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Cognitive and Behavioral Nutrition: Reading the Labels

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One of my favorite topics in my blogs has been family dinners. My usual purpose in writing about them is to talk about the research that shows how important and effective they are for the health and development of children. Being a father of three and grandfather of eight, however, I know that all of our life decisions are not, should not and cannot be based on scientific data; there are different ways of knowing in this world.

However, as a research psychologist, a quiet, unspoken aspect of my blogs, has been supporting the idea that, in those times, when we choose to make decisions about what to do with our children or ourselves based on scientific evidence, that the evidence we use should come from good science. In medicine, procedures based on good science are called evidence-based treatments. In psychology, effective forms of psychotherapy are described as evidence-supported treatments or empirically-validated treatments. Regardless of the terminology, however, the point is the same. If we are going to do something that will affect the physical and/or emotional health and well being of ourselves and our families, we should base what we do on sound, reliable, scientific data -- on good evidence derived from good science.

Now, any introductory philosophy text will tell you that if you use a term like good science, there must be a contrasting term to hold that up against in order to give it meaning. Thus, if there is "good" science, there must be "bad" science. This means, of course that plain old science or plain old scientific evidence ought not be enough to allow or encourage a change in our lives. When I teach introductory psychology I ask my students, by raise of hand, how many of them read the nutrition facts box on food packages before they put that food into their body. (Please raise your hand wherever you are if you do this as well.) Invariably, at least 90 percent of the students raise their hands. This suggests that before most of us put anything into our bodies, we look at what is in it -- calories, salt, fat grams, etc -- and decide whether we will incorporate it (literally, put it into our bodies). I then ask them (you) this question: Do you use that same level of care and consideration of evidence when deciding whether to incorporate ideas and information into your mind or behaviors into your way of living? Based on the scattering of raised hands and the large number of lowered eyes, the answer for all too many of us is, "Rarely, if ever."

Why is this, do you suppose? I think it's because when many of us hear experts telling us to do things (me, included), we all too often do them without really considering their expertise. We also hear testimonials from plain folks just like us (ignoring the small print which says, "results are not typical") and all too often again we run with their recommendations. We buy bottles of pseudo pharmaceutical promises; we buy exercise equipment that "stores out of sight under our beds" -- where it typically remains permanently after the first two weeks of starry-eyed straining. Have you ever heard the joke about someone announcing that the word "gullible" had been removed from the dictionary only to watch people grab their latest Webster's to see if it's true? Indeed, we are awash in pseudo scientific, bad-science-based claims and there are no nutrition labels in the offing.

It's true. There is no nutrition information box posted next to articles on the Internet (not even next to this blog). For people seeking help for psychological problems, for example, there is no handy little box of information that tells them that either there are no data (yes, "data" is a plural word) supporting the efficacy of a psychotherapy method or that there are data that suggest that the treatment can actually be harmful. (If you are interested in reading more about how lack of evidence can identify potentially harmful forms of psychotherapy, see the writings of Dr. Scott Lilienfeld [Lilienfeld, S. O. (2007). "Psychological treatments that cause harm." Perspectives on Psychological Science, 2, 53-70] or a nice summation of his work.)

It could be said that Lilienfeld's writings on psychotherapy are a form of cognitive and behavioral nutrition information. Before we incorporate specific treatments into our lives, we should do as we do with food -- read the label. But where are those handy nutritional fact boxes for other things like educational programs/reforms, for fitness programs, for diet plans? Are they out there? Anywhere?

Well, here's some good news. You can find "cognitive nutrition" and "behavioral nutrition" labels out there. You just need to know what they look like. They're not presented in clean small squares like the nutrition facts on the Krispy Kreme Doughnuts' box, but they do exist in the form of good scientific evidence. And how do we find this information and how do we know what is good scientific evidence? This is where we all need to ratchet up our levels of skepticism and thoughtfulness and decide what we are going to allow into our minds. While not a perfect rule of thumb (witness the autism-measles vaccine fraud), publication of a research finding in a peer-reviewed journal (articles are read and judged by experts in the field before being accepted for publication) is a good indicator of good cognitive and behavioral nutrition. We also need to attend carefully to people who we have good reason to believe are well-trained in making judgments about the goodness or badness of scientific data and their implications. Just because a person who plays a doctor on TV says something is good for you, should you listen? Are testimonials from satisfied weight losers the equivalent to the calorie count on a box of diet cookies or a study published in the New England Journal of Medicine?

OK, so I am suggesting that if we are to be careful users of cognitive and behavioral recommendations (incorporate only good ideas and adopt only good behaviors), we should base what we do on sound scientific evidence both published in solid scientific journals and judged to be good by people whom we should trust. Here is where we really do need to use our own best judgments and where most of us can do a better job. Rather than deciding on our own (I know we are all very smart now, but bear with me) which new fad or notion or educational philosophy or diet plan we should trust, better we should use our judgment skills to decide which people or sources we should trust and then decide to follow their advice. We do this very same thing every time we trust the information on a food nutrition label. I suggest we need to try do the same with ideas and behaviors.

At this point I was going to give an example of a form of psychotherapy -- cognitive behavioral therapy -- that has been shown through much research to be very effective. However, as I sat in my snow-bound Atlanta home yesterday morning and checked in on the "Today Show" to get a weather update, I came upon an example of cognitive and behavioral nutrition labeling with far wider implications. There stood Al Roker with a young cardiologist named James Beckerman who was talking about his book, "The Flex Diet: Design Your Own Weight Loss Plan." "Perfect." I said to myself, "Another fad diet to be skeptical of! A great opportunity to apply my ideas about judging cognitive and behavioral nutrition." I was excited because diet plans are legendary for being put out with very little evidence beyond some shoddy "research," a few endorsements from past-their-prime celebrities (in return for the compensation mentioned in that small print), and the odd looking before and after photos with stomachs distended and sad faces in the former and stomachs pulled in with smiling faces in the latter.

So I decided (having lots of time due to that Atlanta snow) to consider more deeply the cognitive and behavioral "nutrition" information on "The Flex Diet." I downloaded the book to my Kindle; I read his website. Here is what I found out. James Beckerman, M.D. is a Harvard College and Harvard Medical School Graduate, board certified cardiologist with residency at Mass General Hospital, practicing in Portland, Oregon. Good credentials; we might want to trust his judgment. Next, as he described his plan, Beckerman used the specific words "evidence based," meaning that that all of his recommendations are drawn from studies reported in peer-reviewed journals. Further he only reports on those findings that have stood the test of replication and real-world application. He is unafraid to say something is a bad idea if there is no support for it. (In a section called "Nolutions" he condemns for lack of supporting good scientific data, diets involving cider vinegar, acai berries and guar gum.) The result? It seems to me that we have a diet plan developed by someone qualified to make scientific judgments and a plan based on good science. In essence, a careful look reveals a cognitive/behavioral nutrition label that reads pretty darn well. If this were a food, it would be in the health food section. This is a diet plan people should use; it's based on good science; it comes from a credible source. It's solid.

This was one example of looking for and finding cognitive and behavioral "nutrition facts." I am not saying that we should, or can, vacate our responsibility to decide what we incorporate into our bodies, minds and lives. What I am suggesting is that we, all of us, need to be much more careful about following the suggestions of all of the "experts" out there. One big difference between the Internet and the sources of information we had before its advent is that no one edits the goodness or badness of ideas put onto the web. When I submit a research article to a scientific journal, people who are experts in my field will judge its merit and if it is not up to standards or makes little positive contribution (or is potentially harmful), it will not see the light of day. This judgment process might take as long as three months and it might be a year from the time the article is submitted until its actual publication. The uncountable number of other items posted on the Internet daily, can be written today and online tomorrow. This is both amazingly wonderful and soberingly frightening.

So, it is us, the readers and consumers of the information explosion who must do the heavy editing. We must make the judgment about the goodness or badness of the ideas put forward, about whether we are going to incorporate them into our lives or not. Many, many people rightly relish this opportunity and exercise it quite well. A glance at the quality of thoughtful comments that are typically made in response to a HuffPost blog provides evidence that good judgments are being made, sometimes. But sometimes -- many times, they are not. We are not experts in all things; we must accept that. If we become expert in one thing, however, it should be in the ability to know how to decide what is good for us -- to consider the "nutrition" information, not just on the foods we ingest, but on the ideas people wish us to adopt and the actions and experiences they suggest we engage in. All medical treatments are not equally indicated; all forms of psychotherapy are not equally good; all diet plans are not equally effective; all ideas are not equally sound. Read the labels.

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