Why are therapists neglecting to use treatments supported by research?

When seeking help for binge eating and bulimia, much like with other mental health issues, we assume that licensed professionals will provide treatment that’s based on the latest research. Yet, that’s often not the case. New research released online yesterday sought to explain why there is such a divide between scientific research and the practice of therapy in the field of eating disorders.

The divide between academic research in university/hospital settings versus real-world practice in private offices and clinics is nothing new. Recently, the New York Times published an article exploring the divide and how it impacts patients.

In the eating disorder field, the research/practice divide has been increasingly scrutinized as the research on treatments for binge eating and bulimia grows stronger.  The International Journal of Eating Disorders devoted a special issue this month to highlighting the major changes and challenges in the field. Their opening article, written by Scott Lilienfeld and his colleagues, explores the schism between research scientists and therapists in practice.

Cognitive behavioral therapy (CBT) and interpersonal therapy have the most research support in treating binge eating and bulimia. Despite awareness of this, many therapists report they frequently or primarily use others forms of therapy in treatment (e.g. 2007 study, 2012 study study currently in press. Even when clinicians claim to use CBT, it becomes clear they aren’t really doing so when they are probed on specific techniques used (see previous post). 

Lilienfeld and his colleagues propose several explanations for why this is the case. The first is related to attitudes toward science. For example, when deciding to pursue a doctorate in psychology, students may be equally interested in science and practice. As they go through graduate school and conduct their own research, many choose to pursue research full-time or to instead pursue clinical work full-time. Lillenfield and his colleagues suggest that for some who choose full-time clinical work, struggles with scientific analysis may have led to the development of negative attitudes towards empirical research.

Another explanation for the research/practice divide is debate over the definition of “evidence.” At what point can we say that specific forms of therapy are supported by scientific evidence - If we’ve seen people improve after using a certain therapy? If a few research studies have found a certain therapy reduces symptoms in many people? Many researchers would argue against those definitions of evidence and instead rely more heavily on randomized controlled trials (RCTs) which are considered the gold standard of treatment research.

Despite what a clinician may read in research studies, it's almost impossible not to form opinions based on personal experience with clients. After all, no research study can explain all the unique factors that a particular client is struggling with in a private office.  Lilienfeld and his colleagues argue that clinicians often engage in “naïve realism” which is “a belief that we can always trust our perceptions to afford us an accurate view of the world.” So if a clinician sees that several of her clients have experienced a reduction in binge eating after working with her for a few months, she may naively assume that the improvements are a direct result of her therapy techniques and, moreover, that other clients will likely improve if she keeps using those techniques.

Lilienfeld and his colleagues would argue that the same clinician might also experience “confirmation bias” in that she looks for evidence that her style of therapy works. When clients do well, she attributes it to her therapeutic techniques and when clients do worse, she attributes that to other factors. In other words, clinicians may not rely on treatments that have been well researched to work because they instead rely on selective personal experiences.

So what does this mean for people looking for therapists who can best treat binge eating and bulimia?  It’s probably best to do a little online research to learn about the best available therapy and then seek out a clinician who practices that. Unfortunately, it’s tough to really know if you’re getting the same therapy that people in the research studies get. Or even if the therapy in research studies would have helped your individual issues. But, you might as well give yourself the best shot at treatment and start with therapy that has strong research support. 

Have comments or questions? Discuss them on the facebook page or contact Dr. Gupta directly

Dr. Gupta is a professor at Barnard College of Columbia University and provides individual therapy at Tribeca Psychology

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Is your eating disorder therapy based on the latest scientific evidence?

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Cognitive behavioral therapy reduces binge eating in teens and adults

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