What does it mean to provide evidence-based treatment?
Science has given us the gift of guidance to know and tools are helpful and important to offer in evidence-based treatment to ensure the best possible outcomes for clients. Evidence-based treatment refers to the use of interventions that have been rigorously tested and shown to be effective through scientific research for the population of people with a particular profile of symptoms.
For context, here is a medical example of evidence-based practice:
Medical example: The widely known and understood treatment for diabetes is diet, exercise, and insulin but treatment varies based on the tye of diabetes and the individual patient needs. i am not a doctor but, i do know that a doctor would be able to advise me on a particular treatment plan for my body if diabetes were a concern. I would anticipate that the conversation would discussion on my concerns, data collected on my body, and then a plan that involves evidence-based practice recommendations to manage the diabetes. i imagine that in a doctor would need to adjust levels as the body adjusts to its new environment and activity level, or as it adjust to the insulin prescription as time passes. This is all evidence-based practiced tailored to the individual’s needs.
What does “evidence-based” mean?
There are several terms that are often used to refer to evidence-based practice, including "evidence-based," "science-based," and "research-informed," and also these specifiers to suggest individualization of treatment to the person or population that include "tailored to individual” or similar language. These terms all emphasize the importance of using research supported methods that are tailored to the individual needs of the client as each individual will have variance in their presentation of an issue - we are individuals after all! You might hear clinicians use different language to describe a similar treatment. Below you will find additional information about defining factors of treatments that we offer that are supposed by the evidence-base.
High quality CBT includes:
Psychoeducation and teaching
Cognitive and behavioral shifts in behavior
Practice of small incremental steps towards a defined goal
Reward system (varies widely for each person; tangible or relational depending on the treatment needs)
Daily practice of skills
Tailoring skills and tools to the individual person and family.
Consideration of cultural of the individual
Values consideration in treatment
What is the EBP for Anxiety disorders?
One of the most common types of evidence-based treatment is cognitive-behavioral therapy (CBT). CBT is an umbrella term that encompasses a variety of specific modalities and techniques. However, providing evidence-based treatment does not necessarily mean providing rigid, manualized treatments with predefined session descriptions in a certain environment like a University. Rather, it means using evidence-based tools and techniques that have been shown to be effective and tailoring them to the individual client's needs with the resources a clinician has at their disposal.
The goal of evidence-based treatment is to help clients achieve their treatment goals in a way that is effective and tailored to their unique situation. By using evidence-based tools and techniques, mental health providers can help clients make meaningful progress and improve their quality of life.
The tricky thing about behavioral science (behavior therapy) is that the fit with the therapist matters A LOT! There is extensive research showing that the therapeutic alliance (relationship between therapist and patient) matters and it is not just the techniques in EBP that are effective. To add to the conversation, good evidence based practice in the treatment of anxiety includes rapport building before any exposure is completed. This is important to note because we are relational beings. Relationship is the backbone of effective therapy and if this is lacking, it may be difficult for a person to engage in the evidence-based treatment (even though the EBP skills are present).
Do you use EBP to treat selective mutism and other anxiety disorders?
YES! Neural plasticity is a real and beautiful benefit of the brain - this means that new ‘routes’ can develop when we practice a new skill.
Anxiety is often described as a “false alarm” in the amygdala (the fear center of the brain) that causes a person to be over-reactive to an external stimuli. Essentially, the avoidance muscle is really strong in anxiety. In the case of SM, that false alarm is being asked a question or the presence of an expectation to speak and the avoidance muscle makes it easier to be silent (or perform another learned avoidance response). ERP helps an individual’s brain learn that a prompt to speak is not a threat of danger, in small incremental steps. When a clinician breaks down the larger goal of “brave talking” into small, incremental steps, it allows the brain to slowly acclimate to the new reality of being able to speak one small step at a time.
PCIT-SM is currently the most highly evidence-based treatment for selective mutism when considering more defined treatments beyond general CBT that are build specifically for selective mutism.
Do you use EBP to treat defiance, ADHD, and other issues that present as “deeply feeling kids” or “big emotions”?
YES! The same neural plasticity that we can use in anxiety treatment is used to help children who struggle with other presenting problems. All brains can learn new pathways, or routes, to solve a problem!
The treatment of these presenting problems requires clear boundaries, guidance, and skill development to allow the brain to re-learn and use its ability to adjust to its own benefit. Often times, parents are able to edit their language to support their child in the development of new interactions and learn new, positive, ways to get along with others.
The evidence-based recommendations for the treatment of ADHD, oppositionality, defiance and other big emotions directly guides us to parent-training programs. Parent training programs that are supported by the evidence-base include: Parent Child Interaction Therapy, Tripple P: Positive Parenting Program, The Incredible Years and other similar programs. These programs share the core values of parent training and skill development for both parent and child.
Check our our PCIT Clinic for additional information regarding these services at CFTC.