In my post on my Psychology Today blog on November 21, 2011, I discussed how the purveyors of today’s most predominant psychotherapy
methodology, cognitive behavioral therapy, grossly exaggerate the strength of
their research evidence base in the psychotherapy outcome literature.
My opinion was recently confirmed in a review of meta-analyses of the CBT literature in the Journal of the American Medical Association, published online September 21, 2017 (“Cognitive Behavioral Therapy the Gold Standard for Psychotherapy: The Need for Plurality in Treatment and Research” by Falk Leichsenring and Christiane Steinert).
They reported that a recent meta-analysis using criteria of the Cochrane risk of bias tool reported that only 17% (24 of 144) of randomized clinical trials of CBT for anxiety and depressive disorders were of high quality. The “allegiance factor”—study authors were CBT therapists themselves and often designed the studies to make their treatment look better than it was, and opposing treatments look worse that they were—was rarely controlled for.
My opinion was recently confirmed in a review of meta-analyses of the CBT literature in the Journal of the American Medical Association, published online September 21, 2017 (“Cognitive Behavioral Therapy the Gold Standard for Psychotherapy: The Need for Plurality in Treatment and Research” by Falk Leichsenring and Christiane Steinert).
They reported that a recent meta-analysis using criteria of the Cochrane risk of bias tool reported that only 17% (24 of 144) of randomized clinical trials of CBT for anxiety and depressive disorders were of high quality. The “allegiance factor”—study authors were CBT therapists themselves and often designed the studies to make their treatment look better than it was, and opposing treatments look worse that they were—was rarely controlled for.
Compared with "treatment as usual" —letting subjects get whatever other treatments outside of the study treatment that they chose to have, allowing good therapists and bad therapists, and good therapies and bad therapies, to essentially cancel each other out—the sizes of treatment effects were only small to moderate and might eventually even be found to be due to the allegiance effects.
In panic disorder, CBT was not more effective than treatment as usual but only to being on a waiting list.
Even with these amazing biases, for
depressive disorders, response rates of about 50% were reported. This was true
for anxiety disorders as well. “Response” just meant there was some significant
improvement in symptoms, not that the symptoms of the disorders actually went
away. Rates for actual remission from the disorders were even smaller. Conclusion:
a considerable proportion of patients do not sufficiently benefit from CBT.
Last but certainly not least,
there was no clear evidence that CBT was more effective than other
psychotherapies, either for depressive disorders, anxiety disorders, personality
disorders or specific eating disorders.
Personally, my biggest beef with CBT
and other psychotherapy outcome studies has less to do with symptom relief than
with actually changing maladaptive interpersonal behavior. The latter is almost
never even looked at, let alone measured in these studies.
CBT’ers seem to think anxiety,
depression, and self-destructive behavior are all due to screwed up thinking by
individuals rather than being normal reactions to stress-inducing environments.
In experimental psychology circles, this is known as the fundamental attribution error. Telling people with these particular symptoms
that their problems are basically “all in their heads” in this manner is very
invalidating for them. Ironically, an ‘invalidating
environment” is one of the two primary factors these very same therapists cite
as the main causes for borderline personality disorder.
