Psychological treatments general issues

There is high public demand for psychotherapies for unipolar depression. Recently, the use of these interventions in bipolar disorder has also been advocated. (55) Guidelines for the use of psychotherapy in depression are less well developed than for pharmacotherapy and are based on less robust empirical data. Early research into the benefits of psychotherapy in depression comprised single case studies, small case series, and open or non-randomized treatment trials. The increase in randomized, controlled trials of psychotherapy for depression can be attributed both to the introduction of 'manualized' (or 'protocol-driven') therapies, enabling consistency of application^ and valid and reliable evaluations, and to the emphasis on evidence-based medicine and cost-effectiveness. (57)

Almost all the controlled trials of psychotherapy for depression undertaken have employed manualized therapies. The interventions share the common characteristics of being time limited (less than 20 sessions), with primary targets symptom reduction and problem resolution. Cognitive therapy, interpersonal therapy, behavioural therapy, and some models of brief dynamic psychotherapy fall into this category. The largest volume of efficacy research has focused on cognitive therapy (about 50 studies), with fewer studies (about 30 in total) of interpersonal therapy, behavioural therapy, and other dynamic therapies. Sample sizes are often smaller than desirable and many studies have methodological weaknesses including the failure to include pill-placebo control groups.

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