When we break an arm, it is obvious that we need to go to an emergency room and have a cast put on. When we’re experiencing symptoms of depression, however, what we need to do to take care of the problem may not be so obvious. So how can we be sure we are receiving the most effective treatment for our depression as we did for our broken arm?
There is a genuine push toward more scientific, evidence-based approaches to mental health crisis response in today’s world. Evidence-based practices (EBPs) are therapies based on evidence gathered from scientific studies, evaluations, and practices. They consistently have sufficient peer-reviewed scientific evidence that the practice improves client outcomes. As a result, EBPs have received much attention from organizations like the American Psychological Association (APA) and the American Psychiatric Association.
The APA Council of Representatives defined EBP as “the integration of the best available research with clinical expertise in the context of patient characteristics, culture, and preferences.”
As we examine the evidence-based approach to mental health crises, we must ask ourselves what characteristics effective EBPs would share. These would include such things as:
- Based on scientific data,
- Follow a well-defined, goal-directed structure,
- Patient-centered, and
- Data shows meaningful outcomes.
In this article, we will examine each of these characteristics and discuss three examples of EBPs: Cognitive Behavioral Therapy (CBT), Dialectical Behavior Therapy (DBT), and Motivational Interviewing (MI).
Characteristics of an Evidence-Based Approach to Mental Health Crisis Response
David L. Sackett, the “father of evidence-based medicine,” described EBP as “the conscientious, explicit, and judicious use of current best evidence in making decisions about the care of individual patients.” Still today, each patient’s personal and unique concerns, expectations, and values are essential to successful clinician interactions.
It is essential to recognize the role of information technology in supporting evidence-based practices. Ongoing data collection and analysis can provide the means to monitor activity and evaluate outcomes. In addition, electronic health records (EHRs) can provide access to a patient’s real-time information to all providers involved in the person’s care.
Because EHRs contain sensitive information, they must be managed through a secure platform. Julota’s cloud-based platform does just that. As a result, all EHR information from EHRs remains secure according to HIPAA guidelines and from the view of unauthorized parties. The software also bridges the gap between healthcare organizations that use different HER systems.
Sharing information through Julota’s services means that providers can report evidence-based approaches used and measure how those practices worked in specific cases. The sharing also allows other professionals to add their unique insights and critiques. The combined clinical knowledge accrued can help improve the overall health care of a community. For example, states like Minnesota use outcome monitoring data to make informed decisions and allocate resources effectively.
Cognitive Behavioral Therapy
Cognitive behavioral Therapy is probably the most accepted and well-known evidence-based practice. CBT focuses on the premise that if you change how you think, you change how you feel and act. In other words, when you identify and adjust negative thought patterns, you have positive changes in feelings and behaviors. The Mayo Clinic describes it in this way: “CBT helps you become aware of inaccurate or negative thinking so you can view challenging situations more clearly and respond to them in a more effective way.” In recent years, CBT has proven effective in treating depression, anxiety, psychosis, bipolar disorder, and schizophrenia, among other psychological issues.
Cognitive Behavioral Therapy is highly structured and normally requires fewer sessions than many other types of Therapy. It is especially effective in managing symptoms of mental illness, preventing relapses, treating mental illness when medication is not a good option and teaching techniques for coping with mental illness.
It is also helpful in addressing emotional challenges such as loss or grief, trauma associated with abuse or violence, and coping and managing symptoms of medical illnesses. However, in general, this type of Therapy carries minor risks.
Because CBT often brings forth painful feelings and emotions, it may sometimes feel uncomfortable. Many people report feeling physically drained following a session. Working with a skilled therapist will minimize challenges, and the coping skills learned can help you manage negative feelings and fears.
Dialectical Behavior Therapy
Dialectical behavior therapy is based on cognitive behavioral Therapy but is especially adapted for individuals who experience intense emotions. The word “dialectical” means to combine opposite ideas.
The purpose of the Therapy is to find balance and avoid the all-or-nothing type of thinking. Instead, DBT promotes a both-and rather than an either-or perspective. At its core, this Therapy is about acceptance and change.
It has proven effective in relieving the symptoms of borderline personality disorder, post-traumatic stress disorder, and substance use. DBT has proven effective for these conditions because they are thought to be associated with problematic or unhealthy efforts to control intense, negative emotions. The Therapy provides healthier ways for people to cope with those emotions.
Dialectical behavior therapy provides people with skills to manage painful emotions and decrease conflict in their relationships. It focuses on therapeutic skills in four key areas—first, mindfulness, which helps an individual to learn to accept and be present in the moment.
Second, distress tolerance increases a person’s tolerance of negative emotion rather than escape from it. Third, emotion regulation provides strategies for managing and changing intense emotions that are problematic in a person’s life. Fourth, is interpersonal effectiveness, which consists of techniques that help an individual learn to communicate assertively while maintaining self-respect. Finally, DBT treatment generally consists of both individual and group therapy sessions.
Motivational interviewingis a client-focused approach designed to explore a patient’s ambivalence to change. It is an empathetic, practical, short-term process that considers the difficulty of life changes. It is a counseling style that emphasizes acceptance and unconditional personal regard.
It is especially effective for those who are hostile or ambivalent about changing negative behaviors. Thus, it is well suited to those who are admitted to facilities unwillingly. The therapist typically asks specific questions in a curious rather than confrontational way. The non-confrontational approach helps the patient become more motivated to change on their own. MI is frequently used to treat addictions and physical conditions like heart disease, diabetes, and asthma.
William Miller and Stephen Rollnick, in the 1980s, developed motivational interviewing. According to Miller and Rollnick: MI “is a way of being with a client, not just a set of techniques for doing counseling…Put simply, this involves coming alongside the person and helping them to say why and how they might change for themselves.”
Motivational interviewing is a two-fold process. The first goal is to increase the person’s motivation, and the second is to help the person commit to change. Research shows that when people hear themselves express a commitment out loud, they are more likely to do it. Therefore, other interventions, such as cognitive Therapy, support groups, and stress management training, are frequently combined with this technique.
According to the National Alliance on Mental Illness (NAMI), 1 out of every 8 emergency room visits by an adult involves mental illness and substance use disorders. These numbers indicate the importance of timely and effective crisis care.
An evidence-based approach to mental health crisis response can help meet that need. Evidence-based methods that integrate clinical expertise, the best research evidence, and patient values into the decision-making process can result in meaningful patient outcomes.
The American Psychological Association emphasizes ensuring the treatment is executed in the context of the patient’s culture, individual characteristics, and personal preferences. In addition, the policy highlights consideration of the patient’s environment, developmental history, life stage, strengths, and the degree of social and family support to ensure the greatest success.