Health sciences - when does self-help really help? / Maya Shelwitz

The self-help industry in the US is worth 12 billion dollars, but there are dangers in it. How will you recognize the warning signs?

Kirby Brown was not afraid to take risks. The 38-year-old designer learned to ride horses as a child and surfed huge waves in the Gulf of California in Mexico as an adult. However, she was not reckless. "She loved adventure, but she also had a high awareness of safety," says her mother, Virginia Brown. So when Kirby decided in 2009 to participate in a spiritual workshop in the Arizona desert, organized by the well-known self-help guru, James Arthur Ray, she must not have thought her life was in danger.

The workshop, which lasted five days, was defined as a "catalyst for self-transformation" and included 36 hours of continuous meditation without food or water, after which a ceremony was held in a makeshift sweat lodge. Kirby and another participant did not survive the ceremony. A third participant went into a coma and died a week later. Eighteen other participants were hospitalized for various injuries, from heat stroke to kidney failure. "Essentially, these people have been turned away," says Christine Whelan, a visiting sociologist at the University of Pittsburgh who studies the self-help industry.

The deaths in Arizona, as well as suicides and psychotic attacks caused during and following similar workshops, are extreme examples of the dangers that may lurk in the self-help industry in the US, whose scope reaches approximately 12 billion dollars. The self-help philosophy stems from the logical assumption that many people are able to deal with a variety of problems on their own, from financial to mental, and that paid professional help is not always necessary. The broad umbrella of "self-help" approaches includes workshops like Ray's, support groups aimed at improving mental health or changing behavior, and more than 45,000 books and apps designed to help people live happier lives. In particular, self-help books are so popular that the New York Times has a separate bestseller list specifically for them.

Although dozens of studies show that evidence-based self-help can really be helpful, especially in cases of anxiety, depression and drug addiction, more than 95% of self-help books and programs for its use have never been scientifically tested, says John S. Norcross, professor in psychology at the University of Scranton and one of the authors of the book "Effective Self-Help" (Oxford University Press, 2013). However, according to Norcross and other researchers, people can better protect themselves from potentially dangerous self-help rituals by learning and recognizing the warning signs of dubious experts and by understanding the ways in which peer pressure impairs judgment and judgment.

under strict scrutiny

Researchers have so far evaluated the effectiveness and safety of only about 50 self-help programs, Norcross says. And the results show that some of these programs do help. For example, the most researched approaches to treating psychological problems emphasize cognitive behavioral therapy (CBT), which teaches how to identify and redirect anxiety, depression, or other negative thoughts. A review article from 2013 by the Cochrane Organization, an organization that is considered to be experts in the field of health and publishes extensive and systematic review articles, notes, for example, that when it comes to anxiety disorders, a face-to-face meeting with a therapist is probably better than self-help books and apps, but "self-help is probably better For the lack of care."

Besides examining CBT-based approaches, researchers have also paid close attention to 12-step groups, such as Alcoholics Anonymous (AA), where group members encourage each other to follow strict guidelines to overcome addiction. Although a 2006 Cochrane review concluded that "there are no experimental studies that unequivocally demonstrate" the effectiveness of the 12 steps, many observational studies show that people who voluntarily join stop drinking more than those who do not voluntarily participate. (Observational studies, unlike experimental studies, do not involve changing the conditions the participants experience to determine whether the treatment method is effective.) One such study revealed that two-thirds of the people who persisted in the program for at least 27 weeks were still able to abstain from alcohol after 16 years. But according to AA's own surveys, only a small percentage of people who join the program continue to attend the group after the first few months.

Peer pressure

Reading a self-help book in an armchair at home may not seem like a dangerous activity. But anyone who blindly acts according to wrong instructions, such as sticking to a poor diet, is looking for trouble in the long run, such as gum disease in the case of diet.

Self-help becomes even more dangerous when you join a group, and social pressure begins to override self-judgment. In 12-step programs, for example, participants are often reminded not to put themselves in the doctor's shoes, because participants sometimes urged newcomers to stop taking psychiatric drugs on the assumption that any kind of drug would delay recovery. Vulnerable people who did not want to go against the other members of the group, did respond to the advice and as a result they again fell into depression, psychosis, anxiety or other disorders, sometimes to the point of suicide.

Add physical and emotional pressure to social pressure, and you have an even more dangerous mixture. Seminars like the one Ray organized in the Arizona desert are called by psychologists "awareness training in large groups." At the center of such workshops, which sometimes include vague promises about self-improvement, is a charismatic leader who guides a group of people through several consecutive days of meditation, self-hypnosis, fasting, rituals and discussions in which they reveal intimate details about their lives. During this time, the instructor scolds and praises the participants alternately, and deprives them of basic needs, so that they remain psychologically vulnerable.

For example, in the days before Kirby and her friends entered the sweat lodge, their amounts of food and water were limited and they were limited in the number of bathroom breaks and sleeping hours. Hunger, thirst and lack of sleep alone are enough to put the body in a state of stress and change awareness. The ceremony also added an emotional burden. Ray claimed at the time that the experience would bring them closer to death, after which they would undergo a spiritual rebirth. (My repeated requests for an interview with Ray, directed to his representatives, were not answered.)

Such stressful conditions often produce strong emotions ranging from despair to ecstasy, creating a sense of intimacy and affection between strangers. This sense of camaraderie causes people to submit even more to social pressure and to be more obedient in the face of authority figures. Stress also reduces blood flow to areas of the brain important for planning, self-control and reasoning. Even a seemingly small stress, like being denied the opportunity to go to the bathroom, can erode our ability to resist peer pressure, says Whelan.

The end result is that even very intelligent and educated people can behave irrationally, and stay, for example, in a shack covered with tarpaulin sheets where the temperature is so high that people begin to lose consciousness. The smartest people are, in fact, at the highest risk, because they tend to think they are immune to social pressure. One of the participants who died had earlier taken a woman out of the hut, then went back inside. He didn't seem to realize that he was in exactly the same danger. "When people saw what happened [in Arizona], most of them said to themselves, 'Those people were idiots,'" says Whelan. "We want to think we are different, but we are not, and these are powerful methods. If you had been there, you might have died too."

Given the ease with which the brain succumbs to social pressure, experts recommend avoiding group situations in which the leader intentionally induces pressure, a method that, according to the relevant studies, does not lead to beneficial psychological changes. If you end up in such a situation, be aware that these methods can significantly affect your thinking and behavior and do not make decisions that will change your life.

What should you pay attention to?

If so, what are the ingredients of good self-help programs? First, overcoming depression, anxiety, addiction, and other disorders involves acquiring new coping skills over months or years, not days or weeks. This is the reason why successful self-help methods prepare us for a long period of self-improvement and that groups like AA recommend long-term participation. Intense, one-time experiences often do not provide the sustained support needed for long-term change.

Second, successful programs have independent data that proves their effectiveness, not just anecdotes, and they are often based on more conventional and proven treatments given by experts. If there is no scientific literature supporting the program, no matter how popular it is, this is a "red flag".

Whelan now serves on the advisory board of Seek Safely, an organization founded by the Brown family that advises people who may be drawn to dangerous self-help programs. The organization has also drafted a pledge that self-help gurus can sign, in which they promise to take necessary precautions to avoid using pressure to make people more submissive.

Ray, who had re-established his self-help business, did not sign the pledge. The biography on his website makes no mention of the sweat lodge deaths, his manslaughter conviction and his 20-month prison sentence, although he alludes to it briefly in old blogs. In addition, in a prominent place on his home page, a video of his appearance on Oprah Winfrey's show in 2007, before the disaster, is shown. Ultimately, of course, signing a safety pledge is no substitute for doing your homework, which means checking the scientific claims and maintaining a healthy dose of skepticism. It is important to understand that the survival instinct of each of us may collapse under certain conditions, and this understanding is important to protect us from harm.

on the notebook

Maia Szalavitz writes about neuroscience and lives in New York. Her articles have been published in Time magazine, the New York Times, Elle and the Washington Post.

The article was published with the permission of Scientific American Israel