There is currently a debate in the world of psychology that you need to know about. The American Psychological Association (APA) released guidelines for treating PTSD. It recommends only using evidence-based treatments. Amazingly, there is some fairly strong opposition to this. Apparently many psychologists and therapists oppose these research guidelines because they don’t want to be told what to do, disagree with the research, and/or they believe that mental health treatment should not involve following evidence-based practice guidelines. These people essentially believe that their opinion and experience of what works, is superior to the research. Because of this, I wanted to write about the importance of evidence-based treatment.
Now to be fair, treatment isn’t always about just following the research guidelines. There are reasons why someone might deviate. In particular, research often only goes to a certain number of sessions, and treatment to get rid of all symptoms may take longer than this. However, evidence-based treatment should be the first line of defense. And the second and third! Just like in medicine, you try the thing that works best first, and you try other things if all else fails. Opposing this basic standard of care seems to neglect the well-being of those seeking mental health treatment.
The whole reason I began this website was to promote evidence-based treatments. Quite honestly, I am fed up that these treatments are not more broadly incorporated in the field. In fact, for anxiety disorders specifically, the research shows that only somewhere from 10-30% of clinicians give the number one treatment; exposure therapy. That is a shocking statistic.
What is an Evidence-Based Treatment?
An evidence-based treatment is the “best practice” for a psychological treatment, based on scientific evidence. The scientific evidence is typically guided by a type of study called a randomized-controlled study (RCT).
What is a Randomized Controlled Study?
This is the gold-standard study. Essentially, you randomize who gets a specific treatment and compare outcomes for people given one treatment to people given another treatment (called a control group).
In more modern day research (and this certainly applies for RCTs on exposure therapy in anxiety treatment) the control group is often “treatment as usual.” Treatment as usual reflects treatments typically found in the community. Exposure response prevention therapy has been shown as vastly superior to typical treatment in the community. Thus it has become the evidence-based treatment for all anxiety disorders.
RCTs are not the be all and end all, and they definitely have their problems. This includes that they are often only a set number of sessions, whereas finished treatment often takes longer than this. There are also other types of research available that are valuable and should be considered. However, RCTs are unique because they allow us to make more direct comparisons between treatments. This helps us know which treatments are better than no treatment, the placebo effect, or other treatments.
Why Is Evidence-Based Treatment Important?
Put simply, if you are giving an evidence-based treatment then you are doing what we know works. Like anything, it may not work for all people. However, it is likely to work, and there is a mechanism of action to explain why it works.
Imagine if you are unfortunate enough to be diagnosed with cancer. You would want the best treatment possible. Nothing else, right?! When you see your doctor you would be given various treatment options, and a recommended treatment. That recommendation is based on randomized controlled research. In the field of psychology, at least for most anxiety disorders, the option that should be recommended is cognitive behavioral therapy, and specifically exposure response prevention therapy. However, the people who oppose the APA’s guidelines disagree. They want to discard the research and instead advocate for treatments such as talk therapy because they just know it works, even though the research shows that there are more effective options available.
If you’re meeting with a psychologist or therapist, just like when you meet with a physician, you should be given treatment options that are based on research. You can then choose what works for you. This is good practice, and what the APA’s guidelines encourage. If you are not even given the choice to do an evidence-based practice then I’d honestly have to question what’s going on. Again, imagine having cancer and your doctor not even giving you the choice to do chemotherapy. That doctor would certainly not fill me with confidence. Yet that is essentially what the opposition to the APA’s guidelines is pushing for.
How Do I Know What The Evidence-Based Treatments Are?
Well, this is exactly what the guidelines from the APA are for. In addition, the UK developed a series of NICE (National Institute for Health and Care Excellence) guidelines that give a good indication of what evidence-based treatment options are. You’ll notice that for anxiety disorders, none of them say talk therapy.
What Action Can you Take?
1) Research the NICE or APA guidelines. If you know what the recommended treatments are, then you will know if you are receiving them.
For PTSD, you can view them here.
2) Ask your clinician a series of questions to help figure out whether they are providing you with evidence-based treatment options.
- What is the treatment I am receiving?
- What does the research show about this treatment?
- What other treatments exist?
- How many sessions will it take to make progress?
- What is the mechanism of action?
If your clinician can answer these questions satisfactorily then you know you’re onto something good.
3) If you’re not receiving an evidence-based treatment, question why, and consider a second opinion.
By rejecting the recommendation to use evidence-based practice as a first line for treatment, it is my opinion that these psychologists and therapists do a disservice to their patients. They are essentially arguing for the field to remain in a state where you can do whatever you want based on your own opinion rather than what is proven by science. That, I believe, is not high quality psychological care. In fact, it keeps people receiving treatment in distress for longer. Can you imagine any other field following the same practice? I believe psychologists and therapists that follow evidence-based practice provide superior treatment. This is because the evidence shows that people who receive this treatment get better more quickly and these changes last. To me, it’s a travesty that evidence-based practice is not the standard of care.