Category: Mental health

Have we overestimated the effectiveness of psychotherapy?

Depression ReliefBy Christian Jarrett

Most people who undertake psychotherapy seem to benefit from it. How do we know? Arguably, the most important evidence comes from meta-analyses that combine the results from many – sometimes hundreds – of randomly controlled trials. Based on this, it’s been estimated that psychotherapy is effective for about 80 per cent of people (meanwhile, between five to 10 per cent of clients may suffer adverse effects).

But now the more concerning news: a team of researchers led by Evangelos Evangelou at the University of Ioannina, Greece has assessed the quality of 247 of these psychotherapy meta-analyses and they report in Acta Psychiatrica Scandinavica that many of them have serious methodological short-comings.

Coincidentally, a separate research group led by Brent Roberts at the University of Illinois, Urbana-Champaign has just published in Journal of Personality some of the first observational data on how people’s personalities change after undertaking psychotherapy. In contrast to what’s been found in the clinical literature, they report that people who’ve been in therapy seem to show negative changes in personality and other psychological outcomes.

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New study fails to find any psychological benefits of volunteering, but that doesn’t mean you should stop

The London 2012 Olympic VolunteersBy Alex Fradera

Volunteer! Universities, community groups and even the NHS recommend it, citing benefits for society and also yourself. The claimed personal outcomes include boosting your health and subjective wellbeing, but while the former is slowly gathering experimental backing, the wellbeing research is overwhelmingly correlational, making it hard to prove that volunteering is causing the gains (it’s certainly plausible, for instance, that happier people are simply more inclined to give up their time for free). Now the journal Comprehensive Results in Social Psychology has published a more robust test: a randomised study. The researchers looked for evidence to support the mental wellbeing benefits from volunteering … but they looked in vain.

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There’s such a thing as “autism camouflaging” and it might explain why some people are diagnosed so late

By guest blogger Helge Hasselmann

While autism is usually diagnosed in childhood, some people remain “off the radar” for a long time and only receive a diagnosis much later. One possible reason is that they have learned socially appropriate behaviours, effectively camouflaging their social difficulties, including maintaining eye contact during conversations, memorising jokes or imitating facial expressions.

This pattern of behaviour could have serious consequences for the lives of some people with autism. It is easy to imagine that camouflaging demands significant cognitive effort, leading to mental exhaustion over time, and in extreme cases perhaps also contributing to anxiety and depression.

If there are gender differences in camouflaging, this could also help explain the well-known male preponderance in autism spectrum disorders. At least part of the gender imbalance may, in fact, stem from an under-diagnosis of autism in girls because they are better at “masking” symptoms.

Before now, autism camouflaging has not been studied in a systematic and standardised manner: a recent open-access study in the journal Autism, by Meng-Chuan Lai and his colleagues, is the first to offer an operationalisation of camouflaging, which they define as the discrepancy between internal and external states in social-interpersonal contexts. For instance, if an autistic person maintains eye contact during a conversation because they have learnt that this is socially appropriate, even though this clashes with how they really want to behave, this would be an example of camouflaging.

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Textbook fail: Rosenhan’s classic “On Being Sane In Insane Places” covered without criticism

16373344899_be8f8a89e1_bBy Christian Jarrett

Back in the 1970s, eight mentally well people, including psychologist David Rosenhan, presented themselves at psychiatric hospitals, where they showed signs of mild anxiety and complained of auditory hallucinations, specifically words like “empty” and “hollow”. All were admitted and either diagnosed with schizophrenia or, in one case, manic depression, and, despite acting “normal” after arrival, they were kept in hospital for an average of 19 days. On discharge all were described as having schizophrenia (or depression) “in remission”.

This was Rosenhan’s classic study “On Being Sane in Insane Places” which he claimed showed the stigmatising power of psychiatric labels and the inability of psychiatric staff to distinguish normality from supposed abnormality, as have many others since.

But from a methodological perspective, the study was problematic for a number of reasons and Rosenhan’s interpretation has been hotly disputed. In their highly regarded book on psychology myths, Scott Lilienfeld and his co-authors discuss the problem with Rosenhan’s study at length, such as the fact that in the 70s “in remission” was a very rare discharge diagnosis that actually showed psychiatric staff had realised the “pseudo patients” were mentally well.

Ultimately, Lilienfeld et al argue that it is a myth that “psychiatric labels cause harm by stigmatising people” and that the overly gullible interpretation of the Rosenhan study has helped propagate this myth. Others may disagree, but it’s at least fair to say that Rosenhan’s study had serious issues and that not all psychologists agree that psychiatric labels are in themselves harmful (consider too research that’s found that while clients say psychiatric labels can be difficult to deal with, they can also be beneficial in some ways, in terms of helping them understand their experiences and helping them to access appropriate treatments).

So, how is this classic study covered in textbooks relating to clinical psychology and mental health (the sub-discipline usually referred to on university courses as “abnormal psychology”)? In a new survey of 12 contemporary abnormal psych textbooks in the journal Teaching of Psychology, Jared Bartels and Daniel Peters found that half of them still give space to Rosenhan’s flawed study, but only two include any criticism or alternative interpretation of it at all.

This is a small survey and we’re not told the titles of the books, but the findings suggest that the problem of uncritical textbook coverage of social psychology’s classic, myth-like studies, such as the Stanford Prison Experiment and Milgram’s “obedience research”, may also extend to the realm of classic mental health-related research. Is it that textbook authors are unaware of the criticisms of the Rosenhan study? Possibly, although Bartels and Peters surmise that perhaps authors know of the issues and alternative interpretations, but that these “shortcomings … are considered less important than the edifying message of the stigmatising effect of labels”.

Coverage of Rosenhan’s “On Being Sane in Insane Places” in Abnormal Psychology Textbooks

Image via Flickr/Freaktography

Christian Jarrett (@Psych_Writer) is Editor of BPS Research Digest

 

Where do women look when sizing each other up?

Friends enjoying a party in nightclubBy Christian Jarrett

Studies show that when heterosexual women look at other women’s bodies, they, just like men, tend to spend a disproportionate amount of time looking at their waists, hips and breasts, as if estimating how much they will appeal to men. This is consistent with “mate selection theory” which argues, among other things, that women have evolved strategies to monitor potential love rivals. However, psychologists are interested in this topic, not only from an evolutionary perspective, but also because women who feel dissatisfied with their bodies, and who are vulnerable to developing eating disorders, may be especially pre-occupied with comparing their body against others, potentially exacerbating their anxieties.

Past research is mixed: some studies suggest women with body dissatisfaction and/or eating disorders pay disproportionate attention to the bodies of thin women, other studies suggest the opposite. A new exploratory paper in Psychological Research says hang on a minute, we don’t actually know much about how healthy, confident women behave when they look at other women, nor whether their attention is influenced by their feelings about their own bodies.

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We know what will make us happy, why do we watch TV instead?

By Christian Jarrett

The luxury microwave meal was delicious, the house is warm, work’s going OK, but you’re just not feeling very happy. Some positive psychologists believe this is because many of us in rich, Western countries spend too much of our free time on passive activities, like bingeing on Netflix and browsing Twitter, rather than on active, psychologically demanding activities, like cooking, sports or playing music, that allow the opportunity to experience “flow” – that magic juncture where your abilities only just meet the demands of the challenge. A new paper in the Journal of Positive Psychology examines this dilemma. Do we realise that pursuing more active, challenging activities will make us happier in the long-run? If so, why then do we opt to spend so much more time lazing around engaged in activities that are pleasant in the moment, but unlikely to bring any lasting fulfilment?

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The reasons why, once we start worrying, some of us just can’t stop

By Christian Jarrett

A certain amount of worrying is a normal part of life, especially these days with barely a moment passing without a disconcerting headline landing in your news feed. But for some people, their worrying reaches pathological levels. They just can’t stop wondering “What if …?”. It becomes distressing and feels out of control. In the formal jargon, they would likely be diagnosed with Generalised Anxiety Disorder, but excessive worrying is also a part of other conditions like panic disorder. There are many factors that contribute to anxiety problems in general, but a new review in Biological Psychology homes in on the cognitive and emotional factors that specifically contribute to prolonged bouts of worry. Its take-home points make an interesting read for anyone who considers themselves a worrier, and for therapists, the review highlights some approaches to help anxious clients get a hold of their excessive worrying.

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A fear of feeling guilty might be key to some forms of OCD

On/Off SwitchBy Christian Jarrett

There’s increasing recognition that our vulnerability to mental health problems isn’t just about how much we are prone to certain emotions such as anxiety and low mood, but also how we relate to those emotions. If we find them aversive and intolerable, we’re more likely to develop problems. A new study in Clinical Psychology and Psychotherapy applies this principle to people’s experience of guilt and their vulnerability to Obsessive Compulsive Disorder (OCD), helping make sense of why past research has been inconsistent on whether guilt-proneness is a risk factor for OCD or not. Gabriele Melli and his colleagues provide new evidence that the inconsistent results might be because the key factor is not how much guilt you suffer, but whether you’re highly guilt-sensitive. They found that clients with OCD who said they found guilt unbearable were especially likely to have OCD symptoms related to compulsive checking, such as checking doors are locked and ovens switched off. Though preliminary, the results point to new ways to help clients with this kind of OCD.

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After half a century of research, psychology can’t predict suicidal behaviours better than by coin flip

African American Depressive Sad Broken Heart ConceptBy guest blogger Tomasz Witkowski

“There is but one truly serious philosophical problem and that is suicide” the French author and philosopher Albert Camus stated. But it is not only philosophers who are moved by this issue. Psychologists are seeking ways of preventing this tragic death, and health care organisations are sounding the alarm. Around a million people die at their own hand every year, which makes suicide the tenth most common cause of death. Additionally, for every completed suicide, there are 10 to 40 survived attempts, which means that in the USA alone 650,000 people each year are taken to emergency rooms following an attempt on their own life. Yet what is most disturbing is that the number of suicides is continually rising. The WHO reports that since the 1960s this number has grown over 60 per cent.

Is psychology capable of identifying the risk factors that can push people to take their own lives? Joseph Franklin at Florida State University and his research team at the Technology and Psychopathy (TAP) Lab have provided an answer, but it is a disappointing one. Our capacity to predict whether someone will make a suicide attempt is no better than chance. What is worse, we have not made any progress in this area in the last half-century. These striking conclusions come as the result of a meta-analysis of 365 studies into suicide risk conducted over the last 50 years and published recently in Psychological Bulletin (pdf).

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A little discussed effect of therapy: it changes your personality

By Christian Jarrett

Imagine the arrival of some high-tech brain device for treating mental health problems. It’s effective for many, but there’s an important side-effect. It changes your personality. Alarm ensues as campaigners warn that users risk being altered fundamentally for years to come. Now replay this scenario but replace the neuro-gizmo with good old-fashioned psychotherapy, and realise this: we’re talking fact, not fiction. A new meta-analysis in Psychological Bulletin has looked at 207 psychotherapy and related studies published between 1959 and 2013, involving over 20,000 participants, with measures of personality taken repeatedly over time. The analysis has found that just a few weeks of therapy is associated with significant and long-lasting changes in clients’ personalities, especially reductions in the trait of Neuroticism and increases in Extraversion.

Continue reading “A little discussed effect of therapy: it changes your personality”