Source: Emerson Lima / Unsplash
At the end of each year, I choose post-traumatic stress disorder (PTSD) research studies that I think represent the most and least useful examples of research in this area.
I think the best types of studies are the ones that are actually useful for real patients, and it’s usually around prediction:
- Predict who will develop problems so that problems can be avoided.
- Prediction of response to treatment in controlled environments.
Unnecessary studies in psychological research tend to be unnecessary in one of three ways:
- Attempts to confirm ideological biases of which the authors seem only weakly aware.
- Poorly designed studies that do not provide any important new information but are dressed in fanciful jargon to seem momentous.
- Convenience samples that lack controls and / or quality control.
With that introduction, here’s the good and bad of 2021.
1. A voice of reason going against the tide of COVID hysteria
Roel van Overmeire, from Vrije University Brussel in Belgium, is on the list for the second year in a row. He wrote a critical commentary on a study published by other authors that claimed journalists suffered from PTSD while covering the COVID-19 pandemic. Van Overmeire pointed out several major flaws in the study, but the main one he astutely noted was that the researchers never made it clear whether journalists covering stories about other people faced the most basic test of PTSD, which is exposure to events where someone has been threatened with death, serious injury, or sexual violence. Thus, journalists’ responses to the measurement of PTSD are invalid. Van Overmeire concluded that diagnosing journalists with PTSD who don’t really have it was “to problematize possibly normal behavior.” I call it false positives and politicized research.
2. Another Cut for Evidence-Based Practices (EBP)
Brian Shiner and his colleagues wanted to examine how the culture shift within the Veterans Administration to implement EBP has played out. Their study tells at least two interesting stories. First of all, while it is positive that the percentage of PTSD patients who received EBP increased from 0.7% in fiscal year 2004-2005 to 14% in 2012-2013, it is unfortunately conceivably 86% of veterans with PTSD still do not receive treatment. based on EBP. Second, they classified patients into three levels on the quality of service delivery:
- Psychotherapy received of the lowest quality of eight or more sessions
- Average grade received eight or more sessions from the same therapist
- Highest quality received them within 14 weeks. The group that received the highest quality service delivery improved the most. These data are useful for the VA’s ongoing attempts to set the bar where a standard of quality should exist for the delivery of psychotherapy for PTSD.
3. A small step back from the mother’s blame
Ellisa Brown and the two founders of trauma-focused cognitive behavioral therapy (TF-CBT), Judith Cohen and Anthony Mannarino, reviewed the literature to determine whether parental involvement in TF-CBT work has a impact on children’s outcomes. Their conclusion was that âthe inclusion of non-delinquent caregivers in TF-CBT can improve outcomes for young people. But that’s not what I found remarkable. What I think is remarkable is that luckily they did not try to phrase the review blaming parents for causing their children’s PTSD. Developing a review of the literature that did not address the old-fashioned parent-blame myth probably took enormous restraint. It’s so rare that it’s worth mentioning. I think they still greatly overestimated the impact of parenting behaviors, but it was a small step away from the traditional denigration of mothers in our field.
4. Myth of the trauma-informed approach is on the bestseller list
Child psychiatrist Bruce Perry and talk show host Oprah Winfrey have written a book called What happened to you? Conversations about trauma, resilience and healing. This book was a full-blast commercialization of the toxic stress myth in a book-length treat with the brilliant twist of talk show-style anecdotes, but no research. Among their many unsubstantiated claims, the main one is that if you received love and affection in the first two months of your life, your neural development resiliently protects you. If you haven’t, your brain has been permanently altered in a number of inappropriate ways that literally affect everything in your life as it allegedly shapes the very core of ourselves. As I and others have written before, none of this comes close to being proven, but this narrative has been used to support ideologically based social agendas.
5. A Complex Study of PTSD by (fill in the blank)
The so-called complex syndrome of PTSD is not proven by any diagnostic validation measures, as I and many other researchers have noted, but it appears to be only increasing in popularity. This is one of the most counterfactual developments in the history of the field of trauma. There are too many studies published on this subject each year to be able to cite one study as more egregious than the others, so I chose an example written by three of the biggest producers of this phenomenon. Joseph Spinazzola, Bessel van der Kolk, and Julian Ford have shown that children diagnosed with traumatic developmental disorder (DTD), which is essentially the childhood version of complex PTSD, experienced more emotional abuse and separation from caregivers than from parents. children diagnosed with regular PTSD. Since DTD includes emotional abuse and caregiver separations as criteria, and regular PTSD does not, this was entirely circular reasoning, which the authors, reviewers, and the editor seemed blissfully oblivious.
6. Towards the Fading Promise of Machine Learning
Research using machine learning’s number calculator started appearing in psychology journals around 2010, and researchers are already noting the inability to produce useful results. Like so many other promises of new technologies that never materialized, machine learning has captured little significant new knowledge about human behavior. In a typical example, Jiang and his colleagues applied a machine learning technique to diagnose PTSD. Their conclusion was that instead of using an interview with the 20 symptoms of PTSD, you could get good, but not perfect, diagnostic accuracy with 16 items for men and 14 items for women. Obviously, that wouldn’t cut down on interviewing time much.
7. Towards the Vanishing Promise of Network Analysis
Take everything I wrote about machine learning above and apply it to network analysis, except network analysis has been around longer. Network analysis was believed to be a promising new statistical methodology for optimizing tasks too complicated for the human brain. In the social sciences, this was supposed to discern how large sets of variables come together, which would somehow shed some light on how to best help individuals. As the typical example I chose next shows, we’re still waiting for this to happen. In a study by Zhu and colleagues, they applied network analysis to functional resting magnetic resonance imaging. Using functional connectivity profiles, they were able to accurately distinguish people with PTSD from non-PTSD with 89% accuracy. When a simple diagnostic service can achieve nearly 100% accuracy faster and at a lower cost, one wonders how network analysis is a significant advance.