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Book Review: All Therapy Books

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Re: Book Review: All Therapy Books

#21

Hmmm... I'm pretty skeptical of the premise that "All therapy books start with a claim that their form of therapy will change everything." My wife practices Cognitive Behavioral Therapy (CBT), and the foundation of her approach and all CBT books on her bookshelf is that CBT in fact doesn't change anything at all. You will still have symptoms (depression, anxiety, etc.) after CBT, but the goal of CBT is to help you ma…

> You will still have symptoms (depression, anxiety, etc.)

how can a human being not have these. Even my cat has these from time to time.

Re: Book Review: All Therapy Books

#22

Hmmm... I'm pretty skeptical of the premise that "All therapy books start with a claim that their form of therapy will change everything." My wife practices Cognitive Behavioral Therapy (CBT), and the foundation of her approach and all CBT books on her bookshelf is that CBT in fact doesn't change anything at all. You will still have symptoms (depression, anxiety, etc.) after CBT, but the goal of CBT is to help you ma…

> You will still have symptoms (depression, anxiety, etc.) how can a human being not have these. Even my cat has these from time to time.

Part of the damage of depression and other mental health problems is that all normal sadness and anxiety becomes associated with illness. The work to heal is doomed if the person aims to never feel these things.

Re: Book Review: All Therapy Books

#23
post #20

Maybe placebo effect is falling – when people viewed it as an astounding miracle therapy, it got astounding miracle results, but now that it’s lost its luster nobody takes it seriously anymore. I don't think "placebo effect" is an adequate term when the benefit from a therapy derives from the work patients put in. It's more like dieting than like a drug. Faith in the program helps people invest the required work and…

What you describe could well be the explanation, but it's not the same mechanism that Alexander is suggesting.

You're suggesting the therapy has a dose-response, and as perception of the therapy changes, patients are motivated less and so they get smaller doses.

What Alexander is suggesting there is that for a given level of work that a patient put in (i.e. for a constant dose), the placebo effect has been reducing due to a "miracle effect" halo that is fading over time.

I.e. he is explicitly talking about just the placebo effect here.

Re: Book Review: All Therapy Books

#24

Hmmm... I'm pretty skeptical of the premise that "All therapy books start with a claim that their form of therapy will change everything." My wife practices Cognitive Behavioral Therapy (CBT), and the foundation of her approach and all CBT books on her bookshelf is that CBT in fact doesn't change anything at all. You will still have symptoms (depression, anxiety, etc.) after CBT, but the goal of CBT is to help you ma…

For what it's worth, CBT was hugely helpful for me. I read The Feeling Good Handbook (kind of the CBT bible, a new edition of Feeling Good). CBT is definitely a tool that you want on your tool belt if you're struggling with anxiety/depression. It may not be the be all end all, but I like that it puts control and responsibility into the person's hands, namely the thesis that thoughts precede emotion. It's helped me re…

> I'm guessing CBT is probably not as effective if you're experiencing severe mental health problems

I'm bipolar. CBT is ineffective for problems that aren't resulting from bad thoughts. But it just as important as medication for my treatment plan.

CBT is absolutely critical to maintaining stability when I am rational. Stopping bad thoughts before they get time to spiral out of control significantly reduces the severity of my symptoms.

While CBT can't fight irrational thoughts resulting from my mood swings, it's taught me what I can and can't change. As a result, I know when to switch to a different coping skill to get through a bad day.

As far as in-person therapy goes, a therapist is a guide. They can point you in the right direction and provide a different perspective.

Re: Book Review: All Therapy Books

#25

Hmmm... I'm pretty skeptical of the premise that "All therapy books start with a claim that their form of therapy will change everything." My wife practices Cognitive Behavioral Therapy (CBT), and the foundation of her approach and all CBT books on her bookshelf is that CBT in fact doesn't change anything at all. You will still have symptoms (depression, anxiety, etc.) after CBT, but the goal of CBT is to help you ma…

> CBT in fact doesn't change anything at all

> CBT [...] help[s] you manage those symptoms and live a meaningful life despite those symptoms

So... it... does actually change things?

I'll be explicit rather than flippant: giving someone tools to manage symptoms and live a full life can be a huge change.

Re: Book Review: All Therapy Books

#26
post #25

Hmmm... I'm pretty skeptical of the premise that "All therapy books start with a claim that their form of therapy will change everything." My wife practices Cognitive Behavioral Therapy (CBT), and the foundation of her approach and all CBT books on her bookshelf is that CBT in fact doesn't change anything at all. You will still have symptoms (depression, anxiety, etc.) after CBT, but the goal of CBT is to help you ma…

> CBT in fact doesn't change anything at all > CBT [...] help[s] you manage those symptoms and live a meaningful life despite those symptoms So... it... does actually change things? I'll be explicit rather than flippant: giving someone tools to manage symptoms and live a full life can be a huge change.

That was my point. From a psychiatrist's perspective, "change things" means reduce/eliminate symptoms. From a psychologists perspective, however, the goal is to manage symptoms rather than reduce symptoms. This distinction is often lost in resources that are not aimed at the clinical audience.

Re: Book Review: All Therapy Books

#27
Alexander is maybe reading the wrong therapy books and literature. He should look up Bruce Wampold's research, for example. The dodo bird effect is well documented: therapy works relative to all sorts of placebos, but therapist effects dwarf therapy effects, not everything works for everyone, therapist-client cohesiveness is paramount, and there are really no replicable superiorities of any given therapy with regard to general functioning and well-being, even if specific therapies might be more effective for specific behavioral problems.

To be fair to Alexander, therapy research and literature has the kind of weird duality he points out, and it permeates academics as well, where the problems he mentions are maybe even worse. Everyone does know about the dodo bird effect, but then people either embrace it or they ignore it.

A big problem is the exact same thing that's permeating all of medical science, which is a huge pressure to obtain grants and notoriety for discovering a cure. There's much more rewards for overhyping than being sober in science. You could replace therapy with drugs in his essay and it would read the same. In fact, I sincerely was confused for a bit by his figure because the exact same sorts of figures have been published about psychiatric medications, and it took me a while to be sure what he was talking about.

One thing that's maybe not immediately clear to the general public is that with psychiatry and psychology there's an additional pressure to "be scientific" which then often backfires in the way he's witnessing. Both psychiatrists and psychologists are the targets of witch doctor labels, which then leads to this behavior where researchers and theorists jockey to outdo themselves in being "real scientists". The good part of this is that then you get a ton of randomized controlled studies and so forth, but the downside of this is you end up with this additional reason to promote your drug or therapy as being somehow better than treatment as usual, or to denigrate other interventions as being "unscientific". That is, certain things (e.g., CBT in therapyland, or arguably things like prozac in medicationland) become banners that you're expected to carry if you want to be part of the "real science" club. Criticizing the efficacy of these interventions implicitly doesn't just mean criticizing those particular interventions, or criticizing the specificity of their mechanisms, it means you get labeled as not being on board with the "real science" club. It is just one more reason for hype, in addition to the typical hype that is flooding biomedical research at the moment.

Alexander mentions that he feels like he's never seen "sudden, extraordinary, long-lasting" effects of therapy. I'd suggest it's one of those situations where you get to pick 2 of 3, nothing more.

Re: Book Review: All Therapy Books

#28

Hmmm... I'm pretty skeptical of the premise that "All therapy books start with a claim that their form of therapy will change everything." My wife practices Cognitive Behavioral Therapy (CBT), and the foundation of her approach and all CBT books on her bookshelf is that CBT in fact doesn't change anything at all. You will still have symptoms (depression, anxiety, etc.) after CBT, but the goal of CBT is to help you ma…

> I'm pretty skeptical of the premise that "All therapy books start with a claim that their form of therapy will change everything."

Nicely spotted. This is certainly a good point to question.

The article reads to me as (intentionally) hyperbolic, in a dry humor kind of way. Perhaps the author is frustrated with the state of things. Anyway, I feel like "change everything" can be considered a stand in for "effect any change more than other therapeutic methodology."

With that reading, the main point that stands out to my eye is that CBT or any methodology is no more effective than the next. They are all the same basic process, just with different dressings.

As an extreme example, even far-field woo like Dianetics can boast the kind of therapeutic help you describe. This makes it seem like the particulars of CBT are mere detail and the thing that is working is mostly the patient's earnest work toward some form of "better."

Re: Book Review: All Therapy Books

#29

Hmmm... I'm pretty skeptical of the premise that "All therapy books start with a claim that their form of therapy will change everything." My wife practices Cognitive Behavioral Therapy (CBT), and the foundation of her approach and all CBT books on her bookshelf is that CBT in fact doesn't change anything at all. You will still have symptoms (depression, anxiety, etc.) after CBT, but the goal of CBT is to help you ma…

For what it's worth, CBT was hugely helpful for me. I read The Feeling Good Handbook (kind of the CBT bible, a new edition of Feeling Good). CBT is definitely a tool that you want on your tool belt if you're struggling with anxiety/depression. It may not be the be all end all, but I like that it puts control and responsibility into the person's hands, namely the thesis that thoughts precede emotion. It's helped me re…

Thank you for giving this detailed reply.

The evidence for CBT for things like psychosis is mixed. The English NICE say that CBT should be offered to everyone who has psychosis, and to most people at risk of developing psychosis. https://www.nice.org.uk/guidance/cg178/chapter/1-Recommendat...

Other people think the NICE committee is biased (and I think they're probably right) https://twitter.com/Keith_Laws/status/1205833799826890752?s=...

Sometimes people point to the English IAPT scheme (which offers mainly CBT) as evidence of lack of effectiveness of CBT for depression. They say that it only works for about 60% of the people who try it.

I think this is a misunderstanding of the data, which can be found here: https://digital.nhs.uk/data-and-information/publications/sta...

IAPT has 4 tiers. The higher tiers are delivered face to face, one to one, with an experienced therapist, and you get up to 16 weeks of therapy. The lower tiers might be group work, or telephone based, or maybe even delivered over computer. If you have a therapist they may be less experienced. And you get 5 weeks of therapy. But the results of all these tiers are mashed together.

Re: Book Review: All Therapy Books

#30

Hmmm... I'm pretty skeptical of the premise that "All therapy books start with a claim that their form of therapy will change everything." My wife practices Cognitive Behavioral Therapy (CBT), and the foundation of her approach and all CBT books on her bookshelf is that CBT in fact doesn't change anything at all. You will still have symptoms (depression, anxiety, etc.) after CBT, but the goal of CBT is to help you ma…

>all CBT books on her bookshelf is that CBT in fact doesn't change anything at all. You will still have symptoms (depression, anxiety, etc.) after CBT, but the goal of CBT is to help you manage those symptoms and live a meaningful life despite those symptoms

You're describing Acceptance and Commitment Therapy, not CBT.

https://en.wikipedia.org/wiki/Acceptance_and_commitment_ther...

>psychologists use therapy, and the reduction/elimination of symptoms is not necessarily their primary measure of success

Aaron T. Beck invented both CBT and the most widely used instruments for measuring the severity of depression and anxiety symptoms (the Beck Depression and Anxiety Inventories). CBT was the first psychotherapy to a) explicitly make the reduction of symptoms the primary goal and b) measure the success of therapy using standardised questionnaires to quantify symptomatic reduction. Using a repeatable psychotherapeutic model to measurably reduce the symptoms of psychiatric illness is pretty much the raison d'etre of CBT. Beck's work is by no means immune from the "eureka" anecdote of a patient suddenly entering remission thanks to the acute insights of $theoreticalModel.

https://en.wikipedia.org/wiki/Cognitive_behavioral_therapy

>found that most results are things like "CBT for Dummies" and "Teach yourself CBT in 7 weeks". These are not books for doctors, but books for laymen that are merely self-help books with a veneer of science/therapy to help the book sell. Who knows what sort of crap is in these books.

Both CBT for Dummies and Cognitive Behavioural Therapy: Teach Yourself were written by qualified and accredited psychotherapists.

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