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

The 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? (http://www.rcpsych.ac.uk/pressparliament/pressreleases2006/ pr955.aspx)

[1]  A. Mack,et al.  Clinical Response and Risk for Reported Suicidal Ideation and Suicide Attempts in Pediatric Antidepressant Treatment: A Meta-analysis of Randomized Controlled Trials , 2009 .

[2]  J. Stockman Selective serotonin reuptake inhibitors (SSRIs) and routine specialist care with and without cognitive behaviour therapy in adolescents with major depression: randomised controlled trial , 2009 .

[3]  谷将之 最強のエビデンスをめざして 今後の臨床試験への提言) Treatment for Adolescents With Depression Study (TADS) 現在までの報告を中心に , 2008 .

[4]  Harold Alan Pincus,et al.  Clinical response and risk for reported suicidal ideation and suicide attempts in pediatric antidepressant treatment: a meta-analysis of randomized controlled trials. , 2007, JAMA.

[5]  David C. Atkins,et al.  Randomized trial of behavioral activation, cognitive therapy, and antidepressant medication in the acute treatment of adults with major depression. , 2006, Journal of consulting and clinical psychology.

[6]  B. Birmaher,et al.  Emergent suicidality in a clinical psychotherapy trial for adolescent depression. , 2005, The American journal of psychiatry.

[7]  J. A. Boer,et al.  Evidence-based guidelines for the pharmacological treatment of anxiety disorders: recommendations from the British Association for Psychopharmacology , 2005, Journal of psychopharmacology.

[8]  R. DeRubeis,et al.  Cognitive therapy vs medications in the treatment of moderate to severe depression. , 2005, Archives of general psychiatry.

[9]  Benedetto Vitiello,et al.  Fluoxetine, cognitive-behavioral therapy, and their combination for adolescents with depression: Treatment for Adolescents With Depression Study (TADS) randomized controlled trial. , 2004, JAMA.

[10]  E. Foa,et al.  Does imaginal exposure exacerbate PTSD symptoms? , 2002, Journal of consulting and clinical psychology.

[11]  G. Lloyd Post traumatic stress disorder diagnosis, management and treatment , 2001 .

[12]  J. Morrison,et al.  Psychiatrists disciplined by a state medical board. , 2001, The American journal of psychiatry.

[13]  D. Klein,et al.  Flawed meta-analyses comparing psychotherapy with pharmacotherapy. , 2000, The American journal of psychiatry.

[14]  D. Nutt,et al.  Post-traumatic Stress Disorder: Diagnosis, Management and Treatment , 2000 .

[15]  H. Möller Attempted Suicide: Efficacy of Different Aftercare Strategies , 1992, International clinical psychopharmacology.

[16]  Klerman Gl The Osheroff debate: finale. , 1991 .

[17]  G. Klerman,et al.  THE OSHEROFF DEBATE : FINALE. AUTHOR REPLY , 1991 .

[18]  R. Priest,et al.  A comparison of the hypnotic effects of temazepam capsules and temazepam elixir. , 1991, International clinical psychopharmacology.

[19]  S D Imber,et al.  National Institute of Mental Health Treatment of Depression Collaborative Research Program. General effectiveness of treatments. , 1989, Archives of general psychiatry.

[20]  J. Modestin,et al.  Counter-transference reactions contributing to completed suicide. , 1987, The British journal of medical psychology.

[21]  S. Olarte,et al.  Psychiatrist-patient sexual contact: results of a national survey. I: Prevalence. , 1986, The American journal of psychiatry.

[22]  P. Tyrer,et al.  Hypomania following Cognitive Therapy , 1986, British Journal of Psychiatry.

[23]  S. Crown Contraindications and Dangers of Psychotherapy , 1983, British Journal of Psychiatry.

[24]  V. Rippere Psychobattery—A chronicle of psychotherapeutic abuse (with medical discussion by Ralph Spitzer): Therese Spitzer: Humana Press, Clifton, New Jersey (1980). xviii + 236 pp. £6.70 , 1981 .

[25]  A. Stone Suicide precipitated by psychotherapy. A clinical contribution. , 1971, American journal of psychotherapy.