1. Patients launch $1.27 million crowdfunding campaign for ME/CFS gut microbiome study.
    Check out the website, Facebook and Twitter. Join in donate and spread the word!
August 8th - What is the one thing about suffering with severe ME that the world needs to know?
Andrew Gladman brings our coverage of the Understanding & Remembrance Day for Severe ME, airing the voice of patients ...
Discuss the article on the Forums.

Keith Laws 'Has cognitive behavioural therapy for psychosis been oversold?'

Discussion in 'Other Health News and Research' started by Esther12, Apr 2, 2014.

  1. Esther12

    Esther12 Senior Member

    Messages:
    5,176
    Likes:
    5,168
    http://www.theguardian.com/science/...havioural-therapy-for-psychosis-been-oversold

    The crowd at tonight's Maudlsey debate voted :

    The final vote: Oversold: 47 Not oversold: 132 Abstain: 25 CBTp has not been oversold. Well done to all involved #maudsleydebates

    https://twitter.com/PsychiatrySHO/status/451430156021022720

    To me, it seems that Laws got a friendly motion there, and what I've seen has made it look very clear that CBT for psychosis has been oversold... but maybe the opposing side revealed data I was not aware of? I would love to have a debate on 'CBT for CFS has been oversold'.
    Valentijn, alex3619, WillowJ and 3 others like this.
  2. Esther12

    Esther12 Senior Member

    Messages:
    5,176
    Likes:
    5,168
    I was just reading some of the twitter reports from the debate - made me think 'CFS is in trouble'.

    So many people (therapists/researchers) just don't see the harm to allowing therapists/researchers to make unduly positive claims about their ability to help people. To me, this is an important moral matter... seemingly not for the Maudsley crowd though.
    Last edited: Apr 2, 2014
    Min, Valentijn, alex3619 and 2 others like this.
  3. WillowJ

    WillowJ Senior Member

    Messages:
    2,943
    Likes:
    2,376
    WA, USA
    from the above article:
    thanks for the links, E12
    Valentijn and biophile like this.
  4. WillowJ

    WillowJ Senior Member

    Messages:
    2,943
    Likes:
    2,376
    WA, USA
    I can't really find any substantive comments on the #maudsleydebates. It looks to me like they are saying they don't give a fig about blinded studies: having some treatment or other which is not a [probably-inappropriate, in their view*] drug seems to be all that matters to them.

    *not entirely unreasonable, as it is difficult to get from diagnostic classification to appropriate drug, but that doesn't mean drugs are necessarily bad, just that the current system doesn't help arrive at the correct medicine and probably doesn't even include enough classes of drugs as options to think about
    Last edited: Apr 2, 2014
    Min and Valentijn like this.
  5. Esther12

    Esther12 Senior Member

    Messages:
    5,176
    Likes:
    5,168
    Here's a storify: https://storify.com/PsychiatrySHO/m...gn=&utm_source=t.co&utm_medium=sfy.co-twitter

    I find that really depressing actually.

    I guess that for schizophrenia/psychosis there may be some legitimate reasons for treating patients in manipulative/misleading ways which, for healthy people, would be seen as unacceptable, but that didn't really get touched upon (not something I know much about, and I certainly don't see this as a legitimate reason for giving them unduly positive claims about the efficacy of CBT anyway). I'm not sure how those with schizophrenia are viewed within MH. To me, it seems that lots of people in medicine just see the sick as their playthings, and assume that anyone with health problems must want 'care', regardless of whether it's likely to be genuinely helpful for them or not.
    Last edited: Apr 2, 2014
    Valentijn and WillowJ like this.
  6. WillowJ

    WillowJ Senior Member

    Messages:
    2,943
    Likes:
    2,376
    WA, USA
    I don't think there is any reason for manipulation/misleading. I once knew someone with schizophrenia/psychosis, and I can't think of a reason why this would be useful.
    Valentijn, SOC and Esther12 like this.
  7. alex3619

    alex3619 Senior Member

    Messages:
    7,019
    Likes:
    10,797
    Logan, Queensland, Australia
    This is critical. Its one way to separate science from nonscience.
    peggy-sue, Valentijn and WillowJ like this.
  8. alex3619

    alex3619 Senior Member

    Messages:
    7,019
    Likes:
    10,797
    Logan, Queensland, Australia
    Unduly positive claims are like positive thinking. They create depression, disappointment, disillusionment, distrust and self doubt when they fail. Positive thinking may have have caused widespread misery according to some. I see no difference with making positive claims for treatment. When they fail, the doubts begin.

    Its not that positive thinking is bad, its that overselling positive thinking is more likely to be bad than good.
    peggy-sue, Valentijn, Tito and 4 others like this.
  9. Esther12

    Esther12 Senior Member

    Messages:
    5,176
    Likes:
    5,168
    I think I gave the impression that I was more open to that possibility than I was! I was also partially trying to look at it through the eye of the debate's audience, and consider why they'd respond as they did.
    WillowJ likes this.
  10. biophile

    biophile Places I'd rather be.

    Messages:
    1,372
    Likes:
    4,304
    Good luck trying to convince anyone, particularly someone with paranoid schizophrenia, that you are still trustworthy once they see through your manipulating and misleading therapeutic tactics!
    SOC, justy, alex3619 and 2 others like this.
  11. biophile

    biophile Places I'd rather be.

    Messages:
    1,372
    Likes:
    4,304
    Possibly. Another explanation is that like any vote or referendum, the outcome may be heavily influenced by politics.
    Valentijn likes this.
  12. WillowJ

    WillowJ Senior Member

    Messages:
    2,943
    Likes:
    2,376
    WA, USA
    from Storify:
    Sidereal and Valentijn like this.
  13. WillowJ

    WillowJ Senior Member

    Messages:
    2,943
    Likes:
    2,376
    WA, USA
    we're good :)

    I think they actually don't see themselves as being manipulative. I did see some "well we have to have some kind of treatment on offer" comments indicating they are not willing to abandon something that's proven ineffective (as they feel this is the same as abandoning their patients altogether), but for the most part, I think they are

    1) going by anecdotal incidents and applying these as if they were somehow applicable evidence and

    2) noticing that it's hard to decide what medicine goes with what diagnosis and there is a lot of drug company manipulation of studies [pot, kettle!] and incorrectly reasoning from there to "medical=bad" for these patients anyway, rather than that some of the other inputs [e.g. seratonin=central] badly need revising.
    Last edited: Apr 3, 2014
    SOC and Valentijn like this.
  14. alex3619

    alex3619 Senior Member

    Messages:
    7,019
    Likes:
    10,797
    Logan, Queensland, Australia
    Anecdotal evidence is usually dangerous, in part because it does not take into account special circumstances, and in part because both bias and outright error can hide in it. This applies to all anecdotal evidence. You can learn from anecdotal evidence, gather clues, but its never proof of anything.

    All this without mentioning fraud. Quackery often uses abundant anecdotal evidence and one or two small dodgy almost-scientific studies to support their claims.
    SOC, WillowJ and Valentijn like this.
  15. justy

    justy Senior Member

    Messages:
    2,461
    Likes:
    2,310
    U.K
    I'm pretty shocked that anyone thinks CBT would be very effective when used for people with severe and enduring mental health problems like schizophrenia or psychosis.

    On the other hand, I believe CBT is fairly effective for people with stress conditions, mild depression etc, as well as to help people who are just struggling in life and need to set some goals and get things in perspective - too often dangerous drugs are given to people with mild depression, or genuine reactive issues like grief etc.

    Mu husband works as a psychotherapeutic counsellor with adults and young people and finds some CBT techniques useful for some groups of people, but he also believes the whole CBT bandwagon is over the top - but then so is the prescribing of medications for 'mental health' problems.

    I remember then best thing a friend ever said to me, many years ago when we were having a very long and intense discussion and I was telling her that i felt crazy and couldn't stop crying and was worried I was going mad. She very calmly told me that I had every right to feel crazy, angry, mad, and mired in sadness and tears - she said it is a natural and normal response to the major life event I had been through (the break up with my childrens father) and that if I didn't feel that way she would think perhaps it wasn't right.

    Most distress is a normal response to the situation we find ourselves in and pathologising this situation is just wrong.

    http://www.psychologytoday.com/blog/feeling-relating-existing/201202/pathologizing-grief

    http://nymag.com/news/intelligencer/grief-2012-5/
    Cheshire, biophile, Bob and 3 others like this.
  16. A.B.

    A.B. Senior Member

    Messages:
    568
    Likes:
    1,549
    I think we need a study in which psychologists are told that they will be assessing the mental health of a CBT patient group and a control group, but with neither group actually having received CBT.

    Let's see whether the success of CBT is all in the head of psychologists.
    Sidereal, peggy-sue, SOC and 6 others like this.
  17. Valentijn

    Valentijn Activity Level: 3

    Messages:
    6,054
    Likes:
    8,418
    Amersfoort, Netherlands
    :rofl:
    Countrygirl, Sean and WillowJ like this.
  18. alex3619

    alex3619 Senior Member

    Messages:
    7,019
    Likes:
    10,797
    Logan, Queensland, Australia
    I completely agree, and often people can benefit from counseling to help them sort these issues out. This is often beneficial in part because the therapist is not bound up in the circumstances.

    In part this is about individual circumstances too, which a therapist has to take into account, though sadly too many psychiatrists seem to fail at this and reach for off-the-shelf treatments. Unusual behaviour, feelings or thoughts can often be from unusual circumstances, not unusual cognition. People living with severe, disabling and life-long chronic disease are definitely in an unusual circumstance. When such disease elicits abusive behaviour from strangers, friends, colleagues and relatives, that's very unusual circumstances.
    Cheshire, Sidereal, peggy-sue and 2 others like this.
  19. Sean

    Sean Senior Member

    Messages:
    1,178
    Likes:
    1,830
    Sometimes, in my bleaker moments, I wonder if some of them are deliberately piling very nasty and stressful (and of course, completely illegitimate,) double binds on us, just so they can then point at the consequences and say:

    'See, we told you it is a stress based psychological disorder. QED.'
    Min, Cheshire, peggy-sue and 2 others like this.
  20. alex3619

    alex3619 Senior Member

    Messages:
    7,019
    Likes:
    10,797
    Logan, Queensland, Australia
    Its all about implication, not proof. Imply, imply, imply. It is no wonder that their implications are often contradictory, counterfactual, or can be used for manipulation.
    Min, peggy-sue, biophile and 2 others like this.

See more popular forum discussions.

Share This Page