Evidence-based practice in psychology and behavior analysis.

This paper outlines the development of the evidence-based practice (EBP) movement in medicine and psychology and discusses the criteria by which a given intervention is deemed evidence-based, in accordance with American Psychological Association's (APA) guidelines. Although the EBP movement has its benefits, there are a number of weaknesses that mitigate against implementing these in day-to-day practice. This paper discusses these weaknesses. Readers familiar with Chambless et al.'s (1996, 1998) report on empirically-validated therapies will note that a number of items pertain to behavior analytically-based interventions developed in the 1960s and 1970s. Few would argue that these were flawless upon their inception, however, as indicated on the list, have not been updated nor improved upon. This paper discusses why this might be so in a general context that suggests that applied behavior analysis has drifted from its empirical roots. This paper concludes by discussing the potential usefulness of behavior analytic technologies within the context of quality improvement. Keywords: evidence-based practice, empirically-validated therapies, applied behavior analysis, quality improvement. ********** In an effort to increase the use of evidence-based psychological interventions in the United States task forces were formed to define, identify, and disseminate information about extant empirically supported, psychologically based therapies (Chambless & Ollendick, 2001). According to the American Psychological Association's (APA) Presidential Task Force on Evidence-Based Practice (2006), evidence-based practice (EBP) in psychology refers to "the integration of the best available research with clinical expertise in the context of patient characteristics, culture, and preferences" (p. 273). What the APA means by "best available research" will be taken up in a moment. Apart from a few modifications, this definition is almost identical to the definition adopted by the Institute of Medicine (2001): "Evidence-Based practice is the integration of best research evidence with clinical expertise and patient values" (p. 147). APA's adoption of medicine's definition makes sense from a socio-political standpoint. The medical community and medically oriented administrators are more likely to adopt these guidelines the closer they parallel their own guidelines. Before proceeding, a comment about two terms related to the concept of EBP warrants mention, as these terms might be confusing. Readers familiar with the evidence-based practice movement have, no doubt, noticed that the term has changed over the years, from empirically validated therapies (EVT) to empirically supported therapies (EST), to EBP. Generally speaking, these terms are synonymous. Although there are some differences, all of these refer to psychologically based treatments that have undergone scientific evaluation, employing established research methodologies, and have proven to be efficacious. EBP, of course, is the most current iteration of this concept, and, in keeping with this trend, will at some point likely be supplanted by a newer term. In this paper, we first outline the development of the evidence-based practice movement in medicine and psychology. Second, we discuss the criteria for EBPs. In particular, we describe what the APA defines as well-established treatments and probably efficacious treatments, the criteria by which they deem a given therapy "evidence-based" (Chambless et al., 1996). Although APA's efforts at promoting empirically sound therapies is a step in the right direction, there are a number of major weaknesses that mitigate against the usefulness of employing these criteria as they bear on day-to-day practice (for which they were intended). The third section of the paper discusses these weaknesses. Behavior analysis started as being principle-based and process-oriented (Keller& Schoenfeld, 1950). …