Evidence-Based Psychotherapy

The State of the Science and Practice

Daniel David, Steven Jay Lynn, Guy H. Montgomery

• Publisher: Wiley-Blackwell
• Year: 2018
• ISBN:
  9781118625583
• Edition: 1
• Topic: Psychologie
• Subtopic: Psychothérapie

A Comprehensive, Systematic Evaluation of Treatment Effectiveness for Major Psychological Disorders

With over 500 types of psychotherapy being practiced in the field today, navigating the maze of possible treatments can be daunting for clinicians and researchers, as well as for consumers who seek help in obtaining psychological services. Evidence-Based Psychotherapy: The State of Science and Practice offers a roadmap to identifying the most appropriate and efficacious interventions, and provides the most comprehensive review to date of treatments for psychological disorders most often encountered in clinical practice.

Each chapter applies a rigorous assessment framework to evaluate psychotherapeutic interventions for a specific disorder. The authors include the reader in the evaluation scheme by describing both effective and potentially non-effective treatments. Assessments are based upon the extant research evidence regarding both clinical efficacy and support of underyling theory. Ultimately, the book seeks to inform treatment planning and enhance therapeutic outcomes.

Evidence-Based Psychotherapy: The State of Science and Practice:

• Presents the available scientific research for evidence-based psychotherapies commonly practiced today
• Systematically evaluates theory and intervention efficacy based on the David and Montgomery nine-category evaluative framework
• Covers essential modes of treatment for major disorders, including bipolar disorder, generalized anxiety disorder, PTSD, eating disorders, alcohol use disorder, major depressive disorder, phobias, and more
• Includes insightful discussion of clinical practice written by leading experts
• Clarifies "evidence-based practice" versus "evidence-based science" and offers historical context for the development of the treatments under discussion

Evidence-Based Psychotherapy: The State of Science and Practice is designed to inform treatment choices as well as strengthen critical evaluation. In doing so, it provides an invaluable resource for both researchers and clinicians.

1
An Introduction to the Science and Practice of Evidence-Based Psychotherapy: A Framework for Evaluation and a Way Forward

Daniel David,¹ Steven Jay Lynn,² and Guy H. Montgomery³

¹ Department of Clinical Psychology and Psychotherapy, Babeş-Bolyai University, Cluj-Napoca, Romania

² Psychology Department, Binghamton University, Binghamton, USA

³ Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, USA

The terrain of contemporary psychotherapy is vast. In fact, patients can choose from more than 500 brands of psychotherapy. The challenges in navigating this bewildering landscape of psychotherapeutic interventions can be daunting (Lilienfeld, 2007). In this volume, we guide consumers of psychotherapy, clinicians, researchers, and students in the task of ascertaining the psychological treatments that are most rigorously evaluated, the treatment mechanisms that are best established, and the interventions that are most likely to be associated with positive outcomes for an array of disorders.

1.1 Evidence-Based Psychotherapies and Clinical Practice

Many psychotherapies in vogue today have never been subjected to rigorous scientific scrutiny, and there is no guarantee that a consumer of psychotherapy will receive an effective, evidence-based treatment. Although researchers have demonstrated that some psychotherapeutic interventions are successful, many individuals with major mental disorders still fail to receive treatments grounded in rigorous research (see Lynn & Lilienfeld, 2017). As Lilienfeld (2007) points out, surveys of clinical practitioners reveal that “substantial pluralities or even majorities do not treat patients with empirically supported methods” (p. 63). One such survey (Kessler et al., 2003) revealed that only about a fifth of individuals with clinical depression received adequate, empirically based clinical treatment in the year in which they were interviewed (see also Wang, Berglund, & Kessler, 2000, reporting similar findings for anxiety disorders). A more recent representative community household survey from 21 countries found that, among respondents who received treatment for depression, only 41% received treatment that met even minimal standards (Thornicroft et al., 2017). Most people with depression receive no psychological treatment, grossly suboptimal treatment, or ineffective treatment (Kessler et al., 2003; Shim, Baltrus, Ye, & Rust, 2011). Much the same can be said for anxious individuals. In a study of 582 patients with anxiety disorders treated in community mental health settings, only 13.2% received cognitive–behavioral therapy, an empirically based treatment for anxiety (Sorsdahl et al., 2013; Wolitzky-Taylor, Zimmerman, Arch, De Guzman, & Lagomasino, 2015).

There is reason for equal, if not more, pessimism regarding treatment of disorders other than anxiety and depression. About one-third of individuals with autism receive nonvalidated interventions (Romanczyk, Turner, Sevlever, & Gillis, 2015); the majority of therapists who treat posttraumatic stress disorder fail to implement exposure and response prevention, one of the consensus treatments of choice for this condition (Freiheit, Vye, Swan, & Cady, 2004; Lilienfeld, 2007; Russell & Silver, 2007; see also Chapter 7); most therapists who treat eating disorders fail to capitalize on scientifically based treatments (Lilienfeld, Ritschel, Lynn, Brown et al., 2013); and as many as three-quarters of licensed social workers deliver one or more interventions with no research grounding whatsoever (Pignotti & Thyer, 2009).

Other interventions (e.g., attachment therapies, memory recovery techniques, critical incident stress debriefing, grief counseling for normal bereavement) not only lack empirical support but are also potentially harmful. Several produce “deterioration effects” in as many as 3% to 10% of patients, in which patients become worse after psychotherapy (see Lilienfeld, 2007). Moreover, a quarter or more of therapists report they use highly suggestive techniques (such as guided imagery or repeated prompting of memories) that are known to increase the risk of false memories of abuse (see Lynn, Krackow, Loftus, Locke, & Lilienfeld, 2015). Thomas Insel, the director of the National Institute of Mental Health, framed the situation this way: “Mental health care in America is ailing” (Insel & Fenton, 2009).

Unfortunately, many mental health professionals administer scientifically questionable or pseudoscientific techniques (see Lilienfeld, Lynn, & Lohr, 2015). For example, a large national survey by Kessler and associates (2001) revealed that substantial numbers of clinically depressed and anxious individuals receive such interventions as “energy therapy,” massage therapy, aromatherapy, acupuncture, and even laughter therapy (see also Lee & Hunsley, 2015; Lilienfeld et al., 2015; Lilienfeld, Ruscio, & Lynn, 2008). Even if treatments such as equine assisted therapy (i.e., animal-assisted therapy), which lack rigorous empirical support (Anestis, Anestis, Zawilinski, Hopkins, & Lilienfeld, 2014), do little or no harm, mental health consumers who engage in them may forego effective interventions. Economists term this little-appreciated adverse effect an “opportunity cost.” Such unsupported techniques also deprive mental health consumers of valuable time, money, and energy, sometimes leaving them with precious little of all three (see Lynn & Lilienfeld, 2017; Lynn, Malakataris, Condon, Maxwell, & Cleere, 2012). Nonscientific practices can also tarnish the reputation and credibility of mental health professionals, rendering members of the general public more reluctant to turn to them for greatly needed psychological help (Lynn & Lilienfeld, 2017).

In the main, psychotherapy is helpful. Scientists have established that many interventions—those that focus on directly changing people's thoughts, feelings, behaviors, and interpersonal relationships—are superior to no therapy, and often work as well as, or even better than, medications for common psychological conditions such as depression and anxiety (Barlow, Gorman, Shear, & Woods, 2000; Butler, Chapman, Forman, & Beck, 2006; Dimidjian et al., 2006; Lemmens et al., 2015; Stewart & Chambless, 2009; Weitz et al., 2015). Moreover, psychotherapy combined with medication produces better outcomes in the treatment of depression than medication alone (Cuijpers, De Wit, Weitz, Andersson, & Huibers, 2015).

Still, implementing interventions, maximizing their outcomes, and getting them to patients in need are by no means without challenges. Although evidence-based therapies are available for a diversity of clinical conditions, there exists a pressing need to more widely disseminate (by teaching, training, and practice) and increase the accessibility of such services (Barnett, Rosenberg, Rosenberg, Osofsky, & Wolford, 2014; Karlin & Cross, 2014; Stewart et al., 2014). For example, as many as 70% of individuals with anxiety and mood disorders do not use or have access to psychological services (Kazdin & Rabbitt, 2013; Lilienfeld, Lynn, & Namy, 2018). Moreover, there is much room for improvements in evidence-based therapies, as many patients with clinical conditions do not respond satisfactorily to treatment, and, even when they do respond, they often relapse months to years after treatment (Steinert, Hofmann, Kruse, & Leichsenring, 2014).

1.2 Classifying Psychotherapies: Tricky Business

As David and Montgomery (2011) argued, the meaning of the term “evidence-based psychotherapy” is a moving target that varies considerably among (a) researchers, (b) classification schemes that identify therapies as “empirically supported,” and (c) international organizations. A particular therapy may be considered empirically supported vis-à-vis one classification system, yet not be listed as supported in another classification system. Indeed, multiple evaluative frameworks for evidence-based psychotherapies have generated conflicting views and diverging standards regarding the status of individual psychological interventions. For example, the National Institute for Health and Care Excellence's guidelines (http://www.nice.org.uk) are not always consistent with those stipulated by Division 12 (the Society of Clinical Psychology) of the American Psychological Association (https://www.div12.org/psychological-treatments) or the American Psychiatric Association (http://www.psych.org), or with the conclusions of typically comprehensive Cochrane Reviews (http://www.cochrane.org). This lack of consistency instills confusion among professionals and patients alike, both of whom are seeking to select empirically validated treatments, and strongly supports the need for a unified, more scientifically oriented system for categorizing psychological treatments.

Most of the abovementioned classification systems are limited to a focus on the empirical status of the therapy package. Typically, the schemes evaluate the intervention package by comparing it with various control conditions (e.g., no intervention, waitlist, placebo/attention control, treatment as usual, active treatment, evidence-based treatment). Nevertheless, a treatment package is typically allied with a hypothesized underlying theory/mechanism of change, which should, we contend, impact the evidence-based status of the treatment delivered. Unfortunately, as David and Montgomery (2011) have argued, the current evaluative psychotherapy frameworks ignore the support, or lack thereof, for underlying theory and mechanism of change. Conceivably, a technique based on voodoo practices could be classified as “probably efficacious” in current evaluative frameworks of psychotherapy, based on a clinical trial comparing voodoo therapy with a waitlist control condition.

The lack of a concerted focus on mechanisms of change is not surprising given that science (Kuhn, 1962), and the science of psychotherapy in particular, can be described as evolving in loosely demarcated stages or phases. Acknowledgment of the need to consider potential mechanisms that moderate or mediate treatment success is only of recent origin. DiGiuseppe, David, and Venezia (2016) have argued that the psychotherapy field can be described in terms of the following phases: (1) a preparadigmatic phase (e.g., schools of psychotherapy proliferated, often based on who would “shout the loudest” to attract attention, rather than based on rigorous controlled studies); (2) a paradigmatic phase (e.g., the first science-based paradigm was arguably behavior therapy); (3) crisis (e.g., behavior therapy was strongly challenged by new learning theories that emphasized cognitive processes); (4) new paradigms (e.g., cognitive therapies emerged as contenders to behavior therapy); (5) paradigm clashe...

Table of contents

• Cover
• Title Page
• Copyright
• List of Contributors
• 1: An Introduction to the Science and Practice of Evidence-Based Psychotherapy: A Framework for Evaluation and a Way Forward
• 2: Varieties of Psychotherapy for Major Depressive Disorder in Adults: An Evidence-Based Evaluation
• 3: Evidence-Based Psychological Interventions for Bipolar Disorder
• 4: The Treatment of Panic Disorder and Phobias
• 5: The Psychological Treatment of Generalized Anxiety Disorder
• 6: The Treatment of Obsessive–Compulsive Disorder
• 7: Evidence-Based Practice for Posttraumatic Stress Disorder
• 8: Evidence-Based Psychological Interventions for Eating Disorders
• 9: Evidence-Based Treatment for Alcohol Use Disorders: A Review Through the Lens of the Theory × Efficacy Matrix
• 10: Psychotherapeutic Treatments for Male and Female Sexual Dysfunction Disorders
• 11: The Psychological Treatment of Psychopathy: Theory and Research
• 12: The Treatment of Borderline Personality Disorder
• 13: The Treatment of Dissociation: An Evaluation of Effectiveness and Potential Mechanisms
• 14: Psychotherapy for Schizophrenia-Spectrum Disorders
• 15: Psychotherapy and Autism Spectrum Disorder: Conceptual and Pragmatic Challenges
• 16: Varieties of Psychotherapy for Attention-Deficit Hyperactivity Disorder: An Evidence-Based Evaluation
• 17: The Treatment of Insomnia
• 18: The Scientific Status of Evidence-Based Psychotherapies: Concluding Thoughts
• Index
• EULA