Feature

For APA, developing clinical treatment guidelines is an important way to ensure that psychology maintains its autonomy.

"It's far better for psychology to be in the driver's seat when it comes to figuring out what guidelines about psychological interventions are needed rather than waiting for someone else to do it," says Lynn Bufka, PhD, Assistant Executive Director for Practice Research and Policy in APA's Practice Directorate.

APA's Council of Representatives voted last year for the association to begin developing evidence-based treatment guidelines for the first time. A long-term effort that will involve both practitioners and scientists, the guidelines will offer recommendations for treatment of specific disorders and conditions. The steering committee overseeing the process has decided what topics to tackle first: depressive disorders and obesity.

The goal is to produce patient-centered guidelines that are useful to consumers as well as psychologists and other health-care professionals, says Steven D. Hollon, PhD, the Vanderbilt University psychology professor who chairs the steering committee.

"If you're somebody who's looking to be a good health-care consumer, you want to know what your various options are, what kind of empirical support they have behind them and what the pros and cons are, so you can make an educated choice," says Hollon.

APA's decision to develop guidelines was prompted in part by changes in the health-care system.

Health-care reform has brought a growing emphasis on comparing the effectiveness of various treatments. As electronic records are developed, they're starting to incorporate treatment guidelines to help clinicians think through their decision-making about the best way to help patients. Insurers increasingly look to guidelines as they make coverage decisions. And many organizations — including the Institute of Medicine; federal agencies, such as the Agency for Healthcare Research and Quality and Department of Veterans Affairs; and professional groups, such as the American Psychiatric Association — have gotten involved in guidelines.

"Guidelines have become part of the health-care landscape," says Howard Kurtzman, PhD, Deputy Executive Director for Science in APA's Science Directorate. "If psychology wants to be part of where health care is going, we have to develop our own guidelines. No one else is going to develop clear and complete guidelines for behavioral and psychosocial treatments."

Kurtzman and Bukfa are members of a team of APA staff members working with the steering committee.

APA already has several of what it calls "practice guidelines," which offer tips on providing treatment to particular populations or in particular settings. The new treatment guidelines will be different because they will synthesize the research and offer treatment recommendations for specific conditions.

That will be a boon for practitioners who may be struggling to keep up with the expanding research literature, says Bufka.

"Instead of psychologists having to read thousands of published articles, a good guideline will have done the work of identifying the research that's pertinent to the clinical treatment question, identifying the good quality studies and figuring out how all those studies come together to point in a particular direction," she says. "Guidelines are a tool for translating basic research from multiple studies into what makes sense in practice."

The guidelines aren't intended to be absolute requirements, adds Kurtzman. "No individual client who comes into a psychologist's office exactly matches the average patient who has participated in a particular study, so there's always room for the clinician's judgment," he says. "We just want to inform the clinician about the best and most current research."

The members of the steering committee won't review the literature themselves. Instead, the committee will oversee a process of systematic reviews.

The process of developing each guideline is expected to take up to two years. The committee will begin by pulling together panels that may include practitioners, researchers and consumer and patient advocates, as well as biostatisticians and methodologists, who will work on each topic. The call for nominations for the depressive disorders panel closed in November; the call for nominations for the obesity panel will go out in early 2012.

The panels will work with the steering committee to decide what questions they hope a systematic review will answer. An outside organization or separate office within APA will then conduct an exhaustive review of the literature and synthesize the findings in a way that indicates the strength of the evidence for each treatment in specific clinical situations. The panels will then use those systematic reviews to produce guidelines.

That process ensures objectivity, says Kurtzman.

"The idea is that you want the systematic review to be done completely objectively by people who are not involved in the formulation of the questions," he explains. "They can take a fresh look at the literature without being concerned about how the outcome of their review will be used for the development of a guideline in the future."

Once they're completed, the guidelines will benefit psychological scientists as well as practitioners, he adds.

That's because the guidelines will make it clear where the research leaves questions still unanswered, says Kurtzman. "That's a great outcome for science," he says, adding that a lack of evidence about a given treatment doesn't imply a lack of effectiveness. "It will help direct future research."

APA will likely issue a call in 2012 for suggestions of topics for the next round of guideline development. The steering committee has discussed oppositional-defiant disorder and post-traumatic stress disorder as potential topics, but is open to other suggestions.


Rebecca A. Clay is a writer in Washington, DC

Treatment Guideline Steering Committee members

Chaired by Steven D. Hollon, PhD, of Vanderbilt University, the steering committee overseeeing the production of APA's new treatment guidelines includes:

  • Patricia A. Areán, PhD, of the University of California, San Francisco
  • Michelle G. Craske, PhD, of the University of California, Los Angeles
  • Kermit A. Crawford, PhD, of Boston University School of Medicine
  • Daniel R. Kivlahan, PhD, of the Veterans Affairs Puget Sound Health Care System
  • Jeffrey J. Magnavita, PhD, of Glastonbury Psychological Associates
  • Thomas H. Ollendick, PhD, of Virginia Polytechnic Institute and State University
  • Thomas L. Sexton, PhD, of Indiana University
  • Bonnie Spring, PhD, of Northwestern University