Evidence-Based Practice in Behavior Activation for the Treatment of Depression - Term Paper Example

Applying principles of evidence-based practice to a case example; how evidence based practice and research has informed clinical decision-making and the method of choice. Name: University: Introduction Principles of evidence based practice and research has continuously played an informed clinical decision-making across the world and shows the method of choice or specific interventions within it. According to Sackett (1996), evidence based practice in therapy is defined as the use of latest available evidence in making decisions about the welfare of a patient. It involves the combination of individuals’ skills with the best industry practices from the medical fields. Description of evidence based practice Evidence based practice is a treatment approach where the doctor uses proven past cases to treat a patient. According to Sackett (1997; 59), evidence based practice is the “The conscious, explicit and judicious use of the current best evidence in making decisions about the care of individual patients”. “It means integrating individual clinical expertise with the best available external clinical evidence from systematic research,” (Sackett, 1997; 34). According to Field and Lohr (1990), it is evidence based practice is the systematic development of statements to assist practitioners and patient decisions about appropriate health care for specific clinical circumstances. In using evidence based practice, the therapist considers the best evidence about a certain treatment approach and tries to apply the method to make sure that he or she can replicate the results in the patient who is being treated currently. However, as Levkoff (2006) warns, with regard to evidence based practice, it is best to note that it is based in evidence which then brings in a new issue of defining what evidence in the context of practice is. To help practitioners to be able to deal with this issue, the use of hierarchy of evidence is necessary in order to qualify some evidence as evidence and others as not evidence. Arguments for and against it evidence based practice The other problem with using Evidenced Based Practice in treating mental disorder patients is the fact that it may not be fully suited for this filed. Evidenced Based Practice has its roots in medicine and this means that applying it in psychotherapy can create a gap that will make it impossible or unnecessarily difficult to treat the patient in a way that produces positive patient outcomes in an efficient way. At the same time, EBP fails to have a natural feed-back loop. This means that it does not help in the creation of theory which can be applied in the development to the very evidence that is required for Evidenced Based Practice (Melnyk & Fineout-Overholt, 2011). In this regard, Evidenced Based Practice as used in the context of psychotherapy seems to work against the very idea that it is predicted on. Additionally, because of the fact that there is a gap between drug funding and the support needed for Evidenced Based Practice, this may lead to a paucity of the practice thus leading to negative results. Other problems also come up with regard to using Evidenced Based Practice in the treatment mental patients. To begin with, unlike in biological medicine, mental illness may not have discreet illnesses. This especially happens when a patient has multiple mental disorders. In such a case, it may be futile to use Evidenced Based Practice to treat such a patient. Co-morbidity is much more prevalent in mental patients than in the medical sphere where the origin of Evidenced Based Practice is. As a result, hoping to apply Evidenced Based Practice in the psychotherapy can bring in issues in such a case where trans-diagnostic cognitive processes have to be used for a patient. Even worse, Evidenced Based Practice seems to assume that lack of evidence that a certain method of treating a patient means that that method is ineffective. This is hardly so in many cases and as such, where the Evidenced Based Practice is strictly used to treat a patient, it can lead to the practitioner being hundred from using a method that could have otherwise delivered positive results in treating the patient. While evidence based practice is a god way to look at the issues, it is also faces a number of setbacks and not all practitioners agree that EBP is the best way to go. Those who argue against the evidence based practice approach have the following reservations against the mode of treatments. The first problem is with regard to defining what evidence is. While there are guidelines on how to inspect the evidence and to determine what qualifies to be used as evidence, the rules are not explicit and this means that it is harder for practitioners to be able to have a clear way to know what can be taken as evidence and what cannot. The other problem with this is the fact that the definition of evidence to be used in evidence based practice is narrowed to evidence in empirical studies only and not considering other forms of evidence impoverishes the way a practitioner is able to treat the patient. The treatment of a patient uses a broad spectrum of factors that cannot be catered for by just applying evidence from treatment of other past patients. This is because each patient is unique and his disease is as unique as the patient. As a result, limiting the treatment of a patient to past evidence becomes in most cases a detriment rather than a positive resource. It is good for any practitioner to be able to recognize that the hierarchy of evidence does not always mean that that evidence is applicable to all patients. This idea of the hierarchy of evidence is just a systematic way of trying to apply best practice with regard to identifying what can be used as evidence and what should not be used as evidence of effective therapy approach. As a result, it does not automatically mean that because a certain practice approach has passed the test of the hierarchy of evidence that the practice or approach is them applicable and usable. The practitioner must also apply her own judicious wisdom based on her knowledge and skills, to determine whether a certain approach should be used on a patient (Gillespie et al, 2002). Advantages of Evidenced Based Practice It is also good to note that EBT has its own advantages. For instance, it provides for a way to develop the field of psychology and psychotherapy. This is because all experts are supposed to share their experiences and knowledge with others in the same filed. This principle is called beneficence in which case the practitioner is supposed to share any practice, theory or modality that has helped him to achieve positive benefit. By using EBT, the whole practice of psychotherapy benefits in that the practitioners are able to learn from others in the same field what works and what does not work in producing positive results. Applying EBT makes it possible for the practitioner to be able to only what works and ignore what has not been proven to produce positive results. This, when used properly enhances the process of treating he patient and the patient can be treated fast and efficiently. Additionally, the use of Evidenced Based Practice gives credibility in that the practitioner is using something that has been proved to work with regard to treating a patient. This is very critical because it minimizes the risk of practitioners using methods that are their own concoctions. At the same time, use of Evidenced Based Practice is the best way to encourage and support dialogue between practitioners and scientists and this can be agreed upon as a best practice with regard to developing any profession, let alone psychotherapy. Practitioners who use Evidenced Based Practice are also benefited by having a way to make ethical decisions that are useful in making sure that the practitioners does not go outside the delimitations of his or her practice. Cognitive Behavior Therapy Cognitive Behavior therapy refers to a situation where the patient is allowed to participate in his or her own therapy program (Knaus, 2006). The patient is expected to have and allowed to make informed decisions about her therapy as opposed to the therapist commanding on everything she needs to do. Allowing a patient to be able to participate in her own therapy is useful in making sure that the patient is engaged in her own therapy ad that the best patient outcomes will be achieved (Otto, 2011). In Cognitive Behavior therapy, the therapist is able to guide the patient to be able to select the best method to deal with their problem. Cognitive Behavior therapy is very useful when treating psychological disorders such as post traumatic disorders (PTSD) Brief outline of the case study An analysis of a 32 year old female suffering from chronic depression; she has had three miscarriages in her 8 year old marriage first one at age of 23, second one at age of 25, and third at age of 27. She is married and afraid that this may lead to a break up. As such, the condition had driven her husband into alcoholism. She also has frequent stomach upsets especially at night and this frightens her husband so much. She is depressed. A colleague has advised her to take a therapy treatment and wants to know if this procedure is effective. Cognitive based theory analysis of the principles of evidence based practice in behavior activation for treatment of depression articulates that identifying and analyzing the patient’s problem in details is very important (Knaus, 2006). Based on the evidence (Bieling, McCabe & Antony, 2009) presented in the past, it was determined that it would be necessary to help the patient and help her to overcome the hopelessness. She was given counseling with regard to her attitude and informed that her feeling that the method would not work was as a result of her depression. In line with cognitive behavior therapy, she was involved in the decision as opposed to just making the decision regardless of her wish. She was asked to carry out some activities and promised that if this did not work within a week, she would not be asked to carry out these activities for the rest of the therapy. The premise was that by the end of the week, she would not only be feeling better with regard to her abilities but will be feeling that the mode of therapy being used, was not only useful but would be effective in helping her. Client’s reluctance to complete the homework The patient did not show interest in the activities that were selected for her to do while at home. This introduced a new dimension to the situation because as Wright et al (2005) say, the choice of the patient with regard to the mode of therapy is also important determining how effective it is going to be. From the onset of the therapy, it became clear that she did not have any faith or confidence in the procedure. This means that she did not feel that the mode of therapy that was being used to treat her would yield any results, at least not positive ones. My rational for setting homework such as thought records, activity diaries and behaviour activation. Arguments for and against As identified above, Cognitive Behavior therapy involves the patient in the process of treatment and the patient ahs to carry out some actions as part of their treatment process (Sturmey & Hersen, 2012). The use of homework therefore can and does play a major role in this regard. In this case, the treatment process uses both the therapy sessions with the people and the patient is then given homework to go and carry out at home. The advantage of this is that the homework that the patient receives acts as a way to help the patient to participate in his or her own practice as deemed in the concept of Cognitive Behavior therapy. On the other hand, as Sturmey and Hersen (2012) say, the problem is the fact that there is no available way for the therapist to be able to determine whether the patient will carry out the homework that he receives. In such a case, the treatment process can be ineffective if the patient fails to do his or her homework. The other disadvantage with regard to using homework assignments in Cognitive Behavior therapy is the fact that most patients are reluctant and may not be willing to cooperate with the therapist. This introduces a new problem with regard to the fact that the patient may not benefit fully from the process. For instance, in the treatment of depression patients, the use of homework can be very difficult and detrimental because depressive patients are least likely to have any motivation to carry out these homework assignments (Zettle, 2007). Low levels of motivation for anything is one of the symptoms of depression and this means that the patient is going to be unable to do the homework as given by the therapist. The other issue with regard to assigning homework to patient in the context of CBT is the fact that this goes against one of the fundamental theories of Cognitive Behavior Therapy, which is, to allow the patient to make her own cognitive decisions. By giving the assignments to the patient, the therapist will be taking this function away and denying the patient the right to make her own decisions with regard to the therapy. How homework impacts the outcome of CBT for depression According to Burns and Nolen-Hoeksema1(1991, 305-311), the level of willingness by the patient to do the homework assignments to him or her increases the effectiveness of homework assignments in CBT. There are various advantages of using homework in treating the patient for depression in the context of CBT. To begin with since the participation of the patient in his or her own therapy is an important part of the therapy, using homework gives the patient being treated the opportunity to participate in the process of recovering from her mental problem. In this regard, the use of homework assigned to the patient is regarded as a way to make sure that cognitive behavior therapy has been implemented in the right way. At the same time, it offers the practitioner a way to continue with the assessment of the patient even as the process of treating her goes on. This means that the doctor is able to continually adjust the process in order to meet the needs of the patient as they arise. On the con side of using homework assignments in cognitive behavior therapy, the patient may not receive the assignments as directed by the doctor. This kind of resistance by the patient can lead to a delayed process of recovery by the patient. However, as Michael and Callan (2006, 162-177) says, the use of homework is useful in that it has a didactic element to it that helps the therapist to understand the patient’s problem deeply. At the same time, Burns and Spangler (2000, 46-56) in their study proved that depression patients who did homework improved much better than those who did not. The same conclusion was also reached by Kazantzis and Lampropoulos (2002, 577–585) who also argued that there is enough evidence that homework used in CBT improves the therapy outcomes. The level of effectiveness however depends on a number of factors. For instance, as Brent et al (2010) found, the level of effectiveness depended on factors such as the source of homework (client or therapist), timing of homework and type of homework. Additionally, Gonzalez, Schmitz and DeLaune (2011, 78-87) found that there was a correlation between homework compliance and the way cocaine addicts were able to recover from addiction. Conclusion Evidence based practice in behavior activation for treatment of depression in cognitive behavior therapy is one of the best and widely forms of treatment for several forms of mental disorders. The practice is result oriented and all inclusive in that the patient’s feelings, attitudes, values and beliefs are included in the process of treatment. Conditions related to mental disorders affect all of us and the society at large. Homework in CBT improves the effectiveness of the treatment of a patient. This is widely accepted as a way to improve the application of Cognitive Behavior Therapy. Reference list Bieling, P. J., McCabe, R. E., & Antony, M. M. (2009).Cognitive-behavioral therapy in groups. New York: Guilford Press. Brent, et al (2010 ). The Relationship Between Homework Compliance and Therapy Outcomes: An Updated Meta-Analysis . Springerlink.com Open Acess , 1-6. Burns, D.D. & Spangler, D.L.. (2000). Does Psychotherapy Homework Lead to Improvements in Depression in Cognitive—Behavioral Therapy or Does Improvement Lead to Increased Homework Compliance? Journal of Consulting and Clinical Psychology, 68, 1, , 46-56. Burns, D. & Nolen-Hoeksema1, S. (1991). Coping styles, homework compliance, and the effectiveness of cognitive-behavioral therapy. Journal of Consulting Clinical Psychology 59, 2 , 305-311. Field, M.J. & Lohr, K.N. (1990). Clinical Practice Guidelines:: Directions for a New Program. New York, NY: National Academies Press. Gillespie, K. et al. (2002). Community based cognitive therapy in the treatment of posttraumatic stress disorder following the Omagh bomb. Behaviour Research and Therapy, 40 , PP. 345–357. Gonzalez, V.M., Schmitz, J.M. and DeLaune, K.A. (2011). The Role of Homework in Cognitive–Behavioral Therapy for Cocaine Dependence . University of Texas Medical School—Houston , 78-87. Kazantzis, M.N. & Lampropoulos, K.G. (2002). Reflecting on Homework in Psychotherapy: What Can We Conclude from Research and Experience? . Periodicals, Inc. J ClinPsychol/In Session, 58, , 577–585. Knaus, W. J. (2006). The cognitive behavioral workbook for depression: A step-by-step program. Oakland, CA: New Harbinger Publications. Michael, T.E. & Callan, J.A.. (2006). The role of homework in cognitive behavior therapy of depression. Journal of Psychotherapy Integration, 16, 2, , 162-177. Levkoff, S. (2006).Evidence-based behavioral health practices for older adults: A guide to implementation. New York: Springer Pub. Melnyk, B. M., & Fineout-Overholt, E. (2011).Evidence-based practice in nursing & healthcare: A guide to best practice. Philadelphia: Wolters Kluwer/Lippincott Williams & Wilkins. Otto, M. W. (2011).10-minute CBT: Integrating cognitive-behavioral strategies into your practice. Oxford: Oxford University Press. Ovid Technologies, Inc. (2007). Lewis child and adolescent psychiatry: A comprehensive textbook. Philadelphia, PA: Lippincott Williams & Wilkins. Sturmey, P., & Hersen, M. (2012). Handbook of evidence-based practice in clinical psychology. Hoboken, N.J: John Wiley & Sons. Wright, J. H. (2009). Cognitive-behavior therapy for severe mental illness: An illustrated guide. Washington, DC: American Psychiatric Pub. Wright, J. H. et al. (2005).Learning cognitive-behavior therapy: An illustrated guide. Washington, DC: American Psychiatric Pub. Zettle, R. D. (2007). ACT for depression: A clinicians guide to using acceptance & commitment therapy in treating depression. Oakland, CA: New Harbinger Publications. . Read More