What Research Evidence Is Valid for Psychotherapy Research?

Overview

Journal Front Psychiatry

Specialty Psychiatry

Date 2021 Jan 28

PMID 33505325

Citations 6

Authors

Bjorn Philips

Fredrik Falkenstrom

Affiliations

Soon will be listed here.

Abstract

Evidence-Based Medicine (EBM) have contributed to improved clinical practice with increased use of effective and life-saving treatments for severe diseases. However, the EBM model is less suitable for psychotherapy research than for pharmacological research and somatic medicine. The randomized controlled trial (RCT) design is an example of experimental methodology, which inevitably has more imperfections in psychotherapy research because psychotherapy RCTs cannot use double-blinding and the treatments tested are composite treatment packages. Long-term psychotherapy for severe and complex mental disorders is especially difficult to study with an RCT design. During the last decades, advanced analytic methods have been developed in psychotherapy process research, which enables investigation of causal connections regarding change mechanisms in psychotherapy. Therefore, we propose that the top of the research evidence hierarchy for psychotherapy should encompass: (1) RCT for circumscribed disorders, (2) cohort studies for complex disorders, and (3) advanced process studies for change mechanisms.

Citing Articles

Effectiveness of psychotherapy for Hwa-Byung: A systematic review of interventional studies.

Kwon C, Lee B Medicine (Baltimore). 2025; 104(6):e41315.

PMID: 39928831 PMC: 11813000. DOI: 10.1097/MD.0000000000041315.

Cognitive Behavioral Therapy and Mindfulness-Based Cognitive Therapy for Depressive Disorders: Enhancing Access and Tailoring Interventions in Diverse Settings.

Druge M, Guthardt L, Haller E, Michalak J, Apolinario-Hagen J Adv Exp Med Biol. 2024; 1456:199-226.

PMID: 39261431 DOI: 10.1007/978-981-97-4402-2_11.

Two people making sense of a story: narrative exposure therapy as a trauma intervention in early intervention in psychosis.

Sparrow R, Fornells-Ambrojo M Eur J Psychotraumatol. 2024; 15(1):2355829.

PMID: 38856038 PMC: 11168218. DOI: 10.1080/20008066.2024.2355829.

Process and outcome of outpatient psychotherapies under clinically representative conditions in Austria: protocol and feasibility of an ongoing study.

Schaffler Y, Jesser A, Humer E, Haider K, Pieh C, Probst T Front Psychiatry. 2024; 15:1264039.

PMID: 38510799 PMC: 10951102. DOI: 10.3389/fpsyt.2024.1264039.

Mentalization-based treatment for adolescents with conduct disorder (MBT-CD): a feasibility study.

Hauschild S, Kasper L, Volkert J, Sobanski E, Taubner S Eur Child Adolesc Psychiatry. 2022; 32(12):2611-2622.

PMID: 36434148 PMC: 9702655. DOI: 10.1007/s00787-022-02113-4.

References

Gregory R, Chlebowski S, Kang D, Remen A, Soderberg M, Stepkovitch J . A controlled trial of psychodynamic psychotherapy for co-occurring borderline personality disorder and alcohol use disorder. Psychotherapy (Chic). 2011; 45(1):28-41. DOI: 10.1037/0033-3204.45.1.28. View

Zilcha-Mano S . Toward personalized psychotherapy: The importance of the trait-like/state-like distinction for understanding therapeutic change. Am Psychol. 2020; 76(3):516-528. DOI: 10.1037/amp0000629. View

Boutron I, Moher D, Altman D, Schulz K, Ravaud P . Extending the CONSORT statement to randomized trials of nonpharmacologic treatment: explanation and elaboration. Ann Intern Med. 2008; 148(4):295-309. DOI: 10.7326/0003-4819-148-4-200802190-00008. View

Backmann M . What's in a gold standard? In defence of randomised controlled trials. Med Health Care Philos. 2017; 20(4):513-523. DOI: 10.1007/s11019-017-9773-2. View

Ware J, Hamel M . Pragmatic trials--guides to better patient care?. N Engl J Med. 2011; 364(18):1685-7. DOI: 10.1056/NEJMp1103502. View

Falkenstrom F, Finkel S, Sandell R, Rubel J, Holmqvist R . Dynamic models of individual change in psychotherapy process research. J Consult Clin Psychol. 2017; 85(6):537-549. DOI: 10.1037/ccp0000203. View

Chambless D, Hollon S . Defining empirically supported therapies. J Consult Clin Psychol. 1998; 66(1):7-18. DOI: 10.1037//0022-006x.66.1.7. View

Porter R, Frampton C, Joyce P, Mulder R . Randomized controlled trials in psychiatry. Part 1: methodology and critical evaluation. Aust N Z J Psychiatry. 2003; 37(3):257-64. DOI: 10.1046/j.1440-1614.2003.01175.x. View

Burger J, van der Veen D, Robinaugh D, Quax R, Riese H, Schoevers R . Bridging the gap between complexity science and clinical practice by formalizing idiographic theories: a computational model of functional analysis. BMC Med. 2020; 18(1):99. PMC: 7333286. DOI: 10.1186/s12916-020-01558-1. View

10.

Cuijpers P, Cristea I, Karyotaki E, Reijnders M, Hollon S . Component studies of psychological treatments of adult depression: A systematic review and meta-analysis. Psychother Res. 2017; 29(1):15-29. DOI: 10.1080/10503307.2017.1395922. View

11.

Tucker J, Roth D . Extending the evidence hierarchy to enhance evidence-based practice for substance use disorders. Addiction. 2006; 101(7):918-32. DOI: 10.1111/j.1360-0443.2006.01396.x. View

12.

Falkenstrom F, Solomonov N, Rubel J . Using Time-Lagged Panel Data Analysis to Study Mechanisms of Change in Psychotherapy Research: Methodological Recommendations. Couns Psychother Res. 2021; 20(3):435-441. PMC: 8171261. DOI: 10.1002/capr.12293. View

13.

Guyatt G, Sackett D, Sinclair J, Hayward R, Cook D, Cook R . Users' guides to the medical literature. IX. A method for grading health care recommendations. Evidence-Based Medicine Working Group. JAMA. 1995; 274(22):1800-4. DOI: 10.1001/jama.274.22.1800. View

14.

Fonagy P, Luyten P . Fidelity vs. flexibility in the implementation of psychotherapies: time to move on. World Psychiatry. 2019; 18(3):270-271. PMC: 6732688. DOI: 10.1002/wps.20657. View

15.

Guidi J, Brakemeier E, Bockting C, Cosci F, Cuijpers P, Jarrett R . Methodological Recommendations for Trials of Psychological Interventions. Psychother Psychosom. 2018; 87(5):276-284. DOI: 10.1159/000490574. View

16.

Westen D, Novotny C, Thompson-Brenner H . The empirical status of empirically supported psychotherapies: assumptions, findings, and reporting in controlled clinical trials. Psychol Bull. 2004; 130(4):631-63. DOI: 10.1037/0033-2909.130.4.631. View

17.

Carey T, Stiles W . Some Problems with Randomized Controlled Trials and Some Viable Alternatives. Clin Psychol Psychother. 2015; 23(1):87-95. DOI: 10.1002/cpp.1942. View

18.

Moller C, Karlgren L, Sandell A, Falkenstrom F, Philips B . Mentalization-based therapy adherence and competence stimulates in-session mentalization in psychotherapy for borderline personality disorder with co-morbid substance dependence. Psychother Res. 2016; 27(6):749-765. DOI: 10.1080/10503307.2016.1158433. View

19.

Djulbegovic B, Guyatt G . Progress in evidence-based medicine: a quarter century on. Lancet. 2017; 390(10092):415-423. DOI: 10.1016/S0140-6736(16)31592-6. View

20.

Linehan M, Schmidt 3rd H, Dimeff L, Craft J, Kanter J, Comtois K . Dialectical behavior therapy for patients with borderline personality disorder and drug-dependence. Am J Addict. 1999; 8(4):279-92. DOI: 10.1080/105504999305686. View