Nudging us to better health
The first output from the government’s new Behavioural Insight Team (BIT), already nicknamed the ‘Nudge Unit’ by the media, was published on the last day of 2010 – a discussion paper on applying psychological principles to improve public health.
The paper notes how health and lifestyle issues, including loneliness, are the major contributor to half of all UK deaths. ‘Strong-armed regulation is not the answer to rebalancing our diets, changing our desire to drink too much alcohol on a Friday night, or making our lives more active,’ it says, arguing instead that people can be encouraged to live more healthily using cheaper and more effective ‘Nudge-style’ interventions, which emphasise prevention rather than cure.This general philosophy, referred to as ‘libertarian paternalism’ by the authors of Nudge, was enshrined in the coalition government’s agreement statement published last May: ‘Our government will be a much smarter one, shunning the bureaucratic levers of the past and finding intelligent ways to encourage, support and enable people to make better choices for themselves.’
The bulk of the new discussion paper is made up of case studies of this new psychological approach as applied to smoking, organ donation, teenage pregnancy, alcohol, diet and weight, diabetes, food hygiene, physical activity and social care (see below for more examples).
For example, in relation to organ donation, the BIT is working with the DVLA to include a compulsory question about registering as an organ donor on the form for applying for, or renewing, a driving licence. Previously this question could be skipped, but now people must answer, even if only to say that they don’t want to decide now – an approach known as ‘prompted choice’.
In relation to smoking, the team is working with the high-street chemist Boots to exploit the principle of loss aversion by having smokers sign a contract in which they agree to pay a fine if tests show they have smoked.
‘It is clear to us from our work with the Department of Health, health professionals and businesses that there is a great deal of energy and enthusiasm for the new health agenda,’ the paper concludes. ‘If we can combine the insights from behavioural science with this enthusiasm and professional expertise, the benefits are likely to be very substantial indeed – fewer lives lost, better value for money and better health.’
Anyone with examples of how psychology is being, or could be, applied to health is invited to e-mail the Behavioural Insight Team on [email protected]. David Halpern, director of the BIT and a psychology graduate, told us that economics and law are long-established disciplines in Whitehall and Westminster, but there is a growing recognition of the importance of psychology. ‘Most policy challenges have a strong behavioural component – from health, to the green agenda, to economic growth and confidence. The creation of the Behavioural Insight Team within government is an acknowledgement of this importance,’ he said. ‘But it is a very small team, and we are very reliant on the wider academic and research community – we are always open to new evidence, ideas and support.’
A related development in December was the creation of a dedicated Behaviour and Health Research Unit at the University of Cambridge, tasked with informing government policy on assisting people to behave more healthily. The Unit is headed by Chartered Health Psychologist, Professor Theresa Marteau. The Behavioural Insight Team also played a key role in the Giving Green Paper published by the government just before Christmas. This is a public consultation on ways to encourage social action – volunteering, philanthropy and the provision of mutual social support. cj
- For the report, see tinyurl.com/29s2rp2
More healthy ‘nudges’
The UK charity Teens and Toddlers aims to reduce teenage pregnancies through a programme in which teenagers spend 20 weeks mentoring a toddler. The idea is that the experience brings home the magnitude of the responsibility of bringing up a child.
The Welsh Assembly Government and the charity Drinkaware are developing a year-long ad campaign to communicate accurate information about student drinking norms to students. Past research has shown that students consistently overestimate how much their peers drink.
Research by Collin Payne at the New Mexico State University College of Business found that shoppers bought more fruit and vegetables when trolleys were designed with a dedicated compartment labelled as being for fruit and veg.
The Behavioural Insight Team and Department of Health have formed a partnership with LazyTown, an Icelandic TV show with a healthy superhero character, Sportacus, who motivates children to eat healthily and be more active. When a supermarket chain in Iceland branded their fruit and veg as ‘Sports Candy’, the name used in LazyTown, sales went up by 22 per cent.
Blood monitoring can be challenging for children with diabetes and their parents. A collaboration between Bayer Healthcare and Nintendo has led to a Didget device in which children earn game points for consenting to pin-prick blood-sugar tests.
A new food hygiene rating scheme aims to make information on restaurant hygiene as salient and accessible as possible, for example by encouraging hygiene-based restaurant league tables and the voluntary use of rating stickers on entrances and windows.
Professor Gilbert is a consultant clinical psychologist for Derbyshire Mental Health Services NHS Trust, holds a chair in clinical psychology at the University of Derby and is a Fellow of the British Psychological Society. He received his honour for services to mental health care. He told us he’s delighted with the news although conscious that ‘there are many psychologists equally if not more deserving of recognition’.
Gilbert is planning a randomly controlled trial of the CFT approach. Another focus is to continue building the Compassionate Mind Foundation (www.compassionatemind.co.uk), which he founded: ‘We are trying to fund compassion-focused research, put as much free descriptive and training materials as we can on the site, and link compassion-focused therapists around the world.’
‘In a time when psychology seems to be increasingly marginalised (especially in the NHS), as if it is a luxury, we psychologists must resist this and gain the confidence to point out that many of the world’s problems arise from how our minds work,’ Gilbert said. ‘Rage, vengeance, selfishness, exploitation, empathic failure, along with harnessing the motives for justice, fairness and compassion all come down to how our minds work in specific social contexts. We can be angels or demons. Psychology is no luxury.’
Dr Jeune Guishard-Pine is a consultant psychologist for the NHS and in private practice, and an Associate Fellow of the BPS [see also ‘One on one’, October 2010]. ‘I’m thrilled,’ she told us. ‘I was shocked that it was an OBE [for services to families] rather than an MBE, so I feel really proud of myself.’ Guishard-Pine first became serious about supporting disadvantaged children through education when she was aged just 16 – helping them find a route out of persistent poverty, and finding ways of giving vulnerable children their childhood back. ‘These were the reasons why I decided to be a child psychologist,’ she said. ‘I am proud of my track record of achieving these aims and that the contribution of child psychology to wider society is being noticed in this way.’ Looking to the future, Guishard-Pine is currently fund-raising to conduct research into the viability of developing an accredited counselling skills course for foster carers, ‘because their contribution to children’s well-being goes largely unrecognised in a formal way.’ Guishard-Pine’s personal aim is to become a Fellow of the BPS. ‘I hope it’s only a rumour,’ she said, ‘that it would be harder for me to demonstrate that I can be accepted as a Fellow of the BPS than being awarded an OBE! Only time will tell…’ cj
Tuition fees protest - lessons for crowd control
The student tuition fees protest that took place in London on 9 December raised numerous questions about the psychology of policing large crowds. As the demonstrations descended into violence, dozens of people were injured, national monuments and government buildings were vandalised and multiple arrests were made. An objective appraisal of the events was hard to come by, as the Metropolitan Police were subsequently criticised for being both too soft and too brutal by commentators from different ends of the political spectrum.
As we reported last February, the latest government advice to the police on how to manage crowds is underpinned by psychological theory. This advice is contained in a report published by Her Majesty’s Inspectorate of Constabulary (HMIC) in 2009, and subsequently incorporated into official training manuals.
The elaborated social identity model (ESIM), developed by Professor Steve Reicher at the University of St Andrews, Dr John Drury at Sussex University and Dr Clifford Stott at the University of Liverpool, explains how protest situations are characterised by a shifting dynamic of social influence, whereby the peaceful majority can come to identify either with a violent minority or with the police. Which way their allegiance falls depends in part on whether police action is perceived as legitimate.
Stott tells The Psychologist that research he’s conducted with Reicher and Drury shows how a general norm of non-violence in a crowd can change radically in response to indiscriminate policing, which is what he believes happened in Parliament Square on 9 December.
‘You cannot understand the events in Parliament Square in isolation from previous protests. But kettling [the police tactic of containing a large crowd in a confined area], by definition, is extremely indiscriminate and it changes people’s perception of the legitimacy of the police,’ Stott says. ‘My question is why are the Metropolitan Police not moving more rapidly toward modes of policing that reflect the latest evidence and theory given that this provides the formal framework for Association of Chief Police Officers guidance on policing crowds?’
Another psychological angle relates to the importance of communication before, during and after large protests. Stott argues that the police need to understand that there is a history behind any large demonstration, with memories of previous police action influencing crowd behaviour. The police need to manage this ongoing historical dynamic that feeds into demonstrators’ perceptions of legitimacy. They also need an improved capability to make dynamic, real-time risk assessments, and to respond differentially to different sections of the crowd, such that those provoking conflict can be undermined, whilst at the same time allowing the peaceful majority to continue protesting.
Does this mean there’s a need for more intelligence and more informers, as some commentators called for? ‘No, we have seen from the collapse of the Ratcliffe trials [concerning a plan by climate protestors to shut down a power station], covert intelligence for these kinds of protest is not the way,’ Stott says. ‘It’s about liaising openly, understanding and facilitating peaceful protest, which is a cornerstone of democracy. But the police don’t always have that capability because of a lack of commitment at a strategic level.’
For Stott, the key juncture on 9 December was when crowds of people started pouring into Parliament Square and the presence of fences (apparently left in place by the local authority) around the grass led to crushing and pushing. ‘This was when the police needed to communicate with the crowd about what was required, necessary and legitimate. But that didn’t happen – there was simply no communication with the crowd. Inevitably, the police were forced to move toward containment. But even if that were necessary, they should have had elements of the police ready to communicate during the containment itself, to assist in dynamic risk assessment, and straight away they should have started working with the crowd to work out who was and wasn’t a risk. The vast bulk of the crowd were students who simply wanted to protest and then go home.’
Stott is also critical of the police use of social media tools such as Twitter and Facebook, which if deployed appropriately could play an important role in real-time communication and ongoing liaison. The first tweet sent by police on the day reportedly said, ‘Anyone who engages in crime will be arrested.’ Stott says the use of Twitter is to be welcomed but that the problem is with message content. ‘The police need people in place with the relevant competencies to use social media to best effect – to communicate at crucial junctures the legitimacy of police action and the illegitimacy of violent action. We can only hope that over time the police learn to accommodate the recommendations flowing from our research more fully.’ cj
I HMIC report: tinyurl.com/4dz9947; Dr Clifford Stott’s report to HMIC: www.liv.ac.uk/Psychology/staff/cstott.html
Amygdala size and social networks
People who belong to a larger and/or more complex social network tend to have larger amygdala (Nature Neuroscience: tinyurl.com/28rgcwm). The amygdala is a bilateral structure, located in the medial temporal lobes, that is involved in emotional learning. The researchers, led by Kevin Bickart at Boston University School of Medicine, said their finding was ‘consistent with the hypothesis that the primate amygdala evolved, in part, under the pressure of increasingly complex social life’.
Past research has shown that non-human primate species that mix in larger social groups tend to have increased amygdala volume compared with species that mix in smaller social groups. But this investigation of 58 healthy human adults is reportedly the first time that amygdala volume has been shown to be correlated with social network size within a single species.
The main finding was specific. Amygdala volume did not correlate with life satisfaction or perceived social support. Moreover, other subcortical structures, including the hippocampus, were investigated, but their volume did not correlate with social network size or complexity. A whole-brain surface analysis also failed to reveal any equivalent correlations. When a more lenient threshold was used, three further fronto-temporal regions that correlated with network size were identified, two of which have dense connections with the amygdala.
‘Humans are inherently social animals…’ the researchers said. ‘A large amygdala might enable us to more effectively identify, learn about and recognise socioemotional cues in conspecifics, allowing us to develop complex strategies to cooperate and compete.’
Not everyone was impressed by the findings. The US-based Neurocritic blogger baulked at the study’s failure to find (at conventional significance thresholds) further brain structures that correlated with social network size. ‘Are we supposed to believe that only one area of the brain is involved in maintaining social networks? I think not,’ he wrote. He also raised the issue of clinical case studies, including those with amygdala damage: ‘Anecdotal evidence suggests [these patients] can have close ties with their families and can even become more social after their brain injuries,’ he said. cj
No voodoo, just the can- and can't-do of brain scanning
The brain scanner – has it provided a window into the mind as so many claimed it would? Or is it little more than an expensive toy?
Brain-imaging labs attract generous grants and their output is published in high-impact journals. But in 2009 a paper surfaced prior to publication (tinyurl.com/34mp83u; see News, February 2009) in which Ed Vul and his colleagues claimed that numerous neuroimaging studies in social neuroscience had deployed iffy statistical methods, leading them to identify ‘voodoo correlations’ between psychological states and regions of brain activity. The charge caused a storm of controversy and the paper, when it finally came out in print, had been renamed with a less provocative, voodoo-free title. Now the dust has settled, the same journal, Perspectives in Psychological Science, has published a special issue on what brain imaging can and can’t tell us.
In the lead article, Gregory Miller of the University of Illinois, himself a user of brain-imaging techniques, is highly critical of ‘naive’ reductionists who claim that psychological phenomena are somehow based in brain processes or located in particular neural structures. ‘Functions do not have a location,’ he writes, adding later, with reference to a particular study on voters: ‘Trust decisions and political attitudes do not occur in the brain. Decisions, feelings, perceptions, delusions, memories do not have a spatial location. We image brain events… We do not image, and cannot localise in space, psychological constructs.’
Miller reminds readers that brain-imaging studies are only able to provide correlations between brain activity and psychological processes and that how each affects the other, if at all, remains largely mysterious. He also reminds us that although many researchers act as though the neural is somehow more fundamental than the psychological, there are many examples of the causal direction apparently flowing the other way – for instance, psychotherapy has been shown to trigger various brain changes.
In her contribution, Diane Beck of the University of Illinois discusses the allure and popularity of brain-imaging data among the media and general public. Part of the story is likely to be the appeal of colourful blobs-on-brain images and the fact that neural correlates are somehow seen as lending biological credibility to behavioural results. Ultimately Beck says that responsibility lies with individual researchers not to allow the media to make unsubstantiated claims based on mere neural correlates. ‘We should be careful not to encourage portrayals of our research as explaining a behaviour or condition when it does not,’ she writes. ‘In short, every time we allow the press to mischaracterise our results or overstate our conclusions, we run the risk of damaging the reputation of our entire field.’
Other contributors defended the value of neuroimaging research to psychological inquiry. Brian Gonsalves and Neal Cohen at the University of Illinois gave the example of brain-imaging memory studies, which consistently reveal activity in the posterior parietal cortex (PPC), an area usually associated with attentional processes. This finding has prompted searches for the specific memory-based factors associated with PPC activity, with retrieval success and the perception of memory ‘oldness’ emerging as relevant. ‘These ideas have led to a great deal more theorising about the interactions of memory and attention,’ Gonsalves and Cohen write, ‘tested not only with neuroimaging methods but in neuropsychological studies as well.’
For neuroimaging to become more productive, Russell Poldrack at the University of Texas argues that psychologists need to develop a comprehensive and agreed ‘cognitive ontology’ – that is, ‘the component operations that comprise mental function’. To this end, Poldrack and his colleagues have established a collaborative, online tool, the Cognitive Atlas (www.cognitiveatlas.org). Once established, Poldrack believes the Cognitive Atlas will help neuroimagers identify examples of ‘selective associations’, which is when activity in a given neural structure is associated ‘with only one putative cognitive process’, thus allowing the inference that ‘the reality of this process has been established’. If researchers can predict, based on neuroimaging data, whether a particular mental process was engaged, then, Poldrack says, that would be evidence for a selective association. Poldrack concludes that using ‘detailed ontologies along with large-scale data-mining approaches, it may finally be possible to determine the joints at which the brain carves the mind.’ cj
I The special issue, which is at tinyurl.com/32zlynr, also includes a contribution from Jean Decety and John Cacioppo and another from Arthur Shimamura
To harness the power of the placebo effect with an inert pill, doctors must take the morally dubious step of tricking their patients into thinking the pill has an active ingredient. Or must they? The first study of its kind, led by Ted Kaptchuk at Harvard Medical School, suggests not, at least not when dealing with patients with irritable bowel syndrome (PLOS One: tinyurl.com/2et68az).
Kaptchuk and his colleagues randomly allocated 37 patients with IBS to receive two inert pills twice daily and 43 to act as no-treatment controls. The former group were told the pills had no active ingredient and were further informed that: ‘placebo pills, something like sugar pills, have been shown in rigorous clinical testing to produce significant mind–body self-healing processes’. Before the group allocation, all patients were talked through the benefits and power of the placebo effect by a physician, including the fact that taking the pills is critical for the effect to work.
The researchers took care to ensure that patient–physician contact time and quality was similar across the two groups. Amazingly, the placebo group, even though they knew they were taking inert pills, reported improved symptoms relative to the control group, both at the 11-day mid-point and at the study conclusion after 21 days. The size of this difference was described by the researchers as clinically meaningful (and comparable to active drug treatments), reaching an effect size of .79, which is conventionally considered large. The placebo group also showed greater increases in quality-of-life measures.
‘Our results suggest that the placebo response is not necessarily neutralized when placebos are administered openly,’ the researchers said. ‘Thus our study points to a potential novel strategy that might allow the ethical use of placebos consistent with evidence-based medicine.’
The strength of the results are undermined by the small sample size, the short study length and the possibility that patients were giving the researchers the answers they wanted (a double-blind paradigm was a logical impossibility). For these reasons, the researchers said their work could be considered as a ‘proof-of-principle pilot study’. cj
If your snack-based new year’s resolutions are already failing, you could try applying the lessons from a new study by psychologists at Carnegie Mellon University. Carey Morewedge and his colleagues showed that imagining repeatedly eating a specific food led participants to subsequently eat less of that food when given the opportunity (Science: tinyurl.com/5vgn7gu).
Across five experiments, Morewedge’s team found that participants who imagined eating 30 chocolate sweets subsequently ate fewer sweets from a bowl than control participants who imagined eating just three of them, or control participants who imagined inserting 30 quarters into a laundry machine. The effect was specific – imagining eating the chocolates did nothing to reduce participants’ subsequent consumption of cheese.
The researchers think the effect occurs via habituation. After imagining eating lots of cheese cubes, participants worked less hard at a simple computer game in which they could earn points in return for cheese. Yet their self-reported liking of cheese remained unchanged by the imagination task. In other words, the participants’ motivational drive to obtain the food was attenuated even while their liking was unaffected, which is indicative of habituation.
‘The results show that top-down processes can enact habituation in the absence of pre-ingestive sensory stimulation,’ the researchers said. ‘The difference between actual experience and mental representations of experience may be smaller than previously assumed.’ cj
The Society’s London Lectures continue to entice psychology’s next generation. In December, over 800 students packed out Kensington Town Hall with demand so high that the venue could have been filled twice over.
Rhiannon Turner of Leeds University opened the event with an overview of the contact hypothesis – Gordon Allport’s idea that meaningful contact between social groups reduces prejudice. Turner’s research has shown that the benefits of contact are mediated by reduced anxiety and increased self-disclosure between members of different groups. It’s as if, by mixing with each other, we learn that we’re not so different after all.
A problem when attempting to apply the contact hypothesis to real situations is that segregation remains rife and inter-group contact isn’t always possible. To overcome this, Turner presented fascinating findings showing that prejudice can be reduced by extended contact (having a friend who has a friend from an outgroup) and even by merely imagining a positive encounter with an outgroup member.
Turner is currently looking at how the effects of these different forms of contact interact – for example, perhaps experiencing extended or imagined contact first could increase the likelihood that face-to-face contact will be beneficial.
Next up, Rosa Hoekstra of the Open University (standing in for Simon Baron-Cohen) focused on the causes of autistic spectrum disorders (ASD). She discussed the assumption, common until the 1970s, that autism was caused by ‘refrigerator mothers’, describing how since then a wealth of twin studies helped demonstrate the high heritability of autism, undermining the notion that responsibility lay with parenting style. She stressed, however, that there is no single genetic cause for autism, with almost every chromosome containing at least one gene implicated in some people with ASD.
Autism is a highly variable condition, with strong variation both in the types of symptoms that are present and in the severity of these symptoms. Some of this variability may be explained by different genes being involved in different people with autism. Hoekstra explained that the characteristics of autism can be understood as a continuum of traits that are, to some extent, also seen in the general population. People with a clinical autism spectrum diagnosis have an extreme accentuation of traits found in milder form in people without a diagnosis. Just like clinical autism, Hoekstra discussed evidence that these milder traits in the general population are also strongly influenced by genes.
In the Q&A session that followed, Hoekstra discussed the complications involved in finding a ‘cure’ for this complex range of disorders. Because autism is so variable, it is unlikely that researchers will find one overall cause and discover a miracle cure. Instead researchers are trying to find interventions that cater for specific subgroups of people on the autism spectrum. She also mentioned that people with autism, especially those at the more high-functioning end of the spectrum, are not necessarily looking to be cured. Their functioning may be different from the norm, but autism is part of who they are. They may seek help to improve their social interaction or communication abilities, but they don’t want all autism characteristics to be wiped out of their personality..
Sports psychologist Dave Shaw of Lancaster University began the post-lunch slot with candour (‘I keep marrying women who don’t like sport’ he lamented), before listing several indicators that psychology plays a key part in sport – top athletes are similar to each other physiologically; someone who breaks a world record is unlikely to break another; and having won one gold medal, most athletes are unlikely to win more (people like Steve Redgrave are the exception). Or, Shaw said, consider a classic study from 1980, in which Rejeski and Ribisl instructed two groups to exercise at the same intensity, one of them for 20 minutes, the other for 30 minutes. When both groups were interrupted at 20 minutes, the participants who had expected another 10 minutes were less tired, even though they’d been working at the same intensity. A striking example of mental attitude having a physical effect.
Shaw also dealt with the question of whether it’s all just common sense. For example, he highlighted the contrasting approaches of different football managers including Fergie’s hair-dryer treatment and Eriksson’s cool, reserved style. ‘Totally different ways of motivating players…that’s why we need to do the research [to find out what really works best],’ Shaw said.
Attachment was next on the agenda as John Oates of the Open University described some cutting-edge research showing how genes and the environment interact to affect attachment style. He focused on the gene that codes for the D4 dopamine receptor: DRD4 (dopamine is a neurotrotransmitter involved in motivation and rewa
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