What is Evidence Based Treatment?

The last quarter of a century has produced an amazing amount of scientific knowledge about treatments that “work” for specific psychiatric problems  (such as major depression, panic disorder, PTSD, alcoholism, etc). State of the art medical care involves using this research knowledge to guide treatment in the real world. At PMA we see evidenced-based treatment as having both a “group” and an “individual” component.

EVIDENCED BASED TREATMENT – USING EVIDENCE FROM SCIENTIFIC STUDIES OF LARGE GROUPS OF PATIENTS TO GUIDE TREATMENT RECOMMENDATIONS

The “gold standard” for clinical knowledge comes from a type of scientific study called a “randomized clinical trial”. In this scientific model, a group of research volunteers with a particular psychiatric problem  are randomly selected to receive either a new treatment (a medication or specific psychotherapy) or an inactive treatment (a placebo medication for medication studies or a nonpecific treatment such as waitlist, a self help book, or unstructured “support” if a specific type of psychotherapy is being tested). In the best randomized clinical studies, neither the research volunteer nor the research team knows if the patient is receiving a placebo treatment or the treatment in question. This helps to eliminate subtle biases about the treatment effect. At the conclusion of the study, the efficacy of the treatment is compared between the volunteers who got the “real” versus the placebo treatment.

The results of these clinical studies tell us, on average, which are the most effective treatments for the overall population of patients with a mental health conditions that we treat (such as depression). The studies provide scientific evidence that a treatment “works”: hence the name “evidence based treatment”. Before recommending a treatment, we need to know, not only that it is helpful, but also that more patients get better on the active treatment than on placebo. A randomized clinical trial gives us this information.. There are a number of treatments that are touted to be helpful for mental health conditions that have not been subjected to these rigorous criteria.

In our practice at PMA, we emphasize first trying treatments that this rigorous scientific evidence of benefit for most patients with a particular problem. We do not want to subject our patients to side effects or costs of unproven interventions. We hence hold ourselves accountable to staying on top of the latest scientifically based treatment recommendations. Of course, it is always possible that some patients have a different form or variation of a psychiatric illness  (such as  depression or anxiety) and might not respond to the standard series of treatments.  When this happens, other treatments with less evidence can be tried next. 

EVIDENCE BASED TREATMENT – USING THE EVIDENCE THAT OUR INDIVIDUAL PATIENTS PROVIDE TO GUIDE ONGOING CARE.

Of course, people that come for care are complex individuals who may differ from carefully selected research volunteers. Even if we use scientifically based treatments, how can we know whether a treatment is working for a given person? The most accepted approach is to use “measurement based care” to decide if the treatment is working.  This involves measuring a patients clinical symptoms and well being at regular intervals. By measuring the same symptoms over time, we can much more efficiently and accurately determine what is working. We can strategically adjust the course of treatment if needed. Adjustments to the initial course of treatment might include medication dose adjustments, additions or subtraction of medications, behavioral health recommendations, or the recommendation of a specific psychotherapy matched to the specific disorder, life conflict, or symptom complex. This is the individualized or personalized part of evidence-based treatment. This is why we ask all of our patients to complete rating scales or forms before many of our sessions.

Of course, these measurements, while clearly useful, are only a start. As in all medical care, there is an art to psychiatry as well as a science. Any effective mental health treatment requires the establishment of an ongoing and mutually respectful healing relationship. The scientific evidence from large group studies, and the results from individual measurement scales, both serve to complement what we discover uniquely about you through more open ended conversation. Ultimately, all of these strategies are designed to help you to optimize your mental health.