Are certain therapeutic modalities better suited for specific disorders? Like depression or Bipolar disorder?

This forum made possible through the generous support of SDN members, donors, and sponsors. Thank you.
T

Tom4705

Full Member
5+ Year Member
Joined
Mar 23, 2019
Messages
76
Reaction score
6
Obviously a connection with the therapist matters, I'm just asking if there is more efficacy demonstrated amongst various modalities for certain issues. Like I heard that DBT is better for Borderline patients. Is psychodynamic/psychoanalytic useful for depression/bipolar disorder? Assuming of course that psychopharmacology is incorporated into the treatment plan.
Members don't see this ad.
 
My understanding is that CBT is most effective for depression
 
  • Like
Reactions: 1 user
The below link is Division 12's collection of treatments with each one's listed level of empirical support for treating stated conditions:

Treatments | Society of Clinical Psychology

div12.org div12.org

I'll confess it is not exhaustive, as for example, it leaves out a number of pediatric treatments, such as Coping CAT, which has a robust body of literature supporting the efficacy in treating anxiety, or CBIT, which has a robust body of evidence in effectively treating tic disorder.
 
  • Like
Reactions: 7 users
Members don't see this ad :)
ExRP is pretty definitely more effective than other treatments (including psychodynamic ones) for OCD.
CBT-P is pretty definitely more effective for psychosis than are psychodynamic treatments.
CPT, PE, and CBT-TF are pretty definitely more effective than psychodynamic treatments for trauma disorders.

There are some pretty compelling and strong arguments/data which challenge the so-called "Dodo bird verdict," or the notion that all bona fide therapies are essentially equally effective.
 
  • Like
Reactions: 2 users
EnPsychlopedia said:
ExRP is pretty definitely more effective than other treatments (including psychodynamic ones) for OCD.
CBT-P is pretty definitely more effective for psychosis than are psychodynamic treatments.
CPT, PE, and CBT-TF are pretty definitely more effective than psychodynamic treatments for trauma disorders.

There are some pretty compelling and strong arguments/data which challenge the so-called "Dodo bird verdict," or the notion that all bona fide therapies are essentially equally effective.
Click to expand...

I mean, yeah, if you want to be intellectually honest about things. But, it's so much easier to lump disparate things together to wash out variance to pursue a pre-established narrative.
 
  • Like
Reactions: 9 users
WisNeuro said:
I mean, yeah, if you want to be intellectually honest about things. But, it's so much easier to lump disparate things together to wash out variance to pursue a pre-established narrative.
Click to expand...
Wampold and Shedler don't want to hear it, but it's true!
 
  • Like
Reactions: 2 users
EnPsychlopedia said:
ExRP is pretty definitely more effective than other treatments (including psychodynamic ones) for OCD.
CBT-P is pretty definitely more effective for psychosis than are psychodynamic treatments.
CPT, PE, and CBT-TF are pretty definitely more effective than psychodynamic treatments for trauma disorders.

There are some pretty compelling and strong arguments/data which challenge the so-called "Dodo bird verdict," or the notion that all bona fide therapies are essentially equally effective.
Click to expand...
Also, for SUDs, CBT approaches have a much more robust evidence base than psychodynamic approaches (as far as I know).

Really, the whole "all therapies are equal" narrative only works if you pick like 2-3 categories of disorder (unipolar depression, mild to moderate general anxiety) and exclude anything more complex.
 
WisNeuro said:
I mean, yeah, if you want to be intellectually honest about things. But, it's so much easier to lump disparate things together to wash out variance to pursue a pre-established narrative.
Click to expand...
So psychoanalysis/psychodynamic/psychoanalytic psychotherapy is not effective for the treatment of mood disorders or any other psychological disorders? Or at least, doesn't have evidence demonstrating effectiveness?
 
Tom4705 said:
Is psychodynamic/psychoanalytic useful for depression/bipolar disorder?
Click to expand...

Time-limited/brief dynamic therapy has some utility for this (refer to the link in the post above), but the efficacy studies generally support CBT for depression (i.e., cognitive therapy, behavioral activation, problem-solving therapy etc.). For (edit: bipolar symptoms), psychoeducation and support from psychiatrists and case managers is typically most useful, but the patient might benefit from CBT if there are comorbidities like ADHD or an anxiety disorder.
 
Last edited:
  • Like
Reactions: 1 user
Tom4705 said:
So psychoanalysis/psychodynamic/psychoanalytic psychotherapy is not effective for the treatment of mood disorders or any other psychological disorders? Or at least, doesn't have evidence demonstrating effectiveness?
Click to expand...

I made no comment on that at all. My comments were strictly about the severe empirical/methodological limitations and missteps of an area of literature that many people parrot and take to be a universal constant, but very few people have even read the material, let alone understand how to actually evaluate it to determine it's strengths and weaknesses.
 
  • Like
Reactions: 1 user
R. Matey said:
Time-limited/brief dynamic therapy has some utility for this (refer to the link in the post above), but the efficacy studies generally support CBT for depression (i.e., cognitive therapy, behavioral activation, problem-solving therapy etc.). For mania, psychoeducation and support from psychiatrists and case managers is typically most useful, but the patient might benefit from CBT if there are comorbidities like ADHD or an anxiety disorder.
Click to expand...

IPSRT is a thing that has a fair amount of evidence for bipolar disorder, but if we're talking about what therapies are useful for treating someone who is acutely manic, probably not helpful. But not sure I buy that much else is in that moment.
 
  • Like
Reactions: 2 users
  • Like
Reactions: 1 user
Members don't see this ad :)
clausewitz2 said:
IPSRT is a thing that has a fair amount of evidence for bipolar disorder, but if we're talking about what therapies are useful for treating someone who is acutely manic, probably not helpful. But not sure I buy that much else is in that moment.
Click to expand...
This thread made me imagine an analyst trying to do free association with someone in the throes of mania.

The only helpful therapy in mania is behavioral therapy...specifically the behavior of taking medications.
 
  • Like
Reactions: 8 users
aim-agm said:
This thread made me imagine an analyst trying to do free association with someone in the throes of mania.

The only helpful therapy in mania is behavioral therapy...specifically the behavior of taking medications.
Click to expand...
Behavior of ensuring adequate sleep is also extremely helpful IME
 
  • Like
Reactions: 2 users
I think what confuses some people is that in order to implement any technique or therapeutic strategy, you need to be able to establish rapport. If all you do is establish rapport, that would probably only really be helpful for the milder cases. Developing good skills and understanding of how and why those skills work to establish rapport and engagement and motivation to implement change is critical and we could probably use more research on that. In other words, I work with patients all the time who failed at and hate on DBT and ERP and CBT. Mainly because the modality was clumsily delivered by poor clinicians and institutions.
With Bipolar Disorder, helping the patient deal with the sequelae of the condition and engage in collaborative and effective medication strategies with their psychiatrist is essential and requires great skills. Same with schizophrenia.
For any patient with significant mental illness, we can help them improve interpersonal functioning which I think can have a lot of benefit regardless of diagnosis, but I don’t know if we have much research on that aspect.
 
  • Like
Reactions: 1 users
R. Matey said:
He's also got a nice review that in essence argues that both paradigms have statistical flaws: The Role of Common Factors in Psychotherapy Outcomes - PubMed

I guess we should all just move to Hawaii and start a shawarma stand. Dibs on Pirate Pita.
Click to expand...
The only shawarma stand in Honolulu is run by some jerk who refuses to follow health department rules, so there’d be a market! ;) You’d have to get used to not having air conditioning in 80-90 degree weather, though…
 
  • Like
Reactions: 1 user
Tom4705 said:
Obviously a connection with the therapist matters, I'm just asking if there is more efficacy demonstrated amongst various modalities for certain issues. Like I heard that DBT is better for Borderline patients. Is psychodynamic/psychoanalytic useful for depression/bipolar disorder? Assuming of course that psychopharmacology is incorporated into the treatment plan.
Click to expand...

In truth no clinician should live in the bubble of 1 modality. Not because it is effective for 1 person’s underlying lived experience does it mean it will apply to everyone’s. Then again, most clinicians will think otherwise. That is why the field of mental health currently lives in a vacuum with not only a lack of efficiency, but a lack of effectiveness. As a mental health professional your training should equip you with a variety of “tools” to help varied circumstances whether they end with depression or not.

I applaud your asking this question, and do hope I have not offended your desire to learn more. In fact, I find that to be missing almost everywhere I look. Humans were not meant to live in vacuums, and neither have their experiences.
 
itsmelily said:
In truth no clinician should live in the bubble of 1 modality. Not because it is effective for 1 person’s underlying lived experience does it mean it will apply to everyone’s. Then again, most clinicians will think otherwise. That is why the field of mental health currently lives in a vacuum with not only a lack of efficiency, but a lack of effectiveness. As a mental health professional your training should equip you with a variety of “tools” to help varied circumstances whether they end with depression or not.

I applaud your asking this question, and do hope I have not offended your desire to learn more. In fact, I find that to be missing almost everywhere I look. Humans were not meant to live in vacuums, and neither have their experiences.
Click to expand...
I understand what you're saying but isnt it better to specialize in one modality and be able to effectively help those more likely to respond positively to it than it is to be a jack of all trades and not become especially proficient in one modality? I'm aware that one modality cannot help everyone in the same way a mechanic cannot fix all cars, but wouldn't it be more effective to specialize in one so you become more proficient at treating a subset of the population?
 
  • Like
Reactions: 1 user
futureapppsy2 said:
The only shawarma stand in Honolulu is run by some jerk who refuses to follow health department rules, so there’d be a market! ;) You’d have to get used to not having air conditioning in 80-90 degree weather, though…
Click to expand...

The ocean will be my air conditioner and adherence to health department regulations will be my EPB.
 
  • Like
Reactions: 2 users
Tom4705 said:
I understand what you're saying but isnt it better to specialize in one modality and be able to effectively help those more likely to respond positively to it than it is to be a jack of all trades and not become especially proficient in one modality? I'm aware that one modality cannot help everyone in the same way a mechanic cannot fix all cars, but wouldn't it be more effective to specialize in one so you become more proficient at treating a subset of the population?
Click to expand...
I'm not frequently a therapist in my day job, but it's typically very possible for many/most psychologists to have in-depth training and expertise in more than one therapeutic modality or technique. The terminology differs, but there's probably more overlap between modalities than many people initially realize.
 
PsyDr said:
Back in my day, we called that Functional Analytic Psychotherapy. Oh god, are we on 4th wave CBT now?
Click to expand...
Tomato, tomato... :p

I'm a fan of anything that moves away from "CBT for..." X, Y, or Z condition and focuses instead on the effective processes that cut across various treatment "packages." ACT is basically graded exposure and behavioral activation in a nice package. Beck's CT is cognitive restructuring and behavioral activation in a similarly nice package.

In practice, I often use a little bit of Beck-like cognitive restructuring (cough, cough... defusion) to help build tolerance (or "space") for difficult thoughts, feelings, and realities (e.g., grief, hopelessness, disability, chronic pain, anxiety, etc. -- acceptance, self-as-context). Unlike Beck, and to be a little pedantic, I'm really "restructuring" the relationship someone has with those thoughts, feelings, or realities as opposed to their actual content (which is why I'm able to include "realities," like disability, on that list). At the same time, I also focus heavily on self-monitoring (mindfulness) and values-based behavioral activation (values, committed action) with (not despite) those difficult thoughts, feelings, and realities.

If you squint... you can start to see a hexaflex. While what I described is essentially ACT, you can see how I'm also specifically utilizing different CBT "processes." You can also see that I didn't mention a specific diagnosis or patient population for whom I tend to utilize this approach. This model is very similar to many "traditional" CBT for "anxiety NOS" packages (e.g., CBT for panic, CBT for chronic pain). My understanding is that Hayes did his postdoctoral training with Barlow, so this overlap is not by accident. Depending on patient need, I'll shift the degree to which I focus on the different processes described above (e.g., more exposure ["acceptance"] for someone with significant anxiety, more behavioral activation ["commitment"] for someone with depression, more tracking ["mindfulness"] for someone with significant cognitive dysfunction, etc.).

Having an idea of "active ingredients" (even if not totally born out in the science... although behavioral activation for depression essentially has been) from different treatment packages is an important skill. Consistent with ACT, this expertise allows clinicians to flexibly treat patients based on their needs and circumstances.

ETA: Not mentioned above but given that most patients I treat do have cognitive impairment, I often pull specific processes and strategies from problem-solving therapy and "CBT for ADHD," although I really wish the latter was called "CBT for executive dysfunction." I also casually incorporate some aspects of DBT in my work, too.
 
Last edited:
  • Like
Reactions: 6 users
Tom4705 said:
I understand what you're saying but isnt it better to specialize in one modality and be able to effectively help those more likely to respond positively to it than it is to be a jack of all trades and not become especially proficient in one modality? I'm aware that one modality cannot help everyone in the same way a mechanic cannot fix all cars, but wouldn't it be more effective to specialize in one so you become more proficient at treating a subset of the population?
Click to expand...

Yes. I agree completely! But in my experience, especially with mental health practitioners, clinicians, psychologists, they have more so focused on the person and not so much the modality. I think that effectiveness would come in that focus. My comment was meant as a general statement, but as aligned to your question, I say become an expert. That’s what I find missing. Ma h people consider themselves as CBT experts. Okay. But do you truly want to use CBT for everyone? This is actually a huge issue, internationally, right now. There is a desire for a more in-depth approach.
 
itsmelily said:
Yes. I agree completely! But in my experience, especially with mental health practitioners, clinicians, psychologists, they have more so focused on the person and not so much the modality. I think that effectiveness would come in that focus.
Click to expand...
Yes, many clinicians consider themselves not to be modality-focused. Often this leads to them not having a firm, competent grasp on any modality and just performing some messy, personally-derived "integrative" form of care that is usually just supportive listening. Not having a focus on at least one modality of treatment is not a good thing. "Person-centered" can be the modality (e.g., Rogerian approaches), but at least have a modality and be extremely competent in it.

itsmelily said:
My comment was meant as a general statement, but as aligned to your question, I say become an expert. That’s what I find missing. Ma h people consider themselves as CBT experts. Okay. But do you truly want to use CBT for everyone? This is actually a huge issue, internationally, right now. There is a desire for a more in-depth approach.
Click to expand...
More "in-depth approach" to what? Are you juxtaposing CBT against "in-depth?" Or is "in-depth" being juxtaposed against something else? If the former, I would challenge your understanding of CBT if you don't think it is "in-depth." To your larger point, no patient is best served by a clinician who is so concerned with being everything to everyone that they go about trying to learn every modality that might be helpful to someone who might one day walk in the door. Patients are far better served by a clinician who is extremely competent in a small handful of populations and/or scientifically-validated treatment approaches, and who isn't afraid to refer out when a particular patient does not not seem to be suitable for those central competencies. This is admittedly tougher in rural and other under-resourced areas where targeted intervention is much more difficult (or impossible) to access, but the answer isn't to just abandon modality focus and try on every hat, but rather to work flexibly within one's core competencies to try and serve as many folks as is prudent.
 
  • Like
Reactions: 4 users
EnPsychlopedia said:
Yes, many clinicians consider themselves not to be modality-focused. Often this leads to them not having a firm, competent grasp on any modality and just performing some messy, personally-derived "integrative" form of care that is usually just supportive listening. Not having a focus on at least one modality of treatment is not a good thing. "Person-centered" can be the modality (e.g., Rogerian approaches), but at least have a modality and be extremely competent in it.


More "in-depth approach" to what? Are you juxtaposing CBT against "in-depth?" Or is "in-depth" being juxtaposed against something else? If the former, I would challenge your understanding of CBT if you don't think it is "in-depth." To your larger point, no patient is best served by a clinician who is so concerned with being everything to everyone that they go about trying to learn every modality that might be helpful to someone who might one day walk in the door. Patients are far better served by a clinician who is extremely competent in a small handful of populations and/or scientifically-validated treatment approaches, and who isn't afraid to refer out when a particular patient does not not seem to be suitable for those central competencies. This is admittedly tougher in rural and other under-resourced areas where targeted intervention is much more difficult (or impossible) to access, but the answer isn't to just abandon modality focus and try on every hat, but rather to work flexibly within one's core competencies to try and serve as many folks as is prudent.
Click to expand...

“To your larger point” the subjectivity in your replies is so terribly defensive, and offensive, that you leave other peoples’ posts at the door when replying to them. Your interpretations change a statement. “their point” to yours only. Have you realized the bully you are on these forums?
 
  • Like
Reactions: 1 user
EnPsychlopedia said:
Yes, many clinicians consider themselves not to be modality-focused. Often this leads to them not having a firm, competent grasp on any modality and just performing some messy, personally-derived "integrative" form of care that is usually just supportive listening. Not having a focus on at least one modality of treatment is not a good thing. "Person-centered" can be the modality (e.g., Rogerian approaches), but at least have a modality and be extremely competent in it.


More "in-depth approach" to what? Are you juxtaposing CBT against "in-depth?" Or is "in-depth" being juxtaposed against something else? If the former, I would challenge your understanding of CBT if you don't think it is "in-depth." To your larger point, no patient is best served by a clinician who is so concerned with being everything to everyone that they go about trying to learn every modality that might be helpful to someone who might one day walk in the door. Patients are far better served by a clinician who is extremely competent in a small handful of populations and/or scientifically-validated treatment approaches, and who isn't afraid to refer out when a particular patient does not not seem to be suitable for those central competencies. This is admittedly tougher in rural and other under-resourced areas where targeted intervention is much more difficult (or impossible) to access, but the answer isn't to just abandon modality focus and try on every hat, but rather to work flexibly within one's core competencies to try and serve as many folks as is prudent.
Click to expand...

Your assumptions, of what others are saying, writing, communicating is leading the whole conversation astray. If you choose to “challenge” my understanding, maybe you should be open to reading the post first. Your challenge is cornering before you begin to listen. That’s not a challenge. It’s an assault.
 
  • Like
Reactions: 1 user
itsmelily said:
“To your larger point” the subjectivity in your replies is so terribly defensive, and offensive, that you leave other peoples’ posts at the door when replying to them. Your interpretations change a statement. “their point” to yours only. Have you realized the bully you are on these forums?
Click to expand...
With respect, I asked a question based on a somewhat unclear post you made on a public forum. Nothing I said was rude or combative. Several people evidently agreed with me. I said “If this is the point you’re making, then…”

You are more than welcome to describe your point more clearly and to object to my interpretation of it. Calling anything I’ve said “bullying” or “an assault” is a really dramatic reaction to a post on a public forum in which no insults have been levied and no harsh or otherwise inappropriate language used.

It is extremely difficult to understand your point without asking slightly leading questions because you use vague, somewhat opaque language. I gave you the courtesy of providing two interpretations of what you said (justaposing “more in-depth” with CBT or with something else, and then simply said “If the former, then…” I am not assuming that you meant the former, just responding to a point you may have been making…).

So, should you like me or anyone else to have a better understanding of the point you’re making in your original comment, then please feel free to correct the record. Unlike many people on the Internet, I don’t want to waste my time arguing (by which I simply mean “Conversing with the intent to make a point,” not “Being combative”) against straw men. If you feel your point has been represented unfairly, then please let me know and I’ll be happy to engage with a different version of your position.
 
Last edited:
  • Like
Reactions: 1 user
When folks characterize CBT as 'not deep', it just signals to me that they clearly have never seen someone conquer an anxiety disorder or talked with a patient about their core beliefs. It's pretty meaningful stuff considering that's why they walked through the door in the first place.
 
  • Like
Reactions: 4 users
R. Matey said:
When folks characterize CBT as 'not deep', it just signals to me that they clearly have never seen someone conquer an anxiety disorder or talked with a patient about their core beliefs. It's pretty meaningful stuff considering that's why they walked through the door in the first place.
Click to expand...
Very few folks in the field, relatively speaking, are actually trained in CBT. Many folks in the field have been introduced to very basic aspects of it, and simply "don't know what they don't know" when they try to talk about it beyond some simple CBT exercises and concepts/
 
  • Like
Reactions: 5 users
WisNeuro said:
Very few folks in the field, relatively speaking, are actually trained in CBT. Many folks in the field have been introduced to very basic aspects of it, and simply "don't know what they don't know" when they try to talk about it beyond some simple CBT exercises and concepts/
Click to expand...
I assume all mental healthcare providers are offering supportive psychotherapy until I have evidence to support that they're actually offering something evidence-based and / or consistent with CBT.
 
  • Like
Reactions: 3 users
bcliff said:
I assume all mental healthcare providers are offering supportive psychotherapy until I have evidence to support that they're actually offering something evidence-based and / or consistent with CBT.
Click to expand...

I run under a similar assumption. My specific referral list is pretty much only doctoral providers of whom I know their training backgrounds.
 
  • Like
Reactions: 1 user
R. Matey said:
When folks characterize CBT as 'not deep', it just signals to me that they clearly have never seen someone conquer an anxiety disorder or talked with a patient about their core beliefs. It's pretty meaningful stuff considering that's why they walked through the door in the first place.
Click to expand...
An easy example of this is CPT.
itsmelily said:
Yes. I agree completely! But in my experience, especially with mental health practitioners, clinicians, psychologists, they have more so focused on the person and not so much the modality. I think that effectiveness would come in that focus. My comment was meant as a general statement, but as aligned to your question, I say become an expert. That’s what I find missing. Ma h people consider themselves as CBT experts. Okay. But do you truly want to use CBT for everyone? This is actually a huge issue, internationally, right now. There is a desire for a more in-depth approach.
Click to expand...
Can you explain what you mean?
 
  • Like
Reactions: 1 user
itsmelily said:
Your assumptions, of what others are saying, writing, communicating is leading the whole conversation astray. If you choose to “challenge” my understanding, maybe you should be open to reading the post first. Your challenge is cornering before you begin to listen. That’s not a challenge. It’s an assault.
Click to expand...

Seriously?
 
  • Like
Reactions: 1 user
R. Matey said:
Right, that's my take. I'm not formally trained in CPT, but it seems very similar to cognitive therapy for depression in which I've had a good amount of supervision and training.
Click to expand...
Doing CPT with patients has me feeling a lot like Albert Ellis.
 
  • Like
Reactions: 1 users
WisNeuro said:
Dead, both within and without?
Click to expand...
Season 3 Episode 304 GIF by Rick and Morty
 
You must log in or register to reply here.
Next unread thread

Similar threads

calimich
PhD/PsyD panic disorder, major depression, anxiety disorder, brief psychotic disorder, tbi, ptsd?
Replies
2
Views
824
PsyDr
PsyDr
B
bipolar affective disorder terminology
Replies
28
Views
1K
bluecolourskies
B
L
PhD program for personality disorder research
Replies
39
Views
2K
smalltownpsych
smalltownpsych
Fan_of_Meehl
Chronic Pain and the Differential Diagnosis of Mood Disorders
Replies
13
Views
924
PsyDr
PsyDr
futureapppsy2
Interesting article on students with clinical depression who do and do not identify as depressed/having depression
Replies
45
Views
2K
R. Matey
R. Matey
Top