During the 1980s, a shift began in which increasing numbers of mental health practitioners and researchers widened their previously narrow views on etiology and treatment of mental illness.
Increasingly, it became recognized that one-dimensional models, whether psychological or biological, fell short of explaining the tremendous complexities of human psychological functioning and psychopathology.
This transition to more complementary and integrated views of cause and cure can be attributed to several new developments:
The side effects of medications historically resulted in very poor compliance rates among psychiatric patients, and the most effective medication available is useless if the patient doesn’t take the drug as prescribed.
Compounds introduced in the 1980s and early 1990s have yielded effective medications with much more user-friendly side-effect profiles.
Discoveries have been made in which new medications and newer uses for existing medications provide very good results in treating certain types of mental illnesses, such as panic disorder and obsessive-compulsive disorder. This approach greatly increases the psychiatrist’s arsenal of effective medications.
Research Supports Psychotropic Drug Efficacy
A growing body of well-controlled research studies (double-blind, randomized, placebo-controlled) lend convincing support to the efficacy of psychotropic drugs.
Neuroimaging techniques, such as PET and SPECT scans, allow researchers to view metabolic activity in the living brain. These technologies have been able to isolate localized brain abnormalities in certain mental disorders, including major depression, schizophrenia, ADHD, and obsessive-compulsive disorder.
They can provide data on particular sites of drug action or binding, and can illustrate changes between the pre- and post-treatment status of particular brain structures. Imaging techniques have added considerable “hard data” to various theories of biochemical etiology in selected mental illnesses.
Neuroimaging techniques have been accompanied by a host of new laboratory procedures that allow neuroscientists to assay the neurochemical by-products found in spinal fluid. Although early psychopharmacology was implemented without any real knowledge of the underlying pathophysiology, in the past decade, biochemical theories have gained tremendous scientific support.
These new developments in psychiatry and the neurosciences have been difficult to ignore. Many formerly hard-line psychotherapists have been won over by the flood of research findings and their personal experiences in treating people with psychoactive drugs.
Advances Made in Psychotherapy
During this same period, important advances were made in the theory and practice of psychotherapy. During the late 1970s and 1980s, the first truly well-controlled psychotherapy studies emerged (including the now popular meta-analyses). The results of these studies cast doubt on the findings of early research that had suggested that psychotherapy was ineffective.
Of the many forms of psychotherapy that have been developed, the meta-analyses suggest that no single school of therapy is clearly superior and that psychotherapies across the board are often much more effective than no treatment.
Also during this time, we witnessed the development of novel treatment approaches, such as cognitive behavioral psychotherapy and interpersonal psychotherapy as a treatment for particular disorders, such as depression and panic disorder.
These approaches have appeal in that they can be somewhat systematically applied; some even provide “canned” formats or “cookbooks” referred to as manualized therapies. Also, the methodology is a bit less reliant on the personal characteristics of the therapist. These approaches then lend themselves to a short-term format and can often be conducted in groups.
And, finally, these psychotherapies can be more easily studied. Both cognitive behavioral and interpersonal psychotherapies have a solid track record of effectiveness.
Finally, both clinical-anecdotal and research studies have emerged that support the combined use of pharmacotherapy and psychotherapy in the treatment of particular disorders. At times, the combined treatments have been shown to be superior to either single treatment alone. The area of combined treatment, or what some refer to as integrated treatment, is a relatively new area of inquiry in mental health. It’s only been over the last two decades that the majority of research in combined treatments for mental health conditions has appeared.
For many in the mental health community, the writing on the wall has become far more legible: A single model for understanding and treating mental disorders is too narrow and is simply inadequate.
Current evidence suggests that particular disorders do respond best to certain medical treatments, and for these, medications are the treatment of choice. Other disorders have little to do with biochemical dysfunction, and medications play little or no role in their treatment. And still other disorders require the skillful integration of biological and psychotherapies.
*This article is based on Dr. Moore’s latest book, “Handbook of Clinical Psychopharmacology for Therapists” published by New Harbinger Press and co-authored by John Preston, John O’Neal, and Mary Talaga.
Preston, J., O’Neal, J., Talaga, M., & Moore, B. A. (in press). Handbook of Clinical Psychopharmacology for Therapists-Ninth Edition. Oakland, CA: New Harbinger Press.