Horses for courses: choosing an evidence-based psychological therapy for your patient, 2018, David McCormack, Trudie Chalder

Sly Saint

Sly Saint

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BJPsych Advances:
Horses for courses: choosing an evidence-based psychological therapy for your patient


Summary
Choosing an intervention for a patient experiencing distressing symptoms and/or suffering with a mental disorder is part of routine practice for clinicians. While there are now many effective pharmacological and psychological therapies for mental health problems, syndromes and persistent physical symptoms (e.g. chronic pain), choosing the ‘right’ therapy can sometimes be a challenge. This can certainly be the case when it comes to psychological therapies. There are many different approaches to choose from and many have not been subjected to rigorous study.

In this article, we aim to help inform and guide the busy clinician in choosing a psychological therapy for their patient. We give a brief overview of the major psychotherapy modalities and consider which guidelines to refer to and which psychological therapies have been found to be most effective for the presenting problem(s) seen in clinic. Lastly, we discuss the limitations of the current guidelines in relation to comorbid presentations and consider how this can be best addressed.

LEARNING OBJECTIVES
  • •Develop knowledge regarding the major psychotherapy approaches
  • •Be aware that there is no psychotherapy equivalence
  • •Learn that there is good evidence that some approaches are more effective than others for specific problems and be better able to choose a psychological therapy
DECLARATION OF INTEREST
D. McC. works on research trials funded by the Guy's and St Thomas’ Charity. T. C. receives salary support from the National Institute for Health Research (NIHR) Mental Health Biomedical Research Centre at South London and Maudsley NHS Foundation Trust and King's College London, and receives several grants for evaluating the efficacy of different cognitive–behavioural approaches. This article received no specific grant from any funding agency, or from the commercial or not-for-profit sectors. The views expressed in this article are those of the authors and not necessarily those of the NIHR or the NHS.
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"There are many different approaches to choose from and many have not been subjected to rigorous study."

https://www.cambridge.org/core/jour...your-patient/7491C909027E3466BAFEE53C704CC2B5
 
:rofl::laugh::rofl::laugh:!!! Here's how the article begins. I'm not making this up, it really starts like this!
Pioneering work by Janet (1901) and Breuer & Freud (1895) demonstrated that non-invasive treatment (i.e.'talking therapy') could enable patients to overcome emotional and psychological disturbance. Following on from the work of these early pioneers there has been considerable progress in our understanding of what maintains common mental health conditions and syndromes, and how psychological therapies can help to treat such difficulties.
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It gets funnier. In their blurb, the authors say that one of the learning objectives is to:
Learn that there is good evidence that some approaches are more effective than others for specific problems and be better able to choose a psychological therapy
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But they provide no evidence in the paper to support this statement at all! Here's what they say:
However, while there is evidence that most of the major psychotherapy approaches are effective, this does not mean that we can reach the 'Dodo bird verdict', as not all psychotherapies are equivalent when it comes to outcomes. Some approaches are more effective than others at treating certain presenting problems.
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That's it. Just a bald pronouncement. They give no evidence to support it, not even a reference to someone else's work. Nothing. Just the statement, given as fact.

And of course the reality is far from this. There's very little evidence that positively distinguishes the effectiveness of one type of psychological therapy from another. Mostly, they all seem to "work", at least in the loose way we currently evaluate them.

I know these authors have a particular bias, but this is a step farther than they usually go - now they are just creating articles based on complete falsehoods.
 
alex3619 said:
Psychiatry often embraces the concept of the benevolent lie ... its OK to lie if you think its in the patient's best interest.
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A lot of patients have adopted the concept of the benevolent lie when involved with NHS CFS clinics ‘yes here’s my homework activity schedule - I’ve been doing extra activity and I’m not making it up honest’
 
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