News and Media, September 2008

Milgram redux

Psychologists in America are to publish a partial replication of the infamous Milgram experiments on obedience to authority. The classic 1960s research is often invoked by commentators seeking to explain the latest human atrocities – for example, the abuse of Iraqi prisoners by American guards at Abu Ghraib. But Stanley Milgram's paradigm, which involved participants being led to believe they were administering electric shocks to another person, hasn't been replicated in over three decades, due to ethical concerns.

To recap, in Milgram's experiments participants were allocated the role of teacher in a fixed draw, and were told they would be issuing shocks to another participant, the 'learner', (actually an actor) each time this person made a mistake in a memory test. Participants were told the shocks were painful but not harmful, although labelling on the shock generator carried warnings of harm for the highest voltages.

Like many social psychologists, Jerry Burger at Santa Clara University, California and his colleagues knew that Milgram's original data showed the 150-volt shock level was a pivotal point in the experiment. 'But as I was looking over these tables,' Burger tells The Psychologist, 'I was struck by the fact that 150 was more than a common stopping point. It was actually something of a point of no return.'

In Milgram's best known 'Experiment 5', the 150v level was the first moment at which the actor being shocked said he wanted the experiment to stop. If a participant continued to administer shocks beyond this level it was extremely likely they would go all the way to administering the highest 450v shock (79 per cent of such participants did).

The new study replicated Milgram's methodology with great attention to detail, including the use of a replica shock generator and with a script that stayed faithful to the original. Crucially, however, the new version was stopped immediately after participants made their decision as to whether or not to continue issuing shocks beyond 150v. Potential participants were also subjected to extensive screening, with the psychologically vulnerable or anyone aware of Milgram's research being excluded.

The new study, in press at American Psychologist, found 70 per cent of 40 participants were willing to proceed beyond the 150v shock level – a proportion only slightly lower than Milgram's figure of 82.5 per cent. Burger's team said their finding provided compelling evidence that people's obedience to authority today, under lab conditions, is comparable to that which was observed in the 1960s.

To the researchers' surprise, disobedience was no higher in another condition in which participants witnessed what they thought was another participant (actually an actor) refusing to continue with the experiment. Further analysis also showed participants' empathy levels had no bearing on their obedience, although a greater desire for control was linked with more disobedience.

Burger says he hopes this new approach to replicating Milgram's work will allow psychologists to further investigate the situational factors that impact on obedience levels. 'Understanding how and why people respond to these situational factors could provide valuable information for policy makers,' he says. 'We have to be careful when making the leap from a laboratory study to something as complex as the Holocaust. But understanding the social psychology operating in the kinds of situations that interested Milgram – atrocities, massacres, genocide – is an important step in the process.'

By coincidence, a new meta-analysis of data combined from eight of Milgram's obedience experiments has also just been published in Perspectives on Psychological Science. Dominic Packer, a researcher at Ohio State University, also identifies the 150v shock level as a critical moment in the Milgram studies. He found that of those participants who were ultimately disobedient, 36.8 per cent chose to stop at the 150v level (with 29 possible shock levels, a random distribution would have seen just 3.5 per cent disobey at 150v).

Milgram observed that at the heart of his experiments lay a conflict, between the desires of the experimenter and of the electrocuted 'learner'. According to Packer, the 150v level, when the learner of the experiment first said he wanted to stop, was the moment that participants saw this conflict in stark relief – when they had to choose between the authority of the experimenter or the rights of the suffering learner. By contrast, expressions of pain from the learner, which began from the earliest shocks and grew in intensity with higher voltage, did not have a significant impact on the participants' decision making.

Packer says these observations have important implications for the treatment of prisoners in interrogation scenarios. Post-9/11 there has been a tendency for authorities to ignore legal rights, for example, as laid down in the Geneva Convention, claiming instead that prisoners will not be subjected to undue pain. However, as Packer concluded, 'pain did not tend to be sufficient for disobedience in these studies; thus, when prisoners' rights are curtailed or ambiguous, expressions of pain may provide little protection from inhumane treatment'. Packer says this means 'harmful treatment of prisoners may be more likely when standards for their appropriate treatment are ambiguous... and, in particular, when authority figures appear to imply that the harsh techniques (e.g. waterboarding) are necessary and relatively innocuous'.

When do we tell the children – the impact of artificial insemination
 

Children who are conceived through artificial insemination should be told the truth about their origins as early as possible, new research suggests.

Dr Vasanti Jadva of the Centre for Family Research, at the University of Cambridge, used the US-based Donor Sibling Registry to identify 165 people born through artificial insemination and invite them to complete online questionnaires.

Speaking at the 24th annual meeting of the European Society of Human Reproduction and Embryology held in Barcelona, Jadva said she found levels of anger, confusion and shock tended to be higher the later people were told about their conception history. For example, 37 per cent of those told between the ages of four to 11 reported feeling confused, compared to 52 per cent told when they were 12 to 18 years, and 69 per cent told in adulthood. Negative feelings towards their mothers were also more common among people told late.

Jadva said that her findings were consistent with research on adoption, 'which also shows that children benefit from early disclosure about the circumstances of their birth.'

A similar message was provided by a second study presented at the same conference that investigated the psychological well-being and attachment of 39 children born to surrogate mothers, 43 by donor insemination and 46 by egg donation, all aged seven years at data collection.

Polly Casey, also from Cambridge University's Centre for Family Research, found that the children born through assisted reproduction generally had the same quality of relationships with their parents as the 70 naturally conceived children who served as control.

There was a tendency for the mothers who had no genetic link to their children to exhibit a more 'involved' parenting style. Also, parents who had told their children about their conception origins were apparently more emotionally sensitive and warmer.

'The children themselves showed positive psychological adjustment and did not differ as to family type. We were particularly interested to find that, according to teachers, those children who had been told of their origins tended to do slightly better emotionally than those who had not,' Casey said.

 

Eyewitness memory in London Dungeon

New research conducted at London Dungeon's Labyrinth of the Lost shows eye witnesses' memories are even more fallible than laboratory studies have so far led us to believe (Applied Cognitive Psychology).

In real life, witnesses to crimes are likely to be in an anxious state when their memories are laid down, yet most lab studies of eyewitness memory fail to recreate a stressful context. The London Dungeon setting allowed Tim Valentine and Jan Mesout (Goldsmith's College, University of London) to investigate the effects of anxiety on memory without provoking any ethical objections, and also without participants realising their memories were to be tested. Participants thought their only task was to answer questionnaires at the end of the Dungeon visit.

While in the Labyrinth, 56 participants had their path blocked by an actor wearing a hooded robe and with scars on his face – part of the usual mirror-filled horror experience, which also involves the appearance of a skeleton and a ghostly woman in a rocking chair. After completing their subterranean visit, the participants were asked to identify the man who had blocked their path from among a series of photographs that also included eight foils all wearing similar costume and makeup.

Anxiety appeared to have had a deleterious effect on some of the participants' memories. Those participants who retrospectively reported feeling more anxious while in the Labyrinth were strikingly less accurate at identifying the actor who had blocked their path. Only 17 per cent of participants who scored above the median on an anxiety questionnaire correctly identified the actor compared with 75 per cent of participants who scored below the median. (A separate investigation confirmed that people's retrospective reports of their anxiety levels in the Labyrinth correlated with a heart rate measure of their physiological arousal taken while they were underground).

The 29 female participants reported being more anxious in the Labyrinth than the men. Because of the observed association between anxiety and memory, this meant the women's memory performance was significantly worse than the men's – an observation that could have implications for real-world witnesses.'The experience in the Labyrinth of the Lost is much less extreme than the stress a victim of crime may experience,' Valentine said, 'but we still observed a catastrophic failure of identification by visitors who found the experience stressful.'

'The research doesn't suggest there is anything wrong with the identification procedures that the police use, but does demonstrate just how difficult it can be for a victim to identify the offender.'

 

Debate on the efficacy of antidepressants

It's rare for a journal article to trigger the intensity of debate provoked by psychologist Professor Irving Kirsch's meta-analysis, published earlier this year, which purported to show that for the majority of patients with depression, antidepressant medication is clinically no more effective than placebo.

For the 36th Maudsley Debate, held at the Institute of Psychiatry, Kirsch, with psychiatrist Dr Joanna Moncrieff in support, defended the conclusions of his research findings. Arguing against their motion – that antidepressants are no more effective than placebo – were psychiatrist and expert on the psychopharmacology of depression Professor Guy Goodwin and biology Professor Lewis Wolpert, who has written a book about his own experience of depression.

Kirsch's meta-analysis used the Freedom of Information Act in America to access all drug trial data, published and unpublished, submitted to the Food and Drug Administration by pharmacological companies seeking approval for their antidepressants. Taking all the trials together showed that while drugs are statistically more efficacious than placebo, their advantage, for all but the most extremely ill patients, is not clinically significant (using the National Institute of Health and Clinical Excellence threshold of a three-point score difference on the Hamilton Depression Rating Scale).
Commentators have criticised the quality of these trials, Kirsch explained, but they are all the evidence we have for the efficacy of antidepressants. Either you trust these randomly controlled trials, hich show drugs are rarely more effective than placebo, or you reject the validity of these trials, in which case we are still left with zero scientific evidence for the effectiveness of antidepressant drugs.

Next up, Guy Goodwin took issue with the idea that it is easy for drugs to do well in the kind of clinical trials described by Kirsch. Merck, for example, invested heavily in Aprepitant as a possible antidepressant only to find over several trials that it was no more effective, statistically and clinically, than placebo, whereas the same trials found the established antidepressant Paroxetine was more effective. 'These trials have real consequences, they aren't just intellectual games,' he said. 'The idea that you just have to do a study, chuck in anything and you'll get a response is not a myth that you must carry away from this debate.'

Goodwin said some of the strongest evidence for antidepressant drug efficacy comes from so-called continuation trials. For example, one study looked at patients who had responded positively to the drug Agomelatine, switching half the sample to placebo after eight or ten weeks, but ensuring the patients were unaware of whether they had been switched or not. Twelve weeks after the switch, 21 per cent of the patients still on Agomelatine had relapsed compared with 47 per cent of the patients switched to placebo.

None of this persuaded Moncrieff, who argued the idea that we have truly 'antidepressant' drugs is a myth. What we traditionally think of as antidepressants are merely psychoactive drugs, with a variety of non-specific effects, including sedation and stimulation. Any such drugs are likely to have an impact in placebo-controlled trials (e.g. simply improving sleep can lead to substantial point changes on the Hamilton Rating scale), she said, but they aren't actually treating the disease process. They cut people off from their emotions, they overlay the depression rather than replacing it. Perhaps the most compelling evidence for the ineffectiveness of antidepressants, she argued, is that rates of depression are not decreasing, as we might expect if we had an effective drug treatment.

'The last speaker has clearly never suffered from depression herself,' Lewis Wolpert began in characteristically pugnacious fashion. 'When you enter into a depressed state, it's unlike anything ever experienced before.' Wolpert emphasised the biological basis of depression: it's inherited; post-mortem studies show brain abnormalities in the depressed; and treatment with interferon alpha for hepatitis triggers depression, unless the patient is also prescribed an ntidepressant. Also, macaque monkeys and mice with induced depression-like states benefit from antidepressants, in a way that can't be dismissed as placebo.

Wolpert also drew on his own personal experiences. He had switched antidepressants several times before finding an effective drug, a fact he felt cast doubt on the idea he was only responding to a placebo effect. 'This article of yours has done enormous damage to people with depression,' Wolpert said, addressing Kirsch. 'Such people rarely want medical help as it is. Please vote against this absurd motion,' he asked the audience.

In the minute allocated to round-up, the speakers moved no closer to consensus. Kirsch pointed to research showing that serotonin depletion in healthy people fails to trigger depression, thus undermining the popular idea that drugs work by correcting such an imbalance. Goodwin said Moncrieff reminded him of famed anti-psychiatrist Thomas Szasz, but without the conviction to go all the way. Moncrieff simply re-stated that all placebo-controlled trials are invalid because they fail to take account of psychoactive effects. Wolpert agreed good new clinical trials were needed, but he maintained that the efficacy of drugs for severe depression was clearly established. 'If you're taking an antidepressant, for goodness sake, don't stop now!' he said.

 

From the Research Digest…Teaching old dogs

We all vary in how much we believe people's attributes, such as their intelligence, are fixed or subject to change. Now a new paper in Current Directions in Psychological Science (see tinyurl.com/6c52yw) shows that managers with a fixed view of people's attributes tend to ignore improvements or deterioration in the performance of their staff, and that they are also less likely to ensure staff receive the training they need.

In one study, Peter Heslin and Don VandeWalle gave managers negative background information about a fictional employee before they were shown that same person performing well at a negotiation task. Managers with a fixed view of personal attributes (they tended to agree with statements like 'As much as I hate to admit it, you can't teach an old dog new tricks. People can't change their deepest attributes') subsequently rated the employee less positively than managers with a belief that people can change. Another study found that managers who think people's attributes are fixed gave their staff less coaching, presumably because they think such interventions will be ineffective.

However, on a more positive note, there's research showing that managers who think people can't change, can be persuaded to the contrary by a range of exercises, including showing them scientific evidence for people's ability to change and getting them to think about why it is important for staff to develop their abilities.

Heslin and VandeWalle concluded that this body of research has real-world implications. 'To enhance workforce productivity, cues for managers to adopt a growth mindset [a belief that people can change] could be built into performance evaluation systems,' they said. 'These cues might include written, verbal and video-based reminders to managers…that all employee skills tend to be developed over time with practice and helpful feedback.'

 

Where Voting makes a difference

Where people vote could influence how they vote, according to new research conducted in America (PNAS; tinyurl.com/6g5mds). Jonah Berger at the University of Pennsylvania and colleagues analysed votes cast in Arizona in 2000 either for or against a tax increase to fund schooling. They found that people who voted in polling stations located in schools were significantly more likely to vote for the tax rise (56.02 vs. 53.99 per cent) than were people who voted elsewhere. This remained true even after controlling for a host of alternative explanations – for example, that people who vote in schools do so because they have children and therefore live near a school.

The idea that environmental cues might influence people's choice of vote was given further credence in a second study that exposed people to either school-related or office-related images, ostensibly as part of a more general image rating task. Those participants cued with more school-related images were more likely to say they'd vote for a tax rise to fund schools (63.6 vs. 56.3 per cent).

This is one of the first studies to show that environmental primes can have a significant impact on real-world decisions. Given the lengths that are taken to ensure political voting is conducted fairly, the researchers said the authorities may also wish to consider the polling environment itself.

'If certain polling locations are clearly related to initiatives or candidates,' they wrote, 'administrators could use more neutral locations (if equally convenient and accessible) to minimize bias.'

 

Award for BPS journal article

An article published in one of the Society's journals has been named as one of the 50 best articles in management published in 2007.

Adam M. Grant and Elizabeth M. Campbell's article 'Doing good, doing harm, being well and burning out: The interaction of perceived prosocial and antisocial impact in service work', published in the Journal of Occupational and Organizational Psychology, wins a Citation of Excellence Award from Emerald Management Reviews.

Each year the Emerald Management Reviews Accreditation Board, comprising management experts from industry and academia, selects the world's top 400 management titles. Independent subject experts then assess every article in each of these journals – over 15,000 in 2007 – and 50 outstanding articles are singled out for an award. pdh

The article is available for free via www.bpsjournals.co.uk/joop. A full list of the 2007 winners, as well as lists of previous winners, is available at tinyurl.com/6nb6qu

Debate on psychologists' role in national security

The chasm dividing opinion on the role psychologists should play in national security appeared wider than ever in July when two Society members, Professor Karen Carr of Cranfield University's Defence Academy and Dr David Harper of the University of East London, clashed on BBC Radio 4's All in the Mind programme.

The pair's verbal sparring followed a Ministry of Defence (MoD) statement that their psychologists play no part in interrogation and are not in the military chain of command. 'MoD occupational psychologists are committed to enhancing the working lives and effectiveness of our Armed Forces,' reads the statement, from Dr Gail Walker-Smith (Ministry of Defence Head of Profession for Occupational Psychology). 'We are privileged to provide a small contribution to the support of our Service personnel who are protecting our nation.' However, the MoD statement doesn't cover the role played by psychologists in the British security services, which remains unclear.

During the Radio 4 debate, Professor Carr said calls for psychologists to play no part whatever in national defence and security were political. 'If we as a society believe that we need military and the police in order to have stability and a safe society, then I believe that professional psychological bodies should be a part of society – all within the constraints of ethics and what's acceptable. They shouldn't hold themselves separate.'

Carr outlined several ways psychologists can make a valuable contribution to national security, including guiding the right way to treat people, helping understand cultural influences on the way people behave, aiding equipment design, and by improving the decision making of our leaders.

Carr also said there was potential value in psychologists acting in a supervisory role during interrogations, so long as they were truly independent and free of peer pressure from the security organisation. 'For psychologists to say "we don't want to get involved, we'll stand back", is abdicating responsibility. The ethical and legal frameworks are in place...The value a psychologist can bring in terms of understanding the sometimes subtle effects that can be happening would be a better way of ensuring that due process was carried out...[and] in terms of looking after the ethical situation,' she said.

However, Dr Harper couldn't have agreed less. Echoing similar calls among psychologists in America, Harper said psychologists (like medical professionals in America) should play no role whatever in interrogations, at least not until 'there are clearer regulations, and until the legal situation abides by international human rights standards.'

Harper explained that whereas the Police and Criminal Evidence Act, in place since the 80s, protects the rights and freedoms of the public, he said such safeguards do not apply in the UK's defence and security sector. He also questioned the ability of psychologists to remain independent and to challenge their colleagues when living and working in high-pressure teams.

The pair also disagreed on the appropriateness of the stance taken on these issues by the British Psychological Society. Carr said the ethics code is clear and that a possible route to preventing inappropriate practices could be to ensure that psychologists working with the military are chartered.

By contrast, Harper said that the Society should take a more assertive, proactive stance. 'It's all very well to make general statements, but to show how in practice you're going to follow up on that, monitor it, how you're going to scrutinise the practice of psychologists involved in those things – all those are unanswered questions.'

Stress award

A Society member has been recognised at the recent Healthcare People Management Association awards, for best management practice in tackling workplace stress.

Teresa Jennings, Consultant Clinical Psychologist in Occupational Health, together with Margaret Walker, Head of Human Resources at Northumbria Healthcare Foundation Trust, noticed that referrals relating to stress were higher in some wards and departments than others. They developed a system of identifying these 'hotspot areas' by looking at a range of organisational indicators, including stress-related referrals, absence and turnover data, discipline and grievance figures, and areas where there was change, conflict or high rates of violent incidents.

Once hotspot areas were identified, team stress-risk assessments were used to drill down to the specific causes. This involved collaborating with occupational psychologists to use a Health and Safety Executive questionnaire to measure demands, control, role, relationships, support and change. Focus groups were used to verify findings, and action plans were then developed with staff to address specific problem areas.

'Stress is now the biggest cause of sickness absence in the public sector, and psychologists have an increasingly important role to play in helping organisations to tackle this problem,' says Teresa, who also manages the staff support service at her trust. 'Our focus is now on monitoring and evaluating the effectiveness of this process. However, I am delighted that the work has been recognised as a model example of a systematic approach to reducing stress.' JS
I    For more information contact [email protected] or see www.hpma.org.uk for a copy of the awards compendium

CBT for CFS

When it comes to the treatment of chronic fatigue syndrome, the limited evidence available suggests cognitive behaviour therapy is more effective than treatment as usual (i.e. seeing a doctor and receiving advice and reassurance) and other psychological therapies, including relaxation and counselling. That's according to a new systematic review by the highly regarded Cochrane Collaboration (tinyurl.com/6n8gg5). Fifteen studies involving over a thousand patients demonstrated the superior benefits CBT can bring, although the researchers, led by Jonathan Price, at the University of Oxford, said more research comparing treatment approaches was needed, especially at follow-up.


Explaining autism rise

An investigation of 38 adults diagnosed with a developmental language disorder in their childhood has found that 12 of them would meet contemporary diagnostic criteria for autism or autism spectrum disorder, based either on their current behaviour or on parental reports of how they behaved in childhood (tinyurl.com/62cbqh). Dorothy Bishop (University of Oxford) and her colleagues said their findings help explain the increased prevalence of autism in recent decades. Another implication is that studies into developmental language disorders published in the last century would likely have included in their samples children who would today be classified as autistic. Cj

Therapy waiting times

Five mental health organisations have together published a report While We Are Waiting that calls on primary care trusts (PCTs) to reveal waiting times for psychological therapies, and to provide a greater choice of therapies and therapists to clients (tinyurl.com/5b8cr7).

Although the report welcomes the government's Improving Access to Psychological Therapies programme, it says that half of PCTs will remain uninvolved, and that the benefits of the new programme won't be clear unless all PCTs publish their waiting times.

A survey of 75 service users conducted for the report last autumn found that 10 per cent had to wait between one and two years just to receive an assessment, with further waits before they subsequently received therapy.

One person described her experience: 'When I was told that the wait after assessment was two years it felt like a real let-down, offering a lifeline and [then] snatching it away.'

Other recommendations include the introduction of more flexible appointment times for psychological therapy, including evenings and weekends, and greater contact with people who are on a waiting list, for example to inform them how much longer they have to wait.

Emily Wooster, policy officer at Mind, one of the partner organisations behind the report, said: 'People are still struggling to access a choice of treatments, still waiting months and even years for urgently needed support, and still watching their lives deteriorate while they are stuck on waiting lists. The government needs to hold primary care trusts to account on this issue.'