Developing and Disseminating Effective Psychological Treatments: Science, Practice and Economics

By Clark, David M. | Canadian Psychology, February 2013 | Go to article overview

Developing and Disseminating Effective Psychological Treatments: Science, Practice and Economics


Clark, David M., Canadian Psychology


Abstract

In many countries there is growing interest in the identification, development, and dissemination of evidence based psychological therapies. The cognitive-behaviour therapy (CBT) movement has been particularly successful in developing effective new treatments. It has been suggested this is partly because of the close interplay between theory, experimental psychopathology, and treatment development that characterizes much of CBT research. This article provides an illustration of such an interplay before moving on to discuss one of the world's largest attempts to disseminate evidence-based therapies to the general public. The English Improving Access to Psychological Therapies (IAPT) program aims to vastly increase the availability of evidence-based psychological treatments for anxiety disorders and depression by training an extra 6,000 psychological therapists and deploying them in new, stepped care therapy services. Outcomes are assessed with a session-by-session monitoring system that achieves unusually high levels of data completeness. Around 600,000 patients per year are currently being seen in IAPT services. The background to the initiative, the scientific and economic arguments on which it is based, the training and clinical service models, a summary of progress to date, and future developments are described.

Keywords: dissemination, cognitive-behaviour therapy, anxiety disorders, social anxiety, depression, outcome monitoring, cost-effectiveness, IAPT

Clinical psychology is at a potentially important moment in its history. For decades clinical psychologists have been providing assessments and treatments to aid people with mental health problems. Unfortunately, in most countries only a small proportion of people with such problems have been able to benefit from such help. However, there are now real possibilities for expanding the provision of psychological therapies in many western countries. Policymakers have long been aware of the individual suffering produced by mental health problems. Recently, they have also become aware of the enormous economic cost of untreated mental health problems. This new awareness, in conjunction with a general political move toward seeing the success of a nation at least partly in terms of the well-being of its population, has created a new openness to consider the potential value of psychological therapies. It is crucial that clinical psychologists respond to this by promoting the case for the individual, societal, and economic benefits of making evidence-based psychological treatments more widely available.

The Canadian Psychological Association is strongly and positively responding to this challenge through the work of its evidence-based practice task force and other activities. As a fellow traveller on the road, I am touched to have been selected as the Association's Honorary President for 2012. My presidential address covers two aspects of evidence-based therapy. First, how can psychological science be used to develop new, and hopefully more effective, psychological therapies? Second, how can these therapies be made more widely available?

A Strategy for Developing New Therapies

The way in which psychological therapies are developed is rarely discussed in the literature. Informal discussion with researchers indicates that there are a multitude of routes. My own research team has pursued a particular strategy over the last 20 years that has proved fruitful in developing effective forms of therapy for panic disorder (Clark et al., 1994, 1999), hypochondriasis (Clark et al., 1998; Warwick, Clark, Cobb, & Salkovskis, 1996), posttraumatic stress disorder (PTSD; Duffy, Gillespie, & Clark, 2007; Ehlers, Clark, Hackmann, McManus, & Fennell, 2005; Ehlers et al., 2003; Smith et al., 2007), and social anxiety disorder (Clark et al., 2006, 2003; Mörtberg, Clark, Sundin, & Àberg Wistedt, 2007; Stangier, Heidenreich, Pietz, Lauterbach, & Clark, 2003; Stangier, Schramm, Heidenreich, Berger, & Clark, 2011). …

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