@cognitivedefusion / cognitivedefusion.tumblr.com
Here is the most recent edition of The Behavior Therapist investigating the biomedical model of psychological disorders, and how reducing mental disorders strictly to neurological markers is not only empirically erroneous (i.e., there are still zero biomarkers for any mental disorder) but can actually be harmful (e.g., worsened prognoses, increased negative stigma).
File under REQUIRED READING. This has some of the brightest minds in the field today.
How to handle your panic attacks and anxiety attacks, step by step.
“Surviving” panic attacks...The definition of “survive” is to continue existing in spite of danger. The thing about panic attacks is they are not dangerous. They are really entirely harmless based on all medical and psychological accounts.
The anxiety leads people to believe they are dangerous, but they aren’t, and that’s the entire point of exposure: to directly and behaviorally challenge the notion that panic attacks are harmful in some way. To show someone they can endure a panic attack or the anxiety stemming from the threat of one and be perfectly okay.
Relaxing and coping just reinforces the notion that they are dangerous or harmful.
self diagnosing is so hard because everytime you’re like “maybe I am mentally ill” theres also a big part of you going “nah you’re probably just a naturally lazy/nasty/disgusting/useless...
I don’t really see self-diagnosis as inherently positive or negative; I think it largely depends on the person doing it, the resources they are utilizing in arriving at their conclusion, and most importantly what they plan on doing with that information.
That said: the idea that self-diagnosis is going to be as accurate as professional and objective diagnosis is definitely erroneous. Professionals who diagnose without objective tools are really bad at diagnosing, so I doubt there’s any reason to expect that non-professionals without objective tools are going to be any more valid.
Assessment is a pretty intricate process, and many diagnoses get mistaken for another. In many cases this may not matter a whole lot because treatment might look similar (e.g., GAD vs. MDD), but in other cases it can make a world of difference (e.g., ADHD vs. Bipolar). It’s not as easy as treating the DSM as a checklist of criteria, and lining up your perceptions to what they say on there.
Cliff notes: self-diagnosis is likely not very valid, but that should be less of a concern than what the individual is going to do with the information they gather.
People with social anxiety will be able to relate with this easily
The first one is me any time a doorbell rings.
me
Yepyepyepyep
Currently doing social anxiety exposure with a young adult. It’s been pretty damn awesome.
Hello, I read your piece on EMDR. I'm a bit confused what's bothering you about it. I thought EMDR is alternating stimulation of the brain sides. I thought this stimulation could be due to visual things, like the handmovements, but tapping on the legs as well, or vibrating things to hold, or even sound. You make it sound like it's strictly handmovements. I'm sorry for my language, English is not my native language, and I might have phrased things weird or even wrong.
What bothers me about EMDR is that it lacks evidence. Specifically, there is no evidence to date that suggests the eye movement exercises are remotely helpful for long-term outcomes, yet proponents continue to tout how powerful EMDR is as a treatment. This stems from a really basic misunderstanding of outcome research, and more specifically, how component analyses work.
EMDR, when done correctly and as intended, contains two parts: an exposure-based component, and the eye movement component. We know the exposure-based component works because it’s derived from exposure therapy, the most efficacious treatment for anxiety disorders that we know of. So the question is simply what about the eye exercises?
Simple studies can help us out with that question. Take one group and give them exposure, then take another group and give them exposure + eye exercises. What happens? Well, from what we see, there’s no difference. This leaves us with an inescapable conclusion that the eye movement exercises seem to do absolutely nothing.
So what, right? It’s still supposedly comparable to exposure when done correctly which means it is still effective. Who cares? Well, there are a few problems with that. First, what about therapists who receive subpar training and understanding about EMDR implementation? What if therapists who are trained to do EMDR over-emphasize the eye movement exercises and underutilize the exposure component? Then what we would have is a watered-down exposure, which would likely reduce efficacy. Second, thousands of therapists are basically being scammed of money. EMDR training requires certifications, credits, and various “levels” of expertise. People who want to be considered EMDR therapists are paying thousands of dollars to do so. On the other hand, you could spend 1/10 of that and find a really great workshop on exposure without all the bells and whistles and scamming.
So, just a few things. Basically: it’s pseudoscience, nonsensical, and is basically robbing thousands of clinicians of their money. It’s turned into a multimillion dollar industry.
I don’t have an opinion on this, but could you provide sources supporting your view?
Hello, I read your piece on EMDR. I'm a bit confused what's bothering you about it. I thought EMDR is alternating stimulation of the brain sides. I thought this stimulation could be due to visual things, like the handmovements, but tapping on the legs as well, or vibrating things to hold, or even sound. You make it sound like it's strictly handmovements. I'm sorry for my language, English is not my native language, and I might have phrased things weird or even wrong.
What bothers me about EMDR is that it lacks evidence. Specifically, there is no evidence to date that suggests the eye movement exercises are remotely helpful for long-term outcomes, yet proponents continue to tout how powerful EMDR is as a treatment. This stems from a really basic misunderstanding of outcome research, and more specifically, how component analyses work.
EMDR, when done correctly and as intended, contains two parts: an exposure-based component, and the eye movement component. We know the exposure-based component works because it’s derived from exposure therapy, the most efficacious treatment for anxiety disorders that we know of. So the question is simply what about the eye exercises?
Simple studies can help us out with that question. Take one group and give them exposure, then take another group and give them exposure + eye exercises. What happens? Well, from what we see, there’s no difference. This leaves us with an inescapable conclusion that the eye movement exercises seem to do absolutely nothing.
So what, right? It’s still supposedly comparable to exposure when done correctly which means it is still effective. Who cares? Well, there are a few problems with that. First, what about therapists who receive subpar training and understanding about EMDR implementation? What if therapists who are trained to do EMDR over-emphasize the eye movement exercises and underutilize the exposure component? Then what we would have is a watered-down exposure, which would likely reduce efficacy. Second, thousands of therapists are basically being scammed of money. EMDR training requires certifications, credits, and various “levels” of expertise. People who want to be considered EMDR therapists are paying thousands of dollars to do so. On the other hand, you could spend 1/10 of that and find a really great workshop on exposure without all the bells and whistles and scamming.
So, just a few things. Basically: it’s pseudoscience, nonsensical, and is basically robbing thousands of clinicians of their money. It’s turned into a multimillion dollar industry.
100% on the money.
Huh.
I mean, I could probably make a small amount of a case that the mysticism of EMDR could relax some people and make some them more comfortable with exposure therapy that comes after. (Exposure therapy works, but it’s also like…not fun.) I sort of made that argument about Rorschach inkblots here. ….but like yeah, mostly annoyed by EMDR.
Relaxation is 100% at odds with proper implementation of exposure. The entire learning process, the entire driving force of exposure, requires fear and anxiety to be present and intense. If EMDR is relaxing individuals, then long-term prognoses are likely not great. Unfortunately EMDR literature doesn’t look at this, though.
Thank you for your answer, though I don't think it answers my question. I actually do have a fair understanding of component analysis. But maybe it only seems like everyone who practices EMDR is only concerned about the eye movement, while in reality there are people who know it goes beyond that, or just isn't limited to the eye movement? It's just that you're bashing on a therapy which works, while in my opinion it would be more appropriate to bash on the people who misuse it.
I take issue with the very statement “a therapy whichworks” in reference to EMDR, because the therapy as a whole does not work,just a single component. That’s almost a fallacy of composition.
Ask yourself this: what does “work” mean inthe context of anxiety treatment? What is the etiology of anxiety and fear? Further, how does EMDR address that etiology?That is, what are the mechanisms of change at play for anxiety treatment and inwhat way do eye movements have any role in facilitating those mechanisms? The answers to these questions illustrate the unequivocalconclusion that anyone who does EMDR doesn’t have the most rudimentary grasp ofanxiety pathology, nor the mechanisms of change which address that etiology.
What do EMDR therapists tell their clients, do you think? Are they open about the fact that their therapy is literally labeled “controversial” by the organization which classifies treatment efficacy? Are they open and honest about the lack of evidence for half of the treatment components? Do they promote a firm grasp of anxiety pathology and how to address that pathology, and the fact that half their therapy has absolutely no role in facilitating change? What about the millions of dollars being made off of it - do the people running the workshops openly share the controversial literature, and the unsubstantiated claims being made? Isn’t that kind of like fraud?
Ultimately, I just don’t believe science should be in thebusiness of pseudoscience apologism all out of some misplaced sense ofpolitical correctedness, or “politeness” or whatever drives it. It’sup to the proponents of EMDR to make a case for the incorporation of eyemovement efficacy, and they have failed to do so. We have a responsibility to clients and those suffering from psychopathology, not a therapist’s right to do whatever they want because they feel like it.
Hello, I read your piece on EMDR. I'm a bit confused what's bothering you about it. I thought EMDR is alternating stimulation of the brain sides. I thought this stimulation could be due to visual things, like the handmovements, but tapping on the legs as well, or vibrating things to hold, or even sound. You make it sound like it's strictly handmovements. I'm sorry for my language, English is not my native language, and I might have phrased things weird or even wrong.
What bothers me about EMDR is that it lacks evidence. Specifically, there is no evidence to date that suggests the eye movement exercises are remotely helpful for long-term outcomes, yet proponents continue to tout how powerful EMDR is as a treatment. This stems from a really basic misunderstanding of outcome research, and more specifically, how component analyses work.
EMDR, when done correctly and as intended, contains two parts: an exposure-based component, and the eye movement component. We know the exposure-based component works because it’s derived from exposure therapy, the most efficacious treatment for anxiety disorders that we know of. So the question is simply what about the eye exercises?
Simple studies can help us out with that question. Take one group and give them exposure, then take another group and give them exposure + eye exercises. What happens? Well, from what we see, there’s no difference. This leaves us with an inescapable conclusion that the eye movement exercises seem to do absolutely nothing.
So what, right? It’s still supposedly comparable to exposure when done correctly which means it is still effective. Who cares? Well, there are a few problems with that. First, what about therapists who receive subpar training and understanding about EMDR implementation? What if therapists who are trained to do EMDR over-emphasize the eye movement exercises and underutilize the exposure component? Then what we would have is a watered-down exposure, which would likely reduce efficacy. Second, thousands of therapists are basically being scammed of money. EMDR training requires certifications, credits, and various “levels” of expertise. People who want to be considered EMDR therapists are paying thousands of dollars to do so. On the other hand, you could spend 1/10 of that and find a really great workshop on exposure without all the bells and whistles and scamming.
So, just a few things. Basically: it’s pseudoscience, nonsensical, and is basically robbing thousands of clinicians of their money. It’s turned into a multimillion dollar industry.
The captions in this photo perfectly illustrate the stigma that surrounds each of the illnesses. The MRI and fMRI brain scans show the biological nature of the mental illnesses and the inaccuracy of the stigma.
Except the biomedical model of mental disorders has been well-documented as increasing negative stigma. This is a very small peak of what the general consensus tends to be.
I cannot make this any more clear, but perpetuating the biomedical model of mental disorders (i.e., mental disorders are caused by biological dysfunction) creates and sustains stigma.
Including a lit up brain without context (like what was the statistical threshold for what counts as activity? What were people doing in the task?) is meaningless. Yes, literally meaningless.
Showing that NT and ND brains are different is a statement of fact that is compatible with either a medical or social model. Your brain can be different because you have different genetics that lead your brain to develop differently, or because you are treated differently by society, or both. Both “nature” and “nurtire” interact and together determine brain development. It ticks me off when people assume anything using scientific methods is “medical model” and therefore bad and stigmatizing. That ain’t what medical model means and it falsely makes science the enemy. That’s unfair to ND scientists, among other problems.
I’m not sure how much of that post was directed towards me, but I’ll clear up any misunderstandings just in case. The contention is when people suggest that biomedical explanations alone can account for mental disorders, or even play the majority role. In reality the answer is much more complex, and it likely varies among diagnoses and individuals.
Last I checked, there is not a single biomarker that can reliably diagnose or predict the onset of a mental disorder. Hence, when people point to biomedical causes, there’s a serious dearth of actual data to support such claims. This is where my contention lies; not that there are not biological correlates.
Again, not sure if directed towards me, but I don’t assume scientific methods = medical model = bad/stigmatizing. But I do acknowledge that scientific methods have shown that the biomedical model of mental disorders increases and perpetuates negative stigma.
Just for a third time: I’m not sure how much of your post was in response to mine, but I felt obliged to respond just in case.
The captions in this photo perfectly illustrate the stigma that surrounds each of the illnesses. The MRI and fMRI brain scans show the biological nature of the mental illnesses and the inaccuracy of the stigma.
Except the biomedical model of mental disorders has been well-documented as increasing negative stigma. This is a very small peak of what the general consensus tends to be.
I cannot make this any more clear, but perpetuating the biomedical model of mental disorders (i.e., mental disorders are caused by biological dysfunction) creates and sustains stigma.
summary of RDoC: Research Domain Criteria (RDoC) is an initiative by NIMH to encourage researchers to “Develop, for research purposes, new ways of classifying mental disorders based on behavioral dimensions and neurobiological measures.” It focuses on using mostly psychophysiological and other...
All of these things. I’m still...wary, you might say.
Hello, first off big fan of your blog and have been for a long time. I think it's great. It has definitely inspired me to think differently about psychology and not just take everything at face value. But anyway on to my question. I was wonder do you have or know any good resources or articles on ACT, particularly with addressing or treating addiction or substance use? I'm trying to find a good starting point and haven't really found much. Do you have any recommendations? Thanks!
Lots of good resources on ACT! There are great books, reviews, and individual studies which delineate ACT and how it differs from other modalities. I’d be happy to make further suggestions if you have something more specific in mind as to what you’re looking for.
Regarding substance use/addition, see: https://contextualscience.org/act_for_addictions_studies_and_publications
There’s a section in there titled Substance Abuse Research. Something tells me there might be some worthwhile things in there…just maybe.
The notion that ticklish conversations must be scrubbed clean of controversy has a way of leaking out and spreading. Once you designate some spaces as safe, you imply that the rest are unsafe. It follows that they should be made safer.
An interesting perspective.
This post stems from a thought I had the other day while perusing tumblr and seeing all the “you have flawed brain chemistry, not character” posts in support of depression sufferers. I had to ask myself, is this true? And the answer is not necessarily. But before you get angry at me, let’s discuss this further.
Just skimmed this, but I mean, I agree (as most of my followers know by now). The known biological components of most mental disorders are vastly inflated, meaning, we know far less than we think we do, and the importance we assign to biological variables without sufficient evidence to do so is kind of overwhelming. Of course biological correlates exist (I mean, biological correlates exist for everything you do), but the emphasis placed on said correlates, which are largely unknown, is astounding.
All this said, it’s a shame you have to be cautious to post something like this. I totally understand why, and I’ve had my posts misconstrued in serious ways in the past, but it’s a shame we can’t be scientifically honest. It’s like this construct has been built around psychological disorders that relies on biomedical explanations, and the moment you question that, it’s as though you are questioning other things (moral judgments about people, evidence behind a diagnosis’ legitimacy, etc.)
Hi! I'm a French second year (undergrad) psychology student, and I'm kind of hoping to get a PhD or doctorate later on (I'm hesitating between wanting to be a researcher or a clinician). I'm curious about how you published so much as a Master's student! Was in something you did in school, or by yourself, or as a part of an internship, or..? And what do you mean by "getting research experience"? How can you do that, as a student? Are publications required to be accepted to a Phd program in (cont)
America? I also have another question. My school only offers a 5 year degree (Masters). We are required to do 1200 hours of internships and write a Master’s thesis to graduate. This gives us the title of “clinical psychologist” in France. However, though we have physiology and neuropsychology classes, we also have Jungian psychoanalysis, Lacanian psychoanalysis, neuropsychoanalysis, and Freudian psychoanalysis classes. The classes with the most credits are the Rorschah and T.A.T. classes (cont.)
We even had graphology classes in 1rst year! Our psychopathology classes are “psychodynamic” (which means our psychiatrist teacher believes in refrigerator mothers cause autism). And we can’t choose our classes like in the US. On the plus side we have /some/ research methods, stats, cognitive psychology and psychometry classes, and supervision for internships. What I’m afraid of is if I apply to a Phd program in any research oriented school, they’ll take one look at my school reports and (cont)
and I’ll be a laughing stock. I read as much as I can, and I have an opportunity for an internship with my experimental psych teacher who works at the CNRS next year. But I’ll still be spending most of my next 3 years learning to interpret the Rorschach. And I can’t transfer schools. Realistically, do I have any chance of being taken seriously if I apply for a PhD program? And even if I am, how can I be ready for it? My GPA is not even that good from zoning out in class whenever we are (cont)
are told that if children sleep in their parent’s room they might become psychotic, or that children can’t learn to talk while they are still breastfeeding, or that people with BPD are confused about what is inside and what is outside their skin, and this problem also makes them bulimic. So I’m really worried about all this! All these future clinicians being taught nonsense (I feel sorry for their patients), and also my own future if I want to do research! (Sorry for the long message.)
Hi there! Thanks for the message. I’ll try to respond in chunks:
Let me know if there’s anything else you’re hoping to know! I can only speak on behalf of my experience/understanding, however.
cognitivedefusion I’m waiting for you to step in to critique this.
I’m here, I’M HERE!
It all depends. Some of these could be perfectly acceptable (e.g., discuss what is happening - that could very well get you in touch with what you are experiencing), while others are clearly rooted in avoidance (e.g., leave the environment).
Some are kind of in the gray area. Reading a good book can be fine, so long as it’s not done as a means to get rid of the urges, but rather something one can engage in with the urges. That is, making room to experience life so that valued behavior can occur even when urges are present, and working against the “either-or” mentality. “I’m going to read a good book with my urges, and without attempts to try and rid myself of them.”
Etc. etc. etc.
