Psikolojik Müdahalelerde Kanıt Temelli Uygulamalar: Güncel Duruma Dair Genel Bir Bakış

Öz

Günümüzde işe yarar ve de etkili olduğunu iddia eden pek çok farklı psikolojik müdahale veya psikoterapi yaklaşımı ile karşılaşmak mümkündür. Bu karmaşayı ve kötüye kullanma olasılığını gidermek üzere Amerikan Psikoloji Derneği (APA), özellikle işe yararlık ve etkililiğin ne olduğu uluslararası alanda da kabul gören objektif ölçütler belirlemiş; bunları da geliştirerek Kanıt Temelli Uygulamalar (KTU) yaklaşımını başlatmıştır. Bu yaklaşımda tek başına belirli sorunlara özgü etkin sonuçlar ürettiğini ispatlayan nitelikli bilimsel araştırma bulguları ile danışan tercihleri ve terapist özelliklerinin de harmanlanması temel alınmaktadır. Bu makalede, Türkiye’de klinik psikoloji alanında bu yaklaşıma yönelik farkındalığın arttırılması amacıyla, yaklaşımın tarihsel arka planı ve temel prensipleri detaylıca açıklanmıştır. Buna ek olarak, APA’nın 12. Birimi olan Klinik Psikoloji Topluluğu’nun internet sayfasında yer alan ve KTU yaklaşımının temelini oluşturan Ampirik Olarak Desteklenen Tedavi Yöntemleri listesinden bahsedilmiş; ardından alanyazında KTU yaklaşımına yönelik var olan bilimsel çalışmalar derlenmiştir. Son olarak, alanyazındaki çalışmalardan hareketle KTU yaklaşımının tanınması ve uygulanır hale gelmesi adına atılabilecek adımlara yönelik belli çıkarımlarda bulunulmuştur.

Anahtar Kelimeler

• Ampirik Olarak Desteklenen Tedavi Yöntemleri
• farkındalık
• Kanıt Temelli Uygulamalar
• uygulama
• yayılma

Evidence Based Practice on Psychological Interventions: A Literature Review on Current Situation

Öz

Numerous psychological interventions and psychotherapy approaches claim they are effective and functional. To prevent confusion and potential misuse, the American Psychological Association (APA) has established objective criteria for the efficiency and functionality of these approaches that were also internationally agreed upon. Then, it ultimately announced the Evidence-Based Practice (EBP) approach in clinical psychology. This approach merges robust scientific research findings highlighting influential outcomes on certain psychological problems with client preferences and clinician features. In order to raise awareness in the field of clinical psychology in Turkey, this article first outlines the fundamental characteristics and basics of the EBP, as well as its historical context. Moreover, the Society of Clinical Psychology website is the 12th section of the APA that includes a list of psychological interventions announced as Empirically Supported Treatments and relevant resources. Finally, general findings and discussions obtained in the scientific literature review on the concept of the EBP were presented, and later, an evaluation of studies on the dissemination and implementation of the EBP was focused. Relevant implications were also presented based on the current findings of this article.

Anahtar Kelimeler

• Emprically Supported Treatments
• awareness
• Evidence Based Practice
• implementation
• dissemination

Kaynakça

1. Aarons, G. (2004). Mental health provider attitudes toward adoption of evidence-based practice: The evidence-based practice attitude scale (EBPAS). Mental Health Services Research, 6(2), 61–74. https://doi.org/10.1023/B:MHSR.0000024351.12294.65
2. Aarons, G. A., Cafri, G., Lugo, L. ve Sawitzky, A. (2012). Expanding the domains of attitudes towards evidence based practice: The evidencebased practice attitude scale-50. Administration and Policy in Mental Health and Mental Health Services Research, 39(5), 331–340. https://doi.org/10.1007/s10488-010-0302-3
3. American Psychological Association. (1947). Committee on training in clinical psychology. Recommended graduate training program in clinical psychology. American Psychologist, 2(12), 539–558. https://doi.org/10.1037/h0058236
4. American Psychological Association. (1995). Template for developing guidelines: Interventions for mental disorders and psychosocial aspects of physical disorders (1. Basım). Washington DC: Author.
5. American Psychological Association. (2002). Criteria for evaluating treatment guidelines. American Psychologist, 57(12), 1052–1059. https://doi.org/10.1037//0003-066X.57.12.1052
6. American Psychological Association. (2023). Advisory steering committee for development of clinical practice guidelines. Amerikan Psikoloji Derneği (American Psychological Association) sitesinden alınmıştır: https://www.apa.org/about/offices/directorates/guidelines/steering-committee
7. APA Presidential Task Force on Evidence-Based Practice. (2006). Evidence-based practice in psychology. The American Psychologist, 61(4), 271-285. https://doi.org/10.1037/0003-066X.61.4.271
8. Babione, J. M. (2010). Evidence-based practice in psychology: An ethical framework for graduate education, clinical training, and maintaining professional competence. Ethics & Behavior, 20(6), 443-453. https://doi.org/10.1080/10508422.2010.521446

9. Baker, M. ve Kleijnen, J. (2000). The drive towards evidence-based health care. İçinde N. Rowland ve S. Goss (Edl.), Evidence-based Counseling and Psychological Therapies: Research and applications (ss. 13–33). Routledge.
10. Barrett, J., Gonsalvez, C. J. ve Shires, A. (2019). Evidence‐based practice within supervision during psychology practitioner training: A systematic review. Clinical Psychologist, 24(1), 3-17. https://doi.org/10.1111/cp.12196
11. Bearman, S. K., Wadkins, M., Bailin, A. ve Doctoroff, G. (2015). Pre-practicum training in professional psychology to close the research–practice gap: Changing attitudes toward evidence-based practice. Training and Education in Professional Psychology, 9(1), 13. https://doi.org/10.1037/tep0000052
12. Beidas, R. S. ve Kendall, P. C. (2010). Training therapists in evidencebased practice: A critical review of studies from a systemscontextual perspective. Clinical Psychology: Science and Practice, 17(1), 1 – 30. https://doi.org/10.1111/j.1468-2850.2009.01187.x
13. Beutler, L. E. (1998). Identifying empirically supported treatments: What if we didn't? Journal of Consulting and Clinical Psychology, 66(1), 113. https://doi.org/10.1037/0022-006X.66.1.113
14. Booth, A., Clarke, M., Dooley, G., Ghersi, D., Moher, D., Petticrew, M. ve Stewart, L. (2012). The nuts and bolts of PROSPERO: an international prospective register of systematic reviews. Systematic Reviews, 1(1), 1-9. https://doi.org/10.1186/2046-4053-1-2
15. Chambless, D. L. ve Hollon, S. D. (1998). Defining empirically supported therapies. Journal of Consulting and Clinical Psychology, 66(1), 7. https://doi.org/10.1037/0022-006X.66.1.7
16. Clark, D. M., Layard, R., Smithies, R., Richard, D. A., Suckling, R. ve Wright, B. (2009). Improving access to psychological therapy: Initial evaluation of two UK demonstration sites. Behaviour Research and Therapy, 47(11), 910–920. https://doi.org/10.1016/j.brat.2009.07.010
17. Cuijpers, P. (2019). Targets and outcomes of psychotherapies for mental disorders: an overview. World Psychiatry, 18(3), 276-285. https://doi.org/10.1002/wps.20661
18. Çay, M. ve Daşbaş, S. (2020). Kanıta Dayalı Uygulama Ölçeğinin Türkçeye uyarlanması: Geçerlik ve güvenirlik çalışması. Toplum ve Sosyal Hizmet, 31(4), 1514-1546. https://doi.org/10.33417/tsh.733462
19. DiLillo, D. ve McChargue, D. (2007). Implementing elements of evidence‐based practice into scientist practitioner training at the University of Nebraska‐Lincoln. Journal of Clinical Psychology, 63(7), 671-684. https://doi.org/10.1002/jclp.20375
20. Djulbegovic, B. ve Guyatt, G. H. (2014). Evidence-based practice is not synonymous with delivery of uniform health care. Jama, 312(13), 1293-1294. https://doi.org/10.1001/jama.2014.10713
21. Fairburn, C. G. (2013). Overcoming binge eating (2. Basım). Guilford Press.
22. Fairburn, C. G., Marcus, M.D. ve Wilson, G. T. (1993). Cognitive-behavioral therapy for binge eating and bulimia nervosa: A comprehensive treatment manual. İçinde C. G. Fairburn ve G. T. Wilson (Edl.), Binge eating: Nature, assessment and treatment (ss. 361-404). Guilford Press.
23. Foa, E. B., Yadin, E. ve Lichner, T. K. (2012). Exposure and response (ritual) prevention for obsessive-compulsive disorder: Therapist guide (2. Basım). Oxford University Press.
24. Frank, G. (1984). The Boulder model: History, rationale, and critique. Professional Psychology: Research and Practice, 15(3), 417. https://doi.org/10.1037/0735-7028.15.3.417
25. Guyatt, G. H., Oxman, A. D., Vist, G. E., Kunz, R., Falck-Ytter, Y., Alonso-Coello, P. ve Schünemann, H. J. (2008). GRADE: An emerging consensus on rating quality of evidence and strength of recommendations. Bmj, 336(7650), 924-926. https://doi.org/10.1136/bmj.39489.470347.AD
26. Hadjistavropoulos, H. D., Kehler, M. D., Peluso, D., Loutzenhiser, L. ve Hadjistavropoulos, T. (2010). Case presentations: A key method for evaluating core competencies in Professional psychology? Canadian Psychology/Psychologie Canadienne, 51(4), 269–276. https://doi.org/10.1037/a0021735
27. Hamill, N. R. ve Wiener, K. K. K. (2018). Attitudes of Psychologists in Australia towards evidence‐based practice in psychology. Australian Psychologist, 53(6), 477-485. https://doi.org/10.1111/ap.12342
28. Higgins, J. P. T., Altman, D. G., Gotzsche, P. C., Juni, P., Moher, D., Oxman, A. D., Savovic, J., Schulz, K. F., Weeks, L., Sterne, J. A. C., Cochrane Bias Methods Group ve Cochrane Statistical Methods Group. (2011). The Cochrane Collaboration’s tool for assessing risk of bias in randomised trials. British Medical Journal, 343(2), 1-9. https://doi.org/10.1136/bmj.d5928
29. Higgins, J. P. ve Green, S. (Edl.). (2008). Cochrane handbook for systematic reviews of interventions (1. Basım). Wiley- Blackwell.
30. Hollon, S. D., Areán, P. A., Craske, M. G., Crawford, K. A., Kivlahan, D. R., Magnavita, J. J., Ollendick, T. H., Sexton, T. L., Spring, B., Bufka, L. F., Galper, D. I. ve Kurtzman, H. (2014). Development of clinical practice guidelines. Annual Review of Clinical Psychology, 10(1), 213-241. https://doi.org/10.1146/annurev-clinpsy-050212-185529
31. Hunsley, J. ve Lee, C. M. (2007). Informed benchmarks for psychological treatments: Efficacy studies, effectiveness studies, and beyond. Professional Psychology: Research and Practice, 38(1), 21. https://doi.org/10.1037/0735-7028.38.1.21
32. Jiménez-Pérez, A. L. ve Vargas-Contreras, E. (2020). Transfer of learning for evidence-based practice in psychology. International Education Studies, 13(5), 72-79. https://doi.org/10.5539/ies.v13n5p72
33. Jones, J. L. ve Mehr, S. L. (2007). Foundations and assumptions of the scientist-practitioner model. American Behavioral Scientist, 50(6), 766–771. https://doi.org/10.1177/0002764206296454
34. Kagee, A. ve Lund, C. (2012). Psychology training directors' reflections on evidence-based practice in South Africa. South African Journal of Psychology, 42(1), 103-113. https://doi.org/10.1177/008124631204200111
35. Kazdin, A. E. (2008). Evidence-based treatment and practice: New opportunities to bridge clinical research and practice, enhance the knowledge base, and improve patient care. American Psychologist, 63(3), 146-159. https://doi.org/10.1037/0003-066X.63.3.146
36. Lander, B. ve Balka, E. (2019). Exploring how evidence is used in care through an organizational ethnography of two teaching hospitals. JMIR Yayınları (JMIR Publications) sitesinden alınmıştır: https://www.jmir.org/2019/3/e10769
37. Le Grange, D. ve Lock, J. (2007). Treating bulimia in adolescents: A family-based approach (1. Basım). Guilford Press
38. Liberati, A., Altman, D. G., Tetzlaff, J., Mulrow, C., Gotzsche, P. C., Ioannidis, J. P. A., Clarke, M., Devereaux, P. J., Kleijnen J. ve Moher, D. (2009). The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate health care interventions: Explanation and elaboration. BMJ Publishing Group sitesinden alınmıştır: https://www.bmj.com/content/339/bmj.b2700
39. Lilienfeld, S. O., Ritschel, L. A., Lynn, S. J., Cautin, R. L. ve Latzman, R. D. (2013). Why many clinical psychologists are resistant to evidence-based practice: Root causes and constructive remedies. Clinical Psychology Review, 33(7), 883-900. https://doi.org/10.1016/j.cpr.2012.09.008
40. Luebbe, A. M., Radcliffe, A. M., Callands, T. A., Green, D. ve Thorn, B. E. (2007). Evidence‐based practice in psychology: Perceptions of graduate students in scientist–practitioner programs. Journal of Clinical Psychology, 63(7), 643-655. https://doi.org/10.1002/jclp.20379
41. Luoma, J. B., Hayes, S. C. ve Walser, R. D. (2007). Learning ACT: An acceptance and commitment therapy skills-training manual for therapists (1. Basım). Harbinger Publications.
42. March, J. S., Silva, S. G., Compton, S., Shapiro, M., Califf, R. ve Krishnan, R. (2005). The case for practical clinical trials in psychiatry. American Journal of Psychiatry, 162(5), 836-846. https://doi.org/10.1176/appi.ajp.162.5.836
43. McHugh, R. K. ve Barlow, D. H. (2010). The dissemination and implementation of evidence-based psychological treatments: a review of current efforts. American Psychologist, 65(2), 73. https://doi.org/10.1037/a0018121
44. Middleton, J. C., Kalogeropoulos, C. ve Drapeau, M. (2020). What is evidence-based practice? A survey of psychotherapy service providers and leaders in psychology about evidence-based practice in psychology. Canadian Journal of Counselling and Psychotherapy sitesinden alınmıştır: https://cjc-rcc.ucalgary.ca/article/view/61212/53847
45. Moseley, A. ve Tierney, S. (2005). Evidence-based practice in the real world. Evidence & Policy, 1(1), 113-119. https://doi.org/10.1332/1744264052703212
46. Mozdzierz, G. J., Peluso, P. R. ve Lisiecki, J. (2011). Evidence-based psychological practices and therapist training: At the crossroads. Journal of Humanistic Psychology, 51(4), 439-464. https://doi.org/10.1177/0022167810386959
47. Mozdzierz, G. J., Peluso, P. ve Lisiecki, J. (2014). Principles of counseling and psychotherapy: Learning the essential domains and nonlinear thinking of master practitioners (2. Basım). Routledge.
48. Newnham, E. A. ve Page, A. C. (2010). Bridging the gap between best evidence and best practice in mental health. Clinical psychology review, 30(1), 127-142. https://doi.org/10.1016/j.cpr.2009.10.004
49. NICE. (2023). About. Ulusal Sağlıkta ve Bakımda Mükemmellik Enstitüsü (National Institute for Health and Care Excellence) sitesinden alınmıştır: https://www.nice.org.uk/about
50. Norcross, J. C. (Ed). (2002). Psychotherapy Relationships That Work: Therapist Contributions and Responsiveness to Patients. (ss. 300- 311). Oxford University Press.
51. Norcross, J. C. ve Wampold, B. E. (2011). Evidence based therapy relationships: Research conclusions and clinical practices. Psychotherapy, 48(1), 98–102. https://doi.org/10.1037/a0022161
52. Padmanabhanunni, A. ve Sui, X. C. (2017). Mental healthcare providers’ attitudes towards the adoption of evidence-based practice in the treatment of post-traumatic stress disorder in South Africa. South African Journal of Psychology, 47(2), 198-208. https://doi.org/10.1177/0081246316673244
53. Rogers, E. M. (2003). Diffusion of innovations (5. Basım). Free Press.
54. Rubin, A. (2008). Practitioner’s guide to using research for evidence-based practice (2. Basım). John Wiley.
55. Ruzek, J. I., Karlin, B. E. ve Zeiss, A. M. (2012). Implementation of evidence-based psychological treatments in the Veterans Health Administration. İçinde R. K. McHugh ve D. H. Barlow (Edl.), Dissemination of evidence-based psychological treatments (ss. 78–96). Oxford University Press.
56. Rye, M., Torres, E. M., Friborg, O., Skre, I. ve Aarons, G. A. (2017). The Evidence-based Practice Attitude Scale-36 (EBPAS-36): A brief and pragmatic measure of attitudes to evidence-based practice validated in US and Norwegian samples. Implementation Science, 12(1), 1-11. https://doi.org./10.1186/s13012-017-0573-0
57. Savovic, J., Jones, H. E., Altman, D. G., Harris, R. J., Juni, P., Pildal, J., Als- Nielsen, B., Balk, E. M., Gluud, C., Gluud, L. L., Ioannidis, J. P. A., Schulz, K. F., Beynon, R., Welton, N. J., Wood, L., Moher, D., Deeks, J. J. ve Sterne, J. A. C. (2012). Influence of reported study design characteristics on intervention effect estimates from randomized, controlled trials. Annals of Internal Medicine, 157(6), 429–438. https://doi.org/10.7326/0003-4819- 157-6-201209180-00537
58. Shea, B. J., Hamel, C., Wells, G. A., Bouter, L. M., Kristjansson, E., Grimshaw, J., Henry, D. A. ve Boers, M. (2009). AMSTAR is a reliable and valid measurement tool to assess the methodological quality of systematic reviews. Journal of Clinical Epidemiology, 62(10), 1013–1020. https://doi.org/10.1016/j.jclinepi.2008.10.009
59. Society of Clinical Psychology. (2022). Professional Home of Clinical & Health Service Psychologists. Klinik Psikoloji Topluluğu (Society of Clinical Psychology) sitesinden alınmıştır: https://div12.org/
60. Spring, B. (2007). Evidence‐based practice in clinical psychology: What it is, why it matters; what you need to know. Journal of Clinical Psychology, 63(7), 611-631. https://doi.org/10.1002/jclp.20373
61. Steketee, G. (Ed). (2011). The Oxford handbook of obsessive compulsive and spectrum disorders. (pp. 1-545). Oxford University Press.
62. Stice, E. ve Presnell, K. (2007). The Body Project: Promoting body acceptance and preventing eating disorders, facilitators guide (1. Basım). New York: Oxford University Press.
63. Stuart, S. ve Robertson, M. (2012). Interpersonal psychotherapy: A clinician's guide (2. Basım). CRC Press.
64. The GRADE Working Group. (2023). What is GRADE. GRADE Çalışma Grubu (The GRADE Working Group) sitesinden alınmıştır: https://www.gradeworkinggroup.org/
65. Tolin, D. F. (2014). Evidence-based practice: Three-legged stool or filter system. Klinik Psikoloji Topluluğu (Society of Clinical Psychology) sitesinden alınmıştır: https://www.div12.org/wp-content/uploads/2014/08/TCP_Summer2014_FINAL1.pdf
66. Tolin, D. F., McKay, D., Forman, E. M., Klonsky, E. D. ve Thombs, B. D. (2015). Empirically supported treatment: Recommendations for a new model. Clinical Psychology: Science and Practice, 22(4), 317. https://doi.org/10.1037/h0101729
67. Wachtel, P. L. (2010). Beyond “ESTs”: Problematic assumptions in the pursuit of evidence-based practice. Psychoanalytic Psychology, 27(3), 251. https://doi.org/10.1037/a0020532
68. Wampold, B. E., Goodheart, C. D. ve Levant, R. F. (2007). Clarification and elaboration on evidence-based practice in psychology. American Psychologist, 62(6), 616–618. https://doi.org/10.1037/0003-066X62.6.616
69. Wilson, J. L., Armoutliev, E., Yakunina, E. ve Werth Jr, J. L. (2009). Practicing psychologists’ reflections on evidence-based practice in psychology. Professional Psychology: Research and Practice, 40(4), 403. https://doi.org/10.1037/a0016247
70. Yates, C. (2013). Evidence-based practice: The components, history, and process. Counseling Outcome Research and Evaluation, 4(1), 41-54. https://doi.org/10.1177/2150137812472193
71. Yıldız, E. ve Güngörmüş, Z. (2016). The validity and reliability study of the Turkish version of The Evidence-based Practice Evaluation Competence Questionnaire. Nurse Education Today, 45(1), 91-95. https://doi.org/ 10.1016/j.nedt.2016.05.030