Advancing psychotherapy in psychiatry: the contribution of the WPA Section on Psychotherapy
Authors: César A. Alfonso, Allan Tasman, Alma L. Jimenez, Constantine D. Della
Journal: World Psychiatry (2021)

Psychotherapy has been an essential component of psychiatric theory and practice for over a century. There is sufficient evidence to consider it a treatment which may produce enduring epigenetic, neuro­endocrine and structural changes in the brain1. Many psychotherapy modalities have been manualized over the last three decades and proven helpful for most mental disorders. Randomized controlled trials show that all psychotherapies are equally efficacious for anxiety and mood disorders, with a robust effect size for supportive psychotherapy, interpersonal therapy (IPT), cognitive behavioral therapy (CBT) and psychodynamic psychotherapy2. Clinicians often combine psychothera­py modalities in daily practice3, and common factors such as empathy, validation, support, affirmation, the therapeutic alliance, reflective functioning/mentalization, and expression of affect promote symptom reduction and improvement in functional domains. Effectiveness studies have shown that common factors may be at the core of positive outcomes3, 4. The WPA Section on Psychotherapy supports efforts to delineate the role that these factors play in patient care even when formal psychotherapy is unavailable or deliberately not used, and to develop educational approaches to foster their implementation. Individual participant data meta-anal­yses are now being used to examine the differential treatment efficacy among empirically supported treatments, to help identify if subgroups of patients may respond better to particular forms of psychotherapy5. Preliminary findings are encouraging and could help clinicians triage patients to one or more forms of therapy, based on the presence of comorbid conditions or the duration and severity of symptoms. For example, there is pooled data showing that psychodynamic psychotherapy may be more efficacious than CBT, when combined with antidepressant medication, for depressive episodes of longer duration. On the other hand, CBT may be superior for patients with shorter duration of depressive symptoms and with comorbid anxiety5. These research developments, expanding the availability of data sets to significantly increase statistical power, may advance the field to create guidelines to select psychotherapy modalities based on specifiers and subgroups of patients with anxiety and depressive disorders2, 4-8. The WPA Section on Psychotherapy pro­vides a forum to advance the practice, train­ing and research on evidence-based psy­chotherapies within psychiatry. The Section currently has over 200 active members, representing 32 countries. Given the eagerness to develop expertise in evidence-based psychotherapies, we created eleven special interest groups to promote targeted formal academic and educational activities. These groups are further subdivided into two categories: “Psychotherapy for Spe­cial Populations” and “Cultural Adaptations of Evidence-Based Psychotherapies”. The “Psychotherapy for Special Populations” groups seek to explore the delivery of psychotherapies in an economically responsible way to disenfranchised and underserved groups or populations. They include “Psychotherapy with Refugees, Displaced Persons and Survivors of Trauma”, “Psychotherapy with Lesbian, Gay, Bisexual, Transgender, Queer and Others (LGBTQ+)”, “Psychotherapy in Late Life”, “Psychotherapy in Consultation and Liaison Psychiatry”, and “Psychotherapy with Adolescents and Young Adults”. During the last triennium, these groups contributed presentations at the WPA Co-Sponsored Meeting on Psychotraumatology held in Duhok, Iraq in June 2019, and the WPA Intersectional Congress on Psychological Trauma held virtually in December 2020. The “Cultural Adaptations of Evidence-Based Psychotherapies” groups seek to de­velop culturally consonant and sensible psychosocial treatments. They include “Cultural Adaptations of CBT”, “Cultural Ad­aptations of IPT”, “Cultural Adaptations of Third-Wave Psychotherapies”, “Cultural Adaptations of Psychodynamic Psychotherapies”, “Cultural Adaptations of Supportive Psychotherapy”, and “Cultural Adaptations of Motivational Interviewing”. The leaders of these groups were instrumental in developing the WPA Supportive Psychotherapy Course in April 2021, which had close to 1,000 registrants and was offered free of charge on a virtual platform. Additionally, they designed eight comprehensive teaching modules on Evidence-Based Psychotherapies now available on the WPA website (www.wpanet.org). Each module is composed of a variety of educational materials, such as journal and chapter reprints, slide presentations, self-assessment multiple-choice questions, informative the­oretical and clinical video links, and a comprehensive bibliography. Another educational activity coordinated by the Section at the beginning of the COVID-19 pandemic was a lecture series for health care workers in China, delivered in Chinese and English, dealing with psychotherapeutic interventions for COVID-19-related stress, anxiety and mood disorders, burnout prevention and physician well-being. These lectures were given virtually over a period of three months in early 2020. All leaders and many members of the Section’s special interest groups presented at the First WPA Psychotherapy Conference held in Kuala Lumpur, Malaysia in July 2019. This conference, hosted by the Malaysian Psychiatric Association and co-sponsored by the World Association of Dy­namic Psychiatry and the American Academy of Psychodynamic Psychiatry and Psychoanalysis, had almost 500 registrants from 20 countries. Given the success of this collaborative conference model, we are plan­ning to hold a second and a third conference during this triennium, hosted respectively by the Egyptian Association of Cognitive Behavioral Therapy and the Philippine Psychiatric Association. We are also developing ways to interface and liaise with the International Federation for Psychother­apy. Cultural adaptation of psychotherapies takes into consideration values and belief systems, idioms of distress, health-seeking behaviors, and culture-specific understand­­ing of disease processes and illness experiences9. Although some academics debate the merits of developing manualized cultural adaptations of evidence-based psychotherapies2, 9, 10, the leadership of our Section agrees that, in clinical practice, all psychotherapists intuitively perform a cultural adaptation. Our Section contributed in 2021 a special issue of the journal Asia-Pacific Psychiatry 9 addressing transcultural aspects of the delivery of psychotherapy services, with authors from 19 countries. Further research areas are now emerging that are likely to enhance our field, such as exploring the biological underpinnings of the curative factors of psychotherapy, streamlining the delivery of Internet-assisted psychotherapies, and studying the effectiveness of tele-therapy. The WPA Section on Psychotherapy welcomes all psychiatrists worldwide interested in developing their psychotherapeutic skills and affirming the place of psychotherapy in psychiatry.