Coming to Terms with the Failures of Youth Psychology Research

The complexity of youth mental health requires a scientific humility conspicuously lacking from the past 50 years of psychology research.

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A recent article traces a historical mismatch between clinical researchers’ aspirations in youth psychotherapy and the methods used to meet those aspirations, highlighting the importance of epistemic humility and the complexity of the research subjects. The researchers, Michael Mullarkey and Jessica Schleider, from Stony Brook University, write:

“For more than half a century, a single empirical question has remained a key driver for psychotherapy research: ‘What treatment, by whom, is most effective for this individual with that specific problem, and under which set of circumstances?”

Evidence-based interventions, however, never benefit all individuals equally. In the context of youth psychotherapy, there are no reliably detected moderators for any disorder. In articulating this persistent difficulty in attempts to universalize treatment results, the authors highlight three major mismatches between aspiration and research method in clinical research as an argument for epistemic humility and embracing complexity in youth psychotherapy research.

The complex etiology of youth mental health is well-documented. A diverse range of factors, including loneliness, racism, exercise, self-empowerment, and peer support, have been shown to affect youth mental health, requiring flexible approaches to treatment to improve treatment outcomes. Because of this etiological complexity, it has proven difficult for researchers to identify reliable moderators for treating youth with mental health challenges.

Acknowledging the complexity of youth mental health and the repeated failure of researchers’ attempts to find reliable moderators in youth psychotherapy requires that researchers refine their aspirations and research methods to fit the empirical reality of their subject matter. The authors identify three principles highlighting the mismatches between researcher aspirations and methods:

  1. Testing one moderator at a time will not reveal “what works for whom” in youth psychotherapy. In psychotherapy research, there are at least hundreds of candidate-moderators that may help us to personalize care; therefore, any individual treatment moderator is unlikely to have large effects. Indeed, “Many interaction effects identified as statistically significant provide negligible benefit in explaining how well individuals respond to a given treatment.”
  2. Most clinical trial samples are too small and non-representative to reveal what works for whom. Here, the overwhelming majority of individual trial participants identify as white and thus do not include enough people of color to examine differential effects within individual racial groups.
  3. We prioritize group-level design and statistics over approaches that directly assess what works for individuals. The desire for widely generalizable results thus elides the fact that there is evidence that clinical findings based on “between-subjects designs” may not be generalizable to individual people.

Thus, as the authors point out, “a large body of well-intentioned, painstaking clinical research has yielded few practical improvements for personalized youth psychotherapy.” Rather than persisting in these ineffective methodologies, researchers must embrace the complexity in the youth psychotherapy field and adopt scientific humility in their attempts to identify “what works for whom.”

Embracing humility must be a goal for individual researchers and institutions like journal editorial boards, grant review panels, and funding agencies. The authors conclude with five recommendations for rethinking research practice to maximize the chances of discovering what works for whom:

  1. Streamline and normalize clinical trial data sharing – with a national database, for example.
  2. Develop a “best practice” battery of psychotherapy research moderator variables.
  3. Capitalize on passive sensing technology to collect low-burden behavioral data – and recognize that generalizability of findings from group to individual is a continuum, not an on/off switch.
  4. Prioritize (very) large-scale clinical trials.
  5. Use models that can robustly test many high-dimensional moderators simultaneously.

For research across the diverse types of issues and treatments for youth tackling the “devastatingly hard” problem of finding reliable treatment moderators, “taking steps to center our goal of identifying “what works for whom” should take precedence over continuing to rely on standard approaches.”

 

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Mullarkey, M., & Schleider, J. (2021). “Embracing Scientific Humility and Complexity: Learning “What Works for Whom” in Youth Psychotherapy Research.” Preprint under review. (Link)

10 COMMENTS

  1. Let me just ask this:

    How do you “treat” a child who is being chronically abused at home by parents and older siblings? Who doesn’t know where they’re going to live from one day to the next because neither parent actually wants them? Who is being chronically bullied at school because they go to school in dirty clothes and unbrushed hair with bad breath and body odor? Who is targeted as a violent juvenile offender when they are old enough and big enough to fight back at home?

    I could go on. Who is it that actually needs treatment in this situation? Is it really the child? Is there never going to come a time when kids’ behaviors are understood in context? How can kids like I was possibly fit into the tidy diagnostic labels matched to treatment methods required for rigorous research? How do researchers control for abject chaos in a child’s life?

    The answer is, they don’t.

    And the reality is that a lot of research is complicated by the inability to control for circumstances in a person’s life. I see the same problems in drug withdrawal research. Investigators treat people as if they are lab rats living under controlled conditions. Whenever I see claims that a person has “relapsed” the very first thing I wonder is what are the external circumstances beyond their drug withdrawal? Are they even safe at home? Why are doctors and researchers so quick to assume that ongoing or recurrent problems are a condition within the study subject?

    This isn’t science. It’s wishful thinking.

    • It has always both fascinated and repelled me that those oppressed by abuse and social discrimination are the ones identified for “treatment,” while those who do the abusing and oppressing are not “diagnosed” with anything at all. What’s wrong with this picture?

      Your points are all very well taken.

    • “It is no measure of health to be well adjusted to a profoundly sick society.” -Jiddu krishnamurti

      @Steve M.
      It is common for groups to sit and do nothing when someone else is bullied. The authorities will often proclaim they don’t care who started it and will punish both people when the victim fights back. For whatever reasons many people blame the victim and identify toughness and righteousness with the perpetrator. The bully humiliates their victim and that humiliation makes the victim appear unlikable to others. In our society people’s circumstances are blamed on themselves. In another forum certain people would harass a certain commenter. When i pointed out this behavior other people would attack me for “stirring up shit and derailing the conversation.” I was eventually banned for calling out bullying.

      Abusive people gain their power by getting bystanders to identify with them, and to dislike the victims. Psychiatry utilizes the same strategy by proclaiming that it’s all the fault of “defective brains” that make people so dangerous they need less rights than criminals. A reason psychiatry flourishes is because it gives everyone involved a scapegoat. A scapegoat that appears unlikable because of the abuse constantly heaped on them.

    • I couldn’t agree more, kindredspirit, and Steve. It’s shameful our society has a group of, primarily child abuse covering up, “mental health” industries, and it’s all by DSM design.

      https://www.indybay.org/newsitems/2019/01/23/18820633.php?fbclid=IwAR2-cgZPcEvbz7yFqMuUwneIuaqGleGiOzackY4N2sPeVXolwmEga5iKxdo
      https://www.madinamerica.com/2016/04/heal-for-life/
      https://www.psychologytoday.com/us/blog/your-child-does-not-have-bipolar-disorder/201402/dsm-5-and-child-neglect-and-abuse-1

      And our societies’ systemic child abuse covering up problems exist when a person is dealing with a pedophile on their child’s school board, and a likely pedophile pastor. Or at least a Holy Spirit blaspheming, child abusing, and child abuse covering up pastor, too.

      Child abuse is not only a problem within families. Unless you consider the religions, that claimed they are our families. And the doctors, who had promised to “first and foremost promise to do no harm,” but don’t, for greed inspired reasons, behave in an ethical manner, but didn’t.

      Those hypocritical, systemic child abuse covering up doctors, pastors, and bishops are a part of the problem. As at least somewhat recorded this book, written by an ELCA synod office insider. Read at a minimum, the Preface. I’d be one of the many “widows” described in the Preface of this book, after the author likely read the medical proof of my story, and was appalled by the Lutheran bishops’ denial response.

      https://books.google.com/books?id=xI01AlxH1uAC&printsec=frontcover&source=gbs_ge_summary_r&cad=0#v=onepage&q&f=false

      I’m quite certain this “conspiracy” between the paternalistic “mental health professions'”, who are literally functioning as the systemic child abuse covering up arm of the religions’, who have confessed to me that they are in “partnership” with the paternalistic religions, should be put to an end. Since we need to put an end to “the dirty little secret of the two original educated professions.”

      https://stateofthenation2012.com/?p=59031

      But, since the “mental health professions,” and their religious leaders, the lawyers, judges, and the corrupt banksters, who funded the miseducation of these paternalistic, satanic systems, don’t want to end their “dirty little secret of the two original educated professions,” and other crimes. Let’s hope and pray God judges all fairly instead.

      No society should have systemic child abuse covering up “mental health” industries, since they help to bring about a “pedophile empire.”

      https://www.amazon.com/Pedophilia-Empire-Chapter-Introduction-Disorder-ebook/dp/B0773QHGPT

      And none of us should wish to live in a “pedophile empire.” We need to bring about a better world instead. Let’s hope and pray we can all help to take our world elsewhere instead.

  2. To me, this is a rich example – in its verbiage if nothing else – of how far these people can stick their heads up their butts.

    I am convinced that most of these “researchers” would prefer to remain confused and ignorant to the end of time. If this were not their secret goal, wouldn’t they look a little harder in directions that are turning eyes in other fields, such as the ever-growing parapsychology literature, or the results being obtained by some of the more serious spiritual practices, such as fully awake past life recall?

    The issue of child psychology is particularly troubling, as this is a perfect time of life to start getting oneself straightened out and flying right, before the full weight of adult life falls on one’s shoulders. Yet I am sure many kids today, with absent or over-worked parents, feel that weight and need help coping. The field of “mental health” has the potential to help younger people in many ways. But in its current state, it is usually causing more trouble than it is worth. At this point I would not hesitate to council parents and their kids to stay away from the “mental health” system!

  3. Until the psychologists stop utilizing the “invalid” DSM stigmatization “bible,” I’m quite certain they will be unable to actually help the children, or adults. They need to stop believing in the “chemical imbalance” theory, as well.

    And until “forced treatment” is made illegal, which is what gives the psychologists and psychiatrists undeserved power. It’s highly unlikely we’ll be seeing too much “humility” in the “mental health professionals,” IMHO.

    • Anyone who actually practices “first do no harm” wouldn’t slap on a stigmatizing label that serves as a self fulfilling prophecy of doom.

      A major issue with forced “treatment”is that it causes all treatment to contain force. A patient that can be locked up and drugged against their will at any time does not have the autonomy and power to provide consent. If someone physically harms someone else to get them to do something and threatens to do it again unless that person abides by their dictations there is no consent if the harmed individual does what the abuser says in the future. This is especially true when the abuser is backed by the government because the victim has little to no recourse or ability to fight.
      The horror of forced treatment touches all because it makes all treatment coerced. How many people take psych drugs or go to therapy because they in part fear being forcibly hospitalized? One is too many, and there are many.

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