Psychotherapy Use Declines, Medication Use on Upswing

Psychotherapy Use Declines, Use of Medications on UpswingIn a special issue of Clinical Psychology Review edited by two Brown University professors of psychiatry and human behavior, psychologists analyze why the use of psychotherapy has declined despite a strong evidence base for the efficacy of some psychosocial treatments. The problems, they find, lie within the profession as well as outside.

Psychotherapy is the collective term for a range of mental health treatments centered on specific forms of doctor/patient communication rather than on the use of medications. Current scientific evidence supports the effectiveness of these “talking” treatments in addressing serious mental conditions such as mood disorders, substance use disorders, anxiety disorders, schizophrenia and eating disorders. However, despite its track record for effectiveness, use of psychotherapy has declined in the 2000s. In a study review scheduled for publication in the November 2013 issue of the Clinical Psychology Review, researchers from Brown University explain some of the reasons behind this decline.

Psychotherapy Basics

Psychotherapy also goes by names such as psychosocial therapy and counseling. All psychotherapeutic techniques rely on communication between a therapist and patient(s) to do such things as transmit information about the specific technique in use, transmit information about the known effects of specific mental illnesses, instruct the patient(s) in ways to recognize those effects when they arise and instruct the patient(s) in ways to cope with the effects of illness and return to a healthier, more balanced state of mind. Specific forms of psychotherapy currently used in the U.S. include cognitive behavioral therapy (CBT), interpersonal psychotherapy, psychodynamic psychotherapy, psychoanalysis, supportive psychotherapy, acceptance and commitment therapy, and dialectical behavioral therapy. In addition to their role in mental illness treatment, these therapies are used to help generally healthy people improve their ability to cope with the stresses and challenges of everyday life.

Evidence for Effectiveness

In 2010, the federal Substance Abuse and Mental Health Services Administration (SAMSHA) issued an extensive report that examined the effectiveness of psychotherapy as a treatment for mental illness. This examination was based on a review of dozens of previous, well-designed studies from a large number of research institutions. After completing their review, the authors of the SAMHSA report concluded that 75 percent to 80 percent of all affected individuals treated in the previous studies experienced a substantial improvement in the symptoms of their disorders. They also concluded that all commonly used forms of psychotherapy gain their effectiveness just as much from the establishment of secure relationships between therapist and patient as they do from the use of any given therapeutic technique. Therapies that withstand the scrutiny of scientific research and review are collectively referred to as evidence-based psychotherapy.

Reasons for Declining Use

In a study published in 2010 in the American Journal of Psychiatry, a multi-institution research team examined the rate of psychotherapy use in mental disorder treatment between 1998 and 2007. The authors of this study found that the number of patients treated only with psychotherapy declined by more than 30 percent during this time period. They also found that the number of patients treated only with medications increased by more than 30 percent during this same timeframe. In the study published in 2013 in the Clinical Psychology Review, the Brown University researchers looked for potential explanations for these trends, which would appear to make no sense given the proven track record of psychotherapy as a mental health treatment.

After completing their analysis, the authors of the report came to several important conclusions regarding psychotherapy’s decline. First, they found that, while evidence-based psychotherapy is firmly rooted in scientific research, less than half of all psychotherapists practicing in the U.S. have employed evidence-based methods when working with their patients. What’s more, only 6 percent of practicing therapists regularly employ evidence-based methods. At the same time, more than three out of four therapists have knowingly used treatments that have no firm basis in scientific research. Since psychotherapists commonly use unproven methods and fail to use evidence-based methods, many patients likely receive far less benefit from treatment than the current state of scientific knowledge would lead one to expect.

The authors of the study in the Clinical Psychology Review also point to a parallel trend currently taking place among mental health professionals who do not practice psychotherapy. These professionals are increasingly showing a preference for medications in the treatment of mental disorders. In part, this preference may stem from the concerted advertising and promotional efforts of large pharmaceutical companies that rely on drug sales for their income. However, critically, this preference also stems from an understanding that all medications distributed legally in the U.S. must go through a multi-step process designed to scientifically prove their effectiveness in treating specific conditions. This means that, generally speaking, all medications are evidence-based, and therefore meet standards that many psychotherapeutic approaches don’t meet.

Posted on August 29th, 2013
Posted in Mental Health

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