Cuijpers2019 - Targets and outcomes of psychotherapies for mental disorders, an overview

  • Type:#article
  • Year read:#read2022
  • Subject: (in brackets, can also bracket keywords in text)
  • Bibtex: @cuijpers2019
  • Bibliography: Cuijpers, P. (2019), Targets and outcomes of psychotherapies for mental disorders: an overview. World Psychiatry, 18: 276-285.

Example citation

Symptom reduction for specific mental disorders as classified in the DSM and ICD systems have been the dominant therapy target, but other types of outcomes (for example, quality of life, mechanisms of action, economic outcomes) should be considered [@cuijpers2019].

Key takeaways

  • Targets
    • Symptom reduction
    • Personal targets (from the patient’s perspective)
    • QoL
    • Intermediate outcomes (mediators and mechanisms)
    • Negative outcomes to be avoided
    • Economic outcomes
  • Most research on symptom reduction and QoL
  • We don’t have objective tests of mental disorders, or clear thresholds

Critique of DSM/ICD dominance

  • Most mental disorders should be considered as dimensions rather than discrete diagnoses
  • Comorbidity rule rather than exception
  • Pharmacotherapy and psychotherapy generic rather than specific
  • RDoC launched as an alternative - dysfunction in systems (could also discuss network theory here)

How select outcomes

  • Depends on who we ask: clinician, patient, relatives, society at large
  • Symptom reduction is also important for patients

Drawbacks of symptom reduction

  • Publication bias
  • Low quality in many trials
  • Researcher allegiance
  • Long-term investigations lacking

Mediators and mechanisms

  • Dysfunctional thinking as mechanism in CBT? Well it changes in other therapies as well so may as well be a general thing in depression
  • Common factors model: working alliance, expectations

As Kazdin83 argues, “after decades of psychotherapy research, we cannot provide an evidence-based explanation for how or why even our most well studied interventions produce change”.

To prove causality: temporal, dose-response, no third variable (I have read some article about this back during my deep dives no?)