In no mood for therapy
Has one of the most popular treatments for depression been oversold?
Psychiatrist David Burns is the most well-known popularizer of CBT. His book Feeling Good: The New Mood Therapy has more than 4 million copies in print. He says: "I'm no less in love with the cognitive model than I was 30 years ago." But even Burns agrees that the studies are "underwhelming" and that "there's a huge need to improve how we do research." Along with faulty methodology, he says, there are several human variables that make valid testing difficult. For example, most studies have no way to control for a patient's motivation. Exercises and other "homework" are a big part of the therapeutic process in CBT. Some patients do the work, and some don't bother, and that could account in part for the mixed outcomes.
Nor do the studies take into account an individual therapist's skills and manner. As a consequence, it's hard to tell if a patient's success or failure is due to the therapeutic technique or the therapist. "We have seen many therapists with big reputations who have poor empathy and get terrible results, and we've seen therapists who seem rather inept get incredible results," says Burns. This despite the fact, he adds, that "all therapists fancy themselves empathetic and warm."
The CBT debate is guaranteed to continue as the studies keep coming. One published last week in the Journal of the American Medical Association showed that young, low-income Latin and African-American women on CBT did almost as well as they did on antidepressants.
advertisement
