Evidence-based practice: Where is the evidence? the case of cognitive behaviour therapy and depression

AbstractThe validity and utility of terms such as evidence-based in relation to clinical practice in psychology are here subjected to critical analysis. The method of the analysis is to closely review the findings of a major study investigating treatment efficacy with depression and to consider how seriously these findings compromise the status of cognitive behavioural therapy (CBT) as evidence-based with respect to its efficacy for treatment of depression. It is concluded that this study raises serious doubts as to whether CBT has superior efficacy, compared with other treatment approaches, and also raises doubts as to whether treatment effects that can be detected derive from treatment-specific factors. It is argued that there is little basis for according CBT a privileged status as evidence-based in relation to treatment of depression. The broader implication of this conclusion for the development of treatment guidelines or practitioner training standards is discussed.