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.