Cognitive-Behavioral Therapy and Psychodynamic Psychotherapy: Techniques, Efficacy, and Indications

Article excerpt

In this article, we provide an overview of the techniques and efficacy of the two most commonly used psychotherapeutic treatments of psychiatric disorders in adults: cognitive-behavioral and psychodynamic therapy. Psychotherapeutic techniques, major indications, and empirical evidence will be presented. The focus will be on empirically supported models of treatment.

Context: Cognitive-behavioral therapy and psychodynamic psychotherapy are the most frequently applied methods of psychotherapy in clinical practice.

Objective: To give an up-to-date description of cognitive-behavioral therapy and psychodynamic psychotherapy and to review empirical evidence for efficacy in specific mental disorders.

Data Sources: Systematic reviews of psychotherapy outcome research based on evidence-based methods were used. In order to identify more recent trials, Medline, PsycInfo, Pubmed, and Current Contents were searched in addition in July 2005 using database-specific keywords. In October 2005, the search was updated. Text books and journal articles were used as well.

Study selection: The authors reviewed the available systematic surveys and meta-analyses as well as the additionally identified studies using established inclusion criteria.

Data extraction: Following the evidence-based methods of the Canadian Task Force on Preventive Health Care, an established hierarchy of study designs was applied. Using rigorous criteria, only evidence from randomized controlled trials (Type 1 studies) was included. The authors independently assessed for which mental disorders randomized controlled trials provide evidence for the efficacy of cognitive-behavioral therapy or psychodynamic psychotherapy in specific disorders.

Data synthesis: The efficacy of cognitive-behavioral in many mental disorders has been demonstrated by a substantial number of randomized controlled trials and several meta-analyses. However, for specific disorders the rates of treatment responders are not yet sufficient. For psychodynamic psychotherapy, clearly less efficacy studies are available. However, the available studies provided evidence that psychodynamic psychotherapy is an effective treatment of specific mental disorders as well.

Conclusions: Although there is substantial evidence for the efficacy of cognitive-behavioral therapy and some evidence for the efficacy of psychodynamic psychotherapy, further studies are required to improve the positive outcome rates of treatment responders in specific mental disorders. For psychodynamic psychotherapy further studies of specific forms of treatment in specific mental disorders are required to corroborate the available results.

DEFINITION OF COGNITIVE-BEHAVIORAL THERAPY

Cognitive-behavioral therapy (CBT) represents a unique category of psychological interventions based on scientific models of human behavior, cognition, and emotion (Dobson, 2000). It includes a wide range of treatment strategies that take the current knowledge about the etiology and maintenance of the different mental disorders into account (Beck, 1995; Beck, 2005; Cutler, Goldyne, Markowitz, Devlin, & Click, 2004; Hayes, Follette, & Linehan, 2004; Kanfer & Phillips, 1970; Masters, Burish, Hollon, & Rimm, 1987). Patients and therapists work together to identify and understand problems in terms of the relationship between thoughts, feelings, and behavior. The focus lies in the here and now. Individualized, usually time-limited therapy goals are formulated. CBT intends to directly target symptoms, reduce distress, re-evaluate thinking and promote helpful behavioral responses. The therapist supports the patient to tackle problems by harnessing his or her own resources. Specific psychological and practical skills are acquired (e.g., reflecting and reevaluating the meaning attributed to a situation with subsequent behavior changes) and the therapist actively promotes change with an emphasis on putting what has been learned into practice between sessions ("homework"). …