Bad Science Department
Sometimes the names of the trauma-focused therapies that folks come up with make me shudder all by themselves, they’re so weirdly Orwellian. That’s the case for “reprogramming therapy,” of which Accelerated Resolution Therapy (ART) is being hyped as the latest and greatest “cure.” Here’s the headline: “Scottish nurses are to be trained in a treatment for post-traumatic stress disorder that works by reprogramming the brains of combat veterans.” Though it sounds like a kind of Orwellian brainwashing, it’s yet another version of Francine Shapiro’s endlessly “promising” (no-longer-so-)new therapy, Eye Movement Desensitization and Reprocessing (EMDR). EMDR and its variants have proved no more effective than any other trauma-focused therapy, which means they’re moderately effective at relieving clinical symptoms in the short-term, for a very small segment of the population that suffers from PTSD (the 20% of women, and about 12% of men with no co-morbid psychological disorders). The description of how ART works is pretty weak: “The patient is asked to move their eyes back and forth while recalling traumatic events, a process which is thought to “unlock” the memory and enable the therapist to start a discussion aimed at detaching the associated negative emotions.”
Since even variations on EMDR that don’t use eye movements all seem to work about the same, it’s pretty hard to argue convincingly that eye movements are the key to “unlocking” the memory. The idea of “unlocking” is purely metaphorical anyway, since there’s no proof that the memory mechanism (whatever it is) “locks” or “unlocks” at all. Since we don’t (even the neuroscientists) have good models for the mechanisms by which we remember, forget, revise or associate, “explanations” like the above are no better than “just so” stories, and often worse than no explanations at all. Sterling University of the UK is teaming up with University of South Florida (USF) to implement ART, which was developed at USF. The rationale is a an allegedly successful study “carried out among 80 war veterans in the US found that the proportion showing signs of PTSD fell from 90 per cent to 17 per cent after four sessions or fewer. (When I found the study, it did not seem to include any war veterans. See next paragraph.) Incidences of depression in the same group dropped from 80 per cent to 28 per cent.” The people who report on science these days are so dim that they don’t understand that stats like this are like giving half a baseball score. A drop from 90% to 17% sounds pretty stunning, but it sure would be nice to know the response rate in the control group (if there was a control group), if they accounted for the placebo effect, and if there was a follow-up study to find out if the treatment had lasting effect. So I poked around and looked for the study (not referenced in the article).
“Brief Treatment of Symptoms of Post-Traumatic Stress Disorder (PTSD) by Use of Accelerated Resolution Therapy (ART®)” wasn’t hard to find. It was published in June of this year in a relatively new open-access journal called Behavioral Sciences. It’s so new that it’s published a total of 45 articles and I can’t find any record of its impact factor. This doesn’t make it a bad journal, and it’s from a reputable publisher, but a more robust study would have found a more prominent home. So let’s see what the study says… 1) Those selected for the study suffered from PTSD, but veteran status was not a criteria for inclusion; 2) 77% of the subjects were women, and 29% were Hispanic: those numbers are not representative of the population of British veterans (none of the subjects appeared to be vets); 3) 17.5% of the subjects dropped out before the end of the study, and 18.2% of the remaining subjects dropped out before the 2-month followup, which means that they collected full data on less than 70% of the full group of participants (54 people); 4) they excluded substance abusers (which would exclude 64%-84% of veterans with PTSD); 5) there was no control group, and all therapists were trained in and administered only ART therapy, which means that the effect of researcher allegiance on the patient was unaccounted for; 6) all data was self-reported. So there is no way to know if the amazingly large effect they reported was due to ART or simply a product of entering any kind of very short-term trauma-focused treatment. Section 4.2, “Possible Therapeutic Mechanisms,” is pretty funny. I’ve rarely seen a longer list of “may be.. postulate… may help… may occur… may simultaneously…” and so on. The chain of conjecture continues for miles. Some of it is just plain pseudoscientific gobbledygook: “… ART involves an additional therapeutic element known as the ‘Director’ intervention that directs the patient to establish a new narrative to address ‘unfinished business’ in much the way that Gestalt techniques are used experientially to achieve positive results. Success of the intervention is determined by the therapist asking the participant to pull up the original distressful [sic] images, and reporting being unable to do so.” In light of the fact that the study did not include combat veterans, the final line of the paper is telling: “Future controlled studies with ART are warranted, particularly given its short treatment duration, and in light of current heightened emphasis on health care cost constraints, as well as the very large clinical burden of treatment of PTSD being experienced from the lengthy wars in Iraq and Afghanistan.” To me, this just screams: “We’re gonna sell this to the military!” And, of course, the military bought it: the DOD paid for the initial research, and now ART® (don’t forget that trademark!) is a product now offered to British war veterans.
PTSD Made Them Do It!
In Denver, a military veteran named Daniel Abeyta was arrested for allegedly shooting two women and blowing up a propane tank. The CBS Denver headline was “Neighbors say shooting suspect is vet with PTSD,” but that’s not mentioned in the article until the final paragraph: “Neighbors said Abeyta… suffers from post-traumatic stress disorder and is involved in a difficult marriage.” It’s always fun when your neighbors diagnose you for the news media and then the news affiliate headlines the hearsay. In other news, 43-year-old Dinalynn Inez Andrews Potter, a retired Navy vet, allegedly jumped on stage and clobbered elderly soul singer, Lester Chambers when he sang a song dedicated to murdered teenager Trayvon Martin. Apparently Potter’s claim she has PTSD makes this “not a racial attack” in the eyes of the arresting officer, even though Potter yelled, “It’s all your fault, you caused this shit,” before she knocked the frail singer on his ass. This “It’s not racism, it’s PTSD” stuff is just silly. It’s not like the two are mutually exclusive. PTSD doesn’t change your political beliefs or give you prejudices you didn’t have in the first place, even though it might remove your inhibitions to acting on them.