The Psychology Thread 🧠

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This is from Peter Attia’s newsletter this morning, discussing the potential benefit of creatine in treating depression. No issues with this whatsoever. The problem I have is that when they say “CBT,” which I practice, what do they mean? This is the world’s largest umbrella, essentially the impact of thoughts, feelings, and behavior on one another. So I’m all about positive psychology and self-esteem, and if I had a motto it would probably be Eleanor Roosevelt’s “No one can be made to feel inferior without their consent,” with “inferior” easily subbed out with words like “responsible,” “guilty,” “ugly,” “slutty,” or what have you.

Other therapists practicing CBT have worksheets offering the standard cognitive distortions, and so the therapy consists in identifying which you’re doing and making strategies not to, or whatever. Very curriculum-driven.

Not all therapists are intelligent, insightful, learned, sensitive, etc. Many are burnt out.

They’re always careful to match apples to apples in terms of the study participants, but what about the therapists in these studies of therapy? Every time I read a study of this sort, this piece bangs at me. Anyone have any insight?

Also, the article is interesting nonetheless. An excerpt:

An emerging role for creatine with behavioral therapy

For this double-blind, randomized controlled trial, authors Sherpa et al. examined 100 participants in India with clinical diagnoses of depression. Participants (mean age 30.4 ±7.4 years, 50% female) were randomized to either CBT plus creatine (5 g/day) or CBT plus placebo for a treatment period of 8 weeks.8 The CBT protocol for both groups involved a total of five 45-min CBT sessions (one every other week), and the primary outcome — improvement in symptom severity — was assessed by the Patient Health Questionnaire-9 (PHQ-9), a standard method for evaluating depressive symptoms. Scores on the PHQ-9 can range from 0 to 27, with higher scores indicating more severe depression (mild depression: scores of 5–9, moderate: 10–14, moderate-severe: 15–19, and severe: ≄20).

Results indicated that both groups improved significantly in symptom severity from baseline to the 8-week timepoint. However, the creatine group showed statistically significantly greater improvements, with scores dropping an additional 5.12 points compared to placebo (95% CI: −7.20 to −3.52). Specifically, the CBT-creatine group moved from moderately severe depression (17.8±6.1) to mild depression (5.8±4.8), while the CBT-placebo group remained in the moderate range (shifting from 17.6±6.4 to 11.9±6.6). Additionally, twelve participants in the CBT-creatine group achieved remission (PHQ-9 score <5) compared with five in the CBT-placebo group.

While these findings represent the intention-to-treat cohort (i.e., all participants who started treatment, regardless if they completed the entire treatment protocol), dropout rates were high among both groups (around 40%). This certainly may have impacted results, as those who dropped out may have been experiencing less benefit from either treatment. Indeed, the authors also conducted per-protocol analyses (i.e., excluding drop-outs) and reported a slightly greater difference between groups (the mean improvement in the CBT-creatine group exceeded that of the CBT-placebo group by 6.07 points, 95% CI: −7.88 to −4.25).

However, an important limitation of this study is that it lacked any comparison to traditional pharmacological antidepressants, and thus, we are restricted in our ability to fully understand the scale of this effect. A difference of five points on the PHQ-9 scale is unequivocally clinically significant, so these new data from Sherpa et al. suggest that creatine can indeed improve outcomes from CBT compared to placebo (though it’s worth noting that the CBT protocol employed here was very light compared to more typical weekly or twice-weekly sessions). Further, according to a meta-analysis including over 50,000 patients, CBT is often just as effective as pharmacological therapies, and individuals who combine medications with CBT fare better than with either treatment alone,9 but is the combination of creatine and CBT as effective as a combination of SSRIs and CBT? If so, this opens new avenues for patients who do not respond to SSRIs or do not tolerate their side effects to achieve comparable relief as others achieve on traditional medications. Perhaps creatine added to both CBT and antidepressants would show still greater benefit, offering hope to those with the most severe forms of depression. We currently have no direct comparisons to answer these questions, so further clinical studies are warranted.
An emerging role for creatine supplementation in the treatment of depression - Peter Attia

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I can certainly co-sign that not all therapists are created equal. The two I’ve had most recently are in my opinion, very good. Learned, diligent and genuine.

One I saw in 2012 was also very experienced, but near retirement, and knew my insurance only covered 6 sessions. There was no lack of heart on her part, but she was tired. She did give me some great practical advice and insight into the anxiety I was experiencing, but it was also mutually understood that my time with her was limited and that I’d be moving on when the coverage was up.

On creatine- my one observation of its effects on the brain were with a friend who had brain damage. He could not use creatine because it would activate and strengthen the signals and firing in his brain that increased and intensified seizures brought on by the damaged area.
So it does have some clear effects on brain function.

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Beck’s CBT principles adapted as a low-intensity intervention.

-Biweekly sessions. 5 sessions total.

-45 minutes each.

-Individual therapy with a board-registered clinical psychologist.

-Included thought logbooks and activity charts for between-session practice.

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I’m not sure where you got more than “five 45-minute sessions every other week” - I didn’t see anything beyond that listed in the article - but my point is that “CBT” is extremely variable, and “board-registered clinical psychologists” come in all shapes and sizes, intellectually and relationally speaking. Paul Conti (psychiatrist) says “it’s the relationship that heals,” and this has been my experience.

There was a 40% dropout rate, which perhaps reflects the study group, but I would suggest that it might also reflect that the clinician was not someone people wanted to return to.

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“Why Rich Kids Are So Good at the Marshmallow Test”?

Higher socioeconomic status is largely a proxy for inherited traits like IQ and conscientiousness. Both of which are important in something like the marshmallow test.

Parents with lower IQ and other traits are more likely to remain socioeconomically disadvantaged and have kids that share those same traits.

Accounting for the mother having a college degree means nothing. What was the degree in?

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The first marshmallow test from 1972 just connected willpower with later success in life. This later study tried to explain why, thus exploiting the shortcomings of the previous study. It may come as no surprise that psychosocial and economical status is correlated with later success in life.

It doesn’t matter what college degree they/we are referring to. It is what it is (and it’s no surprise). If we just don’t fuck up our kids upbringing completely - Things will turn out positive. Just being there for them is more than enough (and doesn’t cost a fortune).

From another standpoint, I know quite a few “rich” and successful people. They are not entirely present for/with their kids, as they work a lot and pay for external child support. I can unscientifically say that these kids are more or less neglected by their parents. Will this turn out negative in the long run - or does it still account for success according to the later study?

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Even the original author of the marshmallow test was an author on the subsequent recent paper saying that the test may suggest impatience but does not really mean very much in terms of prognostic value.

CBT is extremely variable in practice. Wth so many dropouts and those not continuing likely to be finding therapy unhelpful, I would put creatine firmly in the “interesting result, deserves further study” box with regard to this. Creatine has shown considerable promise in terms of cognition, other mood studies, neuroprotection from aging/stroke/Parkinson’s etc. but more research is needed.

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An old buddy of mine was the 2nd child of one successful Md. and one extraordinarily successful Md. Went to the best prep schools in the nation, all of only the best in life, great university, nothing but the finest, and a Humongus trust fund.

Never did a single fucking thing in his entire life. Was an ocd hypochondriac narcissist that ended up dead in large part to his self obsession.

Not pointing at the exception and calling it the rule, but he definitely would have benefitted from a man in his life to instill a work ethic and greater sense of purpose.

Dude used to look at me like I was an alien when I would talk about work and life stuff in general. Could never understand how I could talk to women plainly and simply yet they would find me attractive while ignoring him, his expensive watches, and his tales of wealth and privilege. :man_shrugging:t2:.

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This is interesting and may indicate something overlooked. I’ve always been more impressed by generalists than specialists. It seems the “school of life” brings more survival (social) skills, than strictly academic skills does. That said, the combination of theoretical, practical and social skills is rare and not sufficiently recognized, in my humble opinion.

Furthermore, there seems to be an inflation of unacademic skills, as everything needs to be formally and academically proven (even the “simplest” jobs). The point I’m trying to make here is the importance of grit, combined with an ABILITY to learn. I’d rather have an uneducated co-worker with curiousity (and ability to learn) - Than a well-educated narrow-minded person who thinks he/she knows best (though often being wrong).

Obviously, there’s no black and white in all this. And I’m definitely not stating I’m entirely right here in my assumtions. This is merely thoughts from many years in the trenches, as well as my own “class journey”.

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I better stay away from this guy!

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Very much agree on all points. :+1:

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He was legit terrifying in Mad Max
 The Immortan Toe!!! You are hereby known as thus

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He’s Toe Cutter! A little factoid I just stumbled upon.

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You really didn’t know??

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If we ever meet I’m doing this to you

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I did not. Mad Max falls within the timespan of me not watching much TV, and virtually no movies.

I’m always amazed at people’s ability to recall and make references to that stuff though.

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Top 5
 Bubba Zanetti, Toecutter, Johnny the Boy, Mud Guts
 and the good guys were all memorable too

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Intellectual curiosity is really important. I sometimes wonder if it is something people outgrow. As a kid, perhaps you wanted to know everything about trucks and dinosaurs. But a majority of Americans don’t finish three books a year.

I think there is value in academic achievement. But if it means you can’t understand alternate viewpoints, can’t express empathy with other people, can’t reevaluate things when the data changes or think you are a hammer and can only see the world in terms of nails - then there is a lack of creativity and wellroundedness. Nobody is right all the time.

Academic knowledge is only one type of intelligence, which also includes social and relationship skills, practical knowledge, wisdom and life experience, savoir vivre, cultural knowledge, economic and financial understanding, health and nutrition discipline, intellectual curiosity and even a degree of humility - even if the latter has gone out of fashion.

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You and I, and likely @SkyzykS, are agreed! For some reason these different “intelligences” seem to be underrated. I can recall an interesting comment from the movie “Hired Guns” (about rented musicians alongside a main artist): It’s not about how good the musician is - It’s mostly about tolerating the other person (while on tour). I think this says something about formal competence vs reality.

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