Wednesday, June 23, 2010

Psychology's Absence from Mainstream Media

Scientific journalism can be both informative and interesting -- qualities that are likely prioritized by editors and producers of media. However, scientific journalism occasionally falls short in terms of the writers' ability to present information in an accurate and balanced manner. For example, stories will sometimes avoid discussion of a study's limitations, or present correlational research findings as causal -- to name a few.

As a psychologist, one of the main problems I have with scientific journalism is the media's tendency to under-report on findings from psychological outcome studies. Indeed, whenever I read a newspaper or watch a news report on TV, I am more likely to be exposed to research on antidepressants or alternative medicine, in terms of their relationship to mental health.

Why is this important? Well, if you are someone wanting to know about current treatment options for depression, including any new outcome studies demonstrating positive effects, mainstream media outlets are a popular option for learning more on this and other health topics. The amount of exposure that a particular treatment receives can influence people's understanding of treatment in general. If people only ever read stories about pharmaceutical drugs' effects on a particular problem, then over time the general public comes to consider this treatment to be the gold standard.

So, if treatment A gets 85% of the media coverage, then treatments B and C are likely to be considered less important, regardless of their true efficacy. And this is the problem -- the general public should be given more clear and direct information about various treatments' effectiveness. Furthermore, if there is going to bias in coverage, then it should go in the favour of treatments with large effect sizes (the most effective treatments) for serious issues.

But this is not the manner in which scientific journalism operates. Treatments are more likely to be covered if a company issues a press release. This type of coverage was exemplified in a recent Montreal Gazette story on Omega-3 vitamins and their impact on depression.

I've read the actual research article on which this story was based. Basically, the researchers designed a nice study examining the effect of this Omega-3s on depression, using a double-blind randomized trial. The researchers failed to find a significant overall effect. However, they found a small effect for people who had depression, but no anxiety disorder. The effect size was .27 which is in the small-moderate range.

The Gazette has run similar stories over the past few months. They ran a large story on micronutrient therapy for mood disorders. They ran a study recently showing a link between vitamin-B deficiency and depression in older adults. There are also periodic stories on antidepressants, which tend to portray the treatment of depression as follows: antidepressants are the gold standard of treatment, and sometimes counseling can help.

The problem with all of this is that these stories misrepresent the state of knowledge on treatment of depression. For example, hundreds of studies on the treatment of depression with Cognitive-Behavioural Therapy (CBT) have been published, and what you find is an average effect size of .82(1) versus placebo/ wait-list control. This is 3 times larger than Omega-3 treatment! Furthermore, CBT's effect size is statistically equivalent to antidepressants. You also find that CBT has a lower relapse rate than medication (29.5% vs. 60%), and is more cost-effective. Research has also found CBT to be equally effective as medication for moderate to severe cases of depression(1).

Does anyone ever see this in the news cycle?

Well, you might ask, have there been recent psychological findings worthy of printing a story about?

Let's see. How about a recent meta-analysis showing that mindfulness based therapy is an effective treatment for anxiety and depression(2). Or how about really interesting research showing that computer software programs designed to retrain people's attention significantly reduces their anxiety?(3) Or how about the ability of psychological treatment to simultaneously treat depression and reduce smoking?(4)

At the end of the day, psychologists have to work harder to promote these findings. But the media has to work harder to better represent health research....and not simply follow-up a press release from a company with financial ties to the findings.

Dr. Roger Covin
Montreal Psychologist


1 Butler, A.C., Chapman, J.E., Forman, E.M., & Beck, A.T. (2006). The empirical status of cognitive-behavioral therapy: A review of meta-analyses. Clinical Psychology Review, 26, 17-31.
2 Hofmann et al. (2010). The effect of mindfulness-based therapy on anxiety and depression: A meta-analytic review, Journal of Consulting and Clinical Psychology, 78(2), 169-183. 
3 Amir, N., Beard, C., Taylor, C., Klumpp, H., Elias, J., Burns, M., et al. (2009). Attention training in individuals with generalized social phobia: A randomized controlled trial. Journal of Consulting and Clinical Psychology, 77(5), 961-973.
4 MacPherson, L. et al. (2010). Randomized controlled trial of behavioral activation smoking cessation treatment for smokers with elevated depression symptoms. Journal of Consulting and Clinical Psychology, 78(1), 55-61.

Wednesday, June 9, 2010

Why See a Psychologist for Obesity?

Readers of this blog have no doubt noticed that I tend to highlight research evidence on psychological outcome studies, primarily those testing Cognitive-Behavioural Therapy (CBT), which tends to be very effective for many psychological issues -- often equally and sometimes superior to medication.

Well, I wanted to use this post to address psychology's role in obesity treatment. As most readers know, obesity has become a hot-button issue because the majority of people living in the US and Canada are at least overweight, with significant numbers meeting criteria for obesity (generally defined as a BMI >30). There are various treatment options available for obesity, including diet, medication and even surgery. But how do people know which are effective treatments?

Fortunately, people do not have to be left in the dark on decision-making for treatment options. There are experts in the area who can wade through the vast amounts of research, including outcome studies that examine whether various treatment strategies are effective. In 2007, the Canadian Medical Association published treatment recommendations based on the work of an expert committee. (Side Note: I had the pleasure of working at the same clinic with the lead author of this panel, Dr. David Lau from Calgary).

This expert panel recommended that psychologists be included in the treatment of obesity. Furthermore, they gave comprehensive lifestyle interventions, such as CBT, a grade A rating (this is the highest rating possible in the treatment guidelines).

Why would a psychologist be needed to help treat obesity? An entire book could be written to fully answer this question. But to give you an idea of the association between psychological variables and obesity, I offer the following research findings from recent studies:

(1) According to a recent Canadian study, obesity was associated with the following psychological problems -- depression, mania, panic attacks, social phobia, and agoraphobia without panic disorder. It was also associated with suicidal behaviour.

(2) A similar American study basically replicated most of the findings of the Canadian study.

(3) A recent US study found that 66% of obese patients undergoing bariatric surgery had a lifetime history of a psychological disorder.

Indeed, the link between psychological problems and overeating has been well-demonstrated. If you are someone thinking of making a concerted effort to lose weight, you should consider the advice of health experts and consider consulting a psychologist -- particularly one with experience in health psychology.

Dr. Roger Covin
Montreal Psychologist


Mather et al. (2009). Associations of obesity with psychiatric disorders and suicidal behaviors in
a nationally representative sample. Journal of Psychosomatic Research, 66, 277-285.

Simon et al. (2006). Association Between Obesity and Psychiatric Disorders in the US Adult Population. Archives of General Psychiatry, 63, 824-830.

Kalarkian et al. (2007).Psychiatric Disorders Among Bariatric Surgery Candidates: Relationship to Obesity and Functional Health Status. American Journal of Psychiatry, 164, 328-334.

Lau et al. (2007). 2006 Canadian clinical practice guidelines on the management and prevention of obesity
in adults and children. Canadian Medical Association Journal, 176 (Suppl. 8), Online 1-117

Tuesday, June 8, 2010

Back Pain is Overtreated

A very interesting story by the Associated Press was released today highlighting a disturbing trend in treatment for back pain in the United States. Although the vast majority of acute back pain subsides after 4-6 weeks, Americans are receiving way too many tests (ex: MRI; X-Rays) for back pain, and opting for unproven and unwarranted surgeries. It is estimated that Americans spend up to $86 billion every year on health care costs for back pain.

This pattern of behaviour is quite consistent with other indicators of the quick-fix mentality that has become so prevalent in North America. Pharmacology sales (particularly mental health prescriptions) and surgeries for obesity are on the rise. Advances in modern technology allow for such improvements in health care, but there tend to be at least two problems with some of these approaches.

First, the health care costs are tremendous. Second, they do not always target the problem. There is a widespread assumption that back pain must be due solely to physical tissue damage, obesity is due to genetic and biological problems (or a lack moral character -- ex: laziness) , and mental health problems reflect problems with neurochemistry. Unfortunately, things are more complicated than this, and such uni-theoretical models are often inadequate to explain complex problems.

Thus, I was very happy to see a list of recommendations posted with this story. One of the recommendations listed is that Cognitive-Behavioural Therapy be included as part of treatment. This kind of recommendation, for the inclusion of a psychologist, is now standard practice in pain treatment. Unfortunately, I rarely see mention of this fact when I read about pain in the popular press.