Move Over, Couch: Psych Pills Take Over
In the era of pills, fewer psychiatrists do talk therapy.
Aug. 4, 2008— -- CHICAGO (AP) - Cartoons about the psychiatrist's couch wererecently the subject of a museum exhibition. Now, the couch itselfmay be headed for a museum.
A new study finds a significant decline in psychotherapypracticed by U.S. psychiatrists.
The expanded use of pills and insurance policies that favorshort office visits are among the reasons, said lead author Dr.Ramin Mojtabai of Johns Hopkins Bloomberg School of Public Healthin Baltimore.
"The 'couch,' or, more generally, long-term psychoanalyticpsychotherapy, was for so long a hallmark of the practice ofpsychiatry. It no longer is," Mojtabai said.
Today's psychiatrists get reimbursed by insurance companies at alower rate for a 45-minute psychotherapy visit than for three15-minute medication visits, he explained.
His study found that the percentage of patients' visits topsychiatrists for psychotherapy, or talk therapy, fell from 44percent in 1996-97 to 29 percent in 2004-05. The percentage ofpsychiatrists using psychotherapy with all their patients alsodropped, from about 19 percent to 11 percent.
Psychiatrists who provided talk therapy to everyone had morepatients who paid out of pocket compared to those doctors whoprovided talk therapy less often. And they prescribed fewer pills.
As talk therapy declined, TV ads contributed to an "aura ofinvincibility" around drugs for depression and anxiety, saidCharles Barber, a lecturer in psychiatry at Yale University andauthor of "Comfortably Numb: How Psychiatry is Medicating aNation."
"By contrast, there's almost no marketing for psychotherapy,which has comparable if not better outcomes," said Barber, who wasnot involved in the study.
The findings, published in Monday's Archives of GeneralPsychiatry, are based on an annual survey of office visits to U.S.doctors. Of more than 246,000 visits sampled during the 10 years,more than 14,000 were to psychiatrists. The researchers analyzedthose psychiatrist visits.
The study did not survey visits to psychologists or other mentalhealth counselors who are not medical doctors, but who alsopractice talk therapy.
Psychotherapy uses verbal methods to get patients to exploretheir emotional life, thoughts or behavior. The goal is to easesymptoms, sometimes through getting the patient to change behavioror mental habits.
Its benefits can be seen in brain imaging studies, said Dr. EricPlakun, who leads an American Psychiatric Association committeeworking to restore interest in psychotherapy by psychiatrists.
"The couch is far from dead," Plakun said. "The couch turnsout to be an effective 21st century treatment."
Talk therapy can be done by psychiatrists less expensively thansplit treatment, where a patient sees a doctor for pills and acounselor for talk therapy, Plakun said, citing two prior studies.
It also works better than drugs for some patients, such as thosewith chronic major depression and a history of childhood trauma, hesaid.
Accreditation requirements for psychiatric residency programsare putting more emphasis on talk therapy, Plakun said. That mayslow the decline of the couch.
The new study doesn't answer an important question: whetherother professionals are picking up the slack, said psychologistDavid Mohr of Northwestern University's Feinberg School ofMedicine. Psychologists and social workers provide counseling butmost cannot prescribe drugs, so it's possible that for patients whorequire both talk and pills, some coordination in care may be lost,Mohr said.
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On the Net: Archives of General Psychiatry: http://archpsyc.ama-assn.org/ American Psychiatric Association: http://www.psych.org/
(Copyright 2008 by The Associated Press. All Rights Reserved.)