Major findings from the past 55 years of psychological treatment research indicate that 3 questions are now pivotal to continued practice-relevant progress: What is the nature of the problem(s) to be treated? What are the causal change mechanisms of efficacious psychological treatments? Can more efficient and broadly effective psychological treatments be developed? Contemporary cognitive, affective, and behavioural neurosciences offer particularly promising resources for psychological treatment research that can help accelerate progress regarding these questions. This article explains why the questions are pivotal and presents neuroscience findings to illustrate how progress can be made on each one and for diverse problems and disorders such as major depression, posttraumatic stress disorder, obsessive–compulsive disorder, drug addiction, and regulation of negative affect.
DavidsonRJPizzagalliDNitschkeJBPutnamK.Depression: Perspectives from affective neuroscience. Annu Rev Psychol2002;53:545–74.
2.
LaneRDNadelL.Cognitive neuroscience of emotion. New York (NY): Oxford University Press; 2000.
3.
MorasK.Research in psychotherapy. In HersenMSledgeW, editors. Encyclopedia of psychotherapy. Volume 2. New York (NY): Academic Press; 2002. p 525–45.
4.
MorasK.Extending the scientific foundation of psychotherapy research. Presidential address presented at the Conference of the Society for Psychotherapy Research; 2003 June; Weimar (DE).
5.
ChamblessDLBakerMJBaucomDHBeutlerLECalhounKSCrits-ChristophP, and others. Update on empirically validated therapies II. Clin Psychol1998;51: 3–16.
6.
ChamblessDLOllendickTH. Empirically supported psychological interventions: Controversies and evidence. Annu Rev Psychol2001;52:685–716.
7.
Task Force on Promotion and Dissemination of Psychological Procedures. Training in and dissemination of empirically-validated psychological treatments: Report and recommendations. Clin Psychol1995;48:3–24.
8.
BarlowDHGormanJMShearMKWoodsSW. Cognitive-behavioral therapy, imipramine, or their combination for panic disorder: A randomized controlled trial. JAMA2000;283:2529–36.
9.
CasacalendaNPerryJCLooperK.Remission in major depressive episode: A comparison of pharmacotherapy, pspychotherapy, and control conditions. Am J Psychiatry2002;159:1354–60.
10.
DeMaatSDekkerJSchoeversRDeJongheF.Relative efficacy of psychotherapy and pharmacotherapy in the treatment of depression: A meta-analysis. Psychotherapy Res2006;16:566–78.
11.
ElkinISheaTWatkinsJTImberSDSotskySMCollinsJF, and others. National Institute of Mental Health Treatment of Depression Collaborative Research Program: General effectiveness of treatments. Arch Gen Psychiatry1989;46:971–82.
12.
InselT.Beyond efficacy: The STAR*D trial. Am J Psychiatry2006;163:5–7.
13.
JoyceASWolfaardtUSribneyCAylwinAS. Psychotherapy research at the start of the 21st century: The persistence of the art versus science controversy. Can J Psychiatry2006;51:795–809.
14.
SmithMLGlassGV. Meta-analysis of psychotherapy outcome studies. Am Psychol1977;32:752–60.
15.
ElkinIParloffMBHadleySWAutryJH. NIMH Treatment of Depression Collaborative Research Program. Background and research plan. Arch Gen Psychiatry1985;42:305–16.
16.
LuborskyLDeRubeisRJ. The use of psychotherapy treatment manuals: A small revolution in psychotherapy research style. Clin Psychol Rev1984;4:5–14.
17.
WilsonGT. Manual-based treatments: The clinical application of research findings. Behav Res Ther1996;34:295–314.
18.
BarlowDH. Psychological treatments. Am Psychol2004;59:869–78.
19.
HollonSDDeRubeisRJSheltonRCAmsterdamJDSalomonRMO'ReardonJP, and others. Prevention of relapse following cognitive therapy vs medications in moderate to severe depression. Arch Gen Psychiatry2005;62:417–22.
20.
BaxterLRJrSchwartzJMBergmanKSSzubaMPGuzeBHMazziottaJC, and others. Caudate glucose metabolic rate changes with both drug and behavior therapy for obsessive-compulsive disorder. Arch Gen Psychiatry1992;49:681–89.
21.
SchwartzJ M. Neuroanatomical aspects of cognitive-behavioural therapy response in obsessive-compulsive disorder. Br J Psychiatry1998;173(suppl 35):38–44.
22.
MartinSDMartinERaiSSRichardsonMARoyallR.Brain blood flow changes in depressed patients treated with interpersonal psychotherapy or venlafaxine hydrochloride: Preliminary findings. Arch Gen Psychiatry2001;58:641–8.
23.
DavidsonRJKabat-ZinnJSchumacherJRosenkranzMMullerDSantorelliSF, and others. Alterations in brain and immune function produced by mindfulness meditation. Psychosom Med2003;65:564–70.
24.
PaquetteVLevesqueJMensourBLerouxJMBeaudoinGBourgouinPBeauregardM.“Change the mind and you change the brain:” Effects of cognitive-behavioral therapy on the neural correlates of spider phobia. Neuroimage2003;18:401–9.
25.
GoldappleKSegalZGarsonCLauMBielingPKennedyS, and others. Modulation of cortical-limbic pathways in major depression: Treatment-specific effects of cognitive behavior therapy. Arch Gen Psychiatry2004;61(1):34–41.
26.
StraumanTJMerrillKA. The basic science/clinical science interface and treatment development. Clin Psychol Sci Prac2004;11;263–6.
27.
AndreasenNC. Linking mind and brain in the study of mental illnesses: A project for a scientific psychopathology. Science1997; 275:1586–93.
28.
MaybergHSLiottiMBrannanSKMcGinnisSMahurinRKJerabekPA, and others. Reciprocal limbic-cortical function and negative mood: Converging PET findings in depression and normal sadness. Am J Psychiatry1999;156:675–82.
29.
MaybergHSBrannanSKTekellJLSilvaJAMahurinRKMcGinnisS, and others. Regional metabolic effects of fluoxetine in major depression: Serial changes and relationship to clinical response. Biol Psychiatry2000;48:830–43.
30.
KalivasPWVolkowND. The neural basis of addiction: A pathology of motivation and choice. Am J Psychiatry2005;162:1403–13.
31.
BeckATRushAJShawBFEmeryG.Cognitive therapy of depression. New York (NY): Guilford Press; 1979.
32.
BeckJS. Cognitive therapy: Basics and beyond. New York (NY): Guilford Press; 1995.
33.
MorasK.Treatment resistant depression: Clinical and research perspectives on patient features and alternative treatments. Panel session at the Conference of the Society for Psychotherapy Research; 2000 June; Chicago (IL).
34.
SiegleGJGhinassiFThaseME. Neurobehavioral therapies in the 21st century: Summary of an emerging field and an extended example of cognitive control training for depression, Cogn Ther Res March 2007. Forthcoming.
35.
American Psychiatric Association. Diagnostic and statistical manual of mental disorders. 4th ed. Text revision. Washington (DC): American Psychiatric Association Press; 2000.
36.
KieslerDJ. Beyond the disease model of mental disorders. Westport (CT): Praeger; 1999.
37.
KruegerRFWatsonDBarlowDH. Introduction to the special section: Toward a dimensionally based taxonomy of psychopathology. J Abnorm Psychol2005;114:491–3.
38.
WatsonD.Rethinking the mood and anxiety disorders: A quantitative hierarchical model for DSM-V. J Abnorm Psychol2005;114:522–36.
39.
BarronJW. Making diagnosis meaningful: Enhancing evaluation and treatment of psychological disorders. Washington (DC): American Psychological Association; 1998.
40.
WidigerTAClarkLA. Toward DSM-V and the classification of psychopathology. Psychol Bull2000;126:946–63.
41.
DavidsonRJ. Well-being and affective style: Neural substrates and biobehavioral correlates. Phil Trans R Soc Lond B Biol Sci2004;359:1395–411.
42.
RogersCR. Client-centered counselling. Boston (MA): Houghton-Mifflin; 1951.
43.
KieslerD J. The process of psychotherapy: Empirical foundations and systems of analysis. Chicago (IL): Aldine Publishing Company; 1973.
44.
DossBD. Changing the way we study change in psychotherapy. Clin Psychol Sci Prac2004;11:368–86.
45.
KraemerHCWilsonGTFairburnCGAgrasWS. Mediators and moderators of treatment effects in randomized clinical trials. Arch Gen Psychiatry2002;59:877–83.
46.
PiperWEJoyceASMcCallumMAzimH F A. Interpretive and supportive forms of psychotherapy and patient personality variables. J Consult Clin Psychol1998;66:558–67.
47.
JoyceASOgrodniczukJSPiperWEMcCallumM.The alliance as mediator of expectancy effects in short-term individual therapy. J Consult Clin Psychol2003;71:672–9.
48.
DeRubeisR JBrotmanMAGibbonsCJ. A conceptual and methodological analysis of the nonspecifics argument. Clin Psychol Sci Prac2005;12:174–83.
49.
KazdinAE. Treatment outcomes, common factors, and continued neglect of mechanisms of change. Clin Psychol Sci Prac2005;12:184–8.
50.
KazdinAE. Mechanisms of change in psychotherapy: Advances, breakthroughs, and cutting-edge research (do not yet exist). In: BootzinRRMcKnightPE, editors. Strengthening research methodology: Psychological measurement and evaluation. Washington (DC): American Psychological Association; 2006. p 77–101.
51.
HorvathAOSymondsBD. Relation between working alliance and outcome in psychotherapy: A meta-analysis. J Counseling Psychology1991;38:139–49.
GreenbergLSPinsofWM, editors. The psychotherapeutic process: A research handbook. New York (NY): Guilford Press; 1986.
56.
OrlinskyDEHowardKI. The relation of process to outcome in psychotherapy. In: GarfieldSBerginA, editors. Handbook of psychotherapy and behavior change. 2nd ed.New York (NY): John Wiley; 1978. p 283–329.
57.
OrlinskyDERennestadMHWillutzkiU.Fifty years of psychotherapy process-outcome research: Continuity and change. In: LambertM, editor. Bergin and Garfield's handbook of psychotherapy and behavior change. 5th ed.New York (NY): John Wiley; 2004. p 307–89.
58.
KazdinAE. Developing a research agenda for child and adolescent psychotherapy. Arch Gen Psychiatry2000;57:829–35.
59.
MarksIM. The maturing of therapy: Some brief psychotherapies help anxiety/depressive disorders but mechanisms of action are unclear. Br J Psychiatry2002;180:200–4.
60.
CraigheadWESheetsESBjornssonAS. Specificity and nonspecificity in psychotherapy. Clin Psychol: Sci Prac2005;12:189–93.
61.
WampoldBE. The great psychotherapy debate: Models, methods, and findings. Mahwah (NJ): Lawrence Erlbaum; 2001.
62.
FrankJ.Persuasion and healing. Baltimore (MD): Johns Hopkins University Press; 1961.
63.
FoaEBEmmelkampPMG. Failures in behavior therapy. New York (NY): John Wiley & Sons; 1983.
64.
StruppHHHadleySWGomes-SchwartzB.Psychotherapy for better or worse: The problem of negative effects. New York (NY): Jason Aronson; 1977.
65.
OrlinskyDE. Comments on the state of psychotherapy research (as I see it). North American Society for Psychotherapy Research Newsletter January, 2006. p. 2–3. Available: www.naspr.org/. Accessed 2006 Mar 5.
EtkinAPittengerCPolanHJKandelER. Toward a neurobiology of psychotherapy: Basic science and clinical applications. J Neuropsychiatry Clin Neurosci2005;17:145–58.
68.
KandelER. Psychotherapy and the single synapse: The impact of psychiatric thought on neurobiological research. J Neuropsychiatry Clin Neurosci1979;13:290–300.
69.
TryonWW. Possible mechanisms for why desensitization and exposure therapy work. Clin Psychol Rev2005;25:67–95.
70.
BrewinCR. A cognitive neuroscience account of posttraumatic stress disorder and its treatment. Behav Res Ther2001;39:371–93.
71.
WestenD.Implications of developments in cognitive neuroscience for psychoanalytic psychotherapy. Harv Rev Psychiatry2002;10:369–73.
72.
LeDouxJ.Synaptic self: How our brains become who we are. New York (NY): Viking Penguin; 2002.
73.
DeckersbachTDoughertyDDRauchSL. Functional imaging of mood and anxiety disorders. J Neuroimaging2006;16(1):1–10.
74.
Meyer-LindenbergAPolineJBKohnPDHoltJLEganMFWeinbergerDR, and others. Evidence for abnormal cortical functional connectivity during working memory in schizophrenia. Am J Psychiatry2001;158:1809–17.
75.
Mataix-ColsDWoodersonSLawrenceNBrammerMJSpeckensAPhillipsML. Distinct neural correlates of washing, checking, and hoarding symptom dimensions in obsessive-compulsive disorder. Arch Gen Psychiatry2004:61;564–76.
76.
SchwartzJMStoesselPWBaxterLRJrMartinKMPhelpsME. Systematic changes in cerebral glucose metabolic rate after successful behavior modification treatment of obsessive-compulsive disorder. Arch Gen Psychiatry1996;53:109–13.
77.
SchwartzJMBeyetteB.Brain lock: Free yourself from obsessive-compulsive behavior: A four-step self-treatment method tochange your brain chemistry. 1st ed.New York (NY): Regan Books; 1996.
78.
SchwartzJM. Neuroanatomical aspects of cognitive-behavioural therapy response in obsessive-compulsive disorder: An evolving perspective on brain and behaviour. Br J Psychiatry1998;173(suppl 35):38–44.
79.
MaserJDCloningerCR, editors. Comorbidity of mood and anxiety disorders. Washington (DC): American Psychiatric Press; 1990.
80.
RosenGMDavisonGC. Psychology should list empirically supported principles of change (ESPs) and not credential trademarked therapies or other treatment packages. Behav Modif2003;27:300–12.
81.
MaybergHS. Limbic-cortical dysregulation: A proposed model of depression. J Neuropsychiatry Clin Neurosci1997;9:471–81.
82.
SeminowiczDAMaybergHSMcIntoshARGoldappleKKennedySSegalZ, and others. Limbic-frontal circuitry in major depression: A path modeling metanalysis. Neuroimage2004;22:409–18.
83.
MaybergHSSilvaJABrannanSKTekellJLManhurinRKMcGinnisS, and others. The functional neuroanatomy of the placebo effect. Am J Psychiatry2002;159:728–37.
84.
SimonsADGarfieldSLMurphyGE. The process of change in cognitive therapy and pharmacotherapy for depression. changes in mood and cognition. Arch Gen Psychiatry1984;41(1):45–51.
85.
SchatzbergAFKraemerHC. Use of placebo control groups in evaluating efficacy of treatment of unipolar major depression. Biol Psychiatry2000;47:736–44.
86.
BaskinTWTierneySCMinamiTWampoldBE. Establishing specificity in psychotherapy: A meta-analysis of structural equivalence of placebo controls. J Consult Clin Psychol2003;71:973–79.
87.
HorvathP.Placebos and common factors in two decades of psychotherapy research. Psychol Bul1988;104:214–25.
88.
BenedettiFMaybergHSWagerTDStohlerCSZubietaJ.Neurobiological mechanisms of the placebo effect. J Neurosci2005;25:10390–402.
89.
WampoldBEMinamiTTierneySCBaskinTWBhatiKS. The placebo is powerful: Estimating placebo effects in medicine and psychotherapy from randomized clinical trials. J Clin Psychol2005;61:835–54.
90.
WagarTD. The neural bases of placebo effects in pain. Curr Direct Psychol Sci2005;14:175–9.
91.
ParloffMB. Placebo controls in psychotherapy research: A sine qua non or a placebo for research problems?J Consult Clin Psychol1986;54(1):79–87.
92.
BorkovecTDSibravaNJ. Problems with the use of placebo conditions in psychotherapy research, suggested alternatives, and some strategies for the pursuit of the placebo phenomenon. J Clin Psychol2005;61:805–18.
93.
EysenckHJ. The effects of psychotherapy: An evaluation. J Consult Clin Psychol1952;16:319–24.
94.
TeasdaleJDSegalZVWilliamsJMGRidgewayVASoulsbyJMLauMA. Prevention of relapse/recurrent in major depression by mindfulness-based cognitive therapy. J Consult Clin Psychol2000;68:615–23.
95.
SegalZVTeasdaleJWilliamsJMG. Mindfulness-based cognitive therapy for depression: A new approach to preventing relapse. New York (NY): Guilford Press; 2001.
96.
SchaeferSMJacksonDCDavidsonRJAguirreGKKimbergDYThompson-SchillSL. Modulation of amygdalar activity by the conscious regulation of negative emotion. J Cogn Neurosci2002;14:913–21.
97.
OchsnerKNRayRDCooperJCRobertsonERChopraSGabrieliJDE, and others. For better or worse: Neural systems supporting the cognitive down- and up-regulation of negative emotion. Neuroimage2004;23:483–99.
98.
WellsA.Emotional disorders and metacognition: Innovative cognitive therapy. New York (NY): John Wiley & Sons; 2000.
99.
NorcrossJCKohoutJLWicherskiM.Graduate study in psychology: 1971 to 2004. Am Psychol2005;60:959–75.
