Clinical biases in diagnosis

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In the abnormal psychology option, what is the difference between cognitive biases and clinical biases?

Clinical biases are cognitive biases that take place when a psychiatrist or psychologist is trying to make a diagnosis and label the behaviour. They can arise from experience (‘these symptoms nearly always mean this mental health problem’) and result in a misdiagnosis when other explanations for the behaviour are too readily discarded. This is a confirmation bias – symptoms are interpreted to confirm the mental health professional’s original swift diagnosis. It was demonstrated in Rosenhan (1973)  when the admitting medical staff interpreted the very vague symptoms described as schizophrenia, and even more clearly when the normal behaviour exhibited by the pseudo-patients was interpreted by medical staff to confirm the validity of the original diagnosis.

They can also arise from an existing societal and/or personal bias, such as an ethnic or gender bias. Jenkins-Hall and Sacco (1991) found that a sample of USA psychotherapists showed an ethnic bias against black clients in that they evaluated depressed black clients more negatively than depressed white clients. While both groups were diagnosed with depression, the black clients (ethnic minority in this case) were seen as being less socially capable and were evaluated as more seriously depressed, using a standardised scale. A larger study by Bertakis et al (2001) demonstrated that women were much more likely than men to be diagnosed as depressed by their primary care physicians, even with a similar number of visits. This showed a gender bias in diagnosis.

So, there is a clear link between this material and the study of cognitive biases, especially confirmation bias.

References

Bertakis, K.D., Helms, J., Callahan, E.J., Rahman, A., Leigh, P. & Robbins, J.A. (2001).  Patient Gender Differences in the Diagnosis of Depression in Primary Care.  Journal of Women’s Health & Gender-Based Medicine, 10(7), pp. 689-698.

Jenkins-Hall , K. & Sacco , W.P. (1991).   Effect of Client Race and Depression on Evaluations by White Therapists.  Journal of Social and Clinical Psychology, 10(3), pp. 322-333.

Rosenhan, D. L. (1973). On being sane in insane places. Science179(4070), pp. 250-258.

Taking a holistic approach to the course

connections jigsawI have been trying over the past few years to do this, and am sometimes asked what I mean by ‘a holistic approach.’  The easy way is to demonstrate using an example. If you are teaching/studying the abnormal psychology option, for instance, you will probably be doing this after you have spent some time looking at the core approaches to explaining human behaviour (biological cognitive and sociocultural) and also looking at research methods and ethics.

So, now comes the time to apply your learning to the content of this option. Explore the differences between psychiatry (more medically and biologically based) and psychology (more cognitively and socially based). Take major depressive disorder, for example: how might a psychiatrist explain it?  How might they look for evidence to see if their explanation is correct and what sort of evidence would they see as valuable? How valid is their method of looking for evidence? How reliable is it? Does it allow them to develop a theory of etiology of MDD that has good explanatory power? How might they want to treat MDD once they are sure a person is suffering from it? Discuss the benefits and limitations of this treatment. Are there any ethical considerations regarding this treatment? 

Now, how might a cognitive psychologist explain MDD? How would s/he look for evidence and what would they accept as evidence? How valid is this method? How reliable is it? Does it allow them to develop a theory of etiology of MDD that has good explanatory power? How would a cognitive psychologist treat MDD.  Discuss the strengths and limitations of this treatment. Are there ethical considerations regarding this treatment?

What about sociocultural arguments that childhood trauma, domestic violence, poverty and stress can all singly or in combination be responsible for MDD? That removing the conditions that lead to MDD is the best treatment? 

Finally, consider the eclectic approach that is more common nowadays. What is the evidence that a combined approach to both the diagnosis, explanation of* and treatment for MDD may be more successful than a single approach? What is the evidence that doing nothing also works? What about a choice of approaches, or sequential treatment?

If we start the abnormal psychology option with these questions and work together to answer them, then the specific content becomes easier to understand in context of perspectives on abnormal psychology, and within the framework of approaches to research. This can be put into practice in the other options as well. Put it all together!

*e.g. Interaction between genetic vulnerability, environmental trigger and possible faulty cognition.

FREE – Hallowe’en Offer!

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Whoo Hoo! For HALLOWE’EN our Book 1 Kindle e-book is FREE! Get your best-ever bargain from Oct 31st to Nov 1st (Pacific time, so be patient if you’re in another time zone.) Just click on https://www.amazon.co.uk/dp/B07M6GDF1D and buy for nothing! It was always free to read with Kindle Unlimited, and now it will be free for everyone, but ONLY for two days. Hope you love our ‘Paranormal Distribution.’ 👻

Where I do my writing

Front of house from gardenMindfulness is so much easier when you live on Porto Santo island, Madeira’s ‘golden sister.’ Please excuse me for taking a step sideways this week to advertise the fact that our beautiful holiday home is now up for sale. It is semi-detached (we live next door and have NO plans to leave…ever). But we have decided to stop renting out the house and sell it instead. It is fully-equipped and furnished, and would make a great holiday home, or you could be like us and escape to a permanent paradise.  Other pictures may be seen on the Rightmove site at  https://www.rightmove.co.uk/overseas-property/property-84740432.html 

I am travelling for a few days, and also marking IB Diploma Extended Essays, but will be back with more suggestions from Psychology Sorted books very soon.

Is it all our parents’ fault?

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How attachment styles can affect later relationships.

This topic is part of the syllabus for developmental psychology, with a focus on inter-generational transmission of attachment styles, not through genetic inheritance, but through vertical social transmission, as our parents’ styles affect our own attachment styles as babies, which affect our later relationships and our parenting as adults. Psychology Sorted Book 2 will be out soon, and will cover all the options.

The idea of attachment was developed by Bowlby, but it was his student Mary Ainsworth who looked in detail at how infants developed different attachment styles. Ainsworth and Bell,_1970 conducted research into the correlation between parenting (n this case mothering) and children’s attachment styles, as measured through separation anxiety and fear of a stranger.  She identified three different styles:

Insecure-avoidant attachment (Type A) – seen in 10-15% of strange situation studies

Secure attachment (Type B) – seen in 70% of strange situation studies

Insecure-resistant/ambivalent attachment (Type C) – seen in 10-15% of strange situation studies

Type D (insecure- disorganized/disorientated) was added later by Main and Solomon in 1986, to extend the categories.

John Bowlby suggested that children create an internal working model (schema) that helps them pattern their behaviour  in later relationships, and it is through Ainsworth’s work that we can see one way in which this may develop. Hazan & Shaver developed a ‘love quiz’ that they distributed through a local newspaper, to test the hypothesis that childhood attachment patterns affected adult relationships, through the operation of an internal working model. There is a similar quiz here, if you would like to try it! They concluded that there was a strong positive correlation between (remembered) styles of one’s parents, one’s own attachment styles, and patterns of behaviour within adult relationships.

I can see lots of problems with this theory – especially as we grow older.  Can we really blame our behaviour on our parents once we are ourselves parents or even grandparents? There are response bias issues with ‘love quizzes’ as self-report studies. Memory – do we remember accurately how our parents’ treated us?  Attribution theory – aren’t the least happy of us more likely to blame our parents, and the happiest of us likely to claim our happiness is the result of our personality?  (See research by Gottman et al, which is highly relevant to the Human Relationships curriculum).

These are just some of the questions we should be asking in the classroom.

Extended Essays made easier

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It’s that time of year again, when students who have only been studying psychology for a few months are asked to think of an area of research in which they are interested.  And out come the titles, and questions: ‘What makes a psychopath?’  ‘Does the media cause eating disorders?’ ‘Why do more girls than boys get depressed?’ Aaargh!

Teachers sigh and raise their eyebrows, because none of these is a good question for an extended essay, though of course all are potential topics, and students’ interest in them is understandable.

This is where Psychology Sorted can help.  Underneath the overview tables are links to stimulating news articles, journal discussions and TED talks that will extend the students’ thinking beyond the superficial.  The hyperlinks and QR codes are included, and an hour or two of browsing can help direct students’ interests. For example, if students are interested in the area of new biological treatments for mental disorders, see this page.  If they would like to research the effects of digital technology, see here, and if they are interested in strategies of acculturation and immigrants, see this section.

Even if some students are determined to stick to eating disorders, the book can give them a new approach  – to opportunistic eating and obesity, for example.  Preface any of these topics with ‘To what extent?’ and you get much more nuanced, in-depth and interesting questions to research:

  • To what extent can neural feedback techniques treat phobias?
  • To what extent can artificial intelligence enhance working memory?
  • To what extent may marginalisation be responsible for terrorism?
  • To what extent can brain chemical dysfunction explain overeating?

It is not that there are any ‘off-bounds’ topics; just that a new approach is needed, to get your students out of the trees and on the sunlit route to extended essay success!

 

 

Can we learn to love anything or anyone if we just hang around them long enough?

One of the Cognitive Approach studies that we cover in our fabulous book, ‘Psychology Sorted, Book 1’ is by Slovic et al. (2017) and which concerns the Affect Heuristic. The Affect Heuristic is a cognitive bias composed of several dimensions, one of which is:

  • The ‘mere exposure effect’: this may be a factor in the affect heuristic. It involves a favourable (‘good’) judgement being made of stimuli by participants who had been presented with that stimuli several times over compared to less familiar material. In other words, the participants in the study preferred the stimuli they had simply seen/been exposed to more times than the other stimuli.

So, this finding shows we human beings to be fairly simple creatures: we like something on the grounds that it is more familiar than the alternative choice. This obviously saves us a lot of time and effort in trying to compare the relative merits and demerits of two possibly similar items or people. For example, I am interviewing two candidates for a job. One of the candidates already works at my company and I have known her for two years now. She’s a good enough worker, doesn’t cause any trouble and well, let’s face it, she’s a known quantity.

The other candidate is someone that I don’t know. On paper they seem far more interesting than the candidate I already know: they have some good ideas for the role and they may bring a breath of fresh air to the company. But…..what if they aren’t as good as they seem? What if they don’t get on with the team? What if their ideas never actually see the light of day? Can I be bothered training up someone new? Maybe the candidate I already know is actually the best person for the job. Hmm, yes, maybe the familiar person is best – I’m used to their face, they fit in etc, etc.

This choice may, in fact, turn out to be the best choice but it is still an example of the mere exposure effect guiding someone’s behaviour rather than a fair and unbiased assessment of the evidence. Could the mere exposure effect explain seemingly baffling phenomena such as particular politicians becoming less reviled and more accepted the longer they are in office? Could it explain you humming along to a song you detest simply because it is constantly being played on the radio? Be aware of this in your own life – we all do it and it’s not necessarily the best way to make decisions as to what is good and valuable in our lives.

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