News, October 2013

Decline in psychotherapy

The Improving Access to Psychotherapies programme in England has failed to curb the country's steady, decades-long increase in antidepressant prescription rates, according to a new analysis. Professor Azeem Majeed (Imperial College, London) and his colleagues looked for any changes to prescription rates after IAPT was implemented in 150 Primary Care Trusts (PCTs) across the country (British Journal of General Practice: tinyurl.com/m3wsfrp). From 2008 to 2011 they found that prescriptions for antidepressants rose 10 per cent per year and that the introduction of IAPT to a PCT made no difference to this increase.

Their finding coincides with publication of the latest data for England showing that more prescriptions for antidepressants (over 50 million) were written last year than at any previous time. This is despite a growing literature showing that mental health patients prefer psychotherapy to drugs if given the choice, as confirmed by a newly completed meta-analysis conducted by Kathyrn McHugh at McClean Hospital and reported on our Research Digest (tinyurl.com/krjdnwz)The reason for IAPT's failure to reduce antidepressant prescriptions is unknown, but may be due to GPs prescribing while patients are on an IAPT waiting list, or perhaps the influence of IAPT needs more time to be felt. This news, which will disappoint many clinical and counselling psychologists, arrives in a wider context in which our colleagues across the Atlantic are concerned about the declining practice of psychological therapy and concomitant increase in drug prescriptions. 

Writing in the introduction to a special issue of Clinical Psychology Review devoted to the challenges facing evidence-based psychotherapy, Brandon Gaudiano (Alpert Medical School of Brown University) and Ivan Miller (Butler Hospital, USA) note that this decline is occurring even as the evidence base for cognitive behavioural therapy and other forms of talking therapy has grown substantially. 'One might think that this deep and expanding evidence base would have promoted a similar increase in the use of psychosocial interventions,' they write, '…but it decidedly has not. Thus, a time that should have been a relative boon for psychotherapy based on scientific standards, has become more of a bust.'

Gaudiano and Miller's diagnosis is that the decline of psychotherapy is related to psychology's failure to fully embrace an evidence-based approach, leaving it diminished in healthcare systems that are increasingly dominated by evidence-based medicine and treatment guidelines. The pair highlight a 2008 survey of 79 psychologists that found 30 per cent were using controversial, unsupported treatments. More recently, a team led by Gaudiano found that 42 per cent of practising therapists were using empirically unsupported 'energy meridian therapies'.

Related issues, according to Gaudiano and Miller, include the growing dominance of the biomedical model in psychiatry (an issue that's dominated our own news pages over the last few months) and, in the USA, the influence of direct-to-consumer drug advertising and the fall in health insurance reimbursement rates for psychotherapy.

Contributors to the journal special issue were invited to 'think outside the box' and to 'propose novel solutions' to the challenges that lie ahead for evidence-based psychotherapy. Among the responses, a group led by Scott O. Lilienfeld at Emory University outlined six key reasons why many clinical psychologists remain resistant to evidence-based practice, including: naive realism (a preference for clinical intuition over systematic research findings) and belief in myths about human nature (e.g. believing in the causal primacy of early experiences). They make several recommendations for psychology education and training practices on the back of these observations, including directly challenging the aforementioned myths in student training.

Other contributions include Jerome Wakefield at New York University on the dropping of the bereavement exclusion criteria for major depression, and a team led by Steven Hayes at the University of Nevada with plans for an alternative way to develop new psychotherapy treatment approaches.– Christian Jarrett (CJ)
The special issue is at: sciencedirect.com/science/journal/02727358/33/7

A-level popularity
Psychology remained the fourth most popular subject at A-level and AS-Level in 2012 to 2013, despite a slight drop in the number of candidates from the previous year (there were 56088 and 96908 candidates in the most recent intake, respectively). This is against a background of higher numbers taking physics, chemistry and biology. Grade attainment in psychology A-level and AS-level pass rate was also slightly lower this year. In contrast, the psychology pass rate in the Scottish Highers was up by 5 per cent, and the entries increased by 9 per cent on the previous year (3099 to 3370). – CJ

The happy mirror

Imagine looking into a mirror and seeing a slightly happier version of yourself looking back. Do you think it would affect how you feel? A team of researchers led by Shigeo Yoshida at the University of Tokyo have created a webcam system called 'incendiary reflection' that acts like a mirror depicting either slightly happier or sadder version of those who look into it. The researchers were inspired by the 'facial feedback hypothesis' – the finding that the expression on our face affects our feelings.'We developed a method for deforming a user's face and transforming a user's facial expression in real time, using an image-processing technique,' Yoshida writes on his website (www.shigeodayo.com). In initial tests people reported feeling more positive after looking at a version of themselves distorted to look happier; and said they felt more downbeat after looking at the sad reflection (see a video about the research at youtube.com/watch?v=1ORSFameZZI). A further study involved participants wearing a new scarf as they looked in the 'mirror'. When the reflection was altered to show them smiling back, they were more likely to say they liked the scarf.

The findings were reported in New Scientist (tinyurl.com/nkpa5x5) and presented at SIGGRAPH2013 (the 40th International Conference and Exhibition on Computer Graphics and Interactive Techniques) and the 4th Augmented Human International Conference. – CJ

Playing to learn

A school with a difference opened its doors in Denmark in August. A partnership between the LEGO Foundation and Billund Municipality,  it is the latest step in an ongoing project to make Billund a 'Capital of Children', 'a unique center for children's play and learning'. The International School of Billund, initially for three- to seven-year-olds, will combine the international baccalaureate with the Danish school system and the toy manufacturer's creative philosophy of learning.

LEGO have for many years sought to ensure that their products are informed by academic research in psychology and related disciplines, and that such evidence has the policy impact it deserves (see tinyurl.com/legopsych). We spoke to Bo Stjerne Thomsen, who directs research for the LEGO Foundation. 'The best way of learning is to be playful and make things', he said. 'We're engaged in a big, global efforts to cultivate and raise awareness of this, and to work with the growing academic network and an expanding agenda on the value of play.'

Thomsen says a key question is 'What does "best" mean in terms of what we do for children?' He feels the answer lies in the way we are with children when we are around them. 'Children are not unfinished, they're so powerful,' he says. 'Psychologists are people who understand this, that we need to be engaged with them, and to relax! Policy makers are stressed by the constant push for standardised assessment… how can we create confidence, in teachers and parents, that we can reach educational goals through playful learning?'One prospective parent told The Guardian: 'In the UK you're taught how to pass exams. In Scandinavia you're taught how to think.' Thomsen backs this approach, saying: 'There are so many different ways to build competence to learn – to support the core skills of being curious, keeping attention and self-regulating behaviour.'

Does the LEGO Foundation have a message for our readers? 'There's a lot of isolated work going on,' Thomsen replied, 'and academics often don't have the time, interest or capacity to communicate their work to others. If you can explain why play is exciting, we need to work together for impact.'

LEGO have also launched Cultures of Creativity, a report co-authored by Thomsen that explores the role of play and creativity in the development of societies across cultures (see tinyurl.com/legococ)
– Jon Sutton (JS)

Bias in expert testimony

When forensic psychologists or psychiatrists provide expert testimony in court they're supposed to be objective, but a new study shows that their judgement tends to be biased towards the side that recruited them – the prosecution or defence (Psychological Science: tinyurl.com/p74cgdb).

Daniel Murrie at the University of Virginia and his colleagues recruited just over a hundred forensic experts (most were psychologists) to take part in what they were told was a contract to review sex-offender cases for either a public defender service or a specialised prosecution service.

Following the cover story, the participants completed a two-day training workshop on use of two established risk instruments – Hare's Psychopathy Checklist (PCL-R) and the Static-99R that's used to predict sexual recidivism. Three weeks later the participants met with either a defence or prosecution attorney (played by the same actor) and used these tools to review objectively four real-life sex-offender case files.

Normally, inter-rater agreement for the PCL-R and Static-99R is very high, but in this context the participants' ratings were significantly different depending on whether they thought they were acting for the prosecution or the defence. The finding raises concerns, Murrie and his team said, because it shows that 'some experts who score ostensibly objective assessment instruments assign scores that are biased toward the side that retained them'.

In fact, the researchers believe such biasing effects are likely to be larger in real life. The study involved just 15 minutes spent with the retaining lawyer, yet in real cases this contact could last weeks or months. Moreover, the current research required that the participants review the exact same files and interview transcripts whereas in real-life cases there could be the potential for seeking different sources or interviewing offenders in different ways. The researchers also noted the scope for bias could be greater for more subjective judgements, such as when assessing emotional harm. – CJ

Healthy behaviour and well-being

Public Health England (PHE) – an executive agency of the Department of Health established earlier this year – has published a briefing paper claiming that young children's sedentary life styles, including too much time watching TV and playing video games, is having an adverse effect on their social and emotional well-being (pdf at tinyurl.com/nk8hpm5). The claims will doubtless be welcomed by those experts who have attracted controversy for campaigning about the dangers of modern technology for children.

The PHE document, aimed at parents and the providers of children's services, uses the research literature to make specific claims about the negative outcomes associated with young children spending too much time watching TV, playing video games or using social networking sites. According to the briefing, these adverse outcomes include increased risk of attentional problems, reduced feelings of social acceptance, more loneliness and conduct problems, lower self-worth and self-esteem, and increased anxiety and depression.

The briefing 'How healthy behaviour supports children's wellbeing' also includes information from UNICEF and the WHO that shows the UK is only middle-ranking among OECD and EU countries in terms of our children's life satisfaction (with over 85 per cent rating their life satisfaction highly), and actually below average among OECD countries in terms of children's beliefs about their own health (with 96 per cent rating it as good or very good).

The PHE publication coincides with the release of new research based on the Millennium Cohort Study that's tracking the health of thousands of UK children born between 2000 and 2002. Lucy Griffiths at UCL and her colleagues looked at activity data (derived from accelerometers) for over 6000 of the children when they were aged seven. The results show that fewer than half of the children were engaging in recommended levels of physical activity – that is, at least an hour of moderate to vigorous activity each day (BMJ Open: tinyurl.com/offowax).

Although the PHE briefing document includes caveats about the correlational nature of the data linking screen time with adverse outcomes, it neglects to mention research showing the cognitive and other benefits of some forms of screen entertainment and social networking activities. And in a government press release, PHE summarises the situation without equivocation, claiming that 'Too much time in front of screens – including TV and computer games – combined with a sedentary lifestyle is taking its toll on our children's wellbeing and increasing their anxiety.' Predictable headlines have followed, such as 'Video Games and TV "Make Children Depressed"' from Sky News.

The PHE briefing also cites evidence showing the positive effects of physical activity for children's emotional development. The agency's claims about screen time and exercise are being used to support its Change4Life campaign which is encouraging families to capitalise on the back-to-school period to establish new healthy lifestyle habits, such as swapping car journeys for walking and setting limits on children's non-work screen time.

Professor Kevin Fenton, PHE's Director of Health and Wellbeing said: 'There are many complex factors that affect a child's well-being, such as the wider environment they live in and their social, financial and family circumstances, but there are also some very simple things we can all do every day with our children to help improve their health and well,being.'

We asked BPS member Pete Etchells at Bath Spa University what he thought of the PHE briefing. He said it was strange that there was no mention of recent research (also based on the Millennium Cohort Study) showing a more complicated relationship between screen time and child development outcomes – most associations disappeared when other factors like socioeconomic status were taken into account. Also the results varied between TV viewing and video-game playing (Archives of Disease in Childhood: tinyurl.com/phyg8h4).

'Screen time is a pretty useless construct,' Dr Etchells said. 'We find different effects depending on the type of screen-based technology that's being used – video games vs. TV for instance. But even there, it's not so simple – the types of video games, or the content of the television programmes are surely of more interest. I think what this PHE briefing does highlight is how little we still know about the behavioural effects of modern technology. We really need to start taking a more mature, nuanced approach to the issue before issuing guidelines.' – CJ

Pete Etchells' Guardian blog post on the PHE briefing: tinyurl.com/qap89o2 

Admitting mistakes

Barbara Fredrickson, one of the world's leading positive psychologists, has admitted that a highly influential paper she co-authored in 2005 is fundamentally flawed. Published in American Psychologist, the paper purported to show that flourishing mental health is linked to people experiencing a specific ratio of positive to negative emotions of over 2.9 (tinyurl.com/pvdhomk).

The ratio was consistent with Fredrickson's 'broaden and build theory' – the idea that positive emotions encourage attitudes and behaviours that help build emotional resilience. It also appears on the cover of Fredrickson's critically acclaimed 2009 book Positivity: Top Notch Research Reveals the 3 to 1 Ratio That Will Change Your Life.

However, in a paper published this summer, also in American Psychologist, Nicholas Brown and his colleagues documented 'numerous fundamental conceptual and mathematical errors' in the nonlinear dynamic modelling used by Fredrickson and her co-author Marcial Losada (tinyurl.com/q84nnoc).

Fredrickson published a response in the same journal issue accepting the errors. And in a letter written to the Chronicle of Higher Education in August she says that she and Losada have submitted a formal correction notice to the 2005 paper. She also plans to amend future editions of her book.

But Fredrickson adds: 'Other elements of the original [2005] article remain valid and unaffected by this change, most notably the empirical finding – replicated across two independent samples – that positivity ratios were significantly higher for individuals identified as flourishing relative to those identified as nonflourishing.' – CJ

Police 'super-recognisers

The Metropolitan Police claimed in August that it had deployed 17 police 'super-recognisers' to help spot known offenders at this year's Notting Hill Carnival. 'The highly skilled officers can recall the faces, names, birth dates and other details of offenders, years after seeing them either in person or on file,' the Met said in a press release. The concept of super-recognisers was only recently developed in psychology and came about through work on prosopagnosia – a specific difficulty in recognising faces. Research suggests that super-recognisers substantially outperform most people on a variety of tests including identifying faces in poor light or from unusual angles (see p.726 for more on super-recognisers).  – CJ

Addiction capital

The UK is the 'addiction capital of Europe' according to a new report No Quick Fix published by the Centre for Social Justice in September. The report claims that 40,000 addicts are 'stranded' on substitutes like methadone and that the government has failed to take the urgent action that's required to deal with the rising number of people taking 'New Psychoactive Substances' – also known as legal highs. – CJ
Download the pdf at tinyurl.com/pfrp3tc

Tweet Trouble
A prominent US evolutionary psychologist has been censured formally by his host institution after an investigation into a tweet he sent earlier this year. In June Professor Geoffrey Miller suggested on the social media site that obese PhD applicants are unlikely to have the willpower to succeed at their research. He later claimed the tweet was part of a research project, but the University of New Mexico found this to be untrue.

Nudge US
The Obama administration is reportedly following British Prime Minister David Cameron's lead and setting up its own Behavioural Insights Team or 'Nudge Unit' that will use lessons from psychology to inform public policy. Members of the UK Nudge Unit met recently with the head of the US team, Maya Shankar, 'to discuss how we will exchange ideas and share research'. Shankar is a former Rhodes Scholar in psychology.

Problem gambling award
Dr Mark Griffiths, Professor of Gambling Studies at Nottingham Trent University, has become the first-ever recipient of a lifetime research award given by the US National Council on Problem Gambling (NCPG). The award is given for exceptional long-standing research that assists problem gamblers and their families. Keith Whyte, the executive director of the NCPG, said: 'His work has resulted in a much greater understanding of problem gambling among academicians, therapists, policy makers, and the general public.'

Predicting suicide
Researchers in the USA have discovered six genetic biomarkers for suicide in the blood of patients diagnosed with bipolar disorder and schizophrenia (Molecular Psychiatry: tinyurl.com/pljuzlz). Alexander Niculescu and his colleagues found that when combined with clinical measures of mood, one of these biomarkers (encoded by the gene SAT1) predicted future suicide-related hospitalisations with over 80 per cent accuracy.

Moving forward on reversal theory
Gareth Lewis (University of Leicester) reports from the 16th International Reversal Theory Conference, in Reims

Reversal theory emerged in the early 1970s, created and developed by K.C.P. Smith and Michael Apter, in order to account for observations of psychological, emotional and motivational states reversals, in child and family clinics. Apter has said: 'The primary aim of reversal theory is to show that the various aspects of a wide range of types of experience and behaviour may be explained with reference to certain pairs of states and reversals which occur between them.' For example, you can eat being serious and pursuing a goal in eating, or being in a spirit of seeking pleasure in the moment. Reversal theory has long been known for being an unusually general theory of motivation, emotion and personality. As Etienne Mullet put it in his Ken Smith Memorial Lecture here: 'As reversal theory has deliberately been conceived as a theory of daily life, it is proving to be a convenient tool for intrepid researchers wishing to make a foray into untouched areas of human behaviour.'

This wide scope led to a stunningly eclectic mix of papers presented and interests discussed. New insights and ideas were presented on some perennial research contexts associated with the theory, such as sport (John Kerr, Joanne Hudson), therapy (Nathalie Duriez, Jonathan Wright), education (Kathryn Lafreniere, Ken Cramer, Gareth Lewis), leadership (Christophe Lunacek), smoking cessation (Brian Colwell) and other health issues.

Reversal theory has a lot to say about the experience of rebelliousness, negative emotions and other problematic aspects of human experience, and new aspects of these themes were presented at the conference. For instance, Mark McDermott presented a study demonstrating the association of rebelliousness and attachment difficulties as a result of parental neglect. Mitzi Desselles presented evidence of the enjoyment of negative emotions using the reversal theory construct of parapathic emotions (negative emotions experienced pleasantly when in the playful state).

Etienne Mullet and his research students in Europe and West Africa presented a series of studies that looked at the complex motivational structures involved in socially and personally important choices. The studies all involved motives to perform or not perform health-related behaviours such as surgical amputation, organ or blood donation, bleaching skin, etc. The studies used a classical methodological approach involving the qualitative development of an inventory of motivational items, followed by collection of quantitative data, together with exploratory and confirmatory factor analyses. Mullet presented a synthesis of 10 studies that confirmed reversal theory's capacity to fully account for these phenomena, in contrast to traditional two- and three-factor models of motivation.

It was also refreshing to hear a number of exciting new applications of the theory in the commercial world. Design groups in the Universities of Delft and Twente in the Netherlands are using the theory to develop an approach to the design of products and services, such as the cabin experience in an aircraft, through the hospital experience for young people, to designing the environmental ambience of a train station. Another presentation (Leo Watkins) described how a global sports shoe company was using the theory to research perception of its brand image.

There was also the opportunity to sample the champagne, to make new friends, and to catch up with some of the stalwarts of the reversal theory community, including Richard Mallows (now President of the BPS, who gavea keynote speech) and Michael Apter and Mitzi Desselles, who described how their team at LATech are expanding the empirical foundations of the theory through further research into basic concepts such as parapathic emotions, and the development of a definitive motivational state measure.

We thank Fabien Legrand and his team for being generous hosts, and look forward to meeting in Canada in 2015.
I    For more on the sessions and the theory, see reversaltheory.net/org