Medical Is psychoanalysis pseudoscience ?

[Casco]

I have heard that kind of comments about psychoanalysis, but I am not a expert on the subject. So, can anyone explain to me what is true about this opinion or why many people say this about psychoanalysis? I repeat, I am not an expert on the subject, so if I am wrong in my hypothesis let me know.

 

[zoobyshoe]

It's a complex issue. Freud had some success with it, but most of his followers seemed not to understand how to apply it, so it never developed into an effective therapeutic tool. People would spend years in analysis and get no better.

The current view is that uncovering the root cause of a psychological problem turns out not to automatically constitute a cure. Analysis can, in fact, lead to a good understanding of what started the problem, but fixing it ends up having to be accomplished by separate means.

Cognitive Therapy is considered one of the best tools for actually fixing things, and it doesn't require even knowing how the problem started.

 

[Number Nine]

Psychoanalysis is a bit of vague term. Freud and his work were largely (and rightly) dismissed as pseudoscience by the scientific community from the beginning, but a few characteristics of his theories have been assimilated into modern practice. Cognitive-behavioural therapy has largely supplanted most earlier approaches to psychotherapy.

 

[zoobyshoe]

Psychoanalysis is a bit of vague term. Freud and his work were largely (and rightly) dismissed as pseudoscience by the scientific community from the beginning...

Right. I forgot to address this. The charge of pseudoscience arises from the fact it's based on so many assertions that can't be tested. Freud, himself, understood the validity of these criticisms and incorporated them into his writings, warning the reader that what followed was not scientifically testable.

It should be understood, though, that the same is true of all therapeutic schools. The proponents of Cognitive Therapy try very hard to support their assertions with whatever data seems supportive, but it remains, at very best, a "soft" science, if that. What it has to recommend it is its success rate compared to other therapies.

 

[Pythagorean]

Though there's plenty of skepticism about CBT for many mental illnesses. CBT is mostly only shown to be effective for anxiety disorders. And the CBT is a treatment that the patient must practice for the rest of their life, not a cure.

A 2010 meta-analysis found that no trial employing both blinding and psychological placebo has shown CBT to be effective in either schizophrenia or bipolar disorder, and that the effect size of CBT was small in major depressive disorder. They also found a lack of evidence to conclude that CBT was effective in preventing relapses in bipolar disorder.[47] Evidence that severe depression is mitigated by CBT is also lacking, with anti-depressant medications still viewed as significantly more effective than CBT,[14] although success with CBT for depression was observed beginning in the 1990s.[48]

[14] Driessen E, Hollon SD (September 2010). "Cognitive behavioral therapy for mood disorders: efficacy, moderators and mediators". Psychiatr. Clin. North Am. 33 (3): 537–55. DOI:10.1016/j.psc.2010.04.005. PMC 2933381. PMID 20599132.

[47] Lynch D, Laws KR, McKenna PJ (January 2010). "Cognitive behavioural therapy for major psychiatric disorder: does it really work? A meta-analytical review of well-controlled trials". Psychol Med 40 (1): 9–24. DOI:10.1017/S003329170900590X. PMID 19476688.

[48] Gloaguen V, Cottraux J, Cucherat M, Blackburn IM (April 1998). "A meta-analysis of the effects of cognitive therapy in depressed patients". J Affect Disord 49 (1): 59–72. DOI:10.1016/S0165-0327(97)00199-7. PMID 9574861.

 

[zoobyshoe]

Though there's plenty of skepticism about CBT for many mental illnesses. CBT is mostly only shown to be effective for anxiety disorders.

I have never seen proponents claim it was effective for anything but depression. (Not that I've read anything but two popular books and a couple of studies.)

And the CBT is a treatment that the patient must practice for the rest of their life, not a cure.

True. "Fix" is an unfortunate word choice on my part.

 

[Antiphon]

If Freud were positing his theories for the first time in this day and age, he'd be banned from this forum for posting overly speculative personal theories. That alone indicates that it might be pseudoscience.

Are it's hypotheses falsifiable by experiment? If not, it's on par with Mesmerism and Astrology.

 

[zoobyshoe]

If Freud were positing his theories for the first time in this day and age, he'd be banned from this forum for posting overly speculative personal theories. That alone indicates that it might be pseudoscience.

Are it's hypotheses falsifiable by experiment? If not, it's on par with Mesmerism and Astrology.

Are the tenets of any school of psychology falsifiable by experiment? I can't think of any off the top of my head.

Anyone remember Transactional Analysis?:

In the first half of the book, Berne introduces transactional analysis as a way of interpreting social interactions. He describes three roles or ego states, known as the Parent, the Adult, and the Child, and postulates that many negative behaviors can be traced to switching or confusion of these roles. He discusses procedures, rituals, and pastimes in social behavior, in light of this method of analysis. For example, a boss who talks to his staff as a controlling 'parent' will often engender self-abased obedience, tantrums, or other childlike responses from his employees.

The second half of the book catalogues a series of "mind games" in which people interact through a patterned and predictable series of "transactions" which are superficially plausible (that is, they may appear normal to bystanders or even to the people involved), but which actually conceal motivations, include private significance to the parties involved, and lead to a well-defined predictable outcome, usually counterproductive. The book uses casual, often humorous phrases such as "See What You Made Me Do," "Why Don't You — Yes But," and "Ain't It Awful" as a way of briefly describing each game. In reality, the "winner" of a mind game is the person that returns to the Adult ego-state first.

http://en.wikipedia.org/wiki/Games_People_Play_(book)

Then there was "Gestalt Therapy", which got a lot of play.

No school of psychology I am familiar with falls into the category of Hard Science. At the same time, though, it's abundantly clear that psychological dynamics exist and are always in play when people interact. The same cannot be said of Astrology.

 

[Number Nine]

Are the tenets of any school of psychology falsifiable by experiment?

"Schools" of psychology went out of fashion decades ago, except perhaps in the clinical realm. I do research alongside cognitive psychologists all the time, and their predictions are entirely falsifiable, though I'll agree in general that most fields of psychology tend to be infuriatingly soft.

 

[Antiphon]

Are the tenets of any school of psychology falsifiable by experiment? I can't think of any off the top of my head.

Anyone remember Transactional Analysis?:


http://en.wikipedia.org/wiki/Games_People_Play_(book)

Then there was "Gestalt Therapy", which got a lot of play.

No school of psychology I am familiar with falls into the category of Hard Science. At the same time, though, it's abundantly clear that psychological dynamics exist and are always in play when people interact. The same cannot be said of Astrology.

Astrologers would disagree. But I'll concede it.
But you have to concede Mesmerism.

 

[zoobyshoe]

Astrologers would disagree. But I'll concede it.
But you have to concede Mesmerism.

I can't concede that. I'm brimming with animal magnetism.

 

[Devils]

Psychoanalysis is a bit of vague term. Freud and his work were largely (and rightly) dismissed as pseudoscience by the scientific community from the beginning, but a few characteristics of his theories have been assimilated into modern practice. Cognitive-behavioural therapy has largely supplanted most earlier approaches to psychotherapy.

That's essentially correct. CBT is commonly used but there are plenty of other therapies too.

 

[Devils]

Are the tenets of any school of psychology falsifiable by experiment? I can't think of any off the top of my head.

Anyone remember Transactional Analysis?:http://en.wikipedia.org/wiki/Games_People_Play_(book)

Then there was "Gestalt Therapy", which got a lot of play.

I would class TA as '1960s observations', useful for reading but not really used in therapy.

For some modern pop psychology, The Power of Now by Tolle.
http://en.wikipedia.org/wiki/The_Power_of_Now

Its more about resolving neuroses/internal anxiety,

 

[ilhan8]

unfortunately, psychoanalysis is a pseudoscience.
severest illusion of psychiatric community to treat psychiatric disorders in past.
again unfortunately, psychoanalyis is not illegal and psychoanalytical talk therapies continue still today.
CBT is more legitemate but only effective for mild psychiatric disorders.
modern psychiatry is a neuroscience, and psychiatric disorders are considered to be organic brain disorders.
medications and ECT are golden standards of modern psychiatric treatments.

 

[Casco]

Thank all of you for the information, just another two questions. Which is the reason why psychoanalysis is still being practiced? Even more, it seems that a huge amount of people, specially from the physichologist community, they still believing in it as a "cure" for mental disorders. Another one is a recommendation of a reading on this subject, I am looking for a book that can give me a general picture about what is going on in the world of neuroscience and psychology.

 

[zoobyshoe]

"Schools" of psychology went out of fashion decades ago, except perhaps in the clinical realm. I do research alongside cognitive psychologists all the time, and their predictions are entirely falsifiable, though I'll agree in general that most fields of psychology tend to be infuriatingly soft.

Give me an example of the sort of thing that's falsifiable. I only ever read studies casually here and there and haven't happened to encounter, not have I gone looking for, "hard" psychology. I'd be interested in seeing how that plays out.

 

[Number Nine]

Give me an example of the sort of thing that's falsifiable. I only ever read studies casually here and there and haven't happened to encounter, not have I gone looking for, "hard" psychology. I'd be interested in seeing how that plays out.

Ah...you've put me on the spot now. I not only have to find something falsifiable, I have to find something elegant (I can't have your first exposure to my favourite branches of psychology be some trashy, hillbilly research). I shall return with papers.

 

[zoobyshoe]

Ah...you've put me on the spot now. I not only have to find something falsifiable, I have to find something elegant (I can't have your first exposure to my favourite branches of psychology be some trashy, hillbilly research). I shall return with papers.

I got impatient and googled. Wikipedia reports that Cognitive Psychology is unique among psychologies in its "acceptance" of the scientific method:

Cognitive psychology is a subdiscipline of psychology exploring internal mental processes. It is the study of how people perceive, remember, think, speak, and solve problems.[1]

Cognitive psychology differs from previous psychological approaches in two key ways.

It accepts the use of the scientific method, and generally rejects introspection[2] as a valid method of investigation - in contrast with such approaches as Freudian psychology.

It explicitly acknowledges the existence of internal mental states (such as belief, desire, idea, knowledge and motivation).

In its early years, critics held that the empiricism of cognitive psychology was incompatible with its acceptance of internal mental states. However, the sibling field of cognitive neuroscience has provided evidence of physiological brain states that directly correlate with mental states - thus providing support for the central assumption of cognitive psychology.[citation needed]

However, from the rest of the article we see it is extremely limited in scope compared to all the other psychologies:

the dominant paradigm in the area has been the information processing model of cognition that Broadbent put forward. This is a way of thinking and reasoning about mental processes, envisioning them as software running on the computer that is the brain. Theories refer to forms of input, representation, computation or processing, and outputs.

(They contrast Cognitive Psychology to Freudian in that the CS "accepts" the scientific method, as if Freud rejected it, which he didn't. He realized, as I said earlier, that most of what he proposed couldn't be scientifically tested, and warned potential students that this was the case. Acceptance or rejection of his ideas was a matter of them making sense to you or not.)

 

[zoobyshoe]

Which is the reason why psychoanalysis is still being practiced?

Is it? Talk therapy certainly still exists, but I'd be surprised to find out there were any Freudian Psychoanalysts still out there.

 

[Number Nine]

Comparing cognitive to Freudian psychology is a bit misleading. Early "schools" of psychology (Freudian, behaviourism etc.) were defined largely by their particular views about the nature of consciousness and behaviour; they were, essentially, theories or models (often, poor ones). Cognitive psychology is a discipline; it's a branch of psychology that studies cognitive processes. Comparing the two is a bit like comparing the standard model of particle physics (psychoanalysis) to fluid dynamics (cognitive psychology); one is a model, the other is a field.

Cognitive psychology, today, is probably one of the most diverse and successful of the behavioural sciences. Wiki's description of mental "information processing" is a bit unusual here; cognitive psychology has been extremely heavily influenced by cognitive neuroscience and neuropsychology (my personal interests lie in computational neuroscience, and most of the professors I've known who work in cog psych base their work carefully around developments in neuroscience), and it has adopted into itself the notion that any proposed cognitive process has to be implemented by the brain by some mechanism. Since many of the major processes that interest cognitive psychologists (learning and memory, for instance) have been extensive researched by neuropsychologists using brain damaged patients, who have demonstrated that many characteristics of these processes can be very selectively and independently knocked out*, a lot of the work in cog psych assumes that the way the brain is implementing these processes is modular, to some extent.

* One of the most dramatic examples (though not really the most informative from a cog psych standpoint) is the fact that I can, very reliably, damage your brain in such a way that your vision will remain fully intact, you will completely retain the ability to write, and yet you will lose the ability to read. Aphasias in general provide some very nice examples of the modular arrangement of mental processes.

Is it? Talk therapy certainly still exists, but I'd be surprised to find out there were any Freudian Psychoanalysts still out there.

Very few. There are a few Freudian/Jungian practitioners out there, but their generally regarding as being somewhat...er...off by everyone else. I'd be very surprised and disappointed if any accredited programs in clinical psychology still taught Freudian psychoanalysis.

 

[zoobyshoe]

Comparing cognitive to Freudian psychology is a bit misleading. Early "schools" of psychology (Freudian, behaviourism etc.) were defined largely by their particular views about the nature of consciousness and behaviour; they were, essentially, theories or models (often, poor ones). Cognitive psychology is a discipline; it's a branch of psychology that studies cognitive processes. Comparing the two is a bit like comparing the standard model of particle physics (psychoanalysis) to fluid dynamics (cognitive psychology); one is a model, the other is a field.

Cognitive psychology, today, is probably one of the most diverse and successful of the behavioural sciences. Wiki's description of mental "information processing" is a bit unusual here; cognitive psychology has been extremely heavily influenced by cognitive neuroscience and neuropsychology (my personal interests lie in computational neuroscience, and most of the professors I've known who work in cog psych base their work carefully around developments in neuroscience), and it has adopted into itself the notion that any proposed cognitive process has to be implemented by the brain by some mechanism. Since many of the major processes that interest cognitive psychologists (learning and memory, for instance) have been extensive researched by neuropsychologists using brain damaged patients, who have demonstrated that many characteristics of these processes can be very selectively and independently knocked out*, a lot of the work in cog psych assumes that the way the brain is implementing these processes is modular, to some extent.

* One of the most dramatic examples (though not really the most informative from a cog psych standpoint) is the fact that I can, very reliably, damage your brain in such a way that your vision will remain fully intact, you will completely retain the ability to write, and yet you will lose the ability to read. Aphasias in general provide some very nice examples of the modular arrangement of mental processes.

I'm familiar with all this from casual reading (Sacks and Ramachandran, most notably), but somehow classified it in my mind under "neuropsychology" or, alternately, "neuropsychiatry". The term "Cognitive Psychology" slipped by me. Obviously there's a great deal of overlap of all of these.

All this was born with the attention paid to the grotesque personality change suffered by Phinneus Gage after his frontal lobe brain damage. My own introduction to it was reading about Geschwind's Syndrome, the constellation of personality changes that often accompanies the onset of Temporal Lobe Seizures.

Very few. There are a few Freudian/Jungian practitioners out there, but their generally regarding as being somewhat...er...off by everyone else. I'd be very surprised and disappointed if any accredited programs in clinical psychology still taught Freudian psychoanalysis.

My impression is that what best survived of Freudian Psychology are the Ego Defense Mechanisms. I believe these are still taught in accredited programs.

The interesting thing about Freudian Psychology is that it got disseminated into popular culture in discrete bits and pieces and you find people who would categorically condemn him never-the-less betraying acceptance of a lot of his notions without realizing their origin. Same is true of Jung. A Freudian dynamic might be quietly worked into the plot of a film or novel, for example, and go unquestioned as realistic while a verbal statement of that dynamic would be criticized. The psychiatric examinations on the TV show "Law and Order", for example, are essentially Freudian: he asks questions intended to get the subject to reveal things about their motivations and mental state that they, themselves, are not aware of. Freud pioneered that. (Of course, the TV shrink isn't out to effect any cure, but he is in the important position of having to asses their relative degree of responsibility for the crime.)

 

[Mr.Samsa]

I have heard that kind of comments about psychoanalysis, but I am not a expert on the subject. So, can anyone explain to me what is true about this opinion or why many people say this about psychoanalysis? I repeat, I am not an expert on the subject, so if I am wrong in my hypothesis let me know.

Freud was famous for making up case studies to suit his own intuitions about how behavior works and why certain disorders develop. What he suggested was very backwards for his time, as the science of psychology was thriving and there was really no need to reject the empirical evidence that had been gathered in favour of armchair philosophical musings. Most of his concepts have been outright disproved (memory repression), or never accepted in the first place (his version of the unconscious), and the ones that still stick around are generally broad concepts that have been accepted for a while (e.g. some defence mechanisms).

If you were interested in studying psychology though, or the history of the subject, you can skip Freud and the psychoanalysts completely though, as they added nothing of importance to the field.

With that said, there is a fairly new movement called "psychodynamic psychotherapy", which has vague roots in Freudian theory but it is not psychoanalysis. There has been some positive evidence coming from the area, and some negative evidence, so it's difficult to tell whether it's a successful treatment for some mental disorders or not. The overall trend seems to be suggesting that it has some positive effect.

Though there's plenty of skepticism about CBT for many mental illnesses. CBT is mostly only shown to be effective for anxiety disorders. And the CBT is a treatment that the patient must practice for the rest of their life, not a cure.




[14] Driessen E, Hollon SD (September 2010). "Cognitive behavioral therapy for mood disorders: efficacy, moderators and mediators". Psychiatr. Clin. North Am. 33 (3): 537–55. DOI:10.1016/j.psc.2010.04.005. PMC 2933381. PMID 20599132.

[47] Lynch D, Laws KR, McKenna PJ (January 2010). "Cognitive behavioural therapy for major psychiatric disorder: does it really work? A meta-analytical review of well-controlled trials". Psychol Med 40 (1): 9–24. DOI:10.1017/S003329170900590X. PMID 19476688.

[48] Gloaguen V, Cottraux J, Cucherat M, Blackburn IM (April 1998). "A meta-analysis of the effects of cognitive therapy in depressed patients". J Affect Disord 49 (1): 59–72. DOI:10.1016/S0165-0327(97)00199-7. PMID 9574861.

The fact that there are issues with applying CBT to schizophrenia and bipolar aren't really a reason to be skeptical of CBT as a treatment, given that these are new areas that CBT is being tested in and haven't really been adapted to meet the demands of such disorders. With things like schizophrenia as well, where many of the symptoms are biologically caused, we shouldn't expect to see a massive effect size or change in rates of relapse.

The Lynch paper has also been criticised for the inclusion/exclusion criteria for their section on CBT's effect on depression. Specifically, the definition of CBT that Lynch used was quite rigid and really only focused on one brand of CBT (remembering that CBT is a collection of therapies with a common approach, not a treatment in itself) so the results are a little skewed there. The well-controlled studies are also lumped together with community clinic studies where the therapists self-label what approach they are using, which is a major problem. And the studies included did not attempt to control for severity of symptoms, which we already know is a major component of how successful CBT will be, including whether the depressive episodes are chronic or not.

Also, it's a little inaccurate to say that patients must practice CBT for the rest of their lives, as the purpose of the therapy is for it to eventually become an automatic process. So whilst it's true that patients will technically be 'practicing CBT for the rest of their lives', they will rarely have to consciously practice CBT. It's basically about changing habits - if you get out of the habit of biting your nails, then you don't need to keep applying some foul tasting substance to your nails for the rest of your life to stop yourself.

Are the tenets of any school of psychology falsifiable by experiment? I can't think of any off the top of my head.

All of psychology is falsifiable. It's important though to remember that there are two broad areas of psychology: experimental and applied. The applied area is what is mostly being discussed in this thread. That is, we're discussing clinical psychology; the study and treatment of mental disorders. The rest of psychology, the experimental side, has little to do with mental disorders and often has no interest in humans at all.

The experimental-applied divide is comparable to that between biology and medicine. Medicine is not a science, so it is absurd for people to criticize it for lacking scientific rigour or not being falsifiable, etc. It is, of course, based on science and is evidence-based (especially in the research that underpins its treatment options), but it is not a scientific field. The same applies to clinical psychology. In a broad sense though, these fields still make falsifiable claims in the sense that they say, "Treatment X is effective", which can be empirically tested and disproved.

No school of psychology I am familiar with falls into the category of Hard Science. At the same time, though, it's abundantly clear that psychological dynamics exist and are always in play when people interact. The same cannot be said of Astrology.

There are a couple of fields of psychology which are widely considered hard/natural sciences: neuroscience, and behavioral psychology. Cognitive psychology is also often considered a hard science as well, but there can be softer areas within it.

modern psychiatry is a neuroscience, and psychiatric disorders are considered to be organic brain disorders.
medications and ECT are golden standards of modern psychiatric treatments.

This is untrue. No psychologist or psychiatrist considers mental disorders to be organic brain disorders. This was true in the 50s-60s (and some time before that), but it became patently obvious to everyone in the field that thinking of them as brain diseases was wrong and was so mistaken that it was causing too much harm to the patients. This was why there was a shift in nomenclature around the 70s, where we stopped referring to them as "mental illnesses" and instead started calling them "mental disorders". It wasn't an act of political correctness, but rather an attempt to clarify the thing we are studying and treating by applying a more accurate label that does not have the connotations of a biological disease.

Of course, all of our thoughts and behaviors are generated by our brain, but it's an illogical leap to assume that problem thoughts and behaviors are generated by brain diseases or abnormalities. You can have entirely normal and functional brain processes giving rise to dysfunctional thoughts and behaviors.

Give me an example of the sort of thing that's falsifiable. I only ever read studies casually here and there and haven't happened to encounter, not have I gone looking for, "hard" psychology. I'd be interested in seeing how that plays out.

Have a flick through the Journal of the Experimental Analysis of Behavior.

I got impatient and googled. Wikipedia reports that Cognitive Psychology is unique among psychologies in its "acceptance" of the scientific method:

The wiki article is poorly written there, so it's easy to think that it's saying previous psychological approaches didn't apply the scientific method. Psychologists have been using the scientific method to study psychology since the mid-1800s, with the psychophysicists like Helmholtz and Wundt studying perception, and then Pavlov and the behaviorists like Watson and Skinner came along to solidify psychology as a science. Introspection was still accepted by some early psychologists, like William James, but the rejection of introspection wasn't something unique to cognitive psychology, and neither was the application of the scientific method.

 

[Devils]

This is untrue. No psychologist or psychiatrist considers mental disorders to be organic brain disorders. This was true in the 50s-60s (and some time before that), but it became patently obvious to everyone in the field that thinking of them as brain diseases was wrong and was so mistaken that it was causing too much harm to the patients.

Thats not quite true either. We know that severe depression is linked with BDNF amd a shrinking hippocampus.
http://en.wikipedia.org/wiki/Brain-derived_neurotrophic_factor#Depression
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC60045/

Some schizophrenics have measurable brain changes with CAT/MRI scans.

I would say mental illnesses are psychosocial. For a particular stressor, one person may have severe anxiety, but more resilient person may have no effect. This is evident for example, in how people coped after being released from concentration camps.

 

[lisab]

Is it? Talk therapy certainly still exists, but I'd be surprised to find out there were any Freudian Psychoanalysts still out there.

The only place I ever hear about people doing psychoanalysis is in Woody Allen movies.

 

[zoobyshoe]

The only place I ever hear about people doing psychoanalysis is in Woody Allen movies.

Woody may well have single handedly killed it by ridiculing it to death, yes.

 

[zoobyshoe]

Thats not quite true either. We know that severe depression is linked with BDNF amd a shrinking hippocampus.
http://en.wikipedia.org/wiki/Brain-derived_neurotrophic_factor#Depression
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC60045/

Some schizophrenics have measurable brain changes with CAT/MRI scans.

I would say mental illnesses are psychosocial. For a particular stressor, one person may have severe anxiety, but more resilient person may have no effect. This is evident for example, in how people coped after being released from concentration camps.

The unfortunate fact is that there's no accepted objective explanation, just current models. Schizophrenia isn't diagnosed by brain scan because a lot of schizophrenics don't have enlarged ventricles, and, a lot of people with enlarged ventricles don't have schizophrenic symptoms. Psychiatry is a pseudoscience. Medication is currently prescribed by trial and error on the currently relied upon assumption that mental illness is caused by 'an imbalance of chemicals in the brain'. There's no test for any suspected imbalance or any objective way to justify any given medication. If you read up on a med you'll find it says "Studies indicate..." and "It is believed that..." followed by the suspected chemical mechanism.

That's psychiatry, though. Psychology is aimed at problems thought to result from 'software' as opposed to 'hardware' glitches, to use the usual bad computer analogy.

 

[Pythagorean]

The fact that there are issues with applying CBT to schizophrenia and bipolar aren't really a reason to be skeptical of CBT as a treatment, given that these are new areas that CBT is being tested in and haven't really been adapted to meet the demands of such disorders. With things like schizophrenia as well, where many of the symptoms are biologically caused, we shouldn't expect to see a massive effect size or change in rates of relapse.

The Lynch paper has also been criticised for the inclusion/exclusion criteria for their section on CBT's effect on depression. Specifically, the definition of CBT that Lynch used was quite rigid and really only focused on one brand of CBT (remembering that CBT is a collection of therapies with a common approach, not a treatment in itself) so the results are a little skewed there. The well-controlled studies are also lumped together with community clinic studies where the therapists self-label what approach they are using, which is a major problem. And the studies included did not attempt to control for severity of symptoms, which we already know is a major component of how successful CBT will be, including whether the depressive episodes are chronic or not.

Also, it's a little inaccurate to say that patients must practice CBT for the rest of their lives, as the purpose of the therapy is for it to eventually become an automatic process. So whilst it's true that patients will technically be 'practicing CBT for the rest of their lives', they will rarely have to consciously practice CBT. It's basically about changing habits - if you get out of the habit of biting your nails, then you don't need to keep applying some foul tasting substance to your nails for the rest of your life to stop yourself.

I think you'r first and last paragraph's are a little hair-splitty, but thanks for bringing up the problems with the Lynch paper.

Ultimately, my feelings on CBT are an appeal to authority. In my psychology department, (which awards clinical PhD's) the professors (who are experienced clinicians) generally talk about the challenges to CBT

To specifically address your last paragraph, they claim that once patients leave treatment, their problems often return and that only about 1/N (I want to put N=10 but I can't remember the number) actually adapt the cbt into their regular behavior.

I have no experience in clinical setting (nor is it my interest, I'm a black sheep at my university, more interested in theory) so I take the word of my mentors until evidence is provided. Perhaps you can provide some studies for a comparable range of mental disorders.

Also a caveat. The textbook we were using had CBT as the treatment for EVERY mental disorder in the book and that's what our teachers were responding to, saying that the psychology community was moving away from CBT as a general treatment.

 

[zoobyshoe]

Since these meta-analytical studies uses a statistical technique called funnel plots, they can detect the level of publication bias in antidepressant trials and correct for it. That is, they can detect to which extent unfavorable studies has not been published, and with that, calculate what the effect size of antidepressants would have been if they took into account both those studies that are published and those negative studies that were not.

I had a much closer look at Turner and it seems to me they did more than "detect" the unpublished studies. They actually hunted them up and read them.

The main message of Kirsch et. al. (2008) and Turner et. al. (2008) is that antidepressants are more effective than placebo even if you take into account publication bias. So it is the publication bias rebuttal, not meta-analytical studies, that is largely moot.

To characterize it properly the "main message" of Turner was that they uncovered a clear publication bias in favor of anti-depressants that they found misleading, and they chastised the responsible parties. The still-better-than-placebo angle is something you found salient, not the main message. Let's not miss the fact this paper is saying anti-depressants have been over rated.

The effect size of antidepressants is larger than that of psychotherapy, even taking into account publication bias.

This abstract:

http://www.ncbi.nlm.nih.gov/pubmed/19490745

leaves me with many unanswered questions. I don't understand from it what psychotherapy is being compared to, placebo or anti-depressants, and I don't understand what they are including under the term "psychotherapy" (something whacky like, hypnotic recovery of repressed memories? Is that included?).

Additionally, this Kirsch 2008 paper:

http://www.plosmedicine.org/article/info:doi/10.1371/journal.pmed.0050045

is damning anti-depressants with faint praise, so to speak, finding only, "a relatively small difference for patients with very severe depression". Better than placebo, but just barely.

The general answer is that psychotherapy is non-biological in the sense that it is drug-free, but it has biological effects on the brain, in much the same way that antidepressants have.

You can't be aware of anything without it having a biological effect on the brain in the sense you're referring to. Is this important? If you post something that makes me happy, should I compare you to an anti-depressant?

Furmark et. al (2002) performed a RCT with either SSRIs or psychotherapy (CBT) on patients with social phobia and anxiety. Patients where put in a PET-scanner before and after treatment and made to deliver a quickly prepared speech in front of people around the scanner and measured neural activity in the amygdala-hippocampus-tenporal cerebral cortex. Both treatments showed similar neurological and behavioral changes.

I seriously question whether they are seeing the effects of either therapy or just decreased stage fright from having already encountered and lived through the greater terrors of the experience.

As a final note, psychotherapy is not without side effects. Barlow (2010) discusses a few of them, such as intense anxiety during exposure trials, Bergin’s deterioration effect, negative effects from critical incident stress debriefing and deaths resulting from rebirthing techniques in oppositional children. To that list we can add false memory syndrome (e. g. believing that one has been a victim of satanic ritual abuse or committed multiple murders) and sexual abuse of patients by therapists. Sure, these are rare, but they exist.

Barlow, D.H. (2010). Negative effects from psychological treatments: a perspective. American Psychologist, 65, 13-19.

Even an increase in suicidality has been observed in psychotherapy trials (but not a huge problem as this level is similar to other treatments, even though it is above the placebo group).

Bridge, J. A., Barbe, R.P., Birmaher, B., Kolko, D. J. Brent, D.A. (2005). Emergent Suicidality in a Clinical Psychotherapy Trial for Adolescent Depression. Am J Psychiatry 162(11). 2173-2175.

I'm really only interested in CT. There are a lot of whacky psychotherapies out there that I wouldn't try or recommend. If the Cuijpers P, et al paper from 2010 is including these kinds of psychotherapies, then I wouldn't consider it worth bringing into the discussion since no one here is endorsing things like that.

 

[Ryan_m_b]

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