I’ve just spent the last six months researching and writing the second edition of my Psychopathology text book – and I’ll probably be doing this for the next six months as well. I’ve included DSM-5 diagnostic criteria in the book – if I didn’t then it almost certainly wouldn’t be in the slightest bit competitive in the “Abnormal Psychology” textbook market. But I’ve attempted to be critically evaluative of DSM-5 wherever I can, and included a section specifically devoted to criticisms of the DSM developmental processes itself.

However, this led me to thinking about the value of current psychiatric diagnostic criteria. I got my copy of DSM-5 within days of it being published (all £88-11p of it). I was struck immediately by how similar it looked to DSM-IV-TR – except for the fact that they’d used an Arabic instead of a Roman suffix – very contemporary, and highly likely to be attractive to the youngsters. First, I couldn’t help but be impressed by how easily I could mistakenly pick up DSM-IV-TR and believe it to be DSM-5. How long did DSM-5 take to develop, and how much money did it cost?

Anyway, that’s not the point of this piece. It’s about whether research on diagnostic criteria are converging or diverging. That’s important because there is currently a desire to prioritize harmonization of ICD-11 and DSM-5. Let’s not forget that DSM-5 as published is still very much an arbitrary set of diagnostic criteria only very loosely based on biological and psychological evidence – that is clearly reflected in the move in DSM-5 to spectrum-based disorders. Writing an “abnormal psych” textbook is very instructive, because you’re not only writing about diagnostic criteria you’re also reviewing all the evidence on etiology as well – and very often the two just don’t match up!

Almost all Abnormal Psychology textbooks have etiology sections that cover biological, psychology and, sometimes, sociological explanations of almost every psychopathology. Yet trying to reconcile these different etiological approaches with the simplistic diagnostic criteria in DSM-5 is almost impossible. Given the (supposedly) lucrative market for Abnormal Psychology textbooks, there has been a frenzy to align these books with DSM-5. The 12th edition of Wiley’s Kring et al. Abnormal Psychology textbook even preceded DSM-5 and attempted to predict what the new diagnostic criteria would be!

But the more I research the etiology of individual psychopathologies for the second edition of Psychopathology, the more I realize that DSM-5 is a fabrication that is entirely remote from the diverse research being undertaken on all psychological disorders. Schizophrenia spectrum disorders is a good example. There is a growing wealth of knowledge about the neuropsychology of schizophrenia as a diagnostic category. There is also a growing wealth of knowledge about the psychological processes that give rise to cognitive biases contributing to psychotic symptoms. None of this is apparent in any of the words I read in DSM-5. I would hesitate to say this, but I think I would have a better idea of being able to spot and understand a “schizophrenia”-related disability from reading the literature on schizophrenia etiology research than I would ever have from reading the DSM-5 diagnostic criteria.

There is no doubt that DSM-5 is a poor guide to “understanding” psychiatric disorders – anyone who reads it will get very little insight into what it is like to experience a mental health problem and even less insight into what causes that problem. So is DSM-5 simply a load of very eminent psychiatrists exercising their intellectual muscle to force us all to fit into rather simplistic mental health boxes (and also an attempt by them to impress their more traditional medical compatriots)? And for who’s benefit? Well, as I understand it, much of this is for the benefit of the US health insurance market. So is this why we should have a deliberate convergence of diagnostic mental health criteria when such criteria are currently sketchy and arbitrary?

Don’t get me wrong. It’s important that researchers and practitioners collaborate to further knowledge and diagnostic criteria. But to believe that we are already at a point where we can begin to converge different worldwide diagnostic criteria is frighteningly premature. The development of diagnostic criteria for mental health problems has been a process that has been overseen by medics for far too long – not just in the APA but also in the World Health Organization. Mental health problems are not simply medical problems, many of them are problems stemming as much from ways of thinking and from socio-economic status as they are from medical dysfunction. Yet there is an alarming desire to align DSM with neuroscience – and not with psychology and nor with the socio-economic factors that give rise to many common mental health problems. Wouldn’t it be interesting at this stage in our knowledge development to see different attempts to consolidate diagnostic criteria take their own independent routes rather than deliberately converge as a matter of international medical policy? 

As promised, here is another piece from the forthcoming second edition of Psychopathology. This time, here is a new section discussing mental health stigma, its causes, why it matters, and how we can eliminate it.

There are still attitudes within most societies that view symptoms of psychopathology as threatening and uncomfortable, and these attitudes frequently foster stigma and discrimination towards people with mental health problems. Such reactions are common when people are brave enough to admit they have a mental health problem, and they can often lead on to various forms of exclusion or discrimination – either within social circles or within the workplace. In the following sections we will look at (1) what mental health stigma is, (2) Who holds stigmatizing beliefs and attitudes?, (3) What causes stigma? (4) Why does stigma matter? And (5) How can we eliminate stigma?

What is mental health stigma?: Mental health stigma can be divided into two distinct types: social stigma is characterized by prejudicial attitudes and discriminating behaviour directed towards individuals with mental health problems as a result of the psychiatric label they have been given. In contrast, perceived stigma or self-stigma is the internalizing by the mental health sufferer of their perceptions of discrimination (Link, Cullen, Struening & Shrout, 1989), and perceived stigma can significantly affect feelings of shame and lead to poorer treatment outcomes (Perlick, Rosenheck, Clarkin, Sirey et al., 2001).

In relation to social stigma, studies have suggested that stigmatising attitudes towards people with mental health problems are widespread and commonly held (Crisp, Gelder, Rix, Meltzer et al., 2000; Bryne, 1997; Heginbotham, 1998). In a survey of over 1700 adults in the UK, Crisp et al. (2000) found that (1) the most commonly held belief was that people with mental health problems were dangerous – especially those with schizophrenia, alcoholism and drug dependence, (2) people believed that some mental health problems such as eating disorders and substance abuse were self inflicted, and (3) respondents believed that people with mental health problems were generally hard to talk to. People tended to hold these negative beliefs regardless of their age, regardless of what knowledge they had of mental health problems, and regardless of whether they knew someone who had a mental health problem. More recent studies of attitudes to individuals with a diagnosis of schizophrenia or major depression convey similar findings. In both cases, a significant proportion of members of the public considered that people with mental health problems such as depression or schizophrenia were unpredictable, dangerous and they would be less likely to employ someone with a mental health problem (Wang & Lai, 2008; Reavley & Jorm, 2011).

Who holds stigmatizing beliefs about mental health problems?: Perhaps surprisingly,  stigmatizing beliefs about individuals with mental health problems are held by a broad range of individuals within society, regardless of whether they know someone with a mental health problem, have a family member with a mental health problem, or have a good knowledge and experience of mental health problems (Crisp et al., 2000; Moses, 2010; Wallace, 2010). For example, Moses (2010) found that stigma directed at adolescents with mental health problems came from family members, peers, and teachers. 46% of these adolescents described experiencing stigmatization by family members in the form of unwarranted assumptions (e.g. the sufferer was being manipulative), distrust, avoidance, pity and gossip, 62% experienced stigma from peers which often led to friendship losses and social rejection (Connolly, Geller, Marton & Kutcher (1992), and 35% reported stigma perpetrated by teachers and school staff, who expressed fear, dislike, avoidance, and under-estimation of abilities. Mental health stigma is even widespread in the medical profession, at least in part because it is given a low priority during the training of physicians and GPs (Wallace, 2010).

What factors cause stigma?: The social stigma associated with mental health problems almost certainly has multiple causes. We’ve seen in the section on historical perspectives that throughout history people with mental health problems have been treated differently, excluded and even brutalized. This treatment may come from the misguided views that people with mental health problems may be more violent or unpredictable than people without such problems, or somehow just “different”, but none of these beliefs has any basis in fact (e.g. Swanson, Holzer, Ganju & Jono, 1990). Similarly, early beliefs about the causes of mental health problems, such as demonic or spirit possession, were ‘explanations’ that would almost certainly give rise to reactions of caution, fear and discrimination. Even the medical model of mental health problems is itself an unwitting source of stigmatizing beliefs. First, the medical model implies that mental health problems are on a par with physical illnesses and may result from medical or physical dysfunction in some way (when many may not be simply reducible to biological or medical causes). This itself implies that people with mental health problems are in some way ‘different’ from ‘normally’ functioning individuals. Secondly, the medical model implies diagnosis, and diagnosis implies a label that is applied to a ‘patient’. That label may well be associated with undesirable attributes (e.g. ‘mad’ people cannot function properly in society, or can sometimes be violent), and this again will perpetuate the view that people with mental health problems are different and should be treated with caution.

            We will discuss ways in which stigma can be addressed below, but it must also be acknowledged here that the media regularly play a role in perpetuating stigmatizing stereotypes of people with mental health problems. The popular press is a branch of the media that is frequently criticized for perpetuating these stereotypes. Blame can also be levelled at the entertainment media. For example, cinematic depictions of schizophrenia are often stereotypic and characterized by misinformation about symptoms, causes and treatment. In an analysis of English-language movies released between 1990-2010 that depicted at least one character with schizophrenia, Owen (2012) found that most schizophrenic characters displayed violent behaviour, one-third of these violent characters engaged in homicidal behaviour, and a quarter committed suicide. This suggests that negative portrayals of schizophrenia in contemporary movies are common and are sure to reinforce biased beliefs and stigmatizing attitudes towards people with mental health problems. While the media may be getting better at increasing their portrayal of anti-stigmatising material over recent years, studies suggest that there has been no proportional decrease in the news media’s publication of stigmatising articles, suggesting that the media is still a significant source of stigma-relevant misinformation (Thornicroft, Goulden, Shefer, Rhydderch et al., 2013).

Why does stigma matter?: Stigma embraces both prejudicial attitudes and discriminating behaviour towards individuals with mental health problems, and the social effects of this include exclusion, poor social support, poorer subjective quality of life, and low self-esteem (Livingston & Boyd, 2010). As well as it’s affect on the quality of daily living, stigma also has a detrimental affect on treatment outcomes, and so hinders efficient and effective recovery from mental health problems (Perlick, Rosenheck, Clarkin, Sirey et al., 2001). In particular, self-stigma is correlated with poorer vocational outcomes (employment success) and increased social isolation (Yanos, Roe & Lysaker, 2010). These factors alone represent significant reasons for attempting to eradicate mental health stigma and ensure that social inclusion is facilitated and recovery can be efficiently achieved.

How can we eliminate stigma?: We now have a good knowledge of what mental health stigma is and how it affects sufferers, both in terms of their role in society and their route to recovery. It is not surprising, then, that attention has most recently turned to developing ways in which stigma and discrimination can be reduced. As we have already described, people tend to hold these negative beliefs about mental health problems regardless of their age, regardless of what knowledge they have of mental health problems, and regardless of whether they know someone who has a mental health problem. The fact that such negative attitudes appear to be so entrenched suggests that campaigns to change these beliefs will have to be multifaceted, will have to do more than just impart knowledge about mental health problems, and will need to challenge existing negative stereotypes especially as they are portrayed in the general media (Pinfold, Toulmin, Thornicroft, Huxley et al., 2003). In the UK, the “Time to Change” campaign is one of the biggest programmes attempting to address mental health stigma and is supported by both charities and mental health service providers (http://www.time-to-change.org.uk). This programme provides blogs, videos, TV advertisments, and promotional events to help raise awareness of mental health stigma and the detrimental affect this has on mental health sufferers. However, raising awareness of mental health problems simply by providing information about these problems may not be a simple solution – especially since individuals who are most knowledgeable about mental health problems (e.g. psychiatrists, mental health nurses) regularly hold strong stigmatizing beliefs about mental health themselves! (Schlosberg, 1993; Caldwell & Jorm, 2001). As a consequence, attention has turned towards some methods identified in the social psychology literature for improving inter-group relations and reducing prejudice (Brown, 2010). These methods aim to promote events encouraging mass participation social contact between individuals with and without mental health problems and to facilitate positive intergroup contact and disclosure of mental health problems (one example is the “Time to Change” Roadshow, which sets up events in prominent town centre locations with high footfall). Analysis of these kinds of inter-group events suggests that they (1) improve attitudes towards people with mental health problems, (2) increase future willingness to disclose mental health problems, and (3) promote behaviours associated with anti-stigma engagement (Evans-Lacko, London, Japhet, Rusch et al., 2012; Thornicroft, Brohan, Kassam & Lewis-Holmes, 2008). A fuller evidence-based evaluation of the Time to Change initiative can be found in a special issue dedicated to this topic in the British Journal of Psychiatry (British Journal of Psychiatry, Vol. 202, Issue s55, April 2013).

For those of you that would like to test your own knowledge of mental health problems, Time to Change provides you with a quiz to assess your own awareness of mental health problems.

Summary: Hopefully, this section has introduced you to the complex nature of mental health stigma and the effects it has on both the daily lives and recovery of individuals suffering from mental health problems. We have discussed how mental health stigma manifests itself, the effect it has on social inclusion, self-esteem, quality of life and recovery. We ended by describing the development of multifaceted programmes to combat mental health stigma and discrimination.

DSM-5 is at the binders and being prepared for release in May, but I can report that a new Task Force has already begun its preliminary work on its successor, DSM-6.

While the most recent changes to the DSM have been extensively discussed and researched, many of the revisions have been received critically, and the APA has moved rapidly to stymy criticism of DSM-5 by convening a new Task Force that has already reported on some further significant changes to mental health diagnostic criteria that will refine and elaborate on the changes in DSM-5.

The APA has recently confirmed that "Many of the revisions in DSM-5 will help psychiatry better resemble the rest of medicine", but now the aim of DSM-6 is to align psychiatric diagnosis with car maintenance. This will move diagnosis and treatment away from airy-fairy, psychological concepts such as ‘recovery’ to the more practical notion of fixing something that is clearly broken. Pursuing the ‘car maintenance’ analogy, DSM-6 will recommend that everyone should have an annual “road test” to ensure that their mental health is fit for purpose. Failing the test (e.g. by reporting the experience of at least one negative emotion in the previous 12 months) will require compulsory medication for a period to be determined by a panel of experts recruited from salesmen within the pharmaceutical industry.

Other new changes within DSM-6 include:

1.         An increased number and range of prodromal risk factors for mental health problems. These include dementia compulsio – forgetting whether you’ve locked the door and returning to check; risum cacoethes – uncontrollable inappropriate giggling fits – a known risk factor for a number of diagnosable disorders such as delirium, mania and bipolar disorder; anxietatem dentalis - feeling anxious when reading magazines you’ve previously encountered in your dentist’s waiting room, a precursor for a range of irrational fears.

2.         Nose-picking disorder is recognized as a new independent disorder category, along with Gluttony (formerly known as Binge Eating Disorder), and Jealousy (a former sub-type of Borderline Personality Disorder).

3.         The ‘scorn exclusion’ has been removed from the diagnosis of Antisocial Personality Disorder. This allows scorn (or contempt) to be included as a contributor to a diagnosis of Antisocial Personality Disorder.

4.         All criteria for major Depression have been removed and replaced by the single cardinal feature of ‘low mood’. This will allow GPs and physicians to prescribe antidepressants on the basis of an immediate diagnosis rather than – as before – a financial inducement from a pharmaceutical industry rep.

5.         DSM Criticism syndrome is a new psychosis sub-type characterized by delusional beliefs that DSM is not a necessary requirement for helping people to recover from mental health problems and merely provides labels that stigmatize sufferers. People diagnosed with this disorder should not be approached directly because of their revisionist and anti-establishment views. The APA has set a target date of 2020 for the total eradication of this particularly virulent illness.

You can find a much fuller summary of the recommendations for DSM-6 here. When published, DSM-6 is expected to cost in the region of $45,000 a copy.

First published 27/02/2013 at http://grahamdavey.blogspot.co.uk

That's rather an extreme blog post title, but was inspired by the APA's (American Psychiatric Association) recent comment that  "Many of the revisions in DSM-5 will help psychiatry better resemble the rest of medicine". This alone would be enough to send shivers down the spine of most psychology-minded mental health practitioners, but it led me to thinking about where that might leave psychology as a rather different knowledge-based approach to understanding and treating mental health problems.

Specifically, if the APA want to impose a medical model on mental health then what will our doctors and physicians be learning about how to deal with their patients with mental health problems? The incremental implications are immense. It is not just that mental health is being aligned with medicine on such an explicit basis in this way, this issue is compounded by the fact that medical training still plays lip service to training doctors in psychological knowledge and, in particular, to a psychological approach to mental health. So has medicine taken the decision to align mental health diagnosis and treatment to fit the constraints of current medical training (rather than vice versa)?

I returned to a President's column I wrote in 2002 about the state of psychology teaching in the UK medical curriculum. The same points I made then seem to apply now. The medical curriculum is not constructed in a way that provides an explicit slot for psychology or psychological knowledge. Even though a recent manifesto for the UK medical curriculum (Tomorrow’s Doctors, 2009) makes it clear that medical students should be able to “apply psychological principles, method and knowledge to medical practice” (p15), there is probably no practical pressure for this to happen. Given that the ‘Tomorrow’s Doctors’ document does advocate more behavioural and social science teaching in the medical curriculum, I suspect that what happens in practice is that a constrained slot for ‘non-core medical teaching’ gets split up between psychology, social science and disciplines such as health economics. If a medical programme decides to take more sociology (because there are sociologists available on campus to teach it) – then there will be less psychology.

The second point I made then was related to the expectations of medical students. This was illustrated by a QAA report for a well-respected medical school. This made the point that:

“...there was a student perception that, in Phase I, the theoretical content relating to the social and behavioural sciences was too large. Particular concern was expressed about aspects of the Health Psychology Module....a number of students suggested that the emphasis placed upon theoretical aspects of these sciences in Phase I was onerous”

Well – death to psychology! My own experience of teaching medical students is that they often have a very skewed perception of science, and in particular, biological science. Interestingly, the ‘Tomorrow’s Doctors’ document advises that medical students should be able to ‘apply scientific method and approaches to medical research’ (p18). But in my experience medical students find it very difficult to conceptualize scientific method unless it is subject matter relevant – i.e. biology relevant. I have spent many hours trying to explain to medical students that scientific method can be applied to psychological phenomena that are not biology based – as long as certain principles of measurement and replicability can be maintained.

But there has been a more recent attempt to define a core curriculum for psychology in undergraduate medical education. This was the report from the Behavioural & Social Sciences Teaching in Medicine (BeSST) Psychology Steering Group (2010) (which I believe to be an HEA Psychology Network group). I am sure this report was conducted with the best of intentions, but I must admit I think it’s core curriculum recommendations are bizarre, and entirely miss the point of what psychology has to offer medicine! It is like someone has gone through a first year Introduction to Psychology textbook and picked out interesting things that might catch the eye of a medical student – piecemeal! For example, the report claims that learning theory is important because it might be relevant to “the acquisition and maintenance of a needle phobia in patients who need to administer insulin” (p30). That is both pandering to the medical curriculum and massively underselling psychology as a paradigmatic way of understanding and changing behaviour!

Medical students need to understand that psychology is an entirely different, and legitimate, method of knowledge acquisition and understanding in biological science. Not all mental health problems are reducible to biological diagnoses, biological explanations or medical interventions, and attempts by the APA to shift our thinking in that direction are either delusional or self-promoting. What is most disappointing from the point of view of the development of mental health services is the impact that entrenched medically-based views such as those of the APA will have on the already introverted medical curriculum. Doctors do need to learn about medicine, but they also need to learn that mental health needs to be understood in many ways – very many of which are not traditionally biological in their aetiology or their cure.

First published 21/02/2013 at http://grahamdavey.blogspot.co.uk

Another short piece written as a Focus Point for the second edition of my Psychopathology textbook (due to be published late 2013).


DSM regularly undergoes an intensive revision process to take account of new research on mental health problems and to refine the diagnostic categories from earlier versions of the system. One would assume that this would be a deliberate and objective process that could only further our understanding of psychopathology, and that is certainly the intention of the majority of those involved. However, at least some people argue that the process of developing a classification system such as DSM can never be entirely objective, free from bias, or free from corporate or political interests. Allen Frances and Thomas Widiger were two individuals who were prominent in the development of the fourth edition of the DSM, and they have written a fascinating account of the lessons they believe should be learned from previous attempts to revised and develop mental health classification systems (Frances & Widiger, 2012). They make the following points:

1.         Just as the number of mental health clinicians grows, so too will the number of life conditions that work their way into becoming disorders. This is because the proliferation of diagnostic categories tends to follow practice rather than guide it.

2.         Because we know very little about the true causes of mental health problems, it is easier and simpler to proliferate multiple categories of disorder based on relatively small differences in descriptions of symptoms.

3.         Most experts involved in developing DSM are primarily worried about false negatives (i.e. the missed diagnosis or patient who doesn’t fit neatly into the existing categorizations), and this leads to either more inclusive diagnostic criteria or even more diagnostic categories. Unfortunately, experts are relatively indifferent to false positives – patients who receive unnecessary diagnosis, treatment, and stigma – and so are less likely to be concerned about over-diagnosis.

4.         Political and economic factors have also shaped the ‘medical model’ view of psychopathology on which DSM is based, and also contributed to the establishment and proliferation of diagnostic categories. For example, the pharmaceutical industry benefits significantly from the sale of medications for mental health problems, and its profits will be dependent on both (1) conceptions of mental health based on a medical model that implies a medical solution, and (2) a diagnostic system that will err towards over-diagnosis rather than under-diagnosis (see Pilecki, Clegg & McKay, 2011).

First published 13/02/2013 at http://grahamdavey.blogspot.co.uk

As promised, it's my intention to post some new pieces written for the second edition of my Psychopathology textbook (due to be published late 2013). This post begins that process with a new section written to introduce and evaluate DSM-5 from the Chapter on Classification & Assessment in Clinical Psychology.

"Published in 2013, DSM-5 arguably represents the most comprehensive revision of the DSM so far, and it has involved many years of deliberation and field trials to determine what changes to mental health classification and diagnosis are essential and empirically justifiable (Main chapter headings for DSM-5 are provided in Table 1).

The main changes between DSM-5 and its predecessor (DSM-IV-TR) are listed in Table 2.

First, previous versions of DSM placed mental health problems on a number of different axes representing clinical disorders (Axis I), developmental and personality disorders (Axis II), or general medical conditions (Axes III). This multiaxial system has been scrapped – largely because there was not enough evidence to justify the differences between them. Instead, in DSM-5 clinicians will be encouraged to rate severity of symptoms along continuums developed for each disorder. Secondly, the importance of some disorder categories has been recognised either by allocating them to their own chapter or by recognising them as new individual diagnostic categories. For example, Obsessive-Compulsive Disorder (OCD) is recognized as a significant mental health problem by being allocated it’s own chapter in DSM-5, and new diagnostic categories within this chapter include Hoarding Disorder (see Chapter 6) and Excoriation Disorder (skin-picking disorder). Similarly, DSM-5 has a new chapter on Trauma & Stress-Related Disorders that now includes Post-Traumatic Stress Disorder (PTSD). DSM-5 focuses more on the behavioural symptoms that accompany PTSD and proposes four distinct diagnostic clusters instead of the previous three. Thirdly, major changes have been made to the criteria for diagnosing Autism Spectrum Disorder (ASD), Personality Disorders, Specific Learning Disorders, and Substance Use Disorders. Autistic Spectrum Disorder has become a diagnostic label that will incorporate many previous separate labels (e.g. Asperger’s disorder, childhood disintegrative disorder, pervasive developmental disorder) in an attempt to provide more consistent and accurate diagnosis for children with autism (see Chapter 16). DSM-5 will retain the categorical model for Personality Disorders outlined in DSM-IV-TR, but rating scales are provided to assess how well an individual’s symptoms fit within these different types (Chapter 12). The new Specific Learning Disorder category is broadened to represent distinct disorders which interfere with the acquisition and use of one or more of a number of academic skills, including oral language, reading, written language or mathematics (Chapter 15), and the new Substance Use Disorder category will combine the previous DSM-IV-TR categories of substance abuse and substance dependence into one overarching disorder. Some other important changes include (1) the elevation of Binge Eating Disorder from an appendix to a recognized diagnostic category, (2) Disruptive Mood Regulation Disorder as a new category for diagnosing children who exhibit persistent irritability and behavioural outbursts, and (3) the removal of the “bereavement exclusion” from the diagnosis of Major Depression; this means that depressive symptoms lasting less than two months following the death of a loved one can be included amongst the criteria for diagnosing Major Depression, and reflects the recognition that bereavement is a severe psychological stressor that can precipitate major depression.

Criticisms of Changes in DSM-5:  While these most recent changes to the DSM have been extensively discussed and researched, many of the revisions have been received critically, and it is worth discussing some of these criticisms because they provide an insight into the difficulties of developing a mental disorders classification system that is fair and objective.

First, many of the diagnostic changes will reduce the number of criteria necessary to establish a diagnosis. This is the case with Attenuated Psychosis Syndrome, Major Depression, and Generalized Anxiety Disorder, and this runs the risk of increasing the number of people that are likely to be diagnosed with common mental health problems such as anxiety and depression. It is a debatable point whether increases in the number of diagnosed cases is a good or a bad thing, but it is likely to have the effects of “medicalizing” many everyday emotional experiences (such as ‘grief’ following a bereavement, or worry following a stress life event), and creating “false-positive” epidemics (Frances, 2010).

Secondly, DSM-5 has introduced disorder categories that are designed to identify populations that are at risk for future mental health problems, and these include Mild Neurocognitive Disorder (which would diagnose cognitive decline in the elderly) and Attenuated Psychosis Syndrome (seen as a potential precursor to psychotic episodes). Once again, these initiatives run the risk of medicalizing states that are not yet full-blown disorders, and could facilitate the diagnosis of normal developmental processes as psychological disorders.

Thirdly, there are concerns that changes in diagnostic criteria will result in lowered rates of diagnosis for some particularly vulnerable populations. For example, applying the DSM-5 criteria for Autism Spectrum Disorder to samples of children with DSM-IV-TR diagnoses that would no longer be available in DSM-5 suggested that 9% of this latter group would lose their autism diagnosis with the introduction of the new DSM-5 criteria (Huerta, Bishop, Duncan, Hus & Lord, 2012). Similar concerns have been voiced about changes to Specific Learning Disorder diagnostic criteria in DSM-5, and the possibility that deletion of the term dyslexia as a diagnostic label will disadvantage individual with specific phonologically-based, developmental reading disabilities (http://www.disabilityrightsohio.org/news/dsm5-dyslexia-june-2012).

Finally, two enduring criticisms of DSM generally that have continued to be fired specifically at DSM-5 have been that (1) DSM-5 has continued the process of attempting to align it’s diagnostic criteria with developments and knowledge from neuroscience (Regier, Narrow, Kuhl & Kupfer, 2011), when there is in fact very little new evidence from neuroscience that helps define specific mental health problems, and (2) most mental health problems (and psychological distress generally) are now viewed as dimensional, so any criteria defining a diagnostic cut-off point will be entirely arbitrary. DSM-5 has attempted to recognise the importance of the dimensionality of symptoms by introducing dimensional severity rating scales for individual disorders. But as we have seen from the discussion above, each iteration change in DSM diagnostic criteria changes the number and range of people who will receive a diagnosis, and this makes it increasingly hard to accept diagnostic categories as valid constructs (e.g. Kendler, Kupfer, Narrow, Phillips & Fawcett, 2009).

Despite its conceptual difficulties and its many critics, DSM is still the most widely adopted classification and diagnostic system for mental health problems. Such a system is needed for a number of reasons, including determining the allocation of resources and support for mental health problems, for circumstances that require a legal definition of mental health problems, and to provide a common language that allows the world to share and compare data on mental health problems. Having said this, there are still many significant problems associated with DSM, and diagnosing and labelling people with specific psychological disorders raises other issues to do with stigma and discrimination. Indeed, we should be clear that diagnostic systems are not a necessary requirement for helping people with mental health problems to recover, and many clinical psychologists prefer not to use diagnostic systems such as DSM-5, but instead prefer to treat each client as someone with a unique mental health problem that can best be described and treated using other means such as case formulation (see Section 2.3 for a fuller description and examples of case formulation)."

First published 04/12/2012 at http://grahamdavey.blogspot.co.uk

I often look back on my own research career with some surprise at where it’s all travelled to. When I was a PhD student I was a dyed-in-the-wool behaviourist loading rats into Skinner boxes and clichés into arguments. Cognitions didn’t exist – and even in the remote possibility that they might, they were of no use to a scientific psychology. I was a radical Skinnerian pursuing a brave new world in which behaviour was all that mattered and contingencies of reinforcement would win out against all the airy-fairy vagaries of other approaches to psychology. Just a few years on from this I was still wondering why my PhD thesis on the “determinants of the post-reinforcement pause on fixed-interval schedules in rats” hadn’t been nominated for a Nobel Prize! 

I’ve begun with this personal example, because it emphasizes how relatively narrow interests (and views and approaches) can seem like they are the universe – and that is especially the case when you are personally invested in a specific piece of research like a PhD thesis. But what happens later on in our academic lives? Should we stay focused and hone our skills in a focused research niche, or should we nervously wander out of that niche into new areas with new challenges requiring new skills? 

It is certainly a question for young academics to think about. Stick with what you know, or get other strings to your bow? If you are a newly graduated PhD, you are more likely than not to be a “clone” of your supervisor, and that may well be a block on you getting a lectureship at the institution in which you did your research degree. But then most recruiting Departments will want to know that you are – as they put it - “capable of independent research” before appointing you. Do you go scrabbling for that last section in your thesis entitled “Future Directions” and try to stretch out your PhD research (often in a painfully synthetic way, like seeing how far some bubble-gum will stretch – even though the ‘amount’ there is still the same). Or do you bite the bullet and try your newly-learnt skills on some new and different problems? 

You have one career lifetime (unless you’re Buddhist!) – so should you diversity or should you focus? Let’s begin with those people who focus an entire research career in one specific area – “the stickers” - often concentrating on a small, limited number of research problems but maybe have the benefit of developing more and more refined (and sometimes more complex) theoretical models. Cripes – how boring! Take that approach and you’ll become one or more of the following: (a) The person who sits near the front at international conferences and begins asking questions with the phrase “Thank you for your very interesting talk, but…”, (b) That butcher of a referee who everyone knows, even though your reviews are still anonymous, (c) Someone who sits in Departmental recruitment presentations openly mocking the presentation of any applicant not in your specific area of research (usually by looking down at your clasped hands and shaking your head slowly from side to side while muttering words like “unbelievable” or “where’s the science?”, or, finally, you’ll become (d) Director of a RCUK National Research Centre. 

So what about taking that giant leap for researcher-kind and diversifying? Well first, it’s arguably good to have more than one string to your bow, and become a research “juggler”“. The chances are that at some point you’ll get bored with the programme of research that you first embarked on in early career. Having at least two relatively independent streams of research means you can switch your focus from one to the other. It also increases (a) the range of journals you can publish in, (b) the funding bodies you can apply to, and (c) the diversity of nice people you can meet and chat sensibly to at conferences. It can also be a useful way of increasing your publication rate in early mid-career when you’re looking for an Associate Editorship to put on your CV or a senior lectureship to apply for. 

But there is more to diversifying than generating two streams of research purely for pragmatic career reasons. If you’re a tenured academic, you will probably in principle have the luxury of being able to carry out research on anything you want to (within reason) – surely that’s an opportunity that’s too good to miss? B.F. Skinner himself was one who promoted the scientific principle of serendipity (a principle that seems to have gone missing from modern day Research Methods text books) – that is, if something interesting crops up in your research, drop everything and study it! This apparently was how Skinner began his studies on response shaping, which eventually led to his treatise on operant conditioning. But diversity is not always a virtue. There are some entrepreneurial “switchers and dumpers” out there, who post a new (and largely unsubstantiated) theory about something in the literature, and then move on to a completely new (and often more trending) area of research, leaving researchers of the former topic to fight, bicker and prevaricate, often for years, about what eventually turns out to be a red herring, or a blind alley, or a complete flight of fancy designed to grab the headlines at the time. 

Now, you’ve probably got to the point in this post where you’re desperate for me to provide you with some examples of “stickers”, “jugglers” and “switchers and dumpers” – well, I think you know who some of these people are already, and I’m not going to name names! But going back to my first paragraph, if you’d told me as a postgraduate student about the topics I would be researching now – I would have been scornfully dismissive. But somehow I got here, and through an interesting and enjoyable pathway of topics, ideas, and serendipitous routes. Research isn’t just about persevering at a problem until you’ve tackled it from every conceivable angle, it’s also an opportunity to try out as many candies in the shop as you can – as long as you sample responsibly!

First published 02/11/2012 at http://www.psychologytoday.com/blog/why-we-worry

I’ve agonized for some time about how best to write this post. I want to try and be objective and sober about our achievements in developing successful interventions for mental health problems, yet at the same time I don’t want to diminish hope for recovery in those people who rely on mental health services to help them overcome their distress.

The place to start is a meta-analysis of cognitive therapy for worry in generalized anxiety disorder (GAD) just published by my colleagues and myself. For those of you that are unfamiliar with GAD, it is one of the most common mental health problems, is characterized by anxiety symptoms and by pathological uncontrollable worrying, and it has a lifetime prevalence rate of between 5-8% in the general adult population. That means that in a UK population of around 62 million, between 3 and 5 million people will experience diagnosable symptoms of GAD in their lifetime. In a US population of 311 million these figures increase to between 15 to 25 million sufferers within their lifetime. Our meta-analysis found that cognitive therapy was indeed significantly more effective at treating pathological worrying in GAD than non-therapy controls, and we also found evidence that cognitive therapy was superior to other treatments that were not cognitive therapy based.

So, all well and good! This evidence suggests that we’ve developed therapeutic interventions that are significantly better than doing nothing and that are marginally better than some other treatments. Our results also suggest that the magnitude of these effects are slightly larger than had been previously found, possibly indicating that newer forms of cognitive therapy were increasingly more effective.

But what can the service user with mental health problems make of these conclusions? On the face it they seem warmly reassuring – we do have treatments that are more effective than doing nothing, and the efficacy of these treatments is increasing over time. But arguably, what the service user wants to know is not “Is treatment X better than treatment Y?”, but “Will I be cured?” The answer to that is not so reassuring. Our study was one of the first to look at recovery data as well as relative efficacy of treatments. Across all of the studies for which we had data on levels of pathological worrying, the primary recovery data revealed that only 57% of sufferers were classed as recovered at 12 months following cognitive therapy – and, remember, cognitive therapy was found to be more effective than other forms of treatment. To put it another way, 43% of people who underwent cognitive therapy for pathological worrying in GAD were still not classed as recovered one year later. Presumably, they were still experiencing distressing symptoms of GAD that were adversely affecting their quality of life. I think these findings raise two important but relatively unrelated issues.

First, is a recovery rate of 57% enough to justify 50 years of developing psychotherapeutic treatments for mental health disorders such as GAD? To be sure, GAD is a very stubborn disorder. Long-term studies of GAD indicate that around 60% of people diagnosed with GAD were still exhibiting significant symptoms of the disorder 12 years later (regardless or not of whether they’d had treatments for these symptoms during this period). Let’s apply this to the prevalence figures I quoted earlier in this piece. This means that the number of people in the UK and the USA suffering long-term symptoms of GAD during their lifetime might be as high as 3 million and 15 million respectively. In 50-years of developing evidence-based talking therapies, have we been too obsessed with relative efficacy and not enough with recovery? Has too much time been spent just ‘tweaking’ existing interventions to make them competitive with other existing interventions? Perhaps as our starting point we should be taking a more universal view of what is required for recovery from disabling mental health problems? That overview will not just include psychological factors it will inevitably include social, environmental and economic factors as well.

Second, what do we tell the service user? Mental health problems such as GAD are distressing and disabling. Hope of recovery is the belief that most service users will take into treatment, but on the basis of the figures presented in this piece, it can only be a 57% hope!  This level of hope is not just reserved for cognitive therapy for GAD or psychotherapies in general, it is a figure that pretty much covers pharmaceutical treatments for GAD as well, with the best remission/recovery rates for drug treatments being around 60% (fluoxetine) and some as low as 26%.

I have spent this post discussing recovery from GAD in detail, but I suspect similar recovery levels and similar arguments are relevant to other forms of intervention (such as exposure therapies) and other common mental health problems (such as depression and anxiety disorders generally). It may be time to start looking at the bigger picture required for recovery from mental health problems so that hope can also be extended to the 40-45% of service users for whom we have yet to openly admit that we cannot provide a ‘cure’.

First published 27/08/2012 at http://grahamdavey.blogspot.co.uk

“Normal science does not aim at novelty but at clearing up the status quo. It discovers what it expects to discover.” – Thomas Kuhn.

I was struck by this quote from Thomas Kuhn last week when reading a Guardian blog about the influential philosopher of science. It’s a simple statement suggesting that so-called ‘normal science’ isn’t going to break any new ground, isn’t going to change the way we think about something, but probably will reinforce established ideas, and – perhaps even more importantly – will entrench what scientists think are the important questions that need answering. Filling in the gaps to clear up the status quo is probably a job that 95% of scientists are happy to do. It grows the CV, satisfies your Dean of School, gets you tenure and pays the mortgage.

But when I first read that quote, I actually misread it. I thought it said “Normal science does not aim at novelty but aims to maintain the status quo”! I suspect that when it boils down to it, there is not much difference between my misreading of the quote and what Kuhn had actually meant. Once scientists establish a paradigm in a particular area this has the effect of  (1) framing the questions to be asked, (2) defining the procedures to answer them, and (3) mainstreams the models, theories and constructs within which new facts should be assimilated. I suspect that once a paradigm is established, even those agencies and instruments that provide the infrastructure for research contribute to entrenching the status quo. Funding bodies and journals are good examples. Both tend to map on to very clearly defined areas of research, and at times when more papers are being submitted to scientific journals than ever before, demand management tends to lead to journal scope shrinkage in such a way that traditional research topics are highlighted more and more, and new knowledge from other disciplinary approaches is less likely to fertilize research in a particular area.

This led me to thinking about my own research area, which is clinical psychology and psychopathology. Can we clinical psychology researchers convince ourselves that we are doing anything other than trying to clear up the status quo in a paradigmatic approach that hasn’t been seriously questioned for over half a century – and in which we might want to question it’s genuine achievements? Let’s just take a quick look at some relevant points:

1.         DSM still rules the way that much clinical psychology research is conducted. The launch of DSM-5 in 2013 will merely re-establish the dominance of diagnostic categories within clinical psychology research. There are some who struggle to champion transdiagnostic approaches, but they are doing this against a trend in which clinical psychology and psychiatry journals are becoming more and more reliant on diagnostic criteria for inclusion of papers. Journal of Anxiety Disorders is just one example of a journal whose scope has recently shrunk from publishing papers on anxiety to publishing papers on anxiety only in diagnosed populations. DSM-I was published in 1952 – sixty years on it has become even more entrenched as a basis for doing clinical psychology research. No paradigm shift there then!

This doesn’t represent a conspiracy between DSM and journals to consolidate DSM as the basis for clinical psychology research – it merely reflects the fact that scientific journals follow established trends rather than create new spaces within which new concatenations of knowledge can emerge. Journals will by nature be a significant conservative element in the progress of science.

2.         There is a growing isolation in much of clinical psychology research – driven in part by the shrinking scope of clinical research journals and the adherence of many of them to DSM criteria for publication. This fosters a growing isolation from core psychological knowledge, and because of this, clinical psychology research runs the risk of re-inventing the wheel – and probably re-inventing it badly. Some years ago I expressed my doubts about the value of many clinical constructs that had become the focus of research across a range of mental health problems (Davey,2003). Many of these constructs have been developed from clinical experience and relate to individual disorders or even individual symptoms, but I’m convinced that a majority of them simply fudge a range of different psychological processes, most of which have already been researched in the core psychological literature. I'm an experimental psychologist by training who just happens to have become interested in clinical psychology research, so I was lucky enough to be able to bring some rather different approaches to this research than those who were born and brought up in the clinical psychology way of doing things. What must not happen is for clinical psychology research to become even more insular and even more entrenched in reinventing even more wheels - or the wheels on the bus really will just keep going round and round and round!

3.         OK I'm going to be deliberately provocative here – clinical neuroscience and imaging technology costs a lot of money - so its role needs to be enshrined and ring-fenced in the fabric of psychological knowledge endeavor, doesn’t it? Does it? If that’s the case – then we’re in for a long period of paradigm stagnation. Imaging technology is the Mars Rover of cognitive science while the rest of us are using telescopes - or that's the way it seems. There are some clinical funding bodies I simply wouldn't apply to for experimental psychopathology research – ‘cos if it ain’t imaging it ain't gonna get funded - yet where does the contribution of imaging lay in the bigger knowledge picture within clinical psychology? There may well be a well thought out view somewhere out there that has placed the theoretical relevance of imaging into the fabric of clinical psychology knowledge (advice welcome on this)! There is often a view taken that whatever imaging studies throw up must be taken into account by studies undertaken at other levels of explanation - but that is an argument that is not just true of imaging, it's true of any objective and robust scientific methodology.

Certainly - identifying brain locations and networks for clinical phenomena may not be the way to go - there is growing support for psychological constructionist views of emotion for instance, suggesting that emotions do not have either a signature brain location or a dedicated neural signature at all (e.g. Lindquist,Wager, Kober, Bliss-Moreau & Barrett, 2012). There are some very good reviews of the role of brain functions in psychological disorders -but I'm not sure what they tell us other than the fact that brain function underlies psychological disorders – as it does everything! For me, more understanding of psychological disorders can be gleaned from studying individual experience, developmental and cognitive processes, and social and cultural processes than basic brain function. Brain images are a bit like the snapshot of the family on the beach - The photo doesn't tell you very much about how the family got there or how they chose the beach or how they're going to get home.

But the point I’m trying to make is that if certain ways of doing research require significant financial investment over long periods of time (like imaging technology), then this too will contribute to paradigm stagnation.

4.         When tails begin to wag dogs you know that as a researcher you have begun to lose control over what research you can do and how you might be allowed to do it. Many researchers are aware that to get funding for their research – however ‘blue skies’ it might be – we now have to provide an applied impact story. How will our research have an impact on society? Within clinical psychology research this always seems to have been a reality. Much of clinical psychology research is driven by the need to develop interventions and to help vulnerable people in distress – which is a laudable pursuit. But does this represent the best way to do science? There is a real problem when it comes to fudging understanding and practice. There appears to be a diminishing distinction in clinical psychology between practice journals and psychopathology journals, which is odd because helping people and understanding their problems are quite different things – certainly from a scientific endeavour point of view. Inventing an intervention out of theoretical thin air and then giving it the facade of scientific integrity by testing to see if it is effective in a controlled empirical trial is not good science – but I could name what I think are quite a few popular interventions that have evolved this way – EMDR and mindfulness are just two of them (I expect there will be others who will argue that these interventions didn't come out of a theoretical void, but we still don't really know how they work when they do work). At the end of the day, to put the research focus on ‘what works in practice’ takes the emphasis away from understanding what it is that needs to be changed, and in clinical psychology it almost certainly sets research priorities within establishment views of mental health.

5.         My final point is a rather general one about achievement in clinical psychology research. We would like to believe that the last 40 years has seen significant advances in our development of interventions for mental health problems. To be sure, we’ve seen the establishment of CBT as the psychological intervention of choice for a whole range of mental health problems, and we are now experiencing the fourth wave of these therapies. This has been followed up with the IAPT initiative, in which psychological therapies are being made more accessible to individuals with common mental health problems.  The past 40 years has also seen the development and introduction of second-generation antidepressants such as SSRIs. Both CBT and SSRIs are usually highlighted as state-of-the-art interventions in clinical psychology textbooks, and are hailed by clinical psychology and psychiatry respectively as significant advances in mental health science. But are they? RCTs and meta-analyses regularly show that CBT and SSRIs are superior to treatment as usual, wait-list controls, or placebos – but when you look at recovery rates, their impact is still far from stunning. I am aware that this last point is not one that I can claim reflects a genuinely balanced evidential view, but a meta-analysis we have just completed of cognitive therapy for generalized anxiety disorder (GAD) suggests that recovery rates are around 57% at follow-up. Which means that 43% of those in cognitive therapy interventions for GAD do not reach basic recovery levels at the end of the treatment programme. Reviews of IAPT programmes for depression suggest no real advantage for IAPT interventions based on quality of life and functioning measures (McPherson,Evans & Richardson, 2009). In a review article by Craske, Liao, Brown & Vervliet (2012) that is about to be published in Journal of Experimental Psychopathology, they note that even exposure therapy for anxiety disorders achieves clinically significant improvement in only 51% of patients at follow-up. I found it difficult to find studies that provided either recovery rates or measures of clinically significant improvement for SSRIs, but Arroll et al (2005) report that only 56-60% of patients in primary care responded well to SSRIs compared to 42-47% for placebos.

I may be over-cynical, but it seems that the best that our state-of-the-art clinical psychology and psychopharmacological research has been able to achieve is a recovery rate of around 50-60% for common mental health problems - compared with placebo and spontaneous remission rates of between 30-45%. Intervention journals are full of research papers describing new ‘tweaks’ to these ways of helping people with mental health problems, but are tweaks within the existing paradigms ever going to be significant? Is it time for a paradigm shift in the way we research mental health?

First published 30/09/2012 on http://grahamdavey.blogspot.co.uk

There’s been quite a good deal of discussion recently about (1) how we validate a scientific fact (http://bit.ly/R8ruMg; http://bit.ly/T5JSJZ; http://bit.ly/xe0Rom), and (2) whether psychology – and in particular some branches of psychology – are prone to generate fallacious scientific knowledge (http://bit.ly/OCBdgJ; http://bit.ly/NKvra6). As psychologists, we are all trained (I hope) to be scientists – exploring the boundaries of knowledge and trying as best we can’ to create new knowledge, but in many of our attempts to pursue our careers and pay the mortgage, are we badly prone to creating false knowledge? Yes – we probably are! Here are just a few examples, and I challenge most of you psychology researchers who read this post to say you haven’t been a culprit in at least one of these processes!

Here are 10 ways to risk creating false knowledge in psychology.

1.  Create your own psychological construct. Constructs can be very useful ways of summarizing and formalizing unobservable psychological processes, but researchers who invent constructs need to know a lot about the scientific process, make sure they don’t create circular arguments, and must be in touch with other psychological research that is relevant to the understanding they are trying to create. In some sub-disciplines of psychology, I’m not sure that happens (http://bit.ly/ILDAa1).

2.  Do an experiment but make up or severely massage the data to fit your hypothesis. This is an obvious one, but is something that has surfaced in psychological research a good deal recently (http://bit.ly/QqF3cZ; http://nyti.ms/P4w43q).

3.  Convince yourself that a significant effect at p=.055 is real. How many times have psychologists tested a prediction only to find that the critical comparison just misses the crucial p=.05 value? How many times have psychologists then had another look at the data to see if it might just be possible that with a few outliers removed this predicted effect might be significant? Strangely enough, many published psychology papers are just creeping past the p=.05 value – and many more than would be expected by chance! Just how many false psychology facts has that created? (http://t.co/6qdsJ4Pm).

4.  Replicate your own findings using the same flawed procedure. Well, we’ve recently seen a flood of blog posts telling us that replication is the answer to fraud and poor science. If a fact can be replicated – then it must be a fact! (http://bit.ly/R8ruMg; http://bit.ly/xe0Rom) Well – no – that’s not the case at all. If you are a fastidious researcher and attempt to replicate a study precisely, then you are also likely to replicate the same flaws that gave rise to false knowledge. We need to understand the reasons why problematic research gives rise to false positives – that is the way to real knowledge (http://bit.ly/UchW4J).

5.  Use only qualitative methods. I know this one will be controversial, but in psychology you can’t just accept what your participants say! The whole reason why psychology has developed as a science is because it has developed a broad range of techniques to access psychological processes without having to accept at face value what a participant in psychological research has to tell us. I’ve always argued that qualitative research has a place in the development of psychological knowledge, but it is in the early stage of that knowledge development and more objective methodologies may be required to understand more proximal mechanisms.

6.  Commit your whole career to a single effect, model or theory that has your name associated with it. Well, if you’ve invested your whole career and credibility in a theory or approach, then you’re not going to let it go lightly. You’ll find multiple ways to defend it, even if it's wrong, and waste a lot of other researchers’ time and energy trying to disprove you. Ways of understanding move on, just like time, and so must the intransigent psychological theorist.

7.  Take a tried and tested procedure and apply it to everything. Every now and then in psychology a new procedure surfaces that looks too good to miss. It is robust, tells you something about the psychological processes involved in a phenomenon, and you can get a publication by applying it to something that no one else has yet applied it to! So join the fashion rush – apply it to everything that moves, and some things that don’t (http://bit.ly/SX37Sn). No I wasn't thinking of brain imaging, but.... Hmmmm, let me think about that! (I was actually thinking about the Stroop!)

8.  If your finding is rejected by the first journal you submit it to, continue to submit it to journals until it’s eventually published. This is a nice way to ensure that your contribution to false knowledge will be permanently recorded. As academic researchers we are all under pressure to publish (http://bit.ly/AsIO8B), if you believe your study has some genuine contribution to make to psychological science, then don’t accept a rejection from the first journal you send it to. In fact, if you don’t think your study has any real contribution to make to psychological knowledge at all, don’t accept a rejection from the first journal you send it to! Because you will probably get it published somewhere. I’d love to know what the statistics are on this, but I bet if you persist enough, your paper will get published.

9.  Publish your finding in a book chapter (non- peer reviewed), or an invited review, or a journal special issue - all of which are likely to have an editorial "light touch”. Well, if you do it might not get cited much (http://t.co/D55VKWDm), but it’s a good way of getting dodgy findings (and dodgy theories) into the public domain.

10.  Do some research on some highly improbable effects - and hope that some turn up significant by chance. (http://bit.ly/QsOQNo) And it won’t matter that people can’t replicate it – because replications will only rarely get published! (http://bit.ly/xVmmOv). The more improbable your finding, the more newsworthy it will be, the more of a celebrity you will become, the more people will try to replicate your research and fail, the more you will be wasting genuine research time and effort. But it will be your 15 minutes of fame!

Finally, if you haven’t been able to generate false psychological knowledge through one of these 10 processes, then try to get your finding included in an Introduction to Psychology textbook. Once your study is enshrined in the good old Intro’ to Psych’ text, then it’s pretty much going to be accepted as fact by at least one and maybe two future generations of psychologists. And once an undergrad has learnt a “fact”, it is indelibly inscribed on their brain and is faithfully transported into future reality!