INTRODUCTION

The evidence based movement and its proponents at the practice and health care system levels have begun to influence the mental health field in response to demands for accountability and to address the well-documented disparity between scientific evidence and actual practice. Society, the legal system, managed health care organization, insurances, and government regulators have mandated that clients should have access to the most effective treatments for their specific conditions. Efforts to overview the evidence in mental health using standardized and transparent criteria have been done by American Psychological Association (Chambless and Ollendick, 2001), the Cochrane Collaborative, the British Medical Journal Publishing Group (2002), the Texas Medication Algorithm Project (Miller et. al., 1999) and the National Evidence – based Practices Project (Drake et. al., 2001), which have assembled teams to review and synthesize the evidence regarding treatment of severe mental illness.

EVIDENCE BASED CARE: IMPORTANT CONCEPTS

a) Evidence: Scientific information regarding the effects of a well-defined treatment compared with a comparison group of no treatment, a placebo or, an alternative treatment. Scientific ‘evidence’ refers to data that – (i) Are conducted systematically under specific conditions, which distinguish between treatments and their comparisons, (ii) Control for differences between service recipients, (iii) Control for the bias that recipients may bring to the observation of their conditions, and (iv) Control for the bias that practitioners or researchers may bring to the observation of recipients (Weisz et al., 2004).

Hierarchy of Evidence: The gold standard for scientific evidence is the systematic review of several double blind randomized controlled trials (RCTs). Beneath the randomized controlled trials, are quasi-experimental studies, open clinical trials, systematic observations and unsystematic observations. In addition to the strength of study designs, the hierarchy of evidence should involve the number of studies, the magnitude of treatment effects, the relevance of outcomes, the generalisability of studies and other factors (Abelson, 1995).

Levels of Evidence of Therapeutic effectiveness: Level 1: Either a systematic review of comparable randomized controlled trials or, an individual RCT with a narrow confidence level. Level 2: Either a systematic review of comparable cohort studies or an individual cohort study. Level 3: A systematic review of comparable case-control studies or an individual case control study. Level 4: A reported case series. Level 5: Expert opinion based on consensus or inference from ‘1st principle’ in the absence of formal critical appraisal (Ball et al, 1998).

b) Evidence Based Medicine: Identification (reliably and efficiently) critical appraisal (in terms of validity and usefulness) and implementation of the best available evidence (from research & experience) for a particular intervention or maneuver in a given clinical situation (Sackett et al, 1997).

Principles of EBM: The fundamental goal of EBM is achieved through adherence to four fundamental principles in the process of decision making as to which is the best possible health care decision based on the available evidence (Guyatt and Rennie, 2002 ) 1. The best available scientific evidence should be provided to patients for their consideration when decisions regarding health care have to be taken. 2. The evidence should be adjusted for the individual patient and local circumstances. 3. Patients have a right to self-determination based on (a) Accurate information regarding disease, interventions, adverse effects and outcomes (1) (b) And their own values and preferences for interventions and outcomes. 4. Physicians and other practitioners must have the appropriate clinical expertise – the technical mastery as well as the ability to work collaboratively with patients in order to practice EBM. This involves a shared decision making process by which the practitioner and patient agree on a treatment plan.

Steps in finding and evaluating relevant evidence: Practitioners of EBM must know the current evidence for the effectiveness of various interventions or know how to find and evaluate the evidence. a) Formulating the question regarding treatment option: Clear answers require clear questions. For example, consider a patient suffering from a chronic mild depressive disorder. The clinician diagnoses dysthymic disorder but may be uncertain whether recommending Cognitive Behavior Therapy over non-specific support for a few sessions. The questions are, (i) In patient with dysthymia (the problem) (ii) How effective is CBT (the intervention) (iii) Compared with alternative treatment (the comparison intervention) (iv) In alleviating depressive symptom and improving psychosocial functioning (the outcome)? b) Finding the evidence: Common approaches to gathering evidence include clinical experience, asking colleagues, reading standard textbooks, attending continuing education conferences and using computerized searches. Up to date, Dyna Med, eMedicine, Clinical Evidence and the National Guideline Clearinghouse are on line sources of clinical information. c) Using the Evidence: Translating research finding into clinically usable information is one of the most challenging areas of EBM. It involves summarizing the research finding in ways which contain the maximum amount of information and which are meaningful to clinician. Most commentators favour measures of effect such as absolute risk reduction or the number needed to treat which are most intuitive and more clinically useful (Laupacis et.al, 1988)

c) Evidence Based Practice: Evidence based practice (EBP) is a broadening to healthcare in general, of the principles of EBM. Evidence based practice is the integration of best research evidence with clinical expertise and patient values. EBP’s are interventions that are judged to be effective for groups of patients with a specific condition or outcome goal. The criteria typically include standardization of the intervention, objective outcome measures, multiple controlled studies and research for more than one group

Aims of EBP’s: The underlying philosophy of EBP can be summed up diagrammatically as a transition between two states of affairs:

In the first situation column ‘A’, the majority of available interventions are taken to be ‘Harmless’, with small but significant minorities being either distinctly beneficial or clearly harmful. The task of EBP is to increase the use of the former and to eliminate the latter as represented in column ‘B’. To do this, not only should there be clear-cut standards as to what kind of research findings would be counted as clinical evidence, but a mechanism for translating those into clear, widely disseminated recommendations that fulfill the needs of any clinician and patient who have specific questions (Mace & Moorey, 2001).

An important distinction between EBP and EBM is that a practitioner of EBM learns to formulate a clinical question based on a particular patient, conduct a search for patient information, appraise the literature regarding quality and formulate an answer regarding the specific clinical question. (Sackett et al., 2000). By contrast, a practitioner of EBP learns to provide treatments that have been identified by experts as empirically based (Drake et al, 2004).

(d) Randomized Control Trials: Here the impact of treatment is studied following attempts to eliminate bias by randomly allocating alternative treatments to study patients according to a protocol over which an experimenter has no personal control. Double blind randomized trials are a subset of RCTs that keep the clinicians, patients and raters of outcome in the dark about whether a particular person is a control subject or, has been given the experimental treatment.

(e) Cohort or longitudinal study: A study in which subjects are prospectively followed over time without any specific intervention.

(f) Case control study: A study in which a group of patients and a group of control subjects are identified in the present and information about them is pursued retrospectively or, backward in time.

(g) Certain useful term to know while evaluating the articles:

Control event rate (CER) = b/b+d ratio of out come of control group.

• Experimental event rate (EER) = a/a+c

• Absolute risk reduction (ARR) = EER-CER. This tells us the difference in the number of patients with specific outcome of every 100 patients treated in either way

• Relative risk (RR) = EER/CER. – ratio of the proportions with a positive outcome on treatments X &Y.

• Relative risk reduction (RRR) = 1-RR or ARR/CER. Probability of an event in the active treatment group divided by the probability of an event in the control group.

• Odds ratio (OR) = (a/c)/(b/d) = ad/bc. Odds of an event in the active treatment group divided by odds of an event in the control group.

• Number needed to treat (NNT) = Reciprocal of the ARR. It is the estimate of the number of patients to be treated with the intervention of interest, compared with alternative, in order to achieve one good outcome or avoid one harmful outcome.

EVOLUTION OF EVIDENCE BASED PSYCHOTHERAPY

Psychotherapy research developed later and more slowly than psychotherapy practice, with some of the earliest work published near the mid point of the 20th century. The Task Force on Promotion and Dissemination of Psychological Procedures (referred to as Task Force) of Division 12 (Clinical Psychology) of the American Psychological Association (APA) became interested in promoting the awareness and use of empirically supported treatments (EST’s) as a part of the movement of EBM that arose in the UK (Sackett et al, 1997). Appointed in 1993, the Task Force was charged with considering issues related to dissemination of psychological treatment of known efficacy. After acceptance by the division 12 Board of Directors in October of the same year, the report was circulated to a number of groups for discussion like the APA Board of Educational Affairs, Scientific Affairs, Professional Affairs etc. The final report (1st of 3) was issued in 1995 (Task Force, 1995; Chambless et al, 1996, 1998) in which a number of psychological treatments were identified as empirically validated treatments. In this report, the Task Force published criteria for selection of EST’s and a very preliminary list of 25 treatments that met those criteria. Because the 1st Task Force focused largely on EST’s, Division 12 appointed a 2nd Task Force with an emphasis on EST’s and prevention programs for children, the Task Force on Effective Psychosocial Interventions: A Lifespan Perspective. In subsequent reports, the Task Force expanded the list of EST’s (Chambless et al, 1996, 1998) and it included a list of 71 treatments as well as information concerning training opportunities and materials for therapists. (Sanderson and Woody, 1995; Woody and Sanderson, 1998).

Work group Criteria for Identification of Empirically Supported Therapies:

Well-established Treatments

I. At least two good between-group design experiments must demonstrate efficacy in one or more of the following ways:
A. Superiority to pill or psychotherapy placebo, or to other treatment
B. Equivalence to already established treatment with adequate sample sizes. OR,

II. A large series of single- case design experiments must demonstrate efficacy with A. Use of good experimental design. B. Comparison of intervention to another treatment.

III. Experiments must be conducted with treatment manuals or equivalent clear description of treatment.

IV. Characteristics of samples must be specified

V. Effects must be demonstrated by at least two different investigators or teams.

Probably efficacious treatments

I. Two experiments must show that the treatment is superior to waiting – list control group; OR,

II. One or more experiments must meet well established criteria I A or I B, III and IV above but V is not met; OR,

III. A small series of single – case design experiments must meet well – established treatment criteria. Experimental Treatments Treatment not yet tested in trials meeting Task Force criteria for methodology (Chambless et al, 1998).

EMPIRICALLY SUPPORTED PSYCHOLOGICAL INTERVENTIONS

The following coding system is used to indicate the nature of the supporting evidence in the summary recommendations and references:
[A] Randomized clinical trial: A study of an intervention in which subjects are prospectively followed over time; there are treatment and control groups; subjects are randomly assigned to the two groups; both the subjects and the investigators are blind to the assignments.
[B] Clinical trial: A prospective study in which an intervention is made and the results of that intervention are tracked longitudinally; study does not meet standards for a randomized clinical trial.
[C] Cohort or longitudinal study: A study in which subjects are prospectively followed over time without any specific intervention.
[D] Case-control study: A study in which a group of patients and a group of control subjects are identified in the present and information about them is pursued retrospectively or backward in time.
[E] Review with secondary data analysis: A structured analytic review of existing data (e.g., a meta-analysis or a decision analysis).
[F] Review: A qualitative review and discussion of previously published literature without a quantitative synthesis of the data.
[G] Other: Textbooks, expert opinion, case reports, and other reports not included above.

Behaviour Therapy (BT)

Research on behavioural psychotherapy has developed from several strands and it has been found to be effective in the treatment and management of a variety of problems.
Depression: BT of major depressive disorder includes activity scheduling, self control therapy, social skills training and problem solving. Two meta analyses have concluded that BT is superior to wait listing. (Depression Guideline Panel, 1993 [E]; Jarrett and Rush, 1994 [F]). Results of individual clinical trials have suggested that BT may be superior in efficacy to brief dynamic psychotherapy (Steuer, 1984 [B]) and generally comparable in efficacy to cognitive therapy (Jacobson et al, 1991) or pharmacotherapy (Miller et al, 1989).
Anxiety Disorders: Behavioural and cognitive psychotherapies are the most widely studied psychological interventions for anxiety disorders (Barlow, 2002). The most widely employed behavioural technique is systematic exposure to situations and stimuli that evoke pathological fear.
a) Panic Disorder: Behavioural treatments (e.g. exposure in vivo) have been shown effective when compared to other psychological interventions (Deacon and Abramowitz, 2004).
b) Phobia: Meta analytic findings on psychological treatments for social phobia provide consistent support to the fact that exposure therapy done appear to be effective and results are equivocal about whether adding cognitive restructuring confers additional benefits. Mean effect sizes for cognitive approaches tend to be lower than those for exposure alone, which suggest the superiority of behaviour therapy. (Deacon and Abramowitz, 2004). In the specific phobia, participant modeling has been found to be more effective than non-directive supportive therapy as well as systematic desensitization and filmed modeling (Ollendick & King, 1998; 2000).
c) Obsessive – Compulsive Disorders (OCD): Research on treatment of adult OCD has demonstrated a high degree of specificity, in that different forms of behaviour therapy have significantly different effects. Studies conducted by Fals- Stewart et al. (1993[A]) and Lindsey et al (1997 [A]) compared Exposure and Response Prevention (ERP) to Progressive Muscle Relaxation either alone or as part of anxiety management training and found that ERP was significantly superior to the alterative treatment

Cognitive Therapy (CT)

CT has been found to be effective in treating different disorders that cause emotional maladjustment.
Depression: CT has been effective in treating various types of depression such as unipolar depression, major depression, minor depression, acute depression and endogenous depression (Gitlin, 1995; Simons and Thase, 1992). CT has been found to be more effective than behavioural and interpersonal therapies (Shapiro et al, 1994). Blatt et al. (2000) analyzed data from the National Institute Of Mental Health Treatment for Depression Collaborative Research Program, (NIMH-TDCRP) in which two EST’s – cognitive and interpersonal therapies were compared to treatments with an antidepressant plus clinical management and with a placebo plus clinical management and it was found that the both psychotherapy groups rated their life adjustment significantly more positively than the other groups.
Anxiety Disorders: Arntz and Hout (1996) found that among patients with panic disorder and a secondary diagnosis of social phobia or mood disorder, CT produced superior outcomes in comparison to applied relaxation by reducing the frequency of panic attacks. In the most recent meta analytic review of social phobia treatment, Fedoroff and Taylor (2001) computed effect sizes for seven trials of exposure therapy, seven of CT and 21 of combined exposure plus CT. CT alone and CT plus exposure were considered highly effective and not different from one another.
Generalised Anxiety Disorder (GAD): The most widely studied treatment for GAD has been Beck and Emery’s (1985) CT model. Chambless and Gillis (1993) reviewed studies evaluating the efficacy of this model and found that CT in combination with behavioural techniques was more effective than the placebo.
Schizophrenia: The efficacy of remediation of cognitive deficits like attention and memory problems, by cognitive techniques has been demonstrated in experimental trials (Penn and Mueser, 1996 [F, G]; Corrigen & Yudofsky, 1994[B]) but extended studies have not been carried out. Several controlled and uncontrolled studies have extended Beck’s CT to schizophrenia with encouraging clinical results, including reduction or removal of delusions and hallucinations. (Tarrier et al, 1993 [B]; Kingdon and Turkingdon, 1994 [B]).

Cognitive Behaviour Therapy

CBT represents an integration of schools of psychotherapy, most notably BT and CT. CBT maintains an empiricist tradition and strives for clinical sensitivity with empiric soundness.
Depression: CBT has been shown to be effective in treating patients with dysthymia and chronic major depressive disorder, although responses have been somewhat smaller than when these modalities are used to treat patients with major depressive disorder (Keller et al, 1996[F]). In two decades since it was first evaluated as a treatment for major depressive disorder, CBT has been extensively studied in over 80 controlled trials and the effect sizes for CBT compared to no treatment or minimal treatment have been fairly robust (Glouguen et al, 1998 [E]; Blackburn & Moore, 1997 [B]). Some meta analyses have concluded that effect sizes for CBT are larger than pharmacotherapy (Gloaguen et al, 1998 [E]; De Rubeis et al, 1999 [E]) whereas others suggest that they are equally effective (Clark et al, 1994 [B]). In the NIMH – TDCR study, CBT was observed to be less effective than imipramine plus clinical management among individuals with severe depression and CBT was also found to be less effective than interpersonal therapy (IPT).
Anxiety Disorders: Psychotherapies involving cognitive and behavioural procedures have been established as EST’s for anxiety disorders (Chambless & Ollendick, 2001).
GAD: Borkovec and Costello (1993) found that CBT was significantly superior to non-directive therapy at post-test and one-year follow-up. Overall, meta-analytic literature most strongly support the effectiveness of CBT for GAD (Deacon and Abramowitz, 2004).
Panic Disorder: Treatment using CBT have demonstrated efficacy in the treatment of panic disorder with or without agoraphobia (Gould et al, 1995) Seven meta analytic reviews of panic disorder studies have appeared in the past 10 years, and all of them support the efficacy of CBT (Deacon and Abramowitz, 2004).
Obsessive Compulsive Disorder: Numerous studies conducted in various centers around the world have established Exposure & Response Prevention (ERP) as highly efficacious therapy for OCD (Franklin et al, 2000). Fals – Stewart, Marks and Schafer (1993) found that both a group and individual version of ERP outperformed a relaxation training control. Abramowitz et al (2002) conducted an updated meta analytic study that focus exclusively cognitive behavioural therapy for OCD and found that ERP was a stronger treatment than CT in comparison to no treatment.
Substance Use Disorders: There is abundant evidence that CBT aimed at improving self-control and social skills consistently lead to reduced drinking (Holder et al, 1991[E]). Motivational enhancement therapy, based on cognitive behavioural, client centered systems and social – psychological persuasion techniques, was shown to have positive effects in eight of nine controlled studies (Miller et al, 1993 [B]).
Schizophrenia: Controlled studies of CBT have reported benefits in reducing positive symptom severity in schizophrenia (Dickerson, 2000). In a review of three studies, Rector and Beck (2001) reported a large aggregated effect size favoring CBT over supportive therapy for reducing negative symptoms in schizophrenia patients.

Interpersonal Therapy

The breadth of its clinical application has grown since its early use, as has the empirical evidence supporting the efficacy of IPT (Weissman et al, 2000; Stuart and Robertson, 2003). IPT has been found to be effective in depressed patients from adolescence (Mufson, et al, 1999) to late life (Reynolds, et al, 1992), postpartum depression (O’Hara et al, 2000), medical comorbidities (Stuart and Cole, 1996) eating disorders (Wilfley et al, 2002, Fairburn et al, 1991), social anxiety and bipolar disorders (Lipsitz, 1999). There is some evidence that IPT is superior to CBT in individuals with severe depression (Klein and Ross, 1993).

Group Therapy

After a decade of benign neglect in some quarters and unsophisticated stabs at empirical inquiries in others, there has been a gratifying spurt in group therapy research in recent years. Some initial findings in the 1970’s showed that the then ‘new’ group formats such as Encounter and Self Help groups produced beneficial results (Lieberman and Borman, 1979). These were followed by comprehensive metaanalytic studies by Smith et al. (1980), which concluded that group therapy was as effective as individual treatment in the alleviation of psychological problems. In recent times, short term problem-focused approaches is a renewed interest in research with the purpose of validating earlier theoretical assumptions, and for moving toward developing cost-effective, efficient techniques.
Depression: Specific types of psychotherapy for which there are some data to support that they may be effective in the treatment of depression and when administered in a group format include cognitive behaviour therapy (Bright et al, 1999 [A]; Neimeyer et al, 1995 [C]) and interpersonal therapy. (Mackenzie et al., 1999 and Yalom, 1995) Bright et al. (1999 [A]) found that a mutual support group and cognitive behavioural therapy in a group format were equally effective in reducing depressive symptoms among depressed outpatients and a higher proportion of depressed outpatients had remitted following treatment in groups led by professionals than in groups led by non-professionals.
Panic Disorder: Reports in the literature of group therapy in the treatment of panic disorder have consisted primarily of cognitive behaviors approaches. Telch et al. (1999[A]) found a greater proportion of panic free subjects among those who had been given group CBT than among delayed treatment control subjects and the improvement was comparable to individually administered CBT and pharmacological management. Eight weeks trial of mindfulness meditation (an additional treatment proposed for panic disorder by Kabat et al., 1992) in group format showed significant reduction in rating of anxiety symptoms and panic attacks (Miller et al. 1995).
Substance use Disorders: The types of group therapy used with this population include modified psychodynamic, interpersonal, interactive, rational emotive, Gestalt and psychodrama.
Alcohol Use Disorder: Outcome studies have typically supported the efficacy of behavioural and cognitive behavioural group treatments, including group marital therapy. Patients with less sociopathy and those with neurological impairment fare better in interactional therapy, while those with higher levels of sociopathy and psychopathology fare better in cognitive behavioural groups (Cooney et. al., 1991 [B]).
Opiate Use Disorders: Psychodynamically oriented group therapy, modified for substance dependant patients, appears to be effective in promoting abstinence when combined with behavioural monitoring and individual supportive psychotherapy (Khantzian, 1990 [F]). McAuliffe (1990, [B]) reported that group relapse prevention based on a conditioning model of addiction, when combined with self help groups, was more effective than no treatment in reducing opioid use, unemployment, and criminal activities in recently detoxified patients.
Schizophrenia: The evidence for the efficacy of group therapy in schizophrenia is not strong (Scott et al., 1995 [G]; Schooler et al., 1993 [F]). A number of well-controlled studies involving stable outpatients indicate that there is very modest evidence that group therapy can be effective in improving social adjustment (Malm, 1990 [F]) and coping skills (Kanas, 1996 [F]). Higher functioning outpatients may benefit from interaction oriented group therapy while poorly functioning patients who may be over stimulated may benefit more from group approaches that attempt to reprogram cognitive and behavioural deficits (American Psychiatric Association, 1989).
Borderline Personality Disorder: The limited literature on group therapy for patients with borderline personality disorder indicates that group treatment is not harmful and may be helpful, but it does not provide evidence of any clear advantage over individual psychotherapy. In general, group therapy is usually used in combination with individual therapy and other types of treatment, reflecting clinical wisdom that the combination is more effective than group therapy alone. Studies of combined individual dynamic therapy plus group therapy suggest that the non-specified components of combined intervention may have the greatest therapeutic power (McGlashan, 1986[C]).

Family Therapy (FT)

An evidence-based approach in family therapy emphasizes the value of family participation in treatment and stresses the importance of working together in a collaborative endeavor. The main goal of family interventions referred to, as psychoeducation is to decrease the risk of patient’s relapse. More recent research emphasized other goals such as improving patient and family functioning, and decreasing family burden.
Depression: Techniques for using family approaches for the treatment of major depressive disorder include behavioural approaches (Beach et al., 1990 [G]) and a psycho-educational approach. One adequately sized trial of behavioural family treatment has been completed and investigation have found that behavioural family management (in concert with adequate pharmacotherapy) resulted in a substantial decrease in depressive relapse rates when compared with a usual control condition (Miklowitz et al., 2000 [A]).
Anxiety Disorders: There is some evidence that patients of panic disorder who experience mental distress may benefit from a family intervention. (Jacobson et al., 1989 [F]).
Substance use Disorders: Controlled studies have shown family therapy to be effective for adolescents, patients on methadone maintenance and patients with alcohol dependence (American Psychiatric Association, 2002).
Schizophrenia: While the use of different variants of family management and the different types of control treatments (like individual supportive therapy, medication alone etc) makes it difficult to compare the results of more than 10 controlled studies, relapse rates have typically been halved (Penn et al., 1996 [F, F]; McFarlane et al., 1992 [f]; Randolph et al., 1994 [A]). McFarlane (1994[F]) found slightly better protection against relapse from the multiple family groups in a controlled study in comparison to individual families.

Marital Therapy

Two generations of outcome research demonstrate the potential efficacy of marital therapy in the treatment of depression (Beach et al, 1998). Therapies that have been found to be efficacious include Cognitively Oriented Marital Therapy (COMT), Emotionally Focused Marital Therapy (EFMT) and Insight Oriented Marital Therapy (IOMT) (Wesley and Waring, 1996).

Rational Emotive Behaviour Therapy (REBT)

Starting in the 1960s and continuing into the 1980s, more than 1000 outcome studies have been done on REBT and on closely related forms of CBT (Hajzler and Bernard, 1991; Hollon and Beck, 1994; Lyons and Woods, 1991). The great majority of these controlled studies have shown that, when compared to a control group, clients treated with REBT fare significantly better than those who are not so treated. In addition to empirical studies that tend to back the main therapeutic hypothesis of REBT, literally hundreds of other controlled experiments have been published that tend to indicate that many of the main theoretical hypothesis of REBT now have considerable experimental backing (Dryden and Ellis, 2001). REBT has had many applications to various aspects of psychotherapy, including child and adolescent therapy (Bernard & Joyce, 1984) marriage and family therapy, (Ellis, 1991, 1993, Ellis and Dryden, 1997) sex and relationship therapy (Ellis and Lange, 1994, Ellis and Tafrate, 1997; Wolfe, 1992) brief therapy (Dryden, 1996; Ellis, 1996a, 1996b), treatment of personality disorders (Ellis, 1994a, 1994c), hypnosis (Ellis, 1993e, 1996e), group therapy (Ellis, 1997c), treatment of eating disorders (Ellis, Abrams & Dengelegi, 1992) addiction treatment (Ellis and Di Giuseppe, 1994; Ellis and Velten, 1992) geriatric therapy (Ellis and Velten, 1998), and treatment of OCD (Ellis, 1997 ).

Hypnosis

A review of controlled studies on the efficacy of clinical hypnosis with children records promising findings, particularly for reduction of acute pain, chemotherapy related distress and enuresis (Millings and Constantino,2002). However, no child hypnosis intervention currently qualifies as “efficacious” according to criteria for EST. A 26 critical trial review (Primavera and Kaiser, 1992) pertaining to non-pharmacological treatment of headache suggest that there is no significant difference in the efficacy of hypnosis, biofeedback and relaxation training.

Psychodynamic Psychotherapy (PDP)

Psychoanalytic or psychodynamic psychotherapy encompasses a number of psychotherapeutic interventions that may be brief or long term in duration. Rustin (1997) asserts that psychoanalysis has always had its own distinctive research methods and that these have been productive over 100 years in enlarging the powers of the psychoanalytic paradigm to understand new areas of mental life. These have included new categories of patients (for e.g., the development of psycho-analysis of children) and new categories of difficulty and disorder (psychosis, autism, borderline disorder etc). Psychoanalytic technique is as far as possible controlled and monitored by individual analysts and by analysts working informally together as research group.
Depression: In one of the most comprehensive and accomplished comparative psychotherapy outcome reviews, Roth and Fonagy (1996) found that psychodynamic psychotherapies achieved their minimal criteria for full empirical validation only in the treatment of depression for the elderly and failed to do so for the treatment of any other child or adult disorder. Results of two metaanalyses suggest that brief psychodynamic psychotherapy for the treatment of major depressive disorder is more effective than a waiting list control condition but probably less effective than other forms of psychotherapy (Depression Guideline Panel, 1993; [E], Jarrett and Rush, 1999 [F]).
Anxiety Disorders: Studies conducted by Bash (1995 [G]) reveal that some case reports of brief dynamic psychotherapies that took no longer than CBT to achieve reasonable treatment goals for patients with panic disorder.
Substance Use Disorders: Holder et al (1991 [E]) concluded that there was little empirical evidence from controlled studies that either insight oriented psychotherapy or counseling is an effective treatment for alcoholism. Psychodynamic supportive-expressive psychotherapy (SE), developed by Luborsky et al (1984), has been found to be an effective intervention for opiate use disorders and Woody et al (1983 [B]; 1995 [B]) found that SE was more effective than drug counseling alone for patients with high levels of other psychiatric symptoms like depression .
 

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