Scott Lilienfeld: A Collection of Three Commentaries

Schmaltz, R. M., & Lilienfeld, S. O. (2017) Editorial: Novel approaches to teaching scientific thinking: Psychological perspectives. Frontiers in Psychology, 8, 1-2. https://doi.org/10.3389/fpsyg.2017.00820

Rosen, G. M., Lilienfeld, S. O., & Glasgow, R. E. (2019). Psychiatry’s stance towards scientifically implausible therapies: Are we losing ground? The Lancet. Psychiatry, 6(10), 802–803. https://doi.org/10.1016/S2215-0366(19)30276-7

Lilienfeld, S. O. (2019). What is “evidence” in psychotherapies? World Psychiatry, 18, 245-246. https://doi.org/10.1002/wps.20654

Reviewed by Jacqueline Weber, MEd, BCBA
Endicott College

Dr. Scott Lilienfeld was a pioneer in helping families, researchers, and practitioners understand what constitutes evidence in applied research. The essence of Scott Lilienfeld’s crusade against pseudoscience is captured in this collection of three compositions, two of which he co-authored and one which he authored. The first is an editorial titled, Novel Approaches to Teaching Scientific Thinking: Psychological Perspectives. This piece serves as an introduction to a group of articles that provide instructors with several approaches to facilitate balanced, informed discussion, and support of scientific thinking in students. Schmaltz and Lilienfeld (2017) start with a discussion about living in a world in which it is difficult to discern factual information from misinformation presented to us in varied forms of media. The authors state that now —more than ever— students need to be thinking scientifically as they are exposed to unsubstantiated claims exemplified by recent events regarding climate change and vaccine safety. Most recently, the media coverage of the COVID-19 pandemic across social media, internet platforms, and news outlets, demonstrated this point even further. Students must be taught to use scientific thinking to discern between pseudoscientific work, scientific work, advertising, and hype across all types of media.

Schmaltz & Lilienfeld (2017) define scientific thinking as, “the ability to generate, test, and evaluate claims in ways that minimize our inherent propensities towards bias” (p. 1). Articles in this issue are varied and valuable in promoting scientific thinking. One piece (Lilienfeld et al., 2015) includes a discussion of inaccurate and frequently misused psychological and psychiatric terms, presents ways in which these errors can be corrected, and makes recommendations for appropriate terms to be used in their place. A second article (Matute et al., 2015.) presents how pseudoscience is perpetuated by the “illusion of causality” and how understanding this concept can facilitate scientific thinking. The authors of another article (Hamilton & Hamilton, 2015) discuss the distortion of mind-body dualism in neuroscience and how this can be applied to philosophical arguments. Other pieces (Honey, 2015) discuss the utility of exposing students to the fallacies of pseudoscience and using signal detection in decision-making to assess the accuracy of claims (Anderson, 2015). Schmaltz & Lilienfeld (2017) conclude that the articles in this issue should provide instructors with valuable methods to teach students the skills needed to think scientifically and combat pseudoscience.

Another contribution worthy of being highlighted is a commentary titled, Psychiatry’s stance towards scientifically implausible therapies: are we losing ground? (Rosen et al., 2019). Here Lilienfeld and colleagues discuss how implausible scientific treatments are being classified as empirically supported treatments due to a “blind allegiance to randomized control trials” (Rosen et al., 2019, p. 1). The authors cite the example of the Emotional Freedom Technique (EFT) which involves tapping acupoints (as in acupuncture) at select points on the body which purports to alter energy networks resulting in various cures. They cite the publication of a meta-analysis based on 3 randomized control trials (RCT) that alleged that EFT was the therapeutically active component. A fourth RCT study, which tapped participants at EFT acupoints, sham points on their bodies, and on a doll, reported similar treatment outcomes. This study was omitted from the data with an unsubstantiated ad hoc explanation in which the researchers claimed that the placebo controls were flawed because sham points and doll tapping stimulated an acupuncture point on the fingertip that is supposed to treat mental restlessness (Rosen et al., 2019). Regardless, the meta-analysis on EFT was published in a reputable psychiatric journal and was recommended as a treatment for post-traumatic stress disorder (PTSD) by the National Institute for Health and Care Excellence (NICE, 2019).

The authors argue that researchers should extend their decision-making beyond RCT’s and “adopt broader science-based criteria that consider the plausibility- or lack thereof- of therapeutic rationales and proposed change mechanisms” (Rosen et al., 2019, p. 1). These criteria require that, (a) when examining research in mental health treatments, one should consider not only outcome data, but all evidence that affects the intervention, and (b) journal editors and reviewers should adopt the same skeptical view of theoretically implausible treatments. Lilienfeld and colleagues (Rosen et al., 2019) conclude by stating that adherence to these efforts is essential to preventing scientifically implausible interventions from needlessly competing with proven and effective treatments.

This is applicable to treatments in the field of autism. Applied Behavior Analysis (ABA) is an evidence-based intervention with decades of research to support its effectiveness with teaching skills and reducing challenging behaviors in individuals with autism (National Autism Center, 2015; Steinbrenner, et al., 2020; Hume et al., 2021), Despite this, we still encounter families who have been given inaccurate information regarding fad interventions and who have fallen victim to pseudoscience. Fad therapies can be harmful in terms of wasting parent’s money and children’s time. All of the time they spend engaged in a fad therapy based on pseudoscience is time wasted that they could have spent engaged in evidence-based treatment.

The final item in this series is an editorial titled, What is “evidence” in psychotherapies? in which Lilienfeld (2019) examines and challenges the criteria of how psychotherapeutic treatments are considered empirically supported therapies (EST). He points out that an intervention is currently deemed “well established” by the APA if it “has performed better than a placebo or alternative treatment or as well as an established intervention in at least two independently conducted randomized controlled trials or in a series of systematic within-subject studies” (Lilienfeld, 2019, p. 245). Lilienfeld casts doubt on the process by which treatments are validated as empirically supported. He points out that Thought Field Therapy was added to the evidence-based practice registry by the U.S. Substance Abuse and Health Services Registration in 2016 (National Psychologist, 2016). This treatment is based on the idea that “psychopathology can be treated by removing blockages in invisible and unmeasurable energy fields” (Lilienfeld, 2019, p. 245). Additionally, Lilienfeld and colleagues (2018) describe therapies such as emotional freedom techniques, equine-assisted therapy, group drumming, acupuncture for depression, and music therapy for autism treatment that all claim to be evidence-based interventions. He alarmingly points out that these seemingly unsubstantiated methods may meet the criteria for EST by the APA.

Lilienfeld (2019) recommends that 4 additional lines of inquiry be adopted to EST guidelines to ensure that an intervention is indeed evidence-based:

Treatment outcomes should be extensively replicated by independent teams to ensure their effectiveness. This includes examining all outcome data, whether it be positive or negative, and all published and unpublished data. Evaluators should assess the methodological quality of studies with consistency and adopt statistical procedures to evaluate the strength of the evidence and any biases that exist.
Guidelines should include objective and subjective evaluations of an individual’s ability to function in their daily life as opposed to relying on general symptomatic improvements.
Assessment of harm to a patient should be considered, which can be achieved by examining whether a patient’s condition is worsening during and after treatment as opposed to assessing patient condition on a broader continuum.
Consider the scientific plausibility of proposed treatment rationales instead of just focusing on outcome data. Reliably, Lilienfeld links lack of rigor in definitions, standards, and research methodology to allowing a myriad of pseudo-scientific treatments into a world that should be completely driven by stringent evidence-based evaluation methods.

Much can be gained from Scott Lilienfeld and his advocacy against pseudoscience. His dedication to teaching students how to think scientifically, his call to action to the mental health field to think critically about what is being recommended for clients therapeutically, and his insistence on adopting stricter guidelines in research are lessons that should be heeded now and into the future.

References:

Anderson, N. D. (2015). Teaching signal detection theory with pseudoscience. Frontiers in Psychology, 6, 1-4. https://doi.org/10.3389/fpsyg.2015.00762

Hamilton, S. & Hamilton, T. J. (2015). Pedagogical tools to explore Cartesian mind-bodydualism in the classroom: philosophical arguments and neuroscience illusions. Frontiers in Psychology, 6, 1-6. https://doi.org/10.3389/fpsyg.2015.01155

Honey, L. P. (2015). Why I teach the controversy: using creationism to teach critical thinking. Frontiers in Psychology, 6, 1-5. https://doi.org/10.3389/fpsyg.2015.00793

Hume, K., Steinbrenner, J. R., Odom, S. L., et al. (2021). Evidence-based practices for children, youth, and young adults with autism: Third generation review. Journal of Autism and Developmental Disorders. Early Online. https://doi.org/10.1007/s10803-020-04844-2.

Lilienfeld, S. O. (2019), What is “evidence” in psychotherapies? World Psychiatry, 18, 245-246. https://doi.org/10.1002/wps.20654

Lilienfeld, S. O., Lynn, S. J., & Bowden, S. (2018). Why evidence-based practice isn’t enough: The need for science-based practice. The Behavior Therapist, 41, 42-47. https://doi.org/10.1177/070674371506001203

Lilienfeld, S. O., Sauvigné, K. C., Lynn, S. J., Cautin, R. L., Latzman, R. D. and Waldman. I. D. (2015). Fifty psychological and psychiatric terms to avoid: a list of inaccurate, misleading, misused, ambiguous, and logically confused words and phrases. Frontiers in Psychology, 6, 1-15. https://doi.org/10.3389/fpsyg.2015.01100

Matute, H., Blanco, F., Yarritu, I., Díaz-Lago, M., Vadillo, M. A. and Barberia, I. (2015). Illusions of causality: how they bias our everyday thinking and how they could be reduced. Frontiers in Psychology, 6, 1-14. https://doi.org/10.3389/fpsyg.2015.00888

National Autism Center. (2015). Findings and conclusions: National standards project, phase 2. Randolph, MA: Author. https://www.nationalautismcenter.org/national-standards-project/results-reports/

National Psychologist (2016, July 26). SAMHSA adds Thought Field Therapy to National Registry. https://nationalpsychologist.com/2016/07/samhsa-adds-thought-field-therapy to-national-registry/103335.html

NICE (2018, December 5). NICE guideline [NG116] for post-traumatic stress disorder. https://www.nice.org.uk/guidance/ng116

Rosen, G. M., Lilienfeld, S. O., & Glasgow, R. E. (2019). Psychiatry’s stance towards scientifically implausible therapies: Are we losing ground? The Lancet. Psychiatry, 6(10), 802–803. https://doi.org/10.1016/S2215-0366(19)30276-7

Steinbrenner, J. R., Hume, K., Odom, S. L., Morin, K. L., Nowell, S. W., Tomaszewski, B., Szendrey, S., McIntyre, N. S., Yücesoy-Özkan, S., & Savage, M. N. (2020). Evidence based practices for children, youth, and young adults with Autism. The University of North Carolina at Chapel Hill, Frank Porter Graham Child Development Institute, National Clearinghouse on Autism Evidence and Practice Review Team. https://ncaep.fpg.unc.edu/research-resources

Citation for this article:

Weber, J. (2021). Scott Lilienfeld: A collection of three commentaries. Science in Autism Treatment, 18(9).

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