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Cited by 73Psychotherapy Techniques and ApplicationsCounseling Practices and SupervisionHealth Sciences Research and Education

The gap between science and practice: how therapists make their clinical decisions

Open access
Gyani, Alex, Shafran, Roz, Myles, Pamela, Rose, Suzanna·2014·Behavior Therapy
DOI 10.1016/j.beth.2013.10.004
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Abstract

Recent surveys have found that many patients are not receiving empirically supported treatments and that therapists may not update their knowledge of research. Studies have found that therapists prefer to use their clinical experience rather than research findings to improve their practice, although cognitive behavioral (CB) practitioners have been found to use research more frequently than therapists of other theoretical orientations. The organization in which therapists work has been shown to impact attitudes toward working practices, but studies have not examined whether workplace requirements to use research affect therapists' practice. Studies to date have mainly been conducted in North America. These findings may not be generalizable to the United Kingdom where there is a National Health Service (NHS), which requires the use of empirically supported treatments. The first part of this study aimed to investigate which factors were influential in therapists' choice of theoretical orientation and to see whether CB practitioners differed from other therapists in the factors that influenced their choice of theoretical orientation. The second part tested whether therapists' theoretical orientation or their workplace influenced the frequency with which they used research in their clinical decision-making. The final part investigated whether being a CB practitioner or working in the NHS was associated with having a favorable attitude toward research. An online survey was sent to 4,144 psychological therapists in England; 736 therapists responded (18.5%). Therapists reported that research had little influence over their choice of theoretical orientation and clinical decision-making compared to other factors, specifically clinical experience and supervision. CB practitioners and NHS therapists, regardless of their orientation, were significantly more likely to use research than other therapists and were more likely to have a positive attitude toward research.

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  • More effectiveness studies in routine settings may be required before clinicians regard efficacy trials as helpful for their practice.

    “However, recent evidence suggests that more real world effectiveness trials are needed before clinicians are likely to perceive efficacy trials as being useful for guiding their clinical interventions (Gyani, Shafran, Myles, & Rose, 2014).”

    From Group metacognitive therapy for repetitive negative thinking in primary and non-primary generalized anxiety disorder: An effectiveness trial (2015) · cites this paper as Gyani, Shafran, Myles, & Rose, 2014

    The Results section (headed “INSERT TABLE 2 ABOUT HERE”; no page number available) reports that therapists used controlled studies less often than several other sources of clinical guidance. The Discussion says therapists’ objections concern how research translates into practice. Neither passage says that more real-world effectiveness trials are needed before clinicians will find efficacy trials useful. (LLM, conf=0.83)

    Experimental — accuracy not yet measured

  • Only a limited amount of patients in routine practise actually receives evidence-based treatment.

    “Research suggests that only a limited amount of patients in routine practise actually receives evidence-based treatment (Gyani et al., 2014, Harvey and Gumport, 2015).”

    From Development and initial evaluation of blended cognitive behavioural treatment for major depression in routine specialized mental health care (2016) · cites this paper as Gyani et al., 2014

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Research works printed but not linked: 1

  1. Insel, T. R. (2010). Translating Scientific Opportunity Into Public Health Impact. Archives of General Psychiatry, 66(2), 128-133.

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Authors
Gyani, A., Shafran, R., Myles, P., & Rose, S.
Affiliations
  • University of Reading (GB)
  • Berkshire Healthcare NHS Foundation Trust (GB)
Corresponding author
Gyani, Alex
ORCID
Venue
Behavior Therapy
Publisher
Elsevier BV
Published
2014-03
Volume
45
Issue
2
Pages
199-211
ISSN
0005-7894 (ISSN-L)
DOI
10.1016/j.beth.2013.10.004
OpenAlex
W2002061016
Cited by
73
References
50
Citations by year
2026: 3 · 2025: 8 · 2024: 6 · 2023: 6 · 2022: 7 · 2021: 5 · 2020: 6 · 2019: 5 · 2018: 10 · 2017: 3 · 2016: 5 · 2015: 6 · 2014: 2 · 2013: 1
FWCI
5.19
Type
journal article
Language
en
Open access
Licence
www.elsevier.com/tdm/userlicense/1.0/ (tdm)
Locations
  • Behavior Therapy (publishedVersion)
  • PubMed (publishedVersion)
  • UCL Discovery (University College London) (submittedVersion)
Topics
  • Social Sciences › Psychology › Clinical Psychology › Psychotherapy Techniques and Applications
  • Social Sciences › Psychology › Social Psychology › Counseling Practices and Supervision
  • Health Sciences › Health Professions › General Health Professions › Health Sciences Research and Education
Keywords
clinical decision-making, empirically supported treatments, research utilization, cognitive behavioral therapy, attitudes toward research, National Health Service, clinical experience, supervision, psychotherapists
MeSH terms
Attitude of Health Personnel, Clinical Competence, Decision Making, Female, United Kingdom, Humans, Male, Middle Aged, Psychotherapy, State Medicine, Behavioral Research, Evidence-Based Practice

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