Evidence-Based Treatment

Evidence-Based Treatment In recent years, more and more studies seem to indicate, and more clinicians have been persuaded, that particular therapies are suited for particular mood and anxiety disorders. In several large-scale clinical trials, the National Institute for Mental Health established that drug treatments, cognitive therapy (CT), and interpersonal therapy (IPT) each led to improvements in approximately 70% of depressed individuals, and further that CT was more successful than drug treatment in preventing relapse (Elkin et al., 1989; Shea et al., 1992). Studies of anxiety disorder have supported the following effi cacies (Baez, 2005): General anxiety disorder: relaxation techniques and CT Obsessive-compulsive disorder (OCD): exposure, cognitive-behavioral therapy (CBT), and response prevention Panic disorder: in vivo exposure, CBT, and applied relaxation PTSD: exposure, stress inoculation, and eye movement desensitization and reprocessing (EMDR) Social anxiety: social skills training, relaxation methods, exposure, CBT, and group treatment Specifi c phobias: in vivo exposure, CBT, and systematic desensitization.

Such fi ndings cannot be ignored. Even Martin Seligman, who raises caveats
about the limitations of controlled trials, nevertheless endorses EBT in fl atly
asserting that failing to provide a mood-stabilizing medication for bipolar
disorder is tantamount to malpractice, and one should “beware of any other
form of treatment [besides drugs, electroconvulsive therapy, CT, and IPT] for
unipolar depression” (Seligman, 1993).
Still, there are reasons to be cautious about jumping on the EBT bandwagon,
especially within the college mental health setting. EBT studies generally last
for 20 sessions of uninterrupted treatment, whereas college counseling is usually
far shorter and hardly regular. EBT clinical trials exclude individuals who
have more than one diagnosis, whereas college counseling patients, as noted
above, may have several diagnoses, none at all, or at least no consistent diagnosis
over time. EBT studies based on randomized controlled trails don’t pay
attention to individual diff erences or necessary modifi cations in treatment
(Silberschatz, 1999). EBT treatments are conducted on adults, not college-age
people, and ordinarily don’t take into account developmental stressors or cultural
factors, glaring omissions to any college clinician. EBT studies appear
to be unfair to psychodynamic therapies, which, despite some attempts at
manualizing, generally don’t lend themselves to clinical trials. Perhaps most
important, EBT trials concentrate on methods while giving short shrift to the
therapeutic relationship. Several leading psychotherapy researchers (Norcross,
2002; Wampold, Lichtenberg, & Waehler, 2002) and most practicing therapists
would argue that the bond between patients and therapists is an essential, if
not the chief, active ingredient in psychotherapy.
Th at said, college clinicians obviously should heed any research fi ndings
that point the way to successful interventions. Our own centrist view, similar
to our conclusion about assigning diagnoses, is that empirically supported
treatments off er useful guidelines but must be fl exibly applied, bearing in
mind that each case is a fresh therapeutic challenge. Many of the principles
and strategies discussed in this chapter are in the spirit of EBT practices
within CT, behavior therapies, and IPT.