The Research-Practice Gap: An Enduring Challenge for the Eating Disorders Field

Dr. Timothy Baker and colleagues caused a furor in the field of clinical psychology with the publication of their monograph on the quality of clinical psychology practice in the U.S. (Psychological Science in the Public Interest, 1990; 9: 67-103).

Baker et al. (2009) state that the practice of clinical psychology is substandard because clinical psychologists demonstrate “insouciance to science” and “disregard of scientific evidence.” The authors support this premise by citing surveys revealing that clinical psychologists base their treatment decisions more on “craft” or clinical experience than on scientific research, and point to the low utilization rates of empirically-supported treatments (ESTs) in clinical practice. To remedy this situation, the authors call for a new clinical psychology accreditation system that focuses on an emphasis on training in scientific thought and methods and evidence-based treatments. The article triggered a storm of media attention and professional debate centering on the ethics of practicing clinicians.

Interestingly, the thrust of the Baker et al. (2009) article and the ensuing finger-pointing provide a vivid enactment of the dynamics that fuel the research-practice gap in the field of eating disorders, and in most fields with both applied and basic science components. Baker et al. (2009) are concerned that important research findings are not making their way into clinical practice. We agree. However, we also are concerned that valuable clinical observations and experience are not impacting current research directions. Further, we submit that a top-down approach to the research-practice gap is not a viable solution. Instead, we propose that fostering communication, collaboration and partnership between researchers and practitioners will produce substantive, longstanding improvements in the quality of not only clinical practice but also in the quality of research.

This article briefly reviews evidence regarding the research-practice gap in the field of eating disorders and summarizes possible explanations for the gap from both research and practice perspectives. It also outlines practical strategies clinicians can use to integrate research within their practice, thus enhancing the quality of their clinical work and informing new research directions. (Please note: We are aware that many professionals in our field work in both research and in clinical practice. For the purposes of our discussion, an exaggerated distinction between the two groups is made.)

Evidence for a Research-Practice Divide in the Eating Disorders Field

Our review of the evidence for the research-practice gap is drawn from the work done in this area by the Academy for Eating Disorders (AED), a global multidisciplinary professional association. The AED has conducted informal surveys, focus group discussions, and interviews of its members to gain a clearer picture of the factors perpetuating the research-practice gap. The responses generated by these initiatives suggest that relational, systemic, and attitudinal factors play key roles in generating and perpetuating the research-practice divide.

Relational Factors

A lack of shared respect for the mutual contributions of research and practice to the field, emerged as a significant theme. Responses from the surveys, focus groups, and interviews revealed that clinicians clearly felt “under attack,” including references to “a faith-based assault against clinicians” and the view that they are perceived as “unscientific charlatans.” This perceived lack of respect may stem from the increased focus on the emerging primacy of empirical research over the last decade, contributing to a perceived power differential between clinicians and researchers and a tendency for researchers to be more commonly at the podium espousing the need for clinicians to change (rather than the reverse). Nonetheless, researchers also reported experiencing a lack of respect, noting that their data fail to be translated into practice and that their research findings are dismissed by clinicians who question their relevance.

Attitudinal and Systemic Factors

Perhaps the most salient attitudinal factor contributing to a divide between researchers and practitioners is the difference in their views about what constitutes valid evidence. Clinicians tend to place greater value on evidence born from clinical observation and experience. Conversely, researchers tend to value the evidence derived from structured research trials. This difference in preference of evidence type reinforces the research-practice gap and the accompanying lack of mutual respect between clinicians and researchers. Systemic factors also contribute to research-practice tension, including a lack of shared language and the lack of institutional and economic support for research-practice collaboration. The quantitative, precise language of research and the expressive, process-oriented language of clinical practice have little in common. The relative institutional and funding factors and simple time constraints affecting researchers and practitioners block opportunities for interface between the two groups.

Strategies for Bridging the Gap

Taking this range of factors into consideration, the AED developed the AED Guidelines, and Action Plan for Research-Practice Integration (www.aedweb.org). The principles and strategies put forth in these documents are aimed at institutions and organizations. Building on the directions outlined in the AED initiative, we suggest practical steps individual treatment professionals and treatment facilities can take to begin bridging the gap in their own practice settings.

Step 1: Join research-practice networks.

Increased interaction and dialogue between researchers and practitioners can help develop a more unified language for describing the complex issues related to eating disorders treatment, research, prevention, and education. Propinquity can also foster mutual respect and understanding and establish partnerships to promote translation of practice into research and research into practice. To this end, practitioners can seek out or develop networking groups within their regions, or join professional associations (e.g., the AED), or even online forums (e.g., AED Research-Practice Listserv).

Step 2: Gain access to treatment research.

The complex challenges of eating disorders treatment require clinicians to expand and improve their treatment tools and to stay abreast of key findings. However, for many clinicians, the time it takes to access and read research articles and the language of research is a challenge. The International Journal of Eating Disorders (IJED)provides jargon-free summaries of each article published along with periodic review articles on current topics in research. Eating Disorders Review provides articles that summarize current findings relevant to clinical professionals. In addition, attending conferences, workshops, or meetings (or purchasing their program CDs) where the latest ED research is reviewed can familiarize practitioners with current findings while accruing necessary continuing education credits.

Step 3: Translate practice to research: The benefits of the case study

Disciplined clinical observation has led to important advancements, not the least of which is the earliest description of eating disorders and subsequent identification of different constellations of eating disorders. The individual case study offers clinicians a format and channel for communicating significant observations gleaned from clinical practice. A case study is the systematic evaluation of an individual treatment case or a small number of treatment cases (case series). The narrative can include clinical observations, interviews, past records, and/or measurement tools such as assessment tools or psychological tests. Hypotheses for single case research can be formulated from the careful observations recorded in case studies. In this way, case studies provide clinicians a channel for directly influencing research directions.

Step 4: Incorporate simple research methods and treatment outcome measures into everyday practice.

The eating disorders field’s knowledge base lacks vital information about the quality and effectiveness of ED treatment as it is delivered in community settings. The application of simple treatment assessment instruments in clinical practice provides clinicians with valuable feedback about the effectiveness of their own practices and programs and can also provide data for treatment research. Further, the information provided via these instruments can be used to adapt the therapeutic approach to the needs of individual patients.The AED web site (www.aedweb.org) provides a list of measurement tools that can be easily implemented by busy clinicians and treatment teams. Information is also provided about participating in the AED online Data Network, where unused data can be shared or clinician-researcher collaborations can be forged.

Conclusions

The research-practice gap has presented an ongoing obstacle to the enhancement of the knowledge base in the field of eating disorders. Valuable research findings are not integrated into clinical practice, and valuable practice experience and observations do not impact research directions. A respectful consideration of the value added by the expertise and knowledge of both research and practice is our best hope for a research-practice synthesis that can yield the breakthroughs we need to improve the lives of people with eating disorders and their loved ones.

The AED has produced guidelines and an action plan for research-practice integration within organizations and institutions. We have outlined simple strategies the individual practitioner and/or treatment facility can use to promote research-practice integration within their own practice settings. Through the implementation of these steps, clinicians can help to address the relational, attitudinal and systemic challenges that contribute to the research-practice gap and, at the same time, contribute critical clinical knowledge to advance ED treatment, research, education and prevention.