Why Little Albert wasn't such a great study after all

For those of you choosing to study the Little Albert case study (Watson and Rayner, 1920), you might find this link to be of interest. It's from my new blog, and it's a criticism of the study and why I don't like it. It covers evaluation points such as ethics, bias, and generalizability.

Happy revising! (Apologies for the oxymoron!)
Best wishes
Vicky

For those of you studying minority and majority influence, this might be of interest to you

What does it take to be a leader? Many people think they know the answer, but Simon Sinek's theory seems to really hit the nail on the head. Watch the video here.

Whilst it's not directly part of the syllabus, having background theory or knowledge on how people influence others is going to aid your understanding of the course material, which will help you answer your questions better.

And regardless, this video is great. Enjoy, and happy Saturday!

A quick update from me

Hi there guys, hope the revision is coming along well.

I'd just like to let you know if you need any help, I'll still be answering as many questions as I can, but unfortunately I'm not going to be writing any more full length answers (I honestly would if I had the time to spare!).

Also, I'm here to let you guys know about my new psych blog. After much deliberation, I decided to scrap Psych-Bites due to technical difficulties, and have created Sciency Posts for Sciency Folks. It's going to be about all things relevant to psychology, so if you have any general queries or things you'd like me to blog about, comment below and if I can, I'll blog about it at the next opportunity.

I hope to see you guys around on my new site, and am still humbled by how many of you keep coming back to the site.

Best wishes
Vicky

Tips for the exam and a goodbye from me!

• Read the question fully and highlight the key terms, including the question word (e.g. how/why)
• Spend 10 mins max. on part (a) questions, and 20 mins max on part (b) questions.
• Include as much relevant research as you can 
• Include details if it's relevant
• Use as many evaluative points in part (b) as you possibly can, with regards to the question
• Answer 4 questions: 2 from 1 section, 2 from another. You won't get the marks if you don't! Even if you aren't sure, do your best and don't miss out any questions. Also, don't accidentally answer 3 from one section!
• Don't panic!

Best of luck to everybody tomorrow! With regards to the site, I probably won't be answering any more comments, but I will be posting a link in the next few months about my new blog, which will be more generally about psychology, and posts based on my lectures from university (hopefully!)

So, do your best, and show the examiners what you can do. Hopefully some of you will be visiting my next blog!

Vicky

The DSM-IV and ICD-10

There are two main manuals which give details about the categories of dysfunctional behaviour and thus are manuals on how to diagnose dysfunctional behaviour. The International Classification of Diseases (ICD) is probably more widely used, whilst many studies conducted in the UK and US refer to the Diagnostic and Statistical Manual (DSM), which is a specific manual for psychological disorders, whilst the ICD contains one chapter on psychological disorders and is as a whole a manual on health disorders generally.

The DSM is a practical guide based on field trials and empirical research, as well as referring to past editions of both the DSM and ICD. It was produced by the APA and instructs psychiatrists to evaluate the patient in terms of five axes, although the latter two are optional. The axes are as follows: clinical disorders (such as depression), personality disorders (such as mental retardation), physical health (due to recognising that long-term illness, for example, can influence mental health), environmental factors (such as family problems), and global assessment of functioning. These axes reflect an understanding that disorders result from an interaction of biological, psychological and social factors, and thus it is necessary to look at these axes to give a thorough analysis and diagnosis.

The ICD is an international standard diagnostic classification manual, published by the World Health Organisation – it is now in its tenth revision. Chapter 5 is the only chapter relevant for mental and behavioural disorders, as it is a manual for all health disorders. It is more symptom-based than the DSM, and lists clinical and personality disorders on the same axis. There are also 5 more groups of disorders than in the DSM, with ten therefore in total. These axes include: organic mental disorders, delusional disorders, mood disorders, mental retardation, and stress-related and neurotic disorders.

EVALUATION POINTS FOR AFTER A GUILTY VERDICT

As requested, here is a list of issues and evaluation points you can use for after a guilty verdict. It isn't comprehensive, so feel free to comment and add your own or just use a couple of these. It's completely up to you; use the most relevant evaluation points you can think of.

• Ethics: obviously,  the death penalty and imprisonment are unethical. But, restorative justice is also pretty traumatic. 
• Freewill and determinism: consequences of committing a crime tend to follow the ideology that criminals choose to commit crimes, despite upbringing, cognition, and biology all being deterministic explanations of crime. Thus, you can evaluate the appropriateness of punishing someone for what they didn't choose to do - if it's relevant. 
• Situational versus dispositional: this is one most relevant to imprisonment and treatments. Both seem to adopt the ideology that criminals themselves are to blame for their behaviour, whilst research has suggested situation and environment can play a role in determining criminality. Here you can refer to reductionism. Thus, are treatments likely to be effective if they're ignoring one aspect of why people commit crime?
• Methodology of research: a lot of research is content analysis, which is inexpensive and replicable, but is of course limited by the validity and methodology of the individual studies. You can, as with all research, evaluate population validity, ecological validity (most research is done in the field, which is great), usefulness, etc.
• Effectiveness of treatments: look at reduction in aggressive/anti-social behaviour, time/cost effectiveness, as well as recidivism.
• You can also look at how well research has been applied. Haney and Zimbardo suggested that individual differences should be taken into account, prisons should be used sparingly, and that psychological knowledge should be applied to prison policy. But the actual implementation of this seems slow, and prison is still more widely spread than most of the alternatives. There is still racial bias in US prisons, too. However, research raises the issues surrounding punishment and rehabilitation of offenders, and thus you could say any discussion is beneficial. 

EVALUATION FOR MAKING A CASE

Interviewing witnesses
STUDIES: Bruce, Loftus, Fisher

Generally questions have been based on research, so here are some issues:
Evaluating research;

• ecological validity: Bruce and Loftus are poor in EV, Fisher is high
• population validity/generalisability: all fairly low, but at least Fisher uses real detectives
• all are experiments: good for control and internal validity, and allow for replicability so likely to be somewhat reliable. However, many factors influence information given in witness interviews so it's unlikely that given the same situation, that any two people would give a consistent account and thus reliability is questionable. 
• usefulness and application: knowing about the inaccuracy of e-fit identification, eyewitness accounts and effectiveness of CIT has excellent real-life implications, helps inform policy and could help to change the way that juries perceive eyewitness testimonies. However the results aren't really well known, so this is a drawback.

Interviewing Suspects

• Validity of suspect interviews: police officers only 64.5% accurate at telling truth from lies, interviews lead to social desirability and all associated issues, interrogations lead to false confessions, etc. Research in this area tends to have high EV though, which is good because generalisability of findings should be strong.
• Reliability: similar to interviewing witnesses, affected by individual differences of interviewee and interviewer.
• Ethics is an important issue
• Usefulness/applications of research: shows that police officers may need more training in identifying lies and truth, highlights the unethical nature and poor validity of confessions obtained through interrogation

Creating a Profile

• Validity, effectiveness and usefulness: Mokros and Alison suggested that top down typological profiling is inaccurate as it's too reductionist, Canter found bottom up approaches effective, and Copson found that police officers may not be aware of benefits of profiling but that many would use again for a second opinion
• Reliability: top down is more reliable as it uses pre-existing categories. 
• Qualitative and quantitative data: both approaches feature some qualitative (e.g. looking at details, not numerical data) and some quantitative (e.g. looking at numbers and patterns). Quantitative is good because it's easy to analyse, qualitative is good because it's more in-depth and more humanistic. 
• Determinism: top down assumes that similar criminals create similar crime scenes, which is fairly reductionist and deterministic. Bottom up is less deterministic in that it suggests criminal choose to act consistently, and more holistic as it looks at each characteristic in turn and builds up a picture rather than choosing for example disorganised or organised. 

Identifying disorders and why it's not as simple as it seems

Characteristics for disorders (DSM-IV)

SCHIZOPHRENIA

• Psychotic disorder
• Generally characterised by loss of contact with “reality”
• Must have 2+ symptoms, as well as socio-occupational dysfunction
• Positive symptoms such as delusions, hallucinations and disordered thought/speech/actions
• Negative symptoms such as loss of contact with reality, catatonia, loss of pleasure in usual activities and loss of emotional responses

DEPRESSION

• Affective disorder, so most linked to mood changes
• Can be unipolar or bipolar as well as dysthymic (chronic)
• Must have 5+ symptoms to be classified as depression
• Behavioural symptoms include loss of pleasure and loss of appetite
• Physical symptoms include catatonia, fatigue and insomnia
• Cognitive symptoms include poor concentration and suicidal thoughts
• Emotional symptoms include feelings of worthlessness and persistent negative moods
• Bipolar disorder includes episodes of these characteristics alongside manic episodes, including delusions of grandeur, excessive happiness and feeling restless (those with bipolar may be confused with schizophrenia due to the occasional presence of delusions and disordered speech, thought or actions)

PHOBIA

• Anxiety disorder
• Persistent, excessive fear or anxiety and recognised as so
• Immediate fear response on contact
• Actively seeks to avoid phobic situation
• Disruption to everyday life
• May seem irrational to others but has very real consequences to the individual

Issues with identifying disorders:

• Highly subjective
• Requires self-report from individuals who may not perceive their behaviour as abnormal or dysfunctional, or who may be prone to lying/disordered thoughts and social desirability
• There is significant overlap between disorders e.g. loss of pleasure is a factor in depression and schizophrenia, whilst bipolar disorders and schizophrenia can feature delusions and disordered actions. Anxiety is also somewhat common amongst people who are depressed, due to feelings of worthlessness and pessimistic depressive thought patterns.

Some great short videos on clinical disorders

If you're anything like me, by this point in your revision looking at past papers and studies have started to get so monotonous you aren't sure it's going in. So, try a different approach.

Here's a link to a website some of you might find really useful. It's full of videos and short summaries of characteristics of disorders, explanations and treatments. Just use the search bar at the top to navigate yourself around. 

Enjoy!

Evaluation points for Stress

As requested, I've done some evaluation points for stress. They aren't the only ones, so if you think of any more, feel free to use those. 

Causes of Stress

• You could evaluate the extent to which each of these were nomothetic - does everybody have lack of control/work/daily hassles/life events? Does it cause each person stress?
• You could look at situational versus dispositional - all of these actually tend to favour situational explanations of stress, but the treatments tend to be dispositional, so this could be a good issue to look into. 
• You could maybe also look at how simple these causes would be to fix, and how the knowledge that they cause stress could be use. This leads you to evaluation issues such as usefulness and application. 

Measures of Stress

• Validity is a major issue here. You've got low construct validity in that it's hard to define stress and thus hard to know when you're measuring it, as well as face validity because the measures of stress can be affected by lying, memory, demand characteristics, illness, emotion, etc. Also, different people experience stress differently so using only one measure on participants may not be a valid approach.
• Reliability is also important. As different people experience stress differently, measures are unlikely to give consistent results if used again in similar situations. Too many things affect measures of stress and stress itself in order to give consistent results on physiological or self-report measures.
• Reductionism is a potential issue. Obviously, measures which are only self-report (e.g. SRRS) or only physiological (e.g. heart rate monitor) are reductionist and don't look at many features of stress response or the dynamic between them, whilst combined measures are holistic and thus may be more appropriate and useful.

Managing Stress

• Situational versus dispositional is also appropriate to evaluate here. Social support takes the situational approach whilst cognition is dispositional, as is behaviourism (biofeedback). Though, behaviourist ways of managing stress emphasise the role of positive reinforcement, so it has a situational element as well. You could obviously link this to reductionism and holism. 
• You could look at whether symptoms or causes of stress are targeted, and evaluate whether this is a good approach to managing stress. SIT attempts to prevent stress as well as help the individual overcome their current stress which Meichenbaum suggests is the actual cause of stress, thus it targets causes rather than symptoms. Biofeedback treats the symptoms of stress response rather than the causes as it teaches relaxation, though this may prevent stress too. Social support targets the symptoms and causes in that having strong social networks can provide support to prevent stress, and provide support once stress has onset. 
• You could also look at effectiveness by looking at whether research supports it, or by cost and time effectiveness. Biofeedback in the form of EMG machines are expensive and require a practitioner, it's somewhat difficult and expensive to get a therapist but once you've learned the skills it lasts a long time, and social support is free and lasts a long time, but is not instantaneous. 

Also, some of the studies are pretty unethical, such as Geer and Maisel, and those which put participants on waiting lists rather than giving them therapy. Though control groups help with internal validity checks, they aren't the most ethical. E.g. Meichenbaum's study had a control group of students who did worse on their exams than the experimental groups - if they were in the other group, they'd have benefited and thus they lost out. 

Evaluation points for Turning to Crime

I may be posting more of these, so keep checking back. If you have any other suggestions for the blog, leave a comment! 

S = strength, W =weakness

? = potentially

UPBRINGING

-          Situational perspective (S=useful for government, W=reductionist)

-          Nurture perspective (S=easier to change than biology, W=ignores biology)

-          Determinist explanation (S=follows scientific laws as in physics, may encourage rehabilitation rather than punishment, W=ignores freewill, how can we punish people for something they didn’t choose)

-          Reductionist (S=easier to understand, helps us to determine causality and importance of individual factors, W=ignores dynamic of relationship between factors, may not be valid)

-          Runs in families; not necessarily upbringing (S=easier to change environment than biology, W=may not have face validity)

-          For maximum validity, studies testing this explanation need to be longitudinal (S=more in-depth, track development, W=attrition, observer bias, ethics)

COGNITION

-          Dispositional perspective (S=suggests therapy may be useful, W=reductionist)

-          Doesn’t specify nature or nurture; could be both (S=holistic, W=unknown cause?)

-          Soft deterministic as it suggests that cognitions determine behaviour but we have some freewill over our cognitions (S=more holistic, W=to what extent can we blame the individual?)

-          Cognitions aren’t observable (S=more complex than behaviourist approach, accepts that people have individual differences, W=subjective, non-scientific, may be invalid)

-          Somewhat more holistic as cognition can be influenced by situation as well as nature and nurture (S=likely to be valid as it looks at a variety of factors, W=still reductionist in that biology and upbringing tend to be overlooked, may not enable causality so may be less useful)

-          Relies on self-report (S=allows for attitudes and cognitions to be accessed, qualitative and quantitative data, W=validity may be poor due to demand characteristics, lying, and misinterpretation etc.)

BIOLOGY

-          Deterministic (S= follows scientific laws as in physics, may encourage treatment rather than punishment, W=ignores freewill, how can we punish people for something they didn’t choose)

-          Reliance on correlation (S=more ethical than manipulating biology, W=causality; how do we know whether brain dysfunction/genes/serotonin is a cause or result of criminal behaviour?)

-          Reductionist (S=easier to understand, helps us to determine causality and importance of individual factors, W=ignores dynamic of relationship between factors, may not be valid)

-          Nature approach (S=more scientific, observable, objective, W=harder to rehabilitate, reductionist)

What the examiners are looking for

Obviously, you need to answer 4 questions from 2 sections. You need to answer them well, describe and evaluate research and studies, and show the examiners what you know.

Sometimes though, the mark schemes are less than clear about how to reach that top band (the As and A*s). Here are some generic tips I've found in the mark schemes that are important in getting as close to full marks as you can:

January 2013

• Relevant research should be applied to part a)
• Must address “how” if the question asks for this
• “Discussion” may involve a comparison and following/challenging a viewpoint
• Detail is beneficial in part a)
• Usefulness, application, ecological validity, reductionism, reliability and ethics are all good evaluation points for interviewing witnesses
• A good way to “assess strengths and weaknesses” is to discuss whether or not an apparent “weakness” may actually be desirable or necessary in order to fulfil a function

June 2012

• Responses should be clear, precise and explicit
• To what extent implies a degree of judgement is necessary
• Responses should directly answer the question rather than simply describing research when this is not asked for. Research can be used to illustrate responses but this should be linked to the question.
• Usefulness can be examined in terms of validity, reliability, ethnocentrism, etc.
• Stronger answers with regards to treatments will be contextualised
• Comparison invites similarities as well as differences
• Reliability can be affected by mood, interviewee, social desirability bias, lying and misjudgement 

Behavioural explanation and treatment of depression

Approach	Explanation [Study]	Treatment [Study]
BEHAVIOURAL All behaviour is learned Depression is learned Depression can be unlearned	The behaviourist perspective explains that depression is learned and is the result of the environment; particularly, depression is the result of maladaptive learning experiences. Lewinsohn argued that positive reinforcements were important; lacking positive reinforcement for non-depressed activities and then gaining positive reinforcement for depressed activities could cause depression. Lewinsohn: sample of 30 participants, some with depression and some without. They were asked to self-report their positive reinforcements in a “pleasant events schedule”, and their depression levels were monitored on a “depression adjective checklist”. The results showed a negative correlation between positive reinforcements and depression scores.	The behaviourist perspective assumes that as behaviour can be learned, it can also be unlearned. In terms of positive reinforcements, this means that positive reinforcements can be introduced to the individual’s daily life as a reward for non-depressed activities such as socialising and getting things done. It’s generally part of CBT programmes, rather than administered by itself. e.g. Lewinsohn conducted a study on the CBT course of “coping with depression”, which involved a sample of 69 adolescents with depression. There were 3 groups: a control group, the standard CBT group, and the CBT group with the addition of parents being encouraged to give reinforcements for improvements in behaviour. The control group improved 5%, the standard CBT group improved 43%, and the parent+CBT group improved 47%.

Effectiveness and Appropriateness

These two seem to catch a lot of people out, because they're pretty hard to define and apply to different areas. Here's some generic tips, with an example to help. 

Effectiveness - the extent to which something brings about an effect, usually a positive one.

(Example question: Assess the effectiveness of offender treatment programmes)

Introduction - define effectiveness

1. Who is it effective for?
(e.g. anger management is only effective for non-psychopathic males, who have an anger problem so it isn't effective for a wide audience, whilst cognitive skills programmes are effective for most offenders as they target the cognitions believed to result in criminality, such as taking a social perspective, self-control and morality)

2. To what extent does it make a difference?
(e.g. to what extent do the treatments reduce recidivism or improve behaviour? Anger management is believed to be somewhat effective, but not in all cases. Ireland et al found it did reduce some angry behaviours. Ear acupuncture appears to make a significant difference to aspects of an addicts life such as improving mood and sleep as well as cravings and withdrawal symptoms. Cognitive skills programmes found to reduce recidivism rates by 14% which is positive, but it's obviously not effective enough to reduce it by more)

3. Is it time and cost effective?
(e.g. therapy treatments tend not to be because they require several sessions, whilst biological treatments such as acupuncture are quick and easy to administer)

Conclusion: summary
Somewhat effective, but a holistic approach where two or more methods are combined would be most effective. 

Appropriateness

Appropriateness refers to the extent to which something is suitable, usually in terms of population or situation.

To what extent are treatments for your chosen disorder (e.g. depression) appropriate?

You could answer this by looking at the population: people with depression. Personally, I'd break it down into biological treatments and therapies. 

Biological treatment: drug therapy.
Yes it's appropriate because... it requires little participation from the client, who is likely to feel apathetic, lack motivation, etc. 
No it's not appropriate because... treating a disorder that does not necessarily have a biological cause with drugs may not be treating the real issue, but actually just reducing the symptoms of low serotonin levels.

Cognitive/behavioural therapies: CBT
Yes it's appropriate because... the relationship between the client and therapist may boost confidence in the client and in others and give them a sense of purpose. The behaviourist element to CBT also encourages and rewards self-motivation and non-depressed activities, which helps to teach the client to overcome possible future relapses.
No it's not appropriate because... it requires a LOT of motivation on behalf of the client, it's often quite a lengthy process which people suffering with depression are unlikely to have the energy to go through, etc.

And my conclusion would probably be that drug therapy is appropriate for those with short-term, reactive depression because they need a "quick fix", but if depression is long-term or recurring, therapy enables skills to deal with depression more effectively and thus this may be more appropriate in the long run. 

Characteristics of disorders - Phobia, Depression and Schizophrenia

Anxiety disorders
An anxiety disorder is broadly described as a disorder which gives a continuous feeling of fear or anxiety, which is disabling and reduces daily functioning. Anxiety may be triggered by something that appears trivial to others, or may even be “non-existent” – but it feels very real and can have disastrous effects on the person with the disorder. Anxiety disorders encompass many different types of disorders, such as OCD and phobias.


Phobia
A phobia is defined as having a persistent fear of a particular phobic object or situation, for example of dogs or being in enclosed situations. It must be fairly severe to be classified as a dysfunctional behaviour, and the person must exhibit various symptoms such as avoiding the stimulus of the phobic reaction and feeling very apprehensive or becoming unwell when in the phobic situation. The DSM IV will classify a phobia on the basis that the phobic reaction is marked, persistent and excessive or unreasonable and recognised as so. Other characteristics a psychologist or psychiatrist would look for in order to diagnose someone with a phobia is if the situation is avoided, it disrupts the person’s normal life, and if exposure to the stimulus provokes an immediate anxiety response. Additionally, if the person is under 18, the phobia must have been in excess of six months of duration. These are the symptoms that most with phobias will exhibit; however one or two not shown in the patient is unlikely to hinder their diagnosis as individual differences means people react differently to phobias.
 
Affective (mood) disorders
An affective disorder is one which is affects someone’s mood and emotions. Whilst it is completely normal to have varied and sometimes irrational moods, sometimes such severe or debilitating moods are the result of an affective disorder. The most common affective disorder is depression, which is likely to affect most people directly either through an individual themselves having it or someone they are close to having it.


Depression
The DSM IV would require a patient or client to be exhibiting five or more of the listed symptoms in the manual in order to diagnose somebody with depression. These symptoms can be emotional, such as sadness and loss of pleasure in usual activities, behavioural and physiological such as insomnia and fatigue, or cognitive such as poor concentration and suicidal thoughts – or there can be a mixture of all three. There are many types of depression, but the two most common and most known are unipolar depression and bipolar depression. Unipolar is also known as major depression, and is associated with low mood, a sense of worthlessness, hopelessness and inability to experience pleasure, either in single episodes, periodic outbreaks or continually. Bipolar depression is when somebody’s mood fluctuates between depressive episodes (as described above) and manic episodes which are the extreme opposites. Symptoms are frequently split with episodes of perceived normality, and periods of mania and depression can last anywhere between days and years.


Psychotic disorders
Psychosis is the general term for disorders which involve loss of contact with “reality”, and those diagnosed with psychotic disorders frequently exhibit symptoms such as disordered thought and speech, delusions and withdrawal from the outside world. One psychotic disorder in which these symptoms are typical is schizophrenia.
 
Schizophrenia
Schizophrenia is a psychotic disorder which is characterized by various delusions such as auditory and visual hallucinations, disordered thought and speech and chaotic behaviour and actions. Schizophrenia is described as having positive symptoms, meaning something is gained, such as delusions and disordered behaviour, as well as negative symptoms, such as losing emotional responses and inability to feel pleasure. The DSM would require two or more of these symptoms in order for a diagnosis to be made, as well as social occupational dysfunction which is unexplained by medication or developmental disorders. 

Predictions

A lot of people are trying to guess what'll come up in the paper, but it's such a risky way to revise. Honestly, this paper is unpredictable, so you're going to need to learn all the studies and theories in the 3 or 4 sections from each of your options. The examiners know that people try to guess what will come up, so they are unlikely to give you lots of questions on the sections that haven't come up yet.

There really is no substitute for learning it all, and learning it well.

Some practice questions for Forensic

(a)    Outline how an upbringing in poverty or disadvantaged neighbourhoods could explain why someone might turn to crime (10)
(b)   Discuss the validity of upbringing explanations to crime (15)
 (a)    Describe one piece of research into how criminality might be learnt from others (10)
(b)   Discuss the reliability of research into cognitive explanations of crime (15)
 (a)    Describe one piece of research into the cognitive interviewing technique (10)
(b)   Evaluate the validity of research into interviewing witnesses (15)

Part a) for cognitive skills programmes

              (a)    Outline how cognitive skills programmes can be used as a treatment for offenders

After a guilty verdict, offender may be given numerous sentences which may punish them for their actions, or attempt to rehabilitate them – or both. One way in which an offender may be rehabilitated is through the use of treatment programmes, such as cognitive skills programmes.

Cognitive skills programmes refer to the cognitive approach’s explanation of turning to crime that criminals have distorted cognitions that cause their offending, such as denial of responsibility, optimistic fantasies of anti-social behaviour, poor moral development, and having tendencies to incorrectly attribute actions to hostile intent (Yochelson and Samenow, Palmer and Hollin).

Two examples of cognitive skills programmes offered to offenders are reasoning and rehabilitation therapy, and enhanced thinking skills. Reasoning and rehabilitation therapy targets moral development, and attempts to encourage the offender to take a social perspective on their behaviour, in the hope that this will discourage them to offend if they understand the effects their actions have on others and how to think more morally. Enhanced thinking skills programmes target aspects of cognition such as self-control, and aim to boost pro-social behaviour by teaching interpersonal communication skills.

One study which looked at how cognitive skills programmes can be used as a treatment for offenders is through Friendship et al, which compared the recidivism rates of those on cognitive skills programmes such as ETS, to those who had not been part of such programme. 670 male offenders who had taken ETS or reasoning and rehabilitation therapy were thus compared to 1801 offenders who hadn’t, and the results showed that reconviction rates were 14% lower in the therapy group. This equated to 21000 crimes prevented, based on the researchers’ estimates.

Thus, cognitive skills programmes can be used to treat offenders by improving the different aspects of cognition thought to be responsible for offending, such as interpersonal skills, moral development and self-control.   

Methods of health promotion

Healthy Living: explaining health behaviours

METHODS OF HEALTH PROMOTION

·         MEDIA CAMPAIGNS: Keating et al.

·         LEGISLATION: Wakefield et al.

·         FEAR AROUSAL: Janis and Feshbeck

METHOD: MEDIA CAMPAIGNS

The phrase “media campaigns” refers to various forms of media, which are used to communicate and interact with a range of audiences. There are many forms of media, but typically health campaigns tend to use print media, such as pamphlets, electronic media, such as television and radio, and new-age media, such as social networking. Media campaigns are a prominent method of health promotion as there is a wide range of diversity and accessibility; most households in the West own a television set, and almost everywhere has access to newspapers or the Internet. Health media campaigns can be on various health behaviours, including sexual health and drug use. Health media campaigns are broadly based on the Yale Model of Persuasion from 1953, which describes how for a campaign to be successful, it must consider the communicator of the message, the communication of the message, and the target audience. The health belief model, which roughly fits this but is more complex, is also often used heavily in media campaigns, such as in the TV adverts for Change4Life and Hands-Only CPR.

EVALUATION: MEDIA CAMPAIGNS

Mass media campaigns are a practical method of health promotion in that they can reach a large population in a relatively short amount of time. However, they require access to some resources that people don’t have, can be avoided or ignored, and may not be seen by the full target population, which reduces the effectiveness. Media campaigns are time effective, but not really cost effective, and only reach a certain demographic – so many forms will be needed. It is also important to remember that improved knowledge doesn’t necessarily mean improved behaviour, and particularly stressful campaigns may cause people to switch off from the message.

STUDY: KEATING et al.

Keating et al. conducted a study which aimed to assess the successfulness of the mass-media campaign VISION on reproductive health and HIV/AIDS prevention. A sample of 3278 participants aged between 15 and 49, from various ethnic and economic groups in Nigeria was used. Verbal informed consent was given, and then participants were asked various questions from a questionnaire on sexual health, with 3 critical fixed choice (yes/no) questions: one on talking with a partner about preventing AIDS, one on whether using a condom reduced the chances of getting AIDS, and finally one on whether they used a condom on their last sexual encounter. Chi square and regression analysis was used on the results. It was found that media campaigns were more accessible by males, with females being more exposed to the information from clinics. Exposure to VISION was high, and this appeared to be associated with positive responses to the first two questions; however appeared to have no effect on the third question. It was therefore concluded that different media campaigns reached different people, but whilst campaigns were successful in giving information, this did not seem to directly lead to behavioural changes, and thus media campaigns should also look at giving practical information on how to do certain health behaviours (such as obtaining a condom).

EVALUATION: KEATING et al.

The study used stratified sampling to improve the representativeness of the sample, which was important in Nigeria for ethnic balance. The sample was also large, but ethnocentric to Nigeria. The study was ethical in that verbal informed consent was given, however the questions were quite personal and this may have caused embarrassment or psychological harm. The questionnaire appears to have highlighted the important points about the success of media campaigns rather efficiently; however it would have been more useful if reasons why condoms had not been used had been included in the self-report – a pilot study could have shown this. The study is useful in that it shows that information is not all that is required for a behavioural change, which is something that could be generalized or investigated further for other health behaviours. The study is also useful as it shows the effectiveness of media campaigns varies by population.

METHOD: LEGISLATION

Legislation refers to law making processes, and this is a method of health promotion as laws can be implemented to change health behaviours, by promoting and enforcing positive health behaviours, whilst banning unhealthy behaviours. Certain behaviours that have been made illegal are smoking in public places and smoking if under 18 (rather than 16), whilst behaviours that have been made compulsory in a legal manner include wearing a seatbelt.

EVALUATION: LEGISLATION

Legislation raises the issue of freewill versus determinism, and the ethical nature of forcing or banning certain behaviours. To what extent is it ethical or right to ban dangerous health behaviours, or to enforce improved health behaviours? Some would argue that the legislation against smoking in public places is denying people human rights, such as freedom of movement, whilst others would suggest smoking itself is so dangerous that it should be completely banned. In addition to this, whilst legislation is far reaching and supposed to be enforced equally wherever it applies, obedience is somewhat optional. In areas such as Greece, where there is the same smoking ban as in the UK, people still tend to smoke in public places due to the fact the authorities don’t fully enforce it. Legislation is only effective if people listen to it and abide by the laws.

STUDY: WAKEFIELD et al.

Wakefield et al conducted a cross-sectional study into the effect of restrictions on smoking at home, school and in public places on teenage smoking. A random sample of 17,287 high school students was taken from over 200 schools in the USA – one school in each county of mainland USA. A self-report method of a questionnaire was used to gather demographic data and information on whether adults and siblings at home were smokers, as well as their smoking history and intentions. Participants were then classified into six categories, ranging from non-susceptible non-smokers to established smokers. Further questions asked about restrictions at home and school. Researchers also gathered information on smoking bans and the strength of enforcement. The study found that legal restrictions and enforced bans were significantly associated with not developing an early smoking habit, that home bans were more effective that legal restrictions on taking up smoking, and extensive restrictions on smoking in public places were associated with lower probability of transition between later stages of transition. However, school bans appeared to actually increase the probability of transitions to the last stage. It was concluded that school bans needed to be enforced to actually be effective and that although causality cannot be deduced, their findings are consistent in showing that parental opposition and banning smoking in the home reduces the uptake of smoking amongst teenagers.

EVALUATION: WAKEFIELD et al.

The study used a very large sample, which although was not stratified was random, and so likely to be representative of teenagers across the USA. As the findings are consistent with earlier research, it is likely that the study is reliable; however the use of self-report may reduce this as there is no sure way of checking honesty or accuracy of memory. Social desirability bias may have affected the results. As it was a cross-sectional self-report study, causality cannot be deduced which reduces the usefulness and conclusiveness of the findings; however it is not ethical to do an experiment to determine causality when health is involved. The study highlights that there are complexities within health behaviours, and that there are many factors to consider during health promotion.

METHOD: FEAR AROUSAL

Fear arousal as a method of health promotion refers to using fear and intimidation (usually through strongly emotive media campaigns) to persuade people into doing (or avoiding) certain health-related behaviours. Fear-arousing communication usually features two parts: stressing the severity of the issue using fear, and recommending an action to reduce or eliminate the health risk. The basic underlying assumption is that if the negative consequences of an action are made clear to an individual, they will be more likely to do something to prevent it. A large body of research into fear arousal suggests that high fear campaigns tend to be more successful than low fear campaigns, and this research was guided by the drive reduction model: the idea that fear or emotional tension is a drive to action, and so if a threatening situation is presented, individuals will feel motivated to take action to reduce the threat.  

EVALUATION: FEAR AROUSAL

The major issue with fear arousal is the ethical considerations it raises. Causing someone to feel fear goes against protection from harm, and actually causes psychological harm, which is against BPS ethical guidelines. Aside from this, although it is arguable that fear is a basic human emotion and as such fear arousal is applicable to everyone, people feel and respond to fear differently so fear arousal is unlikely to be effective for large populations. For example, whilst a graphic advert showing the damage smoking does to your body may cause some people to not take up smoking, smokers may ignore or avoid the messages due to it being too emotional and distressing to watch. Fear arousal appears to go against the Yale model, which outlines how too much emotion will not deliver a message successfully, so this is a worthwhile evaluative point. It is reductionist in the way that it is assumed fear arousal will automatically result in a change in behaviour – what about social factors such as the desirability or social pressure to conform to certain lifestyles, or self-efficacy issues such as thinking they cannot do it, and nobody they know would be able to.

STUDY: JANIS AND FESHBECK

Janis and Feshbeck conducted a cross-sectional study to investigate the consequences on emotions and behaviour of fear appeals in communication. A 9^th grade freshman class at a US high school was used as the sample; they had a mean age of 15 years. Janis and Feshbeck used a laboratory experiment, which investigated how the strength of fear arousing material presented in a lecture affected the emotional and behavioural changes in dental practices. An independent measures design was used, with four conditions: strong fear appeal, moderate fear appeal, minimal fear arousal, and the control group. A questionnaire was used before the lecture and afterwards. The strong fear arousal was generally received positively in terms of interest and necessity, but also had higher levels of dislike and unpleasantness. It showed a net increase in positive dental hygiene of 8%, whilst the moderate group had 22% increase, and the minimal fear group showed 36% change. The researchers concluded that fear appeals can be helpful in changing health behaviours, however it is necessary for the level of fear arousal to be appropriate for the appropriate target audience, and that (in teenagers) minimal fear is likely to be more successful.

EVALUATION: JANIS AND FESHBECK

The sample was very limited in that it was small, ethnocentric and age-biased; therefore it is unlikely that the findings could accurately be generalized much further than other American high school students. However, it is useful in that it highlights how high fear arousal does not always result in higher behavioural changes. The use of questionnaires allowed experiences to be relayed; however this raises the issue of internal validity due to the possibility of demand characteristics, dishonesty and social desirability bias.  The use of and findings from the control group however did improve the likelihood that it was the independent variable of fear arousal causing the behavioural changes. The other main issue with this study is the ethics, as children were exposed to material that they knew would be distressing and was intended to cause psychological harm, and whilst it was to try to improve dental hygiene behaviours, the ends here do not justify the means.

Model answer part b) for health promotion

b. Assess the effectiveness of methods of health promotion (15)

When assessing the effectiveness of methods of health promotion, it is first necessary to define effectiveness, and then discuss ways in which effectiveness can be measured. A commonly accepted definition of effectiveness is the degree to which objectives are achieved and targeted problems are solved. Health promotion in terms of media campaigns and fear arousal tend to be based on the Yale model, which describes how for an attempt to be effective, the communication (message), communicator (how the message is given) and audience (keeping in mind the population that is being targeted) must all be considered. Methods of health promotion can be measured in terms of whether they are effective in real life and who they are effective for, as well as time and cost effectiveness.

Ideally, health promotion methods need to reach as wide of an audience as possible to be the most effective. Studies such as Keating et al have shown that different audiences receive more information or advice from different sources; in Nigeria, it was found that men tended to get more information from media campaigns, for example radio advertisements on sexual health, whilst women tended to get more advice and support from clinic visits. This suggests that media campaigns may not be effective in reaching a wide audience, and although this may be less true in populations with higher access to the media, such as in the UK. Fear arousal campaigns of course have the same problem as media campaigns, but also have another issue. Although fear is a basic human emotion, so it could be assumed that studies and theories based around fear arousal are nomothetic, people react to fear in different ways, so individual differences may affect the success of fear arousal campaigns. For example, some may turn off an advert on sexual health that they find shocking, or leave an area with a poster showing mouth cancer as a result of smoking, meaning they avoid the campaigns rather than the dangerous health behaviours. Potentially the most effective way of reaching a large population would be legislation, as laws apply to everyone in the country or state and can be enforced by the police, by giving punishments such as fines and imprisonment if laws are not followed. However, obedience to legislation is arguably optional – some choose to deliberately disobey the law, whilst others simply do not consider it and may even not realise they are doing something wrong. Studies such as Wakefield have demonstrated how the existence of a rule itself does very little to change or reduce (smoking) behaviour unless it is heavily enforced in schools, homes and neighbourhoods, and therefore legislation is only most effective within a population if it is strongly enforced there. Thus it can be assumed that health promotion methods probably cannot reach the entire target audience, and that this would be better achieved through a combination of methods.

The real test of effectiveness of a method of health promotion is the extent to which it improves health behaviours or the overall health of people in the real world. It is often assumed that if a message is put across and seen, heard or known of by a large population, then it is effective. However, whilst a method of health promotion that only reaches a small audience is not effective, equally, one which reaches a large audience but doesn’t actually move much of the population to change their behaviour for the better is ineffective. Studies have demonstrated that media campaigns may not really be effective in changing behaviour, for example, Keating’s study showed that whilst more people who had had access to VISION had discussed and knew about the risks of HIV/AIDS, this didn’t appear to correlate with condom use. However, this is not to say media campaigns themselves are ineffective, but goes to suggest that merely information about risks is not enough. Campaigns with practical advice, such as where to get condoms, or how to quit smoking, rather than just arousing fear or providing statistics, are more likely to be the most effective in real life. Research also tends to suggest that in real life, legislation is effective only if properly enforced (Wakefield), and that fear arousal is only successful if used minimally. It can be assumed that methods of health promotion have limited applications, due to there being conditions for them to be effective which cannot always or easily be met for large populations.

Another aspect of effectiveness is the extent to which a method of health promotion is cost and time effective; that is, that the success of the method is more substantial than the time and money it costs to implement. Legislation is cost effective in that it has minimal cost to implement new laws, however, the legislative process can take years, which means it lacks time effectiveness. It is a long term investment which is good as it only needs to happen once, for example the smoking ban only needs to be implemented once, however until the law is in place, other health promotion methods will be needed – which will actually cost. On the other hand, media campaigns often cost a lot of money especially if the communicator is a celebrity; however they usually take a shorter amount of time to produce – so they have a better time effectiveness but are more expensive. Fear arousal campaigns are problematic in this way in that as they usually fall under a media campaign or visits to schools, these lack both time and cost effectiveness – finding the right amount of fear to induce for the target population takes a fair amount of time and research, whilst visits and media campaigns need money to fund. Therefore, methods of health promotion will usually have at least one “effectiveness area” where they are insufficient – cost effectiveness is achieved by reducing time effectiveness, and vice versa.

In conclusion, it would appear that methods of health promotion are most (and only truly) effective when used in conjunction with one another, as various methods are required to appeal to wide target populations, and to be effective both in the long and short term. Legislation is more effective in the long term; however, media campaigns and fear arousal methods are likely to be more effective immediately.