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        Evidence, not ideology, should guide the use of psychotherapy
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        Evidence, not ideology, should guide the use of psychotherapy
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Prosser and colleagues 1 argue that any distinction between pharmacotherapy and psychotherapy is a fallacy, as both treatment modalities ultimately target underlying disturbances in neural circuitry. However, the justification of psychotherapy on the basis of its ability to deliver neurobiological changes, as the authors argue, is flawed. Specifically, they assume that mental disorders are simply brain diseases and that behavioural aberrations can be accounted for by disordered neurobiological processes. Despite the tremendous resources dedicated to uncovering the biological basis of mental illness, we have yet to identify a reliable biomarker for any mental disorder. 2 Therefore, proposed mechanisms of neurobiological actions of psychotherapy for mental illness are reductionistic at best and highly speculative at worst.

The reformulation of psychotherapy as a neurobiological treatment is yet another example of the creeping trend towards neuroessentialism. 3 The evidence for the efficacy of psychotherapies in the treatment of mental disorders stands by itself, and grounding this in speculative theories of its neurobiological action has no added value. Further, the authors seem to equate psychotherapy with cognitive–behavioural therapy, although a number of other therapies, including psychoanalytic psychotherapy, have demonstrable efficacy, 4 with the therapeutic effects best conceptualised as occurring through the therapeutic relationship rather than reductionistic neural mechanisms.

Although the authors have the noble aim of championing the role of psychotherapy in the contemporary treatment of mental illness, privileging a biological model of mental disorder may actually reduce clinicians' empathy for their patients. 5 In this way, reducing psychotherapy to simply a biological treatment may undermine its effectiveness. Instead, treatments should be evaluated on the weight of the evidence of their efficacy alone.

1 Prosser, A, Helfer, B, Leucht, S. Biological v. psychosocial treatments: a myth about pharmacotherapy v. psychotherapy. Br J Psychiatry 2016; 208: 309–11.
2 Deacon, BJ. The biomedical model of mental disorder: a critical analysis of its validity, utility, and effects on psychotherapy research. Clin Psychol Rev 2013; 33: 846–61.
3 Reiner, PB. The Rise of Neuroessentialism. In The Oxford Handbook of Neuroethics (eds. Iles, J, Sahakian, B): 161–75. Oxford University Press, 2011.
4 Fonagy, P, Rost, F, Carlyle, JA, McPherson, S, Thomas, R, Pasco Fearon, RM et al. Pragmatic randomized controlled trial of long-term psychoanalytic psychotherapy for treatment-resistant depression: the Tavistock Adult Depression Study (TADS). World Psychiatry 2015; 14: 312–21
5 Lebowitz, MS, Ahn, WK. Effects of biological explanations for mental disorders on clinicians' empathy. Proc Natl Acad Sci USA 2014; 111: 17786–90.