Provider Attitudes Toward Evidence-Based Practices: Are the Concerns With the Evidence or With the Manuals?

OBJECTIVE: Studies examining therapists' attitudes toward evidence-based practices, which have at times become conflated with "manualized treatments," have indicated a number of concerns regarding perceived inflexibility, a lack of attention to the therapeutic alliance between provider and client, and a lack of emphasis on clinical judgment. This investigation examined the effect of training in two different formats of evidence-based treatments (standard treatment manuals versus modular assembly of treatment procedures) and with the use of two measures of attitudes. METHODS: As part of a randomized clinical effectiveness trial, the attitudes of 59 therapists were assessed before and after training for a standard evidence-based treatment protocol and for a modular evidence-based treatment protocol. Attitudes were also assessed across two attitude measures that differentially emphasize the use of treatment manuals. RESULTS: Results showed that compared with the standard condition, in the modular condition therapists' attitudes became significantly more favorable toward evidence-based practices but only on the attitude measure that did not refer specifically to the use of manuals. CONCLUSIONS: The findings of this investigation have implications for dissemination of evidence-based practices and policy change. Contextual adaptations in evidence-based practice design and training may result in wider adoption of innovative and efficacious treatment practices.