News, April 2010

Much too much… much too young?

 The 'pornification' of British culture is causing numerous social ills including increased violence against women and teenage girls. That's according to a new Home Office report Sexualisation of Young People Review by the Chartered Health and Counselling Psychologist Dr Linda Papadopoulos of London Metropolitan University (http://bit.ly/d2rgAF).

Drawing on government research and statistics, lobby group publications and academic journals, together with input from a range of invited stakeholders, including Respect and Womankind, the review says that airbrushed adverts, sexist sitcoms, lurid music videos, easily-accessed internet porn, 'lads mags' and other forms of media are sending a message to children that women should make themselves sexually available and that men should be sexually dominant.

Papadopoulos's review, which follows similar publications in Scotland, the USA and Australia, further ties the sexualisation of modern culture to a rise in eating disorders, more and earlier cosmetic surgery, more girls aspiring to become pole dancers, acceptance of the 'rape myth', and sexual aggression.

The review, commissioned by former Home Secretary Jacqui Smith in 2009, calls for more studies but says 'we should acknowledge that the research and evidence…points clearly to the fact that sexualisation is having a negative impact on young people's physical and mental health, and helping to normalise abusive behaviour towards women and children'.

The review makes numerous recommendations, including: promoting gender equality in schools; making digital literacy a compulsory part of the school curriculum; lads mags to be put on the top shelf; sexy music videos to be broadcast only after the watershed; and a rating symbol system to show how much adverts have been digitally altered.
The Home Secretary Alan Johnson welcomed the review and thanked Papadopoulos for her work. Janice Turner, for The Times, said the review 'brims with good sense.' However, other reactions were more hostile. Toby Young, in The Daily Telegraph, pointed to government figures showing that incidents of domestic violence against women have fallen, and likened Papadopoulos's review to a 100-page Cosmopolitan article. Janet Street-Porter, for the Independent on Sunday, highlighted Papadopoulos's work for the media and beauty industry, even going so far as to question whether someone 'who wears disgustingly expensive shoes is the best choice as a government expert on childrearing.' Dr Papadopoulos retorted that 'to suggest that the Home Office would employ me to conduct a review of such a serious nature because I am in her words "eye candy" is both offensive and ridiculous' (see http://bit.ly/dkSYfa).

Elsewhere, the Cambridge-based research consultant Alison MacLeod used her blog 'the human element' to highlight anomalies in the review (http://bit.ly/d5lXpX). For example, she traced the review's claim that 'a high proportion of young women in the UK aspire to work as "glamour models" or lap-dancers' to a web survey conducted
by internet TV company Lab TV, which found 63 per cent of 1000 girls thought Jordan was a good role model.

The Psychologist asked Dr Petra Boynton, a social psychologist at UCL who specialises in research on sex, relationships and media, for her verdict. She told us that the review is 'well-intentioned' and 'passionately written' but that it was not 'robust enough to inform policy and practice'.

'The report mostly seems to have been informed by "desk-based research" with little indication of how literature was searched or appraised,' Boynton said. 'It is worrying that peer-reviewed research is presented as equivalent to a survey for Dove beauty products.''Statistics, studies and surveys are mentioned but not fully explained or referenced, so it is difficult to generalise from them. Focus groups are described in brief with no details of participants, procedure or analysis. Young people are constructed as passive recipients objectified by the mass media. Research that discusses how young people understand and engage with mediated culture is absent.'Boynton added that a similar report on 'sexualised goods aimed at children'

for the Scottish Parliament (http://bit.ly/doAVUg) takes a more nuanced and investigative approach. 'It is this work, rather than the Home Office consultation that should underpin our understanding of this area and direct future research and practice,' she said.

However, Dr Papadopoulos told us she was pleased that the media response to her report had been so positive and that some of her recommendations had already been taken up: 'The PM spoke about backing the recommendation of an online "one-stop shop" for parents and for setting up a working group with the NSPCC to advise corporations on products targeted at children. An ongoing campaign on teenage partner violence is already up and running and getting very good feedback. Also I met with ministers last week and the DCFS have welcomed the recommendations for schools regarding gender equality and media literacy, and many of these are expected to be taken forward as well.'

'The report was rigorously researched and is evidence based – conclusions are derived from an in-depth, critical literature review as well as evidence hearing sessions from clinicians and front-line workers in the area,' Papadopoulos said. 'The findings are in accord with the APA report on sexualisation as well as the Australian government report in this area. This does not mean that we don't need more research. For obvious reasons, outlined in the review, longitudinal research in this area is not yet available.'

For other psychologists who are invited to author reports by the government, Dr Papadopoulos had the following advice: 'Make a lot of space in your diary! This type of work takes a lot of time and commitment – ultimately though it's extremely rewarding to be involved in a project that has the potential to make a real difference.'

 

Flexible working benefits health

A new Cochrane Review has come to the tentative conclusion that flexible working conditions, in the form of employee control over shifts and gradual retirement, are good for our health (http://bit.ly/bPQysB).

Kerry Joyce at Durham University and her colleagues trawled the literature for relevant studies that were randomly controlled and that compared measures before and after interventions. Ten studies involving over 16,000 employees were identified, covering six types of flexible working arrangement. Four studies on self-scheduling of shifts and one study of gradual and partial retirement reported significant health benefits, for example in terms of blood pressure and sleep quality. The single study on flexitime found no effects whilst the study into fixed-term contracts found equivocal or negative effects.

The researchers called for more well-designed intervention studies. 'We need to know more about how the health effects of flexible working are experienced by different types of workers, for instance, comparing women to men, old to young and skilled to unskilled,' said Joyce. 'This is important as some forms of flexible working might only be available to employees with higher status occupations and this may serve to increase existing differences in health between social groups.'

 

US psychologists target homelessness

The American Psychological Association (APA) published a Presidential Task Force Report in February on ways that psychology can help bring about an end to homelessness. Commissioned by the 2009 APA President James Bray, the report calls on psychologists to 'redouble their efforts' to help the two to three million Americans who experience an episode of homelessness every year.

Homelessness occurs as a consequence of a 'cascade of economic and interpersonal risk factors' that converge on people 'marginalized in society', the report says. The homeless in America tend to have poorer physical health than people with homes, it continues, and are more likely to experience periods of hospitalisation. Another assertion, perhaps more surprising, is that the majority of the homeless population do not have a mental illness or substance abuse problem, although prevalence rates for both are higher than in the general population.

Other psychosocial factors linked to homelessness, mentioned by the report, include child welfare involvement and institutionalisation. Up to 30 per cent of children in the US foster care system have homeless parents. Moreover, children who leave foster care, either by running away or turning 18, are at increased risk of homelessness. Regarding institutionalisation, the statistics show that homelessness is far higher among jail inmates than the general population and former prisoners are also at increased risk for becoming homeless (former prisoners are also more likely to reoffend if homeless). Veterans are also at increased risk of homelessness, comprising 13 per cent of all adults (unaccompanied by children) who live in sheltered accommodation.

At the heart of the report is a call for greater recognition that providing more housing is not enough on its own to eliminate homelessness. Psychological needs must be addressed too. Psychologists can help, the report says, not only through providing clinical services, but also through training other service providers and volunteers; by advocating at state and federal levels for better services and educational opportunities for the homeless; and by conducting research to find out which interventions work and how to encourage greater service take up among the homeless. To improve psychologists' ability to help the homeless population, the report calls for changes to be made to graduate school curricula and new work placements to be developed.

'Through research, training, practice and advocacy, the field of psychology can make invaluable contributions toward the remediation of homelessness,' said James H. Bray. 'The report of this task force is a call to our profession to work to end homelessness, which is a major public health concern.'

-      See http://bit.ly/bcwl2g for the report, p.284 for a feature on homelessness and p.360 for a 'One on one' with James Bray.

 

Memory service
A psychologist will be among the specialist staff at a new outreach memory service that was launched in Westminster in February at the Royal Society for Public Health. The 'Westminster Memory Service' will provide memory assessment, support, information and counselling to people with memory problems and their carers. The aim is to help detect memory loss in its early stages and to provide support so that people with dementia can stay in their homes for longer.

 

IN BPS JOURNALS

People can feel unsettled by the prospect of being treated in terms of a stereotype, but what social impact might this 'stereotype threat' have on people with mental health issues? Julie Henry (University of New South Wales) got 30 individuals with a diagnosis of schizophrenia to engage in conversations with two confederates, one of whom they were told knew nothing about them, and the other of whom they were told had been informed of their diagnosis (the 'stereotype threat' condition). In reality, neither confederate knew the participants' mental health status. Although participants with a diagnosis of schizophrenia did not perceive any differences in their own social behaviour across the two conditions, their social skill was rated by the confederates as poorer in the stereotype threat conversation in terms of initiating conversation and switching topics appropriately. Confederates also indicated that they felt less comfortable when they interacted with participants who were in the stereotype threat conversation. The authors say that 'disclosure [of mental health status] may not be advisable when interacting with people for the first time.' (BJCP, March)
 
A meta-analysis led by Konstantine Zakzanis (University of Toronto Scarborough) has demonstrated reliable evidence of cognitive impairment specific to anorexia and bulimia. This impairment (in, for example, verbal recall and visuospatial skill) is related to body mass index in anorexia in terms of its severity, and is differentially impaired between disorders. The authors suggest that disturbed cognition 'is figural in the presentation of eating disorder and may serve to play an integral role in its cause and maintenance.' (JoN, March)
 
Most adults experience intrusive thoughts, images, or impulses that are similar in content to clinical obsessions, but is the same true of younger populations? This is important because two thirds of OCD patients date the onset of their symptoms to childhood or adolescence. Now Jenny Crye, Ben Laskey and Sam Cartwright-Hatton (University of Manchester) have found that 77 per cent of 12- to 14-year-old participants report obsessions. Participants who had high levels of deleterious beliefs about intrusions – for example, that it is bad to think certain thoughts – were also more likely to report that their obsessions were harder to dismiss, caused more interference, and that they were more likely to avoid situations that might trigger them. (PPTRP, March)    

 

DSM-5 progresses despite problems

raft revisions to psychiatry's diagnostic 'bible' were published online in February after months of bitter dispute over the proposed changes. The Diagnostic and Statistical Manual 5 (DSM-5), published by the American Psychiatric Association (APA), is slated for a May 2013 release – a year later than originally planned. Although Europe has its own diagnostic system – the International Classification of Diseases – the influence of the DSM changes will be felt here. Possible new diagnostic categories including 'hypersexuality' and 'binge eating disorder' are sure to enter our popular vernacular and affect what is considered 'normal' by society.

Among the most radical proposals is for dimensional assessment to be included alongside a categorical approach that says someone either has a diagnosis or they don't. Factors likely to be measured in this way cut across fixed diagnostic categories and include depressed mood, anxiety, substance use, and sleep problems. The intent, according to the DSM-5 website,'is to provide clinicians a brief, simple way to obtain ratings for such important areas over time regardless of the specific disorder.'

Other notable proposed or possible changes are for Asperger's syndrome to be collapsed into the diagnosis of autistic spectrum disorder; a radical reconceptualisation of personality disorders; the introduction of a sub-threshold 'psychosis risk syndrome' for people at risk of developing full-blown psychosis; and a new diagnosis of 'temper dysregulation disorder with dysphoria' to describe children aged over six who display frequent outbursts and persistent negative mood.

The decade-long process of revising the DSM, with the assistance of more than 600 experts, has been a bumpy ride. There have been accusations of conflict of interest aimed at task force members, as well as high-level resignations – for example neuroscientist Jane Costello departed the working group on children and adolescence last March citing lack of scientific rigour. There have also been damning editorials, most notably from psychiatrist Allen Frances, who was chair of the task force behind DSM-IV. 'I fear that DSM-5 is continuing to veer badly off course and with no prospect of spontaneous internal correction,' he wrote in The Psychiatric Times last June. 'It is my responsibility to make my worries known before it is too late to act on them.'

All the proposed changes can be found online at www.dsm5.org and feedback is welcomed. 'The process for developing DSM-5 continues to be deliberative, thoughtful and inclusive,' explained Dr Kupfer, chair of the DSM task force. 'It is our job to review and consider the significant advances that have been made in neuroscience and behavioural science over the past two decades. The APA is committed to developing a manual that is both based on the best science available and useful to clinicians and researchers.' 

Inquests on 'radiation link' deaths

Inquests into the deaths of two psychologists, Tom Whiston in 2009 and Arthur Reader in 2008, both from pancreatic cancer, will begin later this year according to a report in The Independent. Both Whiston and Reader had spent time working in the Rutherford Building that was occupied by the University of Manchester's psychology department from the 1970s to the late 1990s when high levels of radiation were detected. The same building was once home to the labs of Ernest Rutherford, the 'father' of nuclear physics. In 2008 the former University of Manchester psychologists John Churcher, Don O'Boyle (both since retired) and Neil Todd (now in the neuroscience department) submitted a report to the university entitled: 'Possible health risks due to ionising radiation in the Rutherford Building (formerly Coupland Building 1) at The University of Manchester'. In response, the university launched an independent review, the provisional findings of which were published last year, stating there was no link between deaths of staff and radiation left behind by Rutherford's research.

 

Understanding the brain 

'Understanding the brain' is among five key challenges highlighted by the Wellcome Trust in its 10-year strategy, which was published in February. '[S]cientific discoveries – and their application to patient benefit – take time, and that is why we are setting out our plans for the next decade,' said Sir Mark Walport, the Trust's director.

The 10-year plan cites six research priorities in relation to understanding the brain: understanding neural networks; integrating research efforts at the interface between basic and clinical neuroscience; gaining new insights into mental health disorders; fostering technology development and innovation; integrating humanities, arts and social science perspectives; and public engagement and dialogue. 'To achieve our goal of understanding the brain, we will need to bridge the gap between the findings that emerge from neuroimaging and behavioural studies, and those being generated from basic studies of nerve function at cellular and molecular levels,' the plan says. 

 

CBT effective for back pain

Chronic lower back pain is the bane of many people's lives and is responsible for countless days taken off work. A new randomly controlled trial has found six sessions of group CBT brings more relief than standard advice. All 701 patients, with an average age of 54 years, received an hour's worth of advice plus 'The Back Book'. Group CBT was then offered to 468 of them. This 'Back Skills Training' (BeST) targeted behaviours and beliefs about physical activity and avoidance of activity (people with lower back pain with a non-specific cause are advised to remain active).

Sarah Lamb at Warwick Medical School and her team found that outcomes, including improvements to disability and self-reported recovery, were significantly better in the CBT group than the control group, and unlike many popular treatments such as acupuncture and manipulation, these benefits were sustained over 12 months. By the study end, 59 per cent of the CBT group reported satisfaction with their treatment compared with 31 per cent of the control group. Moreover, the group CBT intervention was particularly cost-effective compared with other interventions.

'Effective treatments that result in sustained improvements in low-back pain are elusive,' the researchers concluded. 'This trial shows that a bespoke cognitive behavioural intervention package, BeST, is effective in managing subacute and chronic low-back pain in primary care.' A possible obstacle to rolling out this intervention more widely could be patient adherence. Only 63 per cent of participants allocated to the CBT group met the compliance threshold (initial assessment plus three or more sessions), which the researchers had decided was required for the intervention to work.