Empirically-validated therapies are forms of treatment that are strongly backed by scientific data obtained from various observations, studies, or experimentation. The hypothesis obtained is testable using experimentation or observations. An empirical result is obtained is an experimental observation (such as a clinical trial). Usually it has been seen that practitioners do not follow empirically-validated data and instead would go by their clinical experience.
The clinical scientist on the other hand would be concentrating hugely on empirically-validated therapies. In the field of psychiatry, empirically-validated therapies play a very major role. In the last few years, the concentration of mental care has shifted hugely from well-established therapies which are routinely utilized to ’empirically-supported therapies’. It has not only proved to be effective in the treatment of various mental disorders, but has also reduced the costs and has proved to be very useful in managed care settings.
State, local and federal bodies that fund healthcare are now paying greater amount of importance to empirically-validated therapies. In future, the psychiatric practitioner would be concentrating to a very great extent on empirically-validated therapies. In case of medico-legal issues, a practitioner could be held liable for malpractice if he/she holds up an empirically-validated treatment and goes in for a standard treatment process that has been utilized since several years.
Accreditations organizations could also be considering using the extent to which a hospital would be using empirically-validated treatment in the patients. The APA is also considering imposing stricter sanctions for not implementing empirically-validated treatment in mental healthcare (Guimon, 2007 & Levant, 2008). Use of Empirically-validated therapy in the treatment of Borderline Personality disorder –Antidepressants and psychotherapy
One of the classical examples of Empirically-supported treatment has been in the case of patients suffering from borderline personality disorders (BPD). Such a patient would be affected with several symptoms including impulsiveness, hostility, self-destructive behavior, anger outbursts, projective identification, poor interpersonal relationships, long-standing fears, intolerance, mood swings, suicidal behavior, presence of comorbid disorders, etc. Such an individual may give a history of child abuse, child neglect, presence of other psychological or neurological disorders, etc.
The exact cause of the disorders is not known but several factors including biological factors, genetic factors, neurochemical factors, environmental factors, etc, would be playing a major role in the development of the disorder. Borderline personality disorder may be early response mechanisms to sexual and aggressive drives (Guimon, 2007). Traditionally, no specific treatment has been available as a cure for BPD, but only management of the symptoms. Psychotherapy along with short term administration of medications has been traditionally been utilized.
The medications utilized can only treat the symptoms of anxiety, depression and aggressiveness and cannot be utilized to treat BPD per se. Non-clinical studies have demonstrated that SSRI antidepressants, narcoleptics and mood stabilizers can help only to a certain extent in the treatment of BPD. Hospitalization may be required to treat patients with the risk of suicide or causing danger to others. Some psychiatrists may feel that hospitalization of the patient is required only for medico-legal issues.
However, empirically-performed data have shown that chronic suicidal thoughts may be an expression of depression and distress and can be effectively managed through ambulatory settings. Several antidepressants, whose effect on BPD was not known before, have proved to be beneficial through empirically-validated studies. Binks et al (2007) conducted a study to determine the efficacy of several agents utilized in the treatment of BPD. He found that among the antidepressants – Fluoxetine was ideal in comparison to a placebo utilized in the treatment of depression.
There were not much difference between
This rate was seven times higher than anticipated. During the early phases of treatment, psychodynamic therapy seemed to be effective, helping to build good alliances with the patient. Group therapy is today being effective in outpatient settings. In cognitive behavior therapy, greater emphasis is laid upon the application of one’s skill and knowledge in more fruitful outcomes. Psychoanalytical approaches are increasing being utilized to improve the strength of the ego and to experience reality more appropriately.
DBT (through a Cochrane review conducted in 2007 – CA Binks et al), had been compared with other forms of treatment. Not many differences were found between DBT and other forms of treatment, but there was a reduction in parasuicidal behaviors and the general psychiatric severity. Hence today, Evidence-based drug or psychotherapeutic approaches seem to be efficient and safe in people suffering from BPD. More studies in the field of BPD need to be conducted to determine the presence of more effective and safer treatment modes (Binks, 2007, Perry, 1999 & Guimon, 2007).
Use of Empirically-validated therapy in the treatment of Depression – Psychotherapy (A comparison between the traditionally utilized drugs and empirically-validated psychotherapy) Another field in which a lot of evidenced-based studies are being conducted is in the field of depression. This is soon going to be considered the second most commonest of debility and distress across the globe. In the US, more than 50 billion dollars is being spent annually in the diagnosis and treatment of depression. The loss in terms of inability to function appropriately at the workplace is much higher.
Many cases of depression go untreated in the US. In the past, antidepressants have been utilized as the standard in the treatment across the US. Physicians, hospitals and insurance agencies in the US stress on the use of antidepressants in the treatment of depression. However, research today has demonstrated that there are much more effective and safer alternative treatments for depression. Drugs may be useful, but cannot be considered as the only treatment for the condition. Empirically-validated therapies can be considered as conventional, supplemental as well as alternative forms of treatments in the management of depression.
Empirically-validated treatments to be utilized in the treatment of depression may be costly in the short-run, but beneficial in the long-run as they aim to relieve the symptoms and not change the character of the patient. As they would be utilized for short periods of time, the patient is encouraged to make modifications in the lifestyle. One of the important treatment modalities in the management of depression has been psychotherapy. Several modes under psychotherapy such as cognitive therapy, interpersonal therapy, behavioral therapy, etc, seem to be more effective in the treatment of depression compared to before.
They have several advantages when compared to drugs. Antidepressants tend to relieve the motor symptoms of depression before the mood, whereas psychotherapy tends to improve mood before the motor symptoms. Through psychotherapy several issues such as difficulties at the workplace or home, problematic interpersonal relationships, social withdrawals, etc, can be more effectively managed compared to drugs which tend to reduce some of the physical and neurovegetative symptoms. Traumatic life events that are the root cause of depression can be more effectively managed through psychotherapy rather than medications.
Psychotherapy is not only needed in the acute stages of depression, but also in the long-term, as a maintenance therapy. Cases of relapse and recurrences are found to be lower when psychotherapy has been administered. Studies have also demonstrated that combination therapy (short-term administration of medication along with long-term psychotherapy) has been very effective in the treatment of depression. Studies have shown that psychotherapy when administered alone or in combination with medication is more affective than when medication is being administered alone.
Several depressive symptoms, absenteeism and disability in functioning are significantly relieved following psychotherapy. Psychotherapy would help to correct the root causes of depression such as stressful work atmospheres, traumatic interpersonal relationships, fears, etc. Today, empirically-validated forms of psychotherapy can be utilized to a greater extent if they are given a go-ahead by the insurance companies and employers. In the past, these forms of treatment have been considered to be ineffective and costly.
Studies have even demonstrated that patients, who suffer from depression under low lights, could benefit from phototherapy. Only some patients in the experimental group have benefitted from this treatment. Current studies have demonstrated that transcranial magnetic stimulation could be utilized as an effective alternative to ECT. But today, through evidenced-based studies more and more benefits of psychotherapy are being understood (Vaisle, 2001, Moore, 2004 & Markowitz, 2008). Use of Empirically-validated therapy in the treatment of Obsessive Compulsive Disorder –Clomipramine and SSRI’s antidepressants
Obsessive Compulsive Disorder (OCD) is an anxiety disorder in which obsessions (persistent thought and ideas) and compulsions (strange and repetitive behavior) develop. Earlier it was thought that the disorder had a very poor outcome as there was a lack of studies conducted in this area. However, today a lot of experimentations have been conducted with psychotherapy and medications utilized to treat the disorder. About one-third to half the number of patients affected with the disorder are children.
The outcome of OCD is especially poor if found in association with a personality disorder. However, compared to other psychiatric disorders, the response of OCD is low to both medications and psychotherapy. Several antidepressant substances seem to be effective in treating the symptoms of OCD. One of them is Clomipramine which has through a European study found to lower obsessions. In another study, several symptoms such as anxiety, social isolation, depression, etc, were reduced when clomipramine was combined with psychotherapy.
Lower doses of clomipramine were useful in treating the obsessions, but the ritualistic continued to be present. Several studies have shown that clomipramine as very useful in OCD. In another study, SSRI’s were found to be very useful in treating OCD in children. However, these drugs need to be administered in higher doses. In adults, SSRI’s seem to be not very effective in treating OCD. Overall very few drugs have been tested in the past for the treatment of OCD, and this has to change in the future (Herbert, 2001 & Goetz, 2007). Conclusion and Personal Opinion
Today, practitioners should get more and more into following the empirically-validated forms of treatment in another disease, rather than the traditional model. In the past, doctors were only going by experience of what drug or therapy would be ideal to treat a particular condition. Standard forms of treatment may seem to be safe but outdated, and the patient would not be gaining the benefits of updated research work conducted in the medical field. However, today medicine is fast-paced and newer and more and more advanced forms of treatment is coming out, that also seems to be very much effective than the drugs compared to yesterday.
If the practitioners use the traditional model in treating the patients, then the treatment is not going to be effective and safe. Hence, it would be ideal for the psychiatrist to use the evidenced-based findings in their practice. Through several clinical trials conducted on certain mental disorders including BPD, depression and OCD, it has been found that certain pharmacological and psychotherapeutic interventions have proved to be very effective. Further trials are required to help ensure that more effective and safer therapies are understood and made available to the patients.
If the clinical scientists are unable to find efficient use of a particular drug or psychotherapy method on the patient, it does not mean that it is ineffective for use, but rhater means further structured trials need to be conducted which would help to understand the drug better. Evidence-based and ‘empirically-validated’ are new movements that have arisen in the medical and psychiatric world today. These movements have also considered ethical, legal, moral and social implications.