Psychology and psychiatry - pseudoscience?

[paranoid_eyes]

Yes, but I think the film brings up a good point. A patient is subjectively diagnosed with a "chemical imbalance", in which no test can confirm or refute, then prescribed medication to "fix" this chemical imbalance for an indefinite amount of time and with no measurable outcome. Correct me if I'm wrong, but would that ever fly in non-experimental medicine?

I question the DSM's validity as a manual. From what I understand, it was originally intended to standardize the diagnostic criteria, so that two psychologists similarly trained would be able to use the manual to produce the same diagnosis on the same patient independently. How often does this work?

you must be well out of your mind. if that "chemical imbalance" you are referring to is depression, then it has been well tested. NO not on literal human beings. no one is able to produce a transgenic human, it's an ethical issue. but there IS a lot of work done with uptake channel-knockouts and there are MANY clinical trials done before any treatment is authorized. The outcomes are measured with reliable statistics; statistics which have been used in EVER single other clinical trial for every other field of medicine. Sometimes, the medication doesnt work for everyone. Psychiatrist have one of the hardest jobs, because it takes MULTIPLE dosage adjustments and MULTIPLE drug changes to get it "right" for an individual patient. The drugs work, but it takes patience to get everything well adjusted to have a positive outcome. I really don't think you understand what an "experiment" is. You should really read up before making such an ignorant thread.

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[leviathan]

I've seen some physicians, many soon to be physicians, and lots of pre-meds touting "X" study from "X" psychiatry journal as evidence to support a claim. With Psychology and psychiatry's absence of solid controls, do you view them as pseudosciences?

Which research is this "without solid controls" that you're referring to?

 

[cpants]

Yes, but I think the film brings up a good point. A patient is subjectively diagnosed with a "chemical imbalance", in which no test can confirm or refute, then prescribed medication to "fix" this chemical imbalance for an indefinite amount of time and with no measurable outcome. Correct me if I'm wrong, but would that ever fly in non-experimental medicine?

I question the DSM's validity as a manual. From what I understand, it was originally intended to standardize the diagnostic criteria, so that two psychologists similarly trained would be able to use the manual to produce the same diagnosis on the same patient independently. How often does this work?

Actually, no one is diagnosed with chemical imbalance and prescribed a medication to fix it. This is a line out of the scientologist handbook, not something that happens in real life. Patients are diagnosed with a psychiatric illness, and prescribed medications that have been shown in properly controlled clinical studies to improve their symptoms. Psychiatrists are the first to admit that we don't know the way that many of the drugs that we use work to improve psychiatric systems. We do know that the medications work, and that they can improve the lives of patients.

You are right that much of psychiatry is experimental. This does not mean that it is psuedoscience, just that we don't fully understand the biology behind a lot of the pathology that we see in psychiatry. In fact, by definition the disorders found in psychiatry are not fully understood. Once we understand an organic mechansim behind the illness, it gets shifted to neurology or another specialty.

The point of the DSM-IV is to keep all psychiatrists and mental healthcare professionals on the same page. It is actually a tool to help make these disciplines more scientific, since treatments and research can be based on a group of patients that share a similar constellation of symptoms.

 

[Concubine]

Actually, no one is diagnosed with chemical imbalance and prescribed a medication to fix it. This is a line out of the scientologist handbook, not something that happens in real life. Patients are diagnosed with a psychiatric illness, and prescribed medications that have been shown in properly controlled clinical studies to improve their symptoms. Psychiatrists are the first to admit that we don't know the way that many of the drugs that we use work to improve psychiatric systems. We do know that the medications work, and that they can improve the lives of patients.

You are right that much of psychiatry is experimental. This does not mean that it is psuedoscience, just that we don't fully understand the biology behind a lot of the pathology that we see in psychiatry. In fact, by definition the disorders found in psychiatry are not fully understood. Once we understand an organic mechansim behind the illness, it gets shifted to neurology or another specialty.

The point of the DSM-IV is to keep all psychiatrists and mental healthcare professionals on the same page. It is actually a tool to help make these disciplines more scientific, since treatments and research can be based on a group of patients that share a similar constellation of symptoms.

Pharmacology: "The study of drugs, their sources, their nature, and their properties. Pharmacology is the study of the body's reaction to drugs".

You are talking about pharmacology, which I never claimed was a pseudoscience. I'll admit that there is a blurring of research, diagnosis, and therapy in medicine as well as psychology and psychiatry, but it is much more severe in the latter disciplines. In much of psychology and psychiatry, their theories cannot (without stepping over ethical boundaries) and have not been systematically tested but are still perceived as science.

 

[Depakote]

Pharmacology: "The study of drugs, their sources, their nature, and their properties. Pharmacology is the study of the body's reaction to drugs".

You are talking about pharmacology, which I never claimed was a pseudoscience. I'll admit that there is a blurring of research, diagnosis, and therapy in medicine as well as psychology and psychiatry, but it is much more severe in the latter disciplines. In much of psychology and psychiatry, their theories cannot (without stepping over ethical boundaries) and have not been systematically tested but are still perceived as science.

Why do you keep saying these theories cannot be systemically tested. They are tested, just not biologically. As I stated before, psychiatrists use standardized evaluations that are designed to evaluate for these disorders. These have been shown to be efficacious in identifying them.

Additionally, patient's aren't just labeled with psychiatric diseases on a whim, the majority of diseases in the DSM-IV require that they be causing distress or impaired function for a diagnosis. If the patient is fully functional and not having a problem, then it's not a psychiatric disorder.

Not to invoke Burnett's Law, but as I see that you identify yourself as a member of the class of 2012, I suggest you try to be much more open minded about the therapies you will be required to learn about in your first year and then be required to recommend for your patients in your third year.

 

[Concubine]

you must be well out of your mind. if that "chemical imbalance" you are referring to is depression, then it has been well tested. NO not on literal human beings. no one is able to produce a transgenic human, it's an ethical issue. but there IS a lot of work done with uptake channel-knockouts and there are MANY clinical trials done before any treatment is authorized. The outcomes are measured with reliable statistics; statistics which have been used in EVER single other clinical trial for every other field of medicine. Sometimes, the medication doesnt work for everyone. Psychiatrist have one of the hardest jobs, because it takes MULTIPLE dosage adjustments and MULTIPLE drug changes to get it "right" for an individual patient. The drugs work, but it takes patience to get everything well adjusted to have a positive outcome. I really don't think you understand what an "experiment" is. You should really read up before making such an ignorant thread.

Why do you keep saying these theories cannot be systemically tested.

I'm drawing a distinction between pharmacology and psychology. My problem is not in the application of the drug, nor the drugs ability to change behavior, but the issue that psychologists try to classify "normal" or as you say, "positive", when in fact this belongs outside the realm of science (perhaps philosophy?).

Again, I'll state the issue with an example (and I quote):

1. Psychologists counsel teenagers to prevent them from committing suicide.

2. Psychologists believe this counseling to be effective.

3. But ... in order for that to be anything but a belief, there would have to be a scientific study — a scientific study — to validate the belief.

4. Such a scientific study would require a valid experimental protocol, which means a double-blind design consisting of experimental and control groups.

5. At the end of the study, we could compare the number of suicides among the experimental group, who received the test therapy, and the control group, who received a sham therapy.

As described, the study would violate the rights of the subjects in the control group, which is why such a study has never been performed and will never be performed. I'm not saying that the therapy is always without value, but that the psychologists that use the therapy claim it is scientific.

 

[Concubine]

Not to invoke Burnett's Law, but as I see that you identify yourself as a member of the class of 2012, I suggest you try to be much more open minded about the therapies you will be required to learn about in your first year and then be required to recommend for your patients in your third year.

Not to say I'm right, but at least I'm questioning things right?

 

[BigRedder]

Pharmacology: "The study of drugs, their sources, their nature, and their properties. Pharmacology is the study of the body's reaction to drugs".

You are talking about pharmacology, which I never claimed was a pseudoscience. I'll admit that there is a blurring of research, diagnosis, and therapy in medicine as well as psychology and psychiatry, but it is much more severe in the latter disciplines. In much of psychology and psychiatry, their theories cannot (without stepping over ethical boundaries) and have not been systematically tested but are still perceived as science.

You really should not lump psychology and psychiatry together. Psychology is the study of behavior. Researchers in psychology observe how people tend to behave in either normal or abnormal situations. Typically this will either involve watching them perform tasks or asking them questions. Responses are statistically analyzed, and with a reasonable sample size you can get a decent picture of what is "normal". You can do the same with "abnormal" people and see how they differ. It is a science just like any other, except there is that annoying confound that people tend to lie, either intentionally or unintentionally, and that has to be taken into account.

Psychiatry is a medical field that seeks to diagnose and treat very real disorders of the brain. Diagnoses are determined with a structured clinical interview, which in its current form is the result of several decades of research. The categorizations are not perfect, but they evolve as new research comes to light. The fact is that there are millions and millions of people in the world who have real mental problems that can be improved with various forms of treatment. Even ECT, as barbaric as it seems, really works for people who have tried almost everything.

I have a couple of points to make regarding this last post. To say that pharmacology is separate from psychiatry displays a total lack of knowledge about what psychiatry is today. Most of what psychiatrists do is figure out what type of disease a person has, then based on their history and symptoms they almost always prescribe a drug. They then check the symptoms again after a defined period of time, reevaluate, then either stay the course or make a change. Neuropharmacology is the dominant force in psychiatry.

I still do not understand what it is you think cannot be systematically and ethically tested. Using rodents and monkeys we can observe behaviors and modify their brains, receptors, and even their DNA. Using fMRI we can see the regions of the human brain that are active while doing certain tasks. Using PET we can see where pharmaceuticals tend to go in the brain. Using structural MRI we can see naturally occurring lesions in people with abnormal behavior. Until you can show me a legitimate and important theory in psychiatry that cannot be systematically tested, I will continue to believe that you are simply trolling.

 

[Depakote]

I'm drawing a distinction between pharmacology and psychology. My problem is not in the application of the drug, nor the drugs ability to change behavior, but the issue that psychologists try to classify "normal" or as you say, "positive", when in fact this belongs outside the realm of science (perhaps philosophy?).

Again, I'll state the issue with an example (and I quote):

1. Psychologists counsel teenagers to prevent them from committing suicide.

2. Psychologists believe this counseling to be effective.

3. But ... in order for that to be anything but a belief, there would have to be a scientific study — a scientific study — to validate the belief.

4. Such a scientific study would require a valid experimental protocol, which means a double-blind design consisting of experimental and control groups.

5. At the end of the study, we could compare the number of suicides among the experimental group, who received the test therapy, and the control group, who received a sham therapy.

As described, the study would violate the rights of the subjects in the control group, which is why such a study has never been performed and will never be performed. I'm not saying that the therapy is always without value, but that the psychologists that use the therapy claim it is scientific.

First, I'll repeat that the definition of "normal" is not made by the psychiatrist, it is made by the patient. If the patient is in distress, then the clinician intervenes.

Second. There are more types of studies than just X v. Placebo. There are case control studies where a group of patient get the experimental treatment and are compared to the charts an identical subset of patients from before the experimental treatment existed. Then the outcomes may be compared and evaluated. There are waitlist studies (perhaps not the best for your suicide prevention example but works for other studies) where both groups get the therapy but one group waits for X amount of time and is observed as a control in that interim. There are comparative therapy studies. One group gets the experimental therapy, the other gets the standard of care. The standard of care group would be getting the therapy that any other patient would get outside of the study, the experimental group gets the yet to be proven therapy (but the one we hope works better). These types of trials are done all the time in psychiatry (and other medical fields).

So there are lots of ethical ways we can ethically test (and validate) psychiatric therapies.

 

[Concubine]

Until you can show me a legitimate and important theory in psychiatry that cannot be systematically tested, I will continue to believe that you are simply trolling.

Look up "Facilitated Communication".

 

[BigRedder]

I'm drawing a distinction between pharmacology and psychology. My problem is not in the application of the drug, nor the drugs ability to change behavior, but the issue that psychologists try to classify "normal" or as you say, "positive", when in fact this belongs outside the realm of science (perhaps philosophy?).

Again, I'll state the issue with an example (and I quote):

1. Psychologists counsel teenagers to prevent them from committing suicide.

2. Psychologists believe this counseling to be effective.

3. But ... in order for that to be anything but a belief, there would have to be a scientific study — a scientific study — to validate the belief.

4. Such a scientific study would require a valid experimental protocol, which means a double-blind design consisting of experimental and control groups.

5. At the end of the study, we could compare the number of suicides among the experimental group, who received the test therapy, and the control group, who received a sham therapy.

As described, the study would violate the rights of the subjects in the control group, which is why such a study has never been performed and will never be performed. I'm not saying that the therapy is always without value, but that the psychologists that use the therapy claim it is scientific.

You keep using that word, "scientific", but I don't think that you know what it means. You do not need a double blind study in order for a protocol to be "scientific". Also, you do not need to have a sham control. Typically, members of one group would get one accepted treatment, and members of another would get another. Then you see which one works better.

Suicide isn't a very good example anyway, since there are so many reasons why one would want to commit suicide. In any case, I agree with you that counseling is not really a science per se. Are you arguing that counseling is not effective? Most people who are that unhappy really need someone to talk to, and it doesn't need to be a psychologist, it can be anyone. There isn't much science in that, but it doesn't mean we shouldn't do it.

 

[BigRedder]

Look up "Facilitated Communication".

Methinks you chose a poor example of how psychology is not scientific.

The procedure is controversial, since a majority of peer reviewed scientific studies concluded that the typed language output attributed to the clients was directed or systematically determined by the therapists who provided facilitated assistance. However, several peer-reviewed scientific studies found instances of valid FC, and some FC users have reportedly gone on to type independently.

Controversy does not equal pseudo-science. Science is controversial.

 

[Riboflavin13]

Look up "Facilitated Communication".

You make it sound as if facilitated communication is a widely used nd supported practice in psychology. I did as you suggested, looked it up, and this is what I found at CNN. Sounds liks the APA doesn't support it ("even prompting the American Psychological Association to adopt the position in 1994 that 'facilitated communication is a controversial and unproved communicative procedure with no scientifically demonstrated support for its efficacy.'") There's even a link to several studies where the effectiveness of the procedure was tested, and many seem to say it's controversial at best. So don't make it out like psychologist live and die by facilitated communication today; I was a clinical psychology major, and I've never even heard it before. Finding a "therapy" that was tried out, and found to be less then effective doesn't prove that there isn't science in psychology.

link: http://www.cnn.com/CNN/Programs/presents/shows/autism.world/fc/index.html

 

[Concubine]

An interesting statement from the APA for anyone interested.

http://www.apa.org/monitor/feb05/pc.html

 

[Concubine]

You make it sound as if facilitated communication is a widely used nd supported practice in psychology. I did as you suggested, looked it up, and this is what I found at CNN. Sounds liks the APA doesn't support it ("even prompting the American Psychological Association to adopt the position in 1994 that 'facilitated communication is a controversial and unproved communicative procedure with no scientifically demonstrated support for its efficacy.'") There's even a link to several studies where the effectiveness of the procedure was tested, and many seem to say it's controversial at best. So don't make it out like psychologist live and die by facilitated communication today; I was a clinical psychology major, and I've never even heard it before. Finding a "therapy" that was tried out, and found to be less then effective doesn't prove that there isn't science in psychology.

link: http://www.cnn.com/CNN/Programs/presents/shows/autism.world/fc/index.html

I didn't mean to make it sound like all psychologist "live and die" by this, but to show that the use of questionable therapies in psychology is more wide spread than you might think.

 

[Concubine]

Science is controversial.

Only to those that don't understand it.

 

[Concubine]

There are more types of studies than just X v. Placebo. There are case control studies where a group of patient get the experimental treatment and are compared to the charts an identical subset of patients from before the experimental treatment existed. Then the outcomes may be compared and evaluated. There are waitlist studies (perhaps not the best for your suicide prevention example but works for other studies) where both groups get the therapy but one group waits for X amount of time and is observed as a control in that interim. There are comparative therapy studies. One group gets the experimental therapy, the other gets the standard of care. The standard of care group would be getting the therapy that any other patient would get outside of the study, the experimental group gets the yet to be proven therapy (but the one we hope works better). These types of trials are done all the time in psychiatry (and other medical fields).

So there are lots of ethical ways we can ethically test (and validate) psychiatric therapies.

Yes, but x. vs. placebo present the most significant evidence.

 

[BigRedder]

I didn't mean to make it sound like all psychologist "live and die" by this, but to show that the use of questionable therapies in psychology is more wide spread than you might think.

As I recall, I asked you to give me a "legitimate and important theory in psychiatry". You failed on all three counts. Please try again.

 

[BigRedder]

Only to those that don't understand it.

On the contrary, science is only non-controversial to those who do not understand it. If you look in just about any scientific journal, there is a section where people call into question previously published findings in that journal. Often there is a long back and forth over months. Findings presented at conferences are sometimes met with heated questions and refutations. If it isn't controversial, it isn't science, it's religion.

 

[Concubine]

As I recall, I asked you to give me a "legitimate and important theory in psychiatry". You failed on all three counts. Please try again.

See Cognitive behavioral therapy (CBT) as it relates to Depression, in which the APA claims that cognitive behavioral therapy and interpersonal psychotherapy has the best-documented efficacy for treatment of major depressive disorder but admits that "rigorous evaluative studies have not been published".


Source: Treatment Recommendations for Patients with Major Depressive Disorder (Practice Guideline for the Treatment of Patients With Major Depressive Disorder, Second Edition). American Psychiatric Association (2000).

 

[Concubine]

On the contrary, science is only non-controversial to those who do not understand it. If you look in just about any scientific journal, there is a section where people call into question previously published findings in that journal. Often there is a long back and forth over months. Findings presented at conferences are sometimes met with heated questions and refutations. If it isn't controversial, it isn't science, it's religion.

People "calling into question previously published findings in the journal" does not prove that science is controversial, rather that "calling into question" is a vital component of science itself. You are claiming that religion is not controversial? Oh please.

 

[zhenka11230]

Psychotherapy(or even psychology in general) indeed has a lot of philosophy of mind type of problems that makes it hard to be scientific. Since psychotherapy deals with conscious content rather then atoms, and since we have no idea which atom combinations make which conscious experiences and why(well maybe some), thus we are forced with a quite a few assumptions and forced to rely on more of philosophical reasoning and personal phenomenology of the subject matter. But this does not make it pseudo-science, it makes it extremely hard science due to ambiguity.

 

[Concubine]

Psychotherapy(or even psychology in general) indeed has a lot of philosophy of mind type of problems that makes it hard to be scientific. Since psychotherapy deals with conscious content rather then atoms, and since we have no idea which atom combinations make which conscious experiences and why(well maybe some), thus we are forced with a quite a few assumptions and forced to rely on more of philosophical reasoning and personal phenomenology of the subject matter. But this does not make it pseudo-science, it makes it extremely hard science due to ambiguity.

Yet it seems that very few here disagree that the bulk of psychology is hard science.

 

[BigRedder]

People "calling into question previously published findings in the journal" does not prove that science is controversial, rather that "calling into question" is a vital component of science itself. You are claiming that religion is not controversial? Oh please.

Taken as a whole, Science is not controversial. It is a proven method of learning about the world. However, as Science progresses, science is controversy. It's like the construction of a road. A finished highway is nice and flat, and everything is so smooth you don't think about it. At the front edge of construction, everything is a mess with holes, rocks, and machines everywhere. Once science has "happened" everything is orderly, making it Science, but while it is happening there is a large amount of disorder.

Taken as a whole, Religion is controversial, because there are so many competing ideas (plus it isn't testable). To each person in a particular religion, however, their religion is dogma, so there is no controversy at all. If there was no controversy in science, there would only be a static dogma, aka religion.

 

[Depakote]

Controversy does not equal pseudo-science. Science is controversial.

Only to those that don't understand it.

I'll give you that point.

 

[Begaster]

The gene for Huntington's disease was discovered in 1993. Does that mean before we discovered the biological basis, we could not consider it a real disease or diagnose it? Of course not. We diagnosed it from the late 1800s based on the symptoms, like we do thousands of idiopathic disorders.

A biological test for schizophrenia doesn't exist because nobody has discovered it yet. This does not mean schizophrenia does not exist. Nor does it mean bipolar disorder, depression, or a whole slew of psychiatric illnesses are false. Likewise, it does not mean that we cannot diagnose schizophrenia (or treat it) properly. It just means the science isn't there yet. This should not be a surprise - the brain is the most complicated piece of machinery in the world. Figuring it out is going to be the greatest accomplishment of the 21st century.

So no, definitely not a pseudoscience. Regardless of what Tom Cruise tells you.

Edit: Your example of a suicidal teenager is incorrect. I'm far too tired to correct you, but I suggest you search up the literature for how cognitive behavioral therapies are tested.

 

[BigRedder]

See Cognitive behavioral therapy (CBT) as it relates to Depression, in which the APA claims that cognitive behavioral therapy and interpersonal psychotherapy has the best-documented efficacy for treatment of major depressive disorder but admits that "rigorous evaluative studies have not been published".


Source: Treatment Recommendations for Patients with Major Depressive Disorder (Practice Guideline for the Treatment of Patients With Major Depressive Disorder, Second Edition). American Psychiatric Association (2000).

That is a rather long page of guidelines, and cherrypicking the phrase "rigorous evaluative studies have not been published" doesn't mean that there is no science behind it. Since it says that CBT has the "best-documented efficacy" there must be quite a bit of published data. The problem with being rigorous about it is that each therapist is different. The same goes for surgery. A process can be shown to be effective, but due to differences between practitioners it is difficult to get rigidly controlled studies.

You might also notice on that page that pharmaceutical interventions are recommended unless the patient has an aversion to it.

 

[45408]

Correct me if I'm wrong, but would that ever fly in non-experimental medicine?

Of course it would. Pain medications are given when the patient says they're in pain. How much pain? How many milligrams or Newtons of pain? Nobody knows. So we give a medication, and the patient says the pain has gotten better.

There are also plenty of medications with unknown mechanisms of action.

 

[pingouin]

*debates whether to get into the argument*


*decides it's not worth the effort*


*goes back to reading and preparing to see my 6 therapy clients tomorrow, who (n=6) believe there is medical (psychological) benefit to working with me and continuing to take the medications their psychiatrists prescribe*

 

[Concubine]

Overall, I think this poll is pretty revealing of the general attitude of premedical and medical students towards psychiatry, which was my goal in the beginning. Thanks to everyone that is participating!

 

[Quix]

1. In one of my favorite articles critiquing evidence-based medicine, it was rightly pointed out that no experiment to date has tested the effectiveness of a parachute versus a placebo control, and yet the overall efficacy and legitimacy of parachute use is not doubted.

http://www.bmj.com/cgi/reprint/327/7429/1459.pdf

2. Quick search of PubMed:

See Cognitive behavioral therapy (CBT) as it relates to Depression, in which the APA claims that cognitive behavioral therapy and interpersonal psychotherapy has the best-documented efficacy for treatment of major depressive disorder but admits that "rigorous evaluative studies have not been published".


Source: Treatment Recommendations for Patients with Major Depressive Disorder (Practice Guideline for the Treatment of Patients With Major Depressive Disorder, Second Edition). American Psychiatric Association (2000).

Arch Gen Psychiatry. 2008 Apr;65(4):447-55.Related Articles, Links
Achievement and maintenance of sustained response during the Treatment for Adolescents With Depression Study continuation and maintenance therapy.

Rohde P, Silva SG, Tonev ST, Kennard BD, Vitiello B, Kratochvil CJ, Reinecke MA, Curry JF, Simons AD, March JS.

Oregon Research Institute, 1715 Franklin Blvd, Eugene, OR 97403-1983, USA. paulr@ori.org

CONTEXT: The Treatment for Adolescents With Depression Study evaluated fluoxetine (FLX), cognitive behavioral therapy (CBT), and FLX/CBT combination (COMB) vs pill placebo in 439 adolescents with major depressive disorder. Treatment consisted of 3 stages: (1) acute (12 weeks), (2) continuation (6 weeks), and (3) maintenance (18 weeks). OBJECTIVE: To examine rates of achieving and maintaining sustained response during continuation and maintenance treatments. DESIGN: Randomized controlled trial. Response was determined by blinded independent evaluators. SETTING: Thirteen US sites. PATIENTS: Two hundred forty-two FLX, CBT, and COMB patients in their assigned treatment at the end of stage 1. INTERVENTIONS: Stage 2 treatment varied based on stage 1 response. Stage 3 consisted of 3 CBT and/or pharmacotherapy sessions and, if applicable, continued medication. MAIN OUTCOME MEASURES: Sustained response was defined as 2 consecutive Clinical Global Impression-Improvement ratings of 1 or 2 ("full response"). Patients achieving sustained response were classified on subsequent nonresponse status. RESULTS: Among 95 patients (39.3%) who had not achieved sustained response by week 12 (29.1% COMB, 32.5% FLX, and 57.9% CBT), sustained response rates during stages 2 and 3 were 80.0% COMB, 61.5% FLX, and 77.3% CBT (difference not significant). Among the remaining 147 patients (60.7%) who achieved sustained response by week 12, CBT patients were more likely than FLX patients to maintain sustained response through week 36 (96.9% vs 74.1%; P = .007; 88.5% of COMB patients maintained sustained response through week 36). Total rates of sustained response by week 36 were 88.4% COMB, 82.5% FLX, and 75.0% CBT. CONCLUSIONS: Most adolescents with depression who had not achieved sustained response during acute treatment did achieve that level of improvement during continuation and maintenance therapies. The possibility that CBT may help the subset of adolescents with depression who achieve early sustained response maintain their response warrants further investigation. TRIAL REGISTRATION: clinicaltrials.gov Identifier: NCT00006286.

Publication Types:
Multicenter Study
Randomized Controlled Trial
Research Support, N.I.H., Extramural

PMID: 18391133 [PubMed - indexed for MEDLINE]

--------------------------------------------------------------------------------

2: Am J Psychiatry. 2007 May;164(5):739-52.Related Articles, Links
Cognitive therapy versus medication in augmentation and switch strategies as second-step treatments: a STAR*D report.

Thase ME, Friedman ES, Biggs MM, Wisniewski SR, Trivedi MH, Luther JF, Fava M, Nierenberg AA, McGrath PJ, Warden D, Niederehe G, Hollon SD, Rush AJ.

Department of Psychiatry, University of Pittsburgh Medical Center, 3811 OHara St., Pittsburgh, PA 15213-2593, and Massachusetts General Hospital, USA. thaseme@upmc.edu

OBJECTIVE: The authors compared the effectiveness of cognitive therapy and pharmacotherapy as second-step strategies for outpatients with major depressive disorder who had received inadequate benefit from an initial trial of citalopram. Cognitive therapy was compared with medication augmentation and switch strategies. METHOD: An equipoise-stratified randomization strategy was used to assign participants to either augmentation of citalopram with cognitive therapy (N=65) or medication (N=117; either sustained-release bupropion [N=56] or buspirone [N=61]) or switch to cognitive therapy (N=36) or another antidepressant (N=86; sertraline [N=27], sustained-release bupropion [N=28], or extended-release venlafaxine [N=31]). Treatment outcomes and the frequency of adverse events were compared. RESULTS: Less than one-third of participants consented to randomization strata that permitted comparison of cognitive therapy and pharmacotherapy. Among participants who were assigned to second-step treatment, those who received cognitive therapy (either alone or in combination with citalopram) had similar response and remission rates to those assigned to medication strategies. For those who continued on citalopram, medication augmentation resulted in significantly more rapid remission than augmentation with cognitive therapy. Among those who discontinued citalopram, there were no significant differences in outcome, although those who switched to a different antidepressant reported significantly more side effects than those who received cognitive therapy alone. CONCLUSIONS: After an unsatisfactory response to citalopram, patients who consented to random assignment to either cognitive therapy or alternative pharmacologic strategies had generally comparable outcomes. Pharmacologic augmentation was more rapidly effective than cognitive therapy augmentation of citalopram, whereas switching to cognitive therapy was better tolerated than switching to a different antidepressant.

Publication Types:
Case Reports
Comparative Study
Randomized Controlled Trial
Research Support, N.I.H., Extramural

PMID: 17475733 [PubMed - indexed for MEDLINE]

--------------------------------------------------------------------------------

3: JAMA. 2005 Aug 3;294(5):563-70.Related Articles, Links
Comment in:
JAMA. 2005 Aug 3;294(5):623-4.
JAMA. 2005 Dec 14;294(22):2847-8; author reply 2848.
JAMA. 2005 Dec 14;294(22):2847; author reply 2848.

Cognitive therapy for the prevention of suicide attempts: a randomized controlled trial.

Brown GK, Ten Have T, Henriques GR, Xie SX, Hollander JE, Beck AT.

Department of Psychiatry, University of Pennsylvania, Philadelphia 19104, USA. gregbrow@mail.med.upenn.edu

CONTEXT: Suicide attempts constitute a major risk factor for completed suicide, yet few interventions specifically designed to prevent suicide attempts have been evaluated. OBJECTIVE: To determine the effectiveness of a 10-session cognitive therapy intervention designed to prevent repeat suicide attempts in adults who recently attempted suicide. DESIGN, SETTING, AND PARTICIPANTS: Randomized controlled trial of adults (N = 120) who attempted suicide and were evaluated at a hospital emergency department within 48 hours of the attempt. Potential participants (N = 350) were consecutively recruited from October 1999 to September 2002; 66 refused to participate and 164 were ineligible. Participants were followed up for 18 months. INTERVENTION: Cognitive therapy or enhanced usual care with tracking and referral services. MAIN OUTCOME MEASURES: Incidence of repeat suicide attempts and number of days until a repeat suicide attempt. Suicide ideation (dichotomized), hopelessness, and depression severity at 1, 3, 6, 12, and 18 months. RESULTS: From baseline to the 18-month assessment, 13 participants (24.1%) in the cognitive therapy group and 23 participants (41.6%) in the usual care group made at least 1 subsequent suicide attempt (asymptotic z score, 1.97; P = .049). Using the Kaplan-Meier method, the estimated 18-month reattempt-free probability in the cognitive therapy group was 0.76 (95% confidence interval [CI], 0.62-0.85) and in the usual care group was 0.58 (95% CI, 0.44-0.70). Participants in the cognitive therapy group had a significantly lower reattempt rate (Wald chi2(1) = 3.9; P = .049) and were 50% less likely to reattempt suicide than participants in the usual care group (hazard ratio, 0.51; 95% CI, 0.26-0.997). The severity of self-reported depression was significantly lower for the cognitive therapy group than for the usual care group at 6 months (P= .02), 12 months (P = .009), and 18 months (P = .046). The cognitive therapy group reported significantly less hopelessness than the usual care group at 6 months (P = .045). There were no significant differences between groups based on rates of suicide ideation at any assessment point. CONCLUSION: Cognitive therapy was effective in preventing suicide attempts for adults who recently attempted suicide.
Publication Types:
Clinical Trial
Randomized Controlled Trial
Research Support, N.I.H., Extramural
Research Support, U.S. Gov't, P.H.S.

PMID: 16077050 [PubMed - indexed for MEDLINE]

--------------------------------------------------------------------------------

4: Arch Gen Psychiatry. 2005 May;62(5):513-20.Related Articles, Links
Chronic depression: medication (nefazodone) or psychotherapy (CBASP) is effective when the other is not.

Schatzberg AF, Rush AJ, Arnow BA, Banks PL, Blalock JA, Borian FE, Howland R, Klein DN, Kocsis JH, Kornstein SG, Manber R, Markowitz JC, Miller I, Ninan PT, Rothbaum BO, Thase ME, Trivedi MH, Keller MB.

Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA 94305-5717, USA. afschatz@stanford.edu

CONTEXT: Although various strategies are available to manage nonresponders to an initial treatment for depression, no controlled trials address the utility of switching from an antidepressant medication to psychotherapy or vice versa. OBJECTIVE: To compare the responses of chronically depressed nonresponders to 12 weeks of treatment with either nefazodone or cognitive behavioral analysis system of psychotherapy (CBASP) who were crossed over to the alternate treatment (nefazodone, n = 79; CBASP, n = 61). DESIGN: Crossover trial. SETTING: Twelve academic outpatient psychiatric centers. PATIENTS: There were 140 outpatients with chronic major depressive disorder; 92 (65.7%) were female, 126 (90.0%) were white, and the mean age was 43.1 years. Thirty participants dropped out of the study prematurely, 22 in the nefazodone group and 8 in the CBASP group. INTERVENTIONS: Treatment lasted 12 weeks. The dosage of nefazodone was 100 to 600 mg/d; CBASP was provided twice weekly during weeks 1 through 4 and weekly thereafter. MAIN OUTCOME MEASURES: The 24-item Hamilton Rating Scale for Depression, administered by raters blinded to treatment, the Clinician Global Impressions-Severity scale, and the 30-item Inventory for Depressive Symptomatology-Self-Report. RESULTS: Analysis of the intent-to-treat sample revealed that both the switch from nefazodone to CBASP and the switch from from CBASP to nefazodone resulted in clinically and statistically significant improvements in symptoms. Neither the rates of response nor the rates of remission were significantly different when the groups of completers were compared. However, the switch to CBASP following nefazodone therapy was associated with significantly less attrition due to adverse events, which may explain the higher intent-to-treat response rate among those crossed over to CBASP (57% vs 42%). CONCLUSIONS: Among chronically depressed individuals, CBASP appears to be efficacious for nonresponders to nefazodone, and nefazodone appears to be effective for CBASP nonresponders. A switch from an antidepressant medication to psychotherapy or vice versa appears to be useful for nonresponders to the initial treatment.

Publication Types:
Clinical Trial
Comparative Study
Multicenter Study
Randomized Controlled Trial
Research Support, Non-U.S. Gov't

PMID: 15867104 [PubMed - indexed for MEDLINE]

--------------------------------------------------------------------------------

5: Arch Gen Psychiatry. 2005 Apr;62(4):409-16.Related Articles, Links
Cognitive therapy vs medications in the treatment of moderate to severe depression.

DeRubeis RJ, Hollon SD, Amsterdam JD, Shelton RC, Young PR, Salomon RM, O'Reardon JP, Lovett ML, Gladis MM, Brown LL, Gallop R.

Department of Psychology, University of Pennsylvania, Philadelphia, PA 19104, USA. derubeis@psych.upenn.edu

BACKGROUND: There is substantial evidence that antidepressant medications treat moderate to severe depression effectively, but there is less data on cognitive therapy's effects in this population. OBJECTIVE: To compare the efficacy in moderate to severe depression of antidepressant medications with cognitive therapy in a placebo-controlled trial. DESIGN: Random assignment to one of the following: 16 weeks of medications (n = 120), 16 weeks of cognitive therapy (n = 60), or 8 weeks of pill placebo (n = 60). SETTING: Research clinics at the University of Pennsylvania, Philadelphia, and Vanderbilt University, Nashville, Tenn. PATIENTS: Two hundred forty outpatients, aged 18 to 70 years, with moderate to severe major depressive disorder. INTERVENTIONS: Some study subjects received paroxetine, up to 50 mg daily, augmented by lithium carbonate or desipramine hydrochloride if necessary; others received individual cognitive therapy. MAIN OUTCOME MEASURE: The Hamilton Depression Rating Scale provided continuous severity scores and allowed for designations of response and remission. RESULTS: At 8 weeks, response rates in medications (50%) and cognitive therapy (43%) groups were both superior to the placebo (25%) group. Analyses based on continuous scores at 8 weeks indicated an advantage for each of the active treatments over placebo, each with a medium effect size. The advantage was significant for medication relative to placebo, and at the level of a nonsignificant trend for cognitive therapy relative to placebo. At 16 weeks, response rates were 58% in each of the active conditions; remission rates were 46% for medication, 40% for cognitive therapy. Follow-up tests of a site x treatment interaction indicated a significant difference only at Vanderbilt University, where medications were superior to cognitive therapy. Site differences in patient characteristics and in the relative experience levels of the cognitive therapists each appear to have contributed to this interaction. CONCLUSION: Cognitive therapy can be as effective as medications for the initial treatment of moderate to severe major depression, but this degree of effectiveness may depend on a high level of therapist experience or expertise.

Publication Types:
Clinical Trial
Comparative Study
Multicenter Study
Randomized Controlled Trial
Research Support, U.S. Gov't, P.H.S.

PMID: 15809408 [PubMed - indexed for MEDLINE]

--------------------------------------------------------------------------------

6: Arch Gen Psychiatry. 1999 Sep;56(9):829-35.Related Articles, Links
Prevention of relapse in residual depression by cognitive therapy: a controlled trial.

Paykel ES, Scott J, Teasdale JD, Johnson AL, Garland A, Moore R, Jenaway A, Cornwall PL, Hayhurst H, Abbott R, Pope M.

Department of Psychiatry, University of Cambridge, Cambridge, England.

BACKGROUND: Previous studies indicate that depressed patients with partial remission and residual symptoms following antidepressant treatment are common and have high rates of relapse. There is evidence that cognitive therapy may reduce relapse rates in depression. METHODS: One hundred fifty-eight patients with recent major depression, partially remitted with antidepressant treatment (mean daily doses equivalent to 185 mg of amitriptyline or 33 mg of fluoxetine) but with residual symptoms of 2 to 18 months' duration, were included in a controlled trial. Subjects were randomized to receive clinical management alone or clinical management plus cognitive therapy for 16 sessions during 20 weeks, with 2 subsequent booster sessions. Subjects were assessed regularly throughout the 20 weeks' treatment and for a further year. They received continuation and maintenance antidepressants at the same dose throughout. RESULTS: Cognitive therapy reduced relapse rates for acute major depression and persistent severe residual symptoms, in both intention to treat and treated per protocol samples. The cumulative relapse rate at 68 weeks was reduced significantly, from 47% in the clinical management control group to 29% with cognitive therapy (hazard ratio 0.54; 95% confidence interval, 0.32-0.93; intention to treat analysis). Cognitive therapy also increased full remission rates at 20 weeks but did not significantly improve symptom ratings. CONCLUSION: In this difficult-to-treat group of patients with residual depression who showed only partial response despite antidepressant treatment, cognitive therapy produced worthwhile benefit.

Publication Types:
Clinical Trial
Comparative Study
Randomized Controlled Trial
Research Support, Non-U.S. Gov't

PMID: 12884889 [PubMed - indexed for MEDLINE]

Yet it seems that very few here disagree that the bulk of psychology is hard science.

3. Psychology is a *broad* categorization, so I question the validity of you apparently applying the same standards to observational fields like social psychology vs. experimental fields like health psychology (formerly biopsychology) or neuropsychology.

 

[Nanon]

Yes, but x. vs. placebo present the most significant evidence.

No, it really doesn't in all cases. 🙄 Really.

 

[GoldShadow]

Just FYI, with all this talk about control groups and placebos and "x vs. placebo", I decided to look up some court cases on Google.

Turns out, in X vs. Placebo 172 U.S. 942 (1984), X won, not placebo, just to show you the Supreme Court's opinion of placebo. Placebo is not always necessary.

 

[leviathan]

1. Psychologists counsel teenagers to prevent them from committing suicide.

2. Psychologists believe this counseling to be effective.

3. But ... in order for that to be anything but a belief, there would have to be a scientific study — a scientific study — to validate the belief.

4. Such a scientific study would require a valid experimental protocol, which means a double-blind design consisting of experimental and control groups.

5. At the end of the study, we could compare the number of suicides among the experimental group, who received the test therapy, and the control group, who received a sham therapy.

As described, the study would violate the rights of the subjects in the control group, which is why such a study has never been performed and will never be performed. I'm not saying that the therapy is always without value, but that the psychologists that use the therapy claim it is scientific.

That's not really true at all. There have been many studies which compare treatment vs. no treatment. The most common method used is to place the placebo/control group in a "waiting list" for therapy, and then compare their depression with the experimental group. The waitlist will be offered therapy after the trial is over. Often there will also be additional groups made such as placebo vs. SSRI interlinking with CBT vs. no CBT.

The results of all studies using the above method show a definite benefit to CBT and to the use of SSRIs compared to control groups. However, another interesting finding is that the efficacy of psychiatrists/clinical psychologists has not been shown to be any better than a non-trained person running the therapy sessions. This is a fact that my clinical psychology prof in undergrad was not embarrassed to admit, because that's what a good scientist does.