When it comes to mental health you ask anyone and CBT, or Cognitive Behavioral Therapy, will come up.
It has become the gold standard of treating certain mental illnesses like depression and anxiety.
It’s success is no doubt due to it’s empirical backing with many studies reporting it’s effectiveness.
So much so it has become the goto treatment on the NHS, with initiatives to promote and increase the number of practitioners who can offer this treatment.
However trouble seems to be brewing over this therapy. A study shows that the effectiveness of CBT has fallen since it was first used. A loss of 50% has taken place in the past thirty years.
One possible reason for the lower efficacy of of CBT is due to the ‘decline effect’.
Why this takes place is perhaps due to ‘publication bias’. Where scientific claims like the efficacy of medicine decrease over time. Initially journals will tend to publish papers that support a treatment. Then as time goes by such support drifts away until papers criticising it become more desired.
Another reason is ‘regression to the mean’, where results tend to return to the average, which could mean a lowering of efficacy than the initial results.
Another the effectiveness of CBT appears to be declining maybe because the placebo effect is wearing off.
Oliver Burkeman in an article follows this idea to say that it’s not the treatment that has changed, but we have.
What’s meant by placebo effect is the belief that a fake, sham therapy works because it’s expected to by the recipient. But as Burkeman points out that’s a part of any treatment, regardless whether it works or not.
For my part I have always been suspicious of cookie cut, tick box methods in medicine.
Yet modern medicine seems to favour them because they are easy to research. Standardised interventions can be controlled for more easily.
CBT seems to have become a flowchart and that’s why I feel it’s success is perhaps not as warranted as I think it should be.
In the book Psychobabble Dr Stephen Briers points out his own reservations for CBT as a cure all.
The trouble is the public, having been informed by the headlines, now asks for CBT from their practitioner. Regardless of whether a different modality might be a better choice.
Another point he makes is CBT in some cases may perform better than some therapies in the short term, but psychotherapy may actually be a better choice for more complex cases.
Further evidence shows that the relationship with your therapist has a massive effect on treatment outcomes. So much so that the conclusion of the American Psychological Association is that the nature of the therapeutic relationship has just as much impact on outcomes as any treatment method.
Briers goes into the philosophy behind medicine and therapy based upon his own experiences. He asks, what if you can’t seem to find those negative thoughts? Maybe they are not even there?
This lends itself to another question. Since our minds are mostly found in the unconscious, is it possible to address problems of thought by examining them? Reprogramming our minds to have better thoughts?
‘CBT tries to treat us all like good little miniature scientists. It assumes that we are essentially rational, reasonable creatures’
‘While scientists and philosophers may lean on the power of reason and dutifully sift and weigh evidence, in our daily lives most of us operate under the auspices of a very different kind of ‘logic’ and sense making. ‘
Our unconscious is irrational, so much so that I can’t fathom why we think we can use rationality to clean it up. We have been brought up to think that rationality is a better way, but we don’t live like that, our actions and behaviors are not reasoned out.
Brier’s again uses his own experiences seeing patients. ‘People often come into therapy not because they are plagued by illogical thoughts but because they instinctively feel that the stories they have sought to live by are unravelling.’
He goes onto say, ‘When dealing with the steady undertow of someone’s implicit narrative, reason and logic often prove feeble instruments.’
Our neuroses are linked to the stories we tell ourselves. You can’t reduce something complex and dynamic as our personal history into something simple like the ‘equations’ of CBT.
The problems of medicine
I see here a theme of humanity. Trying to remove all uncertainty and mystery in life. Packaging everything in existence into neat little boxes, governed by rules, revealed by science.
The result is a drive where people are all treated the same without any nuances or subtly.
Standardising treatments makes them less applicable to different personalities.
Indeed the effort to standardise is part of the whole dehumanizing effect in medicine, and to a greater extent society.
Listening, empathy, compassion, a kind word, talking about the day to day non clinical stuff. The human connection that builds up trust and empathy, that’s what matters.
But with budgets being squeezed, and an ever increasing workload what practitioner has time for that?
In trying to standardise care medicine has become a rule book.
No wonder medicine is failing society. The biggest killers today are chronic illness, diseases of lifestyle and environment.
You can’t turn people into machines then have a doctor/mechanic service them based upon a manual.
‘People cure people.’ (Click to Tweet)
Ill health is not something fixed with a single pill or method. It’s a process that happens over time, a complex multi faceted approach that manifests as a personal struggle.
I have never tried CBT for my own social anxiety problem because of these fears. Maybe I’m being to harsh in my ignorance, having never really tried it. So I will not deny that CBT has been useful to many.
But instead of a flowchart I’d rather read the words of storytellers, poets and philosophers. CBT itself is based on the ideas of the Stoics.
CBT seems to have been adopted as a magic bullet by some, and I feel that’s where it has gone wrong, and so have we.
When it comes therapy, don’t just advise me.
Forget the forms. Instead enlightenment me.
Put aside the script and inspire me to act.
Then let me run with it, in my own way.
It may take longer, but I feel more empowered this way.
Because it is my way.
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