Відео

Summary Oliver James critiques clinical psychology’s reliance on CBT and its commercialization, emphasizing the importance of addressing root causes of mental health issues. Highlights 🎓 James reflects on his involvement in the happiness forum, highlighting its political significance. 📈 He discusses the rise of CBT and its perceived efficacy in the mental health field. 🧠 James argues that many studies question the long-term effectiveness of CBT. 📚 He critiques Richard Layard’s views on happiness and mental health metrics. 💔 James emphasizes the impact of socio-economic factors on mental health. 🔍 He advocates for a deeper understanding of mental illness, beyond genetic predispositions. 🤝 James calls for a more relational approach to therapy, focusing on emotional connections. Key Insights 📊 Critique of CBT: James argues that CBT lacks long-term effectiveness, citing studies that show no significant difference in outcomes compared to those who did not receive the treatment. This raises questions about the validity of CBT as a standalone solution for mental health issues. 🏛 Political Origins of Happiness Metrics: The establishment of the happiness forum was rooted in political agendas, reflecting how mental health discourse can be influenced by broader socio-political contexts. 🔬 Need for Comprehensive Understanding: James highlights the necessity of addressing the socio-economic factors that contribute to mental illness, rather than solely focusing on individual treatment methods, thus promoting a more holistic view of mental health. 🧬 Criticism of Genetic Determinism: By disputing the notion that mental illness is primarily genetically determined, James emphasizes environmental and relational factors that shape mental health, advocating for a paradigm shift in understanding mental disorders. 🕊 Relational Approach to Therapy: James promotes the importance of emotional connections in therapy, suggesting that fostering a supportive therapist-client relationship can lead to more effective outcomes than traditional CBT methods. 📖 The Role of Evidence: He stresses the significance of relying on robust scientific evidence rather than anecdotal claims or simplistic happiness metrics, advocating for a more rigorous approach to mental health research. 🌍 Vision for Future Mental Health Services: James envisions a national talking therapy service that prioritizes psychodynamic approaches, aiming to address the needs of families and children, which he believes is essential for a healthier society.

Summary Jonathan Shedler critiques the concept of evidence-based therapy, arguing that it often misrepresents the effectiveness of brief, manualized treatments like CBT. Highlights 🧠 Evidence-based therapy has evolved from “empirically validated” to a marketing term. 📉 The term is often misused, implying that only manualized CBT is effective. 🔬 Original research often shows minimal benefits for evidence-based treatments. ❗ Many patients are excluded from studies, skewing results. 📊 The actual effectiveness of these therapies is often overstated. 📖 The American Psychological Association concludes that evidence-based therapies lack superiority over other forms of therapy. 💡 Critical reading of research is essential to understand true efficacy. Key Insights 🧐 Misappropriation of Evidence: The term “evidence-based” has shifted from a call for critical thinking to a branding tool for specific therapies, particularly manualized CBT. This evolution reflects a departure from the original intent of promoting comprehensive treatment approaches. 📊 Questionable Research Practices: Shedler highlights that many studies exclude substantial patient populations, leading to inflated claims about treatment effectiveness. This exclusion means that results do not accurately represent real-world outcomes. ❓ Statistical vs. Clinical Significance: The distinction between statistical significance and clinical relevance is crucial. A statistically significant result may not translate into meaningful improvement for patients, raising questions about the validity of claimed benefits. 🏥 Publication Bias: Evidence suggests that studies showing positive outcomes are more likely to be published, leading to a skewed understanding of therapy effectiveness. This bias obscures the reality of treatment outcomes for many patients. 📝 Need for Critical Evaluation: Shedler urges clinicians and patients alike to critically evaluate research studies rather than accept claims at face value. This practice could reveal discrepancies between reported outcomes and actual efficacy. 📉 Enduring Benefits of Alternative Therapies: Shedler points out that psychodynamic therapies may offer benefits comparable to or greater than those of evidence-based therapies. This challenges the prevailing narrative that prioritizes manualized treatments. 🔍 Call for Informed Choices: Patients should be informed about the limitations and realities of evidence-based therapies to make better choices regarding their treatment options, emphasizing the need for transparency in therapy efficacy.

the shed never disappoints. what an spokesman!

all i am hearing is a defense of psychodynamic therapy. I don't care about your little psychodynamic ego. Does therapy work?

Great lecture, thank you!

Great lecture, thank you!

CBT - soft thought control.

The latest N.I.C.E. recommendation is that menopausal women are given CBT. Goodness gracious me, when will they accept that nutrition is a major factor in all health conditions?

Excellent, excellent presentation.

" MARKETING " CORPORRUPTION 24 / 7 DRUG ADS ( LICENSED MALPRACTICE ) " OBJECTS GET NO CARE COUNTED for PROFIT " ( SALES MASTER DEGREE ) FALL to FELONY CONTEMPT !!!

this is absolutely brilliant

7

That pretty much matches my conclusion on CBT- the follow ups are far too short to indicate a genuine, substantial effect. It’s cheap, quick and shallow.

They have it backwards. Thoughts don't create emotions. Emotions create thoughts. If cbt is so effective, why is the mental health crisis worse than ever?

Thank you for uploading this; incredible value for someone like me who is working in clinical psychology and psychotherapy and training as a psychoanalytic/psychodynamic psychotherapist. There's a lot to think and reflect on and research.

It's a shame that such an important medical presentation was repeatedly interrupted by a broken sound system. I hope the conference organizers will pay closer attention to the sound and video quality in future meetings.

These excellent books include critiques of CBT: “Cultures of Healing” by Robert Fancher, “The Death of Psychotherapy” by Donald Eisner, and “The Undiscovered Mind” by John Horgan. Also check out “The Myth of Psychotherapy” by Thomas Szasz.

Jonathan I don’t know if you’re going to read this but you just saved my life. I am being cancelled by CBT and DBT psychologists In very unkind Waze. I am being told of the therapy I’ve done for 37 years was mistaken and relevant even though I know as a result of discussing this with clients that I have done extremely good work. Thank you so much for your presentation and your willingness to think critically and present facts. Thanks again

Very interesting. It seems clear that the marketing for EBT is, ironically, I’m conflict with the evidence. I think that that’s clear to anyone who has looked into it, and this talk presents some good solid examples of the conflict. I do think that some of the math is off in places, and I’d be happier to have a stronger comparison, such as examples of how many people drop out of psychodynamic therapy, return for the same issue, shown improvement and are completely cured.

Really excellent, thank you.

Outstanding analysis Mr Shedler!

CBT: yes I am not a robot! And it was completely awful. Did not take into consideration ME as a human being. I never went back. Instead I went to psychotherapy which allowed me to ask the questions I has always wanted to ask.

But people do practice like this in the real world, avoiding presenting issues, neglecting their patients, and then they lie about it afterwards. They are never accountable.

Charleton

In the US, it is primarily academic psychologists who favor CBT. Clinical psychologists are, by and large, much less enthusiastic. The salesmen for it here are academia, psychiatrists, and insurance carriers. NOT CLINICAL PSYCHOLOGISTS.

Rubbish

CBT is a scam, doesn't work and will go the way of all scams in time.

I have a strong suspicion that Judith or Tim Beck was working the sound at this conference

Yikes

I applaud your presentation, very refreshing. It reminded of my training under your stewardship. Mostly valuable training.

Beautifully presented.

Now health care professionals are pushing "affirmative care," insisting that children will kill themselves if they are not affirmed. Encouraging children to disassociate from themselves; can't think of anything more counter to good mental health.

CBT looks cheaper and faster to insurance companies.

My experience was: My first therapist said that I was now successfully treated. One Week (!) later, I was sent to the second CBT Therapists and the BDI test showed the same results. I told them that the data showed that CBT did not work at all. They completely ignored my criticism.

Great talk and topic. 12:30 "The language use in literature, and journal abstracts, are mostly without caveats..." Is there strong evidence for this? It would seem likely and damning that in abstracts, important trial population details will be minimized, and overlooked by the type of "evidence gathering" that doesn't go beyond abstracts... But in the body of any half-decent, peer-reviewed paper, (industry sponsored or not) the methods section has their inclusion and exclusion criteria spelled out, usually more than half decently. I'm basing this observation on my stint as a medical writer sifting through papers in the pharmaceutical industry. It's a strong, damning point that Dalal makes but one that I would like to see backed up.

Psychodynamic psychotherapy is definitely much more effective; CBT is popular largely because it also happens to fit 3rd party reimbursement model with time limited therapy. CBT is also friendlier for data analysis and has the veneer of being more scientific. Evidence based practice particularly in psychotherapy is a way of branding "manualized" therapies since it is favored by insurance companies and people who feel psychotherapy could gain respect with CBT. CBT is very superficial as it lacks depth and connection with the patient.

IAPT is a job creation scheme for not very good therapists and an enrichment scheme for senior managers who run these mickey mouse schemes.

great stuff, very generative and named some things that had been on my mind asa training music therapist in Australia . just as an side it'd be worth popping ur name somewhere in the description for easier referencing, thanks

Apart from CBT, isn't this criticism valid for all social sciences using statistical tools for research??

Thanks for the talk Farhad. I'm a clinical psychologist primarily working with CBT, and yes, in a mostly 'third wave' way. Your talk contains many valid criticisms (eg CBT is indeed oversold sometimes and in some areas needs to be re-evaluated), however I'm concerned that there are some straw men here, and this seems common in critiques of CBT. They include (as I interpret the talk): *Second wave (as opposed to third wave) CBT is all about control* There is a risk that poor CBT collaborates with people in reinforcing unworkable attempts to control emotions and cognitions. However, the core of CBT for symptoms like panic attacks and OCD is that we need to help the person let go of unworkable control strategies and realise that the things that they fear happening, are not going to happen. And it then takes behavioural change to get a long term cognitive change. That said, the focus in third wave CBT makes this much more explicit and also in a way that is trans-diagnostic. I think this has been done because often second-wave CBT was done badly by people (for example) who did not understand the underlying principles. *CBT involves an unthinking acceptance of diagnosis and simplistic chemical imbalance ideas.* In my experience the vast majority of clinical psychologists have serious doubts about the utility of diagnostic systems and also reject the disproven or unsupported chemical imbalance theories (eg serotonin deficit causing depression). Indeed, some may go too far in the other direction, unthinkingly tearing down diagnoses that people have found personally useful. The rise of trans-diagnostic models also argues against psychologists being fixed to diagnosis (or more cynically demonstrates the need for academics to generate more models). *CBT as the equivalent of drug treatment.* Well yes sometimes, and this is shown up in some of the RCTs that we run. It's not really how most of us think of it though, I think clinical researchers felt they had to copy the drug study methodology to get taken seriously and get published. *Some other non-straw-man thoughts* *RCT problems.* Yes, important. However psychologists, according to the best of my knowledge, have been much better at publishing their trials than drug companies, and their is much less evidence of publication bias (and no examples that I know of, of the worst kind of deception that B Goldacre reports from pharma). We still have MUCH work to do in teaching the essential importance of pre-registration, trial registries etc. Sometimes it seems like the old generation need to retire first. I've never seen a CBT trial that threw away 80% of the original sample! -24% (extra people who had 50% reductions in symptoms) That's the degree of additional benefit of CBT over treatment as usual with an antidepressant - which is pretty good if true. Of the TAU effect, normally placebo or regression to the mean accounts for about 90% of drug treatment. By standards of treatment for depression (which is hard), that 24% extra is not bad (a pretty good separation from placebo+doctors chats+drug treatment). -CBT has been shown to help. (RCP quote) Yes it has, and it's highly effective for things like phobias, panic attacks, PTSD and OCD, and sadly rather less effective for depression and bipolar (obviously I'm not quite ready to abandon the use of diagnostic terms - just to hold them lightly). We're still working on how to make it more useful, and yes, that does involve picking up approaches from other therapies (that have sometimes been maligned by CBT therapists). I work in Ecuador, and many of my clients have seen multiple therapists who don't have the foggiest how to effectively treat people with OCD symptoms, that to me, is a crime when there are effective treatments. *Teasdale Paper (2000) * I think your criticisms are in general, very valid and I understand your anger at the way the paper presents the data. Most importantly, mindfulness may well have negative side effects (long ago in research I met someone who told me that mindfulness had triggered a manic episode). I teach Questionable Research Practices (QRPs) and certainly see some here. In our CBT doctoral training, we were invited to tear apart this very paper, and as I remember had very similar reservations. I'd add the issue that the subset analysis should be played DOWN, not UP, as I don't think it was a primary hypothesis. I don't remember if the paper had actual p-hacking or if it was possible to even tell (without trial pre-registration it is actually not possible to be certain). Just a few thoughts on the paper. *Prevent vs Reduce* I'm sorry, but this seems like silly semantics, and you make a big deal of it. At an individual level a therapy may *prevent* a relapse. At a group level, it's only ever going to reduce the probability, unless it was a 100% effective intervention, which does not exist. Anyone reading these papers should understand that. Take vaccines as an analogy: you prevent disease in some, you reduce the overall infection rate. *Commonness of relapse.* Yes, Teasdale and other CBT researchers FULLY accept that CBT is not a panacea, and most of us really want to improve the response in depression - hence trying new approaches. We acknowledge that relapse is too common, especially in those with multiple prior episodes... hence the trial of MBCBT. *1/2 people extra out of 10 had a prevention of relapse* IF TRUE, that would still be welcome. *39% reduction* Come on! Your statisticians knew exactly how to calculate it, and you've done it yourself, although you've not explained it in the standard way. (66-40)/66*100 = 39%. That's how you calculate a percentage difference. It's a 39% improvement. It's a pretty normal way or reporting results (it's not muddled, it's GCSE maths). If I can run at 10mph and you can run at 12mph, you are 20% faster than me, but 2mph faster, it's the same thing. That said, the other way of reporting the results is equally valid, it might be more understandable, but I'm not sure - there are many better ways of reporting the results. I like the 2 out of 10 version for example.

Great lecture! CBT is fraud!

CBT is a fraud. They Focusing instead ! It really works !

I have had several clients who have not benefited CBT but have really benefited from Focusing -Oriented Therapy ! Unlike CBT it really is effective !

Cognitive therapies are barely effective and frequently coercive leading to deepening the pathology while superficially offering the patient verbal defensive arguments. In the end nothing is healed excepting the lightest symptoms which respond to many other therapies. These cognitive approaches are frequently the very opposite to how real healing and effective therapies work. Moreover the claims are just marketing and no comparisons were done to compare these cognitive so called approaches to deeper and affect based experiential approaches that effect better more lasting relief and even cures for some diagnoses. There are apparently political and other non scientific motives for the heavy marketing of cbt as a real therapy or more stunningly as the main "evidence based" therapy. This is pure fiction

Outstanding!

Very informative talk and delivered excellently. Can I point out (I might be being pedantic but given that this is an important presentation spelling mistakes should be eliminated) your spelling and pronunciation of Asthma is not "Astha-ma".

I believe the delivery of CBT is partly to blame, not necessarily the modality.

At 50 min: he cites study saying that benefit was inflated by 75%, but then turns this into the claim that the benefit received was only 1/4. But that would require an inflation of 300%. 75% inflation is not even double. Also, I think the study is "Does Publication Bias Inflate the Apparent Efficacy of Psychological Treatment for Major Depressive Disorder? " Or if not, this one is by the same group and is more recent (given pub date). But it seems to claim effect size increase drops by only 25% when unpublished studies are included. That is an inflation of only 33% (Reported effect size .52, total effect size .39). I would appreciate seeing some clarification of this point. It sounds very fishy to me but perhaps I don't understand what he is saying (For starters effect sizes I imagine can't be treated simply on a ratio scale, although that is how the original researcher does it also. But an effect size of .52 compared to .38 doesn't sound like only 1/4 the benefit received!)

and are we nearly there yet...?.ha ha 😘✌

Finally CBT is exposed foe what it truly is, or more importantly what it isn't.