Story of Psychology - Morton Hunt [399]
That’s a change? Haven’t psychotherapists always been guided by the evidence of outcomes of various forms of treatment? Yes, by the outcomes of their own practices. But no, not by empirical research studies. The editors of A Guide to Treatments That Work, a massive 2002 review of empirical studies of psychotherapies and psychotropic medications, acerbically note the “lamentably low value psychotherapists and other mental health professionals more generally continue to attach to psychotherapy research… The clinical activities of most psychotherapists remain largely untouched by findings from empirical research. Many clinicians continue to utilize methods and procedures that lack empirical support.”120
One reason for this is the well-documented phenomenon known as the “expectancy effect.” Therapists (like physicians and scientists) tend to see the results, in their own work, that they expect to see. The results reported by any therapist based on his or her own practice fall far short of the guidelines of scientific rigor. To be genuinely empirical, evidence must be produced by impartial researchers, and by comparing the outcome in a treated group with that in a control group (a strictly similar but untreated group), which enables the researchers to subtract the expectancy effect, the placebo effect, and other distortions from the apparent effect of treatment.
When the APA’s Division of Psychotherapy raised the issue of evidence-based therapy a decade ago, there was a fierce backlash from therapists who feared they would be controlled by managed care officers who would refuse to reimburse them if empirical evidence did not back up the therapy they preferred to use. A heated debate—a “major controversy,” according to an APA Web page offering a course in evidence-based psychotherapy—has continued ever since.
Yet the concept of empirical evidence as a guide to treatment is not new; in medicine it goes back a century or more, and it has been part of the world of psychotherapy for decades. “What’s different today,” says Crits-Christoph, “is that the label ‘evidence-based therapy’ now has political clout. From the early sixties through the nineties there was no process for turning research into practice. No one was pressuring anyone to sign on the dotted line that you would translate empirical research findings into practice.” In England, under socialized medicine, evidence-based therapy is enforced; here, it is beginning to be enforced by managed care providers—and by moral suasion.
For despite the resistance to the evidence-based movement, says Crits-Christoph, “It has raised consciousness of the importance of empirical evidence. The concept of evidence-based therapy has become a fundamental guiding principle. It’s getting very hard to disagree with the idea that empirical evidence should shape practice.”121
Very hard to disagree with the idea—and with the evidence assembled in A Guide to Treatments That Work (and other more recent compilations). The Guide presents the results, primarily of rigorous studies plus some less than rigorous, of dozens of pharmacological and psychotherapeutic treatments of over two dozen major disorders. We heard above of some of the treatments that work; here are a few others:
—bipolar disorders: lithium and several other medications are effective; psychosocial treatments, including CBT, increase medication adherence.
—bulimia: antidepressant drugs produce significant short-term reduction in binge eating and purging; CBT ends binge eating and purging in roughly half the patients.
—major depressive disorder: behavior therapy, CBT, and interpersonal therapy all yield substantial reductions in depression.
—OCD: SSRIs reduce or eliminate both obsessions and compulsions; CBT involving exposure and ritual prevention methods is also a first-line treatment.
—panic disorders: CBT, in vivo exposure, and coping