Praxical.Psych
Unit 3 of 20

The research base I: what counts as evidence

Be able to read a psychotherapy trial and say what it does and does not show.

Sessions 9/21–9/25

What you should be able to do afterwards

  • 1Explain the difference between an empirically supported treatment and evidence-based practice
  • 2Read a randomised trial and identify the comparator, the allegiance, and the blinding problem
  • 3Explain effect size, reliable change, and clinically significant change
  • 4State the case for and against manualisation

The reading

The three terms are not synonyms and the differences matter. An empirically supported treatment is a specific protocol shown to work for a specific disorder in randomised trials. Evidence-based practice is a decision process: the integration of best available research with clinical expertise and patient characteristics, values and preferences — three legs, not one. Practice-based evidence is data generated from routine clinical work, which addresses the external validity that trials lack.

Reading a trial

  1. 1What was the comparator? Waitlist inflates effects substantially; treatment-as-usual less so; another bona fide therapy is the demanding test.
  2. 2Who conducted it? Researcher allegiance is one of the largest predictors of outcome in comparative trials, and is not a sign of dishonesty — it operates through a hundred small decisions.
  3. 3Was it blinded? In psychotherapy it cannot be blinded for the participant or the therapist, only for the assessor. Self-report outcomes are therefore particularly vulnerable.
  4. 4Who was excluded? Trial populations are frequently less comorbid, less suicidal and more literate than clinic populations.
  5. 5What was the attrition, and how was it handled? Completer analyses inflate effects.
  6. 6Is the effect clinically significant, or merely statistically reliable?

What belongs to this unit

Questions to take away

For a seminar, a supervisor, or an argument with yourself.

  1. 1Why does the choice of comparator change the conclusion more than the treatment does?
  2. 2Is manualisation a methodological necessity or a distortion of practice? Argue both.
  3. 3What would a psychotherapy trial look like if it were designed to be maximally informative rather than maximally publishable?

Your notes

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Before you begin

What Praxical.Psych is, and is not

Praxical.Psych is an educational tool. It teaches the theory, evidence base and clinical method of psychotherapy at the level of an advanced survey course, and it lets you rehearse a complete session in a simulator.

It is not medical, clinical, psychological or legal advice. It cannot diagnose or treat anyone, and it does not state the law where you practise — requirements differ by jurisdiction and change. Nothing here creates a clinician–patient or solicitor–client relationship.

  • Every patient, transcript and case in this app is fictional — a composite written for teaching. None depicts a real person.
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  • Do not enter real patient information. Everything you type stays in this browser, but that is not the same as a compliant clinical record system.
If you are in crisis

In the US and Canada, call or text 988. In the UK and Ireland, call 116 123 (Samaritans). Elsewhere, find a local line at findahelpline.com. In immediate danger, use your local emergency number.

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