[Vautrin]

Originally Posted by Meanon

As it has become more widely available, luckily this is no longer the case. It takes some people longer than others to access their cognitions. This could be due to level of introspection, but often it's also to do with the severity, number and type of problems. Those who find a cognitive approach difficult at fist respond well to a more behavioural focus at first, until they are at a point where cognitions may be accessed. I've seen the approach work with people with learning difficulities, with children.

Absolutely! It seems to be the case . However, health care insurance only allows for a limited amount of sessions for most people. Hence, effectivity is operationalised in measurable quantities, after for instance 9 or 12 sessions. For people who find it hard to access their cognitions, the therapy may not be too effective. Simply because it must be terminated after 9 or 12 sessions.
Although for some problems 12 sessions could be more than enough (spider phobia). Also, what constitutes "recovery"? Definitions seem to vary substantially, thus allowing for 10s of percents difference between one type of therapy, compared to another. Even within one country (I read a couple of reports and stats in the Netherlands, from roughly the same year).

CBT is used here in hospitals and by community mental health teams to treat the most chronic, with medication as well if the person agrees but often they don't. I am new to this area of work but have used it to help what some would call hopeless, life long cases with 20+ suicide attempts, people with borderline personality disorder.

It is a fascinating subject why some people don't respond well to CBT or an other form of therapy. That is why it is interesting to note, that if a person relapses into his addiction, what exactly caused it.

If a trial doesn't consider natural relapse and the placebo effect then it wouldn't make the grade and be published as a randomised controlled trial. the evidence base for CBT is based on the same methodology as for the introduction of a new medicine.

I know. But the methodology for the introduction of new medicine seems to be flawed too. Part of the problem cannot be accounted for: by drawing a sample from the population, the behavior of the sample changes; but you cannot know in what direction, and with what magnitude exactly. And then there are the self-selection mechanisms. And the assumption that the control group has an equally high trust in its treatment, compared to the "real" group. Which is not a problem in the case of sleeping pills. But if you are talking about Zyprexa in high doses, the matters become a bit more murky . You would actually need to convince controls to quit driving (same as the Zyprexa condition), for the period they are taking the control drug.

Birth-control pills seem to have some unsuspected side-effects for small groups of people. Viox, was also withdrawn after side-effects popped up, which were deemed unacceptable. But unlike medicine, psycho-therapy does not come up with weird side-effects after an x-number of years.

In the UK we have the National Institute for Clinical Excellence whose job it is to systematically review all the evidence and make recommendations for treatment, including drug treatment.

And that is good; we have similar institutions. However, assuming that in the UK the same happens as in the Netherlands, the trend is to forced short-term therapy, unless the patient pays for the additional sessions. And it is not the case, or at least not necessarily the case, that the therapy that is most effective short-term is also the most effective long-term. There is quite a bit of tension there.

I will read the link hopefully on Wednesday. On election day.