The role of theory in bridging interdisciplinary research with evidence-based practice. Presentation at IDS Conference at Hong Kong Shue Yan University: :Bridging Interdisciplinary Research with Evidence-Based Practice
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The role of theory in shaping and translating research into practice is neglected in the field of psychology at present. Internationally, there has been a growing call for development of an integrative theoretical framework within which research results can be understood as well as applied. A recent article in Nature Human Behaviour (Muthukrishna & Henrich, 2019), has proposed that the replication crisis currently facing the psychological sciences is the result of the lack of development of such integrative theoretical frameworks. Those authors propose that researchers should confine the questions that they ask, and the analyses that they do, to the predictions made within a particular theoretical framework. This is an important suggestion, because without a coherent theory, research results can only ever be applied to practical questions as a heuristic (or problem-solving strategy). It is suggested here that this state of affairs is the reason for the most common critical challenge made of research for evidence-based practice, which is the problem of knowing which intervention to apply, in which way, to which person, at what time, by which professional, and so on. Only a coherent theoretical framework can address these problems in applying research to practice. Finally, following Tretter and Loeffler-Statska (2018), it is proposed that systems theory (including information theory) is the best candidate for a integrative clinical theory framework that not only has potential of successfully bridging different disciplines, but also integrating the key assumptions and propositions of most dominant theories of psychology today.
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The role of theory in bridging interdisciplinary research with evidence-based practice. Presentation at IDS Conference at Hong Kong Shue Yan University: :Bridging Interdisciplinary Research with Evidence-Based Practice
- 1. The role of theory in bridging interdisciplinary research with evidence-based practice PSYCHOTHERAPY AND PSYCHOLOGY
- 2. Speaker Dr Patrick Connolly Counselling psychologist Assistant professor – Hong Kong Shue Yan University Counselling and Psychology department
- 3. Bad news for evidence-based practice (Weisz, et al., 2019; Miller, 2013) Randomised Control Trials (RCTs) on psychotherapy outcomes since 1960 = no significant increase in effectiveness (despite three decades of focus on EBP) Professionals still no better than people with minimal training Therapist quality little influenced by model or techniques they report using
- 4. A number of critiques of Evidence-Based Practice (Cook, Schwartz & Kaslow, 2017) Wide range of approaches EBP focused on behaviour change or symptom reduction, clients want experiences of coping and meaning Level of evidence lacking or unattainable Complexity of actual case situations
- 5. The key problem of complexity Which interventions at which time for which clients, at what life stage, living with which environmental stressors, with which problems, in which treatment context, by which professional? etc etc – Judgement of the practitioner What we don’t have evidence for is much more than what we do have evidence for
- 7. The problem “Although the distinction between researchers and practitioners is ambiguous, researchers have been described as “knowledge creators,” and practitioners have been described as those applying knowledge in service.” (Tabak, et al., 2012, p.3) This view: information flows from research towards practice – but this is part of the problem Practitioners are evidently ‘knowledge creators’ as well.
- 8. A lesson from Adherence research in health psychology (Midence & Myers, 1998) Historically, the problem of patient following doctor’s prescription was problem of compliance. Focus shifted from compliance to adherence. Shift from passive recipient of prescription (only the power to refuse to comply), towards patient as an active agent (makes decisions about own behaviour, based on information they have). What are implications of practitioners as active agents?
- 9. A Bayesian model of practitioner learning (Based on Friston’s 2010 Free Energy Principle)
- 10. Two responses to new information
- 11. The working model develops in a complex hierarchy
- 12. Our theories can be poor approximations of reality We always assimilate research evidence into our theories about things. The problem with this is sometimes very clear: ◦ Parent has been told necessary to allow children to express their negative feelings ◦ The counsellor who has been told that reflecting the meaning of their clients words back to them = better client measures of empathy Creates distrust of evidence based practice amongst practitioners
- 13. Aligning your model with a theoretical framework Takes a long time (incremental) and effort Examples: -Learning psychodynamic theory as a new therapist -Teaching myself systems theory for a PhD A complex structure in the mind that organizes experience, not just a model of the relationship between variables
- 14. Lack of theory in research process Researchers often not encouraged or required to align their working models with these deeper theoretical frameworks Rather expected to align models with methods and become knowledgeable about reduced constructs relevant to area of study Looking at different data AND with a very different working model
- 15. Primary conclusion: Both practitioners AND researchers should be working towards internalizing successful integrative theoretical frameworks Research process should be founded on those frameworks, and findings should develop them further.
- 16. Theory should define the research process Research in EBP in psychotherapy, should be classified around the theory, and should be clear relationship between theory base and data collected (David & Montgomery, 2011, Clinical Psychology: Science and Practice) Replication crisis in psychology can be addressed by researchers limiting themselves to theoretical frameworks (Muthukrishna & Henrich, 2019, Nature Human Behaviour)
- 17. Theoretical work in psychology is devalued Low status of theoretical or conceptual PhDs Low priority for faculty hiring, and awarding grants
- 18. Exemplary centres, research and practice built around shared theory base University of Bern, work of Haken, Tschacher, and colleagues, psychotherapy process, based on systems theory University College London, work of Karl Friston and colleagues, genuinely interdisciplinary work based on systems theory, free energy principle Vienna Medical University, Tretter, Loeffler-Stastka and colleagues, developing Integrative Clinical Systems Theory
- 19. Why systems theory? Genuinely interdisciplinary; any object of interest can be formally described as a system of units and relationships, and hierarchical organization Integrates information science – the one approach that has entered every field of scientific enquiry Potential to integrate all dominant theories in the field of psychology (Tretter & Loeffler-Statska, 2018)
- 20. Key conclusion again Centres for interdisciplinary research in evidence based practice should build their work around integrative theory
- 22. References Cook, S.C., Schwartz, A.C. & Kaslow, N.J. (2017). Evidence-based psychotherapy: advantages and challenges. Neurotherapeutics, 14, 537- 545 David, D. & Montgomery, G.H. (2011). The scientific status of psychotherapies: a new evaluative framework for evidence-based psychosocial interventions. Clinical Psychology: Science and Practice, 18, 89-99 Friston, K.J. (2010). A free energy principle for the brain. Nature Reviews Neurosciences, 11, 127-138 Midence, K. & Myers, L. (1998). Adherence to Treatment in Medical Conditions. Amsterdam: CRC Press Miller, S.D. (2013). The evolution of psychotherapy: an oxymoron. Presentation at The Evolution of Psychotherapy Conference, Anaheim, California, USA Muthukrishna, M. & Henlich, J. (2019). A problem in theory. Nature Human Behaviour, 3, 221-229 Tabak, R.G., Khoong, E.C., Chambers, D. & Brownson, R.C. (2012). Bridging research and practice: models for dissemination and implementation research. American Journal of Preventative Medicine, 43(3), 337-350 Tretter, F. & Loeffler-Stastka, H. (2018). Steps towards an integrative clinical systems psychology. Frontiers in Psychology: Psychoanalysis and Neuropsychoanalysis, 9, 1616 Weisz, J.R., et al. (2019). Are psychotherapies for young people getting stronger: Tracking trends over time for youth anxiety, depression, attention-deficit/hyperactivity disorder, and conduct problems. Perspectives in psychological science, 14(2), 216-237
Editor's Notes
- -I thought that stars in the night sky are a good metaphor for research conclusions from the perspective of the practitioner. The light they shine is lost in the blackness of what we don’t know. -Following the metaphor a little further, for practitioners, we might be grateful for what light they do provide, but its fairly easy to ignore them and get on with what you are doing
- -So, we take a model based on systems neuroscience and the work of Dr Karl Friston, who suggests that human beings, like all organisms, form a working model of their sensory experience, where sensory experience updates the model in a form of Bayesian updating. I don’t really want to get too much into those ideas, just enough to look at the implications for implementation of evidence based practice
- When we are exposed to new information, our brain always tries to minimize the difference between what the information shows us, and what our model predicts. It can do this in two ways, either updating the model further, or where the cost of doing so is higher, taking an action that changes the sensory input. This can mean an action like looking from a new angle, or a cognitive action that reduces the impact of the information on our perception. So it is with exposure to research conclusions, where conclusions easily fit our model, they make little change to it. Where they are far away, we tend to act to disregard the information, and that’s very easy to do, a practitioner can just not make the effort of finding and reading research. Where it does update our model, it usually only does so in small increments
- -This diagram (perhaps you’ve seen it before) tries to show how our learning slowly builds up a hierarchical model that increasing forms connections between data points and information as we develop. This is not a psychological model, but just a common-sense way of representing integration in the learning process. -The point is that from the viewpoint of the practitioner, the findings of research are just data points, lost in a sea of other data points emerging from their experience (similar to the stars in the night sky metaphor I used earlier). Research findings are often just heuristics, or problem solving strategies that apply in some cases, in very particular situations. -Theory is like the level of knowledge in this diagram. It clarifies the relationships amongst the data that provides the basis for new insights about our experience. It reflects a complex structure in our brains that organizes our experience. -It takes a long time to build up. And its counterfactual, meaning it tends to persist no matter what information its exposed to. New data tends to only have a small impact on our theories about things. This may be part of the reason that the dominant theories about psychotherapy, psychodynamic, cognitive, behavioural, person-centered and so on, have had no fundamental change in more than 50 years (is there a correlation with the lack of change in outcomes over this period?)
- However, I meet a mother who shows bruises all over her forearms, from child regularly gouging them. This doesn’t seem to be helping the child, they have become fixated on hurting their mother, and are disturbed by their own behaviour at the same time. However, the client complains to them ‘why do you always just repeat back what I say in different words?’ – the counsellor doesn’t understand the theory that it’s the client’s subjective experience that needs to be reflected, not the content of their words. The point with these examples, is that the research findings are taken by the person as a piece of information that they integrate with their existing view of the world. What they need is probably not necessarily more data points, but rather a better theory about people and psychotherapy that can integrate those data points correctly.