Evidence-Based Treatment (EBT)

Evidence-based treatment (EBT) refers to treatment that is backed by scientific evidence. That is, studies have been conducted and extensive research has been documented on a particular treatment, and it has proven to be successful. The goal of EBT is to encourage the use of safe and effective treatments likely to achieve results and lessen the use of unproven, potentially unsafe treatments.

The Use of EBT in Evidence-Based Practice (EBP)

Evidence-based treatments play a significant role in evidence-based practices in psychotherapy and general health care. EBP evolved from evidence-based medicine (EBM), which was established in 1992 for the same reasons: to encourage the use of safe, effective medicine as opposed to poorly studied, potentially harmful options. The National Registry for Evidence-Based Programs and Practices (NREPP), which is maintained by the United States’ Substance Abuse and Mental Health Services Administration (SAMHSA), lists all evidence-based programs and practices. To be listed in NREPP, a practice must be determined, after extensive research, to have significant impact on individual mental health outcomes.

To date, EBP has received a great deal of attention from organizations like the American Psychological Association (APA), which advocates for more evidence-based practices and treatments in dealing with mental health issues. In a statement from the APA Council of Representatives (2005), EBP was defined as “the integration of the best available research with clinical expertise in the context of patient characteristics, culture, and preferences.”

Increased emphasis on the importance of EBP has led to an increase in demand from insurance companies for clinicians to choose EBP and EBT to qualify for coverage, as well. Considering that the criteria for determining whether a treatment is evidence-based are quite specific and detailed, some have taken issue with this widespread emphasis on EBT as essential. While research is important, especially with regard to medications, some argue that there are treatments available that may not meet EBT criteria and yet, have proven successful in other ways.

Of course, the incorporation of EBT is just one facet of evidence-based practice; EBP also stresses the importance of informed decision-making when determining how to approach a person’s health situation. This requires a physician or mental health professional to be aware of current discoveries and dialogue in the research field, thereby enabling him or her to examine all possible approaches to treatment.

EBT in Child and Adolescent Therapy

Since they are presumably based on scientific evidence, evidence-based treatments are encouraged in coping with issues faced by children and adolescents. However, it is important to note that when choosing a treatment for a minor, parents, guardians, and practitioners should always examine the quality and quantity of the evidence. A strong EBT will be proven effective in several studies—not one or two. It is also important to look at who is funding the research, as well as how and where the studies are conducted; ideally, multiple independent and unbiased studies will be conducted that verify the safety and effectiveness of a treatment.

To aide in determining the efficacy of a particular treatment, EffectiveChildTherapy.com breaks EBTs into five levels:

• “Level #1: Works Well; Well-Established Treatments”—very strong research support; “at least two large-scale randomized controlled trials (RCTs)” conducted by “independent investigatory teams working at different research settings” and not affiliated with the treatment developers
• “Level #2: Works; Probably Efficacious Treatments”—supported by research but lacking independent research support
• “Level #3: Might Work; Possibly Efficacious Treatments”—otherwise known as “promising treatments” with minimal research support
• “Level #4: Unknown/Untested; Experimental Treatments”—being used but not tested properly
• “Level #5: Does Not Work/Tested But Did Not Work”—tested and no positive findings to date; may be harmful

Concerns and Controversy Surrounding EBT

The subject of EBT has sparked a substantial amount of controversy in the mental health field over the years, mainly regarding the process of evaluating whether something is an EBT (Nathan, 2004; Tanenbaum, 2005).

In addition to a general debate over the definition of “evidence” as it pertains to EBT and EBP (Tanenbaum, 2005), there has been considerable dispute over the research methods and models used in evaluating treatments, specifically, the efficacy model versus the effectiveness model (Nathan, 2004). Efficacy models typically describe carefully controlled experiments conducted with time constraints and random assignment of treatments, often in laboratory settings. Randomized controlled trials (RCTs) measure efficacy.

Effectiveness models are associated with real-world research, in which treatments are observed in clinical settings with mental health professionals and the people who regularly come to see them. Practical clinical trials (PCTs) measure effectiveness. Many believe the ideal research situation would somehow combine the two (Nathan, 2004).

Another issue that arises with evidence-based medicine and treatments is the way in which the drug industry has used the popularity of EBT to push prescription drugs and psychotropic medications on clinicians and mental health practitioners, and consequently, the people they treat. A recent article published in BMJ (Spence, 2014) discusses how drug companies quickly figured out how to capitalize on the “evidence” aspect of medicine by producing studies and reports to prove a treatment’s efficacy, often without allowing for proper time to determine side effects and potential long-term dangers. “Today EBM is a loaded gun at clinicians’ heads,” says Des Spence, a general practitioner based in Glasgow. “‘You better do as the evidence says,’ it hisses, leaving no room for discretion or judgment. EBM is now the problem, fueling overdiagnosis and overtreatment.”

Along these lines, there is also the argument that all forms of treatment in psychotherapy offer some benefit, regardless of the quantity or quality of supporting evidence. Consequently, it is difficult to accurately assess what makes one treatment effective over another (Tenenbaum, 2005). Others simply take issue with the heavy emphasis on scientific research over the more intuitive aspects of psychotherapy, such as making sound judgments based on clinical knowledge and experience (Nathan, 2004).

References:

1. American Psychological Association (2005, August). Policy statement on evidence-based practice in psychology. Meeting of the APA Council of Representatives. Retrieved from http://www.apa.org/practice/guidelines/evidence-based-statement.aspx
2. Effective Child Therapy. What is evidence-based practice? Retrieved from http://effectivechildtherapy.com/content/what-evidence-based-practice
3. IFS, an Evidence-Based Practice. (2015, November 23). Retrieved from http://foundationifs.org/news-articles/79-ifs-an-evidence-based-practice
4. Nathan, P. (2004). The evidence base for evidence-based mental health treatments: four continuing controversies. Brief Treatment and Crisis Intervention, Vol. 4, No. 3. doi: 10.1093/brief-treatment/mhh021. Retrieved from http://btci.stanford.clockss.org/cgi/reprint/4/3/243.pdf
5. Spence, D. (2014, January 3). Evidence-based medicine is broken. BMJ. doi: http://dx.doi.org/10.1136/bmj.g22. Retrieved from http://www.bmj.com/content/348/bmj.g22
6. Tanenbaum, S. J. (2005, January). Evidence-based practice as mental health policy: three controversies and a caveat. Health Affairs, Vol. 24, No. 1, 163-173. doi: 10.1377/hlthaff.24.1.163. Retrieved from http://content.healthaffairs.org/content/24/1/163.full

Last Updated: 04-1-2016