The Gold Standard Review: Psychiatry

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This book is a great quick review for any subject and setting. Great to have as a quick review before rounds or after reading a larger text like Kaplan and Sadock or the APA books. Much larger than the Mass General Psychiatry Guide and a bit more cumbersome. Just overall not as user friendly, especially if you are looking for high-yield psychiatry review material. Current Diagnosis and Treatment.

Good coverage of all the topics. Manual of Clinical Psychopharmacology. This is a great psychopharmacology book, especially for board review. It is more high-yield than other textbooks of psychopharmacology. I just love this series. The information is a bit dated , however much of the core information is unchanged.

It is a good quick resource for review before rounds or lectures. First Aid for the Psychiatry Boards.

If you are familiar with the Step books made by First Aid, then you should be familiar with the format of this book. It seems a bit busy and over inclusive to be a great review. Furthermore clinicians vary in their efficacy, both within and between treatment conditions, not only in psychotherapy, but also when delivering pharmacotherapy [ 2 ], p. This problem, however, is not specific to CBT. Some CBT researchers claim that even small differences may be clinically relevant, without, however, providing evidence specifically for CBT [ 4 , 49 ]. These results from randomized clinical trials are consistent with those of recent large-scale naturalistic studies in the United Kingdom [ 55 ].

These findings have, for instance, inspired the UK government to offer patients a choice between different empirically supported treatments. Requiring relatively large sample sizes, only a few studies in psychotherapy research are sufficiently powered to demonstrate equivalence or non-inferiority [ 20 , 24 ]. The lack of statistical power can be solved by use of meta-analysis [ 56 ].

For testing equivalence, a margin has to be specified that is regarded as compatible with equivalence [ 57 ]. In addition, the efficacy of the active comparator must be ensured [ 19 , 58 ].

Why Cognitive Behavioral Therapy Is the Current Gold Standard of Psychotherapy

A recent equivalence meta-analysis fulfilled these requirements [ 33 ]. In addition, researcher allegiance was explicitly controlled for, both on an experimental and a statistical level [ 33 ]. The results of this meta-analysis, however, were recently misinterpreted by a number of CBT proponents as favoring CBT, by stating that [ 4 ], p. In equivalence testing a statistically significant result implies that the effect size and its CI is within the equivalence margin, thus demonstrating equivalence [ 57 ]. Another line of research suggests that the variance explained by therapy-specific factors techniques is rather limited [ 1 , 2 , 59 ].

Meta-analyses did not find evidence that specific factors contribute significantly to treatment outcome [ 60 , 61 ]. These results generally question that one form of therapy may be the gold standard, that is the best available form of psychotherapy. While other researchers plead for plurality in research and treatment [ 1 — 3 ], some proponents of CBT argue for developing an integrated CBT-based form of psychotherapy as a general and apparently the only form of psychotherapy [ 4 ], p.

This claim presents a seriously distorted picture of other treatment approaches [ 9 ], again raising the issue of researcher allegiance. Furthermore, it is not consistent with the available evidence, as shown above and further elaborated in the following. In fact, outcome of CBT does not seem to have improved over the course of time.

During the recent 40 years, effect sizes for CBT in anxiety disorders were found to have stagnated [ 62 ], for depressive disorders even a significant decline was reported [ 63 ]. Also for psychotherapy in youth, including CBT, there has been no increase in efficacy across five decades of research [ 11 ]. Whether other psychotherapies showed such an improvement, however, is not known.

Nevertheless, the results available for CBT suggest that not only or primarily research in CBT should be carried out and funded - which seems to be the case see below 3. There is no evidence for the assertion that little change was achieved in other approaches. In the area of PDT, IPT, or humanistic therapy, for example, efficacious disorder-specific and manualized treatments have been developed [ 31 , 32 , 64 , 65 ]. Often, however, a distorted picture of other approaches such as PDT is publicly presented [ 9 ], especially by some CBT proponents [ 4 ] 2. Claiming that improvements in psychotherapy will derive from CBT apparently denies that CBT benefited from integrating concepts of other therapeutic approaches [ 64 ], often under a new name, frequently without citing their origins.

The unified protocol by Barlow et al. Schema-focused therapy integrated concepts of PDT and humanistic-experiential therapies, too, but cited these origins [ 68 ]. Thus, many innovations of CBT stem from other approaches and, thus, are actually examples for the benefits of pluralism in psychotherapy.

So why include them in CBT? In clinical practice, many therapists apply non-CBT approaches such as psychodynamic, integrative or humanistic [ 69 ]. Not even one quarter reported to use CBT [ 69 ]. Do authors like David et al. The evidence does not support this. At present, no form of psychotherapy may claim to be the gold standard.

Rather many can claim to be beneficial, and none without limitation. For CBT the evidence is less robust than often portrayed. It is of note that many of the reviewed results and conclusions pointing to limitations of CBT were reported by CBT-oriented or independent researchers [ 10 , 13 , 20 , 21 , 23 , 38 , 39 , 44 — 46 , 49 , 62 , 64 ].

Thus, these results and conclusions cannot be simply attributed to a bias against CBT.

With the limitations listed above, there is evidence for CBT. This is true for other approaches as well, including psychodynamic therapy, interpersonal therapy, humanistic therapy and systemic therapy [ 31 — 36 ]. In Germany, for example, psychodynamic therapy, systemic therapy, and CBT have been certified as scientific and efficacious treatments by the scientific board of psychotherapy wbpsychotherapie. This is true for other approaches as well [ 45 ]. For this reason, a plurality of research-supported approaches may be advantageous, for example, in patients not responding to one therapy approach.

Thus, there is a need for studying not only CBT, but other approaches as well. Open questions need to be addressed.

At present, for example, it is widely unclear what patients benefit from which approach. Do patients who did not respond to one approach benefit from another, for example non-responders of PDT from CBT and vice versa? Whereas shifting from one treatment to another is common in pharmacotherapy, it has hardly been studied in psychotherapy [ 70 ]. In addition, further research on dose-effectiveness relations is required, especially for patients with chronic disorders or personality disorders for whom short-term treatments seem not to be sufficient [ 71 ]. Studies addressing these issues need to be supported by funding organizations—in contrast to pharmacotherapy, there is no industry funding research in psychotherapy.

The Gold Standard Review: Psychiatry: Nakul Gupta MD: donnsboatshop.com: Books

Funding organizations, however, were shown to prefer mainstream research [ 72 ]. Many review, funding and guideline committees are largely dominated by CBT researchers which poses another threat in terms of allegiance bias and hampers research in other approaches [ 9 ]. A bias in funding is demonstrated, for example, by data from the UK 3: In the US or Germany, data are likely to be similar 4. Considering these differences in funding, it is actually quite surprising that evidence for CBT is where it is. Anyway, a change in funding policy is urgently required. In addition, also non-CBT-approaches need to be taught at the universities and in training institutions.

Only if other psychotherapies are taught and studied, they will be able to further contribute to the development of psychotherapy at large. The different psychotherapeutic approaches have their strengths, be it a focus on interpersonal relationships, on cognitions and learning, on experiential, affective or unconscious and defensive processes.

Author Contributions

Different patients may benefit from different approaches, or may benefit through different routes. Therapists are different as well. They should be able to choose which approach fits them best: One size does not fit all. Also learning from each others' approaches requires that different forms of evidence-based psychotherapy exist and are valued equally [ 64 ].

All authors listed have made a substantial, direct, and intellectual contribution to the work, and approved it for publication. SR has published books or book chapters dealing with PDT. SR has been trained in CBT. All authors trained scientists, active promotors, and contributors to evidence-based psychotherapy.

Here, more transparency is definitely required. In pursuit of truth: The Great Psychotherapy Debate: Leichsenring F, and Steinert C. Is cognitive behavioral therapy the gold standard for psychotherapy? The need for plurality in treatment and research. Why cognitive behavioral therapy is the current gold standard of psychotherapy. Front Psychiatry 9: Cost and outcome of behavioural activation versus cognitive behavioural therapy for depression COBRA: Cognitive behavioural therapy for adult disorders: J Clin Psychiatry Cognitive behavioral therapy for eating disorders.

Psychiatr Clin North Am. Review of exposure therapy: J Rehabil Res Dev. Bias toward psychodynamic therapy: Recognizing that truth is unattainable and attending to the most informative research evidence. What five decades of research tells us about the effects of youth psychological therapy: Estimating the reproducibility of psychological science.

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Mediators and mechanisms of change in psychotherapy research. Ann Rev Clin Psychol. How expert clinicians prototypes of an ideal treatment correlate with outcome in psychodynamic and cognitive-behavioral therapy. Luborsky L, Woody, GE. Can independent judges recognize different psychotherapies? An experiment with manual-guided therapies. J Consult Clin Psychol.

Therapist's success and its determinants. Arch Gen Psychiatry Psychotherapy Versus Behavior Therapy. Harvard University Press A randomized controlled clinical trial of psychoanalytic psychotherapy for panic disorder. Am J Psychiatry On mechanisms of change in psychodynamic therapy. Z Psychosom Med Psychother.

Measuring diagnostic accuracy in the absence of a "gold standard"

Are all psychotherapies equally effective in the treatment of adult depression? The lack of statistical power of comparative outcome studies. Evid Based Ment Health How effective are cognitive behavior therapies for major depression and anxiety disorders? A meta-analytic update of the evidence World Psychiatry A quality-based review of randomized controlled trials of cognitive-behavioral therapy for depression: Psychodynamic therapy meets evidence-based medicine: Lancet Psychiatry 2: The researcher's own allegiances: Clin Psychol Sci Pract.

Is the allegiance effect an epiphenomenon of true efficacy differences between treatments?

Perspective ARTICLE

Researcher allegiance in psychotherapy outcome research: Better reporting of interventions: The efficacy of cognitive behavioral therapy: Research on humanistic-experiential psychotherapies. The empirical status of psychodynamic psychotherapy - an update: Bambi's alive and kicking.

A meta-analysis testing equivalence of outcomes. Critical review of outcome research on interpersonal psychotherapy for anxiety disorders. Depress Anxiety Interpersonal psychotherapy for depression: Efficacy of systemic therapy Psychother Res. Specificity of CBT for depression: Efficacy of psychotherapies for borderline personality disorder:

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