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Psych watch: rumblings of discontent over CBT. Guardian feature on psych wars

sarah darwins

Senior Member
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2,508
Location
Cornwall, UK
Lengthy article in the Guardian on questions being raised about the effectiveness of CBT (and the ubiquitousness of it). The article’s focus is on CBT for depression, though there seems to be a wider war going on in psychology in which the psychoanalysts are fighting back.

There’s nothing specific to me/cfs in here, but there’s some good stuff about the rise and rise of CBT.

More generally, I feel the very fact that these arguments rage constantly in psychology raises questions about the discipline’s claims to an empirical foundation.

Also a quote from Trudie Chalder which will surprise no one.

http://www.theguardian.com/science/...evenge-of-freud-cognitive-behavioural-therapy

Seek a therapy referral on the NHS today, and you’re much more likely to end up, not in anything resembling psychoanalysis, but in a short series of highly structured meetings with a CBT practitioner, or perhaps learning methods to interrupt your “catastrophising” thinking via a PowerPoint presentation, or online.

Examining scores of earlier experimental trials, two researchers from Norway concluded that its effect size – a technical measure of its usefulness – had fallen by half since 1977. (In the unlikely event that this trend were to persist, it could be entirely useless in a few decades.) Had CBT somehow benefited from a kind of placebo effect all along, effective only so long as people believed it was a miracle cure?

Around the same time, the Swedish press reported a finding from government auditors there: that a multimillion pound scheme to reorient mental healthcare towards CBT had proved completely ineffective in meeting its goals.

Such findings, it turns out, aren’t isolated – and in their midst, a newly emboldened band of psychoanalytic therapists are pressing the case that CBT’s pre-eminence has been largely built on sand. Indeed, they argue that teaching people to “think themselves to wellness” might sometimes make things worse.

There’s little doubt that CBT has helped millions, at least to some degree. This has been especially true in the UK since the economist Richard Layard, a vigorous CBT evangelist, became Tony Blair’s “happiness czar”. By 2012, more than a million people had received free therapy as a result of the initiative Layard helped push through, working with the Oxford psychologist David Clark. Even if CBT wasn’t particularly effective, you might argue, that kind of reach would count for a lot.

And a certain Trudie Chalder fights back ...

“People who say CBT is superficial have just missed the point,” said Trudie Chalder, professor of cognitive behavioural psychotherapy at the King’s College Institute of Psychiatry, Psychology and Neuroscience in London, who argues that no single therapy is best for all maladies. “Yes, you’re targeting people’s beliefs, but you’re not just targeting easily accessible beliefs. It’s not just ‘Oh, that person looked at me peculiarly, so they must not like me’; it’s beliefs like ‘I’m an unlovable person’, which may derive from early experience. The past is very much taken into account.”
 
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“People who say CBT is superficial have just missed the point,” said Trudie Chalder, professor of cognitive behavioural psychotherapy at the King’s College Institute of Psychiatry, Psychology and Neuroscience in London, who argues that no single therapy is best for all maladies. “Yes, you’re targeting people’s beliefs, but you’re not just targeting easily accessible beliefs. It’s not just ‘Oh, that person looked at me peculiarly, so they must not like me’; it’s beliefs like ‘I’m an unlovable person’, which may derive from early experience. The past is very much taken into account.”

Or may derive from being a quack, and mistreating patients.
 

Jonathan Edwards

"Gibberish"
Messages
5,256
“People who say CBT is superficial have just missed the point,” said Trudie Chalder, professor of cognitive behavioural psychotherapy at the King’s College Institute of Psychiatry, Psychology and Neuroscience in London, who argues that no single therapy is best for all maladies. “Yes, you’re targeting people’s beliefs, but you’re not just targeting easily accessible beliefs. It’s not just ‘Oh, that person looked at me peculiarly, so they must not like me’; it’s beliefs like ‘I’m an unlovable person’, which may derive from early experience. The past is very much taken into account.”

What Dr Chalder seems not to realise is how ridiculous what she says seems to anyone who knows anything about evidence. She talks the way physiotherapists used to talk before they realised they needed to have some reason for what they were saying. How does she know the ideas may derive from early experience and more importantly how does she know how this should be 'taken into account'. It sounds like a fortune teller making it up as they go along. It seems extraordinary that anyone should think they can impose this on people in a vulnerable position. And it seems anyone can do the same if the pay for a distance learning course at King's.
 

A.B.

Senior Member
Messages
3,780
So basically the message is that people with depression are depressed because they hate themselves. No wonder there is a problem of stigma in this area.

It seems that every generation of psychiatrists and psychologists fight against the stigma created by the previous generation while promoting their own stigmatizing ideas.

"No of course schizophrenia has nothing to do with refrigerator mothers. Such a stigmatizing idea. People with mental health issues deserve respect. Except those nasty CFS patients and other somatizers."
 

Large Donner

Senior Member
Messages
866
So basically the message is that people with depression are depressed because they hate themselves. No wonder there is a problem of stigma in this area.

Yes also they lose their ability and right to judge facial expressions and body language of people they have encountered and this must only be done for them by the state....

Yes, you’re targeting people’s beliefs, but you’re not just targeting easily accessible beliefs. It’s not just ‘Oh, that person looked at me peculiarly, so they must not like me’;
 

John Mac

Senior Member
Messages
321
Location
Liverpool UK
She probably gets that from the DSM where all sorts of things like this is written down as evidence.

Well if it's in the book it must be true.

e13-701.jpg
 

cmt12

Senior Member
Messages
166
The problem of ME/CFS is that anyone who focuses in on it long enough eventually gets to a point where they are deceived into filling in the gaps through intellectualization. Every doctor in this field, not just the psychologists, has based their understanding on confirmation bias while fully believing it is based on reason. It's just more ironic with the psychologists.
 

xrayspex

Senior Member
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1,111
Location
u.s.a.
I totally get where you guys are coming from and in years past have probably posted similar things. But one thing I like about CBT is to use it to not care as much about what people like Chalder are doing....if a person (like me) sometimes lets other's beliefs and actions get under her skin....its helpful to be reminded that those people don't matter.....sort of like when George on Seinfeld yelled "serenity now" lol......for me CBT doesn't have to mean I am having to accept I am wrong in my perceptions of other's intents etc but rather to find ways of letting go about how I feel about my perceptions and feelings of their judgements

They do use mindfulness and CBT to help with all sorts of illnesses now....heart disease to cancer...I understand why its hard for CFS/Me folks to take the parts of it that might be helpful since its all the field has offered us instead of it being an adjunct to other physical medical treatment

The more things I have tried for my health tho, that are "real" medicines etc....well I have come full circle almost and am starting to think the only things that could save me, a little even, are good food and love....and if those don't work I am SOL with cards i was dealt (just because I have poor tolerance issues with chemicals)

David Burns wrote a lot of CBT books starting in 80s and for the mental health aspect of life research did find his first book was more useful than antidepressants. Our thoughts may not make ME or cancer go away but they might at least help us be more relaxed or not.

Its tricky, because it puts us in position of wanting to throw the baby out with the bathwater....but I like to utilize CBT to let go of anger about injustice of our position....not because I don't believe there are real physical explanations for my disability. I did go through a couple years, when I got really involved on this forum around xmrv time and when I saw Cheney in 08 where I abhored some natural more cognitive approaches to dealing with parts of my health....out of spite probably to how it was historically inappropriately pushed as first line of defense for cfs/me.
 
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Jonathan Edwards

"Gibberish"
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5,256
I totally get where you guys are coming from and in years past have probably posted similar things.

I totally get where you are coming from too xrayspex. I guess my view would be that what you find valuable might be more valuable if it was not called something silly like CBT.

What I worry about is that forty years ago this sort of help was provided by doctors who very often realised that all they could hope to do was to pass on some benefit from experience of seeing people with similar problems before. Doctors have an advantage over therapists in that they do not have to feel that their existence is entirely justified by treatment. I spent most of my life just trying to explain - and very often explaining how little we knew but that for other people in the same situation things often turned out not too bad (when that was the case). But the physiotherapists could only justify themselves by believing they could treat people. Now helpful advice has been handed over to people called therapists and they feel they have to know what they are doing and believe in it. That seems to me to have an altogether bad influence on the process. Bogus theories get involved. Hurtful things are said - and so on. Sure, it happened before, but now it is becoming entrenched.
 

Cheshire

Senior Member
Messages
1,129
I think the main problem with CBT is its theoretical frame. And I'm not talking only of CFS/CBT. The belief that mental illness are caused by unhelpful thoughts and maladaptive behaviors and can be cured by fixing them is just simplistic. Mental illnesses are a complex result of multifactorial causes. And I also think this model mixes up causes and consequences.

That being said, there are really helpful psychotherapeutic tools (including CBT techniques) that can help cope with illness (be it "organic" or "mental"). But that's what they are: coping tools, no more no less. And in some cases, alleviating the stress caused by mental symptoms can be curative.
 
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