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Evidence-Based Practices: How Do I Know If a Trauma Treatment Is Effective?

Jamie Marich, Ph.D., LPCC-S, LICDC-CS, RMT, edited by C. E. Zupanick, Psy.D.

In the following sections, we will be discussing specific treatment models, interventions, and techniques that are being used around the world to help people heal from the impact of traumatic stress. Before we do, it's sensible to wonder whether or not a treatment is safe and effective.

3D Figure leaning on question markMost trauma specialists understand the healing process is both multi-faceted and multi-cultural. For instance, you may recall Heather Bowser whom we highlighted earlier in this section. Painting murals and making music helped Heather to heal, without professional intervention. So feel free to explore any option that brings you closer to health and healing.

Most treatment professionals recognize that a great many people recover without any professional help. This is sometimes called natural recovery. However, readers of this article are likely to be in search of some professional direction. So, we are going to be focusing on the treatments that are widely used in the helping professions.

These treatments generally meet the designation as evidence-based practices (or EBP). So what exactly is an evidence-based practice and why should you care? As mentioned, a great many people recover without any professional assistance. However, for those who need help, they have a right to expect that treatments offered by paid professionals are both safe and effective, for a large number of people. In the scientific world of healthcare, this is determined by research. This does not mean these are the only safe and effective methods. Nor is science the only path toward healing. It just means there is sufficient research to support the safety and effectiveness of those methods. Moreover, just because an EBP is effective and safe for a lot of people, it does not mean that it will be safe and effective for any one individual.

In order to decide the right treatment for an individual person, professionals must use their clinical skills and judgment, as they take into account the specific characteristics and needs of that individual. According to the American Psychological Association (2006), "An evidence-based practice in psychology is the best available research [coupled] with clinical expertise in the context of patient characteristics, culture, and preferences" (p. 280). Thus, research alone cannot determine the best treatment for any one person.

The Substance Abuse and Mental Health Services Administration (SAMHSA) is an agency within the United States Department of Health and Human Services that leads public health efforts to advance the behavioral health of the citizens in the United States. Toward that end, SAMHSA maintains a database of treatment approaches that meet SAMHSA criteria for evidence-based. Because many consider the SAMHSA registry a gold standard, we will indicate which treatments and modalities have merited the classification of "evidence-based practice" according to SAMHSA criteria. For many clients and clinicians alike, having this distinction is important because the quality and quantity of research that is needed to make the list is extensive.

However, there are problems with this gold standard. For one thing, some of the classic approaches to treatment (such as psychoanalysis and gestalt therapies) are too broadly defined. Therefore, they cannot meet the technical precision required by the SAMHSA criteria for their evidence-based practice registry. Likewise, there are many emerging and promising therapies that clients and clinicians insist work better than anything on the SAMHSA list. However, they simply haven't been around long enough for extensive research. Hence the term, "new and promising." It's also very expensive to fund all that research and there are a lot of politics and competing agendas involved in getting research funded.