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Evidence mounts that CBT is bogus

12 Mar, 09 | by Steven Reid, Evidence-Based Mental Health

So writes Zoe Williams in the Guardian newspaper. To be fair, she is taking a swipe at the UK government’s latest wheeze: cognitive-behavioural therapy for anyone finding themselves unemployed in the recession. I’m no CBT evangelist myself and think it gets an all too easy ride, often at the expense of other talking treatments. It’s no quick fix and certainly not a panacea. Like other evidence-based treatments for anxiety and depression CBT works for some people but not for others, and I am not at all convinced that Lord Layard’s army of CBT therapists will cure the nation’s ills. However, Ms Williams’s assertion that cognitive behaviour therapy is bogus is frankly, er, bogus. In fact this article is typical of the lazy, ill-considered journalism that serves to reinforce the stigma that shadows mental illness and its treatment.

I appreciate the difficulties of unravelling professional jargon in a short newspaper article but her attempt to describe CBT in a prison workshop is laughable: “[it] dismantles cognitive illusions, of which prisoners have many (among them high self-esteem, which causes them to esteem their own needs over other people’s)”. Does that make sense to you? For a rather more comprehensible explanation of cognitive-behavioural therapy have a look at this leaflet.

The next step of course is to rope in a guru, in this case the ubiquitous Oliver James, a psychologist who reigns supreme in the field of media-shrinks following the excommunication of Raj Persaud. Apparently James is the pre-eminent anti-CBT fury [sic] and his evidence for the bogus nature of this treatment? One study published in 2004 showing that after 18 months CBT was of little benefit in comparison to no treatment, James summarises, “CBT gives sufferers the illusion that they’re feeling better…it’s hypnosis basically”. Actually this paper isn’t a study or a trial of CBT. It’s a review, a critique of the problems involved when using randomised trials to provide evidence for talking treatments in general. Not quite the same thing then…and no mention of hypnosis either. There are however, an increasingly large number of trials and reviews of trials showing that CBT does work particularly well for anxiety disorders, but also for depression. Rather than relying on one expert and one paper you might be better off sticking with Google.

When it comes to discussing health, the Guardian journos might learn a thing or two from the oft-maligned Red Tops. Take a look at these pieces by ‘Dr Keith’ of the Sun on epilepsy and risk: clear, concise, and importantly, comprehensible.

I’m a Psychiatrist… Get Me out of Here!

16 Nov, 08 | by Steven Reid, Evidence-Based Mental Health

“Take ten volunteers, half have psychiatric disorders, the other half don’t – but who is who? Follow this two-part social experiment to see if you can tell which of the people have a mental health diagnosis”

Reality TV meets mental illness in ‘How Mad are You?’, the first part of which was broadcast last week (in the UK you can still watch it on the BBC iPlayer). The film was made for Horizon, a BBC science programme, but there was little science in evidence here. Ostensibly an exploration of the fuzzy border between mental illness and normality, the producers have rejected the considered investigation that the subject merits and instead invite viewers to indulge in a ‘Spot the Screwball’ contest.

The setup derives from the controversial Rosenhan experiment. This study from the 1970s involved a group of people with no mental health problems attempting to gain admission to a psychiatric hospital by reporting vague psychotic symptoms. The pseudopatients were all admitted, given diagnoses of schizophrenia or manic–depression, and none were identified as imposters by staff. Rosenhan described the experiment in his paper ‘On Being Sane In Insane Places’, a forceful critique of the validity of psychiatric diagnosis, and an insight into the demeaning experiences of psychiatric inpatients. A repeat of Rosenhan’s study, I suspect, is what the Horizon team were looking for but this crass Big Brother escapade falls some way short.

The volunteers have been taken to a picturesque castle in the Kent countryside where they undergo a series of tests that will supposedly reveal symptoms of the six disorders:  social anxiety, OCD, anorexia, depression, schizophrenia, and bipolar disorder. In the first episode they all have a turn at stand-up comedy. Someone with social anxiety should be filled with dread at the prospect, although given that they have already agreed to self-exposure on television is telling a few jokes in a pub likely to lead to panic? The next stunt, or challenge, involved cleaning out a cowshed. No prizes for guessing who they were hoping to flush out with that one. I wonder what they have planned for next week – a banquet perhaps?

Competing with the viewers, hidden away in a darkened room watching proceedings, are the three wise men: a psychiatrist, a psychologist and a psychiatric nurse. The psychologist, Richard Bentall, is a vehement critic of psychiatric classification and diagnosis so his willingness to take part comes as a surprise. These experts don’t have much to go on – video clips and a few brief interviews – so they are reduced to making banal and often risible observations, the sort that would make even a daytime TV sofa-shrink squirm.  So the ‘thin one’ must have anorexia, the ‘risk-taker’ must have bipolar disorder and every time anyone makes an insightful comment it’s an obvious sign of treatment with cognitive behavioural therapy. At the end of the episode the three select one person who they think has a psychiatric disorder, and one who doesn’t. They correctly spot the man with OCD, catching him out as he says that he is planning to throw his boots away after the mucking-out. The programme’s best moment comes when we see the happiness of one of the volunteers after the experts get it wrong, confidently telling her that it’s clear she has no psychiatric history.

Mental health all too rarely gets a fair deal on our TV screens and I think Horizon gets it wrong here, veering toward exploitation for the sake of entertainment. This programme risks trivializing mental illness. Social anxiety means you don’t fancy being a comic, sticking your hands in dung will be difficult with OCD, and depressed people tend to be rather gloomy. In addition, we’re treated to annoyingly repetitive pan shots of the volunteers standing on a lawn looking perplexed, clumsy expressionist lighting presumably signifying the unknowable interiors of the human psyche, interspersed with some irrelevant neuropsychological tests in an effort to ratchet up the science quotient.

As the first episode drew to a close the narrator intoned, “No one knows what the outcome of this challenge will be…” I can’t say that I particularly care either, but if you do the second episode will be shown on Tuesday 18th November. An 0800 number appeared after the credits, but not for viewers to call in and vote to eject a contestant. It was a support-line for those distressed by what they had witnessed. I was sorely tempted.

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