Kazdin (2008). New opportunities to bridge clinical research and practice, enhance the knowledge base, and improve patient care.” - Article summary

It is unclear which treatment is the most effective in particular cases and it is not clear which treatments have sufficient evidence to be used, as there are no guidelines for this. Evidence-based treatment (i.e. EBT) refers to interventions or techniques that have therapeutic changes in controlled trials. Evidence-based practice (EBP) refers to clinical practice informed by evidence about interventions, clinical expertise and patient needs, values and preferences. Evidence-based practice is not what researchers have studied and might lack evidence.

One critique of evidence-based treatment is that key conditions and characteristics of treatment research (e.g. context) is different from clinical practice. This makes the results difficult to generalize. Another critique is that the research tends to focus on the symptoms, rather than the patients as a whole. There are also three points of criticism regarding the methods of treatment research:

1. Criteria
   There are different criteria for determining whether a treatment is evidence-based or empirically supported. The choice I             mplies statistical significance and not necessarily practical significance.
2. Arbitrary rating scales
   The changes in rating scales in research are difficult to translate to changes in everyday life. The metrics are arbitrary. Clinical indices also do not necessarily reflect changes in everyday life of a patient.
3. Mixed results
   There are often mixed results between studies. The measures that show change or do not show change in an individual study are not necessarily the same measures that show these effects between studies. The results are often mixed.

There are also several concerns about evidence-based clinical practice. This includes clinical judgement as a way of integrating information because of concerns of reliability and validity. Many critical clinical issues and concerns are not heavily researched. The clinical decision making is criticized because there is no replicable method of doing it. Furthermore, it is not clear how the results in clinical practice can be generalized. This is difficult to do because it is not always possible to generalize clinical results from one patient to the next. This makes it difficult to make clinical judgement. Another concern is determining which variables make a difference in treatment, as this is always probabilistic (i.e. clinical decision making is analogous to multiple regression). A final concern is the way in which clinical progress is evaluated. This is often done based on clinician impressions rather than systematic observations. There are a plethora of treatments available for clinicians and not all have evidence to support them.

The goals of research are optimally developing the knowledge base (1), provide the best information to improve patient care (2) and materially reduce the divide between research and practice (3). This can be better achieved by shifting the emphasis to give a greater priority to the study of mechanisms of therapy (1), study the moderators of change (2) and by conducting more qualitative research (3).

It is imperative to determine the mechanisms of change in order to assess treatments and close the divide between research and practice. Identifying mechanisms is difficult because studies rarely establish the timeline (1) and studies do not explain how the process unfolds to alter patient functioning (2). Understanding the mechanisms of change can enhance the effects of treatment in clinical application.

Moderators refer to characteristics that influence the intervention-outcome relation. The ways in which moderators are studied and reported (1) and not knowing how the moderator works across multiple conditions (2) makes it difficult to translate research to practice. There are three changes that would improve the research on moderators.

1. The findings should be reported in a way that makes them applicable to clinical work.
2. It should be determined whether variables predict responsiveness to specific treatments.
3. It should be determined what facet of the moderator is relevant or how the moderator works (i.e. mechanism).

Another method of crossing the divide between research and practice is conducting more qualitative research. This could be used to connect metrics that are not arbitrary. Qualitative research could also generate more hypotheses which directly apply to clinical practice.

Clinical practice could diminish the divide by using systematic measures to evaluate patient progress. There are three reasons for using more systematic measures of patient progress:

1. It helps to provide high quality care.
2. It helps make decisions regarding continuation, alteration or termination of the treatment.
3. It helps to complete clinical judgement.

Clinical practice could also diminish the divide by adding to the knowledge base as the therapist accumulates a lot of knowledge through experience. Adding this knowledge to the general knowledge base would be an advantage. The accumulation of cases over time can yield new insights about treatment processes and outcome when the cases are systematically evaluated. It also helps clinicians, as the clinician can draw on prior cases.

There are three interrelated ways to improve the outcome of treatment:

1. Identifying effective interventions and the most effective interventions can improve outcome.
2. Understanding why and how an effective treatment works can improve outcome.
3. Identifying moderators of treatment can improve outcome.