The Moral Urgency of Mental Health • Hacker News Board

Re: The Moral Urgency of Mental Health

#41

Post by hyolaris » Tue, Nov 28, 2017, 2:17 PM UTC

jorgec wrote: post #16

DanBC wrote: post #2

> In the United Kingdom, it costs about £650 per patient to provide psychotherapy, which is effective for about 50% of patients. That figure indicates how much governments would need to spend, but does not take into account what they might get back. they don't appear to provide a source for this. The English NHS collects, and publishes, a lot of data for the IAPT (Improved access to psychological therapies programme)…

psychotherapy is less than 10% effective. In fact, its almost no science.

Citation please, preferably a meta-analysis.

Re: The Moral Urgency of Mental Health

#42

Post by hyolaris » Tue, Nov 28, 2017, 2:26 PM UTC

DubiousPusher wrote: post #11

aaavl2821 wrote: post #9

Earlier quoted context omitted.

It would be great if that were possible, but a lot of the value of therapy comes from the therapeutic relationship rather than a specific type of therapy. Most types of psychotherapy tend to have the same level of effect in studies, suggesting there is no "recipe" for the type of therapy that works. This phenomenon also suggests (but does not prove) that the human relationship, rather than therapeutic program, accoun…

I thought Cognitive Behavioral Therapy was actually the only kind of talk therapy that showed greater effect than placebo.

The idea you're raising, the differential efficacy of CBT, is a myth originating in the politics of psychiatry and psychology, especially in the 70s and 80s. There is abundant evidence for psychotherapy, but no evidence that any type is better than any other, especially when you control for publication bias. It's the "common factors" phenomenon, where therapies that have some baseline characteristics all do about equal. It's well documented and known, but people in the field often pretend it doesn't exist.

There may be some tendency for some therapies to work better for some people more than others, but identifying how to match people to therapies hasn't been demonstrated well or replicably.

Re: The Moral Urgency of Mental Health

#43

Post by DubiousPusher » Tue, Nov 28, 2017, 8:00 PM UTC

hyolaris wrote: post #42

DubiousPusher wrote: post #11

Earlier quoted context omitted.

I thought Cognitive Behavioral Therapy was actually the only kind of talk therapy that showed greater effect than placebo.

The idea you're raising, the differential efficacy of CBT, is a myth originating in the politics of psychiatry and psychology, especially in the 70s and 80s. There is abundant evidence for psychotherapy, but no evidence that any type is better than any other, especially when you control for publication bias. It's the "common factors" phenomenon, where therapies that have some baseline characteristics all do about equ…

Interesting. Is this based on your personal observations of the published literature or are there systematic reviews that concur?

Re: The Moral Urgency of Mental Health

#44

Post by DubiousPusher » Tue, Nov 28, 2017, 8:03 PM UTC

aaavl2821 wrote: post #12

DubiousPusher wrote: post #11

Earlier quoted context omitted.

I thought Cognitive Behavioral Therapy was actually the only kind of talk therapy that showed greater effect than placebo.

Cognitive behavioral therapy is a more standardized and measurable type of therapy than things like interpersonal therapy or problem solving therapy or psychodynamic therapy, and thus it is easier to study in a controlled setting. So there are more studies of CBT than other types of therapy just because it is easier to study I don't have references offhand but there are controlled studies that show benefit of other t…

That makes sense. If you want to go beyond self reporting, you have to use very long term measures like employment, incidence of suicide, etc. And of course it's very hard to guarantee that an individual pursued and sustained a specific type of therapy for a substantial amount of a long term study period.