Posted by Dr. Bob on January 30, 2002, at 19:01:29
In reply to Re: in defense of CBT « sid, posted by Dr. Bob on January 25, 2002, at 15:58:27
[Posted by Elizabeth on January 30, 2002, at 8:19:11
In reply to http://www.dr-bob.org/babble/20020124/msgs/91533.html]
> [Dr. Bob: This post concerns both medications and talk therapies and doesn't necessarily belong in one forum or the other. I prefer to post here in part simply because I don't generally read PSB. I'm not willing to say that one board is better than the other, but the attitudes expressed on PSB seem to me to be more intuitive or emotional than those here, so I feel more comfortable here on PB. I hope you'll respect this. TIA.]
Well, let me try something new: part I left there and part I'm moving here (reposted below). You don't need to read all of PSB, you know, you can just read these particular threads. :-)
Bob
> > Behavior and thoughts affect brain chemistry. CBT does not pretend that depression is not a brain chemistry problem.
>
> CBT isn't an individual. I have encountered some psychotherapists (some of whom favored CBT) who did seem to have a dualistic "brain vs. mind" view, seeing mental disorders as being one or the other (a simplistic and archaic world view, IMO). I have also encountered psychopharmacologists (and plenty of psychoanalytic therapists!) who also had this sort of attitude. It's a world view that really doesn't belong in the third-millenium world, but is nonetheless ubiquitous.
>
> > It can be used, as well as meds to treat depression. It does not have a 100% rate of success, and meds don't either. Acupuncture can help too, and it does not have a 100% success rate either.
>
> YMMV -- everybody needs to find a treatment regimen that works for them. I think talk therapy (not necessarily CBT only) can be worth trying as an aid in the treatment of serious mental disorders, but it's not always successful, and even when it does help, it often is not sufficient.
>
> It is possible for people who are in talk therapy to recognize why it may not be working for them (often, as has been mentioned, because they're just too depressed) and decide to pursue other forms of talk therapy (e.g., psychodynamic psychotherapy instead of CBT) or that talk therapy in general isn't likely to help them (or that they need to wait until they're less depressed, for example). In contrast, we can't see what's going on in our brains at the molecular level, so we don't have a way of evaluating what medication is most likely to yield success, or whether medication is likely to help at all. I hope this illustrates why people feel justified in making a decision to pursue psychotherapy or not but can't be certain that medications will or will not work for them without trying them (it's a mixed blessing that there are so many of them to try these days). I also think there are things that we don't understand about how talk therapy works (although in this regard CBT is probably the most simplistic type of talk therapy), so it's not necessarily a good idea to rule it out altogether.
>
> I've heard it said that all talk therapies (regardless of the therapeutic modality or the problem they're trying to treat) have about the same success rate -- about a third get better, a third stay the same, and a third get worse. I don't know if there's any solid evidence to back this up, but it seems about right to me. There seems to be an element of randomness in the success of psychotherapy. I also think that much of the success attributed to specific psychotherapeutic techniques (such as CBT) may be due to characteristics of psychotherapy in general (such as therapist-client match), and not to the particular technique used.
>
> > I did have success with CBT and acupuncture to get rid of a major depression, and I think CBT helps me everyday of my life now. It is some kind of emotional/psychological education that everybody should have in my opinion.
>
> I agree -- just about everyone could benefit from therapy, including CBT. I think that CBT might be particularly beneficial for adolescents, helping them to learn adult attitudes and improve their awareness of their behavior. It would fit nicely into a classroom setting, too.
>
> But CBT is *not* a cure for any disease. Just about everybody has some bad attitudes or habits that they could stand to unlearn. I think that most of us understand that that's not the same as a mood or anxiety disorder.
>
> > But some people are not open to learning.
>
> This is where some people start feeling like they're being put on the defensive: the implication, whether intended or not, is that when people say that CBT didn't work for them, it's because they're not open to learning. (Ironically, rigidity and lack of openness are among the "bad attitudes" that CBT is supposed to correct.)
>
> The "blame the patient" strategy is sometimes invoked in order to rationalize the failure of medication, too. This is done by changing the diagnosis to "personality disorder" (or adding a personality disorder diagnosis). Indeed, there are some psychiatrists who seem to equate treatment resistance with personality disorder, regardless of the symptomatic presentation!
>
> > I think it's another tool that can help, and I don't see why people don't use it more.
>
> I think that many people try it, but some find that it doesn't live up to its claims. As you say, it's a tool that *can* help. That's no guarantee that it will help everybody. (The above applies to medication too, of course.) It also doesn't mean that people who aren't helped by it simply aren't trying, or that they're lazy and expect the meds to do everything for them without any effort on their part (as you seem to imply -- again, perhaps unintentionally).> > I am not sure if different CBT techniques could help, I just got tired of making efforts and decided to rely on meds at this time. CBT does require efforts indeed, that's the downside: no free lunch.
>
> Again, this is the kind of attitude that can make people feel bad or defensive if they aren't helped by talk therapy. Many people assume that people who don't find talk therapy helpful are simply not trying hard enough. This is probably true in some cases, but I see no reason to assume that it is always (or usually) the case. I also think that the idea that people who take medication are not putting forth effort is mistaken: medications have side effects that need to be endured or managed. Many people are willing to endure these side effects because their response to medication is rapid and dramatic (let's not forget that many people need medication simply to function). For a lot of people, talk therapy produces little benefit rapidly enough to permit them to continue with their lives uninterrupted, and the effects, when they do finally begin to show, aren't that impressive. I suspect that there are people who might be helped a little bit by CBT or other talk therapy, but not enough for it to be worth the time and expense to them. Self-help books like Burns's are useful for people who can't afford to see a therapist, but this approach isn't useful for people whose problems require therapies that are more complicated and can't be written into a manual like CBT can.
>
> > However, it does help for the rest of your life, even if it is not a panacea.
>
> CBT advocates have for some time been trying to prove that it has lasting effects. To date, these efforts haven't shown much success.
>
> There is no panacea for mood and anxiety disorders; we just have to do whatever we can. And we're all individuals -- there's a *lot* of variation among human brains -- so making generalizations doesn't pay off (generally :-) ).
>
> BTW, "johnhill"'s post expresses, better than you or I ever could :-), the extremist (and unsupported) attitudes and assumptions that some people have about psych meds and talk therapy.
>
> -elizabeth
poster:Dr. Bob
thread:17202
URL: http://www.dr-bob.org/babble/social/20020125/msgs/17559.html