Psychotherapy comparative studies

Early Comparative Studies Psychotherapy vs. Drug Treatment... 

Antipsychotics versus psychotherapy (two comparative studies). Both studies covered large, statistically equivalent groups of patients with productive symptoms one study compared group psychotherapy and antipsychotics the other compared analytically orientated individual therapy and antipsychotics. The results were similar inasmuch as both trials showed the drug therapy to be markedly superior in almost all clinically relevant characteristics and symptoms. 

An attempt has been made to discuss the position of drug therapy of various types of mental disorders within a wider perspective, and especially to clarify the relationship between drug therapy and non-drug treatments. It was necessary to deal separately with the various classes of psychopharmaceuticals and the disorders treated with them, and for our purposes it was also sensible to refer as far as possible to controlled, i.e. comparative, studies. The drawback of this evidence-based approach is obvious comparative studies of therapeutic procedures almost necessarily favor one of the compared treatments because they can never be carried out with completely identical preconditions for all treatments (Elkin et high quality, leading to inaccurate conclusions. Thus, meta-analyses based on flawed studies are clearly inadequate for the establishment of treatment guidelines (Klein, 2000). On the other hand, the value of an admittedly incomplete summary such as presented here is that results obtained in different places by different authors with different preconditions can be critically compared and related one to the other. 

Elkin, I., Pilkonis, P.A., Docherty, J.P., Sotsky, S.M. Conceptual and methodological issues in comparative studies of psychotherapy and pharmacotherapy. I Active ingredients and mechanisms of change. Am. J. Psychiatry 145, 909-917, 1988. 

Luborskv, L., Singer, B., Luborsky, L. Comparative studies of psychotherapies. Arch. Gen. Psychiatry 32, 995-1008, 1975. 

Meterissian, G.B., Bradwejn, J. Comparative studies on the efficacy of psychotherapy, pharmacotherapy, and their combination in depression Was adequate pharmacotherapy provided J. Clin. Psychopharmacol. 9, 334-339, 1989. 

Frank JD Persuasion and Healing A Comparative Study of Psychotherapy. New York, Schocken Books, 1974 Fraser HS, Mucklow JC, Bulpitt CJ, et al Environmental factors affecting antipyrine metabolism in London factory and office workers. Br J Clin Pharmacol 7 237-243,1979... 

Alcoholics Anonymous (AA) is a self-help organization for people whose common goal is recovery from alcoholism, and it is the most widely accessed resource for individuals with alcohol problems (McCrady and Miller 1993). The philosophy is based on the concept of alcoholism as a chronic disease that cannot be cured, but one that can be halted by means of complete abstinence. AA has described 12 principles or steps to guide those in recovery. Twelve-step facilitation, a manual-based psychotherapy to promote AA participation (Nowinski et al. 1992), was equally efficacious, compared with cognitive-behavioral and motivational enhancement therapies, in a large study of treatments for alcohol dependence (Project Match Research Group, 1997). 

Various forms of psychotherapy are regarded as effective interventions in mild to moderate depression, but studies comparing the economics of psychotherapy and pharmacotherapy are few (Rosenbaum and Hylan, 1999). One study found that the total health-care costs for patients who received psychotherapy were no different from those for patients who received an antidepressant. However, no efficacy measure was used (Edgell and Hylan, 1997). A randomized, prospective study which evaluated the treatment of depression with nortriptyline, interpersonal therapy or treatment as usual, with outcomes expressed in quality-adjusted life years, found that nortriptyline but not interpersonal therapy was a cost-effective alternative to treatment as usual (Lave et al, 1998). 

Physical exercise as a treatment for clinical depression has not been studied as extensively as dmgs or psychotherapy, but there are a number of clinical trials evaluating its effectiveness.41 In some of these studies, exercise was compared to no treatment at all. In others, it was compared to psychotherapy, medication or attention-control procedures intended to control for the nonspecific placebo aspects of the exercise programme. Some of the trials also looked at the combination of physical exercise with... 

Cuijpers, Pirn, Annemieke van Straten, Gerhard Andersson and Patricia van Oppen, Psychotherapy for Depression in Adults A Meta-Analysis of Comparative Outcome Studies , Journal of Consulting Clinical Psychology 76, no. 6 (2008) 909-22... 

In contrast to the studies above, studies comparing individual CBT to other active treatments (a more stringent control condition than WLC) have been less convincing. Lor instance, two studies have compared individual CBT to an education support (ES) condition. In the ES treatment, educational presentations about anxiety and supportive psychotherapy were used with no specific instructions or encouragement to engage in exposure. In the first study, anxious youth with school... 

Comorbid personality disorders have long been associated with TRD and a poor response to antidepressant treatment. For example, Pfohl et al. (1984) observed only a 16% response rate in inpatients with comorbid depression and personality disorder compared with a 50% response rate in patients with pure depression. Similar results were reported from a study by D. W. Black et al. (1987), in which, with the use of ECT in addition to a TCA, the response rate among those with a comorbid Axis II disorder was lower, 42% compared with a 60% recovery in those without Axis II pathology. The best approach for these patients may be a combination of psychotherapy and medication. This approach was recently borne out by the Treatment of Depression Collaborative Research Project (Shea et al. 1990), which found that cognitive-behavioral therapy yielded a better response than either imipra-... 

In another study, psychotherapy with and without drug therapy was compared with a no formal psychotherapy control group (421,422 and 423). No valid conclusions can be drawn from this study, however, because there was no adequate control group with respect to medication. Further, the majority of the psychotherapy group received medication and the control group was treated in an entirely different milieu, with many apparently transferred to a chronic facility. 

In addition, a number of studies have compared the efficacy of specific forms of psychotherapy, particularly cognitive-behavioral therapy (CBT), and antidepressants in the treatment of patients with an acute episode of major depression (388, 389, 390, 391, 392, 393, 394 and 395). Most studies have reported these forms of psychotherapy and antidepressants to be equally effective. As a result of disparate findings, spirited debate has arisen with regard to this issue. Issues raised in this debate have included relative efficacy in patients with mild versus more severe episodes of major depression and the adequacy of antidepressant treatment in these studies. A summary of these issues is presented in the following paragraphs. 

In any case, there is a pressing need for a systematic study of adolescent depression, comparing psychotherapy or cognitive behavioral thereapy (CBT) and antidepressants, or the combination of both treatments. The National Institute of Mental Health (NIMH) has organized a multicenter study which will analyze the long-term effectiveness of Prozac versus CBT. Results of the study, called Treatment for Adolescent Depression Study (TADS), will not be published for several years, but it is hoped that the results will help resolve whether antidepressants in teens are beneficial and safe. 

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