evidence based medicine – Scott D.Miller

What’s in an Acronym? CDOI, FIT, PCOMS, ORS, SRS … all BS?

“What’s in a name?” –William Shakespeare A little over a week ago, I received an email from Anna Graham Anderson, a graduate student in psychology at Aarhus University in Denmark. “I’m writing,” she said, “in hopes of receiving some clarifications.” Without reading any further, I knew exactly where Anna was going. I’d fielded the same — read more
How not to be among the 70-95% of practitioners and agencies that fail

Our field is full of good ideas, strategies that work. Each year, practitioners and agencies devote considerable time and resources to staying current with new developments. What does the research say about such efforts? When it comes to the implementation of new, evidence-based practices, traditional training strategies routinely produce only 5% to 30% success rates. Said another way, 70-95% of training fails — read more
Psychotherapy Training: Is it Worth the Bother?

Big bucks. That’s what training in psychotherapy costs. Take graduate school in psychology as an example. According to the US Department of Education’s National Center (NCES), a typical doctoral program takes five years to complete and costs between US$ 240,000-300,000.00. Who has that kind of money laying around after completing four years of college? The… — read more
Feedback Informed Treatment as Evidence-Based Practice

Back in November, I blogged about the ICCE application to SAMSHA’s National Registry for consideration of FIT as an official evidence-based approach (EBP). Given the definition of EBP by the Institute of Medicine and the American Psychological Association, Feedback Informed Treatment seems a perfect, well, FIT. According to the IOM and APA, evidence-based practice means… — read more
Improving Outcomes in the Treatment of Obesity via Practice-Based Evidence: Weight Loss, Nutrition, and Work Productivity

Obesity is a large and growing problem in the United States and elswhere. Data gathered by the National Center for Health Statistics indicate that 33% Americans are obese. When overweight people are added to the mix, the figure climbs to a staggering 66%! The problem is not likely to go away soon or on its own as the same figures apply… — read more
Research on the Outcome Rating Scale, Session Rating Scale & Feedback

"How valid and reliable are the ORS and SRS?" "What do the data say about the impact of routine measurement and feedback on outcome and retention in behavioral health?" "Are the ORS and SRS ‘evidence-based?’" These and other questions regarding the evidentiary support for the ORS, SRS, and feedback are becoming increasingly common in the workshops… — read more
The Study of Excellence: A Radically New Approach to Understanding "What Works" in Behavioral Health

"What works" in therapy? Believe it or not, that question–as simple as it is–has and continues to spark considerable debate. For decades, the field has been divided. On one side are those who argue that the efficacy of psychological treatments is due to specific factors (e.g., changing negative thinking patterns) inherent in the model of… — read more
Outcomes in Oz II

Sitting in my hotel room in Brisbane, Australia. It’s beautfiul here: white, sandy beaches and temperatures hovering around 80 degrees. Can’t say that I’ll be enjoying the sunny weather much. Tomorrow I’ll be speaking to a group of 135+ practitioners about "Supershrinks." I leave for home on Saturday. While it’s cold and overcast in Chicago,… — read more
Common versus Specific Factors and the Future of Psychotherapy: A Response to Siev and Chambless

Early last summer, I received an email from my long time friend and colleague Don Meichenbaum alerting me to an article published in the April 2009 edition of the Behavior Therapist–the official "newsletter" of the Association for Behavioral and Cognitive Therapies–critical of the work that I and others have done on the common factors. Briefly, the article,… — read more
Whoa Nellie! A 25 Million Dollar Study of Treatments for PTSD

I have in my hand a frayed and yellowed copy of observations once made by a well known trainer of horses. The trainer’s simple message for leading a productive and successful professional life was, “If the horse you’re riding dies, get off.” You would think the advice straightforward enough for all to understand and benefit. And yet,… — read more
History doesn’t repeat itself,

Image via Wikipedia "History doesn’t repeat itself," the celebrated American author, Mark Twain once observed, "but it does rhyme." No better example of Twain’s wry comment than recurring claims about specifc therapeutic approaches. As any clinician knows, every year witnesses the introduction of new treatment models. Invariably, the developers and proponents claim superior effectivess of… — read more
Practice-Based Evidence Goes Mainstream

For years, my colleagues and I have been using the phrase "practice-based evidence" to refer to clinicians’ use of real-time feedback to develop, guide, and evaluate behavioral health services. Against a tidal wave of support from professional and regulatory bodies, we argued that the "evidence-based practice"–the notion that certain treatments work best for certain diagnosis–was… — read more
The Debate of the Century

What causes change in psychotherapy? Specific treatments applied to specific disorders? Those in the "evidence-based" say so and have had a huge influence on behavioral healthcare policy and reimbursement. Over the last 10 years, my colleagues and I have written extensively and traveled the world offering a different perspective: by and large, the effectiveness of… — read more