1/ The PHQ-2 & PHQ-9 are those ubiquitous depression screening questions in medical offices. New article tells us they're "validated" against structured interviews used in research. But... what are those interviews validated against?
It's not the snarky jamanetwork.com/journals/jama/…
2/ question it may appear to be. Seriously, what were they validated against? The PHQ screeners were designed so non-experts without training in psych could make psych diagnoses by following the instructions. But here's the kicker... the "gold standard" structured interviews
3/ (like SCID) are also nearly always administered by non-experts, typically research assistant or students—not by psychiatrists or psychologists. So the interviews were *also* designed so non-experts could make psych diagnoses by following paint-by-number instructions.
4/ The questions in the PHQ and the structured interviews ask about the same checklist of things. In practice, there's no actual expertise involved in the assessments on either side of "validation" equation. Responses to rote questions administered by non-experts
/5 in one office predict responses to basically same rote questions administered by non-experts in another office. That is literally how it's typically done. Then ppl speak solemnly about "established validity." Few look behind the word "validity."
6/ Researchers will ask, what was questionnaire validated against?" And answer is usually another questionnaire. No asks next question... "And what was THAT validated against?"
Because answer is usually a tautology.
End of today's psychometrics lesson.
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1/ Highlights from this crucially important paper:
About 7 out of 10 patients who get “evidence-based therapy” for depression are still depressed after treatment
Of the 3 that get well, about half would have gotten well without treatment
No significant differences between types of therapy (the “dodo bird verdict”)
“Third wave” therapies (eg, ACT) no better than plain old CBT, or any other form of treatment
From the paper: “Most patients do not respond or remit after therapy, and more effective treatments are clearly needed”
So… can someone please explain to me again why these treatments are routinely called “evidence-based therapy?”
2/ When the benchmark is “getting better”—not just doing better than a control group—this is what research shows
Most patients get little or no benefit from brief therapy. This is what research has has shown for 40-50 years. The findings have been consistent for half a century
3/ Someone here offered and analogy:🙏
Imagine if the benchmark for evaluating a plumber was not doing the job right, but how they compared to not trying to do the job at all? Pipes could be leaking everywhere, the pluming fixtures could be falling off—and researchers would be
1/ This quotation needs more psychological nuance. In fact, it’s in our human nature to take pleasure in others’ downfall, for many reasons—often unconscious
It’s not so much that we “make monsters of ourselves,” because the monster is already within. In the words of Aleksandr
2/ Solzhenitsyn, “The line dividing good and evil cuts through the heart of every human being”
It is that *acting* on these impulses—publicly reveling in sadistic glee, joining in the pile-on, inciting others to pile on—feeds that inner monster. It grows larger and uglier, and
3/ the rest of us is diminished. In time, we become an empty husk of the person we could have become
We can’t reason away our feelings and impulses (sorry, cognitive therapists). We may feel that twinge of pleasure in another’s ruination, we may feel feel that inner impulse to
2/ In historic usage, it referred to taking a position (as a matter of *technique,* aimed at self-knowledge) equidistant from id, ego, & superego—terms that no longer hold currency in contemporary psychoanalytic theory, and that are now meaningless to most
So here’s an update:
3/ The term is a recognition that we humans are of many minds about many things, there is inner contradiction, and the contradictions can be at any level of conscious awareness
“Neutrality” means helping the person become aware of all of the inner facets and contraductions,
1/ Depressive Personality Style
“Despite its omission from the DSM, depressive personality is the most common personality syndrome seen in clinical practice. It is a personality syndrome in every sense of the term: an enduring pattern of psychological functioning evident by
2/ adolescence and encompassing the full spectrum of personality processes.
People with depressive personalities are chronically vulnerable to painful affect, especially feelings of inadequacy, sadness, guilt, and shame. They have difficulty recognizing their needs, and when
3/ they do recognize them, they have difficulty expressing them. They are often conflicted about allowing themselves pleasure. They may seem driven by an unconscious wish to punish themselves, either by getting into situations destined to cause pain or depriving themselves of
1/6 The goal of psychotherapy is to insert spaces for noticing and reflecting where space has not previously existed—and thereby create opportunities to know ourselves more fully, connect with others more deeply, and live our lives more congruently
2/6 Psychotherapy is about slowing things down—so we can begin to see and understand patterns and responses that otherwise happen quickly, automatically, without awareness or understanding
3/6 Talk about “optimizing” psychotherapy or making it more “efficient” betrays a fundamental misunderstanding
We find ourselves in difficulties specifically because we *cannot* slow down to notice and reflect. The rush to optimize every facet of life is the disease—not the cure