[throwaway17824]

I have had treatment-resistant major depression for eight years. During that time I have had long periods with extensive, frequent social interaction and bonding. My depression encompasses most of the time I've known my now-wife, repairing a broken relationship with my father, the acquisition of one new close friend, and the coming and going of many transient relationships.

I don't know what the cure for my own case of depression is, and I'm sure if I were isolated/disconnected my condition would be worse, but the evidence available to me indicates that simply connecting with people is not what's going to fix me.

My wife and mother-in-law are both counselors, and routinely successfully treat people with depression. They have never indicated that level of social connection is either a dominant cause or reliable treatment for depression.

If you want something to read up on, a very popular treatment methodology for depression is CBT (Cognitive Behavioral Therapy). The premise is that depression is often caused by harmful thought patterns about yourself or your life, and CBT trains you to arrest those thoughts and replace them with thoughts that are constructive or more accurate (less exaggerated, etc.). It's not the treatment I need, but it works for an awful lot of people, and its solution isn't built around social connections (though it may reveal social connections as a problem in individual cases).

[cam_l]

First, agree with everything you said (and it must be frustrating to deal with poptart* psychology like this).

>but it works for an awful lot of people

I know CBT is awfully popular on HN. But it is worth reading into the stats on CBT. Even if you take them at face value, it certainly does not work for everyone. It is of course, most effective when there is a clear cause and effect, very effective with anxiety, and also generally with children in particular. But has been shown to be ineffective or even dangerous when used with certain cohorts, ie. significant trauma background, clinical mental illness including depression, psychosis etc.

There have been more studies on CBT than any other form of therapy, and those studies suffer from the same replication crisis that the rest of social science research does.

So if it is your first exposure to getting help (and don't get me wrong, it is good to try as a first response) and it doesn't work for you, it is not your fault. You are not 'treatment resistant', more just at a 'treatment deficit'. Generally speaking, if your counsellor says you are treatment resistant, it is time to get a new counsellor and maybe if it is warranted a referral in combination with other medical expert like a psychiatrist. Each case is different though, and you are always your own best expert in yourself.

*like pop psychology, but it burns your mouth.

[boomboomsubban]

>There have been more studies on CBT than any other form of therapy, and those studies suffer from the same replication crisis that the rest of social science research does.

More studies showing the same results means they aren't suffering from the replication crisis, even if the exact same study isn't being replicated.

CBT isn't for everyone, that is true. And you shouldn't worry or blame yourself if it didn't work, there are more options available. But I wouldn't cast doubt's on it's overall efficacy or claim it's junk science.

[cam_l]

Seriously?! I never claimed it is junk science.. didn't even allude to it. I certainly wasn't casting doubt on research figures where they have been replicated and proven.

Truth is, some CBT studies have repeatedly passed replication and others yet have failed. CBT studies in lots of areas where it is used have shown relatively low efficacy, but close to alternative options. Even across anxiety disorders, where is it most effective, it is with an average-ish 70-80% success, and often only a few points different with alternative options. Meta studies have shown it to be ineffective within certain sub-cohorts, even in general areas where it is shown to be effective. Lots of CBT studies are performed differently or with different cohorts to how or with whom they are instituted in practice.

None of this means it is junk science, it just means you have to be very careful to understand the precise limitations of the science. You cannot separate the outcomes you like from the replication issue, you have to test it all. You also cannot generalise the very real successes of CBT across areas where they have not been shown to be effective, or shown to be ineffective. It is worth keeping these things in mind.

This information is almost never shown to clients. Clients are told 'CBT works', with the implication (or outright claim) that if it doesn't work for you it is your fault. It is popular with clients and it is popular with the profession, because it sets expectations early, it is cheap, it is targeted, and it works for the majority of people with the majority of issues people seek counselling for (ie. anxiety and depression). If this doesn't work for you, and this is all your counsellor offers, they are doing a massive disservice.

[unishark]

> More studies showing the same results means they aren't suffering from the replication crisis, even if the exact same study isn't being replicated.

Not specific to CBT, but as a general point, replication crises are behind the scenes. Publication bias means only positive results get published, even if it's only the occasional lucky studies (or ones with overt cheating or innocent bad statistics) which come out positive. Researchers know about it and grumble privately, because they wasted months or years of effort before figuring out it's largely false. But this knowledge isn't generally what goes into archival publications.

[blunte]

> CBT trains you to arrest those thoughts and replace them with thoughts that are constructive

This part is useful to everyone well beyond the scope of depression. Simply becoming aware of one's thoughts is a revelation. Our ability to ride a stream of thoughts without being actively conscious to them is unfortunate; it must have some evolutionary reason, but it also means we can repeat and experience many bad feelings and thought patterns without recognizing that we have some choice in whether to allow them to run free or to shut them down/replace them.

[webmaven]

> Our ability to ride a stream of thoughts without being actively conscious to them is unfortunate; it must have some evolutionary reason

I suspect that the evolutionary reason is rather mundane; introspection (thinking about thinking and feeling) is expensive, and while it may confer some small epistemic benefit toward constructing and maintaining a theory of mind, the main benefit is in masking the downsides of other traits (like neuroticism, depression, anxiety, paranoia), which, to be frank, don't usually have much in the way of an upside. Historically (and likely prehistorically) it is simpler on a population basis to select against the traits that introspection would mask, which leaves introspectiveness as a trait that isn't strongly selected for, and at least slightly selected against in most situations.

This calculation flips in any situation where neuroticism, paranoia, etc. confer an advantage, which probably happens often enough to keep those traits (and introspectiveness) from dying out, and of course much of the stress of modern living exacerbates any neurotic etc. tendencies, which may give introspectiveness a boost even as those tendencies are selected against more strongly. But on an evolutionary timescale, I'd place a bigger bet on human culture(s) becoming less stressful, rather than on people evolving to better withstand stress.

Much of this speculation, TBH, is a handwavy just-so story. And since a theory isn't much use unless it has predictive power, here is a prediction: low-trust societies are where you would expect to find some minor advantage to neuroticism associated traits and a corresponding greater advantage to an even marginally better theory of mind, so we might find a correlation to greater introspectiveness. I am not aware of any research that addresses that question (although on an individual basis, neuroticism is by definition negatively correlated with trust, since trust is a facet of agreeableness)