Forgive yourself for relaxing in front of the TV and the couch time might actually do you some good

There’s a snobbishness about relaxation time. Tell someone your hobby is watching TV and chances are they’ll look at you with derision. Mention meditation, reading or yoga and you’re far more likely to attract nods of approval.

And yet there is substantial evidence that time watching TV or playing video games can have a powerful restorative effect – just what many of us need after a hard day. This benefit isn’t found for everyone, and in new paper Leonard Reinecke and his collaborators propose that a key reason has to do with guilt.

The researchers think that it is people who are mentally exhausted, who are most likely to experience guilt after vegging out with a box set or video game. This is because, in their depleted state, these people see their behaviour as procrastination. This leads to the paradoxical situation in which it is the people who could most benefit from the restorative effects of lounge-based downtime who are the least likely to do so.

To test their ideas, Reinecke’s team surveyed nearly 500 people in Germany and Switzerland. Participants were recruited via a gaming website and through psychology and communication classes.  Specifically, the participants answered questions about the previous day, including how much work or study they’d done (answers ranged from half an hour to 16 hours), how depleted they felt after work or college, how much TV they’d watched or video-gaming they’d played (this averaged around two hours), whether they viewed it as procrastination, whether they felt guilty, and how recharged they felt afterwards.

The key finding is that the more depleted people felt after work (agreeing with statements like “I felt like my willpower was gone”), the more they tended to view their TV or gaming as procrastination, the more guilt they felt, and the less likely they were to say they felt restored afterwards. The same findings applied for TV or video games.

“Rather than diminishing the beneficial potential of entertaining media,” the researchers said, “we believe that the results of this study may ultimately help to optimise the well-being outcomes of entertaining media use by extending our knowledge of the mechanisms furthering and hindering media-induced recovery and general well-being.” If the researchers are correct, then if you cut yourself some slack when you watch TV after a hard day, you’re more likely feel rejuvenated afterwards.

Unfortunately, as the researchers admit in their paper, their methodological approach has several limitations. Above all, this wasn’t an experimental study (with people allocated randomly to different interventions). This means the data can be interpreted in many different ways. One alternative reading of the results is that when TV or gaming fails to have a restorative effect, this leads people to view the time as wasteful procrastination, thus causing them to feel guilty.

http://digest.bps.org.uk/2014/09/forgive-yourself-for-relaxing-in-front.html

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Did a five-day camp without digital devices really boost children’s interpersonal skills?

“There’s a brilliant study that came out two weeks ago,” Baroness Professor Susan Greenfield said at a recent event promoting her new book, “… they took away all [the pre-teens’] digital devices for five days and sent them to summer camp … and tested their interpersonal skills, and guess what, even within five days they’d changed.”

Greenfield highlighted this study in the context of her dire warnings about the harmful psychological effects of modern screen- and internet-based technologies. She is clearly tapping into a wider societal anxiety around how much time we now spend online and plugged in. But the Baroness’ critics argue that her pronouncements are vague, sensationalised and evidence-lite. The fact she mentioned this specific new study provides a rare opportunity to examine what she considers to be strong evidence backing her claims. Let’s take a look.

The research team led by Yalda Uhls studied two groups of pupils at a state school in Southern California. Both had an average age of 11 years and said they usually spent an average of 4.5 hours a day texting, watching TV and video-gaming. One group of 51 children was sent on a five-day outdoor education camp 70 miles outside of California. Mobile devices, computers and TVs were banned. The children lived together in cabins, went on hikes, and worked as a team to build emergency shelters. The other group of 54 children attended five days of school as usual.

On Monday at the beginning of the week, both groups completed two psychological tests. The first required that they identify the emotions displayed by photographs of actors’ faces. The second involved identifying the emotions displayed by characters in short video clips of social scenes, in which the sound was switched off. At the end of the week, on Friday, both groups completed the tests again.

Uhls and her colleagues highlight the fact that the summer camp group improved more on the face test over the course of the week, as compared with the school group. The summer camp group also showed improvement on the video test, whereas the school group showed no such improvement (the camp scores rose from 26 per cent correct to 31 per cent; the school group flatlined at 28 per cent). The researchers’ conclusion: “This study provides evidence that, in five days of being limited to in-person interaction without access to screen-based or media device for communication, preteens improved on measures of nonverbal emotion understanding, significantly more than the control group.”

Unfortunately there are a number of acute problems with this study, which make this conclusion insupportable. Above all, the experiences of the two groups of children varied in so many different ways, other than the fact that one group was banned from screen technologies, that it is impossible to know what factors may have led to any group differences.

It’s also notable that the summer camp group performed worse at the two tests at the start of the week as compared with the school group. For example, they began with an average of 14 errors on the face task whereas the school group made an average of just 9. Perhaps the camp kids were distracted because they were excited or anxious about the week ahead. We don’t know because the researchers didn’t measure any other psychological factors such as mood or motivation. By the end of the week, the two groups registered a similar number of errors on the face task. In other words, the technology-free summer camp kids didn’t end the week with super interpersonal skills, they’d merely caught up with their screen-addled school colleagues.

We can also speculate about why the school kids didn’t show improvement on the video task, whereas the summer campers did. Perhaps, after a long school week, the children at school were tired out. The campers, by contrast, may well have been on a high after their week in the wilderness with friends. Technology might have had nothing to do with it.

Other problems with the study are more generic, but just as serious. The children were not randomised to the two conditions. There’s no mention that the people administering the emotional tests were blinded to which children were allocated to which condition, nor to the aims of the study, which introduces the risk they might have inadvertently influenced the results.

In fairness, Uhls and her team admit to many of these shortcomings in their paper, but it doesn’t stop them from interpreting their results in line with their prior beliefs about the likely harmful effects of digital technologies, which they outline at the start of their paper. They couch their findings firmly in the wider context of technology fears, and they hope their paper will be “a call to action for research that thoroughly and systematically examines the effects of digital media on children’s social development.”

Is it easy to understand why Baroness Professor Greenfield was pleased with this study. I will leave you to judge whether she was right to label it “brilliant”, and whether the results do anything to support her arguments about the adverse effects of digital technology on developing minds.

http://digest.bps.org.uk/2014/10/did-five-day-camp-without-digital.html

Narcissists can be taught to empathise

Narcissists are apparently growing in number. These are people who put their own interests first, constantly showing off, and taking credit where it’s not deserved. You might know someone like this – perhaps your boss, or even your romantic partner. If so, a new study offers hope. Apparently narcissists can be taught to be more empathic.

Erica Hepper and her colleagues first confirmed that narcissistic traits go hand in hand with low empathy. They surveyed nearly 300 people online, mostly students, and found that those who scored higher in narcissism (they agreed with numerous self-aggrandising and controlling statements like: “I have a natural talent for influencing people”, “I insist on getting respect” and “I wish somebody would write my autobiography”) tended to be unmoved by the story of a person’s distressing relationship breakup.

Next, the researchers tested the effect of a simple intervention. Across two further studies, nearly 200 students either watched a video of a women describing her experience of domestic abuse, or they heard an audio recording of a woman describing her traumatic relationship break up. Crucially, half the students were instructed to: “Imagine how Susan feels. Try to take her perspective in the video/audio, imagining how she is feeling about what is happening.” The other half were told to imagine they were simply watching the video /listening to the audio, at home.

As expected, students who scored highly on narcissism (especially maladaptive narcissism, involving exhibitionism, sense of entitlement and exploiting others), tended to say they had less concern for the women and felt less distress at the stories. The narcissists also showed less of an emotional reaction in terms of their heart rate. However, when they were instructed to take the women’s perspective, the narcissists showed normal levels of empathy, both in terms of their self-reported feelings, and having a raised heart rate. This suggests narcissists are capable of change – their lack of empathy is not due to lack of capacity, but more to do with lack of motivation.

“We hope that the present findings represent a first step toward better understanding of how narcissists can be moved by others, thereby improving their social behaviour and relationships,” said Hepper and her team.

We shouldn’t get too carried away by these findings – the samples are relatively small, and made up mostly of students. The scenarios all involved romantic relationships, so it’s not clear if the results would generalise. We also don’t know if the apparent boosts to narcissists’ empathy would translate to more altruistic behaviour. The researchers recognise these shortcomings, and they’re planning studies involving “real social interactions and ongoing relationships.” Meanwhile, if there’s a narcissist in your life, this study suggests it could be worth asking them make the effort to take other people’s perspective.

Hepper, E., Hart, C., & Sedikides, C. (2014). Moving Narcissus: Can Narcissists Be Empathic? Personality and Social Psychology Bulletin DOI: 10.1177/0146167214535812

-further reading-
Arrogant, moi? Investigating narcissists’ insight into their traits, behaviour and reputation
Student narcissists prefer Twitter; more mature narcissists favour Facebook
For group creativity, two narcissists are better than one

http://bps-research-digest.blogspot.co.uk/2014/06/narcissists-can-be-taught-to-empathise.html

When the going gets tough, supervisors pick on their weaker staff

A crisis changes everything. Friends are gone, and survivors must adapt to a new, dangerous environment. In the aftermath, predators circle to exploit the weak and vulnerable. According to new research, this not only describes the red tooth and claw of nature, it also applies to the workplace. Pedro Neves at the New University of Lisbon provides evidence that following an organisational downsize, employees are more likely to receive abuse from their supervisors.

Neves was guided by displaced aggression theory – the idea that workplace abuse is often a form of “kicking the dog” – venting our frustrations not at their source, rather at those whom we have power over. Neves predicted that this leads supervisors to target those most unable or unwilling to retaliate: submissive individuals characterised by low “core self-evaluation”(CSE; a combination of personal traits relating to self-image including self-esteem and belief in one’s own abilities), and/or those with fewer co-worker allies.

Survey data from 12 large and medium-sized Portugese organisations from a range of industries – financial to construction to healthcare – confirmed that individuals with lower CSE or less co-worker support were at the receiving end of more abuse, based on their self-ratings of items such as “my supervisor blames me to save himself/herself embarrassment” or “tells me my thoughts or feelings are stupid”. Four of the organisations had gone through downsizing in the prior two years, and in these, submissive employees were even more likely to be picked on. A post-downsizing environment involves uncertainty, ruptures to social networks, and a higher sense of individual risk – all of which heightens vulnerabilities and gives confidence to aggressors that their abuse is unlikely to be fought against.

The data also showed that submissive individuals performed more poorly and engaged in fewer organisational citizenship behaviours, which Neves argues is evidence of the employees also “kicking the dog” – in this case channeling their resentment of the supervisor into minor acts to undermine the organisation.

As this was a cross-sectional survey we have to be careful about drawing such causal inferences, but further analysis suggested two obvious alternative explanations were unlikely: that submissive traits were the consequence of supervisor criticism; or that abuse was causing both poor performance and the submissive traits.

Neves advises facilitating co-worker support as a bulwark against exploitation of the vulnerable, and to build the CSE of employees. These are good things to encourage in any case – but ultimately, the responsibility for change lies not with the abused, but the abusers, to cease picking on the weak.

ResearchBlogging.orgNeves, P. (2014). Taking it out on survivors: Submissive employees, downsizing, and abusive supervision. Journal of Occupational and Organizational Psychology DOI: 10.1111/joop.12061

http://bps-research-digest.blogspot.co.uk/2014/06/when-going-gets-tough-supervisors-pick.html

Is it possible to predict who will benefit from cognitive behavioural therapy (CBT)?

The rise of CBT has been welcomed by many as safe, effective alternative to drug treatments for mental illness. However, there are also fears that CBT has grown too dominant, crowding out other less structured, more time consuming forms of psychotherapy.

The fact is, CBT doesn’t work for everyone. Precious resources could be better managed, and alternative approaches sensibly considered, if there were a way to predict in advance those patients who are likely to benefit from CBT, and those who are not.

Jesse Renaud and her colleagues administered a ten-item scale – the Suitability for Short-term Cognitive Therapy, first devised in the 90s – to patients who underwent CBT for depression or anxiety at the McGill University Health Centre between 2001 and 2011. The researchers focused their analysis on the 256 patients (88 men) who completed their course of therapy, which lasted an average of 19 sessions.

Renaud’s team looked for correlations between patients’ answers to the Suitability scale and found that the scale was really tapping two main factors – the patients’ capacity for participation in the CBT process, and their attitudes towards CBT.

The first factor includes a patient’s insight into thoughts that pop into their heads (so-called “automatic thoughts”); their ability to identify and distinguish their emotions; and their use of safety behaviours to cope with their problems (e.g. avoiding parties to cope with social anxiety). In other words, the researchers explained, this is the patient’s “ability to identify thoughts and feelings, and share them in a non-defensive, focused way.” The second “attitudes” factor refers to, among other things, the patient’s optimism about the outcome of therapy, and their acceptance that they must take responsibility for change.

The higher patients’ scored on the first factor (their capacity for participation in CBT), the greater reduction they tended to show in their illness symptoms, based on measures taken before and after the course of CBT. Attitudes towards therapy were not correlated with symptom reductions, but we should bear in mind that this may be because the research focused only on those patients who completed therapy. Also, it may be useful in future to measure how patients’ attitudes change during therapy.

There are other reasons for caution. The amount of variance in symptom change explained by both suitability factors combined was statistically significant, but tiny – just .07 per cent. Also, the same therapists who administered the therapy, recorded their patients’ improvements, so there was clearly scope for bias. Finally, more research is needed on different forms of mental illness besides depression and anxiety. Nonetheless, this study makes a constructive contribution to a neglected area.

“Given that the patient’s capacity provides important information about whether or not a patient will derive benefit from CBT, clinicians who are concerned about limited resources and long wait lists are encouraged to undertake a suitability assessment prior to therapy,” the researchers said, “identify patients low in their General Capacity to Participate in the CBT Process, and consider making referrals to alternative treatments (e.g. other psychotherapeutic approaches, pharmacotherapy.”

Renaud J, Russell JJ, & Myhr G (2014). Predicting Who Benefits Most From Cognitive-Behavioral Therapy for Anxiety and Depression. Journal of clinical psychology PMID: 24752934

http://bps-research-digest.blogspot.co.uk/2014/06/is-it-possible-to-predict-who-will.html

By treating depression, do we also treat suicidality? The answer is far from straightforward

By guest blogger James Coyne.

Edgar Allan Poe’s fictional detective C. Auguste Dupin warns against tackling questions that are too complicated to test, but too fascinating to give up. Whether psychotherapy or medication can reduce suicidality is probably such a question. Particularly if we are really interested in whether treatments can reduce attempted suicides, not whether they change patients’ answers in an interview or on a questionnaire.

There is no doubt about the clinical and public health significance of the question. After all, psychotherapy and medication are treatments of choice for suicidal patients. The logic is that many, even if not all, suicidal persons are depressed; we know about effective treatments for depression; and so we can generalise from knowledge about what works for depression to what works for suicidality. However, we must hope for more definitive evidence, and a new study attempts to provide it.

The authors include suicide expert Ad Kerkhof, and Pim Cuijpers, who has done some of the most influential meta-analyses and systematic reviews on the treatment of depression. Together with doctoral student Erica Weitz and depression expert Steven Hollon, they analyzed data from the US National Institute of Mental Health Treatment for Depression Collaborative Research Project (TDCRP). Conducted in the 1980s, it was then the largest ever comparison of psychotherapy and medication for treatment of depression. Two hundred and fifty patients with major depression were randomized to cognitive therapy, interpersonal psychotherapy, antidepressant medication, or a pill-placebo plus clinical management as a control group.

The original study did not specifically target suicidality. It actually excluded patients with moderate to severe suicidality. However, the two primary depression outcome measures for the study, the self-report Beck Depression Inventory (BDI) and the interview-administered Hamilton Rating Scale for Depression (HRSD), each contained a single item inquiring about suicidal thoughts and behaviour:

Suicidal ideation/suicidality is rated on the HRSD on a 5-point scale:
0—absent,
1—feels life is not worth living,
2—wishes he were dead or any thoughts of possible death to self,
3—suicide ideas or gesture.
4—attempts at suicide (any serious attempt rates a 4).
The suicidality question on the BDI is measured on a 4-point scale:
0—I do not have any thoughts of killing myself,
1—I have thoughts of killing myself, but I would not carry them out,
2—I would like to kill myself,
3—I would like to kill myself if I had the chance.

The new analysis required that patients have at least some suicidal ideation on either measure. Of the 250 patients, 146 met this criterion. At the start of treatment, patients scored a mean of 1.15 on the HRSD suicide item and .74 on the BDI’s item. The sample included one person who had made a suicide attempt. This case proved to be an outlier and was removed from the analysis. Thus, this study captures mostly mild to moderate suicidal thoughts.

Based on measures taken pre- and post-treatment, the authors found that all treatments, including the pill placebo with clinical management, significantly reduced scores on both the interview and self-report measures of suicidality, with all having a medium effect size. According to the interview measure, interpersonal psychotherapy and antidepressant medication reduced suicidality more than the pill placebo with clinical management. No differences were found between treatments using the self-report measure.

The authors recognised that because the comparison-control group (pill placebo plus clinical management) significantly reduced suicidality, no conclusions could be drawn about specific components of the treatments being essential. It is important to note that pill placebo plus clinical management was not an inert control condition. Neither patients nor therapist knew that any antidepressant was not given, and there were considerable positive expectations, support and encouragement. I am sure that outcomes would have been better in this group than for a waiting list control condition, but there was none included the study.

Recall that the items measuring suicidal ideation were part of depression scales. Did these specific items decrease simply as a result of overall improvements in depression? The authors state they ruled that out with complex multivariate analyses, but I was left unconvinced.

Suicidal ideation is a surrogate outcome. That is, it serves as a proxy for the more interesting, but less frequent outcomes of suicide gestures and attempts and completed suicides. However, the problem with a proxy outcome is the treatment can have a positive effect that is insufficient to change the clinical variables of interest. There was a time when pharmaceutical companies relied on surrogate outcomes like reduction in blood pressure when rates of heart attack were the actual variable of interest. In that context, many treatments affected surrogate outcomes without changing the real variables of interest. The same could be happening here.

Overall, the study demonstrates a dilemma. Mild suicidal ideation is common among depressed patients seeking treatment, but overall is a poor predictor of suicide attempts, which are comparatively infrequent. While many of the patients who ultimately attempt suicide present with serious suicidal ideation, most of them start off with signs of only mild to moderate suicidality. The seeming paradox is due to having to predict later infrequent events from imperfect and nonspecific risk indicators.

We can certainly study treatment of patients at high risk because of a recent suicide attempt, but what we learn then is not readily generalisable to the more common clinical situation of patients expressing only mild to moderate suicidality when they enter treatment. On the other hand, if we study the treatment of this moderate suicidality seen in the clinic, we can’t measure the impact on actual attempts or death by suicide, because to do so would involve a prohibitively large sample.

We are left with the uncomfortable situation of attempting to address a clinical problem in studies with poor measures and inadequate sample size. Or simply having to settle for answering the question “Do depression treatments reduce suicidality?” with “Probably: they reduce depression.”

Weitz E, Hollon SD, Kerkhof A, & Cuijpers P (2014). Do depression treatments reduce suicidal ideation? The effects of CBT, IPT, pharmacotherapy, and placebo on suicidality. Journal of affective disorders, 167C, 98-103 PMID: 24953481

Post written by James Coyne (@Coyneoftherealm) for the BPS Research Digest. James Coyne, PhD is Professor of Health Psychology, University Medical Center, Groningen and the 2015 Carnegie Centenary Professor at University of Stirling.

Posted by Research Digest at 9:59 am 1 Comment
Labels: Mental health, Suicide/ self-harm

http://bps-research-digest.blogspot.co.uk/2014/07/by-treating-depression-do-we-also-treat.html

 

Push for Action – Think Autism – NAS Campaign

As a result of our Push for Action campaign, the Government delivered Think Autism.

Please take 30 seconds to send a message to your council to alert them of the new steps that will help them do what they are supposed to.

Think Autism is the refreshed autism strategy that councils and the NHS should be following to remedy the historic barriers that prevent adults with autism and their families from getting the everyday support they need. It includes new national commitments to improve support, as well as programmes to help councils with their duties. We campaigned for the Government to do more to help councils unlock the barriers they were facing with regard to turning the autism strategy into a reality for individuals.

Please send an important reminder through our online form to the Director of Adult Services, who is responsible for making sure Think Autism is delivered.

I’ll be in touch next month when we launch new actions to prevent the care system from overlooking the specific needs of people with autism. Alongside embedding Think Autism in Bury, we’ll be making sure that changes elsewhere don’t undermine the tremendous progress we’re making.

Thank you,

Tom Madders
Head of Campaigns
NAS

 

http://www.autism.org.uk/push