Posted by Anyuser on July 29, 2002, at 10:13:04
Here is a link to an editorial in today's Washington Post that essentially says that use of cognitive behavorial therapy is scientific and use of antidepressants is unscientific: http://www.washingtonpost.com/wp-dyn/articles/A14366-2002Jul28.html.
One thing in this ongoing debate that always makes me crazy is that there is no "placebo" to compare CBT to. I have read in the past that all forms of talk therapy are equally effective, and that no form of talk therapy is more effective than talking to a friend, a clergyman, a counselor, etc. That is, there are as many studies that cast doubt and confusion on the benefits of CBT as there are studies that supposedly tell us we're feeling only placebo effects from our antidepressants. I guess I should stress that I don't mean to knock CBT to anyone who thinks they're benefitting from it.
The best statement I have ever heard on this issue is in a book entitled Clinical Psychopharmacology Made Ridiculously Simple:
"For many years a debate raged in psychiatry with regard to the etiology and treatment of major mental disorders. Two opposing camps emerged: biological psychiatry, whose devotees held that psychiatric disorders had an organic basis; and psychologically oriented psychiatry, probably best represented by the psychodynamic movement, whose converts focused on the role of current emotional stressors, early childhood traumas, interpersonal problems, and intrapsychic conflict as causal agents in the development of psychiatric symptomatology. Although these polar views still exist, in recent years there has been an emerging view that encompasses both psychological and physiological factors in the etiology and treatment of many psychiatric disorders. In many, if not most, mental disorders it is helpful to think of a continuum or spectrum. Almost all mental disorders usually represent heterogeneous syndromes. When one talks about depression, for instance, it is important to realize that depression can present in a number of different ways and may have diverse etiologies. In some instances the cause may be purely psychological, e.g., a reaction to losing a job, death of a loved one, a significant rejection, etc. Likewise, symptoms may be largely psychological, e.g., feelings of low self-esteem and sadness. In other cases the picture is one of a pure biological disorder which has little o.no connection to environmental precipitants, but rather involves an endogenous neurochemical malfunction. In addition to psychological symptoms, the resulting symptoms may include a host of somatic symptoms, such as sleep disturbance and weight loss. Clearly, in some individuals there is an interplay of environmental/psychological factors and biochemical dysfunctions. The question "Is this a psychological or biological problem?" is overly simplistic. Rather, one must ask, "To what extent is this disorder due to psychological factors and to what extent is it due to a biochemical disturbance?" The answer to this question is extremely important in guiding treatment decisions. Most purely psychological problems are not helped by medication treatment. On the other hand, most biologically based psychiatric disorders require medication treatment."
poster:Anyuser
thread:114146
URL: http://www.dr-bob.org/babble/20020725/msgs/114146.html