Cognitive-Behavioral Therapy Declining

[ysabetwordsmith]

This article talks about the declining effects of cognitive-behavioral therapy.  I am fascinated to explore why something that used to work pretty well is now not working as well. 

I can think of some possibilities not mentioned in the article:

1) The longer a therapy is around, the wider it is known.  That means more people have access to it before  official therapy.  You can go online and find CBT theory, techniques, thought distortions and how to fix them, worksheets, and other tools.  This raises the chance that someone already knows CBT and has tried at least some of its methods before seeking professional help.  So if the therapist then does more CBT, it looks less effective measured from the start of therapy,  because the client already did some of that stuff and got whatever benefit they got from it earlier.  In this case, CBT only has a high rate of helpfulness for people who really need guidance and/or advanced techniques that don't work well alone.

2) CBT is terrific at treating certain types of problems, but mediocre or useless for others.  If you have bad tape, this is a go-to therapy for fixing that, and you should definitely try it.  Same with any other logical or practical problem.  It's also ideal for people who do better with facts, logic, numbers, or other objective things than with subjective things.  But if you are feeling unheard, your emotions are bent, unacknowledged memories are gumming up your subconscious, or your biochemistry is out of whack, then CBT is not ideal for those problems and won't help much.  It is possible that certain types of problem are more or less common in different decades.  If the problems presenting now are something other than logical/practical ones, this therapy will seem less useful overall.

Bottom line: If you have head problems that you need help with, start by identifying them as best you can.  Then look at the available options for treatment.  Each type of treatment is good at some things and bad at others.  Pick one that's a good match for your problem(s).  Try it for a while.  If it doesn't help, drop it and try something else.

Comments

[(Anonymous)]

Just out of curiosity do you (or perhaps one of the site regulars)know if it's standard practice for therapists to ask what their patients are doing about whatever issue they've come in for?

Because if that information is floating about somewhere, well we'd have some of the answer on if cbt is waning in effectiveness as that article suggests.

And as an aside... grumbles... I'm not too sure if their assumption about people having no drive to change is really appropriate for a site talking about therapy. That statement, as well as the sparsity of data/facts in the whole makes me inclined to take the lot with a spoonful of salt.

Thoughts

[ysabetwordsmith]

>> Just out of curiosity do you (or perhaps one of the site regulars)know if it's standard practice for therapists to ask what their patients are doing about whatever issue they've come in for? <<

There don't seem to be universal standards. Based on my observations, some so-called therapists are doing a really half-assed job. I suspect that higher quality individuals and organizations may set a standard for asking what clients have already tried. But I have repeatedly heard from people whose therapists have a set routine they go through, and will not permit any deviations, even if people have already tried the same things and that didn't work. Objections are met with nonsense like, "You have to want to get better. I can't help you if you won't do the work."

>>Because if that information is floating about somewhere, well we'd have some of the answer on if cbt is waning in effectiveness as that article suggests.<<

That would be useful, yes.

>> And as an aside... grumbles... I'm not too sure if their assumption about people having no drive to change is really appropriate for a site talking about therapy. That statement, as well as the sparsity of data/facts in the whole makes me inclined to take the lot with a spoonful of salt.<<

Fair point. It is true that some people have no drive to change. However, those people show up in therapy only if forced or pressured by someone else. They don't seek it out. Telling people in therapy that they don't want to change, and/or that it's their fault if the therapy isn't helping, is common but very cruel.

[somecrazygirl]

Generally, therapists will ask that question, or a question like it. However, because of the huge mass of privacy laws around medical treatment (at least within the US), that kind of data is hard to compile. It's not something that can be coded into an insurance file like the name of a diagnosis or the length of time that someone has been in treatment. It would most likely be written in some arbitrary location in the notes for each particular patient, and making counts would require going into the files, finding the information, noting the answers, classifying the answers into groups... And whoever did the legwork would have to have access to this stuff under privacy laws or be willing to let someone who does have access take complete credit for their work. (I'm not arguing that people who don't legally have access to private patient files won't go digging into them anyway; I'm saying that scientific journals these days make at least a token effort to pretend they care about ethics and accepting a paper that is openly founded upon violating privacy laws is so obviously an ethical violation that even they wouldn't dare touch it.)

The discussion about a lack of drive for change is at least attributed to a particular (historical) individual rather than given by the authors as something they believe in. I don't think the article is endorsing that perspective, personally. That said, the article is about as good as science reporting gets these days, which is to say that it's pretty unimpressive but at least doesn't get obvious facts wrong like the actual topic of the study. It does link to the study itself, which means that if you can get through the technical terms, you can decide exactly what the study is saying yourself.

My guess is that there are a lot of factors at play. One of those is that the kinds of people who end up as part of mental health studies are often people whose treatment isn't going well. Early CBT studies would have been deployed in an environment where no one had already had CBT treatment. More recent studies would be done among patients who had already had CBT and had it fail on them--so of course it wouldn't work this time around either. (This is sort of a variant of the cultural exposure hypothesis.)