Skip to main content

mental health mondays :: well it was working before

we've talked a lot about drugs here on mhm, but we haven't paid a lot of attention to the different types of therapy that are available for people with mental disorders. that's a hell of an oversight on my part, because, as most experts in the field will tell you, it's the therapy that's more important. drugs control the symptoms, but they aren't doing anything [as far as science has been able to uncover] to improve the underlying condition. psychotherapy is like physiotherapy for the brain: it doesn't undo the damage, but it teaches you how to function in spite of it in such a way that you won't cause additional damage.

one of the most popular forms of therapy in the last forty or so years- popular with both doctors and patients- has been cognitive behavioural therapy. it's easy to see the appeal of it, because it's short-term, goal oriented and something that, once the therapy sessions have ended, you can continue to practice yourself. it's not just an interaction with an expert, but a way of retraining your brain. there is an in-depth description of the process that you can read right here, but the short version is that it represents a significant departure from the open, discussion-based approach of classical psychoanalysis and places both the onus to improve and the power to effect improvement on the patient, with the therapist playing the role of a coach.

when the practice first became popular in the 70s, it was a revolution. by the 80s and 90s, people were already mocking it [remember the "baby steps" mantra from what about bob? or the emphasis on finding one's "happy place" [a trigger for a state where one can ignore the chaos of the surrounding world and focus on what one's brain is doing], like in the simpsons episode where edna krabappel tries to overcome stress by repeating "calm blue ocean". the mocking, however, was lighthearted, because it was clear that people who were engaged in cognitive behavioural therapy were seeing real benefits, even if the "homework" did seem a little silly at times.

but a recent study- actually an analysis of a number of studies- casts some doubt on whether it continues to be a cure for the disordered brain. after reviewing forty years worth of evidence on its effects, the researchers have come to an inevitable conclusion: cbt's ability to cure people of unipolar depression [the studies were specifically related to this, although cbt is recommended for a wide variety of conditions] has been falling steadily the entire time. its greatest results came when it was first studied in the mid-to-late seventies and everything else has gone downhill. so what's going on?

the paper hints that there may be a sort of placebo effect at work, where people assumed that it was helping more than it actually was because it was just so different and because some progress could be measured. likewise, once word started to get around that this was a sort of miracle cure for brain bugs, the expectations rose as to what it was going to accomplish, expectations that couldn't be fulfilled. that would explain the initial drop, but not the continued decline. at some point, the treatment was no longer novel and expectations were no longer too high, at which point the rate of effectiveness should have stabilised. and yet it continues to go down.

an article about the study in the guardian raises an interesting possibility: that it's not about individuals and their reactions to a particular type of therapy, but rather about shifts in culture as a whole requiring new types of therapy every so often. in the same way that freudian analysis fell by the wayside, so to cognitive behavioural therapy has run its course. it isn't that cbt is bad therapy, it's that it's served its purpose and it's time for a new model. [it also mentions the very obvious possibility that there are just more therapists who are under-qualified, which is something that shouldn't be discounted.]

this isn't like with medication, where, as scientists get to know more about the chemistry of the brain, they're better able to target drugs to promote or suppress certain reactions. finding forms of therapy that work better than others is based on observation and intuition. the results are still measurable, but it's a lot more haphazard and takes a lot of work to refine. that said, once a good system is established, it follows that it should continue to be useful over time. we can't build up an immunity to therapy, can we? well, not in theory, but that's exactly what seems to be happening. more intriguing, it's happening on a societal rather than an individual level. the cbt process isn't just becoming less effective on individual patients, but on everybody.

the implications of that are worthy of study themselves. it's like we, as a society, react to psychotherapy in the same way a teenager [or an adult, who am i kidding] reacts to a new video game. at first, it's interesting and makes you want to push further, then it's all you can talk about, but then you figure out what's happening and it no longer has its magic. it's possible that, as more and more information has been revealed, cbt seems too "easy" to be a solution to what we perceive as complex problems.

the results of this study shouldn't be cause for immediate alarm. cognitive behavioural therapy continues to help people fight their psychological demons, identify the ways in which they compromise and harm themselves, and empowers them to take control over their lives. no one is trying to assert that their progress isn't real. but it does raise the question of what form new therapies need to take. we've gone from the value of talk to the value of goals and action, so what's the next step in the ladder? [you didn't think that i was going to answer that, did you?]

Comments

as long as you're here, why not read more?

long division

after the united states election last year, there were the usual calls for the country to unite behind the new president. that never happens anymore, because, since george w. bush scored a victory in 2004, having launched the country into a war in iraq for no reason, the people on the losing side of a presidential election have been pretty bloody angry about it. democrats hated bush 43. republicans really hated obama. democrats really hate trump.

it didn't help that trump didn't make the typical conciliatory gestures like including a couple of members of the opposite party in his cabinet, or encouraging his party to proceed slowly with contentious legislation. barack obama arguably wasted at least two and as many as six years of his tenure as president trying to play peacemaker before he felt sufficiently safe to just say "screw you guys" and start governing around the ridiculous congress he was forced to deal with. not-giving-a-shit obama was the best president in …

making faces :: i could maybe not buy this one thing

i've been into makeup on some level for a long time- much longer than i've been writing about it, for certain. even as a young woman, i loved the feeling of i got from applying a deep-hued lipstick and some mascara. it took years for me to figure out eyeshadow, and even longer for me to appreciate blush. but at this point, i think we can agree that i'm pretty much into the whole gamut. [except liquid and super-matte lipsticks, and most very sparkly eyeshadows. but that's because they're painful for me to wear.]

the thing about spending a long time collecting and holding onto just about everything is that you accumulate quite a stash. lately, i'm trying to force myself to think about what i already have before laying down money for something new. most recently, i found myself drawn to the modern renaissance palette from anastasia. me and a lot of people. by the time i started thinking about it, it was already sold out in my local sephora and online. i signed up…

when you want a great pair

i have finally come to the realisation that i might be trying to learn too many languages at once. that's not to say that i don't want to learn all the languages that exist in written form, but spreading myself across a dozen at one time doesn't allow for a lot of progress in any of them. therefore, while i'm still "checking in" with all of them, i'm trying to focus on a couple at a time. lately, that's been swedish and norwegian, because they are both grammatically similar to english [even if the swedish accent is very tough for me], which makes things progress faster. in general, i've been trying to pair similar languages because, while it can get a bit confusing, building the skill sets of both at once strengthens each of them. if you want more bang for your linguistic buck, 'pairing' like this can be quite helpful. here's a few suggestions for ones that i'd recommend:

swedish and norwegian :: they are so similar, it's easy …