Purple Hat 🥳 Therapies

Effective Therapy
Written By Luke R. Allen, PhD

A Theory Crisis in Psychology: Same Wine, New Bottles

What Are Purple Hat Therapies? This is when a good, proven therapy, principles, or intervention gets mixed with some weird, unproven stuff (the "purple hat"), and people think the weird stuff is why it works (credit for this metaphor goes to Rosen & Davison, 2003).

By my last count, there are at least 270+ different therapeutic approaches. The sheer number suggests that many theories may be overlapping, redundant, or based more on branding than substantive differences. This, for me, raises doubts about their efficacy and underlying theoretical claims. If hundreds of competing models claim to explain the same psychological problems and guide effective treatment, we should ask: what unique value does each new theory supposedly offer over existing approaches?

Psychology is in the middle of a quiet theory crisis (Eronen & Bringmann, 2021), which I think is damaging to the field. Unlike the better-publicized replication crisis (see Ioannidis, 2005), this crisis may be more insidious, in part, because it remains under-recognized, and therefore, more people are prone to unknowingly be influenced by it.

If so many clinicians are completing their training and going on to practice approaches with little empirical support, it raises the concern: Is the field able to critically apply science to practice? It also leaves clients with the difficult task of trying to figure which form of therapy is right for them.

Rebottling The Old as New

A common pattern in psychology is the recycling of old ideas under new labels. That is: the same wine, just in a new bottle. What often appears as a “new” or “innovative” intervention is frequently a repackaging of familiar cognitive, behavioral, or emotional processes in novel terminologies – just reframed with updated metaphors, trend-driven terminology, or better branding and marketing. Sometimes it comes with new headware (🎩).

For instance, observe the following similarities:

Core Process Delivered or Repackaged As
Cultivating Mindful Awareness & Psychological Distance Mindfulness (Buddhism, MBSR, MBCT); Present moment awareness & defusion (ACT); Decentering (MBCT); Metacognition (Cognitive Psychology); “Self” as compassionate witness (IFS); Somatic experiencing (Levine); Sensorimotor Therapy (Ogden); Focusing (Gendlin); Other related terms: grounding, observer perspective, interoceptive awareness.
Handling Tough Emotions Distress tolerance (DBT); Emotion regulation (Gross’ model); Sitting with feelings (IFS, Mindfulness); Urge/eotional surfing (pop psychology & addiction research); Exposure (behaviorism); Experiential acceptance (ACT).
Modifying Thought Patterns & Emotional Appraisal Cognitive retructuring (CBT); Reframing (Coaching, NLP); Reappraisal (Emotion research); Meaning-making (Existential Therapy); Insight (psychodynamic); Schema work (Schema Therapy); Belief-challenging (REBT); Unified detachment (IBCT).
Initiating & Sustaining Goal-Directed Behavior Behavioral activation (CBT); Values-based action (ACT); Commitment strategies (MI); Habit formation (self-help, behaviorism); Implementation intentions (Gollwitzer); Stages of change / Transtheoretical model (Prochaska & DiClemente).
Working with Internal Parts, Selves, or Modes Parts work (IFS); Ego states (Transactional Analysis); Subpersonalities (Psychosynthesis, Assagioli); Schema modes (Schema Therapy); Dialogical self (Hermans); Internal conflicts (psychodynamic traditions); Voice dialogue (Hal & Sidra Stone); Complexes (Jungian Psychology); Self-as-context & "physicalization" techniques (ACT).

Back to Purple Hats: Wild Claims

“Purple Hat Therapy” refers to any medical or psychological practice in which a well-established, evidence-based intervention is combined with an unlikely or implausible addition: like, metaphorically, wearing a purple hat. The resulting treatment is then claimed to be effective because of the novel addition, rather than the known therapeutic component.

  • Example: Doing exposure therapy while wearing a purple hat. The exposure helps, not the hat.

  • They often have a solid base + a "woo-woo" element. And they claim the woo-woo part is key.

Purple hat therapies may actual work, but not for the reason its proponents claim.

In psychological practice, purple hat therapies often feature:

  • A plausible core (e.g., behavioral activation, exposure, empathic listening),

  • Paired with a speculative or pseudoscientific element (e.g., tapping meridians, tracking eye movements, manipulating “energy fields”),

  • With causal attribution redirected toward the speculative component.

Here are some commonly cited examples:

Modality Credible Core Speculative Addition Evidence Gap
Eye Movement Desensitization & Reprocessing (EMDR) Trauma exposure, memory reconsolidation Guided lateral eye movements Eye movements appear non-essential; structured exposure is likely the mechanism.[1-4]
Neuro-Linguistic Programming (NLP) Rapport building, imitation Claims about neurological programming via language Theoretical vagueness; often relies on vague neuro-talk; lack of empirical support.[5-6]
Energy Psychology (e.g., EFT) Verbal processing, desensitization Tapping meridians, manipulating “energy” No known physiological energy systems; framed in pseudoscientific language. Falsified claims.[7]
Brainspotting Focused attention, trauma recall “Brainspots” accessed through eye position Untested and theoretically implausible.[8]
Polyvagal Therapy (PVT) Autonomic regulation, safety signaling Specific claims about vagus nerve "hierarchies" and social engagement circuits Contradicted by neurophysiological evidence; clinical application lacks controlled support.[9]
📚 Show References

[1] Davidson, P. R., & Parker, K. C. H. (2001). Eye movement desensitization and reprocessing (EMDR): A meta-analysis. Journal of Consulting and Clinical Psychology, 69(2), 305-316.
[2] Houben, S. T., Otgaar, H., Roelofs, J., Merckelbach, H., & Muris, P. (2020). The effects of eye movements and alternative dual tasks on the vividness and emotionality of negative autobiographical memories: A meta-analysis of laboratory studies. Journal of Experimental Psychopathology, 11(1).
[3] McLean, C. P., Levy, H. C., Miller, M. L., & Tolin, D. F. (2022). Exposure therapy for PTSD: A meta-analysis. Clinical Psychology Review, 91, 102115.
[4] Wright, S. L., Karyotaki, E., Cuijpers, P., Bisson, J., Papola, D., Witteveen, A., ... & Sijbrandij, M. (2024). EMDR v. other psychological therapies for PTSD: a systematic review and individual participant data meta-analysis. Psychological Medicine, 54(8), 1580-1588.
[5] Kattimani, S., & Abhijita, B. (2024). Neurolinguistic programming: Old wine in new glass. Indian Journal of Psychiatry, 66(3), 304-306.
[6] Witkowski, T. (2010). Thirty-five years of research on NLP. NLP Research Data Base. State of the art or psuedoscientific Decoration? Polish Psychological Bulletin.
[7] Rosa, L., Rosa, E., Sarner, L., & Barrett, S. (1998). A close look at therapeutic touch. JAMA, 279(13), 1005-1010.
[8] McKay, D., & Coreil, A. (2024). Hypothesis testing of the adoption of pseudoscientific methods. Medical Hypotheses, 182, 111229.
[9] Grossman, P. (2023). Fundamental challenges and likely refutations of the five basic premises of the polyvagal theory. Biological Psychology, 18, 108589.

Are Newer Theories Really Better?

Marketing vs. Meaningful Innovation. These "innovations" often appear driven less by clinical necessity (given the many effective interventions already available) and more by commercial incentives (e.g., book sales, training fees), lack of familiarity with foundational principles (like behaviorism or the philosophy of science), or the pursuit of therapeutic celebrity or guru status. Some new approaches succeed not because they're better, but because they're marketed more effectively.

The Dodo Bird Verdict (from 1936, referencing Alice in Wonderland’s “Everybody has won, and all must have prizes”) acknowledged that many therapies yield similar outcomes. This implies that common factors, like therapeutic alliance, client expectations, or hope, may matter more than the specific techniques these newer models emphasize.

Process vs. Outcome-Based Research

When evaluating interventions, it's useful to distinguish between:

  • Outcome research: shows if a therapy reduces symptoms or improves functioning.

  • Process research: reveals how or why a therapy works.

A therapuetic approach may produce results, but that doesn't mean its proposed mechanisms make sense or are supported by the scientific literature. Some interventions lean toward pseudoscience, relying on anecdote or unfalsifiable claims, yet still yield positive outcomes due to placebo effects, spontaneous recovery, or common factors like relationship quality and client motivation.

Stick With What Works (Until Proven Otherwise)

In medicine and other intervention-based fields, new treatments should outperform existing standards through multiple high-quality, independent Randomized Controlled Trials (RCTs) before adoption. Psychology often falls short of this evidentiary bar.

The field still suffers from a sort of novelty bias: the appeal of new therapies promising faster, deeper, or trendier results. Online therapist communities often show how enthusiasm outpaces evidence. Early studies may show large effects, but these are frequently inflated by small samples, weak designs, or publication bias. As replication increases, these effects tend to shrink or vanish (i.e., the decline effect). Yet clinicians continue training in and promoting such “purple hat” therapies, even when the "hat" adds nothing to outcomes.

So what’s the takeaway?

Stick with what works and be skeptical of what’s new until it consistently and reliably proves better.

Clinicians shouldn’t adopt new therapies unless they:

  • Outperform existing, evidence-based treatments, not just waitlists or placebos.

  • Succeed across multiple, high-quality RCTs, not just a few small or biased studies that may inflate effect size.

Until that happens, established therapies, especially those in the cognitive and behavioral traditions, remain the most reliable options. These approaches are grounded, replicable, and built on mechanisms that have withstood critical scrutiny.

Psychology doesn’t need any more purple hats. They just distract from what already works.

  • If you're interested in exploring these issues more, consider the following recommendations:

    🔍 For Curious Clients

    • PsychoBabble and BioBunk (3rd Ed.) by Carol Tavris: A witty and accessible guide to separating psychological fact from fiction.

    • 50 Great Myths of Popular Psychology by Scott Lilienfeld et al: A myth-busting introduction to what psychology really knows, and what it doesn't.

    🧠 For Practitioners

    🧬 For the Philosophically Inclined

    • Medical Nihilism by Jacob Stegenga: A compelling argument for skepticism about medical (and by extension, psychological) intervention claims. Essential reading for anyone questioning how we know what works.

    Professional Associations Solidly Rooted in the Evidence:

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Luke R. Allen, PhD

Dr. Luke Allen is a licensed psychologist in Oregon and Nevada in full-time telehealth private practice. He has Authority to Practice Interjurisdictional Telepsychology (APIT) in 33+ states granted by the PSYPACT commission. He specializes in gender care, LGBTQ+ health, anxiety, depression, & body-focused repetitive behaviors.

https://www.LukeAllenPhD.com
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