theConversation.com: we've been testing therapy like it's a pill and patients are paying the price

[bobbler]

We’ve been testing therapy like it’s a pill – and some patients are paying the price

Why the NHS keeps offering you the same therapy. And why the science behind that decision is shakier than you think.

theconversation.com

This isn't about ME/CFS and I have placed it here because this is where the IAPT (now 'talking therapies' or something like that) thread is located and because it is implicitly referenced in this and in the fb post a lot of comments mention IAPT

For those not on fb the only text with the link is:

Why the NHS keeps offering you the same therapy. And why the science behind that decision is shakier than you think.

But I think it is really worth us having here because it doesn't necessarily exclude ME/CFS and noting other threads some seem to be caught up in this bigger fallacy of 'these things must work' etc.

The author is:
Sahanika Ratnayake
Postdoctoral Researcher, Evidence Synthesis, University of Manchester

And here is where I want to make my point which is that the argument taken is that the issue is that they have been doing randomised controlled trials - I'm pretty sure the standards used in other conditions for CBT 'trials' are little better than what we see as an ongoing treadmill gravy train here. SO someone might want to get in touch with the conversation or the author (and maybe some commenters)....?


PLus also..... please do discuss the article itself and why it has been written too of course! - because I think it might be interesting to see what comes up in this from the perspective of other angles

 

[ME/CFS Science Blog]

Thanks but I think this is a step in the wrong direction. It mainly argues that treatments like CBT shouldn't be tested in randomised controlled trials.

 

[bobbler]

Thanks but I think this is a step in the wrong direction. It mainly argues that treatments like CBT shouldn't be tested in randomised controlled trials.

Precisely what I’m trying to point out. Either it’s a switch and bait or they’ve not spotted the real issue (that the rct shows the wrong thing because it’s not the same as drug trisls)

If it’s the latter then their move to using iapts dsta under the justification they claim what’s been done a rct and are bad - well we’ve seen how gerrymandered that can be. And maybe pointing them here to the roll call of common issues bps perfected might help them (as they realise they are not ‘done like drug trials’ and the issue is the standards and oversight etc)

If it’s the former of course it feels like when eg Pete glad well and others tried to get the go ahead for a PROm being needed by saying the Chalder fatigue scale was bad (but we’re actually mainly using it to replace the physical function measure instead - because that’s the one they couldn’t get results for) in order to argue later that meant having something even more faulty on the same points was ‘a solution to their straw man’

But whichever way the author leans the fb comments are from a lot of professionals not just patients - some of whom might be interested in a follow-up to point this out going by what they write

 

[ME/CFS Science Blog]

Precisely what I’m trying to point out.

Ah apologies if I misunderstood!

 

[Jonathan Edwards]

An interesting aspect is that badly controlled or uncontrolled studies can provide very reliable evidence for what a treatment approach does not do. PACE was great at showing CBT and GET didn't work usefully. This essay, in itself, shows that the psychotherapy approach does not lead to self-understanding in terms of motives and goals - at least not for the therapist!!

 

[bobbler]

Ah apologies if I misunderstood!

No no worries, I didn’t make that clear - I’m not up to full par atm abd was trying to paste across 2 different threads so sort of ran out of steam at getting across my thoughts / what I meant as it was already quite long with the links etc

 

[Liie]

Thanks but I think this is a step in the wrong direction. It mainly argues that treatments like CBT shouldn't be tested in randomised controlled trials.

That reminds me about this article about psychology research:

Post in thread 'Miscellaneous Research Thread'

May 13, 2026

Some psychology-bashing which the forum might find interesting:

The Conceptual, Cunning, and Conclusive Experiment in Psychology Debrouwere, Stijn; Rosseel, Yves

The ideal experiment in physics must be conceptual, cunning, and conclusive. Adoption of these same standards in psychology has led to experiments that are uninformative and frivolous. We explain why we believe that psychology is fundamentally incompatible with hypothesis-driven theoretical science and conclude that this erodes the logic behind recent proposals to improve psychological research, such as...

• Liie

• 

psychology can focus on the descriptive, taxonomic science that forms the basis of disciplines like zoology, botany, mycology, and even meteorology.
...
In order to learn about the world we may explore and document the great variety of phenomena, to organize them, to see whether there are any obvious regularities.
...
try to find the conditions under which a particular phenomenon or mechanism will or will not show up, what strengthens and weakens it

And this old quote by psychology professor Vincent Deary, cited in a bit by Brian Hughes:

The problem may well be that some of our treatments are too evidence based:

"The problem may well be that some of our treatments are too evidence based"

Professors of psychology can be a strange breed. The problem they see is not bad evidence, but bad interpretation of the evidence (by *other* people).

thesciencebit.net

 

[rvallee]

The idea that there is a better way to do this is obviously incorrect, but the issue of why some forms of therapy, like CBT, have become popular because they are so generic and formulaic that they are easier to loosely adapt into something that could be framed as a randomized trial is interesting. If only the author had not taken the wrong conclusion out of it, that standards need to be tightened, not loosened, that the application of this discipline needs to be scaled back, not expanded further, as in the case of IAPT.

Of course the notion that therapy has been tested like pills is incorrect. If only they were doing that, but they would mostly find that very little of what they do is actually useful. The methodologies of rigorous drug trials are simply not feasible in psychology, and even when it comes to some drugs it has a very flimsy use case, such as with psychotropic drugs, which rank at the bottom of the drug trial methodological hierarchy.

All of which makes even more suspicious the trend of forcing all of this into health care, to "treat" health issues, rather than behavioral or psychological disorders. All it takes is to arbitrarily redefine illness as a psychological disorder, which is too easy to do, and way too error-prone.

Really what this article is arguing is that scientific standards are impossible to meet in psychology, and that's true, but that should lead to a massive downgrading and removal of the creep into health care that has been poorly argued to be valid based on an incorrect application of an error-prone methodology.

Psychology is much closer to sociology. It's a statistical discipline that can define a basic average, models, but is mostly useless in particular cases. The problems all begin with the idea that it can be imposed anyway, that it doesn't matter if it meets those standards, simply because it can't. Downgrading standards further is one way of looking at it. The right way is to accept that very little of this meets quality standards sufficient for many of its applications, and that it's its use that should be downgraded.

Psychological counselling makes sense, in some cases. It can advise, but it shouldn't prescribe or be used to deny medical care, which has pretty much become its most important application.