Jared DeFife Ph.D.

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Treating depression: Many major brands of psychotherapy are equally effective

Effective psychotherapy for depression

Posted Dec 30, 2008

It's 2 a.m. You're having trouble sleeping. Again. You've cried nearly every day for the past two weeks, have stopped talking to your friends, and your favorite activities just don't provide the same enjoyment they used to. You've decided that it's time to get help. You'd like to talk to someone, to get therapy, but what kind? You turn to a listing of local therapists and are bombarded with strange terms or funky acronyms: IPT, CBT, social-skills, psychodynamic, problem-focused, behavioral activation. Like a smart consumer, you want the best treatment you can find, but which to choose?

A new major study has been published in the most recent issue of The Journal of Consulting and Clinical Psychology, a publication of the American Psychological Association (APA), suggesting that many major brands of psychotherapy are equally effective for the treatment of mild-to-moderate depression in adults.

There is no doubt that different psychotherapists practice in quite different ways (see Ryan Howes's wonderful 7 Questions series to illustrate this). Psychotherapy researchers are concerned with answering questions of do treatments work, how, in what ways, and for whom? The finding that major brands of psychotherapy are equally effective has been identified in countless studies across the past 30 years. Still, many practicing therapists find this concept difficult to grasp and accept. Many have been trained in one form of treatment and some dogmatically adhere to their form of practicing as the most effective form of treatment (think about some individuals of differing religious denominations arguing over whose form of faith is better).

Throughout the past decade, the APA has spearheaded a movement to identify effective forms of psychotherapy. They have established lists of so-called "empirically validated treatments", which later became named "empirically supported treatments" and are more recently labeled "evidence-based practice".

It would be ludicrous to argue that therapy should not have evidence supporting its usefulness to people. However, there has been a firestorm of controversy around the APA's methods for identifying "effective psychotherapy". Not surprisingly, their process is highly politicized and extremely oversimplified. Only some forms of evidence are accepted and vast quantities of other empirical data are overlooked. To be labeled "evidence-based", the APA guidelines favor brief forms of treatments which are highly structured, treating very specific disorders, cognitive-behaviorally focused, and manualized so that each patient receives nearly identical treatment.

This recent meta-analysis of treatments for depression directly compares the effectiveness of different major brands of psychotherapy.  Meta-analysis is a way of compiling data from many individual studies in order to get a bigger picture of an overall effect. To give an example, let's say you want to know if a playground slide is fun. One study asks kids in 4th grade in a Pittsburgh school if they think the slide is fun. Another study asks kids in 2nd grade in Sacramento, etc. A meta-analysis would compile all these numbers from individual studies from different schools into one number that describes how much fun kids find the slide.

The researchers (Cuijpers, van Straten, Andersson, and van Oppen) of this latest meta-analysis on psychotherapy for depression compiled 53 studies covering data from over 2,500 depressed patients. Their results found that for the treatment of mild-to-moderate depression in adults, 7 major forms of psychotherapy had similar efficacy: cognitive- behavior therapy (CBT), nondirective supportive treatment, behavioral activation treatment, psychodynamic treatment, problem-solving therapy, interpersonal psychotherapy (IPT), and social skills training. [IPT was found to be slightly more effective than the others, while nondirective-supportive treatment was found to be slightly less effective, but the differences were considered small].

What does this mean to someone seeking psychotherapy for depression? The body of psychotherapy research tends to indicate that important factors related to a

treatment's effectiveness are:

-Qualities of the therapist (e.g. flexible, experienced, honest, alert, warm, confident, trustworthy)

-The strength of the patient/therapist relationship (e.g. agreement on therapy methods and goals, a shared understanding of a patient's problems, confident collaboration, development of mutual bonding)

-Qualities of the patient (e.g. motivation for treatment, psychological mindedness, willingness to collaborate and engage in treatment)

-Number of treatment sessions (acute psychiatric symptoms improve more quickly, while more complex and lasting difficulties are more effectively treated in longer therapies)

Of course, it would be easier and great if to get a working therapy, we could order a type of treatment like ordering a meal at a restaurant. Unfortunately, getting therapy is not that simple. The best way of finding a treatment that works is not to ask, "Is this the best type of therapy?", but to find out "Is this a therapist I can feel comfortable and confident in working with?"


Please feel free to comment below with your thoughts or therapy experiences, or send email to jareddefifePT@gmail.com

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