Podcast: Political deception and the CBT tsunami - Ivan Tyrrell with Farhad Dalal Feb 2020

[Sly Saint]

"Today we are listening in on a fascinating conversation between Ivan Tyrrell - Co-founder of the Human Givens approach and director of Human Givens College - and Farhad Dalal, who is a UK-based psychotherapist and author. Farhad Dalal’s book - CBT: The Cognitive Behavioural Tsunami: Managerialism, Politics, and the Corruptions of Science is a robust, detailed and psychologically sophisticated critique of the frightening place where modern managerialism, regulation and compliance have taken us."

https://www.hgi.org.uk/resources/podcasts/political-deception-and-cbt-tsunami


listening to this now, so far very good.
very critical of NICE, CBT research and IAPT.

More info
https://me-pedia.org/wiki/Farhad_Dalal

eta: references this paper (2006) which was main reason CBT was taken up by the Labour Govt of the time (primarily to save/make money) to treat unemployed people and get them back to work.
The depression report: a new deal for depression and anxiety disorders

Abstract
Crippling depression and chronic anxiety are the biggest causes of misery in Britain today. They are the great submerged problem, which shame keeps out of sight. But if you mention them, you soon discover how many families are affected. According to the respected Psychiatric Morbidity Survey, one in six of us would be diagnosed as having depression or chronic anxiety disorder, which means that one family in three is affected. That is the bad news. The good news is that we now have evidence-based psychological therapies that can lift at least a half of those affected out of their depression or their chronic fear. These new therapies are not endless nor backwardlooking treatments. They are short, forward-looking treatments that enable people to challenge their negative thinking and build on the positive side of their personalities and situations. The most developed of these therapies is cognitive behaviour therapy (CBT). The official guidelines from the National Institute for Clinical Excellence (NICE) say these treatments should be available to all people with depression or anxiety disorders or schizophrenia, unless the problem is very mild or recent. But the NICE guidelines cannot be implemented because we do not have enough therapists. In most areas waiting lists for therapy are over nine months, or there is no waiting list at all because there are no therapists. So, if you go to the GP, all that can be provided is medication (plus at some surgeries a little counselling). But many people will not take medication, either because they dislike the side effects or because they want to control their own mood. The result is tragic. Only one in four of those who suffer from depression or chronic anxiety is receiving any kind of treatment. The rest continue to suffer, even though at least half of them could be cured at a cost of no more than £750. This is a waste of people’s lives. It is also costing a lot of money. For depression and anxiety make it difficult or impossible to work, and drive people onto Incapacity Benefits. We now have a million people on Incapacity Benefits because of mental illness – more than the total number of unemployed people receiving unemployment benefits. At one time unemployment was our biggest social problem, but we have done a lot to reduce it. So mental illness is now the biggest problem, and we know what to do about it. It is time to use that knowledge. 2 But can we afford the £750 it costs to treat someone? The money which the government spends will pay for itself. For someone on Incapacity Benefit costs us £750 a month in extra benefits and lost taxes. If the person works just a month more as a result of the treatment, the treatment pays for itself. So we have a massive problem – the biggest problem they have for one in three of our families. But we also have a solution that can improve the lives of millions of families, and cost the taxpayer nothing. We should implement the NICE guidelines; and most people with mental illness should be offered the choice of psychological therapy. Everyone who wants something done should write to their MP calling for action.

http://eprints.lse.ac.uk/818/

 

[Ravn]

Haven't had time to listen to the podcast but I found this 2015 paper by Dalal very useful: Statistical Spin, Linguistic Obfuscation: The Art of Overselling the CBT Evidence Base
He explains the statistical shenannigans some researchers get up to in a language non-statisticians can understand.

In conclusion, I want to underline the following issues.
The evidence base for CBT is of the statistical kind that speaks
to likelihoods but it is presented as though it were generating
certainties no different to the more objective disciplines of math-
ematics or physics.
This next point is quite important. It is the case that both the
supporters and detractors of CBT seem to be in agreement that
in round figures, CBT is of benefit to about 50% of the popula-
tion. It is on this sort of figure that the Exchequer has been
persuaded to part with eye-watering amounts of money. But if
it is found to be the case that the figures we have come across
in this study (that the efficacy is not 50% but 25%) are repre-
sentative of the CBT research base in general, then something
much more worrying is going on. Then we would have to ask:
is the whole CBT research base infected and corrupted by these
kinds of statistical malpractices?

https://www.researchgate.net/public..._The_Art_of_Overselling_the_CBT_Evidence_Base

 

[oldtimer]

There's a previous thread about Dalal. I found him a breath of fresh air.

https://www.s4me.info/threads/book-review-cbt-the-cognitive-behavioural-tsunami.8252/#post-145695.
Post #3 has a very good video, also entitled Statistical Spin, Linguistic Obfuscation

 

[Sly Saint]

Old 'news' but worth reviving.
(note, the author of the piece is advertising his own form of therapy but the links to relevent stuff are there)

Swedish National Audit Office concludes: When all you have is CBT, mental health suffers
November 10, 2015 By scottdm
https://www.scottdmiller.com/swedis...en-all-you-have-is-cbt-mental-health-suffers/

 

[rvallee]

Then we would have to ask: is the whole CBT research base infected and corrupted by these kinds of statistical malpractices?

I would say so and I think that it has worked for the same reason why CBT was "shown" to be "effective": it's persuasion. On the patients it's persuasion from a position of statutory authority and complete control over the process, what is written down about what happened is entirely at the therapist's discretion and we know that they are not only motivated but sometimes instructed to exaggerate and obfuscate, so it can be written down that patient has agreed to something they did not because their agreement is superfluous, as the whole point of CBT is to manufacture agreement, to persuade into responding one way to certain queries. If the patient has not been wholly persuaded yet it's OK all you need to accomplish is that by the end something has been "agreed".

This persuasion was used on the administrators to convince them they would save money, even though in the end IAPT-style boondoggles literally spend money in order to waste more in the end, and it is roughly the same skills that are used on patients to try and convince them that what they are experiencing in reality is not what is happening.

Deception is apt, and the method is persuasion, developed through decades of trying to control the flow of discussion with people who are not receptive, very convenient when it comes to extracting large budgets from officials and get them to agree to something even when they don't actually agree.

This is evident when you read the literature but especially so when you read the training material. The focus is almost exclusively over how to persuade people of impossible things. It's extremely effective from a position of absolute power but since it aims to only get the minimal agreement, the tiniest statistical bump above "no effect", it's also effective at convincing people that this act of being able to persuade some people using this enormous power imbalance and persuasion skills will mean enormous savings. As long as you never count anything, shut your eyes and wish very hard for it to be true.

There seems to be a strong skills overlap with good salespeople. Normally the process of science should weed this out as nothing but manipulation but the psychosomatic loophole is always wide open and accepting of any and all extraordinary claims that persuade people that it exists and so they rammed that straight through the heart of medicine, persuading officials to part ways with billions in real funding so they could lose much more the other way while giving the illusion that the process comes out as a cost-saving measure.

To persuade budget people, who are very protective of their ROI, that they can confidently spend money to lose money while actually believing it is saving money may be one of the most impressive feats of persuasion ever to succeed. On that CBT is very effective, you can't fault that. Effective at failing while giving the illusion of success, that is.