Evidence-Based Practice: “It’s All in Your Head”

1. Evidence-Based Practice: “It’s All in Your Head” Michael A. Harris, Kurt A. Freeman, Sage N. Saxton, Darryn M. Sikora Mina Nguyen-Driver, & Darren M. Janzen Child Development and Rehabilitation Center Oregon Health & Science University • EBP Pros • Many descriptive and intervention studies that have led us to a better understanding of human behavior. • Manualized treatments with support from RCTs continue to grow in number and focus. • Literature is slowly moving towards effectiveness studies and away from efficacy studies as a means of bridging the research-clinical practice gap. • EBP Cons • Many in the field continue to hold a very narrow view of what constitutes EBP. • Supervisors are not sensitive to the biases in their own understanding of “the truth” about human behavior. • The clinician-researcher gap is still very much a problem such that supervisors who are primarily clinicians are skeptical of RCT findings given the disconnect to real clinical problems and populations. • Examining • Our Own Discoveries of “The Truth” • Where did your understanding of the truth about human behavior come from? • Who imparted the truth about human behavior to you and what were their biases? • At what stage of our own lives did we come to the truth about human behavior (e.g., single, married, kids, young adulthood, emerging adulthood, etc.)? • How has the truth about human behavior changed since we were first exposed to the evidence? • Have we changed our own understandings of the truth about human behavior or looked for ongoing confirmation of our own personal biases about the truth? • Bottom Up Training in Evidence-Based Practice • Examining the evidence about general behavior; human, non-human primate, other animal. • Social Support • Learned Helplessness • Modeling • Identifying the evidence regarding specific behavior • Teasing • Selective Eating • Use of evidence regarding more general treatment variables. • Empathy • Reflective Listening • Knowing the general RTC evidence regarding specific treatment modalities. • Cognitive Therapy • Family Therapy • Marital Therapy • Evidence from RCTs with specific populations. • Manualized Treatments • Trauma-Focused CBT for Rape Victims • Biofeedback for Pain • CBT for Depression Explicit Obstacles Many studies are efficacy studies not effectiveness studies. Training in manualized treatment is time intensive and costs money. Access to the most current evidence base is not readily available to supervisors and trainees. Implicit Obstacles Findings from EBP buck conventional wisdom; much of what we do is based on conventional wisdom. Empirical studies don’t always have strong theoretical basis; a strong theoretical basis drives much of our clinical conceptualizations and treatment. Samples used in RCTs are homogeneous and don’t reflect the clinic populations. Correspondence: Michael A. Harris, Ph.D. Child Development & Rehabilitation Center Oregon Health & Science University harrismi@ohsu.edu