Thursday, 1 May 2008

Have psychotherapies been overhyped?

The Pulse website for GPs features a new debate between the psychopharmacologist Professor David Nutt and the clinical psychologist Dr Stephen Pilling, regarding whether psychotherapies have been overhyped.

The debate comes as the UK government rolls out its "Improving access to psychological therapies" programme across the country, with the promise of massive investment in more therapists to help deliver approved treatments, particularly CBT, to everyone who needs it, including those with problems such as anxiety and depression. This project has also coincided with a cultural backlash against drug treatments for depression and anxiety, amid fears that anti-depressants may do more harm than good, and with a recent high-profile study suggesting such drugs are no more effective than placebo.

Professor Nutt says that psychotherapies are not tested by the same strict criteria faced by drug treatments. He also fears that rates of abuse by therapists of their clients may be as high as 40 per cent. He writes: "Most of the support for psychotherapy is based on a mixture of the desire for it to work and the false supposition that it does. It is doubtful if any form of psychotherapy has yet fulfilled the stringent criteria required for licensing drug treatments."

Dr Pilling retorts that Nutt is simply wrong: high quality randomised controlled trials have demonstrated the superior efficacy of psychological treatments for anxiety and depression. Moreover, he argues, the research shows that psychological treatments may actually have longer lasting benefits than drugs. And he adds that a supervision system should help keep abuse of therapy clients to a minimum. He concludes: "Let us move beyond rhetoric and focus on delivering an effective evidence-based programme of psychological treatments that complements pharmacological interventions, is delivered by competent professionals, is rigorously evaluated and offers real choice to patients."

Post written by Christian Jarrett (@psych_writer) for the BPS Research Digest.

Link to debate on Pulse website.


Paul said...

I thought the comments by the psychopharmacologist were pretty off the mark factually (isn't the 40% statistic regarding therapists sleeping with clients not from the US? Is that applicable to the UK?), downright disrespectful to those researchers trying their best to evaluate psychological treatments (he didn't acknowledge the difficulties of evaluating psychological treatments in RCT's, and he didn't acknowledge the lack of drug-company funding available for those wishing to carrying out such expensive trials), and potentially biased (given his clear competing interests).

Electric Angel said...

To do a valid clinical trial with patients receiving psychotherapy would be very difficult. First of all, there are a wide number of psychotherapuetic paradigms and even with two counsellors using the same paradigm, they may not apply them in the same way.

Secondly, and perhaps a more relevant issue, is that no two patients will have exactly the same complaints ("symptoms"). However, this is where psychotherapy has really made progress.

Psychotherapists are not constantly interested in diagnoses and labels that can be applied to people, but rather the individual experience of that person. Although this more humanistic philosophy of the person may not be entirely prevalent or explicit in all counselling paradigms, for example CBT is arguably reductionist in reducing a person's complaint/s to faulty thinking.

However it is these psychiatric labels (manic depressive, schizophrenic etc.) that allow the drug companies to say drug X can be used for illness Y, implying that it will work for all people with "illness Y", without taking account of the actual person.

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