Dodo Bird Verdict

See also

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Mulder, R., Murray, G., & Rucklidge, J. (2017). Common versus specific factors in psychotherapy: opening the black box. The lancet psychiatry, 4(12), 953-962.

Some studies cite two studies showing that "specific psychotherapies such as cognitive behavioural therapy (CBT), interpersonal therapy, mindfulness, and acceptance and commitment therapy generally do not differ in effectiveness."[1] However, other studies have found contradictory results: "Tolin, for example, reported that CBT was associated with a significant advantage over other therapies, at least in patients with anxiety or depressive disorders. Similarly, Hofmann and colleagues showed evidence for treatment specificity in a review of 269 meta-analytic studies examining CBT for different psychological findings."[2]

There is currently not enough evidence to settle the debate between the common factors and specific factors schools; "the past 30 years of psychotherapy research has paid disproportionate attention to treatment outcome, with relatively little attention to the mechanism of action of psychotherapies." In other words, we know that such therapies as CBT work, but we don't know what about these therapies makes them efficacious.

In some ways this debate is a false dichotomy. The specific factors school concedes that common factors are important. "Psychotherapy training programmes that prioritise CBT interventions for clinical problems, for example, typically commence with substantial training in so-called counselling skills, emphasising common factors such as engagement, optimism, positive regard, explicit collaboration, and structured goal setting." And the common factors school has been "increasingly tightening its definition of bona fide therapy. They suggest that the treatments must be delivered by trained therapists, based on psychological principles, and credible to the patients receiving them." Moreover, "most common factor theorists concede that some specific techniques are more effective than others for particular conditions."[3]

The way forward. "We suggest that there are at least four approaches which might be useful in the future. The first is the transdiagnostic treatment approach. The second is to develop component (ie, dismantling or additive) studies to identify whether specific active ingredients contribute to differential outcomes. The third involves considering the implications of e-therapies, and the fourth is an aspirational call for a thoroughgoing clinical science."
Notes

[1] Arch JJ, Eifert GH, Davies C, Plumb Vilardaga JC, Rose RD, Craske MG. Randomized clinical trial of cognitive behavioral therapy (CBT) versus acceptance and commitment therapy (ACT) for mixed anxiety disorders. J Consult Clin Psychol 2012; 80: 750–65. 12 // Bogels SM, Wijts P, Oort FJ, Sallaerts SJ. Psychodynamic psychotherapy versus cognitive behavior therapy for social anxiety disorder: an efficacy and partial effectiveness trial. Depress Anxiety 2014; 31: 363–73. 13 // Barth J, Munder T, Gerger H, et al. Comparative efficacy of seven psychotherapeutic interventions for patients with depression: a network meta-analysis. PLoS Med 2013; 10: e1001454.

[2] Tolin DF. Is cognitive-behavioral therapy more effective than other therapies? A meta-analytic review. Clin Psychol Rev 2010; 30: 710–20. // Hofmann SG, Asnaani A, Vonk IJ, Sawyer AT, Fang A. The efficacy of cognitive behavioral therapy: a review of meta-analyses. Cognit Ther Res 2012; 36: 427–40.

[3] "A major concession is that exposure-based procedures could be necessary for some types of anxiety disorders, although how exposure is performed might not matter. Both camps acknowledge that moderator factors, such as age, could be important; for example, acceptance and commitment therapy is better than CBT in older adults (≥65 years) with chronic pain, perhaps because the therapeutic focus was more aligned with learning to live well with pain, rather than the treatment being expected to reduce the pain. Parental involvement seems to improve and maintain treatment outcomes for children with anxiety compared with individualised CBT alone, and this effect might be specific to anxiety disorders. Additional parental involvement does not seem to be necessary for the treatment of depression in girls. Whether the bilateral eye movements, tones, or taps of eye movement desensitisation and reprocessing therapy are necessary components for a trauma to be processed is up for debate, although proponents of this therapy believe that it is more rapid and can be more effective than trauma-focused CBT. Other examples for which there is broad agreement for problem-specific effects include treatments for severe motor tics or cognitive deficits in schizophrenia."

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Lambert, M. J., & Kleinstäuber, M. (2016). When people change, and its relation to specific therapy techniques and common factors. Verhaltenstherapie, 26(1), 32-39.

Research on the broad concept of common factors investigates causal mechanisms such as expectation for improvement, therapist confidence, and a therapeutic relationship that is characterized by trust, warmth, understanding, acceptance, kindness, and human wisdom, but also can be expanded to include some mechanisms that are often regarded as unique to a particular form of treatment but are actually present to some degree in all, e.g., catharsis, exposure to anxiety-provoking situations/stimuli, encouragement to participate in other risk-taking behavior (facing rather than avoiding situations that make the patient uncomfortable), and encouraging client efforts at mastery, such as practicing and rehearsing behaviors. Such a broad view of common factors recognizes that while specific theories of psychotherapy may emphasize systematic in vivo or in vitro exposure to frightening situations, or social skills training, or interpretations, nearly all therapies encourage people to review and discuss the things they fear and to face rather than avoid such situations. Common factors, no matter how unimportant they may be from the point of view of a particular theory (theoretically inert or trivial) are central to nearly all psychological interventions in practice, if not, theory. This may explain why therapies have such similar recovery rates; many techniques considered unique to a particular theory are in fact present to some extent in different theory-driven.

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Budd, R., & Hughes, I. (2009). The Dodo Bird Verdict—controversial, inevitable and important: a commentary on 30 years of meta‐analyses. Clinical Psychology & Psychotherapy: An International Journal of Theory & Practice, 16(6), 510-522.

Budd & Hughes (2009) argue that 30 years of meta-analyses support the dodo bird verdict. They argue that RCTs are incapable of detecting the differences between therapies. They propose a individualized, client-catered type of therapy:

To illustrate our favoured approach, let us consider ‘depression’. Typically, within the present, diagnostically driven approach, patients diagnosed as having ‘depression’ are offered a package— often of around 20 sessions—of CBT treatment, which comprises a number of almost invariant elements (e.g., activity scheduling, thought diaries, thought challenging). We consider that such an approach ignores the variability and complexity of the symptoms of people diagnosed as having ‘depression’, and that it also ignores the psychosocial factors maintaining the symptoms (e.g., family relationships, employment problems, the broader environmental context); and, that it also ignores the therapeutic relationship. Low mood, for instance, is a very common feature of ‘depression’. In order to ameliorate it, we would advocate a detailed analysis of its maintaining factors on an individual basis, and then the application of an appropriate technique (e.g., increasing activity levels or resolving relationship conflicts or exploring the validity of negative automatic thoughts). But, importantly, this needs to be done within the context of the therapeutic process, that is to say, at an appropriate time, and in a way that is most likely to promote change within the client.

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Castelnuovo, G., Faccio, E., Molinari, E., Nardone, G., & Salvini, A. (2004). A critical review of empirically supported treatments (ESTs) and common factors perspective in psychotherapy. Brief strategic and systemic therapy European review, 1, 208-224.

Castelnuovo, Faccio, Molinari, Nardone, & Salvini (2004) nicely summarize the perspectives of those who favor empirically supported treatments (ESTs) and those who favor the common factors viewpoint. Those favoring ESTs strike me as eminently reasonable, as they want "clinicians to deliver a psychological intervention that is supported by research.” But the authors point out that there is a great deal of pushback from many clinicians, and they summarize their arguments, which strike me as largely BS (although I haven't studied them in depth). The authors point to the works of Michael Lambert, who "identified four therapeutic factors as the main elements to obtain improvement in psychotherapy: extratherapeutic factors, common ones, expectancy or placebo, techniques."

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Chambless, D. L. (2002). Beware the dodo bird: The dangers of overgeneralization. Clinical Psychology: Science and Practice, 9(1), 13-16.

Chambless (2002) disputes the dodo bird verdict: "Luborsky et al.'s conclusion that there are no meaningful differences in the efficacy of various psychotherapies should be reconsidered for the following reasons: (a) errors in data analysis, (b) exclusion of research on many types of clients (e.g., children and adolescents), (c) faulty generalization to comparisons between therapies that have never been made, and (d) erroneous assumption that the average difference between all sorts of treatments for all sorts of problems can be assumed to represent the difference between any two types of treatment for a given problem. Concern for clients' welfare demands that psychologists be very wary of accepting the Dodo bird.

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Lin, Y. N. (2005). Conceptualizing common factors in counseling. Guidance J, 27(1), 1-21.

Lin, Y. N. (2016). The framework for integrating common and specific factors in therapy: A resolution. International Journal of Psychology and Counselling, 8(7), 81-95.