Why We Need Evidence-Based Psychotherapy Practice Guidelines

William C. Sanderson, PhD


Medscape General Medicine. 2002;4(4) 

In This Article

The Problem: A Gap Between Science and Practice

Consider the following case to illustrate why we need to develop evidence-based psychotherapy practice guidelines. A patient suffering from panic disorder presents to a psychologist for psychological treatment of her panic attacks. What type of treatment is she likely to receive? More specifically, what is the likelihood that she will receive the intervention with the most supporting evidence for its efficacy?

When it comes to the psychosocial treatment of panic disorder, the data are quite clear. A treatment package consisting of psychoeducation, cognitive restructuring, exposure to somatic and situational panic provoking stimuli, relaxation, and breathing exercises has been well established as an effective treatment for panic disorder in more than 20 controlled trials.[4] In addition, several effectiveness studies, aimed at evaluating how well this treatment generalizes to "real-world" settings, support its value.[5,6] The strength of these data is validated by existing practice guidelines, such as those developed by the American Psychiatric Association and National Institute of Mental Health,[7] both of which endorse this treatment as the only first-line psychosocial intervention.

Yet despite the strength of these data, it appears as though only a minority of patients suffering from panic disorder is likely to receive this psychosocial intervention. While we know very little about what type of psychological treatments patients actually receive, the existing data suggest that EBTs are not typically administered. For example, only a small percentage of patients (estimated between 15% and 38%) with panic and phobic disorders actually receive an evidence-based psychological intervention such as exposure therapy and cognitive restructuring.[8,9] An identical survey conducted 5 years later revealed that, unfortunately, the use of psychosocial treatments had declined overall, and that dynamic psychotherapy was still the most frequently used therapeutic approach. The percentage of patients receiving cognitive and behavioral treatment had decreased.[10] The results of the later survey are quite surprising in that one would expect an increase -- not a decrease -- in the use of EBTs with the growing body of research on this topic.

Although these data pertain to treatment of panic disorder, there is no reason to suspect that the same is not true for other commonly encountered disorders as well (eg, major depression, obsessive compulsive disorder, bulimia, social phobia). Simply stated, the problem is that there appears to be a gap between those treatments found to be effective in research trials and those practiced in the "real world."