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Cognitive-Behavioral and Psychodynamic-Interpersonal Therapies

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Cognitive-Behavioral and Psychodynamic-Interpersonal Therapies

Psychological disorders are among the highest contributors to high healthcare costs

globally. According to the World Health Organization (2022), 1 in every eight people,

representing 970 million, live with a mental disorder globally. The number increased

significantly during the COVID-19 pandemic, with anxiety and major depressive disorders

leading. Anxiety disorders in 2019 affected at least 301 million, including 58 million children

and adolescents, while 280 million people were living with depression, including 23 million

children and adolescents in the same year (WHO, 2022). Other potential psychological disorders

include bipolar disorder, post-traumatic stress disorder, schizophrenia, eating disorders,

disruptive behavior, dissociative disorders, and neurodevelopmental disorders. Cognitive

behavioral therapy and psychodynamic psychotherapies are considered appropriate and effective

treatments for various psychological disorders (Cuijpers et al., 2021; Leichsenring & Klein,

2020). Despite being the two most effective therapies for various mental disorders, evidence to

support their effectiveness is insufficient. This paper seeks to interrogate published literature to

find evidence supporting the efficacy and effectiveness of cognitive behavioral therapy and

psychodynamic psychotherapies in treating different mental disorders.

Cognitive behavioral therapy is one of the widely used interventions for mental disorders.

According to David et al. (2018), CBT is arguably the gold standard of psychotherapy. CBT

defines a class of interventions that share the fundamental premise that mental disorders and

psychological distress are maintained by cognitive factors (Linde et al., 2015; Gautam et al.,

2020). The core premise of the interventions is that maladaptive cognitions contribute to the

maintenance of emotional distress and behavioral problems. CBT interventions focus on

behavior modeling to help patients overcome psychological distress and mental disorders.
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Throughout the literature, cognitive behavioral therapies have been applied to treat a range of

mental disorders, including but not limited to depression, anxiety, post-traumatic stress disorder,

and bipolar disorders (van Dis et al., 2020). Sufficient research has been done, and publications

are available to support the efficacy and effectiveness of CBT in treating various mental

disorders.

Evidence for Effectiveness and Efficacy

Werson et al. (2022) did a meta-analysis using 37 peer-reviewed randomized controlled

trials, including 25 adult papers and 12 older adult papers, with 3499 participants. The

participants were aged between 18 and 75 years. The inclusion-exclusion criteria considered

peer-reviewed published research studies written in English. The studies also needed to report

psychological treatment for depression as the primary aim, measured using reliable and valid

psychometric instruments, and participants needed to meet clinically significant depression

symptoms. During the search on Cochrane, PubMed Central, Scopus, Web of Science,

PROSPERO, Ethos, and Embase, among other databases, the researchers used keywords such as

young adult, older people, older adult, retired, middle-aged, and geriat. From the analyses, the

researchers found a statistically significant random effects model, with a confidence interval of

95%, favoring the efficacy of CBT treatment for depression. The overall effect favored CBT

over other treatments for depression. Moreover, the study found that CBT was more efficacious

when restricting analyses to passive control conditions. Therefore, according to the findings,

CBT was an effective intervention for depression.

Another study by Cuijpers et al. (2019) conducted a network meta-analysis of 155 trials

involving 15191 patients tested for acute depression. The study aimed to examine the most

effective delivery format for CBT. The researchers focused on five CBT treatment formats,
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including individual, group, telephone, guided self-help, and unguided self-help in the

experimental group and waiting list, care as casual, and pill placebo in the control group. In

terms of treatment ranking, the researchers found group CBT as the most effective, followed by

individual, telephone, and guided self-help. For acceptability, telephone CBT had the highest

ranking, followed by individual, group, and unguided self-help therapies. A key finding from the

meta-analysis was that individual, group, telephone, and guided self-help CBT treatments were

effective in treating depression compared to other interventions such as care as usual and waiting

list. Therefore, based on the results, CBT remains an effective intervention for acute depression.

Xian-Yu et al. (2022) conducted an additional meta-analysis to examine the effectiveness

of CBT treatment for post-traumatic stress disorder. The researchers conducted an online search

for peer-reviewed articles published before July 25, 2021, on CINAHL, MEDLINE, EMBASE,

Cochrane, Web of Science, Google Scholar, and Scopus. Articles with children and adolescents

under 18 years diagnosed with PTSD were included. Other considerations were articles

discussing other interventions, such as conventional treatments, changes in overall PTSD

symptoms, and psychological treatments. After the meta-analyses, the researchers found

significantly reduced rates of PTSD symptoms with CBT intervention compared to controls. The

researchers also found a significantly reduced possibility of re-experiencing PTSD symptoms

following CBT intervention. However, the study found no significant reduction in avoidance

symptoms following CBT intervention. The meta-analyses confirm that CBT is an effective

intervention for post-traumatic disorder.

With an alternative study to explore the efficacy of interpersonal psychotherapy for post-

traumatic stress disorder, Althobaiti et al. (2020) conducted a systematic review and meta-

analysis on ten clinical trials involving 755 patients with PTSD symptoms. The researchers
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further included nine studies from five databases in the meta-analysis. The articles were selected

and included in the review and meta-analysis based on being peer-reviewed, published until

2018, discussing PTSD as a mental disorder and interpersonal psychotherapies as the primary

intervention. The study found an overall standardized mean difference of -0.44 with a p-value of

0.0005. Moreover, the researchers established that interpersonal psychotherapy was not superior

to other active controls such as medications and non-interpersonal psychotherapies. However,

the study found that interpersonal psychotherapy was significantly superior and more effective

than passive controls such as waiting lists and educational pamphlets as interventions for post-

traumatic stress disorder. Accordingly, the meta-analysis found that interpersonal psychotherapy

is an active and effective therapy for PTSD; however, compared to other interventions, such as

medications, it becomes less preferred and defective.

In another study, Acarturk et al. (2009) investigated the effects of psychological

treatments for social anxiety. The research conducted a meta-analysis using 29 randomized

studies featuring 1628 subjects with social anxiety disorder. In the analyses, the researchers used

a computer program comprehensive meta-analysis. The investigation found a mean effect size of

0.70, 0.80 on cognitive measures, and 0.70 on depression and general anxiety measures. The

study established that psychological treatments are effective interventions for social anxiety

disorder in adults. They also found the interventions less effective in more severe disorders and

in studies in which care as usual and placebo control groups are used. The investigation centered

on interventions such as CBT, exposure therapy, self-help manuals, systematic desensitization,

realization training, homework, in vivo exercises, distorted self-imagery, the Lefkoe method, and

waiting lists. Based on the findings, the researchers concluded that psychological interventions

are effective treatments for social anxiety disorder in adults.

To further examine the comparative efficacy of CBT and psychodynamic therapies and

other interventions for Bipolar disorder, which is one of the deadly and common mental

disorders, Novick and Swartz (2019) conducted a systematic literature review and meta-analysis

on 273 reports. The duo searched for randomized controlled trials investigating the efficacy or

effectiveness of individual and group interventions for bipolar disorder. They focused on key

treatments, including cognitive behavioral therapy, psychoeducation, family-focused therapy,

interpersonal and social rhythm therapy, and peer support. Overall, the researchers found that the

interventions hasten the time to remission, improve functional outcomes, and delay recurrence

among patients with bipolar disorder. They also found that evidence-based practices help

individuals with bipolar disorder develop the higher-order thinking skills needed to manage the

persistent and lifelong psychosocial, vocational, neurocognitive, and interpersonal impacts of the

mental disorder. In addition to the interventions, Novick and Swartz (2019) recommended

functional remediation, adjunctive psychotherapies using modern technologies, and mindfulness-

based cognitive therapy (MBCT) as appropriate interventions with positive outcomes for bipolar

disorder patients.

In another combined study investigating the efficacy and effectiveness of cognitive

behavioral therapies and interpersonal psychodynamic therapies on eating disorders, Moberg et

al. (2021) conducted a meta-analysis of 62 studies. The researchers searched for publications

discussing the effects of using cognitive behavioral therapy and psychodynamic, interpersonal

treatments for eating disorders. In the meta-analysis, the investigators relied on remission and

changes in emergency department-specific and general psychopathology as evidence to confirm

the efficacy of the interventions. After computing the studies, the researchers found that the

remission rate of CBT for binge eating disorder was significantly higher than the effect for other
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diagnostic groups, including anorexia, bulimia, and mixed samples. With the results, Moberg et

al. (2021) concluded that CBT is an effective intervention and therapy for eating disorders

compared to psychodynamic and interpersonal treatments.

Final Thoughts and Conclusion

The above results of the meta-analyses support cognitive behavioral therapy and

psychodynamic, interpersonal treatments as gold standards for treating mental disorders. The

studies confirm that CBT and psychodynamic psychotherapy effectively treat depression, bipolar

disorder, anxiety, post-traumatic stress disorder, and eating disorders, among other mental

conditions (Goldstone, 2016). The studies also affirm that psychological treatments are effective

and commonly used to treat mild to moderate depressive episodes. However, since most of the

meta-analyses focus on a single application of the interventions for specific mental disorders,

future studies and evidence search should thus center on studies that investigate using CBT or

psychodynamic, interpersonal therapies in combination to determine their effectiveness in

reducing symptoms and adverse outcomes for the conditions.

References
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Acarturk, C., Cuijpers, P., van Straten, A., & de Graaf, R. (2009). Psychological treatment of

social anxiety disorder: a meta-analysis. Psychological medicine, 39(2), 241–254.

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Althobaiti, S., Kazantzis, N., Ofori-Asenso, R., Romero, L., Fisher, J., Mills, K. E., & Liew, D.

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systematic review and meta-analysis. Journal of Affective Disorders, 264, 286–294.

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