The undersigned organizations are grateful for the opportunity to respond to the NIMH 2015 Strategic Plan draft. We represent scientists who study psychopathology and its treatment and train the next generation of clinical scientists, and, in some cases, the clinicians who provide science-based treatment. There is much to applaud in NIMH’s recent and proposed initiatives to better understand the “biological basis of complex behaviors.” We agree with the importance of understanding biological factors in mental illness. However, we are deeply concerned with what appears to be a focus on biological factors at the expense of psychosocial/behavioral factors. The Strategic Plan includes a nod to environmental factors as they interact with biological ones, but the overwhelming thrust appears to be a biological one. Moreover, the plan continues a restrictive approach to funding treatment research, eliminating funding for the sorts of investigator-initiated clinical trials that have led to enormous advances in our ability to successfully treat mental disorders with psychosocial approaches (that are often safer than medication, and often more cost-effective and acceptable to consumers).
We believe that it is essential for NIMH to fully support both biological and psychosocial/behavioral research to reduce the burden of mental illness. Increasing the (currently limited) focus on behavioral research in the plan (e.g., more explicitly supporting research on behavioral mechanisms and psychosocial interventions) will lead to the development of novel efficacious and effective approaches to identify, prevent, and treat mental illness, and also dramatically advance what we can learn from biological approaches. Behavioral factors have played a leading role in reducing morbidity and mortality associated with both physical and mental illnesses, and scientific findings suggest a recursive relationship between environmental factors and biological determinants. This strongly suggests that fully supporting psychosocial research will promote greater efficacy of interventions for the full scope of mental illnesses.
We know this to be true based on the many ‘success stories’ from prior NIMH-funded research – stories that have significantly advanced our knowledge of how to prevent and treat a wide range of psychopathology. For instance, NIMH-funded research on Dialectical Behavior Therapy for Borderline Personality has provided an efficacious treatment for a condition previously considered almost completely recalcitrant to intervention. Research on cognitive deficits in schizophrenia, which led to the identification of specific neuroanatomical and functional abnormalities, has uncovered the biological bases of complex behaviors. Moreover, the recent success of a guided self-help version of cognitive behavior therapy for eating disorders that requires less than four hours of therapist contact time illustrates the potential for widespread dissemination of a cost-effective psychosocial treatment with enormous benefits to the public health. Notably, in preparing this comment, we started to compile examples of psychosocial research projects that have transformed our ability to identify, prevent, and treat mental illness – we stopped listing examples after a dozen pages, but could easily have continued. Our point is that these psychosocial approaches have provided tremendous relief to sufferers and have cut morbidity and mortality rates for many devastating mental illnesses, and these results would not have been possible without NIMH support.
Moreover, our field is taking many active steps to advance our ability to disseminate and implement, as well as train students in, empirically supported treatments. These include the development of a new clinical science accreditation body (Psychological Clinical Science Accreditation System; PCSAS), the development of the Delaware Project (which NIMH has strongly supported) to further training in dissemination and implementation, and a strong focus on mobile health and alternate treatment delivery models. These ongoing efforts are fully consistent with the NIMH strategic plan. Thus, we are well positioned to move the field forward in terms of identifying, preventing, and treating mental illness, but this will not happen without strong NIMH support of psychosocial/behavioral research.
In summary, clinical psychological scientists stand ready to advance the development and implementation of evidence-based approaches in the community, which will also continue to advance the aims of biological scientists investigating the bases of mental illness. We are ideally positioned to continue to discover and disseminate cost-effective prevention and cures for mental illness, and greatly strengthen the public health impact of NIMH-supported research. We urge NIMH to enable our science to continue to make its contribution.
Bethany Teachman and Mitch Prinstein (President & President-elect, Society for a Science of Clinical Psychology), Dean McKay and Jon Abramowitz (Immediate Past President and President, Association for Behavioral and Cognitive Therapies), Alan Kraut (Executive Director of Association for Psychological Science), and Robert DeRubeis and Dianne Chambless
With endorsement from (in alphabetical order):
Academy of Psychological Clinical Science
Association for Behavioral and Cognitive Therapies
Association for Psychological Science
Council of University Directors of Clinical Programs
Society for Family Psychology, Division 43 of the American Psychological Association
Society for Psychotherapy Research
Society for Research in Psychopathology
Society for a Science of Clinical Psychology
Society of Clinical Child and Adolescent Psychology, Division 53 of the American Psychological Association