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The British Journal of Psychiatry (2002) 180: 200-204
© 2002 The Royal College of Psychiatrists

REVIEW ARTICLE

The maturing of therapy*

Some brief psychotherapies help anxiety/depressive disorders but mechanisms of action are unclear

ISAAC M. MARKS, FRCPsych

Institute of Psychiatry, London SE5 8AF, UK

Correspondence: E-mail: I.Marks{at}iop.kcl.ac.uk

Declaration of interest I.M.M. shares intellectual property rights in Fear Fighter, BTSteps and Cope.

* Based on the 16th Aubrey Lewis Lecture given at the Institute of Psychiatry, London, 14 December 2000.

Background Psychiatric therapy needs assessment regarding its maturation as a therapeutic science.

Aims Judgement of whether such a science is emerging.

Method Four criteria are used: efficacy; identification of responsible treatment components; knowledge of their mechanisms of action; and elucidation of why they act only in some sufferers.

Results Brief behavioural, interpersonal, cognitive, problem-solving and other psychotherapies have a mature ability to improve anxiety and depressive disorders reliably and enduringly, often only with instruction from a manual or a computer. Therapy's cost-effectiveness and acceptability deserve more attention. We know little about which treatment components produce improvement, how they do so and why they do not help all sufferers.

Conclusions Therapy is coming of age regarding efficacy for anxiety and depression, but is only a toddler regarding the scientific principles to explain its effects.