Scrutinizing the Quick Fix - The College of St. Scholastica

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					       Scrutinizing the Quick Fix:
A critical examination of Pop Therapies

             David X. Swenson PhD LP 2004   1

• to overview the popular
growth of CAM
• to explore reasons for its
• to identify assumptions &
problems with its claims
• to explore ethical and
scientific implications for
this trend

      "The trouble with the world is not what people don't know;
            it's what they know that ain't so." -- Will Rogers
                       David X. Swenson PhD LP 2004                2
What is considered “conventional
treatment” changes over time

I have an earache:
2000 B.C.B Here, eat this root.
1000 A.D.B That root is heathen. Here, say this prayer
1850 A.D.B That prayer is superstition. Here, drink this potion.
1940 A.D.B That potion is snake oil. Here, swallow this pill.
1985 A.D.B That pill is ineffective. Here, take this antibiotic.
2000 A.D.B That antibiotic is artificial. Here, eat this root

                       David X. Swenson PhD LP 2004                3
    What are CAM? (NIH categories)

•   Alternative medical systems– acupuncture,
    ch’I gong, t’ai chi, massage, indigenous systems,
    homeopathy, radionics, naturopathy
•   Bioelectromagnetics– use of magnets &
    electromagnetic fields
                                                         Be very, very careful what you put
•   Biofield– use of subtle energy fields,               into that head, because you will
    Therapeutic Touch, Reiki, ch’i gong                  never, ever get it out
                                                              --Thomas Cardinal Wolsey
•   Biologically-based– herbalism, special diets,
    macrobiotics, orthomolecular therapy, dietary
•   Lifestyle & disease prevention– electro-dermal diagnostics,
    intuitive healing, stress management, self regulation
•   Manipulative & body-based– chiropractic, bodywork,
    reflexology, rolfing, polarity, colonics
•   Mind-body– yoga, meditation, biofeedback, prayer, remote
                          David X. Swenson PhD LP 2004                              4
                                     The Proliferation of CAM

•   In 1990 30% visited CAM practitioners, 46% by 1997
•   Twice as many CAM visits than to primary provider
•   $27 billion business (mostly out of pocket)
•   30-40% use CAM in industrialized countries; 70-
    90% in non-industrialized
•   58% used for health promotion & disease prevention
•   64-70% not disclose CAM use to providers

                    David X. Swenson PhD LP 2004           5
Who uses CAM--

          •      Age 30-50
          •      Women (49%), Men (38%)
          •      Baby Boomers
          •      College educated
          •      Income > $50,000
          •      Worried well or desperately ill
          •      Used for anxiety, depression, headaches, back
          •      Positive attitudes toward holism,
                 environmentalism, feminism, spiritualism, self-
                 determination, naturalism, and personal growth
Eisenberg, D. M., et al. (1998). Trends in alternative medicine use in the United States, 1990-1997: Results of a
follow-up national survey. JAMA, 280(18), 1569-1575.
                                       David X. Swenson PhD LP 2004                                          6
Proliferation in the Professions

•   31% medical schools require CAM
    courses, 64% elective
•   Columbia University College of Physicians &
    Surgeons, Johns Hopkins, School of Medicine,
    Mt. Sinai School of Medicine, Harvard Medical School.
•   13% of US hospitals, 25% inner city hospitals, 30% large
    facilities provide CAM treatments
•   Therapeutic Touch (TT) has taught >50,000 professionals in
    75 countries, 100 university programs, 95 health facilities
•   Several thousand professionals practice Thought-Field
    Therapy (TFT); voice technology costs $100,000
•   There are more than 32 “energy therapy” spinoffs of TFT

                       David X. Swenson PhD LP 2004               7
       Scientific Illiteracy: The Full Moon Effect, or…
       why do you think they call it
homicide rate
traffic accidents
crisis calls to police or fire stations
domestic violence
births of babies
major disasters
casino payout rates
                                         • 43%      of University students
kidnappings                              • 80%      ER nurses
aggression by professional athletes      • 64%      physicians believe in the
violence in prisons                         Full    Moon Effect
psychiatric admissions
agitated behavior by nursing home residents
assaults, gunshot wounds, stabbings
                                                         Journal of Emergency Medicine, 1987
emergency room admissions
sleep walking

                          David X. Swenson PhD LP 2004                                 8
Scientific Illiteracy
•   Overall scientific illiteracy rate is estimated at 95% (Sagan, 1996)
•   91% do not know what a molecule is
•   60% believe UFOs have visited earth & 49% that the government
    conceals visitors
•   50% believe in ESP, telepathy, precognition
•   50% of Americans do not know the earth orbits the sun annually
•   48% believe that humans and dinosaurs coexisted
•   45% believe in faith healing
•   33% believe in astrology & it is scientific
•   20-50% believe in ghosts and haunted houses
•   25% believe in reincarnation
•   14% (est. 25 million people) could not locate the United States on
    an unmarked global map
•   14% believe in fortune telling
•   12 of most popular school science texts have 500 pages of errors
                                     National Science Board & National Science Foundation, 1996
        Follow the money…

•   The annual budget for the National Center for
    Complementary & Alternative Medicine (NIH) was $40
    million in 1999, $113 in 2003
•   NCCAM granted $4.5 million in the study of
    St. John’s wort
•   The estimated annual market for “integrated health
    centers” in the US is $20 billion
•   The Maharishi International University received $2.2 million for
    research of medication on hypertension from the Natl Heart, Lung,
    and Blood Institute
•   The White House Commission on Complementary & Alternative
    Medicine Policy (WHCCAMP) recommends integration of CAM into
    health care agencies, medical education, research, and insurance
•   The Targ research group received $2 million for research on
    remote healing with HIV and glioblastoma patients

                          David X. Swenson PhD LP 2004                  10
Cultural factors in CAM proliferation
•   Stress awareness: Recognition of stress
    & potentially lasting effects of trauma
•   Entitlement: Belief that everyone deserves
    “the good life”
•   Immediacy: Belief in and need for quick
    fixes, everything has a solution
•   Crisis orientation: Preoccupation with trauma,
    crises, emergency, violence, excitement
•   Postmodernism: Widespread uncritical acceptance of Magical
    thinking, paranormal, personal realities
•   Globalization & diversity: curiosity and unquestioning acceptance
    of cross-cultural practices
•   Scientific illiteracy: ignorance or misinformation about scientific
    inquiry, reasoning, & evidence
•   McDonaldization: faster, better, cheaper!
                          David X. Swenson PhD LP 2004                11
       Managed Care factors
     in the proliferation of CAM
•   Competition: Extremely competitive service
•   Financing: Generate revenues with high client
    loads and rapid turnover
•   Cost containment: Cost-effective treatment,
•   Public demand: Reimbursement for some non-
    traditional methods
•   Prevention: Early treatment may cut costs
•   Control: unconventional treatments need to be
    under conventional control

                     David X. Swenson PhD LP 2004   12
             Client factors in
           proliferation of CAM
•   Desperation: Pain, despair, suffering, need to
    find solution when traditional methods don’t
•   Dissatisfaction with limits of traditional care,
    less invasive, misperception CAM is safer &
    less expensive
•   Media promotion: web testimonials,
    infomercials, “news,” requests for
    advertised/popular approaches
•   Cost: Limited financial resources for
    traditional services, do not see long term &          “I don’t want reality, I want
    hidden costs and risk in CAM                          magic.”
                                                                   --Blanche DuBois
•   Uncritical thinking: many people are not              A Streetcar Named Desire
    willing or able to think through complex
    information; peripheral processing
•   Superstition is alive & well
                           David X. Swenson PhD LP 2004                       13
    Therapist/Provider factors
      in proliferation of CAM
•   Good intentions to be effective practitioner,
    desire to help
•   Anyone can be a “Founder” or “Discoverer”
•   Frustration: discouragement with treatment
    resistance and unresponsive conditions
•   Power & control: need for influence
•   Reputation: need for status, recognition
    as a specialist & become the “Ultimate
•   Faith in utility: Belief that “so long as it works” so what?
•   Extreme belief in constructed reality: “If you can think of it,
    it’s real,” it’s our personal realities that are real
•   Snake oil: create dependency, scams, take advantage of
    vulnerable people
                          David X. Swenson PhD LP 2004                14
        Conditions Treated by Energy Therapies--
                    One size fits all?
• Abuse trauma                        • Learning blocks & dyslexia
• Addictions (food, cigarettes,       • Low self esteem
  alcohol, drugs)                     • Migraine headache
• Allergies                           • Negative memories
• Anxiety and Panic Attacks           • Nightmares
• Anger                               • Obsessive-compulsive disorders
• Attraction to the wrong people      • Pain management
• Cancer                              • Peak performance
• Compulsions & obsessions            • Phobias
• Depression and sadness              • PTSD
• Dyslexia                            • Procrastination
• Eating disorders                    • Rejection
• Fears and phobias                   • Self image
• Fibromyalgia                        • Sexual abuse issues
• Frustration                         • Sexual problems
• Gambling
• Grief and loss
• Guilt
• Immune deficiency problems
• Insomnia
                          David X. Swenson PhD LP 2004                   15
    Magical Thinking: Assumptions of “Energy” Therapies

•   all living things have an energy field
•   this field reflects life energy and health
•   energy flows through channels and is
•   expressed through aura
•   energy can be blocked by physical,
•   psychological, or toxic causes
•   blocked energy produces symptoms of
•   energy treatments seek to unblock
    energy and reestablish balance

                          David X. Swenson PhD LP 2004   16
    Qigong & T’ai Chi

•     Chinese movement discipline for
      relaxation, meditation, low impact
      exercise, & self defense
•     Claims to circulate and balance “ch’i”
      (vital energy)
•     Claims to cure an immense variety of
      acute and chronic disorders
•     Chinese research is terribly flawed for
•     Current research shows improvement of
      balance, blood pressure, bone density,
      relaxation, cardio-vascular exercise

                         David X. Swenson PhD LP 2004   17
                     McTherapy Claims
•   Works rapidly, often within minutes,
    “instant relief”
•   Money back guarantees
•   Non-invasive, painless process with little
    or no discussion of painful memories
•   Long lasting or permanent results
•   Results where others fail; 85% - 99% success rate
•   Eliminates problems even when you don’t know what the
    problems are
•   Dramatic testimonials
•   Based on centuries old traditional techniques of healing, new
    discoveries in neurology or physics
•   One size fits all regardless of type of disorder
•   Simple, easy, painless, anyone can do it
•   Training available to anyone who wants to be a healer;
    certification available
                            David X. Swenson PhD LP 2004            18
David X. Swenson PhD LP 2004   19
    Then there’s the “QUANTUM” connection…

•   quantum are packets of subatomic particles that show
    unusual properties, such as being in two places at once
•   events are reducible to both matter and wave form
•   energy and matter are interchangeable

•  thinking is energy
•  thinking makes it so– creates reality
•  thinking can block and unblock energy
•  since thoughts can be in two places at once, one can
•  heal from a distance (also ESP, remote reading, etc.)
•  even physicists can’t agree on how quantum physics works
•  there is no evidence whatsoever that quantum events influence macro events
•  the idea that “the observer makes the difference” is a misinterpretation
•  experimental results in CAM don’t even come close to the rigor of physics
•  it is not appropriate to transfer concepts from one discipline into another
•  nice metaphor… but no cigar!
                             David X. Swenson PhD LP 2004             20
            The problem with “energy” therapies…
•   “energy” is poorly defined (magnetic, electro-chemical, heat…)
•   scientific instruments measure physiological processes not
    “energy” per se
•   pseudo scientific instruments misrepresent measurements
•   Chinese journals have notoriously poor designs & statistics (78%-
    53% flawed)
•   American CAM journals presume
                                                               Emily Rosa testing therapist
    energy & test differences                                    sensitivity to “energy”
•   very low inter-rater reliability
•   conflicting opinions in diagnosis
•   inconsistent conceptualizations

                                David X. Swenson PhD LP 2004                         21
                     Eye Movement Desensitization & Reprogramming (EMDR)
                              (more recently Reprocessing Therapy)

                 •   1987 “wandering eyes walk”; Shapiro received PhD from
                     unaccredited & now defunct school; original study 22 Ss
•   30,000+ professionals trained; over 1m patients; 90% cure within 3
•   Alleges to “unblock the information processing systems” between brain
    hemispheres that somehow restructures memory or balances energy
•   Visual movements unnecessary; got similar results with blind patients
•   No neurophysiological mechanism to explain theory
•   Often combined (contaminated) with other methods such as relaxation
•   Most evidence anecdotal or poorly designed; well-designed
    studies show effects similar to other exposure methods
•   Promoted as “widely validated treatment for PTSD”
    including rape, highway carnage, industrial accidents,
    war, crime, terrorism, sexual abuse, domestic violence,
    natural disaster…        David X. Swenson PhD LP 2004                22
 Left brain,
right brain–
 no brain?

               David X. Swenson PhD LP 2004   23
     Brain-Based Education & Therapy

•   The brain is a completely integrated and
    complementary system, not isolated,
    exclusive units
•   “Using only 10% of our brain” is a myth
•   Sperry’s split-brain research in the 1960s
    gave rise to the topic; there is no separation
    unless by surgery or injury
•   Most neurologists and neuropsychologists
    view the brain as a whole, not left-right
•   “Brain-based instruction” is too simplistic
    and goes way beyond the evidence
•   Many studies referred to by BBE involve rats
    and monkeys, not humans; extending to
    humans is unwarranted
•   “brain-based” references are not necessary
    to applying established learning theories and
•   Developmental windows are not critical–
    people can learn throughout life
•   The Mozart Effect has not been replicated for
    claims on IQ, physical or mental illness         24
    Popular Treatments for Autism
      that have not been proven
•    Auditory integration training
•    Facilitated communication
•    Hyperbaric oxygen
•    Secretin
•    Vitamin B6 and magnesium
•    Dimethylglycine (DMG)
•    Intravenous immunoglobulin (IVIG)
•    AZT (zidovudine, Retrovir)
•    Steroids
•    Antifungal medications
•    Detoxication; chelation
•    Dietary manipulations (elimination of
     gluten, casein, etc.)
•    Hippotherapy; dolphin therapy
•    Sensory integration therapy
•    Craniosacral therapy
•    Behavioral optometry
               David X. Swenson PhD LP 2004   25
       Problems with CAM Approaches
•   Demand characteristics of stage performance
•   Few or no articles in peer reviewed, refereed,
    conventional, professional journals
•   Insufficient design controls
•   Unclear and insufficiently established diagnoses
•   Faulty logic & pseudoscientific comparisons
•   Reliance on self report rather than more objective measures
•   Unfounded transfer of concepts from physics to psychological &
    physical processes
•   Sale and use of quasi-scientific instruments at high prices
•   Diagnosis through unestablished procedures
•   Poorly defined and untestable concepts
•   Denial and rejection of established explanations
•   Nonfalsifiability of approach
•   Defiance and claimed irrelevance of established science
                            David X. Swenson PhD LP 2004             26
                     Proliferation of “McTherapies”
•   Therapeutic Touch (TT): Delores Krieger’s nursing technique for healing by
    brushing & balancing your body’s energy fields (no touch)
•   Brief Strobic phototherapy (BSP): use of colored light on subtle energies of
•   Thought Field Therapy (TFT): Roger Callahan’s algorithmic tapping to balance
    body energies
•   Emotional Freedom Techniques (EFT): Gary Craig’s modification of TFT
•   Tapas Acupressure Technique (TAT): modification of TFT by Tapas Fleming
•   Miracle Acupressure Tapping Technique (MATT): more of the same
•   Energy Psychology (EP): still more by Fred Gallo
•   Touch and Breathe (TAB). Diepold’s combination of tapping and breathing
•   Attractor Field Therapy (AFT): Acupressure for universal energy fields
•   Acupressure Chakra Technique (ACT): acupressure & yogic energy centers
•   Creating, Allowing, Receiving Technique (CART): Tapping 1-2 meridians for
    the future
•   Be-Set-Free Fast (BSFF): Nims’ four-step tapping to resolve unconscious
    energies                 David X. Swenson PhD LP 2004                    27
    “So long as it works, I don’t care…”
    …except that:
•    it may delay effective treatment,
     cause injury, or complicate
     further treatment
•    it is misleading (false hope)
•    it defies informed consent
•    some assumptions imply external locus of control or self
•    it neglects what we know about placebo effect
•    professionals are obligated to identify what works and
•    it contributes to the popular belief that such treatment has
     been validated
•    it predisposes some people to more vulnerability to
     exceptional beliefs and claims
                          David X. Swenson PhD LP 2004              28
    The Growing Herbal Trend:

•   1994 FDA relaxed guidelines
•   33% of US adults use herbals at a
    cost of over $3 billion
•   From 1982-95 physician use of herbals was 16%, referrals
    9%, and interest 23%
•   38 million Americans use fraudulent health products
•   49% use herbal remedies, 24% regularly (44.6 million
•   31% use herbs with Rx meds & 48% with OTC meds
•   70% do not tell their physicians or pharmacists they are
    using herbal remedies
•   Media effects: 2800% St. John’s Wort, 1007% Green Tea,
    500% Kava after news reports                               29
"Poisons and medicines are oftentimes the same substances given with different
intents."                                 -- Peter Mere Latham (1789-1875)

•   Wormwood potentiates phenobarbitol (seizures)
•   Evening primrose lowers seizure threshold
•   Yohimbe & tricyclic antidepressants increase
    hypertension risk
•   Fiber products reduce lithium absorption
•   St. John’s Wort & Kava have MAO inhibitory effect
•   St. John’s Wort & SSRIs produces serotonin syndrome
•   Ephedra interacts with MAO produce hypertension
•   Gensing exacerbates extrapyramidal effects of neuroleptics and
    produces mania with antidepressants
•   Ayurvedic Shankapulshpi diminishes anti-seizure effect of dilantin
•   Ginkgo for mental alertness & Feverfew for migraines potentiates other
    blood thinners
•   Kava & benzodiazepines can produce lethargy & disorientation

                             David X. Swenson PhD LP 2004                    30
         Herbal Treatments:
If it’s natural, it’s got to be good!
   • Lack of standardization
   • Variable dosage
   • Variable potency (can vary 10,000 fold)
   • Fungal, pesticide, & heavy metal contamination
   • Mistaken harvesting
   • Marketing under common rather than botanical names
   • Allergic reactions
   • Interactions with medications
   • Side effects with large dosages
   • Pregnancy/nursing risk

                       David X. Swenson PhD LP 2004       31
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                   David X. Swenson PhD LP 2004                          32
             Intercessory Prayer
• 82% of Americans believe in the
  power of prayer
• Faith/support yields 12x higher
  open-heart surgery survival
• Mortality was 25% lower for church
  attendees than non-attendees
• Lower incidence of blood pressure for
• Positive and negative prayer affects
  seed germination, bacteria, and fungi                James 5:14 “Is any among you sick?
                                                       Let him call for the elders of the
                                                       church, and let them pray over him”
• 64% want providers to pray with them
• NIH funds 5-year study to determine effect of prayer
  on cancer
• Intercessory prayer in the workplace to improve task
• Federal funding for prayer in prisons as treatment
                        David X. Swenson PhD LP 2004                             33
 Research on Intercessory Prayer:
      Possible conclusions

• Omniscient god operates according to human
  experimental design (does not heal those not prayed for)

• Some omniscient force knows how to match prayer with
  unnamed patients; thoughts affect the material world

• We are subject to a veritable ocean of subliminal,
  unconscious, ever-present, intentions, thoughts, emotions,
  and environmental toxins that influence our behavior

• Flawed design, bias, or chance

                       David X. Swenson PhD LP 2004            34
    Alternate explanations of McTherapy cures:
                Likely but not fancy
• Natural history and cyclicity of disease
• Condition runs it course
• Regression to the mean
• Suggestion
• Counter-irritation
• Distraction
• Hawthorne Effect
• Audience demand characteristics
• Confirmation bias
• Stockholm Effect (please powerful figure)
• Fatigue
• Avoidance of painful memories
• Misattribution to CAM when combined with conventional methods
• Cognitive dissonance
• Temporary mood improvement confused with cure
• Habituation
                              These are the alternate explanations that must be
• Reinforcement
                              controlled for with research design in order to establish
• Desensitization             what is treatment effect and what is not.
• Lake Wobegon Effect
• Placebo Effect           David X. Swenson PhD LP 2004                              35
               The Placebo Effect:
      what you see is what you think you get

•   Became prominent with Beecher using normal saline
    when morphine ran out during WWII (33% effectiveness)
•   Krebiozen case (Klopfer, 1950)
•   A study of antidepressants showed that 75% of effect
    was due to expectation (Kirsch & Sapirstein, 1998)
•   Nocebo effect with 57 Japanese students allergic to lacquer tree; real
    touch did not react, fake touch reacted (Ikemi & Nakagawa, 1962)
•   Sham orthoscopic knee surgery showed 60 Ss with improved gait &
    pain (Moseley, et al., 2002)
•   Placebo effect has been documented in cases involving pain
    conditions, headaches, cough, senile dementia, common cold,
    arthritis, seasickness, ulcer, hypertension, anxiety, depression, and
•   Placebo effect ranges from an average of 33% to as high as 75%
•   Level of effect depends on client’s beliefs, practitioner
    beliefs, beliefs resulting from interaction (Benson, 2000)
                             David X. Swenson PhD LP 2004                   36
       The Conditioned Placebo Response

        Unconditioned                                     Conditioned
          Response                                         Response

          Adrenalin        Acetylcholine                    Adrenalin



          Blood Pressure

                           David X. Swenson PhD LP 2004                 37
    How Placebo Possibly Works

Social care &    Reduction of anxiety
  support            & tension

Expectation of     Decreased pain
improvement       perception; higher
                    pain tolerance
Distraction &
redirection of   Production of brain
  attention           opiates
                                                    Improvement in
                                                 Subjective well-being,
 Conditioned         Rebound or                    optimism & hope,
 response to       enhancement of                 symptom decrease,
  treatment       immune response                resolution of disease

  Treatment           Possible                        Response
 Component           Mechanism
                  David X. Swenson PhD LP 2004                    38
       Are you ready to ruuumble?
• Sound research (randomized, double-blind,
  controlled, large sample, representative, reputable
  measurements, etc.)
• Peer reviewed publications: Scientific Review of
  Alternative Medicine
• Committee for Scientific Investigations of Claims of
  the Paranormal (CSICOP)
• National Council Against Health Fraud
• American Council on Science & Health
• Quackwatch
• Evidence-based health care
                     • WHCCAMP (White House Commission on CAM Policy (Final
                       Report March 2002)
                     • Weakening of regulatory agencies
                     • Alternative Health News Online
                     • Center for the Study of Complementary & Alternative
                       Therapies (U. of Vir.)
                     • Rosenthal Center for Complementary & Alternative Medicine
                       (Columbia U.)
                     • Certification programs
                     • Association for Comprehensive Energy Psychology
                              David X. Swenson PhD LP 2004                   39
                    The C.R.A.P. Detector
         (Crackpot, Ripoff and Pretension Detector)
You should be cautious & questioning when:
   • it can’t hurt to try
   • testimonials and anecdotes
   • unclear why or how it works
   • uses pseudo-scientific jargon
   • makes extraordinary assumptions
   • diagnoses or cures “at a distance”
   • secret cures & proprietary knowledge
   • appeals to your vanity (you know best)
   • treats an variety of unrelated disorders
   • it’s too good to be true (“miracle cure”)
   • reliance on “famous” authority or “founder”
   • claims it can’t be tested by conventional means
   • it’s touted as a revolutionary new breakthrough
   • uses “energies” or other vaguely defined mechanisms
   • unusually high effectiveness rate with difficult to treat conditions
   • paranoid accusations against the AMA, pharmaceuticals, government
                          David X. Swenson PhD LP 2004               40
Would you be willing to…

•   Buy land in Florida sight unseen?
•   Purchase a “hot stock” with no performance information?
•   Buy a jar of food with a broken seal?
•   Take medicine out of an unmarked bottle?
•   Undergo a highly unconventional medical procedure?
•   Receive surgery from someone who had a weekend
    workshop on it?

        …so, where is critical thinking when it comes to asking
         for evidence about sound psychological treatment?

                        David X. Swenson PhD LP 2004              41
       Characteristics of “good” science
Randomization– all participants are assigned by
chance to experimental and control groups; controls
for selection bias
Double-Blinding– neither the participants nor
researchers know which participants receive the
treatment or placebo; controls for confirmation bias
Placebo control– the group who receive an inactive or sham treatment in
contrast to the real treatment; controls for the effects of expectation
Falsifiability– an hypothesis must be testable in a way that can show it is false
and can be rejected
Representativeness– the participants in the study match the key
characteristics of the larger population to which the results will be generalized
Standardization– the procedures used (tests, steps, instructions, etc.) are all
presented in the same way to participants
Peer Review– expert peers, wide dissemination, and feedback
Independent replication– multiple reproductions of the study by others who
have no personal stake in it
                              David X. Swenson PhD LP 2004                     42
                                                                        Evidence- based
                  Levels of Credibility                                    Treatment
                     in Research
                                                                        Peer Reviewed
                          Efficacy—                                   Placebo-controlled
                       Whether controlled
                                                                      Multiple replications
                          studies show
                        treatment effects       What is the
This is the
                                                                      Case series studies/
will it hold up                                                         Meta-analyses
                                                that makes it
in applied
                                                appear to work
context?               Effectiveness—           in practice?
                       Whether treatment                         Naturalistic Controlled studies
                        effect occurs in                               (not randomized0
                         clinical work

                                                                      Observational studies

                                                                         Expert opinion

                                                                    Testimonials & anecdotes
                                     David X. Swenson PhD LP 2004                         43
• Keep looking for innovations--better ways to serve clients

• When a novel approach is presented, ask:
    • How do you know it works?
    • What are the assumptions that underlie the
      technique and how do you know they are
    • How do you know that some other
      mechanism isn’t operating?

• If you use these methods
      • make sure the client knows they are
      • keep good records
      • keep partialing out what the mechanism is
                                                         Science is what we have
        (use good science)                               learned about how to keep
      • publish/share your results & seek criticism      from fooling ourselves
                                                                --Richard Feynman
• Challenge proliferation of unconventional
  approaches without sound evidence
                          David X. Swenson PhD LP 2004                     44
“The ideas of great
minds ahead of their
time are often not
Copernicus, Harvey &
Pasteur were all
ridiculed for

However– they
persisted in using the
scientific method and
                               If it was so, it might be; and if it were so, it
through evidence               would be; but as it isn’t, it ain’t.
established their                    -- Tweedledee in Through the Looking Glass

                    David X. Swenson PhD LP 2004                            45

                   David X. Swenson PhD LP 2004      46

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