If you treat patients with bipolar disorder, then you have reached what I call the moment of truth. Your patient has been doing so well, she’s not even sure she still has a psychiatric problem. This is one of the many opportunities for psychotherapy in bipolar disorder—in this case, helping your patient to come to terms with her illness.
Research has generally found that both antidepressants and psychotherapy offer similar efficacy in the short-term, but that after treatment discontinuation, results are better with psychotherapy.
I examined results of multiple meta-analyses published in top tier, peer reviewed journals. The findings were clear and consistent: effect sizes for psychodynamic psychotherapy are at least as large as those reported for other therapies that are promoted as “empirically supported” or “evidence based.” Also, the benefits of psychodynamic therapy are lasting. Patients not only improve, but continue to improve even after therapy ends.
Exposure and response prevention (ERP) is an extremely effective therapy. You can say with conviction that if a patient commits to this therapy, it really has a good chance of reducing suffering.
Some of the CBT techniques that have proven effective for panic disorder include breathing retraining, cognitive restructuring, and relaxation training.
Anxiety disorders are commonly seen in primary care, whether they present on their own, or comorbid with other illnesses. There’s good evidence for both cognitive-behavioral therapy (CBT) and pharmacotherapy in anxiety disorders, but many patients don’t receive such treatment.
We know that for many conditions, both medications and psychotherapy work about equally well. Common sense would dictate that there is some final common pathway of neuropsychiatric change underlying the symptomatic improvements we see. But identifying what is happening in a living human brain is extremely tricky.