
Effectiveness of Talk Therapy Is Overstated, a Study Says - khc
http://www.nytimes.com/2015/10/01/health/study-finds-psychotherapys-effectiveness-for-depression-overstated.html?smid=tw-nytimes&smtyp=cur&_r=0
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jrapdx3
The problem I have with this kind of research are the intrinsic ambiguities
regarding "depression" and its treatment. Depression is notably heterogeneous
in its characteristics and origins. Even when careful diagnosis declares two
people to have the same illness, it can't be assumed their conditions are
actually identical.

Furthermore, we know drug treatments can affect recipients unpredictably,
depending on physiological factors. Similarly, psychotherapies, which are
harder to administer in a consistent way, are subject to even greater
variability in delivery and effect vs. medications.

The bottom line is estimating the real-world effectiveness of any therapy is
at best hazardous, and the results of research (or meta-analysis of studies)
are likely only tangentially applicable to individual treatment situations.

From many years on the front lines, I'm convinced depression and other
disorders _can_ be effectively treated and suffering reduced. What's important
to remember is treatment is as much art as science, it can't be bottled or
reduced to formulas. Outcome mileage varies, but it's largely dependent on the
quality of the treatment team, the power of the partnership between patient
and practitioner can't be overemphasized.

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PhasmaFelis
The original article title doesn't seem to be accurate. Should be
"Effectiveness of Talk Therapy _On Depression_ Is Overstated, a Study Says".

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InclinedPlane
Not surprised. Though really just deciding to do something about depression
can often be enough to be helpful. Simply feeling like there's a path out of
it can give you the strength to keep your life together and maintain ordinary
levels of self-care (keeping your home clean, going to work regularly, keeping
to a sleep schedule, engaging in activities, and so on).

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mpweiher
Hmm...I read about the lack of effectiveness of psychotherapy roughly 20 years
ago in DER SPIEGEL. Within a set time period, around 10% of patients receiving
psychotherapy got better. Of course, within the same period 10% of patients
receiving no treatment also got better :-)

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tormeh
There being no effect at all is a ridiculous statement. Sure, it doesn't work
for many people, but it worked for me. So if it works for some people, which I
prove it does, then it has to inhibit recovery in others in order to have no
net effect. I don't buy that at all.

~~~
brookside
Therapy absolutely has an effect.

That effect, however, happens to be about equivalent to placebo.

~~~
mattmanser
This is wrong and you do many people a disservice who might read this and
think it doesn't work. I don't know where you're getting this and the article
in no way supports your stance. From the article:

 _Engaging in a course of well-tested psychotherapy, according to the new
analysis, gives them an added 20 percent chance of achieving an even more
satisfying improvement, or lasting recovery._

An _added_ 20 percent chance.

Don't forget they're already saying that talking therapy is only 25% _less
effective_ than originally thought. They are still saying that talking therapy
is effective! And at no point do they compare it to placebo.

The very article we're talking about:

1) Disagrees with your extremist stance

2) Never mentions it nearing placebo level

3) You probably didn't read it as you didn't address it

CBT, for example, is known to be particularly effective when dealing with
anxiety as well as dealing with secondary symptoms and making people's lives
better. It has an effect WAY above placebo.

So why did you say this? Are you actively attempting to make people's lives
worse by putting them off therapy?

Also from the article:

 _for those who do well or fully recover, “psychotherapy, particularly
cognitive behavior therapy, seems to be most effective in cutting the risk for
a relapse long-term,” Dr. Hollon [one of the co-authors] said._

~~~
brookside
_They are still saying that talking therapy is effective!_

The most generous interpretation of figures in this article is that NNTT for
depression and therapy is 5. Meaning one out of every five people treated by
therapy will show _some_ improvement due to effects of therapy itself.

We can certainly call this _effective_ in that there is an effect for some
people who try therapy. But not for 80% of them.

Therapy is a 10 billion dollar/year industry in the United States, with its
practitioners often charging desperately unhappy people high rates (beyond
what most of us lucky software devs make), with no advantage to show for their
various methodologies beyond what one gets from talking to an untrained
stranger.

Financially successful yet largely bogus businesses and industries are never
going to put themselves out of business and have little impetus to change the
status quo.

Awareness of the current poor options for mental health treatment is
important. However uncomfortable or against an established narrative of "help
is out there' it is to address these realities, it will be easier to marshall
efforts to finding real mental health solutions if we aren't pretending the
current paradigms are working when the numbers show otherwise.

~~~
mattmanser
Nowhere did it say only 20% are helped. It says 20% more effective with other
treatments. Either you're not reading or you're not comprehending.

I'm sorry therapy didn't work for you or you didn't want to try it, but I'm
not sure what your agenda is.

You seem to have some weird axe to grind about people making money. I'm not
sure what else I can say as you seem to want to believe the whole thing's a
big rip-off. Like where does the claim that untrained listeners are as good as
trained ones come from?

~~~
brookside
Making money is fantastic. Making money from desperate people with
pseudoscience is bad.

 _20% more effective with other treatments._

Not what the article says. (It is most unclearly worded.) You have a 20%
greater chance of improvement with therapy above _talking to a doctor_ (Note
there no pharmaceutical course of action mentioned) not "with other
treatment".

My comparison of therapy to untrained listeners is not drawn from the article.
There have been several studies done on this. Link to the one of first on
google:

[http://citeseerx.ist.psu.edu/viewdoc/download?doi=10.1.1.469...](http://citeseerx.ist.psu.edu/viewdoc/download?doi=10.1.1.469.4634&rep=rep1&type=pdf)

~~~
mattmanser
Paraprofessionals are still trained. If that were about medicine that paper
would be saying 'can we use a nurse instead of a doctor', not 'can we use
anyone instead of a doctor'.

Is that what you're angry about?

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DanBC
These threads always fucking suck on HN.

 _Before_ you comment I would urge you to go find some reporting by the
NYTimes of something you know a lot about - your favoured programming language
or a company you work for, and see how well their reporting matches your
understanding of the topic.

Here's the stuff that newspaper articles usually fail to mention in reports on
therapy / drug studies

1) The definition of major depression has broadened and now includes a much
greater range of people. The effect size of treatment is normally greater for
people with more severe symptoms, although the relapse rate is also usually
higher.

2) The way trials are run has changed, and many trials are not very good. One
of the causes of this is odd regulation.

3) People seem to say that pills for psychiatric use are no better than
placebo (not true) but that pills for physical health (eg hypertension) are
better than placebo (true) but those people should also look at the effect
size, which is often similar for both types of meds.

[http://onlinelibrary.wiley.com/doi/10.1002/wps.20241/abstrac...](http://onlinelibrary.wiley.com/doi/10.1002/wps.20241/abstract)

Anti-depressants vs placebo:
[http://onlinelibrary.wiley.com/doi/10.1002/wps.20241/epdf](http://onlinelibrary.wiley.com/doi/10.1002/wps.20241/epdf)

[http://onlinelibrary.wiley.com/doi/10.1002/wps.20263/epdf](http://onlinelibrary.wiley.com/doi/10.1002/wps.20263/epdf)

Pragmatic randomized controlled trial of long-term psychoanalytic
psychotherapy for treatment-resistant depression: the Tavistock Adult
Depression Study (TADS)
[http://onlinelibrary.wiley.com/doi/10.1002/wps.20267/abstrac...](http://onlinelibrary.wiley.com/doi/10.1002/wps.20267/abstract)

etc.

~~~
pessimizer
Psychologists and pharmaceutical companies don't have any sort of inside
knowledge of how statistics work.

> Before you comment I would urge you to go find some reporting by the NYTimes
> of something you know a lot about - your favoured programming language or a
> company you work for, and see how well their reporting matches your
> understanding of the topic.

This is an argument against all reporting by the NYT, based on a hypothetical
shared feeling. This may be an obvious thing to say, but the reporting of many
newspapers (including the NYT) about things that I know more than most about
has often been right, and sometimes been wrong. They have sometimes been right
in a frustrating way (I felt like they missed a deeper point), or wrong in an
incompetent way. I'm saying this not because it is interesting, but because it
is boring. Making an argument that since everyone who has some expertise has
at some time felt like a story was wrong, therefore this story is wrong - is
noise, not signal. The NYT is not making the case, it's showcasing the
arguments of experts who share a particular opinion.

I'm struggling to figure out how your list speaks to their arguments in any
way. 1) and 3) seem like question begging, to a non-psychologist, and I don't
know what 2) is an argument for, against, or about. What does effect size
matter if the effect over placebo may not even exist?

This is more like reading an article about some issue in real estate when you,
and/or many of your friends and family partially make their living from that
issue.

~~~
DanBC
The submitted article talks about therapy not being as effective as we used to
think.

My links explain why newer studies find less evidence of benefit, and whether
that's a problem.

These threads are always full of people saying "I didn't read the paper; I
didn't read all of the article; but I disagree because my aunt once ..." It'd
be nice if people downvoted contrarian anecdote, but they tend not to.

~~~
chris_wot
I guess I'm just waiting for a headline that says "Study finding effectiveness
of talk therapy is overstated overstated their findings".

Now there's a headline that would make me read the article.

