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Contents

Preface

Acknowledgments

Contributors

Part I: Overview and Foundational Issues

Chapter 1: Evidence-Based Practice in Adult Mental Health

Introduction

Defining Evidence-Based Practice

Purpose

The Process of Evidence-Based Practice

Evidence Appraisal in Evidence-Based Practice

Cultural Competence in EBP

Challenges to Dissemination and Implementation of EBP in Practice Settings

Strategies for Dissemination and Implementation of EBP in Practice Settings

Conclusions

References

Chapter 2: Developing Clinical Guidelines for Adults

Introduction

Developing Clinical Guidelines

The National Collaborating Centre for Mental Health

The Nice Mental Health Guidelines

References

Chapter 3: Professional Training Issues in Evidence-Based Clinical Psychology

Evidence-Based Practice in Clinical Psychology

Does Training in EBP Work?

How to Train Professionals in Evidence-Based Practice

Attitudinal Barriers to EBP

Postgraduate Clinical Psychology Training in EBP

Our Own Experience in Teaching Evidence-Based Clinical Psychology

Summary

References

Chapter 4: Limitations to Evidence-Based Practice

The Democratization of Knowledge

Empiricism and Reductionism

Complexity

From Karl Popper to Thomas S. Kuhn

Benefits and Risks of Evidence-Based Practice

General Limitations to Evidence-Based Practice

Specific Limitations to EBP in Psychiatry, Psychotherapy, and Clinical Psychology

Nonlinear Dynamics in the Course of Diseases

References

Chapter 5: Economics of Evidence-Based Practice and Mental Health

Why Economics?

Financing Mental Health Services

Efficiency and Equity

Cost-Effectiveness Analysis

Decision Making Supported by Economic Evidence

References

Part II: Specific Disorders

Chapter 6: Dementia and Related Cognitive Disorders

Overview of Dementias

Cognitive-Focused Approaches

Cognitive Stimulation

Cognitive Training

Cognitive Rehabilitation

Reminiscence Therapy

Psychological Approaches with Family Caregivers

Challenging Behavior: Behavioral Approaches

Cognitive Behavior Therapies for Depression and Anxiety in Dementia

Psychotherapeutic Approaches

Evidence-Based Practices

References

Chapter 7: Alcohol use Disorders

Overview of Alcohol use Disorders

Evidence-Based Treatments for Alcohol use Disorders

Discussion and Conclusions

References

Chapter 8: Tobacco-Related Disorders

Overview of Tobacco-Related Disorders: Nicotine Dependence and Diagnostic Criteria

Tobacco use and Individual Differences

Impact of Disorder

Face-to-Face Behavioral Counseling

Telephone Counseling

Self-Help

Social Support

Aversive Smoking and Incentives

Biological Marker Feedback

Hypnotherapy

Evidence-Based Practices

References

Chapter 9: Illicit Substance-Related Disorders

Overview of Disorder

Specific Substances

Demographic Variables and Epidemiology

Impact of the Disorder

Motivational Interventions

Behavioral Interventions

Contingency Management and Community Reinforcement

Cognitive Behavior Therapy

Behavioral Couple Therapy

12-Step Oriented Treatment Programs

Treatment of Patients with Dual Diagnosis

Does Psychotropic Medication Enhance Psychological Treatment?

Evidence-Based Practices

References

Chapter 10: Schizophrenia

Overview of Schizophrenia

Token Economies

Single Case Experimental Designs

Operant Behavioral Interventions for Psychotic Symptoms

Social Skills Training

Cognitive Behavior Therapy

Coping Strategy Enhancement

Family Intervention

Relapse Prevention

Compliance Therapy

Psychodynamic and Psychoanalytic Psychotherapies

Cognitive Remediation Therapy

Supportive Counseling

Overall Conclusions

References

Chapter 11: Depression and Dysthymic Disorders

Overview

Methods

Cognitive Behavior Therapy

Efficacy of CBT

Behavioral Activation Treatment

Self-Control Therapy

Problem-Solving Therapy

Social Skills Training

Interpersonal Psychotherapy

Nondirective Supportive Therapy

Short-Term Psychodynamic Psychotherapy

Reminiscence and Life Review Therapy for Older Adults

Couple Therapy

Overall Conclusions

References

Chapter 12: Panic Disorder

Overview of the Disorder

Guidelines for Evidence-Based Treatments for Panic Disorder

Psychological Models of Panic Attacks and Panic Disorder

Cognitive Behavioral Treatment of Panic Disorder

Review of Research on the Efficacy of Cognitive Behavioral Treatments for Panic Disorder

Other Treatments

Empirically Validated Psychological Treatments for Panic Disorder

Current Directions in Panic Disorder Treatment Research

References

Chapter 13: Obsessive-Compulsive Disorder

Overview of Disorder

Psychological Treatments for OCD

References

Chapter 14: Posttraumatic Stress and Acute Stress Disorders

Posttraumatic Stress and Acute Stress Disorders

Posttraumatic Stress Disorder

Acute Stress Disorder

Evidence-Based Practices

References

Chapter 15: Somatoform and Factitious Disorders

Overview of Disorders

Somatization Disorder and Subthreshold Somatization: Overview of Disorder

Conversion Disorder: Overview of Disorder

Pain Disorder

Hypochondriasis: Overview of Disorder

Body Dysmorphic Disorder: Overview of Disorder

Related Conditions—Functional Somatic Syndromes: Overview of Disorder

Factitious Disorder: Overview of Disorder

Evidence-Based Practice and Somatoform and Factitious Disorders

References

Chapter 16: Erectile Dysfunction (ED)

Overview of Disorder

Methods

Results

Discussion

Conclusions

References

Chapter 17: Sexual Dysfunctions in Women

Overview of Disorder

Problems with Low Sexual Desire

Female Sexual Arousal Disorder

Female Orgasmic Disorder

Sexual Pain Disorders

Evidence-Based Practice

References

Chapter 18: Paraphilias and Sexual Offending

Overview of Disorder

Diagnostic Criteria

Demographic Variables

Impact of Disorder

Evidence-Based Practice

Sexual Offending

Evidence-Based Practice for Paraphilias and Sexual Offenses

References

Chapter 19: Sleep Disorders in Adults

Overview of Disorder

Cognitive Behavior Therapy for Insomnia

Comparison Between CBT-I and Pharmacological Therapies

Evidence-Based Practices

References

Chapter 20: Pathological Gambling

Attempting an Evidence-Based Practice

Evidence-Based Assessment

Evidence-Based Practice on Gambling Processes

Evidence-Based Treatments for Pathological Gambling

Evidence-Based Treatments for Pathological Gambling

References

Chapter 21: Adjustment Disorder

Overview of Disorder

Diagnostic Criteria

Demographic Variables

Impact of Disorder

Treatment

Consensus Panel Recommendations

Randomized Controlled Trials

Meta-Analyses of Group Designs

Single-Subject Experimental Analyses

Meta-Analyses of Single Subject Experiments

Conclusions

Evidence-Based Practices

References

Chapter 22: Borderline Personality Disorder

Overview of Disorder

Empirically Supported Treatments

Consensus Panel Recommendations

Comprehensive Treatments

Adjunctive Psychosocial Treatments for Specific Symptoms

Meta-Analyses of Group Designs

What Works for Borderline Personality Disorder?

References

Chapter 23: Other Personality Disorders

Overview of Disorders

Treatment of Personality Disorders

Single Case Studies and Experimental Design Studies

References

Chapter 24: Relational Problems

Overview

Impact of Relational Problems

Traditional Behavioral Couple Therapy

Emotionally Focused Couple Therapy

Promising Treatments

Psychoeducation, Prevention, and Enrichment

Intimate Partner Violence

Evidence-Based Practices

Conclusions

References

Chapter 25: Nonpharmacological Interventions for Chronic Pain

Overview of Disorder

Interventions

Review of the Evidence-Based Literature

Other Chronic Pain Disorders

Evidence-Based Practice and Pain Disorders

References

Chapter 26: Hypochondriasis and Health-Related Anxiety

Overview of Disorder

Clinical Features of Hypochondriasis

Etiology of Excessive Health Anxiety

Description of Treatments

Case Studies and Uncontrolled Trials

Randomized Controlled Trials

Meta-Analytic Research

Consensus Panel Recommendations

Predicting Treatment Outcome

Improving Treatment Outcome

Conclusions

Evidence-Based Practices

References

Chapter 27: Social Anxiety Disorder

Overview of the Disorder

Cognitive Models of Social Anxiety Disorder

Exposure Treatments

Combined Exposure and Cognitive Restructuring Treatments

Social Skills Training

Randomized Controlled Trials

Applied Relaxation

Mindfulness and Acceptance-Based Therapies

Open Trials

Interpersonal Psychotherapy

Psychodynamic Approaches

Evidence-Based Practices

References

Chapter 28: Generalized Anxiety Disorder

Overview of Disorder

Cognitive Behavior Therapy

Analytical Psychotherapy

Evidence-Based Practice

References

Author Index

Subject Index

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Preface

Evidence-based practice in adult mental health has become a driving force for research, professional training, allocation of mental health resources, and service planning. It is also a lightning rod for debate among mental health professionals, researchers, service planners, and mental health economists. This volume brings together some of the leading researchers who have identified the professional, ethical, and economic issues related to evidence-based practice and adult mental health, and who have conducted systematic reviews, meta-analyses, and reviewed the existing literature on evidence-based practice for all the major adult mental health disorders.

Volume 2 is in two parts. Part I provides overview chapters that summarize the field of evidence-based practice in adult mental health, illustrate the application of principals to the planning of adult mental health services in the British National Health Service and professional training, and look at the economics of mental health that sometimes drives work in this area. Thomas Maier’s chapter offers a dissenting voice by highlighting the limits to evidence-based practice. Part II consists of more than 20 chapters that review the current status of evidence-based practice for all the major adult mental health disorders. The chapters differ tremendously in terms of the amount and quality of evidence available for each disorder. As one might expect, those disorders that are most common and have the greatest economic impact have a very large evidence base—for example, there are hundreds of studies for tobacco-related disorders and for depression. These large literatures sometimes permit more confident answers as to “what works,” as they are based on many studies with multiple independent replications. They also permit answers to questions that are more subtle than “Does this therapy work for this problem?,” such as “Is this therapy more effective than another therapy?” A notable observation is that broadly defined cognitive-behavior therapy sweeps the board as an evidence-based practice whether or not one wishes to consider such diverse disorders as social anxiety disorder, sleep disorders, or personality disorders. There are, indeed, examples of other evidence-based practices, but they are much less frequent; there are examples of certain therapies that research has robustly shown to be ineffective or even harmful, such as brief psychological debriefing for posttraumatic stress disorder.

We believe this volume offers a comprehensive review of evidence-based practice in clinical psychology of adult mental health disorders that will be invaluable to students, teachers, and practitioners alike. Although this field is a rapidly changing one—as journals publish new evidence and reviewers reanalyze existing literatures—this volume offers one snapshot of the current status of what works in adult mental health.

Acknowledgments

We would first like to thank our authors. Many of them undertook an enormous task of summarizing sometimes hundreds of articles, systematic literature reviews, and consensus panels and sometimes reviewing the outcome literature for many different forms of treatment for one disorder. They faced the challenge of being accurate and fair in identifying those practices that the literature support, those that researchers had little convincing evidence to support them, and those that research has shown to be ineffective or harmful. We believe they all succeeded in doing so. We should both like to express our unending thanks to Carole Londeree’s persistent and cheerful technical assistance throughout this project. Finally, we would like to express our thanks to the editorial staff at John Wiley & Sons who worked so hard to make this project a success.

Contributors

Jonathan S. Abramowitz is Associate Chair and Professor of Psychology at the University of North Carolina at Chapel Hill. He has published over 150 scholarly articles, book chapters, and books on anxiety disorders, including obsessive-compulsive disorder. He is associate editor of the Journal of Cognitive Psychotherapy and of Behaviour Research and Therapy.

Lesley A. Allen is Visiting Associate Professor of Psychology at Princeton University and Adjunct Associate Professor in the Department of Psychiatry at Robert Wood Johnson Medical School, University of Medicine and Dentistry of New Jersey. She has been awarded numerous grants from the National Institute of Mental Health to study the treatment of somatoform disorders and has published widely on this topic. She is the coauthor of Treating Somatization: A Cognitive-Behavioral Approach.

Gerhard Andersson is Professor of Clinical Psychology at Linköping University, Linköping and the Karolinska Institute, Stockholm, Sweden. He has published widely on Internet-delivered psychological treatments, tinnitus, depression, and anxiety disorders.

Martin M. Antony is Professor and Graduate Program Director in the Department of Psychology at Ryerson University in Toronto, where he also directs the Anxiety Research and Treatment Lab. He has published numerous books, scientific papers, and book chapters on anxiety disorders, perfectionism, cognitive behavior therapy, and psychological assessment.

John G. Arena is Psychology Executive at the Charlie Norwood Department of Veterans Affairs Medical Center, and Professor in the Department of Psychiatry and Health Behavior at the Medical College of Georgia in Augusta, Georgia. He is past president of the Association of Applied Psychophysiology and Biofeedback, and has published widely in the areas of psychological and psychophysiological assessment and treatment of chronic pain disorders, and medical psychology.

Álvaro N. Atallah is full Professor and Head of the Emergency Department and Evidence-Based Medicine Division of Universidade Federal de São Paulo Brazil and Director of the Brazilian Cochrane Centre São Paulo.

David C. Atkins is a Research Associate Professor in the Department of Psychiatry and Behavioral Sciences at the University of Washington. His research has focused on sociological and treatment studies of infidelity as well as treatment and process research on Integrative Behavioral Couple Therapy. He also is actively involved as a quantitative methodologist with particular interests in multilevel models and count regression methods.

Andrew J. Baillie is a Senior Lecturer in the Department of Psychology at Macquarie University in Sydney. He is the Director of Clinical Psychology Training and a member of the Centre for Emotional Health at Macquarie. He also holds an honorary appointment as a clinical psychologist at Drug Health Services, Royal Prince Alfred Hospital, in Sydney. He has published on anxiety disorders and comorbidity with alcohol use disorders from an assessment, treatment, and epidemiological perspective.

Anthony R. Beech is Chair of Criminological Psychology and a Fellow of the British Psychological Society. He is the Director of the Forensic and Criminological Psychology at the University of Birmingham. He has authored over 125 peer-reviewed articles, 30 book chapters, and five books in the area of forensic science/criminal justice. He is the current recipient of the Senior Award for a significant lifetime contribution to Forensic Psychology in the United Kingdom, Division of Forensic Psychology, BPS, June 2009. He has also received the significant achievement award from the Association for the Treatment of Sexual Abusers in Dallas, Texas, October 2009.

Claudi Bockting is Associate Professor of Clinical Psychology at Groningen University in Groningen and works as a clinician in a mental health-care center, Symfora in Almere, the Netherlands. Her research focuses on long-term course of depression and anxiety disorders, processes that cause and maintain mood disorders, and development and evaluation of psychological interventions to prevent recurrence. In addition, she studies processes that cause and maintain mood disorders, as well as the treatment processes that reduce and prevent relapse and recurrence.

Stephanie Both is psychologist and Assistant Professor at the Department of Gynaecology at the Leiden University Medical Center in the Netherlands. She has published widely on male and female sexual functioning, and experimental research in sexual motivation and arousal.

Shawn P. Cahill is an Assistant Professor in the Psychology Department at the University of Wisconsin at Milwaukee. He received his PhD from Binghamton University, State University of New York in 1997. His research interests include understanding the nature and treatment of anxiety and other emotional reactions to stress, such as anger reactions. He has particular interest in posttraumatic stress disorder, obsessive-compulsive disorder, and panic in adults.

Hilary Cartwright co-wrote her chapter for this volume while she was a clinical psychologist and Assistant Professor in the Department of Clinical Health Psychology at the University of Manitoba. She is now a practicing clinician in Fredericton, New Brunswick, Canada. Her research and clinical interests are in child and adolescent psychology.

Linda Clare is Professor of Clinical Psychology and Neuropsychology at Bangor University, Wales, United Kingdom. Her interests focus primarily on the theoretical and clinical issues surrounding awareness and self-concept in dementia, the impact of progressive cognitive impairment on self and relationships, and the potential of neuropsychological rehabilitation for people with early-stage dementia. She has published numerous papers and Cochrane reviews and several books on these topics. She is coeditor of the Handbook of the Clinical Psychology of Ageing (2nd edition: John Wiley & Sons, 2008).

Roger Covin received his PhD in Clinical Psychology at the University of Western Ontario. He completed his residency training in Calgary, Alberta, Canada and is a former staff psychologist with the First Episode Mood and Anxiety Disorders Program in the Department of Psychology at London Health Sciences Centre, London, Canada. He has coauthored a number of journal articles and book chapters on a variety of topics such as cognitive behavior therapy outcomes for generalized anxiety disorder, normative data in clinical practice, and development of the Cognitive Distortions Scale. He currently operates a private practice in Montreal, Canada.

Pim Cuijpers is Professor of Clinical Psychology and Head of the Department of Clinical Psychology at the Vrije Universiteit University Amsterdam, the Netherlands. He is also Vice Director of the EMGO Institute for Health and Care Research of the Vrije Universiteit Amsterdam and Vrije Universiteit University Medical Center. He specializes in conducting randomized controlled trials and meta-analyses on prevention and psychological treatments of common mental disorders, especially depression and anxiety disorders.

Michelle E. Culang-Reinlieb is a fourth-year student in the doctoral subprogram in Neuropsychology at Queens College of the City University of New York. Her research interests focus on late-life depression with an emphasis on the role of executive dysfunction and change in cognitive functioning in antidepressant treatment trials.

Natasha Dagys is a doctoral student in School Psychology at the University of California, Berkeley. Her research interests focus on the consequences of sleep deprivation and on the role of sleep in social, emotional, and cognitive functioning, particularly during adolescence.

Mark R. Dixon is Professor of Behavior Analysis and Therapy at Southern Illinois University and a Board Certified Behavior Analyst. He has published over 90 papers and authored three books on a wide variety of topics including gambling addiction, weight loss interventions, treatment of children with autism, organizational behavior management, terrorism, and verbal behavior.

Michelle A. Doeden is a doctoral candidate at Fuller Graduate School of Psychology, Pasadena, California. She has been involved in couple therapy research throughout her graduate career, including work as a research fellow on an NIMH-funded grant, focused on language and couple therapy process.

David J. A. Dozois is Professor of Psychology and Director of the Clinical Psychology Graduate Program at the University of Western Ontario in London, Ontario, Canada. He is a Fellow of the Academy of Cognitive Therapy and a former Beck Institute Scholar at the Beck Institute for Cognitive Therapy and Research. Dr. Dozois’s research focuses on cognitive vulnerability to depression and anxiety.

Ellen Driessen is a PhD candidate at the department of Clinical Psychology at Vrije Universiteit University Amsterdam, the Netherlands. Her research interest concerns the efficacy of psychotherapy in the outpatient treatment of depression.

Jon D. Elhai is Assistant Professor of Psychology at the University of Toledo. His research is on psychological trauma and posttraumatic stress disorder, exploring assessment, psychopathology, and treatment issues. He teaches undergraduate and graduate courses in clinical psychology. He also serves as an expert witness in his role as a forensic psychological evaluator and consultant.

Paul M. G. Emmelkamp is a licensed psychotherapist and clinical psychologist and full Professor of Clinical Psychology at the University of Amsterdam. Over the years, he has published widely on the etiology and treatment of anxiety disorders. He is involved in therapy-outcome studies on adults with work-related distress, substance abuse disorders, personality disorders, depression, anxiety disorders; on youth with attention-deficit/hyperactivity disorder, conduct disorder, and anxiety disorders; and on the elderly with anxiety disorders. He has written and coedited many books, and over 350 publications in peer reviewed journals or books. He has received a number of honors and awards, including a distinguished professorship (“Academy Professor”) by the Royal Academy of Arts and Sciences.

Eric A. Fertuck is Associate Professor of Psychology at City College of New York and the Graduate Center of the City University of New York and a Research Scientist at Columbia University, New York State Psychiatric Institute. He investigates borderline personality disorder from many perspectives including the social, neurocognitive, physiological, and neural. His research is supported by the National Institute of Mental Health, the American Foundation for Suicide Prevention, the Neuropsychoanalysis Foundation, and the Fund for Psychoanalytic Research.

Jennifer Fidler is a Research Health Psychologist whose research focuses on smoking behavior, adolescent smoking, markers of smoking behavior and dependence, and the development of adolescent smoking behavior. Her current research examines the distribution of cotinine as a biological marker of nicotine intake and sociodemographic factors associated with this objective marker of smoking.

Edna B. Foa is a Professor of Clinical Psychology in Psychiatry at the University of Pennsylvania, where she serves as the Director of the Center for the Treatment and Study of Anxiety. She is an internationally renowned authority on the psychopathology and treatment of anxiety. Her research, aimed at determining causes and treatments of anxiety disorders, has been highly influential. She is an expert in the areas of posttraumatic stress disorders (PTSD) and obsessive-compulsive disorder. The program she has developed for rape victims is considered to be one of the most effective therapies for PTSD. She has published over 200 articles and book chapters, lectured extensively around the world, and received numerous awards and distinctions.

Julian D. Ford is Professor of Psychiatry at the University of Connecticut School of Medicine and Director of the University of Connecticut Health Center Child Trauma Clinic and the Center for Trauma Response Recovery and Preparedness (www.ctrp.org). He also conducts research on posttraumatic stress disorder, psychotherapy and family therapy, health services utilization, psychometric screening and assessment, and psychiatric epidemiology.

B. Christopher Frueh is Professor of Psychology and Director of the Division of Social Sciences at the University of Hawaii, Hilo, Hawaii. He also serves as the McNair Scholar and Director of Clinical Research at The Menninger Clinic in Houston, Texas. His research focuses on clinical trials, health services, epidemiological and qualitative studies relevant to the design and implementation of innovative treatments, and mental health service improvements in a variety of clinical settings.

James L. Furrow is Evelyn and Frank Freed Chair of Marital and Family Therapy at Fuller Graduate School of Psychology, Pasadena, California. He is author of a number of publications on the practice of Emotionally Focused Couple Therapy. He is a certified Emotionally Focused Therapy therapist, supervisor, and trainer.

Sidney Glina is the Director of the Instituto H. Ellis and Head of the Department of Urology in the Hospital Ipiranga, Sao Paolo, Brazil.

Lisa H. Glynn is a doctoral candidate in Clinical Psychology at University of New Mexico. She has published in the areas of Motivational Interviewing, treatment mechanisms, and addictions. She is interested in processes of group-delivered alcohol treatment, coding of therapeutic interactions, and issues of diversity and multiculturalism.

Elizabeth A. Gordon is a doctoral student in clinical psychology at Temple University, Philadelphia, Pennsylvania. She is especially interested in examining the interplay of interpersonal processes and social anxiety disorder. Elizabeth received her BA in Human Biology from Stanford University and her MA in Clinical Psychology from Yeshiva University. Prior to studying clinical psychology, Elizabeth worked in the field of animal behavior and wildlife conservation.

Brenna L. Greenfield is a graduate student in the Clinical Psychology PhD program at the University of New Mexico. She is interested in advanced statistical modeling techniques and collaborating with American Indian communities to develop and disseminate culturally appropriate alcohol use disorders treatment and prevention programs.

Anouk L. Grubaugh is Associate Professor in the Department of Psychiatry and Behavioral Sciences at the Medical University of South Carolina and a Research Health Scientist at the Charleston Veterans Affairs Medical Center. Her clinical and research interests include assessment and treatment of patients with posttraumatic stress disorder and severe mental illness, treatment adherence and attrition in public-sector settings, racial disparities in health outcomes, qualitative research methods, and mental health services methods.

Kevin A. Hallgren is a graduate student in clinical psychology at the University of New Mexico. He is interested in mechanisms of change in psychosocial treatments for alcohol use disorders, with a particular interest in methodologies for studying in-session behavior and changes in social networks as they relate to subsequent alcohol use.

Leigh Harkins is a Lecturer in Forensic Psychology at the University of Birmingham, United Kingdom. She has published a number of articles and chapters on sex offender treatment, risk assessment, and group aggression.

Allison G. Harvey is Professor of Psychology at University of California, Berkeley. She has published widely on sleep disorders, mood disorders, and empirically supported treatments.

Richard G. Heimberg is Professor and Distinguished Faculty Fellow in Psychology at Temple University, Philadelphia, Pennsylvania, where he directs the Adult Anxiety Clinic of Temple. He is Past President of the Association for Cognitive and Behavioral Therapies and Past Editor of its journal Behavior Therapy. He has published more than 325 articles and chapters, as well as 11 books, on the assessment and treatment of anxiety disorders and related topics, and his cognitive behavioral protocols for the treatment of social anxiety disorder have been implemented around the world.

Christopher Jones is a Consultant Clinical Psychologist and Senior Lecturer in Clinical Psychology at the University of Birmingham, United Kingdom. He is an active researcher, most notably in the area of engagement with assertive outreach services, evidence-based practice, and clinical neuropsychology.

Rebecca L. Jump is a clinical psychologist at the Veterans Affairs Medical Center in Augusta, Georgia, and Assistant Professor at the Medical College of Georgia. She has clinical expertise in the areas of chronic pain, behavioral medicine, and sexual trauma/abuse.

Dora Kanellopoulos is a fifth-year doctoral student in the doctoral subprogram in Neuropsychology at The Graduate Center, City University of New York. Her research interests focus on brain abnormalities related to depression and cognition in late life.

Martin Knapp is Professor of Social Policy and Director of the Personal Social Services Research Unit at the London School of Economics and Political Science. He is also Professor of Health Economics and Director of the Centre for the Economics of Mental Health at King’s College London, Institute of Psychiatry. In 2009, he was appointed by the National Institute for Health Research as the inaugural Director of the National School for Social Care Research. Martin’s research activities are primarily in the mental health long-term care and social care fields, focusing particularly on policy analysis and economic aspects of practice.

Naomi Koerner is Assistant Professor in the Department of Psychology at Ryerson University in Toronto, Canada, where she also directs the Cognition and Psychopathology Lab. She has published scientific papers and book chapters on worry, worry-related cognitive processes, anxiety disorders, and psychological assessment.

Benjamin Ladd is a clinical psychology graduate student at the University of New Mexico. He is interested in the influence and impact of social support for change in the treatment and maintenance of treatment gains for alcohol use disorders. He is also interested in integrating the various areas of clinical knowledge, from the neurobiological to psychosocial, to develop comprehensive models of treatment for the spectrum of alcohol-related problems.

Thomas Maier is head of the Psychiatric Services of the Canton St. Gallen-North, Switzerland, and lecturer at Zurich University. He is a psychotraumatologist and has published on posttraumatic stress, obsessive-compulsive disorders, and transcultural psychiatry, and also on complexity and nonlinear dynamics in psychiatry and on limitations of evidence-based psychiatry.

Barbara S. McCrady is a Distinguished Professor of Psychology and the Director of the Center on Alcoholism, Substance Abuse, and Addictions at the University of New Mexico. Dr. McCrady has published widely on her research on conjoint therapy, cognitive behavior therapy, mutual help groups, and therapies for women with substance use disorders. She is a fellow of the American Psychological Association (APA), past President of the Addictions Division of APA, and past member of the Board of Directors of the Research Society on Alcoholism. She has published more than 200 refereed papers, chapters, and books on her work.

David McDaid is Senior Research Fellow in health policy and health economics at both the Personal Social Services Research Unit and the European Observatory on Health Systems and Policies at the London School of Economics and Political Science. His primary research interests focus on comparative international analysis of mental health, health promotion, and public health-care policy and practice.

Dean McKay is Professor, Department of Psychology, Fordham University and Adjunct Professor of Psychiatry, Mount Sinai School of Medicine. He serves on the editorial boards of several journals including Behaviour Research and Therapy and Journal of Anxiety Disorders, and is Associate Editor of Journal of Cognitive Psychotherapy. He has published over 130 journal articles and book chapters, and is editor or coeditor of 10 published or forthcoming books. His research has focused primarily on obsessive-compulsive disorder (OCD), body dysmorphic disorder and health anxiety and their link to OCD, and the role of disgust in psychopathology. His research has also focused on mechanisms of information processing bias for anxiety states.

Mary McMurran is Professor of Personality Disorder Research at the University of Nottingham’s Institute of Mental Health, United Kingdom. Her research interests include social problem solving as a model of understanding and treating people with personality disorders, the assessment and treatment of alcohol-related aggression and violence, and understanding and enhancing offenders’ motivation to engage in therapy. She is a Fellow of the British Psychological Society, and recipient of the Division of Forensic Psychology’s Lifetime Achievement Award in 2005.

Alan Meaden is a Consultant Clinical Psychologist who has specialized in the rehabilitation of those with schizophrenia and other psychoses for over 15 years. He is an active researcher, most notably in the area of cognitive therapy for command hallucinations alongside other research interests in engagement and staff factors.

Tamara Melnik is a researcher and Professor of Internal Medicine and Evidence-Based Medicine at the Universidade Federal de São Paulo (Unifesp) and Brazilian Cochrane Center.

Becky L. Nastally is a Visiting Assistant Professor in the Behavior Analysis and Therapy program at Southern Illinois University-Carbondale (SIUC). She was the 2009 SIUC Student Researcher of the Year and has authored 11 peer-reviewed journal articles, one book chapter, and 19 professional presentations. Her research interests lie in the area of nonsubstance-related behavioral addiction, verbal behavior, and cognitive behavior therapy.

Nisha Nayak is a postdoctoral fellow at the Center for the Treatment and Study of Anxiety at the University of Pennsylvania.

Brian P. O’Connor is a Professor of Psychology at the University of British Columbia Okanagan, in Kelowna, British Columbia, Canada. He conducts research on normal and abnormal personality, on personality disorders, and on interpersonal aspects of psychopathology. He also teaches advanced statistics and research methods courses and has written programs for a variety of specialty statistical procedures. Further information is available at https://people.ok.ubc.ca/brioconn/.

Allison J. Ouimet completed her master’s degree in Clinical Psychology at The University of Western Ontario, in Ontario, Canada. She is currently in the Clinical Psychology doctoral program at Concordia University in Montreal, Canada. Her research at the Fear and Anxiety Disorders Laboratory focuses on the role played by basic cognitive processes in the etiology and maintenance of anxiety disorders.

Lorna Peters is a Lecturer in the Department of Psychology at Macquarie University, Sydney, Australia. She is a member of the Centre for Emotional Health at Macquarie and has published widely on adult anxiety mood disorders.

Stephen Pilling is Professor of Clinical Psychology and Clinical Effectiveness in the Research Department of Clinical, Health, and Educational Psychology, University College London, United Kingdom. He is the director of the National Collaborating Centre for Mental Health, which develops clinical practice guidelines for the National Institute for Health and Clinical Excellence. His research focuses on the evaluation of complex interventions for the treatment of severe mental illness, the development and evaluation of psychological treatments for depression, and the competences required to provide them effectively.

Mark B. Powers is Assistant Professor and Codirector of the Anxiety Research and Treatment Program at Southern Methodist University, Dallas, Texas. He received his bachelor’s degree in psychology at the University of California at Santa Barbara and his master’s degree in psychology at Pepperdine, working with Dr. Joseph Wolpe on anxiety disorders. He received his PhD in clinical psychology from the University of Texas at Austin working with Dr. Michael J. Telch.

Lion Shahab is currently working as a lecturer in health psychology in the Department of Epidemiology and Public Health at the University College London. His expertise lies in epidemiology, tobacco control, public health, and health psychology. Current research interests focus on the detection of smoking-related diseases in the population, the use of smoking-related biomarkers to motivate smoking cessation, the development and impact of potential harm reduction strategies, and public attitudes to tobacco policy.

Joel R. Sneed is an Assistant Professor of Psychology at Queens College and an adjunct Assistant Professor of Medical Psychology in Psychiatry in the Division of Geriatric Psychiatry at Columbia University and the New York State Psychiatric Institute. He is Director of the Laboratory for Lifespan Development and Psychopathology and has published widely in the areas of geriatric, lifespan development, and personality disorders. His research on vascular depression is supported by the National Institute of Mental Health.

Sherry A. M. Steenwyk is a postdoctoral resident at Purdue University Counseling and Psychological Services, West Lafayette, Indiana. Her clinical interests include working with couples, substance abuse issues, grief and loss, anxiety, and spirituality. Her research has focused on exploring the process of integrative behavioral couple therapy.

Steven Taylor is a professor and clinical psychologist in the Department of Psychiatry at the University of British Columbia, and editor-in-chief of the Journal of Cognitive Psychotherapy. He has published over 250 articles and book chapters, and 18 books on anxiety disorders and related topics. He is a Fellow of several scholarly organizations including the American and Canadian Psychological Associations and the Association for Psychological Science. His research interests include cognitive behavioral treatments and mechanisms of anxiety disorders and related conditions, as well as the behavioral genetics of these disorders.

Moniek M. ter Kuile is Clinical Psychologist and Associate Professor at the Department of Gynaecology at the Leiden University Medical Center in the Netherlands. She has published widely on female sexual dysfunction, experimental research in sexual arousal and pain, and treatment outcome.

Jacques J. D. M. van Lankveld is Professor of Sexology at Maastricht University, the Netherlands. He has published widely on male and female sexual dysfunction, experimental research in sexual arousal, and treatment outcome.

Patricia van Oppen is Associate Professor at the Department of Psychiatry, Vrije Universiteit Medical Center, Amsterdam, where she works as a clinical psychologist/behavior therapist. Her main research interest focuses on the evaluation of treatments of depression and anxiety disorders. She has published a substantial number of papers and has been an editor of several books on these topics.

Annemieke van Straten is a psychologist and epidemiologist. She is Associate Professor in the department of Clinical Psychology at the Vrije Universiteit, Amsterdam, the Netherlands. Her research focuses on Internet interventions for common mental disorders in different settings and stepped care. She has published more than 60 international publications.

Ellen Vedel is a cognitive behavior therapist and treatment manager at the Jellinek Addiction Treatment Centre in Amsterdam. As a senior researcher, she is currently involved in clinical trials testing integrated treatment protocols for substance abuse and posttraumatic stress disorder and for substance abuse and intimate partner violence. Together with Paul Emmelkamp, she is the coauthor of Evidence-Based Treatments for Alcohol and Drug Abuse: A Practitioner’s Guide to Theory, Methods and Practice.

Valerie Vorstenbosch is a doctoral student in Clinical Psychology in the Department of Psychology at Ryerson University, Toronto, Canada. Her research interests are in the areas of obsessive-compulsive disorder, specific phobia, and cognitive behavior therapy. She has presented her research findings at several scientific meetings.

Monnica Williams is an Assistant Professor of Psychology at the University of Pennsylvania in the Center for the Treatment and Study of Anxiety. Dr. Williams completed her undergraduate studies at Massachusetts Institute of Technology and University of California at Los Angeles, and received her doctoral degree in clinical psychology from the University of Virginia. Dr. Williams’s scholarly publications include scientific articles on racial/ethnic differences in anxiety disorders and obsessive-compulsive disorder (OCD). Her current research area includes African Americans with OCD, OCD treatment outcomes, and OCD symptom dimensions. Her clinical work is focused on anxiety disorders in adults.

Gill Windle is a Research Fellow in the Dementia Services Development Centre, Bangor University, Wales. Her published research has focused on resilience and well-being in older people, and the effects of exercise on well-being. Her current role includes providing academic support for research networks on aging and dementia in Wales.

Judy Wong is a doctoral student in clinical psychology at Temple University, Philadelphia, Pennsylvania. Her interests focus on the influence of culture on the development and treatment of anxiety disorders. Judy received her BA in Psychology from the University of California, Berkeley.

Bob Woods is Professor of Clinical Psychology of Older People at Bangor University, Wales, United Kingdom, and Director of the Dementia Services Development Centre, Wales. His work on the development and evaluation of psychological interventions with people with dementia and their caregivers began over 30 years ago, and he has published widely on this and related topics, including several Cochrane reviews. He is coeditor of the Handbook of the Clinical Psychology of Ageing (2nd edition: John Wiley & Sons, 2008).

Robert L. Woolfolk is Professor of Psychology and Philosophy at Rutgers University, New Jersey, and Visiting Professor of Psychology at Princeton University. He has published numerous papers and books on psychotherapy and psychopathology. A practicing clinician for over 30 years, he has sought in both his work with patients and his scholarly endeavors to integrate the scientific and humanistic traditions of psychotherapy. He is the coauthor of Treating Somatization: A Cognitive-Behavioral Approach and author of The Cure of Souls.

PART I

Overview and Foundational Issues

Chapter 1

Evidence-Based Practice in Adult Mental Health*

B. CHRISTOPHER FRUEH, JULIAN D. FORD, JON D. ELHAI, AND ANOUK L. GRUBAUGH

INTRODUCTION

There is widespread and growing awareness that behavioral and mental health care, like other sectors of health care, require rigorous practice standards and professional accountability (Institute of Medicine, 2001; Kazdin, 2008; President’s New Freedom Commission on Mental Health, 2003). Evidence-based practice (EBP) and empirically supported treatments are a critical element of these standards for both child and adult populations (APA, 2006; Barlow, 2000; Spring 2007; Spring et al., 2008; Torrey et al., 2001; Weisz, Hawley, Pilkonis, Woody, & Follette, 2000). Unfortunately, interventions used in clinical, behavioral, and mental health practice settings are often not carefully based on empirical evidence, resulting in a discrepancy between research and practice (Cook, Schnurr, & Foa, 2004; P. W. Corrigan, Steiner, McCracken, Blaser, & Barr, 2001; Ferrell, 2009; Frueh, Cusack, Grubaugh, Sauvageot, & Wells, 2006; Gray, Elhai, & Schmidt, 2007; Henggeler, Sheidow, Cunningham, Donohue, & Ford, 2008; Kazdin, 2008; Schoenwald & Hoagwood, 2001; Stewart & Chambless, 2007). In this chapter we provide an overview of EBP in adult mental health, including definitions, purpose, processes, and challenges.

DEFINING EVIDENCE-BASED PRACTICE

Evidence-based practice is an empirically based approach to identify and appraise the best available scientific data in order to guide the implementation of assessment and intervention practices. This entails making decisions about how to integrate scientific evidence with clinical practice, taking account of relevant practice setting, population, provider, and other contextual characteristics. Exact definitions of what constitutes an EBP have been proposed. Some have suggested that designation of an intervention as an EBP requires favorable empirical support from at least two randomized controlled trials (RCTs) conducted by independent researchers/labs (Chambless & Hollon, 1998), or seven to nine smaller experimental design studies each with at least three subjects conducted by at least two independent researchers (Chambless & Hollon, 1998; Lonigan, Elbert, & Johnson, 1998). These requirements were proposed in order to define specific treatment models as empirically supported treatments (ESTs). The ESTs are a subcategory of EBT that focuses on specific (usually manualized) treatment models for which substantial scientific evidence of efficacy or effectiveness has been accrued.