NYT Article - "Does Therapy Really Work?"

[PsyDr]

Interesting that Cuijpers found the research to be underpowered. This 2022 umbrella review of meta-analyses found an overestimation of both psycho- and pharmacotherapy effect sizes, after accounting for risk of bias, weak "intent to fail" comparators, and overall study quality,.

The efficacy of psychotherapies and pharmacotherapies for mental disorders in adults: an umbrella review and meta-analytic evaluation of recent meta-analyses https://onlinelibrary.wiley.com/doi/full/10.1002/wps.20941​

They found small effect sizes for both therapy and pharmaco. This matches my own experience of therapists and psychiatrists generally overestimating their clinical outcomes. I agree with the authors' conclusion that the status quo, ebt's and all, is failing too many people with mental illness. The way we currently conceptualize and treat mental disorders is ripe for change, imho.

Name another meta-analysis where they study the application of a generic category of treatments to a diverse set of diagnoses?

It's like asking if "surgery" works for "bone stuff". It's a silly question.

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[bcliff]

Interesting that Cuijpers found the research to be underpowered. This 2022 umbrella review of meta-analyses found an overestimation of both psycho- and pharmacotherapy effect sizes, after accounting for risk of bias, weak "intent to fail" comparators, and overall study quality,.

The efficacy of psychotherapies and pharmacotherapies for mental disorders in adults: an umbrella review and meta-analytic evaluation of recent meta-analyses https://onlinelibrary.wiley.com/doi/full/10.1002/wps.20941​

They found small effect sizes for both therapy and pharmaco. This matches my own experience of therapists and psychiatrists generally overestimating their clinical outcomes. I agree with the authors' conclusion that the status quo, ebt's and all, is failing too many people with mental illness. The way we currently conceptualize and treat mental disorders is ripe for change, imho.

Haven't had a chance to read the article you shared, but this is the Cuijpers' paper I referenced: https://web.archive.org/web/20190429110724id_/https://ebmh.bmj.com/content/ebmental/19/2/39.full.pdf

In case the article is paywalled and/or the link doesn't work, the DOI is 10.1136/eb-2016-102341.

 

[AcronymAllergy]

Name another meta-analysis where they study the application of a generic category of treatments to a diverse set of diagnoses?

It's like asking if "surgery" works for "bone stuff". It's a silly question.

Does Medication Really Work?

Summary: sometimes, for some things, with some patients, if you can clearly define "work," yes.

 

[Ollie123]

I think this also ties into the belief that suicide is 100% preventable, and if a patient dies by suicide, the mental health professional must be negligent. The said truth is that, for some people, mental illness is truly a terminal illness--I think the Dooce blogger who died by suicide recently (after decades of trying every treatment under the sun) is a good example of this sad reality.

What no one wants to say is 100% suicide prevention necessitates a return to an asylum model where we liberally throw people on locked wards and put them in restraints. And even then it won't be 100%. Not to mention being a terrible idea for many reasons.

We don't even have 100% survival rates from things like sinus infections. I admire the spirit of the idea - prioritizing mental health, ensuring proper screening, etc. I think its great as a motivator/aspirational goal, the problem is the people (i.e., bean counters/cheerleaders with improper education/training) take it literally.

 

[cara susanna]

What no one wants to say is 100% suicide prevention necessitates a return to an asylum model where we liberally throw people on locked wards and put them in restraints. And even then it won't be 100%. Not to mention being a terrible idea for many reasons.

We don't even have 100% survival rates from things like sinus infections. I admire the spirit of the idea - prioritizing mental health, ensuring proper screening, etc. I think its great as a motivator/aspirational goal, the problem is the people (i.e., bean counters/cheerleaders with improper education/training) take it literally.

As a profession we're the ones who advocate for SMART goals.

 

[Ollie123]

As a profession we're the ones who advocate for SMART goals.

For behavior change, yes. The approach needs to be different when discussing politicians/policy, donors, etc. Those folks want to hear about how they can solve the worlds problems completely. I don't take issue with "100% suicide prevention" as a spirited sales pitch to get donors or congress to fund mental health. Or even in a spirited "pep rally" to clinical staff where you admit it is a lofty unattainable goal, but you are trying to drive it forward. This is marketing.

You just do that and then boots on the ground actually implement SMART goals to move things in the right direction while maintaining a grip on reality. As I see it, the issue isn't having some non-profit say "We want to create a world where no veteran ever commits suicide!" to garner donations for research and other initiatives during their fundraiser. It's when this doesn't get translated into actionable goals for the admin at the VA who then decides that whenever someone does commit suicide the clinician is automatically to blame and didn't do their job correctly...

 

[Sanman]

For behavior change, yes. The approach needs to be different when discussing politicians/policy, donors, etc. Those folks want to hear about how they can solve the worlds problems completely. I don't take issue with "100% suicide prevention" as a spirited sales pitch to get donors or congress to fund mental health. Or even in a spirited "pep rally" to clinical staff where you admit it is a lofty unattainable goal, but you are trying to drive it forward. This is marketing.

You just do that and then boots on the ground actually implement SMART goals to move things in the right direction while maintaining a grip on reality. As I see it, the issue isn't having some non-profit say "We want to create a world where no veteran ever commits suicide!" to garner donations for research and other initiatives during their fundraiser. It's when this doesn't get translated into actionable goals for the admin at the VA who then decides that whenever someone does commit suicide the clinician is automatically to blame and didn't do their job correctly...

Disagree on the the bolded. They just want a slogan that they can get behind/campaign for. No veteran suicides is an easy cause. Marked reduction in suicide risk behavior through proximate behavioral interventions is not. This we part we agree on. The problem with admin for the VA is that no one in charge would no how to translate that into an actionable goal. The experts are all midlevel managers with little autonomy.

That said, that we are even having the conversation. Fund managers are not pushing their services because they are best for your 401k. Pharma companies are not pushing for tighter controls on their drugs if they don't improve functioning. Politicians don't remove themselves from office because they are not effective. Lets not get started on insurance companies. The goals is protect your turf at all costs. We are terrible at advocating ruthlessly.

 

[Fan_of_Meehl]

Disagree on the the bolded. They just want a slogan that they can get behind/campaign for. No veteran suicides is an easy cause. Marked reduction in suicide risk behavior through proximate behavioral interventions is not. This we part we agree on. The problem with admin for the VA is that no one in charge would no how to translate that into an actionable goal. The experts are all midlevel managers with little autonomy.

That said, that we are even having the conversation. Fund managers are not pushing their services because they are best for your 401k. Pharma companies are not pushing for tighter controls on their drugs if they don't improve functioning. Politicians don't remove themselves from office because they are not effective. Lets not get started on insurance companies. The goals is protect your turf at all costs. We are terrible at advocating ruthlessly.

These types of discussions always remind me of that C.S. Lewis quote about "omnipotent moral busybodies":

'Of all tyrannies, a tyranny sincerely exercised for the good of its victims may be the most oppressive. It would be better to live under robber barons than under omnipotent moral busybodies. The robber baron's cruelty may sometimes sleep, his cupidity may at some point be satiated; but those who torment us for our own good will torment us without end for they do so with the approval of their own conscience.'
C. S. Lewis