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Is Evidence Based Treatment Possible Without Evidence Based Assessment?

‘no’, this is the take home message from a just published study by Moses et al in the Journal of Anxiety Disorders https://www.sciencedirect.com/science/article/pii/S0887618520300931. An evidence based assessment includes a diagnostic interview, as well as a clinical interview and psychometric tests. Moses et al (2020) summarise the literature that the inclusion of a diagnostic interview improves outcome, by minimising missed diagnosis and misdiagnosis. These authors bemoan their finding that only a small minority of Australian psychologists use a diagnostic interview, but the position is even worse in the UK, as the largest provider of services the Improving Access to Psychological Therapies (IAPT) explicitly excludes the making of diagnosis/diagnostic interviews.   IAPT cannot improve access to evidence based psychological therapies because it does not operate the admission gate of an evidence based assessment.

The absence of an EBA leads to a revolving door, demoralising clients in search of a credible explanation of their difficulties. An EBA is a necessary part of evidence based practice (EBP) in that it highlights candidate evidence supported treatments (ESTs). But clinical judgement is still required to ascertain whether there is a sufficient match between client and the subjects in the EST. Most ESTs have admitted clients to the study with a limited range of comorbid disorders and have not been cognitively impaired, or suffering debilitating pain. Further the clients in the EST have been in a safe environment. 

 

Dr Mike Scott

58 replies on “Is Evidence Based Treatment Possible Without Evidence Based Assessment?”

CBT and IAPT were worked up for the purpose of capturing the ‘treatment’ market for all those cases that could be branded as ‘Medically Unknown Symptoms’ (MUS). By definition this is the opposite of evidence-based medicine.

The term is rarely used by honest people, because logical and trusting people would expect that anything that wasn’t evidence-based would not be allowed. In an honest world, the term is redundant. In this world, in almost every case, those who use it are carrying out an opposite process.

In much the same way, ‘sustainable development’, is only used by those intent on getting around sustainability regulations in order to promote infinite building.

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