What is the place of psychological treatments in mood disorders?

Abstract

While psychotherapy has many applications for mood disorders, this paper focuses on those psychotherapies (cognitive behaviour therapy or CBT, and interpersonal psychotherapy or IPT) that have been manualized, extensively evaluated, and positioned as definitive therapies for unipolar depressive disorders. This paper suggests some reasons as to why their role and utility remain unclear. First, despite many randomized controlled efficacy studies, differentiation from other psychotherapies or control interventions appears to occur only when the actual control treatment possesses few therapeutic ingredients. Second, their testing as if they have universal application for non-specific diagnostic entities (e.g. major depression), in trials where there is a high rate of non-specific responsivity to intervention, has limited our capacity to identify the circumstances in which such treatments have specific benefits. Thus, many of the limitations to the knowledge base more reflect limitations reflecting the current evaluation of all antidepressant therapies rather than being unique to the psychotherapies. This paper argues for a change in the paradigms for evaluating the psychotherapies, and argues for a 'horses for courses' approach for conceptualizing the roles of the psychotherapies in managing mood disorders, rather than any model assuming their universal application.