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National Institute of Mental Health Treatment of Depression Collaborative Research Program. General effectiveness of treatments

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Abstract

We investigated the effectiveness of two brief psychotherapies, interpersonal psychotherapy and cognitive behavior therapy, for the treatment of outpatients with major depression disorder diagnosed by Research Diagnostic Criteria. Two hundred fifty patients were randomly assigned to one of four 16-week treatment conditions: interpersonal psychotherapy, cognitive behavior therapy, imipramine hydrochloride plus clinical management (as a standard reference treatment), and placebo plus clinical management. Patients in all treatments showed significant reduction in depressive symptoms and improvement in functioning over the course of treatment. There was a consistent ordering of treatments at termination, with imipramine plus clinical management generally doing best, placebo plus clinical management worst, and the two psychotherapies in between but generally closer to imipramine plus clinical management. In analyses carried out on the total samples without regard to initial severity of illness (the primary analyses), there was no evidence of greater effectiveness of one of the psychotherapies as compared with the other and no evidence that either of the psychotherapies was significantly less effective than the standard reference treatment, imipramine plus clinical management. Comparing each of the psychotherapies with the placebo plus clinical management condition, there was limited evidence of the specific effectiveness of interpersonal psychotherapy and none for cognitive behavior therapy. Superior recovery rates were found for both interpersonal psychotherapy and imipramine plus clinical management, as compared with placebo plus clinical management. On mean scores, however, there were few significant differences in effectiveness among the four treatments in the primary analyses. Secondary analyses, in which patients were dichotomized on initial level of severity of depressive symptoms and impairment of functioning, helped to explain the relative lack of significant findings in the primary analyses. Significant differences among treatments were present only for the subgroup of patients who were more severely depressed and functionally impaired; here, there was some evidence of the effectiveness of interpersonal psychotherapy with these patients and strong evidence of the effectiveness of imipramine plus clinical management. In contrast, there were no significant differences among treatments, including placebo plus clinical management, for the less severely depressed and functionally impaired patients.
... In the 1980s, further analyses were performed to identify potential differences between the two of the most common forms of psychotherapy, interpersonal psychotherapy (IPT) and cognitive behavioral therapy (CBT). In particular, a 1989 study by the National Institute of Mental Health Treatment of Depression Collaborative Research Program (NIMH TDCRP) found the benefits of both treatments were nearly identical with patients in both treatments showing significant reduction in depressive symptoms and an overall improvement in functioning during the course of the treatment (Elkin et al., 1989). Since this period, effectiveness of a broad range of psychosocial interventions has been established through hundreds of randomized controlled clinical trials and numerous metaanalyses (Barth et al., 2013;Cuijpers et al., 2009Cuijpers et al., , 2010Cuijpers et al., , 2013Cuijpers et al., , 2014. ...
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We are in an important moment for mental health treatment around the world, as many Low and Middle Income Countries (LMICs) – representing an increasing majority of the world’s population – are currently developing and scaling up services for the first time. Yet, research on Global Mental Health (GMH) best practices remains scattered and difficult to synthesize. This review aims to simplify existing GMH research on effective biomedical and psychosocial treatment approaches from both high-income countries and LMICs to enable a more comprehensive understanding of the benefits and drawbacks of existing interventions, based on the highest quality, up-to-date research. By understanding which treatments are most effective and why, we can begin to not only implement more effective practices, but guide the future of GMH research in the right directions. The purpose of this review is therefore to understand mental illness, what it is, how it was treated in the past, how it manifests differently around the globe, and how to best treat it. Ultimately, while psychosocial approaches are advised for patients with more mild to moderate disorders, medications and other biomedical approaches are recommended increasingly only for more severe cases. While significant evidence exists to justify the use of psychotropic medications for mental illness, their adverse effects indicate that psychosocial approaches should be prioritized as first line treatments, particularly for mild to moderate disorders. As one of the first to analyze this research, this review is useful not only for GMH scholars, but for practitioners and public health workers globally, as well.
... La prevalencia en España es inferior a la de otros países europeos, con una prevalencia-vida de 10,6% y una prevalencia-año de 4,0%, destacando una menor edad de inicio y mayores tasas de comorbilidad y cronicidad (Alonso et al., 2004). Según Kessler, Zhao, Blazer y Swartz (1997), el 75% de las personas con este trastorno volverán a presentar un segundo episodio y aquellas que hayan presentado un segundo episodio poseen un riesgo de recaída en torno al mismo porcentaje (Elkin et al., 1989). De este modo, este diagnóstico psicológico es cada vez más frecuente (Bernardo, 2000), lo que ha llevado a utilizar y mantener la denominación de "la época de la depresión" de Klerman y Weissman desde 1989 hasta la actualidad (OMS, 2017) para referirse a la extensión de esta problemática. ...
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Attachment is an affective bond that is formed between an individual and a small number of people, which prompts him to seek proximity and contact with them over time. The functions of attachment are, among others, to favor the survival of the offspring of the human species, and in children, to obtain a feeling of security through contact with caregivers and to receive the necessary stimulation for their mental and communicative development from attachment figures. Social phobia consists of experiencing intense fear or anxiety in one or more social situations in which the individual is exposed to possible examination by other people. Objective: to know the relationship between adult attachment and the possible development of social phobia psychopathology. Method: review of the existing bibliography using the following databases: PsycInfo, Psicodoc, PsicArticles, Proquest, Dialnet and Psychology Database. Results: there is a significant association between insecure attachment styles and social anxiety. Conclusions: some studies relate fearful and worried attachment styles with social anxiety, while other studies give a more important role to the avoidant attachment style.
... Starting with the first randomized controlled trials that included psychoanalysis, in the 1980s, the results indicated an efficacy that was generally equal among the different therapeutic approaches, whether this was for opioid dependence [70] or -in the case of a large-scale project carried out by the US National Institutes of Health -for depression [71]. ...
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... Videre har stor interesse vaert rettet mot å sammenlikne effekten av ulike metoder og psykoterapeutiske retninger. Selv om flere enkeltundersøkelser finner forskjeller, finner man generelt små eller ingen forskjeller mellom forskjellige psykoterapeutiske behandlingsmetoder (Crits-Cristoph et al., 1999;Cross, Sheenan, & Khan, 1982;Elkin et al., 1989;Shapiro et al., 1994) I 1975 utførte Luborsky en oversiktsstudie hvor han dømte konkurransen mellom de forskjellige terapiformene til å vaere dødt løp. Luborsky henviste til dodofuglen fra Alice i Wonderland som sier "Alle har vunnet, og alle skal ha premie", og funnet har siden blitt omtalt som dodo kjennelsen ("Dodo bird verdict") (L. ...
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During the last two decades a number of therapies, under the name of the third wave of cognitive behavior therapy have been developed. One disorder that has gained attention from the third wave is Generalized Anxiety Disorder (GAD), a disorder cognitive behavior therapy finds difficult to treat. Four of these models for GAD are Metacognitive Therapy, Integrative Therapy, Acceptance Based Behavior Therapy, and Emotion Regulation Therapy. The purposes of this review of these third wave treatments were: 1. To describe these models, 2. To evaluate if they currently fulfill the criteria for empirically supported treatments (EST), 3. To discuss whether it is reasonably to assess the treatment models with the EST criteria, and 4: To give some recommendations to research and practice. The result demonstrates that none of the treatment models fulfilled the EST criteria. The review recommends psychologists in research and practice to implement the Policy Statement on evidence based practice in psychology of APA (2005), and broaden the view on evidence based practice.
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The Hierarchical Taxonomy of Psychopathology (HiTOP) is a quantitative nosological system that addresses shortcomings of traditional mental disorder diagnoses, including arbitrary boundaries between psychopathology and normality, frequent disorder co-occurrence, substantial heterogeneity within disorders, and diagnostic unreliability over time and across clinicians. This paper reviews evidence on the validity and utility of the internalizing and somatoform spectra of HiTOP, which together provide support for an emotional dysfunction superspectrum. These spectra are composed of homogeneous symptom and maladaptive trait dimensions currently subsumed within multiple diagnostic classes, including depressive, anxiety, trauma-related, eating, bipolar, and somatic symptom disorders, as well as sexual dysfunction and aspects of personality disorders. Dimensions falling within the emotional dysfunction superspectrum are broadly linked to individual differences in negative affect/neuroticism. Extensive evidence establishes that dimensions falling within the superspectrum share genetic diatheses, environmental risk factors, cognitive and affective difficulties, neural substrates and biomarkers, childhood temperamental antecedents, and treatment response. The structure of these validators mirrors the quantitative structure of the superspectrum, with some correlates more specific to internalizing or somatoform conditions, and others common to both, thereby underlining the hierarchical structure of the domain. Compared to traditional diagnoses, the internalizing and somatoform spectra demonstrated substantially improved utility: greater reliability, larger explanatory and predictive power, and greater clinical applicability. Validated measures are currently available to implement the HiTOP system in practice, which can make diagnostic classification more useful, both in research and in the clinic.
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Guénaël Visentini, après avoir publié un premier ouvrage sur les bases historiques, conceptuelles et épistémologiques permettant d’assoir la psychanalyse comme une science en s’appuyant sur l’épistémologie proposée et développée par Freud depuis la genèse de cette discipline (Visentini, 2015), nous propose aujourd’hui, en 2021, un nouvel ouvrage portant sur « l’efficacité de la psychanalyse » (Visentini, 2021). Malgré l’explosion en France des travaux sur ce champ de recherche et sur ses résultats et preuves, l’ouvrage a le mérite, et la différence, de porter essentiellement sur l’efficacité et l’évaluation de la psychanalyse, et non des psychothérapies au sens large, sans pour autant faire de la psychanalyse un « cas » particulier. A travers cet ouvrage, et notre lecture transversale, nous allons nous interroger sur cette « efficacité de la psychanalyse », prétendument si décriée, autant par ses détracteurs que dans d’honnêtes débats scientifiques. Car à cette question banale du « est-ce que ça fonctionne ? » et si oui, « pour qui et comment ? », Guénaël Visentini nous offre une synthèse particulièrement étayée autant sur le statut épistémologique de ces évaluations, leur juste place et avenir, qui nous permet de faire des liens sur l’actualité et l’avenir des métiers pratiquant la psychothérapie, qu’ils soient psychanalystes ou non.
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