Clinical practice guidelines (CPGs) are intended to improve mental, behavioral, and physical health by promoting clinical practices that are based on the best available evidence. The American Psychological Association (APA) is committed to generating patient-focused CPGs that are scientifically sound, clinically useful, and informative for psychologists, other health professionals, training programs, policy makers, and the public. The Institute of Medicine (IOM) 2011 standards for generating CPGs represent current best practices in the field. These standards involve multidisciplinary guideline development panels charged with generating recommendations based on comprehensive systematic reviews of the evidence. The IOM standards will guide the APA as it generates CPGs that can be used to inform the general public and the practice community regarding the benefits and harms of various treatment options. CPG recommendations are advisory rather than compulsory. When used appropriately, high-quality guidelines can facilitate shared decision making and identify gaps in knowledge.


Article metrics loading...

Loading full text...

Full text loading...


Literature Cited

  1. AGREE Collab 2003. Development and validation of an international appraisal instrument for assessing the quality of clinical practice guidelines: the AGREE project. Qual. Saf. Health Care 12:118–23 [Google Scholar]
  2. Alexopoulos GS, Kiosses DN, Choi SJ, Murphy CF, Lim KO. 2002a. Frontal white matter microstructure and treatment response of late-life depression: a preliminary study. Am. J. Psychiatry 159:111929–32 [Google Scholar]
  3. Alexopoulos GS, Kiosses DN, Klimstra S, Kalayam B, Bruce ML. 2002b. Clinical presentation of the “depression-executive dysfunction syndrome” of late life. Am. J. Geriatr. Psychiatry 10:198–106 [Google Scholar]
  4. Alexopoulos GS, Raue PJ, Kiosses DN, Mackin RS, Kanellopoulos D. et al. 2011. Problem-solving therapy and supportive therapy in older adults with major depression and executive dysfunction: effect on disability. Arch. Gen. Psychiatry 68:133–41 [Google Scholar]
  5. Am. Psychol. Assoc. (APA) 1995. Template for Developing Guidelines: Interventions for Mental Disorders and Psychosocial Aspects of Physical Disorders Washington, DC: Am. Psychol. Assoc. [Google Scholar]
  6. Am. Psychol. Assoc. (APA) 2002. Criteria for evaluating treatment guidelines. Am. Psychol. 57:1052–59 [Google Scholar]
  7. APA Pres. Task Force Evid. Based Pract 2006. Evidence-based practice in psychology. Am. Psychol. 61:4271–85 [Google Scholar]
  8. Areán PA, Alvidrez J, Barrera A, Robinson GS, Hicks S. 2002. Would older medical patients use psychological services?. Gerontologist 42:3392–98 [Google Scholar]
  9. Areán PA, Raue P, Mackin RS, Kanellopoulos D, McCulloch C, Alexopoulos GS. 2010. Problem-solving therapy and supportive therapy in older adults with major depression and executive dysfunction. Am. J. Psychiatry 167:111391–98 [Google Scholar]
  10. Baker R, Camosso-Stefanovic J, Gilliss CL, Shaw EJ, Cheater F. et al. 2010. Tailored interventions to overcome identified barriers to change: effects on professional practice and health care outcomes.. Cochrane Database Syst. Rev. 17:3CD005470 [Google Scholar]
  11. Bastian H, Glasziou P, Chalmers I. 2010. Seventy-five trials and eleven systematic reviews a day: How will we ever keep up?. PLoS Med. 7:9e1000326 [Google Scholar]
  12. Beutler LE, Forrester B, Thompson-Gallagher D, Thompson L, Tomlins JB. 2012. Common, specific, and treatment fit variables in psychotherapy outcome. J. Psychother. Integr. 22:3255–81 [Google Scholar]
  13. Blackburn IM, Eunson KM, Bishop S. 1986. A two-year naturalistic follow-up of depressed patients treated with cognitive therapy, pharmacotherapy and a combination of both. J. Affect. Disord. 10:67–75 [Google Scholar]
  14. Borgerson K. 2009. Valuing evidence: bias and the evidence hierarchy of evidence-based medicine. Perspect. Biol. Med. 52:2218–33 [Google Scholar]
  15. Brouwers M, Kho ME, Browman GP, Burgers JS, Cluzeau F. et al. 2010. AGREE II: advancing guideline development, reporting and evaluation in healthcare. Can. Med. Assoc. J. 182:E839–42 [Google Scholar]
  16. Burgers JS, Grol R, Eccles M. 2005. Clinical guidelines as a tool for implementing change in patient care. Improving Patient Care: The Implementation of Change in Clinical Practice R Grol, M Wensing, M Eccles 71–92 Edinburgh, UK: Elsevier [Google Scholar]
  17. Chambless DL, Hollon SD. 1998. Defining empirically supported therapies. J. Consult. Clin. Psychol. 66:17–18 [Google Scholar]
  18. Chou R, Aronson N, Atkins D, Ismaila AS, Santaguida P. et al. 2010. AHRQ series paper 4: assessing harms when comparing medical interventions: AHRQ and the effective health care program. J. Clin. Epidemiol. 63:5502–12 [Google Scholar]
  19. Chou R, Helfand M. 2005. Challenges in systematic reviews that assess treatment harms. Ann. Intern. Med. 142:12 Pt. 21090–99 [Google Scholar]
  20. Collins LM, Baker TB, Mermelstein RJ, Piper ME, Jorenby DE. et al. 2011. The multiphase optimization strategy for engineering effective tobacco use interventions. Ann. Behav. Med. 41:2208–26 [Google Scholar]
  21. Cuijpers P, Hollon SD, van Straten A, Bockting C, Berking M, Andersson G. 2013. Does cognitive behavior therapy have an enduring effect that is superior to keeping patients on continuation pharmacotherapy?. BMJ Open 3:4e002542 [Google Scholar]
  22. Cuijpers P, Smit F, Bohlmeijer E, Hollon SD, Andersson G. 2010. Efficacy of cognitive-behavioural therapy and other psychological treatments for adult depression: meta-analytic study of publication bias. Br. J. Psychiatry 196:3173–78 [Google Scholar]
  23. Cuijpers P, van Straten A, van Oppen P, Andersson G. 2008. Are psychological and pharmacological interventions equally effective in the treatment of adult depressive disorders? A meta-analysis of comparative studies. J. Clin. Psychiatry 69:111675–85 [Google Scholar]
  24. Damschroder LJ, Aron DC, Keith RE, Kirsh SR, Alexander JA, Lowery JC. 2009. Fostering implementation of health services research findings into practice: a consolidated framework for advancing implementation science. Implement. Sci. 7:4–50 [Google Scholar]
  25. David D, Szentagotai A, Lupu V, Cosman D. 2008. Rational emotive behavior therapy, cognitive therapy, and medication in the treatment of major depressive disorder: a randomized clinical trial, posttreatment outcomes, and six-month follow-up. J. Clin. Psychol. 64:728–46 [Google Scholar]
  26. Dimidjian S, Hollon SD. 2010. How would you know if psychotherapy was harmful?. Am. Psychol. 65:121–33 [Google Scholar]
  27. Dobson KS, Hollon SD, Dimidjian S, Schmaling KB, Kohlenberg RJ. et al. 2008. Randomized trial of behavioral activation, cognitive therapy, and antidepressant medication in the prevention of relapse and recurrence in major depression. J. Consult. Clin. Psychol. 76:468–77 [Google Scholar]
  28. Driessen E, Cuijpers P, Hollon SD, Dekker JJM. 2010. Does pretreatment severity moderate the efficacy of psychological treatment of adult outpatient depression? A meta-analysis. J. Consult. Clin. Psychol. 78:5668–80 [Google Scholar]
  29. Eap S, Hall GCN. 2008. Relevance of RCTs to diverse groups. Evidence-Based Outcome Research: A Practical Guide to Conducting Randomized Clinical Trials for Psychosocial Interventions AM Nezu, CM Nezu 425–43 New York: Oxford Univ. Press [Google Scholar]
  30. Edwards P, Clark M, DiGuiseppi C, Pratap S, Roberts I, Wentz R. 2002. Identification of randomized controlled trials in systematic reviews: accuracy and reliability of screening records. Stat. Med. 21:111635–40 [Google Scholar]
  31. Evans MD, Hollon SD, DeRubeis RJ, Piasecki J, Grove WM. et al. 1992. Differential relapse following cognitive therapy and pharmacotherapy for depression. Arch. Gen. Psychiatry 49:802–8 [Google Scholar]
  32. Falck-Ytter Y, Schünemann HJ. 2009. Rating the evidence: using GRADE to develop clinical practice guidelines Presented at Agency Healthc. Res. Qual. Annu. Conf., Sep. 13–16, Bethesda, MD. http://www.ahrq.gov/news/events/conference/2009/falck-ytter-schunemann/index.html [Google Scholar]
  33. Fournier JC, DeRubeis RJ, Hollon SD, Dimidjian S, Amsterdam JD. et al. 2010. Antidepressant drug effects and depression severity: a patient-level meta-analysis. J. Am. Med. Assoc. 303:147–53 [Google Scholar]
  34. Giguère A, Légaré F, Grimshaw J, Turcotte S, Fiander M. et al. 2012. Printed educational materials: effects on professional practice and healthcare outcomes. Cochrane Database Syst. Rev.CD004398 [Google Scholar]
  35. Grimshaw JM, Eccles MP, Lavis JN, Hill SJ, Squire JE. 2012. Knowledge translation of research findings. Implement. Sci. 7:50 [Google Scholar]
  36. Guyatt G, Gutterman D, Bauman MH, Addrizzo-Harris D, Hylek EM. et al. 2006. Grading strength of recommendations and quality of evidence in clinical guidelines: report from an American College of Chest Physicians task force. Chest 129:1174–81 [Google Scholar]
  37. Harris RP, Hefland M, Woolf SH, Lohr KN, Mulrow CD. et al. 2001. Current methods of the US Preventive Services Task Force: a review of the process. Am. J. Prevent. Med. 20:3 Suppl.21–35 [Google Scholar]
  38. Hawe P, Shiell A, Riley T. 2004. Complex interventions: How “out of control” can a randomized controlled trial be?. BMJ 328:74551561–63 [Google Scholar]
  39. Higgins JPT, Altman DG. 2008. Chapter 8: assessing risk of bias in included studies. Cochrane Handbook for Systematic Reviews of Interventions JPT Higgins, S Green. Version 5.0.1. http://www.cochrane-handbook.org [Google Scholar]
  40. Hoel AW, Kayssi A, Brahmanandam A, Belkin M, Conte MS, Nguyen LL. 2009. Under-representation of women and ethnic minorities in vascular surgery in randomized controlled trials. J. Vasc. Surg. 50:2349–54 [Google Scholar]
  41. Hollon SD. 2011. Cognitive and behavior therapy in the treatment and prevention of depression. Depress. Anxiety 28:4263–66 [Google Scholar]
  42. Hollon SD, DeRubeis RJ, Shelton RC, Amsterdam JD, Salomon RM. et al. 2005. Prevention of relapse following cognitive therapy versus medications in moderate to severe depression. Arch. Gen. Psychiatry 62:417–22 [Google Scholar]
  43. Inst. Med. (IOM) 2001. Crossing the Quality Chasm: A New Health System for the 21st Century Washington, DC: Natl. Acad. Press [Google Scholar]
  44. Inst. Med. (IOM) 2008. Knowing What Works in Health Care: A Roadmap for the Nation Washington, DC: Natl. Acad. Press [Google Scholar]
  45. Inst. Med. (IOM) 2011a. Clinical Practice Guidelines We Can Trust Washington, DC: Natl. Acad. Press [Google Scholar]
  46. Inst. Med. (IOM) 2011b. Finding What Works in Health Care: Standards for Systematic Reviews Washington, DC: Natl. Acad. Press [Google Scholar]
  47. Inst. Med. (IOM) 2012. Best Care at Lower Cost: The Path to Continuously Learning Health Care in America Washington, DC: Natl. Acad. Press [Google Scholar]
  48. Jarrett RB, Kraft D, Schaffer M, Witt-Browder A, Risser R. et al. 2000. Reducing relapse in depressed outpatients with atypical features: a pilot study. Psychother. Psychosom. 69:232–39 [Google Scholar]
  49. Kent DM, Rothwell PM, Ioannidis JP, Altman DG, Hayward RA. 2010. Assessing and reporting heterogeneity in treatment effects in clinical trials: a proposal. Trials 11:85 [Google Scholar]
  50. Kovacs M, Rush AJ, Beck AT, Hollon SD. 1981. Depressed outpatients treated with cognitive therapy or pharmacotherapy: a one-year follow-up. Arch. Gen. Psychiatry 38:33–39 [Google Scholar]
  51. Kraemer HC, Wilson GT, Fairburn CG, Agras WS. 2002. Mediators and moderators of treatment effects in randomized clinical trials. Arch. Gen. Psychiatry 59:10877–83 [Google Scholar]
  52. Kung J, Miller RR, Mackowiak PA. 2012. Failure of clinical practice guidelines to meet Institute of Medicine standards: two more decades of little, if any, progress. Arch. Intern. Med. 172:211628–33 [Google Scholar]
  53. Lambert MA. 2010. Prevention of Treatment Failure: The Use of Measuring, Monitoring, and Feedback in Clinical Practice Washington, DC: Am. Psychol. Assoc. [Google Scholar]
  54. Lei H, Nahum-Shani I, Lynch K, Oslin D, Murphy SA. 2012. A “SMART” design for building individualized treatment sequences. Annu. Rev. Clin. Psychol. 8:2121–48 [Google Scholar]
  55. Leykin Y, DeRubeis RJ. 2009. Allegiance in psychotherapy outcome research: separating association from bias. Clin. Psychol. Sci. Pract. 16:154–65 [Google Scholar]
  56. Liberati A, Altman DG, Tetzlaff J, Mulrow C, Gøtzsche PC. et al. 2009. The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate health care interventions: explanation and elaboration. Ann. Intern. Med. 151:4W65–94 [Google Scholar]
  57. Luborsky L, Diguer L, Seligman DA, Rosenthal R, Krause ED. et al. 1999. The researcher's own therapy allegiances: a “wild card” in comparisons of treatment efficacy. Clin. Psychol. Sci. Pract. 6:195–106 [Google Scholar]
  58. Magnavita JJ. 2005. Personality-Guided Relational Psychotherapy: A Unified Approach Washington, DC: Am. Psychol. Assoc. [Google Scholar]
  59. Magnavita JJ. 2010. Evidence-Based Treatment of Personality Dysfunction: Principles, Methods, and Processes Washington, DC: Am. Psychol. Assoc. [Google Scholar]
  60. Maier SF, Amat J, Baratta MV, Paul E, Watkins LR. 2006. Behavioral control, the medial prefrontal cortex, and resilience. Dialogues Clin. Neurosci. 8:4397–406 [Google Scholar]
  61. Marcus SC, Olfson M. 2010. National trends in the treatment of depression from 1998 to 2007. Arch. Gen. Psychiatry 67:121265–73 [Google Scholar]
  62. McGlynn EA, Asch SM, Adams J, Keesey J, Hicks J. et al. 2003. The quality of health care delivered to adults in the United States. N. Engl. J. Med. 348:262635–45 [Google Scholar]
  63. McHugh RK, Barlow DH. 2010. The dissemination and implementation of evidence-based psychological treatments: a review of current events. Am. Psychol. 65:273–84 [Google Scholar]
  64. McHugh RK, Murray HW, Barlow DH. 2009. Balancing fidelity and adaptation in the dissemination of empirically-supported treatments: the promise of transdiagnostic interventions. Behav. Res. Ther. 47:11946–53 [Google Scholar]
  65. Mellers B, Hertwig R, Kahneman D. 2001. Do frequency representations eliminate conjunction effects? An exercise in adversarial collaboration. Psychol. Sci. 12:4269–75 [Google Scholar]
  66. Minami T, Wampold BE, Serlin RC, Kircher JC, Brown GS. 2007. Benchmarks for psychotherapy efficacy in adult major depression. J. Consult. Clin. Psychol. 75:2232–43 [Google Scholar]
  67. Miranda J, Bernal G, Lau A, Kohn L, Hwang WC, LaFromboise T. 2005. State of the science on psychosocial interventions for ethnic minorities. Annu. Rev. Clin. Psychol. 1113–42 [Google Scholar]
  68. Miranda J, Nakamura R, Bernal G. 2003. Including ethnic minorities in mental health intervention research: a practical approach to a long-standing problem. Cult. Med. Psychiatry 27:4467–86 [Google Scholar]
  69. Moodie ST, Kothari A, Bagatto MP, Seewald R, Miller LT, Scollie SD. 2011. Knowledge translation in audiology: promoting the clinical application of best evidence. Trends Amplif. 15:15–22 [Google Scholar]
  70. Natl. Inst. Health Care. Excell. (NICE) 2012. Implementation Tools London: NICE http://www.nice.org.uk/usingguidance/implementationtools/implementation_tools.jsp [Google Scholar]
  71. Newberry SJ, Ahmadzai N, Motala A, Tsertsvadze A, Maglione M. et al. 2013. Surveillance and Identification of Signals for Updating Systematic Review: Implementation and Early Experience Methods Res. Rep. AHRQ Publ. No. 13-EHC088-EF Rockville, MD: Agency Healthc. Res. Qual. [Google Scholar]
  72. Olfson M, Marcus SC, Druss B, Elinson L, Tanielian T, Pincus HA. 2002. National trends in the outpatient treatment of depression. J. Am. Med. Assoc. 287:2203–9 [Google Scholar]
  73. Ollendick TH, Shirk SR. 2011. Clinical interventions with children and adolescents: current status, future directions. Oxford Handbook of Clinical Psychology DH Barlow 762–88 New York: Oxford Univ. Press [Google Scholar]
  74. Pawson R, Greenhalgh T, Harvey G, Walshe K. 2004. Realist synthesis: an introduction ESRC Res. Methods Progr. Work. Pap. 2, Univ. Manchester [Google Scholar]
  75. Rochon PA, Mashari A, Cohen A, Misra A, Laxer D. et al. 2004. The inclusion of minority groups in clinical trials: problems of under representation and under reporting of data. Account. Res. 11:3–4215–23 [Google Scholar]
  76. Sackett DL, Rosenberg WM, Gray JA, Haynes RB, Richardson WS. 1996. Evidence-based medicine: what it is and what it isn't. BMJ 312:702371–72 [Google Scholar]
  77. Schünemann HJ, Brożek J, Oxman AD. 2009. GRADE Handbook for Grading the Quality of Evidence and the Strength of Recommendations Grade Work. Group, version 3.2, updated Mar. http://www.who.int/hiv/topics/mtct/grade_handbook.pdf [Google Scholar]
  78. Seligman MEP, Rashid T, Parks AC. 2006. Positive psychology. Am. Psychol. 61:772–88 [Google Scholar]
  79. Sexton T, Gordon GC, Gurman A, Lebow J, Holtzworth-Munroe A, Johnson S. 2011. Guidelines for classifying evidence-based treatments in couple and family therapy. Fam. Process. 50:3377–92 [Google Scholar]
  80. Shadish WR, Cook TD, Campbell DT. 2002. Experimental and Quasi-Experimental Designs for Generalized Causal Inference Boston: Houghton-Mifflin [Google Scholar]
  81. Shaneyfelt T. 2012. In guidelines we cannot trust: comment on “Failure of clinical practice guidelines to meet Institute of Medicine standards.”. Arch. Intern. Med. 172:211633–34 [Google Scholar]
  82. Shaw BF, Elkin I, Yamaguchi J, Olmsted M, Vallis TM. et al. 1999. Therapist competence ratings in relation to clinical outcome in cognitive therapy of depression. J. Consult. Clin. Psychol. 67:6837–46 [Google Scholar]
  83. Shea MT, Elkin I, Imber SD, Sotsky SM, Watkins JT. et al. 1992. Course of depressive symptoms over follow-up: findings from the National Institute of Mental Health Treatment of Depression Collaborative Research Program. Arch. Gen. Psychiatry 49:782–87 [Google Scholar]
  84. Shojania KG, Jennings A, Mayhew A, Ramsay C, Eccles M, Grimshaw J. 2010. Effect of point-of-care computer reminders on physician behaviour: a systematic review. Can. Med. Assoc. J. 182:5E216–25 [Google Scholar]
  85. Simons AD, Murphy GE, Levine JE, Wetzel RD. 1986. Cognitive therapy and pharmacotherapy for depression: Sustained improvement over one year. Arch. Gen. Psychiatry 43:43–49 [Google Scholar]
  86. Spring B, Hitchcock K. 2009. Evidence-based practice in psychology. Corsini's Encyclopedia of Psychology IB Weiner, WE Craighead 603–7 New York: Wiley, 4th ed.. [Google Scholar]
  87. Spring B, Moller AC, Falk-Krzesinski HJ, Hall K. 2012. Special Section on Team Approaches to Science, Practice, and Policy in Health. Transl. Behav. Med. 24 New York: Springer [Google Scholar]
  88. Stricker G, Abrahamson DJ, Bologna NC, Hollon SD, Robinson EA, Reed GM. 1999. Treatment guidelines: the good, the bad, and the ugly. Psychotherapy 36:69–79 [Google Scholar]
  89. Turner EH, Matthews AM, Linardatos E, Tell RA, Rosenthal R. 2008. Selective publication of antidepressant trials and its influence on apparent efficacy. New Eng. J. Med. 358:3252–60 [Google Scholar]
  90. Unützer J, Katon W, Callahan CM, Williams JW Jr, Hunkeler E. et al. 2002. Collaborative care management of late-life depression in the primary care setting: a randomized controlled trial. J. Am. Med. Assoc. 288:222836–45 [Google Scholar]
  91. US Census Bur 2008. An older and more diverse nation by midcentury. Washington, DC: US Census Bur http://www.census.gov/newsroom/releases/archives/population/cb08-123.html [Google Scholar]
  92. US Dep. Health Hum. Serv 2001. Mental Health: Culture, Race, and Ethnicity: A Supplement to Mental Health: A Report of the Surgeon General. Rockville, MD: Subst. Abus. Ment. Health Serv. Adm http://www.ncbi.nlm.nih.gov/books/NBK44243/ [Google Scholar]
  93. van Dijk MK, Oosterbaan DB, Verbraak MJ, van Balkom AJ. 2012. The effectiveness of adhering to clinical-practice guidelines for anxiety disorders in secondary mental health care: the results of a cohort study in the Netherlands. J. Eval. Clin. Pract. 79:5791–97 [Google Scholar]
  94. Vandenbroucke JP. 2004. Benefits and harms of drug treatments: Observational studies and randomised trials should learn from each other. BMJ 329:74562–3 [Google Scholar]
  95. Vandenbroucke JP. 2008. Observational research, randomized trials, and two views of medical science. PLoS Med. 5:3e67 [Google Scholar]
  96. Waltz J, Addis ME, Koerner K, Jacobson N. 1993. Testing the integrity of a psychotherapy protocol: assessment of adherence and competence. J. Consult. Clin. Psychol. 61:4620–630 [Google Scholar]
  97. Westen D, Novotny CM, Thompson-Brenner H. 2004. Empirical status of empirically supported psychotherapies: assumptions, findings, and reporting in controlled clinical trials. Psychol. Bull. 130:4631–63 [Google Scholar]
  98. Whitlock EP, Orleans CT, Pender N, Allan J. 2002. Evaluating primary care behavioral counseling interventions: an evidence-based approach. Am. J. Prev. Med. 22:4267–84 [Google Scholar]
  99. Wolf JS Jr, Hubbard H, Faraday MM, Forrest JB. 2011. Clinical practice guidelines to inform evidence-based clinical practice. World J. Urol. 29:3303–9 [Google Scholar]
  100. Woolf SH, Campos-Outcalt D. 2013. Severing the link between coverage policy and the US Preventive Services Task Force. J. Am. Med. Assoc. 309:181899–900 [Google Scholar]
  101. Woolf SH, Grol R, Hutchinson A, Eccles M, Grimshaw J. 1999. Potential benefits, limitations, and harms of clinical guidelines. BMJ 318:7182527–30 [Google Scholar]

Data & Media loading...

  • Article Type: Review Article
This is a required field
Please enter a valid email address
Approval was a Success
Invalid data
An Error Occurred
Approval was partially successful, following selected items could not be processed due to error