Evidence-Based Counselling and Psychological Therapies Evidence-Based Counselling and Psychological Therapies assesses the impact of the international drive towards evidence-based health care on NHS policy and the provision of psychological services in the NHS An outstanding range of contributors provides an overview of evidencebased health care and the research methods that underpin it, demonstrating its effect on policy, provision, practitioners and patients Their thought-provoking chapters look at a variety of relevant issues including: • • • • generating and implementing evidence cost-effectiveness practice guidelines practitioner research Evidence-Based Counselling and Psychological Therapies is essential for mental health professionals and trainees concerned with this movement which is having, and will continue to have, a huge impact on the purchasing, provision and practice of health care Nancy Rowland is the Research & Development Facilitator at York NHS Trust and is Head of Communication/Dissemination at the NHS Centre for Reviews and Dissemination at the University of York She is a member of the British Association for Counselling’s Research & Evaluation Committee Stephen Goss is an Honorary Research Fellow at the University of Strathclyde, a Counsellor at Napier University and a qualified counselling supervisor He is a member of the British Association for Counselling Practice Development Committee and Chair of their Research and Evaluation Committee Evidence-Based Counselling and Psychological Therapies Research and applications Edited by Nancy Rowland and Stephen Goss London and Philadelphia First published 2000 by Routledge 11 New Fetter Lane, London EC4P 4EE Simultaneously published in the USA and Canada by Taylor & Francis Inc 325 Chestnut Street, 8th Floor, Philadelphia PA 19106 Routledge is an imprint of the Taylor & Francis Group This edition published in the Taylor & Francis e-Library, 2001 © 2000 Nancy Rowland and Stephen Goss, editorial matter and selection; the contributors, individual chapters All rights reserved No part of this book may be reprinted or reproduced or utilised in any form or by any electronic, mechanical, or other means, now known or hereafter invented, including photocopying and recording, or in any information storage or retrieval system, without permission in writing from the publishers British Library Cataloguing in Publication Data A catalogue record for this book is available from the British Library Library of Congress Cataloging in Publication Data Evidence-based counselling and psychological therapies : research and applications / edited by Nancy Rowland and Stephen Goss p cm Includes bibliographical references and index Psychotherapy–Outcome assessment–Great Britain Mental health policy–Great Britain Evidence-based medicine–Great Britain National Health Service (Great Britain)–Administration I Rowland, Nancy, 1954– II Goss, Stephen, 1966– RC480.75 E95 2000 362.2'0941–dc21 ISBN 0–415–20506–9 (hbk) ISBN 0–415–20507–7 (pbk) ISBN 0-203-13160-6 Master e-book ISBN ISBN 0-203-18546-3 (Glassbook Format) 00–021257 To my parents Nancy Rowland To Catriona, Andrew and Lynn Stephen Goss Contents List of boxes List of tables List of contributors Preface ix xi xiii xvii JOHN GEDDES PART What is evidence-based health care? 1 Evidence-based psychological therapies NANCY ROWLAND AND STEPHEN GOSS The drive towards evidence-based health care 13 MARK BAKER AND JOS KLEIJNEN Towards evidence-based health care 30 BRIAN FERGUSON AND IAN RUSSELL Economics issues 44 ALAN MAYNARD Evidence-based psychotherapy: an overview GLENYS PARRY 57 viii Contents PART Generating the evidence Randomised controlled trials and the evaluation of psychological therapy 77 79 PETER BOWER AND MICHAEL KING The contribution of qualitative research to evidence-based counselling and psychotherapy 111 JOHN MCLEOD Rigour and relevance: the role of practice-based evidence in the psychological therapies 127 MICHAEL BARKHAM AND JOHN MELLOR-CLARK PART Synthesising the evidence Systematic reviews in mental health 145 147 SIMON GILBODY AND AMANDA SOWDEN 10 Clinical practice guidelines development in evidence-based psychotherapy 171 JOHN CAPE AND GLENYS PARRY 11 Getting evidence into practice 191 STEPHEN GOSS AND NANCY ROWLAND Index 207 Boxes 2.1 2.2 4.1 Journals and databases Articles, by country of origin The Williams checklist for interrogating economic evaluation 9.1 Family intervention for schizophrenia 9.2 Meta-analysis of treatment outcome for panic disorder 9.3 Stages in the systematic review process 9.4 Example of a hierarchy of evidence 9.5 Questions to guide the critical appraisal of a systematic review 11.1 Ways in which practitioners can enhance their involvement in EBHC 19 19 49 151 153 157 160 163 196 202 Stephen Goss and Nancy Rowland research process The formulation of research questions, study design, data collection and interpretation, presentation of the findings and collation of those findings into systematic reviews would all have to satisfy the requirements of each approach This can lead to a surprisingly complex set of processes as the differing paradigms must then constantly interact with each other to ensure that their respective contributions are sustainable from each perspective This has rarely been attempted but does raise the possibility of more fully meeting the needs of the various stakeholders in the output of evidence-based health care initiatives In addition to having greater utility for this wide range of stakeholders, outcome data would be more robust: being supported by a range of methods at every stage, the findings are unlikely to be undermined by the criticisms that protagonists from each perspective typically level at alternative approaches The evidence base as a whole, the clinical guidelines derived from it, and the clinical governance agenda driving EBHC would benefit from such pluralism and might more credibly meet the needs of practitioners and clients, policy-makers and service managers Shifting the balance of power As patients and purchasers become better informed and better able to demand appropriate, effective interventions, it is possible that EBHC may lead to a significant shift in the provision of psychological therapies In time, the general public and clients, as well as managers, purchasers, policymakers and clinicians, will all have access to information on who should be doing what, for whom and how This represents a fundamental shift in the balance of power from the expert educated few towards a more open, egalitarian body of knowledge EBHC has the potential to dispel much, if not all, of the myth and mystique of the psychological therapies How they work, who or what they are good for, what they cost and who should be providing them will be far more clearly discernible than has been the case so far CONCLUSION The unfolding of evidence and the resulting guidance in the psychological therapies has the potential to become one of the most significant revolutions in mental health care It is incumbent on the consumers of research and clinical guidance – purchasers, practitioners, managers and clients – to Getting evidence into practice 203 ensure that it is used appropriately In the end it will be its utility in routine care that will be the criterion of success for EBHC ACKNOWLEDGEMENTS We would like to acknowledge the contributions of Steve Page and Gladeana McMahon in preparing material on practitioner research, some of which has been included in this chapter REFERENCES Baker, M., Maskrey, N and Kirk, S (1997) Clinical Effectiveness and Primary Care Abingdon: Radcliffe Medical Press Bergin, A.E and Garfield, S.L (1994) Overview, trends and future issues, in A.E Bergin and S.L Garfield (eds) Handbook of Psychotherapy and Behaviour Change New York: Wiley Beutler, L.E (1991) Have all won and must all have prizes? Reviewing Luborsky et al.’s verdict Journal of Consulting and Clinical Psychology, 59: 226–232 Bohart, A.C., O’Hara, M and Leitner, L.M (1998) Empirically violated treatments: disenfranchisement of humanistic and other psychotherapies Psychological Research, 8(2): 141–157 Bond, T (1993) Standards and Ethics for Counselling in Action London: Sage Bryman, A (1984) The debate about quantitative and qualitative research: a question of method or epistemology? British Journal of Sociology, 235 (1): 75–92 Bryman, A (1992) Quantitative and qualitative research: further reflections on their integration, in J Brammen (ed.) Mixing Methods: Qualitative and Quantitative Research Aldershot: Avebury Clarkson, P (ed.) (1998) Counselling Psychology: Integrating Theory, Research and Supervised Practice London: Routledge Dale, F (1997) Stress and the personality of the psychotherapist, in V Varma (ed.) Stress in Psychotherapists London: Routledge Dryden, W (1994) Possible future trends in Counselling and Counsellor Training: a personal view Counselling, Journal of the British Association for Counselling, (3): 194–197 Duffy, M.E (1987) ‘Methodological triangulation: a vehicle for merging quantitative and qualitative research methods’ in IMAGE: Journal of Nursing Scholarship, 19(3): 130–133 Etherington, K (1996) The counsellor as researcher: boundary issues and critical dilemmas British Journal of Guidance and Counselling, 24 (3): 339–346 204 Stephen Goss and Nancy Rowland Goss, S.P and Mearns, D (1997) A call for a pluralist epistemological understanding in the assessment and evaluation of counselling British Journal of Guidance and Counselling, 25 (2): 189–198 Goss, S.P and Baldry, S (1999) Information technology – effects and consequences for counselling Presentation at the fifth BAC Research Conference, Leeds Greenhalgh, T (1999) Narrative based medicine in an evidence based world British Medical Journal, 318: 323–325 Howard, G.S (1983) Toward methodological pluralism Journal of Counselling Psychology, 30, (1): 19–21, cited in McLeod (1994) Jenkinson, C (1997) Assessment and evaluation of health and medical care: an introduction and overview, in C Jenkinson, Assessment and Evaluation of Health and Medical Care Buckingham: Open University Press Jick, T.D (1979) Mixing qualitative and quantitative methods: triangulation in action Administrative Science Quarterly, 4: 602–611 Kazdin, A.E (1994) Methodology, design and evaluation, in A.E Bergin and S.L Garfield (eds) Handbook of Psychotherapy and Behavior Change New York: Wiley Luborsky, L., Diguer, L., Schweizer, E and Johnson, S (1996) The researchers therapeutic allegiance as a ‘wildcard’ in studies comparing the outcomes of treatments Presentation at the 27th Annual Meeting of the Society for Psychotherapy Research, Amelia Island, Florida McLeod, J (1994) Doing Counselling Research London: Sage Mearns, D and McLeod, J (1984) A person-centered approach to research, in R.F Levant and J.M Schlien, Client Centered Therapy and the Person Centered Approach New York: Praeger Miles, M.B and Huberman, A.M (1984) Drawing valid meaning from qualitative data: toward a shared craft Educational Researcher, May: 20–30 Morrow-Bradley, C and Elliott, R (1986) Utilisation of psychotherapy research by practising psychotherapists American Psychologist, 41 (2): 188–197 Muir-Gray, J (1997) Evidence Based Health Care London: Churchill Livingstone Parker, M (1995) Practical approaches: case study writing Counselling, Journal of the British Association for Counselling, 6(1): 19–21 Rescher, N (1977) Methodological Pragmatism Oxford: Clarendon Press Rescher, N (1993) Pluralism Against the Demand for Consensus Oxford: Clarendon Press Richards, P.S and Longborn, S.D (1996) Development of a method for studying thematic content of psychotherapy sessions Journal of Consulting and Clinical Psychology, 64 (4): 701–711 Rosen, L.D and Weil, M.M (1998) The Mental Health Technology Bible London: John Wiley & Sons Tolley, K and Rowland, N (1995) Evaluating the Cost-Effectiveness of Counselling in Healthcare London: Routledge Getting evidence into practice 205 Sackett, D.L., Rosenberg, W.M.C., Grey, J.A.M., Haynes, R.B and Richardson, W.S (1996) Evidence based medicine: what it is and what it isn’t British Medical Journal, 312: 71–72 Shafi, S (1998) A study of Muslim Asian women’s experiences of counselling and the necessity for a racially similar counsellor Counselling Psychology Quarterly, 11 (3): 301–314 WHO Regional Office for Europe Working Group (1981) The Assessment of Competence of Students in the Health Field Varna: World Health Organization Wheeler, S and Hicks, C (1996) The role of research in the professional development of counselling, in S Palmer, S Dainow and P Milner (eds) Counselling: The BAC Counselling Reader London: Sage Index accountability, 7, 25, 38, 53 Agency for Health Care Policy and Research (AHCPR), 165, 172; depression in primary care guideline, 165, 173, 179, 180, 181, 182 alcohol problems: treatment comparisons, 32–3 see also Cochrane Drugs and Alcohol Group allegiance effects, 99, 128, 200 American Psychiatric Association (APA), 180 analytic issues, randomised controlled trials, 96–9 anxiety: efficacy evidence, 64; limitations of self-report measures, 114–15 see also Cochrane Depression, Anxiety and Neurosis Group assimilation model, 66 attention-placebo control groups, 84 attrition, 91–2, 96 audit(s), 25, 59, 133; outcomes auditing, 137; as part of everyday work, 198; use of clinical practice guidelines, 70, 172, 179; weak effect on professional behaviour, 70–1 baseline equivalence (patient characteristics), 91 Beck Depression Inventory (BDI), 95, 98, 113, 114, 115, 140 behavioural therapies, 70, 84 see also cognitive behavioural therapies benchmarking, 59, 133, 134, 135–6; outcomes, 135, 137 ‘benchmarking’ research strategy, 134 Bennett, D., 70 Bergin, A E., 111, 201 Berwick, D.M., 35–6 Beutler, L E., 70 bias, 33, 52, 85–6, 96, 98–9, 128; minimising, 200; in systematic reviews, 158, 159–60; in traditional review articles, 148 Birch, S., 36 blind trials, 83, 112 Brief Symptom Inventory, 95 British Association for Counselling, 183, 184 British Confederation of Psychotherapy, 184 British Psychological Society, 184; Centre for Outcomes Research and Effectiveness, 69, 183 Calman/Hine report, 25 Camden and Islington Medical Audit Advisory Group (MAAG) local guideline, 180, 181–3 Campbell, D T., 113 Cape, J., 185 Care Programme Approach, 18, 138, 139 carers, 6, 30, 168; experience as 208 Index performance indicator, 26; involvement in systematic reviews, 166, 167 Cartwright, D S., 113 case studies, as evidence, 197 causal studies, 79, 83, 85 Centre for Evidence-based Medicine, 20 Centre for Evidence-based Mental Health, 20 Centre for Evidence-based Nursing, 21 Centre for Health Information Quality (CHIQ), 167 Centre for Reviews and Dissemination (CRD) see NHS Centre for Reviews and Dissemination child abuse, qualitative study of counselling, 120 child psychotherapy, efficacy studies, 130 Clarke, A., 36 Clarkson, P., 193 clients see patients/clients clinical governance, 6–7, 38–9, 46, 100, 135; definition criticised, 53–4; key elements, 25; role of Health Authorities, 7, 37, 38–40 clinical judgement, 101–2, 176, 177, 199 clinical practice guidelines, 11–12, 37, 38, 46, 59, 68, 70, 100, 133, 171–90, 192; and clinical judgement, 102, 176, 177, 199; criticisms answered, 176–7; dangers of mechanism, 6, 36, 40, 176; definition, 172; desirable attributes, 177–8; development, 174–6; examples, 179–85; facilitating use, 178–9; future directions, 185–6; need to relate to cost-effectiveness, 47, 54 Clinical Psychology: Science and Practice, 59 clinical significance criteria, 97–8, 140 clinician-rated scales, 95 Cochrane, Archie, 21, 31, 32, 37, 47, 96 Cochrane Collaboration, 5, 11, 17–18, 21–3, 63, 141, 147, 149–50, 164, 168; review abstract example, 151 Cochrane Collaboration in Effective Professional Practice (CCEPP), 70–1 Cochrane Database of Systematic Reviews, 152 Cochrane Dementia and Cognitive Impairment Group, 22, 150 Cochrane Depression, Anxiety and Neurosis Group, 22, 150 Cochrane Drugs and Alcohol Group, 22 Cochrane Library, 24, 52, 149 Cochrane Schizophrenia Group, 22–3, 150, 167 cognitive therapy: competency based training, 70; depression in primary care, audit proforma, 179; dismantling study, 85; panic disorder, 185 cognitive behavioural therapies (CBT): alcohol problems, comparative study, 32; availability of research, 58, 68, 177; competency based training, 70; depression, comparative study, 15–16; dismantling study, 85; panic disorder, systematic review, 153–6; psychotic illness, 15; relevant outcomes, 174; selection of patients, clinical guideline, 181–3 cognitive schema, effects of self-report questionnaires, 114–16 combined treatments: depression, 64, 181, 182; panic disorder, 153–6 Commission for Health Improvement (CHI), 6, 26, 39, 46, 54, 55, 192 common factors research, 65–6 community health care, 16, 46, 58 comparative studies, 79, 84–5; benefits of randomisation, 32–3; depression treatments in general practice, 15–16; difficulties of randomised control trial design, Index 209 128; effects of researcher llegiance, 200; format differences, 92; individual case decisions, 67–8; problems of cost minimisation analysis, 48–50; sample size, 97; use of observational methods, 32–3, 170; use of qualitative methods, 122 comparison (experimental), 82–4 comparison groups, 82, 85 competency based training, 70 component analyses see dismantling studies computer support, 71, 173 confounding variables, 80 Consumers Report survey, 65 ‘content experts’, 148 control (experimental), 63, 81–2 control groups, 82–3, 85, 112 controlled before-and-after (CBA) studies, 33, 86 CORE (Clinical Outcomes in Routine Evaluation) Outcome Measure, 137, 140 CORE (Information Management) System, 138; interface with FACE System, 138–9 cost-benefit analysis (CBA), 51 cost-effectiveness see efficiency cost-effectiveness analysis (CEA), 50–1 cost minimisation analysis (CMA), 48–50 cost utility analysis (CUA), 51 counselling, 57; for child abuse, qualitative study, 120, 123; for depression, comparative study, 15–16; ‘disenfranchisement’ of humanistic, 196; provision in primary care, 39; selection of patients, clinical guideline, 181–3; use of more than one treatment orientation, 185 Crits-Cristoph, P., 70 data synthesis, systematic reviews, 161 Database of Abstracts of Reviews of Effectiveness (DARE), 11, 23, 147, 149, 150–2, 164, 168; abstract example, 153–6 Davenhill, R., 59 Department of Health (DoH), 8, 13, 15, 171, 177; clinical guidelines document, 177 mental health policy, 16 dependent variables, 80 depression: HCPR primary care guideline, 165, 173, 179, 180, 181, 182; comparative studies, 15–16, 128; effectiveness of counselling, 39; efficacy evidence, 64; number of sessions, field replication, 129; patient preference of treatment, 175; problems of self-report measure, 114–15 see also Cochrane Depression, Anxiety and Neurosis Group diagnosis see psychiatric diagnosis Didden, R., 164 disease costing, 48 dismantling studies (component analyses), 85, 92 ‘Dodo bird verdict’ (‘caucus race’ conclusion), 83–4, 192 drug (pharmacological) treatments, 100, 103; AHCPR guideline on depression, 181, 182; blind trials, 83; depression in primary care, audit proforma, 179; panic disorder, systematic review, 153–6; research funded by drug companies, 28, 52, 164–5, 166; risperidone, 166, 167; weakness of non steroidal anti-inflammatory drug trials, 53 Drummond, M F., 48 Dryden, W., 194 DSM-IV, 94 Dale, P., 14, 120, 121, 122, 123 data extraction, systematic reviews, 160 ecological validity, 87 economic evaluation techniques, 7, 48–53, 96 210 Index economics-based health care (EcBCH), 7, 44–56 educational outreach, 71 effect size (ES), 130, 131 Effective Health Care (EHC) bulletins, 23, 39, 152; Getting Evidence into Practice, 15, 168; Implementing Clinical Practice Guidelines, 177; Treatment of Depression in Primary Care, 179 effectiveness (clinical utility, health gain): addressed by NHS research programmes, 34; distinguished from efficacy, 52, 64, 88; and economic evaluation, 52–3; efficacy-effectiveness continuum, 128–34; improved by clinical practice guidelines, 173; as key element of evidence-based health care, 6, 30, 31, 32, 58, 79, 99, 194; need for national databases, 141; as performance indicator, 26; policy initiatives encouraging, 37; practice-based evidence, 10, 134–41; qualitative evaluation, 9, 111, 117–23; and resource allocation, 45–6, 60–1, 192; similarity of psychotherapies, 83–4, 192–3 Effectiveness and Efficiency (Cochrane), 99 Effectiveness Matters (EM) bulletins, 23 efficacy: as basis of validated treatments, 60; difficulties inherent in studies, 127, 128; distinguished from effectiveness, 52, 63, 64, 88; efficacy-effectiveness continuum, 128–34; evidence now available, 64; outcomes paradigm in studies, 140 efficiency (cost-effectiveness, resource effectiveness): addressed by NHS research programmes, 34; as key element of evidence-based health care, 6, 30, 31, 32, 58, 194; need for guidelines based on, 7, 47, 54; as performance indicator, 26; policy initiatives encouraging, 37; and resource allocation, 7, 44–7, 60–1, 192 Eli Lilly National Clinical Audit Centre, 179, 183 equipoise, 90 ethnicity, 174 see also race evidence-based health care (EBHC), 30, 31–2, 58, 99; beginnings, 13; challenge to practitioners and managers, 191–2; components of practice, 30; contribution of the NHS Research & Development strategy, 13–16, 34; definitions, 4, 6, 32; future in the psychological therapies, 199–202; and health care costs, 15; implementation, 5, 6, 15, 25, 37–40, 192–6; importance of evaluation, 79; limitations, 100–1, 199; monitoring, 26; proliferation of information, 17–18; successive phases, 127; threats to, 6, 35–7; vs evidence-based medicine, 34–5 evidence-based medicine, 18–24; beginnings, 19, 58; criticism, 66; definitions, 4, 18, 35; development of concept, 17; support for clinical judgement, 177; vs evidencebased health care, 34–5 Evidence-Based Medicine, 17 Evidence-Based Mental Health (Evans et al), 141 Evidence-Based Nursing, 21 evidence-based psychotherapy: case against, 66–8; future of, 68–71, 199–202; need for, 61–2; overview 7–8, 57–75 evidence-based public health, 26–7 expectancy artefacts (placebo effects), 83 experimental studies, 80–1 explanatory trials, 62, 87; contamination, 92; on-treatment analyses, 97; patient populations, 94 exposure therapy, 185 external validity, 68, 81, 98, 131, 134; conflict with internal validity, 62, 87; weakness of randomised Index 211 controlled trials, 63, 93, 100–1, 103, 112 Eysenck, H., 79, 129 FACE (Functional Analysis of Care Environments) Assessment and Outcome System, 138; interface with CORE System, 138–9 fairness (equity): hopes for Service Delivery and Organisation programme, 34; as key element of evidence-based health care, 6, 30, 31, 32, 36, 194; as performance indicator, 26; promoted by clinical practice guidelines, 173–4 family intervention for schizophrenia, review abstract, 151 family therapy, qualitative study, 117–19, 121 First Class Service, A (White Paper), 24, 28, 38 Firth-Cozens, J A., 71 Fiske, D W., 113 follow-ups, 91–2; long-term, 96 Fonagy, P., 62, 111, 112 foreign language studies, 159 Garfield, S L., 111, 201 general practice, 58; comparison of depression treatments, 15–16; computerised clinical guidelines, 173 see also Primary Care Groups General Practitioners (GPs), 16, 39, 45, 57; clinical guidelines for, 180, 181–5; financial incentives, 35; usual care as control, 85 Glass, G V., 148–9 Gold, M R., 48 Golombiewski, R T., 116 Gøtzche, P E., 53 Greenhalgh, T., 199 grey literature, 158, 198 Grimshaw, J M, 173, 178 Guyatt, G H., 184 Hamilton Rating Scale for Depression, 95, 140 Harrison, S., 37 Health Authorities, 14, 35; implementation of evidence-based health care, 16, 34, 39–40; resource allocation, 37, 44; role in clinical governance, 7, 37, 38–40 Health Economic Evaluation Database (HEED), 52 Health Improvement Programme (HImP), 16, 37, 38 Health of the Nation Outcome Scales (HoNOS), 137, 139 Henry, W P., 112 Hicks, C., 193 Hoagwood, K., 133–4 ‘hour-glass’ model, 101, 132 House of Lords, 13; Select Committee on Science and Technology, 34 Howard, G.S., 116, 121, 123 Howard, K I., 66 Howe, D., 117–19, 121, 122 Illsley, Raymond, 33 ‘implicit personality theory’, 114 impression management, 114–15 independent variables, 80 Institute of Medicine, 177 integrative treatment guidelines, 185–6 intention-to-treat analyses, 97 internal validity, 63, 81, 131, 134; conflict with external validity, 62, 87 intervention axis, 133 item response processes, 114–16 Jacobson, N S., 140 Jefferson, T., 48 Jenkinson, C., 193 Journal of Consulting and Clinical Psychology, 112 Journal of Evidence-based Mental Health, 20 Journal of the American Medical Association (JAMA), 18 Kazdin, A E., 201 Korean War, 50 Lambert, M J., 112, 113 212 Index language bias, 159 large sample surveys, 64–5 lifelong learning, 25, 36, 41, 194 Linehan, M M., 132 literature searching, 156–8 Luborsky, L., 70, 200 McKee, M., 36 McKenna, P A., 117, 119–20, 121 McLeod, L, 201 McMaster University, Canada, 17, 58, 177 ‘managed care’, 60, 100 management: challenges of economics-based health care, 47, 54; challenges of evidence-based health care, 191–2; improving mental health services, 27; involvement in evidence-based practice, 192–6; ‘new NHS’ framework, 24–7 manualised treatments, 63, 93, 100, 112, 133 measurement issues, 127, 137 Meier, S T., 113 mental health: Centre for Evidence-Based Mental Health, 20; criticism of policy, 5, 16; improving services management, 27; influences outside treatment, 80; as national priority, 17; NHS Research & Development programme, 14, 15–16; systematic reviews, 147–70; use of meta-analysis, 148–9 Mental Health Foundation, 58 meta-analyses, 58, 99, 148–9; compared with qualitative synthesis, 161; depression treatments, 64; effects of psychological treatment, 97; inappropriate use, 163–4; treatment outcome for panic disorder, 153–6 method factors, 113 methodological pluralism, 123–4, 201–2 Miles, A., 66 Miller, I J., 66 minimisation, 91 Minnesota Multi-phasic Personality Inventory (MMPI), 113 modelling, 52 Motivational Enhancement Therapy (MET), 32–3 Muir-Gray, J., 191 Mulrow, C D., 148 Munoz, R F., 181 Murphy, M K., 175 narrative accounts of therapy, 121 National Framework for Assessing Performance (NFAP), 36 National Institute of Clinical Excellence (NICE), 5, 24–5, 26, 37, 46, 54, 55, 171–2, 192 National Research Register, 14, 24 National Service Frameworks, 6, 25, 26, 37, 61 National Survey of Patient and User Experience, 26 naturalistic studies see observational studies need, 45, 47 New and Emerging Technologies programme, 34 New NHS, The (White Paper), 15, 16, 37, 38 NHS, 171; health care reform, 3; incentives to efficient practice, 53–4; need for clinical performance data, 36; need for shift in culture, 35–6; ‘new NHS’ framework, 24–7; rationing, 37, 44–7; strategic goals in Wales, 31 NHS Centre for Reviews and Dissemination (CRD), 5, 14, 23–4, 27, 52, 63, 149, 192; systematic review guidelines, 152, 158 NHS Economic Evaluation Database (NEED), 23, 52 NHS Executive Review of Strategic Policy, 59–60, 133, 137; criticism, 67 NHS Health Technology Assessment (HTA) programme, 14, 23, 34 NHS National Research Register, 152 Index 213 NHS Patient Partnership Strategy, 167 NHS Performance Assessment Framework, 38 NHS Research and Development (R & D) strategy, 5, 13–16, 27–8, 31, 33, 34, 37 NHS Trusts, 34, 35; clinical governance, 25, 38, 39, 40, 46; mental health management, 16, 27 non steroidal anti-inflammatory drugs (NSAIDs), 53 nursing: Centre for Evidence-based Nursing, 21 observational (naturalistic) studies, 9, 80, 101, 127; large sample surveys, 64–5; limitations 32–3, 62–3, 80 Office of Health Economics, 52 Office of Technology, 132 on-treatment analyses, 97 opinion leaders, 71 Our Healthier Nation (Green Paper), 17, 26–7 outcome axis, 134 outcome studies: efficacy and effectiveness, 129, 133; need for methodological pluralism, 111, 123; quantitative techniques critiqued, 111–17; use of qualitative techniques, 111, 117–24 see also causal studies; comparative studies; observational studies; quasi-experimental designs; randomised controlled trials outcomes: auditing, 137; clarification for clinical practice guidelines, 174; clinical relevance, 10, 28, 68, 97–8, 139–41, 165–6; links to process, 65; measurement in randomised controlled trials, 94–6; need for contextual information, 136; as performance indicators, 26; suicide as measure, 17 see also CORE outcome measure; FACE Assessment and Outcome System Oxman, A D., 184 panic disorder: integrative guideline, 185–6; meta-analysis of treatment outcomes, 153–6 Parry, G., 58, 63 patient allocation, 88–90 patient motivation, 90 patient populations, 63, 93–4, 178 patient preference, 64, 68, 101, 175 patient preference trials, 90–2, 112 patients/clients, 4, 8, 11, 202; criteria for access to care, 45; experience as performance indicator, 26; as individuals, 102; involvement in guideline development, 175; involvement in systematic reviews, 166; research-based information leaflets, 167, 168; response to interviews, 118, 119, 120, 121–2; response to self-report measures, 114–16; right to effective treatments, 61; selection for appropriate treatment, clinical guideline, 181–3; use of clinical practice guidelines, 172, 173; variable benefit from care, 36 Patrick, M., 59 Paulhaus, D L., 114, 115 Persons, J B., 180, 181 pharmaceutical industry (drug companies), 28, 48, 52, 164, 166, 176 phase model, 66 placebo effects (expectancy artefacts), 83 pluralist research, 201–2 policy: criticism of mental health, 5, 16; implications of economicsbased health care, 53–4, 54–5; management and implementation initiatives, 6–7, 24–7, 37–40; psychotherapy provision, 59–60; relevance of practice research networks, 135 population health, 7, 45, 46, 54, 55 population validity, 87 post-traumatic stress disorder, integrative guideline, 185 214 Index Power, M., 66 power of studies, 96–7 practice-based evidence, 10, 127, 134–41 practice research networks (PRNs), 8, 10, 69, 134–6, 198 practitioner allegiance, 193 practitioner-patient relationship, 45, 47 practitioners: access to systematic reviews, 11, 167, 168; challenges of evidence-based health care, 191–2; contributions to the evidence base, 196–8; differences with academics’ views, 100; involvement in evidence-based practice, 12, 192–6; involvement in systematic reviews, 166; training needs, 69–70, 195; use of clinical practice guidelines, 172, 173 see also therapists pragmatic trials, 62, 87–8; contamination, 92; intention-totreat analyses, 97; patient populations, 94 prejudice studies, 116 Primary Care Groups (PCGs), 16, 35, 46; clinical governance, 7, 25, 38, 39, 40; resource allocation, 37, 44 process studies, 65, 101; efficacy and effectiveness, 129, 133 Project MATCH, USA, 32 psychiatric diagnosis, 66–7, 94, 100 psychoanalytic therapies, 84; competency based training, 70; relevant outcomes, 174; research evidence, 64, 68, 177 psychodynamic therapy: competency based training, 70; panic disorder, 185; patient selection, 182–3 psychological therapies (psychotherapies): culture of conservatism, 193; deciding between therapies, clinical guidelines, 181–3, 183–5, 185–6; definitions, 4, 57; descriptive dimensions, 92–3; diversity, 11–12, 164; main approaches, 92; problems of consensus, 175; similar effectiveness, 83–4, 192–3; weakness and gaps in research, 28, 64, 68, 148–9, 164–5, 175–6, 177 see also evidence-based psychotherapy Psychotherapy Research, 59 psychotic illness, 15 qualitative research, 9–10, 65, 101, 111, 117–24; logic of, 120–3; as part of practitioner contribution, 197–8; role not addressed in systematic reviews, 165 qualitative synthesis, 161 quality adjusted life years (QALYs), 45–6, 51, 61 quality evaluation, 10, 127, 136–9 quantitative research; combining with qualitative, 123, 201–2; criticism, 67, 111–17 quasi-experimental designs, 33, 86 race, 198 see also ethnicity randomisation, 33, 63, 85–6 randomised/randomised controlled trials (RCTs), 6, 8–9, 16, 21–2, 31, 32–4, 62, 63, 68, 79–110, 111–2, 128; as basis of clinical practice guidelines, 174; evaluation logic, 120–1; limitations, 10, 63–4, 100–3, 112, 128–31, 165, 176; psychotic illness, 15; use in economic evaluation, 52; use in systematic reviews, 148 rationing, 7, 37, 44–7; distinguished from evidence-based medicine, 19–20 reflective practice, 196–7 reliability, 94 reliable and clinically significant change (RCSC), 140 replication studies, 98–9, 129 representativeness, 129–31 research design, 67–9, 86–103 researcher allegiance, 99, 128, 200 risperidone, 166, 167 Rochon, P., 53 Roth, A D., 59, 62, 63, 111, 112, 185 Index 215 Royal Australian and New Zealand College of Psychiatrists, 180 Royal College of General Practitioners, 184; Clinical Practice Guidelines Programme, 183 Royal College of Psychiatrists, 184; Clinical Guidelines Programme, 183; monograph on clinical practice guidelines, 175; Psychotherapy Section, 183 Russell, I T., 173, 178 Sackett, D L., 4, 18, 19–20, 35 Salkovski, P M., 132 sample size: and baseline equivalence, 91; and power of a study, 96–7 Saving Lives: Our Healthier Nation (White Paper), 27 schizophrenia: poor quality of research, 28, 166; predominance of drug treatment research, 28, 165; review abstract of family intervention, 151 see also Cochrane Schizophrenia Group Schulberg, H C., 181 Schwartz, N., 122 ‘scientist-practitioner’ model, 58, 99 Second Sheffield Psychotherapy Project, 129 selection bias, 33, 85–6, 88–90, 96; in systematic reviews, 158 self-deception, 114–15 self-report measures, 95, 112; limitations, 9, 113–17, 121 see also CORE outcome measure Seligman, M E P., 65 Service Delivery Organisation (SDO) programme, 34 Shadish, W R., 131 Shafi, S., 198 Shapiro, D A., 60, 128 single-case studies, 62–3 Social Behavioural Network Therapy (SBNT), 32–3 social cost calculation, 48 social desirability (SD), 114–15 Society for Psychotherapy Research Northern England collaboration, 69 spontaneous remission, 82 statistical significance, 97; and clinical meaningfulness, 140, 166–7 Stiles, W B., 60 stratification, 91 study protocol, 82 subgroup analyses, 98 suicide, 22, 26; as outcome measure, 17; risk assessment, 67 supervision, 197 surveys see large sample surveys Symptom Check List-90-R, 140 systematic reviews, 11, 23, 68, 99, 147–70; as basis of clinical practice guidelines, 174; dissemination, 23, 161, 167–8; impact throughout health care, 192; minimising bias, 200; need for, 147–9; process stages, 152–61; sources of, 149–52; strengths and limitations, 161–8 technology transfer model, 132 therapeutic alliance, 63, 65, 70, 100, 112 therapists: clients’ criticism in in-depth interviews, 121–2; confounding with therapy, 93; qualities, 98, 112 see also practitioners time-line technique, 119, 121 Todd, D M., 117, 119–20, 121 training needs, 69–70, 195 treatment development model, 132 Truax, P., 140 Twelve-Step Facilitation, 32 UK Alcohol Treatment Trial (UKATT), 32–3 UK Cochrane Centre, 14, 22, 27 UK Council of Psychotherapy, 184 UK Medical Research Council (MRC), 162 University College London, 69 University of Leeds Psychological Therapies Research Centre, 69 216 Index USA, 185; access to health care, 46; clinical practice guidelines, 171, 172, 174, 180; Consumer Report survey, 65; criteria of suitability for psychotherapy, 173–4; definition of practice research networks, 135; development of cost-effectiveness analysis, 50; Project MATCH, 32 validated treatments movement, 60, 199 validity, 94; assessment for systematic reviews, 159–60 see also external validity; internal validity validity axis, 133–4 varicose vein interventions, 48–9 waiting-list controls, 83, 88, 90, 92, 112 Wheeler, S., 193 Williams, A., 48, 51 World Health Organization, 201 YAVIS factors, 174 Zelen, M., 91 .. .Evidence-Based Counselling and Psychological Therapies Evidence-Based Counselling and Psychological Therapies assesses the impact of the international drive towards evidence-based. .. Association for Counselling Practice Development Committee and Chair of their Research and Evaluation Committee Evidence-Based Counselling and Psychological Therapies Research and applications... Publication Data Evidence-based counselling and psychological therapies : research and applications / edited by Nancy Rowland and Stephen Goss p cm Includes bibliographical references and index Psychotherapy–Outcome