Dr Matthew Patrick,Trust Director, Tavistock and Portman
NHS Foundation Trust
Professor Robert Elliott, Professor of Counselling, University
of Strathclyde and Emeritus Professor of Psychology, University
Professor John Markowitz, Research Psychiatrist, New York
State Psychiatric Institute, USA and Clinical Professor of Psychiatry,
Weill Medical College of Cornell University, New York
Professor Lars-Goran Ost, Professor of Clinical Psychology,
Stockholm University, Sweden
Dr Frank Margison, Medical Director and Consultant Psychiatrist,
Manchester Mental Health and Social Care Trust
Biography: Prof. Robert Elliott
Robert Elliott, Ph.D., is Professor of Counselling
in the Counselling Unit at the University of Strathclyde, and Professor
Emeritus of Psychology at the University of Toledo (Ohio). He received
his Ph.D. in Clinical Psychology from UCLA in 1978. He served as
President of the Society for Psychotherapy Research (2000-2001)
and as co-editor of the journal Psychotherapy Research (1994-1998).
He is co-author of Facilitating emotional change (1993, with Leslie
Greenberg and Laura Rice), Learning process-experiential psychotherapy
(2004, with Jeanne Watson, Rhonda Goldman, and Leslie Greenberg),
and Research methods in clinical psychology (2002, 2nd ed., with
Chris Barker & Nancy Pistrang), as well as more than 90 journal
articles or book chapters. He is a Fellow in the Divisions of Psychotherapy
and Humanistic Psychology of the American Psychological Association
and is the 2008 recipient of the Carl Rogers Award from the Division
of Humanistic Psychology of the American Psychological Association.
He is Editor Emeritus of Person-Centered Counseling and Psychotherapies.
Title: Empirical Support for Person-Centred/Experiential
Psychotherapies: Meta-analysis Update
Moderator: Robert Elliott (University of
Co-authors: Beth Freire & Mick Cooper
(University of Strathclyde)
Background: For reasons that are not clear,
the large empirical literature that supports the Person-Centred/Experiential
(PCE) practice is generally not known or reflected in mental health
policy, a problematic situation that extends to PCE therapists and
Aims: Building on previous meta-analytic
studies (e.g., Elliott, Greenberg & Lietaer, 2004), we added
another 30 predominantly recent outcomes studies to the large sample
previously reported, for a total of roughly 140 quantitative outcome
studies on person-centred, process-experiential/emotion-focused,
gestalt and related experiential therapies. In this paper, we summarize
these studies in terms of the three lines of evidence on the effectiveness
of these therapies across a broad range of client presenting problems.
Results: The following results hold across
both previous and current replication samples of quantitative therapy
- Clients in PCE therapies experienced
large amounts of pre-post change.
- Posttherapy gains were maintained over
early and late follow-ups.
- In controlled studies, clients experienced
large gains relative to untreated groups.
- In general, PCE therapies appeared to
be statistically and clinically equivalent when compared to non-PCE
therapies including CBT.
- In the old sample, CBTs did better than
person-centred or nondirective therapies, but the difference is
small, and may be due to researcher allegiance.
- The strongest support for PCE therapies
is for couples problems, depression and PTSD/trauma, where they
meet standard criteria for Evidence Based Practice.
- There is suggestive evidence of effectiveness
for severe disorders (schizophrenia, borderline process) and psychosomatic
Implications: These results are consistent
with complementary lines of evidence relating empathy to outcome
(Bohart et al., 2002), and client treatment preference data. Taken
together, the body of evidence clearly indicates that PCE therapies
should offered to clients in primary care, NHS, and other mental
health settings. Relying on multiple lines of evidence, such as
provided in the present study, provides a sound basis for establishing
public mental health policy.
Keywords: Outcome research, Person-Centred/Experiential
therapies, mental health policy
Biography: Prof. John C.
John Markowitz, M.D. is a Clinical Professor
of Psychiatry at Weill Medical College of Cornell University, Research
Psychiatrist at the New York State Psychiatric Institute, and Adjunct
Clinical Professor of Psychiatry at Columbia University. He was
graduated from the Columbia University College of Physicians &
Surgeons and did his psychiatric residency at the Payne Whitney
Clinic of New York Hospital. He began his research career at Cornell
under the tutelage of Drs. James Kocsis, the late Samuel Perry,
and the late Gerald L.Klerman. In 2001 he shifted from full time
employment at Cornell to the New York State Psychiatric Institute.
An NIMH Faculty Scholar Award allowed him to train in cognitive
behavioral therapy at the Beck Institute in Philadelphia while learning
interpersonal psychotherapy (IPT) from Dr. Klerman at Cornell. Dr.Markowitz's
research has included funded comparative studies of psychotherapy
and pharmacotherapy trials for depressed patients with HIV infection,
and dysthymic and other chronically depressed patients. He is also
conducting trials of IPT for patients with borderline personality
disorder and posttraumatic stress disorder. He has written or co-authored
fourteen books and more than 200 peer-reviewed articles and chapters.
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1. Interpersonal psychotherapy (IPT) is
one of the most tested empirically based psychotherapies. A time-limited,
diagnosis-targeted, manualized treatment, IPT defines psychiatric
diagnoses as treatable illnesses that are not the patient’s
fault. It focuses on the relationship between recent life events
and affects. Repeated randomized controlled trials have demonstrated
its efficacy in treating patients with major depressive disorder
and with bulimia, hence IPT has been included in treatment guidelines
for those disorders. More preliminary evidence suggests its possible
benefit for other psychiatric diagnoses. IPT has not shown efficacy
in four prior trials for substance use disorders.
2. I am currently involved in studies testing
adaptations of IPT for patients with posttraumatic stress disorder
(PTSD), borderline personality disorder, and major depression comorbid
with breast cancer. Other recent studies have evaluated the monotherapy
and combined IPT and nefazodone for major depression (in the Netherlands),
IPT for depressed inpatients (in Germany), an adaptation of IPT
as an adjunct to pharmacotherapy for bipolar disorder (in the US),
and IPT for depressed medically ill patients (in Canada).
3. Although studies of differential therapeutics
are few, IPT may have advantages over cognitive behavioral therapy
for patients with greater depressive severity (cf., the NIMH TDCRP
study) and patients whose present illness contains meaningful life
events or interpersonal stressors. Conversely, CBT may be preferable
to IPT for patients reporting no life events, who fall into the
IPT category of “interpersonal deficits.”
4. Important future research may include:
1) extending IPT to other disorders (e.g., as a non-exposure-based
approach to treating PTSD), 2) more comparative studies with other
psychotherapies to determine differential therapeutics, and 3) sequencing
studies of when and how to combine IPT with pharmacotherapy.
Biography: Prof. Lars-Göran Öst
Lars-Göran Öst, Ph.D. is professor
of clinical psychology at Stockholm University, Sweden, and also
has a part-time position at the University of Bergen, Norway. He
has been doing research on the psychological treatment of anxiety
disorders for the last 30 years, and published randomized controlled
trials on cognitive behavior therapy for adults with specific phobias,
social phobia, agoraphobia, panic disorder, generalized anxiety
disorder and post-traumatic stress disorder. Recently, he has also
done RCTs in children and adolescents with specific phobia and social
phobia. He has published about 200 articles, book chapters and books.
Besides his academic job he also has a small private practice.
Cognitive Behaviour Therapy in anxiety disorders.
Professor Lars-Göran Öst, Department
of psychology, Stockholm University, Sweden
Behavioural and cognitive-behavioural treatments
for various anxiety disorders have been evaluated in randomized
clinical trials (RCTs) for the past 40 years, and there are more
than 400 RCTs published during this time. Various authors have described
which psychological treatments are empirically supported for the
different anxiety disorders.
- Summarizing these reports I found the
following treatments to be empirically supported:
- Exposure in-vivo for specific phobias,
social phobia, panic disorder with agoraphobia.
- Exposure in imagination for post-traumatic
- Exposure and response prevention for
obsessive compulsive disorder.
- CBT (cognitive therapy plus exposure)
for social phobia, panic disorder with or without agoraphobia,
generalised anxiety disorder, PTSD.
- Applied relaxation for panic disorder
without agoraphobia, generalised anxiety disorder.
- Applied tension for blood-injury phobia.
- Panic control treatment for panic disorder
The meta-analyses published showed average
controlled effect sizes (ES) from 0.69 (panic disorder without agoraphobia)
to 1.53 (PTSD), and uncontrolled ESs from 0.72 (social phobia) to
2.10 (GAD). However, a problem with meta-analyses is that they lag
behind and sometimes new and better treatments haven’t been
included in these analyses. To check this possibility I selected
the best treatment within each anxiety disorder and now the controlled
ESs varied from 1.56 (social phobia) to 2.40 (panic disorder without
agoraphobia), and the uncontrolled ESs from 2.26 (social phobia)
to 2.86 (specific phobias). On average, the best treatments yielded
controlled and uncontrolled ESs that were twice as high as the means
from the meta-analyses.
Thus, the efficacy studies show that a number
of CBT-treatments are empirically supported and give high ESs, but
then another question becomes important: Does CBT work in clinical
settings? To answer this question data base searches of effectiveness
studies were done up to 2007. The inclusion criteria were that the
study must be clinically representative, the patients must fulfill
an anxiety diagnosis, and the treatment must be one of the empirically
supported CBT-treatments. A total of 67 studies were found and for
these the uncontrolled ES was calculated. These were then statistically
compared with the mean uncontrolled ES from the most current meta-analysis
of efficacy studies for each anxiety diagnosis. The effectiveness
studies had mean ESs from 1.05 (GAD) to 2.05 (PTSD) but in no case
was the difference between efficacy and effectiveness studies significant,
neither at post-treatment, nor at follow-up. This means that CBT
works as well in clinical settings as in university departments.
Some of the most important questions for
future research are: To improve current treatments and develop new
treatments for OCD, GAD, and PTSD; To develop briefer and less expensive
treatments without losing clinical efficacy; To match patient characteristics
and treatment method; To evaluate early treatment in primary care;
How to best disseminate CBT to clinicians; How to best combine different
treatments; How to switch to another treatment when the first one
- Behaviour Research and Therapy (Elsevier)
- Behavioural and Cognitive Psychotherapy
(Cambridge University Press)
- Behavior Therapy (Elsevier)Cognitive
Behaviour Therapy (Taylor & Francis)
- British Association for Behavioural &
Cognitive Psychotherapies (www.babcp.org.uk)
- European Association for Behavioural
& Cognitive Therapies (www.eabct.com)
- Association for Behavioral and Cognitive