Uncritical positive regard? Issues in the efficacy and safety of psychotherapy

Abstract

EditorialThe recent review of the selective serotonin reuptake inhibitors (SSRIs) by the Committee on Safety of Medicines (CSM) and the Food and Drug Administration was occasioned by media concerns about the safety of this class of antidepressant. In much of the prior and subsequent reporting of this issue, two assumptions have consistently been aired. The first is that psychotherapy is equally effective as drugs and the second is that since psychotherapy is not a drug, it is necessarily safer than drug treatments. From these two assumptions emerges a common presumption that psychotherapy should be the preferred approach for many if not most cases of depressive and anxiety disorders. But is this true? And if not, what implications does it have for the management of the new therapists that will soon be employed following the UK government's award of £150 m for psychotherapy services in depression and anxiety?

World Federation of Societies of Biological Psychiatry (WFSBP) Guidelines for the Pharmacological Treatment of Anxiety, Obsessive-Compulsive and Post-Traumatic Stress Disorders – First Revision

“…Prolonged courses of treatment are often needed to maintain an initial treatment response. Demonstrating efficacy of psychotherapy in a trial conducted at an expert site does not guarantee that the same effect sizes are obtained in ''real life'' (Nutt and Sharpe 2008).…”

Clinical effectiveness and cost-effectiveness of cognitive behavioural therapy as an adjunct to pharmacotherapy for treatment-resistant depression in primary care: the CoBalT randomised controlled trial

“…74 Therefore, in accordance with good clinical practice the CoBalT team recorded and reported any serious adverse events to comply with the National Research Ethics Service annual safety report requirements of non-CTIMP trials.…”

Reporting of harms in randomized controlled trials of psychological interventions for mental and behavioral disorders: A review of current practice

“…Although an increasing number of RCTs show that psychological interventions can be successfully applied to a wide range of mental disorders [3,4], less is known about potential harms (i.e., adverse events, side effects, and symptom deterioration). However, some psychological treatments might induce harm in a significant number of patients [5][6][7][8]. A review from 2007 lists some bona fide therapies that are potentially harmful, such as critical incident stress debriefing, grief counseling for normal bereavement, and boot camp interventions for conduct disorder [5].…”