SCIENTIFIC EVIDENCE
Which psychotherapy really helps
Mental health problems have increased in the pandemic. How to find the right therapy - and what surprising results there are to prove its effectiveness.
Tanja Traxler
May 20, 2023, 17:00
Instant psychotherapy in 90 seconds via social media? An AI chatbot as a mental coach? Anxiety disorders, ADHD and depressive moods are trending on social media. In times of constant crisis, young people on Tiktok, YouTube and Instagram are elevating something to the highest good: mental health.
The Tiktok generation's unconventional approach to mental health may come as a surprise; self-diagnoses are often made prematurely. On the positive side, however, mental illness and its treatment are now far less taboo than they were just a few years ago. Awareness of mental illness and knowledge of possible therapies are increasing.
This destigmatization is urgently needed in view of how widespread mental crises are - especially among children and young people. Not least as a result of the pandemic, mental health problems have increased massively. Various studies have found a significant increase, and some even assume a fourfold increase.
On the couch in Berggasse
A good hundred years ago, in turn-of-the-century Vienna, Sigmund Freud asked patients to sit on his couch at Berggasse 19 and let them talk about their inner lives. In the meantime, different methods of psychotherapy have developed. One is therefore not faced with an easy choice when deciding on psychotherapy. How can one find out what really helps?
For the treatment of physical or mental illness, the general rule is that the best way to find out what works is to conduct large-scale studies. The gold standard is study designs that randomly select who receives a particular treatment and who is included in a control group that receives only a placebo. In technical jargon, this is called controlled randomized trials.
"Patients want to be treated with therapies that are clear to be effective and relieve suffering." - Brigitte Lueger-Schuster, Professor of Psychotraumatology
When it comes to mental health treatments, this gold standard is not so easy to implement. First of all, it requires a larger group of people with the same psychological condition. And given that mental processes are deeply individual matters, establishing objective factors of efficacy is not so easy. Evidence-based research on psychotherapy has only really taken off in recent years - and has produced some remarkable findings.
Sometimes better than medication
"Scientific research for evidence of psychotherapies has several hurdles, but also a great desire, namely on the part of patients," says Brigitte Lueger-Schuster, professor of psychotraumatology at the University of Vienna. "Of course, patients want to be treated with psychotherapeutic procedures that are clear to be effective and actually relieve suffering." For Lueger-Schuster, the evidence-based approach to psychotherapy is therefore extremely important and deserves even more attention than before.
Numerous studies show that psychotherapies are effective. "That is quite clear," says Christian Korunka, professor of psychology at the University of Vienna, who also directs the postgraduate university course Psychotherapeutic Propaedeutic. "Psychotherapies are highly effective, the effects are similar to or even better than drug treatments."
Revolutionary approach
But what continues to puzzle scientists is which psychotherapy works best for a particular person. "This is exactly where psychotherapy science is currently researching," says Markus Böckle, who heads the Department of Research and Science at the Austrian Association for Psychotherapy (ÖBVP). "We would like to be able to predict which therapy is best for which patient." However, the relevant data are still lacking for this.
A revolutionary approach that uses data records of people who have already received treatment to make predictions for the patient who has just entered the treatment room is currently being tested in Germany: At the Psychotherapy Lab in Greifswald, Mecklenburg-Western Pomerania, new patients first work their way through a list of questions before a computer program processes data and links them to those in the database whose individual histories are most similar. Based on previous therapy histories, deductions can be made as to which therapy is most promising.
Eva-Lotta Brakemeier, the head of the experimental laboratory, is a professor of psychology and one of Germany's best-known experts on the treatment of depression. She won't be satisfied with previous findings that psychotherapy is effective for most patients. "We simply have to do better," she recently told Die Zeit.
Four effective currents
The goal, she said, is to further develop therapy approaches and test them scientifically. Part of the experiment is also to develop new therapies in order to use the approaches from different psychotherapeutic methods that are best suited for the respective patient.
In general, there are four major streams in psychotherapy:
Tanja Traxler
May 20, 2023, 17:00
Instant psychotherapy in 90 seconds via social media? An AI chatbot as a mental coach? Anxiety disorders, ADHD and depressive moods are trending on social media. In times of constant crisis, young people on Tiktok, YouTube and Instagram are elevating something to the highest good: mental health.
The Tiktok generation's unconventional approach to mental health may come as a surprise; self-diagnoses are often made prematurely. On the positive side, however, mental illness and its treatment are now far less taboo than they were just a few years ago. Awareness of mental illness and knowledge of possible therapies are increasing.
This destigmatization is urgently needed in view of how widespread mental crises are - especially among children and young people. Not least as a result of the pandemic, mental health problems have increased massively. Various studies have found a significant increase, and some even assume a fourfold increase.
On the couch in Berggasse
A good hundred years ago, in turn-of-the-century Vienna, Sigmund Freud asked patients to sit on his couch at Berggasse 19 and let them talk about their inner lives. In the meantime, different methods of psychotherapy have developed. One is therefore not faced with an easy choice when deciding on psychotherapy. How can one find out what really helps?
For the treatment of physical or mental illness, the general rule is that the best way to find out what works is to conduct large-scale studies. The gold standard is study designs that randomly select who receives a particular treatment and who is included in a control group that receives only a placebo. In technical jargon, this is called controlled randomized trials.
"Patients want to be treated with therapies that are clear to be effective and relieve suffering." - Brigitte Lueger-Schuster, Professor of Psychotraumatology
When it comes to mental health treatments, this gold standard is not so easy to implement. First of all, it requires a larger group of people with the same psychological condition. And given that mental processes are deeply individual matters, establishing objective factors of efficacy is not so easy. Evidence-based research on psychotherapy has only really taken off in recent years - and has produced some remarkable findings.
Sometimes better than medication
"Scientific research for evidence of psychotherapies has several hurdles, but also a great desire, namely on the part of patients," says Brigitte Lueger-Schuster, professor of psychotraumatology at the University of Vienna. "Of course, patients want to be treated with psychotherapeutic procedures that are clear to be effective and actually relieve suffering." For Lueger-Schuster, the evidence-based approach to psychotherapy is therefore extremely important and deserves even more attention than before.
Numerous studies show that psychotherapies are effective. "That is quite clear," says Christian Korunka, professor of psychology at the University of Vienna, who also directs the postgraduate university course Psychotherapeutic Propaedeutic. "Psychotherapies are highly effective, the effects are similar to or even better than drug treatments."
Revolutionary approach
But what continues to puzzle scientists is which psychotherapy works best for a particular person. "This is exactly where psychotherapy science is currently researching," says Markus Böckle, who heads the Department of Research and Science at the Austrian Association for Psychotherapy (ÖBVP). "We would like to be able to predict which therapy is best for which patient." However, the relevant data are still lacking for this.
A revolutionary approach that uses data records of people who have already received treatment to make predictions for the patient who has just entered the treatment room is currently being tested in Germany: At the Psychotherapy Lab in Greifswald, Mecklenburg-Western Pomerania, new patients first work their way through a list of questions before a computer program processes data and links them to those in the database whose individual histories are most similar. Based on previous therapy histories, deductions can be made as to which therapy is most promising.
Eva-Lotta Brakemeier, the head of the experimental laboratory, is a professor of psychology and one of Germany's best-known experts on the treatment of depression. She won't be satisfied with previous findings that psychotherapy is effective for most patients. "We simply have to do better," she recently told Die Zeit.
Four effective currents
The goal, she said, is to further develop therapy approaches and test them scientifically. Part of the experiment is also to develop new therapies in order to use the approaches from different psychotherapeutic methods that are best suited for the respective patient.
In general, there are four major streams in psychotherapy:
- Behavioral therapies
- systemic therapies
- humanistic therapies and
- depth-psychological-psychodynamic therapies.
The effectiveness of all these forms of therapy has been scientifically confirmed, and it can be assumed that they all work similarly well.
However, these different approaches are each based on different concepts of man, and they have emerged in different historical contexts. It should therefore come as no surprise that representatives of these currents do not always agree. Depth psychologists sometimes accuse behavior therapy of merely treating symptoms. Behavioral therapists sometimes fail to understand how the intensive preoccupation with childhood can concretely help to get acute problems under control.
Strongest evidence for behavior therapy
Although studies show high efficacy for all four streams, the evidence is strongest for cognitive behavioral therapy. The focus is on identifying and counteracting pathogenic behaviors. However, it should be noted that behavioral therapy is best suited for standardized tests. Evidence of effectiveness is therefore much easier to establish with this approach than with other therapies.
For Christian Korunka, all four therapeutic streams have their justification and should be preserved. If one takes a closer look at the studies on the effectiveness of psychotherapies, it is interesting to note that the specific method does not play the greatest role. It has been known for decades that the relationship between therapist and patient is a very decisive criterion for how effective a therapy is. "It takes trust, and for that it takes a certain sympathy, and the therapist must also be able to develop and control this professional relationship well," says Lueger-Schuster.
Finding the right person
The patient's characteristics also play a role, such as how willing the person is to undergo therapy or what other ailments exist in addition to the psychological problems. The therapist's characteristics also play a major role: It is known that some therapists have an extremely high success rate, and this seems to be due more to their personality than to the method they use. Only far behind do certain methods and techniques come into play as an effective factor.
"Psychotherapy should not be a class health service," Böckle says. "Everyone who needs it should have access to it free of charge." - Markus Böckle, head of the Department of Research and Science, Austrian Federal Association for Psychotherapy.
But to conclude from this that the specific method is irrelevant is again not true. Because: "The therapeutic relationship is very different in the various therapeutic directions, and it must also be learned accordingly," says Korunka.
Combination with medication
Up to now, psychotherapeutic treatments have been oriented primarily toward one of the four streams. In contrast, the evidence-based approach, which is being developed at the Psychotherapy Lab in Greifswald, for example, aims to combine different methods individually for each patient in order to achieve the best and fastest therapeutic success.
And the approach goes even further: It also promotes the combination of psychotherapy and psychopharmaceuticals. This is a novelty, because until now it has often been the case that there is little exchange between doctors who prescribe psychotropic drugs and psychotherapists who carry out therapies. Yet studies show that the combination of drugs and therapies is even more effective than the respective treatments alone.
Risks of treatment
Another question that has come to the fore as a result of evidence-based research on psychotherapies is that of potential harm. Some experts believe that, in principle, everyone can benefit from actively addressing their own mental health. Others, however, urge caution: under certain circumstances, psychotherapies could also do more harm than good.
In general, there are still quite few studies on possible negative effects of psychotherapies. Böckle cites as a possible risk and undesirable side effect of psychotherapies that "relationships usually change, in that relationship dynamics are better understood." Sometimes these changes are welcome, but sometimes they are perceived as a burden.
New psychotherapy law
An even stronger focus on evidence-based therapy could also come from a new psychotherapy law currently being drafted. In 1991, the first Psychotherapy Act was passed, which remains the legal basis for psychotherapy in Austria today. "At the time, it was a big deal; it's considered one of the best laws in the world in this regard," Korunka says.
From the beginning, however, the law had the shortcoming of the lack of academization of the profession. Korunka expects the law to bring about major changes, and that also has to do with training costs. Up to now, these have been borne privately: for prospective therapists, training currently costs several thousand euros. With the new law, which the black-green coalition has set itself, the training is to become a regular university course, for which - if at all - only tuition fees will be charged. There is no precise timetable yet, but Korunka expects it to happen next year.
Great demand - and a class issue
One sticking point, of course, is how many study places there will be for psychotherapy in the future. This point is all the more delicate in view of the aging among currently active therapists: Around 40 percent will retire or take a shorter career in the next ten years.
According to Korunka, to meet the demand for psychotherapy, about twice as many treatment hours would be needed as are currently offered by psychotherapists; only a small portion is financed by the health insurance funds. Böckle points out that people with psychological problems often come from a socially weak background and have few financial resources.
"Psychotherapy should not be a class health service," Böckle says. "Everyone who needs it should have access to it for free." No matter which therapy one chooses, it is clear that it is the best and most sustainable way to deal with mental health crises. "There's no shame in going to therapy," says Böckle, "it's just the right support service to help you when you're in a bad place mentally."
Therapy by means of Tiktok?
In view of the stigmatization of mental illnesses, as was often the case just a few years ago, the casual approach of many young people to the subject is surprising. Hashtags like #MentalHealth or #Selfcare are among the most popular on platforms like Instagram and Tiktok.
Nevertheless, it would be a fallacy to believe that the popularity of online diagnostic questionnaires or 60-second self-care advice is always beneficial to young people's mental health, as school psychologist Beatrix Haller recently pointed out in the STANDARD: "It's a double-edged sword. Of course, it can help destigmatize, it encourages some to get help. But it can also have a negative impact. Especially for teenagers who are already in crisis or showing the first symptoms of mental illness, such posts can exacerbate the crisis once again."
So there is no way around professional help. Psychotherapies require time and patience, and often money. It would be wrong to expect a quick elimination of all problems through therapy. But it is the most effective means of alleviating psychological suffering. And in view of new findings, it is constantly getting even better. (Tanja Traxler, 20.5.2023)
Source (derstandard.at) | Archive
However, these different approaches are each based on different concepts of man, and they have emerged in different historical contexts. It should therefore come as no surprise that representatives of these currents do not always agree. Depth psychologists sometimes accuse behavior therapy of merely treating symptoms. Behavioral therapists sometimes fail to understand how the intensive preoccupation with childhood can concretely help to get acute problems under control.
Strongest evidence for behavior therapy
Although studies show high efficacy for all four streams, the evidence is strongest for cognitive behavioral therapy. The focus is on identifying and counteracting pathogenic behaviors. However, it should be noted that behavioral therapy is best suited for standardized tests. Evidence of effectiveness is therefore much easier to establish with this approach than with other therapies.
For Christian Korunka, all four therapeutic streams have their justification and should be preserved. If one takes a closer look at the studies on the effectiveness of psychotherapies, it is interesting to note that the specific method does not play the greatest role. It has been known for decades that the relationship between therapist and patient is a very decisive criterion for how effective a therapy is. "It takes trust, and for that it takes a certain sympathy, and the therapist must also be able to develop and control this professional relationship well," says Lueger-Schuster.
Finding the right person
The patient's characteristics also play a role, such as how willing the person is to undergo therapy or what other ailments exist in addition to the psychological problems. The therapist's characteristics also play a major role: It is known that some therapists have an extremely high success rate, and this seems to be due more to their personality than to the method they use. Only far behind do certain methods and techniques come into play as an effective factor.
"Psychotherapy should not be a class health service," Böckle says. "Everyone who needs it should have access to it free of charge." - Markus Böckle, head of the Department of Research and Science, Austrian Federal Association for Psychotherapy.
But to conclude from this that the specific method is irrelevant is again not true. Because: "The therapeutic relationship is very different in the various therapeutic directions, and it must also be learned accordingly," says Korunka.
Combination with medication
Up to now, psychotherapeutic treatments have been oriented primarily toward one of the four streams. In contrast, the evidence-based approach, which is being developed at the Psychotherapy Lab in Greifswald, for example, aims to combine different methods individually for each patient in order to achieve the best and fastest therapeutic success.
And the approach goes even further: It also promotes the combination of psychotherapy and psychopharmaceuticals. This is a novelty, because until now it has often been the case that there is little exchange between doctors who prescribe psychotropic drugs and psychotherapists who carry out therapies. Yet studies show that the combination of drugs and therapies is even more effective than the respective treatments alone.
Risks of treatment
Another question that has come to the fore as a result of evidence-based research on psychotherapies is that of potential harm. Some experts believe that, in principle, everyone can benefit from actively addressing their own mental health. Others, however, urge caution: under certain circumstances, psychotherapies could also do more harm than good.
In general, there are still quite few studies on possible negative effects of psychotherapies. Böckle cites as a possible risk and undesirable side effect of psychotherapies that "relationships usually change, in that relationship dynamics are better understood." Sometimes these changes are welcome, but sometimes they are perceived as a burden.
New psychotherapy law
An even stronger focus on evidence-based therapy could also come from a new psychotherapy law currently being drafted. In 1991, the first Psychotherapy Act was passed, which remains the legal basis for psychotherapy in Austria today. "At the time, it was a big deal; it's considered one of the best laws in the world in this regard," Korunka says.
From the beginning, however, the law had the shortcoming of the lack of academization of the profession. Korunka expects the law to bring about major changes, and that also has to do with training costs. Up to now, these have been borne privately: for prospective therapists, training currently costs several thousand euros. With the new law, which the black-green coalition has set itself, the training is to become a regular university course, for which - if at all - only tuition fees will be charged. There is no precise timetable yet, but Korunka expects it to happen next year.
Great demand - and a class issue
One sticking point, of course, is how many study places there will be for psychotherapy in the future. This point is all the more delicate in view of the aging among currently active therapists: Around 40 percent will retire or take a shorter career in the next ten years.
According to Korunka, to meet the demand for psychotherapy, about twice as many treatment hours would be needed as are currently offered by psychotherapists; only a small portion is financed by the health insurance funds. Böckle points out that people with psychological problems often come from a socially weak background and have few financial resources.
"Psychotherapy should not be a class health service," Böckle says. "Everyone who needs it should have access to it for free." No matter which therapy one chooses, it is clear that it is the best and most sustainable way to deal with mental health crises. "There's no shame in going to therapy," says Böckle, "it's just the right support service to help you when you're in a bad place mentally."
Therapy by means of Tiktok?
In view of the stigmatization of mental illnesses, as was often the case just a few years ago, the casual approach of many young people to the subject is surprising. Hashtags like #MentalHealth or #Selfcare are among the most popular on platforms like Instagram and Tiktok.
Nevertheless, it would be a fallacy to believe that the popularity of online diagnostic questionnaires or 60-second self-care advice is always beneficial to young people's mental health, as school psychologist Beatrix Haller recently pointed out in the STANDARD: "It's a double-edged sword. Of course, it can help destigmatize, it encourages some to get help. But it can also have a negative impact. Especially for teenagers who are already in crisis or showing the first symptoms of mental illness, such posts can exacerbate the crisis once again."
So there is no way around professional help. Psychotherapies require time and patience, and often money. It would be wrong to expect a quick elimination of all problems through therapy. But it is the most effective means of alleviating psychological suffering. And in view of new findings, it is constantly getting even better. (Tanja Traxler, 20.5.2023)
Source (derstandard.at) | Archive
