Cognitive Behaviour Therapy (CBT)

 

A friend endorses CBT—Cognitive Behaviour Therapy. The idea, he says, is that “it identifies self-defeating beliefs and cognitive distortions that maintain depression, anxiety, addiction, etc. And it replaces these beliefs with more accurate, realistic and positive ones.”

But note the assumption here: that the patient/client’s depressing thoughts are wrong, or unrealistic. That is not a fair assumption. We should really expect that the average person has an unrealistic bias towards optimism—people tend to believe what they want to be true. Nobody wants bad things to happen.

There is a theory called “depressive realism.” Some studies that suggest depressed people are better than others at predicting future events, and more realistic in understanding their inability to control events. George Orwell and Winston Churchill both considered their chronic depression their superpower allowing them to face the hard truths others wouldn’t. 

This seems to me a serious problem for CBT. First, it may be convincing some poor patient to walk off a cliff, figuratively speaking, having convinced himself is not really there. 

Second, it may be encouraging him not to make necessary changes in his situation, assuring him that everything is fine as is. So trapping him in his mental illness. 

Third, it is objectively immortal to encourage another to lie to himself, given that truth is of transcendental value. 

Fourth, a perceptive patient is likely to see this flaw in the treatment, and the consolation will not work from the start. It will only deepen their despair. Just like many find it impossible to be moved by a John Denver song. 

“Sunshine almost always makes me high...”

Prayer, by contrast, gives reasons for authentic optimism: God’s in control. All will be well, and all will be well, and all manner of things will be well.

My friend is impressed by studies that show CBT actually works. He quotes AI: “evidence-based methods like CBT are proven to help with various mental health issues, often working as well as medication or even better in combination with it.”

That last clause is the key: “success” is measured as “working as well as medication.” There is decent evidence that psychiatric medication does not work, so this actually suggests CBT and other “evidence-based” psychotherapies do not work.

Following is a passage quoted from an unpublished manuscript of mine:

Trevor Turner writes, in 2004, “recent critiques have shown that recovery and readmission rates in schizophrenia before 1950 were no different and that antipsychotic agents might even do more harm than good.”  A 2013 study by Harrow and Jobe concludes “there is very little systematic evidence for the long-term benefits of antipsychotics. There is even some longitudinal data suggesting the opposite.”  Discouragingly, Harrow and Jobe say that “in our longitudinal studies, the sample of schizophrenia patients who were untreated for many years showed significantly better outcomes than did those on antipsychotics.”  An Alberta Hospitals study in 1978 produced similar results. 

Doubts have surfaced for antidepressants as well. Studies indicate a 10% improvement in symptoms above placebo for the SSRIs, the “Prozac”-like medicines currently favoured.  But as Horowitz and Wilcock point out, this is not a clinically significant result.  Moncrieff and Kirsch point out that, given the criteria used, a sleeping pill would have scored as well.  “Longitudinal follow-up studies,” they add, “show very poor outcomes for people treated for depression both in hospital and in the community.”  

... Moncrieff and Kirsch conclude that “selective serotonin reuptake inhibitors have no clinically meaningful advantage over placebo. Antidepressants have not been convincingly shown to affect the long-term outcome of de-pression or suicide rates.”  In his 2011 book The Emperor’s New Drugs, Kirsch concludes, “When we analyzed all of the data ―those that had been published and those that had been suppressed―my colleagues and I were led to the inescapable conclusion that antidepressants are little more than active placebos, drugs with very little specific therapeutic benefit, but with serious side effects.”

Prayer is better—it gives reason for optimism.