CBT is a therapy based on the belief that one’s negative illogical thoughts can cause depression and correcting them can treat the depression. CBT therapy is usually performed with a therapist however now computer programs are being created to help depressed individuals. While CBT therapy is endorsed by psychiatry it has a number of problems.
Depression is known to cause distorted thinking so what comes first the depression or the distorted thinking? CBT doesn’t clarify this issue. It just says that correcting illogical thinking treats the disorder.
CBT therapy has been shown to be as effective as antidepressant therapy and prevents relapses better than drugs. The problem with this is that antidepressant therapy isn’t all that effective. Antidepressants are, in reality, only slightly more effective than a placebo. Additionally, since major depression is cyclical how does one know for sure if the treatment was actually helping. Many experiments are performed over rather short periods of time and a certain percentage of people will have spontaneous remissions. This of course could be the same issue for antidepressant trials.
Experiments involving CBT vs antidepressants are not double blind which is considered essential for the highest level of objectivity. If the researchers and the patients know what type of therapy is being performed objectivity is diminished.
A major criticism has been that clinical studies of CBT efficacy (or any psychotherapy) are not double-blind (i.e., neither subjects nor therapists in psychotherapy studies are blind to the type of treatment). They may be single-blinded, i.e. the rater may not know the treatment the patient received, but neither the patients nor the therapists are blinded to the type of therapy given (two out of three of the persons involved in the trial, i.e., all of the persons involved in the treatment, are unblinded). The patient is an active participant in correcting negative distorted thoughts, thus quite aware of the treatment group they are in
Researchers say that brain scans show that CBT “works” and yet brain scans are not considered a reliable way to diagnose mental illness. People with mental illness often have more than problem such as depression and ADD. This confounds diagnosing a mental disorder or saying confidently that an individual is in remission. This excerpt from Scientific American explains the problem.
During testing, the system analyzed the shapes of brain regions in each test scan and assigned it to the group it most resembled. The scientists checked its work by comparing the new labels on the test scans with the original clinical diagnoses. They repeated the procedure several times with different randomly generated sets. When the system chose between two disorders or one ailment and a clean bill of health, its accuracy was nearly perfect. When deciding among three alternatives, it did much worse.
The basis of CBT doesn’t explain how people with a rapid cycling form of bipolar disorder cycle between depression and mania. Do they start off having negative thoughts during a depressive episode which eventually cycles with mania and the mania consequently produces delusional thinking? CBT has not been shown to be effective for preventing depressive episodes in bipolar disorder.
CBT has given no biological explanation for how it works and yet implies that possibly negative thoughts might exacerbate stress which in turn precipitates a depressive episode. Even though stress has long been thought to cause depression stress(HPA activation) is not distinctive to just depression. Stress is implicated in numerous health problems in a rather vague manner. To further complicated matters what is stressful to one person isn’t stressful to another. Consequently it is complicated to study stress.
In the end CBT emphasizes that depressed people are responsible for their depression which is still questionable in the eyes of science.