All of KrisMartens's Comments + Replies

TIO: A mental health chatbot

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 w... (read more)

3Sanjay2y
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.
TIO: A mental health chatbot

Interesting idea, great to see such initiatives! My main attempt to contribute something is that I think I disagree about the way you seem to assume that this potentially would 'revolutionise the psychology evidence base'.

Questionable evidence base for underlying therapeutic approach
This bot has departed from many other mental health apps by not using CBT (CBT is commonly used in the mental health app space). Instead it’s based on the approach used by Samaritans. While Samaritans is well-established, the evidence base for the Samaritans a
... (read more)
2Sanjay2y
Thank you for your comment Kris. I'm unclear why you are hesitant about the claim of the potential to revolutionise the psychology evidence base. I wonder if you perhaps inadvertently used a strawman of my argument by only reading the section which you quoted? This was not intended to support the claim about the bot's potential to revolutionise the psychology evidence base. Instead, it might be more helpful to refer to Appendix 2; I include a heavily abbreviated version here: To expand on item (2), the idea is that when I, as someone who speaks to people in a therapeutic capacity, choose to say one thing (as opposed to another thing) there is no granular evidence about that specific thing I said. This feels all the more salient when being trained or training others, and dissecting the specific things said in a training role play. These discussions largely operate in an evidence vacuum. The professionals that I've spoken to thus far have not yet been able to point me to evidence as granular as this. If you know of any such evidence, please do let me know -- it might help me to spend less time on this project, and I would also find that evidence very useful.
Lobbying for better mental health care: organizing a potentially impactful event

Sorry for my late response, Michael. I agree that being plugged into these networks helps, but I think academics (at least in psychology) are very open to this idea but lack the time (and maybe skills) to organize such an event. I think that if a local EA group (or student group) would approach some professors in psychology (or health economics) with the suggestion to organize an event about IAPT for the general public and policymakers in their name, a lot of these professors would love to support that. I bet we can find those professors in each country, and I am of course willing to help find them.

A rough estimate of social impact of a psychotherapist in QALYs added

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... (read more)

0tuukkasarvi4y
Yes, I agree: probably much of the therapy given is not given according to the protocol and that means the average effectiveness is likely lower than the numbers in the studies indicate. In many cases, I think this might not be due to the psychotherapists or therapists themselves but the organization which they work in, e.g. crowded outpatient clinics where the policy is to meet each client in every 3 weeks or in order to not to make the queues to treatment appear so long. I think think there might be potential for big impact for somebody with clinical background who is willing to advocate long-term for systemic change within mental health care and psychotherapy: optimal treatment protocols (best value per therapy-hour or so), triage, adherance to protocols etc.
Mental Health Shallow Review

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 d... (read more)

A mental health resource for EA community

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 ... (read more)

0Julia_Wise5y
Thank you! I agree that trying to force hallucinations and paranoia away or talk someone out of them almost never works. I was citing verbatim the list of what people from the NAMI survey listed as their needs. Just a note that the APA here is the American Psychological rather than Psychiatric Association (both go by APA, confusingly) and lists only talk therapy and social support methods, not including medication. For psychosis in particular, I think virtually anyone in the field would say medication is the first line of treatment. The kinds of treatment listed there are good for ongoing management, but if I ever became psychotic I would absolutely want a psychiatrist or emergency room to be my first stop. Talk therapy would be good to add in later.
Is effective altruism overlooking human happiness and mental health? I argue it is.

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 ... (read more)

0MichaelPlant6y
And yes, I'd love to hear any of all of these people talk at EA events.

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 suff... (read more)

Is effective altruism overlooking human happiness and mental health? I argue it is.

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 dow... (read more)

0MichaelPlant6y
Hello Kris, good to e-hear from you again. I haven't checked this thread in a couple of months so have only just seen this. I'm not totally sure what it is you're suggesting we do (instead). You seem to be objecting to positive psych, but I never said it was all about positive psych, just that it was one of a number of tools that might allow us to increase happiness. My main point was that we've neglected internal happiness interventions and we should explore those alongside the external happiness interventions we're already working on. What sort of theory of suffering might you be referring to? Is that about the nature of suffering, or about what makes suffering bad, or something else? I'd be happy for you to facebook/email me so we can chat through this if you think that's interesting.
3KrisMartens6y
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 [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/ [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 [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/ [https://www.givingwhatwecan.org/post/2015/12/mental-health-interventions-may-be-more-cost-effective/] 4/ David Clarkehttps://