Pragmatic recommendations to address challenges in disseminating evidenced-based treatment guidelines.

Abstract

A clinician who is poised to assist an individual with a particular psychological disorder will ideally have at her disposal clear, unambiguous guidelines pointing to which intervention strategies are most likely to lead to positive outcomes. Ideally, the national and private health care systems paying for care would also be able to make use of treatment guidelines in order to conserve precious resources, to hold clinicians accountable for delivering services with the greatest likelihood of positive impact, and to protect patients. Moreover, given the nonuniform application of treatments for psychological conditions, the consumer seeking treatment would ideally have access to straightforward recommendations for seeking out the treatments and clinicians most likely to benefit him. Unfortunately, the current state of affairs is radically different from this ideal. In fact, not only do consumers not know how to locate evidence-based psychotherapy, but even those who attempt to receive expert help from their physicians- who are the typical gateway to health services-are unlikely to receive it. For example, two surveys of Canadian family doctors revealed that most are unfamiliar with cognitive- behavioral therapy (Grenier, Chomienne, Gaboury, Ritchie, & Hogg, 2008), and very few would refer a patient with a discrete anxiety disorders to specialty treatment (Talbot, Clark, Yuzda, Charron, & McDonald, 2014).Evidence-Based Treatment RecommendationsWhile some researchers and clinicians are skeptical of or even antagonistic toward scientifically based practice (Lilienfeld, Ritschel, Lynn, Cautin, & Latzman, 2013), a steadily growing body of evidence supports the conclusion that treatments do actually differ in efficacy (Tolin, 2010; Weisz, Weiss, Han, Granger, & Morton, 1995). In 1993, the Society of Clinical Psychology (SCP; which is a division of the American Psychological Association [APA]) established a task force to identify (and promulgate) specific treatments that had empirical support (Chambless et al., 1993). For the first time, the field took the position that it was possible to issue and disseminate formalized treatment recommendations based on available scientific evidence of efficacy. A number of other approaches to guiding treatment selection followed suit in the United States, Canada, and other countries. However, the empirically-based guidance that has been developed to date appears to be having limited pragmatic impact such that individuals seeking treatment are unlikely to receive treatment that is based on the best available scientific evidence (Stewart, Chambless, & Baron, 2012). Below, we pragmatically review a number of major treatment guidance systems that have been developed, with an eye toward the impact each has had. (To keep the article focused, we deliberately ignore other important pieces of empirically based practice, such as assessment.) Following this review, we discuss some ideas for greatly increasing the impact of empirically based treatment guidance systems.Approaches for Guiding Treatment Decisions: Description and ConcernsEmpirically Supported Treatment ListsVarious groups have developed lists of empirically supported treatments (ESTs) over the years, the most prominent being the Chambless Task Force which evaluated the level of empirical support for treatments targeting specific psychological disorders or problems (Chambless & Hollon, 1998; Chambless & Ollendick, 2001). The task force formulated two levels of evidential support depending on the rigor and number of studies finding that a particular treatment was efficacious. Treatments were considered probably efficacious if the task force was able to identify, in the published literature, at least one study or a small series of single-case reports. Treatments were considered wellestablished if at least two independently conducted, welldesigned studies or a large series of well-designed and carefully controlled single case studies could be identified. …