Exposure therapy and Psychotherapy’s so-called “image problem.”

I am writing this in response to a New York Times op-ed piece that my father forwarded to me found here. The author reports that the number of people seeking psychotherapy alone is down 34% from 1998-2007, while the number of people seeking medications alone is up 23%. He argues this is not due to a lack of interest, as patients are demonstrating an increase in preference for psychotherapy to medications across multiple studies. Instead, the author claims this is due to an “image problem,” that has left psychotherapy relegated to a lower class of intervention that is not perceived as being as effective. Drug companies, conversely, are pumping billions of dollars into marketing campaigns to make sure the consumers, providers, and insurance companies all understand just how effective medications are across research studies. I agree, that when offered the choice between Exposure therapy with Response Prevention and anti-anxiety medications, the latter is going to involve far less short-term pain and appear more attractive at first. However, I would argue that many of the so-called evidence-based studies for these medications do not take into account longer-term outcomes. Prolonged exposure, as well as several other empirically-supported psychotherapies such as Acceptance and Commitment Therapy (ACT), have demonstrated improvement in functioning in both the short-term and at longer-term follow-up.

Another factor in choosing psychotherapy versus medication is the idea of which treatment is going to produce quicker results for less effort. Unfortunately, it seems to me our society is moving in the direction of expecting things instantly and with little to no effort – (think information and communication on smartphones). Psychotherapy, including exposure therapy and ACT for anxiety disorders, as well as other forms of therapy, do not offer this. The cornerstone of therapy is the client and his or her willingness to put in the effort to get the life they want. It reminds me of the joke, “How many psychotherapists does it take to change a light bulb? Answer: 1, but the light bulb has to want to change.” Medications, on the other hand, allow clients to have almost effortless and sometimes immediate relief from their symptoms. Psychotherapy cannot and should not try to compete with this. Instead, it is up to the clients, as well as providers and the health care industry at large to continue to advocate for the harder, but ultimately, more effective and meaningful treatment that is psychotherapy. Medications have a time and a place in treating mental health issues, but we as a society must be wary about how far we let clever marketing from billion-dollar industries take us away from old-fashioned hard work and self-growth.

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