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Therapy that sticks


Therapy that sticks

Linda Michaels

--- Quote ---Juxtaposed with this mental health crisis, news media and headlines tout the benefits of cognitive behavioural therapy (CBT), explicitly recommended as ‘evidence-based’ and said to work rapidly, especially when combined with drugs such as antidepressants or mood stabilisers. Varieties of CBT apply to a host of different diagnoses: dialectical behaviour therapy (DBT) for personality disorder; cognitive processing therapy (CPT) for post-traumatic stress disorder (PTSD); interpersonal therapy (IPT) for mood disorder. The list goes on: 50 per cent of therapists now define themselves as fitting in the cognitive-behavioural lane, compared with none 50 years ago. People seem to be absorbing these messages with more of us on medication than ever; antidepressant use alone went up 64 per cent from 1999 to 2014. The increase is so steep that an estimated 13 per cent of the US population now take the drugs.

What is wrong with this picture? Why do modern ‘evidence-based’ treatments fail to produce better outcomes? Indeed, why do things seem to be getting worse, with many forms of suffering, even suicide, on the rise?

My conclusion: the biomedical model (favoured by psychiatry) and the short-term, structured therapy model (favoured by psychology) don’t work as well as they should. These treatments seem easy to administer, but is a ‘quick fix’ really what’s called for when addressing complex problems in life? Is it possible that one type of therapy – CBT and its family of treatments – can work for nearly every person and every problem so successfully?
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I can't speak to the drugs, I'm not a doctor. And I shouldn't be speaking to the therapy either, being less than an amateur - but, from my personal experiences and social circle, CBT shows impressive results in my small reality - not big enough sample to mean it's all that on a larger scale, but from my personal social circle's exposure to CBT, it hasn't been presented as a quick fix, so not sure where that's coming from. It's years' long program from what I've seen, but behavior modification, while it seems to be putting the cart before the horse, can and does work. Which blows a "free will" person's mind, such as myself - changing your behavior changes your consciousness and in a way that's more to the repetition, not the enlightenment of learning how to be. After a while, you simply get it - and if you change your behavior back again, you'll change back. How to reconcile that with free will is beyond me.

Well, I think that really depends on how we actually operationalize what "free will" is.

But, on the topic of therapy, I think the point of this article is that CBT (or DBT, or whichever drug is the one of "choice") are touted as being the "evidence based" solution, where "depth psychology" or psychoanalysis are reviled as unscientific and ineffective.

What the article seems to trying to point out is that the only reason one could make that case is because of bias in research methods and results reporting.  So, are CBT or psychotropic drugs really more effective that psychoanalysis?  I don't think there is a universal answer to that.  Insurance companies want to push drugs or CBT, because they have a vested interest in making the case that it delivers results "faster."  But, as you point out, the reality is, it likely is not faster at all.  And maybe not even more effective.

But, we tend to just have an empirical bias, of sorts, maybe born out of a sort of notional sciencism.  Sure science works, empiricism works, but that doesn't mean it works best for everything.

If CBT is a challenge to free will, then wouldn't just about every learned habit-based action be? From training the mind to figure out proofs to training for sports so you act seemingly "in the zone" of semi-conscious action?


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