Evidence Brief Topics

Psych Health Evidence Brief topics include psychotherapeutic interventions for psychological health conditions of relevance to the active-duty population. Topics for new briefs are selected through regular scans of popular topical literature and news stories. Sometimes an Evidence Brief on a specific topic is the result of a request received or a suggestion.

Writing an Evidence Brief

Psych Health Evidence Briefs are presented as a series of questions and answers. The following information breaks down the Psych Health Evidence Brief format into the individual sections, each of which starts with a question, and explains the methodology behind answering each question.

What is the intervention?
What is the treatment model underlying the intervention?
What are the potential mechanisms of action?

A brief overview of the intervention is provided, based on information from the appropriate VA/DOD Clinical Practice Guideline (CPG), literature reviews of the intervention and treatment manuals when available.

Is the intervention recommended in the Military Health System?

The appropriate VA/DOD CPG is consulted to see if that intervention is covered by the CPG. The brief explains whether the intervention is recommended in the CPG, including the grade of the recommendation. 

VA/DOD CPGs assign a grade for the strength for each recommendation, which is part of a continuum, including “Strong For,” “Weak For,” “Weak Against,” and “Strong Against.”  When it is determined that there is insufficient evidence to recommend for or against an intervention, a recommendation is “Not Applicable.”  

The research review ends here for interventions that receive a “Strong” grade of recommendation, whether “Strong For” or “Strong Against,” as the recommendation made by the CPG is based on an existing review of the evidence base and is unlikely to be affected by further research.

Do other authoritative reviews recommend this intervention as a treatment for this disorder?
Several other recognized organizations conduct systematic reviews and evidence syntheses on psychological health topics using similar grading systems as the VA/DOD CPGs. These include the Agency for Healthcare Research and Quality (AHRQ) and Cochrane. Searches are conducted using the AHRQ Systematic Review Repository and the Cochrane Database of Systematic Reviews, and findings from relevant reviews are summarized in this section. Reports by other organizations may be included as needed, provided they follow a similar methodology.

Is there any recent research on this intervention as a treatment for this disorder?

For interventions that receive a “Weak” grade of recommendation, whether “Weak For” or “Weak Against,” this section will include a systematic literature search covering the time period since the literature review for the CPG was conducted. This section will highlight any important research that has emerged that was not taken into account by the CPG with a focus on RCTs and systematic reviews.

For interventions that are not included in the CPG, a systematic literature search will be conducted to identify any existing RCTs and/or systematic reviews of the intervention.

What conclusions can be drawn about this intervention as a treatment for this disorder?

This section contains a summary of the VA/DOD CPG recommendation of the intervention, a summary of any literature that was identified, and a discussion of other factors that providers may take into account when considering the intervention.

Systematic Literature Search

Literature searches include the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, and EMBASE, using both free-text and controlled vocabulary.

The search strategy is informed by the main concepts of the Psych Health Evidence Brief, and include:

• Terms to search for the health condition of interest
• Terms to search for the intervention
• Terms to search for the types of study design to be included

To ensure a comprehensive search, a number of free-text terms are included for each of the main concepts. This includes synonyms, related terms, variant spellings, truncation, and wildcards. Field codes are used to specify the location of these terms.  In addition to free-text terms, controlled vocabulary is used, when appropriate.

Search strategies for common conditions of interest (PTSD, MDD, AUD, and SUD) and randomized controlled trials were adapted from the Cochrane Common Mental Disorder’s ‘core search strategies,’ as well as search strategies from relevant, published Cochrane systematic reviews.

Strategies for other conditions and the intervention or treatment of interest will be created as needed using the above concepts.

Evidence Brief Review

Each treatment brief is drafted by a masters’ level research associate and reviewed by at least one internal Ph.D.-level, subject matter expert.