What You Can Change _. And What You Can't - Martin E. Seligman [1]
This book examines just how good this symptom relief is when different drugs and psychotherapies are compared for different psychological problems. Roughly these treatments are about 65 percent effective. Depression, as you will read below, is typical. Consider two treatments that “work,” cognitive therapy versus SSRI’s (e.g., Prozac). For each, you get roughly a 65 percent relief rate, along with a placebo effect that ranges from 45 percent to 55 percent. This means that the treatment’s net actual effect is between 10 and 20 percent. The more compelling the placebo, the higher the placebo percentage, and therefore the smaller the actual effect. These sobering numbers crop up over and over, whether you’re looking at the percent of patients who experience relief or at the percent of their symptoms for which patients experience relief.1*
Why are the effects of almost all the drugs and psychotherapies only small to moderate? Why have therapists reached a 65 percent barrier?
From the first day I took up skiing until five years later when I quit, I was always fighting the mountain. Skiing was never easy. Every psychotherapeutic intervention is a “fighting the mountain” intervention. The treatments don’t catch on and maintain themselves. In general, therapeutic techniques share the properties of being difficult to do and difficult to incorporate into one’s life. In fact, the way researchers usually measure therapy effects is how long they last before they “melt” once treatment is discontinued.
Scientific ignorance, cost limitations, and the decline of Freudian psychotherapy may not be the only reasons for the 65 percent effect: Better treatments may always be elusive. In the therapeutic century that we’ve just lived through, it was the job of the therapist to minimize negative emotion: to dispense the drugs or the specific psychotherapy that would make people less anxious, less angry, or less depressed. But there is another approach to symptoms, older than the notion of therapy: learning to function well in the face of symptoms—dealing with them.
Dealing with your symptoms is beginning to look more important again in light of the most important research finding in the field of personality of the last quarter of the twentieth century: that most personality traits are highly heritable.2* Symptoms often, but not always, stem from personality traits. As such, I believe that they are modifiable, but only within limits. How do we address the likelihood that most psychological symptoms stem from heritable personality traits that can be ameliorated but not wholly eliminated?
Do you know how snipers and fighter pilots are trained? (I’m not endorsing sniping by the way; I only describe how training is done.) It takes about twenty-four hours for a sniper to get into position, and then it can take another thirty-six hours to get the shot off. Now that means that typically before a sniper shoots, he has not slept for two or more days. He’s extremely tired. Now, let’s say the military went to a psychotherapist or a biological psychiatrist and asked how she would train a sniper? She undoubtedly would use drugs or psychological interventions to break up the sniper’s fatigue.
That’s not how snipers are trained, however. One trains a sniper by having him practice shooting when he is extremely tired. That is, one teaches snipers to deal with the negative state he is in so as to function very well in the presence of fatigue. Similarly, fighter pilots are selected to be rugged individuals and not to scare easily. There are many things that happen to fighter pilots that terrify even the most rugged personality,