Two intriguing studies of treatment effectiveness have controlled for “researcher allegiance effects” and found that CBT may not be as effective as claimed in the past, and psychodynamic therapy compares favorably to CBT. One study finds serious methodological flaws with much of the research that has resulted in the claim that “CBT is the Gold Standard for therapy.” Another intriguing study, using improved methodology, finds stronger support for psychodynamic therapy than previous studies, and concludes that it’s effectiveness may be comparable to CBT.
“Psychodynamic Therapy: As Efficacious Us As Other Empirically Supported Treatments? A Meta-Analysis Testing Equivalence of Outcomes” compared 23 randomized controlled trials, with a total 2000, seven and 51 patients in the studies, with strict criteria for which studies were reviewed. The authors concluded, “Statistical analyses showed equivalence of psychodynamic therapy to comparison conditions for target symptoms at posttreatment,” and,” results suggest equivalence of psychodynamic therapy to treatments established in efficacy. Further research should examine who benefits most from which treatment.”
“Is Cognitive Behavioral Therapy the Gold Standard for Psychotherapy? The Need for Plurality in Treatment and Research” summarizes emerging research findings have questioned the prominent status of CBT, and discuss several potential problems with the body of research that claims that CBT is the “gold standard for therapy.” They cite concerns about weak empirical tests, such as comparing CBT only to waitlist controls. In particular, they report concern about “uncontrolled researcher allegiance;” in other words, too many CBT studies are done by CBT advocates, use CBT supporters as interviews, and “the treatment conditions against which CBT was compared were designed in a way that essential curative factors were excluded.”
The authors report, “A first-line treatment usually is clearly more effective than other treatments. However, there is no clear evidence that CBT is more effective than other psychotherapies, either for depressive disorders or for anxiety disorders. This is also true for several other mental disorders (e.g. personality disorders or specific eating disorders).” They advocate, “no form of psychotherapy can presently claim to be the gold standard, suggesting the need for plurality and treatment research, i.e., a variety different psychotherapy approaches. All evidence-based therapies have their strengths you to focus on cognitive, emotional, interpersonal, or unconscious processes.”
The JAMA Online First Network posting service published Is Cognitive Behavioral Therapy the Gold Standard for Psychotherapy? The Need for Plurality in Treatment and Research on 9-21-17.
This article was published in the American Journal of psychiatry on October 1, 2017, and comes to our attention courtesy of the prolific online psychological posting service provided by Ken Pope, PhD.
MHConciegre’s take: studies done by researchers that are biased towards the treatment being studied, without controlling for this bias, are clearly flawed.