Create your own gold standard of care

A healthy dose of skepticism regarding "gold standards" of care, questions about the validity of most psychology research, and learning to trust yourself.

CBT is the Acai of Therapy

There’s a lot of talk in the world of psychology and psychiatry about evidence-based methods and certain treatments being the “gold standard of care.” Cognitive-behavioral therapy (CBT) currently sits atop the gold-standard throne. However, I’m here to sprinkle some skepticism on that label and to suggest that for many people it may be little more than marketing speak.

In the same way acai bowls were marketed as super-foods loaded with super-antioxidants (whatever that means), common forms of therapy regularly marketed to us as the go-to method have analogously dubious claims. After all, if acai was as super as the lingo would suggest, shouldn’t our diet mostly consist of it? Or does the language serve an alternative purpose; simply to convince you to buy it.

I’m not saying acai may not have some nutritious benefit, nor am I saying that Cognitive-Behavioral Therapy (CBT) may not be good for you as well. Both have value and some amount of them should likely exist as part of your overall wellness routine. However, what I am saying is that you shouldn’t be fooled by clever marketing when it comes to your own well-being and that the solution to feeling better is far more complex than what a label may imply.

After all, a steak is loaded with all sorts of essential nutrients so can’t we say red meat is also a “super-food”? And can’t the same be said about eggs?

I would survive much longer on a deserted island with unlimited slabs of red meat than I would with an endless supply of acai. All you have to do is watch one season of Alone to see how self-evident that is. Sure, the participants attempting to survive in the wild will often be found picking berries whenever their caloric deficit allows them. But those that survive the longest are generally those with the most animal protein and fat to go along with water, shelter, and fire.

Similarly, it’s worth questioning the marketing speak of certain gold-standard treatments for mental health when there may be many other forms of treatment that will work well for you, including methods not currently acknowledged or endorsed by the powers that be at our compromised institutions such as the American Psychological Association.

CBT can be effective. I’ve relied on it myself. Yet it was a small wedge of the full set of modalities that I turned to in order to substantially transform myself. It may be the “gold standard”, but it certainly wasn’t enough.

Much of psychology research can’t be replicated

Let’s broaden our aperture a bit and ask the question: “How much research in psychology can we truly trust?”

A hallmark indicator of trust in scientific research is the replicability of the results.

For example, we trust scientific research undergirding physics because we can replicate the results of a physics experiment again and again and again without a single failure. That’s why we can build reusable airplanes and rockets and trust that they will work. As Dan Brown once said:

“The laws of physics is the canvas God laid down on which to paint his masterpiece.”

However, many fields of study suffer from a replication crisis. Generally speaking, the further the field is from physics, the less it can be replicated, and therefore the less it can be trusted. For example, take a look at a recent study that tackles the question of replicability in various subfields of psychology.

The study used a machine learning model to assess the likelihood of replication for over 14,000 articles published in top-tier Psychology journals since 2000. The aim was to understand how various factors like research methods, author productivity, and institutional prestige affect a study's replicability.

Here’s what the authors found:

• The rate of successful replication varies significantly among psychology subfields

• Papers with higher media coverage tend to be slightly LESS replicable

• They did NOT find evidence that highly cited papers are more replicable

• Nor did they find that research from prestigious schools is more replicable

That’s correct. Several of the factors you may assume would be correlated with trust/replicability (prestige, authority, popularity) had very little to do with how often the insights from a study could be demonstrated again and again. So, to what degree can you rely on their findings?

Results from the study

There are other studies that question the reproducibility of psychological research as well. For example, this was one of the largest efforts yet to replicate psychology studies. It found that only 39% of the 100 prominent psychology papers analyzed could be replicated unambiguously.

Also, this study found that replications were significantly less likely to be successful when there was no overlap in authorship between the original and replicating articles. In other words: new author = new findings!

So, if a very large percentage of psychology studies can’t be replicated, how are we to trust the supposed gold standards of care? Perhaps the gold standard is best understood as “the best we currently have” and nothing more.

Gravity is perfectly replicable in an experimental environment.

Social psychology, not so much.

You must create your own gold standard of care

I’ll state this to be clear: I’m not saying that therapy or various subfields of Western psychology won’t help you if you’re suffering. It helped me some in the early days of my journey toward seeking the end of my psychological suffering.

However, what I am doing is introducing a healthy amount of skepticism regarding the common clinical methods that are promoted because it’s often not enough, nor can they be trusted simply due to authority.

For example, one study states that approximately 50% to 60% of patients with depression and/or anxiety respond to treatment, but only a minority achieve remission. Imagine if only a minority of people received remissions (i.e. full or nearly full recovery) after fixing a broken bone. We wouldn’t call splints, casts, and titanium screws the gold standard of care in that situation, would we? We might if what we meant to say is, “That’s the best we can currently do.” But “best” does not translate to reliable.

Therapy is not a passive experience where you walk in, receive a "fix," and walk out miraculously healed. A skilled professional can certainly help you understand yourself better, help you through a dark time, and give you a few tools for self-management.

But it’s what you do beyond the walls of the therapeutic environment that matters most. You must become your own advocate and find the clues to the methods that work for you.

That said, here’s a bullet-point list of things to consider when creating your own standard of care:

• Mind: commonly referred to as methods that work “top-down.” Talk therapy and mindfulness practices commonly fall into this category. The objective here is to train your mind to fix your mind.

• Body: often referred to as “bottom-up” methods. The food you eat, the quality of your sleep, and what you do to move your body are all essential factors for well-being, including psychological well-being.

• Spirit: think of this as the feeling of a “life force” within you. Some things make you feel more alive. Some things drain you of your life force. Find the people, environments, experiences, and so on that nourish your sense of aliveness. It’s not something to be understood intellectually. Rather, it is to be felt and followed.

• Connection: we talk a lot about “learning to be alone” in this new-age era of healing. Sure, learning to be alone can be useful. But we are also mammals! We are hard-wired for connection. Make being alone a minority effort, not a majority objective. Feed the animalistic need for connection and belonging.

• Purpose: find something — anything — that sustains you, makes you want to fight another day, and continue the heroic effort of Sisyphus. Find your rock, and keep pushing that damn thing uphill.