[lbo-talk] Effectiveness of Psychotherapy, some studies

andie nachgeborenen andie_nachgeborenen at yahoo.com
Tue Jun 19 19:11:08 PDT 2007


One survey is very rah-rah:

Consumer Reports, 1995, study finding psychotherapy is generally effective, supported by Martin P. Seligman (Penn, Am. Psych 1995)

http://homepage.psy.utexas.edu/Homepage/Class/Psy394Q/Research%20Design%20Class/Assigned%20Readings/Clinical%20Trials/Seligman95.p

Others are more skeptical:

A negative/mixed appraisal from a study in the British Medical Journal done for Britain’s National Health Service in 1994:

the evidence on the efficacy and cost effectiveness of the many different psychotherapies is patchy. Randomised trials cover only a limited number of treatments, and many treatments remain unevaluated in relation to many conditions.3 Exclusion rates of 40-70% of presenting patients limit their generalisability to the treatment seeking population,4 and a dearth of long term data, data on quality of life, non experimental evidence, user perspectives, and evidence of the generalisability to NHS practice of studies carried out in other settings hampers rational purchasing decisions. . . . .

Evidence from randomised controlled trials now exists for the efficacy of psychotherapy in depression, panic, generalised anxiety disorder, eating disorder, and personality disorder. Cognitive behaviour therapy, family therapy, interpersonal therapy, cognitive analytic therapy, and some psychodynamic therapy have variously been shown to reduce life impairing mood states and behaviours substantially.3 But with notable exceptions, such as the use of cognitive behaviour therapy for panic disorders, most trials still leave patients with residual symptoms, and most participants in trials relapse or seek further treatment within a year or two of "successful treatment."3 Most patients presenting at clinics are polysymptomatic, and improvement is inversely proportional to the chronicity and complexity of their presenting condition. Duration of treatment is also highly correlated with comorbidity and chronicity, and we know that theoretically based therapies with a coherent theoretical mechanism of action deliver better results than interventions, such as simple interpersonal support, which lack a coherent theoretical model.7 But though the overall picture is diffuse, differences between individual therapies in relation to specific disorders are now emerging. The efficacy of cognitive behaviour therapy in conditions such as panic disorder, specific phobias, and obsessive compulsive disorder is well established, although critics argue that effect sizes have been overestimated because of inappropriate controls.8 w9 Psychodynamic therapy has been shown to be effective in severe personality disorder,9 which responds poorly to cognitive behaviour therapy. w10-w12 Family therapy is effective in anorexia nervosa,10 and structured brief psychological therapies in depression11 are generally effective at least in the short term, although with no clear evidence of advantage to any particular approach.7 Again few trials have extended follow up, and those that do show a clear tendency for patients to relapse.4 w13  BMJ 2004;329(7460):245 (31 July), doi:10.1136/bmj.329

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Jacobson and Truax argue that clinical as oppose to statistical measures of the efficacy of psychoanalytis treatment greatly overstate the efficacy of such treachment: people who get psychoanalysis do better thyan control groups but don’t recover:

http://www.usq.edu.au/users/patrick/PAPERS/clinical%20significance.pdf

A study of which kind of psychotherapeutic interventions reveals that the answer is very much, it depends; moreover the question of efficacy is itself (as the previous article indicated) hotly contested,

Annual Review of Psychology Vol. 52: 685-716 (Volume publication date February 2001) (doi:10.1146/annurev.psych.52.1.685)

EMPIRICALLY SUPPORTED PSYCHOLOGICAL INTERVENTIONS: Controversies and Evidence Dianne L. Chambless ¬ Department of Psychology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina 27599-3270; e-mail: chambles at email.unc.edu Thomas H. Ollendick ¬ Child Study Center, Department of Psychology, Virginia Polytechnic Institute and State University, Blacksburg, Virginia 24061-0355; e-mail: tho at vt.edu Efforts to increase the practice of evidence-based psychotherapy in the United States have led to the formation of task forces to define, identify, and disseminate information about empirically supported psychological interventions. The work of several such task forces and other groups reviewing empirically supported treatments (ESTs) in the United States, United Kingdom, and elsewhere is summarized here, along with the lists of treatments that have been identified as ESTs. Also reviewed is the controversy surrounding EST identification and dissemination, including concerns abou research methodology, external validity, and utility of EST research, as well as the reliability and transparency of the EST review process. Full Text PDF

Chain of Reviews: Annual Reviews chapters http://arjournals.annualreviews.org/doi/abs/10.1146/annurev.psych.52.1.685?cookieSet=1&journalCode=psych
>

Long and short: there's no unqualified consensus that psychotherapy is generally effective. Some forms of it may be more or less effective than other things or nothing, but it depends on for what and how you measure it, and that is very much debated. Which is about what you'd expect.

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