Is Psychology a real science?

[Cunt]

I am glad of Mr. Samsa, too. Though I would express it with better grammar, and without thanking a god.

[Mr.Samsa]

Because demonic possession has no evidence to support it. Aspects of AA do seem to work, it's just that research is having some difficulty recreating those advantageous aspects without the extraneous features. Arguably, things like CBT are the embodiment of this.

But judges, employers and others are considering AA 'treatment'.

It doesn't 'work' as far as I can tell. (of course 'work' means different things to different people)

Yeah I agree that we can debate over whether statistical significance is the same as clinical significance, but this doesn't change the fact that there is some evidence that some people get better after using AA (i.e. more than would get better by themselves).

I'm not sure what you mean?

I mean that repeating that message to all comers, and pressuring them to do the same (social proof kind of pressure, not physical usually) is planting a terrible message in each person - that if they drink a little they are OUT OF CONTROL.

Curiously enough, lots of them believe they are out of control after one drink.

Well there is serious debate over this issue.. Some researchers (like Rachlin and Green) argue the same thing as you: traditional abstinence programs are failing because of this restriction on all drinking. Their argument relies on an understanding of the mathematical laws that control self-control, and how never allowing a drink results in a serious imbalance in the equation (meaning that falling off the wagon is inevitable). I actually agree with this line of thinking, outlined a bit in the book: The Science of Self-Control.

But others disagree, and with theories such as behavioral momentum (like physical momentum, behaviors can 'snowball' given the triggering of an initial response) there is some reason to think that AA might be on the right track. At the very least, their suggestion is not crazy or outlandish.

Why not refer them on to psychologists who specialise in CBT then?

Please move here and hang out a shingle. I mean it.

The last psychologist I spoke with here supports AA completely, and didn't know much about CBT (certainly wasn't trained to practice it)

I guess I got a bit discouraged, but I should poll the few we have here and see if any others know how to work it. I gave some information on it to a fellow who wanted to try it out on himself...don't know how that went for him...

That is terrible.

But it's obviously not a problem with psychology, it's a problem with Canada. The CPA website is terrible, it doesn't have a "psychologist locator" like the APA site, so I can't even try searching for registered psychologists who specialise in CBT.

Most of the research on AA backs up the idea that people who stay in AA will be successful.

Same with any approach to quitting. They all manage to quit sooner or later.

I don't like how AA is getting credit for what was going to happen anyway.

Well the argument is that it wouldn't happen anyway, as some studies suggest that people in AA improve more than the controls. But the evidence is of course weak and debatable. Unfortunately, "weak and debatable" is some of the strongest evidence we have in the area of addiction.

How does it increase binge drinking?

I don't know, it was an observation of the study...it simply noted behaviour, wasn't trying to explain it. It was a while ago, and I certainly don't mind conceding the point, but I will try to dig it up if you think it is important.

I remember reading the study you're referring to, and if I recall, it's suggested that there are serious methodological problems with it (I think they just looked at a regular AA group, including members who were forced to be there by court orders and those who were volunteering to be there).

And the locus of control shouldn't be placed on the individual, it should be placed on changing the environmental variables which cause the behavior in the first place. My main beef with AA is precisely that it places the locus of control on the individual - it assumes that "will" alone is enough to change behavior.

I have personally changed behaviour with 'will'...I am not sure what you mean here. I always found the happiest, most successful (by their own definition) people I know have blamed themselves for pretty much everything that happens to them.
I do acknowledge that circumstances and luck can come into play quite a bit, too.

Our behavior is not controlled by our "will", instead our will is controlled by whatever environmental contingencies are in place combined with our specific learning history. When people say that they have changed their own behavior with their own will, they mean that their environment was most conducive to changing behavior and the result they found was the most probable.

The problem with people like addicts is that they are told they should stop drinking, perhaps told about some horrible consequences if they continue, and then they're expected to just be able to change their behavior. This simply isn't how behavior works. The same applies to criminals who become criminals because their environment made it a likely result, but then they're sent to prison and finally put back in the environment that created the criminal behavior in the first place.

And they do. AA might stay the same, but it's not a psychological treatment. The psychological treatments are the ones that are developed by looking at what works in AA and recreating it - like CBT.

I wish you could tell everyone that. They still use it up here as if it works. (though now that I think about it, while the psychologists seem to favour AA, the psychiatrists haven't, in at least three cases...hmm...)

To be fair, I think that's because the psychologists you have up there are idiots... Here, the reverse is true - the psychiatrists all recommend AA, and the psychologists suggest evidence-based treatments.

They can be appalled all they like but their being offended doesn't change reality.

Behavioral therapy is universally recognised as being the only, and the most, successful treatment for autism. It is so successful, that a child diagnosed with autism at one point can sometimes, after treatment, no longer meet the criteria for autism (and this is statistically different from people who naturally 'grow out' of their diagnosis). Since they no longer have a diagnosis of autism, then they aren't autistic. This is generally referred to as a 'cure'. Obviously there is some variation of the effect of the treatment, but at the very least there is always significant improvement in their symptoms.

I guess, now that I recall, the diagnosis requires that the behavioural abnormalities cause the person difficulty at school, work or home. I guess if you are born with good supports, you don't get (or need) a diagnosis, but if you are less autism-affected, yet have no suitable support, you get the diagnosis.

I'm not quite sure what you mean. Yes, all mental disorders require some difficulties in functioning (like with physical diseases). So if someone is born with a good support system, to the point where a person does not meet the diagnosis, then they never had autism.

Seems sensible, mainly, but not very 'sciency'...more fuzzy.

I'm not sure how it's fuzzy? It's like a doctor getting a test result which shows certain anti-bodies in the blood that indicate some disease, and then giving them treatment, and finding that the anti-bodies are no longer in the blood. Behavioral psychologists actually go one better than doctors in this respect, as they consistently measure and plot behavior over time, so not only can we present someone without the diagnosis at the end, but we can actually show you the data that demonstrates the improvements over time.

That doesn't negate anything. As I mentioned, 'transcendence' is a label given to a subset of specific responses, so very few people would match every single example of transcendence. What matters is your score - so if you're a nihilist, but otherwise happy with yourself, and you have a strong interest in making the world a better place, then you will likely score very highly on the transcendence/spirituality scale. And this means you'll be more likely to have good mental health.

But I don't believe in spirits

I said 'I THINK I am a nihilist'. I am not sure I am, because I haven't looked up the label.

Fair enough, I was just taking the most extreme response as if that still falls within the category of "spiritual" or whatever, then someone who is only mildly nihilist or slightly might lean that way, will certainly fall within it too.

Well psychology isn't a political or moral tool. All they do is look at the evidence for what improves mental health and report the results. (But obviously being spiritual doesn't necessitate being religious, or "drunk" as you compare it to, as demonstrated by the fact that you would score highly on the spirituality scale).

You are much more confident about that than I am. How could I test it to see?

I think you can sign up here and take one of their questionnaires: http://www.authentichappiness.sas.upenn ... fault.aspx (I can't remember which one it is, probably the "meaning of life" one).

I'm just recalling information that was on the army survey a little while back, and the transcendence section included likert scale statements like: "I feel that my life has some meaning", "I often try to help others when they need help", "I like to volunteer for charities or similar organisations", "I am happy with my place in the world", etc.

But AA isn't a psychological treatment. Whether it changes or not is irrelevant to the question of whether psychology is a science.

Very true. I have a niece who is doing her masters in cognitive psychology. She measures and counts things. It is exciting, and certainly science.

She said she would NOT do clinical.

Yeah that's basically my response too. I generally hate people and I don't really give a shit about helping people with mental disorders or studying them (hence why I oppose the claim that psychologists should just fall under a "mental health" qualification).

I'm not sure if a "critical eye" is good enough to reject it.. I don't agree with it as a valid treatment option, but it's a hugely complex issue that requires a fair amount of reading to understand the evidence on it.

I think that reading AA's literature ALONE is enough to refute it as anything remotely sensible.

Hmm.. I don't know. I'm sure people reading about chemotherapy without looking at the evidence would find it a bit silly too.. "You want to inject poison into a sick, dying person?!".

The same reason newspapers don't hire journalists with science degrees to report science. They think they know better. And they do try to apply psychological theories to their work, the problem is that they are businessmen reading through "Psychology Today" and making guesses about how to apply it to marketing..

That is about my level of understanding (or slightly below). I think it would be a bit niave to think that no people have taken psychology into the business world for profit, though...shit, I need more McDonalds...

Oh certainly, there are "business" areas of psychology (I can't remember the name for it?), but generally the people who specialise in that area are idiots..

Thank god for mr samsa I was worried I'd feel compelled to respond to some of crap in this thread otherwise

I was hoping somebody was going to respond before me so I didn't have to..

[Cunt]

Yeah I agree that we can debate over whether statistical significance is the same as clinical significance, but this doesn't change the fact that there is some evidence that some people get better after using AA (i.e. more than would get better by themselves).

I remain unconvinced, but I am trying to think of what kind of evidence I would accept which would change my mind. I can't imagine how a study could be done (though there may be imaginative studies which I can understand a bit)

Well there is serious debate over this issue.. Some researchers (like Rachlin and Green) argue the same thing as you: traditional abstinence programs are failing because of this restriction on all drinking. Their argument relies on an understanding of the mathematical laws that control self-control, and how never allowing a drink results in a serious imbalance in the equation (meaning that falling off the wagon is inevitable). I actually agree with this line of thinking, outlined a bit in the book: The Science of Self-Control.

Just a bit wide of the mark there, Mr.Samsa. The hazard I see is that there are repeated messages, you will be required to listen and encouraged to repeat, which are not helpful to a person in their efforts to quit (in my humble opinion)
They basically stand up and give testimonials about how their lives were ruined without AA, and how if they ever drink again, they will end up dead in a ditch reeking of alcohol.
It makes for a popular belief that one can not slip a little, only majorly.

But others disagree, and with theories such as behavioral momentum (like physical momentum, behaviors can 'snowball' given the triggering of an initial response) there is some reason to think that AA might be on the right track. At the very least, their suggestion is not crazy or outlandish.

I still think crazy and outlandish. I would read a bit more though.

That is terrible.

But it's obviously not a problem with psychology, it's a problem with Canada. The CPA website is terrible, it doesn't have a "psychologist locator" like the APA site, so I can't even try searching for registered psychologists who specialise in CBT.

I don't know about 'terrible'. It ranks right up there with the psychologists I know.

Our behavior is not controlled by our "will", instead our will is controlled by whatever environmental contingencies are in place combined with our specific learning history. When people say that they have changed their own behavior with their own will, they mean that their environment was most conducive to changing behavior and the result they found was the most probable.

Hmmm...my environment didn't change significantly until after I made that change.

When I say I changed it with my will, I mean that I mentally prepared myself for the change, then did it. I did this according to instructions (which I had followed and failed before a couple of times)

The difference the last time? It worked. That's all, I guess.

That's the thing with AA. They can claim it works because they are still there serving coffee and stale pastries long after everyone else has given up, and the 'alcoholic' decides to really change (which they all do eventually, sometimes by dying) there is AA, claiming they are the only thing that worked or could work.

I prefer to think that it might take a few tries, and you might improve quitting skills with practice.

The problem with people like addicts is that they are told they should stop drinking, perhaps told about some horrible consequences if they continue, and then they're expected to just be able to change their behavior. This simply isn't how behavior works. The same applies to criminals who become criminals because their environment made it a likely result, but then they're sent to prison and finally put back in the environment that created the criminal behavior in the first place.

Yes, and our religious-nutter Prime Minister is passing minimum sentencing laws - since they have worked so well in the lab down south of us (USA)

To be fair, I think that's because the psychologists you have up there are idiots... Here, the reverse is true - the psychiatrists all recommend AA, and the psychologists suggest evidence-based treatments.

Weird.

Hmm.. I don't know. I'm sure people reading about chemotherapy without looking at the evidence would find it a bit silly too.. "You want to inject poison into a sick, dying person?!"

Chemotherapy has demonstrated mechanisms which really do observable things to cancer cells (sometimes even predictably).
Not silly at all.

AA claims you have to be ready for God* to remove your shortcomings.
That's a bit over the silly line for me.
Thanks again for sharing, Mr.Samsa

[apophenia]

AA was created decades ago, has many cult characteristics, and consider the effect that the usual meeting would have on a person.
They 'drunk-a-logue' a lot, and tell themselves and everyone else over and over again - 'Drink a little, you will drink a lot and end up dying drunk in the gutter'.
I wonder what a psychologist would think of that kind of 'treatment' for other ailments...

I come at this as a person who has attended ACOA groups, but more pertinently, attended a 12 step group for people recovering from nicotine addiction. While I can't speak authoritatively on the medical picture regarding alcohol addiction and drug addiction, I imagine the picture is largely the same: for the addict, a little always leads to a lot. For cigarettes, a common expression of this truism is that, "one is too many, and a million isn't enough". If I started "casually" smoking again, I would be back to a pack a day in no time. For non-addicts, whether it be alcohol, drugs (I have a friend who is a casual user of many hard drugs, and somehow remains addiction free), or cigarettes, sure, this may not be a necessary message; but these aren't the people seeking out AA and mental health services for addictions -- these people have lost control, it's damaging their lives and relationships, and abstinence is the only way to gain it back.

As it stands, one of the reasons I won't refer to AA is the way they repeat certain messages which seem to increase binge drinking, but not move that locus of control any closer to the individual.

How does it increase binge drinking?

And the locus of control shouldn't be placed on the individual, it should be placed on changing the environmental variables which cause the behavior in the first place. My main beef with AA is precisely that it places the locus of control on the individual - it assumes that "will" alone is enough to change behavior.

Actually, I can't speak for 12 step groups beyond the group I attended, but this is the exact opposite of the message I received. I forget the exact words, but one of the first steps is to recognize that you are powerless over your addiction, that the only real misuse of willpower is blame your willpower for its inability to control your addiction -- believing that willpower is enough -- and that leads directly into the spiritual component which so many people have problems with, with respect to the twelve step model of recovery (e.g. "let go and let god", the serenity prayer and so on).

[mistermack]

Psychology is the study of behavior; a science. Clinical psychology is the application of this science in order to treat mental disorders; it is an evidence-based practice. The distinction is the same as biology vs medicine (i.e. medicine is not a science).

Does that make sense?

Yeh. I suppose it's the roughly the same as what I said, about Psychology being a science as a valid field of study, but less so in it's application.
Like architects use maths and physics, but aren't generally referred to as scientists.
The trouble is though, that you can judge a building by if it stays up, but there is no objective way to judge a treatment.
You can never say what would have happened without the treatment.
You can use statistics, but they themselves are usually made up of or include subjective data.

We had a real scandal here, where many women were put behind bars, and had their kids taken away, on the word of two professors, Roy Meadow and David Southall.
They diagnosed Munchhausens by proxy, and destroyed many peoples lives. Some were guilty, some were innocent.

It's the danger of professionals becoming obsessed, and over-claiming what they know, rather than making clear it's just an opinion.
They wield huge power in these cases, because a jury or judge knows fuck-all.

[Cunt]

AA was created decades ago, has many cult characteristics, and consider the effect that the usual meeting would have on a person.
They 'drunk-a-logue' a lot, and tell themselves and everyone else over and over again - 'Drink a little, you will drink a lot and end up dying drunk in the gutter'.
I wonder what a psychologist would think of that kind of 'treatment' for other ailments...

I come at this as a person who has attended ACOA groups, but more pertinently, attended a 12 step group for people recovering from nicotine addiction. While I can't speak authoritatively on the medical picture regarding alcohol addiction and drug addiction, I imagine the picture is largely the same: for the addict, a little always leads to a lot.

But what is an 'addict'? I have evidence that a little doesn't always lead to a lot (I quit cigarettes, too)

If that isn't true, why teach it?

Actually, I can't speak for 12 step groups beyond the group I attended, but this is the exact opposite of the message I received. I forget the exact words, but one of the first steps is to recognize that you are powerless over your addiction, that the only real misuse of willpower is blame your willpower for its inability to control your addiction -- believing that willpower is enough -- and that leads directly into the spiritual component which so many people have problems with, with respect to the twelve step model of recovery (e.g. "let go and let god", the serenity prayer and so on).

But that is the dilemma. If you were powerless, you would still smoke cigarettes. If you were not powerless, you could quit and the first step is inaccurate.

Is it okay to base the first step of this 'treatment' on a factual inaccuracy?


In Carl Sagan's 'Demon Haunted World', he describes psychologists planting ideas in the minds of patients, even without realizing it. If that can be demonstrated to happen among professionals (who are presumably taught about this kind of hazard), then what would one expect of a group like AA which claims to remain forever unprofessional?

Do you think they ever lead someone to believe what they believe, regardless of the reality of the situation?

[Mr.Samsa]

Psychology is the study of behavior; a science. Clinical psychology is the application of this science in order to treat mental disorders; it is an evidence-based practice. The distinction is the same as biology vs medicine (i.e. medicine is not a science).

Does that make sense?

Yeh. I suppose it's the roughly the same as what I said, about Psychology being a science as a valid field of study, but less so in it's application.

That's not quite what I said though. Clinical psychology is not a science, but it's still a valid field of study (given how successful clinical psychologists are at treating mental disorders, this point is indisputable).

Like architects use maths and physics, but aren't generally referred to as scientists.
The trouble is though, that you can judge a building by if it stays up, but there is no objective way to judge a treatment.
You can never say what would have happened without the treatment.
You can use statistics, but they themselves are usually made up of or include subjective data.

Hold up there... There are some severe misunderstandings here.

There are of course objective ways to judge the efficiency and efficacy of a treatment, and statistics allows us to state without any reasonable doubt that the treatment caused the perceived change. This is how medicine demonstrates that a drug works better than waiting for the patient to get better by themselves, and statistical designs are employed to clearly show that there is a causal relationship between the treatment and outcome. If a study looking at, for example, CBT on depression is conducted without any serious methodological flaws, and it finds that the people in the treatment group (compared to control or placebo group), then we can state with certainty that CBT works better than no treatment at all.

And even if the data they use are made up of subjective data (a claim I'd argue against), what does it matter? If someone comes in claiming they are unhappy, and then later claim that aren't unhappy, then this is a result. There is no objective way to determine that someone no longer feels unhappy. But obviously psychologists aren't stupid enough to take verbal reports as true and as the basis of their claims - that would be ridiculous. Instead they usually use objective measures, like time spent outdoors, number of episodes over a time frame, anxiety scores, etc.

We had a real scandal here, where many women were put behind bars, and had their kids taken away, on the word of two professors, Roy Meadow and David Southall.
They diagnosed Munchhausens by proxy, and destroyed many peoples lives. Some were guilty, some were innocent.

It's the danger of professionals becoming obsessed, and over-claiming what they know, rather than making clear it's just an opinion.
They wield huge power in these cases, because a jury or judge knows fuck-all.

Indeed, it's terrible. Sometimes doctors tell their patients that they have cancer when in actuality they are perfectly healthy.

Fortunately, the mistakes of individuals and extreme outliers do not provide an accurate summary of an entire field of study, hence why we shouldn't reject medicine or psychology based on incredibly rare occurrences.

[mistermack]

If a study looking at, for example, CBT on depression is conducted without any serious methodological flaws, and it finds that the people in the treatment group (compared to control or placebo group), then we can state with certainty that CBT works better than no treatment at all.

That illustrates the problem of measuring success really.
How do you organise a genuine control or placebo group in those circumstances? It's not like giving someone a similar coloured pill, is it?

nd even if the data they use are made up of subjective data (a claim I'd argue against), what does it matter? If someone comes in claiming they are unhappy, and then later claim that aren't unhappy, then this is a result. There is no objective way to determine that someone no longer feels unhappy. But obviously psychologists aren't stupid enough to take verbal reports as true and as the basis of their claims - that would be ridiculous. Instead they usually use objective measures, like time spent outdoors, number of episodes over a time frame, anxiety scores, etc.

But the problem is getting the result that you want, once opinion comes into it.
That's why they do blind trials in medicine.
And if you take reported happiness as evidence, then you might as well pay for a hooker, and sack the clinical psychologist.
Or pay for preachers to save their souls.
And what happens when they find a happiness drug, that doesn't involve physical addiction?

I'm not saying that clinical psychologists aren't useful in some cases, but I'm not convinced that they make enough difference to be used so widely.
After all, homeopaths can point to increased satisfaction and well being. Their bank accounts prove that anyway.
Where they fall down is on real blind trials, which can't really be done for clinical psychology.

[Geoff]

The distinction between psychiatrists and clinical psychologists is arguably a bit more controversial, but the easiest way to explain it is that they approach similar problems from different perspectives. The problem with an issue like mental health is that the brain is an organ of the body, so mental disorders can either be a product of physical malfunctions, or they can be purely mental (or, to confuse matters, a bit of both). This means that we need professionals with degrees in medicine and a specialisation in psychiatry in order to study the brain and how drugs can help certain problems. Clinical psychologists, on the other hand, largely deal with the 'mental' causes of disorders. Generally, clinical psychologists have more tools to deal with mental disorders (e.g. cognitive behavioral therapy, systematic desensitisation, etc).

To summarise:

Psychologists - scientists who study what makes organisms tick
Clinical psychologists - apply the science of psychologists to understanding mental disorders
Psychiatrists - medical doctors who treat mental disorders as if they are physical diseases.

From a patient's point of view, in the UK at least, the distinction is certainly blurred. I've been involved with 3 separate family members who have needed (different) psychiatric/psychological treatment, and their specialists in all 3 cases used a combination of clinical psychology and pharmalogical treatment methods...which makes sense, but I'm not sure which, if either, category they fell into.

[Mr.Samsa]

If a study looking at, for example, CBT on depression is conducted without any serious methodological flaws, and it finds that the people in the treatment group (compared to control or placebo group), then we can state with certainty that CBT works better than no treatment at all.

That illustrates the problem of measuring success really.
How do you organise a genuine control or placebo group in those circumstances? It's not like giving someone a similar coloured pill, is it?

There are a number of ways we can organise controls and placebos for these studies. Controls are the easiest, of course, since a control group can be another treatment group and you compare the differences in effects between the two (this is actually preferred in most sciences to placebo-controls, since there are significant problems with placebo studies). But there are also placebos that can be used for CBT, which can be a pill (especially when we compare CBT to antidepressants, with a placebo pill as a control - incidentally, CBT outperforms antidepressants), however, usually what they use is a 'psychological placebo' which is essentially a sham talk-therapy.

There's a good metaanalysis of the results of CBT here where they go into more detail about these things.

nd even if the data they use are made up of subjective data (a claim I'd argue against), what does it matter? If someone comes in claiming they are unhappy, and then later claim that aren't unhappy, then this is a result. There is no objective way to determine that someone no longer feels unhappy. But obviously psychologists aren't stupid enough to take verbal reports as true and as the basis of their claims - that would be ridiculous. Instead they usually use objective measures, like time spent outdoors, number of episodes over a time frame, anxiety scores, etc.

But the problem is getting the result that you want, once opinion comes into it.
That's why they do blind trials in medicine.

And they do blind trials in psychology too, often with nobody knowing who's in which treatment group, or whether they're receiving a placebo. Therefore we can judge the relative differences in happiness ratings.

And if you take reported happiness as evidence, then you might as well pay for a hooker, and sack the clinical psychologist.
Or pay for preachers to save their souls.

Well none of those things show any efficacy in making people happier or treating mental disorders, so it would be a bit silly to use them instead of evidence-based treatments like CBT. And, importantly, I also highlighted the fact that happiness ratings are rarely (if ever) the primary outcome measure so your objections are a bit redundant.

And what happens when they find a happiness drug, that doesn't involve physical addiction?

Then I imagine people will buy it and be happy. What's the point?

I'm not saying that clinical psychologists aren't useful in some cases, but I'm not convinced that they make enough difference to be used so widely.

Any chance you could provide some evidence or arguments to support why we should be skeptical of psychology?

After all, homeopaths can point to increased satisfaction and well being. Their bank accounts prove that anyway.
Where they fall down is on real blind trials, which can't really be done for clinical psychology.

Psychology invented the concept of a blind trial. It seems odd that you think the field doesn't utilise its own creation.

From a patient's point of view, in the UK at least, the distinction is certainly blurred. I've been involved with 3 separate family members who have needed (different) psychiatric/psychological treatment, and their specialists in all 3 cases used a combination of clinical psychology and pharmalogical treatment methods...which makes sense, but I'm not sure which, if either, category they fell into.

Oh indeed, when I say they specialise in a particular approach, it doesn't mean they ignore all evidence to the contrary. For example, if someone comes to a psychologist with a condition which is known to be best treated by pharmcological methods (e.g. if they had cognitive difficulties due to the progression of syphilis) then they're not going to try to treat them by getting them to talk about their feelings. For some things, like depression, it's been demonstrated that the best treatment is a combination of antidepressants and CBT, so even psychologists will recommend their patient take some antidepressants whilst undergoing therapy (largely because getting a depressed person to want to make their life better, and engage in the CBT can be difficult, so it can be useful to 'artificially' raise their spirits first). Psychologists don't have the ability to prescribe medications though, so they have to refer patients to doctors or psychiatrists to get their pills.

[mistermack]

Mrsamsa, my problem is envisaging how a trial for CBT can be valid.

If you are testing a drug, you can randomly split a group, and one half takes the drug, the other takes a perfect replica with no active ingredient.

How can you perfectly replicate CBT, without the active ingredient? Who is going to be convinced?
And if you attempt that, surely your fake CBT could be producing a negative, rather than the real CBT producing a positive.

Then you have the variables of who is conducting the CBT. Surely some get better results than others? Just by the quality of their personality. After all, some people are much better salesmen than others.

It would be so easy to get the results that you would like in this sort of study. And the people who do the studies are hardly detached uninvolved people.

[Mr.Samsa]

Mrsamsa, my problem is envisaging how a trial for CBT can be valid.

If you are testing a drug, you can randomly split a group, and one half takes the drug, the other takes a perfect replica with no active ingredient.

So if you test a drug to a placebo, then test CBT to the active drug (that outperforms the placebo), and find that CBT works better than the active drug, you wouldn't accept the conclusion that CBT is better than the placebo? Wouldn't the very nature of logic necessitate this conclusion? (Not that all CBT trials are done this way, but given what you're suggesting I'm not sure how you can't accept it as a valid conclusion).

Out of interest, what did you think of the metaanalysis I linked you to?

How can you perfectly replicate CBT, without the active ingredient? Who is going to be convinced?

It's easy to replicate CBT without the active ingredient, you just go through all the motions but leave out the component which changes behavior. People are often convinced because they have little idea of what CBT is, so they have no way of knowing whether the therapy they're receiving is "true" CBT or not.

And if you attempt that, surely your fake CBT could be producing a negative, rather than the real CBT producing a positive.

Of course, but this is true of all placebo-controlled studies (hence why a lot of science prefers to compare a treatment with another treatment). In more technical terms, we have no way of determining whether a sugar pill will have a placebo or nocebo effect.

Then you have the variables of who is conducting the CBT. Surely some get better results than others? Just by the quality of their personality. After all, some people are much better salesmen than others.

As far as I know, the psychologist doesn't impact the effect of CBT at all. This is because the psychologist is irrelevant to the treatment, all they do is teach the person the rules of how to control their own thought processes. Essentially all they do is read instructions from a list. It's because of this that CBT can be, and has been, automated to the point that people can sign up to a website and receive CBT sessions from a computer program - with similar effects to those found by those receiving CBT from a psychologist in person.

It would be so easy to get the results that you would like in this sort of study. And the people who do the studies are hardly detached uninvolved people.

I'm not sure why you think it's easy to get the results you want, especially when the people conducting the studies are using methodologically rigorous standards that are usually far more stringent than those used in medicine (if you read through a medical journal and know a little about statistics, you'd be shocked at some of the conclusions those scientists support..).

And I'm not sure what you mean by your last sentence - the vast majority of the people doing the studies are detached uninvolved people. They are research psychologists who have no gain in reaching one conclusion over the other (and, arguably, finding a result that contradicts CBT would be a huge breakthrough, resulting in that psychologist reaching fame and fortune akin to someone disproving evolution). A minority of researchers of CBT do practice clinical psychology, introducing some bias to their results (which they legally declare on all their research), but similarly there is a minority of researchers who disagree with CBT because they don't practice it, so it would ultimately balance out.

But ignoring all of the above, let's just take one step back: For the sake of argument, assume that the entirety of the research in clinical psychology is misguided, biased, corrupt and demonstrably a pseudoscience. This does not affect the state of psychology. Why? Because research in clinical psychology is a very minor part of the entire field of psychology. So psychology would still be a science, but simply with a deadweight attached to part of it (like attacking physics because some physicists believe in cold fusion).

[mistermack]

So if you test a drug to a placebo, then test CBT to the active drug (that outperforms the placebo), and find that CBT works better than the active drug, you wouldn't accept the conclusion that CBT is better than the placebo? Wouldn't the very nature of logic necessitate this conclusion? (Not that all CBT trials are done this way, but given what you're suggesting I'm not sure how you can't accept it as a valid conclusion).

I wouldn't count a placebo pill as a suitable placebo for CBT.
It doesn't mirror the mental stimulation of face to face counselling.
Your next answer covered what I meant, that to test CBT, you would have to compare it with a very similar procedure that had no active ingredient.

I did start out by asking if psychology was any better than common-sense counselling, so I would personally compare it to that in a trial, rather than CBT with the salient bits removed.
Somehow, I can't see fake CBT succeeding, the sincerity and enthusiasm just wouldn't be there.

But it seems pretty obvious that regular one-to-one sessions could help in many ways. An incentive to keep taking the tablets could be just one. So of course you would expect CBT to out-perform just a placebo pill.

I would expect CBT combined with antidepressants to outperform just antidepressants as well, for the same reasons.

But is it just the personal contact, or the CBT technique of significant value?

Out of interest, what did you think of the metaanalysis I linked you to?

I'm not sure what to make of it. What does the "meta" mean in that context?
Only the conclusions are available free, and the sentence at the end "While limitations of the meta-analytic approach need to be considered in interpreting the results of this review, our findings are consistent with other review methodologies that also provide support for the efficacy CBT." didn't fill me with confidence.
But a look at hard data and methodology is the only way that you could draw your own conclusions.
Otherwise, you're limited to agreeing because they said so, and trusting their conclusions blind.

I think it's fair to question the methodology of testing.

With a drug, you have a fixed formula, and it has to jump extensive and well set-out hurdles before it can be prescribed, and it's quality doesn't depend on the person giving it to the patient.
Even then some pretty useless drugs sometimes get through.

Compare that to a therapy, and almost anything can be changed at any time. It's bound to be less defined.

As far as I know, the psychologist doesn't impact the effect of CBT at all. This is because the psychologist is irrelevant to the treatment, all they do is teach the person the rules of how to control their own thought processes. Essentially all they do is read instructions from a list. It's because of this that CBT can be, and has been, automated to the point that people can sign up to a website and receive CBT sessions from a computer program - with similar effects to those found by those receiving CBT from a psychologist in person.

OK, I should have read down to this before I wrote the above, but I'll leave it there anyway.
If that can be demonstrated to work, you have a good proof.
But I do note that most use a combination of drug and CBT, which clouds the water again.
I read the arguments given for this, but was neither convinced nor sceptical.

One would have thought that if CBT out-performs drugs in trials, it wouldn't be necessary to combine them.
But maybe CBT can't make the initial step as well as drugs can.
It certainly weakens the argument though.

[hadespussercats]

Can you clear up what exactly is the difference between psychologists and clinical psychologists? You said that there is a huge difference, but didn't say what it was. ( and the wiki article makes no distinction at all ! ).
And why do we need psychiatrists, psychologists and clinical psychologists?
Surely there should be a mental health qualification that covers all of it?

Why, when the brain is such a complicated organ, should there be one discipline that covers all aspects of its study?

[hadespussercats]

Mr. Samsa wrote: Psychiatrists - medical doctors who treat mental disorders as if they are physical diseases.

There's no as if about it-- mental disorders are physical diseases.