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August 31, 2012

4 Reasons Why You May Not Be Getting Evidence-Based Care

4 Reasons Why You May Not Be Getting Evidence-Based Care

Re-posted from the Cleveland Center for Eating Disorders (CCED) blog archives and updated with additional Emily Program client thoughts. CCED and The Emily Program partnered in 2014.  Contributions by Sarah Emerman.

Every year our understanding of the brain and eating disorders improves. However, there are still a limited number of truly evidence-based treatment for our patients. The search for evidence-based care may feel overwhelming and sometimes futile. Unfortunately, moving in the direction of care that is not evidence-based reduces the likelihood that clients will achieve recovery. There are several reasons why providers may offer care not based on the literature or published data:

  1. The provider may be trained in only one particular form of therapy. Providers tend to practice in the mode in which they feel most comfortable, even though that type of therapy may be more helpful for some illnesses than others. A patient may therefore receive care that is not evidence-based because their provider does not have an orientation to evidence-based care.
  2. Lack of adherence. Evidence-based care can be challenging to sustain. It usually requires a practice that may be manual based, require expensive or difficult to get supervision, and highly specialized training. Clinicians may be aware of and desire to practice evidence-based care but may not have the resources to provide it.
  3. Bias. Some providers have belief systems about causation, free will, mind, body, culture or multiple other issues that make it difficult for them to believe and accept the literature as it currently exists. Unfortunately, belief systems do influence providers practice and may prevent them from gaining most current knowledge.
  4. Over-reliance on experience. Study after study has shown that therapists’ experiences with their own successes or lack of success may shape the way they provide treatment. There may be a tendency to reject scientific literature for personal experience, which may not be effective for others.

No provider gets up in the morning not wanting to do their best and every provider wants to help their patients find recovery as best they can. But it is only when this desire is paired with a good understanding of the scientific literature that good evidence-based treatment can occur.


Mark Warren, M.D.

Dr. Mark Warren is the Chief Medical Officer for The Emily Program and Veritas Collaborative. He is also one of the original founders of the Cleveland Center for Eating Disorders, which became The Emily Program – Cleveland in 2014. A Cleveland native, he is a graduate of the Johns Hopkins University Medical School and completed his residency at Harvard Medical School. He served as Chairman of the Department of Psychiatry at Mt. Sinai Hospital and Medical Director of University Hospital Health System’s Laurelwood Hospital. A past vice-chair for clinical affairs at the Case School of Medicine Department of Psychiatry, he continues on the Clinical Faculty of the Medical School, teaching in both the Departments of Psychiatry and Pediatrics. He is currently a faculty member and former chair of the Board of Governors at the Gestalt Institute of Cleveland. Dr. Warren is a Distinguished Fellow of the American Psychiatric Association, a two-time recipient of the Exemplary Psychiatrist Award of the National Alliance for the Mentally Ill, and a winner of the Woodruff Award. He leads the Males and Eating Disorders special interest group for the Academy of Eating Disorders.

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