Utility of psychotherapy

Question 1

Write an introduction to discussing the utility of psychotherapy

Answer 1

• Mental health crisis is occuring in the UK, with an estimated 1 in 6 adults affected by common mental disorders (CMD) such as depressive and anxiety disorder
• Psychotherapy is recommended as first-line treatment for a variety of mental illness
• The essay will discuss the vital role of psychotherapy, and the reasons behinds its utility
• With a focus on depression (extensive evidence base) and schizophrenia (example of combination therapy)

Question 2

Discuss the indications for psychotherapy

Answer 2

• Offered alone (mild-moderate depression)
• Offered in combination with pharmacogical therapy (schizophrenia, moderate-severe depression)
• Patient choice is key to what type is delivered
• CBT is often initially offered due to its largest evidence base

Question 3

Discuss the importance of psychotherapy technique

Answer 3

• NICE (2018) recognises that absence of evidence does not mean evidence of no effect
• Like biological therapies, recommended psychotherapies will not necessarily benefit everyone
• Important to remember factors (therapist, alliance) that influence psychotherapy outcome other than the technique utilised
• Some suggest technique (such as CBT) only account for 15% of the overall effect (Assay & Lambert, 1999)
• Patient centred care is crucial for optimal care, as will be discussed

Question 4

Outline the key areas where psychotherapy is a useful tool for treatment of mental health

Answer 4

• Evidence-base supports psychotherapy producing greater outcomes than controls
• Equivocal effect as medication
• Greater effect on relapse rate (29.5% vs 60%)
• Cost-effective
• Improvements in medication adherence (Family intervention therapy)

Question 5

Discuss the effectiveness of psychotherapy

Answer 5

• A review of 40-years of cognitive therapy research (Beck, 2005)
• Clinically significant findings across a variety of CMD
• Improvments in depressive symptomology and relapse rates
• Compared to controls, CBT produced large effect sizes for unipolar depression, GAD, panic disorder, social anxiety disorder, and childhood anxiety and depression
• Adjunctive CBT also produce a large uncontrolled effect size for schizophrenia
• Equivocal effect as ADM in adolescent depression (Iftene, 2015)
• Much more favorable in terms of relapse rates (29.5% vs 60%) (Beck, 2005)

Question 6

Discuss the two common techniques for depression

Answer 6

• CBT helps identify negative beliefs and behaviours, to break maladaptive cycles, and provide new coping strategies
• IPT focuses on social and interpersonal relationships to identify problems areas and provide new coping strategies
• Evidence shows both are effective for depression, with a 55% improvement in symptoms
• CBT is more effective in severe depression (Hutchinson, 2018)

Question 7

Discuss the cost-effectiveness of psychotherapy

Answer 7

• Prevention is better than cure, with Computerised CBT and self-help adovcated for sub-threshold and mild depression, GAD and panic disorder (NICE, 2018)
• These are cost effective strategies of earlier intervention to prevent progression
• Psychotherapy as a whole is effective and often highly cost-effective
• Creates savings across other medical fields (comorbidity is common)
• Societal costs in terms of disability benefits and returning to work (Lazar, 2014)

Question 8

Comment on combination therapy for Schizophrenia

Answer 8

• Combination therapy is the most effective management for schizophrenia (NICE, 2014)
• Interestingly, patients can try psychotherapy alone, but not antipsychotics alone.
• Highlights the important role of psychotherapy for maintance of remission
• Biological therapies form one part of holistic care package to optimise patient case
• Psychological and social interventions play an equal if not more important role, especially with medication adherence
• Need for antipsychotics to restore insight, otherwise potential breakdown of therapeutic alliance

Question 9

Describe the importance of family intervention therapy

Answer 9

• ​Family intervention therapy tackles high expressed emotion (meausre of hostile family)
• This is a key precipitating and perpetuating factor
• Consistently shown to improve medication adherence, reduce relapse and hospitilisation rates, and reduce disease burden (Hutchinson, 2018)
• Recent study reported non-adherence to antipsychotics in shciphrenia to be as high as 50% (Henderson et al, 2015)