Responding to the allegations against APA
As a longtime member, I have followed with great interest APA's response to James Risen's accusations and the recent New York Times article on the allegation that APA may have conspired with the CIA in torturing prisoners at detention sites.
I have been relieved to see APA's strong stance against torture, and its prohibition on psychologists participating in inhumane acts under any circumstances. However, I disagree with APA's decision not to respond to the article until the independent review is completed. I understand APA does not want to appear to be attempting to influence the review's outcome. But remember when George Bush's campaign "swift boated" John Kerry by misrepresenting his military actions? Kerry did not respond effectively, perhaps wanting not to give credibility to such obvious misinformation. But others felt he let the "swift boaters" gather too much momentum, allowing the misinformation to continue.
APA's silence is a similar mistake. This article quoted a supposed insider saying organized psychiatry "had some problems" with torture that organized psychology didn't have, therefore APA was the preferred partner in Guantanamo. We should not allow such allegations to stand without refuting them.
I've always been proud to be a member of a profession that places a high value on understanding human behavior and improving the human condition. These allegations are painful to me, as they must be to psychologists nationwide. I can only hope the independent review reveals them to be baseless. Meanwhile, APA should respond loudly and clearly each time such allegations surface.
Martha Viglietta, PhD
Syracuse, New York
Students respond to APA controversy
The publication of "All the President's Psychologists" in The New York Times, April 30, 2015, has increased public scrutiny of APA. Some emails published in that report allege APA involvement with the CIA's enhanced interrogation program. Our culture values transparency, of which there has been a marked absence from APA's leadership. This secrecy breeds mistrust among professional members, student affiliates and the public. How can members and student members of APA vouch for its values when its activities remain hidden from us?
We have been taught that APA promotes positions based on the best available research and on our Ethics Code, which has as its first principle working for the well-being and doing no harm to those we serve. APA's alleged involvement in the enhanced interrogation program raises a disheartening question: Does APA represent an organization of ethical healers committed to public welfare, or does it represent a few influential members carrying out a harmful political agenda?
We call for those who represent APA to remember that the actions of our leaders shape the future of our field, as we develop our professional identities based on their models. We hope APA leaders will model integrity, transparency, and ethical practices for today's students and tomorrow's professionals.
Daniel Stabin, Anne Conroy and Melani Landerfelt
Students in counseling psychology, Auburn University
Guiding treatment
Regarding "Guiding principles" in the June Monitor, the idea of encouraging treatment derived from evidence-based principles is attractive, but "clearinghouse" lists of evidence-based treatments often fall short when information is supplied only by proponents of therapies or when information is not kept up to date. I recently looked up a specific treatment on the NICE website and saw that it was listed as evidence-based, and that the evidence provided was a 2006 paper reporting an inadequate study; the information about the treatment was drawn from an author's summary. More recent publications and criticisms of the earlier paper were not listed. When I queried NICE about this situation, I was told that NICE makes no claims about listed therapies unless they have been evaluated by the organization — although in fact the initial page of the site states that it provides information about evidence-based treatments.
If APA is going to provide effective guidelines on the evidence bases of treatments, it will be necessary to read all information about a therapy objectively and critically, and to continue to monitor all relevant publications rather than to maintain a decision without further consideration. This would apply if a weakly evidentiated treatment were to present stronger evidence, but it should also apply when strong evidence is succeeded by less supportive results or by convincing critiques.
These matters have become all the more pressing in light of the popularization of the term "evidence-based," which is used loosely to mean "good" by some authors as well as by the lay public.
Jean Mercer, PhD
Moorestown, New Jersey
No safe level of alcohol during pregnancy
The news item on fetal alcohol syndrome disorder in the June Monitor is an important reminder about the negative consequences of drinking during pregnancy. Unfortunately, one facet of the issue was not mentioned — MDs who either encourage or don't discourage their pregnant patients from a drink or two "to help them relax." As the article states, there is no minimum safe level of alcohol consumption during pregnancy, but it appears that not all clinicians are aware of or simply do not believe this research-based axiom. All physicians in this field need to be better educated about the substantial risks inherent in their pregnant patients consuming alcohol.
John S. Searles, PhD
Burlington, Vermont
Teen smoking
Your news report on teen smoking in the May Monitor is a bit misleading, or at least, incomplete. While cigarette smoking among youth has indeed declined the past few years, this reduction has been offset by increased use of other tobacco products — especially electronic cigarettes and, to a lesser degree, hookahs — resulting in no change in overall tobacco use. The Centers for Disease Control and Prevention (CDC) reported that in 2014 e-cigarettes were the most commonly used tobacco product among middle (3.9 percent) and high (13.4 percent) school students. The CDC also reported that in 2014, nearly 25 of every 100 high school students (24.6 percent) and nearly 8 of every 100 middle school students (7.7 percent) used some type of tobacco product in the past 30 days.
Tobacco remains the leading cause of preventable death in the world, causing over 480,000 deaths in the United States and nearly 6 million deaths worldwide each year. It is critical that comprehensive tobacco prevention and control strategies concentrate on all addictive tobacco products, not just cigarettes.
Garland Y. (Gary) DeNelsky, PhD
Solon, Ohio
Mindfulness works, but how?
Your March article "Mindfulness holds promise for treating depression" indicates that Segal's mindfulness-based cognitive therapy (MBCT) "could help prevent recurring depressive episodes as well as medication and better than placebo," but continues: "While mindfulness works to help prevent depression relapse, researchers don't yet know how."
We propose that the existing framework of theory and research provided by psychological behaviorism accounts for the way mindfulness works and suggests an explanation for why it is effective in preventing relapse. The language we learn contains a very large class of words that elicit an emotional response, either positive or negative. As a consequence they act as rewards or punishers, and generate approach or avoidance behaviors.
How does this apply to MBCT? "[O]ne characteristic of depression is a habit of thinking negatively about experiences, one's self or the future." Depressed people, in other words, habitually say fewer positive emotional words to themselves and more negative. They thus have a stronger negative emotional state, they receive less reward for their behavior, and they are attracted by fewer things.
MBCT changes this process by getting clients to use fewer negative words in their inner dialogues. Centrally, clients are taught to avoid such negative thoughts altogether, concentrating on the present "here and now," such as one's breathing, through mindfulness meditation. MBCT also trains clients to use more positive emotional words in rumination. These interventions can have the continuing effects reported, since the newly acquired behaviors relieve the negative feelings, thus rewarding the client's action.
Karl A. Minke, PhD
Arthur W. Staats, PhD
Honolulu
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