4 ms·

If psychotherapy is not a myth, what is the exact mechanism that therapy fixes an issue? If it were science that answer would be readily apparent. I can say exa

If psychotherapy is not a myth, what is the exact mechanism that therapy fixes an issue? If it were science that answer would be readily apparent. I can say exactly how photosynthesis works using chemical structures at every step of the process. But I can’t look up in a book how precisely psychotherapy fixes depression. Psychology has a dearth of actual repeatable testable experiments, which is why it’s not a science. If so many people lack parenting that gives them the skills to tough it out and deal with it, that psychotherapy is necessary, why were so many people able to function prior to psychotherapy? Psychotherapy is only 100 years old, hell it’s only been socially acceptable for like 20 years. But people functioned just fine.

testtestabcdef 3y ago
>But I can’t look up in a book how precisely psychotherapy fixes depression. Well, you can for CBT. CBT goes by the assumption that a lot of depression comes from negative thoughts and it tries to change the way you think and therefore the way you feel. And CBT is the most scientifically backed up form of psychotherapy. So it looks like that works. Sure, we don't fully understand the brain yet, but we are making progress.
stdbrouw 3y ago
It took almost a century before we figured out how photo negatives worked chemically. Didn’t stop anyone from taking photographs though. Mechanistic explanations are great but not a requirement for good science.
- virtualritz 3y ago
  > It took almost a century before we figured out how photo negatives worked chemically. Didn’t stop anyone from taking photographs though. That argument is a strawman as it works with anything that can't be falsiefied. People who believe in astrology/chakras/etc. will also frequently tell you science will "one day" discover that "it's true". "We're just not there yet." Also consider what someone may say in a hundered years: It took almost a century before we figured out that psychotherapy didn't work. Didn’t stop anyone from taking pshychotherapy though. ;)
  - stdbrouw 3y ago
    The point is that we can verify whether something works (with a randomized controlled trial) independently of knowing why it works, and psychotherapy interventions are commonly evaluated with RCTs.
  - DrNosferatu 3y ago
    Psychotherapy presents itself to experimental falsification [1] with epidemiologic studies, whereas astrology/chakras/etc., do not. (Obviously, Psychotherapy is not a magic-bullet. It is however a valuable health tool to have available, and society should be educated - also on recognizing good and BAD therapeutic practices! - on how to use it, and destigmatized.) [1] https://www.cambridge.org/core/journals/epidemiology-and-psychiatric-sciences/article/is-psychotherapy-effective-a-reanalysis-of-treatments-for-depression/5D8EC85B6FA35B5CEE124381F18E51B9 https://www.cambridge.org/core/journals/epidemiology-and-psy...
    - virtualritz 3y ago
      The basic problem is that you can't do double blind studies. Because the very same person would need to be once treated, once not treated and once treated with a placebo therapy. From the same "baseline brain state". I.e. you can gather as much data as you want (referring to the metastudy you linked to) but you can't eleminate the inherent bias. People who are treated can not not know they are treated etc. And while I do believe there is are a lot of forms of psychotherapy that work, I do admit (to myself for that matter) that this is based on belief. Possibly until we can simulate brains with a "sufficient resolution" (whatever that means).
      - circlefavshape 3y ago
        You can't do a double-blind study with tobacco either. Or geology. Double blind studies are not the only source of knowledge
      - stdbrouw 3y ago
        That's not how it works, though. First, if it is not possible to blind the patient to the intervention and/or provide a meaningful placebo (which also happens with surgery and drugs with prominent side-effects) that's not a big deal, it simply changes the interpretation from "the effect of a particular regime of psychotherapy as such" to "the effect of a particular regime of psychotherapy, including expectation effects". Those expectation effects also exist in real life, if you go to a therapist you really really hope you'll get better and may be motivated to make a few changes in your life independently of the treatment, so if anything the trial becomes more realistic. Note that you'd still use a control arm so that if people get better over time without treatment, you're not exaggerating the effects of the intervention. Second, almost every randomized controlled trial compares an experimental group against a control group, you are assigned to a group and don't move between them, and what that means is that we can only compare whether the treatment works on average, not whether it worked for one person in particular because, as you say, we don't know what would have happened (counterfactually) if that one specific person had been randomly assigned to the other group. But again, this hardly matters, because we can still know how well a treatment works on average. What you refer to, an experiment in which every subject receives every treatment, is known as a crossover design and while that design has its advantages, it's not that common because it is harder to pull off and while it can be more efficient (need fewer patients to attain an estimate with a given precision) it is not "less biased" or inherently more trustworthy.
DrNosferatu 3y ago
The mechanisms are actually quite clear, for example: Psychotherapy frontally tries to get the patient unstuck out of Dysfunctional Behavior and Maladaptive Coping Patterns. One possible view is that Society has drastically changed in recent generations with industrialization, mass media & consumption, and minuscule families - it used to take a whole village to raise a child. And to answer your final question, not so long ago, most people also did not know how to read and write, yet “people functioned just fine”. …does that make mass literacy worthless then?
- irundebian 3y ago
  No, that's just the theory of CBT but there are other theories. Studies apparently shows that several psychotherapy types such as CBT are roughly equally effective despite having different underlying theory.
cedilla 3y ago
Would you claim that photosynthesis was a myth if we didn't understand every step of the Krebs cycle? There are loads of natural phenomena we don't understand precisely, but nature doesn't care. We don't understand how many drugs work. There is no book that explains how thalidomide helps with multiple myeloma but is that a reason to say pharmacology is not science?
- sydbarrett74 3y ago
  Not to be overly pedantic, but the Krebs cycle is a part of respiration, not photosynthesis. Maybe you're thinking of the Calvin cycle?
  - adr1an 3y ago
    Exactly my thought!
  - cedilla 3y ago
    You are appropriately pedantic. I learnt this in school almost 40 years ago, so apologies. The point still stands, I hope.
    - sydbarrett74 3y ago
      It most certainly does, and I didn't mean to detract from it.
retrac 3y ago
> why were so many people able to function prior to psychotherapy? Were they? If you look at statistics for harmful behaviours like heavy drinking or interpersonal violence, people in the West were absolute basket cases just 100 years ago by current standards. The incidence of such behaviours is much lower today than back then. A general awareness of psychology might be part of it. Not too long ago we were executing soldiers for cowardice after psychological breakdown due to PTSD. Think about how ignorant that is, compared to what we know today. Anecdotally, mental illness runs in my family. I have the same personality / emotional instability problem almost all males on my father's side of the family have. He did better than most else of ancestors and I've done much better. And I chalk some of it up to psychological awareness of my parents and teachers etc. about how to work with that kind of kid. Good feedback at all stages. I think I would simply have been expelled from school in an earlier era.
thefurdrake 3y ago
> why were so many people able to function prior to psychotherapy Can you explain why society being able to function prior to psychotherapy contributes at all to considerations about its efficacy and validity to science, or is in any way relevant to discussions about modern science? Walk me through your thought process here, because I'm similarly confused as to why we need all these antibiotics, for humanity survived just fine before they were invented in 1940. Especially considering: 1) There are many documented cases of mental disorder throughout history that were either poorly-understood mislabeled. 2) Most psychiatric disorders don't have a completely-debilitating effect on those afflicted. 3) The existence of people being able to function does not say anything about the number of people who died/removed themselves from society due to being unable to interact. History is an interesting lens presented only by the people who succeeded enough to produce it.
eastbound 3y ago
> Psychology has a dearth of actual repeatable testable experiments, which is why it’s not a science. Some sciences are characterized by their inability to perform isolated and repeated experiments with identical initial state: Economics, biology, climate, and anything based on humans. They’re still sciences.

testtestabcdef 3y ago

>But I can’t look up in a book how precisely psychotherapy fixes depression. Well, you can for CBT. CBT goes by the assumption that a lot of depression comes from negative thoughts and it tries to change the way you think and therefore the way you feel. And CBT is the most scientifically backed up form of psychotherapy. So it looks like that works. Sure, we don't fully understand the brain yet, but we are making progress.

stdbrouw 3y ago

It took almost a century before we figured out how photo negatives worked chemically. Didn’t stop anyone from taking photographs though. Mechanistic explanations are great but not a requirement for good science.

virtualritz 3y ago
> It took almost a century before we figured out how photo negatives worked chemically. Didn’t stop anyone from taking photographs though. That argument is a strawman as it works with anything that can't be falsiefied. People who believe in astrology/chakras/etc. will also frequently tell you science will "one day" discover that "it's true". "We're just not there yet." Also consider what someone may say in a hundered years: It took almost a century before we figured out that psychotherapy didn't work. Didn’t stop anyone from taking pshychotherapy though. ;)
- stdbrouw 3y ago
  The point is that we can verify whether something works (with a randomized controlled trial) independently of knowing why it works, and psychotherapy interventions are commonly evaluated with RCTs.
- DrNosferatu 3y ago
  Psychotherapy presents itself to experimental falsification [1] with epidemiologic studies, whereas astrology/chakras/etc., do not. (Obviously, Psychotherapy is not a magic-bullet. It is however a valuable health tool to have available, and society should be educated - also on recognizing good and BAD therapeutic practices! - on how to use it, and destigmatized.) [1] https://www.cambridge.org/core/journals/epidemiology-and-psychiatric-sciences/article/is-psychotherapy-effective-a-reanalysis-of-treatments-for-depression/5D8EC85B6FA35B5CEE124381F18E51B9 https://www.cambridge.org/core/journals/epidemiology-and-psy...
  - virtualritz 3y ago
    The basic problem is that you can't do double blind studies. Because the very same person would need to be once treated, once not treated and once treated with a placebo therapy. From the same "baseline brain state". I.e. you can gather as much data as you want (referring to the metastudy you linked to) but you can't eleminate the inherent bias. People who are treated can not not know they are treated etc. And while I do believe there is are a lot of forms of psychotherapy that work, I do admit (to myself for that matter) that this is based on belief. Possibly until we can simulate brains with a "sufficient resolution" (whatever that means).
    - circlefavshape 3y ago
      You can't do a double-blind study with tobacco either. Or geology. Double blind studies are not the only source of knowledge
    - stdbrouw 3y ago
      That's not how it works, though. First, if it is not possible to blind the patient to the intervention and/or provide a meaningful placebo (which also happens with surgery and drugs with prominent side-effects) that's not a big deal, it simply changes the interpretation from "the effect of a particular regime of psychotherapy as such" to "the effect of a particular regime of psychotherapy, including expectation effects". Those expectation effects also exist in real life, if you go to a therapist you really really hope you'll get better and may be motivated to make a few changes in your life independently of the treatment, so if anything the trial becomes more realistic. Note that you'd still use a control arm so that if people get better over time without treatment, you're not exaggerating the effects of the intervention. Second, almost every randomized controlled trial compares an experimental group against a control group, you are assigned to a group and don't move between them, and what that means is that we can only compare whether the treatment works on average, not whether it worked for one person in particular because, as you say, we don't know what would have happened (counterfactually) if that one specific person had been randomly assigned to the other group. But again, this hardly matters, because we can still know how well a treatment works on average. What you refer to, an experiment in which every subject receives every treatment, is known as a crossover design and while that design has its advantages, it's not that common because it is harder to pull off and while it can be more efficient (need fewer patients to attain an estimate with a given precision) it is not "less biased" or inherently more trustworthy.

DrNosferatu 3y ago

The mechanisms are actually quite clear, for example: Psychotherapy frontally tries to get the patient unstuck out of Dysfunctional Behavior and Maladaptive Coping Patterns. One possible view is that Society has drastically changed in recent generations with industrialization, mass media & consumption, and minuscule families - it used to take a whole village to raise a child. And to answer your final question, not so long ago, most people also did not know how to read and write, yet “people functioned just fine”. …does that make mass literacy worthless then?

irundebian 3y ago
No, that's just the theory of CBT but there are other theories. Studies apparently shows that several psychotherapy types such as CBT are roughly equally effective despite having different underlying theory.

cedilla 3y ago

Would you claim that photosynthesis was a myth if we didn't understand every step of the Krebs cycle? There are loads of natural phenomena we don't understand precisely, but nature doesn't care. We don't understand how many drugs work. There is no book that explains how thalidomide helps with multiple myeloma but is that a reason to say pharmacology is not science?

sydbarrett74 3y ago
Not to be overly pedantic, but the Krebs cycle is a part of respiration, not photosynthesis. Maybe you're thinking of the Calvin cycle?
- adr1an 3y ago
  Exactly my thought!
- cedilla 3y ago
  You are appropriately pedantic. I learnt this in school almost 40 years ago, so apologies. The point still stands, I hope.
  - sydbarrett74 3y ago
    It most certainly does, and I didn't mean to detract from it.

retrac 3y ago

> why were so many people able to function prior to psychotherapy? Were they? If you look at statistics for harmful behaviours like heavy drinking or interpersonal violence, people in the West were absolute basket cases just 100 years ago by current standards. The incidence of such behaviours is much lower today than back then. A general awareness of psychology might be part of it. Not too long ago we were executing soldiers for cowardice after psychological breakdown due to PTSD. Think about how ignorant that is, compared to what we know today. Anecdotally, mental illness runs in my family. I have the same personality / emotional instability problem almost all males on my father's side of the family have. He did better than most else of ancestors and I've done much better. And I chalk some of it up to psychological awareness of my parents and teachers etc. about how to work with that kind of kid. Good feedback at all stages. I think I would simply have been expelled from school in an earlier era.

thefurdrake 3y ago

> why were so many people able to function prior to psychotherapy Can you explain why society being able to function prior to psychotherapy contributes at all to considerations about its efficacy and validity to science, or is in any way relevant to discussions about modern science? Walk me through your thought process here, because I'm similarly confused as to why we need all these antibiotics, for humanity survived just fine before they were invented in 1940. Especially considering: 1) There are many documented cases of mental disorder throughout history that were either poorly-understood mislabeled. 2) Most psychiatric disorders don't have a completely-debilitating effect on those afflicted. 3) The existence of people being able to function does not say anything about the number of people who died/removed themselves from society due to being unable to interact. History is an interesting lens presented only by the people who succeeded enough to produce it.

eastbound 3y ago

> Psychology has a dearth of actual repeatable testable experiments, which is why it’s not a science. Some sciences are characterized by their inability to perform isolated and repeated experiments with identical initial state: Economics, biology, climate, and anything based on humans. They’re still sciences.