Posted by ace on November 3, 2003, at 20:33:45
In reply to More Re: CBT ?ace, posted by mattdds on November 3, 2003, at 11:51:03
> Hey Ace,
>
> I never meant to imply that you weren't entitled to your own opinion - I don't know where you might have interpreted that I said that.Your interpreting that I interpreted that. You are engaged in a cognitive distortion- mind reading. In fact, I never thought you meant to imply that I was not entilted to my own opinion.
My refrain on "everyone is entilted to their own opinion" is something I always say when I have a differing view with someone. I don't mean to say that they are implying I have no right to my own opinion but rather it is said to inveterate an overall sense of democratic free speech...it is a comment which, in a way, says "yeah it's great we have these different opinions, and it's greater we can express them"
It's just that your claim that CBT is worthless and quackery is just not at all founded in anything *but* opinion.I stated it might work for some, and furthermore I have seen Burns's statstical method which I think is fundamentally flawed. Certain follow-ups on panic disorder (and depressive) patients who undertake CBT has shown a consistent rate of relapse.
The science behind the efficacy is unequivocal.
>
Can you point me to this science?
> Does this mean it's universally effective? Absolutely not, but this is true of any drug as well - yes even Nardil.I've never stated Nardil was universally effective. Rather I believe it is extremely effective. I have seen rare cases of people who did not respond to Nardil.
Does this mean CBT is effective for Ace? Well...we know the answer to that question empirically.
>
> >>I just feel [CBT] is more geared towards exogenous depression.
>
> First off, the distinction between "exogenous" and "endogenous" depression is hazy at best, and an outdated relic at worst.All diagnosis in psychiatry is hazy, IMO. This is because, at the end of the day, we have no external proof (ie blood test) to confirm any diagnosis. Diagnosis is gleaned from the subjective impression of another human being.
Different people present with different symptoms. My understanding is that this idea represents pretty old-school thinking about depression. People used to diagnose "endogenous" depression by certain symptom subsets or inability to suppress cortisol with dexamethasone administration - but these methods are not even used anymore because they lack sensitivity / specificity.
>
> It is generally agreed nowadays that *severity*, as measured by the Ham-D or BDI is the best measure we can have - calling a depression "endogenous" or "exogenous" is pure conjecture, IMO.I still think the distinction between the two is very plausible.
>
> So if you are saying that CBT does not work in more severe depression, I'm sorry, but this is just absolutely incorrect.No, I said it SEEMED more geraed towards exogenous depression. So, I was not saying "CBT does not work in more severe depression" I just find it hard to see how it would work in severe depression, as I do not believe thoughts are the basis of our feelings and I find it hard to see how someone can change their emotional state by an act of will.
Here is but one study abstract - which was funded by none other than SKB (the manufacturer of Serzone) and the NIMH:
>
> http://my.webmd.com/content/article/23/1663_53120
>
> You're going to have a tough time arguing anything but that CBT is not effective for *Ace's* severe depression - despite the strength of your feelings / opinions."not effective for "Ace's" severe depression"??- I don't understand...please clarify.
I mean, even the American Psychiatric Association has admitted that CBT is equally effective and has better long-term outcomes.
>
> It would be much more honest and reasonable if you simply said, "CBT did not work for me".I say CBT does not work for me and I personally find it hard to see how it can work for severe depression.Although some people claim it helps their severe depression, which is great.
The fact that I personally find it hard to see how it works for severe depression -- sure, you disagree with me (which is fine), but, I mean, is this statement offensive to you? If it works for you, my opinion doesn't really matter for you, right?
> >...I am just turned off by the CBT money making machine
>
> I have no idea what you mean here. The CBT money making machine? Are you referring to Burns here? If so, forget Burns, and look to the overwhelming data supporting *generic* CBT. Can you explain that away with something besides "opinion"?Can you point me to this data?
>
> If you want to talk about strongly vested financial interest, I think we should first discuss big pharm. There is generally very little money to be made in CBT.When you say there is 'generally very little money to be made in CBT' what context are you refering to- ie in a clinical or commercial context?
>
> >>It certainly is a variant on the Vincent Peal positive thinking...
>
> Umm, It *certainly* has nothing to do with Vincent Peal's work. You might want to re-read Burn's work a bit more thorougly.I've read 4 of his books, hundreds of letters when he had a guru question section, and actually contacted him to quiz him on his method. And yes, I do see parralels with Vincent Peals work.
In the introduction, he actually says "this is not "The Power of Positive Thinking"". This represents a very oversimplified and inaccurate view of CBT.
It is more than Peals method, true, but I think it is a variant on it.
Peale's work blossomed into "positive affirmations", which don't work, but are not in any conceivable way, CBT.
There is actually 'data' that suggests positive affirmations do work- I don't believe they do personally but.
CBT, in fact, advises
> *against* using affirmations.I know Burns does, but which other exponents do as well?
It concentrates on combatting *negative* rumination, as this is known through studies to initiate, perpetuate / prolong depressive episodes.
How is it 'known' through studies? There is no clear causal relationship that can be tested (apart from subjective experience- which is internal and therefore not amenable to the scientific method).
> You don't have to believe this, and again, you are entitled to your opinion, but studies certainly indicate that negative rumination perpetuates depression and increases the likelihood of relapse. CBT treats this rumination.Is it 'known' or is their an 'indication'?
> >>And people are free to believe what they want
>
> I don't remember saying otherwise.I never said you stated otherwise.
> >>I'm just expressing my views
>
> Again, you seem to think that I'm censoring you.I didn't think you were. You're mind reading again. In fact that comment was said to try and get the point across that they are only MY views...I didn't think you were trying to censor me.
I'm not. I just want some clarification and substantiation to what you are saying. Your arguments seem to contain a lot of name-calling (quack) and emotion, but perhaps a bit lacking in substantive evidence.
I thought I only name-called once?...ie quack
I'm not too emotional about this subject, where does my tone indicate this?>
> Again, you can say with 100% certainty, "CBT does not work for Ace". But when you say it's for "quacks",I said Burns was a quack...I never said it was for quacks.
or that it's universally inferior to meds,
Never stated this either.
you run into the problem of having to substantiate your claims with scientific evidence. I think you'll have a tough time doing that.
>
> BTW, I don't know if you're aware, but I recently tried Parnate. It failed, and I also experienced a spontaneous hypertensive crisis.That's no good. I failed Parnate too- caused a preety bad depression.
Does this mean I'm going to go on a crusade against Parnate? No. My own personal "experiment" does not have a large enough "n" to provide a meaningful evaluation of its overall efficacy and safety. So I'm not going to go out and incite people by saying "hey, Parnate is CRAP, look what happened when *I* tried it!". Parnate is very well studied, and a good treatment modality for around 66% to gain some relief. You catch my drift?
Sure, but do you catch mine?
>
> >>He did say this...and he called all psychiatrists 'liars' and used a cuss word to describe their research
>
> Do you have a link to the transcript of where he said this? First off, Burns *is* a psychiatrist, and prescribed drugs to 50% of his patients (he's big on the MAOI's BTW - read his rave reviews of them in his book). So it would not make sense that he called all psychiatrists 'liars', as he lectures to psychiatrists. The dude graduated summa cum laude from Stanford medical school, did his residency at University of Pennsylvania, ran the lithium clinic at the VA in Philadelphia, did intense research on serotonin metabolism, and now is on the *psychiatric* faculty at Stanford. He originally wanted to do brain / pharm research, and was a leader in the field. But he got frustrated with his marginal results with using only drugs, so he teamed up with Aaron Beck to help develop CBT. This appears to be an exaggeration or gross misquotation. It just sounds completely out of character for Burns.It does indeed- but he said it- I'll be back with the link!
> Take care ace,
>
> MattThanks Matt! You take Care too,
Ace.
>
>
poster:ace
thread:275048
URL: http://www.dr-bob.org/babble/psycho/20031030/msgs/276274.html