"Man Therapy" - an online therapy format for men. Does it work?
No additional benefit was found, but don't let that stop the claims!
When it comes to suicide, it is a well known phenomenon in Western cultures that men outnumber women. This is not completely universal; there are some societies in which sex-differentiated suicide rates approximate each other (Western Pacific, Some Southeast Asian Countries, Western Pacific), however in North America and most of Europe, men account for 70-80% of suicides.
Targeting suicide prevention in many nations, therefore, would be advantageous if there was a way to ensure that more men received suicide prevention efforts, and that those efforts worked! Suicide prevention has a few evidence-based approaches (means restriction, post-distress contact, and economic support have some evidence of effectiveness), but evidence supporting any specific therapy (from antidepressants to cognitive behavioural therapy to dialectical behavioural therapy to exercise to etc. etc. etc) for preventing suicide is quite absent.
Enter Man Therapy
Man Therapy is an innovative therapy program specifically designed to address the mental health needs of men. With a humorous and engaging approach, Man Therapy aims to break down the stigma surrounding mental health issues and encourage men to seek help when they need it. The program's website, https://mantherapy.org/, offers a wealth of resources to help men better understand and address their mental health concerns.
Key Features of Man Therapy:
Humor-infused approach: By presenting information in a light-hearted, yet informative way, Man Therapy aims to create a comfortable space for men to learn about and discuss their mental health.
Dr. Rich Mahogany: The face of Man Therapy, Dr. Rich Mahogany, is a fictional character portrayed by an actor. This mustachioed, manly therapist serves as a relatable and engaging guide, offering advice and resources to help men address their mental health issues.
Comprehensive resources: The Man Therapy website offers a wide array of resources, including videos, articles, and self-assessment tools on stress, depression, anxiety, anger, substance abuse, and suicide prevention.
Man Therapy's 20-Point Head Inspection: This unique feature is a comprehensive mental health check-up designed to help men identify any areas of concern.
“A research-backed tool that reduces suicidal ideation” … but does it?!?
I was quite excited to explore this, but what caught my eye was this, on the about page:
Reduces depression? Suicide Risk? $1.2 million dollar study confirms it?
The study is freely available on the website. I read it in full. I would say I was disappointed to read the results, but really, I sort of expect this. The study shows that Man Therapy conferred no additional benefit for men in the study.
From the article itself (bold mine), for suicidal ideation:
No statistically significant effect [on suicidal ideation] was observed for group assignment [Man Therapy intervention vs. control group] on intercept. Although there was no group effect, the negative slope indicates that SI scores decreased over time. [For both groups]
From the article itself (bold mine), for depression:
Group assignments [on depression] were not associated with intercept (b = 0.09, p = 0.08, 95% CI: −0.01, 0.19) or slope (b = −0.03, p = 0.16, 95% CI: −0.08, 0.01). Although there was no group effect, the negative slope indicates that depression scores decreased over time. [For both groups]
That’s right - the primary endpoint - depression and suicidal ideation - did NOT change regardless of whether or not the subjects received Man Therapy in addition to psychoeducation.
An example of Purple Hat Therapy
This is an example of “purple hat therapy.” This is a hypothetical practice (coined by Gerald Rosen and Gerald Davison in 2003) in which something that works or gets better on its own is combined with a purple hat, and then the claim is that the purple hat is what caused the improvement. If I did exactly the same study as the authors but studied “wearing a purple hat” as the intervention versus the control condition, I would get the exact same results (maybe better, because I’m awesome). So, like the authors, I could claim that “wearing a purple hat” works for suicide ideation and depression.
For secondary outcomes, it didn’t get better.
Results indicated that there were no statistically significant differences between the study groups in the change in any risk or protective factor over time. While not statistically significant, most scores on the risk and protective factors improved in the desired direction in both groups.
This is somewhat disappointing, because the authors kind of hide this in their written conclusion: (bolding done by me)
In conclusion, this study showed that online screening for men has potential to reduce SI and depression over time. Regarding MT, this study suggested that the online program may have a role in increasing protective factors for suicide while reducing risk factors. … MT could also be an intervention that responds to recently published guidelines encouraging us to expand “anti‐stigma education and pro‐help‐seeking messaging using creative strategies” and to “increase community‐level services and use of technology and virtual mechanisms” for populations at risk…
Funny… their conclusion doesn’t mention that MT did not change suicidal ideation or depression, and in fact, suggests that it may have a role in changing it. The text of the conclusion goes entirely against the results. (Fortunately, the abstract’s conclusion does indicate that there was no group difference.) I’m quite confident that if their results had been positive, a sentence in the conclusion may have been “MT improved suicidal ideation and depression outcomes compared to the control intervention.”
And it leads to the website’s claims, that men who receive Man Therapy “see decreases in suicidal ideation, depression…” … well, yes, yes they did. So, too, did the men who didn’t receive Man Therapy. The same decreases.
The bottom line: if it works for the person, great, but let’s not claim it’s evidence-based suicide prevention
I’ll admit. I liked the website. I thought it was well done. I think it’s a clever way to deliver psychoeducation to men. Great. Lean into that. If men enjoy the site and it helps them, great. But the evidence done by the authors show that there is no difference between receiving standard psychoeducation and going through the Man Therapy invervention.
Suicide is a complex problem, and a huge cause of death in the first decades of life. I understand wanting to have treatment that works, and I certainly understand the motivation behind the creation of Man Therapy. And hey, we know that it didn’t hurt.
But psychology researchers absolutely have to stop making claims that their Purple Hat therapy works.