Monthly Archives: July 2015

Bereaved? Expect it to be more complicated than 2 years, one month, four days

counselling in exeterThe charity Sue Ryder gained a moderate amount of publicity this month for a survey it commissioned into how long people take to feel better following a bereavement. Some of the major British newspapers picked it up, including The Mail, and the Daily Telegraph as well as a few locals. The survey’s headline figure was that people, on average start to feel better in 2 years, one month and four days. Men take slightly quicker to feel better than women.

There has been little research before this about timescales for recovery after bereavement. The Royal College of Psychiatrists talk vaguely that “Most recover from a major bereavement within one or two years” and that problems can arise for some people who get “stuck” – “Years may pass and still the sufferer finds it hard to believe that the person they loved is dead” the RCP say. People are very interested in the question of how long things are going to feel like this.

So, can we trust this new piece of research from Sue Ryder? Let’s have a look at the people who carried out the survey, an organisation called Census Wide, who describe themselves as “Specialists in robust, quick turnaround surveys for the PR industry.” Ah, I see, so it was a public relations company who completed this “research”? According to their methodology page, it was probably a self-selecting sample of people via an online survey.

I’m already going a bit cold on the accuracy of the headline figure now, and you are too probably, especially if you ever read anything scientist/journalist Ben Goldacre has written about fake PR surveys. Ben’s attempts to extract the background data to one survey about the mental health of teenagers was met with silence.

How long should you expect to take to feel better? Perhaps this isn’t even the right question and that we need to acknowledge that everyone is different. As J William Worden explains in a piece by Karen Carney at Psychcentral, “The loss of a significant loved one is something that is not gotten “over.”. Carney paraphrases him like this: “According to Worden, there may be a sense that you are never finished with grief, but realistic goals of grief work include regaining an interest in life and feeling hopeful again.” That’s a whole lot more complicated than 2 years, one month and four days.

CBT is less effective – and nobody knows why.

CBT - now you need to have hope and trust that it works.

CBT – now you need to have hope and trust that it works.

A new meta-analysis of 70 studies of the effectiveness of cognitive behavioural therapy or CBT has concluded that over time it works less well.

Tom Johnsen and Oddgeir Friborg(pdf) looked at research involving 2426 patients with depression and compared the scores of their pre- and post-therapy questionnaires on two well known scales; the Beck Depression Inventory and the Hamilton Depression Rating Scale. When they looked at results from a period from 1977 to 2015, they found CBT does not help to reduce symptoms of depression as much as it used to.

The results of this study of course flashed around the world from the Huffington Post to the Guardian with journalists hungrily trying to explain the data. Oliver Burkeman speculated on the role of the placebo effect in therapy, others wondered if the clinical landscape had been flooded with rookie therapists who were basically doing it wrong. One interesting idea put forward was that all treatments, over time, gradually show worsening results.

The thing to note, as the BPS did, is that actually the authors of the original study were not able to answer the question of why, but were only able to offer speculations. Perhaps patients belief in the efficacy of CBT have decreased they said: “it is not inconceivable that patients’ hope and faith in the efficacy of CBT has decreased somewhat” The paper they had just written, they noted, might also help to erode patient’s faith in CBT.

The real news from this study appears to be the idea that a patient who receives CBT has to also believe it will work for it to be effective. This is surely a strange belief to have if you are a CBT therapist.

If you practice CBT, your working assumption is that thoughts cause feelings, and by changing one’s thoughts you can change how you feel. How many CBT therapists will now also inform their patients that, by the way, if you want to get better, you’ll need to have hope and faith that this will work?

CBT is presented as the “gold standard” for many mental health issues because it “works”. When was the last time your GP told you, when handing over a prescription for antibiotics, that you also need “hope and faith” that they will be effective? Could there be more to therapy than CBT has room for?