usual. What I first want to do is

finish off the discussion of clinical psychology from last

lecture and then have a little brief discussion about some very

interesting research on happiness.

We talked--we ended last lecture with a discussion of

some early--some of the history of treating mental illness and

we saw that it was rather gruesome,

unsuccessful, and arbitrary. For the most part,

we do better now, and Dr.

Nolen-Hoeksema reviewed some of the therapies with focus on

therapies for depression. The textbook talks in detail

about therapies for different disorders including

schizophrenia, anxiety disorders,

and so on. The question which everyone is

interested in is, "Does therapy work?"

And this proves to be surprisingly difficult to tell.

Part of the problem is if you ask people who go into therapy,

"Did you get better after therapy?"

for the most part they'll tell you that they did but the

problem is this could be a statistical byproduct of what's

called "regression to the mean." So, the idea looks like this.

This line plots how you feel from great through okay to awful

and it goes up and down and in fact in everyday life you're

going to--some days are going to be average,

some days will be better than average, some days worse than

average. You could plot your semester.

You could do a plot every morning when you wake up or

every night before you go to bed.

You could put yourself on a graph and it'll come out to some

sort of wiggly thing. Statistically,

if something is above average or below average it's going to

trend towards average just because that's a statistical

inevitability. When do people go to therapy?

Well, they go to therapy when they're feeling really crappy.

They go to therapy when they're feeling unusually bad.

Even if therapy then has no effect at all,

if it's true that people's moods tend to go up and down

after you feel really bad you'll probably improve rather than get

worse. And so this could happen--the

normal flow could happen just even if therapy has no effect at

all. And so, simply getting better

after therapy doesn't tell you anything.

On the worst day of your life you could do naked jumping jacks

on the roof of your college for ten minutes.

I guarantee you your next day would probably be better.

That doesn't mean naked jumping jacks are helping you.

Rather, it just means that the day after the worst day of your

life usually is not as bad as the worst day of your life.

It can get worse, but usually it just trends to

average. What you've got to do then is

you have to take people at the same point who would get

treatment and compare them to people who do not get treatment

or what we call a "control group."

And this is an example of this. So, this is for people who are

depressed. This is statistically equal.

They start off pre-therapy. They all go for therapy but

because in this example there's a limited number of therapists,

some of them are put on a waiting list and others get a

therapist. It's arbitrary.

It's random, which is--which--making it a

very good experiment. And in this example,

you could see those who received cognitive training were

better off. They had lower depression

scores than those that received no therapy at all.

In general, in fact, we could make some general

conclusions about therapy. Therapy by and large works.

People in treatment do better than those who are not in

treatment and that's not merely because they choose to go into

treatment. Rather, it's people who are in

desperate straits who seek out help.

Those who get help are likely to be better off than those that

don't get help. Therapy for the most part works.

We can't cure a lot of things but we can often make them

better. Different sorts of therapy

works best for different problems, and again,

depression proves to be an illustrative example.

If you have everyday unipolar depression, that is,

you feel very sad and you show other symptoms associated with

depression, an excellent treatment for you

is some combination of cognitive behavioral therapy and possibly

antidepressant medications like SSRIs.

If you have bipolar depression, the cognitive behavioral

therapy is useless but medication is your best bet and

so on for all of the other disorders.

Each disorder has some sort of optimal mode of treatment.

If you suffer from an anxiety disorder, cognitive behavioral

therapy can be of help. If you're a schizophrenic it's

probably not going to be of much help at all.

And so, different disorders go best with different sorts of

therapies. Finally, some therapists do

better than others. So, for reasons that nobody

fully understands, there are good therapists and

then there are better therapists and there are bad therapists.

And there's great individual differences in the efficacy of

an individual therapist. Finally, putting aside then the

difference in therapies and the difference in therapists,

does it make sense to say that therapy, in general,

works? And the answer is "yes."

And this is in large part because of what clinical

psychologists describe as "nonspecific factors."

And what this just is a term meaning properties that all

therapies, or virtually all therapies, share and I've listed

two of them here. One of them is "support."

No matter what sort of therapy you're getting involved in,

be it a psychoanalyst or a behavior therapist or a

cognitive therapist or a psychiatrist who prescribes you

medication or someone who makes you go through different

exercises or keeps a journal, you have some sense of support,

some acceptance, empathy, encouragement,

guidance. You have a human touch.

You have somebody who for at least some of the day really

cares about you and wants you to be better and that could make a

huge difference. Also you have hope.

Typically, there's an enthusiasm behind therapy.

There's a sense that this might really make me get better and

that hope could be powerful. Sometimes this is viewed under

the rubric of a placebo effect, which is that maybe the

benefits you get from therapy aren't due to anything in

particular the therapist does to you but rather to the belief

that things are going to get better,

something is being done that will help you.

And this belief can be a self-fulfilling prophecy.

"Placebo effect" is often used sort of in a dismissive way,

"Oh, it's just a placebo," but placebos can be powerful

and even if it's useless from a real point--from a psychological

theory point of view, even if the therapist runs

around and dances while you – I have dancing on my mind now

– while you sit in the chair and watch him dance;

if you believe the dancing is going to make you better,

it may well help. Okay.

That's all I'm going to say about therapy.

Any questions about therapy? Yes.

Student: [inaudible] Professor Paul Bloom:

Fair enough. The question is the assumption

of regression to the mean seems sort of arbitrary because it

depends what the mean is. Always after the fact you can

apply an average to it and say, "Look.

This is the average," but how do you know beforehand?

It's a good point. When you talk about regression

to the mean, it adopts certain assumptions.

The assumption is there really is an average throughout much of

your life and things go up and down within that average and for

the most part that's true for things like mood.

For most of us, we have an average mood and we

have bad days and we have good days.

It's always possible that you have a bad day and then from

there on in it's just going to go down and down and down but

statistically the best bet is if you have a bad day you're going

to go back up to the mean. It's--in some way you don't

even have to see it from a clinical point of view.

You could map it out yourself. Map out your moods and the days

where you're most depressed sooner or later you're likely to

go up. Similarly, on the happiest day

of your life odds are the next day you're going to go down and

there's nothing magical about this.

This is just because under the assumption that there really is

an average in--built into one--each of us.

If human behavior was arbitrary, it would be like a

random walk but it's not. We seem to have sort of set

points and aspects of us that we fall back to that make the idea

of a mean a psychologically plausible claim.

Yes. Student: [inaudible]

Professor Paul Bloom: That's a good question.

Yes. In that study it's a perfectly

good hypothesis that the sort of anxiety of being told,

"I see you've come here for help.

We can't give it to you. Congratulations.

You're a control group" [laughs]

causes anxiety. In other studies the control