Conitive therapy - is it woo?

[Mr.Samsa]

Is CBT something a person could teach themselves through a book i that person had an aversion to discussing their feelings with people?

Absolutely - you can try this program: "Mood Gym" (there are more resources on the thread that Lazar linked you to over at RatSkep here). With the widespread use of the internet, a lot of psychological therapies are attempting to distribute them this way, with working scientists actually developing these programs and putting them through rigorous testing. The advantage of CBT, in regards to this, is the fact that the patient-therapist relationship is irrelevant to its success, as the success is a result of the specific mechanisms and tools that the therapist aims to teach you. With that said, of course, I'd still recommend trying to see an actual psychologist if you can as there are obviously problems with self-diagnosis and there could be something more serious which can't be helped with a fairly simple computer program. And, in some ways, having someone teach you the tools can be helpful in case you have any questions or concerns etc, so I suppose it's comparable to hiring a guitar teacher versus trying to teach yourself from the internet. It's possible and can be successful, but there are drawbacks.

CBT was primarily developed through a merging of behavior therapy with cognitive therapy. While rooted in rather different theories, these two traditions found common ground in focusing on the "here and now", and on alleviating symptoms

http://en.wikipedia.org/wiki/Cognitive- ... al_therapy

Indeed - this is the misunderstanding of what behavioral therapy is. I could go into a very long and very boring history lesson here, but basically behavioral therapy is based on Skinner's principles of radical behaviorism. Due to popular mischaracterisations of his position (e.g. Chomsky's strawman essay on "Verbal Behavior"), people started to believe that Skinner only focused on external behaviors and ignored thoughts, beliefs and other cognitive phenomenon - this is why people mistakenly view behaviorism as a "black box" approach. This is all false of course, and Skinner's brand of behaviorism was termed "radical" precisely because he believed it was necessary for us to understand cognitive phenomenon in order to understand the behavior of organisms. The confusing part for most people (including wikipedia writers apparently) is that Skinner argued that we should view thoughts as behaviors. Unfortunately, Skinner's use of language here appears to have misled people into thinking that he was suggesting that thoughts and feelings should be interpreted as simply being the external behaviors we exhibit, for example, "sadness" is actually just the behavior of frowning, or whatever. This is completely false and Skinner never suggested this, instead what he was saying is that thoughts and feelings should be understood as operating according to the same behavioral laws as all of our other behaviors. In other words, he developed the basis for CBT decades before it was officially formulated, because he argued that if we can train people to behave in certain ways, then we can use these same laws and principles to train people to think in certain ways.

This is why you'll find many psychologists discussing the "cognitive revolution" in quotation marks, because there was no actual revolution. Cognitive psychology was a part of behaviorism, and the 'revolution' was simply relabelling things that we had already discovered. There is no opposition, or conflict, because not only do they study the exact same phenomena, using the same tools and reaching the same conclusions, but they are in effect the same field.

tldr: The "cognitive" label of CBT is redundant because behavioral therapy includes cognitive phenomena anyway.

It's placebo but placebo is powerful

It's an extremely interesting placebo then. This placebo outperforms placebos in all clinical trials, and outperforms anti-depressants as well (which themselves have outperformed placebos). We've also extensively mapped out the mechanism by which it works and it is consistent with the relevant scientific framework. In other words, it is as much a placebo as anti-biotics are (and just to be clear, anti-biotics aren't placebos).

Is psychotherapy as a whole woo? Something that only works if you believe it will?

I don't know... I had therapy with a guy for like 5 years, and when push came to shove and I sank into real depression again, all that woo peddling jewish SoB did was dunk me deeper and suck me out of more money that I really could not afford.

and some people swear by Psychoanalysis, while others shout that freud and lacan were frauds and that the thing has been thoroughly debunked.

It's important to note that there is a difference between psychotherapy and psychoanalysis. The former is the scientific application of known principles of behavior and the mind to help treat, fix, or cure mental disorders and general mental issues. Psychoanalysis was a big ball of pseudoscience that Freud created, in my opinion, to try to justify his lingering lust for his own mother.

Well, there's some research (could cite, but no time to at the moment) that repetitive thoughts actually create stronger connections between the synapses in our brains involved in transmitting them-- i.e.- the more you think about certain things, or respond to thoughts in one particular way, the more your brain actually gets used to those patterns. This is a theory behind PTSD, and certain compulsive behaviors. Even depressive thoughts can become easier and easier to access with frequent use.

I picture this as being sort of like muscle memory, or training certain muscles to become stronger with repetitive exercises-- though that's a metaphorical image.

Yes - and sort of no. Definitely yes in how you've suggested it, with people thinking something about themselves over and over again basically cementing the belief into their brain, but I think it's important to point out that repetition isn't the only important factor. This was the problem with those "Tell yourself you're beautiful 20 times a day and you will feel beautiful!" self-help ideas from the late-90s onwards. They actually studied this and found that the self-esteem of the control group sky-rocketed, whereas the self-esteem of the depressed group (or whatever they were studying) actually plummeted. They suggested that this kind of repetition only worked when the person believed it already, and so when these "ugly people" (according to their own perceptions) were constantly telling themselves they were beautiful, they basically felt like they were lying to themselves and almost mocking themselves every day.

The idea behind CBT, as I understand it, is to try to retrain your brain to use different synaptic paths, to encourage different behaviors. Another metaphor- trading a rutted mental path for a new one, that might be harder to use in the beginning, but becomes easier to travel with use. I suppose it could be woo. I don't think it is.

:nod: CBT, instead of using repetition, just teaches you how to identify the beginning of these negative thoughts and then teaches you how to eliminate them. It's a fairly simply concept, but pretty powerful it seems.

But yes, I think if you are, as a patient, four-square resisting any attempt to teach your mind new tricks, CBT won't be effective for you.

Definitely. There are a number of tools, manuals and tutorials out there to teach people how to juggle, but if they never pick up the balls in the first place or even try to practice throwing them around, then they're never going to learn how to juggle burning elephants. Or whatever those circus people do these days to entertain us.

[charlou]

Yes - and sort of no. Definitely yes in how you've suggested it, with people thinking something about themselves over and over again basically cementing the belief into their brain, but I think it's important to point out that repetition isn't the only important factor. This was the problem with those "Tell yourself you're beautiful 20 times a day and you will feel beautiful!" self-help ideas from the late-90s onwards. They actually studied this and found that the self-esteem of the control group sky-rocketed, whereas the self-esteem of the depressed group (or whatever they were studying) actually plummeted. They suggested that this kind of repetition only worked when the person believed it already, and so when these "ugly people" (according to their own perceptions) were constantly telling themselves they were beautiful, they basically felt like they were lying to themselves and almost mocking themselves every day.

This is interesting to me ... I don't take personal compliments well because I don't like my own attention drawn to myself when it only serves as a reminder to me of how I feel about myself. I can't do the positive self talk thing, even at the best of times because I just don't believe it. The whole concept feels like a false charade, not least in part due to another idea that plays into it for me: my skepticism about the healthiness of society's need to constantly be evaluating oneself and others, in the first place. The evaluation is too often distorted by family, peers, media, etc, to be trusted, and yet it has such a big impact on how we view ourselves and others.

[Mr.Samsa]

Yes - and sort of no. Definitely yes in how you've suggested it, with people thinking something about themselves over and over again basically cementing the belief into their brain, but I think it's important to point out that repetition isn't the only important factor. This was the problem with those "Tell yourself you're beautiful 20 times a day and you will feel beautiful!" self-help ideas from the late-90s onwards. They actually studied this and found that the self-esteem of the control group sky-rocketed, whereas the self-esteem of the depressed group (or whatever they were studying) actually plummeted. They suggested that this kind of repetition only worked when the person believed it already, and so when these "ugly people" (according to their own perceptions) were constantly telling themselves they were beautiful, they basically felt like they were lying to themselves and almost mocking themselves every day.

This is interesting to me ... I don't take personal compliments well because I don't like my own attention drawn to myself when it only serves as a reminder to me of how I feel about myself. I can't do the positive self talk thing, even at the best of times because I just don't believe it. The whole concept feels like a false charade, not least in part due to another idea that plays into it for me: my skepticism about the healthiness of society's need to constantly be evaluating oneself and others, in the first place. The evaluation is too often distorted by family, peers, media, to be trusted, and yet it has such a big impact on how we view ourselves and others.

Yeah compliments are an odd part of social life. I've never been able to take them or hand them out, hence why I get accused of being too underwhelming at times by my better half

"What do you think of this dress?"
"Oh yeah, it's cool."
"What do you mean by cool? What do you like about it?"
"I like... the dressy part."
"You mean the way it sits, or the fabric, or what?"
"Nah, just like, the dress part. I like the whole thing. It's cool".

More seriously though, Skinner theorised that a large part of our social interactions (like giving compliments I imagine) are a part of 'manipulating' people to behave in ways that we find agreeable. This isn't a conscious attempt to deviously control the minds and behaviors of others, but simply it stems from our very basic behavioral laws - we approach things we find pleasurable, and avoid things we find aversive. So if somebody is cooking something we like, we say, "Wow, you're such a great cook, this food is delicious!". This in turn makes the chef feel good, and through the process of reinforcement we know that any behavior which is followed by a "reward" will increase in probability, so it's more likely to occur again in the future. And this basic fundamental property of our behavior is what gives rise to some of our more complex behavior, like choice, altruism, self-control, etc.

[charlou]

Yes - and sort of no. Definitely yes in how you've suggested it, with people thinking something about themselves over and over again basically cementing the belief into their brain, but I think it's important to point out that repetition isn't the only important factor. This was the problem with those "Tell yourself you're beautiful 20 times a day and you will feel beautiful!" self-help ideas from the late-90s onwards. They actually studied this and found that the self-esteem of the control group sky-rocketed, whereas the self-esteem of the depressed group (or whatever they were studying) actually plummeted. They suggested that this kind of repetition only worked when the person believed it already, and so when these "ugly people" (according to their own perceptions) were constantly telling themselves they were beautiful, they basically felt like they were lying to themselves and almost mocking themselves every day.

This is interesting to me ... I don't take personal compliments well because I don't like my own attention drawn to myself when it only serves as a reminder to me of how I feel about myself. I can't do the positive self talk thing, even at the best of times because I just don't believe it. The whole concept feels like a false charade, not least in part due to another idea that plays into it for me: my skepticism about the healthiness of society's need to constantly be evaluating oneself and others, in the first place. The evaluation is too often distorted by family, peers, media, to be trusted, and yet it has such a big impact on how we view ourselves and others.

Yeah compliments are an odd part of social life. I've never been able to take them or hand them out, hence why I get accused of being too underwhelming at times by my better half

"What do you think of this dress?"
"Oh yeah, it's cool."
"What do you mean by cool? What do you like about it?"
"I like... the dressy part."
"You mean the way it sits, or the fabric, or what?"
"Nah, just like, the dress part. I like the whole thing. It's cool".

More seriously though, Skinner theorised that a large part of our social interactions (like giving compliments I imagine) are a part of 'manipulating' people to behave in ways that we find agreeable. This isn't a conscious attempt to deviously control the minds and behaviors of others, but simply it stems from our very basic behavioral laws - we approach things we find pleasurable, and avoid things we find aversive. So if somebody is cooking something we like, we say, "Wow, you're such a great cook, this food is delicious!". This in turn makes the chef feel good, and through the process of reinforcement we know that any behavior which is followed by a "reward" will increase in probability, so it's more likely to occur again in the future. And this basic fundamental property of our behavior is what gives rise to some of our more complex behavior, like choice, altruism, self-control, etc.

Good points. I have less of a problem with it when it's skill or pleasure related, than when it's something superficial, like appearance ..

.. or compliments extracted under pain of obligation (the reverse form of manipulation, conscious or otherwise, I guess) ... which kinda ties loosely into my dislike of traditional celebratory obligations like mother's/father's day, for example.

[charlou]

A couple of articles I've posted before wrt childhood education, that tie into this area of social manipulation ....

Five reasons to stop saying 'Good Job' - by Alfie Kohn

Behaviour Management in Children - interview with Louise Porter This link is to an ABC Radio National transcript ... if the link is unavailable to you I can c/p the transcript to you, if you like.

[Mr.Samsa]

A couple of articles I've posted before wrt childhood education, that tie into this area of social manipulation ....

Five reasons to stop saying 'Good Job' - by Alfie Kohn

Behaviour Management in Children - interview with Louise Porter This link is to an ABC Radio National transcript ... if the link is unavailable to you I can c/p the transcript to you, if you like.

I haven't had a chance to listen to the second one, but Alfie Kohn is an idiot. He's built a career misrepresenting how reinforcement procedures are used in schools and makes it seem like they focus solely on "extrinsic" rewards at the expense of "intrinsic" rewards; that is, he thinks that saying "good job" replaces the need for the child to enjoy reading, or enjoy drawing. This is obviously wrong because the two are not incompatible, and more importantly, the former necessarily leads to the latter. The conclusion from the second one ("that reward and punishment does not work") is wrong on two levels. Firstly, education systems don't use reward and punishment techniques, they use reinforcement and punishment techniques - slight, but important difference, and secondly, these techniques undeniably do work.

At the end of the day, it is impossible to teach using methods other than reinforcement and punishment. There is no other option. People who think there is don't understand the subject matter they are discussing so they say things like, "No, reinforcement is unnecessary and damaging, instead of praising my child for doing something good, I simply teach him to enjoy the feeling of doing a good job - this way I don't have to reinforce him with praise or candy every time he does something good!". The obvious mistake here is that reinforcement is, simply, anything which increases the probability of a behavior, so if a behavior increases, it has necessarily been reinforced. If somebody thinks they can increase the probability of a behavior without increasing the probability of a behavior, then they need their head checked..

This is probably off-topic though, given the aims of Animavore's OP. If you wanted me to expand on what I've said above, and deconstruct each link claim by claim, I can easily do that but it might be best if we don't ruin Animavore's thread, so if you start a new thread then I'll post more there

[charlou]

This is probably off-topic though, given the aims of Animavore's OP. If you wanted me to expand on what I've said above, and deconstruct each link claim by claim, I can easily do that but it might be best if we don't ruin Animavore's thread, so if you start a new thread then I'll post more there

You seem pretty wedded to your dismissal so I think I'll pass on that.


ETA, though if you want to elaborate I will certainly look at what you have to say.

[Mr.Samsa]

It depends what you mean by 'wedded'. My position comes from studying the research in educational psychology, and the more general field of learning. In neither area is kohn relevant or respected. The arguments levelled against reinforcement concepts are always based on severe misunderstandings, hence why no scientists think they are flawed.

If you want me to discuss the specific research and evidence on this then I will, but I have no desire to do so if you aren't particularly interested.

[Animavore]

This is probably off-topic though, given the aims of Animavore's OP. If you wanted me to expand on what I've said above, and deconstruct each link claim by claim, I can easily do that but it might be best if we don't ruin Animavore's thread, so if you start a new thread then I'll post more there

I don't mind if thread is used. My questions have been answered so anything else is just addendum.

[Ronja]

... At the end of the day, it is impossible to teach using methods other than reinforcement and punishment. There is no other option...

I have thought about this a bit now, and as Ani does not object, am interested in hearing how others reacted to this quite strongly stated claim. At this point my anecdotal evidence from several forms of teaching seems to support this claim. Thus far I have taught (main types of teaching only)

Before college:
-other kids to read when I was a kid myself (a handful, mostly in our basement or back yard)
-newly diabetic patients to inject themselves with insulin when I worked as a nurse (two or three)
-first aid to a class of deaf people, with the help of a sign language interpreter (10-20 people)
-my subordinates to assemble and test computers when I worked as a manufacturing line group chief (half a dozen guys)

While working as TA and/or (assistant) lecturer at college:
-freshmen from all our departments to use email, newsgroups, gopher, IRC and Freenet (some 500 students)
-sophomores the basics of how Internet and mobile phone technology work (some 350 students)
-juniors the details of Internet protocols and the basics of information security (some 250 students)
-seniors the basics of finding information and scientific/scholarly writing (120+ students)
-students with various learning difficulties how to use computers and the Net more efficiently (six people)

And most importantly: all the teaching involved in parenting two children for the last 12 years (including volunteering as a scout leader every now and then).

And yes, I know: it's STILL anecdotal, because no objective outsider has systematically analyzed what I and/or the teaching team have done.

[.Morticia.]

Well, there's some research (could cite, but no time to at the moment) that repetitive thoughts actually create stronger connections between the synapses in our brains involved in transmitting them-- i.e.- the more you think about certain things, or respond to thoughts in one particular way, the more your brain actually gets used to those patterns. This is a theory behind PTSD, and certain compulsive behaviors. Even depressive thoughts can become easier and easier to access with frequent use.

I picture this as being sort of like muscle memory, or training certain muscles to become stronger with repetitive exercises-- though that's a metaphorical image.

The idea behind CBT, as I understand it, is to try to retrain your brain to use different synaptic paths, to encourage different behaviors. Another metaphor- trading a rutted mental path for a new one, that might be harder to use in the beginning, but becomes easier to travel with use. I suppose it could be woo. I don't think it is.

But yes, I think if you are, as a patient, four-square resisting any attempt to teach your mind new tricks, CBT won't be effective for you.

I had c-ptsd.

ptsd as a set of emotions and behaviours are adaptations to extreme life threatening events, once normalcy and safety returns those adaptations are dysfunctional.

Because those adaptations were vital to physical survival they become similar to instinct and nearly impossible to change. It actually hurts to mentally challenge those adaptations.

I read somewhere that teh emotional pain of ptsd is as bad as say, breaking an ankle or kidney stones, childbirth even. ( that was my experience ) But the pain is disembodied. twas bloody horrible and would make me gasp.

Though nothing compares to the sheer awfulness of flashbacks.

Anyway, cbt teaches how to cope with flashbacks, panic attacks, teaches about brain function, teaches healthy behaviours, teaches about acceptable behaviours of others, and after sitting talking and writing about stuff for months and months on end makes you sick to death of it all and you just want to get on with your life. (which is the purpose )

I really wanted to get better, I am better. I don't want to live a life that is full of pain and suffering and fear and stops me from being teh person I want, stops me from being good to my friends and family, and from being a part of teh community.

Your desire for a good life has to be stronger than your fear of what happens in therapy and the discomfort of thinking about your life.

[Mr.Samsa]

... At the end of the day, it is impossible to teach using methods other than reinforcement and punishment. There is no other option...

I have thought about this a bit now, and as Ani does not object, am interested in hearing how others reacted to this quite strongly stated claim. At this point my anecdotal evidence from several forms of teaching seems to support this claim. Thus far I have taught (main types of teaching only)

Before college:
-other kids to read when I was a kid myself (a handful, mostly in our basement or back yard)
-newly diabetic patients to inject themselves with insulin when I worked as a nurse (two or three)
-first aid to a class of deaf people, with the help of a sign language interpreter (10-20 people)
-my subordinates to assemble and test computers when I worked as a manufacturing line group chief (half a dozen guys)

While working as TA and/or (assistant) lecturer at college:
-freshmen from all our departments to use email, newsgroups, gopher, IRC and Freenet (some 500 students)
-sophomores the basics of how Internet and mobile phone technology work (some 350 students)
-juniors the details of Internet protocols and the basics of information security (some 250 students)
-seniors the basics of finding information and scientific/scholarly writing (120+ students)
-students with various learning difficulties how to use computers and the Net more efficiently (six people)

And most importantly: all the teaching involved in parenting two children for the last 12 years (including volunteering as a scout leader every now and then).

And yes, I know: it's STILL anecdotal, because no objective outsider has systematically analyzed what I and/or the teaching team have done.

Hey Ronja

Anecdotes aren't really a problem as they can provide useful clues about where we need to look, as long as we understand their limitations and the fact that due to their subjective nature, we might not be fully aware of all the variables involved. With that said, I'd be interested in hearing how you taught any of these people without reinforcement and punishment - so no praise, no marks, no token systems, no feedback on their progress, no error corrections, no internal pleasure at doing something right, no enjoyment of reading (or whatever the task was), etc. Even imitation and habituation require generalised reinforcement to work, so I'm not sure how any kind of learning could occur without these things.

If I'm wrong though then I have no problem with that. You tell me your secret, and I'll publish it and become a famous (and hopefully rich) learning theorist!

[Ronja]

Samsa, I was *agreeing* with you - against my ingrained skepticism towards strongly worded claims.

...my anecdotal evidence from several forms of teaching seems to support this claim.

emphasis added

[Mr.Samsa]

Samsa, I was *agreeing* with you - against my ingrained skepticism towards strongly worded claims.

...my anecdotal evidence from several forms of teaching seems to support this claim.

emphasis added

Whoops. That's what I get for replying to posts late at night. I interpreted you as disagreeing, and saying here is the evidence which supports this claim, etc.

My apologies

[Gallstones]

There's some good replies here (and over at RatSkep), but just as a quick note: CBT (as opposed to cognitive therapy) is not "talk therapy", and it does not work through the mechanism of 'mind over matter'. CBT is essentially just behavioral therapy but due to the misunderstanding of behaviorism at the time, the psychologists didn't realise that thoughts and beliefs were behaviors too, so they added the "cognitive" label even though there is no difference between CBT and behavioral therapy. Behavioral therapy works by utilising the science of behavior - we've uncovered a number of behavioral laws and we have a decent understanding of how and why organisms behave in the ways they do, at the very least, we know more than enough to be able to manipulate behaviors and thoughts with great success (even if we generally use a Newton-like simplified bastardisation of the behavioral laws in therapies).

In a nutshell, there are universal laws which govern the behavior of living things, and thoughts and beliefs etc are behaviors too (they are "things that an organism does"). So to eliminate negative thinking, bad self esteem, and so on, all we have to do is apply the same principles we use to train dogs to jump through hoops, to the thoughts you're having. Extremely simply, this means identifying a problem, and rewarding yourself when you avoid engaging in this kind of problem thinking, and "punishing" yourself when you engage in this kind of thinking (not "punish" as in feel guilty, or self-flagellate, but in the technical sense of 'punish' which means 'to decrease the likelihood of the behavior occurring again in the future' using a variety of different tools).

Importantly, CBT not only has a massive amount of research supporting its overwhelming success, but it's also founded on a coherent framework of knowledge which, in itself, provides a sound foundation for the mechanisms proposed in CBT. Put another way, there is far more evidence to suggest that CBT is successful at reducing depression than there is to suggest that anti-depressants are successful at reducing depression (and of course CBT is applicable to other cognitive issues).

Worthless. Completely fucking worthless.