Professional Psychology: Research and Practice Copyright 2008 by the American Psychological Association

2008, Vol. 39, No. 6, 658 – 662 0735-7028/08/$12.00 DOI: 10.1037/0735-7028.39.6.658

Evidence-Based Practice in Psychology

Ronald F. Levant and Nadia T. Hasan
University of Akron

This article focuses on the 2005 American Psychological Association Presidential Task Force on
Evidence-Based Practice in Psychology. After describing the rationale and results of this task force, the
authors review the literature that has appeared following the approval of the Policy Statement on
Evidence-Based Practice in Psychology by the American Psychological Association Council of Repre-
sentatives, with reference to the implications for practitioners. Finally, the authors discuss the implica-
tions of the Policy Statement on Evidence-Based Practice in Psychology for graduate students and early
This article is intended solely for the personal use of the individual user and is not to be disseminated broadly.

career professionals.
This document is copyrighted by the American Psychological Association or one of its allied publishers.

Keywords: evidence-based practice in psychology, practitioners, graduate students, early career profes-
sionals

The quest to determine what works in psychotherapy is a critical base their practice to whatever extent possible on evidence. Thus,
one.1 Today, evidence for therapeutic interventions can be defined psychology needs to define EBPP or it will be defined for us.
in many ways (Norcross, Beutler, & Levant, 2006). Building Psychology cannot afford to sit on the sidelines.
consensus on the definition of evidence and ensuring that In fact, EBPP is already being defined. Practitioner leaders
evidence-based practice in psychology (EBPP) recognizes not only learned about the impact of EBPP on state Medicaid-funded men-
the research but also the clinician’s expertise and the patient’s tal health programs at symposia at the 2004 APA State Leadership
preferences, values, and culture is important to the future of the Conference (Reed, Goodheart, Hayes, Bufka, & Levant, 2004).
profession and quality patient care. Some psychologists believe The American Psychological Association Division of Clinical Psy-
that psychological interventions should be based solely on ran- chology (1995; see also Chambless et al., 1998) lists of empirically
domized clinical trials, while others believe that other forms of supported treatments have been referenced by a number of local,
evidence have their value. Some divisions have, or are developing, state, and federal funding agencies, who are beginning to restrict
their own policy statements on evidence-based practice (EBP), but reimbursement to these treatments, as are some managed care and
Ronald F. Levant thought that it was vital that the American insurance companies. The division’s lists were developed using
Psychological Association (APA) speak with one voice on the rigorous scientific criteria in order to demonstrate that psycholog-
issue to avoid potential confusion among members, the public, ical treatments are as effective or more effective than medication
media, legislators, state health officials, and third-party payers. treatments, without the danger of side effects. However, some
Some APA members have asked Ronald F. Levant why he believe the criteria were too narrow to serve as a primary guide for
chose to sponsor an APA presidential initiative on EBPP in 2005, practice. Not taken into account were some of the broader strands
expressing fears that the results might be used against psycholo- of psychological research evidence (such as effectiveness research
gists by managed care companies and malpractice lawyers. To and common factors research) and the other two pillars of what the
respond, he drew attention to the larger societal context. The EBP Institute of Medicine (2001) has defined as the foundation of EBP
movement in U.S. society is truly a juggernaut, racing to achieve in health care, namely, clinical expertise and patient values. Fur-
accountability in medicine, psychology, education, public policy,
ther, interventions conducted under laboratory conditions with
and even architecture. The zeitgeist is to require professionals to
selective participant criteria do not necessarily generalize well in
the real world of human services. Moreover, the requirement of a
treatment manual excluded many forms of therapy, tailored ap-
RONALD F. LEVANT earned his EdD from Harvard University in clinical proaches, or types of patients from consideration. But conceptu-
psychology and public practice. He is currently dean and professor of alizations of EBP are evolving, and psychologists have an oppor-
psychology, Buchtel College of Arts and Sciences, University of Akron. tunity now to influence health care delivery systems, funding, and
His areas of research are the psychology of gender and advancing profes- legislation nationwide.
sional psychology.
If psychologists do not take on this task, the challenge will not
NADIA T. HASAN earned her MA from the University of Akron in psychol-
ogy. She is a doctoral student in the Collaborative Program in Counseling magically disappear. Rather, someone else will dictate what treat-
Psychology at the University of Akron. She currently serves as chair of the ments are acceptable and what types of evidence are privileged.
American Psychological Association of Graduate Students. Her research Psychologists will have more leverage with insurers, courts, and
interests include the psychology of gender and multicultural issues in policy makers when APA has a clear statement asserting that
counseling.
CORRESPONDENCE CONCERNING THIS ARTICLE should be addressed to Ronald
1
F. Levant, Buchtel College of Arts and Sciences, University of Akron, The first section of this article is adapted from Levant (2006, pp.
Akron, OH 44325-1901. E-mail: levant@[Link] 391–392).

658
 EVIDENCE-BASED PRACTICE IN PSYCHOLOGY 659

psychology is a science-based profession and preserving the right research with clinical expertise in the context of patient character-
for psychologists to make the final, evidence-informed decisions in istics, culture, and preferences” (APA Presidential Task Force on
clinical practice. Evidence-Based Practice, 2006, p. 273).
This presidential initiative aimed to affirm the importance of These efforts succeeded. The Council of Representatives at its
attending to multiple sources of research evidence and to affirm August 2005 meeting adopted the policy statement (APA, 2005a)
that good psychological practice based on evidence is also based and received the Report of the 2005 Presidential Task Force on
on clinical expertise and patient values. The mission of the APA Evidence-Based Practice (APA, 2005b). In addition, the report
Presidential Task Force on Evidence-Based Practice in Psychology was published in the American Psychologist (APA Presidential
was threefold, corresponding to the three components of the Insti- Task Force on Evidence-Based Practice, 2006). Of note, the policy
tute of Medicine’s (2001; see also Sackett, Rosenberg, Gray, statement was adopted verbatim by the Norwegian Psychological
Haynes, & Richardson, 1996) definition of EBP (“Evidence-based Association (Norsk Psykologforening, 2007)
practice is the integration of best research evidence with clinical In the balance of this article, we discuss, first, the literature that
expertise and patient values,” p. 147): has appeared following the promulgation of the Policy Statement
on Evidence-Based Practice in Psychology, with particular refer-
This article is intended solely for the personal use of the individual user and is not to be disseminated broadly.
This document is copyrighted by the American Psychological Association or one of its allied publishers.

1. To consider how a broader view of research evidence, ence to the implications for practitioners and, second, we discuss
one that inclusively considers multiple research designs, the implications of the Policy Statement on Evidence-Based Prac-
research in public health, health services research, and tice in Psychology for graduate students and early career profes-
health care economics, should be integrated into a defi- sionals.
nition of EBPP.
Recent Literature on EBPP: Implications for Practice
2. To explicate the application and appropriate role of clin-
Since the release of the policy statement and report of the task
ical expertise in treatment decision making, including a
force on EBPP, there has a great deal of discussion regarding the
consideration of the multiple streams of evidence that
implications of the policy statement. Some of this discussion has
must be integrated by clinicians and a consideration of
taken place in the research literature as well as the gray literature,
relevant research regarding the expertise of clinicians and
which includes newsletters, journal comments, and book reviews.
clinical decision making.
This section provides a summary of both literatures on EBPP since
3. To articulate the role of patient values in treatment deci- the release of the task force report and addresses the implications
sion making, including a consideration of the role of for practice.
ethnicity, race, culture, language, gender, sexual orienta- One important issue that needs to be clarified at the outset is the
relationship between EBPP and ESTs (empirically supported
tion, religion, age, and disability status, and the issue of
treatments, formerly known as empirically validated treatments),
treatment acceptability and consumer choice.
as the latter are sometimes referred to in the literature as evidence-
This task force included 18 scientists and practitioners from a based treatments and erroneously as evidence-based practices.
wide range of employment settings, theoretical orientations, APA According to the report (APA Presidential Task Force on
constituencies, and ethnic heritages. Carol Goodheart served as the Evidence-Based Practice, 2006):
chair. Areas of expertise of task force members include clinical EBPP is the more comprehensive concept. ESTs start with the treat-
expertise and decision making, health services research, public ment and ask whether this treatment works for a certain disorder or
health and consumer perspectives, treatment outcome and process problem under specified circumstances. EBPP starts with the patient
research, full-time practice, clinical research and diversity, health and asks what research evidence (including relevant results from
care economics, and EBP research/training and applications. randomized clinical trials) will assist the psychologist to achieve the
Ronald F. Levant was pleasantly surprised and very impressed best outcome. In addition, ESTs are specific psychological treatments
that have been shown to be efficacious in controlled clinical trials,
with how effectively the task force members worked to hear each
whereas EBPP encompasses a broader range of clinical activities (e.g.,
others’ perspectives and seek common ground. The task force had psychological assessment, case formulation, therapy relationships).
brought together people who would not have been likely to attend As such, EBPP articulates a decision making process for integrating
each others’ programs at the APA annual convention, working in multiple streams of research evidence, including but not limited to
mixed groups to hear and understand the multiple nuances in- RCTs, into the intervention process. (p. 273)
volved in every issue.
The task force developed two documents. The first was a policy Practitioners were excited about the policy statement and report
statement for APA governance action, which was posted on a Web of the task force on EBPP. For instance, Brooke (2006) stated that
page and circulated widely for comment and was reviewed at the Something remarkable has happened this past year in professional
March Consolidated Meetings of APA Boards and Committees. psychology. It can give comfort to those unassuming and quietly
The task force responded to almost 200 sets of comments and competent colleagues who have little time for funded research into
revised the policy statement to take into account the important their work; colleagues who do not like labels, diagnostic or otherwise;
feedback received in the comments. The second document was a people in whose hands we entrusted, with trepidation and increasing
confidence, our own psychological well-being and even our lives (p.
report of the task force, which elaborates on the policy statement,
23).
supporting a broad conceptualization of EBPP. Both documents
offered the following definition of EBPP: “Evidence-based prac- He later noted that “the importance of context and clinical
tice in psychology (EBPP) is the integration of the best available expertise are once again recognized by APA as essential to pro-
 660 LEVANT AND HASAN

fessional competence in an evidence based practice (p. 23).” In response to several of the comments above, Wampold, Good-
Clearly, his sentiment is shared by many clinicians who are excited heart, and Levant (2007) clarified and elaborated the task force
to have the importance of clinical expertise recognized by APA as report and policy statement. These authors addressed some of the
a matter of policy. concerns above and clarified that the main goal of the task force
Hunsberger (2007) commended the task force report for valuing was “to create a scheme that would suggest how evidence should
clinical expertise and research data in psychological practice. As a be used to design and offer services that will benefit patients and
psychologist in independent practice, he argued that “by virtue of to assure the public and the health care system that psychologists
daily personal interactions with clients, clinicians are arguably the are providing evidence-based services” (p. 618). Wampold et al.
true experts on the nature and accessing of psychological evi- also stated that while not all psychologists will agree with every
dence” (p. 614). He also stated that without an ongoing subjective aspect of EBPP, the task force work represented a very significant
collaboration, objective data are unreliable. Hunsberger encour- accomplishment for the field.
aged APA to prioritize subjective emotional and relational skills Coming from an EST perspective, and somewhat at variance
when selecting and training clinical psychology students. with the more integrative perspective of the task force, Hunsley
Whaley and Davis (2007) highlighted the complementary nature (2007b) outlined concerns about the report and provided recom-
This article is intended solely for the personal use of the individual user and is not to be disseminated broadly.
This document is copyrighted by the American Psychological Association or one of its allied publishers.

of cultural competence and EBP in mental health services for the mendations for training psychologists for EBPP. The concerns he
psychological treatment of people of color. They argued that discussed included the potential loss of professional autonomy,
despite the inadequate representation of members of ethnic/racial takeover of psychology by special interest groups or individuals
minority populations in evidence-based treatment studies, there is with specific theoretical orientations, dehumanization of psycho-
significant scientific and clinical overlap between the cultural logical services, unsuitability of the research base underlying
competence and EBP literatures. These authors support the use of EBPP, and the impossibility of basing psychological services on
cultural adaptations of the existing research base for people of research evidence. Hunsley (2007b) recommended the following
color. Whaley and Davis stated that the task force acknowledged changes: promoting efficient strategies for seeking, evaluating, and
the importance of expanding the definition of EBP, and they appropriately using research evidence; redirecting assessment
agreed that a broader definition of EBPP is needed to accurately training efforts to better target the knowledge and skills that have
adapt research findings for people of color. These authors also direct relevance of providing and evaluating evidence-based ser-
echoed the task force recommendation to prioritize efficacy and vices; and emphasizing the critical importance of learning and
effectiveness research with underrepresented groups. using ESTs in combination with other evidence-informed inter-
Of interest, Sobell (2007), a past president of APA’s Division of ventions techniques.
Clinical Psychology (Division 12), suggested that “Division 12 Hunsley (2007a) acknowledged the work of the task force in
could take the lead on taking APA’s Evidence-Based Practice another article and explored some of the main challenges for
(EBP) document to the next level” by incorporating “idiographic psychologists who wish to provide evidence-based treatment ser-
approaches to the more nomothetic activity of identifying and vices. These challenges included (a) How should evidence be used
promulgating empirically supported treatments” (p. 21). in EBPP? (b) Are participants in treatment studies clinically rep-
On the other hand, some researchers expressed concerns about resentative? (c) Is the range of extant evidence-based treatments
the task force report. For instance, Stuart and Lilienfeld (2007) sufficient for clinical practice? And (d) Do evidence-based treat-
applauded the task force’s attention to diversity but reported that ments actually work in the real world? The author believes that the
one aspect of diversity was left out of the task force report. They evidence to date indicates that there are clinically relevant and
argued that a broad philosophy of science consideration on EBPP effective treatment options for many individuals seeking therapeu-
was not part of the discussion. The authors stated that this omission tic services.
led the task force to make some epistemological assumptions that Hunsley (2007a) provided several recommendations to over-
are not based on evidence or rationale and hence violate the come these specific challenges. First, he stressed the importance
evidence-based decision making process. Stuart and Lilienfeld for practitioners to employ a self-critical professional perspective
reported that although the task force indicated that it used empir- so that practitioners can recognize the limits of their competence
ically supported principles, it did not justify why it made this within the changing nature of the health care system. Hunsley
decision and therefore assumed that an empiricist framework re- (2007a) also stated that EBPP is a dynamic process that requires
quired no justification. The authors also noted that qualitative continuing education and consistent quality assurance efforts from
research techniques, which have different epistemological founda- clinicians. In order to find the best research evidence, it is essential
tion, are seen as a second-class methodology. that clinicians are aware of the research literature. This includes
Moreover, Wendt and Slife (2007) commented that the task reviewing clinician-friendly summaries of recent studies, using
force report was silent on three important issues that resulted in the APA databases like PsycINFO and PsycARTICLES, and reading
omission of the evidence necessary to have an EBP. The authors systemic reviews and clinical guidelines from expert sources.
reported that evidence was not operationalized, the report did not Hunsley (2007a) also stressed the importance of understanding
address the problem of iatrogenic treatments, and the report did not the methods used to develop the reviews and guidelines so that
address the need for ongoing objective evaluation of clinical cases. clinicians can trust the resources. He indicated that additional
In order to correct these concerns, Wendt and Slife recommended research is needed to examine the question of comorbidity and its
that the task force provide a more clear operationalization of effect on evidence-based treatments. Clinicians were also encour-
scientific evidence, use current research to rule out the use of aged to use the full range of treatment-relevant research, and not
harmful methods, and use objective criteria to evaluate cases just treatment outcomes. Finally, the author also encouraged cli-
consistently. nicians to use treatment-monitoring strategies to assess how treat-
 EVIDENCE-BASED PRACTICE IN PSYCHOLOGY 661

ment is progressing and to use these data to adjust treatments when and practice implications related to each approach, and as has been
appropriate. He argued that this technique will increase client discussed above, these terms are at times confused in the literature.
improvement rates. As noted earlier, it is essential to distinguish between the terms
Some authors have confused EBPP with ESTs. For instance, empirically supported treatments (ESTs; and its variants empiri-
Gotham (2006) reported that most practicing psychologists do not cally validated treatments, evidence-based treatments) and
use “EBPs” and that academic psychology programs provide vary- evidence-based practice in psychology. ESTs are “specified inter-
ing levels of training in “EBP”; however, this author did not ventions designated as having demonstrated efficacy for individ-
reference the APA policy statement or report in the article, and it uals with specific psychological disorders” (Waehler, Kalodner,
is clear from the citations that she was talking about ESTs. Wampold, & Lichtenberg, 2000, p. 657). The hallmark of ESTs is
Similarly, Aarons and Sawitzky (2006) assessed the association that the demonstration of efficacy through two randomized con-
of organizational culture and climate with attitudes toward adopt- trolled clinical trials required before a treatment is determined to
ing “EBP”; however, they also did not reference the APA policy be empirically supported. This is a very rigorous standard for
statement or report and never defined what they meant by “EBP” experimentally examining psychological treatments; however, it
On the other hand, Rishel (2007) moved the discussion of EBPP leaves much out of the equation for practicing psychologists who
This article is intended solely for the personal use of the individual user and is not to be disseminated broadly.
This document is copyrighted by the American Psychological Association or one of its allied publishers.

into the arena of prevention. She argued that “the field of preven- treat clients in a real world context. The APA EBPP policy has a
tion science should adopt this framework [EBPP] as well to best more inclusive definition of evidence and can be seen as an
position itself to support the need for, and effectiveness of, pre- empirically supported treatments-plus model. The “plus” compo-
vention efforts in the area of mental health” (p. 155). The author nents are the clinician’s expertise and the patient’s preferences,
recommended three steps needed to develop evidence-based pre- values, and culture. Thus, the accumulated expertise of practicing
vention practice in the area of mental health. These are to identify psychologists is valued and can be viewed as an essential ingre-
common outcome measures, conduct comprehensive follow-up dient in selecting the most relevant evidence to apply to a partic-
evaluation, and operationalize program characteristics. Thus, ular case. Patient characteristics are also stressed and included as
Rishel encouraged psychologists in the prevention field to imple- part of the EBPP framework. Hence EBPP envisions clinicians
ment and use EBP in their work. using the research and their expertise in collaboration with pa-
Furthermore, there are two recently edited books that have been tients.
published on this complex and controversial debate. The first, The EBP health care model is increasingly accepted by health
edited by Goodheart, Kazdin, and Sternberg (2006), is Evidence- care systems (Chwalisz, 2003). The task force report and policy
Based Psychotherapy: Where Theory and Practice Meet. The first statement have integrated the EBP model into psychology (Hun-
editor, Carol Goodheart, served as the chair of the task force, and sley, 2007a). Given the growing appreciation for EBP, it is im-
the volume is closely linked to the task force policy and subse- portant that graduate students and early career professionals ask
quent debate. A recent book review by Fertuck (2007) indicated clinical supervisors to model EBP. Chwalisz (2003) encouraged
that this book is an important addition to the debate on EBP in experienced psychologists, early career professionals, and gradu-
psychotherapy and highlights issues that extend well beyond the ate students to play a vital role in utilizing, generating, and dis-
role of psychotherapy in EBP. The second book, edited by seminating EBP.
Norcross, Beutler, and Levant (2006), is titled, Evidence-Based Finally, graduate students and early career professionals are
Practices in Mental Health: Debates and Dialogue on the Funda- strongly encouraged to participate in research on the efficacy and
mental Questions. Again the editors of this book were deeply effectiveness of various treatments. Effectiveness research in par-
involved with the task force work and organized the book to ticular is highlighted because these studies stress external validity
address the fundamental questions in the debate on EBPP. Given and usually occur in clinics that provide psychological service to
that EBPP will have an enormous impact on mental health prac- the community. Although there are some effectiveness studies
tice, training, and policy, it is essential that practitioners, research- available for conditions such as bulimia, depression, insomnia, and
ers, graduate students, and professionals be aware of the detailed substance abuse (Hunsley, 2007a), there is a dearth of research on
debate on EBPP. many important areas including how ethnic minority populations
and other diverse groups respond to ESTs.
Implications for Graduate Students and Early Career
Professionals References
Recommendations for graduate students and early career pro- Aarons, G. A., & Sawitzky, A. C. (2006). Organizational culture and
fessionals are provided as follows. The first recommendation is for climate and mental health provider attitudes toward evidence-based
graduate students and early career professionals to read the orig- practice. Psychological Services, 3, 61–72.
inal materials produced by the task force on EBPP. There are many American Psychological Association. (2005a). Policy statement on
views about EBP. It is important for graduate students and early evidence-based practice in psychology. Retrieved March 26, 2008, from
career professionals to understand the actual task force policy [Link]
American Psychological Association. (2005b). Report of the 2005 Presi-
statement and report. This will provide the most accurate infor-
dential Task Force on Evidence-Based Practice. Retrieved March 26,
mation about the task force’s work, and it will empower graduate 2008, from [Link]
students and early career psychologists to better informed and able American Psychological Association Division of Clinical Psychology.
to make their own judgments about EBPP. (1995). Training in and dissemination of empirically-validated psycho-
The next recommendation is to become familiar with the terms logical treatments: Report and recommendations. The Clinical Psychol-
in this area. It can be challenging to understand the various terms ogist, 48, 3–27.
 662 LEVANT AND HASAN

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