Psychotherapy Research and the NIMH: An Either/Or or Both/And Research Agenda?

There is a need for psychotherapy research to determine the effective, nonspecific or shared elements of psychotherapy regardless of therapy school. In an apparent "either/or" rather than "both/and" choice, the National Institute of Mental Health (NIMH) has committed its research resources to study of neural mechanisms and biomarkers, while greatly reducing funding for research into clinical methods, including psychotherapy. This column explores the potential effect of this decision on patient care and reviews questions raised by some about whether the underlying "big idea" behind the NIMH research approach is supported by the results of several decades of brain and genomics research. Patients are left to hope for clinically meaningful research findings concerning brain or gene mechanisms of mental disorders, as if they are just around the corner, when the actual benefit of such research likely remains decades away.