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Why do Most Psychologists Ignore Science Based Therapy? Evidence Based Psychotherapy and the Failure of Practicioners

Andrew Gottlieb, Ph.D. — Sat, 10 Oct 2009 00:16:41 +0000

A new article in Newsweek magazine titled Ignoring the Evidence documents how most psychologists ignore scientific evidence about treatments such as cognitive behavioral therapy which have been proven to be effective.

A two-year study which is going to be published in November in Psychological Science in the Public Interest, found that most psychologists “give more weight to their personal experiences then to science.”

The Newsweek article has a wonderful quote,

“Thanks to clinical trials as rigorous as those for, say, cardiology, we now know that cognitive and cognitive-behavior therapy (teaching patients to think about their thoughts in new, healthier ways and to act on those new ways of thinking) are effective against depression, panic disorder, bulimia nervosa, obsessive-compulsive disorder, and -posttraumatic-stress disorder, with multiple trials showing that these treatments-the tools of psychology-bring more durable benefits with lower relapse rates than drugs, which non-M.D. psychologists cannot prescribe. Studies have also shown that behavioral couples therapy helps alcoholics stay on the wagon, and that family therapy can help schizophrenics function. “

The article documents how most psychologists fail to provide empirically proven treatment approaches and instead use methods which are often ineffective. The truth is there is very little evidence for most of the types of therapy commonly performed in private practices by psychologists and by Masters level therapists. If you are shopping for the most effective types of therapy you need to find a practitioner who is skilled at cognitive behavioral therapy (CBT) which is one of the few psychotherapy approaches that has been proven to work on a variety of problems.

Another interesting article in Newsweek about evidence-based treatment discussed bulimia. Here’s the summary:

“On bulimia (which affects about 1 percent of women) and binge eating disorders (2 to 5 percent), the verdict is more optimistic: psychological treatment can help a lot, and cognitive behavioral therapy (CBT) is the most effective talk therapy. That’s based on 48 studies with 3,054 participants. CBT (typically, 15 to 20 sessions over five months) helps patients understand their patterns of binge eating and purging, recognize and anticipate the triggers for it, and summon the strength to resist them; it stops bingeing in just over one third of patients. Interpersonal therapy produced comparable results, but took months longer; other therapies helped no more than 22 percent of patients. If you or someone you love seeks treatment for bulimia, and is offered something other than CBT first, it’s not unreasonable to ask why. Cynthia Bulik, director of the University of North Carolina Eating Disorders Program, summarized it this way: “Bulimia nervosa is treatable; some treatment is better than no treatment; CBT is associated with the best outcome.”

So the bottom line is this:

1. Most psychologists who don’t practice Cognitive Behavioral Therapy (CBT) are just winging it, using treatments that haven’t been shown to work by scientific studies. It’s as if you went to a regular physician and got treatment with leaches!

2. Many psychologists claim to use CBT but haven’t really trained in the use of CBT, or have taken a weekend workshop. Unless they prescribe weekly homework that involves writing down thoughts, and learning skills to analyze and change your thoughts, then they aren’t really doing CBT, and I recommend you find someone else.

3. If you have an anxiety disorder, depression, bulimia, or obsessive compulsive disorder, and haven’t been offered CBT, then you are not receiving state of the art treatment.

Overcoming Social Anxiety and Shyness

Andrew Gottlieb, Ph.D. — Tue, 03 Mar 2009 04:55:47 +0000

I’m often asked about social anxiety and shyness, and how to overcome them. I was lucky enough to be quoted in a Forbes Magazine article about that very topic. And here’s a link to a pdf of the article, which is easier to navigate. Enjoy!

Sadder but Not Necessarily Wiser (and not quite as sad as expected)

Andrew Gottlieb, Ph.D. — Sun, 26 Aug 2007 07:16:34 +0000

Here is some more evidence that we poorly predict happiness and unhappiness.

A recent article in the Journal of Experimental Social Psychology again shows how poor we are at predicting our future states of happiness or unhappiness. As I wrote about in previous posts on happiness, we seem to be quite poor at predicting how we will feel in the future.

Eli Finkel and Paul Eastwick at Northwestern University studied young lovers to see if their predictions of unhappiness after a breakup matched their actual suffering when the breakup occurred.

They looked at college students who had been dating for at least two months and had them fill out multiple questionnaires. Twenty six of the students broke up during the first six months of the study and these students predictions of distress were examined. The students at rated how painful a breakup would be on average two weeks before the breakup.

On average people overestimated the pain of a breakup. There was some correlation between how much people were in love and how much pain they suffered after the breakup, but everyone recovered more quickly than they had predicted. Looking at the actual study it appears that people were able to predict somewhat accurately their suffering in the first two weeks after the breakup. The correlation between their prediction and the actual distress was about 0.60 which means that they were able to predict about 36% of their suffering. But between weeks six and 10, the correlations dropped to about 0.30, which means that they were only able to predict about 10% of the variation in their suffering.

This is interesting in terms of the habituation process that I wrote about earlier. We habituate to both good and bad events. And we underestimate our ability to adapt to both types of events.

Now we shouldn’t make too much of this study. Remember this is a study of college students who had been dating for at least two months. This isn’t exactly a study of deep connection and commitment. It would be interesting, but much more difficult, to look at the same data for married couples who later break up.

Shyness Plus Rejection Plus Anger = School Shooters? News from APA Conference

Andrew Gottlieb, Ph.D. — Sun, 19 Aug 2007 23:18:48 +0000

Ah the joy of summer conferences! American Psychological Association had their annual conference in my lovely city of San Francisco this weekend, and one of the more interesting studies discussed was a study of kids who shoot other kids in school in mass murder attacks. They looked at eight teen shooters and rated them on what they call “cynical shyness.” Cynical shyness is a subset of normal shyness that involves anger and hostility towards others, especially when they are rejected.

Bernardo Carducci, lead author of the study and director of the Shyness Research Institute at Indiana University Southeast in New Albany explained:

“In addition to feelings of anxiety about social situations, cynically shy people, who are a small subclass of shy people, also have feelings of anger and hostility toward others and that comes from this sense of disconnect. Shyness has more in common with extroversion than with introversion. Shy people truly want to be with others, so they make the effort, but when they are rejected or ostracized, they disconnect. Once you disconnect, it’s very easy to start being angry and hate other people. It’s you against them, and they become what I call a cult of one. Once you start thinking ‘it’s me versus them,’ then it becomes easy to start hurting these people.”

Rating the eight teen shooters, they found that four of them had scores of 10 (on a 10 point scale) of cynical shyness, three had scores of 8, and one had a score of 6. Both of the Columbine shooters had scores of 10.

Now it should be pointed out that shyness per se is not dangerous. It is only this angry, cynical form of shyness, mainly found in teenage boys, that may be associated with dangerousness. And one weakness of the study is that they only looked at shooters. There may be many teens who score high on cynical shyness that do not escalate into violence. In fact this would be a good study, to identify what allows other cynically shy students NOT to become dangerous.

But shyness in pre-teens and adolescents is a serious disorder, as it can create intense misery in young people. Shy people desperately want to connect, they just don’t know how. Classes and workshops and group therapy approaches may be helpful in helping teens overcome this serious disorder.