Two of the hallmarks of the highly sensitive person are the need for certainty and struggling with self-doubt. These two challenges dovetail when considering a new course of action or making a big decision: Should I take medication? Should I do CBT or try another approach for particular issue? What do the studies show?
It’s normal to seek out studies when making decisions of this nature, but at the end of the day we must act according to our own self-trust if we’re going to be in alignment with our true values. However, when the statistics are contradicting our own experience, this can cause trouble.
To CBT or Not to CBT
This conundrum arose on a group call for my 9-month course a few weeks ago when a member was sharing about how her experience with doing CBT for her sleep struggles was quite different from what the science said. As she explained (shared with permission):
“I find myself spiraling when there’s contradictions between what the ‘science says’ and what my wise self says – or what two people that I respect say. For example, I dealt with some insomnia about a year ago. I tried the CBT method and it made it much worse for me. What worked for me was just getting comfortable laying in bed and relaxing in bed rather than getting up every 20 minutes, which made me crazy.
“Recently I was reading a psychology textbook and it was talking about how so much research supports the CBT method and it supports getting out of bed every 20 minutes if you’re not sleeping. Even though I know that’s not true for me it still messed me up reading that. That’s one example of hearing contradictions and not trusting myself.”
I responded by focusing on how we’re raised in environments where we’re conditioned to abdicate self-trust instead of being raised in a way that encourages us to trust our own bodies and what we know to be true. I talked about how some things might be helpful for some people but that there isn’t one thing that works for everyone. I hoped I was helpful, but I sensed that there might be a missing piece.
A few hours later, another member emailed me with a brilliant offering that I knew would not only be helpful to the member but also to many others in this community who struggle when there’s a difference of opinion or when they read something that is touted as verified “fact” yet goes against their own lived experience. With grateful permission, I’m sharing what she sent here.
I am someone who often does everything I can to seek out certainty over just being with the vulnerability of being human. That said, you often say that sometimes we do need some information as a starting place. One place that I think most people could use more information is about how social research, particularly quantitative statistical research, actually works, what it can tell us, and what it can’t.
I teach and use statistics, and I love teaching and using statistics, and I also have very complicated feelings about statistics, what it can tell us, and how it has and continues to be misused or misunderstood.
It’s very easy to interpret a statement about what the data, research, or science says “works” and take it to mean that if we do that thing, we will have the same, good outcome. At its core, this sets us up to expect a certain fix, a cure, and to blame ourselves if it doesn’t work. But this isn’t what mainstream research does – it cannot tell us what will happen to us with certainty, as much as we wish it could.
There are two particularly important things I want to share with anyone struggling when the science doesn’t seem to fit their own experience.
Identifying the Average
First, most quantitative statistical research focuses on identifying the average. We look for what works on average. For example, if you have 50 people use the hypothetical Gold Standard method to treat insomnia and 50 people do something else, it might be that – on average – the Gold Standard folks report more improved sleep than the something-else group. This does not mean that everyone in the Gold Standard group improved and that everyone in the something-else group stayed the same. In fact, it’s certainly possible (maybe likely) that some individuals have the opposite reaction to the average, with some doing worse in the Gold Standard group and some improving in the something-else group.
The average can also mask a lot – it can show up because 2 people out of the 50 in the Gold Standard group were completely cured and everyone else was unaffected, or it could be that everyone in the Gold Standard group saw marginal improvements (some studies do provide this kind of breakdown, which can help temper expectations).
There are certainly a wide range of statistical methods that do things besides just look at the average, and an even wider array of research tools completely separate from the narrow approach of quantitative statistics, but the average approach is widely used and tends to be what gets the most attention. “The Gold Standard works for some people but not others” is already more nuance than we want when we’re looking for certainty.
Fundamentally, the average is a number used to describe the center of a whole, varied group. It may not even accurately describe any one person in that group, let alone everyone in it.
In fact, a key reason we look at averages in the first place is because of all of the factors we cannot control or even observe that shape individual experiences. Oddly enough, the use of averages is an admission that individuals are complex and varied and that their unique contexts shape their experiences in ways we could never fully and completely account for on their own. Taking the average flattens some of this nuance, which has both benefits and drawbacks – it lets some patterns emerge while hiding others.
The Gold Standard Depends on Comparisons
Second, quantitative statistical testing depends on comparison. To say that the Gold Standard “works” is an incomplete statement. It “works,” on average, compared to “something else.” The Gold Standard method may be better at improving sleep, on average, compared to…business as usual, ignoring the problem, getting a pamphlet about sleep studies, or compared to other therapeutic modalities. It doesn’t mean it works the best, period. It means it’s the best at improving sleep, on average, compared to the things we’ve compared it to in scientific studies.
I’m willing to bet that there aren’t any studies that use dialogue journaling with your wise self or putting your feet in the grass and thanking Mother Earth for a new day as the comparison groups 🙂
On today’s call, you used the phrase “placing authority in somebody else’s hands.” I think it can be helpful to know a little bit more about one set of those hands. Research is presented as so cut and dry, and culturally it seems like we’re all pitted as either believing or not believing in science. Research is amazingly nuanced. It can tell us some things, it can’t tell us others. It gets things wrong, and at its best, learns from it. Research is driven by the infinity of unanswered questions. Research is human.