Tag Archives: Science

Clinical Interviewing, Personal Reflections, Research, Writing

The Delight of Scientific Discovery

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Art historians point to images like John Henry Fuseli’s 1754 painting “The Nightmare” as early depictions of sleep paralysis.

Consensus among my family and friends is that I’m weird. I’m good with that. Being weird may explain why, on the Saturday morning of Thanksgiving weekend, I was delighted to be searching PsycINFO for citations to fit into the revised Mental Status Examination chapter of our Clinical Interviewing textbook.

One thing: I found a fantastic article on Foreign Accent Syndrome (FAS). If you’ve never heard of FAS, you’re certainly not alone. Here’s the excerpt from our chapter:   

Many other distinctive deviations from normal speech are possible, including a rare condition referred to as “foreign accent syndrome.” Individuals with this syndrome speak with a nonnative accent. Both neurological and psychogenic factors have been implicated in the development of foreign accent syndrome (Romö et al., 2021).

Romö’s article, cited above, described research indicating that some forms of FAS have clear neurological or brain-based etiologies, while others appear psychological in origin. Turns out they may be able to discriminate between the two based on “Schwa insertion and /r/ production.” How cool is that? To answer my own question: Very cool!.

Not to be outdone, a research team from Oxford (Isham et al., 2021) reported on qualitative interviews with 15 patients who had grandiose delusions. They wrote: “All patients described the grandiose belief as highly meaningful: it provided a sense of purpose, belonging, or self-identity, or it made sense of unusual or difficult events.” Ever since I worked about 1.5 years in a psychiatric hospital back in 1980-81, I’ve had affection for people with psychotic disorders, and felt their grandiose delusions held meaning. Wow.  

One last delight, and then I’ll get back to my obsessive PsycINFO search-aholism.

Having experienced sleep paralysis when I was a frosh/soph attending Mount Hood Community College in 1975-1976, I’ve always been super-delighted to discover old and new information about multi-sensory (and bizarre) experiences linked to sleep paralysis episodes. Today I found two articles stunningly relevant to my 1970s SP experiences. One looked at over 300 people and their sleep paralysis/out-of-body experiences. They found that having out-of-body experiences during sleep paralysis reduced the usual distress linked to sleep paralysis. The other study surveyed 185 people with sleep paralysis and found that most of them, as I did in the 1970s, experienced hallucinations of people in the room and many believed the “others” in the room to be supernatural. I find these results oddly confirming of my long-passed sleep insomnia experiences.

All this delight at scientific discovery leads me to conclude that (a) knowledge exists, (b) we should seek out that knowledge, and (c) gaining knowledge can help us better understand our own experiences, as well as the experiences of others.

And another conclusion: We should all offer a BIG THANKS to all the scientists out there grinding out research and contributing to society . . . one study at a time.

For more: Here’ a link to a cool NPR story on sleep paralysis: https://www.npr.org/2019/11/21/781724874/seeing-monsters-it-could-be-the-nightmare-of-sleep-paralysis

References

Isham, L., Griffith, L., Boylan, A., Hicks, A., Wilson, N., Byrne, R., . . . Freeman, D. (2021). Understanding, treating, and renaming grandiose delusions: A qualitative study. Psychology and Psychotherapy: Theory, Research and Practice, 94(1), 119-140. doi:https://doi.org/10.1111/papt.12260

Herrero, N. L., Gallo, F. T., Gasca‐Rolín, M., Gleiser, P. M., & Forcato, C. (2022). Spontaneous and induced out‐of‐body experiences during sleep paralysis: Emotions, “aura” recognition, and clinical implications. Journal of Sleep Research, 9. doi:https://doi.org/10.1111/jsr.13703

Romö, N., Miller, N., & Cardoso, A. (2021). Segmental diagnostics of neurogenic and functional foreign accent syndrome. Journal of Neurolinguistics, 58, 15. doi:https://doi.org/10.1016/j.jneuroling.2020.100983

Sharpless, B. A., & Kliková, M. (2019). Clinical features of isolated sleep paralysis. Sleep Medicine, 58, 102-106. doi:https://doi.org/10.1016/j.sleep.2019.03.007

Counseling and Psychotherapy Theory and Practice, Personal Reflections, Research

The Hottest New Placebos for PTSD

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Let’s do a thought experiment.

What if I owned a company and paid all my employees to conduct an intervention study on a drug my company profits from? After completing the study, I pay a journal about ten thousand British pounds to publish the results. That’s not to say the study wouldn’t have been published anyway, but the payment allows for publication on “open access,” which is quicker and gets me immediate media buzz.

My drug intervention targets a longstanding human and societal problem—post-traumatic stress disorder (PTSD). Of course, everyone with a soul wants to help people who have been physically or sexually assaulted or exposed to horrendous natural or military-related trauma. In the study, I compare the efficacy of my drug (plus counseling) with an inactive placebo (plus counseling). The results show that my drug is significantly more effective than an inactive placebo. The study is published. I get great media attention, with two New York Times (NYT) articles, one of which dubs my drug as one of the “hottest new therapeutics since Prozac.”  

In real life, there’s hardly anything I love much more than a cracker-jack scientific study. And, in real life, my thought experiment is a process that’s typical for large pharmaceutical companies. My problem with these studies is that they use the cover of science to market a financial investment. Having financially motivated individuals conduct research, analyze the results, and report their implications spoils the science.

Over the past month or so, my thought experiment scenario has played out with psilocybin and MDMA (aka ecstasy) in the treatment of PTSD. The company—actually a non-profit—is the Multidisciplinary Association for Psychedelic Studies (MAPS). They funded an elaborate research project, titled, “MDMA-assisted therapy for severe PTSD: A randomized, double-blind, placebo-controlled phase 3 study” through private donations. That may sound innocent, but Andrew Jacobs of the NYT described MAPS as, “a multimillion dollar research and advocacy empire that employs 130 neuroscientists, pharmacologists and regulatory specialists working to lay the groundwork for the coming psychedelics revolution.” Well, that’s not your average non-profit.

To be honest, I’m not terribly opposed to careful experimentation of psychedelics for treating PTSD. I suspect psychedelics will be no worse (and no better) than other pharmaceutic-produced drugs used to treat PTSD. What I do oppose, is dressing up marketing as science. Sadly, this pseudo-scientific approach has been used and perfected by pharmaceutical companies for decades. I’m familiar with promotional pieces impersonating science mostly from the literature on antidepressants for treating depression in youth. I can summarize the results of those studies simply: Mostly antidepressants don’t work for treating depression in youth. Although some individual children and adolescents will experience benefits from antidepressants, separating the true, medication-based benefits from placebo responses is virtually impossible.

My best guess from reading medication studies for 30 years (and recent psychedelic research) is that the psychedelic drug results will end up about the same as antidepressants for youth. Why? Because placebo.

Placebos can, and usually do, produce powerful therapeutic responses. I’ll describe the details in a later blog-post. For now, I just want to say that in the MDMA study, the researchers, despite reasonable efforts, were unable to keep study participants “blind” from whether they were taking MDMA vs. placebo. Unsurprisingly, 95.7% of patients in the MDMA group accurately guessed that they were in the MDMA group and 84.1% of patients in the placebo group accurately guessed they were only receiving inactive placebos. Essentially, the patients knew what they were getting, and consequently, attributing a positive therapeutic response to MDMA (rather than an MDMA-induced placebo effect) is speculation. . . not science.

In his NYT article (May 9, 2021), Jacobs wrote, “Psilocybin and MDMA are poised to be the hottest new therapeutics since Prozac.” Alternatively, he might have written, “Psilocybin and MDMA are damn good placebos.” Even further, he also could have written, “The best therapeutics for PTSD are and always will be exercise, culturally meaningful and socially-connected processes like sweat lodge therapy, being outdoors, group support, and counseling or psychotherapy with a trusted and competent practitioner.” Had he been interested in prevention, rather than treatment, he would have written, “The even better solution to PTSD involves investing in peace over war, preventing sexual assault, and addressing poverty.”

Unfortunately, my revision of what Jacobs wrote won’t make anyone much money . . . and so you won’t see it published anywhere now or ever—other than right here on this beautiful (and free) blog—which is why you should pass it on.

Happiness, Love, Personal Reflections, Writing

A Letter to My Happiness Class on Why I Called BS on the So-Called Law of Attraction

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Adler Heart Brain

[This is a letter to my happiness class]

Hello Happy People,

When happiness class ends, sometimes I wish we could continue in conversation. You may not feel that way. You might be thinking, “Thank-you Universe! Class is finally over.” But as a long-time professor-type, on many days I wish we could keep on talking and learning. I know that it may not surprise you to hear that I’m feeling like I’ve got more to say:).

This week (Tuesday, February 11) was one of those days. Many of you made great comments and asked big questions. But, given that time is a pesky driver of everything, I/we couldn’t go as deep as we might have. Here’s an example of a question I loved, but that I felt I didn’t go deep enough with:

“Do you believe in the Law of Attraction?”

This is a fascinating question with deep and profound contemporary relevance. At the time, if you recall, I had dissed inspirational statements like, “If you can imagine it, you can achieve it. If you can dream it, you can become it” as “just bullshit.” Then, in response to the question of whether I believe in the so-called Law of Attraction, I said something like “I don’t completely disbelieve it” . . . and then pretended that I was in possession of a scientific mental calculator and said something like, “I believe things like imagining the positive can have a positive effect, but it might contribute about 3% of the variation to what happens to people in the future.”

Not surprisingly, upon reflection, I’m thinking that my use of the word “bullshit” and my overconfident estimation of “3% of the variation” deserve further explanation. Why? Because if I don’t back up what I say with at least a little science, then I’m doing no better than the folks who write wacky stuff like, “You can if you think you can.” In other words, how can you know if what I say isn’t “just bullshit” too?

At this point I’d like to express my apologies to Dr. Norman Vincent Peale for referring to one of his book titles as “wacky stuff.” However, in my defense, I read the book and I still can’t do whatever I think I can do . . . so there’s that . . . but that’s only a personal anecdote.

Okay. Back to science. Here’s why I said that positive thinking, as in the so-called “Law of Attraction” might account for only about 3% of the variation in life outcomes.

Back in the 1980s, I did my thesis and dissertation on personality and prediction. At the time I had four roommates and I felt I could predict their behaviors quite easily on the basis of their personalities. However, much to my surprise, I discovered that social psychology research didn’t support personality as a very good predictor of behavior. Turns out, personality only correlates with behavioral outcomes at about r = 0.3 or r = 0.4. You might think that sounds big, because you might think that r = 0.3 means 30%. But that’s not how it works. If you do the math and multiply the correlational coefficient by itself (as in 3 x 3 or 4 x 4) you get what statisticians call the coefficient of determination (in this case, 3 x 3 = 9% and 4 x 4 = 16%). The coefficient of determination is an error-filled effort to predict specific future events, as in, if your r = 0.3, then, if you know r, then you can be about 9% accurate in predicting an outcome.

Please note that everything is error-filled, including science, and including me and my shoot from the hip efforts at estimation and prediction. When I say error-filled, I’m not disrespecting science, I’m just acknowledging its limitations.

Okay. Back to the so-called Law of Attraction. In class I was calculating in my mind that if well-measured personality traits like extraversion or introversion only account for about 9-16% of the variation in behavioral outcomes, then the so-called Law (which I’m inclined to rename as the Hypothesis of Attraction) would likely account for significantly less variation . . . so I quickly did some mental math and “3%” popped out of my mouth. What I should have said is that humans are remarkably unpredictable and that personality barely predicts behavior and situations barely predict behavior and so when we hypothesize what might influence our future, we should be careful and underestimate, lest we appear foolishly overconfident, like many television pundits.

Somewhere around this time, someone asked if I thought the authors of books who advocated things like the law of attraction really believed in what they wrote or just wrote their books for profit. My response there was something like, “I don’t know. Maybe a bit of both.” To be perfectly honest—which I’m trying to be—one of my big concerns about things like the law of attraction is that they’re used to increase hope and expectations and typically come at a price. I don’t like the idea of people with profit-driven motives luring vulnerable people with big hopes into paying and then being disappointed. Sometimes I ask myself, “If someone has their life together so much that they discovered a secret to becoming wealthy by visualizing wealth, then they should already be so damn rich that they should just share their secret for free with everyone in an effort to improve people’s lives and the state of the planet!” The corollary to that thought is that if somebody says they’ve got a powerful secret AND THEY WANT TO CHARGE YOU FOR IT, my bullshit spidey sense sounds an alarm. Go ahead, call me suspicious and cynical.

Now. Don’t get me wrong. I’m a big fan of positive thinking. A huge fan. I believe positive thinking can give you an edge, and I believe it can make you happier. But I also think life is deeper than that and multiple factors are involved in how our lives turn out. I don’t want to pretend I’ve got a secret that I can share with you that will result in you living happily ever after with all the money you ever wished for. On the other hand, I do want to encourage everyone to embrace as much as you can the positivity and gratitude and kindness and visions of your best self that we’re talking about and reading about for our happiness class. I want you to have that edge or advantage. I want you to harness that 3% (okay, maybe it could be 7%) and make your lives more like your hopes and dreams.

Later, another student asked how we can know if we’re just fooling ourselves with irrational positivity. Wow. What an amazing question. At the time, I said, we need to scrutinize ourselves and bounce our self-statements or beliefs off of other people—people whom we trust—so we can get feedback. One thing I’d add to what I said in class is that we should also gather scientific information to help us determine whether we’re off in the tulips or thinking rationally. Self-scrutiny, feedback from trusted others, and pursuit of science. . . I think that’s a pretty good recipe for lots of things. It reminds me of what Alfred Adler once wrote about love. . . something like, “Follow your heart, but don’t forget your brain!”

Tomorrow is Valentine’s Day. I hope your weekend is a fabulous mix of following your heart, and hanging onto the science.

John SF