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

Beyerstein, B. (2001). Fringe psychotherapies: The public at risk. The Scientific Review of Alternative Medicine, 5, 70-79.

In this superb introduction to fringe and unsubstantiated psychotherapies, Beyerstein outlines a number of reasons why scientists should be concerned about the dangers posed by these treatments. He discusses some of the historical trends that have led to an apparent upsurge in fringe psychotherapies, including the decreased emphasis on critical thinking in the training of clinical psychologists and other mental health professionals and the rise in pop psychology and postmodernism. Beyerstein then examines several widespread "psychotherapeutic fictions," including claims regarding the superiority of clinical over actuarial (statistical) prediction, the efficacy of psychoanalysis for severe psychopathology, the powerful causal connection between early trauma and later mental disorders, and the widespread existence of recovered memories of child abuse. He also takes aim at a number of questionable or largely unsubstantiated psychological treatment and assessment techniques, including aromatherapy, meditation, rebirthing, and handwriting analysis. Beyerstein predicts that "as long as people refuse to think critically and to put psychotherapy methods to hard-nosed empirical tests, bogus treatments will continue to flood the market" (p. 77).

Callahan, R. (2001). Thought Field Therapy: Initial Research (Special issue). Journal of Clinical Psychology, 57, 1149-1260.

In this special issue of the Journal of Clinical Psychology, a variety of authors discuss the research evidence for and against Thought Field Therapy (TFT), a novel and controversial treatment for trauma that purportedly works by stimulating patient's energy fields. Although Roger Callahan, the developer of TFT, argues that TFT exerts powerful effects on clinical problems and on heart rate variability (which he in turn argues is an important correlate of psychological distress), many of his critics, including Richard McNally, John Kline, Jeffrey Lohr, and James Herbert and Brandon Gaudiano, remain unconvinced. McNally, for example, maintains that Callahan's supportive studies (which involve pretreatment-posttreatment data from successful cases solicited from from practitioners) are so methodologically flawed as to be "uninterpretable" (p. 1172). For example, Callahan's primary claims are based on uncontrolled data that are susceptible to placebo effects, demand characteristics, therapeutic expectancy, and other procedural artifacts. Kline similarly concludes that TFT is "based on a concept without merit" (p. 1192), that the case studies Callahan invokes in support of TFT are unconvincing on methodological grounds, and that "evidence for the merit and efficacy of TFT is still lacking" (p. 1192). Callahan responds to these criticisms by contending that the apparent efficacy of TFT cannot be accounted for by methodological artifacts. For example, he argues that positive findings for TFT cannot be attributed to demand characteristics because TFT has been shown to be "successful with horses, dogs, cats, infants, and very young children" [sic] (p. 1255).

Dell, P. F. (2001). Why the diagnostic criteria for dissociative identity disorder should be changed. Trauma and Dissociation, 2, 7-37.

Dell argues that the current diagnostic criteria in DSM-IV for dissociative identity disorder (DID), known formerly as multiple personality disorder, require substantial revision. According to Dell, "the everyday reliability of the diagnosis of DID is abysmal" (p. 9), although the reliability of the DID diagnosis using structured interviews is satisfactory. In addition, Dell maintains that the current DID criteria lack content validity, overlook important information, and result in frequent misdiagnoses. He proposes a new diagnosis, "Major Dissociative Disorder," and presents a provisional set of diagnostic criteria for this condition. See also replies to Dell by Cardena, Coons, Putnam, Spiegel, and Steinberg, along with a final rejoinder by Dell.

Hines, T. M. (2001). The Doman-Delacato patterning treatment for brain damage. The Scientific Review of Alternative Medicine, 5, 80-89.

Hines critically reviews the theoretical and empirical bases of "patterning" therapy, a treatment for brain damage that involves a series of bodily exercises that are intended to "rewire" the brain. Hines observes that patterning advocates posit models of brain development and organization that are grossly erroneous. Moreover, he finds that the research evidence supporting the efficacy of patterning is weak, methodological flawed, or both. In one ostensibly supportive study, for example, the investigators conducted 276 separate statistical tests and found that only 8.2% of the findings attained statistical significance at the p < .05 level. Moreover, because many of the dependent measures were highly intercorrelated, this overall result may actually represent worse than chance effects for patterning.

Hines, T. M. (2001). The G-spot: A modern gynecological myth. American Journal of Obstetrics and Gynecology, 185, 359-362.

Hines reviews the research support for the existence of the widely discussed "G-spot" (Grafenberg spot), a term first used in a 1982 book on human sexuality. According to some authors, the G-spot refers to an area on the anterior wall of the vagina that, when stimulated, results in intense sexual arousal. According to Hines, however, the behavioral and physiological evidence for the G-spot is virtually nonexistent. For example, contrary to claims by some G-spot proponents, there is no evidence for a dense constellation of neurons in the anterior vaginal wall. Moreover, much of the purported evidence for the G-spot derives from the self-reports of a handful of women. Hines concludes that the G-spot is best thought of as a "gynecological UFO" for which there is no compelling or even suggestive scientific evidence.

Kaplan, R., & Manicavasagar, V. (2001). Is there a false memory syndrome? A review of three cases. Comprehensive Psychiatry, 42, 342-348.

The authors review the recent intense scientific controversy surrounding false memory syndrome (FMS), a putative condition in which individuals recover erroneous memories of trauma, most commonly childhood sexual or physical abuse. They present three cases that illustrate the features of FMS and conclude that there is sufficient scientific evidence for FMS to warrant its inclusion in the diagnostic manual as a condition meriting "further study." They propose a tentative list of diagnostic features for a new DSM diagnosis of "factitious disorder, false memories/beliefs" of abuse that has been "induced by therapy." According to the authors, among the features of this putative condition are "retrieval of memories of sexual abuse, usually but not always occurring in early childhood, in the course of therapy without any pre-existing awareness in the patient," "claims of extensive sexual abuse which went on without discovery by other sources, or other corroborative evidence," and "evidence of suggestion during therapy and/or use of hypnosis or related techniques" (p. 346).

Lilienfeld, S. O., Lohr, J. M., & Morier, D. (2001). The teaching of courses in the science and pseudoscience of psychology. Teaching of Psychology, 28, 182-191.

The authors outline some of the reasons why pseudoscientific and other fringe claims pose a major threat to the field of psychology, and explain why a critical discussion of such claims should be a mandatory component of the education of psychology undergraduates. They then present a model syllabus for the teaching of courses in the science and pseudoscience of psychology, along with valuable resources (e.g., video programs, Web sites) for such courses. Among the topics included in this model syllabus are several directly relevant to mental health claims, including fringe and New Age psychotherapies (e.g., rebirthing, neurolinguistic programming), suggestive techniques for memory recovery (hypnosis, sodium amytal or supposed "truth serum"), and unsubstantiated assessment techniques (e.g., handwriting analysis, human figure drawing techniques).

MacLaren, V. V. (2001). A quantitative review of the guilty knowledge test. Journal of Applied Psychology, 86, 674-683.

MacLaren reports the results of a meta-analytic review of 22 controlled laboratory studies of the validity of the guilty knowledge test (GKT), an alternative to the standard polygraph ("lie detector") test that does not hinge on the questionable assumption of a "Pinocchio" response (i.e., a physiological response specific to lying). The GKT, which was developed by David Lykken, is designed to permit investigators to ascertain the presence of specific "concealed knowledge" that would presumably be available only to the individual who committed the crime. MacLaren found that electrodermal (skin conductance) measures based on the GKT revealed correct classification of 76% of participants with concealed knowledge and 83% without such knowledge.

MacMillan, M. (2001). Limitations to free association and interpretation. Psychological Inquiry, 12, 113-128.

MacMillan critically examines the claims of Freud and his followers that the process of free association is largely or entirely uncontaminated by therapeutic suggestion. He argues that the research evidence for this claim is wanting, and that there are ample reasons to believe that inadvertent therapeutic cues can greatly contaminate the client's free associations, thereby seeming to "confirm" therapists' psychoanalytic presuppositions. MacMillan concludes that "one wonders what is left to psychoanalysis if the rule by which its data are gathered is not objective, if the methods by which those data are translated are indeterminate, and if standards cannot be formulated for evaluating the constructions and histories into which they are forged" (p. 126).

Mercer, J. (2001). Attachment therapy using deliberate restraint: Object lesson on the identification of unvalidated treatments. Journal of Child and Adolescent Psychiatric Nursing, 14, 105-114.

Mercer reviews the rationale for, and procedures involved in, various versions of attachment therapy (AT) that involve physical restraint, including rebirthing, holding therapy, and therapeutic parenting. As she notes, the first of these techniques, which involves wrapping children in blankets and squeezing them forcefully to simulate uterine contractions, was implicated in the death of a 10-year-old girl in Colorado (Candace Newmaker) 2 years ago. Mercer argues that AT does not meet the minimal scientific criteria required for admissibility into court according to the well-known Daubert rules. In addition, she lists several "red flags" to bear in mind when evaluating unvalidated treatments, including harmful side effects, the lack of information in peer-reviewed sources, and an absence of empirical support. She concludes that there is no compelling or even suggestive research evidence for the efficacy of AT, and that AT has the potential to do considerable harm.

Merckelbach, H., & Muris, P. (2001). The causal link between self-reported trauma and dissociation: A critical review. Behaviour Research and Therapy, 39, 245-254.

In this literature review, the authors call into question the prevailing view that childhood trauma (e.g., child sexual abuse) is a major cause of adult dissociation and dissociative disorders (e.g., multiple personality disorder, now referred to as dissociative identity disorder). Specifically, they maintain that the correlations between early trauma and later dissociation tend to be relatively weak in most studies. Moreover, this correlation may be a product of undetected third variables. In addition, they review evidence indicating that individuals with high levels of self-reported dissociation tend to exhibit a reporting bias toward a large number of false memories. This reporting bias may in turn lead such individuals to report early abuse histories, thereby inducing a spurious correlation between childhood trauma and later dissociation. The authors conclude that models of dissociation that ascribe a substantial direct causal role to early childhood trauma are likely to be oversimplified.

Osborne. K. (2001, May 6). Regional disturbances. New York Times Magazine, pp. 98-102.

In this engaging article, Osborne discusses the controversial scientific issues surrounding various "culture-bound" psychiatric syndromes, including "brain fag" among Nigerians, "koro" and "amok" among Malaysians, "susto" in Latin America, and anorexia nervosa among Americans. He places particular emphasis on the diagnosis of "latah" in Malaysia, episodes of which are characterized by a oversensitivity to startle, a tendency to engage in profanity toward others and mimic others' behavior, and amnesia for one's actions during the episode.

Rassin, E., Merckelbach, H., & Spaan, V. (2001). When dreams become a royal road to confusion: Realistic dreams, dissociation, and fantasy proneness. Journal of Nervous and Mental Disease, 189, 478-481.

The authors review evidence from two nonclinical samples indicating that a substantial minority of participants (11.8% and 25.9%) report at least one experience of being incapable of distinguishing a dream from reality. Participants with elevated scores on measures of dissociation and fantasy proneness were especially susceptible to such confusion. The authors conclude that dreams may often be an important source of false memories.

Rosen, G. M., & Davison, G. C. (2001). "Echo attributions" and other risks when publishing on novel therapies without peer review. Journal of Clinical Psychology, 57, 1245-1250.

In a comment on the Journal of Clinical Psychology special series on Thought Field Therapy, Rosen and Davison discuss the perils of publishing non-peer reviewed articles on novel or unsubstantiated therapies. They assert that such articles can often lead to "echo attributions" whereby the proponents of such treatments ascribe the source of their own statements to the journals in which these articles appeared. Such attributions, Rosen and Davison argue, may often lend untested therapies the unwarranted imprimatur of scientific legitimacy.

Schreiber, N., Wentura, D., & Bilsky, W. (2001). "What else could he have done?" Creating false answers in child witnesses by inviting speculation. Journal of Applied Psychology, 86, 525-532.

The authors report data from two experiments examining the impact of a suggestive interviewing technique called "inviting speculation," which is often used with child witnesses in forensic contexts (e.g., cases of reported satanic ritual abuse in day care centers). In this technique, interviewers encourage children to speculate about events that did not occur (e.g., "What else might have the man done with that knife?"). The findings of both experiments indicated that even after a 5- to 6-month delay, there were statistically significant increases in the rates of false answers in the inviting speculation condition compared with those in a baseline condition. The authors concluded that "using the interviewing technique of inviting speculation with preschool-age children contains some possible dangers for the validity of elicited statements" (p. 531).

Sgoutas-Emch, S., Fox, T., Preston, M., Brooks, C., & Serger, E. (2001). Stress management: Aromatherapy as an alternative. The Scientific Review of Alternative Medicine, 5, 90-95.

The authors report the results of a study examining the use of aromatherapy, which has become increasingly popular as a treatment for reducing anxiety. Eighty undergraduates took a 12-minute mental arithmetic task while psychophysiological responses (e.g., heart rate) were monitored. Measures of state anxiety were also administered following the arithmetic task. Before doing so, however, participants were randomly assigned to either receive an extract of lavender (a commonly used aromatherapy treatment) or no treatment. Moreover, half of the participants who received aromatherapy were not informed that they had received this treatment, whereas half of the participants who received no treatment were informed that they had received aromatherapy. The findings revealed no significant effects of lavender on any of the dependent measures, raising questions regarding the efficacy of aromatherapy for short-term stress.

Walach, H., Rilling, C., & Engelke, U. (2001). Efficacy of Bach-flower remedies in test anxiety: A double-blind, placebo-controlled, randomized trial with partial crossover. Journal of Anxiety Disorders, 15, 359-366.

In this placebo-controlled experiment, Walach and his colleagues examine the efficacy of Bach-flower remedies for test anxiety. These remedies, which are a form of aromatherapy developed by English physician Edward Bach in the 1930s, have become increasingly popular as a treatment for psychological distress. Sixty-one participants were randomly assigned to receive either Bach-flower remedies or a placebo, and were assessed on a standardized self-report measure of test anxiety. Both groups showed significant decreases in test anxiety, but these decreases were not significantly different in the treatment and placebo groups. Walach et al. conclude that Bach-flower remedies can be an effective placebo for test anxiety, but that there is no evidence that they possess a specific physiological effect.

Wood, J. M., Nezworski, M. T., Garb, H. N., & Lilienfeld, S. O. (2001). The misperception of psychopathology: Problems with the norms of the Comprehensive System for the Rorschach. Clinical Psychology: Science and Practice, 8, 350-373.

Wood and his colleagues review data from 32 studies that examined 14 important variables (e.g., Reflection responses, ostensibly an indicator of narcissism) from the Comprehensive System (CS), the standard and most commonly used Rorschach scoring and interpretive system. In all of these studies, the Rorschach was administered to nonpatient adults. Wood et al. report that the scores on all 14 variables differed markedly from those provided in the CS norms. Specifically, on all 14 variables nonpatient adults appeared psychopathological compared with the CS norms. These differences were often substantial in magnitude. As the authors note, these unsettling findings suggest that practitioners who use the current CS norms will tend to perceive many normal individuals as psychopathological. The conclude that "use of the CS norms in clinical or forensic settings is inadvisable" (p. 350).

Recent Books of Interest

Beutler, L. E., & Malik, M. L. (2002). Rethinking the DSM: A psychological perspective. Washington, DC: American Psychological Association.

Christophersen, E. R., & Mortweet, S. L. (2001). Treatments that work with children: Empirically supported strategies for managing childhood problems. Washington, DC: American Psychological Association.

Ruscio, J. (2001). Clear thinking with psychology: Separating sense from nonsense. Pacific Grove, CA: Wadsworth/Thomson Learning.

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The Scientific Review of Mental Health Practice, vol. 1, no. 2 (Fall/Winter 2002).
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