Progress in Psychiatry and Psychotherapy: The Half-Full Glass

Here is an excellent introduction to cognitive-behavioral therapy (CBT) for depression, centering on a Stanford psychiatrist named David Burns. I was especially interested in this:

[Burns] currently draws from at least 15 schools of therapy, calling his methodology TEAM—for testing, empathy, agenda setting and methods. . . . Testing means requiring that patients complete a short mood survey before and after each therapy session. In Chicago, Burns asks how many of the therapists [in the audience] do this. Only three [out of 100] raise their hands. Then how can they know if their patients are making progress? Burns asks. How would they feel if their own doctors didn’t take their blood pressure during each check-up?

Burns says that in the 1970s at Penn [where he learned about CBT], “They didn’t measure because there was no expectation that there would be a significant change in a single session or even over a course of months.” Forty years later, it’s shocking that so little attention is paid to measuring whether therapy makes a difference. . . “Therapists falsely believe that their impression or gut instinct about what the patient is feeling is accurate,” says May [a Stanford-educated Bay Area psychiatrist], when in fact their accuracy is very low.

When I was a graduate student, I started measuring my acne. One day I told my dermatologist what I’d found. “Why did you do that?” he asked. He really didn’t know. Many years later, an influential psychiatrist — Burns, whose Feeling Good book, a popularization of CBT, has sold millions of copies — tells therapists to give patients a mood survey. That’s progress.

But it is also a testament to the backward thinking of doctors and therapists that Burns didn’t tell his audience:

–have patients fill out a mood survey every day
–graph the results

Even more advanced:

–use the mood scores to measure the effects of different treatments

Three cheap safe things. It is obvious they would help patients. Apparently Burns doesn’t do these things with his own patients, even though his own therapy (TEAM) stresses “testing” and “methods”. It’s 2013. Not only do psychiatrists and therapists not do these things, they don’t even think of doing them. I seem to be the first to suggest them.

Thanks to Alex Chernavsky.

3 Replies to “Progress in Psychiatry and Psychotherapy: The Half-Full Glass”

  1. Here’s another interesting article about psychotherapy. Science writer John Horgan discusses the “Dodo Effect”:

    “Dodo” refers to an episode in Lewis Carroll’s fable Alice’s Adventures in Wonderland in which Alice and other characters wash up onto an island. There they encounter a dodo bird who persuades them to race around the island. The dodo finally announces that the race is over and proclaims, “Everyone has won, and all must have prizes!”

    Over the last few decades, the psychologist Lester Luborsky of the University of Pennsylvania tested the dodo effect by comparing different psychotherapies, including psychoanalysis, cognitive-behavioral therapy and interpersonal therapy. His research confirmed that all methods are equally helpful to patients. […]

    Other prominent researchers—notably Jerome Frank, a psychiatrist at Johns Hopkins—realized that the dodo effect undermined the validity of all psychotherapies. Frank’s own research corroborated the dodo effect. In one study, he and colleagues provided depressed patients with three treatments: weekly individual therapy, weekly group therapy and minimal individual therapy, which consisted of just one half-hour session every two weeks. “To our astonishment and chagrin, patients in all three conditions showed the same average relief of symptoms,” Frank wrote…

    See: “Cybertherapy, placebos and the dodo effect: Why psychotherapies never get better

  2. Filling out short mood surveys is pretty common when using CBT in the NHS in the UK, and I’m assuming pretty much anywhere that funders want to see effectiveness data (e.g. 42nd Street in Manchester near where I live which is a charity providing free counselling for young people). My experience of private therapists/counsellors is that they tend not to, though.

    Seth: Are the mood surveys daily? Or just when you come to offices for therapy? My guess is the latter.

Comments are closed.