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"For instance, many studies demonstrate that cognitive behavioral therapy (and other behavioral therapies) are as effective or more effective than medications. Yet, these behavioral therapies are underutilized as first-line treatments. Why?"

I think that the answer to this question is so obvious that I am deeply tempted to think that the question is rhetorical and Prof Rust is fully aware of the answer.

The answer is that dispensing a pill is the cheapest way to address virtually any medical issue—unless that pill is remarkably expensive.

Cognitive behavioral therapy involves at least some human intervention, which comes at a high hourly rate. Similarly, if sports coaching could be replaced by a pill that was half as effective, all sports coaching would quickly disappear except on the pro level (which of course includes Division I college sports).

Of course, it may soon be that an AI cognitive behavioral therapist will be as good as the median human cognitive behavioral therapist.

As it is, I received input for my own self-practice of cognitive behavioral therapy from reading two books on the subject several decades ago. This was a human intervention— but not one that every service user can take advantage of.

Incidentally, service user is marginally better than patient, but it is ghastly in its depersonalization and deemphasis on autonomy. Any use of the word service deemphasizes autonomy.)

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Oh right, I used "patient" just now without thinking, but I've always used that of myself. Not because I'm a non-agent overall - far from it - but because I do think you usually have fairly little agency in relation to psych services. To me, "patient" is just more honest about this fact (but everyone can choose whatever terminology they want for themselves! not gonna push it on anyone else)

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The irony in using the word patient to describe a woman seeking psych services is it is so often necessary for women to learn how to exercise MORE agency in their lives.

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See also the push for CBT to replace any other therapy, and the idea that you can train a competent-enough CBT therapist really quickly and then send them out to treat people.

Surely this isn't just because disinterested scientific investigations have shown that, as a matter of empirical factor, CBT is SO much better than any more long-term therapy that it should COMPLETELY replace the latter, CBT only instead of a larger toolbox.

Surely this isn't because we now know that it IS, in fact, super easy to train people to do CBT on patients, and be good enough at it.

Surely, at least PART of the explanation why CBT is the only therapy offered when people ARE offered therapy is that it's cheaper than the alternatives.

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