Part 6 Linden Method “data”; or is it?

In amongst the mess of amazon reviews is …..outcomes for the Linden Method! Or supposedly.
http://www.thelindenmethod.co.uk/faq/default_who.asp
According to this generally uninformative account 1,117 people with anxiety did a “user survey” . This was supposedly to provide “accurate” statistics on how effective the LM programme is vs other anxiety therapies and medication.
Given Charles Linden claims that he is working with people he describes as top scientists, academics and psychologists, one is really forced to wonder what advice he is receiving about “research”.

This is an entirely uncontrolled satisfaction survey with an unspecified sample using an unspecified measurement survey and unspecified methodology carried out and/or commissioned by someone with a clear financial and reputational conflict of interest. It has not been subject to peer review and it is embedded in a marketing webpage which is in turn embedded in a network of marketing pages. Even if it was properly specified (which it is not even slightly) and were appropriately independently reviewed (which it is not even slightly), it meets none of the basic standards which would allow it anywhere near the research literature. It does not look even slightly like scientific research to me; in my opinion it looks more like carefully spun marketing.

At first I thought of itemising the ways in which this “clinical research” falls short of basic principles of scientific research, but decided not to because it can be more simply summarised as: it falls short in all respects.

Think of it this way and look at the Linden “Clinical Research Results” with this in mind, as a way of understanding why it may be important to be sceptical about these extraordinary claims. Imagine something entirely unconnected with the Linden Method; imagine a drug, say “Scammazepan” marketed by SnakOil plc for depression. On the company website they publish a survey saying their research shows that 96.7% of participants recovered, and 2.3% didn’t take Scammazepam. They also say that 82% said they have used a different medication, and 77% believed that it had not helped their depression.

Would we now be writing petitions demanding the National Health Service make Scammazepam available, or would we instead be questioning the financial motives of SnakOil plc in releasing their “evidence”? We would be more than slightly sceptical.

Now lets be clear; this is never going to happen in the pharmaceutical industry. Drug companies are regulated and prevented from making claims of this kind, so you will not see anything like this in the pharmaceutical sector. However, you can and do see this within the “therapy industry”; marketing can dominate, which might explain the massive effort to build a web presence by the Fringe “psychological therapy” companies and their attempts to suppress negative reviews. The closest these commercial companies come to being regulated is through the Advertising Standards Authority.

So what data would allow justification of the claim that programmes such as The Linden Method are effective even minimally?

Wikipedia is a good basic source for such information:
http://en.wikipedia.org/wiki/Evidence-based_practice
“Evidence-based practice of psychology requires practitioners to follow psychological approaches and techniques that are based on the best available research evidence (Sackett, Straus, Richardson, Rosenberg, & Haynes, 2000). Evidence suggests that some therapy approaches work better than others. Criteria for empirically supported therapies have been defined by Chambless and Hollon (1998). Accordingly, a therapy is considered efficacious and specific if there is evidence from at least two settings that it is superior to a pill or psychological placebo or another bona fide treatment. If there is evidence from two or more settings that the therapy is superior to no treatment it is considered efficacious. If there is support from one or more studies from just a single setting, the therapy is considered possibly efficacious pending replication. Following these guidelines, cognitive behavior therapy (CBT) stands out as having the most empirical support for a wide range of symptoms in adults, adolescents, and children.[9] Unfortunately, the term “evidence-based practice” is not always used in such a rigorous fashion, and many psychologists claim to follow “evidence-based approaches” even when the methods they use do not meet established criteria for efficacy (Berke, Rozell, Hogan, Norcross, and Karpiak, 2011).”
The rest of this particular webpage is well worth a look if you want to understand the different levels of evidence which can be identified.

Without Randomised Controlled Trials conducted according to rules intended to prevent bias, the Linden Method clearly cannot yet be regarded as evidence based on any scientifically accepted definition.

Part 5: Is there “science” behind the Linden Method?

The Linden Method website claims that it is backed by science. It is said that the method works by “reconditioning the amygdala”. Great theory; what is the evidence that TLM impacts on this particular brain structure? Er…..not one iota. On TLM pages there is one with a description of the amygdala and a couple of brain imaging and animal conditioning studies. It is again asserted that TLM “reconditions the amygdala”. Notice that there is no research here on TLM, but instead reference to a few studies on fear conditioning and de-conditioning in animals. That’s it. Evidence that TLM impacts the amygdala? No, there is none. Evidence that TLM reduces anxiety more than placebo interventions, allowing a very very idirect inference of this kind? None.

Now we should note the amygdala is part of the Limbic system, and it has certainly been known for a very long time that it was implicated in emotions, including anxiety, fear and anger; how it does so is less clear. The Linden Method, in its unsubstantiated claims that it “reconditions the amygdala” is simply putting a pseudoscientific gloss on the unsubstantiated claims to specifically reduce anxiety. It piggybacks on GCSE psychology…yes the Amygdala is involved in anxiety, that’s not something invented by TLM, that’s something which has been known for a very long time.

And then there is
http://www.lindenmethodanxietyrecovery.com/research-evidence-confirms-our-programs-science/

I can’t even begin to make sense of this stuff. That doesn’t mean that it is incomprehensible neurobabble; alternatively it could be because I am not very knowledgeable about anxiety, psychology and so on. This is something the reader will have to judge that for themselves. Anyway, I personally take the view this stuff provides absolutely no support at all for TLM. There are a load of other very tangential postings out there claiming a scientific basis for it. They do not add up to any scientific support at all for TLM, and are composed of generalities of no direct relevance to, for example, “The Nine Pillars”.

Part 4: Linden Method support staffing offering “unlimited reassurance” and their professional “accreditation”

Charles Linden makes a big issue of my review not including his support staff, so I thought I should look at them. They can currently be found here:
http://www.lindenmethodanxietyrecovery.com/psychology-team/
This page is really interesting. It starts by indicating that the support team will provide “Unlimited Resassurance”. Now anyone who knows about anxiety problems such as health anxiety, OCD and so on will know that “Unlimited Reassurance” is a rather bad idea.
Anyway, it goes on to say that the support team are trained counselors, psychologists all accredited by the BACP and the BPS.
BACP register can be checked here:
http://www.bacpregister.org.uk/check_register/
I tried the support team as listed and found

Charles Linden Not registered or accredited

Beth Linden Not registered or accredited

Jenny Brookes BSc, MS Not registered or accredited

Becky Davenport Not registered or accredited

Kathy Donovan Not registered or accredited

Fiona-Carmen Cullen Not registered or accredited

Tanya Klein Not registered or accredited

Martin Jenson Not registered or accredited

Robert Page Not registered or accredited

Sheila Darley If this is Sheila Joy Darley, then she is registered but not accredited

Jackie Anderson Not registered or accredited

Zoe Korylko Not registered or accredited

Sue Allen Not registered or accredited

Jackie Donkin Not registered or accredited

Alan Smith Not registered or accredited

Ooops!

Now it may be that these people are using other names, but as they are listed on the outward facing components of the Linden advertising machine, only one appears, and that is not as accredited but as registered. The use of multiple names is something that Charles has set us an example with, after all.

Anyway, this list is not looking good for the claim that all are accredited with the BACP and the BPS! In terms of the BPS: not one of these people is registered with the BPS list of register of psychotherapists. One of them might be chartered, but certainly not as a clinical, counselling or health psychologist.

This is all a bit worrying, as in fact none are accredited in this way. They are probably all lovely people who have the best interests of the people suffering from anxiety that they try to work with at heart. However, they are responsible personally for ensuring that their qualifications are not seriously misrepresented by their employer; failure to do so could be regarded as a serious ethical lapse on their part (and that of their employer). Hopefully nothing of this kind is happening here.

Part 3: More recent events and Charles Linden’s critique of Paul Salkovskis’ previous review of the Linden Method.

Recently, several people with personal experience of anxiety have indicated that Charles Linden has sought to prevent his method being discussed on forums and bulletin boards they operate or moderate. This included threats of legal action and more. Now the people concerned are, in my view, dedicated to helping people suffering from anxiety problems, providing a valuable resource to those people and their loved ones. I understand that Charles Linden referred to OCDUK as a “sufferer’s club”! Time, I thought, to review personally the situation vis a vis the Linden Method.

It was easy to get a snapshot of what was going on. A quick search turned up the posting below, which appeared on Amazon reviews

This is part of a sequence, which at my most recent viewing shows a number of posts “removed by user”; as I understand it, this may have been because of the threat of the threat of legal action. However, it seems to sum up Charles Linden’s position so I have focussed on this rather than previous attempts to refute my review. From Amazon, I have pasted Charles Linden’s comments in Italics, then added my thoughts in bold below them.

“Forst of all. Please wait around a month and we will be publishing our 2014 data… this will be more representative of the 2012-2014 client outcomes data recently gathered. “

Great! Some data at last! However, see my comment below. It is indeed data Charles, but not data as we know it….. see section 6 below.

“You provide a quote from Paul Salkovoskis’ review of the Linden Method… let me assure you entirely that:
1. Paul Salkovskis did not have access to The Linden Method material”

I most definitely did.

2. Paul Salkovskis never spoke to a member of my staff

True. Not sure what this is meant to signify? I review scientific and clinical papers along with most of my clinical and clinical academic colleagues. We do not routinely speak to the centres involved, that’s one of the reasons that such reviews are called “independent”. As part of the NICE guidelines group for anxiety, we did not contact the authors of the papers we reviewed; their published material, in the public domain, is what is required. In any case, support for a programme of this kind would be to help the person experiencing the anxiety problem to better implement the programme as set out in the materials I had. My review was of the core, and would be entirely unaffected by any additional support which may or may not be accessed by those trying to make sense of the Linden Method. I will, however, comment on the qualifications (or otherwise) of TLM support staff in the next section of this blog.

3. Paul Salkovskis never requested data from us

This is not true. When I spoke with Charles Linden when the review first appeared, I asked about data and he said that the testimonials of people using the method was all he needed. I pointed out that this was not data of the kind usually required for clinically focussed programmes. As someone once rather cleverly, said, “the plural of anecdote is not data”. Given that I had heard testimonials from people for who it had not worked and who had been refused a refund, this was pretty much the end of this. Glad to see that Charles now claims “science” and “data” supports his position (although this is questionable…see below) but what is crystal clear that he does not have data of the type required by clinicians and scientists who adhere to an evidence based and empirically grounded approach; again see sections below.

4. Paul Salkovskis never spoke to a single TLM client.

No, that’s correct, it was multiple TLM “clients”! I think what Charles means is people he wanted me to speak to. I spoke instead to people I wanted to speak to and who wanted to speak to me.

As far as I can tell from his ‘review’… he hasn’t got a clue about any aspect of what it is we provide or do.

Completely untrue. I had the materials provided. These are the materials TLM provided to their clients at that time and I had read them carefully and, I think, understood them well. More recently, I have seen the narratives on the TLM websites (which are everywhere) and those independent comments which are still up on the web. I have seen various figures on the proportion of people accessing additional support; TLM websites claim 40%, which means that 60% rely on the materials alone at this point. It was, I suspect, a lot less in 2005.

His comment about NICE is 100% incorrect, TLM does indeed fall within CG113 for Guided Self Help… confrmed by NICE, NICE’s regional agent and by use the person who wrote the CG113 guidance.

At the time I wrote the review, I had been a member of the NICE guideline group for anxiety and it was true at the time. I have since been a member of the second guidelines group, and I am able to say that TLM peer review publications were not considered, for the simple reason that there were none in existence. There are still none in existence. A weird point. NICE does not have “regional agents”. He says he spoke to the person who wrote the guidance. The guideline group wrote the guidance….I was a member of that group and was involved in its writing. Again, I need to say: TLM didn’t appear on the horizon, because there were no published or in process peer reviewed articles on it. It is therefore by definition excluded from NICE recommendation; there are no data of the type required by NICE. Remember, NICE is an NHS organisation, and where a guideline exists for a particular problem, the NHS quite appropriately requires NICE approval. Until subjected to appropriate and properly conducted research, TLM is not going to be adopted by the NHS. CG113 refers to guided self-help based on the principles of CBT; the systematic review for the relevant section found guided self help based on the principles of CBT effective; no other approaches were found to be effective. The Linden Method was not included, as there are no data meeting the rather low criteria for inclusion in the review for the method.

His comments around TLM not being evidence based is inaccurate… he never asked for the data required and has made an assumption based on something other than the available data.

Not at all. Back in 2006 I did ask for it. More importantly, in terms of the data required by NICE and Health organisations, there are no peer review publications. None. Perhaps there are some data which might convince me not in the public domain with appropriate quality control, in which case Charles is welcome to send it to me.

His comments around our science being flawed is incorrect… far more informed people than him have confirmed that our science is, in fact, spot on

This is a tough one. I don’t want to make false claims about how well informed I am about anxiety and its problems. How well informed about anxiety and its treatment am I? Should I brag about this? Not sure that’s going to help, and I will simply have to allow people to judge how well informed or otherwise I am on the science. One way of doing that would be to google me on “Google Scholar”.
http://scholar.google.co.uk/
just put “Salkovskis” in the search field and it will show my research publications.
Now try “Teeney”, one of the leading experts used by Linden. You will find not very much from him (there are a few other Teeneys) but as far as I can tell his most cited paper is this one in the journal “Sociology”
http://soc.sagepub.com/content/44/6/1019.short
Its not about anxiety, although it is mildly interesting. But not relevant to people trying to get help for their anxiety.
I looked up the clinical psychologist on the website, Romulo Valdez in terms of peer review publications on anxiety. Not been able to find him so far, but I’m still looking. Relatively speaking, I am happy to claim being well informed about the science surrounding anxiety and its problems. I have even done some of the research and published it in peer review journals.
So back to Linden’s point. I maintain that what I saw in the materials and what I have seen on the websites more recently is seriously flawed science. Experts? From the Linden website I find Romulo Valdez, Jr., Ph.D. I had never heard of him before today. Publication record in anxiety? He has none that I can find. However, he has endorsed the Linden Method and is at least a clinical psychologist. Anxiety researchers in the USA I contacted had not heard of him. Then there is another expert; Dr Francis Teeney Honorary Lecturer in Psychology at Queens University Belfast. He is a Senior Research Fellow, Institute of Conflict Transformation and Social Justice, Queen’s University Belfast andResearch Fellow, University of Aberdeen, Leverhulme Trust funded project in Compromise after Conflict (2009). What he is not is a clinical psychologist. Publications in anxiety? None.

and that the science around CBT is in fact flawed.. in fact that the practice of CBT in the treatment of anxiety disorders is damaging to the sufferer. Even the RCPsych states that CBT isn’t a solution…

What a fantastic out of context quote! Royal College of Psychiatrists says CBT is not the solution for all people with all problems, which is of course fine. However, they do in fact strongly recommend CBT for anxiety as the leading evidence based psychological approach. This can be found in lots of places, but most accessibly here:
http://www.rcpsych.ac.uk/healthadvice/problemsdisorders/anxiety,panic,phobias.aspx
CBT is damaging to sufferers? This claim flies in the face a very large mountain of evidence, real evidence. It is self-evidently absurd.

I have never met a person that has been cured by CBT, not one in 16 years and 160,000 ex clients… I have met many cured sufferers… they are our ex clients.

Wow! But other people have. Many other people. And then, there is the massive outcome literature. Maybe Charles should look at the NICE anxiety guideline in its full version, which summarises the data that were synthesised in meta-analyses to produce the guideline. Or perhaps read some of the actual outcome literature. I think he would find it a useful education.

His price comment is ludicrous when you consider that one of his own paperbacks costs almost as much on amazon

Here it looks like Charles is struggling to understand how Amazon works so I am happy to help him out here. I have seen Charles refer to this before, and I fear that he maybe doesn’t understand the internet, amazon and so on, He has mentioned something like this before. I think he is referring to things like:

Let me help you, Charles. These are second hand sales of an out of print book. Probably you don’t know, but this money does not go to the book’s editor (me) but to the seller. This was originally an academic book I edited, intended mainly for libraries, and very good it was too. However, if you want to see a book for which I am responsible and which is aimed at people suffering from anxiety, try

I should alert readers of this view to a potential financial conflict of interest on my part. I and my co-authors get a percentage of this; I think 12%, divided three ways. We intend to have a good night out on the proceeds in the not too distant future.
So; Charles may think my price comment ridiculous, but I maintain, as I did in the original review, that in my opinion the price of the Linden Method is way too high.

….and that for our very low fee we provide The Method materials, CDs, DVDs, a members area containing dozens of high quality resources and unlimited support by BACP and BPS registered psychotherapists

Tricky that one. Can’t see any of them registered on
http://www.bps.org.uk/bpssearchablelists/ropsip
Again, I will come back to this issue later

by email and phone for up to 12 months – That sounds like a bargain to me…

It indeed should sound like a Great Bargain to you because it is! Assuming that it is true (and the website says it is), that 200,000 people bought the Linden Basic Package (forget the more expensive versions) and, as appears to be suggested in one of the many websites, 160,000 recovered (therefore didn’t get a refund). At an average, say, of £100 per person, then that is at least £16,000,000 paid to the company. Really, it SHOULD sound like a bargain to you Charles. Maybe not so much for those that pay the money though.

We even include the postage all for £137…. (it’s £97 for I ownload version) his final comment about ‘extraordinary claims’ is laughable… the evidence was right there but he never asked for it… in fact, the guy that was originally tasked with writing the review was blown away by what we did when he visited us AT the Linden Centre… he was so impressed that he wrote a wonderful review, which was immediately ditched after he had spent a day with us and my team at the centre gathering REAL facts…. the review was too positive,

Entirely incorrect. The opposite was true. The original reviewer liked your hospitality but still was not prepared to write a positive review, which is why you protested and indicated that you did not consider him qualified to write it. That was precisely the point where I was asked to review it. Extraordinary claims do indeed demand extraordinary evidence.

So they wheeled out Salkovskis to give ita touch of his ‘magic’… a review based on absolutely nothing he had ever seen, touched, researched or been party to.

I firmly maintain that I had all I needed at the time, and was (and am) well qualified to review the Linden Method, whether or not I have wheels.

Is what we offer unfair? Materials plus unlimited qualified support and a ‘money back guarantee’ for up to one year… that sounds pretty fair to me… does Salkovskis offer a gurantee on his ‘psychological care’? Doubtful!

No, what is offered by TLM is, as I said in the review, expensive. Do I offer a money back guarantee? No. However, on the other hand, I don’t charge people with anxiety for my treatment. Like the rest of the NHS its free at the point of delivery, as in my view it should be.

If you visited the centre and spoke to our team, saw the results for yourself and listened to the team working, you wouldn’t attempt to back up the uninformed remarks of the nay sayers… you WOULD indeed support what we do.
I love what we do… why? because I KNOW that we prevent people from having to endure the 27 years of crap that I endured… the testimonials people leave about us are REAL… they are not, despite what some might believe, written by US. We all at the centre defend what we do because what we do changes lives… many lives… if Salkovskis, charities and the like have issues with us changing lives… then they have issues with people recovering and only one conclusion can be drawn from that.

We should all be careful of “Trust me, I’m a doctor and I only have your best interests at heart”. We should similarly be careful of “Trust me, I’m selling my programme and I only have your best interests at heart”. As should be clear, the issues are rather different to the ones Charles Linden is drawing attention to.
Anyway Charles, I’m happy, if you want, to update my review to your present version of the programme. Interested?

Part 2: What else was happening in the meantime around the Linden Method?

Well, Charles Linden’s entry was removed from Wikipedia under odd circumstances as described above. He continued to sell his apparently overpriced “method”. I directly and indirectly heard about failures to offer a refund, and received a troubling email from someone who claimed that they had paid £1200 for individual coaching (on top of the basic £100). In the email to me, this person said “Mr Linden told me I was the “only failure”, which left me feeling incredibly low and very upset as Im sure you can imagine”.
Now I have no idea regarding the facts of this case, but it corresponds to other information, but it fits with other things I have heard regarding refund requests. There is a circular argument involved: it is suggested that the method, when done properly, always works, so if it did not work, then it was not done properly, so no refund is due. I have heard that sufficiently frequently since 2006 to think that that is how people have understood communications from the Linden team, whether or not that is what they intended to communicate!
The link below is a different person from the one sending me an email, but there are striking similarities both in the message alleged to have come from the Linden folks and the reaction of the person who was not improving when clearly trying to apply the method.
See:
https://healthunlocked.com/anxietysupport/posts/130311597/did-anyone-else-find-the-linden-method-confusing
And:
http://www.gapalicious.com/2012/04/26/the-linden-method-review-my-experience/

Now in my review I had questioned whether the claims made about the Linden Method were in any way justified, and concluded that they were not. In November 2011, the Advertising Standards Authority issued an adjudication of complaints made against the Linden Method. Ten points were made, and all were upheld.
http://www.asa.org.uk/Rulings/Adjudications/2011/11/The-Linden-Centre/SHP_ADJ_153052.aspx
In April 2012, the ASA published this further notice following non-compliance:
http://www.asa.org.uk/Rulings/Non-compliant-online-advertisers/The-Linden-Method.aspx
Interestingly, Charles Linden sought online advice about aspects of the legal issues raised by the case here:
http://www.justanswer.com/uk-law/73e70-asa-ruled-against-company-even-though-ruling.html
It is worth a read I think!
Charles Linden appears to have gone onto an online free legal advice website and asked for advice about the ASA ruling, saying (amongst other things) that a company called “Lifewise” in the US was responsible for publishing the claims made about the Linden Method!

The legal adviser on this legal advice website seems to have been on the ball, asking

Legal Expert: so is what they are saying incorrect? Is it the only solution, is it endorsed by medics , has it treated more sufferers etc and are other conventional therapies in effective, or did the site not say any of that?

Linden: Those are there words describing what they read, which is at the core of the problem. From the onset, the ASA have adjudicated using the CAP code, which states nothing specific about any aspect of what we do, to justify their sweeping statements and adjudication. That’s not what was said, they embellish what is actually said for impact. The product is not at fault and it is not the ASA’s remit to be able to comment on product efficacy, only on the language used to advertise the product, however, they have created media that suggests that the product itself is at fault. I think, maybe, this is too in depth for this kind of advice platform…..

Legal Expert: To which I’m afraid that does not answer my questions. Is it the only solution, is it endorsed by medics , has it treated more sufferers etc and are other conventional therapies in effective, or did the site not say any of that?

Linden then falls silent on this rather important issue. There are no more posts. So, the ASA rulings stand. The questionable claims are still being made by Linden, and appear to have been extended to include NHS approval (which has not been got).

One more thing before I bring things more up to date….I was contacted by a Dr Francis Teeney from Queen’s University, Belfast; he tried to persuade me of the value of the Linden Method. Details of Dr Teeney can be found on the Linden webpages, and I mention him in greater detail below. His narrative on the above web page and in my telephone conversations with him fall significantly short of what one might expect of a psychologist with a scientific background. But then, its not clear whether or not he is a psychologist with a scientific background. Who is he? From his web presence he appears to be a sociologist who works in the area of conflict and conflict resolution (perhaps he might advise on the current acrimonous discussions on the amazon website?). But….clinically qualified he is not. He is not on the list of chartered psychologists maintained by the BPS. Bear in mind that the term “psychologist” is not a protected title; anyone can call themselves that. “Chartered Psychologist” is the minimum level to be sure that a UK psychologist is appropriately qualified at the basic level. Beyond that, there are adjectival titles, tightly regulated, such as “Chartered Clinical Psychologist” or “Chartered Health Psychologist”. You can check the register here:

http://www.bps.org.uk/bpslegacy/lcm

He is also a director of a company marketing Mickel Therapy, which is supposed to be helpful in Chronic Fatigue Syndrome. Hasn’t made NICE guidelines for it though! That approach has its critics too.

He features prominently on the following page:

http://charleslindenmethodreviews.com/medical-reviews-statements/

If you look more closely at this, it is odd that these are listed in TLM pages as “medical reviews” by someone who likes to say (correctly, in my view) that anxiety should not be regarded as a medical condition. Also odd because, with the exception of one Dr Claire Bolton, none of those described are medically qualified. Not sure who Dr Bolton is….why, she may even be Charles Linden’s own GP for all we know!

In the next section I will deal with one of several recent attempts by Charles Linden to critique my ancient review.

1. Part 1 The History of my early contact with the Linden Method

A very long time ago (around 2005), I was contacted by the National Phobics Society (now AnxietyUK) about something called the Linden Method. I had never heard of it before. I was told that a couple of members had reviewed it for their members magazine, but that Charles Linden, the “originator” of the method, had objected on the grounds that these people with personal experience of anxiety were not qualified to review it. I will leave to one side the fundamental wrongness of this position; as people with personal experience of anxiety problems, they were, of course, eminently well qualified to review a programme intended to relieve anxiety! However, the objections were, I was told, vociferous, and so they asked if I might review it. I agreed, on the basis of being patron of the charity and having some expertise in the understanding and treatment of anxiety. This review was published in print, and triggered a phone call to me from Charles Linden. I don’t recall the details of that call beyond it being generally cordial and resulting in absolutely no agreement between us. Subsequently, the review began appearing on the web (which I was fine with; I am happy for it to be reproduced by anyone who wishes).

I was aware subsequently that Charles Linden was contacting some of those reproducing my review, and I was told that he was threatening legal action unless it was removed from various bulletin boards. Some sites (especially those run by people with personal experience of anxiety problems) complied, others did not. Here is a link to one of the few places it is still up.

With some other trenchant comments, also here:
http://www.clinpsy.org.uk/forum/viewtopic.php?t=2057

In the meantime, all those years ago, I had discussions with various people, including those who understood themselves to have been threatened by him over comments on bulletin boards they owned or moderated. Although it all seemed rather unpleasant, I didn’t see the point in engaging with a “tit for tat” web based discussion. I thought it best to simply ignore what was appearing on the web, and that included what seemed to me to be some very negative and inappropriate comments on my own review and my expertise.

There were some very strange shenanigans around the Wikipedia entry for Charles Linden; although he was listed for a time, this entry is no more, and if you dig a bit you can find out why. It may not be entirely unconnected with Wikipedia including a reference to my previous review. It all seemed a bit amusing. These various web entries and discussions did not, in any way I can see, show Charles Linden or his “method” in any good kind of light. At one point, AnxietyUK was described as a “competitor” to the Linden Method, and it was implied that my review was motivated by that “competition”, apparently financial! Lets be clear; I do not and never have received any financial return in kind from AnxietyUK.
What this all continued to suggest to me was a particular commercial frame of mind. I was aware of various further attempts made to criticise my review, but given that I regarded these as rather silly, I again didn’t bother to dignify these with any kind of reply.

Although, as I understood it, Charles Linden himself appears to have alleged “defamation” and indicated that he would take legal action against those who reproduced my review or lodged their own negative views, I was never threatened in this way; that is, legal action was never raised with me, which could be seen as odd, given that my review appeared to be what he was seeking to have removed. Difficult to know why this was so; perhaps he thought I may be surer of my ground than people with anxiety problems who moderate bulletin boards? I honestly don’t know. I do know that my review was carefully thought out after lengthy consideration of the programme booklets, the CDs and a DVD. I really worked hard to find something positive to say; in retrospect, I regret that given subsequent events. Sadly, I now believe that I was overly generous in that review.

Summary of an overview of the Linden Method: my contact with it, some facts and some personal opinion

I will be putting up a series of blog posts. The overall title should be

“The Linden Method, presenting “the truth”, and some thoughts on what it means when fair criticism of a commercial organisation by organisations led by people with personal experience and charities results in threats of legal action.”

For me, what has been going on raises questions about the impact of money, power, the place (or not) of marketing in mental health, freedom of expression and criticism, “expert” endorsement, and the need to regulate the “self help” market in the context of extraordinary claims lacking in substance.

In part 1, I will first discuss why I was asked to review the Linden Method and what happened over the following years and concerns I have about Linden’s behaviour towards people who run helpful bulletin boards for people with anxiety problems.

In part 2, I will bring things up to date, and in particular consider the rulings of the Advertising Standards Authority against the Linden group’s advertising.

In part 3, I will specifically address the critique made by Linden of my review, comprehensively refuting it.

In part 4, I will examine the science which is claimed to lie behind the Linden Method, finding it completely wanting.

In part 5 I will examine Claims of efficacy for the Linden Method, finding them completely empty of value.

Finally I will summarise the whole lot, trying to draw it together.

I will add these sections over the next few days

Please note: I am happy to allow parts of these posts to be reproduced by mental health charities registered with the Charities Comission, provided that a link to the original blog post is also included. Private individuals may use links to this blog but should seek individual permission to reproduce sections to ensure that context is retained. I deny permission to any company, group of companies or individual connected with such companies who have a judgement made against them by regulatory bodies including but not confined to the Advertising Standards Authority, as I would personally regard this as a serious violation of ethics.

The Linden Method: Review Originally published in “Anxious Times” in 2005/6

This review was carried out at the request of the National Phobics society (now re-named AnxietyUK). On re-reading it, I can recall straining to find helpful “nuggets” in it. Although I didn’t do this at the time, I would estimate that had I rated it I would have given it 1/10, and that one is for the “nuggets” which are as far as I can see, borrowed from elsewhere. It seems to me what’s new in TLM is not effective, and what’s effective is not new.
Several times it has been suggested that I had not made contact or allowed for the support offered by phone or on-line. This is, in my view, a silly critique. Even if we leave aside concerns about the credentials claimed for some of the support team.

Support for a programme of this kind would be to help the person experiencing the anxiety problem to better implement the programme as set out in the materials I had. My review was of the core, and would be entirely unaffected by any additional support which may or may not be accessed by those trying to make sense of the Linden Method.

Why reproduce this review now? Well, over the years various attempts have been made to suppress this review and people who have reproduced online it have been threatened with legal action (not by me!!) if it was not removed from their bulletin boards and so on, so I thought it would be helpful to put it somewhere where I am responsible for it. So here it is. Shortly I will be adding a longer post detailing some more recent issues with the Linden Method. But for now…

The NPS as was (AnxietyUK now) prefaced the print of my review with the following:

“Following on from the many enquiries received on the helpline on the Linden Method, we asked 3 people – 2 National Phobics Society volunteers (Rachel Fitzsimmons and Dave Davies) and a patron of NPS, Professor Paul Salkovskis to review the programme, Professor Paul Salkovskis review is as follows and has been chosen to be printed because both volunteer reviews were disputed by Mr Linden on the grounds that the first volunteer didn’t suffer with panic attacks and therefore couldn’t accurately assess the package. The 2nd volunteer review was rejected because Mr Linden felt that being a sufferer of an anxiety disorder wasn’t sufficient qualification to review the package”:

Extraordinary Claims Require Extraordinary Evidence

Paul Salkovskis, Clinical Director, Maudsley Hospital Centre for Anxiety Disorders and Trauma

The Linden Method

The claims made in this programme are bullish. We are asked to believe that this is the one true way to rid yourself of panic attacks, anxiety disorders and phobias. At one point it says that it is the only cure for anxiety. But before looking at the evidence for such extraordinary claims, let’s look at the process.
Firstly, one has to learn the “nine pillars”, read the material, do the visualisation exercise twice each day, do Tai Chi exercises as often as possible and do exactly what the Method teaches you. Confusingly, there are then two “powerful” elements; diversion which apparently re-balances the sufferer’s conscious logical thinking and subconscious habits. Secondly, the sufferer needs to breathe correctly and improve their posture.
So what are the nine pillars?
Stop visiting your doctor (and other doctors too)
Talk to your doctor about stopping the medication (confusingly as you are not supposed to visit them)
Stop looking for answers to your problems elsewhere
Only use the Linden method
Stop talking to other people about how you feel
Stop relying on other people for help with your feelings (which follows from not talking to them presumably)
Get rid of memories about your problem
Keep busy as a diversion (distraction)
Don’t allow anxiety to change what you do.

You don’t have to be a psychologist to see that 1-7 are all ways of saying “rely on the this method alone”. That leaves two pillars which are about not giving in to anxiety. Good stuff, but not good enough.

Interestingly for someone who says that the way to getting better is not to dwell on the details of your past problems, Mr Linden offers the story of his own problems in great detail in the “Nine Pillars” booklet. The story comes to its culmination when he received Cognitive-behaviour Therapy. His cognitive therapist taught him all kinds of useful stuff, which Linden applied and added to. I found myself musing about this. Why is this person, who benefited from cognitive therapy (and added to it in ways any sensible CBT therapist would encourage one to do) now taking the position that other people should not seek help from anyone except himself? I’m keeping my answers to myself, I’m afraid.

The Nine Pillars book then offers a reasonable account of the physiology of anxiety (although some of it made me wince). Nothing unique here, and certainly not the best account available. For someone opposed to the use of medication Linden seems very fond of biological accounts of anxiety. Oddly, although he seems to have benefited from cognitive-behavioural therapy, the cognitive component does not come through directly. For example, this early section on Panic Disorder he neglects to mention catastrophic misinterpretation of bodily sensations, choosing instead to suggest that the brain has been programmed to produce panic. Linden is also fond of diagnosis, and paraphrases the American diagnostic system as a way of describing anxiety disorders. This improves later as one listens to the CD based material, but the nuggets are well hidden.

The chapter on stopping anxiety has some good snippets, and Linden is fond of the idea of hyperventilation, resurrecting the old “brown paper bag” idea. Some other practical ideas are to be found in “diversion tactics”; these are good old fashioned distractions, varying from splashing water on the face to eating apples. Maybe he thinks an apple a day keeps the doctor away, so it fits with his first pillar? But there is another major problem here. He gives no consideration to safety seeking behaviour. This is a shame, because a lot of his “behavioural activation” stuff (meaning: don’t let your behaviour be changed, reach for the things you want) fits with current views on and evidence about the role of safety seeking in anxiety disorders. However, in places he is implicitly encouraging safety seeking behaviours. This in my opinion is further evidence that Linden’s science is, as best, muddled.

The supplementary materials are interesting. The introduction on the CD is a pleasant and slightly soporific lecture which re-iterates the positive message in the nine pillars book. In the interview which follows, we are treated to more of the same. The visualisation exercise is even more soporific. It follows the convention set by progressive muscular relaxation, and again is worth doing for its relaxation and distraction potential, if relaxation and distraction is what you need.

The “Panic Attack Eliminator” seemed more promising on the basis of its preamble. And I mean promising; the promise is there, right at the beginning; “this is the conclusive method for disarming panic attacks”. Apparently it can work on the first occasion, but might take up to three times. In the rest of this seven minute wonder, the sufferer is told that they cause their own panic. “Place every square millimetre of your body in my trust” Linden intones. Go with it, let it do its worst. Discover that it can’t do anything bad to you. At last, something resembling cognitive therapy! Not set up properly, but sensible. Fear of fear is emphasised, as are vicious circles. But they are not explained properly, and of course it is not fear of fear which is the problem in panic, but fear of the consequences of fear. Sadly, it is clear that this is not the conclusive method.
This is all a bit sad. One way of looking at it is that Charles Linden had cognitive behavioural therapy, found it helpful, embellished it and now markets it as his own one true way not just for the problem he had, but for all anxiety problems. It’s not.
Now don’t get me wrong, this is mostly sensible stuff for panic, and if it cost £5.99 at the bookshop, I’d be recommending it, suggesting that there might be useful snippets here and there.
My opinion is that it will be of no value to people whose anxiety is not fuelled by panic, and only limited value to most of those with severe and persistent panic. So would I recommend it in a limited way?
What makes any recommendation impossible is the cultic element. The explicit method is, use my method only (and pay my price for it). The National Institute for Clinical Excellence (NICE) anxiety guidelines are now available, summarising the best science. Cognitive behaviour therapy (CBT) is the treatment of choice. The Linden Method has no evidence underpinning it and therefore doesn’t even make third choice for NICE, which is guided self help based on CBT principles. Charles Linden’s method is not evidence based, the science is flawed and the price is ludicrous. In essence Linden claims this treatment is novel and effective; sadly, it seems likely that what is novel is not effective, and what is effective is not novel. My title for this review is that extraordinary claims require extraordinary evidence; there is no such evidence
Professor Paul M Salkovskis