Discussion in 'Health News and Research unrelated to ME/CFS' started by Allele, May 20, 2018.
CBT is fools gold, and i don't mean just for ME/CFS
It basically posits that bad thinking patterns cause depression so stop thinking bad thoughts and your problems will disappear.
Its a very mechanistic, self fulfilling, detached from humanity way of looking at emotions.
Its an evolution and rebuke of Freud, it has some wisdom but it misses the point by design.
Its benefits are its easy to teach clinicians to practice, its not messy (easy to teach/learn), its quick and its sterile (feelings are reduced to mechanistic entities that are dealt with by avoiding or "rising above" the patients emotions).
Its cons are it misses the forest for the trees, its success rate is dismal, and it prevents clinicians from learning anything new because they seem to be trained to stick to it like glue and reject everything else
Today, people are much more in tune with their own thought patterns and emotions. From a young age kids are taught in school incidentally to do 'CBT' on themselves; the ethos of reflecting upon thoughts and emotions has suffused our cultures sufficiently that parents and media encourage this as well. CBT is redundant to many people.
Perhaps two or three generations ago was the golden era of CBT.
This provides interesting background for the PACE debate.
It confirms the concerns we have had about CBT in PACE. But it also sheds light on psychotherapists' views on it. It seems that maybe some psychotherapists do not like having to use CBT all the time. It suggests that the glib use of 'evidence based' as a term for talking therapies may be as poorly grounded as suspected.
The trouble is that the psychotherapists' response to this is to be allowed to do whatever psychotherapy they think suits the patient - which of course is entirely unfounded, even if it seems 'common sense'. Although the authors do not want to be seen as CBT bashing that is because they do not want to be seen as psychotherapy bashing but they have given the arguments that make it clear that psychotherapy as a whole is not in fact evidence based.
If psychotherapy was like massage or pedicure that would be fine - people could go and have it when they wanted to. But it is supposed to be a recommended treatment for ill health based on evidence and the more I read the more I am convinced that it just isn't.
I have found therapists love CBT, it gives them a bunch of easy answers and is very aseptic which they absolutely adore.
As for psychotherapy it often fails because clinicians are using CBT. Chicken and the egg problem. How psychotherapy works is well understood in some circles but in others they realize they are in the forest but can't identify any trees because they have locked themselves into a specific outlook.
That said there is actually a great deal of excellent material written by many authors (and even more fluff unfortunately), one of the best books i have ever read was written by a psychiatrist who touches on therapy but writes about human nature based on his decades of psychotherapy experience, which in my opinion should be used as a text book in every high school.
It does seem more geared toward dealing with personal shortcomings and unhappiness, which should as a general rule not be medicalized. Whether it's even effective for that in many cases...
Based on my experience growing up in the 90's/00's, I think the way of thinking underlying CBT has triumphed by entering the general consciousness and mental practice of society. Which is to say most people are surprisingly reflective, at least when pressed, and are capable of managing their emotions and thought patterns reasonably well so as not to be totally dysfunctional or self-defeating.
(Perhaps proponents of CBT are particularly emotionally unintelligent and poor at reflection and project these attributes onto other people; when they learn the secrets of the master-art of CBT they have a come-to-Jesus moment and are compelled to spread the good word...)
Undoubtedly there are some individuals out there for whom CBT (or perhaps a self-help book on self-CBT?) could open up new worlds of possibilities in life. But this doesn't mean it belongs in medicine. As things stand now it may be that the inclusion of CBT in our medical systems is causing more harm than good because, as you say, it doesn't really treat illness; the pretense that it does so pours lighter fluid on the ideological dumpster fire that is psychosocial treatment of ME, now attempting to spread to MUS and chronic illness/disability more generally.
I am all in favour of CBT being regarded as the gold standard of psychotherapy.
It should have been abandoned in 1931.
CBT is so yesterday if you are really cool now. Its the government "mindfulness" juggernaut that is the new cult, being pushed into primary schools, healthcare and other public outlets.
This is really interesting, just how do you decide on what is the gold standard in an industry that relies on lack of objectivity to supply it with clients?
I think the word gold is a clue in how these things work.
Is it "normal" for young kids to spend time being so introspective? I suspect that the high rates of depression found amongst the young may be one result of this, particularly for girls.
I am so, so, so glad that I grew up long before the age of social media.
When "mindfulness" was the non judgemental awareness of the present moment can the bastardised version touted be considered the same thing anymore than supportive CBT be considered the equivalent of directive CBT
Are they? I agree that people growing up on the 60s, 70, and 80s may seem less emotive to the younger ones but it is not necessarily the case that they are out of tune with their thoughts and feelings.
My friends and I talked about stuff, We listened to bands like Pink Floyd and discussed war, oppression, divisions in society and what that might actually mean and feel like. Admittedly, often after raiding the parents drinks cabinets, but still....
In school, studying poetry and prose, in whatever language, involved going back in time - what would life had been like for the writer? How would they have felt about their situation?
Similarly, history & politics was taught with a view to what life would have been like for the people of the time. Were they aspirational, were they hungry, did they have a voice? How that influenced policies and created history and how that in turn has it's own knock on effect.
We were encouraged to discuss these things in class and in our essays.
Hear hear IW I remember as a teenager being petrified there was going to be a nuclear war. I remember when John Lennon died. I remember punk, UB40s One in Ten, Live Aid. We were definitely in touch with our emotions.
And if you weren’t going to die from nuclear war it was AIDS.
For what it's worth, back in the sixties and seventies we did lots of self awareness stuff - encounter groups, women's consciousness raising groups, endless hours discussing life the universe and everything. And lots of political protest too... Then there was all the hippie stuff - transcendental meditation, Buddhist mindfulness meditation, pot smoking ...
Self exploration and experimental therapies have been going on for a long time.
Its not just that its when the state starts to force it on everybody especially from an early age that makes it so dangerous.
Lots of belief systems have been going on for centuries but when such things are made part of public policy is when its become scary.
When I was in college, um... mumble-years-ago, my psychology professor's initial format was to present study after study showing that psychotherapy did not work. In fact, all sorts of studies showed that psychotherapy/analysis actually prolonged patient recovery from emotional problems (people were in analysis for decades). I think our professor's goal was simply to throw cold water on any romantic notions we had about the power of psychotherapy.
As I recall, the only psychotherapy treatments that did seem to work were for phobias. Gradual desensitization worked very well (taking one step closer to a snake each day), but "flooding," i.e. massive exposure (picking up a snake without working up to it), was even quicker and more effective (perhaps akin to ripping a bandage off quickly).
I think this was at a time of crisis for psychotherapy (late 70's early 80's). The view then seemed to be that new drugs would soon make the field all but obsolete. That did not really turn out to be true, perhaps, in part, because when CBT came along it was seen as restoring relevance to the field. Here, at last, psychotherapists had a treatment that was actually shown to be better than nothing (at least in some instances).
This is probably why the fight over CBT and ME is so heated. It may be considered a sort of "last stand" for psychotherapy.
This is the problem, this is Freduian analysis where the client speaks forever and ever and the clinician says nothing and acts aloof and somehow this fixes the patient. Its utter stupidity mixed with good intentions. Also if it worked why do you need a clinician at all, you could speak to a statue or a teddy bear, it would actually work better because they are superior to a human at not showing emotion or ever responding.
Suffice it to say this "technique" was never double blind placebo tested or it would have failed miserably...
I'd call that a warning sign about lack of benefit.
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