Our Commitment to Evidence-based Psychological Treatment

At the Kurt and Barbara Gronowski Clinic, we are dedicated to providing “evidence-based” psychological treatment. What does this mean? This means that we use the most effective approaches to treatment based upon the best scientific evidence available. As an academic and research center associated with the Pacific Graduate School of Psychology, we keep up to date on the newest and most effective treatments available. We specifically train our students to use these treatments through classroom, work, didactic materials and supervision.

What is “Evidence Based” Psychological Treatment?

“Evidence-based treatments” (EBTs) or “empirically-based treatments” are treatments that have been determined to be effective based on research and a “gold standard” of science. Evidence based practice is defined by the Institute of Medicine as: “the integration of best-researched evidence and clinical expertise with patient values”

Examples of Evidence-based Treatments:

Medication algorithms -- including specific medications for specific conditions delivered systematically (for depression, bipolar disorder and schizophrenia)
Cognitive, behavioral and interpersonal psychotherapies for depression
Cognitive and behavioral therapies for anxiety disorders
Family psychoeducation and family management
Psychoeducation with specific cognitive/behavioral strategies to enhance medication compliance (for schizophrenia and bipolar disorder)
Assertive community treatment (for schizophrenia and psychotic disorders)
Supported employment
Illness management programs (for bipolar and schizophrenic/psychotic disorders)**

**typically these program include targeted psychoeducation of clients and family members, behavioral tailoring, motivational interviewing, symptom identification, training in relapse prevention, coping skills training using cognitive and behavioral therapy.

How to Evaluate Evidence of Effectiveness

It is clear that not all types of evidence are of the same quality. In reviewing the scientific evidence that a treatment is effective, there are several levels of evidence to be considered. In general, researchers examining the evidence base for specific treatments review articles published in peer reviewed journals. Peer reviewed journals require that all journal submissions are reviewed by a group of peers to evaluate the quality of the data and the methodology used and finally the validity of the conclusions reached.

Five Levels of Evidence (I=highest; V=lowest):

I.   Large randomized trials, trials at multiple sites by multiple investigators; or,
     systematic reviews of well designed trials
II. Strong evidence from one well designed randomized trial of adequate size
      (large enough to show benefits of intervention)
III. Trials without randomization
IV. Findings of a research group not using experimental controls
V. The opinions of respected authorities, individual case reports, descriptive
     studies, etc.

There are several common elements of evidence-based treatment programs. These typically include:

√ A systematic, structured approach to treatment in which key elements of
    the treatment are clearly defined
√ Treatment interventions are well-defined and organized into treatment
     manuals
√ Treatment can be replicated in other treatment systems
√ Targeted client populations are clearly defined
√ Outcomes are systemically defined and evaluated
√ Adherence to the treatment model is carefully monitored
√ Treatment interventions are updated to reflect changes in the scientific
     knowledge

Why is it Important that Your Psychological Treatment is Evidence-based?

According to the National Institutes of Mental Health (NIMH), psychological treatment for people with a mood disorder (depression, dysthymia, bipolar disorder) is highly effective if specific guidelines are followed: “For people suffering from a mood disorder, the outlook has never been better. Effective therapies, both pharmacological and behavioral, can help them recover from potentially devastating episodes of depression or mania and prevent possible relapses.

However, the majority of practitioners do not follow specific guidelines for care. “Only half of individuals with anxiety and depressive disorders are accurately diagnosed, and of those diagnosed, only 25 to 50 percent receive guideline-level pharmacotherapy and less than 10 percent receive evidence-based psychotherapeutic treatments.”

Evaluating the Evidence: Where do I look?

In general, the Internet provides a great deal of information with greatly variable quality and reliability. We caution you to carefully examine the source of the information you are viewing to make sure that it is valid and reliable. There are a number of easily accessible and reliable sources for investigating the effectiveness of psychological or psychiatric treatments. Because most individuals do not subscribe to scientific journals and must go to a specialized library, we recommend using publicly available material form the National Library of Medicine and other reliable sources available on the internet. Some reliable sources are listed below:

www.cochrane.org/index0.htm (Cochrane Library)
www.nimh.nih.gov/strategic/stplan_mooddisorders.cfm
(NIMH mood disorder research summary)
www.nimh.nih.gov (general access to Medline database)
www.nlm.nih.gov/medlineplus/bipolardisorder.html (bipolar disorder)