across Approaches
| Humanistic | Relationship is core mechanism of change, built on genuine empathy. |
| Psychoanalytic | Relationship facilitates insight & transferences. Client projects feelings onto therapist who interprets it for unconscious conflicts. |
| Behavioural | Therapist is a role model reinforcing desired behaviours. Focus on observable change. |
| Cognitive-Behavioural | Collaborative relationship focused on guided discovery to identify problems, set goals and practice new skills. |
Aligning Interventions with Evidence- Based Practice
Steps to choose intervention:
- Identify & clarify client issues
- Review relevant research evidence
- Assess clinical expertise
- Explore client preferences & culture
- Consider ethics & constraints
