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

Aldridge, J., Lamb, M. E., Sternberg, K. J., & Orbach, Y. (2004). Using a human figure drawing to elicit information from alleged victims of child sexual abuse. Journal of Consulting and Clinical Psychology, 72, 304–306.

Aldridge and colleagues examine the capacity of human figure drawings to elicit forensically useful information from children suspected of having been sexually abused. They found that these drawings were particularly useful in eliciting such information (once all other information had been “exhausted”) in younger children (4- to 7-year-olds), although the authors acknowledge that the accuracy of such information is undetermined. They also note that the administration of drawings was often accompanied by suggestive memory prompts, which are known to be associated with high rates of false-positive errors. The authors suggest that human figure drawings should be used only at the late stages of abuse investigations to minimize potential errors.

Cumella, E. J. (2003). Is equine therapy useful in the treatment of eating disorders? Eating Disorders: The Journal of Treatment & Prevention, 11, 143–147.

The author discusses the efficacy of equine (horse-assisted) therapy in the treatment of anorexia and bulimia, and offers a tentative “yes” to the question posed in this title. He argues that increasing evidence supports the use of animal-assisted interventions, including equine therapy, for eating disorders and other psychological conditions, and describes the typical activities during an equine therapy session. Nevertheless, the author does not sufficiently emphasize that this procedure has never been examined in controlled outcome studies. Nor does he note that the effects of equine therapy, even if genuine, are potentially attributable to increased attention, relaxation, distraction, or a host of nonspecific factors.

Del Vecchio, T., & O’Leary, K. D. (2004). Effectiveness of anger treatments for specific anger problems: A meta-analytic review. Clinical Psychology Review, 24, 15–34.

The authors conduct a quantitative review of 23 controlled studies examining the efficacy of anger treatments. Overall, they report that such treatments exert medium to large effects on anger. Moreover, they find that cognitive therapies appear to be most efficacious for road rage, anger suppression, and anger-proneness (trait anger), whereas relaxation therapies appear to be most efficacious for short-term anger problems (state anger). They note, however, that the paucity of long-term follow-up studies renders it difficult to ascertain the long-term effects of such treatments. Moreover, the authors point out the absence of controlled studies on popular cathartic treatments, which focus on the release of anger, but caution that such treatments “are likely to be ineffective and may even encourage individuals to engage in aggressive acts” (p. 31).

Devilly, G. J., & Cotton, P. (2004). Caveat emptor, caveat venditor, and critical incident stress debriefing/ management (CISD/M). Australian Psychologist, 39, 35–40.

Devilly and Cotton respond to advocates of critical incident stress debriefing/management (CISD/M) by arguing that critical incident stress debriefing and critical incident stress management appear to be essentially equivalent treatments. Moreover, they maintain that CISD/M has become a multimillion-dollar industry despite the lack evidence that it is efficacious. In addition, they note that approximately 28% of Americans were offered trauma counseling following the September 11 attacks, and that tens of thousands of individuals are trained in CISD/M and related methods each year. They conclude that there are “no reliable studies demonstrating the efficacy of group debriefing” (p. 35) and that there are reasons to suspect that debriefing may be harmful in some instances.

Freiheit, S. R., Vye, D., Swan, R., & Cady, M. (2004). Cognitive-behavioral therapy for anxiety: Is dissemination working? The Behavior Therapist, 27, 25–32.

Freiheit and his coauthors report the results of a survey of 189 Minnesota-licensed, doctoral-level psychologists’ use of treatments for anxiety disorders. As they note, their results “are simultaneously encouraging and concerning” (p. 31). On the positive side, many clinicians appear to be making regular use of behavioral and cognitive-behavioral interventions, which have been shown to be efficacious for most anxiety disorders. On the negative side, substantial numbers of practitioners do not use treatments demonstrated to be efficacious, and use treatments of doubtful scientific standing. For example, 26% percent of respondents said that they never or rarely use exposure and response prevention when treating obsessive-compulsive disorder (OCD), even though this treatment is the most strongly supported intervention for OCD. Between 17% and 21% of practitioners at least occasionally use eye movement desensitization and reprocessing (EMDR) to treat OCD, panic disorder, or social phobia, even though EMDR has only been shown to be efficacious for civilian posttraumatic stress disorder. And between 8% and 10% use energy therapies for anxiety disorders, even though such treatments have no demonstrated efficacy for these conditions.

Guriel, J., & Fremouw, W. (2004). Assessing malingered posttraumatic stress disorder: A review. Clinical Psychology Review, 23, 881–904.

Guriel and Fremouw examine the comparative ability of commonly used assessment instruments, including the MMPI–2, Rorschach, Personality Assessment Inventory, and structured psychiatric interviews, to detect malingered posttraumatic stress disorder (PTSD) among claimants. They note that several measures used commonly to assess PTSD, including the Mississippi Scale for Combat-Related PTSD, appear to be ineffective for detecting malingered PTSD, raising questions regarding their clinical utility. In addition, they point out that many measures commonly used to assess PTSD lack validity indicators to detect faking. They conclude that “there is no method or single instrument that is universally recognized as being the best tool to detect malingering in PTSD claimants” (p 881), although several of these methods appear to do better than chance at this task.

Hayes, S. C., Masuda, A., Bissett, R., Luoma, J., & Guerrero, L. F. (2004). DBT, FAP, and ACT: How empirically oriented are the new behavior therapy technologies? Behavior Therapy, 35, 35–54.

Steven Hayes and his colleagues respond to criticisms that three new and largely “experiential” therapeutic methods—dialectical behavior therapy (DBT), functional analytic psychotherapy, and acceptance and commitment therapy—have been overpromoted relative to the sparse amount of research data available on their efficacy. They identify 42 outcome-based investigations of these three methods, most of which have appeared only in the past few years. In the case of DBT, they conclude that it is “clearly the best empirically validated psychosocial treatment” (p. 48) for borderline personality disorder. Although acknowledging that the evidence for all three treatments is preliminary, Hayes and colleagues assert that their developers have been appropriately circumspect regarding their claims of efficacy. The authors do not directly address, however, the proliferation of well-attended training workshops in these methods at major international conferences.

Henig, R. M. (2004, April 4). The quest to forget. New York Times Magazine, 32–37.

Henig examines the scientific and ethical implications of recent promising, but preliminary, research by Harvard psychiatrist Roger Pitman and others on the use of a beta-blocker (propranolol) to eradicate traumatic memories and perhaps ward off posttraumatic stress disorder in trauma-exposed individuals. She points that the possibility of “therapeutic forgetting” is intensely controversial. Some ethicists contain that such treatment may render us “numb of life’s sharpest arrows” (p. 37) and thereby render us less capable of effectively confronting psychological pain. In contrast, others contend that certain memories, such as horrific memories of wartime combat, serve no adaptive function and are best forgotten.

Hunsley, J. (2003). Introduction to the Special Section on incremental validity and utility in clinical assessment. Psychological Assessment, 15, 443–445.

Hunsley introduces this important special section on incremental validity, which refers to the extent to which a measure provides useful information above and beyond existing sources of data. He maintains that despite its pragmatic and scientific significance, the concept of incremental validity has received insufficient attention in the personality and psychopathology assessment literatures. As he notes (see article by Haynes and Lench in this special section), fewer than 10% of articles submitted to Psychological Assessment (the premier assessment journal in psychology) provide information concerning incremental validity. As Hunsley notes, the paucity of data on incremental validity should lead psychologists to be more circumspect in their claims regarding the utility of clinical assessment measures.

Jittler, S., Beyerstein, D. F., & Beyerstein, B. L. (2003/2004). Placebo effects: A conceptual analysis and a reply to Kienle and Kiene. The Scientific Review of Alternative Medicine, 7, 41–60.

The authors scrutinize previous arguments by proponents of complementary and alternative medicine (CAM) against the placebo concept and against placebo-controlled studies. Specifically, they take aim at the claims by supporters of CAM that placebo-controlled studies are questionable because placebos exert genuine effects on physiology by altering individuals’ attitudes and beliefs. As the authors note, the question of whether the efficacy of previously untested procedures exceeds that of placebo is central.

Jureidini, J. N., Doecke, C. J., Mansfield, P. R., Haby, M. M., Menkes, D. B., & Tonkin, A. L. (2004). Efficacy and safety of antidepressants for children and adolescents. British Medical Journal, 328, 879–883.

Jureidini and his colleagues critically examine and quantitatively analyze the literature concerning the use of antidepressants in children and adolescents. They contend that the efficacy of antidepressants in children and adolescents has typically been overstated (a mean effect of Hedges’s g of .26, which is the small range) and that the adverse side effects of these medications have been understated, especially in individuals with obsessive-compulsive disorder. In addition, they argue that the clinical significance of antidepressants above and beyond placebos for children and adolescents is questionable. For example, their analyses reveal that placebo and other nonspecific effects can account for 87% of the efficacy of sertraline (Zoloft).

Masterpasqua, F., & Healy, K. N. (2003). Neurofeedback in psychological practice. Professional Psychology: Research and Practice, 24, 652–656.

The authors review the status of the research literature on neurofeedback (neurotherapy) for attention-deficit/ hyperactivity disorder (ADHD), mood disorders, and other conditions (e.g., schizophrenia, anxiety disorders). They conclude that four independent research teams have demonstrated the efficacy of neurofeedback in controlled clinical trials. Nevertheless, they note that the evidence for the efficacy of this treatment is preliminary and that its use as a standalone treatment for ADHD and other conditions is premature. Regrettably, they do not cite the critical review of neurofeedback published in this journal by Kline, Brann, and Loney (2002, “A cacophony in the brainwaves: A critical appraisal of neurotherapy for attention-deficit disorders, The Scientific Review of Mental Health Practice, 1, 23–43).

McNally, R. J. (2004). The science and folklore of traumatic amnesia. Clinical Psychology: Science and Practice, 11, 29–33.

McNally addresses common sources of confusion regarding the existence of amnesia ostensibly resulting from exposure to traumatic events. He identifies several major sources of such misunderstanding, including (1) a conflation of ordinary memory failures with traumatic amnesia; (2) a failure to distinguish traumatic amnesia from amnesia due to clear-cut organic causes; (3) a confusion between psychogenic amnesia, which involves massive forgetting in conjunction with a loss of one’s identity, with much more circumscribed traumatic amnesia; and (4) a confusion between a choice not to think about a painful event and repression. See also articles in the same issue by David Gleaves and colleagues, John Kihlstrom, and Marylene Cloitre.

McNally, R. J., Bryant, R., & Ehlers, A. (2003). Does early psychological intervention promote recovery from posttraumatic stress? Psychological Science in the Public Interest, 4, 45–79.

McNally and his colleagues review the research on the efficacy of “psychological first aid” for victims of trauma. As they point out, more than 9,000 counselors administered critical incident stress debriefing (crisis debriefing) and similar early interventions to witnesses and victims of the World Trade Center attacks on September 11, 2001. Their literature review indicates that although many victims of early trauma report that crisis debriefing is helpful, most controlled studies demonstrate no positive effects of this intervention. Instead, at least two controlled studies suggest that crisis debriefing may actually increase the risk of posttraumatic stress disorder among trauma exposed individuals, most likely by impeding natural recovery processes. In contrast, cognitive-behavioral interventions, which (unlike crisis debriefing and other forms of “psychological first aid”) are delivered months after traumatic events, appear to be helpful, and are more efficacious than either supportive therapy or no treatment.

Olatanji, B. O., Feldner, M. T., White, T. W., & Sorrell, J. T. (2004). Graduate training of the scientist- practitioner: Issues in translational research and statistical analysis. The Behavior Therapist, 27, 45–50.

The authors argue that despite the laudable goals of the scientist-practitioner model, few graduate programs in clinical psychology offer training in translational research or statistics, both of which are essential to applying scientific findings to clinical practice. They recommend that graduate programs in clinical psychology incorporate systematic training in research methods used by clinical investigators. They conclude that the current American Psychological Association accreditation requirements emphasize “proving competency in science and practice” rather than “courses that explicitly serve as an integration of the two domains” and that “expanding the applications of the [scientist-practitioner] model to prescription privileges before we have improved current practices (e.g., translational research) could add to current problems in graduate training” (p. 49).

Smith, K. R. (2003). The ethics of anomalous, unconventional therapies: A utilitarian response. The Scientific Review of Alternative Medicine, 7, 26–28.

Smith contends that encouragement and tolerance of unsubstantiated medical therapies may have serious deleterious consequences. In particular, he maintains that premature societal acceptance of such therapies may lead to “a diversion of public and private resources from methods predicated on logic and evidence and a weakening of commitment to science-based medicine” (p. 26). In addition, he argues that the increasing number of medical school courses dedicated to unproven therapies may lend such therapies an undeserved cachet of scientific respectability.

Recent Books of Interest

Benjamin, L. T., Jr., & Baker, D. B. (2004). From séance to science: A history of the profession in psychology in America. Pacific Grove, CA: Wadsworth.

McGrath, M. (2002). Demons of the modern world. Amherst, NY: Prometheus Books.

O’Donohue, W., Fisher, J.E., & Hayes, S.C. (2003). Cognitive behavior therapy: Applying empirically supported techniques in your practice. Hoboken, NJ: Wiley.

You can read this list in
The Scientific Review of Mental Health Practice, vol. 3, no. 1 (Spring/Summer 2004).
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