What Research Evidence Is Valid for Psychotherapy Research?

Björn Philips,Fredrik Falkenström

doi:10.3389/fpsyt.2020.625380

Björn Philips, Fredrik Falkenström

Open Access

https://doi.org/10.3389/fpsyt.2020.625380

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Abstract

Evidence-Based Medicine (EBM) have contributed to improved clinical practice with increased use of effective and life-saving treatments for severe diseases. However, the EBM model is less suitable for psychotherapy research than for pharmacological research and somatic medicine. The randomized controlled trial (RCT) design is an example of experimental methodology, which inevitably has more imperfections in psychotherapy research because psychotherapy RCTs cannot use double-blinding and the treatments tested are composite treatment packages. Long-term psychotherapy for severe and complex mental disorders is especially difficult to study with an RCT design. During the last decades, advanced analytic methods have been developed in psychotherapy process research, which enables investigation of causal connections regarding change mechanisms in psychotherapy. Therefore, we propose that the top of the research evidence hierarchy for psychotherapy should encompass: (1) RCT for circumscribed disorders, (2) cohort studies for complex disorders, and (3) advanced process studies for change mechanisms.

Highlights

The evidence-based medicine (EBM) movement has had a major positive impact in many areas of medicine since it arose in the 1990’s
The EBM model has been developed over time, for example with the Grades of Recommendation Assessment, Development, and Evaluation (GRADE) system, in which factors such as study quality and effect size are included in the appraisal [3]
We claim that the EBM model is less suitable for psychotherapy research than for pharmacological research or other areas of somatic medicine

Summary

Introduction

The evidence-based medicine (EBM) movement has had a major positive impact in many areas of medicine since it arose in the 1990’s. The randomized controlled trial (RCT) is considered the gold standard for testing the efficacy of a treatment for a particular disorder and the foundation for establishing whether that treatment is evidence-based [1, 7].

Results

Conclusion