Summary: Many psychological interventions might not either work or even cause harm. Unlike medications, these therapies are not well regulated. Psychological interventions do not go through approval processes like drugs, and there is also a poorly adverse event reporting system. Experts believe that much psychological research on which these interventions are based is biased or flawed. Moreover, objective data is missing in most psychological studies, and results are based on subjective findings. The studies often have small sample sizes or give higher significance to less vital outcomes. Commonly used interventions like DARE have failed to reduce illegal drug abuse. Critical incident stress debriefing (CISD) does not appear to reduce the risk of PTSD. Most professional organs like APA recognize that the effectiveness of these interventions is controversial, and yet these psychological interventions remain popular.
Understanding some basic medical research concepts is essential to knowing how some psychological therapies are flawed or based on biased results.
Harm does not essentially mean some physical harm or unwanted effects. Even no benefit from therapy can be classified as harmful as it means loss of time and resources, investment in something that does not work.
The efficacy of psychological interventions is more complex to estimate. It is because most measures are “subjective” and not “objective.”
Subjective are like feelings and other symptoms reported by individuals that are difficult to measure. Thus, feel better, degree of fatigue, memory, focus, sadness, emotional stress are all difficult to measure. There is no way to measure these things accurately.
Objective data could be things like blood pressure, body weight, heart rate, blood glucose level. As one can see, these things are pretty measurable.
In psychology, most of the research is based on measuring or quantifying subjective data. Thus, bias can be readily introduced.
Further, many such studies use a smaller sample size, that is, fewer participants. Generally, if any therapy has a small effect, it would need a greater number of participants to confirm or measure its effects.
Another way could be using the false endpoint or paying greater attention to insignificant findings. Just take an example of psychological intervention that involves telling students about the risks of drug abuse. And, at the end of the class asking them if students learned anything. Perhaps most would agree that intervention was beneficial. However, in reality, it may play no role in preventing drug abuse.
Studies show therapies reporting fewer negative results
Researchers worry that many studies are biased these days. Just take an example of a study that analyzed 4600 papers on various medical subjects. The study found that in just seventeen years, between 1990 to 2007, reports of positive results have grown by 22%. It means that the objectivity of reporting is coming down1.
Since in psychology, most data are subjective, things are even worse. One study found that almost close to 90% of research papers have wrong statistical analysis2. Studies already show that there are many potentially harmful therapies (PHTs) due to incorrect reporting, greater significance to less critical facts, over-reporting of therapy effects. Sometimes unclear or difficult to understand statistical methods are used to confuse the readers3.
Unlike medications, US FDA does not regulate psychological therapies
There is a long and complex process to get medical drug approval, taking a decade in many cases. Further US FDA has an adverse effect reporting system. That is why some drugs that were initially shown good and cause harm later are withdrawn from the market4.
However, in the case of psychological interventions, things are very different. US FDA does not approve them. In some cases, they may get approval on the basis that are difficult to understand and even based on a single poorly designed study. Moreover, there is no sound system of reporting harms or lack of any effect from such a therapy.
Therapies that do not work
Many commonly used psychological interventions do not work and may even do more harm. Just take an example of the DARE program (Drug Abuse Resistance Education Program). There is little evidence that it works, and yet millions are allocated to this program each year.
It is true that after the DARE program, many studies report that it helped, and an equal number of students also say that it did not impact them. However, if we look at the data on drug abuse among students since the start of the program, it becomes more than clear that it failed to achieve any of its objectives. On the contrary, statistics show that illegal drug abuse, alcohol abuse, have all risen5. Thus, many experts believe that funds allocated to this program could be put to better use, like improving the education system.
Another example could be critical incident stress debriefing (CISD), which involves a person exposed to stress or trauma to retell about this event to a group of individuals. Psychologists believe that it may result in ventilation and thus relief. It is a psychological therapy even commonly showed in various films to manage PTSD. However, there is no evidence that it works. American Psychological Association (APA) confirms that there are even paradoxical reports showing a higher risk of PTSD in those who were part of CISD6.
Many global organizations share this opinion. Thus, the British psychological society also thinks that most of these therapies do not work and may even cause harm, thus classifying them as PHTs7.
References
1. Fanelli D. Negative results are disappearing from most disciplines and countries. Scientometrics. 2011;90(3):891-904. doi:10.1007/s11192-011-0494-7
2. Nuijten MB, Hartgerink CHJ, van Assen MALM, Epskamp S, Wicherts JM. The prevalence of statistical reporting errors in psychology (1985–2013). Behav Res. 2016;48(4):1205-1226. doi:10.3758/s13428-015-0664-2
3. Williams AJ, Botanov Y, Kilshaw RE, Wong RE, Sakaluk JK. Potentially harmful therapies: A meta-scientific review of evidential value. Clinical Psychology: Science and Practice. 2021;28(1):5-18. doi:10.1111/cpsp.12331
4. Research C for DE and. Questions and Answers on FDA’s Adverse Event Reporting System (FAERS). FDA. Published May 22, 2019. Accessed October 8, 2021. https://www.fda.gov/drugs/surveillance/questions-and-answers-fdas-adverse-event-reporting-system-faers
5. Lesser B. Does the DARE Program Work? | Dual Diagnosis. Accessed October 8, 2021. https://dualdiagnosis.org/drug-addiction/dare-program-work/
6. critical-incident stress debriefing – APA Dictionary of Psychology. Accessed October 8, 2021. https://dictionary.apa.org/critical-incident-stress-debriefing
7. When therapy causes harm | The Psychologist. Accessed October 8, 2021. https://thepsychologist.bps.org.uk/volume-21/edition-1/when-therapy-causes-harm
