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Module: Psychological Foundations of Mental Health Week 4 Beyond basic cognition and emotion Topic 1 Attitudes - Part 2 of 4 Dr Wijnand van Tilburg Department of Psychology, King’s College London Dr Emmanuelle Peters Department of Psychology, King’s College London Dr Mike Aitken Deakin Department of Psychology, King’s College London Lecture transcript Slide 2 Attitudes are functional psychological constructs. That is to say, they help us organise knowledge in an efficient way that saves time and effort in making complex decisions and judgement. The fact that attitudes are functional in this way, however, does not mean that they’re infallible. Slide 3 A good example of attitudes resulting in potentially bad or even dangerous outcomes is prejudice, or a negative effect of prejudgment of a group and its individual members. When people make judgments of others, they often rely on the knowledge they have about the group that these individuals come from, for example, group stereotypes. Although forming attitudes based on stereotypes is highly efficient-- after all, it does not require from us that we process all the information about the speciﬁc individual-- it can lead to prejudiced judgement. Some of these prejudices may be relatively harmless, such as the belief that all Dutch wear wooden shoes. Some of them, however, can be harmful, such as resulting in racism, sexism, and discrimination. Slide 4 In context of mental health, a particularly problematic phenomenon closely related to prejudice are stigma and stigma by association. Stigmatisation happens when people, for example, sufferers of depression, are treated according to a stereotype that people have of mental health patients, even if these stereotypes tend to be incorrect. Stigma by association is a tendency for people to devalue someone because of their association with a stigmatised individual. This happens when a person is liked or disliked merely because this person is somehow related to a stigmatised individual. For example, a child may be avoided by peers because a parent suffers from a mental illness. Stigma by association can have negative consequences for the person being judged. Transcripts by 3Playmedia Week 4 © King’s College London 2017 1. Particularly interesting cases of attitudes or beliefs in general going wrong are present in mental health challenges, such as psychosis. In particular, sometimes, people’s interpretations of events around them, often referred to as appraisals, lead to different outcomes, depending on the beliefs that they hold. In the following section, Dr. Peters will tell you more about beliefs in mental health and how they relate to, for example, psychosis. After that, we return to the topic of attitudes and take a closer look at how attitudes can be changed. Slide 5 So I’m going to talk about how attitudes and beliefs relate to mental health. And speciﬁcally, I’m going to talk about the case of psychosis and anomalous experiences. Slide 6 So the traditional view of psychosis is very much a kind of distinct illness, different distinct category, which is on a normal distribution, completely different to normality, which then sits on another normal distribution. So here you can see that the two distributions do not meet, with this normality at one end and psychotic illness as a distinct category. So that’s the traditional view of psychosis. Slide 7 So a different approach is the so-called continuum view of psychosis. And the continuum model is based on evidence that so-called psychotic experiences-- and what I mean by psychotic experiences are experiences like hearing voices, for instance, or sometimes seeing things that other people can’t see. And these psychotic experiences are actually common and present to different degrees throughout the general population. So if you like, they are on a continuum with normal experience. Now, there’s different estimates of how common these experiences are. But latest meta- analysis suggests that probably about 7% of the general population have these kinds of psychotic experiences. So in other words, there seems to be a continuum, if you like, between health and normality and psychosis, with only the extreme end being the disorder, past the psychotic threshold. But all sorts of eccentricities and unusual experiences happen in between. Slide 8 So this is a slide showing the largest meta-analyses that have been done in this ﬁeld. And if you can see here, in the green box, basically, what that’s telling you is that the majority of psychotic experiences in the general population remit, if you like, of their own accord. So only 20% of people who have psychotic experiences go on to experience them. So 80% of them basically just remit spontaneously. Now, of those 20% who have persistence, sort of ongoing psychotic experiences, then they have a higher risk of developing psychotic disorder than people who don’t have psychotic experiences. But even so, in fact, the majority of people who have persistent experiences don’t go on to develop a psychotic disorder. And if you see at the bottom, in the second green box, you’ll see that, in fact, psychotic experiences that do not cause distress are twice as prevalent as those who do. So what that’s telling you is that, actually, the majority of psychotic experiences are benign and do not lead to a disorder. Slide 9 So what might be the differences between psychotic experiences, which remain benign and where people continue to be healthy members of the general population, if you like, and those that lead to Transcripts by 3Playmedia Week 4 © King’s College London 2017 2. pathological outcomes, like a psychotic disorder? Slide 10 So one way to be looking at this is using the cognitive model, the basic cognitive model, which basically states that it’s not the events that happen to us or the internal experiences that we have that lead us to problems and symptoms of mental health problems. But it’s actually the way in which we think about them. So it’s the appraisals or the interpretations that we have of the events that happen to us and our internal experiences that lead to problematic outcomes. So for instance, imagine that you hear a noise in the middle of the night that wakes you up. Now, what you might automatically assume and interpret is that, my god, there’s a burglar trying to get in. Now, if that’s the automatic thought that pops into your head, then the likelihood is that you’re going to be scared. So that’s a negative emotion. And probably, you’ll either hide under the duvet, or you will perhaps look out for more noises and listen out for anything else that might be happening. And these are behaviours. And of course, they will be behaviours like listening out for noise that make it more likely that you then hear more noises, get more scared. And you get yourself into a vicious cycle. Now, on the other hand, if the ﬁrst thing that pops into your head is, oh my god, it’s that damn cat again, then you’re not going to feel scared, and you’re probably not going hide under the duvet. You’re probably just going to go back to sleep. Now, the point is in both of those scenarios, the noise is the same. It’s the way in which you’ve interpreted the noise that leads you to a different path emotionally and behaviorally. So this is what the basic cognitive model is about for all mental health, almost all mental health experiences. That basically, the kind of clinical symptoms that people have are not simply statements of experience. There’s an appraisal and interpretation stage in between. Slide 11 So in the case of psychotic experiecnces, is it the case that the diffference between people who have benign psychotic experiences and those who end up with pathalogical outcomes is it the case that it is just the experiences that are different between those two groups or indeed is it the case that appraisals are different between those two groups. Slide 12 So this slide shows you the results from a fairly large study that compared people who had psychotic experiences who remained healthy members of the general population. So they didn’t have a need for care, if you like, had never be diagnosed with a mental health problem relating to their experiences. And they’d never been in need of presenting to mental health services. So that’s the non-clinical group, for which there were 92. While the other group were the clinical group, who were people with psychotic experiences, but had been diagnosed with various psychotic disorders and were in receipt of mental health services at the time of testing them. And we wanted to see whether the types of experiences that they had were the same or different. Now, what you can see in middle of the Venn diagram were all the experiences that were common to both groups. So both groups had voices and, in fact, hallucinations in all modalities. So they had visions and also olfactory hallucinations, in other words, smelling things. And they also had what’s called ﬁrst rank symptoms of psychosis, so things like thought insertion or having a feeling or believing that you have thoughts put into your mind, and also believe that people can read your mind or control your mind, and also symptoms of dissociation. So all of these symptoms were found in both groups. And so there was a large overlap of psychotic Transcripts by 3Playmedia Week 4 © King’s College London 2017 3. experiences between them. And in fact, if you look in the left hand side of the blue circle, our non- clinical population had more of particular types of hallucinations than the clinical group. So somatic and tactile hallucinations-- so that’s kind of feeling things that aren’t there-- were more common in that group, and also feelings of elation and having precognitive experiences and being able to tell the future, and having this kind of insight and revelatory experiences. And interestingly, that group, the non-clinical group, also had an early onset of their experiences. So by sort of mid-adolescence, that was the average of the onset of their experiences. And it was a bit later in the clinical group. Now, there were also some types of experiences that were more common in the clinical group, which is the pink circle. So for instance, the type of voices, where voices are commenting on your actions or basically talking about you, were actually quite rare in the non-clinical group. So they tended to be found much more in the clinical group. And also, although the non-clinical group had thoughts inserted into their head, they had fewer experiences of having their thoughts kind of withdrawn from their heads or broadcast to other people. But really, the most striking and important differences between the two groups were that the clinical group tended to have delusions, while the non-clinical didn’t, and especially persecutory delusions, which were the most common types of delusions. So our non-clinical group, people who are in the general population with their psychotic experiences, do not tend to also have paranoid delusions. And the other difference was self-reported cognitive difficulties, so like losing a cognitive grip, so not being able to concentrate, to focus, and just not being able to keep your head straight. And these experiences were only found in the clinical group. And lastly, not surprisingly, what we did ﬁnd was the clinical group have more severe experiences. So there’s something about the relentlessness of having these experiences that are more likely to lead you to a disorder, quite understandably. Slide 13 So the take home message, really, is that it’s not so much what you experience, but it’s how much you experience It, with severity being very important. But having said that, two types of experiences are important. And that’s this kind of cognitive grip, although, of course, that’s a cognitive symptom, not necessarily a psychotic symptom, and also persecutory beliefs, so a kind of paranoid worldview. Slide 14 So going back to the cognitive model, is there a difference in terms of what sense these two groups make of their experiences? So is there a difference in terms of appraisals between these two groups? Slide 15 So in the same study, we compared the appraisals of these clinical and non-clinical groups. Now, the ﬁrst thing to say is that it’s not just the case that the non-clinical group don’t ﬁnd their experiences distressing. They actually ﬁnd them clearly helpful. So you can see from this graph here, the yellow graph is the non-clinical group. And we just asked them to rate on the scale of whether their expenses were destructive, unhelpful, right through to mildly helpful and clearly helpful. And you can see that the non-clinical group most often saying their experience is clearly helpful. So it’s not just an absence of distress. There’s something about these anomalous experiences that enrich these people’s lives. Transcripts by 3Playmedia Week 4 © King’s College London 2017 4. Slide 16 And we also found that the clinical group, so here the bars in black, found their experiences more negative-- so here, the valence graph-- more dangerous, more abnormal, interestingly, and also less controllable. But if you see the last column, which is externality-- in other words, are my experience to do with an external, something which is external, as opposed to the product of my own mind-- there were no differences between the two groups. So it’s not just that people in the general population have, if you like, insight that their experiences are the product of their own mind. That’s not the difference between these two groups, the difference in terms of thinking they’re dangerous, negative, abnormal, and uncontrollable. Slide 17 And there were also lots of other differences in terms of appraisals of their experiences between the two groups. So here, for this graph, we just asked them to explain where their experiences came from and what they thought they were about and basically what sense they made of them. And then, we rated their answers on the basis of a number of different categories. So the categories that we rated were biological, psychological, related to drugs, spiritual or supernatural, normalising-- that’s an explanation which is it’s just part of normal human experience-- and other people. And you can see, there were lots of differences between the two groups. Now, not surprisingly, the non-clinical group were more likely to view their experiences as spiritual experiences or supernatural experiences and also normalising, so part of normal human experience. While the clinical group, on the other hand, made more biological explanations, which probably ﬁts with the fact that that’s what they’re told. So it’s something to do with their brain. That’s what they’re told in mental health services. Slightly more drug related explanations as well. But really, the striking difference-- and we have found this in a number of other studies, so it’s a very robust ﬁnding. That clinical group are more likely to blame other people, think other people are involved in some way in causing their experiences, while the non-clinical group do not believe that at all. Slide 18 So these ﬁndings shed some light in the differences in appraisals between clinical and non- clinical group. But really, just asking people in interviews to talk about their experiences and their explanation is quite a messy way of looking at it, especially when it’s retrospective, because, of course, the way in which people interpret their experiences then have an impact on the way in which the experiences are felt in the ﬁrst place. So we need to ﬁnd a way of somehow disentangling people’s experiences from their appraisals experimentally, if we want to be able to look at this in a more robust fashion. And what has been done to look at this is basically, if you like, creating a symptom analogue in an experimental task. So that’s, if you like, mimicking a very mild anomalous experience, like giving people the experience that their thoughts are being read by a computer or an iPhone or having a kind of hearing voice- type analogue experience. And everybody, every group, gets given the same anomalous experience. So everybody gets the same thing, and it’s controlled for everybody. And then, you can see whether people’s appraisals differ based on the same anomalous experience, which is unrelated to any ongoing experiences they might have. Slide 19 Transcripts by 3Playmedia Week 4 © King’s College London 2017 5. So one of the tasks that was used is a little task called the card task, which you may have come across before. If you haven’t come across it before, just have a quick go at it. So what participants are asked to do, and what you can do if you would like to, is to select one of the cards and concentrate on it. Don’t click on a card or say anything. Just memorise the card. Slide 20 Now, the card that you have chosen will now be selected and removed from the pile. Slide 21 Has it gone? Slide 22 Now, what participants are asked at this stage is, how do you think this was done? So in case you didn’t quite work out how that worked, the reason the card that you chose then was no longer there was because, in fact, all of the cards are different at the second stage. And the trick relies on the fact that people will scan for their own card and not notice that the cards are all different. Slide 23 So what we’ve done is have this little task, and we’ve taken it around in a number of different studies to clinical and non-clinical group. And we’ve got a number of different tasks that use iPhones and an analogue of hearing voices. And when exposed to experimentally induced anomalous experiences, what we found consistently is that the clinical group tend to make more maladaptive appraisals of anomalous experiences than the non-clinical group. And what I mean by maladaptive appraisals-- so the ones that we’ve asked people to rate, basically, have been what we would call intentionalising. So that’s believing that the trick was done with intent. It was done on purpose to make you look foolish. Or personalising, in other words, there’s a person involved in this. It’s not just the computer that did the trick. There’s somebody behind the scenes, basically, that made that happen. Internalising, believing that means that’s something wrong with me. Or conspiracy, basically, believing it’s part of a wider conspiracy. And consistently, the clinical group are more likely to rate those appraisals for these experimentally induced anomalous experiences, while the non-clinical group do not. In addition, the clinical group ﬁnd them more striking. So those little tasks, ﬁnd them more striking, more distressing, and more threatening. And they’re also more likely to think it’s speciﬁc to them. So in other words, it doesn’t just work the same with everybody. And it’s also related to their ongoing experiences. So as you can see, these are quite striking differences, even with just a very small, experimentally induced anomalous experience. Again, the take home message from here is that it’s not necessarily external appraisals that seem to be important in determining whether or not your experiences are pathological or benign. There’s something about seeing these experiences as threatening and having a kind of paranoid worldview, believing other people are involved, that there’s an intent there, that it’s part of a wider conspiracy. These are the appraisals that mean that psychotic experiences either stay benign or lead you to a disorder. Slide 24 Now, these ﬁndings actually have important implications for therapy and the way in which we might help people who come to us with distressing psychotic symptoms, because the implication is that, Transcripts by 3Playmedia Week 4 © King’s College London 2017 6. actually, it’s not necessarily about getting rid of the symptoms, getting rid of the experiences, because these can be meaningful for people. But it’s helping people think about them in a different way, so in a less threatening way, and coping with them differently to reduce the distress that people have about them. So it’s not necessarily the experience that’s the problem. It’s the way people view the experience and what they do about it. Slide 25 And changing the way people think about their experiences can actually have a profound impact on people, as this fMRI study showed, where we gave people cognitive behaviour therapy for psychosis for a period of six to nine months. And at the end of the therapy, people’s brains responded differently to threatening facial expressions. So in other words, therapy can fundamentally alter how information is processed at a neural level. Slide 26 So again, the take home message is the mind can change the brain. And attitudes and beliefs are basically paramount in determining mental health problems. And changing them can change your brain. Transcripts by 3Playmedia Week 4 © King’s College London 2017 7. Module: Psychological Foundations of Mental Health Week 4 Beyond basic cognition and emotion Topic 1 Attitudes - Part 3 of 4 Dr Wijnand van Tilburg Department of Psychology, King’s College London Dr Emmanuelle Peters Department of Psychology, King’s College London Dr Mike Aitken Deakin Department of Psychology, King’s College London Lecture transcript Slide 3 In the previous lectures, you learned about what attitudes are, what functions they fulﬁl, and where they originate from. Furthermore, you learned how these are broadly related to mental health. Attitudes and beliefs in general can clearly be maladaptive or inaccurate in some cases, such as in psychosis or stigmatisation. How can we change people’s attitudes and beliefs? This is the topic of the current lecture. Slide 4 To understand how attitudes can change, let’s take a simple everyday example-- advertisement. In fact, a lot of what we know about attitude changes comes from psychologists researching persuasion. Look at this advertisement for a Lexus car. What methods are the advertisers using to make you adopt a favourable attitude towards the Lexus in the hope that you buy one? A ﬂashy picture of high speed driving, a catchy statement at the top, appealing design, and also a considerable amount of small font details-- price, engine details, information about the interior. Some of these elements could be considered to be critical to making a good decision-- the price, for example. Other pieces of information, say, the design of the advertisement, are of course not very important sources of information. They are more peripheral. How do these pieces of information then inﬂuence or change our attitudes? Slide 5 A famous model that describes how attitudes change in response to information we get is the Elaboration Likelihood Model by Petty and Cacioppo. According to this model, there are two ways in which people process the information-- a central route and a peripheral route. The central route involves deprocessing of the information that we are presented with. In particular, we look at details, make calculations, search for more information, and so on. The peripheral route, on the other hand, involves more shallow information processing. We look at Transcripts by 3Playmedia Week 4 © King’s College London 2017 1. superﬁcial pieces of information that are easy to process. The central processing route leads to enduring, long-lasting changes in attitudes. The peripheral route, on the other hand, leads to short- term changes in attitudes that are easily disappearing over time. Attitudes change as a result of the central processing route leads to more long-term commitment to an attitude. The peripheral route may lead to action-based and temporary changes, such as buying a product in a spur of the moment. The Elaboration Likelihood model is an example of a dual process model-- a psychological framework that postulates two modes of information processing which differ in the extent to which individuals engage in effortful thought about message content. There are several other dual process models across psychological domains. What, then, determines whether people use the central or peripheral route? This is an important question as the choice of route will determine whether attitude changes are lasting or not. The answer, according to Petty and Cacioppo, is motivation. People use only the central route if they are highly motivated to make good decisions. For example, because the decision is very important for them. If, on the other hand, people ﬁnd a decision not so important, then motivation is low and people tend to process the information through the peripheral route. Accordingly, whether attitude change attempts are successful depends on both the type of information that is contained in a persuasive message and the motivation of the person that is being persuaded. Let’s have a look at the advertisement again and see how this may work. Slide 6 We identiﬁed several pieces of information before contained in the persuasive message-- a ﬂashy picture of high speed driving, a catchy statement at the top, appealing design, price, engine details, information about the interior. But keep in mind that what information will be effective in convincing people to buy the car depends on their motivation. People who are not really motivated to make a good decision will be persuaded more by peripheral cues that are easy to process, such as the ﬂashy design of the advertisement, the apparent speed of the car in the picture, and a good sounding statement at a top of the ad. They are not likely to process or be convinced by detailed information. In fact, people who are instead highly motivated to make a good decision are more likely to use detailed information-- price, engine details, further information on the website, et cetera. More generally, attitudes are susceptible to change when people are confronted with peripheral and more central pieces of information. Which of these two pieces of information will persuade them, however, critically depends on their motivation. If they are about the attitude topic, they will attend to central information. If they care little, they may be persuaded by peripheral information instead. Thus, if in the future you wish to convince someone of something, it is important to keep in mind what their motivation is and what kind of information you therefore need to present. Slide 7 The discussion of persuasion and attitude so far assumed that people are aware of their attitudes, that is to say, they know what they like and dislike. But is this really the case? Or is it possible that we like and dislike things and people without even being aware of it? For example, if someone claims not to be a racist, can we be sure that this is indeed the case? Or could it be that unconsciously they still hold negative views towards other groups of people? Slide 8 You may be surprised to hear that it seems, indeed, very likely that people hold attitudes that they are not even aware of. We call these implicit attitudes. These are evaluations whose origin is unknown to the individual and they affect implicit responses. These are different from normal or explicit attitudes, which are evaluations whose origin we know and that effect explicit responses. Transcripts by 3Playmedia Week 4 © King’s College London 2017 2. You can think of implicit attitudes as part of the proverbial iceberg that hides underneath the water surface. Explicit attitudes are the only ones we consciously notice. There are sophisticated ways to measure people’s implicit attitudes, including reaction time tests and various computer tasks. We will not go into detail about these methods, but it is good keep in mind that attitudes can be both conscious and unconscious. Indeed, a wealth of research indicates that people who believe not to be, for example, racist or sexist do, nonetheless, have these attitudes implicitly. And these implicit attitudes, while unaware of them, make them sometimes behave in racist and sexist ways. Transcripts by 3Playmedia Week 4 © King’s College London 2017 3. Module: Psychological Foundations of Mental Health Week 4 Beyond basic cognition and emotion Topic 1 Attitudes - Part 4 of 4 Dr Wijnand van Tilburg Department of Psychology, King’s College London Dr Emmanuelle Peters Department of Psychology, King’s College London Dr Mike Aitken Deakin Department of Psychology, King’s College London Lecture transcript Slide 2 At the start of this topic, I discussed the functions of attitudes. They serve symbolic purposes by helping us to express our values. Furthermore, they give us a means of making fast decisions without having to rely on all the information. As a result of this second function, attitudes guide us in approaching what we desire and avoiding what we dislike. But how does this work? What information do we use to form these attitudes and beliefs? Slide 3 Some of the most important processes that determine our attitudes are heuristics, simple rules that are used to form an attitude judgement with little cognitive effort. Slide 4 How do these heuristics operate and result in attitudes? Let’s give an example based on the game of chess. Don’t worry if you’re not familiar with chess. I’ll explain the relevant details to you. In the game of chess, your goal is to capture your opponent’s piece called the king. You have 16 pieces of your own to attempt doing so, but so does your opponent. Games of chess can last a long time and involve several turns, in which you and your opponent move one of their pieces across the board. In order to win the game of chess, you usually need to capture ﬁrst many of the opponent’s pieces, before you can capture her or his king. But which one of the opponent’s pieces to catch ﬁrst? You can capture pieces called pawns, rooks, knights, and more. Which one to choose? What strategy will get you to victory closest? Ideally, at the start of the game, it would be great if you could work out your entire strategy. You plan your ﬁrst move, second, third, and all the others, keeping in mind what your opponent could do in response. Unfortunately, this is impossible to do. It is far too complex. Even our most sophisticated computers cannot calculate all the different options to obtain a strategy that guarantees victory. Transcripts by 3Playmedia Week © King’s College London 2018 1. So how do we and chess computers, for that matter, play a game of chess? We use heuristics or rules of thumb. For example, the piece called queen in chess is much more powerful than a pawn. As a result, a good way to get closer to victory is to try to capture the opponent’s queen, if that is possible. Although capturing the opponent’s queen is no guarantee for victory, it is generally a good strategy to do so. It is effective. So when playing chess, you may use this simple rule of thumb, when I get the opportunity, I will try to capture the opponent’s queen. Heuristics work in much the same way. They do not guarantee success, such as being entirely accurate in our attitudes. But they are usually not too far from incorrect. Slide 5 What kind of heuristics do people use when forming attitudes or beliefs? There are many of them, and I will discuss brieﬂy two. Imagine the following. You see a fellow student in the cafeteria. He looks shy and reads The Principles of Philosophy by Rene Descartes. What do you think? Does this person study business or philosophy? Chances are that you will assume that the person is a philosophy student, and research indicates that this is, indeed, typically what people would conclude. After all, the person ﬁts the stereotypical view of philosophy students and not that of business students. The problem with this inference is, however, that on the whole, there are far fewer students of philosophy than business. It is, therefore, not unlikely, based on the mere number of students in business compared to philosophy, that the person is actually a business student. The example, where people base their beliefs on the similarity between a target, the student, and a population, philosophy students or business students, is known as a representative heuristic. People base their judgement and attitudes on the level of similarity between a target and a population. This may often be correct. But sometimes, the heuristic leads to wrong conclusions. Another prevailing heuristic is the availability heuristic. This works as follows. How likely do you think it is to die from a shark attack? Say, of one million people, how many die of a shark attack? According to National Geographic, most likely, not a single one. In fact, they estimate the number of deaths due to shark attacks at one in 3.7 million. To put that in perspective, they estimate the chances of dying from the ﬂu at one in 63. Why do people tend to think that shark attacks are a more common cause of death than they really are? According to the availability heuristic, this could be because such an event is easy to imagine or remember, for example, because you saw it in a movie or in a news report. Indeed, according to the availability heuristic, people estimate the frequency of an event is higher, the easier it is to bring it to mind. This may be an effective and reliable heuristic in many cases. But, as you can see from the shark example, sometimes it is not. Now that you have a bit of an understanding of how these heuristics work, how do they relate to mental health or maladaptive behaviour? Heuristics are usually inﬂuential in many problem behaviours, such as in addictions. Think of gambling, for example. Big wins, such as winning the lottery or getting the jackpot when playing a slot machine, may be very easy to bring to mind. After all, we see them in movies, advertisement. And when they occur, they’re highly memorable. Transcripts by 3Playmedia Week © King’s College London 2018 2. As a result of the availability heuristic, people may subsequently start to believe that winning with gambling is much more likely to happen than it is in reality, potentially leading to irresponsible gambling. In the next bit, Dr. Aitken Deakin will discuss how attitudes can, unfortunately, lead to problematic attitudes and behaviours, such as in the context of gambling. Slide 7 Cognitive psychologists who study decision making have proposed that we often use heuristics, simple rules of thumb to allow us to make efficient decision making. Heuristics attempt to explain how we make our decisions or judgement very rapidly, seemingly effortlessly, on the basis of very little information. Now, these heuristics, which we might experience as gut feelings, may be a very good way of making a simple decision, especially a small decision, such as whether to spend a very small amount of money. In these cases, the cost of getting a wrong answer or a slight error in our decision might well be very small. And it may be that the kind of costs we incur by buying something at a slightly higher price are less valuable to us than the time we might lose trying to ﬁnd out the most efficient price or the best way to purchase something. However, any small errors will add up if we keep making similar decisions over and over again. Now, in the example of gambling, as you might expect, popular gambling games, which, of course, are popular with casinos, as well as with players, provide an excellent case study of situations where heuristics can prove very costly. Gambling, by which I mean the placing of monetary bets for uncertain rewards as a form of entertainment, is a very common behaviour. And for a small proportion of people who gamble, it can become a huge problem. Slide 8 Gambling is a very common activity in the UK. Recent surveys have indicated that around 70% of the British adult population gambles at least once every year. Much of this is gambling on the national lottery, but around a half of adults gamble at least once a year on games other than national lottery, with scratchcards, horse race betting, and slot machines being the most common form of gambling behaviour. In 2007, it was estimated that the per capita expenditure in the UK averages out to around 155 pounds per year. To put that example into context, in the way The Guardian newspaper did, means a typical British family will spend 3.60 each week on gambling, which is 80 pence more than it will spend on fruit. Slide 9 Cognitive psychologists who want to understand gambling and problem gambling focus on the types of cognitions that those who engage in gambling rely on. We use verbal report measures, questionnaires where we ask people questions along the lines of, do you have particular lucky numbers? Do you engage in superstitious behaviour? Now, people who agree that they do have luck related cognitions and superstitions will report a distorted sense of their chance of winning in something such as a lottery. Problem gamblers, that is, people who have difficulty in controlling how much gambling they engage in, are or become more susceptible to these types of cognitive distortions, these tendencies to overestimate their chances of winning in certain types of gambling game. Understanding these distortions is also important, because we know that individuals who show higher levels of distortion tend to have poorer responses to treatment for gambling addiction. Conversely, Transcripts by 3Playmedia Week © King’s College London 2018 3. cognitive therapy that directly targets this type of distortion has been shown to be effective in helping people with problem gambling get their behaviour under greater control. Slide 10 Now, we can look at two different common forms of gambling game and consider each of them in terms of the ways in which they may lead to cognitive distortions. The ﬁrst example we’ll look at is slot machines or fruit machines. In these machines, the reels move, and when they line up, a jackpot or large win can be recovered. When playing these machines, as well as winning, it is possible to nearly win, that is, when the reels line up in such a way that if one of the reels had moved a little bit further or a little less far, a jackpot would have been won. This is an example of a near miss or near win, which is a special kind of failure to reach a goal. It’s when the person comes close to success. And in the mind of the gambler, we could regard them as not constantly losing, but rather, constantly almost winning. Cognitive psychologists who have studied gambling behaviour in laboratory have investigated the degree to which these near-miss effects inﬂuence gambling behaviour. What we found is that when the near misses occur on roughly a third of the non-winning trials, people will maintain their gambling behaviour in the face of a large sequence of losses more than if no such near misses occur. Now, near misses are taken by the gambler as indications, somehow, that they are more likely to win. Why might this be so? Well, we could think about the role that near misses play in games of skill. If you’re taking a penalty in a game of soccer, and when you strike the ball, it comes off the post, you didn’t score a goal, but you very nearly did. If the ball bounces back off a corner ﬂag, you didn’t score a goal, but clearly, you had less control over where the ball was going than if you hit the post. So in a game of skill, where you have or are learning control, a near miss could indicate that you are gaining control and that you are more likely to succeed next time. It has been shown when people playing slot machines have control in terms of whether or not they are spinning the reels, they show a greater sensitivity to near misses, that is, that a near miss leads to increased desire to play, only if they themselves are spinning the wheel and not if the wheel is being spun by the computer without their engagement. So near-miss effects may indicate an example where people believe they have more control over the outcome of a gambling game than they really do. There is considerable evidence to suggest that this happens. For example, people are more likely to place large bets when they roll the dice themselves in a dice game in casinos. And people will pay a lot more money for a lottery if they get the chance to choose the number on the tickets. Now, in either of these cases, the fact that the player themselves roll the dice or the player themselves chose the numbers on the lottery has no actual effect on their probability of winning. Slide 11 When playing roulette, players frequently bet on red or black outcomes from the roulette wheel. And it’s typical in a casino for the wheel to display a recent sequence of red or black outcomes. A well- known phenomenon is that most people believe that after a run of red outcomes, a black outcome seems more predicted or more likely. This is often referred to as the gambler’s fallacy. The gambler’s fallacy, that is, the tendency for people to believe that an outcome that hasn’t occurred for a while is somehow becoming more likely, can be understood if we think about the heuristic of representativeness. Because we know that a sequence of outcomes from a roulette wheel contains some black and some red outcomes, we expect a small sequence of outcomes to contain the same properties to be Transcripts by 3Playmedia Week © King’s College London 2018 4. representative of a larger sequence. Because we expect a small sequence to contain both red and black items, after a run of red items, we think the remaining ones have to be black. This has some real world cost to people who play roulette, insofar as they mistakenly believe that there are opportunities within the game when the odds are in their favour. They believe that if they wait until they see a run of red outcomes, they can bet on a black outcome at some point where the bet has a higher probability of winning. Unfortunately, despite its intuitive appeal, the gambler’s fallacy is entirely misleading. The probability of whether the next spin of the wheel will come up red or black is completely independent of what’s happened up to now. The wheel has no memory. And thus, knowing what happened on the last few spins of the wheel gives us no information and can be of no help to us in predicting which of the outcomes will occur next. Slide 12 As well as studying people’s behaviour, cognitive psychologists have also attempted to look at the biological processes which underpin these cognitive distortions observed in gambling. For example, using simpliﬁed roulette wheels and slot machines, we can identify which parts of the brain responds to particular events in an MRI scanner. Recent results have shown that when people experience a near big win, that is, a near miss to a jackpot in a slot machine, their brain activation looks very similar to the activation that’s seen to a win, suggesting that in some sense, people are responding to near wins as if they were wins. Slide 13 The amount of activation associated with a win, having bet on the black part of the wheel, is inﬂuenced by whether that was inconsistent with the gambler’s fallacy, that is, it followed a run of red outcomes, or it was less consistent, that is, it came from a short run of red or following black outcomes. Slide 14 Understanding the cognitive processes that lead people to engage in and enjoy gambling behaviour and understanding the neural processes that support these types of cognitions are an ongoing and important research area that helps us not only to understand people, but also to help people and to develop new treatments for those who have difficulty in controlling their gambling behaviour. Transcripts by 3Playmedia Week © King’s College London 2018 5. Module: Psychological Foundations of Mental Health Week 4 Beyond basic cognition and emotion Topic 2 Evaluation: interpretation and appraisal - Part 1 of 3 Dr Wijnand van Tilburg Department of Psychology, King’s College London Dr Victoria Pile Department of Psychology, King’s College London Lecture transcript Slide 3 In the previous session I discussed attitudes and Dr. Peters brieﬂy introduced the concept of appraisals-- interpretations of the world around us. The current session will build on these topics-- in particular, in four parts. I and another speaker will discuss in more detail what appraisals are, how they shape our thoughts and beliefs, and what changes how we appraise the world around us. A major focus is on the relationship between appraisals and emotions, which is a large area of psychological research and is particularly relevant to psychological well-being. We will also cover how appraisals inﬂuence people’s ability to cope with stressful situations. For example, in the last session, Dr. Pile will discuss the role of appraisals in mental health in particular. Slide 4 Look at this picture. What do you see? Do you see a rabbit, or do you see a duck? In fact, it is possible to see both. Here’s a hint-- the rabbit’s ears are on the beak of the duck. Can you spot both of them? You may be familiar with this or other examples of pictures that can be perceived in different ways. Besides pictures such as the one here, there are many occasions on which we can interpret the same things in different ways. Slide 5 For example, how would you describe two dogs running? You may think that the one behind is chasing the other or that the one in front is leading the second. Perhaps you interpret this situation as playful behaviour, or instead you may think that the dogs are ﬁghting. Clearly, people can interpret this situation and many others like it in different ways. Psychologists call these appraisals-- deﬁned as a particular set of psychological interpretations of the current situation. Psychologists are interested in appraisals because they are highly relevant to understanding how emotions-- for example, sadness-- change the way people view the world. For example, people who are sad may interpret a new situation in a negative way, potentially making them feel even worse. Transcripts by 3Playmedia Week © King’s College London 2018 1. Slide 6 One of the most famous studies on how emotions relate to our interpretations of the world around us was conducted by Strack and colleagues in 1988. These researchers tested the facial feedback hypothesis, which states that our brain uses information of facial muscle contraction to conclude how we feel. In other words, our bodily expressions directly change the way we feel. For example, standing tall may make you feel more self-conﬁdent. Strack and colleagues investigated this in a now classic study. In their famous pen study, they asked participants to hold a pen in their mouth while reading comics. Participants were told that they had to hold the pen in their mouth as part of an investigation of pen use for people with hand injury. However, the real reason was different. Participants were instructed to either hold the pen with their teeth or with their lips-- as illustrated in these photographs. As you can see, holding a pen between the teeth looks like an expression very similar to a smile. Holding the pen between the lips instead mimics sadness. What these researchers found was that those participants who held the pen between their teeth thought that the comics were funnier than those who held the pen between their lips. It seems that the emotions-- for example, joy-- came after their expressions. These ﬁndings are remarkable. Intuitively, it seems to make more sense that we smile because we feel joy rather than the other way around. But these results seem to indicate the opposite-- we experience joy because we express a smile. In fact, Strack and colleagues were not the ﬁrst ones to look at the perhaps surprising effect of emotions and expressions. Let’s go a little back in time. Slide 7 Almost a century before Strack and colleagues’ pen study, William James and Carl Lange independently developed what we now call the James-Lange theory. This theory goes right against most people’s intuition. James and Lange considered opposites, such as, do we feel ﬁrst sad, and then we cry, or do we cry, and then we know that we’re sad? According to them, it is the second. We know that we are sad because we are crying. Or in William James’ own words, “Common sense says that we lose our fortune, are sorry, and weep-- we meet a bear, are frightened, and run. The hypothesis here to be defended says that this order is incorrect. The more rational statement is that we feel sorry because we cry, angry because we strike, and afraid because we tremble.” Slide 8 Let’s put that theory into a schematic. What is the correct sequence of events according to the James-Lange theory of emotions? First, there is some stimulus to which people respond. As an example, let’s say this is a growling dog. Next, people perceive and interpret this stimulus. This perception and interpretation leads to a direct physiological response, such as a change in autonomic arousal. In the case of the growling dog, this might be a faster heartbeat, faster breathing, and sweating. According to the James-Lange theory, the emotion is experienced after this physiological response. People conclude that they must be afraid because they have a fast heartbeat, breathe fast, and sweat. See? This is very different from the intuitive idea that people have a fast heartbeat, breathe fast, and sweat because they are frightened. Transcripts by 3Playmedia Week © King’s College London 2018 2. Slide 9 It is hardly surprising that the counter-intuitive claims made by the inﬂuential James-Lange theory have received a great deal of criticism besides praise. In particular, the James-Lange theory has some limitations, which is not to say that it is a poor theory. In fact, it is one of the most inﬂuential theories of emotion. Cannon and Bard were amongst the various people who criticised the James-Lange theory. In particular, they argued that it is incorrect based on their own research. The ﬁrst criticism they expressed is that emotions do not necessarily change when the viscera-- the abdominal organs-- are disconnected from the central nervous system. Why is this a problem for the James-Lange theory? Well, remember that the James-Lange theory argues that emotions occur in response to physiological changes. People’s emotional experiences should thus not change when there is no longer a neural connection between the viscera. Likewise, when a physiological change is artiﬁcially induced in the viscera, this does not always lead to a spontaneous emotion. Furthermore, these physiological changes are sometimes quite slow and happen after people already experienced the emotion. Also, the James-Lange theory cannot account for the fact that sometimes the same physiological changes are associated with different emotional experiences. For example, a fast heartbeat, breathing fast, and sweating should-- according to the James-Lange theory-- trigger fear. However, people who are exercising do not spontaneously become scared, even though their physiological responses are very similar. Based on these criticism, should we abandon the James-Lange theory as incorrect, or is it possibly just incomplete? Slide 10 In response to the limitations of the James-Lange theory, Schachter and Singer proposed that the James-Lange theory of emotions was indeed incomplete rather than entirely incorrect. They proposed a new model of emotions that placed emphasis on both physiology as well as cognitive appraisals-- the interpretations of the situation that this session introduced earlier. In particular, Schachter and Singer argued that the emotions that people experienced are determined jointly by people’s perceptions of their physiological state, such as autonomous arousal, and by people’s appraisals of the situations in which these physiological changes occur. Slide 11 To give you an idea of how this process works, consider the following experiment these researchers conducted. They ﬁrst divided participants into two groups. Those in the experimental group received a shot of adrenaline, which leads to increased autonomous arousal and the physiological characteristics of anger. Participants in the other group received instead a salt solution shot, which does not have any effect on autonomic arousal. These people were in a placebo condition. Thus, the groups differed at the level of physiology. Next, Schachter and Singer further split up the adrenaline shot group. Half of this group were told that the injection induced arousal, whereas the other half were not told about this. Thus there were three groups in total. First, there were those who experienced high arousal and knew that this was caused by the injection. Second, there were those who experienced high arousal and did not know that this was caused by the injection. And third, there were those who did not experience high physiological arousal because they were given a salt solution-- a placebo condition. Transcripts by 3Playmedia Week © King’s College London 2018 3. Next, these researchers asked the participants a number of provoking questions, such as, how many men, besides your father, has your mother slept with? What do you think happened? Which of these three groups felt most angry? Schachter and Singer found that participants who received the adrenaline shot and did not know that this caused their high, autonomous arousal reported the most anger. Why? Because they experienced both the physiological signs of anger-- high arousal-- and interpreted the situation as provoking. This was different from the other conditions. Those who were told that the adrenaline injection would increase their autonomous arousal did not feel particularly angry. They instead attributed their arousal to the injection rather than to the questions. Those in the placebo condition may have appraised the questions as provocative, but their arousal levels were relatively low, therefore they did not feel particularly angry. What these ﬁndings suggest is that emotions are indeed jointly determined by physiology and appraisals. Only when people experience physiological arousal and interpret the situation as provocative that they feel angry. Slide 12 In the previous lecture I introduced Schachter and Singer’s theory of emotions. This theory builds on the James-Lange theory of emotions, but emphasises the importance of appraisals. In particular, Schachter and Singer stress that both people’s perceptions of their physiological state, such as autonomic arousal and appraisals of the situation, inﬂuence what emotions people experience. The theory by Schachter and Singer has three ancillary positions. In particular, Schachter and Singer make three intriguing claims. We’ll go through the most important two and explain what they mean. After that, I will give you an example of their counter-intuitive implications based on the classic study. The ﬁrst proposition is that when an individual has no causal explanation for an arousal state, he or she will label arousal in terms of available cognitions. What that means is the following-- if someone experiences high arousal, such as excitement or stress, and he or she does not know where this originates from, then the person will use available appraisals to decide on a cause for their state. For example, if you were secretly given adrenaline, which increases your arousal, and did not know about this, you may look at the situation you are in and blame it on something in that situation-- say, you might attribute your arousal to the learning session, concluding that learning is very stressful. Note that this would be a false attribution, or misattribution. In this setting, the real reason for your arousal is the secretly administered adrenaline. The second proposition is that when someone has an appropriate explanation for their arousal, then they will not use this alternative cognitive labelling strategy. This is essentially the opposite to the ﬁrst proposition. If you know that you have been given adrenaline, which causes your high arousal, then you will not blame your high arousal on something else. These two propositions relate to the process of misattribution-- of falsely blaming particular circumstances as the reason for your emotion. Let me give you an example. Slide 14 In a classic study, Dutton and Aron investigated the misattribution of emotions. For this purpose, they conducted an experiment that is now known as the scary bridge experiment. In this experiment, male participants had to walk across a bridge suspended over a great depth. Transcripts by 3Playmedia Week © King’s College London 2018 4. Although perfectly safe, the participants became quite stressed when doing so. A little after reaching the other side of the bridge, while still high in arousal from the scary bridge, these male participants were asked several questions by an attractive female experimenter. After these questions, the female experimenter offered the men her contact details in case they had further questions about the study. What these researchers found was that these male participants were more likely to contact the female experimenter compared to another group of men who had walked a non-scary bridge instead. What is going on? Why did the men who walked the scary bridge contact the female experimenter? According to Dutton and Aron, the reason for this was the men’s misattribution of their arousal. After walking across the scary bridge, the men’s arousal was high. When talking to the attractive female experimenter, they falsely attributed their arousal to the experimenter. They interpreted it as feeling attracted to her. As a result, they were more likely to contact her than men who had walked the non-scary bridge, and were therefore less aroused. This experiment is a classic demonstration of misattribution of emotions based on appraisals that people make of the situation. Since then several other studies-- often better designed and conducted better-- have conﬁrmed that people tend to misattribute their physiological state based on their appraisals of the situation. Slide 15 Schachter and Singer’s theory of emotion remains one of the most inﬂuential theories of emotions to date. In particular, their suggestion that people’s appraisals of the situation can determine what emotions we think we experience is wildly inﬂuential. However, besides appraisals inﬂuencing emotions, emotions also inﬂuence appraisals. That is to say, our emotions colour the way we interpret our environment. A pioneering investigation of how emotions inﬂuence our appraisals of the world around us was conducted by Smith and Ellsworth in 1985. In this study, they asked people to describe in detail several common emotions, such as shame, pride, anger, and many more. They found important differences between these emotions. An obvious one is that sadness involves a more negative interpretation of events, and happiness more positive ones. Fear and anger, while both negative emotions accompanied by high levels of physiological arousal, differed more subtly. Fear involves appraising events with great uncertainty, whereas anger is the opposite. People who are angry feel very conﬁdent about what is going on in their surroundings. These investigations help us to understand how emotions change the way people interpret and interact with their environment. Slide 16 Here are some examples of the surprising impact of appraisals caused by emotions on people’s behaviour. In 2001, Lerner and Keltner published a study of anger and fear. Recall that these emotions differ in terms of their certainty appraisals. Fear makes people interpret their environment as insecure or risky, whereas anger involves, instead, appraised certainty. These researchers ﬁrst measured people’s fear and anger, and then gave them the choice between a risky and safe option. The researchers found that fearful participants were far less likely to choose the risky option than the angry ones. In particular, because angry participants feel a greater sense of certainty about their environment, they are less averse to risk. Essentially, they are more optimistic about a Transcripts by 3Playmedia Week © King’s College London 2018 5. positive outcome. Experiments like these show how important appraisals are. The emotions in this study were not directly related to the decisions that people had to make, yet they nonetheless inﬂuenced how people interpreted the choices and how they decided. In the next lecture, we will look closer at appraisals and how they relate to stress and coping. Transcripts by 3Playmedia Week © King’s College London 2018 6. Module: Psychological Foundations of Mental Health Week 4 Beyond basic cognition and emotion Topic 2 Evaluation: interpretation and appraisal - Part 2 of 3 Dr Wijnand van Tilburg Department of Psychology, King’s College London Dr Victoria Pile Department of Psychology, King’s College London Lecture transcript Slide 2 Appraisals of our environment inﬂuence how we feel, and how we feel inﬂuences how we appraise the environment. It is not surprising that psychologists are therefore very interested in how these processes work and what can be done to promote well-being and happiness or minimise suffering through the lens of appraisals. One particular focus is how people can effectively deal with stress, which occurs when people appraise events as harmful, threatening, or challenging, and these events are perceived to tax or exceed ones resources. Trying to manage demands that are appraised as taxing or exceeding one’s resources is known as coping. Indeed, appraisals are key to understanding how people cope with stress and how we can increase people’s coping skills. Dr. Pile will discuss appraisals and mental health in more detail in the next lecture. And I will ﬁrst introduce to you some general theories on appraisals in the context of coping. Slide 3 Lazarus cognitive-motivational-relational theory is one of the most inﬂuential frameworks for understanding how people process potentially stressful experiences. According to Lazarus theory, appraisals can be separated into two categories of appraisals. Accordingly, these appraisals are referred to as primary and secondary appraisals. Slide 4 When people are confronted with an event, their primary appraisal is typically characterised by an assessment of whether the event is congruent with their own goals and how relevant the event is for themselves. For example, a student learning that she failed her exam may appraise this event as highly relevant and incongruent with her goal of mastering a subject, leading to negative emotions, such as sadness or disappointment. Passing the exam, on the other hand, would likely elicit positive emotions, such as pride and happiness. Events that are perceived as irrelevant-- for example, because they are not seen as important-- are unlikely to elicit emotions. Transcripts by 3Playmedia Week 4 © King’s College London 2017 1. Slide 5 The secondary appraisals involve an assessment of the options that are available to the person for coping with the event-- especially when it is eliciting negative emotions-- and what resources are available to do so. For example, the person may appraise whether the cause for the emotion is oneself or another person. Going back to the student who failed her exam, she can seek to blame herself for the situation-- for example, for not studying hard enough-- or blame another, or the situation for the event-- for example, that the exam was unfairly difficult. Furthermore, the secondary appraisal process involves an assessment of coping potential-- does the person possess the resources to deal with a negative event and how the problem can be tackled. This is also called self-efficacy-- the perception that one is able to perform a certain action. One factor here is people’s belief in their potential for problem-focused coping. Are they able to change the situation to make it congruent with their goals? In context of the student failing the exam, this may be difficult, for it would require changing the outcome of the test. In that example, the potential for problem-focused coping would therefore likely be appraised as low. Another strategy is emotion-focused coping. In particular, as part of the secondary appraisals, people assess their potential for changing the way they relate to the situation rather than changing the situation itself. In the student example, the girl may convince herself that she does not care about studying after all or she may remind herself that failing one exam does not mean the end of the world. In these cases, she has changed the way she relates herself and her goal to the unpleasant event. If people appraise their coping potential-- be it emotion-focused or problem-focused-- as high, then they are unlikely to feel particularly stressed about the event. If, on the other hand, coping potential is appraised as low, then they are likely to become stressed. Lazarus model is one of various models that describe how stress and appraisals relate, albeit an important one. You can see this model as complimentary rather than contradictory to Schachter and Singer’s more general theory of emotions. Whereas Schachter and Singer’s theory focuses on emotional experiences in general, Lazarus theory focuses on coping in particular. In the next lecture, Dr. Pile will discuss the relationships of these appraisal processes in more detail with a particular focus on mental health. Transcripts by 3Playmedia Week 4 © King’s College London 2017 2. Module: Psychological Foundations of Mental Health Week 4 Beyond basic cognition and emotion Topic 2 Evaluation: interpretation and appraisal - Part 3 of 3 Dr Wijnand van Tilburg Department of Psychology, King’s College London Dr Victoria Pile Department of Psychology, King’s College London Lecture transcript Slide 3 In our lecture today we will explore interpretations and appraisals in more detail. Firstly, we will think about how interpretation biases are studied in the lab in terms of social anxiety. Second, we will look at how they aid our understanding of what contributes to vulnerability and depression in terms of appraisals of life events. Thirdly, we will examine how cognitive models have enabled us to develop person-speciﬁc formulations that guide treatment. We will think about this in terms of faulty appraisals of anomalous experiences in psychosis. Slide 4 The way that we interpret a situation impacts on our behaviour as well as the way we feel. For the same situation, our thoughts can lead to very different behaviours. For example, a man leaves his house to go to work. He locks his door and walks onto the street. He steps in some dog poop. This is awful! Bad things always happen to me. I feel sad. I go home back to bed. I don’t leave the house for the rest of the day. This was on purpose. People are trying to make me look stupid. I feel angry. I shout at the next person with a dog. Oh, no, germs! If I don’t get this off, I will infect and kill my family. I feel anxious. I scrub my shoes in bleach for an hour. I wash my hands for an hour. Oh, well, these things can happen to anyone. I feel ﬁne. I wipe it off on some grass and I carry on with my day. Stable individual differences in the way we evaluate situations are essential to our psychological understanding of what drives and maintains mental health disorders. Slide 5 So to begin by looking at the tools we use to assess interpretation biases in the lab-- we might use a questionnaire to assess interpretation biases. Transcripts by 3Playmedia Week 4 © King’s College London 2017 1. Slide 6 Think about this situation and how you would answer it. Slide 8 How about this one? Slide 9 Miers et al showed that negative interpretations of social situations were more common in young people with high anxiety than controls. High anxious adolescents only showed more negative interpretations for social situations and not for non-social situations. This is important as it demonstrates this interpretation bias is speciﬁc to social contexts. Slide 10 Interpretation biases can also be measured experimentally. One measure is the recognition test. In this task, participants are asked to read 10 stories which are ambiguous. After reading the stories, they are asked to rate how similar false statements are to the stories. These statements have a positive or negative valence with two being interpretations of the story-- the targets-- and two being statements related to the story but that are not interpretations-- the foils. Read through this example. Slide 11 There is good research evidence linking anxiety and negative interpretation biases in both children and adults. This has led researchers and clinicians to ask whether we can use computer training tools to target these biases. An example of this is cognitive bias modiﬁcation. This aims to directly target the processes that give rise to dysfunctional thoughts, and so prevent them from occurring. It does this through the presentation of quick and repeated low-level information processing tasks to reinforce a more adaptive processing style. Studies so far have demonstrated that CBM is effective in altering interpretation style, but the effect on mood states are weaker. CBM offers a promising avenue to make treatments more accessible, but additional research is required to demonstrate whether it can reduce clinical symptoms and improve functioning. Slide 12 Thinking now about depression. Two key risk factors for depression are environmental adversity and negative cognitive appraisals about the self, about the world, and about others. However, there has been debate about whether people with depression appraise situations negatively or whether they actually view themselves and the world in a more realistic way compared to their non-depressed peers. Slide 13 Krackow and Rudolph designed an experiment to investigate this. They wanted to look at the accuracy of depressed youths’ appraisals of life events. They compared young people with a diagnosis of depression, subsyndromal symptoms of depression, and no symptoms of psychopathology on measures of life stress. First, they demonstrated that those with depression had experienced more independent and self- generated interpersonal stress than non-symptomatic youth. Transcripts by 3Playmedia Week 4 © King’s College London 2017 2. Slide 14 Second-- consistent with a cognitive bias-- those with depression overestimated the stressfulness of events and overestimated their contribution to events relative to non-symptomatic youth. So they demonstrated that the group with depression both had experienced more environmental adversity, but also appraised these events differently compared to their peers. This highlights the need to consider both realistic interpersonal difficulties and biassed appraisals of experiences. But what about the future? Could it be that people with depression are more realistic about their future? Slide 16 Research has shown that despite having no evidence, people expect positive events to happen to them in their future. This includes people expecting to both live longer and be healthier than the average person, as well as overestimating their occupational success. This has been called the optimism bias. People also show an optimistically biassed updating pattern. They incorporate desirable information more into their future predictions than undesirable information. Cohn et al has shown that people with depression do not show the same bias. Slide 17 Moving on to cognitive models in the context of psychosis-- these place interpretations and appraisals are central to understanding the distress experienced by the person. A basic model is applicable to a range of disorders. This is that an intrusion into awareness can be interpreted differently by different people and that these interpretations lead to different emotions, like what we thought about earlier in the dog poo example. Slide 18 So misinterpretation of the same situation leads to different concerns and are associated with different disorders. Morrison gives examples of this. So if the person experiences racing thoughts or palpitations, then a person with delusions may interpret this as alien control or persecution via telekinesis, whereas a person with panic disorder might interpret this as a sign of a heart attack. Similarly, a benign lump in one’s skin might be interpreted as a sign of cancer by someone with health anxiety. Whereas someone with psychosis might interpret this as a transmitter or homing device installed by the secret police. An unacceptable blasphemous thought might be interpreted by someone with OCD that something bad will happen unless it is atoned for, whilst it might be seen as evidence of demonic possession by someone with psychosis. For psychosis, a key factor seems to be that the interpretation is culturally unacceptable, as well as being distressing. Slide 19 There is growing acceptance that intrusions such as voices are a normal psychological phenomenon that may be potentially experienced by anyone. For example, it’s been shown that hallucinations are very common in older adults following bereavement. And surveys suggest that 10% to 25% of the general population have had such experiences at least once. What seems important for causing distress is not the experiences themselves, but rather how they are interpreted by the individual. This is the cognitive model Morrison proposes. Slide 20 So let’s think about how this model might guide our understanding. Let’s consider a young mother who was physically abused during her childhood by her father. As a child, she was always very Transcripts by 3Playmedia Week 4 © King’s College London 2017 3. worried about doing the wrong thing, as her father would respond by severely beating her and calling her a devil child. When she tried to ask people for help, she was told not to be so silly and that her daddy loved her very much. She left home at age 16, found a job and a ﬂat, and was doing well. She is now 22 and has recently had a baby girl of her own. This has meant that she had had to stay at home much more and is becoming increasingly isolated and lonely. So in her experiences, we might add that she was abused by her father and the birth of her own child has meant increased isolation. In therapy, you might explore some of her beliefs. Let’s assume for now that she has beliefs, such as adults can’t be trusted with children, I can’t ask for help, I am a bad person, people are dangerous. She experiences some intrusions into awareness, such as hearing some voices that tell her to hit her baby, or experiences her mind racing. She interprets these as the devil telling her to hurt her child and the devil being able to control her thoughts. This makes her feel anxious and guilty and leads to difficulty sleeping. Her attention towards these thoughts is also likely to increase. She may be trying to do things like avoid children, as well as other people. These factors all interact in a vicious cycle to enhance the beliefs that she has about herself and make her distressing interpretations more likely. Slide 21 Creating a model like this helps guide our intervention. The model is usually generated together with the person to help create a shared understanding of their experiences and identify areas to change. It highlights interpretations and beliefs to address with cognitive techniques, as well as behaviours and factors in the environment to modify. Individual formulation is important to help understand the person’s distress and what might be helpful for them. This is a highly collaborative process and it is crucial that the therapist is sensitive to the person’s beliefs and current experiences. Slide 22 So today we have explored interpretations in mental health in three ways-- in terms of how they are assessed, how they inform our understanding of what contributes to vulnerability, and, ﬁnally, how cognitive models help us to generate a person-speciﬁc formulation to guide treatment. Transcripts by 3Playmedia Week 4 © King’s College London 2017 4. Module: Psychological Foundations of Mental Health Week 4 Beyond basic cognition and emotion Topic 3 Delving deeper into social cognition - Part 1 of 4 Dr Wijnand van Tilburg Department of Psychology, King’s College London Dr Caroline Catmur Department of Psychology, King’s College London Professor Francesca Happé Department of Social Genetic & Developmental Psychiatry, King’s College London Lecture transcript Slide 3 So far we covered in week four the topics of attitudes and appraisals. Here and there we looked at how attitudes and appraisals are inﬂuenced by other people or how our social environment shapes how we evaluate our environment, others, and ourselves. In the current lectures, this social aspect of these processes will be examined. In particular, we will discuss a number of important social cognitive processes. Before getting into detail about social cognition, let me ﬁrst give you a little overview on what is to come in these sessions. First, I will introduce brieﬂy the ﬁeld of social cognitive research. We will cover perspective taking and theory of mind. Extending these topics, Dr. Caroline Catmur will give a guest lecture on the neural basis of empathy. Next, we will have a closer look at social inference processes-- in particular, how do people form an opinion of others? Of course we cannot cover these topics fully, so these sessions will serve as a taster of the more important phenomena. Finally, Dr. Francesca Hape will look at social cognitive processes from a different angle. What happens when social cognition goes wrong? In particular, she will discuss social cognitive processes in people with an autistic spectrum disorder and the consequences for social perceptions and inferences. Slide 5 Social cognition is an area of psychology that is located on the intersection of social psychology-- the study of psychological processes in the presence of others-- and cognitive psychology-- the study of mental processes, such as attention, perception, and memory. Social cognition developed around the ‘60s and looks at the processes that people use to make sense of and navigate through their social world. Transcripts by 3Playmedia Week © King’s College London 2018 1. Social cognition developed in response to three psychological assumptions that researchers made. First of all, people are consistency seekers. That is, people wish to hold coherent, meaningful perceptions of the world around them. When confronted with inconsistency, people are motivated to address this issue-- for example, by changing their beliefs or dismissing the inconsistent information. A classic example of consistency research is that by Festinger. Festinger studied cognitive dissonance-- an inconsistency between one’s beliefs and one’s actions-- and found that people who were performing behaviour that is inconsistent with their beliefs simply changed their beliefs to accommodate their inconsistency. Another perspective that social cognition incorporates is that people are naive scientists. What does that mean? It means that social cognition researchers often assume that people actively try to make sense of the world. They try to form accurate perceptions of what is going on around and within them. Mind you, these perceptions need not be correct, and the way in which people try to gain these accurate perceptions may be wrong. As covered in the earlier session, people, for example, use heuristics to make sense of the world around them. Although these are efficient, they do not always lead to accurate judgements. The idea that people use heuristics and other mental shortcuts to achieve a seemingly accurate and consistent perspective of the world is part of the [INAUDIBLE] assumption. People are cognitive misers. That means that they save their cognitive resources, such as effort or time, when possible. Slide 6 As mentioned before, social cognition has two pillars-- cognitive psychology and social psychology. How are these united? Let’s look at the cognitive pillar ﬁrst. An important insight from cognitive psychology was that people often go beyond the available information in their environment when perceiving the world around them. Consider the words on this slide. What do you read? Probably you read the cat. But have a closer look at the letters H in “the” and A in “cat.” Notice that they are the same? So how is it possible that when confronted with the identical letter, on one occasion, we see an H and on the other occasion we see an A? One of the reasons for this is that people use existing knowledge structures when processing stimuli. In other words, “the” and “cat” and this prior existing knowledge is used to make sense of novel information, such as the ambiguous words presented here. In a way, we go beyond the information that is presented to us in our perception, we also use existing knowledge that we possess. In this particular case, we interpret the ambiguous letter in a way that is consistent with our prior knowledge. Cognitive psychologists are interested in the processes that result in these perceptions. Likewise, social cognitive researchers try to ﬁgure out what cognitive processes, such as the use of existing knowledge, change the way we perceive the world around us. Slide 7 So what about the second part of social cognition-- the second pillar of this ﬁeld? Obviously, a characteristic of social cognition as compared to cognition in general is that social cognition is interested in how people make sense of social stimuli. How might that differ from other stimuli? For example, consider the boxes on this slide. Cognitive psychologists may study how we perceive these boxes and how people make judgments of their sizes and other comparative judgements. Now consider this picture. What kind of judgement do we make about the two persons? Similar to the boxes, we could compare them in terms of sizes or some other physical characteristic. But you may also make more subjective judgments. How trustworthy are the speakers? How much Transcripts by 3Playmedia Week © King’s College London 2018 2. do you like them? Who would you vote for in an election? Relative to comparing boxes, it seems there is something special going on about the judgments of these social targets. We judge also their internal characteristics. Social cognitive psychologists hold that such judgments are quite different from how people evaluate non-social targets. In particular, people make social inferences and make subjective attributions about social targets. And these judgments may include a host of information that goes beyond what seems immediately present in the stimuli itself. We rely on history and prior knowledge, stereotypes, our own motives and attitudes, and so on. Slide 8 Social cognition is a very large ﬁeld and deals with a great many topics, some of which are listed here. We will focus on a few particularly relevant ones. Accessibility and salience are key cognitive processes that describe what kind of information we tend to-- whether this is social or non-social information. Theory of mind-- people’s ability to understand what goes on in another person’s mind-- is an essential process to understanding empathic behaviour, such as perspective taking and understanding another person’s emotions. Relatedly, social cognition focuses on person perception-- what attributions do we make when we see another person? Do we hold ourselves to differen

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