Cognitive Behavioral Therapy "Evidence-Base" Is Exaggerated (Psychology Today)

rvallee

rvallee

Senior Member (Voting Rights)
Not about ME but the general evidence basis for CBT. This aligns with work by Keith Laws, who regularly reports on CBT trials failing left and right and being shown to be no better than, well, nothing. There is growing evidence that ALL the evidence for the efficacy and safety of CBT is exaggerated.

https://www.psychologytoday.com/gb/...havioral-therapy-evidence-base-is-exaggerated

Mostly inspired by:
My opinion was confirmed in a review of meta-analyses of the CBT literature in the Journal of the American Medical Association, published online September 21, 2017 (“Cognitive Behavioral Therapy the Gold Standard for Psychotherapy: The Need for Plurality in Treatment and Research” by Falk Leichsenring and Christiane Steinert).
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The CBT cult is starting to falter. Who knew that overhyping something with zero reliable evidence could be a problem? Everyone? Oh, yeah. Everyone.

Did anyone say crisis of replicability? Again.
They reported that a recent meta-analysis using criteria of the Cochrane risk of bias tool reported that only 17% (24 of 144) of randomized clinical trials of CBT for anxiety and depressive disorders were of high quality.
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Any plans on actually addressing this crisis? The current approach of going full-speed ahead, ears fully plugged and the pie hole screeching LALALALALA is very much not addressing the crisis. Just saying.
 
Thank you @rvallee for this thread.

So, wonder what the high quality studies said. I hope they didn't say CBT works - but maybe the methodology was high quality, despite the fact CBT is ineffective.

CBT just seems like brain washing for any bad, or unhappy situation; e.g. cancer, divorce, you name it. It just suggests spinning, or describing an awful situation into a happy clappy one. Nonsense!
 
DokaGirl said:
Thank you @rvallee for this thread.

So, wonder what the high quality studies said. I hope they didn't say CBT works - but maybe the methodology was high quality, despite the fact CBT is ineffective.

CBT just seems like brain washing for any bad, or unhappy situation; e.g. cancer, divorce, you name it. It just suggests spinning, or describing an awful situation into a happy clappy one. Nonsense!
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From the phrasing it's not so much high-quality as "not so overly biased as to render the conclusions suspect". Overall quality in unblinded trials with self-reported outcomes is always of the lowest possible tier.

I doubt that any CBT study would qualify as high quality on its own merits, outside of the curve grading that psychological research is granted. At best it would be high quality compared to the usual garbage, but that's like the best-tasting burnt toast on the menu.

The real tell is an entire field of research that systematically avoids any objective measures, especially when it consists mainly of influencing participants and then grading how much they were influenced. When the outcome is itself what is being influenced, you're not doing real science and if there was confidence at this point that it could hold up to it, it would have been done already.

That's one of the biggest lessons from PACE: it doesn't even matter if you planned for objective outcomes and arbitrarily dropped them, you can still claim to have succeeded and people will allow it. In the end, the only guarantee is a passing grade, it doesn't follow that anything of value was actually learned.
 
Practical, tangible assistance, e.g. an increase in pension, disability funds etc., can, and likely will provide much more relief than counselling (CBT), for persons dealing with poverty and illness.

Practical help for many issues, rather than trying to get the individual to accept a dreadful situation is likely better much of the time.
 
I disagree and think it will be better likely all of the time, but at least most of the time.

I struggle to think of a situation where giving people the help, practical, financial and social, that they need is worse than telling them to buck up their ideas and just get on with it.

Of course with my many, many false beliefs and maladaptive behaviours I may be missing the blindingly obvious.

I frequently do.
 
Yes, @rvallee, it is doubtful that any studies on CBT would qualify as high quality, unless the study concluded CBT is not effective because it is unblinded, with subjective outcome measures.

It is at once amazing, and yet not, how humanity can get carried away for
decades and accept nonsense theories like CBT.

We see these mistaken theories in many areas. I recall hearing after the earthquake and tsunami in Japan, that earthquake
scientists' understanding of this phenomenon is based on a faulty, 40 year old premise.

ETA: changes for clarity.
 
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OK, yes, @Wonko, I think you're right. I was just hedging my bets.

Of course practical help for people is seen by some as not helping the person stand on their own two feet. It depends on one's perspective. The psych movement seems clearly on the side of those who cut back welfare funds. These "experts" are hired to tell the masses to "chin up" and "carry on", even in hopeless and unliveable situations.

I vote for practical help over trying to force people to accept bad situations.
 
I spend 2 and a half years studying counselling before switching to psychology. CBT was not my favourite technique but it has uses. I credit CBT for having a role to play in keeping me depression-free for many years despite numerous circumstances any one of which would on its own be an understandable cause for depression. I’ve had my good cries over those situations. I’ve felt sad. I’ve felt loss. I’ve felt angry. I’ve talked about them to friends and counsellors. I’ve grieved. But I haven’t been gripped by depression.

CBT is based on a basic idea that works, but it gets misapplied by the misinformed—and that’s when it becomes a nice pile of poop :mask:. The basic idea, at least on the cognitive leaning side of the technique, is that you can’t control emotions directly, but what you think does strongly affect your emotions. Thoughts are easier to control than emotions. Applied correctly CBT can be used to question untruthful thoughts (everyone hates me, I might as well not exist) to more truthful thoughts (it’s stink Jane isn’t nice to me, but I’m still ok as a person). Of course if the industry starts creating CBT courses to replace truthful thoughts (if I exert myself I will crash) with untruthful thoughts (I’m not really sick, I can do whatever I want and by next week I’ll be flying!) then it’s going to utterly and harmfully fail. It’s harmful exactly because it’s powerful.

Keep CBT as one potential technique for some types of depression, alongside other supports. But leave it out of “curing” medical illnesses.
 
theJOYdecision said:
The basic idea, at least on the cognitive leaning side of the technique, is that you can’t control emotions directly, but what you think does strongly affect your emotions.
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That's a nice idea, which in a sense every parent knows when bringing up their children, regardless of any psychology training, but do we know formal CBT WORKS in any useful sense?

The more I hear and read about this the more it becomes inescapable that clinical psychology is based on wishful thinking and bad methodology. It doesn't use the method of science - which is to make sure your evidence is reliable just in common sense terms. Maybe the greatest irony is that clinical psychology does not seem to understand the way psychology intrudes into gathering evidence.
 
Thread reminded me of this study, a few years back, from the University in Tromsø (northern Norway). They found that over the last 30 years or so, the 'treatment effect' of CBT in studies have halfed.

In journal for norwegian psychologist - Therapeutic effect decreases (norsk)

Note - CAT = CBT (norwegian acronyme is KAT)

The speeches are clear: The effect of cognitive behavioral therapy (CAT) falls. Since the first treatment studies came in the late 70's, the effect has fallen by about 50 percent. This is the main finding in a recently published summary article in the renowned journal Psychological Bulletin (Johnsen and Friborg, 2015).
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However, 30-40 percent of patients have an unsatisfactory effect of CAT, and relapse is a common challenge. Thereafter, therapy-comparing studies have also been published that do not find that CAT is superior to other therapies, a knowledge that also reaches the patients. Over time, optimism may have weakened.
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pdf link to paper:
https://uit.no/Content/418448/The effect of CBT is falling.pdf


They checked every variable they could think of, to find an explanation as to why this is happening. Just not the obviouse one - the hype around cbt when introduced in the 70's likely made patients fill out questionaires more favorable. A bit like LP today....?


In forskning.no - Widely used theraphy not as effective as it used to (norsk)

"All the depressed patients who participated in the 70 international studies ranked their ailments on a form both before and after their cognitive treatment.

In addition, many of the studies used results based on the therapist's assessment."
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Patients and therapists reported major improvements after treatment in the 70s and 80s, but the situation was somewhat different for patients treated thereafter.

Then the therapy had less effect.

- There is a big difference in the end result of treatment in the last thirty years.Cognitive therapy is widely used today, and then it is important to be able to measure how the effect development is and has been, says Johnsen.

- The therapy form is simply not as effective as before
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Was not able to find a source for this, it's from the forskning.no article, but it still is interesting. Is there really any difference in how psycologist work, when claiming to use different treatment models?

"According to HelpLink Psychology Center in Oslo, a study showed that when an expert panel saw video footage with practicing psychologists, they had great problems judging which therapy model the psychologists used in their work."
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DokaGirl said:
Practical, tangible assistance, e.g. an increase in pension, disability funds etc., can, and likely will provide much more relief than counselling (CBT), for persons dealing with poverty and illness.

Practical help for many issues, rather than trying to get the individual to accept a dreadful situation is likely better much of the time.
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I'd love to see a solid clinical trial (using both subjective and objective outcomes) that compared CBT with simply providing patients with adequate material support, and otherwise getting off their backs.
 
Sean said:
I'd love to see a solid clinical trial (using both subjective and objective outcomes) that compared CBT with simply providing patients with adequate material support, and otherwise getting off their backs.
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perhaps the reason that the CBT for the elderly did not have a befriending comparator group?
lonliness in the elderly is a factor in health outcomes.
 
Sean said:
I'd love to see a solid clinical trial (using both subjective and objective outcomes) that compared CBT with simply providing patients with adequate material support, and otherwise getting off their backs.
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That should have been the SMC arm in PACE but since the PACE team are dishonest hacks and couldn't allow themselves to fail they set it up as an ersatz comparison and made it meaningless.

With accurate and relevant information from genuinely well-informed GPs, including symptom management, the SMC arm would have been far superior, on relative comparison anyway. But since PACE was not real research and instead was merely an evidence-fabricating exercise they made sure it would look bad in comparison.
 
Amw66 said:
perhaps the reason that the CBT for the elderly did not have a befriending comparator group?
lonliness in the elderly is a factor in health outcomes.
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As it is with us. I'm fairly convinced that this alone counts for at least half of the questionnaire effect "benefits" in the overall body of ME psychosocial research. Most likely more than that but I'm just playing it safe.
 
Not sure where else to post this:


See, the reason we refuse the superiority of CBT is because we are illogical, which is evidenced by the fact that we reject the extraordinary claims of the all-powerful CBT cure for everything. QED
 
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