CONTRADICTING ADVICE
I was confused by your October/November issue. In Nikolas Westerhoff’s article “Fantasy Therapy” I read that psychologists “treated male disaster workers traumatized by the World Trade Center attacks of September 11 by exposing them to realistic renditions of planes flying over virtual twin towers....” But then in “Brain Stains” I read, “For example, research ... has shown that reliving traumatic memories shortly after a terrifying event—performed in a popular therapeutic technique called crisis debriefing—may cause unnecessary stress and impede recovery.”
Are some traumas so damaging that once they have occurred there is not much therapy can do?
Chuck Kollars
Ipswich, Mass.
LAMBERT AND LILIENFELD REPLY: Regarding the question of when, if ever, therapeutic exposure to traumatic experiences is helpful, both learning theory and scientific evidence offer guidance. Exposure can be helpful, but only when it is sufficiently prolonged to permit clients’ anxiety to dissipate. One of the key shortcomings of crisis debriefing is that it is typically conducted in an uncontrolled fashion—some clients may leave sessions less anxious than when they entered, whereas others may leave sessions more anxious. For the latter individuals, crisis debriefing may be harmful.
MOOD MEDS VS. PLACEBOS
“The Best Medicine?” [Facts and Fictions in Mental Health], by Hal Arkowitz and Scott O. Lilienfeld, is a valuable article on the advantages of cognitive-behavior therapy over antidepressants. But the authors err in repeating the highly inflated claim of 67 percent effectiveness for antidepressants in the study by psychiatrist A. John Rush and his colleagues, which offered patients a four-step sequence of different antidepressant medications. If patients did not attain remission at one stage, they could then try a different antidepressant.
It is important to note that this study included no placebo control groups. Published studies that do include such controls typically find a 25 to 30 percent success rate with placebo. Only one drug in Rush’s study achieved even that rate of remission—all other drugs and drug combinations did worse. Rush’s 67 percent figure came from cumulating across trials without taking into account the placebo effects operating within each trial.
Moreover, supporting the explanation that antidepressants provide primarily a placebo effect, patients showed very high relapse rates consistent with the time-limited value of placebos.
The widely quoted 67 percent figure is bogus. I am the second author of an article soon to be submitted for publication that provides a critique of this study, citing the placebo problem as well as other issues.
Allan M. Leventhal
Silver Spring, Md.
ARKOWITZ AND LILIENFELD REPLY: Leventhal raises two different but related questions about Rush’s study. The first is, How effective was the treatment sequence used in this study (regardless of what was responsible for its effectiveness)? We disagree that the 67 percent finding is “bogus.” Irrespective of what caused this outcome (active medication or placebo effect), it is true that 67 percent of the patients were in remission by the end of the study.
The second question relates to the degree to which the outcomes could be attributed purely to the active effects of the medications. Leventhal correctly points out that the absence of placebo control groups in the study makes it unclear whether the outcomes were the result of the drugs or placebo factors such as expectations of change and supportive contact with the research staff. This issue becomes even more significant in light of the fact that most studies comparing antidepressants with placebos usually show only a small advantage for the medications.
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Add CommentI was disturbed by the conclusion by David Pizarro that "Utilitarianism may, in the end, be the right moral theory." The decision whether to push one man onto a train track to save 5 men further down the tracks, is a deeper question than he apparently assumes. A person making such a decision is not deciding simply if 5 is greater than 1. He is deciding how bad will he feel if 5 die versus how bad he will feel if he pushes one man to his death. Now, this 'feeling' he is weighing is more than just some squishy sentimentalism. Pushing that one man is deciding to push the whole of human trust on the tracks. It is the fabric of human society which is being spent here to save those 5 workmen. After all, how could we function if we had to always watch our backs so as not to be sacrificed? These 'feelings' are there for a good purpose -- evolved from a system of trust and respect for each other which allows us to function successfully as a society.
Reply | Report Abuse | Link to thisThis whole VMPFC brain damage theory, I believe though, has offered a possible explanation why some people would prefer the good of the group over the individual in many political areas of our lives.
David Butler
Mission Viejo, CA
Reply | Report Abuse | Link to thisAlthough Richard McNally's book, "Remembering Trauma", has in no way prevented me from seeking therapy, it is an irritant to be told I don't exist!
Today, because I am at a point of great sadness over my crumbling facade of "happy childhood", Dr McNally's stupidity particularly irked me and I wrote this on Amazon.com .............
I have yet to decide whether Richard McNally ,although well educated,is congenitally stupid or an environmentally mediated victim of fullblown denial (hanging out too long with the FMSF crowd).
His arguments appear cogent and appealing, "common sense wise". However, arguing that 100,000s of people don't exist, does not make them cease to be !
Quote............
In 1977, scientists diving on the Gal�pagos Rift in Alvin made a discovery that shook the foundations of biology. They found oases of animals thriving in the sunless depths around hydrothermal vents. Instead of photosynthetic plants, chemosynthetic microbes comprise the base of the food chain at vents. They obtain energy from chemical-rich fluids generated by volcanic processes on mid-ocean ridges, the 50,000-mile (80,000-kilometer) undersea mountain chain that encircles the globe and marks the edges of Earth's tectonic plates.
Unquote
I wonder that Dr McNally spends SO much energy arguing that chemosynthetic microbes don't exist. They're actually just therapy- deluded photosynthetic plants.......... (although in real life, as opposed to his ivory tower world, memories returned BEFORE therapy in the majority of cases and it was the memories which caused the therapy, not vice versa).
Actually, A genius (tested at actual genius level of 180 IQ), Ron Davis "The Gift of Dyslexia" graphically depicted traumatic memory as a bell curve, with memory
on the vertical axis and stress /arousal on the horizontal. As stress levels rose, memory encoding improved ,right up to the top of the 'bell' ,but with increasing arousal
the organism was overcome and could no longer process what was happening..........memory encoding fell away and amnesia progressively resulted.
So simple yet so easy to comprehend and so "common sense" true for we who have experienced amnesia of abuse.
Ron observed the "black hole" (loss of memory) out there among the stars and tried to describe/understand it. Richard can't even see the "black hole", because he doesn't
look through a radio telescope, but spends books trying to explain why black holes don't exist.
Just by the way, he gives ammunition to those accused of molesting children that their victims are mendacious.