EBP vs. EST

Man, there are a lot of acronyms in psychology. It’s all very confusing and I often see even mental health and medical professionals get certain terms wrong. I want you to understand Evidence-Based Practice (EBP) versus Empirically Supported Treatment (EST) because you are the advocate for your own mental health and maybe this will be relevant to you in some way. If not, send this to a psychology trainee friend and they’ll be able to show off in a lecture or meeting. Buckle up, mes amis, because this is a word-heavy post!

First, let’s define Empirically Supported Treatment. Let’s say I create a new therapy for child anxiety disorders called Dr. Cam’s Cool Therapy for Kids. Do kids who receive Dr. Cam’s Cool Therapy for Kids learn to face their fears and get back to thriving at home, school, and with friends? Researchers will put this question to the test in a randomized control trial (RCT), meaning that Dr. Cam’s Cool Therapy for Kids is being compared to another treatment (ideally) or some sort of waitlist (AKA people who are not receiving treatment) to see if the children and families who receive treatment do better than those who receive no or a different treatment. If the therapy is successful in treating the kids, after completing two RCTs, Dr. Cam’s Cool Therapy for Kids could be considered an EST. Sweet!

Evidence-Based Practice is the ideal: the therapist should select an EST (if available for the disorder/problem area) and then combine it with knowledge of the patient’s unique cultural variables (gender, age, ethnicity, sexual orientation, etc.), and their own clinical judgment as a professional. This is where things get interesting.

Let’s say they only tested Dr. Cam’s Cool Therapy for Kids on 2- to 4-year-olds. I’m working with an 8-year-old with fear of separating from her parents and I’m trying to find the best treatment for her. I know there’s an evidence-based treatment called Coping Cat that I could try for this child and it’s likely to work. But, if that didn’t exist and there were no other ESTs for separation anxiety for 8-year-olds, then the best thing would be to use Dr. Cam’s Cool Therapy for Kids and to make it more relevant for an older child. Then, I would measure progress to make sure it’s working. If it is, awesome (and now we know maybe this treatment works for other populations) and if not, then I would make adaptations based on my understanding of treatment and what might be going wrong.

As you can see, a treatment could be considered an EST but does not have research backing for a particular population or problem area. All therapy should be delivered as evidence-based practice. Unfortunately, this is more the exception than the rule. Non-evidence based practice would include selecting treatments that do not have sufficient research backing, applying a treatment to a diagnosis different from intended, or assuming that a treatment will work for an individual without any evidence that it addresses their unique needs. For example, if my treatment was a video series and I presented it to a child who is deaf and blind with no adaptations, I should not expect it to work.

I’ve heard people say things in professional lectures like “Yes, it’s an evidence-based treatment, but for who!?”. They are mixing up EBP and EST. EBP inherently takes into consideration the unique cultural/demographic variables of the patient.

Okay, this is a cool discussion for a psychology student, but does this mean anything if you’re the patient?

Let’s say you’re a Latina woman who is searching for therapy for your young son, who is having behavior problems. You’ve figured out there’s an EST called Parent-Child Interaction Therapy. Although you speak English well enough, you’re more comfortable in Spanish. You also wonder if your Mexican heritage impacts your parenting style. Do these things matter, as we move from EST to EBP? Yes!

Perhaps you can find a therapist who is Latine and/or speaks Spanish. Or, at least, you can receive your handouts in Spanish for your review when you go home. Maybe it is relevant to discuss your parenting style and the things that are important to your family with the PCIT therapist.

tldr: Your therapist should select the treatment with the most research backing for your diagnosis/problem area and then also personalize the treatment for your or your child’s unique needs and preferences.