Is it true that "All have won and deserve prizes"?

A recent discussion of this issue on the Academy of Cognitive Therapy listserv made a number of good points:

1. Of course there are a number of "common factors" that are important.

2. It is risky to draw the conclusion that treatments are equivalent on the basis of having failed to find a significant difference between treatments unless one has examined the power of the statistical tests being used. If the statistical tests being used have inadequate power, they may fail to find a significant difference even if there are real differences.

3. It doesn't make a lot of sense to conduct meta-analyses that lump together studies conducted on different problems and different populations. Doing this kind of meta-analysis to see whether all psychotherapies are equally effective is like asking whether all medications are equally effective and doing a meta-analysis of all medication trials.

4. In general, post-hoc comparisons that lump disparate studies together fail to find significant differences between therapist. Studies that compare two or more treatment approaches for a specific problem often find significant differences.

5. Those who are arguing that all therapies are equally effective are really missing the point. The question isn't whether all therapies are equally effective or not. The question is "Which treatment approach is likely to be most effective for this individual with this problem?"

Here are some relevant references:

Ablon, J.S. & Jones, E.E. (1999) Psychotherapy process in the National Institute of Mental Health Treatment of Depression Collaborative Research Program, Journal of Consulting and Clinical Psychology, 67, 1, 64-75.

Ablon, J.S. & Jones, E.E. (2002) Validity of controlled clinical trials of psychotherapy: findings from the NIMH Treatment of Depression Collaborative Research Program, American Journal of Psychiatry, 159, 5, 775-780.

Barrowclough, C. et al. (2001). A randomized trial of the effectiveness
of cognitive-behavioral therapy and supportive counseling for anxiety
symptoms in older adults. JCCP, 69, 756-762.

Bowers, T.G., & Clum, G.A. (1988). Relative contribution of specific and
nonspecific treatment effects: Meta-analysis of placebo-controlled
behavior therapy research. Psychological Bulletin, 103, 315-323.

Brent, D.A. et al. (1997). A clinical psychotherapy trial for adolescent
depression comparing cognitive, family, and supportive therapy. Archives
of General Psychiatry, 54, 877-885.

Ehlers, A., & Clark, D.M. (2003). Early psychological interventions for
adult survivors of trauma: A review. Biological Psychiatry, 53, 817-826.

Frank, J.D., & Frank, J.B. (1991) Persuasion and Healing: Comparative Study of Psychotherapy. Baltimore: John Hopkins Press.

Gabbard, G.O., Gunderson, J.G., & Fonagy, P. (2002) The place of psychoanalytic treatments within psychiatry, Archives of General Psychiatry, 59, June, 505-510.

Jones, E.E. & Pulos, S.M. (1993) Comparing the Process in psychodynamic and cognitive-behavioral therapies, Journal of Consulting and Clinical Psychology, 61, 2, 306-316.

Martell, C.R., Addis, M.E., & Jacobson, N.S. (2001) Depression in Context: Strategies for Guided Action. New York: Norton & Company.

Shear, M.K. et al. (2001). Emotion-focused psychotherapy for patients
with panic disorder. Am. J. Psychiatry, 158, 1993-1998.

Wampold, B.E. (2001) The Great Psychotherapy Debate: Models, Methods, and Findings. Mahwah, NJ: Lawrence Erlbaum

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