How the cult of trauma took over mental health

[borne_before]

How the cult of trauma took over mental health

You may have noticed over the last decade a steady increase in the promiscuous use of the word ‘trauma’. A word that once referred exclusively to grievous injuries of body and mind (gun-shot wounds, PTSD, that sort of thing) can now describe virtually anything. Psychotherapists and clinical...

www.spectator.co.uk

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[Fan_of_Meehl]

How the cult of trauma took over mental health

You may have noticed over the last decade a steady increase in the promiscuous use of the word ‘trauma’. A word that once referred exclusively to grievous injuries of body and mind (gun-shot wounds, PTSD, that sort of thing) can now describe virtually anything. Psychotherapists and clinical...

www.spectator.co.uk

Believe it or not, I went through my entire clinical psych grad school training (in the mid to late 1990s) including working at an anxiety disorders research and treatment center (university affiliated) without ever hearing, reading, or using the word 'triggered'--at least that I recall. It just wasn't even part of the literature or the clinical parlance back then.

They're not the only cult that took over mental health, though, lol. They're all over the place these days.

 

[futureapppsy2]

I was posed to agree with that author, but his argument basically came down to “it’s only trauma if they physically beat you and even then they have to really beat you, not just slap you a few times when you deserve it.” Like, holy ****, dude.

 

[WisNeuro]

I think it's an important issue, but just a poorly written article. The author almost gets to the issue of appraisal of the events likely being more important than the experience of the event itself.

 

[The Cinnabon]

I think it's an important issue, but just a poorly written article. The author almost gets to the issue of appraisal of the events likely being more important than the experience of the event itself.

Is this more of a battle of semantics? I do hear trauma get thrown around a lot and it's not always descriptive, but I'm curious to hear the thoughts of the elders on here as a PTSD focused applicant this cycle.

 

[Fan_of_Meehl]

Is this more of a battle of semantics? I do hear trauma get thrown around a lot and it's not always descriptive, but I'm curious to hear the thoughts of the elders on here as a PTSD focused applicant this cycle.

Richard McNally put it very aptly when he observed that the more we loosen the brackets around what counts as a Criterion A event, then the impact (and explanatory relevance) of the 'traumatic event,' per se, recedes into the causal 'background,' while other factors such as temperament, personality dysfunction, substance misuse (basically, everything else) enters the causal 'foreground,'--essentially, rendering the labeling of the events as 'traumatic' a meaningless afterthought. I'm paraphrasing but that was the argument he was making for opposing 'bracket creep' with respect to Criterion A.

 

[psych.meout]

Is this more of a battle of semantics? I do hear trauma get thrown around a lot and it's not always descriptive, but I'm curious to hear the thoughts of the elders on here as a PTSD focused applicant this cycle.

Are semantics and appraisals not clinically relevant?

 

[PsyDr]

Trigger is a silly idea. A trigger has zero leeway because it a pure lever.

If someone is using this as a behavioral analogy, they're just telling me they are wrong. Unless it's a pure classical conditioning.

 

[The Cinnabon]

Are semantics and appraisals not clinically relevant?

No no they definitely are in our field. I'm just trying to get a better lay of the land, so to speak.

 

[texanpsychdoc]

Yeah..I routinely encounter folks who have been told by others, the media, and even other MH professionals that what they experienced was trauma, when it wasn't. I usually reinforce this by explaining how the focus of treatment I use will look at specific thought patterns that tend to underly trauma and trauma responses, thus, if their description or perception of the supposed trauma isn't something that would be amenable to the treatment I implement, then it will likely not be useful, thus, we are likely not looking at a criteria A trauma.

 

[AcronymAllergy]

Yeah..I routinely encounter folks who have been told by others, the media, and even other MH professionals that what they experienced was trauma, when it wasn't. I usually reinforce this by explaining how the focus of treatment I use will look at specific thought patterns that tend to underly trauma and trauma responses, thus, if their description or perception of the supposed trauma isn't something that would be amenable to the treatment I implement, then it will likely not be useful, thus, we are likely not looking at a criteria A trauma.

This. Or that solely because they've experienced a Criterion A event, they must therefore have PTSD, even when they're fairly obviously struggling with something else that long pre-dates the trauma (and they have no actual PTSD symptoms beyond sleep disturbance and irritability). It's similar to when we hear patients being told that because they've had a concussion, they're never going to be the same, and this must now be the reason for all the problems they're having.

 

[BuckeyeLove]

Whenever I hear newish therapists or current genZers say the word, I immediately think of dude in Princess Bride. "You keep using that word. I do not think it means what you think it means."

 

[Ollie123]

Whenever I see these discussions I'm reminded of my counseling center supervisor in graduate school, who expressed concern that teaching basic cognitive therapy skills to an anxiety patient would be re-traumatizing them because their father was directive. Not abusive, mind you. Not even particularly harsh. Just directive. So it was very important we not even try anything CBT-related. And forget about doing graded exposures for someone with social phobia. That's basically just giving someone PTSD.

I do think there is some nuance here. On the one hand, I strongly dislike the fragilization of humanity that the trauma cult has imposed. I think the intuitive appeal to patients (and many providers) is that it inherently blames external forces rather than internal processes. Yet the scope creep has led to "One kid said something mean to me on the playground when I was 4, so nothing I did from that point on is ever my fault" type attitudes becoming more widespread, failing to recognize that resilience is the modal outcome even for "true" traumatic events let alone something like the above. I also find it ironic that the clinicians pushing the trauma agenda are also - at least in my experience - rarely trained in modalities for treating trauma, which just makes no sense to me. If you believe trauma is THAT widespread that virtually everyone has it, why on earth would you not get trained in the gold standard modalities for treating it?

At the same time, as a mechanisms researcher I'm genuinely fascinated by criterion A definitions. Is our definition arbitrary or is there actually something about these specific types of experiences that makes them inherently different from things that are certainly objectionable terrible (not my above examples, I'm talking about actual edge cases where there could be reasonable debate about whether it met criterion A)? There are two many different types of experiences to clearly highlight any singular driving mechanism. This makes me think that there must be a continuum of these, though that doesn't preclude the existence of a severity threshold somewhere along the continuum below which PTSD can't take hold. What drives that is an utterly fascinating question though.

 

[bcliff]

I also find it ironic that the clinicians pushing the trauma agenda are also - at least in my experience - rarely trained in modalities for treating trauma, which just makes no sense to me. If you believe trauma is THAT widespread that virtually everyone has it, why on earth would you not get trained in the gold standard modalities for treating it?

What are you talking about? They're all trained in EMDR.

 

[Ollie123]

What are you talking about? They're all trained in EMDR.

Honestly, as much as I hate EMDR I would take it. My experience is not even that and it is almost exclusively vague non-directed "supportive" therapy or psychodynamic approaches.

 

[WisNeuro]

Honestly, as much as I hate EMDR I would take it. My experience is not even that and it is almost exclusively vague non-directed "supportive" therapy or psychodynamic approaches.

As long as they self-label as "Trauma Informed," it's all good.

 

[Sanman]

Whenever I see these discussions I'm reminded of my counseling center supervisor in graduate school, who expressed concern that teaching basic cognitive therapy skills to an anxiety patient would be re-traumatizing them because their father was directive. Not abusive, mind you. Not even particularly harsh. Just directive. So it was very important we not even try anything CBT-related. And forget about doing graded exposures for someone with social phobia. That's basically just giving someone PTSD.

I do think there is some nuance here. On the one hand, I strongly dislike the fragilization of humanity that the trauma cult has imposed. I think the intuitive appeal to patients (and many providers) is that it inherently blames external forces rather than internal processes. Yet the scope creep has led to "One kid said something mean to me on the playground when I was 4, so nothing I did from that point on is ever my fault" type attitudes becoming more widespread, failing to recognize that resilience is the modal outcome even for "true" traumatic events let alone something like the above. I also find it ironic that the clinicians pushing the trauma agenda are also - at least in my experience - rarely trained in modalities for treating trauma, which just makes no sense to me. If you believe trauma is THAT widespread that virtually everyone has it, why on earth would you not get trained in the gold standard modalities for treating it?

At the same time, as a mechanisms researcher I'm genuinely fascinated by criterion A definitions. Is our definition arbitrary or is there actually something about these specific types of experiences that makes them inherently different from things that are certainly objectionable terrible (not my above examples, I'm talking about actual edge cases where there could be reasonable debate about whether it met criterion A)? There are two many different types of experiences to clearly highlight any singular driving mechanism. This makes me think that there must be a continuum of these, though that doesn't preclude the existence of a severity threshold somewhere along the continuum below which PTSD can't take hold. What drives that is an utterly fascinating question though.

1. It scares that your program allowed this person to supervise you.

2. If this trauma cult and "avoid everything" mentality continues, Gen Z and Gen Alpha are going to be a therapy gold mine in the future as they will develop no positive coping skills.

3. It is an interesting question. My personal opinion is that criterion A can be any event that sufficiently overwhelms positive coping resources and results in trauma. So, where is the severity level of criterion A such that the vast majority have developed coping skills to adapt? We know that younger individuals tend to develop PTSD at higher rates, so will criterion A be on a gradient based on age?

 

[Ollie123]

For whatever consolation it may provide for #1, I was actually the first student to have that placement and I'm not sure anyone knew what to expect. We'd had other rotations in our CC that were more EBP-focused. This was during the peak of the internship shortage so we students were desperate for more hours and pushing for additional placement options - this was one of several created in response to that push. I believe it was removed from the list of placement options either that year or the following one because of these issues.

This was a clinical science program and they actually were sticklers about making sure our placements were EBP-focused. I wanted counseling center experience just for the young adult population so I could claim "diverse setting" experiences on internship applications given everything else I did outside our department clinic was hospital-based. Had the bad luck of being the first one to try something new.

 

[futureapppsy2]

At the same time, as a mechanisms researcher I'm genuinely fascinated by criterion A definitions. Is our definition arbitrary or is there actually something about these specific types of experiences that makes them inherently different from things that are certainly objectionable terrible (not my above examples, I'm talking about actual edge cases where there could be reasonable debate about whether it met criterion A)? There are two many different types of experiences to clearly highlight any singular driving mechanism. This makes me think that there must be a continuum of these, though that doesn't preclude the existence of a severity threshold somewhere along the continuum below which PTSD can't take hold. What drives that is an utterly fascinating question though.

As a trauma researcher, I'm forever going to side-eye the fact that emotional abuse is not considered criterion A, when studies have repeatedly shown that abuse survivors often find that as much, if not more, harmful psychologically than physical abuse. Plus, sexual assault is included in criterion A and not all sexual assault is physically violent, so you can't even say that criterion A is limited to physically violent things. It's the main reason why I can't be a hardcore criterion A truther.

 

[futureapppsy2]

As long as they self-label as "Trauma Informed," it's all good.

I hate that term. It's very, very rarely operationally defined.

 

[WisNeuro]

I hate that term. It's very, very rarely operationally defined.

I saw a local therapist the other day that billed themselves in the following way "Trained and skilled in the trauma informed therapies of Brainspotting, IFS, and Somatic Experiencing." I'd say 90% of the time I hear/read someone or something say that they/it are "trauma informed," it's usually followed by a hefty dose of pseudoscience. Unfortunately, the snakeoil markleting sounds good to the layperson, so most patients don't know they're being scammed.

 

[cara susanna]

Is this more of a battle of semantics? I do hear trauma get thrown around a lot and it's not always descriptive, but I'm curious to hear the thoughts of the elders on here as a PTSD focused applicant this cycle.

I really dislike Criterion A creep because:

1) IMO if we call everything "trauma," we risk losing the original meaning of the term. For instance, in the infertility world a lot of people call infertility "traumatic." I'm sorry, infertility sucks but it's not the same experience as, like, being sexually assaulted or almost getting killed. People also don't really understand that even someone getting a cancer diagnosis doesn't meet criterion A. Which leads me to...

2) the biological acute trauma response is VERY important to the development of PTSD. Stressful situations have their own physiological response and impact, but it's not going to be the same as the fight/flight/freeze response experienced during a Criterion A event.

I also think that it's better for mental health advocacy if we acknowledge that non-traumatic things can be distressing and upsetting, and still have a huge negative impact on us. As I always tell patients, PTSD is a very specific reaction to a very specific type of event. Just because you don't meet criteria for PTSD doesn't diminish what you went through or the effect it's having on you.

 

[Sanman]

I saw a local therapist the other day that billed themselves in the following way "Trained and skilled in the trauma informed therapies of Brainspotting, IFS, and Somatic Experiencing." I'd say 90% of the time I hear/read someone or something say that they/it are "trauma informed," it's usually followed by a hefty dose of pseudoscience. Unfortunately, the snakeoil markleting sounds good to the layperson, so most patients don't know they're being scammed.

I really dislike Criterion A creep because:

1) IMO if we call everything "trauma," we risk losing the original meaning of the term. For instance, in the infertility world a lot of people call infertility "traumatic." I'm sorry, infertility sucks but it's not the same experience as, like, being sexually assaulted or almost getting killed. People also don't really understand that even someone getting a cancer diagnosis doesn't meet criterion A. Which leads me to...

2) the biological acute trauma response is VERY important to the development of PTSD. Stressful situations have their own physiological response and impact, but it's not going to be the same as the fight/flight/freeze response experienced during a Criterion A event.

I also think that it's better for mental health advocacy if we acknowledge that non-traumatic things can be distressing and upsetting, and still have a huge negative impact on us. As I always tell patients, PTSD is a very specific reaction to a very specific type of event. Just because you don't meet criteria for PTSD doesn't diminish what you went through or the effect it's having on you.

I am trauma informed...I am familiar with the spelling of the word and I had quite the traumatic experience just the other day. I stopped in at the local purveyor of coffee drinks and sugary foods one morning and ordered an iced coffee beverage. Not only was there not enough ice in the drink, they only put one shot of flavored syrup in and they spelled my name wrong on my cup. Just talking about it retraumatizes me. How can I ever go back in there again? Mobile orders delivered to me from now on. That's trauma, right?!

 

[WisNeuro]

I am trauma informed...I am familiar with the spelling of the word and I had quite the traumatic experience just the other day. I stopped in at the local purveyor of coffee drinks and sugary foods one morning and ordered an iced coffee beverage. Not only was there not enough ice in the drink, they only put one shot of flavored syrup in and they spelled my name wrong on my cup. Just talking about it retraumatizes me. How can I ever go back in there again? Mobile orders delivered to me from now on. That's trauma, right?!

******TRIGGER WARNING*************

Iced coffee is terrible.

 

[Sanman]

******TRIGGER WARNING*************

Iced coffee is terrible.

Let's explore this feeling....Are we talking standard iced coffee only or does this extend to cold brew and iced lattes as well?

 

[smalltownpsych]

As a trauma researcher, I'm forever going to side-eye the fact that emotional abuse is not considered criterion A, when studies have repeatedly shown that abuse survivors often find that as much, if not more, harmful psychologically than physical abuse. Plus, sexual assault is included in criterion A and not all sexual assault is physically violent, so you can't even say that criterion A is limited to physically violent things. It's the main reason why I can't be a hardcore criterion A truther.

Agreed. I was talking about this to a patient yesterday. In order to validate the level of abuse that they had experienced as a child, I used the term psychological torture because the experience was very much like being a prisoner that was maltreated for a long period of time. Helps to separate it from people they know who use abuse to describe any negative social interaction.
The iced coffee example illustrates well why my patients feel invalidated when they hear someone describe that as “trauma” and what I am finding now is that my patients with trauma are less likely to call it that. “Yes, I was raped repeatedly and threatened with physical violence and witnessed parent being beaten regularly and hid in the closet, but I don’t think that was really that traumatic.” Some of it is a defense mechanism, but part of it is not wanting to be lumped in with the Karens.

 

[Sanman]

Agreed. I was talking about this to a patient yesterday. In order to validate the level of abuse that they had experienced as a child, I used the term psychological torture because the experience was very much like being a prisoner that was maltreated for a long period of time. Helps to separate it from people they know who use abuse to describe any negative social interaction.
The iced coffee example illustrates well why my patients feel invalidated when they hear someone describe that as “trauma” and what I am finding now is that my patients with trauma are less likely to call it that. “Yes, I was raped repeatedly and threatened with physical violence and witnessed parent being beaten regularly and hid in the closet, but I don’t think that was really that traumatic.” Some of it is a defense mechanism, but part of it is not wanting to be lumped in with the Karens.

The big problem with using trauma in the non-clinical context is that it is relative to your personal reference points. To someone who has been raped, suffered physical abuse, or even emotional abuse a fender bender is not traumatic. To someone that lives a fairly pleasant life, it may be very traumatic because it is the only experience to pierce the bubble of "nothing bad will ever happen to me" and without a strict definition this will continue in the mainstream. It is easy to hate on the Karens, but often these people have such low resilience because they were insulated from many of life's problems prior to that. That also makes the Criterion A debate interesting.

 

[cara susanna]

I definitely noticed this trend on the therapist subreddit where people (including MH professionals) think every problem is trauma related and that trauma will always lead to persistent negative effects

 

[futureapppsy2]

I really dislike Criterion A creep because:

1) IMO if we call everything "trauma," we risk losing the original meaning of the term. For instance, in the infertility world a lot of people call infertility "traumatic." I'm sorry, infertility sucks but it's not the same experience as, like, being sexually assaulted or almost getting killed. People also don't really understand that even someone getting a cancer diagnosis doesn't meet criterion A. Which leads me to...

2) the biological acute trauma response is VERY important to the development of PTSD. Stressful situations have their own physiological response and impact, but it's not going to be the same as the fight/flight/freeze response experienced during a Criterion A event.

I also think that it's better for mental health advocacy if we acknowledge that non-traumatic things can be distressing and upsetting, and still have a huge negative impact on us. As I always tell patients, PTSD is a very specific reaction to a very specific type of event. Just because you don't meet criteria for PTSD doesn't diminish what you went through or the effect it's having on you.

Is the last part true, though? Even in this thread itself, we have people discussing (validly) lack of resilience and people who can’t tolerate any distress or discomfort. I think the appeal of “trauma” and one of reasons for Criterion A/“PTSD” creep is that relatively fewer people are going to call someone weak for developing PTSD after, say, rape or a bad car accident, but many more would call developing depression after things like medical issues, or job loss or infidelity weak. “Trauma” is coded as inherently more valid and less of a sign of “just being weak”, and I think that’s why the annoying word creep has happened. Ironically, as @smalltownpsych , pointed out, the creep is causing the word “trauma” to loose its salience with people as well as its clinical meaning.

I sometimes wish we as a field were better at communicating that “most people who go through X thing don’t develop psychopathology and if you went through X and did, it doesn’t make you a weak person.” Usually one part of that sentence gets muddled or left out. Hell, I went through something like that recently with a surgery complication where I kept reading that it was relatively rare and so thinking “oh, so, I couldn’t have that—I must be over-exaggerating these symptoms and just need to toughen up”. After a few days of symptoms, I finally broke down and went to the doctor—turns out I did have that complication after all and that it needed to be treated.

 

[tr]

I sometimes wish we as a field were better at communicating that “most people who go through X thing don’t develop psychopathology and if you went through X and did, it doesn’t make you a weak person.” Usually one part of that sentence gets muddled or left out. Hell, I went through something like that recently with a surgery complication where I kept reading that it was relatively rare and so thinking “oh, so, I couldn’t have that—I must be over-exaggerating these symptoms and just need to toughen up”. After a few days of symptoms, I finally broke down and went to the doctor—turns out I did have that complication after all and that it needed to be treated.

The flip side of that, which I think is not widely understood but would really ruffle some feathers if it were more well described to the general public, is the degree to which pre-Criterion A susceptibility factors contribute to the development of post-traumatic symptoms.

I had to touch on this with a media person recently and I found myself completely mincing my words for fear of getting cancelled.

 

[cara susanna]

Is the last part true, though? Even in this thread itself, we have people discussing (validly) lack of resilience and people who can’t tolerate any distress or discomfort. I think the appeal of “trauma” and one of reasons for Criterion A/“PTSD” creep is that relatively fewer people are going to call someone weak for developing PTSD after, say, rape or a bad car accident, but many more would call developing depression after things like medical issues, or job loss or infidelity weak. “Trauma” is coded as inherently more valid and less of a sign of “just being weak”, and I think that’s why the annoying word creep has happened. Ironically, as @smalltownpsych , pointed out, the creep is causing the word “trauma” to loose its salience with people as well as its clinical meaning.

I sometimes wish we as a field were better at communicating that “most people who go through X thing don’t develop psychopathology and if you went through X and did, it doesn’t make you a weak person.” Usually one part of that sentence gets muddled or left out. Hell, I went through something like that recently with a surgery complication where I kept reading that it was relatively rare and so thinking “oh, so, I couldn’t have that—I must be over-exaggerating these symptoms and just need to toughen up”. After a few days of symptoms, I finally broke down and went to the doctor—turns out I did have that complication after all and that it needed to be treated.

Right, I think there's a sensitive place to be in terms of validating and not minimizing non-Criterion A experiences (the opposite of that article author, imo) while also protecting the Criterion A definition. Society is the problem, and changing the meaning of a word doesn't actually address that.

 

[DynamicDidactic]

What a pile of **** article in many ways:

Helping professionals like counsellors and psychologists are almost overwhelmingly left-leaning, so Felitti’s work was well received in such circles. It seemed to vindicate their convictions that social ills like health inequality and addiction had purely sociological causes, and could therefore be solved only by direct government action.

The last paragraph is also over-the-top.

While I agree with the view that the term trauma is becoming so broad that it is starting to lose any sort of clinical use (like the term neurosis), the bent this author takes is unnecessarily political. My view is this current movement is similar to other fads that are common throughout history (and as we discussed here: Psychotherapy Fads: The Case of Trauma-Informed Therapy). I wouldn't blame the left-leaning psychologists (like me that do not have a biology-blind perspective) or throw in that these problems can only be solved by the gov't as the primary reason this approach has rapidly spread. I am fairly certain there are a bunch of right-leaning trauma-informed practitioners as well.

 

[DynamicDidactic]

Also, I just wiki'ed The Spectator and that makes most sense.

 

[futureapppsy2]

I think the broadening of “trauma” has a lot in common with the broadening of “neurodiverse” and “autistic”—they are cool and flashy and it means you’re special and vulnerable and it’s not your fault and people might give you a cute service dog. “Disability”, “mental illness”, “distress”? Those are icky and bad and not cool or special enough and people will give you far less sympathy for them. So make every mental illness “neurodiverse” or “autistic” and every bad thing “trauma” and no one has to be in those icky, more stigmatized categories.

Edit: Not discounting the very real ableism faced by autistic people or the suffering of people with PTSD—just noting how people tend to want those labels more than other ones, even if they don’t really fit, because they are often seen as more socially acceptable in the current social discourse. And those people tend just to want the perceived “cred”, not the actual symptoms and limitations that come with them.

 

[cara susanna]

I think the broadening of “trauma” has a lot in common with the broadening of “neurodiverse” and “autistic”—they are cool and flashy and it means you’re special and vulnerable and it’s not your fault and people might give you a cute service dog. “Disability”, “mental illness”, “distress”? Those are icky and bad and not cool or special enough and people will give you far less sympathy for them. So make every mental illness “neurodiverse” or “autistic” and every bad thing “trauma” and no one has to be in those icky, more stigmatized categories.

Edit: Not discounting the very real ableism faced by autistic people or the suffering of people with PTSD—just noting how people tend to want those labels more than other ones, even if they don’t really fit, because they are often seen as more socially acceptable in the current social discourse. And those people tend just to want the perceived “cred”, not the actual symptoms and limitations that come with them.

There are two lines of thought I've been having lately that are imo tangentially related to this:
- There is this view that autism is untreatable and disabling and will automatically cause trauma because of the person's interactions with the ableist world. Isn't that in itself harmful to people with autism? Like, do you really want to believe that you're automatically screwed if you have the diagnosis and there aren't varying degrees of severity or functioning?
- I've also read that the autism advocacy community really emphasizes people who are higher functioning and ignores or dismisses experiences from people who are lower functioning (or the people who care for them, as these individuals may not be able to communicate effectively themselves). I've heard this especially in regards to the ABA "debate."

 

[Shiori]

How has the network analysis of PTSD/trauma-based syndromes been looking? It seemed promising, but I haven't kept up with it.

 

[Fan_of_Meehl]

How has the network analysis of PTSD/trauma-based syndromes been looking? It seemed promising, but I haven't kept up with it.

I just hope that the studies providing the data for any meta-analytic analyses or multivariate analyses scrying n-dimensional space for the latent factors representing these constructs...

Screened for or, in any way, tried to measure/covary response bias (overreporting, malingering) and/or disability-seeking/litigation status (especially if much of these data come from veteran populations)...otherwise, they are going to end up trying to 'carve nature at its joints' with a popsicle stick.

Garbage in...garbage out.

I don't think that anyone who doesn't see this population daily in a full-time clinical capacity truly realizes how meaningless a lot of these data are and how much non-construct-related variance is distorting these research efforts.

It is so crucial that researchers remember that 'hypotheses are always tested in bundles' rather than in isolation. Many of the researchers' assumptions/hypotheses about the validity of the self-report data or what they mean is dependent on the assumption/label of them as 'PTSD symptoms.' I've had veterans mark the anhedonic or insomnia items on the PCL-5 higher than the corresponding items on the PHQ-9 during the same encounter...likely due to their awareness that one was a 'PTSD test' and the other supposedly measures 'depression.'

From an epistemological perspective, I think that recent decades have seen the field shift to placing WAY too much faith in the validity of transparently face-valid self-report data as some sort of fundamental operational definition of hypothesized clinical constructs.

 

[futureapppsy2]

There are two lines of thought I've been having lately that are imo tangentially related to this:
- There is this view that autism is untreatable and disabling and will automatically cause trauma because of the person's interactions with the ableist world. Isn't that in itself harmful to people with autism? Like, do you really want to believe that you're automatically screwed if you have the diagnosis and there aren't varying degrees of severity or functioning?
- I've also read that the autism advocacy community really emphasizes people who are higher functioning and ignores or dismisses experiences from people who are lower functioning (or the people who care for them, as these individuals may not be able to communicate effectively themselves). I've heard this especially in regards to the ABA "debate."

Re: the second part—in my experience, FWIW, people tend to assume a lot of autistic self-advocates are more high functioning than they actually are. Like, I think there’s a jump to assume that everyone who can communicate is the Aspie “quirky” stereotype but a lot of these people have pretty significant sensory issues, restrictive-repetitive behavior, etc, issues and would probably be seen as at least moderately severely autistic if you saw them in clinic. Of course, that doesn’t capture people at the furthest end of the severity spectrum, and I don’t know if there’s a good way to. Of course, you have parent/caregiver report, which can help, but that’s still a proxy report with all the limitations inherent in that, and, let’s be real, parents of disabled children don’t always have their kids’ best interests at heart (they often do, but the subset that don’t often really, really don’t).

I actually think this is a cross-disability issue—that less severely disabled people tend to have louder voices in the dialogue, especially if they are white, from wealthy families, and conventionally attractive, and their perspectives get listened to more, even if they aren’t necessarily representative. It’s one of the reasons that some of my colleagues who do a lot of developmental disability-focused work deliberately go out of their way to include more severely autistic people, people with ID, disabled BIPOC, etc, on their research teams, even though it often creates more work for them in terms of accommodations, pay, hiring, etc.

 

[cara susanna]

Re: the second part—in my experience, FWIW, people tend to assume a lot of autistic self-advocates are more high functioning than they actually are. Like, I think there’s a jump to assume that everyone who can communicate is the Aspie “quirky” stereotype but a lot of these people have pretty significant sensory issues, restrictive-repetitive behavior, etc, issues and would probably be seen as at least moderately severely autistic if you saw them in clinic. Of course, that doesn’t capture people at the furthest end of the severity spectrum, and I don’t know if there’s a good way to. Of course, you have parent/caregiver report, which can help, but that’s still a proxy report with all the limitations inherent in that, and, let’s be real, parents of disabled children don’t always have their kids’ best interests at heart (they often do, but the subset that don’t often really, really don’t).

I actually think this is a cross-disability issue—that less severely disabled people tend to have louder voices in the dialogue, especially if they are white, from wealthy families, and conventionally attractive, and their perspectives get listened to more, even if they aren’t necessarily representative. It’s one of the reasons that some of my colleagues who do a lot of developmental disability-focused work deliberately go out of their way to include more severely autistic people, people with ID, disabled BIPOC, etc, on their research teams, even though it often creates more work for them in terms of accommodations, pay, hiring, etc.

That makes a lot of sense, thanks for the input.

 

[Shiori]

I just hope that the studies providing the data for any meta-analytic analyses or multivariate analyses scrying n-dimensional space for the latent factors representing these constructs...

Screened for or, in any way, tried to measure/covary response bias (overreporting, malingering) and/or disability-seeking/litigation status (especially if much of these data come from veteran populations)...otherwise, they are going to end up trying to 'carve nature at its joints' with a popsicle stick.

Garbage in...garbage out.

I don't think that anyone who doesn't see this population daily in a full-time clinical capacity truly realizes how meaningless a lot of these data are and how much non-construct-related variance is distorting these research efforts.

It is so crucial that researchers remember that 'hypotheses are always tested in bundles' rather than in isolation. Many of the researchers' assumptions/hypotheses about the validity of the self-report data or what they mean is dependent on the assumption/label of them as 'PTSD symptoms.' I've had veterans mark the anhedonic or insomnia items on the PCL-5 higher than the corresponding items on the PHQ-9 during the same encounter...likely due to their awareness that one was a 'PTSD test' and the other supposedly measures 'depression.'

From an epistemological perspective, I think that recent decades have seen the field shift to placing WAY too much faith in the validity of transparently face-valid self-report data as some sort of fundamental operational definition of hypothesized clinical constructs.

I think what has been most compelling to me about network analysis is the focus on patterns and relationships vs specific constructs or factors. I'm pulling this out of a hat, but it's fair to think that there is a strong relationship for a patient who is experiencing sleeplessness due to nightmares to also experience irritability and dysphoria. As a clinician, that tells me a lot more about what someone was experiencing compared to sticking it in a factor analysis. It helps with case conceptualization. It is helpful to see how they are related rather than that they are related. Network analysis strives to answer causal questions as well.

When I got busy with other life stuff, researchers were examining how effective it is to tailor interventions to "interrupt" networks of symptoms. I have my fingers crossed though because it pulls us out of more syndromal-based treatment approaches to something potentially more practical. It fits with what clinicians often do anyway. If a client will let me, I treat PTSD first and see what's left over. They often walk in with 4-5 long-standing disorders and I can't treat them all. Fortunately, I usually don't have to do that if I can get them decently participating in exposure-based treatment.

 

[R. Matey]

I think what has been most compelling to me about network analysis is the focus on patterns and relationships vs specific constructs or factors. I'm pulling this out of a hat, but it's fair to think that there is a strong relationship for a patient who is experiencing sleeplessness due to nightmares to also experience irritability and dysphoria. As a clinician, that tells me a lot more about what someone was experiencing compared to sticking it in a factor analysis. It helps with case conceptualization. It is helpful to see how they are related rather than that they are related. Network analysis strives to answer causal questions as well.

I wouldn't put a ton of faith in network models--they're notoriously unstable and, like factor analysis, require some decision-making. Also, inputting a invalid factor structure can lead to some wonky results. See the following, especially the discussion about within-person causality:

Network analysis of multivariate data in psychological science - Nature Reviews Methods Primers

Network analysis allows the investigation of complex patterns and relationships by examining nodes and the edges connecting them. Borsboom et al. discuss the adoption of network analysis in psychological research.

www.nature.com

https://psyarxiv.com/ke6qn/

Critiques of network analysis of multivariate data in psychological science - Nature Reviews Methods Primers

www.nature.com

https://eiko-fried.com/wp-content/uploads/ReplyToNeal.pdf

All the papers should be on either researchgate or psycharxiv, but PM me if you can't find something

 

[futureapppsy2]

I wouldn't put a ton of faith in network models--they're notoriously unstable and, like factor analysis, require some decision-making. Also, inputting a invalid factor structure can lead to some wonky results. See the following, especially the discussion about within-person causality:

Network analysis of multivariate data in psychological science - Nature Reviews Methods Primers

Network analysis allows the investigation of complex patterns and relationships by examining nodes and the edges connecting them. Borsboom et al. discuss the adoption of network analysis in psychological research.

www.nature.com

https://psyarxiv.com/ke6qn/

Critiques of network analysis of multivariate data in psychological science - Nature Reviews Methods Primers

www.nature.com

https://eiko-fried.com/wp-content/uploads/ReplyToNeal.pdf

All the papers should be on either researchgate or psycharxiv, but PM me if you can't find something

Thanks for the links--I'm increasingly asked to review papers with these, and I review them if the other aspects of the study are in my wheelhouse but recommend getting a reviewer with more familiarity with network analysis as well.

 

[Shiori]

Thanks for the links! It was all rage for a minute, so it's good to be skeptical.

 

[Fan_of_Meehl]

Thanks for the links--I'm increasingly asked to review paper with these, and I review them if the other aspects of the study are in my wheelhouse but recommend getting a reviewer with more familiarity with network analysis as well.

One of the cool things about psychology is that there is always more to learn...dangit/yippee!!!

 

[R. Matey]

Thanks for the links! It was all rage for a minute, so it's good to be skeptical.

If I were ever to venture a neck tattoo, the bolded portion would be my first go to.

 

[Fan_of_Meehl]

If I were ever to venture a neck tattoo, the bolded portion would be my first go to.

One of my favorite quotes by Philip Kitcher...

'Fallibility is the hallmark of science'

(from his awesome essay, 'Believing Where We Cannot Prove')

 

[R. Matey]

One of my favorite quotes by Philip Kitcher...

'Fallibility is the hallmark of science'

(from his awesome essay, 'Believing Where We Cannot Prove')

Oh, man. That's a good one. Will check that out. I like this one from Popper--I've only read selections from his work though:

“Whenever a theory appears to you as the only possible one, take this as a sign that you have neither understood the theory nor the problem which it was intended to solve.” -Objective Knowledge: An Evolutionary Approach.

 

[Fan_of_Meehl]

Oh, man. That's a good one. Will check that out. I like this one from Popper--I've only read selections from his work though:

“Whenever a theory appears to you as the only possible one, take this as a sign that you have neither understood the theory nor the problem which it was intended to solve.” -Objective Knowledge: An Evolutionary Approach.

I like that one! It's new to me (and I'm always looking for quotes about science).

"There is one thing even more vital to science than intelligent methods; and that is, the sincere desire to find out the truth, whatever it may be."

- Charles Sanders Pierce

 

[MateoGM416]

This discussion reminds me of my favorite scene from my one of my favorite shows of all time

 

[Fan_of_Meehl]

This discussion reminds me of my favorite scene from my one of my favorite shows of all time

Pretty awful therapy...but good television.