Science Vs - Therapy: Does It Work?

Episode Date: September 9, 2021

Our mental health has taken a turn for the worse the past couple of years. We keep hearing that therapy can help, but it can be a big investment of time and money. So is it worth it? How often does therapy really help people? To find out, we talked to Jacquelyn Revere and psychologists Dr. Jonathan Shedler, Professor Bunmi Olatunji and Dr. Nancy McWilliams. Here’s a link to our transcript: https://bit.ly/2X9Ylzp  Note: in this episode we discuss mental health. Please take care when listening to the show, and here are some resources: SAMHSA's National Helpline US: 1-800-662-HELP (4357) National Suicide Prevention Lifeline: 1-800-273-TALK (8255), or text the Crisis Text Line (text HELLO to 741741).  International mental health hotlines: https://unitedgmh.org/mental-health-support  Check out Jacquelyn Revere’s tiktok and Instagram accounts.  This episode was produced by Meryl Horn with help from Wendy Zukerman, Rose Rimler, Nick DelRose, Michelle Dang, Taylor White, and Ekedi Fausther-Keeys. We’re edited by Blythe Terrell. Fact checking by Diane Kelly and Eva Dasher. Mix and sound design by Bumi Hidaka. Music written by Bumi Hidaka, Peter Leonard, Marcus Bagala, Emma Munger and Bobby Lord. Thanks to the researchers we got in touch with for this episode, including Dr. Felicitas Rost, Dr. Bruce Wampold, Dr. David Taylor, Professor Julie Ancis, Professor Stefan, Hofmann, Dr. Erlanger Turner, Dr. Janee Steele, Professor Marvin Goldfried and Professor Elizabeth Lunbeck. Learn more about your ad choices. Visit podcastchoices.com/adchoices

Hi, I'm Rose Rimler, filling in for Wendy Zuckerman. She'll be back soon. And you're listening to Science Versus from Gimlet. This is the show that pits facts against Freud. On today's show, therapy. Does it actually work? And before we jump in, talking about therapy means we'll be discussing mental health. So if you're feeling depressed or if you just want to talk to someone, in the U.S., you can call the National Mental Health Helpline.

The number is 1-800-662-HELP. That's 1-800-662-4357. The number will be in the show notes along with other resources. Okay, on to the show. This past year or two has been kind of a nightmare, and for many of us, we're having a really hard time dealing with it. If you need data to back this up, here it is. The U.S. government did a survey earlier this year and found that more than 40% of people reported symptoms of anxiety or depression. More than 40%. That's way more than before the pandemic.

So what can we do about this? Well, one thing a lot of people turn to or think about turning to is therapy. There are ads for it all over our podcasts and on Facebook. And it made us wonder, how good is therapy? Like, how often does it actually help people?

This has been a big question for Jacqueline Revere. She first heard about therapy back in high school. She got a scholarship to this fancy LA high school. And when she got there, it seemed like all the cool kids were doing it. And all the kids were like, I'm going to therapy. God, I was talking to my therapist and I was like, what is this? Like, what is this? Oh my gosh. But it kind of got Jacqueline thinking because she actually had some real issues that she needed help with. At that time, I was battling a eating disorder and my stutter at that time was like so bad

and I was afraid of talking and communicating and then on top of that I came from a household that silenced me. So she decided to do what the cool kids were doing and go to therapy.

But it didn't turn out the way she wanted. It just, it didn't feel the way that I thought that it would. You know, we talked through some stuff, but it wasn't the very in-depth therapy that I needed. What some of it felt like was just a lot of like blaming my parents. We never really went to the core of where the issues lied. She said her therapist just didn't really connect with her, which could have been partly because the therapist was white. Yeah, I just...

I just don't think she knew how to relate to a 17-year-old Black girl. But Jacqueline still thought maybe therapy could work. So she gave it another try a couple years later. And again, it was pretty unhelpful. She talked to producer Meryl Horne about it. You know, I was sort of like, okay, like, I could or could not be here. Did you think that those sessions helped you at all?

No. Yeah, no. I don't think so. Lots of people have these kinds of experiences with therapy where they feel like, is this really helping? And since that time, for Jacqueline, things have just gotten harder. Several years ago, her mom got dementia, and Jacqueline became the full-time caregiver

for both her mom and her grandmother. My life wasn't about me at all. I had literally given up everything, and I was not sure how I could gain it back at all. It was all really overwhelming for Jacqueline, and she didn't know how to turn things around. A lot of us have been in a situation where we feel like we're at the bottom of a hole,

and we could really use some help getting out of it. And we've heard that therapy can be that help, that sitting in a room and talking to someone can somehow transform people's lives. But it can also be a big investment of time and money. So today we're turning the tables. We're putting therapy on the couch and probing its secrets to find out what's the science behind therapy and how well does it actually work science versus therapy is coming up after the break bumble knows it's hard to start conversations hey no too No, too basic. Hi there. Still no. What about hello, handsome?

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I'm Steve Strogatz. And this is... Quantum Magazine's podcast, The Joy of Why. New episodes drop every other Thursday, starting February 1st. Welcome back. Today we're talking about therapy. And we're going to start by chatting with Jonathan Shedler. He's a psychologist, and he's been practicing for decades. And Jonathan figured out that this is what he

wanted to do back in college. It's this bizarre story that we just really want to tell you. Okay, so it all started back in the 1970s with a dream that Jonathan's girlfriend had. She dreamed that she and I were in a store together, a hat shop, and I was trying on hats, one hat after another. And then the scene changed, and we were in a car, and we were driving over bridges, over some kind of body of water. Jonathan started telling this odd dream to one of his professors. He spoke to Wendy about it. He was crusty and larger than life, and he had a southern drawl.

I mean, yeah, he was really intimidating. And the guy, the professor just interrupted me. I guess I was telling a dream. And he said, covering the head with a hat means covering the head of the penis for the condom. And water represents birth and driving over, you know, bridges over the water represents a desire to not get pregnant. So the dream is about your girlfriend's wish to not get pregnant by having you use a condom properly. And I just died inside because what the professor didn't know was we had been having sex with a condom and the condom broke.

And she had missed her period. We were terrified that she was pregnant. He didn't know any of this. He didn't know any of it? He didn't. He literally didn't know any of it. And I was, you know, I mean, I was blown away. I mean, if his words had been accompanied by, you know, celestial trumpets from heaven,

you know, I couldn't have been more moved by it. And I remember deciding then that if there are people in the world who understand this sort of thing, I have to be one of them. If you're curious, Jonathan's girlfriend at the time was not pregnant. So after this, Jonathan went on to study what this intriguing type of therapy was, psychoanalysis. This was Sigmund Freud's baby, and it really kicked off at the turn of the 20th century. As Jonathan would find out, Freud basically invented a bunch of stuff about our dreams and how lots of us secretly want to have sex with our parents. But also this really important idea, which is this.

Things in your past, your childhood, your past relationships, things you might not be aware of below your consciousness, they can all influence who you are today. Let's say something traumatic happened to you and you've just kind of buried it and gone on with your life. A psychoanalyst might be like, you've put it out of your mind, but you actually can't put things out of your mind. Right. This is, you know, this is your mind serving up all of the things that you're trying to not think about. And Freud's basic idea was that you need a psychoanalyst like Jonathan to help you dig that stuff up, to find out what's causing problems below the surface. And that whole process will help you. So we're asking

of somebody in therapy to do something, you know, very strange, saying we're going to meet, we're going to talk about anything and everything that comes to mind. So that's the idea. But the big question is, does it actually work to dive into your unconscious with some rando? Well, for decades at the start of psychoanalysis, very few studies were done to test whether any of this helped anyone. And this was partly because Freud and other people running the show didn't really feel a need to do formal studies. Psychoanalysts of the day really didn't have much interest in research. And they were kind of haughty and dismissive of it. Jonathan says they didn't think they needed research because they could see

psychoanalysis working on the couch right in front of them. And this has been Jonathan's experience too. I know this is going to help because I've seen how it helps over and over and over again. The problem is, especially in those early days, without proper studies, we couldn't answer simple questions like, what are the chances that all this talk will work for you? And how long will it take? But then the world changed in a way that would challenge the Freudians. In 1948, the randomized controlled trial came along,

which is basically a study that pits a treatment against a placebo. And this really transformed the way science is done. Meanwhile, antidepressants were shaking up the mental health world, and drug makers were using these fancy trials to test whether their meds worked. All this lit a fire under the ass of therapy researchers to start doing more rigorous science themselves. They were like, we need to respond to this. We need to come up with studies. We need to do studies the way they're doing pharmaceutical trials. And it was one camp of therapists in particular that jumped on this. They were doing a technique that's now known as cognitive behavioral therapy or CBT. And in 1977, a group

of researchers tested CBT against an antidepressant drug in a randomized controlled trial. And in that study, CBT actually worked better. Since then, CBT has been getting bigger and bigger, all the while billing itself as evidence-based therapy. Cognitive behavioral therapy, or CBT, is an evidence-based treatment. That means it's been proven to be effective more often than most other types of therapy. There are now proven treatments for issues like depression, anxiety, insomnia, and even relationship problems. These treatments are called evidence-based psychotherapies. And best yet, these treatments usually work in a short amount of time.

Yeah, we're being told that CBT can work for a lot of conditions and that it can work really fast, like in just a few months, which makes it sound like some kind of wonder treatment. So to find out more about how it works, we called up a pro, someone who's been using CBT with his patients for more than a decade, Professor Bunmi Olatunji. He's a clinical psychologist at Vanderbilt University. When did you decide you wanted to become a psychologist at all? Was this something that little Bunmi always wanted to do? No, little Bunmi wanted to be in the NBA, to be honest with you. But in college, Bunmi heard about CBT and became fascinated with it. While psychoanalysis felt all chatty-chatty and no science-science, everything about CBT felt different, right down to the approach. It was this radical idea that instead of focusing on your past,

you would look at your present, problems right in front of you. Let's say you have anxiety. If you went to a psychoanalyst, they'd probably ask you about your childhood. But if you go to BoonMe, he won't focus on that. Instead, he'd probably try to find out how that anxiety is affecting your behavior, like what you're worried about when you leave the house. For a lot of patients who are socially anxious, you know, they are already kind of going over the worst case scenario, right?

People are going to laugh at me, you know, that I'm going to trip and fall, that I'm going to be mumbling my words. Boonmi then picks each of these fears apart in a very systematic way. He has the patient fill out worksheets where they answer these questions. Okay, well, what is the likelihood that something like that might happen? And also, if something like that were to happen, how bad would it be? So the patient makes these predictions,

and then Bhumi has them go out into the world and test those predictions. Sometimes he goes with them. So for example, he told us about one patient who had a lot of anxiety about making a fool of themselves in public. Bhumi was like, all right, let's go and do something that might make you feel that way. Let's go to the mall, buy something, and return it right away. Which, for this patient, was like a worse nightmare.

The patient was afraid that, A, they were concerned about being embarrassed, and B, they were concerned that the customer person is going to ridicule them for returning something so quickly. But with Bumi around, the patient went ahead and marched up to the return desk and... The experience is not as bad as the patients anticipate it's going to be. Do you remember in that example if the cashier was like giving any attitude about it? No, because they're like most cashiers. They have other things to be concerned about. They're not worried about you.

Yeah. So this is one way CBT can work. It's meant to be like its own little science experiment. You actually kind of make a hypothesis about what will happen in the real world. But then by going out and testing whether that's actually true, you might learn a different way of seeing things. Bumi says when he saw CBT working with that patient, it was awesome. Here's Wendy again. Without turning this into a psychoanalysis session,

how did that make you feel? I think that's the thing about CBT that really resonates with me. It's really very rewarding to be able to deliver an intervention that you know has a very good chance of being successful, right? That the patients will be able to, you know, to go back to work or to have a better relationship with their family. You asked me, how does it make me feel? It makes me feel pretty good, because you are, in fact, changing people's lives in a way that is really quite encouraging. How many studies do you think there are out there that show CBT works? Oh, goodness. I would be shocked to come across a study that showed that CBT didn't work. That would be puzzling to me.

So after the break, is CBC really as good as the boonies of the world say it is? And does that mean psychoanalysis is total crap? That's coming up. Welcome back. Today, we're diving into the science on therapy. Now it's time to put it under the microscope. When we left you, CBT had stormed the therapy world. And since it first came onto the scene, it's slowly been eating up other types of therapy. By 2010, nearly 80% of therapists in the U.S. said that CBT was their main treatment approach. And many of them say they have science on their side, showing that it will help you with just about anything. And it is true. There are tons of studies looking at CBT.

You can find literally hundreds and hundreds of them. So what do they tell us? Well, CBT does seem to be really great for some things. The conditions that it can work the best for are anxiety, OCD, and acute stress disorder. Sometimes the benefit people get is really big. Like in one study of OCD, researchers found that CBT cut their symptoms in half. And we know that part of this is from our old friend, the placebo effect. But even when studies control for that, they find big effects from CBT.

Here's Boonme again. The effect size, that is how well it works, is really quite large. So that's good news. But there are a couple of places where the claims of CBT do seem to be a little exaggerated, like that idea that it can help pretty fast over just a few months. And best yet, these treatments usually work in a short amount of time. While it's true you can often see a benefit from CBT quickly, the problem is this. If you're only going to therapy for a few months, there's a pretty big chance your symptoms will come back. So for example, one

review found that after getting CBT for depression, about half of the people who get better initially relapse two years later. We asked Boonmi about this. Some of the criticisms suggest that like it doesn't help people in the long run. That if you, once the studies end and they're published and their patients go, ultimately need to go back to therapy, what's your experience? Well, I think there are some, there's some truth to that. Have I had patients who've had to come back? And the answer to that question is yes. I mean, we've, I've had patients who've had to come back and we just had to kind of, you know, go at it again. I've had patients who've called me up

and say, Hey doc, I just need a couple of booster sessions. Can I just see you for a couple of weeks? And usually when patients come back, it's not as if they're starting from scratch, right? Because they still have the skills. So the fact that therapy isn't always a quick fix, it's something to keep in mind. And there's one more place where CBT might be a little overhyped. This idea that it is the evidence-based therapy. We actually found lots of evidence that other types of therapy work too, sometimes just as well as CBT, including one that's partly based on the ideas from our old friend Freud. That's called psychodynamic therapy. And there are now dozens of studies showing that it can work. Here's Jonathan again, our psychologist from earlier in the show.

So there's no shortage of studies. There's more studies of CBT, you know, but more studies doesn't mean it's a better therapy. So for example, several meta-analyses have found that psychodynamic therapy can help people with depression and anxiety just as much as CBT can. And these days, the divide has shrunk. A lot of therapists do both kinds of therapy, or other kinds of therapy we haven't talked about here. So this idea that you need to do CBT if you want a science-backed therapy is CBT-echnically not true.

People can have amazing, transformative experiences with other kinds of therapy. Like, take this patient Jonathan told us about. He came to Jonathan because he was being haunted by these horrible mental images of people being tortured, drowned, and waterboarded, which at the time was in the news a lot. The man couldn't stop picturing these upsetting things, and he'd gone to a bunch of doctors who couldn't figure out why this was happening to him. And I said, you know, when exactly did they start? What was going on in your life then? Did something change in your life? And he goes, well,

it was around the time my sister died. And the story was that the sister owned a ranch and was walking across a frozen pond and the ice broke and she fell in. She got trapped beneath the ice and drowned. And I said, what did you make of that? That must have been a shock. And he said, well, you know, yeah, it was, but, you know, there's no point dwelling on pain. And I said, tell me more about the specific images, the waterboarding, people suffocating. And I said, you know, a lot of those images seem like ideas your mind would have constructed about what your sister's last moments must have been like.

And the guy just, I mean, his whole expression changed. His face changed. His jaw dropped. He goes, yeah, I never thought about that before. Damn. And hey, we all want that damn moment of clarity. So the final thing we want to talk about is this one thing that you can do to up your chances that therapy will work for you. It comes down to finding a good therapist, because there are some real clunkers out there. There are bad therapists, like there are bad doctors and there are bad teachers and there are bad everybody kind of. And you may stay a long time with somebody who's not

doing you any good. This is Nancy McWilliams. She's a therapist and visiting professor at Rutgers University. And when Nancy says bad, she means bad. Like, one professor we spoke to followed hundreds of therapists and thousands of patients over three years and found that a few of the therapists didn't manage to help a single person in all that time. Scientists have tried to pinpoint exactly what makes a crappy therapist, and it seems like a lot of it comes down to their personality. Some people are pretty good therapists just because they care about other people

and are curious about them and have a nice way about them. And other people can have a PhD and a postgraduate training and they still just, they don't have the ear for it. They know all the words and none of the music. Generally, and maybe not surprisingly, a warm and empathetic person makes for a better therapist than someone who tends to be belittling or patronizing, which Nancy gets. I am allergic to being talked down to by men who think they're more powerful than I am. I think that's a very common analogy. I think it's, it's really, Yeah, you've got a mansplain to me, you're toast.

I think it's on the rise as well. You know, kind of like the gluten, the gluten thing. And it's not just about getting any old decent therapist. You got to find someone who's right for you. Someone you click with. This may not sound super sciencey, but studies back up this idea. If you need a fancy word for it, it's called a therapeutic alliance, which kind of sounds like what might happen if Luke Skywalker and Princess Leia teamed up to fight mental illness together. And as you're searching for your alliance, Nancy says don't focus on credentials or where they went to school, or even if the therapy is happening over a screen like on Zoom.

That can totally work. Overall, it might make sense to shop around. You've got to trust your gut. Go and tell your story to somebody and see if you feel safe and if you feel like you can open up to them. And since we know that lots of different types of therapy can work, you also might need to experiment to figure out which one is right for you. Like Nancy is a psychoanalyst. She loves talking to patients about their childhoods

and helping them dive into their unconscious. But she told us that some patients are not interested in that at all. And for them, she'll suggest something else, like CBT or another type of therapy. Like she told us about this one person. Well, I just talked about it with them when they and I both felt that they were not moving forward the way we typically expect. And they were feeling miserable with my just trying to get them to go deeper into their feelings and say whatever came to mind um we both started talking about you know maybe this isn't the best model you'd be so

good in a breakup I feel like like if we were dating and we were going through a breakup I'd feel so good by the end of that conversation. You'd probably have set me up with someone else as well by the time we were done. Okay. So when we pull all this therapy research together, here's what we make of it all. Therapy can definitely help with a lot of conditions, but it's not like you sign up for any old therapist, go for a few months, and boom, you're guaranteed to feel better. It might take a lot of work and time and money to find the right person and the right treatment for you. And not all of us can afford to do that. But despite all this, sometimes it can work out. Let's go back to Jacqueline, who we met at the start of the show.

She tried two different therapists, and neither of them helped her. And since then, she had been thrust into this life as a full-time caregiver for her mom and her grandma. My life wasn't about me at all. I had literally given up everything. It all came to a head after her grandmother died. I was just mourning a lot. And it got to a point where like, so embarrassing. I would go on my Insta stories and I would just sort of like talk about what's going on. But there was

about, there was a handful of times where I would just like start crying and I would just like, just like be like, I don't know why, what's going on? Oh my God. Oh my God. And so two of my friends had messaged me saying like, hey girl, we see that stuff is really crazy. They offered to pay for six months of therapy for her. And they said they knew a therapist who they thought would be a really good match. And so after two therapists where things didn't click, Jacqueline gave it another go. This new therapist was a Black woman like Jacqueline, and that was just one thing that helped them connect more easily. And so the simple fact that I was able to see someone that got me, you know, it, it, it it's invaluable.

It was like a breath of fresh air. Overall, this therapist was a really good fit. She made Jacqueline feel worthy, validated the intensely difficult position that she was put in, and gave her strategies to feel better when things were particularly stressful. Teaching me how to while I'm in that moment, like pause, reassess what's being said,

and then like figure out my true thoughts on it. Just reminding me that the situation's not fair and it's not ideal and someone should help and it's not me, you know, and to just kind of take that with stride. And so learning to change that is what helped me move forward. During the pandemic, Jacqueline started this TikTok account about taking care of her mom. It blew up. A community has kind of popped up around it. And for the first time in a long time, things are looking up.

How do you feel now? Oh my God, I'm the happiest that I've ever been so far. And I think that this has all prepared me for where I'm at right now. That's Science Versus. Hey, Meryl. Hey. Meryl Horn, producer at Science Versus. How many citations are in this week's episode? There are 91 citations in this week's episode.

And if some total nerd wanted to check them all out, how would they find them? They can go to our website or our show notes and follow the links to the transcripts. And then also in the show notes, you'll find links to Jacqueline's TikTok and Instagram. It's called mom of my mom. And it's great. I've been following her on TikTok and I highly recommend it. You have a TikTok? Yeah. Oh, man, I am way addicted to TikTok now. It's great. I've been following her on TikTok and I highly recommend it. You have a TikTok? Yeah. Oh, man, I am way addicted to TikTok now.

It's bad. What's your TikTok account? Tell the people. I haven't posted anything. You don't do the dances? Isn't that what TikTok is for? It's not just for dances anymore. Oh, okay.

Okay, see you later. Bye. This episode was produced by Meryl Horn, with help from Wendy Zuckerman, me, Rose Rimler, Nick Delrose, Michelle Dang, Taylor White, and Aketi Foster-Keys.

We're edited by Vlad Sorrell. Backchecking by Diane Kelly and Eva Dasher. Mix and sound design by Bumi Hidaka. Music written by Bumi Hidaka, Peter Leonard, Marcus Begala, Emma Munger, and Bobby Lord. Thanks to the researchers we got in touch with for this episode, including Dr. Felicitas Ross, Dr. Bruce Wampold, Dr. David Taylor, Professor Julie Ansis,

Professor Stefan Hoffman, Dr. Erlinger Turner, Dr. Janae Steele, Professor Marvin Goldfried, and Professor Elizabeth Lundbeck.