Paper criticizing CBT for EDs

[cara susanna]

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Just found out about this paper and am curious as to what people think, especially those who have ED expertise

Cognitive behavioural therapy is not universally evidence-based: implications for eating disorders - PMC

Cognitive behavioural therapy (CBT) is widely described as an evidence-based psychological treatment, including within eating disorder (ED) care. However, evidence claims are only valid within the boundaries of the populations, outcome measures, and ...

pmc.ncbi.nlm.nih.gov

I did see that this is the author who wrote that paper criticizing the construct of BPD, btw

 

[R. Matey]

I stopped reading at "decolonial." Seems like the latest version of "CBT doesn't work for [my favorite special population]!" despite evidence showing that CBT can be modified for special populations.

 

[WisNeuro]

Meh, he cites pretty junk science to support his views. Like a convenience, self-selected population of 10 people with ADHD who were dissatisfied with therapy, to claim that ADHD is harmful to people with ADHD. Between that and some other cites I looked at, opinions are on very shaky ground. Hard to take any of it seriously.

I stopped reading at "decolonial."

Yeah, this usually means I'm in for a buzzword heavy, light on real data, read. GIGO

 

[R. Matey]

Meh, he cites pretty junk science to support his views. Like a convenience, self-selected population of 10 people with ADHD who were dissatisfied with therapy, to claim that ADHD is harmful to people with ADHD. Between that and some other cites I looked at, opinions are on very shaky ground. Hard to take any of it seriously.



Yeah, this usually means I'm in for a buzzword heavy, light on real data, read. GIGO

Hilarious that anyone would claim this when behavioral interventions are the most effective psychosocial treatment we have for ADHD.

 

[PsyDr]

"Drawing on decolonial and neurodiversity scholarship and lived experience-led literature..."

 

[Fan_of_Meehl]

I stopped reading at "decolonial." Seems like the latest version of "CBT doesn't work for [my favorite special population]!" despite evidence showing that CBT can be modified for special populations.

Thanks for the heads up. LOL, not even gonna bother reading that.

Aw, hell...maybe I'll give it a read later on during commercial breaks while watching reruns of The Rockford Files smoking a cigar wearing my 'Don't Tread On Me' socks, powdered white wig and tricorn hat.

Or maybe while watching Battlestar Galactica (the 2005 version, the good version). Maybe that's what they meant by 'colonial' (like Colonial Vipers).

 

[Justanothergrad]

I stopped reading at "decolonial." Seems like the latest version of "CBT doesn't work for [my favorite special population]!" despite evidence showing that CBT can be modified for special populations.

I see plenty of reason to do decolonial work, broadly. It clearly relates to the white background of psych and the huge community distrust as a result of scientific abuses. Thats true. It certainly is true in other treatments. And cbt. Suggesting that all 'special populations' are not the default treatment is sort of ... the point of decolonial movements.Research on modification is nearly non existent eith the expectation of 'work with majority culture first'. It also fails to account for general equifinality issues. Im in assessment and you see the same thinking. Items generated by white proeststants make up most items on the mmpi. The a-rf has less than 30 Hispanic youth. Total. This is the point behind this decolonization movement. The name is generally what people object to, not the idea. Just like toxic masculinity.

But yeh. Citing junk science is a separate issue.

 

[Sanman]

I can understand the argument for maybe altering teaching styles in neurodivergent samples. Throwing indigenous people and racial groups in there is silly. That argument just boils down to we are all special individuals, just like most diversity discussions. We can modify treatment, but no reason to throw out everything.

 

[R. Matey]

I see plenty of reason to do decolonial work, broadly. It clearly relates to the white background of psych and the huge community distrust as a result of scientific abuses. Thats true. It certainly is true in other treatments. And cbt. Suggesting that all 'special populations' are not the default treatment is sort of ... the point of decolonial movements.Research on modification is nearly non existent eith the expectation of 'work with majority culture first'. It also fails to account for general equifinality issues. Im in assessment and you see the same thinking. Items generated by white proeststants make up most items on the mmpi. The a-rf has less than 30 Hispanic youth. Total. This is the point behind this decolonization movement. The name is generally what people object to, not the idea. Just like toxic masculinity.

But yeh. Citing junk science is a separate issue.

They often go together.

I'm personally fine with critical scholarship, but these articles often begin from the assumption that because it came out thirty or fifty years ago, it must be burned down to the ground rather than systematically studied. Heavy on emotional appeals. Lite on actual science and data.

 

[Justanothergrad]

They often go together.

I'm personally fine with critical scholarship, but these articles often begin from the assumption that because it came out thirty or fifty years ago, it must be burned down to the ground rather than systematically studied. Heavy on emotional appeals. Lite on actual science and data.

Yeh totally. Im with you there. 100%. I just felt a need to defend critical psych broadly cause it gets a lot of attacks needlessly

 

[WisNeuro]

I can understand the argument for maybe altering teaching styles in neurodivergent samples. Throwing indigenous people racial groups in there is silly. That argument just boils down to we are all special individuals, just like most diversity discussions. We can modify treatment, but no reason to throw out everything.

The thing is, though, that we're supposed to modify treatment for the individual in every situation. The whole "manualized CBT therapy is so rigid" is mostly a myth, though I imagine some poorly trained people only know how to rigidly follow a manual.

 

[Sanman]

The thing is, though, that we're supposed to modify treatment for the individual in every situation. The whole "manualized CBT therapy is so rigid" is mostly a myth, though I imagine some poorly trained people only know how to rigidly follow a manual.

Agreed. I think research on cultural differences that can help with modification is useful. However, saying cbt is not useful in xyz culture because most studies are on white people is a bit ridiculous. As if xyz is a homogenous monoculture. Treatment that is effective on caucasian folks will not work on ANY indigenous person?

 

[psych.meout]

The thing is, though, that we're supposed to modify treatment for the individual in every situation. The whole "manualized CBT therapy is so rigid" is mostly a myth, though I imagine some poorly trained people only know how to rigidly follow a manual.

There are so many blatant misconceptions and mischaracterizations about CBT throughout that article, but my favorite part is when their own sources explicitly mention CBT adapted for ADHD populations.

Agreed. I think research on cultural differences that can help with modification is useful. However, saying cbt is not useful in xyz culture because most studies are on white people is a bit ridiculous. As if xyz is a homogenous monoculture. Treatment that is effective on caucasian folks will not work on ANY indigenous person?

Exactly, it's presumptuous to treat groups as monoliths like this and assume that someone of that group will have the same opinions, beliefs, and values simply based on group membership. If only there was a pithier term for that kind of thing....

 

[WisNeuro]

Agreed. I think research on cultural differences that can help with modification is useful. However, saying cbt is not useful in xyz culture because most studies are on white people is a bit ridiculous. As if xyz is a homogenous monoculture. Treatment that is effective on caucasian folks will not work on ANY indigenous person?

The irony of people claiming that there is more overlap than there are differences on cognitive/psychological domains, but asserting those differences as gigantic effect sizes when they want to make a specific point never ceases to amaze me.

 

[WisNeuro]

There are so many blatant misconceptions and mischaracterizations about CBT throughout that article, but my favorite part is when their own sources explicitly mention CBT adapted for ADHD populations.

Yeah, I noticed that as well when poking around the articles cited. Didn't know that journal was that bad in its review policies.

 

[PsyDr]

I see plenty of reason to do decolonial work, broadly. It clearly relates to the white background of psych and the huge community distrust as a result of scientific abuses.

I think the term “decolonial” is hilariously bad. It clearly ignores several aspects of culture, while selectively focusing on others. If you take a position of not using the language of your oppressors, then central and south America are going to have some interesting times ahead. If the term refers to "race", then millions of white and black Hispanics are going to be moving against their wills. But this term is never meant to be used uniformly.

 

[cara susanna]

Yeah, I noticed that as well when poking around the articles cited. Didn't know that journal was that bad in its review policies.

Yeah, that's what surprised me most. I thought this was a good journal.

 

[WisNeuro]

I think the term “decolonial” is hilariously bad. It clearly ignores several aspects of culture, while selectively focusing on others. If you take a position of not using the language of your oppressors, then central and south America are going to have some interesting times ahead. If the term refers to "race", then millions of white and black Hispanics are going to be moving against their wills. But this term is never meant to be used uniformly.

Are you saying that definitionally vague terms with questionable empirical backing, almost always used to make political statements, are of questionable empirical utility at the moment? I am shocked!

In all seriousness, though, much of this type of research is suffering from self-inflicted wounds by this use of poorly defined terminology and methodology in their study. If it wants to be taken more seriously, it needs to grow the **** up and stop relying on terrible studies and reliance on papers that always read like opinion pieces.

 

[PsyDr]

Are you saying that definitionally vague terms with questionable empirical backing, almost always used to make political statements, are of questionable empirical utility at the moment? I am shocked!

In all seriousness, though, much of this type of research is suffering from self-inflicted wounds by this use of poorly defined terminology and methodology in their study. If it wants to be taken more seriously, it needs to grow the **** up and stop relying on terrible studies and reliance on papers that always read like opinion pieces.

It's not vague, because it's not intended to apply to every group that participated in colonization. The term doesn't mean, "get the Berber influences out of Spain", or "speak Nahuatl and discourage Catholicism when treating natives of Mexico", or "remove the Roman influences from Britain". It's simply picking and choosing who historically participated in colonization, and which parts of that history to address.

I'm always interested in psychologists' adoption of political issues, as a practice.

 

[WisNeuro]

It's not vague, because it's not intended to apply to every group that participated in colonization. The term doesn't mean, "get the Berber influences out of Spain", or "speak Nahuatl and discourage Catholicism when treating natives of Mexico", or "remove the Roman influences from Britain". It's simply picking and choosing who historically participated in colonization, and which parts of that history to address.

I'm always interested in psychologists' adoption of political issues, as a practice.

I mean, of course we wouldn't want to remove Berber influences, what would we do with our carpet choices then?

 

[Fan_of_Meehl]

We should look out for men made of straw on our way to the barn.

The APA definition of 'evidence-based practice / psychotherapy' is:

"Evidence-based practice is the integration of the best available research with clinical expertise in the context of patient characteristics, culture and preferences."

All three elements are crucially important.

Manuals/protocols do not implement themselves, nor are they a 'fixed script' than can be implemented by clerks.

I wish I could remember the exact citation but there was a recent article arguing against the 'protocol-for-syndrome' approach to training people how to treat patients with "EBP's" since---just limiting yourself to all the possible 'protocol x for condition/diagnosis y' combinations you very quickly get to an impractical state of affairs (who is going to complete rigorous training on the hundreds of protocol-for-syndrome-specific combinations required?) And what about 'staged treatment' combinations for commonly comorbid conditions? It's simply impractical. I believe the field is (and should be) moving to a more "process based" approach (individualized case formulation and use of empirically-supported principles of behavior change).

Consideration of INDIVIDUAL patient characteristics, culture, and preferences is a crucial and indispensable element of evidence-based practice. We treat individuals, not entire cultures (as monolithic groups) in a course of psychotherapy. To the extent that an individual's cultural heritage meaningfully impacts implementation of an empirically-supported principle of behavior change then this fact (if shown to be true) should absolutely be taken into account during implementation. However--and this is crucial--any such hypotheses regarding particular culture x intervention interactions are mere theoretical speculation (at the group level) until these hypotheses are properly tested (as formal research hypotheses) and shown to be either empirically 'true' (corroborated) or empirically false (unsupported). At the individual (idiographic, single case design) level, these hypotheses should be collaboratively and empirically explored with the patient in the context of the ongoing therapeutic relationship.

https://www.apa.org/practice/resources/evidence

 

[ForensicPsychFightClub]

Ultimately, while I love the spirit and concept behind critical scholarship and studies - I mean, most of us on this forum have complained about the limitations of the discourse in the field or people that perpetuate outdated, even harmful information under the dogma of tradition - every time I read one, it is executed along the same paradigm, with the same language, that just…for lack of a better word, gives me the ick.

This paper, for example, has such a wierd message. Nothing can ever be considered evidence-based unless specifically validated and studied on a particular population. Except as the study noted, racial and ethnic pops often have different presenting problems based on psychopathology - it’s why they argue CBT is harmful to people with EDs from Indigineous pops. But then they also add neurotype into tha. So CBT cannot be called evidence based because it hasn’t been validated on *checks notes* neurodivergent Indigineous populations suffering from an ED. Because of that, we cannot call CBT evidence based.

Which if you take it to its logical conclusion, means that without proper validation on literally every combination of therapeutic variables, you cannot call anything evidence based ever. That’s not even getting into the fact that they don’t like validation studies because they are eurocentric and prioritize internal validity to the degree of excludingoutliers. So, then their position is to emphasize individual voices. But then only those voices that agree with their argument in the first place. Elwyn, a person who went through CBT and didn’t like it and then wrote research on their experience, is cited 4 times. This qualitative study of 17 people with bulimia who found CBT helpful, acceptable, and beneficial is uncited. Because individual voices only matter when they agree with the authors position - that established treatment sucks and is somehow racist or sexist or prejudicial because of that. That’s not even getting into the scientific value of a single narrative versus a structured amalgamate of hundreds or thousands of cases. All of these issues and more permeate most critical studies i read.

 

[PsyDocNess]

I'm still stuck at the "lived experience-led literature". If only that was a dissertation option....

 

[AcronymAllergy]

Ultimately, while I love the spirit and concept behind critical scholarship and studies - I mean, most of us on this forum have complained about the limitations of the discourse in the field or people that perpetuate outdated, even harmful information under the dogma of tradition - every time I read one, it is executed along the same paradigm, with the same language, that just…for lack of a better word, gives me the ick.

This paper, for example, has such a wierd message. Nothing can ever be considered evidence-based unless specifically validated and studied on a particular population. Except as the study noted, racial and ethnic pops often have different presenting problems based on psychopathology - it’s why they argue CBT is harmful to people with EDs from Indigineous pops. But then they also add neurotype into tha. So CBT cannot be called evidence based because it hasn’t been validated on *checks notes* neurodivergent Indigineous populations suffering from an ED. Because of that, we cannot call CBT evidence based.

Which if you take it to its logical conclusion, means that without proper validation on literally every combination of therapeutic variables, you cannot call anything evidence based ever. That’s not even getting into the fact that they don’t like validation studies because they are eurocentric and prioritize internal validity to the degree of excludingoutliers. So, then their position is to emphasize individual voices. But then only those voices that agree with their argument in the first place. Elwyn, a person who went through CBT and didn’t like it and then wrote research on their experience, is cited 4 times. This qualitative study of 17 people with bulimia who found CBT helpful, acceptable, and beneficial is uncited. Because individual voices only matter when they agree with the authors position - that established treatment sucks and is somehow racist or sexist or prejudicial because of that. That’s not even getting into the scientific value of a single narrative versus a structured amalgamate of hundreds or thousands of cases. All of these issues and more permeate most critical studies i read.

There are no universal human experiences or themes. If it hasn't been studied on every single individual, it's not evidence-based and can't be assumed to work with that individual. N of hundreds or thousands? Pssh, don't talk to me until it's in the billions.

 

[Justanothergrad]

Are you saying that definitionally vague terms with questionable empirical backing, almost always used to make political statements, are of questionable empirical utility at the moment? I am shocked!

In all seriousness, though, much of this type of research is suffering from self-inflicted wounds by this use of poorly defined terminology and methodology in their study. If it wants to be taken more seriously, it needs to grow the **** up and stop relying on terrible studies and reliance on papers that always read like opinion pieces.

No joke.

Its because many of the people in leadership arent the researchers. Ive worked with d12 and d17 for years now, and its a major and increasing issue for areas of need. Its true of apa more broadly (actually a convo i was having with some apa staff on our friend vaca this week).

The issues are real. The names and approaches to scientific engagement with them are... sensational. So much trash research.

There are no universal human experiences or themes. If it hasn't been studied on every single individual, it's not evidence-based and can't be assumed to work with that individual. N of hundreds or thousands? Pssh, don't talk to me until it's in the billions.


Re: sample size of billions
I worry less about the sample size rather than not finding or taking efforts at inclusion I dont typically see the argument youre making. I suspect thats actually a rarity relative to other representative requests, like participant research.

Did you know the mmpi3 has no people with diagnosed psychotic disorders in the normative sample, for instance? Probably why those scales are utter trash

 

[Therapist4Chnge]

Did you know the mmpi3 has no people with diagnosed psychotic disorders in the normative sample, for instance? Probably why those scales are utter trash

But like…..how?!!

I was already sticking w the -2RF bc I trust that data, but that’s wild.

 

[oliversacks4thewin]

Did you know the mmpi3 has no people with diagnosed psychotic disorders in the normative sample, for instance? Probably why those scales are utter trash

Can you point me in the direction of the technical manual where it states this? To me, it looks it was just a community sample of 1,620 adults (810 men and 810 women) ages 18 and older. Am I missing the part of exclusion based on diagnosis?

 

[R. Matey]

I worry less about the sample size rather than not finding or taking efforts at inclusion I dont typically see the argument youre making. I suspect thats actually a rarity relative to other representative requests, like participant research.

More like "People are too beautiful and unique that our trashy white eurocentric statistical methods can't capture them, then that's why we need to burn down the CBT establishment because it relies on faulty starting assumptions." That's the logic the decolonizers commit themselves too. The argument becomes an epistemological argument about the nature of scientific inquiry, rather than an issue of underrepresentation. That's what they wrote in that decolonizing manifesto published in American Psychologist last year.

If the argument were inclusion of diverse samples, an emphasis of qualitative knowledge as *one* equally legitimate method of inquiry that can be more nuanced in scope, and a willingness to use the same methods of inquiry (i.e., statistics) to challenge some of our assumptions of CBT (as Cuijpers does) I could be on board with that. I'm comfortable with admitting flaws in the EBP movement because they do exist. I am far less on board with advocating for unfalsifiable claims that the epistemic of therapeutic knowledge is somehow irrevocably flawed because it was not studied in someone's preferred manner.

 

[Ollie123]

Yeah, that's what surprised me most. I thought this was a good journal.

Note that its a "letter." Varies by journal, but in some cases these go through a different channel than normal pubs. They may or may not be peer-reviewed and sometimes it is just the editor who reviews. Something at JAMA will still be somewhat scrutinized but small disciplinary journals may not. Especially now as finding reviewers has become immensely harder these last few years per everyone I know in those roles.

RE: the broader topic, it just always feels like a straw man. "This therapy doesn't work for everyone". Well of course not, no one ever said it did. Ask any CBT practitioner on earth and they will tell you not all their clients get better. "It might not work for these populations." Well, sure but: (A) You can't assume that; and (B) Do you have something that would work better? (and have you proven it works better)?

If you believe treatment X works better than CBT for comorbid ADHD/ED/whatever else, that's great! Go run an RCT and show us. I think > 99% of CBT practitioners would be fully supportive of that. Most of the time when people write things like this its to justify some voodoo treatment that hasn't been demonstrated to work for anyone...let alone the folks they are claiming it helps. Look, generalization is a real concern but you also need to start somewhere whether it is psychology or medicine. No one includes people with advanced cardiac disease in a phase 2 antidepressant trial, but if I'm a depressed person with cardiac disease in the early 90's I'd much rather my doc start with fluoxetine vs a cocktail of dish soap, lime juice and dog urine they think is "totally better for people with cardiac disease" just because no one has run ta trial testing it in people with disease yet.

Its the same with my criticism of psychoanalysis. You think you have something that works better....great! I'm a professional, this isn't my religion. I have precisely zero loyalty to any treatment modality and will jump ship the second I get convincing evidence there is something better. Just get off your ass and run the damn trial. Until you do, you just come across as lazy and incompetent. Almost all the practitioners I see complaining about these things would never DREAM of actually just running the damn study.

 

[Therapist4Chnge]

I'm still stuck at the "lived experience-led literature". If only that was a dissertation option....

The Raven dissertation isn’t looking so bad now, eh?!

 

[aim-agm]

It's not vague, because it's not intended to apply to every group that participated in colonization. The term doesn't mean, "get the Berber influences out of Spain", or "speak Nahuatl and discourage Catholicism when treating natives of Mexico", or "remove the Roman influences from Britain". It's simply picking and choosing who historically participated in colonization, and which parts of that history to address.

I'm always interested in psychologists' adoption of political issues, as a practice.

Every human outside of the Great Rift Valley is technically a colonist.

If these were studies by the British Empire about Indians living under the British Raj, I would heartily agree that we should be reexamining them. But "decolonizing" CBT doesn't make sense, because it was developed in a place and culture that hadn't been a colony in some 200 years at the time. Also, how could Aaron Beck be considered a colonist in a place established by British Protestants when he was a Ukrainian Jew?

 

[The Cinnabon]

Its the same with my criticism of psychoanalysis. You think you have something that works better....great! I'm a professional, this isn't my religion. I have precisely zero loyalty to any treatment modality and will jump ship the second I get convincing evidence there is something better. Just get off your ass and run the damn trial. Until you do, you just come across as lazy and incompetent. Almost all the practitioners I see complaining about these things would never DREAM of actually just running the damn study.

If r/PsychotherapyLeftists read this they might implode.

 

[The Cinnabon]

Every human outside of the Great Rift Valley is technically a colonist.

If these were studies by the British Empire about Indians living under the British Raj, I would heartily agree that we should be reexamining them. But "decolonizing" CBT doesn't make sense, because it was developed in a place and culture that hadn't been a colony in some 200 years at the time. Also, how could Aaron Beck be considered a colonist in a place established by British Protestants when he was a Ukrainian Jew?

This is a bit too literalist and missing the forest through the trees imo

"Decolonial" name aside, it's not bad science to consider the cultural framework of the population used in a RCT. Aaron Beck still ran his intial RCTs in the United States, there's a reason replication studies in other parts of the world were also ran to ensure results were equivocal. Maybe I'm just off on what "decolonial" refers too, but my understanding was that we simply shouldn't assume treatments developed with western populations would automatically work in non-western contexts. So yeah, same s*** that everyone already agrees with, just with a contentious label (decolonial).

 

[futureapppsy2]

I'm still stuck at the "lived experience-led literature". If only that was a dissertation option....

I mean, there's a lot of value, I think, in research studies that involve researchers or community members with lived experience (it's how we got DBT, after all) that gets overlooked by people asking a panel of white men in bowties their thoughts on abortion (hope somebody gets that reference!), but it still has be good, solid science, and it's totally possible to have something be lived-experience-led and rigorous science!

 

[Ollie123]

If r/PsychotherapyLeftists read this they might implode.

Not familiar with that subreddit and even as psychotherapist and a leftist I'm now a little afraid to look. I honestly stay away from all the therapy groups on reddit because it just makes me embarrassed that these are my colleagues?

I mean, there's a lot of value, I think, in research studies that involve researchers or community members with lived experience (it's how we got DBT, after all) that gets overlooked by people asking a panel of white men in bowties their thoughts on abortion (hope somebody gets that reference!), but it still has be good, solid science, and it's totally possible to have something be lived-experience-led and rigorous science!

I actually think DBT is a phenomenal example here. What did Marsha Linehan do? She ran the ****ing study. Repeatedly. With more rigor then anyone. Not a case study. Not asking her former patients "Do you like me?" on completion. Not a poll of reddit users on r/dogurinefixedmybpd. And because she actually worked her ass off her entire life trying to make the world a better place for people who are struggling and needed help, now we have a wildly successful intervention for a condition that was largely untreatable previously.

If you have lived experience AND a brain AND give a damn, you run the ****ing study.

 

[futureapppsy2]

Not familiar with that subreddit and even as psychotherapist and a leftist I'm now a little afraid to look. I honestly stay away from all the therapy groups on reddit because it just makes me embarrassed that these are my colleagues?

I actually think DBT is a phenomenal example here. What did Marsha Linehan do? She ran the ****ing study. Repeatedly. With more rigor then anyone. Not a case study. Not asking her former patients "Do you like me?" on completion. Not a poll of reddit users on r/dogurinefixedmybpd. And because she actually worked her ass off her entire life trying to make the world a better place for people who are struggling and needed help, now we have a wildly successful intervention for a condition that was largely untreatable previously.

If you have lived experience AND a brain AND give a damn, you run the ****ing study.

Yeah, that's what I said...

 

[EnPsychlopedia]

Its the same with my criticism of psychoanalysis. You think you have something that works better....great! I'm a professional, this isn't my religion. I have precisely zero loyalty to any treatment modality and will jump ship the second I get convincing evidence there is something better. Just get off your ass and run the damn trial. Until you do, you just come across as lazy and incompetent. Almost all the practitioners I see complaining about these things would never DREAM of actually just running the damn study.

My experience has been that folks who argue in favor of psychoanalysis love to use the escape hatch of "RCTs or other trials are fundamentally incompatible with psychoanalysis, and not all forms of human experience and healing can be quantified." Which is of course reeking with irony because the fact that some of the claims are incompatible with trials is itself evidence of unfalsifiability. Unfortunately, many of them seem to have no problems with that.

 

[EnPsychlopedia]

This is a bit too literalist and missing the forest through the trees imo

"Decolonial" name aside, it's not bad science to consider the cultural framework of the population used in a RCT. Aaron Beck still ran his intial RCTs in the United States, there's a reason replication studies in other parts of the world were also ran to ensure results were equivocal. Maybe I'm just off on what "decolonial" refers too, but my understanding was that we simply shouldn't assume treatments developed with western populations would automatically work in non-western contexts. So yeah, same s*** that everyone already agrees with, just with a contentious label (decolonial).

I completely agree that it's super important to consider cultural frameworks and to make thoughtful treatment adaptations rooted in cultural humility. My understanding of the decolonial framework, though, has suggested that the term seeks to run to the very roots of the scientific method. Some of the critical psychology papers I've read which espouse the decolonial framework imply (if not outright state) that the very epistemology of post-positivist science is fundamentally rooted in Western values. I personally find that somewhat unsatisfying because (a) it seems to overlook centuries of empirically-based discoveries by Indigenous and non-European peoples across the globe (even if they didn't use the word "science" or have a formal philosophical definition of the methods thereof, they were absolutely "doing science"); (b) offers very few concrete suggestions for replacement (other than vague notions of constructivist narratives which are by nature ungeneralizable); and (c) throw out the baby with the bath water (yes, we should consider that the cultural terminology and standards of therapeutic care valued in the Western ethos may not translate to folks from other backgrounds, but it's still more likely that a course of CBT delivered with appropriate cultural accommodations will treat someone's ED than will some untested form of practice). A lot of the decolonial work I've read seems to imply that they'd like to scrap the whole enterprise and replace it, but do not say it so plainly.

 

[R. Matey]

I completely agree that it's super important to consider cultural frameworks and to make thoughtful treatment adaptations rooted in cultural humility. My understanding of the decolonial framework, though, has suggested that the term seeks to run to the very roots of the scientific method. Some of the critical psychology papers I've read which espouse the decolonial framework imply (if not outright state) that the very epistemology of post-positivist science is fundamentally rooted in Western values. I personally find that somewhat unsatisfying because (a) it seems to overlook centuries of empirically-based discoveries by indigenous and non-European peoples across the globe (even if they didn't use the word "science" or have a formal philosophical definition of the methods thereof); (b) offers very few concrete suggestions for replacement (other than vague notions of constructivist narratives which are by nature ungeneralizable); and (c) throw out the baby with the bath water (yes, we should consider that the cultural terminology and standards of therapeutic care valued in the Western ethos may not translate to folks from other backgrounds, but it's still more likely that a course of CBT delivered with appropriate cultural accommodations will treat someone's ED than will some untested form of practice). A lot of the decolonial work I've read seems to imply that they'd like to scrap the whole enterprise and replace it, but do not say it so plainly.

Psychologists are lazy philosophers and decolonizers are no exception. The argument is folk knowledge to take the place of scientific inquiry as a more legitimate epistemic because it empowers marginalized voices. That's all fine and good and it definitely acts on our moral sense of equity, but the obvious problem with folk knowledge is that it's often wrong and when it comes to people's heath, the stakes of being wrong are not low. TikTok is a living, breathing 21st century example of this. NyQuil chicken, anyone? What about a cold plunge to balance that black bile and rid yourself of depression once and for all? In fairness to folk knowlege, there are times when they get it right, which usually occurs through careful observation and replication. Hmm...that's beginning to sound familar.

 

[The Cinnabon]

A lot of the decolonial work I've read seems to imply that they'd like to scrap the whole enterprise and replace it, but do not say it so plainly.

Ultimately this is what never resonated with me, especially when there's pretty solid literature out there both validating CBT's usage in non-western populations and examining cultural adaptations in treatment. I never got the baby in the bathwater mindset as bottom-up cultural adaptation frameworks really seem to achieve your average decoloniast end point without eschewing ... everything we know about psychotherapy.

 

[Fan_of_Meehl]

Do they even teach things like Feynman's 'cargo cult science' cautionary tale any more or is that considered offensive (or passe) these days? Serious question. Has Feynman been 'cancelled' these days?

-----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
{from a quick Google search):

The Core Principles of Scientific Integrity
To avoid doing "Cargo Cult Science," Feynman outlined three main pillars of absolute intellectual integrity:

• Full Disclosure: You must provide all the information necessary to let others judge the value of your work. This means including details that could invalidate your results, not just the data that proves your hypothesis.
• Honest Reporting: If an experiment has variables or quirks that might make it invalid, you must explain them to ensure others do not misinterpret the data.
• The "First Principle": You must not fool yourself, and you are the easiest person to fool. Real science requires active effort to try and prove yourself wrong, rather than seeking out data that simply confirms your biases.

Feynman warned that scientists must actively protect their work from motivated reasoning and prioritize empirical reality over external incentives, institutional pressure, or the desire for a specific outcome. You can explore the essay further through the Feynman's Warning About "Cargo Cult Science" video on Youtube:
_______________________________________________________________________________________________________________________

"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

To me, the most fundamental flaw in nearly every piece of 'decolonizing' drivel I read is that it clearly isn't about 'finding out the truth' or questioning their own theory or methods. It's about their ideological and sociopolitical message 'being right' and 'their side' doing the 'winning' in the culture war.

This paper we're discussing is no exception to that rule.

 

[AcronymAllergy]

Can you point me in the direction of the technical manual where it states this? To me, it looks it was just a community sample of 1,620 adults (810 men and 810 women) ages 18 and older. Am I missing the part of exclusion based on diagnosis?

I also don't see an exclusion based on diagnosis? I see that portions of the normative sample had histories of psychiatric hospitalization as well as past and current mental health treatment. And then the various clinical samples, including individuals across settings reporting a history of antipsychotic medication use. But I could be missing something.

 

[Fan_of_Meehl]

I also don't see an exclusion based on diagnosis? I see that portions of the normative sample had histories of psychiatric hospitalization as well as past and current mental health treatment. And then the various clinical samples, including individuals across settings reporting a history of antipsychotic medication use. But I could be missing something.

Also, most of the scales--and especially the restructured clinical scales--remained largely unchanged from the MMPI-2-RF to the MMPI-3 and research on those scales go back to the MMPI-2 era.

The claim that the MMPI-3 lacks valid normative data to yield meaningful or valid interpretations in contexts of testing patients with psychotic disorders is a pretty bold claim. I'm not going to dismiss it outright and we surely need to look into it. It would be one of the most monumental scientific scandals in all of psychological assessment history if true. I know that it has widespread forensic use and courtrooms are usually, at least over a good period of time, pretty effective at rooting out such obvious tomfoolery or scandal on the part of highly-paid expert witnesses and consultants.

I know there's a 'defending MMPI-3' testimony article (e.g., examining the Daubert standard, etc.) as well as one for the MMPI-2-RF floating around the forensic psych literature. Maybe someone more expert at the psychometric underpinnings of the MMPI-3 or who is a forensic psychologist who uses it routinely could chime in.

Alternatively, if someone would like to chime in with a citation to a piece of published work that makes a substantive and well-reasoned argument that the MMPI-3 lacks appropriate normative data to allow it to be used effectively to address psychotic spectrum disorders or populations with such diagnoses, I'm all ears.

I think it's also important to consider the fact that (if I understand things correctly) the MMPI-2-RF and MMPI-3 reflect changes in how the field is viewing psychopathology (including psychosis or unusual bizarre thinking styles or patterns) these days as more of a continuum rather than a dichotomy. I know that some of the materials used for interpreting, say, elevations on the thought disorder scales of the MMPI-2-RF emphasize that fact. The MMPI-2-RF (and MMPI-3) scales that tap into dimensions of aberrant thinking or 'thought disorder' are not supposed to be some sort of 'test' for a psychotic disorder/condition, per se (e.g., above this t-score cutoff, looks like they have schizophrenia). They are supposed to be a measure of how much of that variable appears present or relevant in that individual patient's case (as a dimensional construct) and this is merely one piece of info to be utilized as part of a multi-method approach to psychological assesment and diagnosis. Obviously, when we're talking about diagnosing specific psychotic disorders, information from direct observation, interview (especially around psychotic symptoms), chart review and other sources of info (collateral informants) becomes paramount.

If I took the approach of just naively thinking that significantly elevated THD, PSYC-r, RC6, RC8 or such scales on the MMPI-2-RF meant clear indicators of a psychotic disorder (schizophrenia, schizoaffective d/o, etc.) that was currently unmedicated and out of control exhibiting florid psychosis then more than half of the veterans I give MMPI-2-RF feedback to would end up going immediately to the inpatient unit after the feedback session.

That being said, we are DEFINITELY in need of more empirical data on contrasting the following three groups (a) patients with validated psychotic disorders diagnosed after a structured interview (e.g., SCID-5) vs. (b) veterans presenting for disability evaluation for PTSD (or veterans presenting to BHIP/ PCT clinics at the VA) vs. (c) veterans with confirmed PTSD after 'passing' embedded validity scales on the MMPI-3 (i.e., no significantly elevated F or F-p) and who have PTSD as per the CAPS-5 results and clinical interview.

We REALLY need a critical compare and contrast between / among those three specific groups in relation to normative data on how they all elevate (or fail to elevate) THD, PSYC-r, RC6, or RC8 on that instrument.

Now THAT is a critique I could get behind of the MMPI-3 scales based on my own extensive first hand experience with its cousin (the MMPI-2-RF). Unfortunately, the VA is too cheap / bureaucratic to update its access to the MMPI-3 for its clinicians at the present time.

 

[Shiori]

Just to provide some clarity, the foundational theoretical perspectives that many of these papers are pulling from (often poorly) include Frantz Fanon, Ignacio Martín-Baró, and Paulo Freire. They were deeply impacted and influenced by European colonialism. Their works are definitely worth a read for a better understanding of what they were hoping to deconstruct/"decolonize."

 

[R. Matey]

Just to provide some clarity, the foundational theoretically perspectives that many of these papers are pulling from (often poorly) include Frantz Fanon, Ignacio Martín-Baró, and Paulo Freire. They were deeply impacted and influenced by European colonialism. Their works are definitely worth a read for a better understanding of what they were hoping to deconstruct/"decolonize."

Link them and I’ll take a look

 

[Shiori]

Link them and I’ll take a look

So Fanon can be a little intense. I would read Black Skin, White Mask. That's probably his most widely read book.

Freire's big classic is Pedagogy of the Oppressed.

Martín-baró wrote Liberation Psychology.

There are, of course, a lot of influential people, but they are probably the most widely read for a historical understanding. They also all wrote a ton, so pick up anything that looks interesting.

I have been wanting a refresher for history and systems. I might get back into this bit. Baby Shiori is still contact napping, so I could make that time more productive.

ETA: The Wretched of the Earth is Fanon's most popular book.

 

[Justanothergrad]

But like…..how?!!

I was already sticking w the -2RF bc I trust that data, but that’s wild.

The official reason give was, "covid".

The rorschach has about equal effects to the rf for scid. Around .3. The mmpi3 is around .11 iirc from our in review paper

 

[Justanothergrad]

Can you point me in the direction of the technical manual where it states this? To me, it looks it was just a community sample of 1,620 adults (810 men and 810 women) ages 18 and older. Am I missing the part of exclusion based on diagnosis?

To be clear, there was no intentional collection of those folks or those with that diagnosis for collection with the EX. The result is that no diagnosis was captured for the normative sample, and no inclusion for those folks outside of paid normative sampling based on demographics of the census- which is unlikely to do a whole ton.

It snt in the tech manual. It was personal correspondence with the test author. Ive been part of a lot of mmpi/pai test development and I can tell ya, the tech manual and those reading it regularly miss many of the findings it in. And I can tell you explictly that reviews are NOT rigorous and that a lot of the test is just untested theory and weak science. For instance, how many longitudinal studies on the substantive scales exist (not many)? The validity theory is weak and limited. Recent tests like the iop see it the same way I do- domains dont show up on self report in a reliable and meaningful way

 

[PsyDr]

How is sampling affected, with disorders with equivalent cross cultural prevalence?

 

[Fan_of_Meehl]

To be clear, there was no intentional collection of those folks or those with that diagnosis for collection with the EX. The result is that no diagnosis was captured for the normative sample, and no inclusion for those folks outside of paid normative sampling based on demographics of the census- which is unlikely to do a whole ton.

It snt in the tech manual. It was personal correspondence with the test author. Ive been part of a lot of mmpi/pai test development and I can tell ya, the tech manual and those reading it regularly miss many of the findings it in. And I can tell you explictly that reviews are NOT rigorous and that a lot of the test is just untested theory and weak science. For instance, how many longitudinal studies on the substantive scales exist (not many)? The validity theory is weak and limited. Recent tests like the iop see it the same way I do- domains dont show up on self report in a reliable and meaningful way

You bring up some good points. I think this is why a multi-method assessment approach is so important. Data from scales on broadband tests of personality/psychopathology are meant to be ONE (of many) channels of data/information that are considered in the context of a multi-modal, iterative, hypothesis-generation-and-testing psychological assessment enterprise.

And (sincere question), are there any alternative broadband tests of personality/psychopathology that you would recommend using with this population (psychotic disorders)? Or any brief, self-report instruments that supposedly serve the function(s) that the various thought disorder scales on the MMPI-2-RF (or 3) attempt to estimate/measure as dimensional elements of psychopathology?