Posted: Nov 13, 2020 1:45 am
by rejoin11
I know CBT (cognitive behavioral therapy) is well accepted. I just wonder WHY.
What tends to be completely ignored is that CBT pretty much builds it's own selection-bias, it simply lacks double blind studies and often ignores confirmation bias in studies done about it. There's usually is not even a control group with people who didn't receive any treatment to compare cbts effectiveness to.

And how could anything objective be said about the effectiveness of a therapy that just excludes so many patients? CBT drop out rates were found to be 17% higher than other therapies in one meta-analysis.
(Cuijpers P, van Straten A, Andersson G, van Oppen P (December 2008). "Psychotherapy for depression in adults: a meta-analysis of comparative outcome studies". Journal of Consulting and Clinical Psychology. 76 (6): 909–22. doi:10.1037/a0013075. PMID 19045960. S2CID 23341989.)

If you simply aggregated the dropouts as "fails" into studies, would it be considered effective at all? Why is this not done? A therapeutic method is not a pill you can force somebody to swallow. People dropping out of it means it failed them - what else?

And the long term effects seem to be unclear too. All i found was a few flimsy studies, that again ignore the selection bias at the beginning. They don't worry much if a former patients lives turned out any better in comparison. Essentially they just ask "how are you? and are your symptoms better?" All in the context of "did our therapy help you. Confirmation bias and
social-desirability right there.
Do they even remember what they did during cbt? Shouldn't that be something that is asked?
Would they say what they learned in cbt is still effective?
What about medication? Shouldn't there at least be a control group that wasn't medicated and is still taking those meds?

My suspicion is that CBT is essentially a fashion. Its a theory of the mind that bows to a consumer-perspective. People today like problems solved in this manner. Quick and blunt. Instead of asking "Why do you want this?" a CBT-service-oriented-therapist says: "Tell me what you want, ill give you tools to make it happen". It pretends it's open-outcome - but its not. That's why we got the life-coaches industry springing up. Sports-training-mentality, clear instructions, short time period, low complexity. Any concept that is remotely vague is downplayed or ignored. (like the subconscious, reactance, underlying motivations) Its all a "black box". We'll just push your buttons. Some of them tend to work.