Monday Miscellany: Cotard’s CBT, Clients

1. A cultural history of pain.

2. Sexts from the void. That is all.

3. Beth Israel hospital is testing a system where clients can read their therapist’s notes. I was always a fan of reading my therapist’s notes (of the three I saw, one didn’t mind), but could see this becoming a problem on a larger scale; where therapists write notes for their clients, constantly needing to anticipate how they’ll be interpreted.

4. Scott claims this is much more about antidepressants than you wanted to know. Relevant to some previous posts around these parts:

SSRIs get used more than psychotherapy for the same reason they get used more than tricyclics and MAOIs – not because they’re better but because they have fewer problems. The problem with psychotherapy is you’ve got to get severely mentally ill people to go to a place and talk to a person several times a week. Depressed people are not generally known for their boundless enthusiasm for performing difficult tasks consistently. Also, Prozac costs like 50 cents a pill. Guess how much an hour of a highly educated professional’s time costs? More than 50c, that’s for sure. If they are about equal in effectiveness, you probably don’t want to pay extra and your insurance definitely doesn’t want to pay extra.

Contrary to popular wisdom, it is almost never the doctor pushing pills on a patient who would prefer therapy. If anything it’s more likely to be the opposite.

However, given that we’re acknowledging antidepressants have an effect size of only about 0.3 to 0.5, is it time to give psychotherapy a second look?

No. Using very similar methodology, a team involving Mind The Brain blogger James Coyne found that psychotherapy decreases HAM-D scores by about 2.66, very similar to the 2.7 number obtained by re-analysis of Kirsch’s data on antidepressants. It concludes:

Although there are differences between the role of placebo in psychotherapy and pharmacotherapy research, psychotherapy has an effect size that is comparable to that of antidepressant medications. Whether these effects should be deemed clinically relevant remains open to debate.Another study by the same team finds psychotherapy has an effect size of 0.22 compared to antidepressants’ 0.3 – 0.5, though no one has tried to check if that difference is statistically significant and this does not give you the right to say antidepressants have “outperformed” psychotherapy.

If a patient has the time, money, and motivation for psychotherapy, it may be a good option – though I would only be comfortable using it as a monotherapy if the depression was relatively mild.

5. Leah with a defense of Cognitive Behavioral Therapy. “Just treating the symptoms” can be a great approach if you want the symptoms to go away, stat.

6. Two different thoughtful looks at the idea of being addicted to pornography. First, from Emily Nagoski, second from The Guardian.

7. Cotards Delusion: believing you’re dead. Here’s a first-person account. (h/t Mind Hacks)

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