New Psychotherapies for Mood and Anxiety Disorders: Necessary Innovation or Waste of Resources?
Notice bibliographique
Résumé
Dear Editor: With much interest we read the systematic review from Stirman et al1 about new psychotherapies for mood and anxiety disorders. Although the study has been well conducted, we think the authors have not sufficiently answered the question of whether we actually need new psychotherapies. On the one hand, there is a clear need for better treatments, as mood and anxiety disorders constitute a considerable burden for patients and society. Further, modelling studies have shown that current treatments can reduce only one-third of the disease burden of depression and less than one-half of anxiety disorders, even in optimal conditions.2 However, there are already dozens of different types of psychotherapy for mood and anxiety disorders, and there is very little evidence that the effects of treatments differ significantly from each other. In depression, we found that interpersonal psychotherapy is somewhat more effective than other therapies,3 but differences were very small (Cohen's d We think that new therapies are only needed if the additional effect compared with existing therapies is at least d = 0.20. Larger effect sizes are not reasonable to expect as 0.20 is the largest difference between therapies found until now. Further, this effect needs to be empirically demonstrated in high-quality trials. However, to show such an effect of 0.20 we would need huge numbers. A simple power calculation shows that this would require a trial of about 1000 participants (STATA [Statacorp, College Station, TX] sampsi command). As a comparison, the large National Institute of Mental Health Treatment of Depression Collaborative Trial examining the effects of treatments of depression included only 250 patients. We want to suggest, therefore, that the field stops with developing new psychotherapies for mood and anxiety disorders unless the developers can convince financers of research to conduct a well-powered comparative study that shows that this therapy is indeed more effective than existing therapies. In the meantime, the field should focus on the real problems that limit the contribution of therapies to the reduction of disease burden, including the large number of patients who do not respond to any treatment, the patients who still have considerable residual symptoms after successful treatments, and patients who relapse. References 1. Stirman SW, Toder K, Crits-Christoph P. New psychotherapies for mood and anxiety disorders. Can J Psychiatry. 2010;55:193-201. 2. Andrews G, Issakidis C, Sanderson K, et al. Utilising survey data to inform public policy: comparison of the cost-effectiveness of treatment often mental disorders. Br J Psychiatry. 2004;184:526-533. 3. Cuijpers P, van Straten A, Andersson G, et al. Psychotherapy for depression in adults: a meta-analysis of comparative outcome studies. J Consult Clin Psychol. 2008;76:909-922. Pim Cuijpers, PhD Annemieke van Straten, PhD Amsterdam, The Netherlands Reply Re: New Psychotherapies for Mood and Anxiety Disorders: Necessary Innovation or Waste of Resources? …
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Comment cette classification a été obtenuedéplier
Prédiction machine sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Le volet Gemma est une étiquette directe du modèle pour chaque travail de la base, lue sur la notice réduite au titre. Le volet Codex est un classifieur appris des 10 348 étiquettes directes de Codex et calibré sur les taux pondérés de l'échantillon; les champs sans appui suffisant ne portent aucun appel Codex. Le mode candidate est l'union des deux volets; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont pas des étiquettes humaines.
Scores du classifieur distillé par catégorie (deux têtes)
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,030 | 0,192 |
| Méta-épidémiologie (sens strict) | 0,002 | 0,001 |
| Méta-épidémiologie (sens large) | 0,006 | 0,003 |
| Bibliométrie | 0,003 | 0,003 |
| Études des sciences et des technologies | 0,001 | 0,003 |
| Communication savante | 0,005 | 0,009 |
| Science ouverte | 0,006 | 0,002 |
| Intégrité de la recherche | 0,016 | 0,016 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,011 | 0,004 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule source (Gemma direct ou Codex distillé), pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».