Where is the Evidence for Evidence-Based Therapy?

Sly Saint · Nov 2, 2019

Challenging the Cognitive Behavioural Therapies: The Overselling of CBT's Evidence Base
Jonathan Shedler - Where is the Evidence for Evidence-Based Therapy?
23 Jan 2015

The term “evidence-based” has become a form of marketing, used to refer to brief therapies conducted by following instruction manuals (“manualized” therapy).

It is widely claimed that these therapies have proven clinical effectiveness and are superior to traditional forms of psychotherapy.

However, the scientific evidence indicates that these manualized treatments are unhelpful for most patients most of the time.
Research shows that
a) the treatments help only a small fraction of patients,
b) the benefits the patients receive are clinically trivial and fail to pass the “So what?” test,
c) the benefits evaporate quickly,
d) patients remain symptomatic after treatment,
e) the majority of patients seek additional treatment for the same condition within six months, and
f) traditional (e.g., psychodynamic) psychotherapy is at least as effective and confers longer-term benefits.

If anything, research shows that for the most common mental health conditions, the treatments promoted as “evidence based” have been empirically invalidated. Proponents of the treatments appear to conflate mere existence of research studies with scientific support, disregarding the actual findings of the studies and their clinical implications. The popularity of “evidence-based” therapies may represent a triumph of marketing over science.
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very interesting talk; many parallels with PACE.

shows that CBT in fact has very little evidence to support it for any condition and it's rise in 'popularity' largely due to misquoting and misrepresenting the results.

(His argument is similar to Mike Scott of cbt watch; but nevertheless the evidence he presents that exposes how CBT was, and continues to be, falsely promoted as an 'evidence-based' treatment relates to all the problems with that field of research in general)

eta: Other material of interest

Empirically supported psychological interventions: controversies and evidence.

Chambless DL1, Ollendick TH. 2001

https://www.ncbi.nlm.nih.gov/pubmed/11148322

https://sci-hub.tw/10.1146/annurev.psych.52.1.685

https://twitter.com/user/status/1180324569980100608

eta3:

https://www.youtube.com/watch?v=3UpHl9kuccc

eta4: see Shedlers article on same title
https://jonathanshedler.com/wp-cont...s-the-evidence-for-evidence-based-therapy.pdf

Jonathan Edwards · Oct 25, 2019

I have not listened to the whole talk but my impression is that this guy is even worse than the people he is criticising.

His argument is that 'manualised' treatments, i.e. treatments that can be done according to an agreed written protocol, are not as good as personalised psychodynamic therapy, which is what he sells to people.

He is probably right to say that the evidence for the manualised treatments is poor, although he does not seem to aware of all the problems we have discussed here. He says the benefits are only for some and transient. It seems to me more likely from looking at trials like PACE that there is actually no benefit at all.

But his alternative is to go on using personalised therapies which like homeopathy are totally lacking in evidence because there is no protocol to follow to test them. He is using the argument I have heard from a psychotherapist who treats ME 'Oh but we do not treat people like in trials like PACE, we tailor the treatment to each person'. So how does anybody know how to do that? and How do you know if the tailoring makes any difference if you have never tried tailoring differently?

In other words the talk shows not just that CBT is poorly evidence based but that traditional psychotherapy is even worse on the same score. He has let the cat completely out of the bag. Psychotherapists are complete phoneys it seems. Moreover, they do not understand what it is to be a phoney.

NelliePledge · Oct 25, 2019

He says they should be doing traditional psychodynamic therapy which I didn’t know anything about so I googled and it appears to be Freudian stuff about maladaptive behaviour stemming from childhood. Not sure how that’s an improvement on CBT..........

Jonathan Edwards · Oct 25, 2019

NelliePledge said: ↑

He says they should be doing traditional psychodynamic therapy which I didn’t know anything about so I googled and it appears to be Freudian stuff about maladaptive behaviour stemming from childhood. Not sure how that’s an improvement on CBT..........
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It is much worse.

This is what Simon Wessely was worried about when he emailed me years back - manual-based therapy doing proper psychodynamic therapists out of a job. That might at least be a positive for CBT.

Sean · Oct 26, 2019

I just love watching turf wars between competing versions of nonsense.

Sly Saint · Oct 26, 2019

https://twitter.com/user/status/1107589125815832576

Mental health: transforming research and treatments

Health treatments are most effective when scientists and clinicians have a clear understanding of how they work. This isn’t the case for mental health, where many treatments are no more advanced than they were 30 years ago. We believe a radical new approach is needed to drive science forward and improve people’s lives.
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Wellcome has long been a supporter of research into mental health. The work we’ve funded has led to NICE recommendations on the use of psychological therapies in the UK, including establishing the Improving Access to Psychological Therapies programme, and research into whether mindfulness training in schools can prevent the onset of mental health problems.
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But some underlying problems need to be addressed before the field can make significant progress.
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Mental health research is fragmented with problems described and measured in different ways. There’s little understanding of why treatments are only effective for some of the people who receive them, or how they really work.
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What we want to achieve
We want to help shape a new super-discipline of mental health science in which scientists and clinicians work with a common purpose, using standardised measures and approaches.

We're committing £200 million in funding to this area, and we’ll look particularly at:

treatments for anxiety and depression, as over 615 million people worldwide have these conditions

psychological treatments, because we think there’s a real opportunity to innovate to make these treatments more successful, and to gain new understanding of how they work

early life and early illness, because most common mental conditions start between the ages of 15 and 24, and the longer someone has a condition the harder it is to provide effective help.

This funding is in addition to the funding we already offer for research across all areas of neuroscience and mental health. Applications for our existing schemes won’t change, and your research won’t stand a greater or lesser chance of being funded if it includes a focus on depression and anxiety, young people or psychological therapies.
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https://wellcome.ac.uk/what-we-do/our-work/mental-health-transforming-research-and-treatments

maybe they should start by looking more closely at the research that shows the therapies are effective(?)

rvallee · Oct 27, 2019

https://twitter.com/user/status/1188512922684874753

https://twitter.com/user/status/1188518938038149125

Sean · Oct 30, 2019

If these psychs were really serious about reducing mental illness (particularly depression and anxiety) they would be focusing primarily on advocating for the reduction in the socio-economic stressors in society, not on playing games with individuals' inevitably limited capacity to respond to those stressors.

Instead they are doing the opposite, and actively allowing their profession and science to be abused to cover up these underlying external causes, and misdirect blame and responsibility onto the victims.

Sly Saint · Feb 24, 2020

https://twitter.com/user/status/1231947243646783488

Snowdrop · Feb 24, 2020

Therapy helps the vast majority of those who receive it. Happily – if the discipline embraces reform in research, and cultivates a humble, flexible approach to therapy – it could help even more
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Sounds like minor tweaking and all is well.

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Where is the Evidence for Evidence-Based Therapy?

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