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Christian Jarrett/BP 2017-4-06
Have we overestimated the effectiveness of psychotherapy?
Christian Jarrett/BPS 著
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Most 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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$R"l i)[E!l}0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)。

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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5]8NQ T%W1qJ\0rA*r

u9z-fI z*G&JG0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。

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Coincidentally, 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。心理学空间a7`N \9YS

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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?v$w Cn }GN)z/s e3`


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Overall, 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”.


a7kp6m,L |1A2InF0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”。


The researchers identified a number of issues:心理学空间0^)M2uG[i&cZm

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研究人员 发现了一些问题:心理学空间"n(cAJb

O7v7O:_7XO0Evangelou 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.

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2vo9t'L k5cIu7j0Evangelou和他的团队认为,心理治疗研究领域需要努力确保在发表的阴性结果时也要及时发表好消息的结果,尤其是要考虑到最近的另一项研究的建议,这个领域有一个问题,未公布的研究者效忠于特定的治疗方法的研究。其中一个方法是确保所有试验和元分析在他们实施前是在预先登记后才进行的,这与他们进行的统计测试信息是并行的。心理学空间Ob8N%~{!Obc3f%~ R


For 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.

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'H kkL3x0对于进行心理治疗的读者或者了解一些情况的人来说,值得保留一些观点:这只是一个批评,同时证据的重要性仍然表明,心理治疗往往不是有益的。


$z X&z;O'RGad0For 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UF2]"W%`x5? U

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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。心理学空间(FR2T%i'F XHji0Hg:Y

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An 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.心理学空间(x3]~N0g \?:I|

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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4kt b pC)K


Brent 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。

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/w1om gS2v0Crucially, 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m0Lr$B_g&F


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。


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”.