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As a supporter of evidence-based treatment (EBT), and someone who endeavours to cite my sources and back up my claims wherever possible, I find the lack of science in some circles really frustrating. I recently stumbled upon an organization called International Suicide Prevention run by Matthew D. Dovel that makes very fantastic claims about the effectiveness of a treatment or set of treatments called “Nu-Rekall” on mental health and suicide, unmatched by any other treatment and without any peer reviewed studies to support their efficacy.
Naturally, my curiosity was piqued, but the Nu-Rekall treatment is vague and the proprietor, as I explain below, appears not to have the background necessary to treat mental health disorders. My hope with this article is to stimulate discussion on EBT, and to publicly challenge Mr. Dovel to bring his work in-line with established best practices.
All the quoted content below is used within the DMCA and 17 U.S.C. § 107 on Fair Use in the United States and § 29.1 of the Copyright Act of Canada.
Matthew D. Dovel
Matthew Dovel says on his website that he is a suicide prevention expert. He also says he is a scientist. Everyone has different criteria for that word, but I would define a scientist as someone who contributes to the body of knowledge in a field through academic scholarship, like publishing in a journal.
His academic education includes:
- Charter College-Anchorage (2 years), took Computer Aided Drafting (CAD)
- University of Nevada-Las Vegas (3 years), majored in Civil Engineering and minored in Psychology and Business. It’s unclear if Dovel earned a degree here.
- Palomar College (2 years), he indicates mostly computer-related topics but may have taken a couple Psychology courses
In addition to these formal educational pursuits Dovel also notes PSI Seminars and other self-help workshops. There is no evidence that he has participated in any training or education related to Social Work, Psychology, Medicine or an allied field relevant to mental health, nor has he indicated any evidence-based training in suicide intervention like Applied Suicide Intervention Skills Training (ASIST), QPR, or others.
Since March 2015, Dovel has sat on the Editorial Board of the prestigious-sounding International Journal of Emergency Mental Health and Human Resilience which is published by OMICS Group. That someone can sit on an editorial board with no graduate study or published literature themselves is worrisome. That journal is not indexed by PubMed or other reputable warehouses for scientific data, like most of the OMICS Group journals.
His LinkedIn proclaims that “There is no one better than I am at preventing suicides!”, I have my doubts.
Dovel has written a book called “Life After Death” chronicling two Near Death Experiences (NDE). It appears to be these NDE, not his suicide prevention work, that led him to be profiled on Good Morning America (you can see that interview here), A&E and 20/20. This is clearly stated on his LinkedIn in the publications section, but is less clear in other areas, such as the about page of his organization ISP (detailed below) where he states under a column about partnerships with ISP “As seen on:CBS, NBC, ABC, FOX, ESPN, Coast to Coast, Good Morning America, 20/20,.” This is very misleading.
Some of his other (self) publications include:
- Suicide Prevention Guide Booklet (S.P.G.B.) (detailed more below)
NEW Self-help for depression, anxiety and/or suicidal thoughts (4 Phase) This page introduces the 4 Phase model, also described below
Suicide is a Temporary Solution to a Permanent Problem. This article, published in the International Journal of Emergency Mental Health and Human Resilience (of which Dovel is an editor) appears not to be written at the level of a peer-reviewed journal article
Other potentially misleading items include an article titled “Psychology Today: Abstract – New Treatments that Cure Suicidal Ideation“. This article has no connection to the magazine Psychology Today but rather that is part of the article’s title.
International Suicide Prevention (ISP)
International Suicide Prevention is Dovel’s charity. It is a registered 501(c)(3) non-profit (EIN#20-4671131), though its Form 990 indicates less than $25,000 in revenue.
On the contact page, there is an opportunity to buy posters promoting ISP with their 24/7 helpline number (which Dovel claims he answered himself for 10 years.)
There is no attribution indicating he has permission to use the intellectual property of Fox, which owns the rights to the Fry character from the TV series Futurama. Update: Dec-20-2016: This image has been removed, though other potentially infringing images may remain.
On the page for law enforcement targeted initiatives, Dovel notes that his Suicide Prevention Guide Booklet has been “endorsed by mental health professionals, doctors, and advanced behavioral studies experts as a viable solution to drastically reduce suicide rates.” Although he does list one endorsement by a Psychologist in the back of the handbook, the other individual listed is a neurolinguistic programming practitioner. There is insufficient evidence to support the efficacy of NLP (Sturt, et. al., 2012).
On an ISP page listing endorsements Dovel lists an orthopedic surgeon (Andrea E. Salvi) as endorsing his material. This surgeon is also a Board Member of an OMICS Group Journal, and appears to have has no professional experience in psychology or suicide. I can find no evidence to support Salvi’s assertion that he has performed any work for the US military.
Nu-Rekall (trademarked) is the basis for the treatments that Dovel promotes. The website claims that “Nu-Rekall™ has self-help procedures that are completely autonomous removing suicidal ideation permanently.” Dovel does not link to any peer-reviewed studies evaluating his techniques. Dovel claims he helps over 200 individuals daily, but as this page suggests, he is likely counting every visitor to his website as a client he has delivered service to.
He charges nearly $5,000 on his website for training in his Nu-rekall methods.
4 Phase Model
Dovel does actually describe his 4 phase model on one page. I’ve paraphrased it here to the best of my ability.
- The client should ask themselves how long they’ve been suicidal and what occurred at the time those suicidal thoughts started?
- Next, because the treatment can cause amnesia, the client fills out a questionnaire about the event that triggered the suicidal thoughts and its emotional intensity
- Now the client imagines the event occurring again, but changes details about it (such as altering the weather)
No peer-reviewed studies are provided to explain why this movement technique is supposed to have any impact on one’s suicidality or emotional state, and ignores that for many people suicidal thoughts are not caused by a single distressing event but rather a constellation of risk factors, with no identifiable cause at all (see the Suicide Prevention Resource Centre’s list of suicide risk factors, the majority of which are not negative life events.)
Suicide Prevention Guide Booklet (SPGB)
This booklet (running 32 pages with wide margins and a large font) includes two ad spaces, both unused. Rather than go through the book line by line I’ve picked out some quotes for commentary.
“it takes fewer muscles to smile than to get angry according to Japanese’s” (this article confirms the origins of the concept that it takes fewer muscles to smile than to frown are uncertain; there’s no evidence suggesting they are Japanese.)
“Education has been shown to be the best method for reducing suicide rates.” Certainly, training gatekeepers is important. But educating clients themselves in methods of self-help has a limited contribution to the suicide rate when compared to broad community interventions that works on multiple levels, as Fountoulakis, Gonda, & Rihmer (2011) explain.
“According to scientific research humans have only two core emotions: love, and fear.” This is also incorrect. It used to be thought that there were 6 core emotions (anger, fear, surprise, disgust, happiness and sadness), although research from the University of Glasgow (Jack, Garrod & Schyns, 2014) suggests four (anger, fear, happiness, sadness.)
Russell (2003; 2009) conceptualizes “core affect” as the idea of feeling either good or bad – but there are no studies that I could find indicating two core emotions of love and fear.
“At the University of Berkley, California a study was done on a group of Manic Depressants with just the following self-therapy for one year. At the end of the year ALL were declassified as Manically Depressed.” Note the spelling errors and the use of the outdated term “manic depressive” (manic depression was replaced in the DSM-III in 1980 with “bipolar disorder”) while person-centered language would suggest calling the participants “people with bipolar disorder” instead. There’s is no citation listed and I would doubt if any such study ever existed.
“Top two reasons for a suicide attempt[:] The sudden change of status for an individual’s: romantic, and/or financial situation.” While there is support to the idea that relational changes commonly precede a suicide attempt (e.g. Yen et. al., 2005; Bagg, Glenn & Lee, 2013; Conner, et. al., 2012) that is because social support is an important buffer to suicide. (Gonçalves, et. al., 2014; Kleiman, Riskind, & Schaefer, 2014; Farrell, Bolland & Cockerham, 2014; Kleiman, et. al., 2012; Hirsch & Barton, 2011)
While Hempstead & Phillips (2015) notes that financial issues can lead to suicide, “mental illness, health problems, and other personal issues [and] access to lethal means also importantly affects suicide risk.” It appears that financial issues only commonly precede suicide in middle age.
Near the end is an “EMR” (Emotional Memory Removal) chart that requires an individual to think about a strong emotion while raising or lowering their hands (the chart indicates when to do which) and saying a number out loud, and then repeating the process but raising an arm and a leg. No sources are provided for why this would be effective.
I reached out to Dovel for some clarification on the evidence-base for his work. He responded linking me to some of the sources that you see above. He also linked me to this suggested evaluation of his techniques.
The way the study appears to be constructed was that Dovel would have each participant rate their suicidal thoughts on a scale of 1-10. Then they would perform the Nu-Rekall procedures and receive a follow up call at 1 week, 1 month and 6 months to determine if the level of their intensity increased or decreased, and whether they had demonstrated any suicidal behaviour.
There are a number of methodological issues with this study that would prevent it from being accepted for peer review. Just a few that come to mind:
- He indicates he had 500 volunteers (gender-matched exactly 50/50), but he only started with 60. Each month he surveyed other callers for a total of 500 surveys. If that’s the case, there is not 6 months of continuous data (as in a longitudinal design) for 500 people, there is 6 months of data for 60 people, severely limiting the usefulness of the large sample size.
- There is a failure to define intensity (how do you verify a change if you’re not defining the variables?)
- There is a failure to define suicidal behaviour or how he determined there was no recurrence in suicidal behaviour
- There is a failure to control for the impact that emotional support from any helper would provide (a control group where someone received supportive check-ins without doing Nu-Rekall would have showed this)
Best Practices and Recommendations
I invite Dovel to follow some recommendations for himself, his website and the Nu-Rekall program. These include:
- Taking a proper suicide intervention training like ASIST so that he can incorporate the evidence-base into his literature
- Change references to the ISP helpline number to the National Suicide Prevention Lifeline (1-800-273-8255) until such time as Dovel has completed helpline training through an NSPL or AAS-accredited crisis line. This will ensure he is competent to perform suicide risk assessment
- Consider completing the AAS Crisis Worker certification
- Write up a proper proposal for a study of the Nu-Rekall techniques that includes repeatable methods, proper controls, and results and then having that study performed by an independent third party
- Get that study peer-reviewed and published in a PubMed-indexed journal to open it to critique
- Remove references to media like Good Morning America and 20/20 from the ISP websites so that visitors are not misled into thinking those appearances were related to suicide prevention work; make it clear those appearances were focused on near-death experiences
- Provide citations for claims throughout existing pamphlets (like the UC Berkeley study noted above)
Bagge, C. L., Glenn, C. R., & Lee, H. (2013). Quantifying the impact of recent negative life events on suicide attempts. Journal Of Abnormal Psychology, 122(2), 359-368. doi:10.1037/a0030371
Conner, K. R., Houston, R. J., Swogger, M. T., Conwell, Y., You, S., He, H., & … Duberstein, P. R. (2012). Stressful life events and suicidal behavior in adults with alcohol use disorders: Role of event severity, timing, and type. Drug & Alcohol Dependence, 120(1-3), 155-161. doi:10.1016/j.drugalcdep.2011.07.013
Sturt, J., Ali, S., Robertson, W., Metcalfe, D., Grove, A., Bourne, C., & Bridle, C. (2012). Neurolinguistic programming: a systematic review of the effects on health outcomes. The British Journal Of General Practice: The Journal Of The Royal College Of General Practitioners, 62(604), e757-e764. doi:10.3399/bjgp12X658287
Farrell, C. T., Bolland, J. M., & Cockerham, W. C. (2014). Original article: The Role of Social Support and Social Context on the Incidence of Attempted Suicide Among Adolescents Living in Extremely Impoverished Communities. Journal Of Adolescent Health, doi:10.1016/j.jadohealth.2014.08.015
Fountoulakis, K. N., Gonda, X., & Rihmer, Z. (2011). Review: Suicide prevention programs through community intervention. Journal Of Affective Disorders, 13010-16. doi:10.1016/j.jad.2010.06.009
Gonçalves, A., Sequeira, C., Duarte, J., & Freitas, P. (2014). Suicide ideation in higher education students: influence of social support. Atencion Primaria, 46(Supplement 5), 88-91. doi:10.1016/S0212-6567(14)70072-1
Hempstead, K. A., & Phillips, J. A. (2015). Research Article: Rising Suicide Among Adults Aged 40–64 Years. The Role of Job and Financial Circumstances. American Journal Of Preventive Medicine, 48491-500. doi:10.1016/j.amepre.2014.11.006
Hirsch, J. K., & Barton, A. L. (2011). Positive Social Support, Negative Social Exchanges, and Suicidal Behavior in College Students. Journal Of American College Health, 59(5), 393-398. doi:10.1080/07448481.2010.515635
Jack, R. E., Garrod, O. G., & Schyns, P. G. (2014). Dynamic Facial Expressions of Emotion Transmit an Evolving Hierarchy of Signals over Time. Current Biology, (2), 187. doi:10.1016/j.cub.2013.11.064
Kleiman, E. M., Riskind, J. H., & Schaefer, K. E. (2014). Social Support and Positive Events as Suicide Resiliency Factors: Examination of Synergistic Buffering Effects. Archives Of Suicide Research, 18(2), 144-155. doi:10.1080/13811118.2013.826155
Kleiman, E. M., Riskind, J. H., Schaefer, K. E., & Weingarden, H. (2012). The moderating role of social support on the relationship between impulsivity and suicide risk. Crisis: The Journal Of Crisis Intervention And Suicide Prevention, 33(5), 273-279. doi:10.1027/0227-5910/a000136
Russell, J.A. (2003) Core Affect and the Psychological Construction of Emotion. Psychological Review. 110(1). 145-172. DOI: 10.1037/0033-295X.110.1.145
Russell, J. A. (2009). Emotion, core affect, and psychological construction. Cognition & Emotion, 23(7), 1259-1283. doi:10.1080/02699930902809375
Yen, S., Pagano, M. E., Shea, M. T., Grilo, C. M., Gunderson, J. G., Skodol, A. E., & … Zanarini, M. C. (2005). Recent Life Events Preceding Suicide Attempts in a Personality Disorder Sample: Findings From the Collaborative Longitudinal Personality Disorders Study. Journal Of Consulting And Clinical Psychology, 73(1), 99-105. doi:10.1037/0022-006X.73.1.99