CBT doesn't really work much and science in mental health

Lynch, D, 2010, Cognitive behavioural therapy for major psychiatricdisorder: does it really work? A meta-analytical review of well-controlled trials, Psychological Medicine
http://journals.cambridge.org/download.php?file=/PSM/PSM40_01/S003329170900590Xa.pdf&code=b62ffa4b898268608a9e7b504bdd5319

Cognitive behavioural therapy - changing the way people think and behave by using talking techniques from therapists - doesn't really work according to this high quality review.The review uses a different inclusion criteria to the 'mega-analysis' which is often used to show that CBT really does work.
Butler, A. et al. 2006, The empirical status of cognitive-behavioral therapy: A review of meta-analyses, Clinical Psychology Review
http://www.sciencedirect.com/science/article/pii/S0272735805001005

So which one is true? The massive review (the 2006 one) which includes loads of papers but has a weaker inclusion criteria and, if I remember right, doesn't include a funnel plot or the smaller review of higher quality trials (the 2009 one at the top of the page)?

I'm afraid it's the one of controlled trials. At least based on the current paradigm of evidence based medicine. Blindness is so important.

The double blind randomised controlled trial gained success when it showed insulin shock or insulin coma therapy to be as effective as other treatments at the toime for...think it was schizophrenia. At the time
the insulin treatment was considered best practice around the world but the introduction of random assignment to the control or active treatment group showed that, in fact, it wasn't the best treatment.

Time and again it's the reviews that select the highest quality trials which show treatments thought to work suddenly don't. The recent noteable example is electro-convulsive therapy or ECT. This barbaric
treatment is what I hope is the last in the line of psychiatric treatments which induce seizures. The history of inducing seizures to treat mental disorder can be traced back to the work of Hippocrates who
notices paitents who had malaria seizures also had behavioural changes. The recent Bentall and Read review on ECT picked high quality trials with long term follow. This treatment of last resort was shown to be as
effective on follow up as sham ECT (where no electricity is used to shock a person into a seizure) and slightly more effective during treatment.
http://www.mindfreedom.org/kb/mental-health-abuse/electroshock/ect-review-2010-read-bentall.pdf/view
(Link to paper at the bottom of the page.)

Many, many people have died because of this treatment. Some people who've had it done are major advocates of the treatment. This presentation on TED is an example.
http://www.ted.com/talks/sherwin_nuland_on_electroshock_therapy.html

The speaker may have gotten the same benefit from sham ECT and less damage to his brain.

And so back to CBT. The controls in the trials are as effective as this new dogma of treatment for all but depression where the evidence for it's effect is small. The effect size is far below what got the Improve
Access to Psychological Therapies scheme approved.then factoring in publication bias...that demon of good
research....which is the effect of trials with negative results being hidden...well it knows off about a third of the effect size of CBT studies.
http://bjp.rcpsych.org/content/196/3/173.full

In a sense it's saddening that there's few effective cures for mental disorder. Perhaps it's all the hedonic treadmill.
http://en.wikipedia.org/wiki/Hedonic_treadmill

Or perhaps it's the operational cluster of symptoms approach doesn't provide a good way to assign treatment to diagnosis?

2 articles I like on Breakdowns and Upbringing and Psychosis

Understanding Madness as Life Management Breakdown by Brian Davey

http://www.bgmi.us/web/bdavey/Breakdowns.htm

I like this so much I'd like to cut and paste the whole (short) article here. It's one of about interpretations of breakdowns.

The second one is from the Lecture to World Congress of Social Psychiatry, Hamburg, June 1994 by the same author.

Upbringing and Psychosis

http://www.bgmi.us/web/bdavey/Psychosis.htm

Here's one snip I like. The author puts his personal experience in brackets. I like the rest of both of these articles and I think many people who are going through a hard time might have something to learn from either of these pieces.

"

(One of my greatest frustrations eventually lay in trying to communicate my developing theory of madness - since this was mostly ignored by local medical psychiatrists. One of them said 'We don't have to listen to him, he's only a patient'. Others listened but it has made little difference to their practice. I knew I was on to something important and was desperate for the breakthrough when I hoped they would realise the value of what I was saying. The fact that they ignored what I had to say aroused powerful feelings that became too frustrating. The anger spilled over into all my relationships and periods in which I would withdraw from everyone. In isolation nearly all thinking is fantasy as there is no feedback to reality-check in conditions of intense aroused emotion. Later I saw I was rather 'father/teacher fixated' as I was appealing to local psychiatrists to support my attack on their work. I wanted them to accept me even as I attacked them - acting out repressed feelings as rebellious son/pupil. This was a reproduction of, and a failure to go beyond, chronically unsatisfactory childhood relationships. It was Professor Romme, who did see the value of my work, who advised me, very wisely, to address my ideas to those who would listen, not to those who would not).

"

Sadly I disagree with Prof Romme about presenting work to those who won't listen but then I'm a miserable loser who's pretty unhappy because of his own misadventures and Prof Romme...well...he's a professor. His work has been instrumental in getting other people to listen to the voices of patients, people who otherwise wouldn't bother to even look a severely mentally ill person in the eye nor consider their experiences to have any meaning.

Medication and psychological therapies

Psychiatric medication induces physical illness and there is a risk to life. This is true of many of the chemicals used in mental health. The worst are the antipsychotics but even antidepressants have been shown to caused Sudden Cardiac Death syndrome and suicide in some people.

Its doesn't take advanced knowledge of neurobiology to realise that none of the treatments are truly selective in the neurotransmitters and brain functions they target. That's why there are side effects unrelated to serotonin transmission or the treatment of unhappiness. This action outside the target sites affects other autoneurological mechanisms, some of which may regulate body function. Affecting this will change the way other systems in the body work and this could be a cause of reduced life expectancy. The dramatic effect of antipsychotic drugs is well established in the studies on dementia patients where life expectancy was reduced by half in very old people.

Medication is not a solution to mental ill health either. The drugs can remove symptoms but its just as easy to say, you're unhappy - go get high. Antidepressants are narcotics though they don't act as quickly as the illegal narcotics. Antipsychotics are a chemical cosh or straight jacket in pill form. Mood stabilisers remove a person's full range of emotion.

The solution of medication means that people never learn to cope with a life crisis and there's no need for healthcare to make an attempt to explore the deeper nature of the individual and understand the reasons behind their pain and suffering. Its probably because that wisdom has become in short supply over the last century as the convenience and effectiveness of drugs meant consensus thought focused on those treatments.

The safer alternative is psychological therapies but few people understand what that actually means, including myself. I think psychological therapies are like going to see a sage or a life teacher. Its not about offering an answer or a solution but helping the individual find the solution themselves. That paradigm doesn't easily fit simplistic outcome measures but that's a sign of the lack of wisdom that's so pervasive in modern society.

The solution to life's distress, unexplainable phenomenon, intense emotional crisis, life events impacting on mental health and ability to cope are treated in modern times by drugs because there are few true teachers of life left. The Royal College of Psychiatry's motto is "Let wisdom guide" but there's little wisdom in supporting state-funded opiates of the masses instead of helping people find the wisdom themselves to live life. It is a sign of psychiatists ineptitude however the wisdom has remained in the true psychologists remaining, the true sages.