Cognitive behavioural therapy is falling out of favour
&quot;What’s going on? One theory is that, as any therapy grows more popular, the proportion of inexperienced or incompetent therapists grows bigger. But the paper raises a more intriguing idea: the placebo effect.&quot;<p>The placebo effect, and effects like it, happen everywhere. Everything given with a good or bad attitude will have some beneficial or detrimental effect. In that sense this article isn&#x27;t that interesting.<p>What I think is more interesting is combining the interaction between inexperienced therapists and the placebo effect. Well trained psychologists have a stronger -- and I&#x27;d guess more nuanced -- belief of when CBT is useful and how it is useful. Since they have that belief, it has the potential to create a positive placebo. I always have to think of the Pygmallion effect and similar effects.<p>People who treat patients CBT but are inexperienced do not have that enthusiasm and have a weaker belief that it will work. Maybe they only think intellectually that it would work, but don&#x27;t feel an emotional tsunami of conviction -- in particular cases -- that it will work. It&#x27;s easier to have that when you know that in 7 out of 10 particular cases it worked really well (i.e., having experience).<p>That would be my guess anyways.<p>---<p>Now I read a couple of comments with people giving the sentiment that they think CBT is nonsense. Allow me to address that.<p>When I looked into CBT (@ 17&#x2F;18 yo) and its pseudoscientific brother  -- reframing in NLP -- I noticed that it was all about changing perspective. Learning to see that multiple emotional perspectives can be equally true was mind blowing for me. I came to the conclusion that I might as well pick the most positive one. I learned a couple of nuances on the way. For example, for some goals it&#x27;s useful to hold multiple positive and negative perspectives at the same time.<p>I used it even today, now that I think of it. I was learning Django and it took me 4 hours to write simple custom email validation. I had a bug, a very simple one if you know the framework, but I don&#x27;t. I was pissed after 4 hours, I felt like I wasted my time. I found the bug though :)<p>Since I didn&#x27;t want to feel pissed I looked for a reframe. The reframe was: it&#x27;s the first time that I learned to debug in Python with pdb, read source code from a framework so intensely, have a better understanding in transferable skills since I have experience with gdb and have the guts to debug the framework and understand it, for the first time. While I didn&#x27;t progress much in writing actual code, my confidence in tackling issues in Python has grown tremendously. After thinking this I felt pretty good and figured that tomorrow it would be another day. So yea, I didn&#x27;t progress in my initial goal (completing a tutorial) but I got something way more cooler for it in return. Now, if I hadn&#x27;t known CBT I would&#x27;ve stopped at my first thought and stayed pissed, I&#x27;d then enter a lot of thought trains that would go to destructive places.<p>So yes, changing perspectives works. I also call it &#x27;simple CBT&#x27;.<p>And when heavy stuff happens, then it doesn&#x27;t completely cure you (perhaps reduces the pain by 5 to 20% IME, got no scientific sources). In many ways that&#x27;s because the pain from the problem does not only stem from cognitive distortions -- e.g. generalizing the slightest thing to a negative epic scale -- which is the main assumption that CBT makes. If you lose a person (breakup, passing away, etc.), for example, you also need to be reconditioned since a lot of habits are still there that are only applicable to the other person which may trigger an immediate pain. You can&#x27;t just think your way out of that, and the &quot;behavioral&quot; part of CBT will take a longer time and may not work (habit formation and destruction is a difficult topic).<p>Disclaimer: studied psych., I know a lot more about reframing than CBT (I skimmed a couple of texts and was like &quot;hey that looks like reframing&quot;). So my knowledge is <i>not</i> a 100% sharp and may miss important details. I read a book about ACT and compared that with CBT.