Question RE: Hayes' CBT research in the 25 Feb 06 "Salon.com" article
BELOW: Relevant text from the Salon article:
"Most forms of empirically supported therapy have bought into the idea that the real problem in behavioral health is the presence of private events that are negative. Specifically with regard to cognitive therapy, which for 30 years has been ascendant in the field, the idea has been that you should monitor, detect, challenge and change your negative thoughts, and when you do that, you'll live better. But in a couple of recent randomized trials, that [theory] was shown to be not true."
>>> I'd like to review these studies. Would someone please point me in the right direction? :-)
Dave
P.S. I just joined ACBS and ordered some ACT literature by Hayes, et. al. Any newcomer groups being formed? ACT is a new wrinkle on an old brow, and I'm intrigued.
Testing the Core Idea in Traditional Cognitive Therapy
This is a paragraph from an article by Evan Foreman and James Herbert that deals with this issue in part, as it compares ACT and traditional CBT:
"Another challenge to the cognitive mediation hypothesis comes from dismantling-type studies that have compared behavior therapy with and without a cognitive component. For instance, a series of studies have found that exposure-only therapy was at least as effective as an exposure plus cognitive therapy in the treatment of social anxiety disorder (Emmelkamp, Mersch, Vissia, & Van der Helm, 1985; Gelernter, Uhde, Cimbolic, Arnkoff, & et al., 1991; Hope, Heimberg, & Bruch, 1995; Mattick, Peters, & Clarke, 1989; Scholing & Emmelkamp, 1993) and PTSD (Foa et al., 1999; Foa et al., 2005; Lovell, Marks, Noshirvani, Thrasher, & Livanou, 2001; Paunovic & Ost, 2001), and that behavioral activation alone was as effective as activation plus cognitive therapy in the treatment of depression (Jacobson et al., 1996). Similarly, meta-analyses have suggested that exposure plus cognitive interventions offer no advantage over exposure only treatments for GAD (Gould, Otto, Pollack, & Yap, 1997) and OCD (Feske & Chambless, 1995)."
My comment in the Salon.com interview was focused on Jacobson et al., 1996 (it appeared in the Journal of Consulting and Clinical Psychology) and the replication, Dimidjian et al, in press, which will also appear there. I don't know, but I would imagine that Sonja Dimidjian can send you the in press article. Her email address is sdimidji@myuw.net
There were two large randomized trials comparing Beck's complete CBT package for depression with a) the same package without any cognitive intervention at all -- that is the 1996 study, and b) the same package without any cognitive intervention at all plus a great focus on cognitive and emotional avoidance (very much in line with some of the ACT work) -- that is the "in press" study.
The results: In the 1996 study both groups has the same outcome,
in the "in press" study the package without the putatively key feature of cognitive therapy plus an ACT-consistent focus on avoidance worked better than Beck's package, particularly for the more severe cases.
In the Time Magazine story you will find that Tim Beck admits that there are no experimental studies showing that the core idea in his approach is correct, but he says that there are only two studies (these two, presumably) showing that it is not. That is an OK response until you remember that it is up to those who make knowledge claims to show that these claims are based in good evidence -- it is not up to critics to show they are false.
25 years atop the heap shold be enough time to provide this evidence. It is not only not there, however, there is a growing base of evidence to show that the idea is incorrect.
To my mind that is enough. We have to find another way to move forward.
If you get to Google scholar or an academic library internet site you can find all of these references easily enough.
- S
Steven C. Hayes, University of Nevada
Follow Up tp S. Hayes Response
Thank you so much for your prompt, thoughtful response. I have online access to a medical Library in Heidelberg. I'll follow up, and I look forward to reviewing the texts that I've ordered.
Dave Nawrocki, Stuttgart Clinic, Germany