Evidence-based practice in psychology and behavior analysis.

Abstract

This paper outlines development of practice (EBP) movement in medicine and psychology and discusses criteria by which a given intervention is deemed evidence-based, in accordance with American Psychological Association's (APA) guidelines. Although EBP movement has its benefits, there are a number of weaknesses that mitigate against implementing these in day-to-day practice. This paper discusses these weaknesses. Readers familiar with Chambless et al.'s (1996, 1998) report on empirically-validated therapies will note that a number of items pertain to behavior analytically-based interventions developed in 1960s and 1970s. Few would argue that these were flawless upon their inception, however, as indicated on list, have not been updated nor improved upon. This paper discusses why this might be so in a general context that suggests that applied behavior analysis has drifted from its empirical roots. This paper concludes by discussing potential usefulness of behavior analytic technologies within context of quality improvement. Keywords: practice, empirically-validated therapies, applied behavior analysis, quality improvement. ********** In an effort to increase use of psychological interventions in United States task forces were formed to define, identify, and disseminate information about extant empirically supported, psychologically based therapies (Chambless & Ollendick, 2001). According to American Psychological Association's (APA) Presidential Task Force on Practice (2006), practice (EBP) in psychology refers to the integration of available with clinical expertise in context of patient characteristics, culture, and preferences (p. 273). What APA means by best available research will be taken up in a moment. Apart from a few modifications, this definition is almost identical to definition adopted by Institute of Medicine (2001): Evidence-Based practice is integration of evidence with clinical expertise and patient values (p. 147). APA's adoption of medicine's definition makes sense from a socio-political standpoint. The medical community and medically oriented administrators are more likely to adopt these guidelines closer they parallel their own guidelines. Before proceeding, a comment about two terms related to concept of EBP warrants mention, as these terms might be confusing. Readers familiar with practice movement have, no doubt, noticed that term has changed over years, from empirically validated therapies (EVT) to empirically supported therapies (EST), to EBP. Generally speaking, these terms are synonymous. Although there are some differences, all of these refer to psychologically based treatments that have undergone scientific evaluation, employing established methodologies, and have proven to be efficacious. EBP, of course, is most current iteration of this concept, and, in keeping with this trend, will at some point likely be supplanted by a newer term. In this paper, we first outline development of practice movement in medicine and psychology. Second, we discuss criteria for EBPs. In particular, we describe what APA defines as well-established treatments and probably efficacious treatments, criteria by which they deem a given therapy evidence-based (Chambless et al., 1996). Although APA's efforts at promoting empirically sound therapies is a step in right direction, there are a number of major weaknesses that mitigate against usefulness of employing these criteria as they bear on day-to-day practice (for which they were intended). The third section of paper discusses these weaknesses. Behavior analysis started as being principle-based and process-oriented (Keller& Schoenfeld, 1950). …