Psychotherapy: the requirements of experts from INSERM

Collective expertise conducted by INSERM on the comparison of three therapeutic approaches to mental disorders, concluded the superiority of cognitive-behavioral therapy on psychoanalysis and group therapy.

The therapeutic methods

Under the mental health plan implemented by the Ministry of Health, Directorate General of Health (DGS) has sought to achieve an Inserm collective expertise from the international scientific literature on the evaluation of different psychotherapies applied to the treatment of mental disorders.

French associations, the National Union of friends and families of mentally ill (UNAFAM) and the National Federation of ex-psychiatric patients associations are associated with this approach.

The experts analyzed approximately 1,000 articles from the international scientific literature and evaluating three approaches: psychodynamic or psychoanalytic approach, cognitive-behavioral, family approach or couple. The report was made public.

The psychoanalytic approach is based on psychoanalytic theory, including the transfer. Born of the work of Sigmund Freud, it has diversified into practice, with many clinical variants: psychoanalysis, psychoanalytic therapy, brief psychodynamic therapy, psychodynamic interpersonal therapy. These therapies aim deep and lasting changes in the patient.

Cognitive-behavioral therapies are primarily based on the theories of learning, before then taking reference to cognitive theories of psychological functioning, and in particular the model of information processing. The first step is based on the analysis of the relationship between behavior, thoughts, emotions, and the social and physical environment.

The approach family or couple can rely on several principles: psychodynamic, ecosystem, behavioral and cognitive. It integrates various techniques including psycho-education, as a family as domestic.

For people with schizophrenia or acute hospital under antipsychotics, data showed effectiveness of family therapy on the relapse rate in two years, moderate and short-term effectiveness of cognitive therapy, lack of efficacy psychodynamic therapies.

For schizophrenic patients stabilized as outpatients treated with medication, efficiency is established for the cognitive-behavioral approach to social skills and better management of emotions. Family therapy is also effective on the relapse rate in two years.

Direct comparisons between the different approaches used to establish a superior efficacy of psychoeducational approach family and cognitive behavioral therapy.

For bipolar disorder (manic-depressive) belonging to mood disorders, the available data show the effectiveness of psychoeducational approach spousal associated with drug treatment. This efficiency has been demonstrated including the overall functioning, treatment adherence and the occurrence of relapses only maniacs

For major depressive disorders in hospitalized patients on antidepressants, cognitive-behavioral therapies are effective. Controlled comparing psychodynamic and cognitive-behavioral studies conclude that the superiority of the latter. Family psychoeducation has a short-term effect on the overall functioning of patients and psychodynamic therapies affect social adjustment and duration of hospitalization of patients.