The clinical utility of randomized controlled trials

Gt, Wilson

doi:10.1002/(sici)1098-108x(199807)24:1<13::aid-eat2>3.0.co;2-3

Cited by 44 publications

(20 citation statements)

References 43 publications

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“…These findings support the position that, within the field of eating disorders, the number of therapists skilled in the use of CBT based on empirically supported standardized methods remains small (Arnow, 1999;Wilson, 1995Wilson, , 1998a. They also illustrate the need for improved transmission of knowledge of empirically supported treatments to clinicians.…”

Section: Discussionsupporting

confidence: 72%

“…It is important to consider potential implications of promoting empirically supported treatments (e.g., restriction of practice) with regard to issues of ethics, reimbursement, and training (Silverman, 1996;Kendall, 1998). The extent to which specifically following a manualized approach promotes favorable outcome in treatment of individuals with eating disorders remains an empirical question (Wilson, 1998a). Considerable effort has been devoted to developing and empirically testing manual-based treatments for individuals with eating disorders.…”

Section: Discussionmentioning

confidence: 99%

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Utilization of empirically supported psychotherapy treatments for individuals with eating disorders: A survey of psychologists

Mussell

Crosby

Crow

et al. 2000

Int. J. Eat. Disord.

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Objective The purpose of this study was to assess the primary methods used by psychotherapists in treating individuals with eating disorders and to determine the extent to which certain empirically supported psychotherapies (i.e., cognitive behavioral therapy [CBT] and interpersonal psychotherapy [IPT]) are used in clinical settings. Method Surveys developed for this study were sent to 500 psychologists randomly selected from a list of all licensed doctoral‐level psychologists in an upper midwestern state. Results Despite the findings that CBT techniques were reported to be frequently used, most respondents identified something other than CBT or IPT as their primary theoretical approach. In addition, the majority of repondents indicated not having received training in the use of manual‐based, empirically supported treatment approaches for working with individuals with eating disorders, although most reported a desire to obtain such training. Conclusions Although commonly referred to as the “treatments of choice” in research literature, manual‐based, empirically supported approaches to working with individuals with eating disorders has not received adequate dissemination. © 2000 by John Wiley & Sons, Inc. Int J Eat Disord 27: 230–237, 2000.

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Section: Discussionsupporting

confidence: 72%

Section: Discussionmentioning

confidence: 99%

Utilization of empirically supported psychotherapy treatments for individuals with eating disorders: A survey of psychologists

Mussell

Crosby

Crow

et al. 2000

Int. J. Eat. Disord.

View full text Add to dashboard Cite

show abstract

“…It is clear that many of the efficacy studies that provide the empirical support for manual‐based treatments do not exclude patients with multiple problems (Jacobson & Christensen, 1996). Rather, many include patients with severe psychopathol‐ogy, high rates of psychiatric comorbidity, and frequent histories of previously failed therapy (Wilson, 1998).…”

mentioning

confidence: 99%

Manual-based treatment and clinical practice.

Wilson¹

1998

Clinical Psychology: Science and Practice

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117

103

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The role of empirically supported, manual-based t n a tments in clinical practice is controversial. This article attempts to clarify misunderstandings that may impede their effective use. Manual-based treatments encourage focal interventions, faciliite training and supervision of therapists, and expedite clinical audit. They are consistent with an actuarial approach t o treatment, which, on average, is likely t o prove superior t o subjective clinical judgment. Treatment manuals can provide greater flexibility and self-correcting features than is often assumed. Comohidity does not exclude their use. Far from hampering innovation, their use is likely to spur new developments. Manual-based treatments require specific therapeutic skills. Although effective, empirically supported manuals fall short of helpinglarge numbers of patients. Treatment manuals must become more "therapist friendly" by including richer practical details on their use, as well as greater specification of some of the "nonspecific" factors in therapy.

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“…The implication for psychological practice is that an overreliance on one's own intuition in treatment, especially when there is good evidence-based practice in existence, can lead to ignoring important treatment factors and poor treatment outcome (Wilson, 2007). Manuals can be used to bypass these biases by automatically targeting what clinicians should do; providing a sequential order for providing treatment; not overloading the limited memory and attention capacity by which all humans are bound; and providing methods for monitoring progress (Bishop & Trout, 2004;Wilson, 2007;Wilson 1998a;Wilson, 1998b). For all these reasons, it would certainly seem safe to say that, when manuals exist with a robust evidence-base behind them, they should be used as the first line of action.…”

Section: The Importance Of Manualsmentioning

confidence: 99%

Mechanical/Algorithmic Versus Flexible/Creative Clinical Practice: How Underlying Principles Bridge the Gap

Lichtman¹

2017

PCSP

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In the case of "Hiro" (Lichtman, 2017) I described the successful use of Comprehensive Behavioral Intervention for Tics (CBIT) in a young boy with Tourette Syndrome (TS). In three different commentaries on this case, authors noted important concepts regarding the use of manuals in treating TS; how an understanding of underlying principles is important in flexible use of manuals; and how training impacts the treatment of TS. In my response to these commentaries, I hope to continue the conversation of how to use manuals in psychotherapy in general as well as in the treatment of TS in particular. Specifically, I hope to address the seeming dichotomy between a mechanical, algorithmic approach to treatment versus a flexible, creative approach, and to ultimately show that an understanding of the underlying principles guiding manualized treatment provides room for ingenuity that proves this dichotomy false.

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The clinical utility of randomized controlled trials

Cited by 44 publications

References 43 publications

Utilization of empirically supported psychotherapy treatments for individuals with eating disorders: A survey of psychologists

Utilization of empirically supported psychotherapy treatments for individuals with eating disorders: A survey of psychologists

Manual-based treatment and clinical practice.

Mechanical/Algorithmic Versus Flexible/Creative Clinical Practice: How Underlying Principles Bridge the Gap

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