As a former pipe smoker and current cognitive behavioral therapist, I gave up smoking a pipe long ago-actually, several years after I abandoned psychoanalytic approaches. I read the evidence on effectiveness and I thought, "I owe it to my patients to provide them with the best treatments available." Those treatments were CBT.

Let me address Allen's criticisms, which I think are based on a lack of understanding of CBT, a lack of ability to recognize the importance of scientific evidence, and a practiced misrepresentation of the reality that exists.

1. Yes, CBT is empirically based

Allen minimizes the importance of the empirical support for CBT, claiming that it appears to deal with simple problems (see below). But what would it mean to you as a patient—or a family member of a patient—who had life-threatening cancer if your doctor said, "I don't really care about all this empirical research. I base my practice on my experience?" I doubt that one could stay in practice very long with that approach. Our patients deserve the very best treatments-treatments that have empirical support. Fortunately, one of those treatments is available—it's called CBT. Research on the effectiveness of treatment can be summarized in "meta-analyses" where numerous studies can be surveyed, combined, and effect sizes extrapolated. I cite three such analyses for those interested (below). In each analysis, CBT has been found to be effective for a wide range of disorders. These are not simply studies by true-believers—they are well-controlled, the data are analyzed sufficiently, and the results (repeatedly) speak for themselves. CBT works.

If psychiatry or psychotherapy is to be taken seriously it must rely on empirical research. We cannot simply use anecdotes, testimonials, narratives, or tirades to guide our choice of treatments.

The interested reader can consult these articles for further review:

Butler, A.C., Chapman, J.E., Forman, E.M., & Beck, A.T. (2006). The empirical status of cognitive-behavioral therapy: A review of meta-analyses. Clinical Psychology Review, 26(1), 17-31.

Chambless, D.L., & Ollendick, T. H. (2001). Empirically Supported Psychological Interventions: Controversies and Evidence. Annu. Rev. Psychol, 52, 685-716.

Tolin, D.F., Is cognitive-behavioral therapy more effective
than other therapies? meta-analytic review, Clinical Psychology Review (2010),

2. Yes, CBT deals with serious problems

It is not uncommon for psychoanalytic or other therapists to criticize the empirical support for CBT. Allen claims that CBT "is a simplistic approach that only addresses simple problems." What are these "simple problems" that we address? Well, they include major depressive disorder, Post-traumatic Stress Disorder (PTSD), social anxiety disorder, panic disorder, generalized anxiety, specific phobia, OCD, dysthymia, substance abuse, ADHD, eating disorders, marital distress, and other significant problems. Indeed, labeling "depression" as a simple problem is not only insensitive to the millions of people who suffer, but also is in total disregard of the devastating effects that result from depression. Let me quote from my Huffington Post article:

"Depression is the leading cause of medical disability for people aged 14 to 44 (Stewart, Ricci, Chee, Hahn, & Morganstein, 2003). Depressed people lose 5.6 hours of productive work every week when they are depressed (Stewart, 2003). Eighty percent of depressed people are impaired in their daily functioning (Pratt & Brody, 2008). Fifty percent of the loss of work productivity is due to absenteeism and short-term disability (R. C. Kessler, et al., 1999). In any 30 day period, depressed workers have 1.5 to 3.2 more short-term disability days (Druss, Schlesinger, & Allen, 2001).

People with symptoms of depression are 2.17 times more likely to take sick days (Adler, et al., 2006; Greener & Guest, 2007). And when they are at work their productivity is impaired—less ability to concentrate, lower efficiency, and less ability to organize work. In fact, absenteeism and work performance are directly related to how severe the depression is—the more severe the depression, the worse the outcome. In one study the costs of absenteeism were directly related to actually taking antidepressant medication (Birnbaum, et al., 2010; Dewa, Hoch, Lin, Paterson, & Goering, 2003). Those who took the prescribed medication had a 20 percent lower cost of absenteeism. Depressed people are seven times more likely to be unemployed (Lerner, et al., 2004)."

Moreover, CBT has been found to provide significant advantages in the treatment of bipolar disorder and schizophrenia, with higher functioning for patients receiving adjunctive CBT (along with medication), higher medication compliance, and fewer days in hospital. Dialectical Behavior Therapy (DBT), which was developed by Marsha Linehan, has received more empirical support than any other treatment for helping individuals with Borderline Personality Disorder—again, resulting in fewer days in hospital, lower rates of suicide, and lower rates of para-suicidal or self-injurious behavior.

My colleagues and I find it quite alarming that a psychiatrist would characterize these as simple problems. Indeed, these are sometimes life-threatening problems with pervasive effects on individuals and their families. The fact that we have empirically supported treatments is a considerable advance in psychotherapy and one that should be lauded and advanced further.

3. Yes, CBT examines the origins of problems