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

Assefi, S. L. & Garry, M. (2003). ABSOLUTŪ memory distortion: Alcohol placebos influence the misinformation effect. Psychological Science, 14, 77-80.

The authors report the results of an ingenious study of undergraduates (N=148) which demonstrates that alcohol placebos can produce memory distortions in an eyewitness paradigm. All participants imbibed nonalcoholic tonic water, but half were incorrectly told that that it was actually a vodka and tonic, whereas half were correctly told that it was nonalcoholic. They were then shown a film of a crime (a man shoplifting items from a store) and read a narrative summary of the film that contained misinformation regarding some of the shoplifted items. Participants who were told that the tonic water actually contained alcohol displayed higher levels of false recall of the film (in accord with the misleading information provided in the film summary) than did participants who were told that the tonic water contained no alcohol. In addition, participants in the former condition were significantly more confident about their recall than were participants in the latter condition.

Beutler, L. (2002). Introduction to the Special Series on EMDR. Journal of Clinical Psychology, 58, 1451-1452.

Beutler provides a brief introduction to a special section on EMDR edited by Francine Shapiro, the developer of this treatment. This special section (which, regrettably, does not contain any articles by skeptics or critics of EMDR) features articles on the use of EMDR for dental phobia and chronic pain, the efficacy of EMDR for posttraumatic stress disorder, and changes in cortisol response before and after EMDR.

Bovan, J., & Craig, R. J. (2002). Validity of projective drawing indices of male homosexuality. Psychological Reports, 90, 175-183.

The authors examined the validity of 21 purported "signs" (indicators) of male homosexuality on the Draw-A-Person test. The participants were 88 homosexual and 88 heterosexual men. Nineteen of the signs failed to distinguish significantly between the groups. The only two signs that showed any evidence of validity were the presence of hair and hips in the drawings. These findings are consistent with a voluminous body of literature demonstrating that the scientific support for the sign approach to human figure drawings is feeble.

Buchanan, T. (2002). Online assessment: Desirable or dangerous? Professional Psychology: Research and Practice, 33, 148-154.

The author reviews the research literature bearing on the psychometric properties of online assessment techniques, such as personality questionnaires available on the Web. He concludes that although the extant evidence provides promising support for the reliability and validity of some online personality measures, he cautions that "equivalence cannot be assumed" (p. 148) and that at least some studies suggest that Web-based test versions are not always isomorphic with their non-Web-based analogues.

Garb, H. N., Wood, J. M., Lilienfeld, S. O., & Nezworski, M. T. (2002). Effective use of projective techniques in clinical practice: Let the data help with selection and interpretation. Professional Psychology: Research and Practice, 33, 454-463.

Using a disturbing case history as a jumping off point, the authors review the research evidence concerning the psychometric properties of widely used projective techniques (Rorschach, Thematic Apperception Test, and human figure drawings) and outline the implications of this evidence for the practicing clinician. They place particular emphasis on recent findings indicating that the current norms for the Comprehensive System for the Rorschach tend to overpathologize respondents and thereby often make normal individuals appear "sick." In addition, they contend that many widely used projective indices have not been consistently supported in independent validation studies. Garb and his colleagues conclude that projective techniques have certain legitimate circumscribed uses in clinical practice (e.g., the use of the Rorschach to detect thought disorder), but that practitioners must base their interpretations only on projective indices that demonstrate consistent (well-replicated) empirical support.

Hawley, K. M., & Weisz, J. R. (2002). Increasing the relevance of evidence-based treatment review to practitioners and consumers. Clinical Psychology: Science and Practice, 9, 225-230.

The authors briefly discuss obstacles toward identifying and implementing evidence-based psychological interventions, including problems involving treatment transportability to real-world settings and controversies concerning how treatments are defined.

Hays, K. A., Rardin, D. K., Jarvis, P. A., Taylor, N. M., Moorman, A. S., & Armstead, C. D. (2002). An exploratory survey on empirically supported treatments: Implications for internship training. Professional Psychology: Research and Practice, 33, 207-211.

Hays and colleagues report the results of a survey of empirically supported treatment (EST) use among American Psychological Association-accredited internship sites. They found that only 28% of such sites offered more than 15 hours of training in ESTs. The rates of EST implementation appeared to be particularly low in university counseling centers. Among the principal obstacles toward EST use cited by internship sites were the lack of flexibility in the number of therapy sessions allotted for treatments, the absence of a requirement to justify treatment plans to managed care organizations, and the perception that some ESTs do not address clients' primary presenting problems. Four percent of responding internship sites reported that they did not believe that EST training was important, and 2% reported that they did not know for certain which psychological treatments are regarded as empirically supported.

Hollon, S. D, Thase, M. E., & Markowitz, J.C. (2002). Treatment and prevention of depression. Psychological Science in the Public Interest, 3, 39-77.

The authors provide a comprehensive review of the major psychological and psychopharmacological treatments for depression. They conclude that there is convincing support for the efficacy of both cognitive-behavior and interpersonal therapy for depression, as well as for antidepressant medication (e.g., selective serotonin reuptake inhibitors) and electroconvulsive therapy, although the lattermost intervention is generally recommended only for treatment-refractory cases. The also conclude that the evidence for the efficacy of several other widely used treatments, including psychodynamic therapy, is weaker and in many cases still preliminary.

Koide, R., Chien, C. P., Iizuka, S., & Morita, N. (2002). A mass of flesh: Schizophrenic Rorschach percepts. Comprehensive Psychiatry, 43, 474-477.

The authors investigate previous informal observations that Rorschach percepts involving a mass of flesh (e.g., "the carcass of an animal") are more frequent among schizophrenic patients than among other individuals. They examined the Rorschach protocols of 22 patients with acute schizophrenia, 30 patients with anxiety disorders, 18 patients with psychotic mood disorders, and 28 normal comparison participants. As predicted, responses involving flesh masses were significantly more frequent among schizophrenic patients than among individuals in the other groups.

Lampropoulos, G. K., & Spengler, P. M. (2002). Introduction: Reprioritizing the role of science in a realistic version of the scientist-practitioner model. Journal of Clinical Psychology, 58, 1195-1197.

The authors introduce a special section of the Journal of Clinical Psychology that deals with approaches to conceptualizing a realistic version of the scientist-practitioner (Boulder) model. They point out that survey research has consistently indicated that practicing clinicians tend to underutilize research evidence on therapeutic efficacy, and that only a small proportion (11%) of therapists report conducting any formal outcome evaluations in their clinical practice. Moreover, there are serious pragmatic obstacles (e.g., time limitations) confronting practitioners who wish to keep abreast of published psychotherapy outcome research. The articles in the special section focus on how a scientist-practitioner model can realistically be integrated into everyday clinical practice. The articles focus on such issues as how (a) client-focused research can be used to inform private practice work, (b) clinicians can draw from treatment outcome research to inform the selection of interventions, and (c) thoughtful approaches to psychotherapy integration can enhance the scientist-practitioner model.

Largo-Marsh, L., & Spates, C. R. (2002). The effects of writing therapy in comparison to EMD/R on traumatic stress: The relationship between hypnotizability and client expectancy to outcome. Professional Psychology: Research and Practice, 33, 581-586.

The authors compared the efficacy of structured journal writing, which has been used as an intervention for traumatic or otherwise stressful events, with that of eye movement desensitization and reprocessing (EMDR). The participants, who were 24 individuals who experienced symptoms of posttraumatic stress disorder (PTSD), were randomly assigned to one of these two conditions and assessed for a variety of psychopathological symptoms at post-treatment and one-month follow-up. Repeated measures analyses of variance revealed significant reductions in symptoms for both interventions at both posttreatment and follow-up, with no clear differences favoring either intervention. The authors concluded that their findings "lend support to the use of structured writing as a viable intervention for traumatic stress conditions" (p. 585). Nevertheless, the absence of a no-treatment control group renders their findings difficult to interpret.

Lees-Haley, P. R., Price, J. R., Williams, C. W., & Betz, B. P. (2001). Use of the Impact of Events Scale in the assessment of emotional distress and PTSD may produce misleading results. Journal of Forensic Neuropsychology, 2, 45-52.

The authors examined the extent to which the use of the Impact of Events Scale (IES), which is used widely in the research and clinical literatures on posttraumatic stress disorder (PTSD), may yield false-positive results. They asked 58 college students to fill out the IES with the target stressful event being the worst television program or film they had viewed recently. Remarkably, participants' IES scores were in the range associated with clinical levels of PTSD symptoms. These findings raise serious concerns about the use of the IES to assess symptoms of PTSD, as was done in a number of studies conducted in the wake of the September 11 terrorist attacks.

Lilienfeld, S. O. (2002). When worlds collide: Social science, politics, and the Rind et al. (1998) child sexual abuse meta-analysis. American Psychologist, 57, 176-188.

Lilienfeld reviews the political firestorm surrounding the meta-analysis by Bruce Rind and his colleagues, which appeared in Psychological Bulletin in 1998. This quantitative review, which suggested that the associations between child sexual abuse and subsequent psychopathology were often quite weak in magnitude, was condemned vociferously by conservative talk show hosts (e.g., Dr. Laura Schlessinger) and conservative politicians (e.g., Rep. Thomas Delay of Texas) as well as by some advocates for sexually abused children. The Rind et al. article also became the first scientific article ever formally condemned by the United States Congress. The American Psychological Association, which published the article, was widely perceived as capitulating to Congress by apologizing for the article's primary findings and conclusions. Lilienfeld argues that the Rind et al. incident raises significant and troubling questions regarding academic freedom, the integrity and autonomy of the peer review process, the need for social scientists to better educate the public and politicians regarding the nature of the scientific enterprise, and the challenges of communicating the key differences between science and common sense. See also articles in the same issue by Brian Baird, Nora Newcombe, Richard McCarty, Robert Sternberg, and others.

Litz, B. T., Gray, M. J., Bryant, R. A., & Adler, A. B. (2002). Early interventions for trauma: Current status and future directions. Clinical Psychology: Science and Practice, 9, 112-134.

The authors report the results of a meta-analysis of treatments for early trauma. They conclude that psychological debriefing, which was used widely in the aftermath of the September 11 terrorist attacks on New York City and Washington, DC, does not appear to be effective as an intervention for early trauma. The mean effect size (Cohen's d) of psychological debriefing on measures of posttraumatic stress disorder was -.11, which suggests that this intervention may exert iatrogenic effects. In contrast, Lidz and his colleagues found that cognitive-behavioral therapy has yielded promising results as a treatment for early trauma.

Loftus, E. F., & Guyer, M. J. (2002, May/June). Who abused Jane Doe? The hazards of the single case history. Skeptical Inquirer, 26, 24-32.

The authors begin by discussing both the strengths and limitations of case histories and anecdotal reports in social science. They note that case report evidence can be immensely useful for generating psychological hunches and hypotheses, but that such evidence is susceptible to numerous methodological limitations (e.g., biases in retrospective recall, the idiosyncratic interpretations of the storyteller). Loftus and Guyer illustrate these points with the case of "Jane Doe," a woman whose videotaped descriptions of her childhood sexual abuse were widely proclaimed as offering an "existence proof" for the presence of recovered memories of sexual abuse. They maintain that the evidence surrounding the Jane Doe case is considerably less compelling than most advocates of recovered memories have maintained. Loftus and Guyer regard the Jane Doe story as "a cautionary tale not only for those professionals who advance the case history, but also for those who base their theories on it or would readily accept it as proof" (p. 25). See also the follow-up articles by Loftus and Guyer and by Carol Tavris in the succeeding (July/August, 2002) issue of Skeptical Inquirer.

Margolin, A., Kleber, H. D., Avants, S. K., Konefal, J., Gawin, F., Stark, E., et al. (2002). Acupuncture for the treatment of cocaine addiction: A randomized controlled trial. Journal of the American Medical Association, 287, 55-63.

The authors report the findings from a randomized, controlled trail of auricular (ear-based) acupuncture on cocaine dependence conducted over a 3-year period. In this study, 620 cocaine-dependent adults were randomized to one of three conditions: auricular acupuncture, a needle control, and a relaxation control. The results revealed no significant differences in cocaine use either during treatment or after 3- and 6-month follow-ups, although cocaine use declined following treatment in all three conditions. The findings call into question the efficacy of acupuncture for cocaine addiction.

Merckelbach, H., Devilly, G. J., & Rassin, E. (2002). Alters in dissociative identity disorder: Metaphors or genuine entities? Clinical Psychology Review, 22, 481-497.

Merckelbach and his colleagues review the research evidence bearing on the psychological reality of "alters" (purported alternative personalities) among patients with dissociative identity disorder (DID), the condition known formerly as multiple personality disorder. They contend that neither studies of implicit or explicit memory nor studies of physiological (e.g., electroencephalographic, functional brain imaging) differences across alters provide compelling evidence that alters constitute genuine personalities. Merckelbach and his colleagues conclude that the extant evidence is consistent largely with a sociocognitive model of DID advanced by Spanos and others, which posits that alters can be best explained by a process of role enactment triggered by sociocultural expectations and inadvertent therapist cueing of purported latent identities.

Mihura, J. L., & Weinle, C. A. (2002). Rorschach training: Doctoral students' experiences and preferences. Journal of Personality Assessment, 79, 39-52.

The authors report the results of a survey of psychology graduate students in the American Psychological Association (N=254) concerning their training experiences and interests involving the Rorschach Inkblot Test. They found that 87% of students received an introductory assessment course that included the Rorschach, and that approximately one fourth were offered an advanced course on the Rorschach. Eighty-one percent of students felt that that the Rorschach was useful for "understanding personality dynamics," although only about one half felt that it was useful for either treatment planning or formal diagnostic assessment. Overall levels of satisfaction with Rorschach training were significantly correlated with several variables, including enrollment in a Psy.D. (as opposed to a Ph.D.) program and enrollment in a psychodynamic or eclectic (as opposed to a cognitive-behavioral) program.

Nanya, S. (2002). Traffic deaths and superstition on Friday the 13th. Archives of General Psychiatry, 159, 2110-2111.

In a population-based study of traffic accidents in Finland (1971-1997), Nanya found that for women (but not for men) the number of traffic deaths on Friday the 13th exceeded significantly the number expected by chance. The author conjectured that this increase was attributable to the anxiety engendered among women by belief in the Friday the 13th superstition (known technically as "paraskevidekatriaphobia"), and estimated that 38% of traffic-related deaths among women on Friday the 13th were attributable to this date per se.

Pope, H. G., Cohane, G. H., Kanayama, G., Siegel, A. J., & Hudson, J. I. (2003). Testosterone gel supplementation for men with refractory depression: A randomized, placebo-controlled trial. American Journal of Psychiatry, 160, 105-111.

Pope and his colleagues examined the efficacy of a testosterone transdermal gel among males who had both treatment resistant depression and low or borderline levels of testosterone. They conducted an 8-week randomized controlled trial in 19 men who received either testosterone gel or an identically appearing placebo gel. The authors reported that males who received the testosterone gel exhibited significantly greater improvement on the Hamilton Depression Rating Scale and on measure of global functioning (but not on the Beck Depression Inventory) than did males who received placebo. Pope and his coauthors concluded that testosterone gel may hold promise as a treatment for depressed males with low levels of testosterone, although further investigation of this possibility is necessary.

Power, K., McGoldrick, T., Brown, K., Buchanan, R., Sharp, D., Swanson, V., et al. (2002). A controlled comparison of eye movement desensitization and reprocessing versus exposure plus cognitive restructuring versus waiting list in the treatment of post-traumatic stress disorder. Clinical Psychology and Psychotherapy, 9, 299-318.

Power and his colleagues randomly assigned 105 participants with DSM-IV posttraumatic stress disorder to one of three conditions: eye movement desensitization and processing (EMDR), exposure plus cognitive restructuring (ECR), or a waiting list control. Repeated measures analyses of variance revealed significant improvements in PTSD symptoms for the EMDR and ECR group (but few differences between these two groups), but not the wait-list control group, at the conclusion of treatment (10 weeks). Most of these improvements were maintained at 15-month follow-up, again with few differences between EMDR and ECR (although participants in the EMDR condition showed significantly greater improvement than did those in the ECR condition on assessor-rated depression). The authors conclude that "both EMDR and ECR are effective in the treatment of PTSD with only a slight advantage in favor of EMDR" (p. 300).

Raz, A., Shapiro, T., Fan, J., & Posner, M. I. (2002). Hypnotic suggestion and the modulation of Stroop interference. Archives of General Psychiatry, 59, 1155-1161.

Raz and his colleagues report a study of 16 highly hypnotically suggestible and 16 less hypnotically suggestible participants who were administered the Stroop color-naming task, a well known test that requires participants to name the colors of ink (e.g., blue) of words that spell the name of a competing color (e.g., green). Participants were given a posthypnotic suggestion to read only the colors of ink. The results showed that posthypnotic suggestion eliminated the Stroop interference effect in highly suggestible participants.

Simons, R., Goddard, R., & Patton, W. (2002). Hand-scoring error rates in psychological assessment. Assessment, 9, 292-300.

The authors followed up on recent findings (Allard & Faust, 2000, Assessment) suggesting that serious errors in the hand scoring of commonly used psychological tests are considerably more frequent than commonly believed. They examined seven tests (e.g., Beck Depression Inventory) that are used widely by practitioners and found that major scoring errors were frequent for all tests. For example, approximately 5% of Beck Depression Inventory protocols scored by professionals contained at least one error. The authors also found that the complexity of test scoring appeared to be related to scoring error rates.

Smith, J. D., & Dumont, F. (2002). Confidence in psychodiagnosis: What makes us so sure? Clinical Psychology and Psychotherapy, 9, 292-298.

The authors begin by noting that mental health professionals have been found to be prone to overconfident interpretations on many judgmental and predictive tasks. To investigate the sources of such overconfidence, they presented 36 practitioners with a case-file from a client and asked them to offer clinical interpretations aloud as they read from it. Smith and Dumont found that "dispositionism," that is, the tendency to invoke trait-oriented rather than situational attributions for client behavior, was significantly associated with practitioner overconfidence.

Tanguay, P. E. (2002). Commentary: The primary of the scientific method. Journal of the American Academy of Child and Adolescent Psychiatry, 41, 1322-1333.

Tanguay comments on the negative findings concerning the efficacy of secretin for infantile autism by Unis et al. (see below) and discusses the importance of the scientific method as a safeguard against unvalidated or invalidated treatments for this condition. Among the treatments he mentions that fall into this class are facilitated communication, megavitamins, special diets, chelation, and auditory integration. Tanguay concludes that "no matter how reassuring, no matter how exciting the finding, no matter what hope it holds out to parents and children, the results of anecdotal studies, single-subject trials, nonrandomized designs, and non-placebo-controlled investigations must be looked upon with skepticism" (p. 1323).

Unis, A. S., Munson, J. A., Rogers, S.J., Goldson, E., Osterling, J., Gabriels, R., et al. (2002). A randomized, double-blind, placebo-controlled trial of porcine versus synthetic secretin for reducing symptoms of autism. Journal of the American Academy of Child and Adolescent Psychiatry, 41, 1315-1321.

This study was designed to examine the efficacy of secretin, a polypeptide hormone widely touted (on the basis of initial anecdotal reports) as an efficacious treatment for infantile autism, on the primary symptoms of this condition. The authors randomly assigned autistic participants to one of three conditions: biological secretin, synthetic secretin, and placebo. Both parent and teacher reports yielded statistically significant improvements on the primary outcome measures, with no statistically significant differences between secretin and placebo. This investigation, which is the sixth negative placebo-controlled trial of the efficacy of secretin (out of six such trials), raises serious questions concerning the continued use of secretin for infantile autism.

Viglione, D. J., & Taylor, N. (2003). Empirical support for interrater reliability of Rorschach Comprehensive System coding. Journal of Clinical Psychology, 59, 111-121.

Viglione and Taylor review the literature bearing on the interrater reliability of 70 variables derived from the Rorschach Comprehensive System (CS). They conclude that the overwhelming majority (approximately 95%) of variables derived from this system enjoy high (intraclass correlation >.80) interrater reliability, and that previous claims of low CS interrater reliability are attributable to the inclusion of low base rate Rorschach variables. According to Viglione and Taylor, the research literature "supports the view that CS Rorschach variables are reliably coded when administered and scored by well-trained individuals" (p. 119).

Wood, J. M., Garb, H. N., Lilienfeld, S. O., & Nezworski, M. T. (2002). Clinical assessment. Annual Review of Psychology, 53, 519-543.

The authors review major recent developments in the assessment of personality and psychopathology, with particular focus on the importance of evidence-based assessment practices. They note that managed care has exerted increasing pressure on practicing psychologists to use assessment devices that possess strong empirical support. Wood and his colleagues review the recent research evidence concerning multicultural clinical assessment, forensic assessment, the Rorschach Comprehensive System, self-report measures, and clinical judgment and decision making, and offer four predictions for the future of clinical assessment. Specifically, they predict that (a) the demands on assessment practice imposed by managed care are likely to continue or increase; (b) empirically supported approaches to multicultural assessment will become increasingly important in coming years; (c) assessment methods used by forensic psychologists will come under heightened scrutiny by lawyers; and (d) developments in basic science (e.g., genomics) will exert a powerful influence on assessment approaches of the future.

Zanarini, M. C., & Frankenburg, F. R. (2003). Omega-3 fatty acid treatment of women with borderline personality disorder: A double-blind, placebo-controlled pilot study. American Journal of Psychiatry, 160, 167-169.

The authors report the results of an 8 week, randomized, double-blind study of the use of omega-3 fatty acid (which has demonstrated preliminary support in the treatment of bipolar disorder and recurrent major depression) in the treatment of borderline personality disorder. Twenty participants who met DSM-IV criteria for borderline personality disorder were randomized to either an omega-3 fatty acid condition or a placebo condition. After controlling for baseline symptom severity, the authors found that omega-3 fatty acid produced significantly greater decreases in mood symptoms and hostility compared with placebo.

Recent Books of Interest

Antony, M. M., & Barlow, D. H. (Eds.). (2002). Handbook of assessment and treatment planning for psychological disorders. New York: Guilford Press.

Boese, A. (2002). The museum of hoaxes. New York: Dutton.

Helzer, J. E., & Hudziak, J. J. (Eds.). (2002). Defining psychopathology in the 21st century: DSM-V and beyond. Washington, DC: American Psychiatric Association Press.

Lilienfeld, S. O., Lynn, S. J., & Lohr, J. M. (Eds.). (2003). Science and pseudoscience in clinical psychology. New York: Guilford Press.

McNally, R. J. (2003). Remembering trauma. Cambridge, MA: Harvard University Press.

Myers, D. G. (2002). Intuition: Its powers and perils. New Haven, CT: Yale University Press.

Wood, J. M., Nezworski, M. T., Lilienfeld, S. O., & Garb, H. N. (2003). What's wrong with the Rorschach? Science confronts the controversial inkblot test. New York: Jossey-Bass.

You can view this list in
The Scientific Review of Mental Health Practice, vol. 2, no. 1 (Spring/Summer 2003).
Subscribe now!

  ©2004 Center for Inquiry    | SRMHP Home | About SRMHP | Contact Us |