Science and Pseudoscience in Clinical Psychology, Part III PSYC 4500: Introduction to Clinical PsychologyBrett Deacon, Ph.D.September 10, 2013
From Last Class • Psychology Today blog exchange about relevance of science to psychotherapy • Pignotti (2007) article discussion • Equine therapy in Wyoming • Costs of pseudoscientific practices • Reasons why therapists dispute the relevance of research to clinical practice
Questions for Kirk, Gomory, & Cohen (2013) Chapter, due this Thursday • List and describe what you believe to be the three most significant problems associated with the DSM diagnostic system raised by the authors.
Questions for Satel & Lilienfeld (2013) Chapter, due next Tuesday • List and describe what you believe to be the three most significant problems associated with the brain disease theory of addiction raised by the authors.
Schedule • Today: essential features of science and pseudoscience; how to distinguish them • Thursday: Diagnosing mental disorders (response paper due) • Next Tuesday: psychological and biological theories (Satel & Lilienfeld response paper due) • Next Thursday: Exam 1
Clinical Psychology In the News • “The New Science of the Mind”, Nobel Prize- winning psychiatrist Eric Kandel’s op-ed in NY Times http://www.nytimes.com/2013/09/08/opinion/sunday/the-new-science-of-mind.html?src=me&ref=genera&_r=0 • “The problem for many people is that we cannot point to the underlying biological bases of most psychiatric disorders. In fact, we are nowhere near understanding them as well as we understand disorders of the liver or the heart…But this is starting to change.”“Our understanding of the biology of mental disorders has been slow in coming, but recent advances like these have shown us that mental disorders are biological in nature, that people are not responsible for having schizophrenia or depression, and that individual biology and genetics make significant contributions.” • “In years to come, this increased understanding of the physical workings of our brain will provide us with important insight into brain disorders, whether psychiatric or neurological.”
First, a Disclaimer • The “purity” of the scientific method stands in contrast to the “impure” manner in which this process actually works in the real world • Science is conducted by people, and people can suffer from cognitive distortions, prejudices, pride, laziness, conflicts of interest, sociopathy, and other problems that make the process of science frustratingly political, messy, and slow • “All our science, measured against reality, is primitive and childlike – and yet it is the most precious thing we have.” -Albert Einstein
Michael Shermer’s Presentation on Skepticism • http://www.youtube.com/watch?v=8T_jwq9ph8k
Essential Features of Science • FiLCHeRS(Lett, 1990) • Falsifiability • Logic • Comprehensiveness • Honesty • Replicability • Sufficiency
Essential Features of Science • Falsifiability – it must be possible to conceive of evidence that would prove a claim false • 2 ways this is violated: • 1. making a claim meaninglessly vague (so that it can’t be measured or tested) • 2. explaining away falsifying evidence • The Dragon in my garage (Carl Sagan) http://www.youtube.com/watch?v=jJRy3Kl_z5E
Essential Features of Science • Logic - any argument offered as evidence in support of a claim must be logically sound • Example: • How do patients value the relationship-oriented and science-related aspects of psychotherapy? • Claim: “Evidence of a Pronounced Preference for Therapy Guided by Common Factors” (Swan & Heesacker, 2013)
Essential Features of Science • Swan & Heesacker (2013): Participants rated preferences for psychotherapy involving: • #1. “a space to freely talk about and work through your problems with a therapist you can trust • #2. “works just like taking medicine;” therapist can “choose the correct therapy to fix your particular problem” • Participants preferred #1 to #2 • Authors’ conclusion: patients have “pronounced preference” for relationship-oriented therapies over science-based psychotherapy; prefer providers who “accentuate the nonspecific aspects of therapy” • Logical analysis?
Essential Features of Science • Comprehensiveness – all of the available evidence must be considered in evaluating a claim • Example: effectiveness of SSRI medications vs. placebo for depression (Turner et al., 2008) • 51% of all industry-sponsored clinical trials found significant advantage over placebo • 94% of published industry-sponsored clinical trials reported significant advantage over placebo
Essential Features of Science • Honesty - the evidence for a claim must be evaluated honestly and without self-deception • Example: TFT perspective on reasons for treatment failures • Apex problem • Toxins
Essential Features of Science • Replicability – evidence for a claim must be replicated in multiple studies • Clinical trials of “intercessory prayer”
Replicability • Extraordinary claims require extraordinary evidence, including replicability • Examples of extraordinary claims in psychology?
Replicability • Example extraordinary claim: medical patients who are prayed for have better outcomes • Strongly supported by Cha, Worth, & Lobo (2001) • From Wikipedia (http://en.wikipedia.org/wiki/Studies_on_intercessory_prayer): • In 2001 the Journal of Reproductive Medicine published an experimental study by three Columbia University researchers which claimed that prayer for women undergoing in vitro fertilization-embryo transfer (IVF-ET) resulted in a double success rate (50%) of pregnancy compared to that of women who did not receive prayer.Columbia University issued a news release claiming that the study was carefully designed to eliminate bias.
Replicability • The most important skeptic was Bruce Flamm, a clinical professor of gynecology and obstetrics at the University of California at Irvine, who not only found the experimental procedures flawed, but also discovered that some of the authors themselves were frauds. The first-named author Kwang Y. Cha never responded to any inquiries. Daniel Wirth, a.k.a. John Wayne Truelove, is not an M.D. but an M.S. in parapsychology who has since been indicted on felony charges for mail fraud and theft, committed apparently at the time the study was claimed to be conducted, and he pled guilty. On November 22, 2004, Wirth was sentenced to five years in prison followed by three years of supervised release (parole). In December 2001 an investigation of Columbia University by the U.S. Department of Health and Human Services (DHHS) revealed that the study’s lead author, Dr. Rogerio Lobo, first learned of the study six to twelve months after the study was completed, and he subsequently denied having anything to do with the study’s design or conduct and claimed to have provided only editorial assistance. The name of Columbia University and Lobo were retracted.[15
Replicability • Benson et al. (2006). Study of the therapeutic effects of intercessory prayer (STEP) in cardiac bypass patients: A multicenter randomized trial of uncertainty and certainty of receiving intercessory prayer. American Heart Journal, 151, 934-942. • Methods: “We evaluated whether (1) receiving intercessory prayer or (2) being certain of receiving intercessory prayer was associated with uncomplicated recovery after coronary artery bypass graft (CABG) surgery. Methods Patients at 6 US hospitals were randomly assigned to 1 of 3 groups: 604 received intercessory prayer after being informed that they may or may not receive prayer; 597 did not receive intercessory prayer also after being informed that they may or may not receive prayer; and 601 received intercessory prayer after being informed they would receive prayer. Intercessory prayer was provided for 14 days, starting the night before CABG. The primary outcome was presence of any complication within 30 days of CABG.” • Results: “In the 2 groups uncertain about receiving intercessory prayer, complications occurred in 52% of patients who received intercessory prayer versus 51% of those who did not. Complications occurred in 59% of patients certain of receiving intercessory prayer compared with the 52% of those uncertain of receiving intercessory prayer.”
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
Essential Features of Pseudoscience • Overuse of ad hoc hypothesis that immunize claims from falsification • Example: Francine Shapiro’s (1998) response to a negative component analysis of EMDR by Pitman et al. (1996): • “This [control procedure] duplicated the focused attention, rhythmical aspect, and bilateral stimulation of the guided eye movements all in one condition. It was unsurprising that there were no differences. To complicate it further, the success of focusing on a dot may not even rule out the possibility of bilateratlity, since the optic nerve is crossed to both hemispheres—and maintaining the focus demands bilateral muscle stimulation to hold the gaze.”
Essential Features of Pseudoscience • Absence of self-correction • Examples: TFT, Alcoholics Anonymous
Essential Features of Pseudoscience • Evasion of peer review • Example: Critical Incident Stress Debriefing proponents came up with a unique solution: the International Journal of Emergency Mental Health
Essential Features of Pseudoscience • Emphasis on confirmation rather than refutation • Overemphasis on the hits, underemphasis on the misses • "The essence of science is bending over backwards to prove oneself wrong” -Richard Feynman
Essential Features of Pseudoscience • Reversed burden of proof • Burden of proof rests on the claimant • Skeptics are not obligated to take a claim seriously in the absence of evidence
Essential Features of Pseudoscience • Absence of connectivity (to existing scientific knowledge) • 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
Essential Features of Pseudoscience • Overreliance on testimonial and anecdotal evidence • Example: Monica Pignotti’s personal experience with TFT
Essential Features of Pseudoscience • Use of obscurantist language • Fancy, scientific-sounding terms that are devoid of scientific meaning • Example: EMDR theory
Essential Features of Pseudoscience • “[The] valences of the neural receptors (synaptic potential) of the respective neuro networks, which separately store various information plateaus and levels of adaptive information, are represented by the letters Z through A. It is hypothesized that the high-valence target network (Z) cannot link up with the more adaptive information, which is stored in networks with a lower valence. That is, the synaptic potential is different for each level of affect held in the various neuro networks. . . .The theory is that when the processing system is catalyzed in EMDR, the valence of the receptors is shifted downward so that they are capable of linking with the receptors of the neuro networks with progressively lower valences” (Shapiro, 1995, pp. 317–318)
Essential Features of Pseudoscience • Absence of boundary conditions • Example: Equine therapy • “Animal-assisted therapy has shown evidenced-based efficacy in patients including war veterans with PTSD, depression, anxiety, attention-deficit/hyperactivity disorder, conduct disorders, dissociative disorders, and other chronic mental illnesses.” -this verbatim text can be found on 10 websites touting equine therapy
Conclusions • What have we learned? • Why does it matter? • What should you do with this information?