The human mind is a powerful entity, capable of influencing our perceptions, emotions, and even physical health. This power is vividly illustrated by the placebo effect—a phenomenon where a person experiences real improvements in symptoms despite receiving a treatment with no therapeutic value. Recently, I attended an event where author Mark Manson claimed that placebos are 30% effective in treating mental health conditions, compared to 40% effectiveness for common psychological interventions. This raises an intriguing question: How do placebos truly compare to psychological therapies in mental health treatment?

The Placebo Effect: More Than Just a Sugar Pill

The placebo effect is fascinating. It occurs when people experience improvements simply because they believe a treatment will work, even if that treatment has no active therapeutic ingredients. In mental health, placebos can influence symptoms, especially in short-term studies where the power of belief alone may alleviate some distress.

However, research shows that placebo effects are often limited in scope and duration, particularly in mental health. For example, a recent Cochrane review concluded that while placebos can lead to slight improvements in mood disorders, they don’t typically offer the lasting effects necessary for long-term relief. Without underlying therapeutic change, improvements from placebos tend to fade once the belief or expectation is disrupted. So while placebos can produce a “boost” in some cases, they rarely provide the sustained support that many people need.

What Psychological Interventions Really Do

In contrast to placebos, psychological interventions like Cognitive Behavioural Therapy (CBT), Acceptance and Commitment Therapy (ACT), and Mindfulness-Based Cognitive Therapy (MBCT) are structured and evidence-based. These therapies address not just symptoms but also the underlying thought patterns, behaviours, and emotional reactions that fuel mental health challenges.

For instance, CBT has been rigorously studied and proven effective in treating anxiety, depression, and other conditions. Meta-analyses indicate that CBT’s effect size for treating depression is around 0.96, meaning it has a large and clinically meaningful impact—much higher than that of most placebos. Other therapies, like ACT and MBCT, also show significant effectiveness, particularly for individuals managing chronic stress, anxiety, and depression.

In addition to addressing symptoms, these therapies teach long-term skills. Techniques in CBT, for instance, help individuals challenge unhelpful thoughts, while ACT encourages acceptance of difficult emotions and aligning actions with personal values. These skills allow individuals to continue managing their mental health beyond the therapy room, reducing the likelihood of relapse—a benefit placebos simply don’t offer.

Are Placebos Just as Effective as Therapy? Let’s Do the Maths

When Manson suggests that placebos and therapies have effectiveness rates of 30% and 40%, respectively, it’s worth questioning the numbers. Most studies don’t measure effectiveness in simple percentages, because mental health outcomes are complex. Effectiveness varies widely depending on the condition, the individual, and the therapeutic approach.

It’s true that placebos can have a noticeable effect on symptoms in some cases. But in rigorous clinical trials, evidence-based psychological interventions consistently outperform placebos, especially in long-term outcomes. For example, remote or self-guided CBT, which might be expected to have a weaker effect, often matches the effectiveness of face-to-face CBT and remains well above placebo-level improvements. This goes to show that even the least intensive forms of therapy can provide benefits beyond what placebos achieve.

One aspect of therapy that’s often overlooked in comparisons with placebos is the therapeutic relationship. Unlike placebos, which rely on passive belief, therapy involves active collaboration between the client and therapist. This “therapeutic alliance” has been shown to enhance the impact of therapy, as trust and understanding between therapist and client contribute to better outcomes.

This relationship also encourages clients to engage more deeply with the therapeutic process. Studies show that a strong therapeutic alliance is a predictor of treatment success, especially in talk therapies. Placebos, by contrast, lack this relational component and therefore don’t foster the same level of personal growth or empowerment.

While placebos may have some short-term effect on mental health symptoms, psychological interventions go further by providing people with practical tools and strategies to maintain their mental health. Placebos rely on expectation and belief, which can be powerful but are typically not enough to produce lasting change.

Psychological therapies, on the other hand, are backed by decades of research showing their effectiveness for a wide range of mental health conditions. They go beyond mere symptom relief, offering skills and insights that clients can use to navigate future challenges.

So, while Manson’s suggestion may highlight the power of belief, the data makes a clear case for the value of structured, evidence-based therapy. The next time you’re weighing treatment options, consider the long-term gains of psychological therapy—both for symptom relief and for building the resilience to face life’s ups and downs.

In the end, mental health care isn’t about chasing quick fixes or one-size-fits-all solutions. It’s about finding approaches that address both the symptoms and the root causes of our struggles. Placebos remind us of the mind’s power, but it’s the structured, evidence-based approaches in psychological therapy that provide the tools for lasting change.

Disclaimer: This blog post is for informational purposes only and is not a substitute for professional medical advice. If you’re interested in learning more about psychological therapies or seeking support for mental health concerns, consider reaching out to a licensed mental health professional. Remember, help is available, and taking the first step can make a significant difference in your journey toward well-being.