Efficacy vs. Utility
RCT
data are extremely useful for allowing us to identify certain therapies as
“empiri-cally supported treatments.” But some authors are skeptical about the
reliance on RCT data (Nathan et al., 2000; Westen & Bradley, 2005; Westen,
Novotny, & Thompson-Brenner, 2004; Zimmerman, Mattia, & Posternack,
2002). Specifically, they argue that an RCT might inform us about a therapy’s efficacy (whether it works in carefully
designed tests) but might not tell us about its clinical utility (whether it works in more typical circumstances;
APA Presidential Task Force on Evidence-Based Practice, 2006).
We
have already considered one of the bases for this concern—the reliance on
manualized therapy. A different concern hinges on the patient groups used in
many RCT studies. We discussed earlier the need for reasonably uniform patient
groups in an RCT—people whose disorders are relatively uncomplicated by other
problems. This uniformity allows us to ask whether our therapy works for people
in a well-defined group, but it undermines external validity. Many of the
people who seek out therapy do not have a clear diagnosis, and, if they do, the
diagnosis may be complex. That is because many forms of mental disorder have
high rates of comorbidity—they occur
together with some other disorder. Thus, for example, there is considerable
comorbid-ity between anxiety and depression disorders—someone who has one often
suffers from the other as well. As a result, the RCT data may tell us what
happens in therapy with “pure” cases, but not what happens in the (much more
common) mixed cases encountered in most clinics.
For
these and other reasons, we must combine RCT data with other sorts of data,
including studies of ordinary clinical practice, case studies, studies of the
actual process of change within psychotherapy, and more (APA Presidential Task
Force on Evidence-Based Practice, 2006; Shadish et al., 1997). This broader
package of evidence will help us under-stand whether therapy as it is usually
practiced, with more typical patients, has the desired effects; it will also
tell us whether the worries about manualized therapy are justified.
Related Topics
Privacy Policy, Terms and Conditions, DMCA Policy and Compliant
Copyright © 2018-2024 BrainKart.com; All Rights Reserved. Developed by Therithal info, Chennai.