It's Not Me, It's You.

Three weeks ago, I reluctantly dropped my dog, a Siberian Husky/German Shepherd mix named Cal, off at the local SPCA. Standing at the intake desk with Cal on a leash, I answered various questions regarding Cal’s habits and tendencies. Cal happily sniffed and engaged passers-by and occasionally put his paws up on the counter to peek at the lady behind the desk while I explained how he was a happy, energetic dog, but very complex, very emotional. I had spent the past six months with Cal, and despite his very happy daily attitude, we had gotten in a couple tiffs over food. Dogs can sometimes get very possessive of their resources, to the point where they will growl at you when you bring your hand near their food bowl. Cal had this problem. This was not why I was giving him up, however. I was giving him up because I’m a selfish 24 year old who likes to travel a lot and can’t afford a dog, financially or emotionally. Anyway, when I say “tiffs over food,” what I mean is that Cal would growl when I fed him, at which point I had no choice but to take the bowl away (I had to win the argument), and being that he is about my size, this was a challenge - a couple times, it got quite ugly - but I always won. After I took the bowl, he would be very upset. He wouldn’t continue growling, but he was noticeably angry. He would sulk. He would give me dirty looks. If he could walk and talk, I know he would have probably cussed me out and slammed the door behind him on his way to bed. It would take him about 24 hours to start treating me normal again. He was incredibly joyful and friendly, but he was also the deepest, most complex dog I have ever encountered. I was trying to explain all of this to the lady behind the counter, but could tell by the rate of head nods and “uh huh’s” that she displayed, that maybe I wasn’t getting through. She had probably heard owners being grandiose about their dogs' abilities and quirks before, and I was just one more person ranting on about how "special" their pet is.

Well, it circled back around. This morning, I got a call from the SPCA. They’ve tried breaking him of his “resource guarding,” and it isn’t working. They had tried feeding him with a bowl and he reacted violently – to the point where she did not feel comfortable letting anyone at the SPCA interact with him: he was too scary. My heart sank, to say the least. In my head I was thinking that they should have been hand-feeding him, like I did everyday. I was thinking they should let him interact with dogs and people, like I did everyday, and they should never give him treats, unless he does something amazing, and even then, it can’t be an awesome treat, it has to be lame, because he has to constantly be in need. Feeding him in a bowl was the easy way, and Cal wants it the hard way—he wants to work for everything, and he loves a challenge. But as soon as he gets that sense of entitlement that comes with a neatly packaged bowl of food at his disposal, he says “to hell with the relationship!” and starts growling so you’ll bug off. He has to be trained to need you, all the time, everyday.

In the last two months that I had Cal, he never growled. He sat and laid down on command. He trotted next to me while I went for a run, without the aid of a leash. He can learn, he can be obedient, and he is smart. Too smart, in a way.

But things are not going well at the SPCA. They think he’s part wolf. They say he’s not adoptable. They do not feel comfortable handing him over to anybody. He does not fit in society as-is. He belongs in the wild.

I think of him isolated behind the chain-link walls of a dog run, and sigh.

To me, this situation screams the points in Coyne (1999), and Kendler, Kuhn & Prescott (2004). Cal has an optimal flourishing environment, and a non-optimal one. Regardless of whether his optimal environment is feasible for the typical SPCA adopter to provide, he does have the possibility of flourishing. Everybody does.

Removing the computer from your bedroom gains you 10 points.

Both the model for relapse prevention (Witkiewitz & Marlatt, 2004) and the behavioral approach to insomnia (Bootzin & Epstein, 2000) are about cues. Each approach teaches a client to identify the cues that lead to a certain behavior, and then either embrace or avoid them, depending on the circumstance. They both also address the training of some sort of inner animal, separate from the client’s personal mental experience.

I adore the notion of separating the current experience of the body from the long term goals of the mind. Doing so might reduce the occurrence of attributing uncontrollable thoughts and sensations to one’s own personal faults or actions (e.g., I drank too much and feel guilty about it), possibly preventing a worse cascade of bad behavior (e.g., well, I might as well drink again tonight!). The separation of the two thought processes is mighty powerful as well, helping one to think of Person “A” with a brain as trying to regulate Thing “B,” a headless body, might help one disconnect emotional ties more easily, or at least re-label them with physical labels (e.g., changing “I’m so frustrated about not being able to sleep!” to “My body is a bit over-aroused. I should get up and read a book until my arousal level diminishes.”).

Reading the article on sleep was so beautiful in its self-nurturing applications that it made me want to go buy a massive terry-cloth robe and slippers just so I can look forward to putting them on when I wake up in the morning. Maybe I could buy some candles and take a bubble bath every night before bed as my sleep cue. How nice!

Can you teach it to a rat?

Jacobson et al (2001) and I may or may not have had the same mother. After putting down this article, I had a flashback to a few moments in my growing years, when my mom would follow me around the house as I dashed in between an after-school meeting and crew practice. I would stand there, pulling up a pair of short trou, wolfing down a bowl of cereal, and asking her for a note to skip AP history, while she, not having spoken to me in days due to my busy schedule and getting frustrated that various half-started projects of mine were littering the entryway of the house, would say “Cath, one thing at a time. One. Thing. At. A. Time.” She said this knowing that I had been sleeping four hours a night, that I lived out of my car to save time between meetings and sports, and knowing that when I’m sleep-deprived I get crabby and snap at people (or, snap at her).

Jacobson seems to have come up with the “get your ass up!” method for people that do too much, think too hard, and are also in the midst of major depression. Their methods of emphasizing positive reinforcement, easy, one-step-at-a-time goals, and client-based situational analyzation (or, functional analysis) strike me as major life-lessons and extremely cognitive. However, their behavioral approach is right-on, because it avoids the volatile cognition market of the internalized and distraught.

It’s especially mind-blowing to see the redirection of our readings from looking at higher-order cognitions to more animalistic explanations of mental illness. One might counter these explanations by saying that most people are more complicated than a rat – but are we?

I wanted happiness to be a by-product of a large effect size, but it wasn't.

Reading Engels, Garnefski & Diekstra (1993) was like yawning to even out the air pressure behind one’s eardrums during an assent: after previous readings frustrated and tore at our scientific souls, Engels came along and eased the empirical tension, in a way. They painstakingly ripped apart studies of rational-emotive therapy until their hands bled with the lines they drew between the “masking of [an] experimenter” and “masking with data collection” (p. 1084). And their conclusion? Yes, rational-emotive therapy seems to be more effective than sitting on one’s couch and crying, but this difference is not statistically significant (p. 1086). The climax of the story came when, despite seeming to want to have their article support RET as something worth researching, they were frank about the results of their meta-analysis: “The methodologically more rigorous studies tended to produce moderate-to-low treatment effects," and “Concerning age, social class, and seriousness of disturbance, generalizations from this meta-analysis to clinical practice do not seem to be permitted,” and “no superiority over alternative treatments was found. However…methodological rigor…indeed had a decreasing influence on magnitude of ES" (p. 1088). They have more or less come out to say that, by manipulating the studies to find the good data, they found that the data was significant when the results were not applicable to real life, and the data were not significant when the studies were well-executed.

I believe Engels, and at the same time believe that we have it all wrong. Why are we not studying individual, successful therapists? I won’t go as far as to say that I believe in the dodo effect, but all of these articles have me skeptical of whatever it is we are measuring through therapy research.

But then, after reading Butler, Chapman, Forman & Beck (2006), their meta-analytic support for cognitive-behavioral therapy seemed show most of its strength in the follow-up periods after therapy ceased. Rarely, however, did those follow-up assessments take place after one year post-treatment. But then again, what is the goal? Is the goal concrete, such as a reduction in recidivism (p. 27)? Is the goal happiness in the abstract? I thought about these questions when brainstorming of what to write in this blog entry, and penned down the phrase “Happiness is a by-product of ordered thinking.” Then I crossed out “of ordered thinking,” leaving just “Happiness is a by-product.” Then I realized—there’s no way I came up with this phrase…it seems too familiar. So I googled it—turns out, according to some random, unreliable source called thinkexist.com, two people have said this: Sam Levenson, who said, “Happiness is a by-product. You cannot pursue it by itself,” and William S. Burroughs, who said “Happiness is a byproduct of function, purpose and conflict; those who seek happiness for itself seek victory without war.” This is humorous to me, as William S. Burroughs was completely off his rocker and accidentally shot his wife by having her put an apple on her head and trying to pull a William Tell stunt while high. My guess is that Sam Levenson was equally kooky. But still, the phrase makes total sense.

My point is that psychological stability seems too complicated to address in brief treatments and expect some sort of definitive change to take place in a measurable time period. Therapy is not a pill, and that’s why it works in the long term, for the long term. But works at what - flattening the personality, or accepting a bumpy one?

The Empathy Pill

I am tempted to join Kirschenbaum & Jourdan (2005) and Castonguay, Constantino & Holtforth (2006) and throw the rest of psychotherapy research out the EST window, screaming, “Empathy is the answer! All hail unconditional positive regard!”

But how? I found no answers here – for, as they said, it’s not what you do, but what they perceive that you do, that makes the difference between a good therapeutic outcome and a bad one. Where’s the part about “this is how you do it?” I want examples.

However, I found the evidence regarding the impact of the client’s view quite impacting: it is what’s perceived that matters. If you change your perceptions to only let in good things, then your life will be bright and merry, and if therapy consists of a blindingly beautiful bright star of good things (the person-centered therapist), then there will be a good outcome. Is this to lead us to the conclusion that this type of interaction is filling a giant hole in the client’s life? That nothing matters in life except for what we let ourselves believe? If so, can we bottle this “core condition” thing and market it as an emotional perception manipulation pill that will make you emotionally invincible? I would buy it. Seriously.

That's so meta.

Is it me, or did we just read an article that began “Once upon a time,” only to find out that it was a 32-page-long thick-tongued meta-analysis of the depressing state of psychological science? Talk about false advertising.

There are two things I walked away from the Westen, Novotny & Thompson-Brenner (2004) article thinking: the DSM is worthless, and so are psychology articles written by biased researchers (and by biased researchers, I mean all researchers).

I propose three solutions:

1) A DSM Congress.
2) Data in place of language.
3) Open-source data sharing.

Westen, et al. outlines many concrete reasons why the current DSM is hindering the validity of research on ESTs: it doesn’t apply to most people and it leaves out entire conditions which have come to be ignored as a result of not being mentioned (p. 634), among many others. Many of the overall assumptions of EST research seem to be based on the fact that we must draw lines between disorders, and those lines are based on DSM categorizations, which are bogus. The majority of Westen, et al.’s problems with the assumptions in EST research would be solved if an overhaul of our diagnostic system were put into place. Based on this article and the class discussion on September 5th, it seems that the system should be dynamic so as to adjust to the changing literature, and public so that researchers always know the rationalization behind everything. A DSM congress, modeled after the current structure of the US congress, seems to make sense. With knowledgeable representatives, a system to propose bills and amendments, a public record, and the ability to constantly change the system, we would not have to worry about rewriting the constitution every twenty years, or giving researchers reasons to write novella after meta-analytic novella on the problems contained in an unchangeable manual written two decades ago. A DSM congress would allow the diagnostic system to actually benefit from up-to-the-minute research discoveries, and create an open forum for debate. A DSM congress would allow growth in places where, with the current DSM-IV-TR state of affairs, we are crying out for change in the direction of an abyss.

In their section on “Maximizing the Efficacy of Clinical Trials,” Westen, et al. elaborates on what scientists should be reporting in their publications, repeatedly pointing out cases in which researchers clearly misinformed the reader by wrapping their information up to “tell the best story” (p. 653). For example, they pointed out that when setting criteria for qualifying a participant as having completed the therapy, “many of the reports…used different definitions in different analyses. The only reason we even noticed this problem was that we were meta-analyzing data that required us to record Ns, and noticed different Ns in different tables” (p. 654).

In general, it seems that this is a problem with language – articles are written for people to read. But it is silly to read data in the form of words and expect it to lack bias. How many times have you looked at the procedure and results section of a psychology article and scanned for vitals? We don’t need to read these sections – we need a list. What’s more is that lists can be standardized. I say throw out everything between the intro and the discussion, and replace it with a standardized chart created by the journal that is publishing the study before the paper is even submitted. The procedure and the results section would then contain the ALL information we actually need, much like the little box for carbon on the periodic table tells us that it’s got 6 protons and weighs 12.01 au. Let the reader know everything, save time, and conserve space. [edit] Meanwhile, slanted opinions and biases can be shared in the introduction and the discussion sections - this might even lead the discussion sections to grow in length, as the reader has not just had to read statistics in the form of words, and has the energy to absorb a well-synthesized argument for why their data is significant. [end edit]

Regardless of whether the above proposal makes any sense, if research is to move forward, it is clear that we need to change our approach to data sharing. The more people have access to a given data set, the better research will be and the faster we will find the answers we are looking for. Sharing data is not unlike the concept of sharing source-code associated with software programs, termed “open-source software.” In the past, hoarding source code as company secrets has rendered software weak, such as Microsoft’s Windows and pretty much everything associated with it (have you ever tried to successfully use Windows Media Player? I mean come on). Whereas, take for example the success of Mozilla Firefox, the most highly functional and secure internet browser, and also the first to use open-source code. Firefox blows Internet Explorer out of the water with its ability to block pop-ups, its easy-to-use interface, and overall top-notch security. And it’s free. Amazing!

All of the complaints about the fact that money and grant-writing skills guide the research agenda might be appeased if the field utilizes the internet medium in the same way that the tech boom has done. Unfortunately, we are still using clunky programs like PsycInfo and then manually downloading articles as PDF files, which are essentially pictures set in a certain order. It’s 2007 and psychological science is using pictures of text as our main source of information. I’m trying to look for the technological progress in this state of affairs, but find none.

So, I say, democratize the DSM, force researchers to show all their cards if they are going to get published, and put aside pride for the sake of progress by creating an open-source data sharing medium that will utilize research to its fullest extent.

Or maybe we're doomed. Maybe, in the words of Cory Doctorow in his essay Metacrap, "It's wishful thinking to believe that a group of people competing to advance their agendas will be universally pleased with any hierarchy of knowledge. The best that we can hope for is a detente in which everyone is equally miserable."

Dodo? Doe!

As presented to a field where a slew of people strive to quantify actions, predict behaviors, and quantify emotions, Chambless & Hollon (1998) and Hunsley & Di Giulio (2002) do a decent job of outlining the need to be critical in the assessment of effective therapies. However, while it is imperative that there is well-tested empirical support for therapies, for the sake of patients as well as for the reputation of psychology as a respected science, the two articles do not really resolve anything. Hunsley & Di Giulio’s statistical reassessment of review articles does give weight to the claim that not all psychotherapies are equivalent, yet their fight against fire with fire leads me to be skeptical of their argument just as they are asking us to be skeptical of the articles they review. If they use statistics to beat the statistics of others, how are they gaining any ground other than to stomp their feet and claim that their analysis is better? It’s like claiming blue is just better than red because, well, I said so. Additionally, while the Chambless & Hollon article is useful as a reference for someone designing an empirically supported treatment study, the only concrete guideline they call for is that a treatment be successful in two different studies by independent research teams. Their argument strives toward abstraction with phrases like “evaluators are urged to carefully examine data graphs” (p.13), and the arbitrary requirement that three of everything exist (e.g., three participants should benefit from treatment, p. 13). That said, Chambless & Hollon’s call for intense self-critique is vital if the field is to gain and retain any sort of scientific respect.