In 2009/10 NICE partially updated its guidelines on the treatment and management of @entity308 in adults. Due to methodological shortcomings the recommendations for psychotherapy must be treated with caution. Despite recognising the heterogeneous and comorbid nature of @entity308 , and the limitations of @entity308 as a unitary diagnostic category, NICE treats @entity308 as if it were a unitary entity differentiated only by severity. The guidance ignores important aetiological factors such as @entity130 , loss and maltreatment, personality and interpersonal difficulties. It excludes the largest naturalistic studies on clinical populations treated in the National Health Service on the grounds that they are observational studies conducted in heterogeneous groups with mixed @entity6004 . It unquestioningly accepts that the "brand" of psychotherapy has construct validity, and ignores psychotherapy process research indicating significant commonalities, and overlap, between treatment modalities and evidence that individual practitioner effects are larger than the differences between treatment modalities. It fails to consider @entity1 differences and preferences, which are known to influence uptake, completion and response. It takes an exclusively short-term perspective on a chronic relapsing disorder. It does not consider the evidence for longer-term treatments. It is of special concern that NICE misrepresents the findings of its own systematic review by implying that CBT and @entity13583 are superior treatments. NICE's systematic review actually found no evidence of superiority between CBT, @entity13583 , psychodynamic psychotherapy, or counselling. Based on the exclusion of much clinically relevant research demonstrating the effectiveness of psychodynamic psychotherapy and counselling many commentators have alleged a bias towards CBT in the guidance. With regard to service delivery NICE proposes the replacement of psychiatric assessment and individualised treatment plans, with an unproven stepped-care model. These clinical and theoretical limitations, perceived bias in the selection of studies, neglect of @entity1 differences, preferences and values, misrepresentation of results of the systematic review, and the proposal for an unproven service delivery model together seriously undermine the validity of the guidance. The guidance, lacking validity is of questionable use, it undermines @entity1 autonomy, professional expertise and, ultimately, @entity1 welfare.

NICE recommendations for psychotherapy in XXXX : Of limited clinical utility.

@entity1 :: ('9606', 'Species') :: ['patient'] @entity308 :: ('MESH:D003866', 'Disease') :: ['depression'] @entity6004 :: ('MESH:D009497', 'Disease') :: ['neurotic disorders'] @entity13583 :: ('54802', 'Gene') :: ['IPT'] @entity130 :: ('MESH:D014947', 'Disease') :: ['trauma']
@entity308 :: (MESH:D003866,Disease) :: ['depression']
