Thanks for your reply, I hope I’m not wasting your time.
But appendix 2 also seems to imply that the evidence base for CBT is for it as an approach in its entirety. What we think that works in a CBT protocol for depression is different than what we think that works in a CBT protocol for panic disorder (or OCD, or …). And there is data for which groups none of those protocols work.
In CBT that is mainly based on a functional analysis (or assumed processes), and that functional analysis would create the context in which specific things one would or wouldn’t say. This also provides context to how you would define ‘empathetic responses’.
(There is a paper from 1966 claiming that Rogers probably also used implicit functional analyses to ‘decide’ to what extent he would or wouldn’t reinforce certain (mal)adaptive behaviors, just to show how old this discussion is. The bot might generate very interesting results to contribute to that discussion!)
Would you consider evidence that a specific diagnosis-aimed CBT protocol works better than a general CBT protocol for a specific group as relevant to the claim that there is evidence about which reactions (sentences) would or wouldn’t work (for whom)?
So I just can’t imagine revolutionizing the evidence base for psychological treatments using a ‘uniform’ approach (and thus without taking characteristics of the person into account), but maybe I don’t get how diverse this bot is. I just interacted a bit with the test version, and it supported my hypothesis about it potentially being (a bit) harmful to certain groups of people. (*edit* you seem to anticipate on this but not encouraging re-use). But still great for most people!
Thanks very much Kris, I’m very pleased that you’re interested in this enough to write these comments.
And as you’re pointing out, I didn’t respond to your earlier point about talking about the evidence base for an entire approach, as opposed to (e.g.) an approach applied to a specific diagnosis.
The claim that the “evidence base for CBT” is stronger than the “evidence base for Rogerian therapy” came from psychologists/psychiatrists who were using a bit of a shorthand—i.e. I think they really mean something like “if we look at the evidence base for CBT as applied to X for lots of values of X, compared to the evidence base for Rogerian therapy as applied to X for lots of values of X, the evidence base for the latter is more likely to have gaps for lots of values of X, and more likely to have poorer quality evidence if it’s not totally missing”.
It’s worth noting that while the current assessment mechanism is the question described in Appendix 1f, this is, as alluded to, not the only question that could be asked, and it’s also possible for the bot to incorporate other standard assessment approaches (PHQ9, GAD7, or whatever) and adapt accordingly.
Having said that, I’d say that this on its own doesn’t feel revolutionary to me. What really does seem revolutionary is that, with the right scale, I might be able to say: This client said XYZ to me, if I had responded with ABC or DEF, which of those would have given me a better response, and be able to test something as granular as that and get a non-tiny sample size.
Thanks for your reply, I hope I’m not wasting your time.
But appendix 2 also seems to imply that the evidence base for CBT is for it as an approach in its entirety. What we think that works in a CBT protocol for depression is different than what we think that works in a CBT protocol for panic disorder (or OCD, or …). And there is data for which groups none of those protocols work.
In CBT that is mainly based on a functional analysis (or assumed processes), and that functional analysis would create the context in which specific things one would or wouldn’t say. This also provides context to how you would define ‘empathetic responses’.
(There is a paper from 1966 claiming that Rogers probably also used implicit functional analyses to ‘decide’ to what extent he would or wouldn’t reinforce certain (mal)adaptive behaviors, just to show how old this discussion is. The bot might generate very interesting results to contribute to that discussion!)
Would you consider evidence that a specific diagnosis-aimed CBT protocol works better than a general CBT protocol for a specific group as relevant to the claim that there is evidence about which reactions (sentences) would or wouldn’t work (for whom)?
So I just can’t imagine revolutionizing the evidence base for psychological treatments using a ‘uniform’ approach (and thus without taking characteristics of the person into account), but maybe I don’t get how diverse this bot is. I just interacted a bit with the test version, and it supported my hypothesis about it potentially being (a bit) harmful to certain groups of people. (*edit* you seem to anticipate on this but not encouraging re-use). But still great for most people!
Thanks very much Kris, I’m very pleased that you’re interested in this enough to write these comments.
And as you’re pointing out, I didn’t respond to your earlier point about talking about the evidence base for an entire approach, as opposed to (e.g.) an approach applied to a specific diagnosis.
The claim that the “evidence base for CBT” is stronger than the “evidence base for Rogerian therapy” came from psychologists/psychiatrists who were using a bit of a shorthand—i.e. I think they really mean something like “if we look at the evidence base for CBT as applied to X for lots of values of X, compared to the evidence base for Rogerian therapy as applied to X for lots of values of X, the evidence base for the latter is more likely to have gaps for lots of values of X, and more likely to have poorer quality evidence if it’s not totally missing”.
It’s worth noting that while the current assessment mechanism is the question described in Appendix 1f, this is, as alluded to, not the only question that could be asked, and it’s also possible for the bot to incorporate other standard assessment approaches (PHQ9, GAD7, or whatever) and adapt accordingly.
Having said that, I’d say that this on its own doesn’t feel revolutionary to me. What really does seem revolutionary is that, with the right scale, I might be able to say: This client said XYZ to me, if I had responded with ABC or DEF, which of those would have given me a better response, and be able to test something as granular as that and get a non-tiny sample size.