No One Therapy With More Efficacy In Treating Depression?

dar100

http://health.usnews.com/health-news/news/articles/2013/05/28/talk-therapy-can-ease-depression-but-no-single-type-deemed-best

Hey,

What do people think of this research? More importantly, does anyone have access to the original research evidence??

MaxWig

Hi Dar100,

I do not have the original literature, but I have come across very similar literature in the past.

The common factors etc..

dar100

Hi Maxwig,

Yes I was thinking along them lines, but I was of the understanding that CBT was one of the more empirical validated therapies for treating this construct. I wonder if they give a break down of the statistics, I recall reading a paper which suggested CBT was superior to other modalities for treating anxiety and depression

MaxWig

Hi,

I have read the (I assume) same literature. However I have also read many critiques of CBT, some challenging the empirical data.

I will try to find the articles I'm talking about.

I know of some that claimed CBT had initial success, but that improvements receded after therapy was finished.

JuliusCaesar

From the article:

Experts said the results confirm what is generally thought: Psychotherapy can help lift depression, and there is no one form that is best for everyone.

Instead, a person's therapy choice may come down to the nature of the depression, and practical matters -- like finding a therapist you're comfortable with, and being able to pay.

Here's a link to the original paper (easily google-able)

and here's their conclusions - slightly different to the article:

Conclusions

Overall our results are consistent with the notion that different psychotherapeutic interventions for depression have comparable benefits. However, the robustness of the evidence varies considerably between different psychotherapeutic treatments.

But I haven't read the paper so can't say if I'd agree with the conclusions given the evidence gathered. Anyway, they say:

Only 36 of the studies had at least 50 patients who received the same treatment. When they restricted their analysis to those studies, the researchers still saw clear benefits of cognitive-behavioral therapy, interpersonal therapy, and problem-solving therapy, but not for the other four therapies.

dar100

Thanks JC, will have a read later

Lunafizzle

Also, Google the 'dodo-bird verdict' research that has been doing the rounds for the last decade or so.
A great deal of Pim Cuijpers past research also centres on this thesis.

MaxWig

Can you expand on that Lunafizzle?

Is that 'everyone wins, so there are no winners', or something to hat effect?

dar100

It's the common factors MaxWig,basically

JuliusCaesar

MaxWig wrote: »

Can you expand on that Lunafizzle?

Is that 'everyone wins, so there are no winners', or something to hat effect?

If I recall Alice in Wonderland correctly: Everyone has won and all must have prizes!

Lunafizzle

JuliusCaesar wrote: »

If I recall Alice in Wonderland correctly: Everyone has won and all must have prizes!

This! Couldn't have put it better myself
Essentially, all psychotherapies are equally effective (as undertaking psychotherapy is better than doing nothing at all). Additionally, as Dar100 said - shared factors are also evident across therapies - this also accounts for the shared efficaciousness for treating disorders. (I actually read a brilliant paper recently with regards to how therapies have become more 'blended' across time - if I come across it, I will post).

Hopefully these articles might shed some light: http://mentalhealthpros.com/mhp/pdf/Dodo-bird-meta-analys.pdf
and http://www.criticalpsychiatry.net/wp-content/uploads/2010/01/The-Dodo-Bird-Verdict-Controversial-Inevitable-and-Important-A-commentary-on-30-years-of-Meta-Analyses.pdf

Luborsky is also a big name in this area of reseach

JuliusCaesar

It is however disputed. The problem is that therapies as applied aren't compared.

For example, the therapeutic relationship was thought to have been disregarded in Behaviour Therapy. It wasn't - but wasn't studied. Think about it: how the hell did therapists convince clients to undertake therapies like exposure, if it wasn't through the strength of the therapeutic relationship?

The humanistic stance has become the sine qua non - but it isn't sufficient by itself. So other studies will maintain the superiority of certain therapies over others. Well, also some therapies DO a lot of research.

Here's some disputation. I think it's important, because there's something very smug and self-satisfied and unquestioning and comfortable about the Dodo Bird Hypothesis: we don't need to try, because we're ok as we are. Link Link

MaxWig

JuliusCaesar wrote: »

It is however disputed.

Think about it: how the hell did therapists convince clients to undertake therapies like exposure, if it wasn't through the strength of the therapeutic relationship?

I think the conviction/faith of the client in the therapist is among the most important aspects of effective therapy.

It may well be that a therapist/therapy is among the 'most effective', but if a client does not believe this to be the case, it is a dead end.

The empirical testing of outcomes in therapy is always going to be problematic. There are too many variables.

i.e. it seems impossible to objectively measure such a subjective experience

JuliusCaesar

MaxWig wrote: »

The empirical testing of outcomes in therapy is always going to be problematic. There are too many variables.

i.e. it seems impossible to objectively measure such a subjective experience

Only this morning I came across an article on Outcomes in Routine Clinical Practice. I think everyone should be measuring their outcomes: HSE, private practice, etc; humanist, psychoanalytic, whatever. What are the clients' desired outcomes? Why are they engaging in therapy? To feel better. Outcome measurement is being done all the time in areas that I practice in. It would be an insult to everyone concerned if we said what we do is immeasurable.

Given knowledge of outcomes, and their own personal preferance, clients can choose on an educated basis.

MaxWig

JuliusCaesar wrote: »

Only this morning I came across an article on Outcomes in Routine Clinical Practice. I think everyone should be measuring their outcomes: HSE, private practice, etc; humanist, psychoanalytic, whatever. What are the clients' desired outcomes? Why are they engaging in therapy? To feel better. Outcome measurement is being done all the time in areas that I practice in. It would be an insult to everyone concerned if we said what we do is immeasurable.

Given knowledge of outcomes, and their own personal preferance, clients can choose on an educated basis.

I wasn't suggesting that it should not be done. However, the comparative studies we are talking about seem to cause more confusion clarity.

I take your point of course that it is insulting, and unprofessional to suggest that there is no measurement possible.

However, the process of measuring itself is limiting.
For instance CBT seems to be the most measurable. It seems to be that this is purely based on the fact that CBT is the most constant in its response to clients.

And so we are trapped in a cycle of trying to limit the variables of a given therapy in order to effectively measure it. It seems to me that limiting therapy in any way is a negative step.

JuliusCaesar

MaxWig wrote: »

For instance CBT seems to be the most measurable. It seems to be that this is purely based on the fact that CBT is the most constant in its response to clients.

And so we are trapped in a cycle of trying to limit the variables of a given therapy in order to effectively measure it. It seems to me that limiting therapy in any way is a negative step.

I don't understand either of these statements. Perhaps you would explain.

MaxWig

JuliusCaesar wrote: »

I don't understand either of these statements. Perhaps you would explain.

In order to 'measure' a therapy, or anything for that matter, you require that the variables you are measuring remain relatively constant. Two Humanistic therapists may react in vaguely similar ways, but in reality, be poles apart in terms of their approach. Also, they will not 'treat' depression in any way, shape or form.

CBT (and I speak in relative ignorance about CBT, I admit), to the best of my knowledge, assumes that there is a pathway to a better way of thinking - a correct way, so to speak.

There are certain thoughts and behaviours that should be challenged - across the board - as they are incorrect, or maladaptive.

So, in this sense, I assume that CBT lends itself more easily to measurement.

It has a predetermined purpose in a much more concrete sense than many of the other therapies, or at least when we speak of 'treating depression'.

i.e. I imagine, and again could be very wrong, that CBT has markers on the road to 'correct/healthy thinking' that can be measured more easily.

Velvety

No, when you're comparing treatments for a problem you use the same outcome measures across treatments. Wouldn't be comparing like with like otherwise.

So if you had an experiment comparing CBT, antidepressant medication, and humanistic therapy, in the treatment of depression, there would be a standardised outcome measure across all conditions. For example, the completion of a Beck's Depression Inventory by all participants post treatment.

Valmont

MaxWig wrote: »

In order to 'measure' a therapy, or anything for that matter, you require that the variables you are measuring remain relatively constant.

What variables could remain constant in any sort of therapy?

MaxWig

Valmont wrote: »

What variables could remain constant in any sort of therapy?

As Velvety pointed out, I worded my point ass-ways.

What I was attempting to say, badly, was that (as an example) CBT and Humanistic Therapy do not seem to me to be easily measured in even terms of outcome.

A C.B Therapist will treat depression, while a Humanistic Therapist will not (in the pure sense).

CBT is hedonistic, in that it suggests that there is a way of thinking that is correct, and commensurate with 'happiness'.

Humanistic therapy is not (to the best of my knowledge, though I am gladly corrected).

Valmont

MaxWig wrote: »

A C.B Therapist will treat depression, while a Humanistic Therapist will not (in the pure sense)...
...

This all assumes there is a 'pure' depression, the presence and quality of which is constant between the affected individuals. However, each individual's subjective perception of their depression, what it means to them, and what 'recovery' would involve is going to be different. I'm unsure at the moment how this fact would affect any comparisons between the efficacy of various therapies.

Lbeard

MaxWig wrote: »

CBT is hedonistic, in that it suggests that there is a way of thinking that is correct, and commensurate with 'happiness'.

This is especially bad if the therapist has ICPD (Irish conservative personality disorder). They see their narrow and twisted experience of reality as the only possible "sane" and "normal" experience. They're not happy, and they're possessed by all kinds of traumas and neurosis themselves - and that's their idea of a "cure". I wouldn't go as far to say these people are walking pathogens....just that you will have to consider whether they are or not yourself. ....And I will not prod you in any particular direction. You have to make up your own mind. I will not make your mind up for you. I'm just saying, the facts are the facts.

dar100

Lbeard wrote: »

This is especially bad if the therapist has ICPD (Irish conservative personality disorder).

Irish Conservative Personality Disorder???? Must be a new addition to the DSM 5

They see their narrow and twisted experience of reality as the only possible "sane" and "normal" experience.

Maybe so, but who's going to say their subjective reality and worldview is anything but?


They're not happy, and they're possessed by all kinds of traumas and neurosis themselves - and that's their idea of a "cure".

Did you not mention a number of times that you hate idiots who think they know what other people are thinking????


I wouldn't go as far to say these people are walking pathogens....just that you will have to consider whether they are or not yourself. ....And I will not prod you in any particular direction. You have to make up your own mind. I will not make your mind up for you. I'm just saying, the facts are the facts.

Ye your not trying to influence anyone with this statement, smells of a poor attempt at NLP. What are these facts you mention?

Lbeard

dar100 wrote: »

What are these facts you mention?

The fact are the facts......And I'm afraid I cannot change them

The fact is there are people who should not be allowed near people in distress. But because we have a warped culture, they are.

And I bet, if there were tighter regulations, we'd only have more awful people causing harm.

Valmont

MaxWig wrote: »

A C.B Therapist will treat depression, while a Humanistic Therapist will not (in the pure sense).

Could you elaborate on this point please, MaxWig? I don't understand how a humanistic therapist cannot treat depression in a 'pure sense'? What is 'pure' depression or even the 'pure' form of treatment for it?

MaxWig

Valmont wrote: »

Could you elaborate on this point please, MaxWig? I don't understand how a humanistic therapist cannot treat depression in a 'pure sense'? What is 'pure' depression or even the 'pure' form of treatment for it?

I did not say they 'cannot' treat depression. But I don't believe they 'treat' anything.
I simply mean that a humanistic therapist will make less promises.

A humanistic therapist, to my mind, will not claim that they can rid a client of depression. At least they should not, from a purely humanistic stance. There must be room for at least the possibility that the 'depression' is functional. Or you could say, the distinct possibility.
Whether the depression lifts or not is completely down to the client.

CBT practitioners (correct me if I'm wrong) will work from the assumption that depression is simply a disordered way of thinking. That is, depression can be corrected with practice, and with a new way of thinking. Listen to the therapist - think as they teach - and the depression goes away.

MaxWig

Just wanted to follow up and emphasise that I am not being critical of CBT.

Wasn't sure if my post came across as such.