Announcements

1. Science and Pseudoscience in Clinical Psychology Part III;Psychological Models I PSYC 4500: Introduction to Clinical PsychologyBrett Deacon, Ph.D.September 8, 2008

2. Announcements • Sona pretest is open • Next response paper is due a week from today • France, C. M., Lysaker, P. H., & Robinson, R. P. (2007). The “chemical imbalance” explanation for depression: Origins, lay endorsement, and clinical implications. Professional Psychology: Research and Practice, 38, 411-420.

3. Questions for France et al. (2007) article; Response paper due Tuesday 9/15 • 1. The United States is one of 2 countries in the world to allow direct-to-consumer marketing of prescription drugs. How do you think this practice affects the beliefs and behaviors of persons living in the United States? • 2. Look at the percentage of participants who endorsed “agree” or “undecided” to questions 3, 4, and 5 in Table 4 on page 417. Why do you suppose so many people endorsed these questions? • 3. Describe two ways in which depressed clients who believe they suffer from a chemical imbalance might pose a challenge for providers of psychotherapy.

4. How to Distinguish Science from Pseudoscience: A Primer (Continued)

5. Essential Features of Science • FiLCHeRS(Lett, 1990) • Falsifiability • Logic • Comprehensiveness • Honesty • Replicability • Sufficiency

6. Essential Features of Science • Sufficiency – the evidence offered in support of a claim must be adequate to establish the truth of that claim • The burden of proof rests on claimant • Extraordinary claims demand extraordinary evidence • Evidence based on authority or testimony is insufficient

7. Sufficiency • Lett (1990): “The absence of disconfirming evidence is not the same as the presence of confirming evidence” • Former APA President Ronald Levant: “there is a big difference between a treatment that has not been tested empirically and one that has not been supported by the empirical evidence.” In your opinion, what exactly is the difference?

8. Essential Features of Pseudoscience • Overuse of ad hoc hypothesis that immunize claims from falsification • Example: AA/disease model of alcoholism and the observation that some former alcoholics successfully resume controlled drinking without treatment

9. Essential Features of Pseudoscience • Absence of self-correction • Examples: Alcoholics Anonymous

10. Essential Features of Pseudoscience • Evasion of peer review • Example: Critical Incident Stress Debriefing proponents came up with a unique solution

11. Essential Features of Pseudoscience • The International Journal of Emergency Mental Health • The Journal of Studies Brett Deacon Can’t Get Published In Other Journals

12. Essential Features of Pseudoscience • Emphasis on confirmation rather than refutation

13. Essential Features of Pseudoscience • Reversed burden of proof • Example: The value of eye movements in EMDR

14. Essential Features of Pseudoscience • Absence of connectivity • Example: Reflexology – “based on the principle that there are reflexes in the feet, hands and ears and their referral areas within zone related areas, which correspond to every part, gland and organ of the body. Through application of pressure on these reflexes without the use of tools, crèmes or lotions, the feet being the primary area of application, reflexology relieves tension, improves circulation and helps promote the natural function of the related areas of the body.” http://en.wikipedia.org/wiki/Reflexology

15. Essential Features of Pseudoscience • Overreliance on testimonial and anecdotal evidence • Example: Listening to Prozac,golf club infomercials

16. Questions for Lett (1990) article • 3. Why are testimonials and anecdotal evidence insufficient to establish the validity of a claim?

17. Essential Features of Pseudoscience • Use of obscurantist language • Example: New Age therapies

18. Essential Features of Pseudoscience • What does this mean? • “How would you like to dramatically reduce your stress and anxiety, feel more peaceful and relaxed, gain perceptual clarity, feel greater joy and confidence, increase your energy, improve your physical health, and awaken you to your holiness? You can do all this by removing imbalances in your human energy field, chakras, and aura. With Noetic Field Therapy, an alternative medicine, the therapist discerns and clears blocks from your aura through a practiced focus and spiritual alignment. It is important to remove blocks and increase the energy flow because the more balanced the energy, the healthier we are. Energy blocks or imbalances can cause illness, depression, distort our perceptions, and dampen our feelings. Removing the blocks restores the natural energy flow resulting in feelings of peace and harmony.” -http://energytherapy.net/

19. Essential Features of Pseudoscience • Absence of boundary conditions • Example: Equine therapy

20. A Case Study in Pseudoscience: Thought Field Therapy • http://www.tftrx.com/ • “Thought Field Therapy (TFT) provides a code to nature's healing system. When applied to problems TFT addresses their fundamental causes, providing information in the form of a healing code, balancing the body's energy system and allowing you to eliminate most negative emotions within minutes and promote the body's own healing ability. We provide common recipes (algorithms) or codes in our books and tapes. Specific or individual Codes are elicited through TFT's unique assessment procedures taught in Steps A, B, and C training programs.”

21. Thought Field Therapy • http://www.thoughtfield.com/about.htm • “Thought Field Therapy ™ (TFT) is a safe and effective technique for the elimination of emotional distress. It gives immediate relief for PTSD, addictions, phobias, fears and anxieties by directly treating the blockage in the energy flow created by a disturbing thought pattern. It virtually eliminates any negative feeling previously associated with a thought.”

22. Thought Field Therapy • http://www.thoughtfield.com/about.htm • “TFT eliminated disturbances created by negative emotions by using key meridian points in specific sequences. The gentle training program offers the latest technology in removing disruptions in the body's energy system. These disruptions are responsible for causing physical problems, negative emotions, addictions and cravings. It is truly a mind-body treatment using a combination of modern science, Oriental medicine, and the body's energy system.”

23. Critical Analysis • Thought field therapy: science or pseudoscience?

24. Chapter 3: Psychological Models in Clinical Psychology

25. Models in Clinical Psychology • Theoretical model – simplified pattern that shows how something might work • “Science is built of facts the way a house is built of bricks, but an accumulation of facts is no more science than a pile of bricks is a house.” -Henri Poincare

26. Models in Clinical Psychology • How models help in clinical psychology… • 1. Observe the experience/symptoms of a problem • 2. Develop a theory about what causes and/or maintains the problem that might explain these observations • 3. Gather scientific evidence to test the theory • 4. If the theorized causes/maintaining factors are scientifically supported, develop treatment strategies that directly target them • 5. Evaluate the effectiveness of these strategies in clinical trials

27. Models in Clinical Psychology • Nearly all empirically supported psychological treatments were developed via this process • Examples: • Cognitive therapy for depression • Behavioral activation for depression • Interpersonal therapy for depression

28. Models in Clinical Psychology • Contrast this process with the development of pseudoscientific therapies • 1. Observe the experience/symptoms of a problem • 2. Develop a theory about what causes and/or maintains the problem that might explain these observations ----------------------------------------------------------------------------------------- • 3. Gather scientific evidence to test the theory • 4. If the theorized causes/maintaining factors are scientifically supported, develop treatment strategies that directly target them • 5. Evaluate the effectiveness of these strategies in clinical trials

29. Models in Clinical Psychology • Models are not always helpful. Why? • 1. They may be incomplete • Example: What causes depression? • Cognitive factors – cognitive therapy • Behavioral factors – behavioral activation • Interpersonal factors – interpersonal therapy • Biological factors – medication or electroconvulsive therapy or transcranial magnetic stimulation

30. Models in Clinical Psychology • 2. They may be wrong. • Actual quotes from medical charts: • “From a psychodynamic perspective, he could be using his OCD as a shield against other psychological conflicts or fears regarding dating, education, and career.” -psychiatry resident • “In any case, Prozac did help him a long time ago and theoretically, his brain may have reverted back to the state in which it was responsive to Prozac, so we decided to go back on Prozac.” -psychiatry resident

31. Models in Clinical Psychology • 3. They may be pseudoscientific, thereby failing to advance knowledge. • Example: • Psychodynamic theory of panic disorder

32. Psychodynamic Model of Panic Disorder • Due either to early childhood trauma or a biologically-caused behavioral inhibition, the child becomes angry with his/her parents rejecting or frightening behavior. “As a result, the child becomes fearful of loss and frightened that his or her angry fantasies will destroy the parent on whom he or she depends. In this vicious cycle, rage threatens the all-important tie to the parent and increases the child’s fearful dependence. This process leads to further frustration and rage at the parent, whom the child views as the source of his or her inadequacies…Immaturity or failure of the ego’s signal anxiety function leads to the uncontrollable onset of panic levels of anxiety.” -Milrod, Busch, Cooper, & Shapiro (1997, pp. 9-10).

33. Psychodynamic Model of Panic Disorder • This theory was based on a single study using “psychodynamic interviews” with 9 patients • FiLCHeRS violations? • Psychodynamic treatment for panic disorder was superior to relaxation in a clinical trial (Milrod et al., 2007) • Can this result be used to support psychodynamic theory of panic disorder?

34. Models in Clinical Psychology • 4. They may lead to ineffective or harmful treatment • 5. They may cause harm in other ways • Example: The “schizophrenogenic mother” idea that schizophrenia was caused by mothers who displayed rejecting behavior to their children, imperviousness to the feelings of others, and rigid moralism concerning sex and fear of intimacy

35. Psychoanalytic and Humanistic Models • Development and influence on contemporary mental health practice • Popular ideas: • Problems are symbolic, treatment must uncover the hidden meaning of symptoms • The therapeutic relationship is necessary and sufficient for overcoming problems • FiLCHeRS analysis: problems with falsifiability, comprehensiveness, honesty, sufficiency

36. Therapy Training Across Disciplines (Weissman et al., 2006)