I'm a fan of Horgan myself! Thanks for sharing this article. I plan on writing about antidepressants in the future too and placebos in psych more generally.
I wonder if they are no better than placebos (whatever that may mean in psychotherapy trials) are we still justified in calling psychotherapy effective? If for instance, psychotherapy turns out to be no more effective than talking to an open minded friend. Why would anylne ever need to pay for a very expensive talk placebo with a venere of science to it?
I think the issue is that it's hard to separate a talk therapy placebo from the real thing. Like talking to your open minded friend could be equally beneficial because it's all a placebo, or because the act of talking to someone who is open minded *is* the treatment. But yeah I don't think "scientific" therapies really deserve higher status or are worth paying for more than talking to good, open-minded friends, except perhaps in certain specific situations, or when such friends are unavailable. That being said, we live in such a "scientific" culture that pretending it's sciencey might be a good way to get people to seek treatment if they need it.
Maybe a simple idea. But what if they add Chatgpt as a chatbot as a therapeutic placebo next time? 😜 What would it be if that would be equally effective as talking to a friend or a therapist. Or maybe it's the semi-unbiased outsiders perspective and less a listening ear? Do you maybe know research that has compared multiple Domains of the social World with talking therapy?
Good, open-minded friends can be in short supply. So regardless of the placebo issue, you might be justified in paying someone to simulate such a friend.
I don't know, I would jot like to pay for homeopathy just because there was a short supply of real medicine. Even if it would make me feel good in the short term. I know that talking therapy effects don't last long. Thats I think one of the flaws of talking therapy. I'll see if I can find that reference somewhere.
History rhymes — the conclusion that approximately all therapeutic modalities have about the same efficacy is at least as old as the Luborsky paper, Everybody Wins & All Must Have Prizes. The Method of Levels people think this is because the "active ingredient" of therapy is letting the person reorganize their own conflicting drives.
In the social sciences there is a constant drive to forget useful knowledge and then later rediscover it. Since success comes from inventing new techniques, fads, theories, frameworks, etc. one tends to succeed by discrediting older works instead of honoring them. We see this in education, psychology, political science, etc. "Progress" via amnesia.
Yes — you'd think we'd figure out not just a way of archiving info but also of reducing it to useful form, but then that would run counter to the need to publish.
I misremembered the name of the paper, by the way. It is Luborsky, L., & Singer, B. (1975). Comparative Studies of Psychotherapies: Is It True That Everyone Has Won and All Must have Prizes? Archives of General Psychiatry, 32, 995.
I find it fascinating how this dodo effect is interpreted that all is well and all modalities work. Whilst the comparisons used are pathetic and unrealistic. Wait list as a comparison, is one of those examples. Almost everything is better than a wait list, as waiting is depressing and boring. So if you compare anything with any social element to it to a wait list, I think they will all seem effective to some degree to that. The same goes for business as usual (copied from medical science I presume), whatever that may mean in most cases in clinical mental health practices. I think even homeopathy(placebo water) would be effective compared to these comparisons.
The same goes with many of the somewhat pathetic criteria of what is considered a met al disorder when it is surveyed among people, ones or twice I your live being depressed? Or having two or more symptoms of a certain mental "disorder", that seems a very low bar and does not seem surprising that you get high numbers with those criteria. Another thing with those criteria and those measures is how valid are they? I think that the test-retest reliability ovr the year with multiple measures in a year would be very poor, as the emotional state of people will shift significantly over a few months let alone over a year or more, how well can these tests seperate the natural variation of people from actual mental disorders? In these cases I think that faulty statistics should be the least of the worries in this science.
John Horgan (who is one of my favorite science writers) has written about the "Dodo Effect", the hypothesis that all psychotherapies are equal. This principle can also be extended to antidepressants, which are all about equally effective -- and just as effective (or ineffective) as placebos. https://blogs.scientificamerican.com/cross-check/cybertherapy-placebos-and-the-dodo-effect-why-psychotherapies-never-get-better/
I'm a fan of Horgan myself! Thanks for sharing this article. I plan on writing about antidepressants in the future too and placebos in psych more generally.
I wonder if they are no better than placebos (whatever that may mean in psychotherapy trials) are we still justified in calling psychotherapy effective? If for instance, psychotherapy turns out to be no more effective than talking to an open minded friend. Why would anylne ever need to pay for a very expensive talk placebo with a venere of science to it?
I think the issue is that it's hard to separate a talk therapy placebo from the real thing. Like talking to your open minded friend could be equally beneficial because it's all a placebo, or because the act of talking to someone who is open minded *is* the treatment. But yeah I don't think "scientific" therapies really deserve higher status or are worth paying for more than talking to good, open-minded friends, except perhaps in certain specific situations, or when such friends are unavailable. That being said, we live in such a "scientific" culture that pretending it's sciencey might be a good way to get people to seek treatment if they need it.
Maybe a simple idea. But what if they add Chatgpt as a chatbot as a therapeutic placebo next time? 😜 What would it be if that would be equally effective as talking to a friend or a therapist. Or maybe it's the semi-unbiased outsiders perspective and less a listening ear? Do you maybe know research that has compared multiple Domains of the social World with talking therapy?
Good, open-minded friends can be in short supply. So regardless of the placebo issue, you might be justified in paying someone to simulate such a friend.
I don't know, I would jot like to pay for homeopathy just because there was a short supply of real medicine. Even if it would make me feel good in the short term. I know that talking therapy effects don't last long. Thats I think one of the flaws of talking therapy. I'll see if I can find that reference somewhere.
History rhymes — the conclusion that approximately all therapeutic modalities have about the same efficacy is at least as old as the Luborsky paper, Everybody Wins & All Must Have Prizes. The Method of Levels people think this is because the "active ingredient" of therapy is letting the person reorganize their own conflicting drives.
In the social sciences there is a constant drive to forget useful knowledge and then later rediscover it. Since success comes from inventing new techniques, fads, theories, frameworks, etc. one tends to succeed by discrediting older works instead of honoring them. We see this in education, psychology, political science, etc. "Progress" via amnesia.
Yes — you'd think we'd figure out not just a way of archiving info but also of reducing it to useful form, but then that would run counter to the need to publish.
I misremembered the name of the paper, by the way. It is Luborsky, L., & Singer, B. (1975). Comparative Studies of Psychotherapies: Is It True That Everyone Has Won and All Must have Prizes? Archives of General Psychiatry, 32, 995.
I find it fascinating how this dodo effect is interpreted that all is well and all modalities work. Whilst the comparisons used are pathetic and unrealistic. Wait list as a comparison, is one of those examples. Almost everything is better than a wait list, as waiting is depressing and boring. So if you compare anything with any social element to it to a wait list, I think they will all seem effective to some degree to that. The same goes for business as usual (copied from medical science I presume), whatever that may mean in most cases in clinical mental health practices. I think even homeopathy(placebo water) would be effective compared to these comparisons.
The same goes with many of the somewhat pathetic criteria of what is considered a met al disorder when it is surveyed among people, ones or twice I your live being depressed? Or having two or more symptoms of a certain mental "disorder", that seems a very low bar and does not seem surprising that you get high numbers with those criteria. Another thing with those criteria and those measures is how valid are they? I think that the test-retest reliability ovr the year with multiple measures in a year would be very poor, as the emotional state of people will shift significantly over a few months let alone over a year or more, how well can these tests seperate the natural variation of people from actual mental disorders? In these cases I think that faulty statistics should be the least of the worries in this science.