CBT a scam?

dar100

Ok, so I know this link isn't a research paper , so don't eat the head off me. But, what are people's thoughts on it, who's this guy? Any idea where he's getting his opinion from, research papers etc?

http://www.dailymail.co.uk/health/article-2828509/CBT-scam-waste-money-Popular-talking-therapy-not-long-term-solution-says-leading-psychologist.html

Torakx

Behavioural therapy i presume works on habits of thinking.
This is how NLP works as well and the effect is temporary IF the habits are not reinforced. More so with CBT I would say, as with NLP some techniques you cannot just reinforce an anchor by yourself and so would need another visit.
With CBT those patients who 2 years later reverted, may have taken up their old way of life or thinking and retrained themselves to their former states.

Sometimes I question the validity of counseling long term for this reason.
I see people going to counselors for years and not really seeing much change.
But I do appreciate some counselors may be better than others.
I am mostly for providing the tools to create our own change, which Io think is what CBT is all about.
For me philosophy has been very helpful in allowing me to ponder my own thoughts and actions and change my own thinking to suit.
Interestingly I found out not long ago that philosophy in the states was at the root of CBT.
Personally I think more people with psychological issues thatare not really severe, should try philosophy to gain control of their lives and thoughts.


Is that newpaper article a case of psychiatry versus psychology? As in sponsored by psychiatry..

JuliusCaesar

1. It's the Daily Mail.
2. It's Oliver James. I *think* he takes a psychoanalytic approach; at any rate, both he and psychoanalysts tend to be very critical of CBT, not least because (due to its vast body of evidence) it was chosen to be the therapy of the NHS, thus leaving psychoanalysis in the ha'penny place.
3. Investigation brought me to Oliver James' own website, which gives the references he used.
4. he may have overstated the case a little. 'Scam' might be the DM's interpretation - see point no. 1 above.

Quote from Durham 2012:

Manualised and relatively brief treatment may well turn out to produce lasting and effective treatment for a proportion of people with acute disorders but the present findings suggest that there will be a substantial proportion of patients (at least 30%) whose long term course is chronic and unresponsive to current treatment. Evidence of a short and medium term positive response to therapy, as found in all clinical trials included in this cohort, is no guarantee of long term gains.

Still, that's ~70% better. Hardly a scam.

Durham 2005:

Treatment with CBT was associated with a better long-term outcome than non-CBT in terms of overall symptom severity but not with regard to diagnostic status.
The positive effects of CBT found in the original trials were eroded over longer time periods.
No evidence was found for an association between more intensive therapy and more enduring effects of CBT.

Long-term outcome was found to be most strongly predicted by the complexity and severity of presenting problems at the time of referral, by completion of treatment irrespective of modality and by the amount of interim treatment during the follow-up period. ...

Poor outcomes over the long term are related to greater complexity and severity of presenting problems at the time of referral, failure to complete treatment irrespective of modality and the amount of interim treatment during the follow-up period.

These studies are of course of concern, and definitely need more investigation. There may be any number of factors involved in chronicity and recurrence.


However, his third reference Weston et al, 2004, is a study entitled

The Empirical Status of Empirically Supported Psychotherapies:
Assumptions, Findings, and Reporting in Controlled Clinical Trials

and concludes:

A reconsideration of both the assumptions and the findings of RCTs generally interpreted as evidence of a specific set of manualised treatments suggests both a need for a more nuanced view of outcome and a reexamination of the enterprise of compiling a list of evidence supported therapies.

Nothing new or surprising there; we all look open-mouthed at the differences between RCTs and treatment in routine clinical practice. CBT also is inclined to do the odd dismantling study to find out what aspects of treatment are relevant and which are just fluff.



I'd be interested to hear your opinions, but do have a look at the references!



and one last quote of my own, from the wiki on Aaron Beck, one of the originators of Cognitive Therapy:

The American Psychoanalytic Institute rejected Beck's membership application, "on the grounds that his mere desire to conduct scientific studies signaled that he’d been improperly analyzed", a decision that still makes him angry.

!

dar100

JuliusCaesar wrote: »

1. It's the Daily Mail.
2. It's Oliver James. I *think* he takes a psychoanalytic approach; at any rate, both he and psychoanalysts tend to be very critical of CBT, not least because (due to its vast body of evidence) it was chosen to be the therapy of the NHS, thus leaving psychoanalysis in the ha'penny place.
3. Investigation brought me to Oliver James' own website, which gives the references he used.
4. he may have overstated the case a little. 'Scam' might be the DM's interpretation - see point no. 1 above.

Quote from Durham 2012:


Still, that's ~70% better. Hardly a scam.

Durham 2005:


These studies are of course of concern, and definitely need more investigation. There may be any number of factors involved in chronicity and recurrence.


However, his third reference Weston et al, 2004, is a study entitled


and concludes:

Nothing new or surprising there; we all look open-mouthed at the differences between RCTs and treatment in routine clinical practice. CBT also is inclined to do the odd dismantling study to find out what aspects of treatment are relevant and which are just fluff.



I'd be interested to hear your opinions, but do have a look at the references!



and one last quote of my own, from the wiki on Aaron Beck, one of the originators of Cognitive Therapy:



!

Great response JuliusCaesar.

As I've stated before, my critical appraisal of research data, is not up to much. However, I will give my own opinion, based on my limited ability to do so., from a scientific perspective.

It is quite telling how the psychoanalytic society treated Beck, in his effort to become a member. The response is a bit of a joke, imo. My sense is that this is a bit of a psychoanalytic v CBT debate, and one which has clearly been running for some time.

My own opinion, well I'm still on the fence. I believe CBT, broadly defined, has and will continue to offer the field numerous benefits. It's disorder specific treatment approach, shows it's flexibility and adaptability in treatment, across a number of constructs/domains.

One of my main concerns/criticisms, is that of the level it operates on. e.g is it superficial and what is the longevity of the benefits? As pointed out, there are not many longitudinal studies researching this element (I may be wrong on this). In addition, I do think that the intellectual level that it operates on can play into some peoples resistance/ defenses, by keeping them from experiencing emotionality.

However, this is probably the reason it works so well with anxiety and depression. I do believe that CBT is best utilised with these disorders, and indeed the gold standard. Lots of meta analysis contesting to this.

As I've said before, I'm still training and wouldn't have a core training or in debt knowledge of any particular modality. So my opinion, is probably just that, with a limited amount of evidence supporting it

Saipanne

dar100 wrote: »

Ok, so I know this link isn't a research paper , so don't eat the head off me. But, what are people's thoughts on it, who's this guy? Any idea where he's getting his opinion from, research papers etc?

http://www.dailymail

I read this far.

JuliusCaesar

dar100 wrote: »

My own opinion, well I'm still on the fence. I believe CBT, broadly defined, has and will continue to offer the field numerous benefits. It's disorder specific treatment approach, shows it's flexibility and adaptability in treatment, across a number of constructs/domains.

One of my main concerns/criticisms, is that of the level it operates on. e.g is it superficial and what is the longevity of the benefits? As pointed out, there are not many longitudinal studies researching this element (I may be wrong on this). In addition, I do think that the intellectual level that it operates on can play into some peoples resistance/ defenses, by keeping them from experiencing emotionality.

Well, I'm not hugely in favour of a disorder specific approach - mainly due to my doubts about the legitimacy of diagnostic criteria. I'm much more in favour of looking at mechanisms of psychological distress (for example, perfectionism leading to low self-esteem which leads to anxiety and depression).

No, it isn't superficial - if anyone is telling you that, they don't know enough about it. We work with underlying core beliefs and attitudes that the person often doesn't even know they have. We can therefore bring about fundamental changes.

No, it isn't an intellectual approach. Any approach that is purely intellectual will not bring about changes on a behavioural and emotional level - and that is generally what people attending CBT (or any other therapy) want. I'm a bit annoyed and frustrated at seeing this trotted out in PI and elsewhere!

Bit short because I'm in a hurry.

.

hotspur

JuliusCaesar wrote: »

CBT also is inclined to do the odd dismantling study to find out what aspects of treatment are relevant and which are just fluff.

Given that the cognitive components of the treatment for depression have been found to have no additivity to the purely behavioural components of Beck's 1979 protocol, or later more nuanced and theoretically informed behavioural activation (Beck's behavioural components being fairly atheoretical), then what is the rationale for cognitive work with depression if the component analyses have shown it is superfluous in respect of efficacy?

Noobascious

Psychiatry and psychology just utter bs, pseudo science. I've been in a psychiatric ward. A load of complete assholes walking around stoned out of their tree on big pharma drugs. Biology, a real science dictates that there are mostly 6 different types of people. 100% straight men and women, 66% straight men and women then 33% straight men and women(gay people). Without this knowledge and understanding people are prone to confusion and "mental illness". Biology stands on one side which would fall under the nature aspect. Whereas nurture would fall on the otherside. Nurture is the way you are programmed to live from your youth or training of the powerful brain. Any other reasoning is hocus pocus money making racket.

El_Duderino 09

Noobascious wrote: »

Psychiatry and psychology just utter bs, pseudo science. I've been in a psychiatric ward. A load of complete assholes walking around stoned out of their tree on big pharma drugs. Biology, a real science dictates that there are mostly 6 different types of people. 100% straight men and women, 66% straight men and women then 33% straight men and women(gay people). Without this knowledge and understanding people are prone to confusion and "mental illness". Biology stands on one side which would fall under the nature aspect. Whereas nurture would fall on the otherside. Nurture is the way you are programmed to live from your youth or training of the powerful brain. Any other reasoning is hocus pocus money making racket.

Well that's it folks, we can all go home and start looking for new jobs.

What Bertrand Russell said about the fool being full of certainty and the wise being full of doubt comes to mind.

Noobascious, if you think the information above can replace the totality of psychological research, then you don't know what psychology is.

kitkat.3b4t

CBT practice has evolved over the years and although the earlier Beckian approach may have been symptom specific and quite rigid I have found that those who use CBT as a core practice are much more flexible in their method than that espoused by those who support a more scientific symptom specific model. My understanding of CBT theory is as follows: Emotions and physical sensations/reactions are automatic, initial thoughts are automatic, but behaviour is where an individual can exercise choice.

I acknowledge that other CBT practitioners may have their focus on other aspects of this model. I think it is unfair to view CBT as a prescriptive ‘one fits all’ approach to helping people deal with psychological distress. CBT has been widely promoted as an evidence based approach and although I support this, mainly because I believe it is important to have some mechanism for evaluating psychotherapeutic methods, I also doubt that any research can, or ever could fully capture the dynamic interaction that happens during counselling. I believe that the therapeutic relationship is fundamental to making progress with a client and it is such a multi faceted process that it is not easily reducible to any scientific method of evaluation. I do realise that I am contradicting myself somewhat, but maybe accepting contradiction is more authentic than trying to claim certainty.

JuliusCaesar

hotspur wrote: »

Given that the cognitive components of the treatment for depression have been found to have no additivity to the purely behavioural components of Beck's 1979 protocol, or later more nuanced and theoretically informed behavioural activation (Beck's behavioural components being fairly atheoretical), then what is the rationale for cognitive work with depression if the component analyses have shown it is superfluous in respect of efficacy?

I believe the research shows that Behavioural Activation is the evidence-based treatment for severe depression; as the depression improves cognitive change can be aided by cognitive interventions; and the mindfulness is the most effective treatment in preventing relapse.



The therapeutic relationship in CBT is seen as necessary, but not sufficient. Of course the therapist needs to have a good relationship with the client. Even in the days of behaviour therapy, the relationship was fundamental to the therapy.