SOCIAL PSYCHOLOGY APPLIED: SOCIAL PSYCHOLOGY IN CLINIC

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FINAL REVIEW:Social Psychology and related fields, History, Social cognition >>

Social Psychology (PSY403)

Lesson 44

SOCIAL PSYCHOLOGY APPLIED: SOCIAL PSYCHOLOGY IN CLINIC

Aims:

· To understand the use of social psychology theories and principles in clinical settings

Objectives:

· To discuss clinician's biases in making clinical judgments

· To discuss the relationship of faulty cognitions and mental and physical illness

· To describe social-psychological approaches to reverse the maladaptive patterns of behavior

· To ascertain the relationship between positive resources and well-being

Chapter Summary

This chapter focuses on the social psychological perspective on health and illness. Health psychology is

based on the biopsychosocial model, which suggests that health and illness are each multiply determined by

biological, psychological, and social factors. The relationship between negative cognitions and physical

and mental health is discussed. Basic attitudes that determine health behaviors including attitude toward

illness, optimism vs. pessimism, and explanatory styles are highlighted. The importance of positive

resources and social support is reviewed in the light of current research. The ability of people to recognize

their physical symptoms is discussed as a contributor to illness and recovery. The interaction between

patients and practitioners is considered as a contributor to low adherence to treatment programs, and

interventions that can improve adherence are discussed. Discussing several methods to reverse maladaptive

behaviors, the chapter concludes by indicating that the best treatment strategy is that patients are equipped

with the ability to have a control and mastery over their negative cognitions and maladapted behavior.

Introduction:

Among the many thriving areas of applied social psychology is one that relates social psychology's

concepts to depression, to other problems such as loneliness, anxiety, and physical illness, and now to

happiness and well-being. This bridge-building research between social psychology and clinical

psychology seeks answers to four important questions:

· As lay people or as professional psychologists, how can we improve our judgments and predictions

about others?

· How can the ways in which we think about self and others feed such problems as depression,

loneliness, anxiety, and ill health?

· How might these maladaptive thought patterns be reversed?

· What part do close, supportive relationships play in health and happiness?

Making clinical judgments

Social psychologists are also interested to know whether influences on our social judgment also affect

clinicians' judgments of clients. If so, what biases should clinicians (and their clients) be wary of?

Is Anjum suicidal? Should Ali be admitted to a mental hospital? If released Shaukat will be a homicide

risk? Facing such questions, clinical psychologists struggle to make accurate judgments, recommendations,

and predictions.

Such clinical judgments are also social judgments and thus vulnerable to illusory correlations,

overconfidence bred by hindsight, and self-confirming diagnoses. Professional clinicians are "vulnerable to

insidious errors and biases," concludes James Maddux (1993).

Illusory correlations

The assumption here, as in so many clinical judgments, is that test results reveal something important.

Some projective tests relate people's responses (e.g., drawing big ears, bushy eyebrows, pointed hands,

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figure without feet, etc.) with suspiciousness, hostility, anger, conflicts, insecurity, etc. Some tests are

indeed predictive. Others, such as a projective test, "Draw-a-Person", has correlations far weaker than their

users suppose. Why, then, do clinicians continue to express confidence in uninformative or ambiguous

tests?

Pioneering experiments by Loren Chapman and Jean Chapman (1969, 1971) helped us see why. They

invited both college students and professional clinicians to study some test performances and diagnoses. If

the students or clinicians expected a particular association they generally perceived it, regardless of whether

the data were supportive. For example, clinicians who believed that suspicious people draw peculiar eyes

on the Draw-a-Person test perceived such

Hindsight bias

It has often been criticized that the clinicians are too readily convinced of their own after-the-fact analyses.

If someone we know commits suicide, how do we react? One common reaction is to think that we, or those

close to the person, should have been able to predict and therefore to prevent the suicide: In hindsight, we

can see the suicidal signs and the pleas for help. One experiment gave people a description of a depressed

person who later committed suicide. Compared to those not informed of the suicide, those told the person

committed suicide were more likely to say they "would have expected" it (Goggin & Range, 1985).

Moreover, if they were told of the suicide, their reactions to the victim's family were more negative. After a

tragedy, an I-should-have-known-it-all- along phenomenon can leave family, friends, and therapists feeling

guilty.

David Rosenhan (1973) and his seven associates provided a striking example of potential error in

after-the- fact explanations. To test mental health workers' clinical insights, they each made an appointment

with a different mental hospital admissions office and complained of "hearing voices." Apart from giving

false names and vocations, they reported their life histories and emotional states honestly and exhibited no

further symptoms. Most were diagnosed as schizophrenic and remained hospitalized for two to three

weeks. Hospital clinicians then searched for early incidents in the pseudo-patients' life histories and

hospital behavior that confirmed and "explained" the diagnosis.

Rosenhan later told some staff members (who had heard about his controversial experiment but doubted

such mistakes could occur in their hospital) that during the next three months one or more pseudo-patients

would seek admission to their hospital. After the three months, he asked the staff to guess which of the 193

patients admitted during that time pseudo-patients were really. Of the 193 new patients, 41 were accused by

at least one staff member of being pseudo-patients. Actually, there were none!

Overconfidence

A third problem with clinical judgment is that people may also supply information that fulfills clinicians'

expectations. In a clever series of experiments at the University of Minnesota, Mark Snyder (1984), in

collaboration with William Swann and others, gave interviewers some hypotheses to test concerning

individuals' traits. Snyder and Swann found that people often test for a trait by looking for information that

confirms it. If they are trying to find out if someone is an extravert, they often solicit instances of

extraversion ("What would you do if you wanted to liven things up at a party?"). Testing for introversion,

they are more likely to ask, "What factors make it difficult for you to really open up to people?"

Clinical versus statistical prediction

Given these hindsight- and diagnosis-confirming tendencies, it will come as no surprise that most clinicians

and interviewers express more confidence in their intuitive assessments than in statistical data (such as

using past grades and aptitude scores to predict success in graduate or professional college). Yet when re-

searchers pit statistical prediction against intuitive prediction, the statistics usually win. Statistical

predictions are indeed unreliable, but human intuition-- even expert intuition--is even more unreliable.

Three decades after demonstrating the superiority of statistical over intuitive prediction, Paul Meehl (1986)

found the evidence stronger than ever.

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Social cognition in problem behaviors

Negative cognitions can be related to host of problems as mentioned below:

· Social cognition and depression

· Social cognition and loneliness

· Social cognition and anxiety

· Social cognition and illness

Social cognition and depression

As we all know from experience, depressed people are negative thinkers. They view life through dark-

colored glasses. With seriously depressed people--those who are feeling worthless, lethargic, uninterested

in friends and family, and unable to sleep or eat normally--the negative thinking becomes self-defeating.

Their intensely pessimistic outlook leads them to magnify bad experiences and minimize good ones.

Depressive realism is the tendency of mildly depressed people to make accurate rather than self-

serving judgments, attributions, and predictions.

In over 100 studies involving 15,000 subjects, depressed people have been more likely than

nondepressed people to exhibit a negative explanatory style (Sweeney et al. 1986)

Figure 1: Depressive explanatory style

Is negative thinking a cause or a result of depression?

Depressed moods cause negative thinking

· Currently depressed people recall their parents as having been rejecting and punitive. But formerly

depressed people recall their parents in the same positive terms as do never-depressed people

(Lewinsohn & Rosenbaum, 1987).

· Edward Hirt and his colleagues (1992) demonstrated, in a study of Indiana University basketball

fans, that even a temporary bad mood induced by defeat can darken our thinking. After the fans

were either depressed by watching their team lose or elated by a victory, the researchers asked

them to predict the team's future performance, and their own. After a loss, people offered bleaker

assessments not only of the team's future but also of their own likely performance at throwing

darts, and solving anagrams. When things aren't going our way, it may seem as though they never

will.

Being depressed has cognitive and behavioral effects: A depressed mood also affects behavior. The

person who is withdrawn, glum, and complaining does not elicit joy and warmth in others. Stephen

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Strack and James Coyne (1983) found that depressed people were realistic in thinking that others

didn't appreciate their behavior. Their pessimism and bad moods trigger social rejection. Depressed

behavior can also trigger reciprocal depression in others. College students who have depressed

roommates tend to become a little depressed themselves. In couples, too, depression is often

contagious (Katz & others, 1999).

Negative thinking causes depressed mood

· Negative explanatory style contributes to depressive reactions.

· One study monitored university students every six weeks for two and a half years (Alloy & others,

1999). Only one percent of those who began college with optimistic thinking styles had a first de-

pressive episode, but 17 percent of those with pessimistic thinking styles did.

· "A recipe for severe depression is preexisting pessimism encountering failure," notes Martin

Seligman (1991, p. 78). Patients who end therapy no longer feeling depressed but retaining a

negative explanatory style tend to relapse as bad events occur (Seligman, 1992). If those with a

more optimistic explanatory style relapse, they often recover quickly

· Vicious cycle of depression makes one more vulnerable to depression (see below in Figure 2)

Figure 2: Vicious cycle of depression

Social cognition and loneliness

If depression is the common cold of psychological

Depressed

SELF

disorders, then loneliness is the headache. Loneliness,

FOCUSED

Mood

whether chronic or temporary, is a painful awareness that

AND SELF

BLAMED

our social relationships are less numerous or meaningful

than we desire. Jenny de Jong-Gierveld (1987) observed in

her study of Dutch adults that unmarried and unattached

people are more likely to feel lonely.

But loneliness need not coincide with aloneness. One can

feel lonely in the middle of a party and one can be utterly

alone in a room. Chronically lonely people seem caught in

Cognitive

Negative

a vicious cycle of self-defeating social cognitions and

and

Experiences

Behavioral

social behaviors. When paired with a stranger of the same

Consequence

sex or with a first-year college roommate, lonely students

are more likely to perceive the other person negatively

(Wittenberg & Reis, 1986).

Adolescents experience such feelings more commonly than do adults. When beeped by an electronic pager

at various times during a week and asked to record what they were doing and how they felt, adolescents

more often than adults reported feeling lonely when alone (Larsen & others, 1982). Males and females feel

lonely under somewhat different circumstances--males when isolated from group interaction, females

when deprived of close one-to-one relationships (Berg & McQuinn). As many recently widowed people

know, the loss of a person with whom one has been attached can produce unavoidable feelings of

loneliness (Stroebe & others, 1996).

Social cognition and anxiety

Shyness is a form of social anxiety characterized by self-consciousness and worry about what others think.

Compared to unshy people, shy, self-conscious people (whose numbers include many adolescents) see

incidental events as somehow relevant to themselves. Shown someone they think is interviewing them live

(actually a videotaped interviewer), they perceive the interviewer as less accepting and interested in them

(Pozo & others, 1991).

Shy, anxious people also overpersonalize situations, a tendency that breeds anxious concern and, in

extreme cases, paranoia. They also overestimate the extent to which other people are watching and

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evaluating them. If their hair won't comb right or they have a facial blemish, they assume everyone else

notices and judges them accordingly. Moreover, shy people often are conscious of their self-consciousness.

They wish they could stop worrying about blushing, about what others are thinking, or about what to say

next.

Social cognition and illness

· Reactions to illness

o Noticing symptoms

o Explaining symptoms: Am I sick?

o Do I need treatment?

o Socially constructed disorders (Small & others, 1991).

On April 13, 1989, some 2,000 spectators assembled in an Auditorium in

California, USA, to enjoy music performances by 600 secondary school students.

Shortly after the program began, the nervous students began complaining to one

another of headaches, dizziness, stomachaches, and nausea. Eventually 247

became ill, forcing evacuation of the auditorium. A fire department treatment

operation was set up on the lawn outside. Later investigation revealed nothing--no

diagnosable illnesses and no environmental problems. The symptoms subsided

quickly and were not shared by the audience. The instant epidemic, it seemed, was

socially constructed.

Emotions and illness

· Heart disease has been linked with a competitive, impatient, and--the aspect that matters--

anger-prone personality (Matthews, 1988). Under stress, reactive, anger-prone "Type A"

people secrete more of the stress hormones believed to accelerate the buildup of plaque on the

walls of the heart's arteries.

· Optimism and health:

o Link between optimism & later good health (Peterson et al., 1988): In 1946 Harvard

University students were assessed for optimism, and in 1980 they were reassessed. The

results showed a link between early optimism and later health.

o A link between optimism and immunity to common illnesses, like cold, sore throat,

and flu has been identified (Scheier & Carver, 1991).

Stress and illness

o People who undergo highly stressful experiences become more vulnerable to disease

The death of a spouse, the stress of a space flight landing, even the strain of an exam week

have all been associated with depressed immune defenses (Jemmott & Locke, 1984)

Explanatory style and illness

o As defined earlier, negative and pessimistic explanatory styles are related with poor

outcomes in mental and physical health.

Social-psychological approaches to treatment

Inducing internal change through external behavior

Consistent with this attitudes-follow-behavior principle, several psychotherapy techniques prescribe action.

Behavior therapists try to shape behavior and assume that inner dispositions will tag along after the

behavior changes. Assertiveness training employs the foot-in-the-door procedure. The individual first role-

plays assertiveness in a supportive context, then gradually becomes assertive in everyday life. Rational-

emotive therapy assumes that we generate our own emotions; clients receive "homework" assignments to

talk and act in new ways that will generate new emotions.

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Breaking vicious cycles

If depression, loneliness, and social anxiety maintain themselves through a vicious cycle of negative

experiences, negative thinking, and self-defeating behavior, it should be possible to break the cycle at any

of several points--by changing the environment, by training the person to behave more constructively, by

reversing negative thinking. Several different therapy methods help free people from depression's vicious

cycle.

Engaging in Social skills training

Depression, loneliness, and shyness are not just problems in someone's mind. To be around a depressed

person for any length of time can be irritating and depressing. As lonely and shy people suspect, they may

indeed come across poorly in social situations. In these cases, social skills training may help. By observing

and then practicing new behaviors in safe situations, the person may develop the confidence to behave

more effectively in other situations.

Explanatory style therapy

The vicious cycles that maintain depression, loneliness, and shyness can be broken by social skills training,

by positive experiences that alter self-perceptions, and by changing negative thought patterns. Some people

have social skills, but their experiences with hypercritical friends and family have convinced them they do

not. For such people it may be enough to help them reverse their negative beliefs about themselves and

their futures. Among the cognitive therapies with this aim is an explanatory style therapy proposed by

social psychologists.

One such program taught depressed college students to change their typical attributions. Mary Anne

Layden (1982) first explained the advantages of making attributions more like those of the typical

nondepressed person (by accepting credit for successes and seeing how circumstances can make things go

wrong). After assigning a variety of tasks, she helped the students see how they typically interpreted

success and failure. Then came the treatment phase: Layden instructed each person to keep a diary of daily

successes and failures, noting how they contributed to their own successes and noting external reasons for

their failures. When retested after a month of this attributional retraining and compared with an untreated

control group, their self-esteem had risen and their attributional style had become more positive. And the

more their explanatory style improved, the more their depression lifted. By changing their attributions, they

had changed their emotions.

Maintaining change through internal attributions for success

· Once improvement is achieved, it endures best if people attribute it to factors under their own

control rather than to a treatment program.

More recent focus less on the therapist than on how the interaction affects the client's thinking

(Neimeyer et al., 1991)

The thoughtful central route to persuasion provides the most enduring attitude and behavior

change.

Social support and well-being

There is one other major topic in the social psychology of mental and physical well-being. Supportive close

relationships--feeling liked, affirmed, and encouraged by intimate friends and family--predict both health

and happiness. However, relationships are associated with both stress and happiness.

Our relationships are fraught with stress.

"Hell is others," wrote Jean-Paul Sartre

Still, on balance, close relationships contribute less to illness than to health and happiness.

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Close relationships and health

· Those who have close relationships with friends, kin, or other members of close-knit religious or

community organizations are less likely to die prematurely. And losing such ties heightens the risk

of disease.

A Finnish study of 96,000 widowed people found their risk of death doubled in the week following

their partner's death (Kaprio & others, 1987).

A National Academy of Sciences study reveals that those who are recently widowed become more

vulnerable to disease and death (Dohrenwend & others, 1982).

Among the elderly, those having long-term close relationships with less than three people were

much more likely to die in the next three years (Cerhan & Wallace, 1997).

In more than 80 studies, social support has been linked with better functioning cardiovascular and

immune systems (Uchino & others, 1996).

Close relationships and happiness

· Friendships and happiness

o Being attached to friends with whom we can share intimate thoughts has two effects, "It

redoubleth joys, and cutteth griefs in half" (Francis Bacon).

Marital attachment and happiness

o Compared to those single or widowed, and especially compared to those divorced or

separated, married people report being happier and more satisfied with life (Inglehart,

1990)

The tighter social bonds of collectivist cultures offer protection from loneliness, alienation, divorce,

and stress-related diseases.

Readings:

· David G. Myers, D. G. (2002). Social Psychology (7th ed.). New York: McGraw-Hill.

Taylor, S.E. (2006). Social Psychology (12th ed.). New York: Prentice Hall.

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