"We are currently in an exciting era for psychological research"
Five questions for Professor Emily Holmes of the Department of Clinical Neuroscience at Karolinska Institutet, who led The Lancet Psychiatry Commission on psychological treatments research in tomorrow’s science.
How did this post come to you and what were the commission’s conclusions?
“Two years ago, a large group of us met in London for a full day of brainstorming and discussion in small groups. Our number included researchers and clinicians in fields such as psychology, experimental psychology, psychiatry and neuroscience. During that day, there was fantastic energy in the room. We therefore continued to work over the following months, which proved to be an extremely creative period. We have questioned things that we previously took for granted. The ten areas we collectively decided to highlight are actually ten examples of big questions. Among other things, these reflect our desire to see research aimed at helping more people more effectively. One of the questions deals with how pharmacological and psychological treatments work in combination. We also ask the questions: what should we do in order to improve psychological treatments, and to achieve global reach?”
The 10 action points for future psychological research will be presented in more detail at a conference in Nobel Forum, Karoliska Institutet campus Solna on 16 March at 9:00-12:00 hrs (registration required).
The Commission was led by Emily Holmes, and the coauthors are Ata Ghaderi, Catherine J Harmer, Paul G Ramchandani, Pim Cuijpers, Anthony P Morrison, Jonathan P Roiser, Claudi L H Bockting, Rory C O’Connor, Roz Shafran, Michelle L Moulds and Michelle G Craske.
Why was the commission necessary?
“We are currently in an exciting era for psychological research. Although we have good evidence-based psychological treatments in areas such as anxiety and depression, we need to do better. Even our best treatments may help only 50 percent of patients and, from a global perspective, there are many people who do not have access to them.”
How do you believe that these ten areas/questions will be received?
“There is a great deal of exciting research waiting to be undertaken! We believe and hope that the questions will lead to a debate and inspire discussion about the goals of future psychological treatment research. And that these discussions will contribute to new ways of thinking. For example, we would like to engage those already researching so that they begin to question why a given psychological treatment works.”
What is your personal favourite among the ten areas/questions?
“Number 1 is, what are the underlying mechanisms that make treatments effective? But of course, we need to work together on all of the questions and even more areas we have not been able to cover here in order to ensure success and ongoing development across the entire research field of psychological treatments and mental health.”
What are your hopes for future psychological treatment methods?
“Karolinska Institutet is one of the first medical universities in the world with a clinical psychology training programme. Everyone who teaches on the programme is an active researcher. This creates a strong connection between scientific research and education. This helps us to enable a new generation of psychologists and clinicians who are interested in learning why therapies work and we believe that this will make them open to new treatment developments.”
Text: Maja Lundbäck (in translation from Swedish)
Ten action points for future psychological treatment research
1. How do existing treatments work? We know that some psychological treatments are effective. However, this knowledge is insufficient. What is required now are research initiatives that put their finger on exactly what provides the positive effects of individual treatments (and also when they don’t work). What are the key mechanisms behind existing successful methods? Research into these mechanisms may offer us good opportunities to identify better treatments.
2. Where? Research to improve mental health worldwide. Lack of access to psychological treatment is a major problem. In order to promote access to psychological treatment globally, we must continue to develop rapid, flexible initiatives. We also need to continue to assess how effective these initiatives are and adapt them to work in many cultures.
3: With what? The potential for synergistic treatment effects. A greater understanding is required into the clinical effects of psychological treatment in combination with other treatments, such as pharmacology. Attempts to develop and investigate the effects of new combined treatments may contribute to new advances in treatment.
4. At what stage of life? The science of psychology, prevention and early intervention. Poor mental health early in life often leads to social and economic problems. We should therefore prioritise the development of effective, preventative interventions for use early in life. We need to identify risk factors for mental illness, as well as identify an optimal point in time for these preventative interventions, thereby increasing the chances of a child growing up with good mental health.
5. Psychological treatment through new technologies. New technologies have provided us with exciting opportunities for disseminating evidence-based methods and obtaining improved effects from various treatments. The Internet, VR and mobile apps are examples of how technology can be utilised in renewing and making available psychological treatments, as well as helping us to evaluate new treatments.
6. Trials to assess psychological treatments. The results of randomised, controlled studies assessing psychological therapies provide us with important data about how therapies should be used. The Commission has developed several proposals for how further improvements can be made regarding the design and implementation of these types of studies. The purpose of this is to increase the credibility and quality of future studies in order to better guarantee auditing and, over time, increase the quality of treatment.
7. Education – cultivating a vision of interdisciplinary training. Past collaboration between basic researchers and clinicians have led to historical advances in psychological treatments. Such collaborations have become less apparent over recent years. The Commission therefore proposes opportunities for improving interdisciplinary education. Improved links between clinical psychology, psychiatry and basic research skills may provide greater opportunities for new advances in treatments.
8. Who should we treat, for what and how? Mental health is complex and evidence-based treatments must take account of this complexity. Aside from the variation in symptoms from illness to illness, there is also a large degree of comorbidity. When selecting a form of treatment, there is a choice between individual treatment models or more universal methods that work against a variety of mental health difficulties. One future goal will be to investigate whether individual methods improve the effects of the treatment or if universal methods are better.
9. Suicidal tendencies – saving lives. Despite developments in understanding risk factors for suicide attempts, and a certain degree of development in treatments and preventative interventions, many questions remain as to how more lives can be saved. Some areas that the Commission has identified as important for future research includes the use of new technologies, the role of culture, and input from individuals and others with personal experience related to suicide– we need to expand and use many approaches here.
10. Innovation and audit of future psychological treatment research. The task of improving psychological treatments is an exciting one for all researchers and clinicians with an interest in the science “mental life” and all associated disciplines. New ideas must be investigated and we need to consider what people are actually interested in being treated for. New ideas must be audited carefully while still encouraging innovation. We are currently only at the beginning and more than just these ten areas require our attention if we are to advance psychological treatment research.
The Lancet Psychiatry Commission on psychological treatments research in tomorrow’s science
Emily Holmes, Ata Ghaderi, Catherine J Harmer, Paul G Ramchandani, Pim Cuijpers, Anthony P Morrison, Jonathan P Roiser, Claudi L H Bockting, Rory C O’Connor, Roz Shafran, Michelle L Moulds och Michelle G Craske
The Lancet Psychiatry, online 23 February 2018, doi: 10.1016/S2215-0366(17)30513-8