The use of evidence-based practice

In psychology, we often strive for research that is scientific, objective, replicable and has high validity. Researchers face many obstacles in creating research that is up to this standard, but with methods such as randomized controlled trials which reduce the effect of confounding variables, and the use of statistical tests to ensure significance, research of a high scientific standard is continuously produced.

However, what is the purpose of research if it doesn’t have practical implications? This is where the idea of evidence based practice (EBP) is introduced; to bridge a gap between research and intervention. EBP involves the application of current evidence when making decisions about treatment for individual patients (Sackett et al, 1996). It strives for the identification and application of interventions that have shown to be effective by empirical evidence (Norcross et al., 2006).

In a field which aims to be scientifically based, one would assume EBP is the best and most effective method forward in designing interventions. Because of this, bodies such as ‘The National Institute for Health and Clinical Evidence’ are responsible for producing evidence-supported guidelines for treatments in the UK (Morrison & Bennett, 2009). These guidelines attempt to reduce the vast variations of practice in the profession (Walshe and Rundall, 2001 as cited in McCurtin & Roddam, 2011), by making the process of choosing suitable interventions less subjective.

The idea seems promising, yet EBP is not used as much as one would assume. For example, surveys show that only 5.5-17.7% of Speech and Language Therapists use research to determine their practice (McCurtin & Roddam, 2011).

From this, it is clear EBP has its flaws. Several of these were highlighted by the NHS Centre for reviews and Dissemination report (1999). The report showed that health professionals (including psychologists) are often resistant to change, as they feel it will bring extra unnecessary stress. They prefer to conform to old practices they know are successful, rather than trialling new ones, despite the provision of supporting evidence.

The field of research is vast, and it would be impossible for a health professional to know of all the research. There are also conflicts and inconsistencies in this research (Cohen & Hersh, 2004 as cited in McCurtin & Roddam, 2011), which creates a further barrier for the application of EBP. Yet, isn’t the use of any research better than using none at all?

It is important to remember that EBP often only uses the most scientific, supported research. Research that is considered scientific enough for EBP often uses randomized controlled trials, and is done in a controlled environment to ensure a causal relationship can be established. However the generalisation and transferability of research to practice is questionable. People are individuals, and as Baumann (2010) suggested this raises the question, can we really measure clinical outcomes and patients’ satisfaction purely through objective and scientific measures? Patients have the free will to disagree with a treatment, and unlike in controlled conditions, can choose to drop in and out of treatment as they please (Nelson et. al, 2006 as cited in McCurtin & Roddam, 2011).

Inevitably, although EBP provides a bridge between the theoretical and practical areas of psychology and other health-related areas, the links between research and practice need to be strengthened before EBP can truly be effective.

References

Baumann, S. L. (2010). The limitations of evidence-based practice. Nursing Science Quarterly, 23(3), 226–230.

McCurtin, A., & Roddam, H. (2011). Evidence-based practice: SLTs under siege or opportunity for growth? The use and nature of research evidence in the profession. International Journal of Language and Communication Disorders, 47(1), 11-26.

Morrison, V. & Bennett, P. (2009). An introduction to health psychology (2nd ed.). UK: Pearson Education Limited.

NHS Centre for Reviews and Dissemination (1999). Effective healthcare: getting evidence into practice. NHS CRD, 5(1). London: Royal Society of Medicine Press.

Norcross, J.C., Garafalo, A., & Kocher, G. P. (2006). Discredited psychological treatments and tests: A Delphi poll. Professional Psychology: Research and Practice, 37(5), 515-522.

Sackett D.L., Rosenberg W.M.C., Gray J.A.M., & Richardson W.S. (1996). Evidence based medicine: what it is and what it isn’t. British Medical Journal, 312, 71-72.

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2 responses

  1. The potential power of the evidence-based practice model for counselling psychology is particularly apparent in the area of multicultural counselling training. It has long been advocated by multicultural researchers that an expanded view of what constitutes evidence allows for the investigation of topics that might otherwise be dismissed. Although, key position papers on multicultural competence have been called into question due to a lack of empirical support, these are narrowly defined. The diversity of methods available to evidence-based practitioners facilitates the generation of research evidence in support of important assumptions in counselling psychology. To be an evidence-based practitioner it is important to possess critical thinking and creativity. Cognitive psychological knowledge in these areas can be used to inform and improve this area of psychology.

    Chwalisz, K. (). Evidence-based practice: A framework for twenty-first-century scientist-practitioner training. (2003). The Counselling Psychologist, 31(5), 497-528

  2. My suggestion is that whilst it may in theory make sense to instigate new practices according to research evidence, the impracticality would mean that in reality, such practises would be no more useful than the original ones. The disruption to the system currently in place could result in multiple problems, (for example, as you mentioned, reluctance on part of the practitioners) particularly in the transition phase. This would mean that for an amount of time, the system would be much less useful than usual, and certainly not more useful, as would be intended. This could mean that the change is simply not worth it.

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