4 ms·
"What’s going on? One theory is that, as any therapy grows more popular, the proportion of inexperienced or incompetent therapists grows bigger. But the paper r
by mettamage 10y ago
"What’s going on? One theory is that, as any therapy grows more popular, the proportion of inexperienced or incompetent therapists grows bigger. But the paper raises a more intriguing idea: the placebo effect."
The placebo effect, and effects like it, happen everywhere. Everything given with a good or bad attitude will have some beneficial or detrimental effect. In that sense this article isn't that interesting.
What I think is more interesting is combining the interaction between inexperienced therapists and the placebo effect. Well trained psychologists have a stronger -- and I'd guess more nuanced -- belief of when CBT is useful and how it is useful. Since they have that belief, it has the potential to create a positive placebo. I always have to think of the Pygmallion effect and similar effects.
People who treat patients CBT but are inexperienced do not have that enthusiasm and have a weaker belief that it will work. Maybe they only think intellectually that it would work, but don't feel an emotional tsunami of conviction -- in particular cases -- that it will work. It's easier to have that when you know that in 7 out of 10 particular cases it worked really well (i.e., having experience).
That would be my guess anyways.
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Now I read a couple of comments with people giving the sentiment that they think CBT is nonsense. Allow me to address that.
When I looked into CBT (@ 17/18 yo) and its pseudoscientific brother -- reframing in NLP -- I noticed that it was all about changing perspective. Learning to see that multiple emotional perspectives can be equally true was mind blowing for me. I came to the conclusion that I might as well pick the most positive one. I learned a couple of nuances on the way. For example, for some goals it's useful to hold multiple positive and negative perspectives at the same time.
I used it even today, now that I think of it. I was learning Django and it took me 4 hours to write simple custom email validation. I had a bug, a very simple one if you know the framework, but I don't. I was pissed after 4 hours, I felt like I wasted my time. I found the bug though :)
Since I didn't want to feel pissed I looked for a reframe. The reframe was: it's the first time that I learned to debug in Python with pdb, read source code from a framework so intensely, have a better understanding in transferable skills since I have experience with gdb and have the guts to debug the framework and understand it, for the first time. While I didn't progress much in writing actual code, my confidence in tackling issues in Python has grown tremendously. After thinking this I felt pretty good and figured that tomorrow it would be another day. So yea, I didn't progress in my initial goal (completing a tutorial) but I got something way more cooler for it in return. Now, if I hadn't known CBT I would've stopped at my first thought and stayed pissed, I'd then enter a lot of thought trains that would go to destructive places.
So yes, changing perspectives works. I also call it 'simple CBT'.
And when heavy stuff happens, then it doesn't completely cure you (perhaps reduces the pain by 5 to 20% IME, got no scientific sources). In many ways that's because the pain from the problem does not only stem from cognitive distortions -- e.g. generalizing the slightest thing to a negative epic scale -- which is the main assumption that CBT makes. If you lose a person (breakup, passing away, etc.), for example, you also need to be reconditioned since a lot of habits are still there that are only applicable to the other person which may trigger an immediate pain. You can't just think your way out of that, and the "behavioral" part of CBT will take a longer time and may not work (habit formation and destruction is a difficult topic).
Disclaimer: studied psych., I know a lot more about reframing than CBT (I skimmed a couple of texts and was like "hey that looks like reframing"). So my knowledge is not a 100% sharp and may miss important details. I read a book about ACT and compared that with CBT.
- chillacy 10y agoYour story is spot on with my experiences dabbling with reframing lately (the kind presented in Learned Optimism, where the practitioner is aware of their beliefs and debates internally to install new beliefs. Negative things are reframed to be temporary or impersonal while positives are permanent general traits about the individual) I've known some people who have seemingly indestructible self confidence, bordering on delusional, and this seems to be how they do it. I don't particularly want to be delusional, but I'd rather be happy than right.
- mettamage 10y ago"but I'd rather be happy than right" Me too, to add: I'd rather be both ;)