For this assignment, you will, in 250 words, summarize and critique a psychology research article from the PsycINFO database. You get to choose the topic so make sure you pick a topic that you enjoy learning about! Your paper must be written in APA format. The article chosen is attached. Thank You!!

Back 1 article(s) will be saved. To continue, in Internet Explorer, select FILE then SAVE AS from your browser’s toolbar above. Be sure to save as a plain text file (.txt) or a ‘Web Page, HTML only’ file (.html). In FireFox, select FILE then SAVE FILE AS from your browser’s toolbar above. In Chrome, select right click (with your mouse) on this page and select SAVE AS EBSCO Publishing Citation Format: APA (American Psychological Assoc.): NOTE: Review the instructions at http://support.ebsco.com.saintleo.idm.oclc.org/help/?int=ehost&lang=&feature_id=APA and make any necessary corrections before using. Pay special attention to personal names, capitalization, and dates. Always consult your library resources for the exact formatting and punctuation guidelines. References Cosgrove, L., Troeger, R., & Karter, J. M. (2020). “Do antidepressants work?” A humanistic perspective on a long-standing and contentious debate. The Humanistic Psychologist, 48(3), 221–231. https://doiorg.saintleo.idm.oclc.org/10.1037/hum0000154 “Do Antidepressants Work?” A Humanistic Perspective on a Long-Standing and Contentious Debate By: Lisa Cosgrove Department of Counseling and School Psychology, University of Massachusetts Boston Rebecca Troeger Department of Counseling and School Psychology, University of Massachusetts Boston Justin M. Karter Department of Counseling and School Psychology, University of Massachusetts Boston; Biographical Information for Authors: Lisa Cosgrove, PhD, is a clinical psychologist and professor at the University of Massachusetts Boston, where she teaches courses on psychiatric diagnosis and psychopharmacology, and she is a former research fellow at the Edmond J. Safra Center for Ethics, Harvard University. Her research addresses the ethical and medical–legal issues that arise in organized psychiatry because of academic–industry relationships. She has published widely on these topics, and her research has been cited and discussed in major media outlets. Rebecca Troeger, MA, is a doctoral student in Counseling Psychology at the University of Massachusetts Boston. She is interested in how individuals, groups, organizations, and communities build their capacity to hold complexity and stay connected in the face of challenging and uncertain circumstances. She brings this lens to research projects on client-centered clinical practice, intergroup racial dialogues, and antioppressive organizational change. Justin M. Karter, MA, is currently a doctoral student in Counseling Psychology at the University of Massachusetts Boston and has master’s degrees in Community Psychology and Journalism. He is an active student member of the Society for Humanistic Psychology and the Society for Theoretical and Philosophical Psychology. His research interests fall at the intersection of critical psychology, critical psychiatry, and philosophy of psychology. Acknowledgement: There has been ongoing controversy over the effectiveness and safety of antidepressant medications (ADMs), particularly for the treatment of mild to moderate depression. For example, substantial evidence, including meta-analyses (Fournier et al., 2010; Kirsch et al., 2008) and reanalyses of antidepressant clinical trial data (Le Noury et al., 2015), as well as narrative reviews (Baumeister, 2012) have explicitly concluded that antidepressants should only be used for more severe major depressive disorder (MDD) because of the risk–benefit ratio. However, in April 2018, Cipriani’s team published the largest and most comprehensive meta-analysis to date, over 116,000 patients and 21 ADMs, on the comparative efficacy and tolerability of ADMs (Cipriani et al., 2018). The researchers concluded that all of the ADMs were more efficacious than placebo and identified differences between drugs. In assessing the net efficacy and relative tolerability (i.e., typically based on trials lasting approximately 8 weeks), three ADMs—agomelatine, escitalopram, and vortioxetine—were identified as the most preferable. These conclusions resulted in extensive media coverage and reignited long-standing debates about the effectiveness of ADM. Unfortunately, patients as well as providers end up caught in the crosshairs of these debates, more confused than ever about the conditions under which pharmacological treatment for depression should be initiated and maintained. Confusion ensued because, although the researchers acknowledged important limitations of the meta-analysis and did state that their recommendation was for acute MDD, these caveats were not emphasized in The Lancet paper or in the widespread media coverage (Adlington, 2018). The public was then left with headlines ranging from “More people should get pills to beat depression: Millions of sufferers would benefit, doctors told” (Smyth, 2018) to “Why we are skeptical of antidepressant analysis” (Moncrieff, Middleton, Read, Penman, & Yardy, 2018). Psychiatrists were equally divided about the take-home message from the meta-analysis, with one leading psychiatrist stating, “Our profession seems devoted to believing that antidepressants ‘work.’ They don’t, at least not for MDD” (Ghaemi, 2018), and another countering, “Why Do We Continue to Doubt Antidepressants’ Efficacy?” (Lieberman, 2018). In light of these opposing views and the fact that results were not reported in a way that enhanced clinical decision-making, we begin by discussing the findings, limitations, and implications of this meta-analysis. We then offer, from humanistic perspective, a critique of this study and of the assumptions that ground the debate about ADM use. In an effort to show the contributions that a humanistic approach can make in terms of enhancing client-centered care and decision-making, we examine antidepressant use in light of humanistic theories of depression and treatment. Efficacy Versus Effectiveness Translating the results of this meta-analysis into clinically useful information is difficult because efficacy is often conflated with effectiveness, when, in fact, they are operationalized differently. Effectiveness refers to clinically relevant effects in real-world patients. Efficacy, on the other hand, refers to “any arbitrarily chosen effect which may or may not be clinically relevant” (Bero & Rennie, 1996, p. 209). For example, the widely accepted National Institute of Health and Clinical Excellence (NICE) recommendations on treating depression (NICE, 2009), which state that standardized mean differences of 0.50 are significant, have been criticized along these lines. Critics have pointed out that there were no empirically validated criteria used to support this recommendation, NICE abandoned the .50 cutoff in 2009, and researchers should be careful not to conflate statistical significance with clinical relevance (Cuijpers, Turner, Koole, Van Dijke, & Smit, 2014). For example, when the .50 criterion is applied to depression screening instruments, it translates to a difference of only 3 points on the Hamilton Depression Scale (HAM-D), arguably not a clinically meaningful one. In fact, Moncrieff and Kirsch (2015) found that a 7-point difference on the HAM-D corresponds to a rating of minimal improvement on the Clinical Global Impressions–Improvement scale. Additionally, the short duration of randomized clinical trials (RCTs) makes it difficult to determine medication effectiveness over the long term, information patients struggling with depression most want to know. Although Cipriani et al. (2018) found a 50% reduction in HAM-D scores, most of the effect sizes were small. Small effect sizes should prompt cautiousness when considering an intervention (Sullivan & Feinn, 2012) because they give critical information about whether the statistical significance found is clinically meaningful. Ghaemi (2018), looking more closely at effect sizes, pointed out that almost 75% of the trials in this metaanalysis showed little to no benefit. Also, the vast majority of the trials included enrolled participants with severe depression, which can limit the generalizability of trial results (because most people being seen by mental health professionals have less severe depression and often have comorbid conditions such as anxiety). Most studies have shown (e.g., Fournier et al., 2010; Kirsch et al., 2008) that efficacy is directly related to depression severity, and many treatment guidelines for depression explicitly recommend against the use of routine ADM as a first-line intervention because the risk–benefit is poor (see, e.g., Cosgrove et al., 2017). Risks and Side Effects Overall, the Cipriani meta-analysis (Cipriani et al., 2018) found that taking an antidepressant increased the risk of dropping out compared to placebo (odds ratio = 2.3), which is likely related to tolerability. However, the meta-analysis does not provide data on which adverse events were reported and how frequently for each drug. The three ADMs recommended for their “effectiveness and relative tolerability” (agomelatine, escitalopram, and vortioxetine) surprised many prescribing providers—and for good reason. Strong concerns about the risk–benefit ratio have been raised for two of the three ADMs. In fact, one—agomelatine—is not approved for use in the United States because of documented cases of liver impairment and damage (Gahr, 2014). Independent (i.e., nonindustry-funded) researchers who reexamined the clinical trial data for vortioxetine found that the generic comparator drugs were actually more efficacious in a number of the trials (Cosgrove, Vannoy, Mintzes, & Shaughnessy, 2016; Meeker, Herink, Haxby, & Hartung, 2015; Pae et al., 2015). Risk of Bias Cipriani et al. (2018) rated 82% of the 522 trials reviewed as having a moderate to high risk of bias. That is, using a standard risk of bias instrument, which assesses for biased allocation, unblinding, and attrition (among other indices), they found that most of the RCTs may be at risk of design flaws that could render the findings questionable. The fact that 82% of the trials were at risk for bias is particularly disconcerting because most bias in industry-funded trials has been found to escape standard risk of bias assessments (Lundh, Sismondo, Lexchin, Busuioc, & Bero, 2012), and 78% of the trials in this meta-analysis were industry funded. In fact, the authors acknowledge their findings’ susceptibility to industry-influenced bias, noting that the meta-analysis included few nonindustry trials and a number of trials that did not divulge funding information. In addition, Cipriani et al. (2018) also reported a specific bias, a “novelty effect,” which can occur when a new drug is perceived or assumed better than older ones. When the treatment was a newer drug, it was significantly more effective than when older drugs were used as comparators—and adjusting for this novelty effect diminished differences between antidepressants. In the following section, we refer back to some of the basic principles of humanistic psychology in order to avoid the reductionism inherent in the way in which the question of ADM efficacy is framed within the medical field. Starting from the Heideggerian notion that moods attune us to the world—they are part and parcel of being in the world—and thus should not be understood as episodic, we offer an account of depression that is unencumbered by the assumptions of the medical model. Why the Question “Do Antidepressants Work?” Is Problematic In order to see depression as sadness, we need do little more than recall the experiential base of sadness from which depression has been abstracted, reified, operationalized, measured, and made into a disease. To recognize sadness is to recognize a certain narrative structure and content that expresses it, contains it, and makes it comprehensible to human beings. In contrast, to see the disease Major Depressive Disorder is to lose the narrative content of sadness. (Keen, 2011, p. 66) The “what” that phenomenology targets are experiences such as emotions . . . the “what” is not the object per se, but the experience of the object. What gets disclosed are not “things” or “bare facts” but rather the “affairs of consciousness” themselves. (Churchill, 2014, p. 1) Appreciating the Lived Experience of “Depression” As Keen, among other existential phenomenological researchers and clinicians (Elkins, 2009; Wertz, 1998), has noted, reifying sadness as depression-qua-disorder undermines our ability to have a genuine appreciation for an individual’s suffering. Indeed, from a humanistic perspective, suffering is both a social and moral reality that has a “unified horizon of experience . . . and a meaning structure that can not be reduced [e.g., to a disease category]” (Morrissey & Whitehouse, 2016, p. 117). The clinical trial data (upon which the meta-analysis is based) are grounded in a disease model and thus use disease-oriented (vs. patient-oriented) outcome measures (i.e., symptom reduction). In contrast, from a humanistic perspective, we have an ethical imperative to avoid measurement-based symptom reduction models and instead bear witness to the depressed person’s effortful existing. Instead of being attuned to the “affairs of consciousness,” the disease model takes “major depressive disorder” to be the object and neglects the person. Most important, there is a temporality and bodily nature to all emotions (Heidegger, 1927/1962; Merleau-Ponty, 1964) that is eclipsed when the disease model is adopted. Heidegger invokes the concept of Befindlichkeit in order to demonstrate the impossibility of “having” a mood (Stimmung). That is, human beings are not rational creatures with neutral mood states and who may sometimes experience mood episodes (e.g., a “major depressive mood” episode). Rather, one is always “found” in a mood; Stimmung is fundamental to Dasein. Although a full account of embodiment is missing in Being and Time (Aho, 2005), the connection among Stimmung, Dasein, and the lived body was made explicit in Heidegger’s (1987/2001)Zollikon Seminars, where he discussed the priority of the relationship of the body to the world, which in turn makes affective attunement possible (for a detailed discussion, see Churchill, 2018). As Merleau-Ponty astutely noted, “I can only understand the function of the living body by accomplishing it and to the extent that I am a body that rises up toward the world” (Merleau-Ponty, 1945/1962, p. 105), meaning that emotions should never be taken as discrete psychic objects—they engage (or impede engagement) with the (intersubjective) world. Thus, rather than using an acontextual symptom reduction model, adopting a humanistic approach calls us to enter fully and empathically in the other’s world (see, e.g., Muller, 2003). It is an approach that relies on the “intuitive talent of the caring professional . . . [who is willing] to move beyond what the other is able to say to a more deeply felt attunement to what is being revealed to us in the other’s presence” (Churchill, 2014, p. 1). Moreover, studying the efficacy and tolerability of ADM using a symptom reduction model risks individualizing the person’s suffering and moves the focus away from the sociopolitical context in which “depression” is always manifest (see, e.g., Cosgrove, 2000; Vilhelmsson, 2014). An increasing number of psychiatrists have cautioned against considering symptoms on their own (e.g., using DSM criteria and/or a depression checklist approach; see, e.g., Frances, 2013a, 2013b; Ghaemi, Vöhringer, & Vergne, 2012; Muller, 2017; Parnas, Sass, & Zahavi, 2013; Summerfield, 2006). They argue that using symptom checklist approaches for both diagnosis and treatment is unlikely to lead to a helpful understanding of the patient or helpful treatment because such checklists “do not take into account the gestalt of the disorder and inadvertently reduce clinical assessment to a mathematical exercise of adding up reported symptoms” (Duffy, Malhi, & Carlson, 2018, p. 411). This point is congruent with one of the most fundamental principles of humanistic psychology —that clients must be understood holistically and that we must appreciate the relational and cultural context in which they forge their identities and give meaning to their experiences of distress (Bland & DeRobertis, 2017). Questioning the Ontological Status of “Depression” The RCT model of psychotropic medication assessment reifies depression as a quasi-medical object and takes it out of the interpersonal and social world; as a result, critical opportunities for understanding the phenomenon and for responding with empathy are lost. In many ways, “depression is really a bureaucratized notion of sadness” (Keen, 2011, p. 69). This bureaucratization causes us to lose sight of the intentional structure of an individual’s experience of “depression,” making it difficult for clinicians to adopt a comportment of empathy and respond with authenticity to a client’s experience. Mental health professionals’ perceptions of clients are influenced by reified disease descriptions, and clinicians applying a disease model are more likely to consider medication as a primary treatment strategy and to perceive clients as less informed and capable of reason (Ahn, Proctor, & Flanagan, 2009; Fricker, 2007; Kim & Ahn, 2002). The way depression is operationalized in RCTs and conceptualized in clinical practice may thus lead to a discounting of clients’ preferences, capabilities, and unique life stories (Crichton, Carel, & Kidd, 2017). Although it is beyond the scope of this article to address Husserl’s description of a transcendentally informed psychology, it is worth noting that the disease model of depression is transcendentally naive. According to Husserl (1931/1977), a transcendentally naive approach assumes that the intentional constitution of an individual’s life world is a psychological function of the individual subject. Instead, he maintains that subjective processes are not isolated—they “reach beyond isolated subjective processes” (Husserl, 1977/1931, p. 48; see also Davidson & Cosgrove, 2002). In other words, although a phenomenon (e.g., depression) may have a psychological aspect, it should not be assumed that it is solely psychological in nature. This insight has profound implications—rather than viewing the (depressed) subject to be deficient and needing to be changed by treatment, the transcendental turn views the subject as a sociocultural, historical, political, and ethical actor (Paci, 1972) whose experience of emotional distress must always be understood in its sociopolitical context. However, the disease model of depression not only reifies and homogenizes sadness and loss but also is transcendentally naive insofar as it assumes a predetermined “objective” world that depressed persons can only adjust to, adapt to, or accept (Davidson & Cosgrove, 2002). We can easily see how the implicit assumption of a predetermined world can become the justification for sustaining relations of dominance and subordination. An example of this can be found in the World Health Organization’s (WHO’s) recent “Let’s Talk About Depression” campaign (World Health Organization, 2017a). A main focus of this campaign was on the “mental health” of Syrians: “When sadness doesn’t stop: helping Syrians with depression” (World Health Organization, 2017b). The campaign not only used a Western model of diagnosis and recommended Western modes of intervention (antidepressants and cognitive–behavioral therapy) but also intraindividualized the expe …