Thanks to Tyler Cowen.
Here is an excellent introduction to cognitive-behavioral therapy (CBT) for depression, centering on a Stanford psychiatrist named David Burns. I was especially interested in this:
[Burns] currently draws from at least 15 schools of therapy, calling his methodology TEAM—for testing, empathy, agenda setting and methods. . . . Testing means requiring that patients complete a short mood survey before and after each therapy session. In Chicago, Burns asks how many of the therapists [in the audience] do this. Only three [out of 100] raise their hands. Then how can they know if their patients are making progress? Burns asks. How would they feel if their own doctors didn’t take their blood pressure during each check-up?Burns says that in the 1970s at Penn [where he learned about CBT], “They didn’t measure because there was no expectation that there would be a significant change in a single session or even over a course of months.” Forty years later, it’s shocking that so little attention is paid to measuring whether therapy makes a difference. . . ”Therapists falsely believe that their impression or gut instinct about what the patient is feeling is accurate,” says May [a Stanford-educated Bay Area psychiatrist], when in fact their accuracy is very low.
When I was a graduate student, I started measuring my acne. One day I told my dermatologist what I’d found. “Why did you do that?” he asked. He really didn’t know. Many years later, an influential psychiatrist — Burns, whose Feeling Good book, a popularization of CBT, has sold millions of copies — tells therapists to give patients a mood survey. That’s progress.
But it is also a testament to the backward thinking of doctors and therapists that Burns didn’t tell his audience:
–have patients fill out a mood survey every day
–graph the results
Even more advanced:
–use the mood scores to measure the effects of different treatments
Three cheap safe things. It is obvious they would help patients. Apparently Burns doesn’t do these things with his own patients, even though his own therapy (TEAM) stresses “testing” and “methods”. It’s 2013. Not only do psychiatrists and therapists not do these things, they don’t even think of doing them. I seem to be the first to suggest them.
Thanks to Alex Chernavsky.
Thanks to Alex Chernavsky.
Thanks to Casey Manion and Adam Clemens.
Thanks to Allan Jackson and Casey Manion.
For many years I have used the services of Heart Watch to measure my cholesterol and other health-related things, such as HbA1c. The couple that runs Heart Watch, Sandy and Glen, travels up and down California. I was able to get tested only every three months. Feeling that this was inadequate, just as I did, a man named Karl Corbett recently started a business called My Heart Watch that allows much more frequent tests in the Bay Area, at similar price. My Heart Watch uses the same portable testing devices as Heart Watch.
The Berkeley location is almost across the street from Whole Foods. I signed up online (I was the first person to use their online sign-up service), which was very convenient.
Corbett told me that he greatly improved his cholesterol numbers by changing to a Caldwell-Esselstyn “plant-based diet” that included lots of vegetables, some fruit, no oils, and no animal-based products. (Since the usual oils, such olive and soybean oil, are plant-based, this is a curious feature. Esselstyn seems to ignore bad effects of cholesterol lowering.) The more often you can test yourself, the more easily you can determine what controls what you’re measuring. When you can test yourself often enough to be sure whether a dietary (or other) change has made a difference, you can begin to ignore large clinical trials and their many limitations, which include poor choice of control group, poor statistics, incomplete reporting, biassed reporting, publication bias, confoundings, investigator fraud, on and on. They are the fool’s-gold standard. If I can determine if alternate-day fasting improves my HbA1c, I can ignore what clinical trials say about it.
Before writing this post I spoke to Corbett about getting discounted testing in return for publicizing My Heart Watch.
Thanks to Dave Lull.
Thanks to Jazi Zilber and Phil Alexander.
This graph shows how much work I did in early 2013 (one point = one day). It gradually rose from about 2 hours/day to about 8 hours/day. I did not literally get to 8 hours/day because some tasks got counted extra. For example, one minute of Chinese counted as 2 minutes and one minute of book writing counted as 1.5 minutes. The data is in three blocks because sometimes I didn’t use the tracking program (e.g., due to travel).
I gathered the data with a program that gave percentile feedback. Percentile feedback compares where you are now (measured in various ways, such as time of day, e.g., 3 pm) to where you were at the same time on previous days and summarizes the comparison with a percentile: 75 means more work done than on 75% of previous days at the same time; 50 means more work done than on 50% of previous days at the same time. Displays of such feedback, I noted earlier,
are curiously likable. They usually praised me, in the sense that the percentile score was usually well above 50. . . . They are calm, in the sense that they do not change quickly. . . . Every improvement was noticed and rewarded — and every non-improvement was also gently noted. It was as if the display cared.
Nick Winter used with an earlier version of percentile feedback (video). “The percentile feedback has been a huge success,” he wrote. “I’m getting way more done than I ever did, and I’m much better at prioritizing toward my main project.”
The new version has several improvements. The biggest change is weights — different tasks may have different weights. Tasks that are more valuable or more difficult get more weight. If you keep failing to do something important, you increase its weight, making it more attractive. For a long time, I have had trouble making myself study Chinese. This has helped a lot.
It has also pushed me away from blogging (less valuable) toward book writing (more valuable). I am writing a book about personal science. The chapter I am writing now is about procrastination.
This program has been a big help with procrastination and has improved my use of time in other ways. To get material for the procrastination chapter, I am making the program (written in R) available, along with a draft of the procrastination chapter. I want to find out what happens when other people use it.
To get the program and use it, you need to install R (which runs under Windows, MacOS, and many UNIX platforms), use Dropbox, and use PayPal. You can do some work away from the computer but it won’t work unless you do most of your work at or near the computer.
For better or worse I have learned it is a waste of time to give software to others for free. If you are interested in using it, please send me an email with the following information:
1. Your job.
2. Why you want to try this.
3. How much you will pay (non-refundable after 2 days).
4. How long you will commit to using it.
5. How much you will pay if you don’t meet the commitment (= a refundable amount).
I’ll pick the highest bidders. If you’re one of them, you’ll give me the amount in #3 plus the amount in #5 via PayPal. I’ll install the program on your computer via Dropbox and show you how to use it (in addition to the written instructions). If you use it for the promised length of time, I’ll refund the amount in #5.
Thanks to Bryan Castañeda and Andy.