Conference

Reports from the Society’s 2010 Annual Conference in Stratford-upon-Avon

A strong performance in Stratford

Evidence showing the benefits of managers focusing on their employees’ strengths is ‘colossal’. So argued Alex Linley (Centre for Applied Positive Psychology) in an impassioned keynote showcasing the emerging field of strengths psychology. Over 19,000 employees from more than 80 companies were investigated, and when managers focused on staff strengths, performance improved by 21 to 36 per cent. ‘That’s colossal in terms of industrial productivity,’ Linley said. Our natural inclination is towards negativity, Linley explained – a phenomenon known as ‘negativity bias’. Negative events have a more potent effect on us than positive events, we react to negative events more quickly, and negativity comes from more varied sources. Linley said this fundamental human bias has widespread social implications: look at the ‘dismal science’ of economics, the ever-expanding diagnostic system in psychiatry, clinical psychology’s fixation on the medical model, and the focus of public policy on problems.

But Linley argued that positive psychology has identified ways to make positives outweigh the negatives: by paying more attention to our strengths; finding a language of positives; adopting a more positive mindset; and collecting evidence (such as the employee productivity study) for the benefits of focusing on strengths. Other research shows that focusing on our strengths reduces stress whilst boosting our self-esteem, resilience, energy and vitality.

Of course, our awareness of negativity and danger is there for a reason, Linley acknowledged, so the right approach is to find a healthy balance between the positive and negative. Linley’s ‘realise2’ model also highlights how our strengths are not simply the things we’re good at. Our strengths are those things we’re good at that, like walking or like an alternator on a battery, energise us the more we do them (see www.realise2.com).

The right path, Linley explained, is to maximise our unrealised strengths (a ‘goldmine’), marshal our realised strengths, minimise our weaknesses and moderate our learned behaviours. This latter category describes those activities which we’re good at but which don’t energise us. ‘Focusing on learned behaviours can drag people in the wrong direction,’ he said.

‘Who will win the battle of ideas?’ Linley asked. ‘Positive or negative? It’s our choice. Negativity is normal but we can tone it up or down. We can do it, we can all be catalysts [for more positivity], in schools, organisations and in setting social policy.’ cj 

Follow-up care for parents of children in intensive care

In the adult field, there’s a trend for intensive care unit patients and their relatives to be offered follow-up psychological care. It’s generally considered to be a good thing, although Gillian Colville of St George’s Hospital said there’s little actual research to show the difference it makes. Colville works on a paediatric intensive care unit and she’s recently conducted a study to find out whether follow-up care for parents is beneficial. The great fear, of course, is that it could actually do more harm than good, as has been found in the trauma literature in relation to immediate psychological debriefing.

Colville had the parents of 133 children complete a measure of stress within 48 hours of their child’s discharge. Half the parents were offered a follow-up session with a psychologist or nurse two months later, the remainder acted as controls. Follow-up measures of anxiety and depression were taken five months after discharge.

Many parents failed to turn up to the psychological after-care (especially if their child had been in intensive care for less than two days) and of those who did, their levels of anxiety and depression were no lower than among the control group parents.

However, Colville probed the data more deeply and, focusing only on the most highly stressed parents at the study outset (using a median split), the results were more promising. Those highly stressed parents who received the psychological after-care subsequently showed reduced anxiety and depression scores at five month follow-up relative to highly stressed controls. ‘This suggests that screening could help to identify those who could benefit from follow-up psychological care,’ Colville said. cj

Paying attention to addiction

Imagine you’ve gone an entire hot summer’s day without any liquid refreshment. Then you walk past a poster of a tumbler of iced water – what happens, cognitively speaking? It grabs your full attention that’s for sure! It’s a similar story for alcoholics and smokers confronted with cues related to booze or cigarettes. Laboratory studies using a version of the classic Stroop task and others using eye-tracking show that drinkers and smokers are attentionally biased towards stimuli representative of their particular vice. In a wide-ranging keynote, Matt Field (University of Liverpool) – winner of the Society’s Spearman Medal – discussed this field, which he’s worked in for over 10 years, and in particular he focused on the question of whether attentional bias in addiction has any clinical relevance.

Some past research has shown that the amount of attentional bias an addict exhibits predicts their success in treatment, but other papers have failed to replicate this association. In 2005, Field and a colleague directly tested whether training to pay less attention to alcohol would have any benefit for heavy social drinkers. Unfortunately, while it was possible to increase craving by using training to exaggerate the drinkers’ inherent bias towards alcohol, the reverse wasn’t true. Training the drinkers to ignore alcohol cues had no beneficial effect on their urge to drink. A follow-up study similarly showed that attention training had no benefit it terms of amount of beer actually consumed.

Other work with smokers was similarly disappointing. ‘The clinical implications aren’t great,’ Field said. However Field noted that these studies used single session training – ongoing research using multi-session training is having more success.

A clue as to why attention training may not be as successful as hoped comes from research with patients in treatment who are motivated to change and who have no access to alcohol. For these people, alcohol imagery is not attention-grabbing, it’s aversive. These kinds of paradoxical effect could undermine the use of attentional training as an intervention. An alternative approach, however, relates to what’s known as ‘approach bias’ – smokers, for example, are quicker at moving towards a picture featuring a cigarette than an equivalent featuring lipstick. An initial clinical trial targeted this approach bias. Drinkers were trained to avoid alcohol-related pictures and a beneficial effect was found in terms of reduced risk of relapse. ‘This is very promising,’ Field said. 

Communication during surgery 

A 2007 analysis by the United States Joint Commission of over 3000 adverse medical events found that nearly 70 per cent were caused by communications problems. In the case of surgery, approximately 10 per cent of patients experience some kind of adverse event including the wrong patient being operated on, the wrong limb being treated or instruments being left in the body. It’s against this backdrop that Helen Wong of Imperial College London introduced her study into spoken communications in surgery between surgeons, anaesthetists and nurses – the ‘first ever’ attempt to map communications actually in surgery rather than relying on retrospective reports.

Wong eavesdropped on 40 operations – 20 open hernia procedures and 20 keyhole hernia procedures. The two types of procedure both averaged about 47 minutes, and communications in each were brief but frequent – about two to three every minute. Nearly 80 per cent of communications were initiated by the surgeon, nearly 80 per cent related to the primary task and there was little (less than 5 per cent) extraneous, off-topic conversation. ‘The next step is to look at the quality of communications and to look at communications in a crisis situation,’ Wong said.

In a separate study, Wong interviewed 33 surgical team members, including 16 clinicians and 17 non-clinicians, including nurses. Participants were asked to rate the importance of information from different sources and the usual quality of information from those sources.

Clinicians tended to say that information from nurses was less important than information from other clinicians, perhaps an issue to do with professional culture, or perhaps, Wong said, the more holistic approach of nurses is not favoured by clinicians. Another trend was the clinicians rated information from imaging teams as better quality than did the non-clinical staff, perhaps because they had the training to interpret it. Generally, the more experienced the clinician, the more negative they tended to be. It’s possible they had developed a better idea of what they wanted.

Another key finding to emerge from the interviews was the importance of patients as a source of reliable information. ‘It’s important to deal directly and personally with the patient, to get to know and meet them,’ one surgeon said. Overall, clinicians were more critical than non-clinical staff, but they also tended to make more proposals for improving communications – including introducing training, standardising communications protocols and developing a central IT information repository. cj

In brief
Order and CHAOS

‘You can’t hear yourself think in our home’ is a common refrain of stressed parents across the land. Now overcrowding, lack of routine and noise can all be assessed in a confusion, hubbub and order scale (CHAOS), and Ken Hanscombe (Institute of Psychiatry) has used the large-scale Twins Early Development Study to discover that experience of family chaos is a complex and heritable trait. Worryingly for those homes struggling to stay on top of things, increased family chaos is associated with decreased school performance and lower general cognitive ability. js

Competence and humour

Funded by an award from the BPS, Claire Fox (Keele University) set about investigating the links between humour style and social competence in middle childhood. Adaptive and maladaptive forms of humour were identified. Interestingly, aggressive humour was associated with lower anxiety and increased social competence in boys, but with reduced self-worth in girls. js

Mathematical ability

Speaking as a joint recipient of the Society’s Award for Outstanding Doctoral Research Contributions to Psychology, Yulia Kovas (Goldsmiths College, University of London) made the case for ‘generalist genes’ in mathematical ability. That is, mostly the same genes contribute to individual differences in diverse aspects of mathematics, and most of these genes are the same genes that affect reading, spatial ability and general cognitive ability. The same genes are largely involved in both normal variation and low mathematical performance. Kovas’ work with the Twins Early Development Study has identified 10 genetic polymorphisms, on different chromosomes, that are associated with maths ability. js

Reducing exposure

Attempts to deter people from sunbathing and using sunbeds by highlighting the health risks have met with limited success. According to a meta-analysis by Lorna Dodd (Newman University College) and Mark Forshaw (Staffordshire University) the alternative approach of focusing on the adverse effects for attractiveness, in terms
of premature wrinkles and pigmented age spots, could be more promising. However, some studies found this approach increased use of sun protection without reducing UV exposure, so future interventions should stress the need to reduce exposure alongside increasing protection. cj

 

Standing up to failing memory

In his award lecture as one of the recipients of the Society’s Excellence in Teaching Award, David Groome (University of Westminster) had some words of advice for anyone planning to write an introductory cognitive psychology textbook: ‘You will always be competing with Eysenck.’ Thankfully Groome was up to the challenge in this forum, providing an engaging overview of why we sometimes find it impossible to remember things and why we sometimes can’t forget them.

In particular Groome presented evidence from the phenomenon of ‘retrieval induced forgetting’ (RIF) to argue that memories are subject to both activation and inhibition mechanisms, and it is the interplay of these that determines whether a memory can be retrieved. For example, if you present a participant with 60–70 words of different categories (fruit, furniture, animals, and so on), and then ask them to retrieve one item again and again (say, ‘orange’), what tends to happen is that subsequent retrieval of other items in that category (e.g. ‘apple’) are inhibited.

Intriguingly, Groome reported data that suggests a relationship between depression and RIF; with Fiorentina Sterkaj he found that RIF disappeared altogether in a depressed group of participants. This striking pattern of results links to similar findings that anxiety impairs RIF. Currently however, it is difficult to say whether depression results in impaired RIF – for example by impairing the inhibitory functions of memory that are likely to underlie RIF – or whether impaired RIF can makepeople susceptible to depression by making them more vulnerable to intrusive memories.

So what advice might be offered to students on the basis of this research? Firstly, you shouldn’t test yourself on a concept until you have learned it properly. This is because active retrieval of a memory inhibits rival memories; in other words, if you retrieve the wrong answer, you are also inhibiting your memory of the right answer. Secondly, avoid last minute cramming; based on what we know about RIF, all that will do is suppress the important stuff that you have learned during term. Finally, we know that anxiety impairs selective memory; perhaps it is this disruption of the brain’s inhibitory systems that results in the ‘mind gone blank’ exam experience of many unhappy undergraduates. Groome finished by offering some more general words of advice to teachers: relate everything to students’ experience, make it amusing if you possibly can (it might stop their depressed mood messing with their inhibitory systems), don’t include everything you know, and finally (and possibly most importantly), ‘try not to fall over’. sc

Close to the Mark

There’s a famous effect in psychology known as the ‘suppression-induced rebound effect’. The more that you try to forget an idea, such as ‘white bears’, the more you end up thinking about white bears. So how come then, asked Marcelle Fernandes (Swansea University), we don’t see any rebound effect following retrieval induced forgetting? This is the phenomenon whereby the act of successfully recalling some items in a to-be-remembered list occurs at the expense of related, but not recalled, items in that list, which instead end up suppressed. Why don’t these suppressed items bounce back like the white bears?

Fernandes’ research shows that the items suppressed via retrieval induced forgetting do indeed bounce back if you use an implicit, rather than explicit, measure. Participants were presented with positive and negative items describing a man called Mark. The negative items were rehearsed and recalled and subsequent memory for the negative items was better than for the positive items. Consistent with retrieval induced forgetting, memory for the positive items was also actually worse than for control items of a different category that hadn’t been rehearsed. This confirms that recall of the negative items had caused suppression of the positive items (some participants did things in reverse, rehearsing positive items and the opposite effect was found).

But here’s the clever bit. Fernandes then asked participants to wait outside with Mark. Participants for whom the positive items describing Mark had been suppressed chose to sit closer to him than did participants in the reverse condition in which the positive items were rehearsed and the negative items suppressed. That is, the positive items appeared to have rebounded from the suppression of retrieval induced forgetting, influencing participants
to want to sit closer to Mark. cj

The borderlands of mental illness

Clinician or not, most of us probably have a good idea of what’s meant by a diagnosis of depression, anxiety or schizophrenia. But what about the diagnosis of ‘borderline personality disorder’ (BPD), which according to the National Institute of Health and Clinical Excellence applies to up to 2 per cent of the population? Barbara Douglas of the University of Exeter opened this symposium with a historical tour of the borderline personality concept.

In the 19th century, experts described a condition that occupied the borderland between neurosis and psychosis. Irving Rosse in the 1890s wrote of a person ‘standing in the twilight of right reason and despair’. The 1940s saw a shift to a focus on personality, Douglas continued, then later that focus turned to disorder, and today the emphasis is on the life course. Psychiatry’s diagnosis manual,the DSM-IV, describes BPD as ‘A pervasive pattern of instability of interpersonal relationships, self-image, and affects, and marked impulsivity beginning by early adulthood and present in a variety of contexts…’.Douglas argued that the label is problematic – it provokes anxiety among health professionals, and staff are more pessimistic about the prognosis for BPD than they are for depression or anxiety. ‘Perhaps it’s time to reframe the concept once again, this time as a form of complex trauma,’ Douglas said.

Next to speak, Pamela James of Liverpool John Moores University shared her experiences of working with two women with a diagnosis of BPD. Mistrust, resentment, shyness, substance misuse, and an ongoing risk of self-destruction were recurring themes. James tried to provide her clients with coping strategies and to build trust. It can be a balancing act – clients often want to be independent, but they also desire ongoing support.

About a year ago, the Avon and Wiltshire Mental Heath Trust set up
a dedicated service for BPD based on Marsha Linehan’s dialectical behaviour therapy (DBT) model. Claire John described how she and her colleagues completed the 10-day in-house training before selecting suitable clients from their existing case loads. Only if clients recognised BPD as an appropriate diagnosis for themselves were they admitted into the DBT programme.

Six clients began group DBT training in mindfulness, distress tolerance, interpersonal effectiveness and emotional regulation. Two clients chose to drop out at the first or second module; a third client was too stoned to continue. The remaining three are making good progress and using the skills in real-life contexts (although one client has just been admitted on to an acute ward, delaying her involvement for the time being).

On reflection, John said the start was promising, clients were clearly getting something from the programme. However she warned that the process is labour-intensive. It had taken six to seven months to get this far, and with only three ‘successes’ out of six, there were clearly issues for cost-effectiveness. She said more rigorous pre-treatment training and screening could be useful, and she advised providing a bespoke mobile telephone contact for clients on the programme. Even if not permanently staffed, clients can leave a message and it can engender
a feeling of ongoing support.

Anyone can experience mental health problems, a fact that was brought home in the final presentation by Nicola Gale of UCL Hospitals NHS, who provides a BPD service for clients who work in the NHS. A large part of assessment is about untangling to what extent the individual or the organisation has contributed to the problems being experienced. There are often difficulties for line managers, who can find staff with a diagnosis of BPD problematic and unpredictable. The question of risk also has to be dealt with, for example if self-harm is conducted in the workplace. ‘There are particular issues of stigma for health professionals,’ Gale said. ‘Often these clients have all the clinical features of a diagnosis but they’re too high-functioning for referral to other services.’ cj

MPs are people too

In the wake of the expenses scandal, MPs have sunk to an all-time low in the public’s perception; however Ashley Weinberg (University of Salford) was on hand to persuade us that MPs are people too. Weinberg reported findings from a longitudinal study that assessed MPs’ personality, psychological health and physical health. He found that MPs were generally more extraverted than members of the general population, and (perhaps surprisingly to some) scored higher on agreeableness. They also scored higher on emotional stability, although they scored similarly to the general population for conscientiousness and slightly lower on openness. Weinberg reported that the expenses scandal had had a negative impact on MPs’ view of their jobs and particularly their view of the House of Commons, with the MPs who scored lower on stability being most affected. MPs work long hours, report high levels of psychological strain and struggle to find
a balance between their work and home life.

There are occupational health facilities at the House of Commons, but little formal structure for supporting MPs. It is easy for us to dismiss the problems faced by MPs; however, none of us would want to be placed in the care of an air traffic controller or doctor who was experiencing extreme stress and receiving no support. As Weinberg pointed out, why do we feel so differently about the people who run our country? sc

Setting the prison study free

As joint recipients of the Society’s teaching award, Alex Haslam (Exeter University) and Steve Reicher (St Andrews University), provided delegates with a fascinating overview of their BBC Prison Study, a reimagining of Zimbardo’s Stanford Prison Experiment.

Zimbardo’s study was famous for the speed with which ordinary young men, given a uniform and assigned the role of guard, began to mete out brutal treatment to those playing the roles of prisoners in their care. Zimbardo argued that people cannot resist the roles into which they are cast; most recently this ‘role account’ was invoked to account for the appalling events at Abu Ghraib. But Haslam questioned the role account of brutality, arguing that (despite his assertions to the contrary), Zimbardo had given the guards in the Stanford Prison Study clear instructions on the role, which may have contributed to their behaviour. Also, although the study is often cited as evidence of the inevitability of brutal behaviour, there was actually considerable variability in the behaviour of the prison guards. Haslam argued that the Stanford study focuses too much on the endpoint of tyranny; what is more crucial is the process by which normal people identify with tyrannical leaders and follow their orders.

Social identity theory (SIT) argues that people do not passively accept the roles assigned to them: instead, they must internalise it as an aspect of their social identity. Importantly, this need not be a negative thing; this process could just as well be the basis for a group’s resistance to tyranny as it could provide the basis for terrible actions. By removing themselves from the process but systematically varying the permeability of the boundaries between prisoners and guards in order to test the predictions of SIT, the experimenters found results consistent with SIT principles. Far from automatically adopting the behaviour of oppressors, the guards’ discomfort at their role in the study and their different perspectives on how to cope resulted in an inability to develop a shared social identity. The guards’ authority eventually collapsed and the participants attempted to create a more egalitarian system. However, this was ultimately unworkable and it was this collapse that revealed an appetite for firm leadership. The final message from the BBC Prison Study is that tyranny is not
a consequence of a scripted role; rather, the pathway to tyranny lies through group failure. It is when groups fail that people become open to the possibility of extreme and tyrannical solutions; if we want to strengthen democracy, then we need to strengthen groups.

Following on from Haslam’s talk, Reicher spoke of the process of engaging the public with the BBC Prison Study – a successful and ongoing venture that was recognised in the award. Reicher railed against the ‘rhetoric of tedium’ in academia, the assumption that being partisan is the enemy of science, and the unfortunate tradition in academia to reward ‘obscuration and irrelevance’ in the dissemination of research findings, publishing in journals that only a small handful of other academics will read or cite. However, Haslam and Reicher have worked hard (with the help of many others) to make the findings and theoretical implications of their study accessible to all. A key component of this was distilling the message to a level appropriate for A-level students. The study has resulted in a single-lesson format DVD, a book, articles (e.g. www.bps.org.uk/srah) and www.bbcprisonstudy.org, which receives an impressive 10,000 hits a day. As well as A-level students, Haslam and Reicher have spoken to a wider non-academic audience, including business leaders, civil servants, defence workers and teachers. Only time will tell if the study enters into the public consciousness in the way that the original Stanford Prison Experiment did, but it will not be for want of public engagement. sc

Is society prejudiced?
Delivering the final keynote of the conference, Professor Dominic Abrams (University of Kent) asked whether we are a prejudiced society. A nationally representative survey of 3000 people on endorsed values would suggest not, with top billing going to ‘equal opportunities and treatment’. However, around one in six people say that attempts to give equal employment to certain groups in Britain – namely gay/lesbian, black or Muslim people – have gone too far. Only a third think that more employment equality is needed for women, the elderly, or disabled people. Abrams sees these results in terms of prejudice as
a conflict, between private and public morality. In surveys, people are reporting that they are suffering from prejudice even though very few feel that they are expressing it.

Referring to work by Susan Fiske, Professor Abrams showed how stereotypes are aligned on dimensions of warmth and competence. This leads to either hostile or benevolent forms of prejudice: for example, cold attitudes towards a group perceived as incompetent would lead to contempt, but warm attitudes could lead to pity. Hence, according to Abrams, the elderly or disabled might be considered ‘loveable but useless’.

Extending this emotional view of prejudice, Abrams showed how good relations can actually exist alongside high prejudice, leading to a situation of ‘rivalrous cohesion’: a cohesive, engaged community that is nevertheless competitive towards subordinates and rivals. Is this the way the UK is headed, Abrams asked?

Abrams highlighted his practical work with the Equality and Human Rights Commission and the Department for Children, Schools and Families. Stereotypes create disadvantage, he argued, via the burden of suspicion that a negative stereotype is at work (so called ‘stereotype threat’). Multiple perspectives on prejudice must be understood and tackled, not feared, ignored or repackaged. He ended with a rallying call, saying that psychology is uniquely placed to affect social policy. js

Professional practice award

As a joint recipient of the Society’s Professional Practice award, Professor David Lane (Professional Development Foundation) delivered a stirring speech reflecting on the scientist-practitioner model of therapy. Do we work with the client’s story as they want to tell it, he asked, or do we require them to tell it in a way that fits the dictates of the provision that we have? He called for psychologists to work towards the principle of ‘unfettered free enquiry’ as defining our stance, building on the client’s creativity and adapting the way we build stories according to the particular circumstances.
The other award recipient, Professor Graham Turpin (University of Sheffield), delivered an update on the Improving Access to Psychological Therapies programme. Over 75,000 people have now completed treatment via the initiative, with a 32 per cent recovery rate in initial quarters that is now heading towards 50 per cent. Nearly 7000 people have moved off sick pay and benefits, and Turpin believes we should celebrate the fact that psychology is the dominant profession within the IAPT team. Some psychologists may be uncomfortable with the service philosophy, but Turpin says we should take some credit for IAPT and help to shape and evaluate its roll-out: one focused on care pathways the client requires, not just what the profession wants to provide. js


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