Cognitive behavioral therapy for schizophrenia, bipolar or major depression is about as effective as the therapeutic equivalent of a sugar pill.
From the University of Hertfordshire: The authors noted that not a single trial employing both blinding and psychological placebo has found CBT to be effective in schizophrenia and surprisingly few well-controlled studies of CBT in depression.
“The results of this review are important because in March NICE re-approved CBT for use in all people with schizophrenia. The Government is also investing millions of pounds to provide CBT for depression and anxiety in 250 dedicated therapy centres across England,” said Professor Laws. “Yet the evidence here is that the effectiveness of this form of therapy may be less than previously thought, to the point of being non-existent in schizophrenia.”
Lynch D, Laws KR, McKenna PJ., “Cognitive behavioural therapy for major psychiatric disorder: does it really work? A meta-analytical review of well-controlled trials, ” Psychol Med. 2009 May 29:1-16 doi:10.1017/S003329170900590X
Cognitive behavioral therapy gets mixed reviews — there are few controlled trials to demonstrate its effectiveness in anything.
That’s what struck me about the article in the NYT recently about treating Borderline Personality Disorder. The premise for treating patients with borderline personality is that they consent to treatment.
Personality disorders are like any other kind of organic problem, some are treatable, some are not. Because of the neural wiring, my guess is that many of those who could be classified as having a personality disorder don’t believe they have anything wrong with them, and further, the rest of the world is just a bunch of dupes, and it’s the others who have problems. This is the natural outcome of not having a moral center: hurting others isn’t a problem for you. It’s only a problem for the others.
Yet therapy is popular. By far, the people who go in for therapy do so because they are dealing with a crazy person not because they are the ones who are especially crazy.
So, how do you perform therapy on someone who is dealing with a crazy person? The best therapy is get rid of the problem, but if you are the therapist, you have no way to do that. Plus, if the person actually ditches the crazy family/significiant other/boss, then you lose money. Their problem goes away without your help. If you can’t get away from the crazy person, the next best thing is to understand that they are crazy, not you (well, you might be too, but at least understand it all). This is a matter of education, not therapy, particularly.
Of course, shamelessly plugging this blog, we have lots of education about dysfunctional behavior. Free! We are a public service, thank us later, and if you would like to put our name on a park bench or something, we won’t object. “Neurological Correlates — For every twisted thought, there’s a twisted molecule!” Hey, catchy!
As to CBT. . . people who have had crimes committed against them by someone with a personality disorder — whether in their family or in the workplace — are the same as crime victims anywhere, traumatized. (Read the NYT comments here). Cognitive behavioral therapy via videoconference is showing some promise for that.
Germain V, Marchand A, Bouchard S, Drouin MS, Guay S.Effectiveness of cognitive behavioural therapy administered by videoconference for posttraumatic stress disorder. Cognitive Behaviour Therapy, Volume 38, Issue 1 March 2009 , pages 42 – 53
Blanket disclaimer: I’m not a therapist or in the medical profession, and nothing in this blog should be taken as any kind of advice for any aspect of your life, least of all your health, mental or otherwise. Sorry for this, but you know how it is.
It’s nice that you have put the case so succinctly.
However, as you no doubt know, this viewpoint is far from unanimous, and not at all fashionable at the moment, as the “pills: threat or menace?” school of thought appears to be ascendant again. Emotions are an emotional topic, you could say, even though everything I see and read in the field of neurochemistry leads me to believe that the way you have characterized the situation is right on the mark.
DH, thanks — “emotions are an emotional topic”
Can I steal that line? LOL.
I dunno where the anatomy/genetics/physiology/environment thing will end up, but I’d like to see some kind of personalized brain mapping, like a personal genome. I mean, it’s information, I don’t know if it’s helpful or useful, but at least see it and decide.
The “pills: threat or menace?” crowd is legit, too.