Research-Practice Think Tank Session
Saturday, April 25
4:45 – 6:15 p.m.
Empirically Based Practice: The Art and Science of Combining Clinical Expertise with Available Research
Michael Strober, PhD, ABPP, FAED, United States; Theresa Carmela Fassihi, PHD, CEDS, United States; Wayne Bowers, PhD, FAED, United States
Health care providers in clinical practice rarely use empirically validated treatments. Two major factors account for this neglect: first, opportunities for training in these treatments are limited; second, their generalizability to “real-world” clinical populations and the settings in which care is administered remains little studied. For these, as well as myriad other reasons, clinicians generally rely on approaches they are accustomed to, and they often tailor interventions to patient-specific treatment needs, empirically supported or not.
The common trend approximates (but only partly) Evidenced-Based Practice (EBP). First discussed nearly two decades ago, EBP rests on three pillars: available research; clinician expertise; and patient characteristics, values, and preferences. Simply put, decision making in EBP is an amalgam of clinical expertise in patient care, and research – mainly what is learned from randomized controlled clinical trials (RCTs). As regards RCTs, although they are justly referred to as the “gold standard” of treatment research, there is a caveat which even staunch advocates of RCTs are quick to remind us: that ‘absence of evidence should never be taken as absence of value.’
Within our field, the caution is sometimes ignored; in short, the principles of clinical care advocated by academic physicians who pioneered the concept of empirically supported medicine – balancing personally valued experience with openness to new data and a shunning of theoretical preconceptions when making decisions about a specific individual’s care needs – are, in some circles, being narrowly interpreted. The dilemma – “So what, then, are we supposed to do?” – is obvious, as any one clinician’s assertion of expertise is as fallible, as unknowable, as the reliability and generalizability of any single RCT. Stated differently, experience is easy for a clinician to state about themselves, but who’s to know? An RCT can show an effect, but is it real?
Against the backdrop of this uncertainty, EBP requires broadly aimed discussions of case material, peer networks for consultation and acquiring knowledge of treatments being tested across a range of diagnostic conditions, and practice-centered outcome data. And note here that these needs parallel cautions voiced early on in the RCT literature; that most RCTs neither generalize to the needs of “complex” patients, nor can they easily test the effects of the multimodal therapies such patients typically need.
This Think Tank will approach these challenges by discussing: a) the problems and prospects of RCTs – the questions they can address along with their challenges and limitations; b) empirically supported therapies tested in other areas of psychopathology germane to our field; and c) how clinical practice in outpatient and inpatient settings can yield objective data to inform future practice parameters.
- Improved understanding of how clinical trials are designed, the questions they ask, how to interpret their results, and whether they generalize to the patients they treat.
- Improved understanding of theory and treatment research in other areas of psychopathology, and how these theoretical constructs and research developments apply to everyday challenges in the care of patients with anorexia and bulimia nervosa.
- Improved understanding of how to design cost-free, practice-centered research protocols to test the effects of specific, real-world interventions, and how to modify clinical care based on the results obtained.