Introduction
“There is a competing conjecture that the therapeutic factors of psychotherapy are derived from procedures common to all treatments.” (Baardesth, 2013). Many studies attempt to prove the superiority of one type of psychotherapy over another, but the results are rarely conclusive because there is too much bias. This study reanalysed a previous meta-analysis and conducted another meta-analysis trying to avoid bias to conclude on the efficacy of CBT and non-CBT treatment. This paper comes at a time when psychological thinking is in turmoil and psychopathological disorders are finally being recognized as important. Psychology, although threatened by other bodies, tends to assert itself and define its place among other disciplines. As a result, each approach seeks to show that its psychotherapy is the best, especially the cognitive-behavioral therapies (CBT, Tolin, 2010).
Summary
In 2010, Tolin attempted to remedy the problem of bias in treatment evaluation by conducting a meta-analysis of reviews of previous studies. In order to avoid bias, this meta-analysis evaluated the effectiveness of CBT in terms of symptoms and compared it to other treatments. But even after that, some blind spots remain. First, Tolin relied on categorizations of disorders, not on categorization based on specific disorders. For example, he found that CBT is more efficient than non-CBT treatment for anxiety disorders, without distinguishing panic disorder from obsessive-compulsive disorder. Secondly, his conclusions seem to diverge from the literature, maybe due to the absence of some very well conducted studies in Tolin’s (?) meta-analysis. Another limit is that the term “CBT” includes many different treatments. Finally, Tolin considered the measurement of specific symptoms whereas many treatments consider the global change of the patient as an evolution. The study we reviewed is a meta-analysis that aims to test the effectiveness of CBT treatments to establish whether they really are superior to others by reanalyzing Tolin’s methodology. The aim was to avoid the bias recorded previously by taking into account specific and non-specific symptoms, defining CBT treatment according to the Association of Behavioral and Cognitive Therapists (ABCT) consensus and by focusing on 2 specific disorders: anxiety and depression. Then this study conducted a comprehensive meta-analysis on anxiety with 91 CBT experts from the ABCT. Whether referring to the reanalyzing of Tolin’s study or to the new meta-analysis conducted, the results do not provide evidence to support the conjecture that CBT is superior to non-CBT treatments for any of the disorders studied, thus supporting the dodo bird paradigm that all psychotherapies are equally effective.
Critical évaluation
The authors proposed to re-examine Tolin’s results by including additional criteria. They assumed that there was a contradiction between the studies indicating that there was no difference between CBT and other treatments and those that claimed the opposite. Also, if this meta-analysis argues that some criteria are not included in Tolin’s analysis, one can question the criteria of Baardseth, who chose to include non-disorder specific measures. In addition, we can also question the choice of disorders for the study (anxiety and depression), although these disorders are very widespread, they may not be the most representative in order to define the effectiveness of one therapy over another. On the other hand, Baardseth proposes in his new analysis to base his work on a consensus between the members belonging to the ABCT to determine which treatment belongs to the CBT methods and which doesn’t. However, we can notice that the definition of cognitive-behavioural therapies according to this association is quite blurred: “the term used for a group of psychological treatments that are based on scientific evidence.”According to these studies, one could include several other therapies that have different objectives and ideologies of care. Moreover, some treatments are considered by some authors as belonging to CBT while for others they don’t (e.g. EMDR Ehlers et al., 2010).
Although the issue with the goal of the therapy is highlighted in the review, Baardseth does not propose a solution to overcome this problem. This seems to be a major limitation of the study. Indeed, each psychotherapy approach seeks aparticular purpose. For example, psychodynamic-oriented therapies assess their effectiveness on the subject’s potential for change, whereas CBTs focus on the disappearance of symptoms. It’s the same for systemic therapy where the goal is to unbalance the system in order to bring changes by using the symptom and not in simply making it disappear. Moreover, the effectiveness of a therapy depends on its objective, which is defined with the patient and can’t be standardized. It is therefore delicate to assert that one therapy is better than another, especially in a context where society seems to “pathologize” everything.
Nevertheless, although this meta-analysis still has some methodological biases, it helped to qualify the study carried out by Tolin and the arguments used to promote psychotherapy. In this way, it could help to decrease the various wars between the different psychological fields. It could also enhance the choice of the patient for what he desires in psychotherapy, thus privileging his or her subjectivity and uniqueness.
Conclusion
To conclude, mentioning the utility of this meta-analysis seems interesting to us. Our current society emphasizes immediate, rapid effectiveness and financial profitability at the risk of forgetting the subjectivity and freedom of choice of the patient, as can be seen with recent governmental reforms. From this point of view, the study appears all the more interesting and relevant because it allows us to restore the place and interest of each psychotherapy while putting an end to the incessant rivalries between the different psychological disciplines. One can legitimately question the potential dangers of affirming that one therapy is superior to another. The consequences of such an assertion could have direct repercussions on the patient and the professionals.
Key terms: cognitive-behavioral therapies (CBT) ; efficacy ; meta-analysis ; bias ; dodo bird paradigm
Words we have learned:
Turmoil : a state of extreme agitation
Blind spot : an aspect of something that is not well known
Widespread : spread over a considerable extent
Blurred : unclear
Uniqueness : the quality of being unique
Assertion : the action of maintaining a claim