Psychological treatments for Mental Disorder in adults

A review of the evidence of leading organisations

Fri, 10 May 2019

Psychological treatments for Mental Disorder in adults: A review of the evidence of leading organisations

Juan Antonio Moriana, Mario Galvez-Lara, Jorge Corpas

Introduction

Evidence-based psychological treatments is regarded as the best practice for treatment of mental health morbidities. The study analyses RCTs, reviews, meta-analysis, guides and reviews from 4 different organisations in relation to mental health disorders and the level of agreement among organisations associated evidence-based psychological treatments.

Organizations

  1. Society of Clinical Psychology (Division 12) of the APA
  2. National Institute for Health and Care Excellence (NICE)
  3. Cochrane Collaboration
  4. The Australian Psychological Society (APS)

Objective

The main objective of the study is to analyse best practice for the treatment of mental health disorders.

Abbreviations Used

  • CBT: Cognitive Based Therapy
  • ACT: Acceptance and Commitment Therapy
  • AR: Applied Relaxation
  • BT: Behavioural Therapy
  • ET: Exposure Therapy
  • IPT: Interpersonal Therapy
  • MDFN: Mindfulness
  • PDT: Psychodynamic Therapy
  • PE: Psycho-education
  • SHT: Self-Help Therapy
  • SST: Social Skill Training
  • ST: Supportive Therapy
  • CAT: Cognitive Analytical Therapy
  • DBT: Dialectical Behaviour Therapy
  • FBT: Family-based Treatment
  • EMDR: Eye Movement Desensitisation and Reprocessing
  • PCT: Present-Centred Therapy
  • PEX: Prolonged Exposure
  • SIT: Stress Inoculation Therapy
  • BAT: Behaviour Activation Therapy
  • CCBT: Computerised Cognitive Based Therapy
  • EFT: Emotion-Focussed Therapy
  • CRT: Cognitive Remedial Therapy
  • COMET: Competitive Memory Training
  • COT: Couples Therapy
  • REBT: Rational Emotive Behaviour Therapy

Findings

The authors used ICC (Intra-Class Correlation) statistic for assessing IRR (Inter-rater reliability) to assess the level of agreement among organization for each diagnosis. Higher ICC suggests higher IRR. ICC 1 indicates perfect agreement. -1 Suggest strong disagreement.

Mental health Illness Most Used Treatments ICC
1 Generalised Anxiety Disorder CBT 0.889
2 Panic Disorder CBT 0.485
3 Social Anxiety Disorder CBT 0.435
4 Specific Phobias Exposure Therapy 0.816
5 Anorexia Nervosa FBT, CBT 0.741
6 Bulimia Nervosa CBT, IPT 0.819
7 Binge Eating Disorder CBT 0.396
8 Post Traumatic Stress Disorder EMDR 0.435
9 Adjustment Disorder CBT, MBCT -1
10 Depression BAT, CBT 0.022
11 Obsessive Compulsive Disorder CBT 0.809
12 Bipolar Disorder FBT, IPSRT 0.075
13 Schizophrenia CBT, FFT 0.704
14 Personality Disorder DBT 0.53
15 Insomnia CBT -0.112
16 ADHD CBT 0.731
17 Hypochondriasis CBT, CT, psycoeducation -1.39
18 Body Dysmorphic Disorder CBT

Discussion

  1. The results of analysis shows that agreement is low for most of the disorders. \

  2. Excellent Agreement (ICC between 0.75 and 1): GAD, Specific Phobias, bulimia nervosa, OCT

  3. Good Agreement (ICC between 0.60 and 0.74): Anorexia nervosa, Schizophrenia, ADHD

  4. Low Agreement (ICC between 0.40 and 0.59): Panic Disorder, SAD, PTSD, Personality Disorder.

  5. Poor Agreement (ICC less than 0.40): All others.

  6. Several reasons for these low level disagreement are discussed in the paper including: organisation’s biases; the fact that different organisations used different study to determine their effectiveness; different criteria used by different organisations to evaluate treatments; evidences were made at different time periods.

The study compare evidence provided by for leading International organisations on different psychological treatments for the principal adults mental disorders. From the main findings, it should be highlighted that there is no consensus regarding the evidence presented to support the effectiveness of psychological treatments for most mental disorders in adults. The therapies based on CBT models are those that have shown higher level of evidence. In addition, although there are plethora of treatments for many of the disorders mentioned above, not all offer the same quality of evidence to support them. As a result, we need to contribute to improving the quality of Randomized Controlled Trials (RCTs) through more independent studies that promote and contemplate reproducibility as a much more important criterion than evisaged so far.

References

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Suresh Kumar Mukhiya

I (Suresh Kumar Mukhiya) am a Ph.D. candidate with passion in Artificial Intelligence (Machine Learning, Deep Learning), Big data analytics and Web Application development using latest technologies like React, Redux, Redux-Saga, ECMAScript 6 and WordPress. I prefer spending time reading about big data and AI. Apart from that, I do photography.