Cognitive Behavioral Therapy: Escape From the Binds of Tight Methodology - See more at: http://www.psychiatrictimes.com/cog...vioral-therapy-escape-binds-tight-methodology
This is on depression. However, many of the criticisms are similar to points some of us have made about CBT's use in ME/CFS.
This reminds me of what happens in ME/CFS: inactivity is said to be the (ongoing) cause of ME/CFS so (similar to the point they make) a symptom of an illness is also construed to be the cause.1. The premise of CBT that negative cognitions are the cause of MDD is the only instance in all of medicine and psychiatry where a symptom of an illness is also construed to be the cause.
This has been said of CBT trials for ME/CFS, although possibly not as much as it should be.2. The statement that CBT clinical trials are “randomized and controlled” obfuscates that the studies are not double-blind (ie , neither subjects nor therapists in psychotherapy studies are blind to the type of treatment).
(It is possibly easier to understand what he is saying by reading the full section)3. Symptoms in MDD include primary symptoms such as low mood, and negative cognitions as secondary reactions to these symptoms such as hopelessness and despair that may be easily assuaged by a psychotherapy. The person is then deemed a responder because “responder” is defined as a 50% improvement on a rating scale.
This point is about the outcome measures. Criticisms have also been made about the outcome measures used in ME/CFS CBT trials (questionnaires).
This is interesting. I'm not sure if it is true or not but his basic point is that melancholic and psychotic MDD is more biological while non-melancholic is less so and it's more easy to treat it, or get people to give good responses on questionnaires, than melancholic or psychotic MDD. This is similar to discussions about CBT (or GET) possibly working for people with chronic fatigue but not so much for (strictly defined) CFS or ME.4. Patients’ response to psychotherapy can strongly differ depending on whether they have non-melancholic, melancholic, or psychotic MDD (Figure 2), and this can critically affect the results of a clinical trial.
Don't be put off by the graph - the piece is not mathematical.
(I can't remember where I became aware of this article so apologies for not acknowledging somebody here if somebody here mentioned it)