Why do they call some forms of psychotherapy evidence-based? Isn’t everything in science and medicine supposed to be informed by evidence?
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Evidenced based means there are research studies that back it. You can come up with a new method that you think is awesome and are gathering evidence to show it works- one day it may be evidenced based but currently it’s not.
Quick edit: it can also be evidenced based for a certain thing and not another.
In the context of psychotherapy, “evidence-based” refers to practices that have been rigorously tested through controlled research studies and have consistently demonstrated their effectiveness in improving patient outcomes. While it’s true that evidence should inform all scientific and medical endeavors, there are reasons why not everything can be considered evidence-based.
Psychotherapy deals with complex human behaviors, emotions, and interactions, making it challenging to design studies that can capture all the nuances. Each patient presents unique characteristics, making it difficult to develop a single, universally effective treatment approach.
To add to it, research studies in psychotherapy often face methodological challenges, such as small sample sizes, high dropout rates, and limited follow-up periods. And while evidence-based practices are important, clinical practice guidelines also consider factors like patient preferences, cultural nuances, and provider expertise.
You have to have well designed studies that are peer reviewed, replicable, and have consistent outcomes. That’s not always but so possible in the field. EDIT: I should add, this is not always possible due to ethical considerations and the responsibility to prioritize humane testing above all.
You’d probably be shocked and horrified to learn how little therapeutic practices were actually backed by science across the years. These ideas also don’t go away either. You can still find therapists and psychologists who are super into Freudian cocain bullshit.
Then there’s a lot of new age stuff. I mean basically anybody can say anything about human psychology and get an audience.
So that’s like, the base everything is built on. So we differentiate tested new ideas or reaffirmed ideas from all the noise.
So much of it is marketing
There are certain psychological treatments that are highly formulaic in nature and involve the therapist teaching the same steps over and over again
Because of this, they are easily analyzed via standard scientific methods and, as a result, can often claim to be the “only scientifically proven therapy for X”
That doesn’t actually mean anything about the success of the therapy, it just means that the therapy is amenable to the testing process. Cynically, they are also the therapies most likely to be replaced by ChatGPT
In my experience with therapy, I always got the least benefit out of the most formulaic treatments – and usually had to work the hardest at them
Medicine is hard. So what evidence-based medicine means that the practice is back up by evidence.
But why wouldn’t medicine be backed up by evidence and science/studies? Because some of medicine is backed by mechanism of action. We know that this condition is caused by this organism, therefore this antibiotic works for it. That makes sense to me, let’s treat it that way
But by the time the studies have been conducted (which takes years to decades based on conditions (heart failure vs infection), and often need numerous studies in different areas, as well as ethical approval, and there are so many confounding factors (studying heart failure for example can be hard, because you ideally want to control for diet, smoking, exercise, comorbidities)), we have been treating something something in a way for years, because we felt a need to do something
And then the question comes up, is what we were doing clinically significant. So we have studies that show that this med reduces cholesterol, which we know contributes partially vascular disease. But then decades later we discover, that though we are doing this, and are lowering cholesterol, ultimately clinically it didn’t matter, as the amount we lowered it by didn’t significantly increase lifespan (or affect how quickly something healed)
Indeed. And for most of its history, the amount of actual science behind psychotherapy has been – rather limited, shall we say?
A lot is cultural or a result of the space they work in.
Therapists can’t switch methods like a GP switches drugs, each method requires training. So that discourages experimentation, and switching methods. Also they’ll be less experienced at the new method, so even if it is more effective on average there may be a cost to switching.
Trials have to be large to eliminate effects of different therapists (and others involved in that patient’s care). If you had a therapist who was really good at convincing people to try new things it might be whatever arm they are on has more success despite the actual intervention being tested. So trials need to be larger, or longer, or more cross overs to remove or mitigate these, all of which makes them more expensive.
I think they’ll get there, but it will be slower, and more costly. I do think there is a risk we end up with interventions that test well. It may look a lot less like traditional psychotherapy that wasn’t based on evidence.
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