Deconstructing misleading media coverage of neuroscience of couples therapy

Do we owe psychotherapists something more than noble lies and fairy tales in our translations of fMRI results?

hold me tightThe press release below was placed on the web by the University of Ottawa and refers to an article published in PLOS One. As I have noted in blog posts here and here, the PLOS One article is quite bad. But the press release is worse, and introduces a whole new level of distortion.

Comparing the article to the press release or my blog posts. You can get a sense of the nonsense in the press release. I will summarize the contradiction between these sources in my comments interspersed with excerpts from the press release.

True love creates resilience, turning off fear and pain in the brain

OTTAWA, May 1, 2014— New research led by Dr. Sue Johnson of the University of Ottawa’s School of Psychology confirms that those with a truly felt loving connection to their partner seem to be calmer, stronger and more resilient to stress and threat.

In the first part of the study, which was recently published in PLOS ONE, couples learned how to reach for their lover and ask for what they need in a “Hold Me Tight” conversation. They learned the secrets of emotional responsiveness and connection.

If you go to the PLOS one article, you will see no mention of any “Hold Me Tight” conversation, only that couples who were selected for mild to moderate marital dissatisfaction received couples therapy. The therapy was of longer duration than typically been provided in previous studies of Emotionally Focused Therapy (EFT). At completion, the average couple was still experiencing mild to moderate marital dissatisfaction and would still have qualified for entry into the study.

So, for a start, these were not couples feeling “loving connections to each other,” to the extent that the authors assume their quantitative measures are valid.

The second part of the study, summarized here, focused on how this also changed their brain. It compared the activation of the female partner’s brain when a signal was given that an electric shock was pending before and after the “Hold Me Tight” conversation.

The phrase “changed the brain” is vague and potentially misleading. It gives the false impression that there is some evidence that differences in fMRI results represent enduring, structural change, rather than transient, ambiguous changes in activity. Changes in brain activity does not equal change in structure of the brain. It seems analogous to suggesting that the air-conditioning coming on rearranged a room, beyond cooling it down temporarily. Or that viewing a TV soap opera changes the brain because it is detectable with fMRI.

Before the “Hold Me Tight” conversation, even when the female partner was holding her mate’s hand, her brain became very activated by the threat of the shock — especially in areas such as the inferior frontal gyrus, anterior insula, frontal operculum and orbitofrontal cortex, where fear is controlled. These are all areas that process alarm responses. Subjects also rated the shock as painful under all conditions.

Let us ignore that there is no indication in the PLOS One paper of a “Hold Me Tight” conversation. It is a gross exaggeration to say that the brain “became very activated.” We have to ask “Compared to what?” Activation of the brain is relative, and as the neuroscientist Neurocritic pointed out, there is no relevant comparison condition beyond partner versus stranger versus being alone. Nothing to compare them to and such fMRI data do not have anything equivalent to the standardization of an oven thermometer or a marital adjustment measure.. And the results are different than the press release would suggest. Namely,

In the vmPFC, left NAcc, left pallidum, rightinsula, right pallidum, and right planum polare, main effects ofEFT revealed general decreases from pre- to post- therapy in threat activation, regardless of whose hand was held, all Fs (1, 41.1 to 58.6) >3.9, all ps <.05. In the left caudate, left IFG, and vACC, interactions between EFT and DAS revealed that participants with the lowest pre-therapy DAS scores realized the greatest decreases from pre- to post-therapy in threat related activity, all Fs (1, 55.1 to 66.7) $6.2, all ps <. 02. In the right dlPFC and left supplementary motor cortex, interactions between handholding and EFT suggest that from pre- to post- therapy, threat-related activity decreased during partner but increased during stranger handholding, Fs (1, 44.6 to 48.9) = 5.0, ps = .03 (see Figure 5). [Emphasis added]

Keep in mind that these results are also derived from well over 100 statistical tests performed on data from 23 women and so they are likely due to chance. It is difficult to make sense of the contradictions in the results. By some measures, activation while holding both strangers and husbands’ hand decreased. Other differences were limited to the women with lower initial marital satisfaction.

It is also not clear what decreased activation means. It could mean that less thought processes are occurring or that thought processes take less effort. An fMRI is that ambiguous.

It is important to note what we are not told in the article. We are led by the authors to expect an overall (omnibus) test of whether changes in brain activity from before to after therapy will occur for when husbands’ hands are held, but not strangers or alone. It is curious that specific statistic is not reported where it should have been. It is likely that no overall simple difference was found, but the authors went fishing for whatever they could find anyway.

There is no mention in the paper of ratings of the shock as to degree of painfulness. There are ratings of discomfort.

We need to keep in mind that this experiment had to be approved by a committee for the protection of human subjects. If in fact the women were being subject to painful shock, the committee would not have granted approval.

The actual shock was 4 mA. I put a request out on Facebook for information as to how painful such a shock would be. A lab in Australia reported that in response, graduate assistants had been busy shocking themselves. W with that amperage could not produce a shock they would consider painful.

However, after the partners were guided through intense bonding conversations (a structured therapy titled Emotionally Focused Couple Therapy or EFT), the brain activation and reported level of pain changed —under one condition. While the shock was again described as painful in the alone and in the stranger hand holding conditions (albeit with some small change compared to before), the shock was described as merely uncomfortable when the husband offered his hand. Even more interesting, in the husband hand-holding condition, the subject’s brain remained calm with minimal activation in the face of threat.

Again, there are no ratings of painfulness described in the report of the experiment. The changes occurred in both husband and stranger handholding conditions.

The experiment explored three different conditions. In the first, the subject lay alone in a scanner knowing that when she saw a red X on a screen in front of her face there was a 20% chance she would receive a shock to her ankles. In the second, a male stranger held her hand throughout the same procedure. In the third, her partner held her hand. Subjects also pressed a screen after each shock to rate how painful they perceived it to be.

Here we are given a relevant detail. The women believed that they had a 20% chance of receiving a shock to their ankles. It is likely that the anticipation was uncomfortable, not the actual shock. The second condition is described as having their hand held by a male stranger. Depending on the circumstances, that could either be creepy or benign. Presumably, the “male stranger” was a laboratory assistant. That might explain why the actual results of the experiments suggest that after therapy, handholding by this stranger was not particularly activating of areas of the brain that it had been earlier.

But, the press release provides a distorted presentation of the actual results of the study. This presentation seems to indicate that the EFT it had occurred between the first and second fMRIs had produced an effect only for the condition in which the woman’s hand was held by a partner, not a stranger.

The actual results were weak and contradictory. They do not seem to be overall effects for free versus post therapy fMRI. Rather, effects were limited to a subgroup of women who had started therapy with exceptionally low marital satisfaction and persisted after they had therapy. The changes in brain activation associated with having their handheld by a partner were not different than a changes for having their hand held by a stranger.

These results support the effectiveness of EFT and its ability to shape secure bonding. The physiological effects are exactly what one would expect from more secure bonding. This study also adds to the evidence that attachment bonds and their soothing impact are a key part of adult romantic love.

How this could be accurate? The women did not have a secure bonding with the stranger, but their brain activation nonetheless changed. And apparently this did not happen for all women, mostly only those with lower marital satisfaction at the beginning of therapy.

From the press release, I cannot reconstruct what was done and what was found in the study reported in PLOS One. A lot of wow, a lot of shock and awe, but little truth.

Surely, you jest, Dr. Johnson.

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