Book

CBT: The Cognitive Behavioural Tsunami: Managerialism, Politics and the Corruptions of Science

Authors:
  • Institute of Group Analysis

Abstract

Is CBT all it claims to be? The Cognitive Behavioural Tsunami: Managerialism, Politics, and the Corruptions of Science provides a powerful critique of CBT’s understanding of human suffering, as well as the apparent scientific basis underlying it. The book argues that CBT psychology has fetishized measurement to such a degree that it has come to believe that only the countable counts. It suggests that the so-called science of CBT is not just “bad science” but “corrupt science”. The rise of CBT has been fostered by neoliberalism and the phenomenon of New Public Management. The book not only critiques the science, psychology and philosophy of CBT, but also challenges the managerialist mentality and its hyper-rational understanding of “efficiency”, both of which are commonplace in organizational life today. The book suggests that these are perverse forms of thought, which have been institutionalised by NICE and IAPT and used by them to generate narratives of CBT’s prowess. It claims that CBT is an exercise in symptom reduction which vastly exaggerates the degree to which symptoms are reduced, the durability of the improvement, as well as the numbers of people it helps. Arguing that CBT is neither the cure nor the scientific treatment it claims to be, the book also serves as a broader cultural critique of the times we live in; a critique which draws on philosophy and politics, on economics and psychology, on sociology and history, and ultimately, on the idea of science itself. It will be of immense interest to psychotherapists, policymakers and those concerned about the excesses of managerialism.
... Boaventura afirma que o modelo científico fechou as portas para muitos outros saberes sobre o mundo, pois o conhecimento científico moderno reduziu o suposto diálogo experimental ao exercício de uma preponderância sobre a natureza. O conhecimento científico, fundado na matemática, é um rigor que quantifica, mas, ao quantificar, acaba por desqualificar os outros fenômenos (Santos, 2006 conflito, como se buscasse transpor as distâncias do abismo criado pelo paradigma dominante" (Neubern, 2001, p. 243 É precisamente aí, salienta Dalal (2018), que houve uma distorção nos ideais iluministas, pois várias disciplinas, como das ciências humanas, passaram a buscar evidências, baseando-se nos modelos da natureza. Para ele, o que ocorreu foi justamente o contrário: as ciências humanas buscavam o conhecimento para ganhar a autonomia, mas, ao submeterem sua busca às leis mecanicistas próprias das ciências naturais, as questões do ser humano passaram a ser vistas partindo das leis da natureza. ...
... Neste sentido que Dalal (2018), afirma ter havido uma hiper-racionalidade em relação ao ser humano e seu comportamento. Um paralelismo entre o método das ciências naturais e a busca de evidências no comportamento humano, a tentativa de universalizar o método das ciências naturais como único conhecimento aceitável para as ciências. ...
... Para Kant, assim como para os pensadores modernos, o universo funciona de maneira mecânica pelas relações de efeito e causa. São destas relações de efeito e causa, como afirma Dalal (2018), que nasce a previsibilidade apregoada nas ciências e aplicada nas psicologias baseadas em evidência. ...
Article
O presente artigo visa a discutir os paradigmas do pensamento moderno na psicologia e a possibilidade de uma nova compreensão, perpassando os horizontes da hermenêutica filosófica de Paul Ricoeur. Paradigmas são como modelos para determinada prática científica em dado momento histórico. Baseando-se no movimento de um novo paradigma para a psicologia, indo para além das epistemologias lastreadas nas ciências naturais, vislumbra-se a identidade narrativa como base epistemológica, como um caminho na psicologia da perspectiva da psicoterapia. O pensamento moderno, com suas múltiplas contribuições para as ciências, pode se tornar uma visão de mundo obsoleta, diante da complexidade descortinada pelo pensamento novo paradigmático nos tempos contemporâneos. Nesta perspectiva, a psicologia é convidada a ampliar seus horizontes para outros caminhos, capazes de responderem aos desafios impostos pelas concepções de subjetividade vigentes. É nessa linha de raciocínio que a identidade narrativa pode ser uma possibilidade para abordagens psicoterapêuticas.
... This decline has been notably induced by international questioning of the efficiency of psychoanalysis and psychoanalytic psychotherapies (Mills, 2015;Rabeyron, 2020;Visentini, 2021). It was initially driven by the generalisation of evidence-based medicine, associated with a social-economical and positivist ideology of psychological support (Dalal, 2018;Jackson & Rizq, 2019;Rabeyron, 2019). This critique has led to a worldwide decrease in the use of psychoanalytical concepts and therapeutic techniques despite recent meta-analyses and randomised control trial publications ratifying the effectiveness of psychoanalysis and psychoanalytic psychotherapy (P&PP) (Briggs et al., 2019;Fonagy, 2015;Leichsenring & Rabung, 2011;Steinert et al., 2017;Woll & Schönbrodt, 2019). ...
... Second, depending on these new classifications, the development and dissemination of new approaches, such as humanistic or cognitive and behavioural therapies, started to question the relevance of psychoanalysis in the field of clinical psychology and psychiatry. These new therapeutic techniques were presented as cheaper and better fitted for governmental mental health schemes (Dalal, 2018). Third, the development of health economy adapted to international classifications favoured short and standardised therapeutic methods (Dalal, 2018;Eyraud & Velpry, 2011;Jackson & Rizq, 2019;Rabeyron, 2019). ...
... These new therapeutic techniques were presented as cheaper and better fitted for governmental mental health schemes (Dalal, 2018). Third, the development of health economy adapted to international classifications favoured short and standardised therapeutic methods (Dalal, 2018;Eyraud & Velpry, 2011;Jackson & Rizq, 2019;Rabeyron, 2019). Fourth, numerous debates, oppositions, and critics between the different schools of psychoanalysis have weakened the coherence of psychoanalytical theories and how these were considered in society (Stepansky, 2009). ...
... This decline has been notably induced by international questioning of the efficiency of psychoanalysis and psychoanalytic psychotherapies (Mills, 2015;Rabeyron, 2020;Visentini, 2021). It was initially driven by the generalisation of evidence-based medicine, associated with a social-economical and positivist ideology of psychological support (Dalal, 2018;Jackson & Rizq, 2019;Rabeyron, 2019). This critique has led to a worldwide decrease in the use of psychoanalytical concepts and therapeutic techniques despite recent meta-analyses and randomised control trial publications ratifying the effectiveness of psychoanalysis and psychoanalytic psychotherapy (P&PP) (Briggs et al., 2019;Fonagy, 2015;Leichsenring & Rabung, 2011;Steinert et al., 2017;Woll & Schönbrodt, 2019). ...
... Second, depending on these new classifications, the development and dissemination of new approaches, such as humanistic or cognitive and behavioural therapies, started to question the relevance of psychoanalysis in the field of clinical psychology and psychiatry. These new therapeutic techniques were presented as cheaper and better fitted for governmental mental health schemes (Dalal, 2018). Third, the development of health economy adapted to international classifications favoured short and standardised therapeutic methods (Dalal, 2018;Eyraud & Velpry, 2011;Jackson & Rizq, 2019;Rabeyron, 2019). ...
... These new therapeutic techniques were presented as cheaper and better fitted for governmental mental health schemes (Dalal, 2018). Third, the development of health economy adapted to international classifications favoured short and standardised therapeutic methods (Dalal, 2018;Eyraud & Velpry, 2011;Jackson & Rizq, 2019;Rabeyron, 2019). Fourth, numerous debates, oppositions, and critics between the different schools of psychoanalysis have weakened the coherence of psychoanalytical theories and how these were considered in society (Stepansky, 2009). ...
Article
Even if psychoanalysis no longer prevails with the extraordinary enthusiasm it inspired after World War II, it still retains an important place for many in the mental health field. This paper’s objective is to describe the current situation of psychoanalysis and psychoanalytic therapies in the French health system, showing how, in our country, it has developed to this unique position. So far, influenced by the evolution of psychoanalysis in France, historical, cultural, and societal factors added with a strong lobby from psychodynamic scholars and strong support offered by clinical psychology, psychoanalysis and psychoanalytic psychotherapies have maintained a significant practice framework in France. Despite being challenged by the dominant global position of DSM psychiatry and cognitive psychology, psychoanalysis’ influence remains strong as it does not affect only psychology and psychiatry but also extends to the humanities and social sciences. New practice types and future directions for psychoanalysis and psychoanalytic therapies are then discussed.
... Psychotherapy theories have long been criticized for its White western cultural assumptions (Katz, 1985;Sue et al., 2024), ranging from the self-actualization goal of humanistic therapy, which assumes an individualistic concept of self (Ingle, 2021), to the western centering of rational thought that undergirds cognitive behavioral therapy (CBT; Dalal, 2018;Pilgrim, 2011). Even the incorporation of mindfulness into third-wave behavior therapies, such as dialectical behavior therapy, acceptance and commitment therapy, and mindfulness-based cognitive therapy, has appropriated mindfulness from its spiritual context of Asian and Indigenous cultures and turned it into a decontextualized intervention used to ultimately support White neoliberal production (Mehta & Talwar, 2022). ...
... In parallel, psychotherapy came to be more regulatory, valuing quantifiable "techniques" that realign individuals' thinking to the status quo (Ferraro, 2016). The push for CBT and other so-called evidencebased treatments was partly driven by the neoliberal capitalist agenda of getting people back to work as quickly as possible at as little cost as possible (Dalal, 2018;Rasmussen, 2018). Students could learn about these sociopolitical contexts and implications of CBT, after which, they could learn CBT as it was originally envisioned. ...
Article
Full-text available
Psychotherapy theories have long been criticized for their White western cultural assumptions (Katz, 1985; Sue et al., 2024). With the growing call to decolonize psychology (e.g., Singh, 2020), we re-envisioned a psychotherapy theories curriculum from a liberation psychology framework (Martín-Baró, 1994). This framework contextualizes and historicizes people’s lived experiences and highlights the ways in which oppressed communities have survived and resisted. A liberatory pedagogy for teaching psychotherapy theories involves critical consciousness (concientización; Freire, 1970), which allows students and instructors to bring a critical lens as they learn and discuss theories of counseling and psychotherapy; reflexivity, to locate themselves within the colonial, White supremacist and capitalist structures in which the classroom is situated; and somatic and affective engagement to decenter colonial rationality. The bookend approach (Wright et al., 2022) can be used to interrogate psychotherapy theories (a) as an overarching strategy for the entire course and (b) as a teaching strategy within each week’s lesson on a specific theory. It is our hope that students will be equipped to re-envision psychotherapy and healing as located in our collective liberation from oppressive structures.
... Over time, the rationality of the Enlightenment period has been distorted into a hyperrationality -the use of reductive versions of rationality in contexts that are not suited to it. This has promoted a version of science that triumphs conformity over thinking and questioning and asserts that only evidence-based claims are valid, where evidence is required to be arithmetic (considered to be objective and 'real') (Dalal, 2018). ...
... In 1953, Friedman asserted that a theory should be judged by its predictive outcomes, not on the basis of whether it realistically represented the world or not (Dalal, 2018). Consistent with Adam Smith's 'invisible hand' metaphor (Smith, 1937), Friedman's economics suggested that beneficial social and economic outcomes arise from the accumulated actions of individuals acting in their own self-interest. ...
Article
The authors discuss the potential of community engagement as a way of building mutually beneficial long-term relationships in sites of education, facilitating learning through dialogue.
... CBT interventions are helpful in alleviating symptoms of distress. They are considered to be evidence-based interventions even though the scientific empirical evidence upon which they depend may be contentious, and their philosophical and foundational premises lack a thorough understanding of the human psyche and suffering predominant in the aftermath of trauma (Dalal, 2019). Hence, the parallel feelings of despair, helplessness, and a loss of identity and meaning that trauma therapists experience based on their therapeutic encounters with survivors of refugee trauma necessitate the incorporation of a deeper understanding of the human psyche and a wider perspective beyond a narrow focus on cognitive and behavioral deficits alone (Dalal, 2019). ...
... They are considered to be evidence-based interventions even though the scientific empirical evidence upon which they depend may be contentious, and their philosophical and foundational premises lack a thorough understanding of the human psyche and suffering predominant in the aftermath of trauma (Dalal, 2019). Hence, the parallel feelings of despair, helplessness, and a loss of identity and meaning that trauma therapists experience based on their therapeutic encounters with survivors of refugee trauma necessitate the incorporation of a deeper understanding of the human psyche and a wider perspective beyond a narrow focus on cognitive and behavioral deficits alone (Dalal, 2019). The adoption of a holistic, contextualized approach, as suggested by existential philosophers and therapists, could be more useful (Adams, 2019;Aho, 2018;Kevin, 2018;Yalom, 1980). ...
Article
Consistent exposure to refugee narratives of trauma and torture can profoundly impact trauma therapists. This secondary analysis reanalyzed data from a narrative inquiry investigating the lived experiences of refugee trauma therapists. We aimed to explore emergent concerns through an existential lens to enrich understanding and provide additional insights into the lived experiences of these individuals. Participants in this purposive sample ( N = 19) were therapists who had provided interventions to refugees for 2–34 years. Narrative construction, theory‐guided data analysis, and memo writing were used to reanalyze data generated by semistructured interviews augmented by photo elicitation. The findings indicate that being forced to reevaluate familiar beliefs consequent to one's professional roles induced intense existential moments, described as “a dark night of the soul,” “the paradox of life and death,” “uncanny feelings of not being at home,” and “a falling.” Acknowledging the complexities of the field, an existential framework to assist refugee trauma therapists in metabolizing and living with the professional challenges they encounter instead of focusing on alleviating decontextualized symptoms of distress is recommended. Research to inform requirements of the space to enable refugee trauma therapists to share their concerns and facilitate transitions toward more authentic, nonevasive sense of “being‐in‐the‐world” is suggested.
... Preferring to remain within the limits of what positivist methodologies can validate or construct, the authors of the Diagnostic and Statistical Manual of Mental Disorders (DSM) focus on the observable cognitive and behavioral manifestations of distress. Consequently, there is little room for subjectivity in the allegedly rigorous scientific procedures of psychiatry and psychology (Teo, 2009;Dalal, 2018;Hook, 2017). ...
... I believed that therapists could help us speak honestly about the suffering concealed by our symptoms, and would eventually help us become less preoccupied, less painfully self-aware, and more open to the world beyond our private distress. Many therapists do this; however, I was disappointed to discover that clinical practice in a neoliberal context takes an increasingly managerial approach to a person's thoughts, feelings, and behaviors without much consideration for the texture of their inner world (Dalal, 2018). In mainstream practice, the avoidance of the patient's subjectivity may inadvertently negate their personhood. ...
Article
Full-text available
The demand for narrative coherence within a nonnegotiable normative frame may enact a form of what Judith Butler calls ethical violence. Through an interpretive analysis of archival data from O’Loughlin, Arac-Orhun and Queler’s research with psychosocial clubhouse members, I argue that this ethical violence can be countered through recognition of the unsymbolizable elements of personhood that elude conscious narration. Drawing from Lacan, Bion, and Butler, I argue that by risking our exposure to the opacity of the psychiatric sufferer’s subjectivity, we may avoid objectifying patients and reifying the unsymbolizable psychic violence encoded in severe forms of psychiatric distress. Full Text Link: https://rdcu.be/cZgXw
... Psychodynamic therapy, in contrast, had gathered influential opponents, such as Lewis Wolpert, echoing Eysenck (1952) and Popper (1959) previously. We have been living with being a loser in the NICE/IAPT race for a while now and some are already crying foul about this result (Dalal, 2018;Jackson & Rizq, 2019). I think these cries will go unheeded, even if part-justified (Clarke, 2020a). ...
... As we will see in Part 3, the consensus that we broadly know what works for depression has fragmented. Layard and Clark (2014)'s formula is disputed (Dalal, 2018;Jackson & Rizq, 2019). An All Party Parliamentary Group have sponsored guidance for therapists on the use and misuse of anti-depressants that challenges over-prescribing, attacks their purported mechanism of action, and warns about their harms (Guy et al., 2019). ...
... In this essay, the words depth approaches and depth psychology refer to any psychoanalytic or analytical school of thought all of which value introspection and the role of the unconscious. One of the axioms of the behavioural lens, the joint effort of Skinner and Watson, is to deem one can augment one's self-awareness through introspection is a misbelief and while Arron Beck's cognitivist worldview restored the belief in the human's mind by going beyond the mechanical human of behaviourism, it depicted the mind as a hyper-rationalist one (Dalal, 2018). Diagnostic and Statistical Manual of Mental Disorders (DSM-5) is the child of this marriage. ...
Article
Research shows eating disorders increase the mortality rate: anorexia nervosa has the highest mortality rate and yet an accurate morbidity rate of bulimia nervosa remains hidden. However, research on the endopsychic structural dynamics that perpetuate in patients with eating disorders is scant. This essay depicts the use of Fairbairn's theory of endopsychic personality structure in understanding anorexia nervosa, binge eating disorder and bulimia nervosa. Fairbairn, of the independent group of British object relations theorists, provides a picture of the endopsychic structure based on the conscious and unconscious psychodynamics between partial ego/part-object dyads. Using three case histories, the following pages illustrate the incessantly present endopsychic permutations of the aforementioned dynamics and the possibility of the entrapment in one of these or swinging from one to the other in eating disorders. The essay also shows that early traumatic experiences are present in the case history of individuals with any one of these eating disorders and despite their manifested behavioural differences, they result from the widening of fissures in the universal split in the psyche due to emotional and/or physical abuse. Finally, using Fairbairn's theory, the analysis in the essay explains the comorbidity of certain eating disorders and borderline personality structure.
... Despite this, biases find their way into the research inadvertently, unconsciously if you will. But more troublingly, research protocols have been 'gamed' over recent decades, that is manipulated to make outcomes fit with preconceptions and convenient ends already decided on, ideological ends driven by vested interests having to do with money, professional status and rivalry (Dalal, 2018;Goldacre, 2012). ...
Article
Full-text available
Today, professions and disciplines of all kinds fall over themselves to present their claims as being ‘evidence-based’ in order to garner for themselves the kudos of being a positivist science. In this paperI will critique attempts made by the ‘psy’ disciplines’ (psychiatry, psychology and psychotherapy) to use positivism to enter the citadel of science. Amongst other things, I will argue that their efforts have resulted in the corruption and distortion of the principles of (positivist) science. I will argue that positivist methodologies are unable, even in principle, to capture the intricacies of human exchange; in lieu of positivism, notions of emergence and complex responsive processes are more appropriate. Additionally, the argument will also raise questions about the idea of science itself, and claim that much of what passes for science in this territory is a distortion of reality rather than a description of it.
... The obvious exemplar is cognitive-behavior therapy (CBT), which-after essentially translating social-cognitive science into straightforward clinical interventions-has succeeded in branding itself as the preeminent evidencebased approach to psychotherapy. This claim, alas, is not always in the best interest of their patients (Swedish National Audit Office, 2015;Dalal, 2019). In addition to CBT, familysystems, experiential-gestalt, and humanistic-existential psychotherapeutic perspectives also embraced the socialcognitive nomenclature. ...
Article
Full-text available
In contrast to the fruitful relationship between psychoanalysis/psychoanalysts and the humanities, institutionalized psychoanalysis has been largely resistant to the integration of psychoanalysis with other empirical branches of knowledge (infant observation, psychotherapy research, psychological and neurobiological sciences), as well as clinical ones [primarily cognitive-behavioral therapy (CBT)]. Drawing from two decades of theoretical and empirical work on psychopathology, psychotherapy, and psychoanalysis, the author aims to show how a reformulation of object relations theory (RORT) using (neuro-)psychological science may enhance a clinical-psychoanalytic understanding and treatment of suicidal depression, which constitutes one of the most formidable health challenges of our time. Specifically, he rewrote the notion of Melanie Klein positions—primarily the depressive position—using extant knowledge of structure of emotions, the centrality of mental representations of the future (“prospection”) and the toxic nature of criticism-based emotions. This reformulation enables a dialog between clinical psychoanalysis and other therapeutic schools of thought and sheds light on the understanding and treatment of suicidal depression.
... Practitioners rightly seek to earn a living from their valuable work and do so within turbulent and competitive professional waters within a paradoxical context of, on the one hand, regulation and hyper-rationality (Dalal 2018) and on the other hand, the deregulation of care (Weintrobe 2021). The temptation to become aligned to powerful and dominant discourses is alluring. ...
Thesis
This PhD by publication is a practice-led, critical commentary assemblage on a portfolio of five published works through a new materialist, posthuman, postqualitative (NMPHPQ) lens, developing a thematic focus on posthuman subjectivity. Postqualitative research is used in this re-turning as a departure from qualitative research methodologies that underpin the existing publications in my portfolio, following an NMPHPQ ontological and epistemological turn in my practice and research. This research inquiry explores the concept of posthuman subjectivity as it manifests in transdisciplinary practice embracing, firstly, dance as a participatory process, secondly, ecopsychology as a practice that locates the human subject within a wider ecology and, thirdly, critical disability studies as a portal to non-binary practice. These diffractive intersections unveil power-laden, ethical discourses that have subordinated matters of the body, privileging particular bodies over others. As this thesis unfolds, a knowledge symposium maps out the research assemblage, theorising the body as process, the environmentally contextualised human subject and the (dis)abled body, problematising notions of the human subject and reaching towards posthuman subjectivity. This practice-led, NMPHPQ inquiry employs diffractive analysis in challenging binary discourses, towards considering how the subordination of matters that have been made to matter less hold the potential for redefining how identities are organised and subjectivities are conceived and performed. This thesis moves transversally across disciplines and genres and is presented via text, photography and film in a trans-modal style, with an emphasis on transdisciplinarity. In moving towards the posthuman dancing subject, I consider the implications for practice in the field of psychotherapy, identifying the transdisciplinary potential of diffracting across dance movement psychotherapy (DMP), ecopsychotherapy and critical disability studies, embedding the notion of the posthuman subject into practice.
... The advocates of CBT often affirm that these therapies will ultimately be recognized as "the most effective of all" in light of the scientific-experimental status of their concepts. To which advocates of psychoanalysis respond that these arguments are more declarative than scientific[24,25].xxx.e3 ...
Article
Objective Since the 2000s, “mental health” policies in France have to be based on evidence. A report on various forms of psychotherapy, published by the INSERM (the French National Institute of Health and Medical Research) in 2004, and whose conclusion was that there is no evidence of effectiveness for psychoanalysis, remains an important reference. The aim of this article is to re-examine its scientific value, fifteen years later. Method After returning to the context in which this report was written and the controversies surrounding its publication, we propose a review of the efficacy studies that have since evaluated psychoanalysis. This recent literature, mostly international, remains relatively little known in France. Results The INSERM's expert report – whose status could in part be promoted at the time of its publication – now appears to be relatively dated, both in terms of methodology and in its conclusions. The majority of current efficacy studies show that psychoanalytical and cognitive-behavioral therapies do not show any significant differences in efficacy for all known disorders. Discussion These results give rise to debate. Some scientists believe that they are only due to a lack of rigor in the experimental protocols. Others, on the contrary, maintain that the search for specific factors of efficacy is a dead end and promote studies in natural conditions, in order to assess the cumulative contextual factors of therapeutic effectiveness. Conclusions Without prejudging future research orientations and results, it nevertheless appears that the INSERM report can no longer be the dominant reference in France today for recommending psychotherapeutic “good practices.” Research has progressed considerably. In view of the international scientific literature available today, psychoanalysis is one offer of care to be advocated among others – a position to which many countries subscribe.
... The entrenchment of the OBM perspective in psychopathology has led to separation and, in some cases, competition between therapeutic interventions, such that treatment plans are often limited and fragmented. Furthermore, this perspective may arguably have contributed to the excessive dominance of certain psychotherapeutic models, such as CBT (Dalal, 2018), within the psychopathological sphere. It is extremely difficult to obtain traction for novel interventions when they are often confined to the status of "adjunct therapies" rather than incorporated more equally and collaboratively with the dominant intervention approaches. ...
Article
Mental disorders are arguably one of the most complex and serious problems facing health practitioners today and yet their causes remain, largely, a mystery. Accordingly, there is frequent and heated debate over which of the many available models of mental disorder and their associated therapeutic interventions are likely to be most useful. The prevailing attitude toward the conceptualization of mental distress appears to be that a single superior model will emerge that neatly accounts for one or more disorder presentations: the “One Best Model” (OBM) perspective. In this article, we argue for a transition away from the OBM perspective toward a multiple model approach to psychopathology that is collaborative and pluralistic. We begin by outlining the particulars of the OBM perspective and elaborating on the problems it presents for psychopathology theory and practice. We then suggest specific ways in which this problem may be ameliorated, by adjusting how we approach the processes of modelling disorder, translating models into interventions, and applying models and interventions in practice.
... Following this rich series of articles, William Cornell offers an inspired book review essay: "The Corruption of Science and the Destruction of Meaning." He discusses Anne Harrington's (2019) Mind Fixers: Psychiatry's Troubled Search for the Biology of Mental Illness and Farhad Dalal's (2018) CBT: The Cognitive Behavioural Tsunami: Managerialism, Politics and the Corruption of Science. These authors both challenge the contemporary practices of psychiatry and cognitive-behavioral therapies. ...
Article
In Inghilterra nel 2007 è stato avviato un esperimento nazionale con l'obiettivo di affrontare "il più grande problema sociale del Paese": la depressione. È stato così lanciato il programma Impro-ving Access to Psychological Therapies (IAPT), che consiste nell'offrire terapie psicologiche evidence-based a tutti i pazienti con depressione e ansia. Il NICE (National Institute for Health and Care Excellence) stabilì che la terapia cognitivo-comportamentale (cognitive-behavior therapy [CBT]), non i farmaci, doveva essere la prima scelta. La via era spianata. Lo IAPT si propose tre obiettivi: aumentare rapidamente l'accesso alla CBT, diminuire la prevalenza di depressione e an-sia e, il più ambizioso, ottenere un guadagno per le casse dello Stato riducendo il peso economico della depressione, cioè abbassando le assenze lavorative per malattia. Era un New Deal per la depressione, e anche per la CBT. Ma ha funzionato? Noi psicoanalisti siamo disposti a cogliere ciò che ci ha insegnato lo IAPT e sostenere un New Deal per la psicoanalisi evidence-based? Di fron-te alle sfide della disoccupazione, delle crescenti disuguaglianze, del cambiamento climatico, delle guerre e dei lutti dovuti alla pandemia di COVID-19, la necessità di questo New Deal non può essere più urgente.
Article
This article addresses the imbalance in research focus, highlighting a pronounced emphasis on research in the American context compared to the field of group analysis, which is underscored by the identification of two literature reviews. The discussion delves into Lorentzen’s research contributions and the introduction of Focus Group Analytic Psychotherapy. Diverse perspectives on research are presented, with Nitsun and Lorentzen advocating for its importance, while Dalal takes a critical stance. The text investigates discrepancies within key concepts of group analysis, specifically the social unconscious, with Nitsun critiquing an undue emphasis on its significance and questioning its practical relevance in group settings. The relationship between group analysis and neuroscience is explored, shedding light on the reinterpretation of certain concepts through a neuroscientific lens, notably examining the framework of the neurobiology of intergroup relations. Ultimately, the article emphasizes the necessity of believing in and validating the advantages of collective thinking.
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Die Positive Psychologie ist um die Jahrtausendwende mit einem umfassenden Forschungsprogramm angetreten: mit der Erforschung und Förderung positiver Emotionen, Charaktereigenschaften und Institutionen. Seither prägt sie nicht nur den psychologischen Diskurs maßgeblich mit, sondern ist auch in zahlreichen Anwendungsfeldern verankert. Doch welches Menschenbild und Handlungsmodell wird von dieser Psychologie eigentlich vertreten? Sind Glück und Wohlbefinden tatsächlich trainierbar wie ein Muskel? Wo soll zur Schaffung eines glücklicheren, produktiveren und resilienteren Menschen angesetzt werden? Nachdem zunächst metatheoretische Vergleichsperspektiven vorgestellt werden, macht sich der vorliegende Artikel auf die Spur wichtiger anthropologischer Grundannahmen. Zudem werden zur Rekonstruktion Menschenbilder aus den Wirtschaftswissenschaften und der (Klinischen) Psychologie herangezogen. Es zeigt sich, dass das Menschenbild und Handlungsmodell der Positiven Psychologie in vielen Aspekten als illusionär und veraltet zu beschreiben ist.
Article
This paper offers a brief overview of the historically predominant form of psychotherapy research both for individual and group psychotherapies, the randomized control trial (RCT), and its surrounding controversies and critiques as the backdrop from which new directions in both clinical theory building and research are being pursued, including efforts at building integrative models of treatment. The paper explores one promising integrative model, namely the incorporation of process and dynamic orientations into the province of group cognitive behavioral therapy (CBT) and identifies challenges in implementing this model.
Article
Digital mental health interventions (DMHIs) have potential to provide effective and accessible care to entire populations, but low client uptake and engagement are significant problems. Few prior studies explore the lived experiences of non-engagers, because reaching this population is inherently difficult. We present an observational inquiry into the barriers to sign-up and early use of a DMHI, along with reasons for initial interest in the DMHI. We collected 205 online questionnaire responses and 20 interviews from self-referring participants across four healthcare ecosystems in the UK and US. Questionnaire results revealed that uncertainty about DMHI usefulness and usability were the main barriers to uptake, whereas forgetting about it, not finding time for it and not finding it useful were the main barriers to early engagement. Participants reported multiple reasons for considering the DMHI, reflecting the contextual, subjective nature of mental health. Our thematic analysis generated themes around 1) the need for human connection, 2) the impact of self-stigma on help-seeking, 3) the lack of knowledge around DMHIs and psychological therapy, 4) the desire for personally relevant care, and 5) the fluctuating, perennial nature of mental health. We discuss implications for DMHI design, implementation and future research, as well as transdisciplinary opportunities.
Article
In the UK in 2007 a national experiment was initiated with the aim of tackling “Britain's Biggest Social Problem”—Depression. Improving Access to Psychological Therapies (IAPT) was devised as the solution. A universal free‐to‐access talking therapies program would make available evidence‐based treatment to all adults with depression. NICE (National Institute for Health and Care Excellence), the body that decides on what is cost‐effective, said CBT, not antidepressants, should be its first line offer. The starting gun was fired. The promise from IAPT was 3‐fold: to scale up access to CBT rapidly; to achieve recovery targets that would reduce the prevalence of depression over time; and—most ambitious of all—to ensure the Treasury would see a return on its investment by reducing the economic burden from depression. People who were on invalidity benefits due to depression would be supported back into employment. It was a New Deal for depression. As well as for CBT. But did it work? A decade and a half on with IAPT, are we in any position to give an answer? This paper will seek to draw lessons about “What Worked”, and what didn't, to ask ourselves a question: are we —those of us in the applied psychoanalytic community—willing to garner what can be learned from IAPT to advocate a new deal for evidence‐based psychoanalysis? Faced with challenges from unemployment and widening inequalities, against a backdrop where global economic recovery must heed the existential threats from climate change and ongoing warfare, to say nothing of the scale of loss and grief for those already impacted by bereavement due to the pandemic, the need for some such deal could not be more urgent.
Article
Ideas in this article are a development of those in Strawbridge (2016).
Article
In 1988, the APP hosted a conference on psychoanalytic psychotherapy (PP) in the public sector in other European countries. This taught us that Britain had much to learn from other countries as well as much to share. The APP realised the need for a European Federation of PP in the public sector (EFPP) to represent and facilitate the field. The APP therefore joined with representatives from the Association of Child Psychotherapy and the Institute of Group Analysis and in 1991 formally created such an organisation by linking with similar representatives from European Union countries. This article takes an overview of PP in European countries, comparing the situation now in 2022 with the time of the founding of the EFPP in 1991. Despite significant setbacks in some countries, the indications are that PP has made very significant process in most countries in terms of the number of training organisations and practitioners in all four EFPP sections. The impact on public mental health provision is impressive in some countries but remains limited if not very limited in many. The article reviews some of the factors that have led to progress and setbacks, pinpointing ‘lessons’ and warning signs.
Article
Psychological science constructs much of the knowledge that we consume in our everyday lives. This book is a systematic analysis of this process, and of the nature of the knowledge it produces. The authors show how mainstream scientific activity treats psychological properties as being fundamentally stable, universal, and isolable. They then challenge this status quo by inviting readers to recognize that dynamics, context-specificity, interconnectedness, and uncertainty, are a natural and exciting part of human psychology – these are not things to be avoided and feared, but instead embraced. This requires a shift toward a process-based approach that recognizes the situated, time-dependent, and fundamentally processual nature of psychological phenomena. With complex dynamic systems as a framework, this book sketches out how we might move toward a process-based praxis that is more suitable and effective for understanding human functioning.
Article
Après avoir brièvement rappelé les premières influences de cette discipline universitaire, nous verrons comment elle s’est détachée de son ancrage au sein des sciences humaines, et s’est ainsi privée de réflexions théoriques et pédagogiques. Nous faisons l’hypothèse que les réformes récentes de l’université et la gestion de la crise sanitaire Covid 19 ont aggravé cette dérive. Nous poserons la question des outils conceptuels nécessaires à la formation des psychologues du développement, qui devrait permettre d’accompagner, de façon professionnelle, plurielle et humaine, les développements psychocognitifs, socioaffectifs et leurs aléas.
Article
Dans cet article, il va s’agir de revenir sur la notion de santé mentale et les implications que celle-ci apporte dans la prise en charge et la considération du malade mental dans la société. Et même, nous montrerons comment l’objectif de « santé mentale » parfaite vient conditionner l’expérience de tout sujet, en tant qu’elle se constitue comme dispositif, au sens dégagé par Foucault et repris par Agamben.
Article
Much of Western media has promoted the idea that we are facing an epidemic of mental illness and psychiatric emergencies in contemporary Western society and worldwide, and that young people are a particularly vulnerable group. Schools have become a prominent site of concern and focus for this discourse as mental health problems are said to start early in life; thus, targeting intervention at people in their early years and greater mental health awareness amongst staff and pupils are perceived as important mental disorder prevention strategies. However, the belief that mental disorders can be classified and investigated using the same tools as physical health has led to a system of knowledge that lacks validity being constructed. This ideology, far from leading to enlightened progress that will prevent and/or ameliorate future mental health problems, inadvertently sets young people on a path towards alienation from, and suspicion of, their emotional lives and a lack of curiosity about, or tolerance of, suffering. This article explores how a lack of understanding about what sort of ‘thing’ a mental health problem/disorder/diagnosis/illness is leads to confusion about the meaning and consequences of experiencing mental distress and/or mental difference. Interviews with secondary school teachers carried out by one of the authors (ZT) show how awareness of mental health and mental disorder has increased in UK secondary schools over the last decade and how this has led to an expansion in the numbers of students thought to have mental health problems that required professional intervention. As a result, teachers now identify many behaviours and experiences they previously deemed ordinary and/or understandable as likely mental health problems that required professional expertise they lacked. Rather than preventing mental health problems, it is likely that this ideology, and the resulting practices it encourages, are creating them.
Article
We reflect on decolonization and in particular the process of decolonizing our own minds. We discuss the need for radical decolonization of psychology and for critique of community psychology's relationship to both psychology and the Academy, noting ways in which community psychology itself becomes appropriated for the colonizing project of the Academy. Using collaborative autoethnography (CAE), a method that involves “collaborative poetics,” which chimes with the emphasis on participatory research in community psychology and the decolonialist emphasis on rescuing repressed epistemologies, we review our own careers and identify ways in which our values have been compromised and our work assimilated into wider colonizing and oppressive practices that sustain the modern university. We conclude that community psychology can only decolonize if it is positioned in an agonistic relationship to mainstream psychology and exists as a radical, explicitly political, and ethical practice outside the Academy. The message of the decolonization and disalienation movements is that the biggest barrier to our effectiveness, and to social justice, is the fascism of our minds. Succumbing to the power and privilege embedded in the Academy and the oppressive and colonizing practices that sustain it conflicts with community psychology's purported values. The biggest barrier to our effectiveness, and to social justice, is the fascism of our minds. The power and privilege embedded in the Academy conflicts with community psychology's values. Disalienation will involve revolutionary shock, opening up rather than closing down ways of being. The biggest barrier to our effectiveness, and to social justice, is the fascism of our minds. The power and privilege embedded in the Academy conflicts with community psychology's values. Disalienation will involve revolutionary shock, opening up rather than closing down ways of being.
Chapter
Much of western media has promoted the idea that we are facing an epidemic of mental illness and psychiatric emergencies in contemporary western society and worldwide and that young people are a particularly vulnerable group. Schools have become a prominent site of concern and focus for this discourse as mental health problems are said to start early in life, thus targeting intervention at people in their early years is perceived an important mental disorder prevention strategy. Drawing on interviews with 19 UK secondary school teachers, this chapter explores changes in their beliefs concerning mental health over the last decade and how this informs changes in their practice. All teachers' felt that awareness of mental health and disorder had increased. This had led to an expansion in the numbers of students thought to have a mental health problem that required professional intervention. Teachers identified many behaviours and experiences they previously deemed ordinary as likely mental health problems that required professional expertise that they lacked. Teachers have thus been co-opted into becoming agents for the growing market of the troubled person's industry. Rather than preventing mental health problems it's likely that this discourse and the resulting practice it fosters are creating them.
Article
The article is a critique of Cognitive Behavioral Therapy. It questions CBT’s understanding of human suffering as well as the so-called science that underlines it, and the philosophy that underlines that. CBT psychology has fetishized measurement and believes that only the countable counts. It is argued that the science of CBT is not just “bad science” but “corrupt science.” The article also tracks the ways in which managerialist bureaucracies in the United Kingdom have distorted statistical realities in order to sustain the impression of CBT’s efficacy. It is argued that the claims of CBT are vastly exaggerated from the degree to which symptoms are reduced, the durability of the improvement, as well as the numbers of people it claims to help.
Article
In this paper, we explore the dialectical nature of psychoanalytic social work practice and the benefits - theoretical and clinical - of doing so. We posit being mindful of the dialectic 1) aides us in our effort to identify and speak to differing themes, each of which ‘...each of which is understood...’ understood to be a piece of glass in the mosaic that is the totality of the client’s experience as a human being, 2) enhances our awareness of what might be going on in the clinical moment, particularly the shared ­experience between client and clinician, and 3) facilitates holding multiple perspectives in mind. On the other hand, non-­acknowledgement of the dialectical nature of our theories and interventions seems linked with moments of clinical impasse and fuels the false dichotomies that often confront psychoanalytic social workers, individually and collectively. Appreciation of the dialectic can help us overcome these challenges and enables us to conceptualize our work as a process of becoming, which we see as highly relevant to clinical work with pressing contemporary issues such as trauma, diversity, and the theme of access. We demonstrate these claims through two vignettes, one explicitly clinical and the other an example of contextual factors affecting practice, to show how dialectical thinking allows for a deepening of things both inside and outside the consulting room.
Article
The paper investigates the role of ethics and codes of conduct within psychotherapy organizations. It is argued that managerialist bureaucracies have usurped codes of ethics and put them in the service of compliance and control. The paper begins with a critical delineation of the three ways that philosophers have approached ethics: deontology, consequentialism and virtue ethics. It asks the question: is psychotherapy a scientific activity? The answers to this question gives rise to different sorts of ethical requirements. The paper then moves onto the ways that power relations within and between institutions inform thinking about ethics. It is argued that psychotherapy organizations are becoming increasingly managerialist in their structure and ways of working, a consequence of which is that communication is controlled and constrained, and that this in itself is unethical.
Article
This article argues for the relevance and meaning of mentalizing in leadership and management roles. The relations in organizations are multiple and vulnerable to failure and misunderstandings. A leader has to be both self-aware and aware of others and take into consideration that behind actions there are mental states, emotions and thoughts, wishes and needs. The concept of authority is central in organizational work and in leadership roles. The leader must be able to take relevant action and will be held responsible for it in the organization. In order to act and to understand the consequences it is crucial to have an open mind to oneself and to others. The theory and practice of mentalization can be helpful in understanding the construction of shared meaning in the organization. Reduced capacity to mentalize may be undermining change and the function of the work-group, and thus be inducing irrationality and deadlocks in the organization. Instead of that, mentalizing leadership can stimulate a potential space in the organization for new and non-rigid modes of experiencing.
Article
This paper highlights the question, often asked, why does racism persist despite the many attempts to eradicate it? The paper provides some answers, first for social relations generally and second for systemic psychotherapy. Central to the answers is an acknowledgement of the obstacles in both spheres to address the structures, systems, organisation and processes which lie behind conceptualisations of race, racism, identity and relationships. It is in these structures and systems that the suffocating and inevitable effects of racism originate. The paper suggests that, if we want to begin to eradicate racism, we need to look in those places (mostly White) where we least suspect it, the places which seem ‘natural’ and therefore foundational. It concludes that we cannot teach race and equity, because by singling out this topic without looking behind it, we perpetuate a violence through which the very relations we want to eradicate are produced. This does not mean, however, that we should ignore the topic. Practitioner points • Racism is deeply rooted in action and ideas. • The recent murders of Black persons demonstrate the slow, suffocating and strangling aspects of racist systems and structures in our society. • Ideas and concepts are difficult to address because they tend to be buttressed by basic assumptions about life and relationships. • Race, ethnicity and culture are processes rather than a list of items/things. • Tools such as the Social GRRRAAACCEEESSS and the cultural genogram are inadequate for training because the assumptions they are based on are rarely made transparent.
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This paper contends that sociotherapy, a sociologically informed approach to therapy, is a viable alternative to the diagnostic model recognized by the College of Registered Psychotherapists in Ontario (CRPO). The Psychotherapy Act (2007) along with the Regulated Health Professions Act (1991) gives the CRPO authorization to regulate the practice of psychotherapy and to control titles affiliated with the act of psychotherapy. I offer a discussion of sociotherapy and socioanalysis as clinical alternatives to the conservative and normalizing approaches endorsed by the College. I situate sociotherapy and socioanalysis in the discipline of sociology and in relation to Freudian psychoanalysis. I offer my own sociotherapeutic practice as an illustration of how the societal and the psychological, the social, and the psychic must be engaged in concert. I underscore the importance of dialogue, as opposed to diagnostics, interpretation as opposed to assessments and psychosocial contemplation as opposed to cognitive-behavioral treatment in clinical practice.
Article
Therapeutic working has long been considered a fundamental part of the educational psychologist’s (EPs) role. Yet, little attention has been given to the ethical ambiguity which exists between the terms therapeutic practice and therapy, and the implications this has for practice. This paper starts with a definition of therapeutic practice, identifying three different approaches and exploring the practical and ethical differences between them. It is proposed that these approaches sit within a therapeutic continuum, which presents a range of nuanced, ethical complexities for consideration. Those issues are explored further, with a focus on ethical blind spots (EBS). The paper concludes with illustrative examples of EBS, bringing together dilemmas in initial decision-making along the therapeutic continuum and the practice-based issue of contracting with children and young people (CYP) and how these might be overcome.
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Existential concerns such as death, responsibility, meaninglessness, and isolation not only are the hallmark of existential psychotherapy but also are frequently encountered by CBT therapists—nevertheless, due to epistemological and ideological differences, existential and CBT approaches to psychotherapy had little overlap historically. During recent years, existential issues are increasingly discussed in empirical clinical psychology, e.g., the potential role of the fear of death for a variety of mental disorders by Iverach et al. ( Clinical Psychology Review , 34(7), 580–593, 2014), and there is increasing experimental evidence for a causal rather than correlational role of death anxiety discussed by Menzies and Dar-Nimrod ( Journal of Abnormal Psychology , 126(4), 367–377, 2017). Further, existential concerns are common themes in CBT discussed by Grober et al. ( Psychotherapeut , 61(3), 229–236, 2016) and may play an important role in the training of CBT therapists discussed by Worrell et al. ( Journal of Psychotherapy and Counselling Psychology Reflections , 3(1), 9–16, 2018) as well as in personal therapy and supervision.
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BMJ Press Release BMJ provides resources to support disaster relief efforts in Nepal In response to the recent earthquake in Nepal, BMJ has opened up access to a range of online resources. They include content from The BMJ and BMJ Journals, decision support tools from BMJ Best Practice, and learning resources from BMJ Learning. Anyone with an IP range originating in Nepal will have free access for three months, providing the latest and most accurate medical information to support to doctors, relief workers and healthcare institutions as they deal with the aftermath of this disaster. BMJ content is also freely available through the Emergency Access Initiative (EAI), a collaborative partnership between the US National Library of Medicine and participating publishers to provide free access to biomedical journals, reference books and online databases to medical staff in regions affected by disasters. Content will continue to be reviewed and updated on a regular basis by BMJ's expert team of clinicians, based on the latest scientific evidence.
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A meta-analysis examining temporal changes (time trends) in the effects of cognitive behavioral therapy (CBT) as a treatment for unipolar depression was conducted. A comprehensive search of psychotherapy trials yielded 70 eligible studies from 1977 to 2014. Effect sizes (ES) were quantified as Hedge's g based on the Beck Depression Inventory (BDI) and the Hamilton Rating Scale for Depression (HRSD). Rates of remission were also registered. The publication year of each study was examined as a linear metaregression predictor of ES, and as part of a 2-way interaction with other moderators (Year × Moderator). The average ES of the BDI was 1.58 (95% CI [1.43, 1.74]), and 1.69 for the HRSD (95% CI [1.48, 1.89]). Subgroup analyses revealed that women profited more from therapy than did men (p < .05). Experienced psychologists (g = 1.55) achieved better results (p < .01) than less experienced student therapists (g = 0.98). The metaregressions examining the temporal trends indicated that the effects of CBT have declined linearly and steadily since its introduction, as measured by patients' self-reports (the BDI, p < .001), clinicians' ratings (the HRSD, p < .01) and rates of remission (p < .01). Subgroup analyses confirmed that the declining trend was present in both within-group (pre/post) designs (p < .01) and controlled trial designs (p = .02). Thus, modern CBT clinical trials seemingly provided less relief from depressive symptoms as compared with the seminal trials. Potential causes and possible implications for future studies are discussed. (PsycINFO Database Record (c) 2015 APA, all rights reserved).
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Binge eating occurs across the entire range of eating disorders. It is required for a diagnosis of bulimia nervosa but it is also seen in some cases of anorexia nervosa and in many cases of eating disorder not otherwise specified (usually referred to as eating disorder NOS or atypical eating disorder). This article focuses on the management of those eating disorders in which binge eating is a prominent feature.
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The interpretation of research into the eating disorder bulimia nervosa is complicated by the use of two different sets of diagnostic criteria. In North America the DSM III criteria are usually employed (American Psychiatric Association, 1980), whereas in Britain Russell's criteria (Russell, 1979) are preferred. While the two sets of criteria appear to be designed to identify people with essentially the same disorder, they embrace different, but over-lapping, populations. Discrepancies between the findings of various investigations may therefore be attributed in part to the fact that different patient groups have been studied. In this paper both these sets of diagnostic criteria and the proposed DSM III R criteria (American Psychiatric Association, 1985) are reviewed in the light of current knowledge. In addition, the relationship between bulimia nervosa and anorexia nervosa is examined. Certain revisions to the diagnostic criteria for both disorders are suggested reflecting the view that extreme concerns about shape and weight are a central psychopathological feature uniting anorexia nervosa and bulimia nervosa.
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The current paper presents an analysis of the NICE guidelines on depression and attention deficit hyperactivity disorder (ADHD) from the perspective of the philosophy of science, guided particularly by Foucault's notion of the symbiosis of knowledge and power. It examines how data that challenged the orthodox position on the validity and drug treatment of these conditions was managed in the process of guideline development. The depression guideline briefly considered the complexity and heterogeneity of depression, and numerous methodological problems with evaluating treatments, including antidepressants. However, the guideline recommendations made no reference to these issues and ignored evidence that questioned the analysis of antidepressant trials. The guideline on ADHD reviewed validity, but did not consider evidence from the critical literature, and overlooked inconsistencies in the data. The guideline identified that drug trials have shown no long-term benefit in ADHD, but still recommended treatment with stimulant drugs for children with severe symptoms and for all adults claiming consensus for this position. Both guidelines demonstrate how contradictory data are managed so as not to jeopardise the currently predominant view that ADHD and depression are valid and un-contentious medical conditions that should be treated with drugs. The subjective nature of guideline formation that is revealed illustrates Foucault's suggestion that the authority of medicine operates to promote a technological view of the nature of certain human problems, which in turn strengthens medical hegemony over these areas.
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Posted 06/26/1998. Mean effect sizes for changes in depression were calculated for 2,318 patients who had been randomly assigned to either antidepressant medication or placebo in 19 doubleblind clinical trials. As a proportion of the drug response, the placebo response was constant across different types of medication (75%), and the correlation between placebo effect and drug effect was .90. These data indicate that virtually all of the variation in drug effect size was due to the placebo characteristics of the studies. The effect size for active medications that are not regarded to be antidepressants was as large as that for those classified as antidepressants, and in both cases, the inactive placebos produced improvement that was 75% of the effect of the active drug. These data raise the possibility that the apparent drug effect (25% of the drug response) is actually an active placebo effect. Examination of pre–post effect sizes among depressed individuals assigned to no-treatment or wait-list control groups suggest that approximately one quarter of the drug response is due to the administration of an active medication, one half is a placebo effect, and the remaining quarter is due to other nonspecific factors.
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This article reports an analysis of the efficacy data submitted to the U.S. Food and Drug Administration for approval of the 6 most widely prescribed antidepressants approved between 1987 and 1999. Approximately 80% of the response to medication was duplicated in placebo control groups, and the mean difference between drug and placebo was approximately 2 points on the 17-item (50-point) and 21-item (62-point) Hamilton Depression Scale. Improvement at the highest doses of medication was not different from improvement at the lowest doses. The proportion of the drug response duplicated by placebo was significantly greater with observed cases (OC) data than with last observation carried forward (LOCF) data. If drug and placebo effects are additive, the pharmacological effects of antidepressants are clinically negligible. If they are not additive, alternative experimental designs are needed for the evaluation of antidepressants.
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The empirical literature offered in support and validation of Linehan's dialectical behavior therapy (DBT) is critically examined in this article. Although results to date are promising, there remain methodological difficulties in the limited research base that supports this eagerly received clinical approach to borderline personality disorder. Implications for clinical decision making are discussed and suggestions offered as to how future investigations can begin to better substantiate DBT as a thoroughly established clinical approach to treating this challenging disorder.
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We study economic growth and inflation at different levels of government and external debt. Our analysis is based on new data on forty-four countries spanning about two hundred years. The dataset incorporates over 3,700 annual observations covering a wide range of political systems, institutions, exchange rate arrangements, and historic circumstances. Our main findings are: First, the relationship between government debt and real GDP growth is weak for debt/GDP ratios below a threshold of 90 percent of GDP. Above 90 percent, median growth rates fall by one percent, and average growth falls considerably more. We find that the threshold for public debt is similar in advanced and emerging economies. Second, emerging markets face lower thresholds for external debt (public and private)—which is usually denominated in a foreign currency. When external debt reaches 60 percent of GDP, annual growth declines by about two percent; for higher levels, growth rates are roughly cut in half. Third, there is no apparent contemporaneous link between inflation and public debt levels for the advanced countries as a group (some countries, such as the United States, have experienced higher inflation when debt/GDP is high.) The story is entirely different for emerging markets, where inflation rises sharply as debt increases.
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(This partially reprinted article originally appeared in Psychological Review, 1913, Vol 20, 158–277.) Notes that psychology has failed to make good its claim as a natural science, due to a mistaken notion that introspection is the only direct method of ascertaining facts. Psychology, as the behaviorist views it, is a purely objective, experimental branch of natural science that needs introspection as much as do chemistry and physics. The behavior of humans and the behavior of animals must be considered on the same plane, as being equally essential to a general understanding of behavior. The elimination of states of consciousness as proper objects of investigation in themselves will remove the barrier from psychology that exists between it and the other sciences. Psychology as behavior will have to neglect but few of the really essential problems with which psychology as an introspective science concerns itself. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
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Empirical evidence supports the efficacy of psychodynamic therapy. Effect sizes for psychodynamic therapy are as large as those reported for other therapies that have been actively promoted as "empirically supported" and "evidence based." In addition, patients who receive psychodynamic therapy maintain therapeutic gains and appear to continue to improve after treatment ends. Finally, nonpsychodynamic therapies may be effective in part because the more skilled practitioners utilize techniques that have long been central to psychodynamic theory and practice. The perception that psychodynamic approaches lack empirical support does not accord with available scientific evidence and may reflect selective dissemination of research findings.
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This study evaluated mindfulness-based cognitive therapy (MBCT), a group intervention designed to train recovered recurrently depressed patients to disengage from dysphoria-activated depressogenic thinking that may mediate relapse/recurrence. Recovered recurrently depressed patients (n = 145) were randomized to continue with treatment as usual or, in addition, to receive MBCT. Relapse/recurrence to major depression was assessed over a 60-week study period. For patients with 3 or more previous episodes of depression (77% of the sample), MBCT significantly reduced risk of relapse/recurrence. For patients with only 2 previous episodes, MBCT did not reduce relapse/recurrence. MBCT offers a promising cost-efficient psychological approach to preventing relapse/recurrence in recovered recurrently depressed patients.
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Recovered recurrently depressed patients were randomized to treatment as usual (TAU) or TAU plus mindfulness-based cognitive therapy (MBCT). Replicating previous findings, MBCT reduced relapse from 78% to 36% in 55 patients with 3 or more previous episodes; but in 18 patients with only 2 (recent) episodes corresponding figures were 20% and 50%. MBCT was most effective in preventing relapses not preceded by life events. Relapses were more often associated with significant life events in the 2-episode group. This group also reported less childhood adversity and later first depression onset than the 3-or-more-episode group, suggesting that these groups represented distinct populations. MBCT is an effective and efficient way to prevent relapse/recurrence in recovered depressed patients with 3 or more previous episodes.
Chapter
Intense marketing of antidepressants over recent decades has resulted in a dramatic rise in their use, and in the widespread social acceptance of the idea that depression is caused by a ‘chemical imbalance’ that can be rectified by drugs. In 2002 eleven per cent of women and over 5 per cent of men in the United States were taking antidepressants (Stagnitti, 2005). This situation led Nikolas Rose to conclude that a large proportion of people have come to ‘recode their moods and their ills in terms of their brain chemicals’ (Rose, 2004: 28). Although there has been some criticism of levels of prescribing of antidepressants, and recent guidelines recommend that their use is restricted to people with more severe conditions (NICE, 2004), the idea that an antidepressant drug can reverse depression has not seriously been challenged. In this chapter I describe evidence that suggests that the very concept of ‘an antidepressant’, rather than emerging from scientific data, was constructed to fulfil the pre-existing desire of the psychiatric profession, allied with the pharmaceutical industry, to present psychiatric interventions as specific treatments. At the time the concept was invented there was little evidence to support the idea that drugs could exert a specific ‘antidepressant’ action, and there remains little such evidence to this day.
Chapter
I used to think that antidepressants worked. As a clinical psychologist, I had for years referred some of my clients to psychiatric colleagues who could prescribe antidepressants for them. Sometimes the antidepressants did not seem to help, but when they did, I assumed that the benefit derived from the chemical properties of the drug. In this chapter, I describe the process by which I came first to doubt and then to disbelieve the hypothesis that antidepressants had a biochemical affect on depression, a process more fully documented in The Emperor’s New Drugs: Exploding the Antidepressant Myth (Kirsch, 2010).
Book
Originally published in 1975, Equality and Efficiency: The Big Tradeoff is a very personal work from one of the most important macroeconomists of the last hundred years. And this new edition includes “Further Thoughts on Equality and Efficiency,” a paper published by the author two years later. In classrooms Arthur M. Okun may be best remembered for Okun’s Law, but his lasting legacy is the respect and admiration he earned from economists, practitioners, and policymakers. Equality and Efficiency is the perfect embodiment of that legacy, valued both by professional economists and those readers with a keen interest in social policy. To his fellow economists, Okun presents messages, in the form of additional comments and select citations, in his footnotes. To all readers, Okun presents an engaging dual theme: The market needs a place, and the market needs to be kept in its place. As Okun puts it: Institutions in a capitalist democracy prod us to get ahead of our neighbors economically after telling us to stay in line socially. This double standard professes and pursues an egalitarian political and social system while simultaneously generating gaping disparities in economic well-being. Today, Okun’s dual theme feels incredibly prescient as we grapple with the hot-button topic of income inequality. In his foreword, Lawrence H. Summers declares: On what one might think of as questions of “economic philosophy,” I doubt that Okun has been improved on in the subsequent interval. His discussion of how societies rely on rights as well as markets should be required reading for all young economists who are enamored with market solutions to all problems.
Book
This book discusses what makes a person crazy. For many mental health professionals, the DSM is an indispensable diagnostic tool, and as the standard reference for psychiatrists and other psychotherapists, it has had an inestimable influence on the way we view other human beings. What goes in it, and what stays out, is of monumental importance. This book also discusses how things have taken a strange turn. The fight is no longer about who escapes DSM labeling, but rather, how a person can qualify for a diagnosis. Now mental health professionals must label their clients as pathological in order for them to be reimbursed by their insurance companies. This disturbing trend toward making us crazy when we are simply grappling with everyday concerns has even worse public implications. The authors also argue that the DSM is not the scientifically based reference work it purports to be, but rather a collection of current phobias and popular mores. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
Article
The following values have no corresponding Zotero field: ID - 2
Article
The interpretation of research into the eating disorder bulimia nervosa is complicated by the use of two different sets of diagnostic criteria. In North America the DMS III criteria are usually employed, whereas in Britain Russell's criteria are preferred. While the two sets of criteria appear to be designed to identify people with essentially the same disorder, they embrace different, but overlapping, populations. Discrepancies between the findings of various investigations may therefore be attributed in part to the fact that different patient groups have been studied. In this paper both these sets of diagnostic criteria and the proposed DSM III R criteria are reviewed in the light of current knowledge. In addition, the relationship between bulimia nervosa and anorexia nervosa is examined. Certain revisions to the diagnostic criteria for both disorders are suggested reflecting the view that extreme concerns about shape and weight are a central psychopathological feature uniting anorexia nervosa and bulimia nervosa.
Article
Grace's (2001) critical analysis of the use of operationism in psychology is founded on two basic claims. First, he argues that the main difficulty with mid-20th-century psychologists' interpretation of Bridgman was that they believed a single operation to be sufficient to define a new concept. Second, he claims that the main thrust of recent criticisms of operationism is that operational definitions should be used for existing concepts only and not to create new ones. In his view, both the earlier difficulty and the recent criticism are effectively quashed by the adoption of `convergent operationism', first proposed in the 1950s. In the present commentary, I try to show that neither of the basic claims is quite correct, nor does `convergent operationism' do much to resolve the matter. The primary difficulty with operationism, in contrast to Grace's analysis of the situation, was that it was proposed as a solution to a metaphysical problem which it was not even remotely adequate to meet, and, in addition, that the presumed metaphysical problem it was intended to solve was, in the first place, a mistaken diagnosis of the difficulties that faced science in the 1920s, when operationism was first proposed.
Article
This article presents evidence that published results of scientific investigations are not a representative sample of results of all scientific studies. Research studies from 11 major journals demonstrate the existence of biases that favor studies that observe effects that, on statistical evaluation, have a low probability of erroneously rejecting the so-called null hypothesis (H0). This practice makes the probability of erroneously rejecting H0 different for the reader than for the investigator. It introduces two biases in the interpretation of the scientific literature: one due to multiple repetition of studies with false hypothesis, and one due to failure to publish smaller and less significant outcomes of tests of a true hypotheses. These practices distort the results of literature surveys and of meta-analyses. These results also indicate that practice leading to publication bias have not changed over a period of 30 years.
Article
There is some evidence that in fields where statistical tests of significance are commonly used, research which yields nonsignificant results is not published. Such research being unknown to other investigators may be repeated independently until eventually by chance a significant result occurs—an “error of the first kind”—and is published. Significant results published in these fields are seldom verified by independent replication. The possibility thus arises that the literature of such a field consists in substantial part of false conclusions resulting from errors of the first kind in statistical tests of significance.* The author wishes to express his thanks to Sir Ronald Fisher whose discussion on related topics stimulated this research in the first place, and to Leo Katz, Oliver Lacey, Enders Robinson, and Paul Siegel for reading and criticizing earlier drafts of this manuscript.
Article
Milton Friedman (1912–2006) was born in Brooklyn, New York, and received his Ph.D. in economics from Columbia University. He taught at the University of Minnesota, and then for many years at the University of Chicago. After 1977, he was a Senior Research Fellow at the Hoover Institution in Stanford, California. Friedman is best known for his work in monetary theory and for his concern for free enterprise and individual liberty. Milton Friedman was awarded the Nobel Prize in economics in 1976. The following essay, which is reprinted in its entirety, is the most influential work on economic methodology of this century. In his admirable book on The Scope and Method of Political Economy John Neville Keynes distinguishes among “a positive science … [,] a body of systematized knowledge concerning what is; a normative or regulative science … [,] a body of systematized knowledge discussing criteria of what ought to be …; an art … [,] a system of rules for the attainment of a given end”; comments that “confusion between them is common and has been the source of many mischievous errors”; and urges the importance of “recognizing a distinct positive science of political economy.” This [essay] is concerned primarily with certain methodological problems that arise in constructing the “distinct positive science” Keynes called for – in particular, the problem how to decide whether a suggested hypothesis or theory should be tentatively accepted as part of the “body of systematized knowledge concerning what is.”
Book
When it comes to understanding and treating madness, distortions of research are not rare, misinterpretation of data is not isolated, and bogus claims of success are not voiced by isolated researchers seeking aggrandizement. This book’s detailed analyses of coercion and community treatment, diagnosis, and psychopharmacology reveals that these characteristics of bad science are endemic, institutional, and protected in psychiatry. This is mad science. Mad Science argues that the fundamental claims of modern American psychiatry are not based on convincing research, but on misconceived, flawed, and distorted science. The authors address multiple paradoxes in American mental health, including the remaking of coercion into scientific psychiatric treatment in the community, the adoption of an unscientific diagnostic system that now controls the distribution of services, and how drug treatments have failed to improve the mental health outcome. This book provides an engaging and readable scientific and social critique of current mental health practices. The authors are scholars, researchers, and clinicians who have written extensively about community care, diagnosis, and psychoactive drugs. Mad Science is a must read for all specialists in the field as well as for the informed public.
Article
Background: Only a third of patients with depression respond fully to antidepressant medication but little evidence exists regarding the best next-step treatment for those whose symptoms are treatment resistant. The CoBalT trial aimed to examine the effectiveness of cognitive behavioural therapy (CBT) as an adjunct to usual care (including pharmacotherapy) for primary care patients with treatment resistant depression compared with usual care alone. Methods: This two parallel-group multicentre randomised controlled trial recruited 469 patients aged 18-75 years with treatment resistant depression (on antidepressants for ≥6 weeks, Beck depression inventory [BDI] score ≥14 and international classification of diseases [ICD]-10 criteria for depression) from 73 UK general practices. Participants were randomised, with a computer generated code (stratified by centre and minimised according to baseline BDI score, whether the general practice had a counsellor, previous treatment with antidepressants, and duration of present episode of depression) to one of two groups: usual care or CBT in addition to usual care, and were followed up for 12 months. Because of the nature of the intervention it was not possible to mask participants, general practitioners, CBT therapists, or researchers to the treatment allocation. Analyses were by intention to treat. The primary outcome was response, defined as at least 50% reduction in depressive symptoms (BDI score) at 6 months compared with baseline. This trial is registered, ISRCTN38231611. Findings: Between Nov 4, 2008, and Sept 30, 2010, we assigned 235 patients to usual care, and 234 to CBT plus usual care. 422 participants (90%) were followed up at 6 months and 396 (84%) at 12 months, finishing on Oct 31, 2011. 95 participants (46%) in the intervention group met criteria for response at 6 months compared with 46 (22%) in the usual care group (odds ratio 3·26, 95% CI 2·10-5·06, p<0·001). Interpretation: Before this study, no evidence from large-scale randomised controlled trials was available for the effectiveness of augmentation of antidepressant medication with CBT as a next-step for patients whose depression has not responded to pharmacotherapy. Our study has provided robust evidence that CBT as an adjunct to usual care that includes antidepressants is an effective treatment, reducing depressive symptoms in this population. Funding: National Institute for Health Research Health Technology Assessment.
Article
This article explores the key assumptions that underpin the National Institute for Health and Clinical Excellence's (NICE) approach to guideline development and describes how those assumptions have led to the current reduction in the range of available therapies in primary care. This reduction, it is argued, conflicts with the government's recent commitment to increase patient choice. It is suggested that we are witnessing a paradigm war between those who seek to treat psychotherapy and counselling as if it was a drug and those who regard it fundamentally as a dialogue. Further, it is contended that though NICE may acknowledge the serious debates concerning the relevance and appropriateness of its approach, by subjecting issues of mental well-being to a biomedical model of research it is effectively ignoring those debates. NICE's process is deconstructed and areas of contradiction and ambiguity within NICE's own work are highlighted. The case is made for NICE to move beyond its use of strict diagnostic categories and follow the lead of the American Psychological Association (APA) in adopting a pluralistic approach to psychotherapeutic and counselling research evidence.
Article
We examine the evidence on episodes of large stances in fiscal policy, both in cases of fiscal stimuli and in that of fiscal adjustments in OECD countries from 1970 to 2007. Fiscal stimuli based upon tax cuts are more likely to increase growth than those based upon spending increases. As for fiscal adjustments, those based upon spending cuts and no tax increases are more likely to reduce deficits and debt over GDP ratios than those based upon tax increases. In addition, adjustments on the spending side rather than on the tax side are less likely to create recessions. We confirm these results with simple regression analysis.
Article
abstractThe Labour government's response to the Layard (2004) report was to implement the ‘Improving Access to Psychological Therapies’ (IAPT) programme within Primary Care Trusts in the NHS. In this paper, I argue that the IAPT programme's explicit commitment to ‘well-being work’ risks distorting the unconscious anxiety-containing function that society traditionally allocates to mental health practitioners. Drawing on the social defence paradigm of Menzies Lyth (1959) and later work by Stein (2000), I use an organizational case example to explore some of the unconscious dynamics within an IAPT service and explore how mechanisms such as defensive splitting and projective identification within the multidisciplinary team result in psychotherapists coming to represent an unwanted, vulnerable and expendable aspect of the service. I contend that psychotherapists may serve an important function as unconscious ambassadors of a split-off affective aspect of IAPT primary care mental health services, and that as such they will urgently need to ensure they do not succumb to burnout or unhelpful ways of working and relating within the team.
Chapter
When I hear businessmen speak eloquently about the “social responsibilities of business in a free-enterprise system”, I am reminded of the wonderful line about the Frenchman who discovered at the age of 70 that he had been speaking prose all his life. The businessmen believe that they are defending free enterprise when they declaim that business is not concerned “merely” with profit but also with promoting desirable “social” ends; that business has a “social conscience” and takes seriously its responsibilities for providing employment, eliminating discrimination, avoiding pollution and whatever else may be the catchwords of the contemporary crop of reformers. In fact they are — or would be if they or anyone else took them seriously -preaching pure and unadulterated socialism. Businessmen who talk this way are unwitting puppets of the intellectual forces that have been undermining the basis of a free society these past decades.
Article
Government regulators have increasingly accelerated new cancer drugs on to the market by granting them approval based on less clinical data supporting drug efficacy than permitted under standard regulations. With more lenient regulatory standards, pharmaceutical companies have keenly sought to develop cancer drugs. Focusing on the US, this article examines how the emergence and implementation of such accelerated approvals should be understood, particularly in relation to corporate bias and disease-politics theories. Drawing on longitudinal and case study data analysis, it is argued that the emergence of accelerated approval regulations for cancer drugs should be regarded primarily as part of a deregulatory regime driven by the interests of the pharmaceutical industry in partnership with all major aspects of the state, rather than as a response to patient activism in the aftermath of AIDS. Furthermore, even in cases when some patients successfully demand accelerated marketing approval of cancer drugs, such approval by regulators, while in manufacturers' interests, may not be in the interests of patients' health because the political culture of the regulatory agency is reluctant to uphold its own techno-regulatory standards of public-health protection when that would challenge the agenda-setting influence of manufacturers, including industry collaborations with patients and the medical profession.