Behavioural Science Blog

The Science of Human Behaviour

Archive for the ‘Clinical Psychology’ Category

How popular beliefs about obesity contribute to the growing problem

leave a comment »


Obesity is becoming more common in western cultures. Because the genetic component linked to obesity remains the same as it has in the past, there is an increased concern about the cultural and environmental causes of overeating (Lissner, 1997). Affluent western cultures have higher incidences than cultures that have more limited resources. Western cultures also hold more beliefs about individual control over outcomes and value thinness more than non-western cultures (Klaczynski, Goold, & Mudry, 2004). Both of these observations contribute to the increased problem of weight control and overeating in western cultures. Beliefs about individual control are associated with negative affect toward people with obesity and these beliefs are internalized by people who struggle with overeating themselves (Fabricatore & Wadden, 2004). Additionally, the pressures to be thin in western societies contribute to feelings of failure in people battling overeating. In turn, the prejudice and negative attitudes toward obese individuals negatively impacts body esteem subsequently leading to binge eating (Klaczynski, Goold, & Mudry, 2004).

The influence of prejudice and negative attitudes toward people struggling with overeating is widespread. In 2004, Fabricatore and Wadden stated that in the U.S. “ridicule and disparagement of obese individuals seems to remain a socially acceptable form of prejudice” (332). Unfortunately, this prejudice extends from the medical community to the mental health community to the population of overeaters themselves (Fabricatore & Wadden, 2004; Klaczynski, Goold, & Mudry, 2004; Brownell & Puhl, 2003). The scope of this prejudice is so widespread that it does not leave much of a window of opportunity for individuals who are stigmatized by this stereotype to seek the help that they need to overcome their eating problem. Additionally, it increases the risk for low body image, thus enhancing the likelihood for further binge eating. The relationship becomes almost circular in nature.

Another implication of the prejudices that people hold toward overeating and obesity is that it leaves a much smaller window of opportunity for treatment of overeating. Brownell and Puhl (2003) suggest that “negative attitudes in physicians may lead obese persons to avoid seeking health care” (p.16). Additionally, having the belief that overeating and bingeing is due to internal flaws such as laziness also decreases the likelihood that overweight people will seek help or continue with their treatment programs if they fail to see improvement (Brownell & Puhl, 2004).

A study by Klacynski, Goold, and Mudry (2004) investigated people’s attributions of the causes of obesity and found that after stereotypes of obesity were primed, scores that attributed obesity to internal causes increased whereas scores that attributed physical and social causes for obesity remained the same. That is, being thin is an achievement of will and, therefore, being fat (the antithesis) is likely due to lack of will. They also found a negative correlation between self-esteem and anti-fat attitudes and negative stereotypes of the obese. More crucially, this correlation remained significant among participants who’s BMIs were 25 or higher (with 24 being the upper limit in the “normal” weight category). This suggests that the prejudice is so strong that it permeates into the group at which it is targeted.

Body esteem has been linked to obesity such that people with low body esteem who are also exposed to other risk factors are more likely to engage in binge eating (Klacynski, Goold, & Mudry, 2004). Low body esteem is related to negative attitudes about obesity and overeating and is related to the beliefs people hold about obesity (whether it is due to internal or external causes). More specifically, the negative attitudes people hold about obesity mediate the relationship between beliefs about control and body esteem: people who believe that overeating is due to lack of motivation and control over their own eating habits are more likely to hold negative views toward those who overeat, and consequently, negatively influences body esteem (Klacynski, Goold, & Mudry, 2004). Another explanation is that individuals who suffer from the negative stereotypes adopted from beliefs about control and negative attitudes toward obesity are more likely to experience low body esteem which contributes to binge eating. Both explanations are in accordance with the dual-pathway model which shows that low body esteem is negative affect which is a risk factor for binge eating (Van Strien & Ouwens, 2007).

Due to the rampant prejudice toward individuals with obesity and the unfortunate consequences of that prejudice, it is not surprising that there is a steady increase in weight related disorders, particularly overeating. Additionally concerning is the notion that people generally hold internal causes of obesity as the strongest influence on overeating with lesser consideration for the physical and social causes. Because these beliefs are associated with prejudice, and subsequently low body imagine and binge eating, it is particularly difficult for those who struggle with binge eating to overcome it. The prevalence of prejudice within the mental health and medical realms is overwhelming. Awareness and training of the known risk factors and maintenance of overeating is called for in these fields, and perhaps more thoroughly with the public in general, to help individuals at risk for overeating.

References

Brownell, K., & Puhl, R. (2003). Stigma and Discrimination in Weight Management and Obesity. Health Systems, 16-18.

Fabricatore, A.N., & Wadden, T.A. (2004). Psychological Aspects of Obesity. Clinics in Dermatology (22), 332-337.

Klaczynski, P.A., Goold, K.W., & Mudry, J.J. (2004). Culture, Obesity Stereotypes, Self-Esteem, and the “Thin Ideal”: A Social Identity Perspective. Journal of Youth and Adolescence,33, 307-317.

Lissner, L. (1997). Psychosocial aspects of obesity: Individual and societal perspectives. Scandinavian Journal of Nutrition (41), 75-79.

Polivy, J. & Herman, C.P. (2002). Causes of eating disorders. Annual Review of Psychology (53), 187-213.

Van Strien, T., & Ouwens, M.A. (2007). Effects of distress, alexithymia and impulsivity on eating. Eating Behaviors (8), 251-257.

Advertisements

Written by Christina S

November 20, 2009 at 3:01 pm

Behavioral Assessment of Social Anxiety in the Free Speech Task

with one comment


The current study aimed to improve understanding of the behavioral indicators of social anxiety in the Free Speech Task. Building on the current theoretical knowledge about social anxiety, we developed a rating system to maximize the sensitivity of the behavioral anxiety assessment in the Free Speech Task. Participants with social anxiety and a control group were asked to give a free speech about their study for two minutes. A general measurement of anxiety and different specific behavioral indicators of anxiety were assessed. The scores were rated on interrater reliability and the behavioral strategies for socially anxious and nonanxious participants were compared. The rating of general anxiety did not differ between the anxious and the nonanxious group, only one specific measurement (fumbling/selfmanipulation) did differ significantly between these two groups. These results indicate that socially anxious and nonanxious individuals differ in their internal physical behavior. This finding might have implications for the behavioral assessment of social anxiety.

Read the full article: Behavioural Assessment of Social Anxiety

Written by Martin Glanert

December 14, 2008 at 1:00 pm

The Origins of FAD therapies

leave a comment »


The ability to choose an evidence-based psychotherapy on the base of scientific knowledge has been a negligible factor in the evolution of the human brain. One could argue that empirical science itself fosters a style of thinking that is counter-intuitive for many of us. Personally I believe that the human way of trying to identify causal relations in a chaotic universe is the main reason of the evolution our kind has taken in the last few thousand years. But our susceptibility to see causal relations can also be a big problem. Thus I believe the main reason why fad therapies can book so much success is that the human mind is not made to think empirically. And if people do think the scientific way there are lots of downfalls, because the empirical science we have today is far from perfect and methodological problems lurk around many corners. It is easy to express (warrant) criticism of the scientific method (which currently is strongly connected to positivism) and shake up people’s reality. This can be a good thing, if you want to get people start thinking themselves, but far more often those who condemn the scientific system propose to let go of all empirical science altogether and adopt a system of their own choice. Funny enough these systems often try to build on the credibility of science, but in the end are not provable.

Whereas in the field of medical health, imbalanced can often be cured by the ingestions of medication, the parallel in the mental health would be ingestion of new thoughts in order to resolve psychic imbalance. While the body can react quickly to changes in the system, the plasticity of the neuronal structure is less flexible. Ingestions of new mental processes need to be repeated many times in order to change the underlying biological substrate. While most people understand that the process of loosing weight requires constant attention to food intake and regular exercise, most people do not understand that mental change is comparably slow. When a “quick and easy” fix is offered, people hope to circumvent the long trajectory of psychotherapy.

To sum it up (and two minor new points):

  • The human mind is not made to think in a scientific way.
  • Problems with the scientific method often lead people to turn to religion/quick’n’easy solutions/fad therapies.
  • Normal therapy usually takes time, money and is painful.
    People love to fall for the “it’s easy and painless” trick
  • Many conditions do not have a real “cure”. Some can not accept that.
  • Authority figures support fads and get rich doing so.

Elements of scientific approach violated in fad therapies

If any given theory is considered scientific (within the current paradigm), this usually means that it is objective, testable and replicable. There are different ways in which fads can be non-scientific. Mostly they are scientific in some ways, but not in all. Here are some of the preferred ways of fads for being non-scientific:

  • There is no operational definition, no specifications of the processes and how they are related to important constructs and variables.
  • There is no theory at all.
  • The cause and effect relationship between the characteristics and consequences of environmental events and experiences has not been researched using sound methodology.
  • Causal relationships are presumed without any reason or people are made to believe that there is a causal relationship by presenting correlational evidence.
  • Alternative explanations are not pursued.
  • Effects are generalized without reason to do so.
  • Evidence is subject to biases.
  • Unwarranted predictions are made.

Written by Martin Glanert

November 30, 2008 at 11:54 am

Advantages and Risks of Internet-Based Psychotherapy

leave a comment »


Internet-based psychotherapy is a hot topic since a few years. The main advantage is money: Computers are much cheaper to run than licensed psychotherapist. So if a computer could achieve the same or nearly the same treatment outcome as a human expert this would be a huge advantage, as computer systems can be replicated almost infinitely (and once the program is written at almost no costs). We have to keep in mind that for political and economical decision making the effect size is not the only important factor. When considering which project to found something like “effect size“ / costs is more appropriate. In times of long waiting lists and many people without health insurance, cheap treatment means reaching more people. Another advantage is that physical boundaries are not important anymore. If a specialist for a specific therapy is 1000km away it just does not matter anymore. Furthermore the possibilities for comprehensive care, by involving personal with different expertise (social workers, psychologists, physicians) can be achieved by using the internet as a medium.

On the other hand there are some drawbacks. Privacy is a difficult factor as digital information is much more vulnerable than a handwritten dossier. Traffic which uses the internet (and not some special intranet) is always at risk, not to mention the risks on the computer of the client and therapist itself (viruses, Trojan horses, etc…). Face to face contact also offers additional information about the client (non-verbal communication, punctuality, interaction with other patients/staff members) that are lost in a digital environment. Therapeutic alliance is also more difficult to achieve in purely internet-based psychotherapies. I believe that ultimately internet-based therapy will play huge role in mental health care, especially in the concept of stepped-care. There are many ways to use computers and the internet to improve on the (very expensive) system we have today, but face to face therapy will always be an important part of every sever disorder, as (disturbed) human interaction often lays at the core of the problems. That said, we should try to develop digital forms of psychotherapy because not only will that give access to important help to much more people, but we will also be able to learn about the therapeutic process from that experience. In turn that will also increase efficiency of traditional psychotherapy and supply us with new hypothesis and theories.

Written by Martin Glanert

November 26, 2008 at 3:10 pm

Three Recent Applications of Virtual Reality in Psychotherapy Training

with 3 comments


http://www.vrphobia.com (which turned up as #1 in Google) is an organization that is called Virtual Reality Medical Center. They treat all kinds of anxiety related disorders, but seem to focus mainly on specific phobias. After the intake session the client is taught skills to suppress automatic fear reactions. In the following sessions the client is gradually exposed to the feared stimulus. In other words: VR desensitisation.

http://www.cybertherapy.info/RIVA_Obesityasaddiction.pdf

Obesity and addiction have some common properties. This research seeks to integrate some findings of addiction research into eating disorder therapy. In that light they make use of VR for distinct goals: Help the client to experience the own body in situations that are normally avoided. This experience is supposed to have influence on body perception and also empower the client. In the VR patients came “face to screen” with their personal risk situations (supermarket, gym, etc…) and could train emotion regulation and problem-solving skills in a save environment. The randomized clinical trial seems to indicate that the ECT group did indeed better than standard CBT.

As http://www.cybertherapy.info/cybertherapy/8_Optale.pdf shows also psycho-dynamic therapists start to see the merits in using new technology. Erection dysfunction and premature ejaculation are treated in a virtual environment (the porn industry will love that application) together with standard psychotherapy. The possibility to enact the new strategies in a save and private environment is supposed to speed up the therapeutic process. First clinical trials seem to indicate that this might indeed work for some clients, also it is not clear for whom exactly. Sample size is not adequate in study 1, power is much stronger in study 2. Results are not telling a clear story (yet?).

By the way:

http://www.cybertherapy.info/ is the most comprehensive and excellent source for material about VR in psychotherapy that I could find on the net. Especially have a look at the free books, like http://www.cybertherapy.info/pages/book2.htm or http://www.cybertherapy.info/pages/book3.htm. The articles are downloadable as PDF (just scroll down). Especially look at book 3 session 2 that comprises some clinical controlled trials with cybertherapy (which seems to be the keyword I was desperately looking for).

Written by Martin Glanert

November 15, 2008 at 11:43 am

The Motivation for Designing a Computer-assisted Procedure for Training Therapists

leave a comment »


While research has found differences between novice and expert therapists those differences do not seem to be significant for treatment outcome. A crucial factor in this finding is that certain processes keep the psychotherapist from learning effectively. One of those processes is the lack of good feedback (on the macro and the micro level). If there is any feedback, it is probably biased (those who get better do not return for more therapy) and incomplete (patients are not routinely followed over a longer period of time). Due to client privacy it is also not possible for a supervisor to be part of a therapy session and intervene at critical moments. A virtual, interactive environment would not pose such limitations. Psychotherapists could train on quite realistic avatars how to intervene in a critical situation (for example suicide) without putting anyone at real risk. The “role-playing” skills of a digital avatar will be much better than a fellow colleague within a few years and the program can be stopped anytime to discuss the process and repeat parts of the intervention. A virtual training would also make sense economically. After the programming, the costs depend only on the running costs of the hardware and the supervisors. Speaking of which, master psychotherapists that now supervise the trainings would gain a lot of free time to do other important things. If the medium of the digital training is video / text-based (and thus does not require VR equipment) the internet would pose an ideal way to reach thousands of interested graduate students.

Written by Martin Glanert

November 10, 2008 at 8:40 pm

Heterotypic Continuity & Comorbidity

with 2 comments


Heterotypical continuity means that an underlying (developmental) process or impairment stays the same, but the manifestations do not stay the same. For example a child with autism might first show impairments of non-verbal skills and problems in eye-contact. In a later developmental stage the manifestations would be different, such as stereotypical behaviour or language problems.

In psychopathological progression one disorder can be seen as a risk factor for developing another disorder. For example eating disorders such as anorexia nervosa have a influence on neurotransmitter levels such as serotonin. Imbalance of that neurotransmitter is related to general anxiety disorder and depression. In that way eating disorder do not cause depression, but it certainly puts the individual at a higher risk.

Whereas comorbidity is a correlational construct, the concepts of heterotypic continuity and psychopathological progression are causal theories in a developmental framework, that take the development of the individual into account. One could argue that, where comorbidity uses data to state a fact, the other two concepts actually try to explain the process.

Homeotypic continuity can be seen as the opposite of heterotypic continuity. Whereas in heterotypic continuity the process stays the same and the manifestations change, in homeotypic continuity the manifestations stay the same, but the underlying process changes. For example a child might resort to aggression, because it lacks the necessary skills to make contact with peers at schools. Later in life aggression against peers might be mainly attributed to an antisocial personal disorder.

Written by Martin Glanert

October 22, 2008 at 10:22 pm