Coming from the field of substance abuse where complete abstinence over a prolonged period of time is often an unrealistic goal, Nathan told PT, "I don't think it's necessarily fair that treatment should only be judged effective if all the symptoms disappear. If the treatment results in an improved quality of life with a substantial reduction in symptoms, that's success." Westen countered, "The data argue for humility."
If therapy-outcomes researchers have cast their findings in the best possible light, they may have been motivated by the contentious and politicized environment in which they have had to conduct their research. "People really wanted to dispel the myth that the most effective treatment was always medication," Westen said.
On another front, proponents of cognitive-behavioral therapies had "disdain for long-term, especially psychodynamic, treatment that had never been tested in the laboratory," according to Westen. The catch-22 of testing those therapies now is that their methodologies do not fit the short-term, manualized, controlled efficacy trials that have developed as the gold standard for assessing treatments -- whether pharmacological or psychological.
"The requisites of doing good science from a controlled clinical trial point of view -- brief, manualized treatments that are as close to identical across subjects as possible -- has made it virtually impossible for anything but a small range of treatments to be tested," explained Westen.
Medication trials are now coming under Westen and Morrison's scrutiny. How do they compare with the empirically validated therapies? "The data look about the same or worse for most classes of medications for most disorders," said Westen. "The reporting practices are equally problematic, and there is very little research that follows patients up at clinically meaningful outcome intervals of a year or more."