Prions, Memory and PTSD: A conversation with Nobel prize winning neuroscientist Dr. Eric R. Kandel

Posttraumatic Stress Disorder (PTSD) has been described as a disorder of memory. It has become quite apparent that there are two types of memory in PTSD: the first being the involuntary intrusions of the trauma, and the second being the voluntarily recalled memories that constitute the trauma story, also known as the trauma narrative. Both are fundamentally different in their quality and form. The involuntary intrusions are vivid, highly emotional, and involve a sense of reliving the original trauma. In contrast, the voluntarily recalled trauma narratives do not share this same intensity, but their content is notable for being significantly disorganized. Such disorganization can be found very soon after the traumatic event and hence is not attributable to poor recall, but to the very nature of these traumatic memories themselves. In essence, there is an inability to put into words the most emotional part of a traumatic event, a period of time which could have lasted anywhere from several seconds to several hours. Traumatic memories are also unstable, so what is under voluntary and involuntary control varies over time. For this reason, the recall of trauma over different points in time creates different trauma accounts, with such discrepancies being more noticeable as the symptoms of PTSD become more severe.

For such disorders of memory, a natural follow up question is what are the molecules and chemical building blocks that our memories are made from? Unlike taking a blood sample, a saliva swab or a sample of bone marrow, there is no simple way to sample brain tissue from a live human. For this reason, neuroscientists have relied on animal models to discover what goes on in the brain when memories are made. The work of Eric R. Kandel forms the basis for much of what we understand about how memories are formed. Dr. Kandel was awarded the 2000 Nobel Prize in Physiology or Medicine for his extensive body of pioneering work investigating the synaptic connections between nerve cells in sea slugs. His work has illuminated some of the basic molecular mechanisms underlying learning and memory in animals and is central to understanding not only normal memory, but also disorders that affect memory, such as PTSD. More recently, Dr. Kandel and his colleagues identified a molecule, a prion protein called CPEB, (cytoplasmic polyadenylation element-binding protein 3) that plays a key role in the maintenance of long-term memories in the sea slug Aplysia and in mice. In a 2015 study, Kandel and his colleagues trained mice to memorize a way to navigate through a maze, then the researchers knocked out the mouse homolog of the CPEB gene called CPEB3 and this knocked out the maintenance of long-term memories and caused the mice to forget how to navigate the maze.

Dr. Kandel is a Professor at Columbia University, the Kavli Professor and Director of the Kavli Institute for Brain Science, Co-Director of the Mortimer B. Zuckerman Mind Brain Behavior Institute and a Senior Investigator at the Howard Hughes Medical Institute. I spoke with him about this recent publication and the relevance of such findings to disorders of memory, such as PTSD.

Credit: NIAID

Credit: NIAID

Dr. Jain: The first question I had was about prions. They have a really bad reputation in the world of medicine as being associated with horrific diseases like Creutzfeldt-Jakob Disease (CJD) and Bovine Spongiform Encephalopathy (BSE). Your work has shown that in order to maintain long term memory, we need local protein synthesis at the synapse. You and your colleagues have identified the CPEB protein as a functional prion which has this role of keeping memory indefinitely. Could you talk a little bit more about functional prions and how they differ from prions that cause pathological changes in the brain?

Dr. Kandel: Well, functional prions differ from pathological prions in two ways. First, in pathological prions, the conversion from the soluble form to the aggregated self-perpetuating form is spontaneous. In functional prions, it is regulated by a physiological signal. Secondly, in pathological prions, once the prions assume an aggregated self-perpetuating form, prion proteins then kill the cell. They are then released by the dying cell and taken up by other cells, they kill the next cell and are passed on from one cell to another like an infection. The functional prions are not only turned on by a physiological signal, but when they are turned on and reach the aggregated self-perpetuating form that is their normal function. They are inactive when they are not in the aggregated form. So they fulfill their normal function, which in this case is regulating local proteins synthesis.

Dr. Jain: Taking this one step further, when we think specifically about a psychiatric disorder, such as PTSD, can you speak a little bit as to what these recent findings mean in terms of understanding what the molecular basis for PTSD might be?

Dr. Kandel: Before we come to PTSD, we now have  information on  Age Related Memory Loss indicating that one of the key defects is  upstream from CPEB-3,  the same  functional prion that we found important for maintaining normal memory.

PTSD very likely has prion mechanisms. Joseph Rayman in our lab identified a second prion in addition to CPEB that seems to play a role as a protective factor in PTSD. We have not done enough to talk about it and it has not been published yet.

image credit: Rama

image credit: Rama

Dr. Jain: Neuroscience data comes from studies using animal models (sea slugs, mice etc.). Can you speak a little bit to those of us who are not so familiar with cutting edge neuroscience methodologies, how do we infer from animal models what might be happening in the human brain?

Dr. Kandel: Well, one cannot be certain unless one explores the molecules directly in the human brain, but there is a homologue in the human brain. There is no obvious reason for thinking it does not have a similar function, but until one tests it one cannot know for sure.

Dr. Jain: We hear about these amazing discoveries about these prions and homologues in humans. What is your vision for how basic science research will actually translate clinically into impacting people living with memory disorders?

Dr. Kandel: We are already there in some areas. We have far to go in other areas, but I will give you an example. We have a pretty good understanding of Alzheimer’s disease. We know the toxicity of beta amyloid. We do not know why the drugs that are directed against beta amyloid do not work, but one possibility that is being seriously entertained is that by the time the patient comes to see a physician, they have had the disease for ten years. That is a very long time and you lose a lot of nerve cells in ten years, and drugs do not bring nerve cells back once they are dead.

We need to diagnose the disease earlier and a major effort now, in Alzheimer’s research, is early diagnosis. Imaging, cerebral spinal fluid, genetic warning signals etc.

The other thing is it has proven possible to define an independent disorder, age related memory loss. Recent work from our lab, and that of Scott Small, ,has shown there is a separate entity, independent of AD, called Age Related Memory Loss. We have identified the molecular pathways involved in that disorder. We have treatments that work very effectively in animals. I think the time is going to come soon when these will be tried in people.

All of these came out from a basic science and work with experimental animals. So even though we are in the very early stage of understanding the really complex functions of the brain, we are making progress and all of this will hopefully have some therapeutic impact.

Category: mental health care, Psychiatry, PTSD | Tagged , , , , , | Comments Off on Prions, Memory and PTSD: A conversation with Nobel prize winning neuroscientist Dr. Eric R. Kandel

More sciencey than the rest? The competitive edge of positive psychology coaching

sciencyIs positive psychology coaching better than what its competitors offer? Is positive psychology coaching the science-oriented brand or does it just look sciency? How do we judge?



In Mind the Brain, we have been showing that critical appraisal tools like risk of bias assessment for studies evaluating interventions and a vigilance for signs of confirmatory bias, p-hacking, and significance chasing are crucial in interpreting often untrusworthy scientific claims. Yet, these alone are not enough.

We have also been seeing the need to pay attention to the institutional context, like how journals decide what is publishable, and how universities require that professors prove their worth by publishing lots of papers and telling them where they should publish.

We need to look at the incentives for individual researchers. Do they get rewarded for telling like it is- publishing the fairest interpretation of all their studies  or rather for claiming breakthrough, newsworthy  findings even when the data don’t show that? We need to consider what is suppressed or radically distorted because of these powerful filtering processes. Or else place our faith in the fairness and thoroughness of the peer review Peer-Review-Cartoon2-604x256process: it must be good science because it got through peer review.

We can’t understand what passes for science in positive psychology unless we grasp the larger context of the positive psychology community, the multimillion dollar industry associated with positive psychology, and incentives that the community and its industry offer to those claiming to provide the science of positive psychology.

Shaping what passes for science are the needs of thousands of positive psychology coaches competitively marketing their services. These coaches are themselves a market for positive psychology ”science,” and they promote their “science-based” products and services to individual clients and corporations. At both levels, claims become important of being more sciencey than competitors not sharing the brand of positive psychology.

A recent interview with a designated “positive psychology expert”, Lisa Sansom provides some fascinating insights into the sciencey branding of positive psychology coaching. Positive Psychology Coaching: 12 Urgent Questions Answered is available at PositivePsychologyProgram: Your One-Stop Positive Psychology Resource. At the outset, the interview promises to answer the questions

What is positive psychology coaching? How does it differ from regular coaching? When can I call myself a positive psychologist?

And more. In this blog post, I’m going to probe this interview to understand the distinctiveness of the positive psychology brand of coaching and its implications for what passes for science and evidence in positive psychology.

We will encounter some tensions. Calling oneself a coach does not require any background in psychology or research methodology. Yet coaches claim they interpret and apply scientific findings and promise that makes their brand better than the rest.

If coaches don’t have a background in psychology and the critical skills to interpret new findings, how are they going to do this? They depend on the eminence of those whom they consider scientists, not the actual evidence their research provide. Researchers may become gurus to an audience that cannot appreciate either whether authoritative statements by the researchers are faithful to their actual findings or whether any evidence is actually relevant to the pronouncements being made.

resident_science_guru_novelty_mug-r2eca08dfba82417d91c636949ef1a320_x7jg5_8byvr_324What a temptation! An audience that cannot tell the difference between reasonable and unreasonable interpretations of the evidence, but will pay more for interpretations that help them sell more of their product and services.

Being an authoritative source has rich rewards in terms of opportunities for lucrative trainings corporate talks and direct-to-consumer marketing of their “science.” But success in this market benefits from claiming stronger findings than the spin and confirmatory bias required for publication.

i know more than you doPositive psychology research comes out of social and personality psychology that already has rampant problems with hype, hokum, and unreproducible findings. Do the temptations of the positive psychology market increase pressures on psychologists doing relevant research to produce simplistic, but seemingly unambiguous answers ? Think of having to match reporting of findings to the wonder, drama, and magic of advertisements for positive psychology products.

Positive psychology articles rarely if ever has declarations of conflict interest. Yet, we know investigators’ financial stakes in obtaining particular outcomes lead to exaggerated and simply false claims. Do investigators seeking market claims in positive psychology further contaminate troubled areas of personality and social psychology with undisclosed conflicts of interest? In other areas of social science, there is growing appreciation for the need for routine declarations of conflicts of interest. Some areas have seen dozens of errata and correction notices to articles that previously did not have a declarations.

The interview quotes a chapter by Carol Kauffman, Ilona Boniwell and Jordan Silberman  in giving a definition of positive psychology coaching:

“Positive Psychology Coaching (PPC) is a scientifically-rooted approach to helping clients. increase well-being, enhance and apply strengths, improve performance, and achieve valued goals. At the core of PPC is a belief in the power of science to elucidate the best.”

The interview keeps emphasizing that it is being rooted in science that distinguishes positive psychology coaching from its competitors.

So how does it differ from regular coaching?

On the surface, it might not look or feel much different to a client. However, what is different is that the PP coach continues his or her life-long learning in the field of positive psychology by staying engaged with the research, the literature, the researchers and other PP professionals.

The PP coach also adjusts his or her coaching techniques, methodologies, etc, accordingly when new findings are discovered. “Regular” coaches may not be as tied to the empirical evidence and research findings, and so their techniques and methodologies may change only as a function of their own experiences, or attending conferences where they learn from other coaches’ anecdotal experiences, or they may not change substantially at all.


Perhaps the one thing that is different, as I alluded to above, is that the PP coach also believes in staying close to the science and adjusting his or her approach (etc) accordingly. Coaches that are getting their PP from mass media books only are not getting the full richness and subtleties that are inherent in positive psychology research.

Yet no background in psychology is required to do this:

Overall, to be an effective PP coach or practitioner, one does not need a strong background in traditional psychology and one does not need to be a certified, qualified psychologist.

Even without a coach having a background in psychology,

the benefits to working with a PP coach who is well-trained and qualified are potentially that you will be drawing on a valid body of research (as opposed to just intuition and that individual’s personal coaching experience) and that your coach will know the why and wherefore of the practices, rather than just guessing that things might work for you.

27 factsSurfing around the PositivePsychologyProgram website, I encountered the free resource, 27 of Positive Psychology’s Most Fascinating Facts that advertised

To the point and easy to read (37 pages)

Written by academics, 100% science-based

More free PDF’s, Downloads, Videos…



Of course, I clicked on the

yes send mePNG

And opened to

Fascinating Fact #4: Positive psychology interventions have the power to reduce depressive symptoms.

Sin and Lyubomirsky’s meta-analysis is the single source. It is described as revealing

positive psychology really does increase wellbeing and sooth depression. Furthermore, the status of depression, the age of the participants and the intervention all had an impact on the effectiveness of the interventions. Because of this, clinicians are strongly encouraged to begin incorporating positive psychology techniques into their work.

You can find specifics here  of my evaluation of Sin and Lyubomirsky. I used the same standards I would apply to any other meta-analysis. I found it to be substandard work:

 Sin and Lyubomirsky provides a biased and seriously flawed assessment of positive psychology interventions. Uncritical citation of this paper suggest either subsequent authors are naïve, careless, or bent on presenting a positive evaluation of positive psychology interventions in defiance of available evidence.

But on to

Fascinating Fact #6: The principles and practice of positive psychology are relevant to brain injury rehabilitation.

 Positive Psychology actually has the ability to foster posttraumatic growth, meaning it can make injury sufferers over-all happier (even more so than they were before). Positive psychology allows individuals to re-assess what is important in life, live more in the moment, identify what they are grateful for and to develop personal and intra­personal goals for recovery. All this makes individuals with brain injuries more appreciative of all aspects of life and allows them to return to their social and physical lives faster.

These are patently ridiculous claims. They leave me thinking that we should all put in our advance directives that if we ever suffer traumatic brain injury, we must be protected from positive psychologists and coaches trying to help us to grow from the experience. And just what the hell do these coaches think they are doing in caring for persons with traumatic brain injury?

In the context of a great debate about positive psychology in cancer care, Howard Tennen and I concluded

We are at a loss to explain why positive psychology investigators continue to endorse the flawed conceptualization and measurement of personal growth following adversity. Despite [Chris] Peterson’s warning that the credibility of positive psychology’s claim to science demands close attention to the evidence, post-traumatic growth—a construct that has now generated hundreds of articles—continues to be studied with flawed methods and a disregard for the evidence generated by psychological science.

More recently, Patricia Frazier, Howard Tennen , and I published a commentary  on Jayawickreme and and Blackie’s updated Posttraumatic Growth as Positive Personality Change: Evidence, Controversies and Future Directions. We concluded that a lot of research had accumulated but it did not change our skeptical assessment. We suggested a lot less, but better research was needed.

thank youAnyone who assumes that psychological science will produce a set of 27 fascinating proven facts ready for application in interventions seriously misunderstands both science and psychological interventions.

Just look at any other area of psychological interventions. Research does not produce fascinating facts, but tentative findings, graded in terms of strength of evidence. That evidence is likely to be limited in quality and quantity and will probably have to be modified with new findings.

Taking a larger overview, we can expect that psychological interventions that are credible and structured will have modest differences among themselves and modest advantages over interventions that are simply supportive and delivered with positive expectations. And psychological interventions are most reliably effective when they are delivered to persons who are sufficiently distressed to register benefit.

The large literature concerning psychological interventions will be very disappointing to anyone seeking ways to produce dramatic change with simple interventions. Anyone or anything that guarantees this should be treated with great skepticism.

Look at the personality and social psychology research from which the positive psychology community draw. Findings are not robustly durable. Newsworthy dramatic breakthroughs typically prove to be false positives or simply nonsense. The shelf life of spectacular claims is increasingly shortened by critics waiting to show the tricks by which such magic was produced.

The positive psychology community may be collectively engaging in wishful thinking, but it attracts and richly rewards those who promise to fulfill the great hunger and pressing marketing needs for sciencey findings. And few in the community will understand the difference in what they get.

If the positive psychology community is serious about making a credible claim for the distinctiveness of their approach, I suggest that everybody drop the vague references to “science” and substitute “evidence-based.”

The  “evidence-based” brand is subject to lots of abuse, but the label at least invites application of some well specified principles for deciding the extent to which claims are indeed evidence-based and grading of the evidence by noncontroversial, established criteria. And to keep a grounding in being evidence-based, interventions need to adhere to the procedures that were validated. This is not a matter of jumping from a correlational study with college students to claims of dramatic effects being achieved in everyday life, as so much of the positive psychology literature does. It is a matter of being faithful –having fidelity to the manualized procedures of the original study.

Or is all of this analysis for naught because the claims of positive psychology being more sciencey than the rest are just vapid advertising slogans and not to be taken seriously? Some researchers notably pitch their work to this waiting audience that lacks the critical skills to evaluate. Should we treat their scholarship as less serious or should we scrutinize it more for bias because of their undeclared conflicts of interest?

DISCLAIMER: I am grateful for PLOS blogs providing me the space for free expression. However, the views I present here are not necessarily those of PLOS nor of any of my institutional affiliations.

Category: coaching, Conflict of interest, evidence-supported, happiness, positive psychology, publishing | Tagged , , | 1 Comment

Barney Carroll on domesticating psychosis

Although posted only a couple of days ago, my presentation from Royal Edinburgh Infirmary, Division of Psychiatry, University of Edinburgh is now passing the benchmark of over 1000 views.


Chrys Muirhead

You can also find an interesting Storify of my lecture by a mental health activist and correspondent for the Critical Psychiatry Network, Chrys Muirhead. I’m sure she’ll also be presenting an alternative view of my lecture at her blog.

In one of my introductory slides [slide 2], I acknowledge a number of go-to’s to whom I am indebted. I actively engage with the go-to’s through social media with questions and requests for feedback. They have kept me from what would have been embarrassing gaffes.  They allow me to present and write smarter than I am, when I let them. However any excesses or inaccuracies in my work are entirely my own.

One of these go-to’s is Bernard “Barney” Carroll. In future blogs I will be saying a lot about his influence on me, although we have never actually met. In hindsight, it’s too bad that my decade at the University of Michigan Mood Disorders Program that he developed started only after he had left.

Barney has

made major contributions to research on the biology and treatment of depression. He is best known as a pioneer of the neuroendocrine research strategy for depression, and as developer of the field of laboratory markers in psychiatry.

Barney often says profound things with a relaxed elegance, particularly when engaging in debate. Long before Kris Kristofferson, I’m sure those with whom he disagreed saw him as the original silver tongued devil.

I realize this comment dates me, because few of my younger readers even know Kris Kristofferson is, not even that he wrote Me and My Bobbie McKee that Janis Joplin made famous. So, here, distract yourself with some 70s music.


domesticating-page-0Anyway, on slide 37 of my presentation, I used Barney’s term domesticating psychosis as a heading for some direct quotes from Understanding Psychosis and Schizophrenia, the British Psychological Society Division of Clinical Psychology document that I  critiqued in coming slides. Here is the elaboration on that graphic phrase that Barney provided on my Facebook wall July 27, 2015.

Barney Carroll, in his own words:

I guess I am the person who gets the credit for characterizing the BPS report Understanding Psychosis and Schizophrenia as domesticating psychosis. Ronald Pies called it romanticizing psychosis and Joseph Pierre termed it trivializing psychosis.
The BPS folks, and Lucy Johnstone in particular, deserve all the frowns and brickbats that are coming their way for this misstep. It is an appalling document: Self-neglect due to impaired frontal executive function is niced down to “When people are in a state of distress and confusion they can sometimes need help to maintain an adequate diet, or look after their home.” That does not begin to capture the clinical reality of decompensating psychotic patients smashing furniture to stop the voices, smearing faeces, living in filth, going to the streets, eating out of dumpsters…. The report’s pervasive focus on just hearing voices as emblematic of psychosis is a domesticating strategy: One hallucination does not a schizophrenia make. This domestication distracts attention from the more serious features of psychosis such as negative symptoms, social and occupational decline, first rank positive psychotic symptoms, formal thought disorder, formal language disorder, catatonia, cognitive impairment, affective lability, delusions, and loss of ego boundaries in psychotic decompensations. These get short shrift in the terminal niceness of the BPS report.

fear my squirreley wrathI can only agree with James Coyne that the BPS folks, and Lucy Johnstone in particular, have been squirrelly in their responses to challenges. We saw that earlier this year. Look at the threads linked here on the 1Boringoldman blog:; and They are especially reckless in their glossing over of completed suicide in psychotic states. I discussed that on Joseph Pierre’s blog earlier in the year: see the several comments on this thread –

1 Boring Old Man » which side of the street?…

You can read Barney’s set of comments at Mickey Nardo’s 1 Boring Old Man website, along with Barney’s engagement with critics. But here’s an excerpt

… This approach is what I call domesticating psychosis. The BPS document fails adequately to convey the range of symptoms and associated behaviors in psychosis/schizophrenia. Even when these are mentioned, they are not addressed in a way that matches their clinical salience. Thus, decompensating psychotic crises are discussed unhelpfully in the framework of poor sleep habits. Acute inpatient psychiatric units are discussed in a patronizing way and are faulted as being unhelpful for some patients – never mind their rescue function. Catatonia as a common feature is not acknowledged. Psychotic terror and panic are not acknowledged. Formal thought disorder with truly crazy speech is not acknowledged. The 10% lifetime incidence of suicide among schizophrenic patients is not acknowledged. Core negative symptoms are brushed away as demoralization or as neuroleptic drug side effects. All of the recommendations made in the BPS document for improvement of psychological and social services are admirable but none are really new – they all fall within the traditional biopsychosocial model of psychiatry. We can all agree that psychiatry has not implemented that model consistently, in large measure because of underfunding, but that does not invalidate the model.

Their intellectual bias is further evidenced by their halfhearted endorsement of the need for antipsychotic drugs. They go out of their way to emphasize that, even though these are sometimes helpful, “… there is no evidence that (the drugs correct) an underlying biological abnormality.” Well, bless my heart, we can say the same of most drugs used in medicine: steroids for autoimmune diseases; bronchodilators for respiratory diseases; anticonvulsant drugs for seizure disorders … So, what is their point here, exactly, beyond gratuitous negative innuendo? It seems to me that the BPS document is a manifesto in the professional turf wars, heavily slanted towards gaining funds from the U.K regulators, rather than driven by an understanding of the classic psychotic disorders

Well said.

From Where's NAMI?

From Where’s NAMI?

Category: antipsychotics, mental health care, psychosis, schizophrenia | Tagged , , , | 1 Comment

Lucrative pseudoscience at the International Positive Psychology Association meeting

A plenary session dripping with crank science may be an outlier, but it’s on a continuum with the claims of mainstream positive psychology.

 Follow the conference attendees following the money, does it take you to science?


HMI-Bio-Speaker-Rollin-217x300Imagine a PhD student going to her first positive psychology conference, drawn by the opportunity to hear research oriented psychologists such as Richard Davidson and Jonathan Haidt in one place. But at the first plenary session she attends, Rollin McCraty is talking to an enthralled audience about “the science of what connects us.” McCraty says the heart radiates a measurable magnetic field which carries emotional state information, and can be detected by the nervous systems of nearby.”

Puzzled, she googles McCraty and comes to websites and articles making even more bizarre claims, like

 There is compelling evidence to suggest that the heart’s energy field (energetic heart) is coupled to a field of information that is not bound by the classical limits of time and space.

And even better

This evidence comes from a rigorous experimental study conducted to investigate the proposition that the body receives and processes information about a future event before the event actually happens (McCraty et al 2004a, b). The study’s results provide surprising data showing that both the heart and brain receive and respond to pre-stimulus information about a future event. Even more tantalizing are indications that the heart receives intuitive information before the brain, and that the heart sends a different pattern of afferent signals to the brain which modulates the frontal cortex.

“…about a future event before the event actually happens”? Wow, this puts Daryl Bem’s  claim of precognition to shame. But this claim cannot possibly prepare our PhD student for

A Tidal Wave of Kindness

In the fall of 2013, the IHM [Institute of HeartMath, where McCraty is Director of Research] launched the Global Coherence Initiative. The ambitious goals of this campaign are unprecedented: to quantify the impact of human emotion on the earth’s electromagnetic field and tip the global equation toward greater peace. While this may sound like a utopian fantasy, Dr. McCraty points out that science once again supports this possibility. “If the earth’s fields are a carrier, we are all coupled to this field, all the signals are out there,” he says. “So every emotion we experience is coupled to that field. This creates a global humanity field, if you will.” According to Dr. McCraty, this field is continually fed by our feelings, both positive and negative. The goal is to shift the balance toward the positive. “Any time we’re putting out love and kindness, that energy is not wasted,” he adds.

HeartMath graphThis is crank science far beyond the satire of Alan Sokal hoax article, Transgressing the Boundaries: Towards a Transformative Hermeneutics of Quantum Gravity. But we’re not done yet:

Current IHM research demonstrating the interconnectedness between people has Dr. McCraty very excited. Two studies going on in northern California and Saudi Arabia are monitoring HRV 24/7 to help quantify the interconnectivity between people and how it is affected by nervous system dynamics, the earth’s magnetic fields, solar flares, and even radio frequencies.

happy facesAt the reception that evening, our PhD student desperately searches for familiar faces of other research oriented PhD students. She manages to find only a few among the oppressively bubbly crowd. And none of her colleagues actually went to the McCraty plenary. Some dismissed him as just pushing the merchandise of the very commercial HeartMath.

Who was attending the International Positive Psychology Association meeting?

Advertisements for the conference advised

who should attend

But any research-oriented attendees were disappointed if they sought first-ever reports of breakthrough, but reproducible science. Personal coaching and organizational and executive consulting themes predominated in the preconference workshops and presentations.

Elements of a trade show blended into a revivalist meeting. Hordes of “certified” life coaches and wannabes were seeking new contacts, positive psychology products, and dubious certificates to hang in their offices. These coaches had paid out-of-pocket, without scholarship for degrees from “approved” masters of arts in positive psychology programs (MAPPs) costing as much as $60,000 a year. Many were hungry. But there are inspiring -positive psychology is about inspiring- stories on the Internet of big bucks being made immediately:

make money

  • MAPP programs typically require no background in behavior science and provide very little training in critical appraisal of research or even ethics.
  • Graduates of MAPP programs general lack ability to determine independently whether claims are evidence-based. They are suckers for anything that superficially sounds and looks sciencey. They are as vulnerable as marital and family therapists who can be readily seduced by claims about therapies that are “soothing the brain” hawked by unscrupulous “neuroscientists” and self-promoters.

Indeed, just go to some coaching websites and see claims of being able to provide clients with wondrous transformations take takes little effort from them.

Positive psychology merchandise. Get certified as a trainer now.

The science is often superficial and even quack. Yet, to compete effectively in a crowded field, positive psychology coaches brandish a label of ‘we are more sciencey than the rest’.the pp scientist

McCraty’s HeartMath promises that big time science backs its claims of effectiveness.

Over the years we have received numerous reports that coherence training has improved performance in a wide range of cognitive capacities, both short and long-term. These include tasks requiring eye-hand coordination, speed and accuracy, and coordination in various sports as well as cognitive tasks involving executive functions associated with the frontal cortex such as maintaining focus and concentration, problem solving, self-regulation, and abstract thinking.

A study of California correctional officers with high workplace stress found reductions in total cholesterol, glucose, and both systolic and diastolic blood pressure (BP), as well as significant reductions in overall stress, anger, fatigue and hostility with projected savings in annual heath care costs of $1179 per employee (McCraty et al 2009).

stand back scienceUnfortunately McCraty et al 2009 turns out to be a rather dodgy source

McCraty R, Atkinson, M., Tomasino, D., & Bradley, R. T (2009) The coherent heart: Heart-brain interactions, psychophysiological coherence, and the emergence of system-wide order. Integral Review 5: 10–115.

But why stop there?

Hospitals implementing HM programs implementing have seen increased personal, team and organizational coherence. The measures most often assessed are staff retention and employee satisfaction. Cape Fear Valley hospital system in Cape Fear, North Carolina, reduced nurse turn over from 24% to 13%, and Delnor Community Hospital in Chicago saw a similar reduction from 27% to 14% – as well as a dramatic improvement in employee satisfaction, results that have been sustained over an eight year period. Similarly, Duke University’s Health System reduced turnover from 38% to 5% in its emergency services division. An analysis of the combined psychometric data from 3,129 matched pre-post HM coherence trainings found that fatigue, anxiety, depression and anger were reduced by almost half. Another workplace study conducted in large chain of retail stores with in-store pharmacies that employed 220 pharmacists across multiple locations found a reduction is medical errors ranging from 40 to 71%, depending on the store location (HeartMath 2009).

Specific statistics, yes, but, alas, these data are not independently peer reviewed claims nor even transparently presented. They call upon our faith in HeartMath.

If your methods are so powerful, HeartMath, submit your evidence for legitimate peer review.

Shame on me for not doing a systematic review of this literature.

When I posted a critical comment about McCraty on my Facebook wall, I was quickly chastised by a “friend” whom I do not actually know:

Have you read the body of research published by HeartMath? Which articles have you critically reviewed and found flawed? Can you discuss that in detail? Do you know what the Global Coherence Project is? Do you know those methods, their datasets? Are you dismissing this on the idea alone, or on the details of their generated body of scientific work? Are you an expert on electrical fields generated by the human body? Do you know all the work on heart rate variability and its associations with human health and communication? Which part of that body of work are you taking issue with?

Dear Facebook “friend,” don’t you realize that the burden of proof lies on the quacks who wish us to believe ridiculous claims with zero obvious scientific basis? Evidence, please. No plausible mechanism means not worth a serious investigation. And by the way, does anyone know ‘their methods, their data sets,’ outside of HeartMath?

There is so much junk out there and so little time to evaluate it. Skeptics should not waste their time, when they quick-screen for plausible mechanism and find none. That eliminates the bulk of the nonsense bombarding us, even from successful academic positive psychology gurus. Sure, we might miss some dramatic breakthroughs, but prior probabilities are on our side.

The positive psychology – corporate – military complex

Touchy question in the positive psychology community: Was US Defense Department grant money used to reward psychologists for involvement in the CIA torture program for those who protected them from ethical sanctions? There has not been much discussion of this on the tightly controlled Friends of Positive Psychology listserv, only swift denials, but can others get in on the money? Can Rollin McCraty help? A good reason to go to his talk. But, first, some background.

Psychologist Stephen Soldz, Ph.D and colleagues produced a report, American Psychological Association’s Secret Complicity with the White House and US Intelligence Community in Support of the CIA’s ”Enhanced” Interrogation Program. The report contained a number of linked emails that included Paul Ekman, James Mitchell and…Marty Seligman.

Blogger Vaughan Bell states

 To be clear, I am not suggesting that Ekman and Seligman were directly involved in CIA interrogations or torture. Seligman has gone as far as directly denying it on record.

But there is something else interesting which links Ekman, Seligman and Mitchell: lucrative multi-million dollar US Government contracts for security programmes based on little evidence.

Seligman was reportedly awarded a $31 million US Army no-bid contract to develop ‘resilience training’ for soldiers to prevent mental health problems. This was surprising to many as he had no particular experience in developing clinical interventions. It was deployed as the $237 million Comprehensive Soldier Fitness programme, the results of which have only been reported in some oddly incompetent technical reports and are markedly under-whelming. Nicholas Brown’s analysis of the first three evaluative technical reports is particularly good where he notes the tiny effects sizes and shoddy design. A fourth report has since been published (pdf) which also notes “small effect sizes” and doesn’t control for things like combat exposure.

Money from the ineffective Comprehensive Soldier Fitness Progam has been an enormous bonanza for positive psychologists – and even critics willing to mute what they say. Is Rollin McCraty a useful way in? Aside from being Director of Research at Institute of HeartMath (IHM), Rollin McCarty is also Director of Military Training – the HeartMath website tells us – he is working with Major Robert A. Bradley (USAF, Ret., Director of Veterans Outreach.

HeartMath once had a million dollar grant from the US Navy. Their grant portfolio has apparently shrunk to a few thousand dollars. But HeartMath offers training and certification in nice sounding programs. Can hungry MAPP graduate attendees get trained and certificates suitable for framing and make big bucks through HeartMath? The hell with the science, there are sciencey claims that must sell.

We cannot tell how much profit HeartMath is making. We can only get the financial details on their not-for-profit institute, not their for-profit wing. The split between profit and nonprofit wings of training institutes making money and the secrecy is common in training enterprises a common organizational structure for entrepreneurs.

An outlier, but on a continuum with positive psychology (pseudo) science?

Rollin McCraty may be an outlier, but he still lies on a continuum with the most recognized scientists of positive psychology.

Barbara Fredrickson is considered a rock star in the positive psychology community. She has an endowed chair, lots of grant money, and numerous publications in journals where you would never find Mcraty. Yet her papers are often tied to her heavily marketed commercial products, though without the requisite declaration of conflict interest in her papers. Some of her claims have not fared so well with strong hints of shaky and even pseudo science.

Positivity ratio. Fredrickson and Losada (2005) infamously applied a mathematical model drawn from nonlinear dynamics and claimed that a ratio of positive to negative affect of exactly 2.9013 separated flourishing people from those who are merely languishing. Nick Brown, Alan Sokal, and Harris Friedman examined this claim and found

no theoretical or empirical justification for the use of differential equations drawn from fluid dynamics, a subfield of physics, to describe changes in human emotions over time; furthermore, we demonstrate that the purported application of these equations contains numerous fundamental conceptual and mathematical errors.

In response, Fredrickson partially retracted her claim, where visitors can take a 2- minute test to determine whether they are flourishing or languishing and watch Youtube videos.

Meaning is healthier than happiness. Fredrickson and colleagues claimed to have used functional genomics to settle the classical philosophical question of whether we pursue meaning (eudaimonism) in our lives or happiness (hedonism). These claims echoed in the popular press  as

People who are happy but have little-to-no sense of meaning in their lives have the same gene expression patterns as people who are enduring chronic adversity.

My colleagues and I (including Nick Brown and Harris Freidman) took a critical look and reanalyzed Fredrickson and colleagues’ data. We concluded

Fredrickson et al.’s article conceptually deficient, but more crucially that their statistical analyses are fatally flawed, to the point that their claimed results are in fact essentially meaningless.

The journal where the article originally appeared, PNAS has so far resisted a number calls, including one from Neuroskeptic for retraction of the original article.

Better health and relationships through loving kindness meditation. Much like McCarty, some of Fredrickson’s work makes strong claims about transforming people’s lives by changing cardiac vagal tone. She and colleagues claimed to have shown that practicing loving-kindness meditation (LKM) generates an “upward spiral” of mutual enhancement among positive emotions, social connectedness, and physical health. So,

“Advice about how people might improve their physical health . . . can now be expanded to include self-generating positive emotions.”

My group -again with Nick and Harris, but also James Heathers – took a closer look and reanalyzed the data. We found the study was actually a badly reported clinical trial with null results, evidence concerning the association of cardiac vagal tone and established valid parameters of physical health were contradictory, and carrdiac vagal tone was certainly not a suitable proxy outcome for health in a clinical trial, especially for persons of the age included in Fredrickson’s trial.

love 2Nonetheless, the first hit when I googled “Fredrickson loving kindness meditation” was another Fredrickson commercial website, Love 2.0  offering a book and other products with an eye-catching question:

What if everything you know about love is wrong?

It’s time to upgrade your view of love. Love 2.0 offers new lenses for seeing and more fully appreciating micro-moments of connection. Dr. Barbara Fredrickson gives you the lab-tested tools to unlock more love in your life.

Any wonder why the attendees at International Positive Psychology Association had trouble distinguishing between science and nonsense like what McCarty offered?



Category: coaching, genomics, happiness, hedonia, positive psychology, social genomics | Tagged , , , , , , , | 8 Comments

Advocating CBT for Psychosis: “Ultimately it is all political.”

Political… Or just cynical?

Frida Kahlo, “Without Hope”

Frida Kahlo, “Without Hope”

Professor Paul Salkovskis and his colleagues organized a lively, thought-provoking conference at University of Bath “Understanding Psychosis and Schizophrenia: How well do we understand and what should we do to improve how we help?”

Presenters and members of the roundtable discussion panel included a number of authors of the British Psychological Society’s Understanding Psychosis and Schizophrenia. But they noticeably  avoided engaging anyone outside their tight knit group, especially speakers disagreeing with their manifesto. The Understanding Psychosis and Schizophrenia authors appeared glum and dyspeptic throughout lively discussions. The conference nonetheless went on around them. Highlights included presentations by Professors Robin Murray and Clive Adams.

In his “Genes, Social Adversity and Cannabis: how do they interact?” Professor Robin Murray gently chided the authors of the British Psychological Society’s Understanding Psychosis and Schizophrenia for their insensitivity to the suffering, debilitation, and sometimes terror posed by schizophrenia. For me, his talk clarified confusion caused by the authors of Understanding Psychosis repeatedly claiming Professor Robin Murray had endorsed their document. He did not. He is an exceptionally kind and well-mannered person and I think his polite comments at the earlier launch meeting for Understanding Psychosis were misinterpreted. His presentation at the Bath conference left no doubt where he stood.

A diagnosis of schizophrenia encompasses a wide range of conditions that will undoubtedly by sorted into a tighter, more useful categories as we use existing categories to organize the evidence we accumulate. As Joe McCleary summarized in comments on my FB wall, if we use existing – admittedly imperfect and provisional – categories, we can learn about

the nature of the individuals symptoms and experience, the likelihood and time course of improvement, recovery, and/or relapse, persistence of difficulties in particular domains (intellectual, social, emotional, adaptive functioning), which interventions might be most useful to try, what co-occurring disorders and risks are high and low (e.g., suicide, aggression, dissociation), likely levels of dependence vs independence, impacts on family, reliance on family, impacts on society, reliance on society, risk for harm (e.g., being taken advantage of or abused), etc., etc., etc.

These correlates of a diagnosis of schizophrenia check out well when we go to the available literature.

Professor Peter Kinderman who is President-Elect of the British Psychological Society, as well as an author of Understanding Psychosis was a member of the afternoon roundtable panel at Bath But he mostly sat in silence. He rejects the idea that the diagnosis has led to any progress:

Diagnostic systems in psychiatry have always been criticized for their poor reliability, validity, utility, epistemology and humanity.


The poor validity of psychiatric diagnoses—their inability to map onto any entity discernable in the real world—is demonstrated by their failure to predict course or indicate which treatment options are beneficial, and by the fact that they do not map neatly onto biological findings, which are often nonspecific and cross diagnostic boundaries.

Kinderman repeats these points in every forum he’s given until he lapses into self-plagiarism. Compare Imagine there’s no diagnosis, it’s easy if you try  to Drop the language of disorder.

What does Kinderman offer in place of diagnosis? That we respond to patients in terms ofmy paradigm their nonspecific distress, which is a “normal, not abnormal, part of human life.” This insight, according to Kinderman, places us on the “cusp of a major paradigm shift in our thinking about psychiatric disorders.”

Kinderman leaves us with sweeping declarations and no evidence to support them. He gets quite fussy when challenged. During the Roundtable Discussion, he went off on one of his usual rants, peppered by a torrent of clichés, allusions to unnamed professionals describing schizophrenia as a genetic disease, and argument by anecdote.

But what if we took seriously his suggestion that we drop diagnosis and substitute a generic distress? He concedes that many patients are helped by antipsychotic medication. But getting the best candidates for this treatment depends on the diagnostic label schizophrenia. And just as importantly, keeping patients who are likely to be poor candidates and for whom it will be ineffective, also depends on using the criteria associated with the label schizophrenia to rule out this treatment is appropriate. Unless Kinderman can come up with something else, it would seem that we risk both undermedication of those who desperately need it and overmedication of those who get more harm than benefit, if we abandon such labels.

And turning to Professor Clive Adam’s presentation organizing the available literature around the diagnostic label of schizophrenia, we can see from Cochrane reviews the likelihood that treatment with cognitive behavior therapy in the absence of medication is likely to be ineffective and not at all based on available evidence.

Clive Adams delivered a take-no-prisoners “CBT-P and medication in the treatment of psychosis: summarising best evidence.”  Adams’ presentation is captured in a blog post but its message can be succinctly stated

I just cannot see that this approach (CBTp), on average, is reaping enough benefits for people.

None of the authors of Understanding Psychosis responded to Adams’ strictly data oriented presentation. They simply mumbled among themselves.

Maybe we should simply accept that when the authors of Understanding Psychosis call for extensive discussion and dialogue, it is not what would be usually meant by those terms. They don’t want their monologue  interrupted by anything but  applause.

What the authors of Understanding Psychosis  get is that with Twitter and blogs, you cannot not engage in a dialogue when you put outrageous claims out there. You can only risk your social media identity being defined what others say.

Let’s examine what Peter Kinderman says in another monologic blog post, strikingly free of any reference to evidence, Three phrases. The post discusses three phrases that organized an international meeting concerning cognitive behavior therapy held in Philadelphia in May, 2015.

It’s probably better to read the outcomes of our discussions in peer-reviewed scientific papers and in the policy documents of our various nations. For me, however, three phrases stood out as we discussed our shared interests.

I can’t wait! But until then we have his blog.

The first phrase “Trauma-informed practice” is described

In all kinds of ways, we’re learning how psychotic experiences can relate to trauma – in childhood and as adults. And we’re learning how the ways in which we purport to care for people – with the labels that we attach to their problems, with the explanations (and non-explanations) that we propose, and especially with the treatments that we use (and occasionally impose, even forcefully) – can potentiate experiences of trauma. So I welcome the fact that there appears to be increasing discussion of how we might base our therapies, and indeed our whole service design philosophy, on an appreciation of the role of trauma, for many people, in the development of their difficulties.

Presumably the forthcoming “peer-reviewed scientific papers” will allow us to evaluate the evidence for the efficacy of “trauma-informed” treatment of schizophrenia. I can’t find it. I don’t see where any of the randomized trials of CBT for psychosis that have been conducted are organized around this concept. Does Kinderman have any sense of the history or usage of “trauma-informed” in the United States and elsewhere?

mindbody connection“Trauma informed practice” typically refers to an approach that is more hermeneutic than scientific. The assumption is made that psychological trauma causes both mental disorder and physical illnesses.

Understanding Psychosis takes for granted that traumatic experiences are at the root of most psychotic disturbance. When they invoke evidence at all, it is the work of one of its authors, Richard Bentall. The literature concerning the role of child adversity in psychotic disturbance is  methodologically flawed, but even if we accepted at face, the effect sizes it generates would not justify the assumptions that trauma is behind all psychotic experiences.

In the United States, evidence-based, research-oriented clinicians are skeptical of the slippery slope whereby calls for “trauma-informed practice” too often lead down to nonsense about trauma being embodied in organs and peripheral tissue, not just the nervous system. Untrained and incompetent therapists insist that conditions like diabetes and asthma are linked to trauma, and if patients cannot report relevant traumatic experiences, there should be an effort to recover their repressed memories. Serious damage was done to a lot of patients and their families before the fad of recovering memories of sexual abuse and participation in devil worshiping cults was put down with legal action.

Kinderman’s second phrase is “CBT-informed practice”

It’s hardly a surprise that the acronym ‘CBT’ means slightly different things to different people.

There’s a valuable debate about ‘fidelity’ (whether a therapist is or is not adherent to the accepted elements of CBT). But there’s also an appreciation that, in the field of psychosocial interventions in mental health care, common therapeutic factors, the fundamental role of a good ‘therapeutic alliance’ (a relationship based on respect) and the heterogeneity of individual experiences means that we are now much more likely to talk about “CBT-informed practice”. Again, for me, this is welcome. I believe that it not only allows for valuable innovation and development of psychosocial interventions, but also permits an appreciation of the uniqueness of each person’s experience.

The retreat from any claim to being evidence-based continues. If a therapy carries the branding of evidence-based, it is assumed that it is delivered with some fidelity to what has been tested in clinical trials. Branding as “evidence-based” cannot be retained unless the innovations and further development are themselves subjected to clinical trials. “Evidence-based, is not a branding they can be casually transferred to new products without testing.

Kinderman’s final phrase is “_ ultimately, it’s all political_.”

The attendees of these meetings are all applied scientists (although some have some influential roles in shaping healthcare policies). But it was interesting that many of our discussions referred back to the social circumstances of those people accessing our services, and on the political decisions taken about how those services are commissioned, planned and delivered We discussed, for instance, the role of social determinants of health generally and mental health in particular. We discussed how different psychological and social problems seem to have similar social determinants (and the implications of this). We talked about how trauma, discrimination, racism, the struggles of undocumented migrants and the pressures on unemployed people can affect their mental health. We discussed how people access high-quality healthcare in different states and nations, and we discussed how political decisions – such as those related to involuntary detention and compulsory treatment, the funding of healthcare and provision of different forms of care – impact on our clients. We also discussed how, as a group of professionals, we are increasingly being asked to contribute to these debates.

So for me, it was a very positive and encouraging trip. I am – I remain – confident that conventional CBT, a form of one-to-one therapy that of course has its limitations, can be very positive for people experiencing psychosis. But, given the views I hold about the fundamental nature of mental heath and wellbeing, the phrases that echo most encouragingly from last week’s meeting are “trauma-informed practice”, CBT-informed practice” and “ultimately, it’s all political.”

I think I finally get it. Kinderman is saying that his followers should hold on to claims of being evidence-based, even in the face of clinical trials and meta-analyses providing evidence to the contrary. And they should incorporate elements of “trauma-based practice.” This is not taking  seriously principles of evidence-based evaluation of best practices. but that is not what Understanding Psychosis is about.

Advocating CBT is political, not evidence-based, but we need the latter label for credibility and controlling credentialing.

This is cynical, not political.

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Category: antipsychotics, cognitive behavioral therapy, distress, evidence-supported, professional organizations, psychotherapy, schizophrenia | Tagged , , | 2 Comments