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Does therapy actually work? I’ve always been under the impression that it was mostly placebo, and that only medication produces meaningful results. Happy to be

Does therapy actually work? I’ve always been under the impression that it was mostly placebo, and that only medication produces meaningful results. Happy to be proven wrong though

tonyarkles 5y ago
During my diagnosis I discussed both pharmaceutical and therapy options with my psychiatrist. His take, which is definitely subject to his own biases, was "lots of my patients choose to do both therapy and pharmaceuticals, but after starting the drugs they kind of lose interest in the therapy part of things because the drugs work so well for most patients. Not all. Some have benefited tremendously from therapy."
- caddemon 5y ago
  The meds available for ADHD are remarkably effective relative to other psychiatric disorders though. For depression there are a number of (placebo-controlled) studies showing CBT + meds reduces symptoms more than either alone do, to the point there is a hypothesized complementary effect. It's also pretty common for moderate depression cases to continue with maintenance therapy but go off meds (with proper supervision ofc) once things are under control. Therapy is a lot more work for the patient - more time consuming, more costly, can be emotionally taxing in the early stages, etc. So I understand the desire for a meds only solution, and in some cases that is possible. But talking about therapy more generally I would encourage anyone who can to give it a try, just as I would encourage people to put effort into their diet, exercise, etc. Obviously make sure it is evidence-based therapy though, something like CBT that has been well-studied. There are flavors of talk therapy that are total pseudoscience.
- PragmaticPulp 5y ago
  It’s less because the medications are so effective relative to therapy. Ideal solution is a combination treatment. However, it’s hard to convince people to make scheduled appointments to interact with another person and discuss part of themself they’re not proud of, so many people reach for medications instead of therapy in all psychiatric conditions (not just ADHD). Therapy is actually a wonderful adjunct to medication because it helps instill lasting behavioral changes. A lot of people mistake the early motivational boost of stimulants for ADHD remission, but once the energizing effect of stimulants disappears due to tolerance, they’re left with the same bad habits they started with. Therapy can help build a better foundation for when the energizing side effect of stimulants disappears and only the attention-enhancing effects remain.
- BadCookie 5y ago
  Most people seem to think that medication for ADHD is great, but for my son, the side effects were unacceptable: nausea, vomiting, extreme irritability. If therapy is even an option, none of the medical professionals we’ve spoken to has offered it. Maybe it’s because he’s on the young side (7). Anyway, it’s frustrating that everyone sees medication as the answer when the side effects are so awful—but maybe our experience is outside the norm.
  - n8cpdx 5y ago
    That sounds somewhat unusual, but side effects are a very individual thing. It might be you can't get a low enougb dose for your child. I'm a full, rather large adult, and I only need abouy 5-10mg of ritalin, and going above that is unpleasant. I'm sure I'd have been quite sick if I was taking that dose (5mg seems to be close to the minimum they'll do) at 7. A lot of doctors start patients at crazy high doses (over 10mg) and a lot of patients do indeed benefit from 50+mg. If medication isn't tolerated, starting therapy early seems like a great idea.
    - TeMPOraL 5y ago
      Side effects also vary with the active substance used, release mode, and other factors. Like with depression, ADHD treatment also starts with a process of matching the right meds to the person. So if the first prescription has bad side effects, tell your doctor and get them to prescribe an alternative. There's easily a dozen options to go through before giving up on meds entirely.
jstx1 5y ago
> I’ve always been under the impression that it was mostly placebo I don't think placebo is relevant in the case of therapy because placebo itself is a psychological effect. CBT seems to be somewhat effective but with these things people's experiences vary a lot.
- caddemon 5y ago
  They do placebo-controlled trials of therapy techniques like CBT, although for an educated patient it may not be a great placebo - similar to the problem with trying to placebo psychedelics. But basically you can assign the patients randomly to either an informational session on the disorder + unstructured talk "therapy", or the actual therapy method such as CBT. CBT does perform quite well repeatedly in these sorts of experiments, particularly for depression (it is less studied in some other disorders although still promising). You're right there can be a lot of variance between people though. There can also be additional variance IRL due to therapist quality IMO.
levi-epstein 5y ago
Each ADHD individual is unique and will have unique responses to therapy, medication and other treatments or self-help measures. While we have worked hard to build Inflow for all members of our extremely diverse community, we acknowledge it may not be right for everyone.
chrsig 5y ago
It depends on your definition of "work" -- the impairments will not be impacted, but you can learn a lot of coping strategies to live a higher quality life.
nonbirithm 5y ago
From my experience, I have found that therapy is only as useful as the work you are willing to put into it. If you have trouble opening up, interacting with people in general or committing to changing yourself, your ultimate goals with therapy will become vague, and without well-defined goals the entire system falls apart. I don't know what to feel when people around me say I ought to talk to a therapist, leaving it as the only possible option for my mental salvation or outright refusing to listen to me about certain topics by saying the therapist needs to hear it, not them, only for the therapist to say they don't know how to help me. That is because I went just because someone told me to, because they did not want to listen to me, so I'm not motivated enough to get the most out of each session. I started going with the intention of receiving CBT and I'm not sure if what we do can even be called that anymore after all this time. About the only reason I see my therapist each week is to have one person who is willing to listen to me in person instead of zero, and nothing particularly changes as a result. If seeing someone in person each week who is actually willing to listen is all that prevents me from becoming depressed, then it is a net positive result, but it is not life-changing in any real regard because of my lack of motivation or inability to properly utilize therapy.

Does therapy actually work? I’ve always been under the impression that it was mostly placebo, and that only medication produces meaningful results. Happy to be proven wrong though

tonyarkles 5y ago

During my diagnosis I discussed both pharmaceutical and therapy options with my psychiatrist. His take, which is definitely subject to his own biases, was "lots of my patients choose to do both therapy and pharmaceuticals, but after starting the drugs they kind of lose interest in the therapy part of things because the drugs work so well for most patients. Not all. Some have benefited tremendously from therapy."

caddemon 5y ago
The meds available for ADHD are remarkably effective relative to other psychiatric disorders though. For depression there are a number of (placebo-controlled) studies showing CBT + meds reduces symptoms more than either alone do, to the point there is a hypothesized complementary effect. It's also pretty common for moderate depression cases to continue with maintenance therapy but go off meds (with proper supervision ofc) once things are under control. Therapy is a lot more work for the patient - more time consuming, more costly, can be emotionally taxing in the early stages, etc. So I understand the desire for a meds only solution, and in some cases that is possible. But talking about therapy more generally I would encourage anyone who can to give it a try, just as I would encourage people to put effort into their diet, exercise, etc. Obviously make sure it is evidence-based therapy though, something like CBT that has been well-studied. There are flavors of talk therapy that are total pseudoscience.
PragmaticPulp 5y ago
It’s less because the medications are so effective relative to therapy. Ideal solution is a combination treatment. However, it’s hard to convince people to make scheduled appointments to interact with another person and discuss part of themself they’re not proud of, so many people reach for medications instead of therapy in all psychiatric conditions (not just ADHD). Therapy is actually a wonderful adjunct to medication because it helps instill lasting behavioral changes. A lot of people mistake the early motivational boost of stimulants for ADHD remission, but once the energizing effect of stimulants disappears due to tolerance, they’re left with the same bad habits they started with. Therapy can help build a better foundation for when the energizing side effect of stimulants disappears and only the attention-enhancing effects remain.
BadCookie 5y ago
Most people seem to think that medication for ADHD is great, but for my son, the side effects were unacceptable: nausea, vomiting, extreme irritability. If therapy is even an option, none of the medical professionals we’ve spoken to has offered it. Maybe it’s because he’s on the young side (7). Anyway, it’s frustrating that everyone sees medication as the answer when the side effects are so awful—but maybe our experience is outside the norm.
- n8cpdx 5y ago
  That sounds somewhat unusual, but side effects are a very individual thing. It might be you can't get a low enougb dose for your child. I'm a full, rather large adult, and I only need abouy 5-10mg of ritalin, and going above that is unpleasant. I'm sure I'd have been quite sick if I was taking that dose (5mg seems to be close to the minimum they'll do) at 7. A lot of doctors start patients at crazy high doses (over 10mg) and a lot of patients do indeed benefit from 50+mg. If medication isn't tolerated, starting therapy early seems like a great idea.
  - TeMPOraL 5y ago
    Side effects also vary with the active substance used, release mode, and other factors. Like with depression, ADHD treatment also starts with a process of matching the right meds to the person. So if the first prescription has bad side effects, tell your doctor and get them to prescribe an alternative. There's easily a dozen options to go through before giving up on meds entirely.

jstx1 5y ago

> I’ve always been under the impression that it was mostly placebo I don't think placebo is relevant in the case of therapy because placebo itself is a psychological effect. CBT seems to be somewhat effective but with these things people's experiences vary a lot.

caddemon 5y ago
They do placebo-controlled trials of therapy techniques like CBT, although for an educated patient it may not be a great placebo - similar to the problem with trying to placebo psychedelics. But basically you can assign the patients randomly to either an informational session on the disorder + unstructured talk "therapy", or the actual therapy method such as CBT. CBT does perform quite well repeatedly in these sorts of experiments, particularly for depression (it is less studied in some other disorders although still promising). You're right there can be a lot of variance between people though. There can also be additional variance IRL due to therapist quality IMO.

levi-epstein 5y ago

Each ADHD individual is unique and will have unique responses to therapy, medication and other treatments or self-help measures. While we have worked hard to build Inflow for all members of our extremely diverse community, we acknowledge it may not be right for everyone.

chrsig 5y ago

It depends on your definition of "work" -- the impairments will not be impacted, but you can learn a lot of coping strategies to live a higher quality life.

nonbirithm 5y ago

From my experience, I have found that therapy is only as useful as the work you are willing to put into it. If you have trouble opening up, interacting with people in general or committing to changing yourself, your ultimate goals with therapy will become vague, and without well-defined goals the entire system falls apart. I don't know what to feel when people around me say I ought to talk to a therapist, leaving it as the only possible option for my mental salvation or outright refusing to listen to me about certain topics by saying the therapist needs to hear it, not them, only for the therapist to say they don't know how to help me. That is because I went just because someone told me to, because they did not want to listen to me, so I'm not motivated enough to get the most out of each session. I started going with the intention of receiving CBT and I'm not sure if what we do can even be called that anymore after all this time. About the only reason I see my therapist each week is to have one person who is willing to listen to me in person instead of zero, and nothing particularly changes as a result. If seeing someone in person each week who is actually willing to listen is all that prevents me from becoming depressed, then it is a net positive result, but it is not life-changing in any real regard because of my lack of motivation or inability to properly utilize therapy.