Researchers Suggest Anxiety Is Caused By Too Much Serotonin

Rob Wipond
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In what a press release from Sweden’s Uppsala University called a “major leap forward” in understanding of mental disorders, a study in JAMA Psychiatry reported that, “Individuals with social phobia make too much serotonin. The more serotonin they produce, the more anxious they are in social situations.”

“Previous studies have led researchers to believe that individuals with social anxiety disorder/social phobia have too low levels of the neurotransmitter serotonin,” explained the press release about the significance of this new study. Indeed, some psychiatric researchers are today trying to distance themselves from older, unproven claims that anxiety and depression were linked to low levels of the neurotransmitter serotonin in the brain; however, the Uppsala researchers said that they’ve discovered that the real problem is that people with social anxiety disorders (SAD) produce too much serotonin.

According to the press release, the Uppsala University study involved using “a so-called PET camera and a special tracer to measure chemical signal transmission by serotonin in the brain.” The study itself explained that the researchers actually measured proxies; namely, “The influx rate of [11C]5-HTP as a measure of serotonin synthesis rate capacity and [11C]DASB binding potential as an index of serotonin transporter availability.”

The researchers then determined the mean of each of the groups, and based on that stated that they identified increased levels of “serotonin synthesis” in the people who’d been diagnosed with social anxiety disorder compared to healthy controls, as exhibited in the accompanying figure below.

Image not available.

“Serotonin can increase anxiety and not decrease it as was previously often assumed,” said lead author Andreas Frick. The press release did not mention that all of the brain scans were done while the participants were in resting states and were not reported to have been actively experiencing any anxiety.

The examination of serotonin synthesis rate capacity involved 18 people with SAD and 18 controls. The examination of serotonin transporter availability involved 26 people with SAD and the same control group. There was no mention by the authors in their limitations section that the small sample size might limit the strength of their conclusions. And though the study excluded participants with current use or previous histories of “long-term” use of Selective Serotonin Reuptake Inhibitor (SSRI) antidepressants, presumably because SSRIs can fundamentally alter the brain’s serotonin-related functions, the study’s limitations did not mention that about 16% of the participants with SAD had previously taken SSRIs. However, the authors did note that their measurements may not have actually reflected serotonin levels in people’s brains. “Among the study limitations, we could not correlate [11C]5-HTP and [11C]DASB PET measures in a meaningful way because these tracers were collected in different SAD cohorts. This lack of correlation limits the inferences that can be made of the interaction between serotonin synthesis and reuptake. Moreover, some issues regarding the capacity of [11C]5-HTP to measure the serotonin synthesis rate have been raised. For example, since the decarboxylation of 5-HTP to serotonin involves the enzyme amino acid decarboxylase, which is found not only in serotonergic but also in dopaminergic and noradrenergic neurons, the [11C]5-HTP tracer trapping may reflect amino acid decarboxylase activity.”

And while lead author Andreas Frick, a doctoral psychology student, was quoted in the press release stating that the study had discovered that, “Serotonin can increase anxiety,” in the study itself the authors stated that any potential “causal” relationships between serotonin and anxiety were not actually examined and were a matter about which they could only “speculate.”

Frick A, Åhs F, Engman J, and et al. “Serotonin Synthesis and Reuptake in Social Anxiety Disorder: A Positron Emission Tomography Study.” JAMA Psychiatry, June 17, 2015. doi:10.1001/jamapsychiatry.2015.0125. (Full text)

Individuals with social phobia have too much serotonin — not too little (Uppsala University press release on ScienceDaily, June 17, 2015)

68 COMMENTS

  1. The SSRI drugs are off patent. The media is making benzo addiction more of an issue lately. I think we’ll soon see a whole new, patented, expen$ive group of “innovative” psych meds for…everything. Anything. Whatever ails you.

    First we had barbiturates. Then Valium was safe and good. Then Valium was bad, but xanax was good. Then the SSRI drugs were the best thing ever. For a time, everyone was bipolar I-V, so tranquilizers for everyone (hooray!). Now, even the atypicals are going off patent…plus, TD lawsuits are expen$ive, soooo….a whole new generation of Holy Grail pills is coming our way. Get ready!

    • I agree, and beware. It is amazing how little the psychiatric industry knows about the brain and body, but there’s no lack of hubris within that industry. No doubt because our country’s been taken over by the evil banks and corporations, about which our founding fathers warned us. Historically, and today, only evil governments / people advocate belief in psychiatry’s unjust social control and torture system.

        • No, but it might possibly make you ‘spellbound’. You should check out Robert Whitaker’s “Anatomy of an Epidemic”.

          If psych meds are so *good*, how do you explain the increase in and the prevalence of so much ‘mental illness’ in this country (or other ‘western civilization centers or outposts’)? Meds are a first option for treatment for a variety of physical and psychic ills, and a big big business. Big Pharma has the *largest* lobbying presence in Washington DC! More than oil, more than the military industrial complex, more than *the bankers*!

          If you truly had informed consent before starting your ‘treatment’ with pharmaceuticals, and still think it’s worth the risk, then knock yourself out. If you look around this site at all you will notice how many stories there are of folks who went to their doctors for help with some sort of distress, and ended up harmed by the treatment that was suppose to ‘help’.

          Best wishes.

  2. The fascination with serotonin continues. In my book, I cover the raphe nucleus where serotonin is produced. Turns out there are at least 7 circuits in the raphe. One of these circuits is a major player in anxiety and learned helplessness. Another circuit, which is induced by warm temperatures, calms the anxiety circuitry. I guess one can say anything about serotonin and be correct.

  3. Ah yes! “…a matter about which they could only ‘speculate.'” They can only speculate because they are paid to. Conversely, and tragically, they will continue to do so as long as they are paid to – with their brains in gear or otherwise. Why do people support these pundits – and hand over their children (and other nuisances) to them?

  4. When a colleague sent me this article, and it looked like it was published in Madinamerica, I swear to you that my immediate thought was that this had been published in The Onion as a joke — because everyone knows that Madinamerica would never publish something that goes so totally against what Robert Whitaker has long and bravely stood for. How many readers of Madinamerica — especially those with no background in scientific methodology (and I do have that background but find that the criticisms in this form make my eyes glaze over) — will understand the important implications of the minimal bit of Vipond’s “critique” of this study, which comes across as though these are just some limitations of the study? Rob Vipond, I am at a loss to know why you failed to state clearly that the whole article is based on a never-proven, indeed a disproven and harmful claim about serotonin. Finally, does the headline Madinamerica chose allow room for the minimal critique to be seen as substantial? It looks like a headline that Pharma would have written. Can we now expect that Madinamerica’s policy will be to publicize more pieces of “research” that are based on the kinds of disproven assumptions that have destroyed the lives of so many readers of Madinamerica?

  5. Rob, I would have to agree with Paula on this one. Why are we giving space to psychiatry’s latest claims? If we are doing it to soundly critique them, or at least mainly in the spirit of critique, I get it. If not, the purpose somewhat mystifies me. We after all have every reason to believe the new psychiatric claims are as bogus as earlier ones. So questions that I think need to be asked and let me raise them here is: Is what constitutes news from a critical perspective? And how does that differ from news as hegemonically defined? An issue I think it would be worthwhile for all of us to grapple with.

  6. Looks like a BS study to me. The people aren’t even experiencing anxiety – wouldn’t it make more sense to create an anxiety-ridden situation and watch what changed? Oh, but that would suggest that the environment causes anxiety and that the serotonin increase is in response to stress. Which would be a much more reasonable hypothesis, but it doesn’t fit the desired narrative. So they get to freely “speculate” as to the supposed “relationship” they never actually tested out.

    I do agree with Paula and Bonnie that more of a proviso would be helpful – perhaps the title could state “researchers CLAIM that anxiety is caused by increased serotonin, despite serious study limitations.” Something to alert readers who don’t regularly visit that this is a claim to be looked at very skeptically.

    It is also worth mentioning that SSRIs have claimed to be helpful to people with anxiety for a long time, maybe with more actual supporting data than claims about depression. If they actually are reportedly helpful, how could this be if increased serotonin leads to more anxiety?

    Pretty shoddy stuff.

    —- Steve

      • I think they are generally a waste of time, even if they make people feel better. A shot of Jack Daniels reduces anxiety just great. But it’s not a medical treatment. It’s just a temporary way to feel better. Using psych drugs to improve mood, even if they “work,” is a false approach, because it subverts any real attempt to figure out what’s going on. Some people report feeling better when they take them, but to me, that’s not the goal.

        • @Steve McCrea How exactly do you find out what’s going on? And once you do, how exactly do you cure it? therapy? oh please, Therapy is practically useless for chronic physiological disorders like severe social anxiety. it takes a lot more than mere therapy to tackle that disorder. Medicines that work are far more beneficial. Some of these disorders is physiological, meaning no amount of therapy is going to change how the brain is wired. Stop peddling that useless therapy crap. it doesn’t work for everyone. Some even think therapy is the most useless profession in the medical field when it comes to chronic disabling mental disorders.

      • They actually made me super anxious (Prozac) so I could support the article. Which I don’t either way since I don’t believe that complex emotions like anxiety can be switched on/off by a simple global neurotransmitter manipulation.

  7. This study is a farce because they are actually paid by pharma companies to do a study that focuses on the specific chemicals they are looking at to try to tie it into the biomedical model of drug mechanisms.

    Interesting here, you have too much serotonin in social phobia disorders, but they give drugs that dysregulate and amp up the amount of it for the condition ie Paxil or Zoloft.

    The thing is this study might not tell you that serotonin production isn’t actually the cause of social phobia but instead is the fault of underlying functions and cognition that goes on in socially phobic patients, indicating not a cause and effect relationship but a functional relationship. Social phobia is the same process when you feel the underlying emotions and go through the cognitive difficulties that a socially phobia person experiences. That seems like a fine assessment that I have made.

    The idea that too much serotonin causes the problem is a farce debate though. Because these chemicals are a functional part of the brain, they are not responsible by themselves for any conditions.

    The study authors want us to think the conditions are caused by the chemical issue, but in reality they use their limited descriptions in hopes of backing up drug researchers for the next neuro chemical altering drug. The drugs themselves do not correct neuro chemical imbalances but do knock out regulating function or use of specific chemical binding sites, which damages nerve function, destroying the persons emotions and other functions and resulting in something else. People are basically made sick by the drugs and develop new personalities and features while taking them, like a corrupted or damaged program might generate different data from a normally operating one. The brain itself, is a quantum computer, and interfering with signals and matter processes damages the computational results enough to cause something different to show.

    BTW. Pro tip: this article might indicate that all social phobias and anxiety disorders were being mistreated even by psychiatries old models of thinking (lying to the public). The idea that social phobia and anxious peoppe had too low of serotonin and thus had the same problem as depressed people was obviously always a farce, and what we were doing to these people was damaging their brain and not actually fixing any problem. In fact, the people sold these treatments likely never saw a benefit, and like the mass/school shooters might have simply been made manic and sick and forced off into mass/school rampages, suffering memory loss, cognitive loss, personality losses, and even worse anxiety than ever before. Thanks for lying to us all for decades, psychiatry/pharmaceutical companies.

    http://www.ObamasWeapon.com

    • Revised one sentence.

      “The thing is this study might not tell you that serotonin production isn’t actually the cause of social phobia but instead is the fault of underlying functions and cognition that goes on in socially phobic patients, indicating not a cause and effect relationship but a functional relationship. Social phobia the same processes all people are capable of, when you feel the underlying emotions and go through the cognitive difficulties that a socially phobia person experiences. That seems like a fine assessment that I have made.”

      Let the lawsuits fly.

      Brought to you by Prozac. Effexor XR/ER. Lexapro. Celexa. Wellbutrin XL SR. Cymbalta.

  8. Hmmm, serotonin huh? So if you did a lot of drugs then you will have anxiety?

    I have been dealing with panic attacks since I was in the 8th grade, I have developed anxiety and social anxiety as well within the last 3 years. Some days are worse that others and some days are better. However I have found a way to cope and control my anxiety and panic attacks at least to a certain extent. And although I am not 100 percent cured It has helped me out tremendously and I am starting to get ahold of myself.

    I hope this helps somebody out there out because it is something I have wished I could change for nearly 10 years.

    Take a look at anxiousreview.com

    It is an excellent read and was very helpful to me 🙂

    • Psychiatry caused me to have panic attack and swaths of other issues that I never had before and I’m largely rid off now (except for psychiatry induced trauma and associated phobias). They are a bunch of harmful quacks and calling them witchdoctors is and insult to all the witches and shamans out there.

  9. I hope that Bob and/or Rob will write an article about the apparent and quite dramatic change in the policy of Madinamerica, since it now is giving space to the kinds of unfounded and dangerous claims that Bob has spent years — at great personal cost, I suspect, and certainly with great courage — exposing. And it would be good to know why this particular study is presented as news, when there are enormous numbers of such studies coming out all the time. If MIA wanted to publish full-fledged, thorough, informed critiques of many of these, that would be great. Having taught critical thinking and research methodology for decades, I have a neat “How To Do a Critique” page composed of the step-by-step way one goes about evaluating a study. Bob and/or Rob, would you like to publish that page and invite people to write in-depth critiques so that readers of MIA will be well-armed to refute Pharma’s irresponsible claims, you could do a great service. I would be glad to help with this in other ways and write some such critiques myself. Just let me know.

  10. I appreciate these comments and may write a blog about it. I can see we didn’t handle this in the way I thought would be clear to readers that this, in essence, is an example of bad science that just won’t die.

    This study, of course, is ludicrous. First, you have the historical context, which is that researchers were making the opposite claim, that mood disorders were due to too little serotonin, for years, on “reports” that when looked at critically didn’t stand up. This study is presented in complete ignorance of that history.

    Second, you have the present context, which, at least in the United States, is that the notion of chemical imbalances for mood disorders has completely collapsed in the research community, and they have moved on to new biological models. This study is presented in complete ignorance of that.

    Third, if you look at the study itself, it is ridiculous, and all the bad science is here. Composite scans for the two groups (which hide the fact that there will be remarkable overlap between the control and experimental group), prior exposure to SSRIs or even current exposure, and a method that may not even be reliable in measuring serotonin release.

    Rob Wipond initially put on a mocking headline on the story and ran it by me, but I thought, for an item to run in the news, as opposed to in a blog, it was a bit much, and we should put on a somewhat straighter title, with the critique making it clear that this was yet more bad science for a model that, in Sweden anyway, just won’t die. Obviously, that didn’t come through here, and that is the failure.

    We probably could have just ignored the study altogether. For me, its import was that here was an example of researchers in Sweden (where they haven’t given up the chemical imbalance story at all, as researchers there have a personal investment in it, as it was Swedish researchers who helped give rise to the theory in the first place) now coming up with a finding that said all the previous research and theories about low serotonin were wrong, but now, based on this rather ridiculous study, were announcing that the opposite problem was true!

    I thought that was the point worth having in the news, and that our readers would understand why we picked it as news. We obviously failed to communicate that. We actually have wanted to start a section for regular in-depth critiques of science of this sort, which does need to be picked apart, and so perhaps this will provide us with an opportunity to do that. The deconstruction of bad science of this sort is a necessary task but unfortunately an unending one too. The junk science is endless.

    • Yes, I had kind of figured that out, which is why, Robert, in my first response, I invited a rethinking of what constitutes “news” and what objective news reporting looks like. Here more globally is what I am inviting people to grapple with: To accept mainstream understandings of what constitutes new and how look is something that I do not thinks stands us in good stead. While “looking objective”, they are in the final analysis hegemonically defined. So the question is: What what would a critically informed understanding of “news” look like? And how would it differ both in appearance and in ist inclusion and exclusion guidelines from what we see now?

    • Robert Whitaker, I appreciate you highlighting Swedens somewhat fanatic relationship to Serotonin and/or different unproven chemical imbalance theories.
      Furthermore you are much welcome this autumn to really make your voice Heard in our Swedish media as you attend ‘Driving us crazy’- festival.

      The established beliefs here are almost impossible to change, even for you and your friends in the academic World. It’s like a slow moving lump of mud, that just swallows any critics in its path.

      And way out in the wasteland are people like me, the end user of SSRI’s that have suffered ‘great distress’, for decades, but helplessly ignored. Just because our academic society ignores the fraud and lies that have created the SSRI-beast, any help is not on the horizon.
      HELP!
      Ove, Sweden.

    • I am missing one thing in this post: information about any conflicts of interest that the authors have, especially in terms of pharma sponsorship.

      Personally I think this particular “study” was worth reporting on since it nicely shows the nonsense of the whole “too much/too little serotonin” so-called research. Also it has been quite widely reported in the media so I’m only waiting for people on the internetz starting to quote it as absolute proof for this and that.

  11. Surely more interesting studies than this tired BS can be found…

    Social anxiety disorder is not a real illness which can be studied with any scientific precision or rigor, let alone linked to particular brain chemicals… this whole study is dead in the water ab initio because of the lack of validity and reliability of the condition being studied.

    As another commenter said, this study should be on the Onion, not on MIA.

  12. One small point to add to Bob and Rob;

    My understanding, when I was doing the “In the News,” is that this section – in counterpoint to the blogs – was to function primarily as an aggregator. I looked for articles that would be of interest to our readership, and presented them in a straightforward manner. My editorial perspective was primarily in what I chose to be of interest; the mandate was to stay as current as possible, not to editorialize, while providing material that would contribute to an evolving conversation. I thought of it as a graduate seminar, where material is presented for discussion. As much as I might be appalled and/or horrified by yet another claim to the discovery of this-or-that prime cause of such-and-so, it was my job to present the material in as straightforward a manner as possible, so as to create a level playing field for intelligent – or at least passionate – discussion.

    I can say that I often thought of ironic (and sometimes even witty) headlines or commentary that Bob would wisely enjoin me from using. Sometimes this was frustrating and painful. But I hoped that some astute reader would pick up on what I thought was interesting and meaningful, and was rarely if ever disappointed. I believe that the discussions that followed were generally deeper than they might have been in the write-ups had been more directive. I think this is what an effective facilitator does; cull the material to frame a discussion, and step back.

    Of course this meant that people often assumed that I actually believed the study to be true as the researchers presented it. But they said this in the context of criticizing it in exactly the way I would have, if it had been my job to do so.

    As to the fact that many of the studies were just like so many others that had already been published; the point was to keep the conversation current. Right along those articles are other ones that found the opposite conclusions. It was a matter of keeping the conversation timely. I’ve so often found when I’ve been making the arguments that lead to being involved with MIA that among the reasons my arguments were dismissed was that I was basing them on old research. Of course, I happen to believe that old research is not necessarily less valid or important than new research, and much new research is based on faulty paradigms where the old research was still in touch with something true; but nevertheless there is strength in being able to stay current. So that was the point of “In the News.” Not that it was necessarily “newsworthy,” from our perspective, but that it was research that just happened to be “In the News,” and therefore was worth at least knowing about, if only because it was likely to be brought up by someone, somewhere, sometime, so it is helpful to know about it ahead of time and have your perspective on it at the ready.

    I will add that keeping current on the research in that way is a backbreaking, onerous, soul-sapping job. Once I managed to get through the 100 or so journals that I would review, sometimes daily, and sort through the relative significance of the articles, mustering the energy to write more about my perspective was more than I had in me, even if I were allowed to. I would get the articles over the goal line and collapse. For the first two years I loved doing it, and felt I was doing something important, and swore I would do it for as long as Bob would allow me to. I did get physically and spiritually depleted, eventually stepped away from it to make room for other things (such as getting some exercise, after two years of being at the computer from pre-dawn to dusk.)

    Since then I’ve been awed and amazed by Rob’s work. We’ve talked about trying to find ways to streamline the process, and it keeps coming around to the fact that there aren’t any. So I know better than anyone how hard Rob is working and it pains me to see him getting negative feedback. I can see how carefully he frames his outlines of the articles; allowing them to present themselves on their own arguments and their own merits, while deftly presenting exactly what needs to be presented to give the critical reader what is needed to see through the artifice. It’s a delicate thing to do, and I don’t think it’s augmented by adding any “those idiots” commentaries to what are supposed to be straightforward presentations of current events.

    In “In the News” the editorial position is all about what is aggregated. What is relevant; which means sometimes it’s research that seems to support a position that is critical of psychiatry, and sometimes it’s research that seems to support psychiatry. To address another of Paula’s criticisms of Jay Joseph’s piece, that it seems to support the existing diagnoses; I often found myself publishing research that presented, for instance, articles showing that CBT as equal to or better than medication. I got roundly criticized for promoting CBT. This was not my intent; my intent was only to show that medication was not the be-all, end-all; that early intervention, for instance, needn’t be only – or even at all – about medication. At the time there was little or no research available to make that point (there is much more now) so I was grasping at straws, and studies involving CBT were all there were. Now things have changed, and early intervention (and CBT) are getting the more critical look they deserve. But I had to work with what there was at the time.

    I think Jay’s piece is a good critical examination of whether the research that purports to show heritability in psychiatric diagnoses is valid. I was excited to post it. I happen to be very critical of existing diagnostic formulations. My divergence from a mainstream view began with reading the DSM and thinking “this doesn’t make any sense at all; you tug at one thread and it all falls apart.” From there I went on to discover the critical literature, including Paula’s. Still, it’s hard to deconstruct the whole edifice without taking it piece-by-piece, as in; does the statement that there is demonstrated genetic heritability hold up? The NEXT step after an answer of “no,” if one is being honest, is to look at the system itself.

    We look at this in so many ways – in terms of outcomes, in terms of the medical model, and – especially – in terms of the voices of those who have been directly affected, that I think it would be hard for anyone who looks at the totality of what we do on MIA to not at least begin to question their support for the existing paradigm. This would seem to be the case in terms of the many who decry MIA as “anti-psychiatry,” if not in terms of those who characterize themselves as “anti-psychiatry” who look at what we do and find us wanting. But we do try to hold a line that will keep those who are skeptical of MIA engaged, and continuing to read. And to that end, presenting the aggregated research in an apparently unbiased way on a daily basis is something that Rob does to all of our benefit. He acknowledges that the tone of this particular review wasn’t pitch-perfect. I’m sure that this discussion will inform future selection and presentation. I mainly feel obliged, being, as I said, perhaps the person in the world best in a position to appreciate the effort, passion, and personal sacrifice involved in doing what Rob is doing, to say – I hope for all of us – thank you. Keep up the great work. We are up against an endlessly resourced and implacable problem; which is the ease with which caring for people in the tried-and-true ways that we have known for generations, which can be difficult, frightening, uncertain, and often materially unrewarding ways, have always been and will always be in danger of being replaced by apparently easier, apparently less frightening, apparently more certain, and definitely more materially rewarding ways such as giving people pills. It is not even necessary to say here that pills are never helpful – just that the dangers of going in that direction are so great as to be potentially catastrophic for both individuals and society, and should not therefore be justified on the basis of a claimed benefit to the few without careful analysis. And, of course, we think that research such as Harrow’s, Wunderink’s, Open Dialogue’s and others shows that other approaches must be given their due.

    One more point, on Open Dialogue; it is a continual frustration that it is difficult to present the Open Dialogue research without someone saying “well, they’re not dealing with schizophrenia.” This is, of course, because the experience of those in Tornio has been that using this approach resolves crises that in earlier times would go on to meet criteria for schizophrenia – simply because the crisis has to go on for six months in order to do so. So, by the existing criteria, people are technically right to say that they were not dealing with schizophrenia in Tornio. As they say in Tornio; “schizophrenia is failed treatment.”

    But of course this means that it’s hard to get traction using the Tornio research on questioning the approach employed to treat schizophrenia, if you can’t call it “schizophrenia.” And while an intellectually honest appraisal of what the research finds would lead, inevitably, to a wholesale review of the schizophrenia treatment, if not the whole concept of schizophrenia, insisting that we question the construct itself at every turn – as meritorious as this might be – runs the risk of leaving some people who are currently caught in treatment under this failed paradigm still caught. Speaking for myself (and many others) I’ll say that I have been successful at extricating people who have been given life-long diagnoses and prognoses. And every single time I’ve succeeded at that the outcome was dismissed as an outlier, a fluke, a dodged bullet, a “misdiagnosis,” an unjustified risk, etc. Never, if ever – to my knowledge at least – has there been on those occasions a reappraisal of the diagnosis itself, and certainly not a reflection on the real and potential injustice of the diagnosis having been applied and of a life, therefore, having been potentially stolen. Certainly not a reappraisal of all the lives that had been impacted – and lost – as a result of similar “misdiagnosis.” But on those occasions my interest and loyalties lay with the individual, not the whole system, and I preferred to take my satisfaction at their good fortune rather than co-opt their success to further a larger agenda. It didn’t necessarily help, at that point, to say to a family member, or a psychiatrist, “you were wrong,” or “you are a terrible person for having done this.” They, like everyone involved, were scared. And, sometimes, the risk was real, and people got hurt, which hasn’t changed my view but has changed how I’m willing to calculate the odds when I’m taking risks like this. There was a time when I thought that the depth of the injustice being perpetrated on individuals justified any risk I might take, and I was willing to take any risk. Now, having experienced the consequences that can come even from people you are wholeheartedly committed to help, I don’t necessarily feel differently about the justice issues, but I’m just more respectful of the fact that to go against the paradigm is to willingly take risks on to yourself and others that have to be done very consciously and deliberately.

    So, I’m trying to say, that if all one article can do is say “hey, there might be a different way of looking at this,” but doesn’t happen to take on the responsibility of pulling down the whole edifice once and for – and risk getting crushed in the process – then there’s still a place for that article. And this is one of those. If we are going to criticize research for being overweening and hubristic in its claims, it’s on us not to be overweening and hubristic in the process. This is the strength of Bob and his work; he humbly takes on the science, and simply asks; by their own logic, and their own research, how are they doing? We try to aggregate this. And after three and a half years of being involved in MIA I can more conclusively than ever say; in the aggregate, by their own logic, and their own research, not so good.

  13. Thank you, Kermit, for this eloquent post. It’s helpful to hear your insider’s perspective.

    You wrote, “Now things have changed, and early intervention (and CBT) are getting the more critical look they deserve.” I’m curious, Kermit, why do you believe CBT deserves critical treatment at MIA?

    As you described, the news editor’s task involves highlighting articles and related content that would be of interest to MIA’s readership. What the news editor chooses to present, and not present, is filtered through the editor’s notions of what is consistent with MIA’s mission. Like you, Ron obviously believes content that questions the value of CBT is of particular importance to MIA. Why?

    CBT-related posts at MIA in 2015 have been largely negative, occasionally equivocal, and rarely complimentary. This interests me because CBT is by far the most evidence-based alternative to biomedical treatment (e.g., psychiatric medications) in terms of the amount of available supportive scientific evidence. But based on the CBT-related content at MIA, the site and its contributors appear to view CBT as part of the “current system of psychiatric care” that needs to be resisted.

    I searched all 2015 news items for content related to CBT specifically or psychotherapy in general. I found 6 posts, each linked to a published article. The titles are: “Cognitive Behavioral Therapy Is Losing Its Effectiveness In Clinical Trials,” “All Therapies Equal, “Therapeutic Alliance” Makes the Difference,” “Mindfulness As (In)Effective as Antidepressants at Preventing Relapses?”, “Desensitization” Therapies Show Promise for Treating PTSD and Psychosis,” “There are No Proven Psychosocial Therapies that Reduce Self-harming in Teens,” and “No Treatments Have ‘Clinically Meaningful’ Impacts On Negative Symptoms of Schizophrenia.”

    Together, these articles Ron selected tell the story that CBT is not particularly effective, psychotherapies in general are not particularly effective, and psychotherapies are equally (in)effective. Had he wanted to, Ron could have just as easily cited studies highlighting the effectiveness of certain psychotherapies like CBT for particular problems, or showing that some psychotherapies are much more effective than others for certain problems, or that the therapeutic alliance does not account for the benefit of psychotherapies for certain problems. The story Ron has chosen to share here is obviously a product of his perspective that questioning the value of psychotherapy in general, and CBT in particular, is consistent with MIA’s mission. What is the basis for this belief? Is psychotherapy (including CBT) part of the “current system of psychiatric care” that MIA seeks to oppose? Do CBT and other psychotherapies deserve to be lumped in together with biomedical psychiatric approaches?

    I encourage MIA staff to seriously think about this issue. Denigrating CBT and other psychotherapies may appeal to those who dislike all conventional forms of “treatment,” but is an exasperating turn-off to those who view psychotherapies like CBT as appealing evidence-based alternatives to biomedical psychiatric approaches. MIA presently exists as a force with little reach into professional communities that might support its mission to oppose the current system of psychiatric care and contribute to a paradigm shift. It doesn’t have to be this way. But this is unlikely to change as long as MIA editors and contributors cherry pick content to support a narrative that opposes evidence-based alternatives to biopsychiatric treatment.

    • Regarding this, “CBT is not particularly effective, psychotherapies in general are not particularly effective, and psychotherapies are equally (in)effective.” – It’s junk science to quantify therapy as if it can be measured like Prozac or Zoloft.

      Each psychotherapy relationship is different, the therapist and client in each pair interact in myriad different ways, the way the therapist practices their form of therapy varies, the length of therapy aries, the baseline emotional capacities of the client varies, and so on. To think that one can say that “psychotherapy is or not not very effective” is just meaningless even at a group level. Psychotherapy is not one thing, and there is so much variation between different human pairings and lengths of interaction, that such research becomes worthless cotton candy.

    • I wonder if one of the reasons why CBT is getting critical treatment (if such is indeed the case) is that it implicitly promotes the idea that something is wrong with the “mad” person that needs correcting.
      However nice and sympathetic the CBT therapist is, the message getting through is still almost inevitably going to be, “There is something wrong with your brain and I’m going to fix it for you.”
      In other words, the “mad” experience is essentially meaningless – just another example of faulty wiring – and the person who went through it is left demoralised, perhaps depressed – certainly not inspired to do anything positive with the experience which is just a waste of time of his life.
      My impression from most articles on MIA is that those who work so hard on this site are endeavoring to present an alternative picture of madness that is inspirational, empowering, optimistic, and intensely meaningful.
      That’s certainly what I’ve got out of your articles – and I wish you much continued success.

      • I always believed the criticism of psychotherapy was because it really doesn’t change how a persons brain is wired. the hubris is thick, and when a patient believes that the therapy is doing much to help them, the therapist will blame the patient for apparently not trying hard enough. Therapy doesn’t do what medicine does, it can’t treat physiological disorders. It was completely useless for me and countless others I’ve met. Also your idea of madness is not what people are talking about, mental disorders actually do EFFECT the sufferer in a NEGATIVE way. stop romanticizing mental illness. mental illness is tragic and should not be something to romanticize.

  14. I’m afraid that this is why I need to be careful when I wade in, given that it’s difficult to say anything without inadvertently saying something that then becomes over-determined, and thought of as indicating a general trend of MIA.

    I do think it’s MIA’s job to be looking at any purported treatment with a critical eye. That said, I come to this believing that there is much that is true and beautiful in the ways of thinking, being, and helping that come out of many approaches to helping people who are suffering.

    That said, I was trying to say that when comparing CBT to pharmaceutical care, it was only because it was about the only psychosocial treatment for which there was even the basis to make the comparison, at least on any statistically meaningful basis. This was then immediately criticized for seeming to promote CBT, which wasn’t true; it wasn’t about promoting or criticizing CBT; it was just the metric that existed.

    And, that said, I’ll say this; from my perspective the problem of presenting anything “evidence-based” isn’t that there isn’t necessarily evidence for something, it’s just that that evidence doesn’t necessarily translate into anything meaningful in terms of efficacy in the real world. We all know this, but it’s a tricky concept in many directions: even if there is solid evidence for something called CBT, it’s my (and others’) observation that “CBT”, qua CBT, isn’t what is actually practiced in the world, hardly ever. People who recommend treatment to others say “CBT” either because it’s a term they know, or it’s the one they know there’s research on, or any number of reasons. This doesn’t mean that what is being practiced is CBT.

    And I question whether CBT is even CBT when it’s being practiced exactly per the book. As we know, the research on the “common factors” of what produces effective therapy finds, consistently, that something called “the quality of the therapeutic relationship” – whatever that is – is what makes the difference, no matter what treatment modality is being offered. I say that this suggests there is something “affective” going on, in addition to the cognitive or behavioral components of CBT.

    But CBT’s stock in trade, and/or its public image, has something to do with how “affective” is NOT included in the “cognitive” and the “behavioral.” So there’s some contortions it goes through to keep that out, if only to keep the appearance of a theoretical purity.

    But when a group of CBT researchers – Zindel Segal, et al. – researched CBT’s basic premise that when you change the thoughts, the affect changes, what they found was something quite different; the change in affect began prior to the change in thoughts; it began upon the change of relationship to thoughts themselves when realizing that thoughts were just “thoughts,” a realization that made letting go of them possible. From this came Mindfulness Based Cognitive Therapy for depression, which I teach.

    So, in a way, I am engaged in practicing CBT, of a kind. But I say that knowing that there are those who rightly criticize the ways CBT is used to buttress the medical model, when there is no justification for its use in that way. That’s not what I happen to be doing, but the criticism is not out of place, given that there are places where this is true.

    Ultimately I’m trying to say that it’s complex. And this may be the most important fact about all of this; that people suffer for myriad reasons, and any time someone tells you there’s an easy or quick fix, they’re probably selling you something. It’s about constantly stepping back, and stepping back again, and stepping back again any time someone offers you something that’s supposed to be a sure thing. One must train one’s self to enter any relationship with one’s eyes and ears – as well as one’s heart – open.

    I think people perceive MIA as being closed-minded. I think I just realized the way in which that’s wrong; I think the mission on MIA is to open minds, always. To open minds, and eyes, and hearts. Now that I’m writing this, I think I may be realizing something very important about our editorial stance; that we are trying to always expand the conversation, always be open to the next unknown.

    Because that’s the key to helping people; always remembering what you DON’T know yet; you don’t know everything about what and who a person is; you don’t know what they might be capable of. You don’t know this about anybody, ever. Once you think you do, you are not respecting them, and you cannot help them. This is as true if you are trying to “just be” with them as it is if you are offering a pill. If you cannot humble yourself in front a person, you have no business trying to help them.

    I think that one aspect of the complaint that is being expressed by people on MIA who might be described as – or who would describe themselves as – antipsychiatry is that they have been treated with this lack of respect; instead labeled, categorized, diagnosed, and prescribed as if this was all they were. Many have been deeply harmed, physically and/or mentally. This can result from psychosocial modalities just as much as it can from drugs. It happens any time people are treated with expediency and efficiency as being more important than realizing a person’s full potential, or at least more important than extending them complete justice.

    I wanted to respond since I saw Academic’s post this morning. This is the first chance I got, and I’m falling asleep at the keyboard, with much else to do as soon as I wake up. So in the interest of simply not failing to respond, I’ll hit “post,” and just hope I haven’t said anything that goes too off the rails.

    Basically I wanted to say to Academic; yes. It’s more complex than I initially managed to say. It’s always more complex. That’s the point of all this. Be humble; do the best you can. But what I’ve learned is that almost every time I “knew” that I was doing the right thing, I was about to make a huge mistake. It’s only when I’ve entered the space in which a person was in crisis with humility, and an appropriate fear, and was willing to start from square one – with whatever book learning I was able to meaningfully muster, but without “knowing” anything that we didn’t figure out together, that I did any good. I say this having study a whole slew of approaches, and being grateful for all of it. But when I walk into the crisis space with someone, I walk in empty. The people I really like to work with are people for whom “cognition” is scary to them, at best, and their “behavior” is scary to others. That is to say, not necessarily people for whom “CBT” in its classical sense is really apropos. This might be where the divide is – though I say this with some trepidation, because I would be offended (and have been) when people suggest that if things have turned out well, then the client must not have been so bad off in the first place (whatever diagnosis or prognosis they had walked in with). But perhaps when you’re talking about CBT you just don’t happen to be talking about working with people past a certain level of crisis.

    Again, I don’t know, and regrettably I have to post and sign off, lest I feel that I haven’t responded to you. So I’ll just hope for the best and hope I fall asleep after I get to bed, and not before.

  15. Ron and Kermit, thank you for your thoughtful replies. I wrote, then deleted, several lengthy responses. In them I had included links to well-publicized studies showing that CBT is highly effective for certain problems and sometimes works much better than other therapies (e.g., http://www.nytimes.com/2015/06/09/upshot/the-evidence-points-to-a-better-way-to-fight-insomnia.html?_r=0&abt=0002&abg=1; http://ajp.psychiatryonline.org/doi/abs/10.1176/appi.ajp.2013.12121511), and studies that convincingly refute the notion that the therapeutic alliance always accounts for therapeutic benefits regardless of the modality (e.g., http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4219070/). I found myself developing other arguments, but then stopped. The issue for me, which this exchange lays bare, is that as much as I support MIA’s vigorous opposition to our current system of biopsychiatric care, I do not support MIA’s general anti-science and anti-CBT positions. You may take issue with this characterization, but I have read virtually every post and comment on this site for years and I believe the sentiment at MIA is consistently opposed to the notion that science is a useful guide to helping people with psychological problems, as well as the notion that CBT has anything particularly useful to offer clients with any type of problem. I do not accept these ideas, nor does any healthcare system in the developed world, nor do any of the many people in my profession I know who would otherwise be kindred spirits with this community and might be poised to offer high-profile support from within the healthcare system. It saddens me not to be able to fully support MIA’s noble efforts, but it’s difficult to deal with the cognitive dissonance that comes with supporting an organization that actively opposes some of the values I hold dear. Given the almost complete lack of participation here by high-profile CBT researchers or proponents, I suspect others share my concerns. There isn’t really anything more to say, and I don’t wish to continue this conversation here so please don’t spend your valuable time replying. I’ll end by humbly asking you, once again, to consider whether alienating potentially powerful allies with consistent anti-science and anti-CBT rhetoric is the direction you wish to continue to steer MIA in the future. Thank you for listening.

    • So much of the comments put out by psychiatrists or psychologists seem like they’re promoting their own particular guild all the time. Psychologists sometimes think they get support from this modern criticism of psychiatry, but then get dismayed when they find out that some people in that party also criticise their own field. Psychology and CBT has its own problems, often as severe as those of psychiatry.

    • I do feel moved to respond, because I’m saddened to have given the impression, if I have, that I am anti-science. I love science, and some of what I most cherish about what I feel I know, who I think I am, and what I believe about what it means to be human I have learned while buried deep in the stacks of a medical school library. Understanding more of how the body and brain function unlocked, for me, some understanding of the human experience that had been hidden from me. In fact I’m about to start working on a doctorate that is going to delve, in part, into the physiology (and the somatic experience of it) involved in certain mental processes, such as memory- and meaning-formation. This is obviously not anti-science.

      But in the same vein, questioning whether science has gone down some dead-ends and blind alleys is not anti-science. It’s pro-science. I might say (hoping that this does not come off as grandiose) that it’s as when Galileo said that pursuing science was not anti-religion or anti-God. It was simply learning more about God’s creation, at the pace that God had established as appropriate; certainly no more could be known (if I remember what he wrote correctly) than God would allow, so it is right to pursue it, and could only result in more reverence and wonder.

      That might seem tangential, but it feels connected. I feel deeply devout about science. I feel awe and wonder at good research. But I also feel disdain at bad science, especially when it makes claims to knowledge that is not justified, and those claims become the basis for beliefs that hurt people, especially when they are desperate for answers. And I do believe that psychiatry in the last few decades has been barking up the wrong tree. Not all psychiatrists, but the ones who I have found to be honest and wise operate far from the mainstream, usually without much support, and usually with a lot of opposition.

      I think that science, properly done, involves endlessly stepping back and questioning one’s assumptions and hypotheses, and that psychiatry has for the most part not done due diligence on its basic operating assumptions when the poor outcomes scream out that the paradigm has failed. Similarly, any manualized, operationalized approach is susceptible to the same thing. That’s just the nature of trying to do something good, in any kind of reproducible way; it becomes bureaucratized, and then is at risk of losing its humanity.

      There’s a joke; the devil and his minion are walking, and see a man pick up a piece of paper and get happy. The minion asks “what was that?” The devil says “he found a piece of the truth.” The minion says “well, doesn’t that concern you?” The devil says “no; I’ll just make him organize it.”

      That, to me, describes the problem here. Whenever any of us finds a good thing, whether it’s how to be meaningfully present for a fellow person in crisis, or a pill that seems to help them, we try to figure out how to make more of that; make it replicable, efficient, monetizable, and pervasive. The second we do this we are at risk of unintended consequences. Scaling up the good inevitably risks scaling up the bad as well.

      When I made a film I was proud of once, and it made it into theaters and on TV, I was proud of the scale I’d achieved; I thought maybe I’d helped to change the world in a good way. Maybe I had, but I felt completely disconnected from it, and therefore didn’t trust my judgment about it, and I realized I didn’t aspire to large audiences or to making big change any more; I aspired to be able to be with one person at a time, and KNOW in my bones whether it was right or not. I am still on that path. I will probably write about it on MIA soon, now that I’ve begun to feel that I have some actual traction on work I feel good about. This is why I’ve been content to limit my big-world contributions to supporting Bob and his work. I have far more confidence in his potential to make a positive impact on the larger world than I have in myself, and so I’m happy behind the scenes.

      I’ve rambled enough for now. Mostly I wanted to say; I’m not anti-science, at all. I’m just anti-bad science. Which includes science that fails to be humble about its achievements, remembering that the larger part of what it means to be human is not reducible to physiological mechanisms. There is something beyond the mere fact of life, the mere fact of having bodies and brains, that comprises the larger and more miraculous possibilities of being human. And I don’t think psychiatry, or any ONE approach to ministering to the fears, foibles and frailties that arise from the fact that every human is aspiring to the miraculous – to being more than just they themselves have been born to be – can credibly claim to have found the all the answers. I’m immediately suspicious of anything or anyone who does.

      I am ideologically agnostic. I think that CBT can be a very good thing, at the right time, for the right combination of people. I’ve also seen good results from acupuncture, Haldol, and barking at the moon. It’s all about timing, and being honest with ourselves and each other. Do that, and anything’s possible.

    • Academic

      I am one of the writers here at MIA who has been partially critical of CBT (under writers you can read my blog “Cognitive Behavioral Therapy: The Good, The Bad, and the Limitations” or read my comments under Ron Unger’s current blog).

      I have also used CBT for over 22 years working as a therapist in community mental health; it is a useful tool in helping some people some of the time.

      I am also a firm believer in the value of the scientific method and believe that in order for humanity of liberate itself from all forms of oppression it will be necessary for EVERYONE to become MORE scientific as one important step in this struggle.

      BUT the key issue in this entire discussion is the fact that no matter how well intension someone may be in trying to help people (including with CBT) in today’s mental health system ALL OF THIS is taking place in a profit based system dominated by Biological Psychiatry; this poisons and potentially contaminates EVERTHING we do. NOBODY can escape or stand above this reality. If people think they can avoid or stand above this reality they are suffering from a serious delusion.

      This represents the BIGGEST LIMITATION in all of our work and is the reason why mere reform of this “diseased” system will mean nothing at the end of the day.

      Academic, I hope you stick around for the Long March.

      Richard

      • Well said Richard,

        You point out a major problem with our system, and also how CBT is being used (or misused) CBT can ann is being used by the mental illness industry to support the idea that people have “wrong” brains and the only thing one has to do is to focus and push away symptoms. Cognitive techniques can and are being used by good therapists who strive to help people with real life problems. Working with cognitive distortions has always been an aspect of good therapy, far before CBT was conceived, but CBT has highlighted the importance of being more active in working with cognitions. The whole debate of whether one is working with thoughts or feelings is often overstated, as thoughts and feelings are implicated all the time, as Kermit pointed out. Therapy is always an emotional experience, and this aspect, especially understanding the impact of the therapeutic relationship, is crucial. So, we should really be talking about good therapy and limited therapy. When a therapists works with a person’s real life problems, helps them understand and deal with their symptoms, feelings and relationships, and honours the importance of the therapy experience, that is good therapy. If a therapist sticks to a few tools without listening well to the person, and gives the person the message that their is something essentially wrong with them as a person, that is limited therapy. As this article on anxiety and serotonin brings out, brain chemistry is complex, and the biological model knows too little to make claims about the value of medication. The same can be said of the therapy field. People are complex, and research will never show what will be most helpful to any individual. This is where listening to our patients becomes so important, because they are the people who will always teach us more than research about what can be helpful.

  16. I agree with you! I will indeed stick around for the long march. Just not here, for reasons I’ve described above. I can make much more of a positive difference opposing the biomedical paradigm by changing hearts and minds from within my profession than by supporting MIA’s efforts (however unintended they may be) to distort and antagonize my profession, which will only turn people away.

  17. Academic

    People say this because, more often than not, this is how CBT is employed in therapy in today’s mental health system. Do you deny this fact?

    This happens because most people doing therapy today have been negatively influenced by the theory and practice of Biological Psychiatry and/or do not have enough critical thinking skills to avoid giving their client this impression. Do you deny this fact?

    Practically every therapist at my clinic, on every progress note, indicates that CBT was employed as an intervention in the therapeutic process. How often is this actually carried out in a positive and productive manner, or without being contaminated by all the other negative influences within the community mental health system ? NOT VERY OFTEN!

    Richard

    • Do I deny the “fact” that CBT is based on the idea that people have broken brains, or chemical imbalances, or some other biomedical abnormality? Um, YES, I sure as hell do. CBT theories emphasise problematic thoughts and behaviors as influences on emotional problems. CBT is often used from within the biomedical healthcare system and involves the use of the language of diagnosis, and I’m sure many therapists don’t try hard enough to disabuse their clients of the disease model, and frankly many therapists are probably unaware of their tacit support for this model. But CBT theories and interventions target the mind, and the notion advanced by some in this thread that CBT relies on the idea of a broken brain is mistaken. I’m not saying it never happens, but this is not an inherent feature of CBT. I have a shelf full of CBT books, attend CBT conferences, teach CBT classes, and do CBT research, and this idea is NOT a standard part of CBT.

      • Academic

        I NEVER said anywhere that “Broken Brain” theory was a part of CBT. My main point, if you reread my prior comments, was to emphasize how powerful these disease based theories are, and how they have such a powerful influence on how CBT is conducted in the real world today.

        Richard

    • Added point: there is a very real distinction between what CBT actual is (in theory and in programmatic application) AND how it is actually applied in today’s world.

      Part of its failure in application (separate from the negative influences of the profit system and Biological Psychiatry’s influence) is its inherent philosophically idealist limitations as an all encompassing form of liberating theory and practice.

      CBT has pragmatic value to help some people some of the time, period!

      Richard

    • As knowledge about good therapy evolves, the practice of CBT is evolving to become closer to the good therapy models that have been around for decades. This is the case for both Schema therapy, that is very similar to active models of psychodynamic therapy and mindfulness based CBT that allows a more positive approach to “negative” thoughts. But, I agree with Richard that the way CBT is used in institutions is often very negatively oriented. Often the same tools, such as using thought records are just stated over and over again until the patient either shuts up about symptoms or drops out. I have heard from numerous people of their bad experiences with CBT (not that I haven’t heard many reports about bad experiences with other therapies). There are stereotypes of all kinds of therapies, but unfortunately, there are too many therapists who do represent these stereotypes. The most common types of psychotherapy research tends to be done on therapies that do resemble these stereotypes, as therapies need to be standardized to do this type of research. A lot of the research that has been used to support the massive use of CBT in institutions is this type of research, which for all forms of therapy shows statistically significant but overall poor results (typically 50% reduction of symptoms in 65% of patients). We need expert models of therapy to be promoted, and not research models.

      • Norman

        We can talk about statistics all we want, but until there is a revolutionary transformation of the status quo there will always be a percentage of the masses who will inevitably be crushed by this system NO MATTER HOW GREAT THE THERAPIST OR THERAPEUTIC TECHNIQUES USED!

        This is the most important thing to take away from this discussion, in my opinion.

        Respectfully, Richard

        • Hi everyone,

          Last night I was in a group of people and a ‘worry’ (that I could have spent hours on) came into my head. I put it onto a shelf and had a look at it again today. In about 3 minutes I could see it was more or less okay and I could put it to one side. Is this CBT?

          Everyone gets anxiety but my anxiety could have driven me mad, now it’s down to less than 5 per cent.

          The compulsive anxiety (over everything) started, when I stopped taking strong “antipsychotics”.

  18. Also important to take away is understanding what a great team of thoughtful caring people Bob Whitaker has put together to help create a place for discussions and inquires that I’m sure for so many people has resulted in helped and saved lives and even helped clarify a meaning and direction for their lives.