作者: Christian Jarrett/BP / 754次阅读 时间: 2017年4月06日
来源: 陈明翻译
Have we overestimated the effectiveness of psychotherapy?
Christian Jarrett/BPS 著

&D(B,pt R-eZ}0Most people who undertake psychotherapy seem to benefit from it. How do we know? Arguably, the most important evidence comes from meta-analyses that combine the results from many – sometimes hundreds – of randomly controlled trials. Based on this, it’s been estimated that psychotherapy is effective for about 80 per cent of people (meanwhile, between five to 10 per cent of clients may suffer adverse effects).

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%tk^U+n\,n0Rw J0大多数接受心理治疗的人似乎都会从中受益,这件事,我们是怎么知道的呢?可以说,最重要的证据来自于结合了许多甚至数百个随机对照试验的结果的元分析,基于此,据估计,心理疗法对约80%的人有效(同时,5%~10%的来访者可能会受到不利影响)。心理学空间h:u1X-oG6I

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But now the more concerning news: a team of researchers led by Evangelos Evangelou at the University of Ioannina, Greece has assessed the quality of 247 of these psychotherapy meta-analyses and they report in Acta Psychiatrica Scandinavica that many of them have serious methodological short-comings.心理学空间3jy"q5i h G+O

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但是,现在出现了相关与此的更多的消息:由希腊的艾奥尼纳大学Evangelos Evangelou领导的一个研究小组评估了发表在斯堪的纳维亚精神病学学报的247个心理治疗的元分析质量报告,其中的很多研究都有非常严重的方法学缺陷。


bx q8vR"s0Coincidentally, a separate research group led by Brent Roberts at the University of Illinois, Urbana-Champaign has just published in Journal of Personality some of the first observational data on how people’s personalities change after undertaking psychotherapy. In contrast to what’s been found in the clinical literature, they report that people who’ve been in therapy seem to show negative changes in personality and other psychological outcomes.

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巧合的是,一个由伊利诺伊大学厄本那-香槟分校的Brent Roberts领导独立的研究小组,在刚刚出版的《人格期刊Journal of Personality》上发表了关于接受心理治疗后人格的变化的第一手的观察数据。与临床文献中发现的相反,他们报告说,那些一直在治疗的人,似乎表现出负面的人格变化和其他心理结果。

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In their “umbrella review” of the psychotherapy literature, Evangelou and his team chose to include published meta-analyses covering any form of psychotherapy and almost any kind of target mental health condition, but with the proviso that each meta-analysis had itself combined the results from a minimum of ten studies. Their comprehensive search resulted in 247 unique meta-analyses which collectively synthesised data from over five thousand randomly controlled trials.心理学空间#NvnD4rw0qyZ#W

:h q:w1k,~V9l$I0在他们对心理治疗文献的““伞形回顾”中,Evangelou和他的团队选择的已发表的元分析,涵盖了所有的心理疗法和几乎所有类型的精神健康状况,但每个元分析附带的是结合了自己的数十项的研究结果。他们的全面搜索了247个独一无二的元分析结果,共同合成了超过五千个随机对照试验的数据。

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O&]!m4_.hY$~0Overall, 80 per cent of the published psychotherapy meta-analyses had reported a significant and positive benefit of whatever form of psychotherapy was their focus. This sounds impressive at first, but after applying “state-of-the-art” tests of their robustness, Evangelou and his colleagues report that just 16 of the 247 meta-analyses had provided “convincing evidence”.心理学空间.zj:[+R{L/bHu0RA"{

+H8d|&OF(n h)M6i0总体而言,80%已发表的心理治疗元分析报告了,来自于他们所关注的任何形式的心理治疗有着显著积极的益处。起初,这听起来令人印象深刻,但是在应用了最先进的测试后,Evangelou和他的同事们报告说,247个元分析中只有16个提供了“令人信服的证据”。心理学空间*Sudyp BB&Q9C

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The researchers identified a number of issues:心理学空间C&V.Yq J3]*}h


研究人员 发现了一些问题:心理学空间/L7C!MA4l%[ os W*a

  • Many meta-analyses showed a statistically significant amount of heterogeneity between the trials that they’d combined. The worry is that too many meta-analyses are comparing apples and oranges, although there is scholarly debate about what level of heterogeneity is unacceptable.   


  • The researchers found many instances of the “small study bias”, which is the tendency for smaller, less robust studies to report larger effects.   心理学空间!?&w/mK3X)|


  • They found evidence of “excess significance bias“, which is when an over-abundance of trials seem to report positive findings given what we know so far about psychotherapy’s effectiveness. This suggests negative findings are remaining unpublished for whatever reason.   心理学空间LGr&XqS3O

    他们发现了“过度的显著偏差”的证据,过多的实验似乎报告了到目前为止的,我们知道的心理治疗的有效性积极的结果。这表明。无论什么原因,消极的结果仍然未被发表。 心理学空间+W2K8m$S+NQ,a8y9X


Evangelou and his team conclude that the field of psychotherapy research needs to work harder to ensure that negative results are published as well as good news results, especially given the findings of another recent paper suggesting that the field has a problem with undeclared researcher allegiance to particular therapeutic approaches. One way round this is to ensure all trials and meta-analyses are preregistered before they are conducted, alongside information on the statistical tests that are planned.




lF FdgFu0For the reader undertaking psychotherapy or who knows someone who is, it is worth keeping some perspective: this is just one critique and the weight of evidence still suggests that psychotherapy is, more often than not, beneficial.心理学空间x} @5o5b;wn#F)YA



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For scholars, the methodological concerns raised by this new paper feed into an already contentious field. Some experts believe that, high-quality or not, randomly controlled trials (and by extension, meta-analyses based on those trials) are not really an appropriate way to gauge the effectiveness of psychotherapy because of all complex, myriad factors involved in the dynamic between a client and his or her therapist.心理学空间6~;S l R zf-upY;YLH

5j:OJ8N.n Ob n0对于学者来说,这种新的文献将方法论所关心的领域注入了一个已经有争议的领域。一些专家认为,优质与否,随机对照试验(以及扩展到基于这些临床试验的元分析)不是衡量心理疗法的效果的适当方式,因为所有的事情都是复杂,在来访者和他或她的治疗师之间包含着很多因素。


lP%G1Zo+`&_,Z0An alternative approach is to look at observational data. Rather than signing people up to a controlled trial, with all the contrivances that that entails (such as standardising the delivery of therapy as much as possible), this approach is less hands-on and involves looking instead at the outcomes of people who happen to have been in therapy and those who haven’t.



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Brent Roberts and his colleagues found two sources of this kind of data: hundreds of students in Tübingen who were enrolled in a long-term personality study and who’d completed measures twice across four years; and a group of thousands of older Americans who similarly had completed personality and other measures twice across four years.心理学空间](\O [+G$R

Y|)\Muk"O0Brent Roberts和他的同事们发现,这类数据的两个来源:在宾根的数百个学生参加了一项长期的人格研究,他们在在四年内完成两次完整的测量;以及数千名美国老年人在4年内完成了同样两次人格测量。


+^-kDY&R5YQ0Crucially, both these longitudinal surveys included a question about whether the participants had undertaken psychotherapy in the intervening period between the two data collection points. One hundred and twenty-eight of the Tübingen students had completed some therapy and, compared to the other students, they showed negative changes in their personality in terms of higher scores in neuroticism, less extraversion and conscientiousness, as well as reductions in self-esteem, increases in depression, and less life satisfaction. It was a similar story for the older American adults who’d been in therapy: they showed negative changes in personality and other psychological outcomes.心理学空间Oy9S?%d6b [8D

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关键的是,这两个纵向调查包括了一个问题,参与者是否在两个数据收集点之间进行心理治疗。宾根大学生128人已完成一些治疗的学生和相比其他学生,在神经质、外向性和责任心的高分中,他们的人格表现出了负面的变化,较少的外向性和严谨性,以及自尊的降低,抑郁症的增加,和更少的生活满意度。参与治疗的美国老年人 也有相同的状况:在他们的人格和其他心理结果中表现出了消极的变化。心理学空间4U{%O v6z%b

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There are problems with how to interpret these findings – an obvious shortcoming of observational data of this kind is that it’s less controlled than an experimental trial. For example, perhaps undertaking therapy was a consequence of these unwelcome psychological changes rather than the cause (although this still wouldn’t explain why the therapy hadn’t been more helpful, more often). Whatever the explanation, however, the results stand in contrast to the findings from controlled psychotherapy trials which have pointed overwhelming to positive personality changes arising from therapy. As Roberts and his team conclude, “the gravity of the issue necessitates that researchers investigate the apparent discrepancy between these findings and those from well-controlled trials”.


zq'Ur i~8uTy0在解释这些发现时有很多的问题——一个显著的缺陷是,这种观测数据比实验性的试验相比,缺乏控制。例如,也许进行治疗是这些不受欢迎的心理变化的结果,而不是原因(虽然这仍然不能解释为什么治疗没有像通常的那样有更多的帮助)。然而,不管结果如何,结果与对照性心理治疗试验的结果形成了鲜明对照,这些都反映了治疗带来的积极的人格变化。正如罗伯茨和他的团队得出的结论,“问题的严重性必须让研究者调查这些发现与那些对照试验的明显差异”。心理学空间/?6VC#[(y]u

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