[lelanthran]

The problem with mainstream therapy is that, unless you're being treated by a psychiatrist, there's very little in the way of objective evidence of therapy working.

Sure, lots of self-reported successes by patients with no control to compare against, but at this point there is just as much self-reported evidence that prayer works.

For medical treatments, the bar should be higher than "patient believes it worked".

[codingdave]

Therapy is skills training, not medical treatments. Which is also why the reliability is varied - not everyone wants to learn mental health skills. Not everyone who learns them wants to do them. Not everyone who wants to do them is able to make themselves do so.

When you go to a psychiatrist, now we are talking medical treatments. That is where you get a specific diagnosis and possibly medicine to change how your body and mind work. That is where to expect objective results.

Both explore what is needed by talking to patients, often with some testing... but they are not the same thing. And neither are going to solve all problems for all people. But it helps to evaluate them properly if you understand what they are, and what they are not.

[kragen]

Some skills training is well supported by empirical evidence. People who take piano lessons observably improve their ability to play piano, on average, even though some don't, even though they often regress after they stop, and even though some people improve without taking lessons. Similar remarks apply to golf lessons, JavaScript bootcamps, calculus courses, and plumbing apprenticeships.

Most kinds of therapy, by contrast, are closer in their empirically measured effectiveness to studying geography through astral travel or studying history through past-life regressions. CBT and exposure therapy are among the few exceptions.

[bengale]

> but at this point there is just as much self-reported evidence that prayer works.

If you remove the assumption that a deity answers the prayer; what they're doing is focusing on gratitude and if asking for things they are identifying goals. This is a healthy mindset so unsurprising that they report it "working".

[fabioz]

I believe this view is actually outdated -- it was actually true in the past, but I know that currently "Cognitive Behavioral Therapy" does define things much more objectively than previous approaches...

It's a bit unfortunate that people out of the psychology area don't even really know that there are multiple different Psychotherapies approaches and that they vary wildly in how problems are tackled/studied (source: my wife works in the area).

[megous]

No. CBT is still a mumbo jumbo of concepts and approaches that have no relation to reality (like any other therapeutic school), other than "if you follow these practices, you will maybe get better".

You'll not be able to prove validity of the concepts behind this school of therapy themselves in any other sense, even if you would be able to identify some coherent set of concepts from all the various techniques and approaches that CBT subsumed over the years.

And certainly just because "if you follow these practices, you will maybe get better" metric does not say anything about validity of the concepts of a particular school of therapy in any case, no matter what school you're talking about.

I mean yeah, many people usually care about whether some therapy works and how well, and not whether the concepts that you're told in therapy to justify what the therapy is doing make coherent sense or can be scientifically validated, so this is usually not a problem for people in need of care. But idea that CBT's concepts are more objective than other mumbo jumbo therapies out there is just plain wrong.

[wruza]

if you follow these practices, you will maybe get better

Idk if my therapist used something from outside of CBT, but he definitely marketed himself as a CBT-ist. I was never given this "these practices" thing. I've solved my:

- Environment control anxiety (long story)

- Strong anxiety of being late. Eradicated via specific methods that I fully understand and were specific to me: recollecting the actual source event through pre-sleep questioning, realization of specific anxiety behavior loops (just by talking about my routines) - long preparation and inability to do anything deep 4-5 hours before an appoinment, then few times intentional being late, then later unintentional, now I mostly don't care when it's not a big deal and not my need. Can just do my things up until a notification, or miss it completely.

- Depression with one heavy clinical episode without using pills. Basically I have found a key misconception in my life, work related, and adjusted thoughts radically to a real reality rather than old made-up (which was so comfortable to people I worked with).

Is that mumbo jumbo? Cause if it is, I couldn't care less how anyone calls it. That said, I can see how different people could fail to perform the methods and ideas involved. It really requires a skill of debugging and questioning yourself. Lots of people are too stubborn to even think about being less stubborn for just a minute, ime.

[megous]

Yes, it's still mumbo jumbo. And yes, I acknowledged your view in advance in the last paragraph.

Therapy school can have simplistic invalid theories of functioning of human beings, and still be useful to some people. Just like religion can be psychlogically useful to people but it's all nonsense. Whether some therapy works says nothing about rationales and theories behind it, in other words.

Whether you got better or not is irrelevant to the question of whether CBT views on how human beings function are valid.

[wruza]

I’ll try to take your point and let’s assume that it worked for me due to “therapothropic principle”. But I have three questions, all seem to be related.

1) It still involved structured work without which it couldn’t sort out on itself. Okay, this is still religious. I believed (wanted) that it should work, and it did. But we’re talking about modifying thinking itself here, beliefs themselves. That’s a strange area because how can you even avoid that? It’s sort of an incompleteness theorem thing. Like, a therapist changed me, but he can’t change those who don’t believe in change, while “belief” is a part of the… yadda yadda. Iow, how does one falsify a therapy, I guess?

2) Since we’re talking statistics and not structure (are we?), can it be that naturally only a part of population can be “cured”? Like, you can’t cure really bad medical cases either, and some of these are common. What if there’s a consistent set of prerequisites and “therapothropism” is not random? I guess this question is naive and there’s more to it, but can’t think of anything here.

3) In my experience, religion is much more shallow wrt to “you”, and is fixed. In a sense that cbt solutions are more “meta” and then get tailored to the personal events. While religion is usually an omnidude watching you and many others and rules and requirements are all the same. CBT actively refrains from judging and giving specific advices. Even from both-religious position, is it fair to put both on the same line?

[kirsebaer]

Exposure therapy for PTSD, phobias, and other anxiety disorders has lots of evidence from clinical trials. It is based on animal studies of “fear extinction”. You often see good results after 10-12 hours of focused therapy sessions.

[theGnuMe]

EMDR works as well.

[bowsamic]

Who cares, though? If I feel better it worked. And yes if I was in a mental health crisis and I thought prayer would help I’d definitely try it

[BizarreByte]

All kinds of pseudoscience makes people believe they feel better. Without proof therapy works it’s no better than homeopathy.

[yladiz]

How would you even measure the improvement of mental health objectively? You can’t just measure some levels of neurotransmitters and say “okay this is better, dopamine went from X to Y” because the patient may not feel any better.

It’s not like with a broken bone where you can look at an image of the bone and see that it has healed, you have to rely on what a person tells you, which is inherently subjective, and since a person can’t be cloned, you can’t have a “control” either.

[Hasnep]

Just because you can't think of a way to measure mental health doesn't mean a way doesn't exist. Scientists have ways of measuring subjective things in objective ways, they're not perfect but you can read the papers where they define them and then find other papers where they're useful.

[Towaway69]

Once it becomes measurable, then you can implant emotions into AI agents. Once you an AI identity that is emotionally indistinguishable from us non-AI identities and which is infinitely smarter than us, what purpose would we have left to fulfil?

[throw5959]

To have fun? No idea how AI changes it...

[NicholasGurr]

My purpose would remain unchanged. What you’re asking is almost the same as asking, “If a person exists who is better (smarter, stronger, more attractive) than you, what point is there in existing?” Because I experience life subjectively and would prefer to continue doing that.

[Towaway69]

You make a good point - purpose is very subjective and personal. Maintaining that purpose regardless of outside influence becomes the hard bit!

OTOH what happens if there is a whole species of beings who are smarter, stronger, … than our species? Would our collective purpose become to accept them as our betterment? Our personal purpose would vary greatly from fear to wonderment.

[brox]

Measurement of subjective wellbeing has a long history in healthcare and can be very useful for both treatment and research; see e.g. pain scales: https://en.wikipedia.org/wiki/Pain_scale

[bawolff]

If you exclude people with diagnosiable mental illness, it seems like it would be hard to come up with an objective definition of therapy "working" beyond patient self-report. Its not like its a broken leg where you can test how well they walk.

If the patient is happier, does it matter if there isn't an objective measure.

[BjoernKW]

> unless you're being treated by a psychiatrist

Quite to the contrary, while there is plenty of evidence of specific types of therapy yielding actual results, there's often very little evidence of the methods commonly applied by psychiatrists (i.e. medication) to be actually beneficial.

In fact, some types of psychiatric drugs (with SSRIs probably being the worst offender) are actively harmful, while evidence of their presumed positive effects is vague and ambiguous at best.

[m90]

> unless you're being treated by a psychiatrist

What tools for "measurement of success" does a psychiatrist have that aren't available to a therapist?

[0xDEADFED5]

if you learn things from therapy that improve your life then i guess it has worked.

i imagine success stories tend to self-select as well. if you go to therapy in the first place it means you're admitting a need and willingness to change.

if a person thinks they know everything and can't benefit from therapy then they're probably unlikely to gain anything from the experience.

[aleph_minus_one]

> if you learn things from therapy that improve your life then i guess it has worked.

To give a very "Hacker-Newish" snappy remark:

So, if the therapy teaches you programming, and you thus get a much better job improving your life, you'd claim that "learn to program" is a suitable therapy? ;-)

[bawolff]

I'd add the caveat that therapy is supposed to be meta (teach you about yourself).

Learning to program isn't therapy. Learning how to learn to program might be.

[aleph_minus_one]

> I'd add the caveat that therapy is supposed to be meta (teach you about yourself).

Then learning to program is therapy. :-D

I am serious: Learning (very abstract) mathematics, and programming, taught me an insane amount about myself:

- how I attempt to model and structure the world

- how better models of very diverse phenomena look like

- what such insights mean for my life

- ...

[drewcoo]

>> I'd add the caveat that therapy is supposed to be meta (teach you about yourself).

> Then learning to program is therapy.

Are you trying to say that learning to program is not learning logic?

[theGnuMe]

In the sense that you learned to reprogram your mind.

[lelanthran]

> if you learn things from therapy that improve your life then i guess it has worked.

But this is true of things that we already know don't work - aromatherapy, homeopathy, acupuncture.

The evidence for therapy is neither more nor less than the "evidence" for things we already know fails double-blind studies.

[mikebonnell]

For CBT therapy, the evidence strongly suggests that it does help in the vast majority (but not all cases). More research is still needed to your point, and we can acknowledge the research done so far has provided evidence in favor.

"The effect's associated prediction interval −0.05 to 0.50 suggested CBT will remain effective in conditions for which we do not currently have available evidence. While there remain some gaps in the completeness of the evidence base, we need to recognise the consistent evidence for the general benefit which CBT offers." https://pmc.ncbi.nlm.nih.gov/articles/PMC7856415/

"Eleven studies compared response rates between CBT and other treatments or control conditions. CBT showed higher response rates than the comparison conditions in 7 of these reviews and only one review reported that CBT had lower response rates than comparison treatments. In general, the evidence-base of CBT is very strong. However, additional research is needed to examine the efficacy of CBT for randomized-controlled studies." https://pmc.ncbi.nlm.nih.gov/articles/PMC3584580/

[disgruntledphd2]

How would one double blind a traial of one or more therapeutic methods?

[mikebonnell]

Honestly, I don't think it's possible.

[disgruntledphd2]

Correct! And even if it was, what's the active ingredient of therapy?

[nick__m]

We know how aromatherapy, homeopathy and acupuncture works, it's called the placebo effect. Now maybe you meant to say: we don't know how the placebo effect works.

[freen]

There are standardized diagnostics and measurements of severity for many, if not most, psychological disorders.

There is an extremely large body of evidence that therapy substantially improves psychological disorders as measured by these diagnostics and measurements.

What are you talking about?

[beardedwizard]

The comments claiming no evidence are totally baffling, there are mountains of studies with data. This thread scares me with the amount of misinformation being aggressively pedaled.

[rmbyrro]

have you ever done therapy for a deep emotional issue? your comment sounds like you've never

[lelanthran]

> have you ever done therapy for a deep emotional issue? your comment sounds like you've never

Yes. With two different therapists. Also people close to me have been.

I see no difference between the results from therapy and the results from prayer and a belief that aliens with UFOs made things better.

[wruza]

People report that you may skip over dozen of therapists until you find the one. They just suck, cause it's an area filled with uh-huh listener scam for your $$$.

[BizarreByte]

“Therapy doesn’t work” is always refuted by this claim that you just haven’t found the right one yet.

It’s tiring honestly, you are not allowed to criticize therapy in the current year.

[wruza]

Not the right one, but the one who actually practices it instead of giving vague mom/dad’s advices.

always

That should mean something. But I agree that people may omit important details about the structure of their therapy work, so it may not feel convincing. To make sense of what I mean by therapy, look at my recent comment history. It does not boil down to the “emotionally right” one. I’m quite different from and not really emotionally connected to mine, for example, although I respect his professional skills very much.