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CBT, like antidepressants, has been misleadingly presented as “the golden standard” for all kinds of mental conditions. “Evidence-base” is it’s nickname, and yet… the evidence suggests a different reality. From sham control trials, to cherry picking patient samples, publication bias, and suppression of negative findings, the reality is that CBT is as effective as placebo in some studies, as antidepressants in others (25%), and a more realistic 5% of all those using it.
In a word buzzing with slogans of “holistic, patient centric, equality, diversity, and inclusion”, CBT moves us more towards a hegemonic, totalitarian, monoculture in which the patient has no choice or say.
Why does it matter? Biased science reporting is fraudulent misrepresentation. I still don’t know why we have white collar financial crime for massaging the data but not white collar scientific crime for the same. If a wide-scale criminal investigation would be conducted in research and media coverage supporting biased narratives causing sufferers and taxpayers billions, and potentially lives, matters will change.
In an article, “Where Is the Evidence for ‘Evidence-Based’ Therapy?”, Jonathan Shedler, PhD, writes:
“Most patients are never counted in the typical randomized controlled trial for “evidence-based” therapies, about two-thirds of the patients are excluded from the studies a priori. Sometimes exclusion rates exceed 80%. That is, the patients have the diagnosis and seek treatment, but because of the study’s inclusion and exclusion criteria, they are excluded from participation.
The higher the exclusion rates, the better the outcomes (a dirty trick in scientific studies few know about).
Typically, the patients excluded are those who meet criteria for more than one psychiatric diagnosis, or have personality pathology, or are considered unstable, or who may be suicidal. In other words, they are the patients we treat in real-world practice. The patients included in the research studies are not representative of any real-world clinical population.
Approximately two-thirds of patients who seek treatment are excluded from the research studies. Of the one-third who are treated, about one-half show improvement. This is about 16% of the patients who initially presented for treatment. But this is just patients who show “improvement.” If we were to consider patients who actually get well, we are down to about 11% of those who originally sought treatment. If we consider patients who get well and stay well, we are down to 5% or fewer. In other words, scientific research demonstrates that “evidence-based” treatments are effective and have lasting benefits for approximately 5% of the patients who seek treatment.”
I highly recommend you read the full article:
In another analytic article, “CBT is wrong in how it understands mental illness”, the CBT model is outrightly questioned:
“CBT’s cognitive model of mental illness, originally developed by Aaron Beck in the 1960s, hypothesised that disorders such as depression were characterised by certain patterns of thought that give rise to the negative emotions and behaviour typical of mental illness. These patterns of thought are referred to as “cognitive distortions” or “negative automatic thoughts”.
But what exactly is wrong with these thoughts? What makes them “distorted”? Generally, vague answers are offered in response. For example, the American Psychological Association describes these thoughts as being “faulty” or “unhelpful”.
Three reasons to doubt the model
There are three reasons to doubt the cognitive model and the association of mental illnesses with errors in reasoning.
First, the sort of issues CBT draws attention to – bias, false beliefs, poor inferences – are all relatively common, even in mentally healthy people. “Faulty” thinking does not obviously correlate with mental illness.
Second, although CBT researchers have studies showing that mental disorder has something to do with cognitive distortions, there is a problem with the tests or measures used in this research. Many of these tests ask questions that have nothing to do with poor reasoning.
Finally, there is research suggesting that it is mental health rather than mental illness that is related to poor reasoning. The “depressive realism hypothesis”, shows that depressed people more accurately: predict how much control they have over outcomes, evaluate their performance and recall feedback.
Mentally healthy people, on the other hand, succumb to an “illusion of control” and tend to recall their own performance and feedback in an excessively rosy light. Although most of this research has been on depression, there are studies suggesting that schizophrenia may be associated with better theoretical reasoning and autism is sometimes characterised by enhanced logical and theoretical reasoning.
Not backed by research
Not only is there contrary evidence showing problems with reasoning are widespread as well as potentially associated with mental health rather than mental disorder. But the evidence in favour of CBT’s take on mental illness is tainted because the tests used in these studies do not even track problems with reasoning. CBT provides a compelling story about mental illness – mental illness is associated with “faulty” reasoning, and in resolving this, negative behaviour and emotions are addressed. Unfortunately, research doesn’t quite back up this story.
We might wonder whether it matters. After all, CBT seems to work, so why should we care how it works or whether it is wrong in its story about mental illness?
It matters ethically. It is one thing to point out that certain patterns of thinking are “unhelpful” or bring about negative emotions and behaviour, quite another to suggest that someone is irrational or reasoning poorly when the evidence for this is shaky. It is what the philosopher Miranda Fricker terms “epistemic injustice”, where a member of a disenfranchised group (that is, the mentally ill), is told their claims are plagued by errors or cannot be taken at face value. Even worse, with CBT they are told this when they come seeking help.
Troubling, at best, unethical at worst.“
Research shows that CBT or certain CBT techniques may be ineffective for many types of mental disorders (source).
“In a landmark 2009 review published in the journal Psychological Medicine, the study authors concluded that CBT is of no value in treating schizophrenia and has limited effect on depression. The authors also concluded that CBT is ineffective in preventing relapses in bipolar disorder.
In a 2009 study published in the British Journal of Psychiatry researchers compared depression treatment in adolescents over a period of 28 weeks. The study authors compared treatment with SSRI antidepressants versus the use of a combination of SSRIs and CBT. At the end of the 28 weeks both groups showed improvement but there were no significant differences between them. It was found that CBT did not add any benefit to the antidepressant treatment.
Dr. Thomas A Richards, director of the Social Anxiety Institute explains how telling the individual with social anxiety to stop thinking negative thoughts is not going to work. He also states that giving the socially anxious person positive affirmations to recite will do nothing.
Dr. Stephen Phillipson writes on OCD Online that a critical element of good cognitive behavioral therapy is that the therapist be warm, understanding and compassionate. He also talks about how more traditional CBT techniques are ineffective for those patients with obsessive-compulsive disorder (OCD). He stresses that OCD is not a thought disorder but an anxiety disorder, which means that it is less likely a manifestation of irrational thoughts. He states that: “Helping OCD sufferers to see the irrational nature of their thought content is counterproductive.”
The experts on PsychCentral agree that CBT has limited potential for helping those with Histrionic Personality Disorder. The authors state that: “Cognitive-oriented approaches are generally largely ineffective in treatment of this disorder and should be avoided.” The reason, they share, is that people with this disorder are often incapable of examining their thoughts and motivations.”
Faulty Assumptions and Limitations of CBT: The egg or the chicken dilema
One of the basic tenets of CBT is that your faulty or irrational thought patterns and cognitions are responsible for maladaptive behavior and mental health problems. In the CBT triad model, thoughts come first leading to negative feelings, which at their turn lead to maladaptive behaviours, in a never-ending negative feedback loop.
The grave error behind the CBT faulty assumption is no different from its contemporary 70′ psychiatric model on which antidepressants’ ‘brain chemical imbalance theory’ was based: Symptoms are confused with the cause!
Whether your brain gets out of whack, whether emotional pain caused by social exclusion causes inflammation found in a majority of depressed patients, or whether your gloomy “dysfunctional” thoughts were caused by more serious factors such as your basic human needs not being met, childhood abuse and neglect, domestic violence, inequality, poverty, bullying at work, systemic injustice, lack of family support, solitude, homelessness, loss of jobs, friends, family members, poor pay and raising living costs, – it’s of little importance to the “evidence-based” “gold standard” CBT social behavioural modification, gaslighting approach.
Under CBT standardised model uniformalising the human experience, conveniently, the problem is no longer with the unjust social structure, with the political and economic corruption wrecking the very fabric of our society, but with your “dysfunctional” thinking and “maladaptive behaviour”. In other words, your anxiety, panic attacks, depression, PTSD caused by trauma and inequality are the result of your dysfunctional thinking, not of the dysfunctional society you have to survive in.
The “evidence based”, when further looking at the evidence is a manipulative misnomer.
“Evidence-based therapy” has become a marketing buzzword. The term “evidence based” comes from medicine. It gained attention in the 1990s and was initially a call for critical thinking. Proponents of evidence-based medicine recognized that “We’ve always done it this way” is poor justification for medical decisions. Medical decisions should integrate individual clinical expertise, patients’ values and preferences, and relevant scientific research.
But the term evidence based has come to mean something very different for psychotherapy. It has been appropriated to promote a specific ideology and agenda. It is now used as a code word for manualized therapy—most often brief, one-size-fits-all forms of cognitive behavior therapy (CBT). “Manualized” means the therapy is conducted by following an instruction manual.”
Only an uninformed, biased ideologue could propose “faulty thinking” as the cause of the pandemic of “mental illness”, another misnomer for our degrading psychic (from psyche, soul) health in the face of the overwhelming evidence of the contrary:
In conclusion, CBT reframing of thinking is no different than NLP, and its action oriented tasks no different than coaching. But is surely not therapy or transformational psychosocial novel approach for addressing the complex underlying causes behind mental health conditions in the orthodox sense!
As a brief personal development manualized intervention poses no problems. In fact those reporting positive benefits were those with very mild symptoms and no comorbidities. But from there to call it “the NICE gold standard evidence based treatment of choice” for depression, anxiety, personality disorders, PTSD, and more, is a lie that costs taxpayers billions per year because the conditions are improperly addressed; the sufferers because they are given the misleading impression to be offered top of the class specific therapy for their conditions, living them in doubt as to their “faulty constitution” when that doesn’t work – proof of the 2.7 million cases of “treatment resistant depression in the UK and 230 million people in the world.
Not last, proposing CBT unilateraly in the NHS without giving the patient the full picture is a breach of informed consent, a blatant discrimination against other novel ideas and methods, and breach of human rights against patients, other therapists and holistic mental health practitioners often discredited as “unscientific”.
How can a new and better, reality-based model of addressing at root mental health become “evidence based” if all innovative approaches are excluded from public healthcare services?
Remember, “evidence based” is a medical term and it requires:
- Individual clinical expertise
- Patients’ values and preferences, and
Relevant scientific research
CBT violates all three criteria, and is not by any stretch of the imagination an “evidence-based” therapy.
In Dr. Jonathan Shedler, PhD words:
“KEY POINTS
The term evidence-based therapy has become a de facto code word for manualized therapy—most often brief, highly scripted forms of cognitive behavior therapy.
It is widely asserted that “evidence-based” therapies are scientifically proven and superior to other forms of psychotherapy. Empirical research does not support these claims. Empirical research shows that “evidence-based” therapies are weak treatments. Their benefits are trivial, few patients get well, and even the trivial benefits do not last.
Troubling research practices paint a misleading picture of the actual benefits of “evidence-based” therapies, including sham control groups, cherry-picked patient samples, and suppression of negative findings.”
A call for the NHS, policymakers, employers offering CBT to their employees at the exclusion of other modalities, and patients alike is made through this article as an attempt to restore the balance, correct the misrepresentation, and remove the protectionist practice of CBT as the poster child therapy for all human psychic suffering.
© 2023, Gratiela Rosu, holistic psychotherapist & counsellor, mental health coach – Founder of CWS Method® – a psychosocial and psychospiritual approach to mental health & wellbeing
Email: cws@infogratielarosu.com
