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Empirically Supported Psychological Treatments: The Challenge of Evaluating Clinical Innovations

Citation

Church, D., Feinstein, D., Palmer-Hoffman, J., Stein, P. K., & Tranguch, A. (2014). Empirically supported psychological treatments: The challenge of evaluating clinical innovations. Journal of Nervous and Mental Disease, 202(10), 699-709.

Abstract

Clear and transparent standards are required to establish whether a therapeutic method is “evidence based.” Even when research demonstrates a method to be efficacious, it may not become available to patients who could benefit from it, a phenomenon known as the “translational gap.” Only 30% of therapies cross the gap, and the lag between empirical validation and clinical implementation averages 17 years. To address these problems, Division 12 of the American Psychological Association published a set of standards for “empirically supported treatments” in the mid-1990s that allows the assessment of clinical modalities. This article reviews these criteria, identifies their strengths, and discusses their impact on the translational gap, using the development of a clinical innovation called Emotional Freedom Techniques (EFT) as a case study. Twelve specific recommendations for updates of the Division 12 criteria are made based on lessons garnered from the adoption of EFT within the clinical community. These recommendations would shorten the cycle from the research setting to clinical practice, increase transparency, incorporate recent scientific advances, and enhance the capacity for succinct comparisons among treatments.

Link to publication: http://journals.lww.com/jonmd/Abstract/2014/10000/Empirically_Supported_Psychological_Treatments_.1.aspx

Craig’s Notes

This article discusses the current requirements for allowing a newer or lesser-known therapeutic method to be implemented in the health care setting, such as EFT. As it should be, clear and transparent standards are required to establish whether a particular therapeutic method is ‘evidence based.” But, even when proper research has demonstrated a method to be efficacious, it may not become available to patients who need it because of a phenomenon known as the ‘translational gap.” This is a lag of an average of 17 years between empirical validation of a method and the clinical implementation of it.

In an effort to shorten the gap, the mid-1990s the American Psychological Association published a set of standards (known as Division 12) that allows the assessment of clinical modalities. In this article, the authors review these criteria, identifying their strengths and discussing their impact on the translational gap. They also give 12 specific recommendations for updates to this criteria.

The discussion and recommendations are based on EFT as a case study, and what they have learned from the adoption of EFT within the clinical community. Several studies showing EFT to be effective are briefly discussed.

Existing studies on EFT have shown it to meet the Division 12 criteria for anxiety, depression, phobias and PTSD. Also EFT outcome studies suggest that it satisfies several other criteria for determining a treatment’s overall efficiency.

The author’s point out that the translational gap can have profound consequences for society, citing the prevalence of PTSD, which, although it is notoriously difficult to effectively treat with accepted modalities, has been shown to be helped by EFT treatments. However, due to the translational gap, the VA has not yet either adopted nor tested the use of EFT for veterans affected by PTSD.

The article concludes with 12 specific recommendations for updating and revising the criteria for research for Division 12. The aims of the recommendations are to:

  1. Shorten the cycle from research setting to clinical practice
  2. Incorporate recently developed models of the biological bases of psychological conditions
  3. Capitalize on social media and other electronic technologies to conduct research.
  4. Minimize duplication and enhance the capacity for succinct reporting and comparison.