The Scientific Review of Mental Health Practice

Objective Investigations of Controversial and Unorthodox Claims in Clinical Psychology, Psychiatry, and Social Work


Recent Papers of Interest

Angold, A., Erkanli, A., Egger, H. L., & Costello, E. J. (2000). Stimulant treatment for children: A community perspective. Journal of the American Academy of Child and Adolescent Psychiatry, 39, 975–984.

The authors examine the prescription of stimulant medications, such as Methylphenidate (Ritalin), in relation to research-based (DSM–III–R) diagnoses of attention-deficit/hyperactivity disorder (ADHD). Approximately 4,500 children were assessed in a predominantly rural U.S. sample. Angold et al. found that approximately one quarter of children with research-based diagnoses of ADHD are not receiving stimulant medication. Nevertheless, they also found that the majority of children who received stimulants were not reported by their parents to exhibit problematic ADHD symptoms. Moreover, many children who received stimulants exhibited teacher- and interviewer-reported ADHD symptoms that fell considerably short of the DSM–III–R threshold for ADHD. Stimulant prescription for non-ADHD children was predicted by the presence of co-occurring (“comorbid”) symptoms of oppositional defiant disorder, suggesting that stimulants may be especially likely to be prescribed for children whose behavior is troublesome or noisome to adults. Angold et al.’s findings raise the possibility of stimulant overprescription among at least a subset of U.S. children, although they also suggest that stimulant underprescription may be a concern for a nontrivial number of children.

Beutler, L. E., & Harwood, T. M. (2001). Antiscientific attitudes: What happens when scientists are unscientific? Journal of Clinical Psychology, 57, 43–51.

The authors delineate some of the ways in which scientists, including academic clinical psychologists, can be unscientific. They place particular emphasis on the tendency of some clinical psychologists to be closed-minded when evaluating scientific evidence that contradicts their prevailing views about the efficacy of certain controversial psychotherapies. In addition, they discuss the consequences of unscientific attitudes in the context of recent controversies regarding the efficacy of eye movement desensitization and reprocessing (see Davidson and Parker, 2001, below).

Chambless, D. L., & Ollendick, T. H. (2001). Empirically supported psychological interventions: Controversies and evidence. Annual Review of Psychology, 52, 685–716.

In this excellent review, the authors discuss the history of the recent emphasis on empirically supported therapies (ESTs) for various psychiatric disorders. They discuss the criteria established for the identification of ESTs and provide helpful summary lists of the major ESTs for adult and childhood disorders. The authors argue that there is especially compelling evidence for treatment specificity in the case of adult anxiety disorders (especially adult obsessive-compulsive disorder, for which exposure plus response prevention has consistently been shown to be more effective than alternative treatments) and childhood and adolescent depression (for which cognitive-behavioral therapy has consistently been shown to be more effective than alternative treatments). In addition, the authors thoughtfully examine common criticisms directed against the identification and dissemination of ESTs to practitioners, including claims that (a) all psychotherapies are equally effective so that the identification of ESTs is inappropriate or unwarranted, (b) the effects of psychotherapies cannot be researched adequately using quantitative procedures, (c) research on ESTs will not generalize to actual clinical practice, and (d) the use of treatment manuals in psychotherapy will impair therapeutic efficacy. They then rebut each of these claims with reference to existing scientific findings.

Davidson, P. R., & Parker, K. C. H. (2001). Eye movement desensitization andreprocessing (EMDR): A meta-analysis. Journal of Consulting and Clinical Psychology, 69, 305–316.

The authors report findings from a meta-analysis (quantitative literature review) of 34 studies that examined the efficacy of eye movement desensitization and reprocessing (EMDR), a controversial treatment that has been hailed by some of its proponents as a major new breakthrough in the treatment of anxiety disorders. The authors found that EMDR was more effective than either no treatment or treatments that did not utilize exposure to anxiety-provoking stimuli. Nevertheless, EMDR was no more effective than other exposure-based techniques, which is consistent with suggestions (e.g., Lohr, Tolin, & Lilienfeld, 1998, Behavior Therapy, 29, 123–156) that EMDR is merely a variant of existing exposure-based treatments. The authors also reported that eye movements were irrelevant to EMDR’s efficacy. Finally, they found that, contrary to earlier claims, there is no convincing evidence that EMDR is effective for noncombat-related posttraumatic stress disorder. The results of this meta-analysis suggest that the efficacy of EMDR probably derives largely or entirely from its incorporation of exposure.

Erwin, E. (2001). The rejection of natural science approaches to psychotherapy: Language and the world. Journal of Clinical Psychology, 57, 7–18.

As Erwin observes, postmodernist approaches to the relation between reality and language have often been used to justify the abandonment of scientific methods for evaluating the efficacy of psychotherapy. Erwin examines three core assumptions of postmodernism, namely that (a) there are multiple “worlds” rather than a single world, (b) reality is constructed, not discovered, and (c) reality is dependent on our language and psychological perceptions, and he finds each of these assumptions to be wanting. He concludes that “the multiple worlds-constructivist thesis provides no support for a rejection of natural science approaches in psychotherapy” (p. 17).

Fombonne, E. (2001). Is there an epidemic of autism? Pediatrics, 107, 411–413.

In this brief commentary, Fombonne critically examines claims that the incidence of infantile autism has been increasing dramatically over the past several decades. He contends that careful scrutiny of the extant data calls into question the widespread assertion that infantile autism is becoming more common. Although Fombonne acknowledges that there is clear evidence that diagnoses of autism are becoming more frequent, he argues that this increase is likely attributable to several methodological artifacts, including a broadening of the diagnostic criteria for infantile autism and closely related conditions, improved identification of infantile autism, and a confusion of age effects with genuine cohort effects. He also demonstrates that a widely cited report on the incidence of autism issued by the Department of Developmental Services in California is methodologically flawed on several grounds. Fombonne’s arguments raise several important caution flags regarding the existence of a potential autism “epidemic” and also raise questions concerning widely reported claims that recently introduced vaccination programs are responsible for this purported epidemic.

Glass, R. M. (2001, March 14). Electroconvulsive therapy: Time to bring it out of the shadows. Journal of the American Medical Association, 285, 1346–1348.

In this editorial, Glass reviews the acrimonious scientific controversies surrounding electroconvulsive therapy (ECT) and the historical context of these controversies. For example, he surveys claims that ECT produces long-term memory loss and brain damage, as well as longstanding disputes regarding the merits and dangers of unilateral versus bilateral electrode placement. Glass concludes that ECT has not been convincingly shown to produce long-term cognitive impairments or structural brain damage, although he maintains that the issue warrants further investigation given the “reports of a minority of patients who believe that they have developed devastating cognitive consequences from ECT” (p. 1347). He also concludes that the “results of ECT in treating severe depression are among the most positive treatment effects in all of medicine” (p. 1348) and that the potential hazards of ECT must be weighed carefully against findings that depression is a severely disabling condition characterized by a very high (perhaps as high as 15%) death rate.

Held, B. S. (2001). Antiscientific attitudes toward psychotherapy: Concluding comments. Journal of Clinical Psychology, 57, 53–62.

Held critically examines the arguments of other authors in this special section of the Journal of Clinical Psychology (including those of Beutler and Harwood, Erwin, and Spence), with particular emphasis on postmodernist challenges to scientific approaches to psychotherapy. She concludes that although postmodernism “exalts . . . the subjectivity of knowing” (p. 61), the roots of antiscientific approaches to psychology and psychotherapy can be traced to movements (e.g., psychoanalysis) substantially predating postmodernism.

Hjobjartsson, A., & Gotzsche, P. C. (2001, May 24). Is the placebo powerless? An analysis of clinical trials comparing placebo with no treatment. New England Journal of Medicine, 344, 1594–1602.

The authors report the results of a meta-analysis of 114 randomized, controlled clinical trials that compared either a placebo—which was either pharmacological (e.g., a sugar pill), physical (e.g., a bogus manipulation), or psychological (e.g., emotional support)—with no treatment. Placebos exerted significant effects on continuous (i.e., dimensional) outcome measures, but not on binary (i.e., dichotomous) outcome measures. Overall, placebos produced significant but small effects on subjective, but not objective, outcome measures. In addition, placebos produced significant but small effects on measures of rated pain intensity. The authors’ findings call into question the oft-reported potent effects of placebos on most outcome measures, and raise doubts concerning the use of placebos as treatments or treatment adjuncts. The authors conclude that “[t]he use of placebos outside the aegis of a controlled, properly designed clinical trial cannot be recommended” (p. 1599).

Kessler, R. C., Soukup, J., Davis, R. B., Foster, D. F., Wilkey, S. A., Van Rompay, M. I., & Eisenberg, D. M. (2001). The use of complementary and alternative therapies to treat anxiety and depression in the United States. American Journal of Psychiatry, 158, 289–294.

The authors examined the use of complementary and alternative therapies to treat anxiety and depression in a sample of 2,055 respondents during 1997 and 1998. They found that 56.7% of individuals with a history of anxiety attacks and 53.6% of individuals with a history of clinical depression reported using complementary and alternative therapies over the past year. Among the more commonly obtained treatments for these conditions were spiritual healing, aromatherapy, massage, hypnosis, energy healing, yoga, acupuncture, herbal remedies, and megavitamins. A small number of individuals with anxiety attacks received laughter therapy as a clinical intervention. Most individuals who sought help from conventional mental health providers used one or more complementary or alternative treatments. Overall, the authors concluded that “complementary and alternative therapies are used more often than conventional therapies by people with self-defined anxiety attacks and severe depression” (p. 289).

Lilienfeld, S. O., Wood, J. M., & Garb, H. N. (2001, May). What’s wrong with this picture? Scientific American, 284, 81–87.

The authors briefly survey the literature on the reliability and validity of the three most commonly used projective techniques for assessing personality and psychopathology: the Rorschach Inkblot Test, the Thematic Apperception Test (TAT), and human figure drawings. They conclude that with a few circumscribed exceptions, these techniques have not shown consistent or replicated empirical support for assessing either personality or mental illness. For example, with the exception of schizophrenia and similar disorders often characterized by disordered thinking (e.g., bipolar disorder, schizotypal personality disorder), the Rorschach Inkblot Test has not been demonstrated to be useful as an aid in making psychiatric diagnoses. In addition, although a few TAT scoring schemes (e.g., scoring systems for assessing achievement motivation and object relations) show promise, most clinicians do not use these systems in their routine practice and instead rely on unvalidated subjective impressions. Moreover, the literature offers little or no support for the use of specific human figure drawing signs (e.g., large eyes) as indicators of personality traits (e.g., suspiciousness). Finally, with only a few exceptions there is little evidence for the incremental validity of projective indices above and beyond more readily collected information (e.g., data derived from self-report measures). The authors urge clinicians to curtail their use of most projective instruments and to limit their administration and interpretation to the handful of projective indices that have received consistent empirical support (for a more complete summary of the findings of this article, see Lilienfeld, S. O., Wood, J. M., & Garb, H. N., 2000, Psychological Science in the Public Interest, 1, 27–66).

Mihm, S. (2000/2001, December/January). Pet theory: Do cats cause schizophrenia? Lingua Franca, 10(9), 32–40.

Mihm discusses the highly controversial hypothesis of psychiatrist E. Fuller Torrey (Professor at the Uniformed Services University of Health Sciences) that viruses spread by cats are a partial cause of schizophrenia. He reviews the evidence supporting this hypothesis (e.g., findings indicating that parents who own cats produce a higher proportion of children with schizophrenia than parents who do not own cats). In addition, Mihm interviews several prominent researchers (e.g., Irving Gottesman) who are skeptical of this hypothesis, some of whom believe that Torrey substantially underestimates the genetic contribution to schizophrenia. Although most scientists are skeptical of Torrey’s conjectures, many agree that a complete picture of the etiology of schizophrenia may ultimately need to include both genetic and viral influences.

Nash, M. R. (2001, July). The truth and the hype of hypnosis. Scientific American, 285, 46–55.

Nash briefly surveys and debunks common myths regarding hypnosis (e.g., hypnosis is related to sleep; hypnotic procedures can be dangerous; hypnotized subjects can be made to perform actions that they would ordinarily view as immoral; hypnotized subjects normally cannot recall what occurred during hypnosis). He reviews the scientific literature on the proper and improper uses of hypnosis, and discusses recent functional neuroimaging work on its effects on brain functioning. Nash notes that recent meta-analyses have shown that hypnosis may be useful in the treatment of pain and that hypnosis may serve as a useful treatment adjunct to the cognitive behavioral treatment of obesity, insomnia, and other conditions. He also observes that there is preliminary evidence of its efficacy for certain traditional “psychosomatic” conditions, including asthma and some skin disorders (e.g., warts). Nevertheless, Nash concludes that there is no evidence that hypnosis enhances memory, although there is substantial evidence that it often results in a markedly increased rate of subjectively vivid false memories. In addition, he contends that the behaviors of participants who are hypnotically age-regressed to childhood “are no more childlike that those of adults playacting as children” (p. 55).

Roediger, H. L., & McDermott, K. B. (2000). Tricks of memory. Current Directions in Psychological Science, 9, 123–127.

The authors review laboratory research on “memory illusions,” i.e., cases in which individuals are presented with a list of semantically related words (e.g., sleep, pillow, rest, snore, blanket) and later recall hearing a word (the “lure” word) that was not on this list (e.g., bed). They point out that in several studies participants have recalled hearing the lure word with roughly the same probability as they have recalled hearing the actual list words. The authors also discuss individual differences in memory illusions and review evidence indicating that older adults, individuals with Alzheimer’s disease, individuals with high levels of self-reported dissociative experiences, and individuals who have reported recovered memories of child abuse are especially prone to laboratory-induced memory illusions. The authors conclude by discussing the implications of their findings for false memories in the real world, and argue that false memories are a natural byproduct of fundamental cognitive mechanisms (e.g., schemata) that generally help us to better comprehend the world.

Shelton, R. C., Keller, M. B., Gelenberg, A., Dunner, D. L., Hirschfeld, R., Thase, M. E., Russell, J., Lydiard, B., Crits-Christoph, P., Gallop, R., Todd, L., Hellerstein, D., Goodnick, P., Keitner, G., Stahl, S. M., & Halbreich, U. (2001, April 18). Effectiveness of St. John’s wort in major depression. Journal of the American Medical Association, 285, 1978–1986.

The authors compared the efficacy of St. John’s wort with a placebo in a randomized, double-blind controlled study of 200 adult outpatients with major depressive disorder. Outcome measures included both self-report and clinician-rated indices of depression, anxiety, and global functioning. St. John’s wort was no more effective than placebo on the primary outcome measures, although the proportion of patients achieving full remission was significantly higher among patients receiving St. John’s wort than placebo. Nevertheless, the proportion of patients achieving full remission was quite low in both groups. The authors also reported that St. John’s wort produced few adverse side effects, as headache was the only side effect reported significantly more often among patients receiving St. John’s wort than placebo. As the authors note, these findings call into question the efficacy of St. John’s wort for major depressive disorder.

Spence, D. P. (2001). Dangers of anecdotal reports. Journal of Clinical Psychology, 57, 37–41.

Spence examines the use of anecdotal case studies in the scientific evaluation of psychoanalysis and other psychotherapies. He argues persuasively that an overreliance on such case studies entails serious epistemic hazards and can lead to grossly erroneous inferences. Specifically, Spence maintains that anecdotal reports can (a) immunize psychological theories from self-correction, (b) lead to marked underestimates of both errors in psychotherapy and psychotherapeutic failures, (c) result in artificially “smoothed” reports of what actually occurred in psychotherapy sessions, and (d) result in the loss of extremely valuable information that is obscured by memory distortion.

Thompson, W. F., Schellenberg, E. G., & Husain, G. (2001). Arousal, mood, and the Mozart effect. Psychological Science, 12, 248–251.

The authors examined the validity of the “Mozart effect” (i.e., the purported phenomenon whereby listening to music by Mozart enhances spatial ability) in a controlled study of 24 college students. They found that performance on a spatial task improved significantly following music by Mozart (but not music by Albinoni) compared with silence. Nevertheless, the music by Mozart also produced significantly greater increases in positive mood and arousal than did the music by Albinoni. When these differences were controlled statistically, the Mozart effect disappeared. These findings raise the possibility that the Mozart effect is actually an artifact of mood and arousal, so that transient increases in positive mood and arousal may lead to modest short-term improvements on certain cognitive tasks.

Recent Books of Interest

Acocella, J. (1999). Creating hysteria: Women and multiple personality disorder. San Fransisco: Jossey-Bass.

Dawes, R. M. (2001). Everyday irrationality: How pseudoscientists, lunatics, and the rest of us fail to think rationally. Boulder, CO: Westview Press.

Eisner, D. A. (2000). The death of psychotherapy: From Freud to alien abductions. Wesport, CT: Praeger Publishers. (Editor’s Note: See the review of this book in the next edition of the Scientific Review of Mental Health Practice.)

Sampson, W., & Vaughn, L. (2000). Science meets alternative medicine: What the evidence says about unconventional treatments. Amherst, NY: Prometheus Books.

Schacter, D. L. (2001). Seven sins of memory: How the mind remembers and forgets. Boston: Houghton Mifflin.

Stanovich, K. E. (2001). How to think straight about psychology (6th ed.). New York: Longman.

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The Scientific Review of Mental Health Practice, vol. 1, no. 1 (Spring/Summer 2002).
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