Research Ethics & Nuremberg Code

Research Ethics Timeline

• 1932-1972: Tuskegee Syphilis Study occurred
• 1945: Penicillin came into use for Syphilis
• 1947: The Nuremberg Code is established
• 1951: Henrietta Lacks' story came to light
• 1963: The Milgram Obedience experiment takes place
• 1974: The National Research Act mandates ethics board approval
• 1978: The Belmont Report outlines respect, beneficence, and justice for all research

Nuremberg Code (1947)

• The Nuremberg Code was the first real code of ethics
• It was developed in response to atrocities of Nazi medical experiments on concentration camp prisoners
• Key principles of the code include:
  • Voluntary consent
  • Research benefits society
  • Avoiding unnecessary suffering
  • No experiments where death or disability is likely to occur
  • Risk should be commensurate with benefits
  • Protecting subjects from harm
  • Using qualified researchers
  • Subjects being free to discontinue, and experimenters concluding when death/disability becomes apparent

Ethical Issues in Landmark Studies

• 1951: Henrietta Lacks' Story includes issues over consent, individual vs. societal benefit, confidentiality, and commercialization
• 1963: Milgram experiment for obedience raised concerns about autonomy, dignity, social responsibility, maximizing benefit, and minimizing harm
• 1932-1972: Tuskegee Syphilis Study had ethical issues because participants never received penicillin, were not informed of the study's purpose, and could not provide informed consent. Furthermore, men were never given adequate treatments, nor the option to quit the study

National Research Act (1974)

• This mandates that all federally funded research involving human participants must be approved by an Institutional Review Board

Belmont Report (1979)

• Key principles include:
  • Respect for people achieved by obtaining informed consent
  • Beneficence is shown through assessment of risks/benefits
  • Justice through fair selection of participants by avoiding power differentials like in the syphilis study

British Psychological Society Code of Human Research Ethics

• These outline respect for autonomy and the dignity of persons
  • Including rights to privacy, self-determination, personal liberty, and natural justice
  • Following procedures for valid consent, confidentiality, anonymity, fair treatment, and due process
• Scientific value requires ensuring accountability and robustness
  • Quality should relate to the scientific design of the research
  • Aims of the research should be transparent, even in cases of deception
• Social responsibility includes:
  • Psychologists using knowledge for beneficial purposes
  • Being aware of social and professional responsibilities
  • Being alert to potential consequences of both expected and unexpected outcomes
• Benefit and harm must be carefully weighed
  • Harm (physical or psychological) must be avoided
  • Management protocols should be developed for unavoidable risks
  • The risk of harm should be no greater than that encountered in ordinary life
  • Awareness of power differentials
  • Balancing costs versus benefits

Specific Ethical Issues

• Risks should be minimized, including factors regarding privacy, beliefs, and potential adverse effects
• Situations with more than minimal risk include vulnerable groups, deception, sensitive topics, and access to personal or biological data
• Valid consent must be given
  • Every person needs to freely consent based on adequate information
  • Participants should be able to withdraw or modify their consent, and request destruction of their data
  • Privacy and anonymity must be maintained
• Vulnerable people need special consideration
• A written consent form includes
  • Aim
  • Type
  • Method of collecting data
  • Confidentiality
  • Time commitment
  • Right to decline
  • Option to withdraw
  • Destroyed data
  • Risks
  • Contact information
  • How the data is used including potential benefits
• Coercion, even subtle, should never occur
• Confidentiality and privacy are protected by law in many countries
• Deception is falsely informing participants about a study's nature
  • It can cause distress and harm
  • Hurt perceptions of psychology research
  • When deception is necessary, the dignity of the participant is prioritised and approval is scrutinized by a Research Ethics Board

Vulnerable Populations

• These are individuals at increased risk of harm or exploitation (e.g., children, elderly, and those with disabilities)
• Researchers must obtain consent from legal guardians for minors or those unable to consent independently

Cultural Sensitivity

• Research design must respect diverse cultural perspectives and avoid harm or stereotypes
• Promoting social responsibility in psychological research
• Indigenous populations need culturally sensitive and respectful practices
• Minortized Groups: Empower racial, ethnic, LGBTQ+, and socioeconomically disadvantaged groups, and do not exploit them

Ethics in Publishing

• Authorship and acknowledgement require:
  • Only those with significant intellectual contribution receive credit as authors
  • Proper acknowledgement of funding, advisors, and supporting individuals
• Plagiarism and fabrication
  • Copying is prohibited, data must be accurate
• Conflicts of interest must be disclosed to ensure transparency and trust
• Duplicate publication requires:
  • Avoiding submitting the same data to multiple journals unless explicitly allowed
  • Ensuring each publication presents original contributions

Researcher Integrity

• Honesty and transparency require:
  • Disclosure of methodologies and limitations even if results do not support hypothesis
• Avoiding bias involves:
  • Objectivity in study design
  • Awareness of personal biases and minimizing them
• Data integrity includes accuracy, authenticity, and raw data should be available for verification
• Transparency in reporting involves positive and negative results; avoid selective reporting
• Maintaining public trust involves integrity promotes confidence

Researcher Ethics Boards

• They are responsible to:
  • Review research involving human participants
  • Ensure independent, competent, and timely ethics reviews
  • Protect the rights and welfare of participants
  • Consider the safety of researchers and interests of stakeholders
  • Make informed judgments on merit of scientific proposals
  • Making recommendations to researchers

Psychometrics and Measurement

• Constructs are operationalized by giving numbers to the amount or level of something
• Rating scales include: Continuous as in Likert or dichotomous as in yes/no
• Ratings include self report, observer reported using a 3rd party like a parent or teacher
• Validity: Does the scale measure what it is supposed to
• Reliability: Are items consistent among themselves, over time, and across raters, test-retest reliability
• Scale Items need developing so:

1. Large pool based on theory, expert, and research are generated for validity.
2. Best selected by giving all to relevant people to observe effect or distribution.
3. Scale is checked again by giving to people for discrimination, relation, and stability.
4. Norms for population are clinical cut-offs and sensitivity.

Psychometric Validity

• Measuring the construct that it's supposed to through accumulated evidence
• Validity covers:
• Construct by developing unidimensional scales or demonstrating independence for multidimensional scales
• Predictive by demonstrating differences between groups
• Concurrent by scoring scales to relate scores
• Content by representing facets
• Discriminant by not correlating unrelated scales
• Criterion by relating to an outcome measured by tests
• Sensitivity to change over time

Psychometric Reliability

• Measuring consistency of scales (coherently) over time and across raters through

1. Questionnaires:

• Testing construct across time or items, using a method like Cronbach's alpha
• Testing scores are reliable with test/re-test

2. Observer Rating Scales:

• Testing consistency of scales through Inter-rater and Cohen's Kappa

Critical Psychometric Factors

• Scales cannot purport to access constructs if they assess them similarly
• Observer rating scales are better for implicit constructs
• Not all questions will asses the same aspect
• Longer scales give better reliability
• Scales on one population will not work the same way on another
• The name or quality of questions cannot be expected
• Developing scales from floor/ceiling can affect these aspects
• Use standardized measures, if possible. And avoid existing changes
• Use multiple measures
• Single or shortened measure is simpler, but may lack validity

Diversity Issues in Assessment

• Culture affects memory, perception, and language
• This is because there are differing cultural perceptions
• This affects cut-offs, standards, translations

Evaluating and Monitoring Patients requires:

• Assessment of patient factors for 30% of outcomes
• Assessing symptom severity, attachment styles, patient preferences
• This means directing patients, their emotions, and challenging therapies
• Follow the Cooper-Norcross Inventory
• Allows for realistic assessment and intervention
• Progress Monitoring helps increase clinical improvement, through tools like questionnaires
• Assessing relationships helps identify alliances
• Outcome measurement for a patient will affect their alliance

Therapeutic Alliance and Repairs and issues according to:

• Greenson on the therapeutic relationship, consisting of transference, alliance, and realness
• Fluckiger on effects the alliance has on outcomes
• Researchers on dynamics in building and impacting alliances
• In groups and at different times
• Research showing the role change has in relation to outcomes
• That alliance must be managed for curative effects

Alliance Rupture

• It comes from a lack of building between therapist and patient
• Can occur throughout
• Arises as a misunderstanding or failure
• Manifests as significant or barely noticeable
• Can affect any one or both members in a group

Types of Alliance ruptures Include

• Confrontation and active working against
• Withdrawal or working away For these some resolution factors include:
• Focus and awareness
• Strength through non defensiveness

How to maintain the relationship

• Meta-communication: describing an interpersonal process that helps with growth
• Reflection and honesty: Exploring yourself
• Providing transparency and clarity: Invite to see how you feel
• Here & Now
• Reduce reativity

Attachment Theory from:

• Bowlby, who separated kids from parents: Variations in tolerance
• Ainsworth, who followed those kids every life: Attachment in various situations
• Main, who took it further with adult interviews: Attachment as disorganized or state of mind scales
• Shows:
• Parent-child style
• Behavior
• Cohesion or deconstruction
• Secure and unattached

Attachment and Theory helps us by:

• Knowing attachment styles and relationship with one another as in:
  • Adaptive, but fearful and overwhelmed
• And more importantly, understanding Attachment in the Mind, with:
  • Organization which involves feelings and consistency
  • Reflective functioning that interprets meaning and expresses it
• And using AAI (Adulthood testing), which is highly stable, reliable (but requires an interviewer ) and influences therapy
• However they all do connect through:
  • Anxiety which is related to some trauma
  • Avoidance that was adapted
  • and disorganization from life
• Which can affect many aspects of ones life with:
  • Regulation and style
  • Coherence and reflection

Measures include:

• Self-Report on relationships measured with dimension scales for Anxiety
• As well as Avoidance But is all solved in Group Therapy ! ...or

Are dimensions in Therapeutic Groups

• There are various types with different dimensions that focus on interactions over limited or unlimited time and different focuses.
• Groups should be lead and not have the same diagnosis

Group Therapy:

• It was has proven efficacy for eating disorders, OCD, anxiety, and depression
• Also It can be better than individual therapy
• Groups need fitness to be effective
• Alliances work as expectations that lead to self-disclosure BUT

To Create a Successful Group in the Long Run, You Will Need:

• 50% Drop Offs
• Understanding between diagnosis, coping, and communication
• Rules for confidentially and attendance
• Goal setting that has alliance

And to Find Members with the right characteristics You Will Also Need:

• People void of abusive relationships or extreme conflict
• As well as with homogeneous minds for communication

As a Therapist Be Mindful in the Phases:

• Forming and setting rules
• Storming over issues
• Establishing norms
• Creating Goals

The Process Involves:

• Content, the details
• Processing the affect
• Understanding transference and conflict

These actions must be taken as:

• A communicative, aware, transparent, validating, and deliberate practice. For we must follow

EVIDENCE for THERAPY

Psychotherapy or the implementation of our understanding must be deliberate and derived from research to affect behavior To achieve the Bona Fide we need to do a theory-driven therapy

The Effect on the Patient can be :

• Measured, by conducting trials with treatment manuals , well-defined groups that need to use short term methods. And all have
• Biases: 1 .For publishing the best

2. For finding the best

How to do better:

• By having therapists respond instead of using manuals
• And testing the Common variables: responsiveness
• And being understanding of limitations
• and considering some of the bad, all while being cautious with allegiance to a method

How could we do this with therapy:

• Make it about the patient and not us
• Understand that they are as effective as drugs and must be used with caution

Transference

• It all started with Anna O and Breuer
• Grew with Fraud and interpretations
• Built with Kohut on creating relationships Transference involves not only an understanding of history, but our own involvement So we must understand
• Ourselves, our responses, and where we may feel that we are on the client’s side For therapists, we can do this by reviewing
• Ourselves. Not overinvolved
• Checking what the client is making us feel as we manage and treat

So with both patient and therapist in mind

• Have we assessed what is and was
• Established what we wish to do (or rather, what they wish to do with our help )