Lobbying for better mental health care: organizing a potentially impactful event

2019-03-14T12:36:59.811Z · score: 4 (6 votes)
Comment by krismartens on A rough estimate of social impact of a psychotherapist in QALYs added · 2018-03-22T08:21:19.119Z · score: 1 (1 votes) · EA · GW

Great, thanks!

To broaden the analysis I think correcting for an implementation bias is useful. Fidelity to the protocol by psychotherapists is often way lower in real life than in research studies. This could make the average numbers more pessimistic, but the added value of a psychotherapist being aware of those cognitive impediments way higher, and possibly a more interesting career option (training and supervising younger therapists, lobbying for evidence based psychotherapy). But that just might be a self-serving bias speaking, the recent meta-analysis by Cuijpers made me doubt if I want to continue my work as a psychotherapist.

Comment by krismartens on Mental Health Shallow Review · 2017-11-21T16:59:35.969Z · score: 1 (1 votes) · EA · GW

Great that mental health is getting more attention. Three random remarks that might be of interest:

(1) psychological treatments will probably evolve to become more transdiagnostic / process-based. For example Unified Protocol from Barlow, core principles in Acceptance and Commitment Therapy, the way the UCLA Depression Grand Challenge is taking shape, or the Research Domain Criteria. So most interventions described in this article are being dismantled which in combination with things like network analysis of symptoms (for example the things Eiko Fried is doing) should boost efficacy.

(2) The treatment gap between what works in research settings (efficacy) and what people really receive (effectiveness) is huge. Lobbying for initiatives like Improving Acces to Psychological Treatments in first world seems like a potential priority as well.

(3) About providing general psycho-education and media campagnes: I once saw an impressive talk by Jim White about Steps for Stress.

Comment by krismartens on A mental health resource for EA community · 2017-05-14T14:41:39.569Z · score: 0 (0 votes) · EA · GW

Great post. I'll try to make a useful contribution. Maybe this can be of help as well: the APA list of evidence based treatments:

Maybe one sentence that can use some more context:

They also listed their most important needs during periods of crisis: Getting rid of voices and paranoia

There is nothing that you can do to help someone getting rid of their voices. On the contrary, encouraging them not to hear voices might make it worse. This is why Acceptance and Commitment Therapy is on the list of evidence based approaches. And why Validation of their experience; someone to listen who could be trusted is on that list of needs as well.

As with most psychopathology, trying not to experience stuff that often results in more of those experiences. Off course, do get help, and medication might help to get rid of voices. But changing how you cope with such experiences is also of use.

Eric Morris is one of the researchers on this topic http://drericmorris.com/ & this is a Twitter feed aimed at contextual behavioral science and psychosis https://twitter.com/ACBSPsychosis

Comment by krismartens on Is effective altruism overlooking human happiness and mental health? I argue it is. · 2016-11-28T09:02:07.422Z · score: 2 (2 votes) · EA · GW

By the way, I e-mailed this before to CEA after attending the ABCT-conference in New York. ABCT= Association for Behavioral and Cognitive Therapies (US). Maybe interesting for some of you:

*Given the fact I heard a lot of ambitious attempts to reduce human suffering the last couple of days, I realized I haven’t encountered these voices in the EA movement yet. Maybe these suggestions have been made before, but I’ll give it a try anyhow.

I make these suggestions as speakers, because I think none of these CBT-interventions are ready to compete with the most efficient ways of reducing human suffering. But still, I guess evidence-based talks on what human suffering is and how to reduce it, are still interesting for EA conferences.

1/ Steven Hayes Stubborn bigshot in CBT, founder of Relational Frame Theory (RFT) & Acceptance and Commitment Therapy (ACT). https://en.wikipedia.org/wiki/Relational_frame_theory Had an enormous impact on how CBT-therapists and researches view human pathology and suffering. He’s a fantastic speaker. And a nerd, I guess he’ll love EA and is able to make a great talk, for example on why human suffering differences from non-human-animals (language!), and what to do about it.

2/ Michelle Craske President of ABCT. Presented this very ambitious project today: http://grandchallenges.ucla.edu/depression/ “Understanding, preventing and treating the world’s greatest health problem’

3/ Vikram Patel https://www.ted.com/talks/vikram_patel_mental_health_for_all_by_involving_all?language=nl But apparently this link already exists a bit https://www.givingwhatwecan.org/post/2015/12/mental-health-interventions-may-be-more-cost-effective/

4/ David Clarke https://www.psy.ox.ac.uk/team/david-clark His work on IAPT is great: implementing evidence based care in UK to reach out to a lot of people. And changing the culture into one where data-collection is a great part of it. https://www.penguin.co.uk/books/184573/thrive/*

I think IAPT is the best way to go for systemic change on human psychological suffering right now. It probably has the biggest added value. Having those meta-organizations like NICE in the UK, the implementation of more mechanism-focused therapies and intervention for prevention will follow automatically.

Comment by KrisMartens on [deleted post] 2016-11-28T09:01:26.613Z

Some random thoughts on psychology and EA. We need to make some distinctions.

On the one hand you have a theory about suffering. CBT doesn't have a clear fixed theory, it updates given the evidence. Most refer to these evolutions as first wave (behaviorism) vs second wave (revolution of cognitions, Beck, 'typical' CBT) and third wave (mindfulness-based (MBCT) & value-based (Acceptance and Commitment Therapy, ACT, a contextual behavioral science). The discussion continues.

Psychoanalytical and psychodynamisch therapies have different theories about suffering as well, but have some fixed ideas on the importance of early experiences.

There shoud be a difference between evidence based vs science based. Psycho-analytical (Freud, Lacan) theories aren't science based, although some interventions might be evidence based.

The dodo-bird effect is overrated and mostly people with different agenda's (promoting non science based interventions) misuse it to make their point. Be careful. Different forms of interventions do matter.

But psychology is a young science and a lot of things need to be fixed, updated and worked upon. Hope EA will contribute to this by taking a decent theory on psychological suffering into account. Before looking at evidence of different interventions. Contextual behavioral science might be a great place to start.

Comment by krismartens on Is effective altruism overlooking human happiness and mental health? I argue it is. · 2016-11-28T07:08:36.887Z · score: 2 (2 votes) · EA · GW

I was in contact with Michael before, and let me first say I'm happy he promotes the focus on IHI vs EHI in the EA community.

However, I disagree on how to think of IHI's. I've been struggling with how to think of human suffering since I learned about EA, and it seems to be caused by different views on human suffering between philosophers and what I've learned from clinical psychology, mainly by more pragmatic contextual behavioral sciences (not as an authority argument, but FYI I'm a clinical psychologist/CBT-therapist/PhD-student).

My argument boils down to these 2 points: 1) The premisse and constructs of the EA movement already causes a bias towards Positive Psychology and 2) there are better potential alternatives out there.

"Classical utilitarianism is understood as having three components. First, hedonism about well-being: what makes someone’s life go well(/badly) is experiencing happiness(/unhappiness) – as opposed to having one’s desires met or achieving items on an objective list – and every moment of experience has the same importance to their well-being. I’ll define ‘happiness’ here as any mental state that feels good to the person feeling it, and unhappiness as the converse."

So I believe this is a false distinction, and there is great added value in using a more pragmatic paradigm that can be considered as a third option. And that is: building contexts wherein people can live value-based lives, and preventing avoidable psychological suffering.

"(I note the distinction between mental illness and ordinary human unhappiness is arbitrary and nothing hangs on its precision: mental illnesses and ordinary human unhappiness are supposed to highlight different points on the happiness spectrum. I could alternatively have called these something like ‘clinical unhappiness’ and ‘non-clinical unhappiness’ instead.)"

Yes it is an arbitrary distinction, and contributes to the bias towards positive psychology. I don't see a reason why to make a distinction: humans are humans, and with the knowledge of how high prevalence rates of psychopathology are, it's more logic to assume that underlying mechanisms are present in each of us. The danger of making this distinction is that you end up with interventions targeting the 'ordinary human unhappiness' and not taking into account what these interventions do with people higher up the continuum of suffering. And that's exactly one of the criticism positive psychology receives.

This bias becomes more explicit in the article when Michael describes branches of psychotherapy.

"Regarding mental health a number of methods which have been shown to work including, but not limited to, Cognitive Behavioural Therapy (‘CBT’), mindfulness-based stress reduction (‘MBSR’) and, to a much lesser extent, Positive Psychotherapy. "

If it is to a much lesser extent, then why acknowledge Positive Psychotherapy? NICE guidelines (UK) and APA guidelines (US) don't regard positive psychology interventions as evidence based. (And by the way, classical CBT and MBCT can be regarded as just being part of the happy family of CBT). Another problem is the word 'methods'. Before we start thinking of methods, we need a theory on human suffering, so that when we think of interventions we don't just start from constructs like happiness. This discussion is very alive in the CBT-family, because of the rise of another branch: Acceptance and Commitment Therapy (ACT).

So EA'ers interested in this topic, please read on ACT and the underlying theory of it (Relational Frame Theory, RFT). Before we use numbers, we need a decent theory on suffering to frame them.

If this topic is still alive, I'll try to write another post on how effective altruism based on contextual behavioral sciences might look like. To say it very briefly, a distinction between two sorts of interventions is needed:

  • building contexts (by EHI) wherein each human being has the possibility to live towards their values (and that has the side effect of unavoidable suffering, e.i. by having the time to worry and grief about the loss of loved ones).
  • promoting contexts (by IHI) with the least possible psychological suffering.