One of our core values at Anxiety Specialists of St. Louis is to provide evidence based practice. What is evidence based care and why does it matter?
Evidence based practice involves three pieces: (Sackett, 2000)
- Research and data
- Your own values and preferences as a patient
- Your therapist’s clinical experience
When we use evidence-based practices, we are blending these pieces of information to get you the best outcomes.
This means a few things.
First, it means that we select treatment interventions and develop treatment plans based on research evidence. We use mostly Cognitive Behavioral Therapy (CBT) and Exposure and Response Prevention (ERP) for anxiety and OCD. These approaches are structured, skills-based, and often more focused than other types of supportive talk therapy. We use these approaches because research suggests that they help people decrease symptoms.
Second, once treatment starts, we continue to use data to make decisions about how treatment is going and to make adjustments as needed. To do this, we use a system called Mirah. Below, I’ll explain what research and data we consult, how it improves treatment outcomes, and how we use Mirah to integrate it into our practice.
What is evidence-based care?
Evidence-based care is a term used to describe the process of making clinical decisions based on the best available scientific evidence.
When we meet with a client for the first time, we ask a lot of questions. This helps us make determinations about symptoms and disorders, which in turn helps us choose treatments based on research.
We use interventions based on evidence from studies that have suggested that a set of specific interventions are helpful for a specific set of symptoms. We consult peer-reviewed, scientific journals and resources provided by professional organizations like the Association of Behavioral and Cognitive Therapies, American Psychological Association, or the International OCD Foundation.
While results are never guaranteed, using data about these treatments allows us to make decisions about what is most likely to be effective for you.
A huge caveat to the discussion on evidence-based care: Underrepresentation of minority groups
It’s important to point out that minority groups are not adequately represented in research studies. This is a problem. Research studies historically over represent white, cisgender, heterosexual, younger, able-bodied, middle and high socioeconomic status groups. This has real implications for research studies because without more studies, we can’t be certain that the findings apply to other groups. We need to do better and include a much better, broader representation of all people in future research. In the meantime, we operate with the best available data that we have, considering the way that information might be limited.
Our goal is to collect data directly from you so that we can provide the most effective treatment possible, despite the fact that more research needs to be done to support those from underrepresented communities.
Why does evidence-based care matter?
Evidence-based care is important because it helps to increase chances that clients receive the most effective care possible (again, to the extent that adequate, representative research exists). In some cases, it also motivates healthcare providers to justify their decisions about the treatment they selected and why.
How does tracking progress improve outcomes?
There is some research that suggests that tracking progress improves treatment outcomes in mental health, primarily by speeding up progress.
One study found that when therapists providing Cognitive Behavioral Therapy (CBT) collected regular feedback, clients needed fewer sessions.(Janse et al., 2018). Another study also found that when therapists collected feedback and reviewed this with their clients, clients saw improvements in depression and anxiety in fewer sessions than those who did not have feedback (Delgadillo et al, 2017).
These studies suggest that tracking progress can be an effective way to improve treatment outcomes, mostly by reducing the number of sessions needed to see improvement.
In addition to the research evidence, there are several reasons why tracking progress might improve treatment outcomes.
First, by monitoring symptoms and progress toward treatment goals, therapists can determine if clients are receiving the right treatment.
If the treatment doesn’t seem to be working, we can talk about what’s going on. This might mean that the therapist needs to make changes to the treatment they’re providing or it might mean that something is getting in the way of the client being able to stick with the treatment. In CBT, this usually means that something is interfering with homework. It’s also possible that some adjustment needs to be made to the dose of treatment. For example, if symptoms are more severe, a once weekly “dose” of therapy might not be adequate, and a referral to an intensive outpatient or residential program might be more helpful.
Second, tracking progress can help to improve collaboration in treatment. When clients know that their progress is being monitored and they’re able to see their symptoms change (or not), they are more likely to be involved. This can lead to better outcomes.
Overall, there is some research evidence to suggest that tracking progress can improve treatment outcomes in mental health. There are several reasons why this might be the case, including the fact that tracking progress can help to ensure that patients are receiving the right treatment, identify patients who are not responding to treatment, improve patient engagement in treatment, and improve communication between providers and patients.
What is Mirah?
We use Mirah to track client progress in treatment. Mirah provides software that allows us to communicate with you before every session to check in about symptoms. Your information is then used to create reports for you and your therapist.
What can I expect as a client?
Mirah invites clients to self-report on their symptoms and functioning prior to their next session by completing clinically relevant measures. Clients are asked to complete a short survey via email or text prior to each scheduled session. The survey includes questions about recent stressors, symptoms of depression and anxiety, and progress on unique therapy goals. The therapist reviews the results before every session and then discusses them with the client about once a month in session.
Participation is totally voluntary, but we strongly believe that knowing more about a client’s experience on a regular basis will help us to provide better treatment.
What happens to my data?
Data is then integrated into visualizations and reports for the therapist to review and monitor progress.
Reports include a number of different symptom scales related to anxiety, depression, relationships, and other strengths and resilience.
When clients report an elevation in symptoms, Mirah flags these for prompt intervention. Similarly, Mirah highlights progress and shows providers and clients what’s working well. These reports form the basis of treatment planning and making adjustments to treatment as needed, so clients get the best care possible.
Please feel free to reach out here with any questions or to schedule your free, 15-minute consultation call.
Sackett DL, Straus SE, Richardson WS, Rosenberg W, Haynes RB. Evidence-based medicine: How to practice and teach EBM (2 edition). New York: Churchill Livingstone; 2000. [Google Scholar]
Delgadillo, J., Overend, K., Lucock, M., Groom, M., Kirby, N., … de Jong, K. (2017). Improving the efficiency of psychological treatment using outcome feedback technology. Behaviour Research and Therapy, 99, 89–97.
Janse, P. D., De Jong, K., Van Dijk, M. K., Hutschemaekers, G. J. M., & Verbraak, M. J. P. M. (2017). Improving the efficiency of cognitive-behavioural therapy by using formal client feedback. Psychotherapy Research, 27(5), 525–538. http://dx.doi.org/10.1080/10503307.2016.1152408