A jolt of transformation

The replication crisis and the Covid-19 pandemic represent two of the most significant challenges to psychologists in the last decade – even seeing them mentioned in the same sentence is enough to fill us with dread. Although they present disparate issues, to those working in the field of psychology, they both represent a threat to the survival of our way of understanding and being in the world.

The replication crisis was an overt threat to the nomothetic principles that many fields of psychology subscribe to. Conclusions and recommendations found in academic publications are predicated on the assumption that meaningful laws and principles have been uncovered on the basis of low p values being reported, characterising the strength of effect sizes, differences and correlations. If results genuinely are meaningful they should stand up to tests of reliability, or else they run the risk of being branded as just another type 1 error – a one-off distribution of data that masquerades being meaningful but actually represents chance, the 'one hit wonder' that promises to be the next big thing but fails to scale those heights with their follow-up song. 

Naturally, when Brian Nosek and colleagues ⁽¹⁾ published their Open Science Collaboration findings, the reliability of key research was called into question, representing a threat to the very foundations that much of modern day psychology is based on. To my mind at least, it was reassuring that the response from the psychological community has been to interrogate research design and analysis, with a range of plausible explanations offered to explain the apparent discrepancy in findings between previously credible studies and their replicated counterparts. Small sample sizes that lack statistical power, divergent samples and a lack of procedural standardisation have been used as conceivable defences against research findings that were not successfully replicated. 

But have we missed something? It is easy for us to lose sight of the fact that the subject of our scientific enquiry is by its very nature, changeable and therefore prone to poor replication. 

Meaning over time

Throughout the history of modern psychology, the meaning of psychological phenomena or instruments has changed over time. Psychological research is littered with such examples. The high levels of conformity reported in Solomon Asch's research ⁽²⁾ from the 1950s were not evident three decades later. The situational and historical context was no doubt a factor in differences observed in the behaviour displayed by prison guards in Zimbardo's now infamous Stanford Prison Experiment ⁽³⁾ and Stephen Reicher and Alexander Haslam's BBC TV version ⁽⁴⁾. The conceptualisation of masculinity and femininity presented in Bem's Sex Role Inventory ⁽⁵⁾ now seems outdated and out of touch with societal values. More recent conceptualisations of masculinity and femininity have departed from the view that either can be seen as a unitary construct. In retrospect, it seems that equating masculinity with adjectives such as competitiveness reflected a moment in patriarchal time, rather than a reliable psychometric property.

The meaning of psychological constructs, research designs and instruments evolves and is forged through the challenges and adjustments that people and society live through. Arguably, our investment in popular values and psychological phenomena changes at a glacial pace. 

But what about now? 

We are in the midst of a global health emergency that is challenging almost every aspect of life as we know it, touching our perceived economic, inter-personal, medical, educational and psychological normalities. Furthermore, the sense of transition is likely to lead to a shift in how we relate to the present and future. It is arguably easier to be mindful when enjoying your sole outing of the day during lockdown but much harder to visualise where you might be this time next year. 

What impact will these seismic changes have on psychological phenomena as we know them? What will this jolt of transformation contribute to the replication crisis? I found myself contemplating these changes from a more philosophical position. Many counselling psychologists will be familiar with Heidegger's phenomenological philosophy and his concept of 'dasein', which literally translates to 'being'. The concept of dasein promotes an exploration of  'average everydayness ⁽⁶⁾. At times like these, our sense of being in the world can be an important resource to draw upon as we attempt to understand people, behaviour and how to support others; after all, our 'average everydayness' has shifted quite significantly of late.

What is appropriate and efficacious?

As a trainee counselling psychologist approaching the conclusion of ten years of studying, my attention is drawn to the field of mental health and psychological interventions. Scientist-practitioners can support society in many ways with our ability to undertake research, assess, formulate and use appropriate and efficacious interventions for our clients. But in times like these, surely we need to be open-minded about what we consider to be appropriate and efficacious? Will our understanding of how to support people with anxiety disorders have the same phenomenological significance in the middle of, or in the aftermath of a pandemic? 

People are being in the world in a way that they have never been before. They are likely to relate to anxiety in a way that outdates many of the randomised control trials that supports the efficacy of therapeutic protocols, not because of any methodological or statistical flaws but because they have a different phenomenological meaning in a post-Covid 19 reality.

There is a kinship between anxiety and the almost unprecedented level of threat, isolation and uncertainty that many us have experienced during lockdown. However, the functional and phenomenological significance of anxiety is anticipated to be particularly pressing for those people with pre-existing anxiety disorders. This poses the question – will formulations and interventions for anxiety disorders stand up to tests of reliability in a new phenomenological context?

This question seems pertinent for those people experiencing agoraphobic symptoms. Typically they avoid situations in which they might experience a panic attack which they anticipate will 'lead to a loss of control, illness or death' ⁽⁷⁾. Cognitive-behavioural therapy formulates agoraphobic symptoms as a series of avoidance behaviours which are maintained through negative reinforcement, which requires the use of cognitive and exposure-based treatments. Paul Salkovskis ⁽⁸⁾ suggests that the effectiveness of exposure exercises is likely to be 'due to the disconfirmation of threat beliefs'. That is, by agreeing to progressive exposure exercises, the client acquires and accumulates evidence to invalidate their fear of losing control, becoming ill or dying. Self-isolating behaviours seen in agoraphobics are conceptualised as a pattern of safety behaviours, which serve to reduce the person's sense of panic but in doing so, increase self-isolating behaviours. 

However, the coronavirus message to stay at home to protect the self, others and even the NHS ⁽⁹⁾, is likely to have resonated with those who have historically stayed at home to feel safe and in control. In the current socio-medical context, it is worth speculating how people's relationship with their avoidant behaviours has changed, when staying in their homes has been confirmed as the safe thing to do. The same goes for people's experience of health anxiety, maintained by: avoidance of situations that trigger health fears, reassurance seeking, scanning and self-checking behaviour ⁽¹⁰⁾. Any of those four safety behaviours are actively promoted as part of the UK's response to control the virus. Members of the public are now being invited to embrace a sense of vigilance towards quite generic physical symptoms. 

Those who have historically experienced health anxiety may pay particular credence to subtle changes in their physiology.

The resonance of public health advice is likely to be perceived as particularly pressing for clients experiencing obsessive compulsive disorder with compulsive cleaning rituals. Public health advice relating to handwashing and or sanitising, wearing face masks to limit of spread of contagious droplets and the Covid-19 rhetoric of the 'invisible killer', will surely be cause for intense distress in those people who feel an exaggerated sense of responsibility to prevent their intrusive thoughts or contaminated hands (or droplets) from becoming a mortal threat to others. Leahy ⁽¹¹⁾ suggests that obsessives perceive that they have a moral obligation to protect their loved ones when they identify a threat. Compulsive cleaning behaviours seen as safety behaviours in a pre-Covid existence, now parallel public health advice endorsed and promoted by the World Health Organisation ⁽¹²⁾. Furthermore, for people experiencing obsessive compulsive disorder, thinking about relatives contracting the coronavirus confirms a self-imposed moral responsibility to save them. 

An evolving landscape

The narratives I have discussed here are likely to present challenges to many commonly used cognitive-behavioural protocols, and higher rates of client resistance may well be observed. Perhaps the efficacy data for treating discrete anxiety symptoms will not be replicated in a context where people's anxiety is more global and inter-connected? 

What is effective today might not be effective tomorrow. In the new normality that we are so rapidly constructing, practitioners may well encounter increased challenges when undertaking cognitive-behavioural treatments. I am not advocating that less impressive efficacy data would represent a false positive per se and further add to our replication woes. But it is important for us to remember that meaningful patterns in data do not operate in a vacuum, but rather as part of an evolving biopsychosocial landscape that we are all learning to be in. As psychologists in times like these, embracing an openness to multi-theoretical practice and tolerating our philosophical origin, will become increasingly important.

Daren Lee BSc, MSc, MBACP, MBPsS

Trainee Counselling Psychologist

References

(1)           Nosek BA, Aarts AA, Anderson JE, Kappes HB, Open Science Collaboration. Estimating the reproducibility of psychological science. Science. 2015;349(6251):aac4716.

(2)           Asch SE, Guetzkow H. Effects of group pressure upon the modification and distortion of judgments. Organizational influence processes. 1951:295-303.

(3)           Haney C, Banks WC, Zimbardo PG. A study of prisoners and guards in a simulated prison. Naval research reviews. 1973 Sep;9(1-17).

(4)           Reicher S, Haslam SA. Rethinking the psychology of tyranny: The BBC prison study. British Journal of Social Psychology. 2006 Mar;45(1):1-40.

(5)           Bem SL. Bem sex role inventory. Journal of Personality and Social Psychology. 1981.

(6)           Horrigan-Kelly M, Millar M, Dowling M. Understanding the key tenets of Heidegger's philosophy for interpretive phenomenological research. International Journal of Qualitative Methods. 2016 Nov 30;15(1):1609406916680634.

(7)           Leahy, R. L., Holland, S. J. F., & McGinn, L. K. (2012). Treatment plans and interventions for anxiety disorders. New York: Guilford Press.

(8)           Salkovskis PM, Clark DM, Hackmann A, Wells A, Gelder MG. An experimental investigation of the role of safety-seeking behaviours in the maintenance of panic disorder with agoraphobia. Behaviour research and therapy. 1999 Jun 1;37 (6):559-74.

(9)           Department of Health & Social Care. [Withdrawn] Coronavirus: stay at home, protect the NHS, save lives – web version. 

(10)        Westbrook D, Kennerley H, Kirk J. An introduction to cognitive behaviour therapy: Skills and applications. Sage; 2011 Mar 17.

(11)        Leahy RL. Overcoming resistance in cognitive therapy. Guilford Press; 2012 Mar 13.

(12)        World Health Organization. (2020b, June 1). Coronavirus disease (COVID-19) advice for the public.