Efficacy Research on Psychotherapy

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Comprehensive reviews have been undertaken of psycho-therapies with demonstrated efficacy in controlled studies (e.g., Chambless et al., 1998; Nathan & Gorman, 1998; Weissman, Markowitz, & Klerman, 2000). Chambless and Ollendick (2001) recently completed the most extensive review of the efforts of eight work groups (from the United States, United Kingdom, and Canada) focused on identifying psychotherapies with existing efficacy data or evidence-based treatments (EBT). Although the criteria used to define EBTs were not the same for each work group, overall the criteria used tended to be conservative. For a treatment to be defined as evidence-based, support from at least one rigorous randomized clinical trial was necessary. Based upon Chambless and Ollendick's (2001) "review of reviews" it is accurate to say that at least one EBT (and sometimes several) exists for the full spectrum of psychiatric disorders, including the following (see Chambless & Ollendick, 2001, for complete list):

Anxiety and Stress

Agoraphobia/Panic with Agoraphobia

Blood injury phobia

Generalized Anxiety Disorder Geriatric anxiety and depression Obsessive-Compulsive Disorder Panic Disorder

Posttraumatic Stress Disorder Public speaking anxiety Social Anxiety Disorder (Social Phobia) Specific Phobia

Chemical Abuse and Dependence

Alcohol Abuse and Dependence

Benzodiazepine withdrawal

Cocaine Abuse

Opiate Dependence

Bipolar disorder

Major Depressive Disorder

Anorexia Nervosa

Binge-Eating Disorder

Borderline Personality Disorder

Bulimia Nervosa

Chronic pain

Irritable-bowel syndrome

Marital discord

Migraine headache

Obesity

Schizophrenia

Smoking cessation

Sexual dysfunction

Psychotherapies are not efficacious for all conditions (for example, interpersonal psychotherapy (IPT) has been shown to be ineffective in two studies with opiate abusers). However, for several disorders, psychotherapies have been shown to be as effective as psychotropic interventions (e.g., cognitive-behavioral therapy [CBT] for Panic Disorder, CBT and IPT for Bulimia Nervosa). For other disorders, psychotherapy is an invaluable adjunct to medication (e.g., bipolar disorder, Schizophrenia).

In this section we highlight data on the efficacy of psy-chotherapies for three commonly occurring psychiatric disorders.

Depression. Both IPT (Weissman et al., 1979; Elkin et al., 1989) and CBT (cf. Glaoguen, Cottraux, & Cucherat, 1998; Elkin et al., 1989) have been shown to be as effective as psy-chotropic medication for the treatment of depression (Depression Guideline Panel, 1993) and have also demonstrated efficacy in decreasing relapse and recurrences in depression (Frank et al., 1990; Jarrett, Basco, & Ritter, 1998; see Sanderson & McGinn, 2001, for a comprehensive review). An amalgam of the two (cognitive-behavioral analysis system of psychotherapy) has demonstrated efficacy in treating chronic depression (Keller et al., 2000).

Anxiety Disorders. A considerable body of evidence has shown that CBT is as effective as, or more effective than, medications in the treatment of the full range of anxiety disorders (cf. Nathan & Gorman, 1998, for a comprehensive review), Agoraphobia (e.g., Chambless, Foa, Groves, & Goldstein, 1979), Generalized Anxiety Disorder (e.g., Barlow, Rapee, & Brown, 1992), Obsessive-Compulsive Disorder (e.g., Fals-Stewart, Marks, & Schafer, 1993), Panic Disorder (e.g., Barlow, Gorman, Shear, & Woods, 2000), Social Phobia (e.g., Heimberg et al., 1998), and Posttraumatic Stress Disorder (e.g., Foa, Rothbaum, Riggs, & Murdock, 1991).

Schizophrenia. Efficacy studies for Schizophrenia focus on relapse prevention and typically compare two or more psy-chotherapies in patients also receiving antipsychotic medication. Overall, when compared to treatment as usual, behavioral, supportive, and systems-based family therapies and social skills training have demonstrated efficacy in reducing relapse in Schizophrenia (e.g., Falloon et al., 1984; Hogarty, Anderson, & Reiss, 1986; Leff, Kuipers, Berko-witz, & Sturgeon, 1985; Schooler et al., 1997). The different family-based interventions appear to be equivalent to each other (Baucom, Shoham, Mueser, Daiuto, & Stickle, 1998; Brent et al., 1997) except that family therapy utilizing insight-oriented techniques and focusing on the past has not demonstrated efficacy in reducing relapse (Kottgen, Sonnichsen, Mollenhauer, & Jurth, 1984) and can be associated with negative outcomes (McFarlane, Link, Dushay, Marchal, & Crilly, 1995).

Effectiveness. The next challenge is determining how well these treatments generalize to clinical practice, where patients often do not have a single diagnosis, where practitioners in the community must be used, and where training programs must be simple and cost-efficient (effectiveness research). Although effectiveness research is in its infancy, the existing data generated thus far support the use of EBTs in clinical practice (Wade, Treat, & Stuart, 1998; Sanderson, Raue, & Wetzler, 1998; Franklin, Abramowitz, Kozac, Levitt, & Foa, 2000; Tuschen-Caffier, Pook, & Frank, 2001; Antonuccio, Thomas, & Danton, 1997; Otto, Pollack, & Maki, 2000).

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