Psychiatry - No Science, no cures video

[Luba]

http://www.associatedcontent.com/vid..._no_cures.html

What do psychiatrists themselves think about Psychiatry, for real?

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A real eye-opener from phychiatrists themselves!

[Vautrin]

I did not see it, but one of my professors, who is one of the top clinical psychologists, told me that the real success rate of medication is dramatically low, and the same holds for psycho-therapy.

The cases that are cured most easily are the easiest of cases - and have a reasonable chance of curing itself over time.

This is not just a problem for people with mental illnesses and addictions. But also for people who need medication to regulate blood pressure, and what not.

Even cognitive therapy has limited value - because once you encounter a situation that was not accounted for in therapy, chances are dramatically high, that the client returns to his old patterns.

[Meanon]

CBT has a strong evidence base for effectiveness across a range of problems. For depression it's a little more effective than drugs and it works about 60% of the time. Of those 75% will avoid relapse within 2 years if they had CBT or keep taking drugs. The risk of relapse with drugs is much higher if you stop taking them.

I'm amazed by how successful it is. I've not had one person I've worked with that's not been able to completely transform their lives, most have chronic, sometimes life long problems. I have the luxury of delivering as many sessions as are needed. Sometimes it's 6, sometimes 26.

On the NHS, it's often 6. If you get someone with a chronic problem, unless they are increadibly receptive to the method, you can get them feeling normal in 6 but they will relapse, or the problem will re-appear in a different way. It's because you've only worked on surface stuff, their core beliefs are still the same.

That's fine for some people, you don't need to go looking far for the cause of a spider phobia, but most need 10-12 sessions or more with a fair chunk on core beliefs to avoid relapse.

[Vautrin]

CBT and other forms of therapy often require a certain intellectual sophistication, in order for people to actually understand what is demanded. Likewise the most hopeless cases are often not considered (they would need a lot of sessions); natural relapse is not considered, and neither is the placebo effect. All these effects add to a relatively high success rate.

Similar problems exist for sleeping medication. Although chances that a certain medication is effective are quite high, but if you would correct for natural relapse and placebo effects the percentages would be a lot lower, sadly.

[TKDLady]

I guess I will just keep trying to heal myself when I feel down.

[Vautrin]

It is really ailment dependent whether or not therapy or medication is effective or not, tkdlady. And what types of therapy or medication work best, is also dependent on the exact ailment.

For depression it is generally better to seek professional help (recovery rates are good), but for some ailments gains are relatively small.

[Luba]

Originally Posted by tkdlady

I guess I will just keep trying to heal myself when I feel down.

I pray first....and I work on myself, too!

[TKDLady]

I do that too.

[Meanon]

CBT and other forms of therapy often require a certain intellectual sophistication, in order for people to actually understand what is demanded. Likewise the most hopeless cases are often not considered (they would need a lot of sessions); natural relapse is not considered, and neither is the placebo effect. All these effects add to a relatively high success rate.

On the first point, it's this assumption that resulted in therapy only being offered to certain groups of clients, often there were class based predjudices about intellectual ability inferred from level of articulation or education.

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.

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 doesn't suit every problem or every person. Some people need a much less focused, more dynamic approach such as psychodynamic therapy.

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.

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. They set guidelines for Doctors. Based on the evidence, they recommend CBT for many common mental health problems and the government is changing service delivery as a result, providing greater access to CBT. They are trying out the new structure now, you can read the original report, if you are interested:

http://www.strategy.gov.uk/downloads.../mh_layard.pdf

[Meanon]

PS Prayer and self help are good too!

[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.