What is "Evidence-Based Psychotherapy"? Is it better than other types of therapy?

Compared to other states in the nation, Alabama has one of the highest rates of mental health concerns, such as insomnia, anxiety, depression, and PTSD. Unfortunately, Alabama also has one of the lowest rates of mental healthcare access for its residents. Although Alabamians who live near larger cities, such as Birmingham, Huntsville, Tuscaloosa, Mobile, and Montgomery, have better access to qualified mental health providers, those who live in smaller communities often have much sparser access to care. As the providers at Upward considered our place in Alabama’s mental healthcare system, we committed ourselves to providing the best possible care to as many Alabamians as possible because we know the need is so great. I am a strong believer in evidence-based psychotherapy and I am excited to talk about this approach to care in today’s blog post.

Evidence-based psychotherapy, by definition, is the use of a scientific protocol that, when facilitated by an experienced provider, has been repeatedly proven to be effective at helping individuals recover from a set of mental health symptoms.

The American Psychological Association describes the use of evidence-based psychotherapy, or EBP, as “empirically supported principles of psychological assessment, case formulation, therapeutic relationship, and intervention.” This is a great framework for describing the tenets of EBP.

Psychological Assessment

Mental health providers who use EBP tend to have a few things in common. First, they use comprehensive evaluation and assessment to investigate the correct diagnosis or diagnoses for their client. Comprehensive evaluation generally consists both clinical interviewing and assessment, such as questionnaires about symptoms, that allow a provider to determine what symptoms a client is experiencing and the severity of their impact. This is a crucial part of treatment as it is a major factor in determining a client’s course of treatment. Although diagnoses may be refined over time, it is important that clients’ initial evaluations be thorough and that providers are familiar with current diagnostic criteria and thoughtful as they assign a diagnosis to clients. A client’s diagnosis will play a significant role in decisions about the course of their care.

Case Formulation

As a provider considers their client’s case, they must evaluate a number of factors: the client’s diagnosis, the client’s self-reported experience of distress and what the client wishes to change, aspects of the client’s past and present life circumstances that may be influencing the client’s mental health, strengths the client brings to treatment and obstacles or barriers the client may be facing, and the client’s culture and values. All of these facets play a role in helping a provider determine what the best course of action will be to help their client make progress.

Therapeutic Relationship

As I said in Upward’s very first blog post, the relationship between a client and their provider plays an enormously-significant role in predicting the success of that client’s care. Research has repeatedly demonstrated that the relationship between a client and their provider can account for as much as 50% of the effectiveness of a client’s care. Positive therapeutic relationships help clients in so many ways. Although the most effective providers often have some innate talent for developing these positive relationships, there are, indeed, evidence-based methods for consistently being able to build positive therapeutic relationships with clients. Seasoned providers often spend years honing their skills so they can help facilitate these important relationships and help their clients as effectively as possible.

Intervention

If 50% of a client’s prognosis can be determined by their relationship with their provider, what accounts for the remaining 50 percent? The effectiveness of the intervention used for that client’s care. Research has demonstrated that unfortunately, therapists often think that their psychotherapy is more effective than their clients actually report. A good therapeutic relationship—even a great therapeutic relationship—on its own will not be enough to help most clients achieve meaningful relief from their mental health symptoms. The best providers continuously hone their skills at both aspects of care: the relationship, and the treatment protocol.

In general, research on EBP compares a protocol against another treatment approach in order to demonstrate that the EBP is more effective than the other approach. In order to be considered an EBP, a protocol must repeatedly be demonstrated in well-conducted research studies to be effective at a level that can’t be accounted for by chance. In other words, the results of repeated studies of the effectiveness of a protocol must be pronounced enough to show that it was definitely the treatment that caused the benefit or the recovery from symptoms rather than any other variable. EBPs that are supported again and again by research eventually become known as “gold-standard” treatments and are generally considered by the healthcare community to be the best treatment approaches because they have been demonstrated repeatedly to be the most likely to bring about change or relief for the clients who receive them.

Chances are that you’ve heard of some EBPs, such as Cognitive-Behavioral Therapy (“CBT”) or Prolonged Exposure. These EBPs are both considered gold-standard treatments because they have been studied extensively and consistently found to be effective in a wide array of clients.

Misconceptions About EBP

Occasionally, I encounter someone with concerns that the practice of EBP isn’t personalized to meet specific clients’ needs and preferences, or that providers who use EBPs don’t spend the time to build strong therapeutic relationships with their clients. I can reassure you that although these concerns are well-intended, they are not a true cause for concern. EBPs are certainly individualized. For example, the Cognitive-Behavioral Therapy protocol has been adapted by researchers to target the symptoms of depression, anxiety, and insomnia for different clients who have different needs. A client with PTSD following an assault and a client with PTSD following a car accident may both receive Prolonged Exposure, but the intervention will be personalized to address their specific circumstances.

Providers who practice EBP prioritize the therapeutic relationship over any other aspect of treatment. After all, science has repeatedly demonstrated that this relationship is crucial, and science has also given us proven methods for building meaningful relationships with clients that facilitate their recovery.

Mastering an EBP and then maintaining that mastery is a big responsibility for a provider. But it is well worth it to a provider if it means getting to reap the best reward: witnessing a client’s recovery from mental health symptoms and seeing their life improve. For a mental health provider, there is no better feeling!