Johnsen, T. J., & Friborg, O. (2015, May 11). The Effects of Cognitive Behavioral Therapy as an Anti-Depressive Treatment is Falling: A Meta-Analysis. Psychological Bulletin. Advance online publication. http://dx.doi.org/10.1037/bul0000015

From the Abstract:

• A meta-analysis examining temporal changes (time trends) in the effects of cognitive behavioral therapy (CBT) as a treatment for unipolar depression was conducted.  A comprehensive search of psychotherapy trials yielded 70 eligible studies from 1977 to 2014. … temporal trends indicated that the effects of CBT have declined linearly and steadily since its introduction, as measured by patients’ self-reports (the BDI, p _ .001), clinicians’ ratings (the HRSD, p _ .01) and rates of remission (p _ .01)… Thus, modern CBT clinical trials seemingly provided less relief from depressive symptoms as compared with the seminal trials.

The authors speculate that the placebo effect may be an important factor in the decline in CBT’s efficacy. They note that the “placebo effect is typically stronger for newer treatments; however, as time passes and experience with therapy is gained, the strong initial expectations wane. One may question whether this is the case with CBT. In the initial phase of the cognitive era, CBT was frequently portrayed as the gold standard for the treatment of many disorders. In recent times, however, an increasing number of studies …have not found this method to be superior to other techniques. Coupled with the increasing availability of such information to the public, including the Internet, it is not inconceivable that patients’ hope and faith in the efficacy of CBT has decreased somewhat, in recent decades. …CBT apparently reached a ceiling effect during its first few years.” (p. 16)

Bottom line: A lot of the promise of CBT may have been due to a placebo effect: high hopes and high expectations, plus a narrative that makes sense of one’s misery. Now that CBT is old hat and just about anyone who has been to a therapist has been exposed to CBT, it no longer has that je ne sais quoi that inspires optimism – or at least a better mood. Not feeling that great? It’s probably because of your irrational and inaccurate cognitions. That used to help – but less and less as time goes by.

A few readings and thoughts.

Quoidbach, Jordi, Berry, Elizabeth V., Hansenne, Michel, and Mikolajczak, Moïra Positive emotion regulation and well-being: Comparing the impact of eight savoring and dampening strategies Personality and Individual Differences Volume 49, Issue 5, October 2010, Pages 368–373

From the Abstract:

“…regulatory diversity (i.e., typically using various strategies rather than a few specific ones), was beneficial to overall happiness. Our findings suggest that there are several independent ways to make the best (or the worst) out of our positive emotions, and that the cultivation of multiple savoring strategies might be required to achieve lasting happiness.”

Useful “savoring strategies” included focusing attention on the present moment, engaging in positive rumination, and telling others about positive experiences. The authors conclude: “Hence, our findings contribute to the increasing body of evidence emphasizing the importance of the flexibility of biological and psychological processes for well-being…. our research suggests that practicing as many savoring strategies as possible, whilst avoiding the many faces that dampening can take, is likely the best way to regulate positive emotions.”

The bottom line: no one size fits all. Flexible use of diverse strategies is the way to go. The following meta-analysis came to a similar conclusion:

Aldao, A. Nolen-Hoeksema, S and Schweizer, S. Emotion-regulation strategies across psychopathology: A meta-analytic review. Clinical Psychology Review 30 (2010) 217–237

From the Abstract:

“We examined the relationships between six emotion-regulation strategies (acceptance, avoidance, problem solving, reappraisal, rumination, and suppression) and symptoms of four psychopathologies (anxiety, depression, eating, and substance-related disorders).”

 The authors found in their review of 114 studies rumination and suppression generally made things worse, problem-solving and, to a lesser degree re-appraisal, made things better, and acceptance didn’t have much of an effect. They note that their “findings suggest that certain strategies (i.e., rumination, suppression, avoidance, problem solving) might be more strongly related to mental health than others (acceptance and reappraisal). The relatively small relationships between psychopathology and acceptance and reappraisal are surprising, given the prominent role of these constructs in two major therapeutic approaches: acceptance-based treatments and cognitive-behavioral therapy, respectively.” (232)

 The authors also found that “non-clinical populations showed less of a relationship between specific emotion-regulation strategies and psychopathology than clinical populations” and speculate this “is because the non-clinical populations are more likely to move flexibly between emotion regulation strategies, and this skill is at least as important as the use of any one strategy in determining psychopathology.” (233)

There it is again: flexibility. No one size fits all. Experiment and find out what works. Which brings me to the next study – hot off the presses:

Skorka-Brown, J. Andrade, J., Whalley B. And  May, J. Playing Tetris decreases drug and other cravings in real world settings  Addictive Behaviors Volume 51, December 2015, Pages 165–170

From the Abstract:

“…Previous laboratory research has found that playing Tetris reduces craving strength. The present study used an ecological momentary assessment protocol in which 31 undergraduate participants carried iPods for a week and were prompted 7 times each day, by SMS message, to use their iPod to report craving. Participants reported craving target and strength (0–100), whether they indulged their previous craving (yes/no), and whether they were under the influence of alcohol (yes/no). …Playing Tetris decreased craving strength for drugs (alcohol, nicotine, caffeine), food and drink, and activities (sex, exercise, gaming), with a mean reduction of 13.9 percentage points, effect size f² = 0.11. This effect was consistent across the week. This is the first demonstration that visual cognitive interference can be used in the field to reduce cravings for substances and activities other than eating.”

So playing Tetris is another useful strategy for increasing well-being. Like other animals, humans enjoy that rush of dopamine. I’m thinking that a little Tetris provides a sufficient dopamine boost to weaken cravings – a form of desire management.

Self-denial alone is rarely enough when dealing with unwanted impulses and desires. In addition to inhibition (“Just Say No!”), successful self-regulation often requires we replace what we want to change with something else, ideally something we find rewarding or pleasurable.

Inhibition without replacement tends to trigger “ironic processes” where the more we want a thought or emotion to just go away, the more it haunts us.

Scarcity: Why Having Too Little Means So Much. By Sendhi Mullainathan and Eldar Shafir. Time Books, Henry Holt & Company LLC, New York, NY

Scarcity is about a perceived mismatch between what is available (supply) and what is desired (demand). You pay more attention to things associated with scarcity, whether it’s scarcity of guesses, friends, time, or income. Scarcity creates a mindset affecting what we notice, how we decide and how we act. A bit of scarcity can be productive: it concentrates the mind. Too little scarcity (i.e., abundance) can lead to procrastination and general slackerdom: why do today when there’s no hurry? Why be upset about a loss when there’s a lot more where that came from? Too much scarcity (e.g., poverty) can lead to short-term thinking, impulsiveness, and tunnel vision. Extreme scarcity taxes our cognitive bandwidth: executive functions and self-regulatory resources take a real hit.

So far, so good. The authors’ thesis is compelling and well-supported and could become a prolific generator of testable hypotheses. The scarcity construct could also be profitably applied to fields of inquiry beyond economics and psychology. For instance, it would be fascinating to study how the sense of scarcity (too much or too little) influences mate-seeking behavior in areas with lopsided sex ratios.

On the other hand, the authors overstate their case. They minimize the effect of other factors (especially anxiety and environmental unpredictability) on human behavior, at one point saying that the scarcity-induced bandwidth tax “explains everything”, referring to the short-term thinking of poor farmers. The authors also indulge in a lot of “rathering” (to use Daniel Dennett’s term), e.g., saying lack of skills is not a problem for poor people; rather, it’s just that scarcity has overtaxed their cognitive bandwidth. Why not both? After all, if scarcity involves a perceived lack of resources and skills are a personal resource, then possession of skills reduces scarcity.

The authors’ tunnel vision regarding scarcity makes some of their policy suggestions woefully misguided. For instance, since the scarcity mind-set “explains everything”, they say farmer training or new crops will do little to help poor farmers. Excuse me? In the 1930s, in our own country, poor farmers made tremendous strides in productivity exactly through technical education provided by the Department of Agriculture.

(Of course, to the extent that improvements in skills, crops and technology encourage consolidation of small farms to achieve greater efficiencies, poor farmers would still suffer hardship through lack of competitiveness with larger farms. But the problem has shifted from poverty per se to the issue of whether farming small plots of land can ever be anything other than a marginal mode of existence. That is a complicated matter involving various  trade-offs and is beyond the scope of this review.)

And then the authors pooh-pooh interventions to increase self-regulatory strength (i.e., “willpower”), saying there’s little evidence supporting the efficacy of such training. Say what? There’s a ton of empirical support for these kinds of interventions. For a good review, see Self-Regulation and Personality: How Interventions Increase Regulatory Success, and How Depletion Moderates the Effects of Traits on Behavior.

Bottom line: I still recommend this book. While the authors exaggerate its importance, the scarcity mindset hypothesis still has lots of explanatory value and is an important consideration when formulating possible solutions to difficult societal problems.

Every once in a while, I’ll be posting excerpts from  Evaluating Research Quality: Evaluating Research Quality – Guidelines for Scholarship (2012) by Todd Litman; Victoria Transport Policy Institute

This clearly written, concise and accessible document “discusses the importance of good research, discusses common causes of bias, provides guidelines for evaluating research and data quality, and describes examples of bad research.” It should be required reading for anyone wanting to be a more discerning consumer of scientific evidence and arguments, especially as found in opinion pieces claiming solid scientific backing. Check it out – the pdf is available online.

One of my favorite parts is Litman’s list of “methodological potholes” frequently encountered in science writing. These are based mostly on Huron (2000)* and include:

Hypocrisy: Holding others to a higher methodological standard than oneself.

Ad hominem argument: Criticizing the person rather than their argument.

Discovery fallacy: Criticizing an idea because of its origin (e.g., from a religious text).

Ipse dixit: Appealing to authority figures  (e.g., “Research increasingly shows that…”).

Confirmation bias: The tendency to see events as confirming a theory while viewing falsifying events as “exceptions”.

Ad-hoc hypothesis: Proposing a supplementary hypothesis to explain why a favorite theory or interpretation failed a test.

Data neglect: Tendency to ignore available information when assessing theories or hypotheses.

Anti-operationalizing: The tendency to raise perpetual objections to all operational definitions.

Presumptive representation: The practice of representing others to themselves.

Magnitude blindness: Preoccupation with statistically significant results that have small magnitude effects.

Regression artifacts: The tendency to interpret regression toward the mean as an experimental phenomenon.

Demand characteristics: Any aspect of an experiment that might inform subjects of the purpose of the study.

Placebo effect: Positive or negative response arising from the subject’s expectations of an effect.

Litman also identifies the pothole of “Know-nothing, which implies that “because some issues are unknown, nothing is known”, to which I would add: “Predict-Nothing”: implies that since we can’t know the future for sure, we shouldn’t put any stock in any predicted scenarios.

*David Huron (2000), Sixty Methodological Potholes, Ohio State University (http://dactyl.som.ohio-state.edu/Music829C/methodological.potholes.html)

I’ll put this out first: I’m not a Climate Skeptic! Say it again: I’m not a Climate Skeptic! That said (twice), I am fine with people questioning the so-called “consensus”. This doesn’t mean that I think their opinions are always logical or backed up by high quality science. It just means there should be room for disagreement. As a principle. And those who disagree with this or that aspect of the Climate Change Consensus shouldn’t be implicitly compared to Holocaust deniers.

We all rely on heuristics. My heuristics include: 1) be wary of arguments based on authority; 2) focus on the details of the case; and, 3) look for Red Flags.

In considering scientific evidence or arguments, Red Flags are clear violations of the scientific spirit (see prior post). The various principles that comprise the scientific spirit I call the Virtues of Science. One of the Virtues is the recognition that a lot of things are Matters of Degree. When I see arguments based on Categorical Thinking (e.g., you’re either in this Camp or that Camp), I see Red. This applies to all sides in the Climate Change debate.

Enthusiasts and amateurs are welcome. Academics are welcome. Observations and questions from the whole spectrum of expertise and opinion are appreciated. Feel free to comment – no need to make sure you understand the whole of something before putting in your two bits worth. Initial impressions can be insightful, partly because they are not weighed down by extensive knowledge. And of course expert knowledge and understanding are also valuable!

A Couple Quotes:

“Science is a method, remember – not a body of fact.”

– Reader’s comment on The Economist’s “Unreliable research: Trouble at the lab – Scientists like to think of science as self-correcting. To an alarming degree, it is not.” (October 13, 2013)

“We used to say “question authority” – should we change that to “question authority only if we don’t like what authority says – and then call it ‘orthodoxy’?”

– Miriam Paisley

 Confession:  I am totally enamored of the Scientific Method and the Spirit of Science, speaking of which:

The Spirit of Science

From the Rational Enquirer, Vol 3, No. 3, Jan 90.(taken from The Kansas School Naturalist, Vol. 35, No. 4, April 1989), EO Wilson, “The Social Conquest of Earth” (2013), and W. Jay Wood, “How Might Intellectual Humility Lead to Scientific Insight?” December 10, 2012

Skepticism: Nearly all statements make assumptions of prior conditions. A scientist often reaches a dead end in research and has to go back and determine if all the assumptions made are true to how the world operates.

Suspended judgment: Diederich* describes: “A scientist tries hard not to form an opinion on a given issue until he has investigated it, because it is so hard to give up opinion already formed, and they tend to make us find facts that support the opinions… There must be however, a willingness to act on the best hypothesis that one has time or opportunity to form.”

Willingness to change opinion: When Harold Urey, author of one textbook theory on the origin of the moon’s surface, examined the moon rocks brought back from the Apollo mission, he immediately recognized this theory did not fit the hard facts laying before him. “I’ve been wrong!” he proclaimed without any thought of defending the theory he had supported for decades.

Awareness of assumptions: Diederich describes how a good scientist starts by defining terms, making all assumptions very clear, and reducing necessary assumptions to the smallest number possible. Often we want scientists to make broad statements about a complex world. But usually scientists are very specific about what they “know” or will say with certainty: “When these conditions hold true, the usual outcome is such-and-such.”

Respect for quantification and appreciation of mathematics as a language of science: Many of nature’s relationships are best revealed by patterns and mathematical relationships when reality is counted or measured; and this beauty often remains hidden without this tool.

An appreciation of probability and statistics: Correlations do not prove cause-and-effect, but some pseudoscience arises when a chance occurrence is taken as “proof.” Individuals who insist on an all-or-none world and who have little experience with statistics will have difficulty understanding the concept of an event occurring by chance.

An appreciation for the concept of the continuum: Scientists tend to consider phenomena in terms of values along a continuum – think gradients like temperature, velocity, mass, or wave length. From this perspective, much of what is typically perceived categorically, like “toxins”, is more a matter of degree or “dose”, which changes the research question, e.g., from “Is this substance toxic?” to “At what dose does this substance have toxic effects?”

An understanding that all knowledge has tolerance limits: All careful analyses of the world reveal values that scatter at least slightly around the average point; a human’s core body temperature is about so many degrees and objects fall with a certain rate of acceleration, but there is some variation. There is no absolute certainty.

Intellectual Humility: W. Jay Wood: “It is integral to science, as a self-correcting discipline, to receive criticism, and to be prepared to admit that some particular theory or practice is incomplete or incorrect. Suitably humble scientists are alive to the possibility that their expectations about how nature should behave may be wrong. Philosopher of science Israel Scheffler dubs this openness to correction “a capacity for surprise,” to which intellectual humility surely contributes.”

*Diederich, Paul B. “Components of the Scientific Attitude,” Science Teacher, February, 1967, pp. 23-24

That said, scientists are imperfect vessels for channeling the Spirit of Science.

So make sure your critical faculty is turned on when reading claims made in the name of science.  A Few Links to help fine-tune your ability to separate the wheat from the chaff:

Why Most Published Research Findings Are False (John P. A. Ioannidis,2005)

Problems with scientific research: How science goes wrong (The Economist – October 19, 2013)

Unreliable research: Trouble at the lab (The Economist – October 19, 2013)

Note: New stuff – reviews, quotes, commentaries – will be posted at least weekly.