Unique and shared techniques in cognitive-behavioural and short-term psychodynamic psychotherapy: a content analysis of randomised trials on depression

Abstract

Randomised controlled trials (RCTs) of psychotherapeutic interventions assume that specific techniques are used in treatments, which are responsible for changes in the client's symptoms. This assumption also holds true for meta-analyses, where evidence for specific interventions and techniques is compiled. However, it has also been argued that different treatments share important techniques and that an upcoming consensus about useful treatment strategies is leading to a greater integration of treatments. This makes assumptions about the effectiveness of specific interventions ingredients questionable if the shared (common) techniques are more often used in interventions than are the unique techniques. This study investigated the unique or shared techniques in RCTs of cognitive-behavioural therapy (CBT) and short-term psychodynamic psychotherapy (STPP). Psychotherapeutic techniques were coded from 42 masked treatment descriptions of RCTs in the field of depression (1979–2010). CBT techniques were often used in studies identified as either CBT or STPP. However, STPP techniques were only used in STPP-identified studies. Empirical clustering of treatment descriptions did not confirm the original distinction of CBT versus STPP, but instead showed substantial heterogeneity within both approaches. Extraction of psychotherapeutic techniques from the treatment descriptions is feasible and could be used as a content-based approach to classify treatments in systematic reviews and meta-analyses.

It's complicated: The relation between cognitive change procedures, cognitive change, and symptom change in cognitive therapy for depression

“…This is because a treatment (say, CT) may contain multiple procedures, some of which may overlap with those that also define other psychotherapeutic modalities (Haaga, 2007). For example, descriptions of psychodynamic therapies often include techniques that could also be categorized as cognitivebehavioral (Barth, Michlig, & Munder, 2014). Moreover, practitioners of a therapy modality can, and in fact often do, use techniques from other modalities (McCarthy & Barber, 2009).…”

Teaching behavioral medicine professionals and trainees an elaborated version of the Y-Model: Implications for the integration of cognitive–behavioral therapy (CBT), psychodynamic therapy, and motivational interviewing.

“…Teachers and supervisors may wish to highlight the commonly shared techniques and unique techniques of CBT and PT, particularly with novice medically oriented learners. Barth, Michlig, and Munder (2014) comprehensively coded 42 randomized control trials of CBT and short-term PT (STPT) from 1979 to 2010. They found that STPT and CBT shared the following domains: development of structure in treatment/ session, homework assignments, education about the disorder, reinforcement, and goal setting.…”

“…They found that STPT and CBT shared the following domains: development of structure in treatment/session, homework assignments, education about the disorder, reinforcement, and goal setting. CBT exclusively applied the following techniques: modification of dysfunctional cognitions, self-monitoring, and activation (Barth et al, 2014). Conversely, STPT exclusively applied the following techniques: emphasis on past experiences, focus on the therapeutic relationship, interpretation, work with unpleasant emotions, transference, work with unconscious conflicts, therapeutic abstinence, and resistance-analysis (Barth et al, 2014).…”

“…CBT exclusively applied the following techniques: modification of dysfunctional cognitions, self-monitoring, and activation (Barth et al, 2014). Conversely, STPT exclusively applied the following techniques: emphasis on past experiences, focus on the therapeutic relationship, interpretation, work with unpleasant emotions, transference, work with unconscious conflicts, therapeutic abstinence, and resistance-analysis (Barth et al, 2014). Blagys and Hilsenroth (2000) examined STPT research and found the following distinct evidence-based characteristics: focus on affect and the expression; exploration of the patient’s attempts to avoid topics that prevent the progress of therapy; identification of patterns in behaviors, thoughts, feelings, experiences, and relationships; emphasis on past experiences; focus on interpersonal experiences; and exploration of wishes, dreams, or fantasies.…”

Transdiagnostic Symptom Dynamics during Psychotherapy

“…Dismantling studies and trials of individual treatment components can be informative, but have frequently been hampered by low-quality methodology 3 . It is widely believed that different psychotherapies share several common causal mechanisms and operate in ways that are more similar than they are different [4][5][6][7] . Common factors, such as therapeutic alliance, are unlikely to improve our understanding of change 2 and there is a need to focus on other mechanisms of change in psychotherapy 8,9 .…”