Staff Perspective: Clinical Skills and Optimizing Treatment - The Case for EBPs

Staff Perspective: Clinical Skills and Optimizing Treatment - The Case for EBPs

Jeffrey Mann, Psy.D.

Over the years I’ve worked with a variety of patients and learned a few lessons along the way about efficiency… especially when it comes to the use of Evidence-Based Psychotherapies (EBPs). As a graduate student, I had very little exposure to EBPs and I was thoroughly immersed in existential and client-centered therapy. As I entered the military for my internship year I had my first introduction to protocol-based treatment and I was very skeptical. That year and the subsequent years have been transformative in the way I approach my patients' problems. I realized that existential and client-centered approaches were creating strong relationships, but not improving many of their core symptoms and difficulty, especially with conditions like PTSD, panic disorders, OCD, insomnia, etc. Over this period, I learned that the skillful implementation of specific protocols was essential to helping my patients improve. One of the more common criticisms of these treatments is that they are mechanical and don’t take the nuance of the patient into account. I used to believe this, but I would argue that it couldn’t be further from the truth, and here are a few reasons:

  1. Expert Knowledge is REQUIRED – EBPs require an in-depth knowledge of the disorder and the theory the treatment is based on. This is because the patient WILL need some modification and accommodation AND there are critical components of a treatment that are essential to its success. The therapist needs to be able to skillfully implement modifications to the protocol that preserve the integrity of the treatment.
  2. Practice, Practice, Practice – EBPs require a skilled therapist and the treatments often ask patients to engage in activities they are desperately avoiding. This requires a confident therapist with solid explanations and rationale for why you're asking the patient to do something. I frequently say “If you’re not clear on why I’m asking you to do this, stop me, let's talk about it.” Confidence, comfort and expertise are critical in being able to effectively implement these EBPs. This is gained through both experience and expert consultation and is the primary reason CDP offers consultation for all of the EBP training we provide

If you are seeking greater efficiency and effectiveness in the patient population you serve, there are a couple of key clinical areas to focus on with regard to EBPs. Over the years that I’ve practiced, supervised and trained therapists, two essential clinical areas related to providing effective treatment have emerged. The first is managing suicidal risk. Being able to effectively assess and treat an individual that experiences suicidal risk is an essential skill and over the last decade treatment advances have been substantial. Our course on Cognitive Behavioral Therapy for Suicide Prevention incorporates the latest research and theory and provides a framework for directly treating suicidal thought and behavior.

The second essential clinical skill area is treating insomnia. Sleep difficulty is an extremely common occurrence in many mental health disorders and frequently can be the primary cause of a mental health disorder or significantly exacerbate another disorder. Frequently individuals are treated with sleep hygiene recommendations or medication as the first line intervention. However, Cognitive Behavioral Therapy for Insomnia or CBT-i is recommended as the front line treatment for insomnia in the American Academy of Sleep Medicine practice guidelines. This EBP training is also offered by the CDP and offers ongoing consultation with our insomnia experts.

By gaining competency in addressing both suicidal thoughts/behaviors and insomnia you can help your patient gain control over their general safety and sleep. No matter what the other challenges and difficulties they present with, helping to restore safety and basic need for sleep can have a tremendous overall effect on the patients well being. When these conditions are untreated it makes any other intervention much less effective. So when you are thinking about optimizing treatment, it’s always best to come back to basics and making sure the essential needs of the patient are being met first. If you haven’t already done so, I encourage you to get trained in the EBPs above, here or anywhere you can find them!

Editor's Note: Check out the CDP Presents webinar "Optimizing Mental Health Treatment with Military-Connected Patients"

The opinions in CDP Staff Perspective blogs are solely those of the author and do not necessarily reflect the opinion of the Uniformed Services University of the Health Science or the Department of Defense.

Jeff Mann, Psy.D., is a Military Behavioral Health Psychologist at the Center for Deployment Psychology (CDP) with the Uniformed Services University of the Health Sciences.