MHM Magazine

automatic thoughts, uncovering core beliefs about themselves, doing homework assignments, and practicing alternative behaviours. Several studies have shown that CBT is among the most effective forms of psychological therapy to help people with depression. It’s an example of an evidence-based intervention. Claims about the effectiveness of CBT rest on an evidence-base, a body of research that has shown, quite robustly that this form of therapy can be quite effective not only for depression but also for a range of other mental health conditions such as anxiety, posttraumatic stress, panic, insomnia, eating disorders, and phobias. It’s therefore important to train psychologists to deliver evidence-based practice (EBP) and to understand the importance of evidence, including how to evaluate studies that seek to show evidence of treatment success. But what do we mean by evidence and EBP? There are various levels of evidence. For example, anecdotal evidence is considered a weak form, because for every story of success there may be stories of failure. Studies in which only one group of participants receive a treatment without being compared to another group are also considered to be limited in terms of being able to make claims about effectiveness – because it’s difficult to say whether the treatment or some other factor led to a particular change. The randomised controlled trial (RCT) is considered the most robust form of evidence to support a claim that a treatment is effective. RCTs are studies in which participants are assessed and then randomly assigned to a treatment or control group. The treatment group receives the treatment that is thought to be effective, and the control group receives either no treatment, treatment as usual, or sometimes a treatment that’s thought to be ineffective. This comparison is important because if participants in the treatment group improve significantly more than participants in the control group, then we can conclude that the treatment being tested is effective (since the randomisation process ensures that the only thing distinguishing the two groups is that one receives the treatment and the other doesn’t). However, people have a range of ideas about what constitutes evidence and EBP. This is why, a few years ago, we conducted a study among directors of clinical and counselling psychology training programmes in South Africa, to understand how they thought about evidence in the context of providing psychotherapy. We’d previously published our data in the SA Journal of Psychology (Kagee & Lund, 2012), and more recently we also presented our data at the Cognitive Behaviour Therapy Association of South Africa (CBTASA) Conference which was held in Cape Town to engage in discussions and training about CBT and to present the latest research showing evidence for using this form of therapy. At the conference we presented our study findings. We had conducted 13 interviews with directors of psychology training programmes around South Africa. The interviews asked directors about EBP and how students are trained to use research in their practice. We found a diverse range of opinions on the matter. Some training directors were quite opposed to EBP because of their concern about what evidence means, the kind of knowledge that is required to support EBP, and concerns about cultural relevance and the lack of a research base for certain psychological needs. Other training directors said they supported the use of EBP, emphasising its necessity for cost-effective services in under- resourced settings like South Africa. And then some training directors were ambivalent. These participants said they recognised the importance of evidence but also highlighted the need for critical engagement with it. In the context of these data we recommend that the Health Professions Council of South Africa and the Psychological Society of South Africa engage more formally with EBP. We suggest developing standardised accreditation criteria for psychology training programmes based on locally developed and valid EBP guidelines. We believe we need a balanced approach to EBP in South African psychology training in which we acknowledge both the benefits of evidence- based interventions and the importance of cultural and contextual factors (which are also important forms of evidence). By applying EBP we believe that if patients such as Vusi, whose symptoms are quite severe and whose quality of life is poor, are treated with evidence-informed interventions, they have a greater likelihood of improving compared to those patients who receive therapies that are not informed by evidence. The implications of this are twofold. First, psychology training programmes should seriously engage with EBP by training clinical and counselling psychologists to implement therapies known to be effective. Second, clinical and counselling psychologists need to be taught skills in research methodology so they can read and understand the research on what works in psychotherapy. Training directors therefore should take seriously the evidence-based movement in mental health and ensure that students are exposed to these debates. Finally, we should say that although we presented this study at the CBTASA conference, CBT is not the only evidence-based treatment. There are several other forms of treatment that have been shown to yield results that show benefit to patients, such as Inter-Personal Therapy (IPT), Behavioural Activation (BA) and Acceptance and Commitment Therapy (ACT). People with mental health conditions such as Vusi can benefit considerably from psychological therapies that are evidence-based. We hope that the findings of our study may be used to strengthen the training of clinical and counselling psychologists in evidence-based therapies, for the benefit of all South Africans. References available on request. MHM | 2024 | Volume 11 | Issue 6 | What do directors of clinical and counselling psychology training programmes think of evidence-based practice? MHM 22 | MENTAL HEALTH MATTERS | 2024 | Issue 6 H