Treatment Manuals, Single-Subject Designs, and Evidence-Based Practice: A Clinical Behavior Analytic Perspective

Abstract

Empirical support of procedures linked to processes of therapeutic change is emerging as an alternative foundation for evidence-based treatment development and selection in clinical psychology, in particular within cognitive-behavioral practice. Single-subject designs conducted with treatment manuals have contributed to the existing evidentiary base of research-supported treatment packages organized around psychiatric diagnoses, but as a rule have not been afforded the same status as randomized clinical trials. From a clinical behavior analytic perspective, single-subject experiments may be positioned to proportionately contribute more to emerging evidence-based practice that is itself more process focused, in particular if at least two recommended adjustments are made in how they are conducted. The first of these is to maximize efficacy and minimize rigidity in developing treatment manuals by creating them in a post-hoc rather than a-priori manner and with an emphasis on therapeutic procedures linked to specific processes. The second recommendation is that clinical behavior analysts routinely collect repeated process as well as outcome measures in conducting single-subject research.