Andrew Marshall

An Overview of Emotional Reasoning

Published on 12/23/202412/24/2024 by Andrew Marshall2 Comments

Introduction

Emotional reasoning is a cognitive process by which an individual concludes that their emotional reaction proves something is true, despite contrary empirical evidence. Emotional reasoning creates an ’emotional truth’, which may be in direct conflict with the inverse ‘perceptional truth’. It can create feelings of anxiety, fear, and apprehension in existing stressful situations, and as such, is often associated with or triggered by panic disorder or anxiety disorder. For example, even though a spouse has shown only devotion, a person using emotional reasoning might conclude, “I know my spouse is being unfaithful because I feel jealous.”

This process amplifies the effects of other cognitive distortions. For example, a student may feel insecure about their understanding of test material even though they are capable of answering the questions. If said student acts on their insecurity about failing the test, they might make the assumption that they misunderstand the material and therefore may guess answers randomly, causing their own failure in a self-fulfilling prophecy.

Emotional reasoning is related to other similar concepts, such as: motivated reasoning, a type of reasoning wherein individuals reach conclusions from bias instead of empirical motivations; emotional intelligence, which relates to the ways in which individuals use their emotions to understand situations or the information and reach conclusions; and cognitive distortion or cognitive deficiency, wherein individuals misinterpret situations or make decisions without considering a range of consequences.

Refer to Motivated Reasoning and Motivated Forgetting.

Origin

Emotional reasoning, as a concept, was first introduced by psychiatrist Aaron Beck. It was included as a part of Beck’s broader research topic: cognitive distortions and depression. To counteract cognitive distortions, Beck developed a type of therapy formally known as cognitive therapy, which became associated with cognitive-behavioural therapy.

Emotional reasoning had been attributed to automatic thinking, but Beck believed that it stemmed from negative thoughts that were uncontrollable and happened without effort. This reasoning has been commonly accepted over the years. Most recently, a new explanation states that an “activating agent” or sensory trigger from the environment increases emotional arousal. With this increase in arousal, certain areas of the brain are inhibited. The combination of an increase in emotional arousal and the inhibition of parts of the brain leads to emotional reasoning.

Examples

The following are simple examples of emotional reasoning.

Emotion	Facts	False Conclusion
I feel jealous	My spouse is apparently faithful and loving.	My spouse is unfaithful, because I wouldn’t feel jealous if my spouse were faithful and loving.
I feel lonely	My friends and family seem to like me and normally treat me well.	I am unlovable, because I wouldn’t feel lonely if I were lovable.
I feel guilty	Neither I nor anyone around me is aware of any wrong I’ve done.	I did something wrong, because I wouldn’t feel guilty unless I had done something wrong.
I feel angry at her	I can’t think of anything upsetting she did or any harm she caused me.	She did something wrong, because I wouldn’t feel angry at her unless she had done something wrong.
I feel stupid	My academic and professional success is typical or better.	I am stupid, because I wouldn’t feel stupid or doubt my proven abilities unless I really was stupid.

Treatment

Before seeking professional help, an individual can influence the effect that emotional reasoning has on them based on his or her coping method. Using a proactive, problem-focused coping style is more effective at reducing stress and deterring stressful events. Additionally, having good social support also leads to lower psychological stress. If an individual chooses to seek professional help, a psychologist will often use cognitive-behavioural therapy to teach the patient how to challenge their cognitive distortions, including emotional reasoning. In this approach, the automatic thoughts that control emotional reasoning are identified, studied, and reasoned through by the patient. In doing so, the psychologist hopes to change the automatic thoughts of the patient and reduce the patient’s stress levels. Cognitive behavioural therapy has been generally regarded as the most-effective method of treatment for emotional reasoning.

Most recently, a new therapeutic approach uses the RIGAAR method to reduce emotional stress. RIGAAR is an abbreviation for: rapport building, information gathering, goal setting, accessing resources, agreeing strategies and rehearsing success.

Reducing emotional arousal is also suggested by the human givens approach in order to counter emotional reasoning. High emotional arousal inhibits brain regions necessary for logical complex reasoning. With less emotional arousal, cognitive reasoning is less affected and it is easier for the subject to disassociate reality from emotions.

Factors

Cognitive schemas is one of the factors to cause emotional reasoning. Schema is made of how we look at this world and our real-life experiences. Schema helps us remember the important things or events that happened in our lives. The result of the learning process is the schema, and it is also made by classical and operant conditioning. For example, an individual can develop a schema about terrorists and spiders that are very dangerous. Based on their schema, people can change what they think or how they are biased about the way they perceive things. Information-processing biases of schema impact how a person thinks and remembers, and their understanding of experiences and information. The bias makes a person’s schema automatically access similar content of schema. For example, a person with rat phobia is more likely to visualise or perceive a rat being near them. Schemas also easily connect with schema-central stimuli. For example, when depressed people start to think about negative things, it can be very difficult for them to think of anything positive.

For memory bias, schema can affect an individual’s recollections to cause schema-incongruent memories. For example, if individuals have a schema about how intelligent they are, failure-related recollections have a high chance to be retained in their minds and they become likely to recall positive past events. The schema also make individuals biased through the way that they interpret information. In other words, schema alters their understanding of the information. For example, when people refuse to help low self-esteem children solve a math problem, the children may think they are too stupid to learn how to solve the problem rather than the other people being too busy to help.

Reduction Techniques

Techniques for reducing emotional reasoning include:

Validity testing: Patients defend their thoughts and ideas using objective evidence to support their assumptions. If they cannot, they might be exposed to emotional reasoning.
Cognitive reversal: Patients are told of a difficult situation that they had in the past, and work with a therapist to help them address and correct their problems. This can prepare the patient for similar situations so that they do not revert to emotional reasoning.
Guided discovery: The therapist asks the patients a series of questions designed to help them realise their cognition distortions.
Writing in a journal: Patients form a habit of writing in a journal to record the situations they face, emotions and thoughts they experience, and their responses or behaviours to them. The therapist and patient then analyse how the patient’s maladaptive thought patterns influence their behaviours.
Homework: Once the patient acquires the ability to perform self-recovery and remember the insights gained from therapy sessions, the patient is tasked with reviewing sessions and reading related books to focus their thoughts and behaviours, which are recorded and reviewed for the next therapy session.
Modelling: The therapist could use role-playing to act in different ways in response to imagined situations so that patients could understand and model their behaviour.
Systematic positive reinforcement: The behaviour-oriented therapist would use a reward system (systematic positive reinforcement) to motivate patients to reinforce specific behaviours.

Negative memories and stressful life circumstances have a chance to trigger depression. The main factor for causing depression is unresolved life experiences. People who experience emotional reasoning are more likely to connect to depression. Emotion-focused therapy (EFT) is a form of psychotherapy which can help people find a positive perspective of their emotional process. EFT is a research-based treatment that emphasizes emotional change, which is the goal of this therapy. EFT has two different alternative therapies for treatments: cognitive-behavioural therapy (CBT), which emphasizes changing self-defeating thoughts and behaviours; and interpersonal therapy (IPT), which emphasizes changing people’s skills to have better interaction with others.

EFT operates on the understanding that a person’s development is influenced by emotional memories and experiences. The purpose of the therapy is to change the emotional process by resurfacing painful emotional experiences and bringing them into awareness. This process helps patients to differentiate between what they experience and the influence of past experiences on how they feel. This can result in greater self-awareness of what they want in their life and enable better decision-making through reducing emotional reasoning. Another purpose of EFT is to promote emotional intelligence, which is the ability to understand their emotions and perceive emotional information, controlling their behaviour while responding to problems.

Emotion-focused coping is a way to focus on managing one’s emotions to reduce stress and also to reduce the chance to have emotional reasoning. Cognitive therapy is a form of therapy that helps patients recognise their negative thought patterns about themselves and events to revise these thought patterns and change their behaviour. Cognitive-behavioural therapy helps individuals to perform well at cognitive tasks and to help them rethink their situation in a way that can benefit them. The treatment of cognitive-behavioural therapy is through the process of learning and making the change for maladaptive emotions, thoughts, and behaviours.

Implications

If not treated, debilitating effects can occur, the most common being depression. However, emotional reasoning has the potential to be useful when appraising the outside world and not ourselves. How one feels when assessing an object, person or event, can be an instinctual survival response and a way to adapt to the world.

“The amygdala buried deep in the limbic system serves as an early warning device for novelty, precisely so that attention can be mobilized to alert the mind to potential danger and to prepare for a potential of flight or fight.”

This page is based on the copyrighted Wikipedia article < https://en.wikipedia.org/wiki/Emotional_reasoning >; it is used under the Creative Commons Attribution-ShareAlike 3.0 Unported License (CC-BY-SA). You may redistribute it, verbatim or modified, providing that you comply with the terms of the CC-BY-SA.

An Overview of Motivated Reasoning

Published on 12/12/202412/27/2024 by Andrew Marshall4 Comments

Introduction

Motivated reasoning (motivational reasoning bias) is a cognitive and social response in which individuals, consciously or sub-consciously, allow emotion-loaded motivational biases to affect how new information is perceived. Individuals tend to favour evidence that coincides with their current beliefs and reject new information that contradicts them, despite contrary evidence.

Motivated reasoning overlaps with confirmation bias. Both favour evidence supporting one’s beliefs, at the same time dismissing contradictory evidence. However, confirmation bias is mainly a sub-conscious (innate) cognitive bias. In contrast, motivated reasoning (motivational bias) is a sub-conscious or conscious process by which one’s emotions control the evidence supported or dismissed. For confirmation bias, the evidence or arguments can be logical as well as emotional.

Motivated reasoning can be classified into two categories:

Accuracy-oriented (non-directional), in which the motive is to arrive at an accurate conclusion, irrespective of the individual’s beliefs; and
Goal-oriented (directional), in which the motive is to arrive at a particular conclusion.

Refer to Motivated Forgetting, Emotional Reasoning, and Motivated Tactician.

Definitions

Motivated reasoning is a cognitive and social response, in which individuals, consciously or unconsciously, allow emotion-loaded motivational biases to affect how new information is perceived. Individuals tend to favour arguments that support their current beliefs and reject new information that contradicts these beliefs.

Motivated reasoning, confirmation bias and cognitive dissonance are closely related. Both motivated reasoning and confirmation bias favour evidence supporting one’s beliefs, at the same time dismissing contradictory evidence. Motivated reasoning (motivational bias) is an unconscious or conscious process by which personal emotions control the evidence that is supported or dismissed. However, confirmation bias is mainly an unconscious (innate, implicit) cognitive bias, and the evidence or arguments utilised can be logical as well as emotional. More broadly, it is feasible that motivated reasoning can moderate cognitive biases generally, including confirmation bias.

Individual differences such as political beliefs can moderate the emotional/motivational effect. In addition, social context (groupthink, peer pressure) also partly controls the evidence utilised for motivated reasoning, particularly in dysfunctional societies. Social context moderates emotions, which in turn moderate beliefs.

Motivated reasoning differs from critical thinking, in which beliefs are assessed with a sceptical but open-minded attitude.

Cognitive Dissonance

Individuals are compelled to initiate motivated reasoning to lessen the amount of cognitive dissonance they feel. Cognitive dissonance is the feeling of psychological and physiological stress and unease between two conflicting cognitive and/or emotional elements (such as the desire to smoke, despite knowing it is unhealthy). According to Leon Festinger, there are two paths individuals can engage in to reduce the amount of distress: the first is altering behaviour or cognitive bias; the second, more common path is avoiding or discrediting information or situations that would create dissonance.

Research suggests that reasoning away contradictions is psychologically easier than revising feelings. Emotions tend to colour how “facts” are perceived. Feelings come first, and evidence is used in service of those feelings. Evidence that supports what is already believed is accepted; evidence which contradicts those beliefs is not.

Mechanisms: Cold and Hot Cognition

The notion that motives or goals affect reasoning has a long and controversial history in social psychology. This is because supportive research could be reinterpreted in entirely cognitive non-motivational terms (the hot versus cold cognition controversy). This controversy existed because of a failure to explore mechanisms underlying motivated reasoning.

Early research on how humans evaluated and integrated information supported a cognitive approach consistent with Bayesian probability, in which individuals weighted new information using rational calculations (“cold cognition”). More recent theories endorse these cognitive processes as only partial explanations of motivated reasoning, but have also introduced motivational[1] or affective (emotional) processes (“hot cognition”).

Kunda Theory

Ziva Kunda reviewed research and developed a theoretical model to explain the mechanism by which motivated reasoning results in bias. Motivation to arrive at a desired conclusion provides a level of arousal, which acts as an initial trigger for the operation of cognitive processes. To participate in motivated reasoning, either consciously or subconsciously, an individual first needs to be motivated. Motivation then affects reasoning by influencing the knowledge structures (beliefs, memories, information) that are accessed and the cognitive processes used.

Lodge–Taber Theory

Milton Lodge and Charles Taber introduced an empirically supported model in which affect is intricately tied to cognition, and information processing is biased toward support for positions that the individual already holds. Their model has three components:

On-line processing, in which, when called on to make an evaluation, people instantly draw on stored information which is marked with affect;
A component by which affect is automatically activated along with the cognitive node to which it is tied; and
An “heuristic mechanism” for evaluating new information, which triggers a reflection on “How do I feel?” about this topic. This process results in a bias towards maintaining existing affect, even in the face of other, disconfirming information.

This theory is developed and evaluated in their book The Rationalizing Voter (2013). David Redlawsk (2002) found that the timing of when disconfirming information was introduced played a role in determining bias. When subjects encounter incongruity during an information search, the automatic assimilation and update process is interrupted. This results in one of two outcomes:

Subjects may enhance attitude strength in a desire to support existing affect (resulting in degradation in decision quality and potential bias); or
Subjects may counter-argue existing beliefs in an attempt to integrate the new data.

This second outcome is consistent with research on how processing occurs when one is tasked with accuracy goals.

To summarise, the two models differ in that Kunda identifies a primary role for cognitive strategies such as memory processes, and the use of rules in determining biased information selection, whereas Lodge and Taber identify a primary role for affect in guiding cognitive processes and maintaining bias.

Neuroscientific Evidence

A neuroimaging study by Drew Westen and colleagues does not support the use of cognitive processes in motivated reasoning, lending greater support to affective processing as a key mechanism in supporting bias. This study, designed to test the neural circuitry of individuals engaged in motivated reasoning, found that motivated reasoning “was not associated with neural activity in regions previously linked with cold reasoning tasks [Bayesian reasoning] nor conscious (explicit) emotion regulation”.

This neuroscience data suggests that “motivated reasoning is qualitatively distinct from reasoning when people do not have a strong emotional stake in the conclusions reached.” However, if there is a strong emotion attached during their previous round of motivated reasoning and that emotion is again present when the individual’s conclusion is reached, a strong emotional stake is then attached to the conclusion. Any new information in regards to that conclusion will cause motivated reasoning to reoccur. This can create pathways within the neural network that further ingrain the reasoned beliefs of that individual along similar neural networks to where logical reasoning occurs. This causes the strong emotion to reoccur when confronted with contradictory information, time and time again. This is referred to by Lodge and Taber as affective contagion. But instead of “infecting” other individuals, the emotion “infects” the individual’s reasoning pathways and conclusions.

Case Studies

Smoking

When an individual is trying to quit smoking, they might engage in motivated reasoning to convince themselves to keep smoking. They might focus on information that makes smoking seem less harmful while discrediting any evidence which emphasizes any dangers associated with the behaviour. Individuals in situations like this are driven to initiate motivated reasoning to lessen the amount of cognitive dissonance they feel. This can make it harder for individuals to quit and lead to continued smoking, even though they know it is not good for their health.

Political Bias

Peter Ditto and his students conducted a meta-analysis in 2018 of studies relating to political bias. Their aim was to assess which US political orientation (left/liberal or right/conservative) was more biased and initiated more motivated reasoning. They found that both political orientations are susceptible to bias to the same extent. The analysis was disputed by Jonathan Baron and John Jost, to whom Ditto and colleagues responded. Reviewing the debate, Stuart Vyse concluded that the answer to the question of whether US liberals or conservatives are more biased is: “We don’t know.”

On 22 April 2011, The New York Times published a series of articles attempting to explain the Barack Obama citizenship conspiracy theories. One of these articles by political scientist David Redlawsk explained these “birther” conspiracies as an example of political motivated reasoning. US presidential candidates are required to be born in the US. Despite ample evidence that President Barack Obama was born in the US state of Hawaii, many people continue to believe that he was not born in the US, and therefore that he was an illegitimate president. Similarly, many people believe he is a Muslim (as was his father), despite ample lifetime evidence of his Christian beliefs and practice (as was true of his mother). Subsequent research by others suggested that political partisan identity was more important for motivating “birther” beliefs than for some other conspiracy beliefs such as 9/11 conspiracy theories.

Climate Change

Despite a scientific consensus on climate change, citizens are divided on the topic, particularly along political lines. A significant segment of the American public has fixed beliefs, either because they are not politically engaged, or because they hold strong beliefs that are unlikely to change. Liberals and progressives generally believe, based on extensive evidence, that human activity is the main driver of climate change. By contrast, conservatives are generally much less likely to hold this belief, and a subset believes that there is no human involvement, and that the reported evidence is faulty (or even fraudulent). A prominent explanation is political directional motivated reasoning, in that conservatives are more likely to reject new evidence that contradicts their long established beliefs. In addition, some highly directional climate deniers not only discredit scientific information on human-induced climate change but also to seek contrary evidence that leads to a posterior belief of greater denial.

A study by Robin Bayes and colleagues of the human-induced climate change views of 1,960 members of the Republican Party found that both accuracy and directional motives move in the desired direction, but only in the presence of politically motivated messages congruent with the induced beliefs.

Social Media

Social media is used for many different purposes and ways of spreading opinions. It is the number one place people go to get information and most of that information is complete opinion and bias. The way this applies to motivated reasoning is the way it spreads. “However, motivated reasoning suggests that informational uses of social media are conditioned by various social and cultural ways of thinking”. All ideas and opinions are shared and makes it very easy for motivated reasoning and biases to come through when searching for an answer or just facts on the internet or any news source.

COVID-19

In the context of the COVID-19 pandemic, people who refuse to wear masks or get vaccinated may engage in motivated reasoning to justify their beliefs and actions. They may reject scientific evidence that supports mask-wearing and vaccination and instead seek out information that supports their pre-existing beliefs, such as conspiracy theories or misinformation. This can lead to behaviours that are harmful to both themselves and others.

In a 2020 study, Van Bavel and colleagues explored the concept of motivated reasoning as a contributor to the spread of misinformation and resistance to public health measures during the COVID-19 pandemic. Their results indicated that people often engage in motivated reasoning when processing information about the pandemic, interpreting it to confirm their pre-existing beliefs and values. The authors argue that addressing motivated reasoning is critical to promoting effective public health messaging and reducing the spread of misinformation. They suggested several strategies, such as reframing public health messages to align with individuals’ values and beliefs. In addition, they suggested using trusted sources to convey information by creating social norms that support public health behaviours.

Outcomes and Tackling Strategies

The outcomes of motivated reasoning derive from “a biased set of cognitive processes—that is, strategies for accessing, constructing, and evaluating beliefs. The motivation to be accurate enhances use of those beliefs and strategies that are considered most appropriate, whereas the motivation to arrive at particular conclusions enhances use of those that are considered most likely to yield the desired conclusion.” Careful or “reflective” reasoning has been linked to both overcoming and reinforcing motivated reasoning, suggesting that reflection is not a panacea, but a tool that can be used for rational or irrational purposes depending on other factors. For example, when people are presented with and forced to think analytically about something complex that they lack adequate knowledge of (i.e. being presented with a new study on meteorology whilst having no degree in the subject), there is no directional shift in thinking, and their extant conclusions are more likely to be supported with motivated reasoning. Conversely, if they are presented with a more simplistic test of analytical thinking that confronts their beliefs (i.e. seeing implausible headlines as false), motivated reasoning is less likely to occur and a directional shift in thinking may result.

Hostile Media Effect

Research on motivated reasoning tested accuracy goals (i.e. reaching correct conclusions) and directional goals (i.e. reaching preferred conclusions). Factors such as these affect perceptions; and results confirm that motivated reasoning affects decision-making and estimates. These results have far reaching consequences because, when confronted with a small amount of information contrary to an established belief, an individual is motivated to reason away the new information, contributing to a hostile media effect. If this pattern continues over an extended period of time, the individual becomes more entrenched in their beliefs.

Tipping Point

However, recent studies have shown that motivated reasoning can be overcome. “When the amount of incongruency is relatively small, the heightened negative affect does not necessarily override the motivation to maintain [belief].” However, there is evidence of a theoretical “tipping point” where the amount of incongruent information that is received by the motivated reasoner can turn certainty into anxiety. This anxiety of being incorrect may lead to a change of opinion to the better.

This page is based on the copyrighted Wikipedia article < https://en.wikipedia.org/wiki/Motivated_reasoning >; it is used under the Creative Commons Attribution-ShareAlike 3.0 Unported License (CC-BY-SA). You may redistribute it, verbatim or modified, providing that you comply with the terms of the CC-BY-SA.

An Overview of Inoculation Theory

Published on 12/11/2024 by Andrew Marshall1 Comment

Introduction

Inoculation theory is a social psychological/communication theory that explains how an attitude or belief can be made resistant to persuasion or influence, in analogy to how a body gains resistance to disease. The theory uses medical inoculation as its explanatory analogy but instead of applying it to disease, it is used to discuss attitudes and other positions, like opinions, values, and beliefs. It has applicability to public campaigns targeting misinformation and fake news, but it is not limited to misinformation and fake news.

The theory was developed by social psychologist William J. McGuire in 1961 to explain how attitudes and beliefs change, and more specifically, how to keep existing attitudes and beliefs consistent in the face of attempts to change them. Inoculation theory functions to confer resistance of counter-attitudinal influences from such sources as the media, advertising, interpersonal communication, and peer pressure.

The theory posits that weak counterarguments generate resistance within the receiver, enabling them to maintain their beliefs in the face of a future, stronger challenge. Following exposure to weak counterarguments (e.g. counterarguments that have been paired with refutations), the receiver will then seek out supporting information to further strengthen their threatened position. The held attitude or belief becomes resistant to a stronger “attack,” hence the medical analogy of a vaccine.

Inoculating messages can raise and refute the same counterarguments in the “attack” (refutational same) or different counterarguments on the same or a related issue (refutational different). The effect of the inoculating message can be amplified by making the message of vested and immediate importance to the receiver (based on Jack Brehm’s psychological reactance theory). Post-inoculation talk can further spread inoculation effects to their social network, and the act of talking to others can additionally strengthen resistance to attitude change.

Therapeutic inoculation is a recent extension in which an inoculation message is presented to those without the targeted belief or attitude in place. Applied in this way, an inoculation message can both change an existing position and make that new position more resistant to future attacks.

Brief History

William McGuire set out to conduct research on ways to encourage opposition to persuasion while others created experiments to do the opposite. McGuire was motivated to study inoculation and persuasion as a result of the aftermath of the Korean War. McGuire was concerned for those who were forced into certain situations which was the main inspiration for this theory. Nine US prisoners of war, when given the opportunity, elected to remain with their captors. Many assumed they were brainwashed, so McGuire and other social scientists turned to ways of conferring resistance to persuasion. This was a change in extant persuasion research, which was almost exclusively concerned with how to make messages more persuasive, and not the other way around.

The theory of inoculation was derived from previous research studying one-sided and two-sided messages. One-sided messages are supportive messages to strengthen existing attitudes, but with no mention of counter-positions. One-sided messages are frequently seen in political campaigns when a candidate denigrates his or her opponent through “mudslinging”. This method is effective in reinforcing extant attitudes of derision toward the opposition and support for the “mudslinging” candidate. If the audience supports the opposition, however, the attack message is ineffective. Two-sided messages present both counterarguments and refutations of those counterarguments. To gain compliance and source credibility, a two-sided message must demonstrate the sender’s position, then the opposition’s position, followed by a refutation of the opposition’s argument, then finally the sender’s position again.

McGuire led a series of experiments assessing inoculation’s efficacy and adding nuance to our understanding for how it works). Early studies limited testing of inoculation theory to cultural truisms, or beliefs accepted without consideration (e.g. people should brush their teeth daily). This meant it was primarily used toward the attitudes that were rarely, if ever attacked by opposing forces. The early tests of inoculation theory were used on non-controversial issues, (e.g. brushing your teeth is good for you). Few refute that brushing one’s teeth is a good habit, therefore external opposing arguments against tooth brushing would not change one’s opinion, but it would strengthen support for brushing one’s teeth. Studies of inoculation theory currently target less popular or common attitudes, such as whether one should buy a Mac or a Windows-based PC computer or if one should support gay marriage.

Implementing inoculation theory in studies of contemporary social issues (from mundane to controversial social issues), and the variety and resurgence of such studies, helps bolster the effectiveness and utility of the theory and provides support that it can be used to strengthen and/or predict attitudes. These later developments of the theory extended inoculation to more controversial and contested topics in the contexts of politics, health, marketing, and contexts in which people have different pre-existing attitudes, such as climate change. The theory has also been applied in education to help prevent substance abuse.

About

Inoculation is a theory that explains how attitudes and beliefs can be made more resistant to future challenges. For an inoculation message to be successful, the recipient experiences threat (a recognition that a held attitude or belief is vulnerable to change) and is exposed to and/or engages in refutational processes (pre-emptive refutation, that is, defences against potential counterarguments). The arguments that are presented in an inoculation message must be strong enough to initiate motivation to maintain current attitudes and beliefs, but weak enough that the receiver will be able to refute the counterargument.

Inoculation theory has been studied and tested through decades of scholarship, including experimental laboratory research and field studies. Inoculation theory is used today as part of the suite of tools by those engaged in shaping or manipulating public opinion. These contexts include: politics, health campaigns marketing, education, and science communication, among others.

The inoculation process is analogous to the medical inoculation process from which it draws its name; the analogy served as the inaugural exemplar for how inoculation confers resistance. As McGuire (1961) initially explained, medical inoculation works by exposing the body to a weakened form of a virus – strong enough to trigger a response (that is, the production of antibodies), but not so strong as to overwhelm the body’s resistance. Attitudinal inoculation works the same way: expose the receiver to weakened counterarguments, triggering refutational processes (like counterarguing) which confers resistance to later, stronger “attack” like persuasive messages. This process works like a metaphorical vaccination: the receiver becomes immune to attacking messages that attempt to change their attitudes or beliefs. Inoculation theory suggests that if one sends out messages with weak counterarguments, an individual can build immunity to stronger messages and strengthen their original attitudes toward an issue.

Most inoculation theory research treats inoculation as a pre-emptive, preventive (prophylactic) messaging strategy—used before exposure to strong challenges. More recently, scholars have begun to test inoculation as a therapeutic inoculation treatment, administered to those who have the “wrong” target attitude/belief. In this application, the treatment messages both persuade and inoculate—much like a flu shot that cures those who already have been infected with the flu and protects them against future threats. More research is needed to better understand therapeutic inoculation treatments – especially field research that takes inoculation outside of the laboratory setting.

Another shift in inoculation research moves from a largely cognitive, intrapersonal (internal) process to a process that is both cognitive and affective, intrapersonal and interpersonal. For example, in contrast to explanations of inoculation that focused nearly entirely on cognitive processes (like internal counterarguing, or refuting persuasive attempts silently, in one’s own mind), more recent research has examined how inoculation messages motivate actual talk (conversation, dialogue) about the target issue. Scholars have confirmed that exposure to an inoculation message motivates more post-inoculation talk (PIT) about the issue. For example, Tweets containing native advertising disclosures – a type of inoculation message – were more likely to include negative commentary which is a sign of resistance to influence consistent with PIT.

Pre-Bunking

It is much more difficult to eliminate the influence or persuasion of misinformation once individuals have seen it which is why debunking and fact checking have failed in the past. Due to this, a phenomenon known as pre-bunking as introduced. Pre-bunking (or prebunking) is a form of Inoculation theory that aims to combat various kinds of manipulation and misinformation spread around the web. In recent years, misleading information and the permeation of such have become an increasingly prevalent issue. Standard Inoculation theory aims to combat persuasion. Still pre-bunking seeks to target misinformation by providing a harmless example of it. Exposure builds future resistance to similar misinformation.

In 2021, Nanlan Zhang examined inoculation by looking at harsh, preconceived ideas of mental health. Such ideas included the association of mental health with violence. The study consisted of two different experiments, including 593 participants. In the first, subjects were shown misinformation regarding gun violence, only to have the misinformation explained away. These inoculative techniques were concluded to be slightly effective. In the second experiment of the study, subjects were shown false messages that had either high or low credibility. In the first half of the study, the inoculation affected > 50% of the participants. The second half of the study showed increased effectiveness in inoculation, with subjects showing distrust in high and low credibility messages.

A common form of pre-bunking is in the form of short videos, meant to grab a viewer’s attention with a fake message and then inoculate the viewer by explaining the manipulation. In 2022, Jon Roozenbeek (with funding from Google) developed five pre-bunking video to test the viability of short-form inoculation messages. A total of 29,116 subjects were then shown multiple fabricated posts from various social media outlets. The subjects were then tasked with differentiating between benign posts and ones containing manipulation. The videos were effective in improving the viewer’s ability to identify manipulative tactics. Viewers showed about a 5% average increase in identifying such tactics.

Explanation

Inoculation theory explains how attitudes, beliefs, or opinions (sometimes referred to generically as “a position”) can be made more resistant to future challenges. Receivers are made aware of the potential vulnerability of an existing position (e.g. attitude, belief). This establishes threat and initiates defences to future attacks. The idea is that when a weak argument is presented in the inoculation message, processes of refutation or other means of protection will prepare for use of stronger arguments later. It is critical that the attack is strong enough to keep the receiver defensive, but weak enough to not actually change those pre-existing ideas. This will hopefully make the receiver actively defensive and allow them to create arguments in favour of their pre-existing thoughts. The more active receivers become in their defence the more it will strengthen their own attitudes, beliefs, or opinions.

Key Components

There are at least four basic key components to successful inoculation: threat, refutational pre-emption (pre-emptive refutation), delay, and involvement.

Threat. Threat provides motivation to protect one’s attitudes or beliefs. Threat is a product of the presence of counterarguments in an inoculation message and/or an explicit forewarning of an impending challenge to an existing belief. The message receiver must interpret that a message is threatening and recognise that there is a reason to fight to maintain and strengthen their opinion. If the receiver of an opposing message does not recognize that a threat is present, they will not feel the need to start defending their position and therefore will not change their attitude or strengthen their opinion. Compton and Ivanov (2012) found that participants who had been forewarned of an attack–i.e. threat–but not given the appropriate tools to combat the attack were more resistant than the control group. In this case, the simple act of forewarning of an attack was enough to resist the counter-attitudinal persuasion.
Refutational pre-emption. This component is the cognitive part of the process. It is the ability to activate one’s own argument for future defence and strengthen their existing attitudes through counterarguing. Scholars have also explored whether other resistance processes might be at work, including affect. Refutational preemption provides specific content that receivers can employ to strengthen attitudes against subsequent change. This aids in the inoculation process by giving the message receiver a chance to argue with the opposing message. It shows the message receiver that their attitude is not the only attitude or even the right attitude, creating a threat to their beliefs. This is beneficial because the receiver will get practice in defending their original attitude, therefore strengthening it. This is important in fighting off future threats of opposing messages and helps to ensure that the message will not affect their original stance on the issues. Refutational preemption acts as the weak strain of the virus in the metaphor. By injecting the weakened virus–the opposing opinion–into a receiver, this prompts the receiver to strengthen their position, enabling them to fight off the opposing threat. By the time the body processes the virus–the counterattack–the receiver will have learned how to eliminate the threat. In the case of messaging, if the threatening message is weak or unconvincing, a person can reject the message and stick with their original stance on the matter. By being able to reject threatening messages a person builds strength of their belief and every successful threatening message that they can encounter their original opinions only get stronger. Recent research has studied the presence and function of word-of-mouth communication, or post-inoculation talk, following exposure to inoculation messages.
Delay. There has been much debate on whether there is a certain amount of time necessary between inoculation and further attacks on a person’s attitude that will be most effective in strengthening that person’s attitude. McGuire (1961) suggested that delay was necessary to strengthen a person’s attitude and since then many scholars have found evidence to back that idea up. There are also scholars on the other side who suggest that too much of a delay lessens the strengthening effect of inoculation. Nevertheless, the effect of inoculation can still be significant weeks or even months after initial introduction or the treatment showing that it does produce somewhat long-lasting effects. Despite the limited research in this area, meta-analysis suggests that the effect becomes weakened after too long of a delay, specifically after 13 days.
Involvement. Involvement, which is one of the most important concepts for widespread persuasion, can be defined as how important the attitude object is for the receiver (Pfau, et al. (1997)). Involvement is critical because it determines how effective the inoculation process will be, if at all. If an individual does not have a vested interest in the subject, they will not perceive a threat and, consequently, will not feel the need to defend and strengthen their original opinion, rendering the inoculation process ineffective.

Refutational Same and Different Messages

While there are many studies that have been conducted comparing different treatments of inoculation, there is one specific comparison that is mentioned throughout various studies. This is the comparison between what is known as refutational same and refutational different messages. A refutational same message is an inoculation treatment that refutes specific potential counterarguments that will appear in the subsequent persuasion message, while refutational different treatments are refutations that are not the same as those present in the impending persuasive message. Pfau and his colleagues (1990) developed a study during the 1988 United States presidential election. The Republicans were claiming that the Democratic candidate was known to be lenient when it came to the issue of crime. The researchers developed a refutational same message that stated that while the Democratic candidate was in favour of tough sentences, merely tough sentences could not reduce crime. The refutational different message expanded on the candidate’s platform and his immediate goals if he were to be elected. The study showed comparable results between the two different treatments. Importantly, as McGuire and others had found previously, inoculation was able to confer resistance to arguments that were not specifically mentioned in the inoculation message.

Psychological Reactance

Recent inoculation studies have incorporated Jack Brehm’s psychological reactance theory, a theory of freedom and control. The purpose is to enhance or boost resistance outcomes for the two key components of McGuire’s inoculation theory: threat and refutational pre-emption.

Such a study is the large complex multisite study of Miller et al. (2013). The main focus is to determine how to improve the effectiveness of the inoculation process by evaluating and generating reactance to a threatened freedom by manipulating explicit and implicit language and its intensity. While most inoculation studies focus on avoiding reactance, or at the very least, minimizing the impact of reactance on behaviours, in contrast, Miller, et al. chose to manipulate reactance by designing messages to enhance resistance and counterarguing output. They showed that inoculation coupled with reactance-enhanced messages leads to “stronger resistance effects”. Most importantly, reactance-enhanced inoculations result in lesser attitude change—the ultimate measure of resistance.

The participants in the Miller et al. study were college students, that is emerging adults, who display high reactance to persuasive appeals. This population is in a transitional uncertain stage in life, and are more likely to defend their behavioural freedoms if they feel others are attempting to control their behaviour. Populations in transitional stages rely on source credibility as a major proponent of cognitive processing and message acceptance. If the message is explicit and threatens their perceived freedoms, such populations will most likely derogate (criticise) the source and dismiss the message. Two important needs for reactance to a threatened freedom from an emerging adult population are immediacy and vested interest Miller et al. discuss how emerging adults need to believe their behavioural freedoms, for which they have vestedness, are being threatened, and that the threat exists in real time with almost immediate consequences. Threats that their perceived freedoms will be eliminated or minimised increases motivation to restore that freedom, or possibly engage in the threatened behaviour to reinforce their autonomy and control of their attitudes and actions. In addition, that threat does not necessarily need anger to motivate counter-argumentation, and simply attempting to provoke anger through manipulation is limited as a technique of gauging negative cognitions. Miller et al. also consider refutational pre-emption as motivation for producing initial counterarguments and provocation of dissension when contemplating the attack message.

A unique feature of their study is examining low-controlling versus high-controlling language and its impact on affect and source credibility. They found reactance enhances key resistance outcomes, including: threat, anger at attack message source, negative cognitions, negative affect, anticipated threat to freedom, anticipated attack message source derogation, perceived threat to freedom, perceived attack message source derogation, and counterarguing.

Previously, Miller, et al. (2007) utilises Brehm’s psychological reactance theory[27] to avoid or eliminate source derogation and message rejection. In this study, their focus is instead Brehm’s concept of restoration. Some of their ideas deal with low reactance and whether it can lead to more positive outcomes and if behavioural freedoms can be restored once threatened. As discussed in Miller, et al. (2013), this study ponders whether individuals know they have the behavioural freedom that is being threatened and whether they feel they are worthy of that freedom. This idea also ties into the emerging adult population of the above study and its affirmation that individuals in transitional stages will assert their threatened behaviour freedoms.

Miller et al. (2007) sought to determine how effective explicit and implicit language is at mitigating reactance. Particularly, restoration of freedom is a focus of this study, and gauging how concrete and abstract language informs an individual’s belief that he or she has a choice. Some participants were given a persuasive appeal related to health promotion with a following post-scripted message designed to remind them they have a choice as a method of restoring the participants’ freedom. Using concrete language proved more effective at increasing the possibilities of message acceptance and source credibility. This study is relevant to inoculation research in that it lends credence to Miller, et al. (2013), which transparently incorporates psychological reactance theory in conjunction with inoculation theory to improve the quality of persuasive appeals in the future.

Postinoculation Talk

Following Compton and Pfau’s (2009) research on postinoculation talk, Ivanov, et al. (2012) explore how cognitive processing could lead to talk with others after receiving an inoculation message in which threat exists. The authors found that message processing leads to postinoculation talk which could potentially lead to stronger resistance to attack messages. Further, postinoculation talk acts virally, spreading inoculation through talk with others on issues that involve negative cognitions and affect. In previous research, the assumption that talk was subvocal (existing only intrapersonally) was prevalent, without concern for the impact of vocal talk with other individuals. The authors deem vocal talk important to the incubation process. Their study concluded that individuals who receive an inoculation message that contains threat will talk to others about the message and talk more frequently than individuals who do not receive an inoculation message. Additionally, the act of postinoculation talk bolsters their attitudes and increases resistance to the message as well as increasing the likelihood that talk will generate a potentially viral effect–spreading inoculation to others through the act of vocal talk.

Straw man Fallacy

Due to the nature of attitudinal inoculation as a form of psychological manipulation, the counterarguments used in the process do not necessarily need to be accurately representative of the opposing belief in order to trigger the inoculation effect. This is a form of straw man fallacy, and can be effectively used to reinforce beliefs with less legitimate support.

Real-World Applications

Most research has involved inoculation as applied to interpersonal communication (persuasion), marketing, health and political messaging. More recently, inoculation strategies are starting to show potential as a counter to science denialism and cyber security breaches.

Science Denialism

Science denialism has rapidly increased in recent years. A major factor is the rapid spread of misinformation and fake news via social media (such as Facebook), as well as prominent placing of such misinformation in Google searches. Climate change denialism is a particular problem in that its global nature and lengthy timeframe is uniquely difficult for the individual mind to grasp, as the human brain has evolved to deal with short-term and immediate dangers. However, John Cook and colleagues have shown that inoculation theory shows promise in countering denialism. This involves a two-step process. Firstly, list and deconstruct the 50 or so most common myths about climate change, by identifying the reasoning errors and logical fallacies of each one. Secondly, use the concept of parallel argumentation to explain the flaw in the argument by transplanting the same logic into a parallel situation, often an extreme or absurd one. Adding appropriate humour can be particularly effective.

Cyber Security

Treglia and Delia (2017) apply inoculation theory to cyber security (internet security, cybercrime). People are susceptible to electronic or physical tricks, scams, or misrepresentations that may lead to deviating from security procedures and practices, opening the operator, organisation, or system to exploits, malware, theft of data, or disruption of systems and services. Inoculation in this area improves peoples resistance to such attacks. Psychological manipulation of people into performing actions or divulging confidential information via the internet and social media is one part of the broader construct of social engineering.

Political Campaigning

Compton and Ivanov (2013) offer a comprehensive review of political inoculation scholarship and outline new directions for future work.

In 1990, Pfau and his colleagues examined inoculation through the use of direct mail during the 1988 United States presidential campaign. The researchers were specifically interested in comparing inoculation and post hoc refutation. Post hoc refutation is another form of building resistance to arguments; however, instead of building resistance prior to future arguments, like inoculation, it attempts to restore original beliefs and attitudes after the counterarguments have been made. Results of the research reinforced prior conclusions that refutational same and different treatments both increase resistance to attacks. More importantly, results also indicated inoculation was superior to post hoc refutation when attempting to protect original beliefs and attitudes.

Other examples are studies showing it is possible to inoculate political supporters of a candidate in a campaign against the influence of an opponent’s attack adverts; and inoculate citizens of fledgling democracies against the spiral of silence (fear of isolation) which can thwart the expression of minority views.

Health

Much of the research conducted in health is attempting to create campaigns that will encourage people to stop unhealthy behaviours (e.g. getting people to stop smoking or prevention of teen alcoholism). Compton, Jackson and Dimmock (2016) reviewed studies where inoculation theory was applied to health-related messaging. There are many inoculation studies with the intent to inoculate children and teenagers to prevent them from smoking, doing drugs or drinking alcohol. Much of the research shows that targeting at a young age can help them resist peer pressure in high school or college. An important example of inoculation theory usage is protecting young adolescents against influences of peer pressure, which can lead to smoking, underage drinking, and other harmful behaviours.

Godbold and Pfau (2000) used sixth graders from two different schools and applied inoculation theory as a defence against peer pressure to drinking alcohol. They hypothesized that a normative message (a message tailored around the current social norms) would be more effective than an informative message. An informative message is a message tailored around giving individuals information pieces. In this case, the information was why drinking alcohol is bad. The second hypothesis was that subjects who receive a threat two weeks later will be more resistant than those receiving an immediate attack. The results supported the first hypothesis partially. The normative message created higher resistance from the attack, but was not necessarily more effective. The second hypothesis was also not supported; therefore, the time lapse did not create further resistance for teenagers against drinking. One major outcome from this study was the resistance created by utilizing a normative message.

In another study conducted by Duryea (1983), the results were far more supportive of the theory. The study also attempted to find the message to use for educational training to help prevent teen drinking and driving. The teen subjects were given resources to combat attempts to persuade them to drink and drive or to get into a vehicle with a drunk driver. The subjects were:

Shown a film;
Participated in question and answer;
Role playing exercises; and
A slide show.

The results showed that a combination of the four methods of training was effective in combating persuasion to drink and drive or get into a vehicle with a drunk driver. The trained group was far more prepared to combat the persuasive arguments.

Additionally, Parker, Ivanov, and Compton (2012) found that inoculation messages can be an effective deterrent against pressures to engage in unprotected sex and binge drinking—even when only one of these issues is mentioned in the health message.

Compton, Jackson and Dimmock (2016) discuss important future research, such as preparing new mothers for overcoming their health concerns (e.g. about breastfeeding, sleep deprivation and post-partum depression).

Inoculation theory applied to prevention of smoking has been heavily studied. These studies have mainly focused on preventing youth smokers–inoculation seems to be most effective in young children. For example, Pfau, et al. (1992) examined the role of inoculation when attempting to prevent adolescents from smoking. One of the main goals of the study was to examine longevity and persistence of inoculation. Elementary school students watched a video warning them of future pressures to smoke. In the first year, resistance was highest among those with low self-esteem. At the end of the second year, students in the group showed more attitudinal resistance to smoking than they did previously (Pfau & Van Bockern 1994). Importantly, the study and its follow-up demonstrate the long-lasting effects of inoculation treatments.

Grover (2011) researched the effectiveness of the “truth” anti-smoking campaign on smokers and non-smokers. The truth adverts aimed to show young people that smoking was unhealthy, and to expose the manipulative tactics of tobacco companies. Grover showed that inoculation works differently for smokers and non-smokers (i.e. potential smokers). For both groups, the truth adverts increased anti-smoking and anti-tobacco-industry attitudes, but the effect was greater for smokers. The strength of this attitude change is partly mediated (controlled) by aversion to branded tobacco industry products. However, counter-intuitively, exposure to pro-smoking adverts increased aversion to branded tobacco industry products (at least in this sample). In general, Grover demonstrated that the initial attitude plays a major role in the ability to inoculate an individual.

Future health-related studies can be extremely beneficial to communities. Some research areas include present-day issues (for example, inoculation-based strategies for addiction intervention to assist sober individuals from relapsing), as well as promoting healthy eating habits, exercising, breastfeeding and creating positive attitude towards mammograms. An area that has been underdeveloped is mental health awareness. Because of the large number of young adults and teens dying of suicide due to bullying, inoculation messages could be effective.

Dimmock et al. (2016) studied how inoculation messages can be used to increase participants’ reported enjoyment and interest in physical exercise. In this study, participants are exposed to inoculating messages and then given an intentionally boring exercise routine. These messages cause the reinforcement of the individual’s positive attitude towards the exercise, and as a result increase their likelihood to continue exercise in the future.

Vaccination Beliefs

Inoculation Theory has been used to combat misinformation regarding vaccine related beliefs. Vaccinations have helped stop the spread of many infections and diseases, but their effectiveness has become a controversial topic in the Western nations. Studies show that misinformation regarding the science has played a major role in the hesitancy for vaccinations. Some of the common misconceptions include the Influenza vaccine giving the flu and a link between the MMR vaccine and autism. Regardless of the many scientific studies debunking these claims, there are people that still cling to these beliefs.

In 2016, a study was conducted to see Inoculation theory combat vaccine misinformation. The participants of this study were a group of 110 young women who had not completed any doses of the human Papillomavirus vaccine (HPV). The study wanted to see the effect of attack messages that questioned the importance and safety of this specific vaccine, and other vaccines. After making arguments against the vaccines and a brief lapse in time, a control group was exposed to inoculation messages, that were in favour of the vaccine. Once the arguments were made, the participants were asked to take part in post-test measurements. The results found that those who received the inoculated messages had more positive behaviours towards the HPV vaccine, and other vaccines.

In 2017, a study was conducted to test Inoculation theory’s role in making vaccine related decisions. A group of 89 British parents were selected, and exposed to one of five potential arguments for a fictitious vaccine. Some groups were exposed to arguments that were completely based in conspiracy, Anti-conspiracy, While the other groups were exposed to both arguments in differing order. After being exposed to these arguments, they were told about a disease that would cause vomiting and a severe fever. The parents were asked if they would get their children the vaccine for this fictitious disease, and the results they gathered displayed Inoculation theory in action. The results showed that those who were exposed to anti-conspiracy arguments were more likely to get the vaccine.

Marketing

It took some time for inoculation theory to be applied to marketing, because of many possible limitations. Lessne and Didow (1987) reviewed publications about inoculation application to marketing campaigns and their limitations. They note that, at the time, the closest to true marketing context was Hunt’s 1973 study on the Chevron campaign. The Federal Trade Commission stated that Chevron had deceived consumers on the effectiveness of their gas additive F-310. The FTC was going to conduct a corrective advertising campaign to disclose the information. In response, Chevron ran a print campaign to combat the anticipated FTC campaign. The double page advertisement read, “If every motorist used Chevron with F-310 for 2000 miles, air pollutants would be reduced by thousands of tons in a single day. The FTC doesn’t think that’s significant.” Hunt used this real-life message as an inoculation treatment in his research. He used the corrective campaign by the FTC as the attack on the positive attitude toward Chevron. The results indicated that a supportive treatment offered less resistance than a refutational treatment. Another finding was that when an inoculative treatment is received, but no attack is followed, there is a drop in attitude. One of the major limitations in this study was that Hunt did not allow a time elapse between the treatment and the attack, which was a major element of McGuire’s original theory.

Inoculation theory can be used with an audience who already has an opinion on a brand, to convince existing customers to continue patronage of a company, or to protect commercial brands against the influence of comparative adverts from a competitor. An example is Apple Computers’ “Get A Mac” campaign. This campaign follows inoculation theory in targeting those who already preferred Mac computers. The series of ads put out in the duration of the campaign had a similar theme; they directly compared Macs and PCs. Inoculation theory applies here as these commercials are likely aimed at Apple users. These ads are effective because Apple users already prefer Mac computers, and they are unlikely to change their minds. This comparison creates refutational pre-emption, showing Macs may not be the only viable options on the market. The TV ads throw in a few of the positive advantages that PCs have over Macs, but by the end of every commercial they reiterate the fact that Macs are ultimately the superior consumer product. This reassures viewers that their opinion is still right and that Macs are in fact better than PCs. The inoculation theory in these ads keep Mac users coming back for Apple products, and may even have them coming back sooner for the new bigger and better products that Apple releases – especially important as technology is continually changing, and something new is always being pushed onto the shelves.

Inoculation theory research in advertising and marketing has mainly focused on promoting healthy lifestyles with the help of a product or for a specific company’s goal. However, shortly after McGuire published his inoculation theory, Szybillo and Heslin (1973) applied the concepts that McGuire used in the health industry to advertising and marketing campaigns. They sought to provide answers for advertisers marketing a controversial product or topic: if an advertiser knew the product or campaign would cause an attack, what would be the best advertising strategy? Would they want to refute the arguments or reaffirm their claims? They chose a then-controversial topic: “Inflatable air bags should be installed as passive safety devices in all new cars.” They tested four advertising strategies:

Defence;
Refutational-same;
Refutational-different; and
Supportive.

The results confirmed that a reaffirmation or refutation approach is better than not addressing the attack. They also confirmed that refuting the counterargument is more effective than a supportive defence (though the refutational-different effect was not much greater than for supportive defence). Szybillo and Heslin also manipulated the time of the counterargument attack, and the credibility of the source, but neither was significant.

In 2006, a jury awarded Martin Dunson and Lisa Jones, the parents of one-year-old Marquis Matthew Dunson, $5 million for the death of their son. Dunson and Jones sued Johnson & Johnson, the makers of Infant’s Tylenol claiming that there were not enough warnings regarding the dosage of acetaminophen What resulted was a Johnson & Johnson campaign that encouraged parents to practice proper dosage procedures. In a review of the campaign by Veil and Kent (2008), they breakdown the message of the campaign utilizing the basic concepts of inoculation theory. They theorise that Johnson & Johnson used inoculation to alter the negative perception of their product. The campaign began running prior to the actual verdict, thus the timing seemed suspicious. A primary contention of Veil and Kent was that the intentions of Johnson & Johnson were not to convey consumer safety guidelines, but to change how consumers might respond to further lawsuits on overdose. The inoculation strategy used by Johnson & Johnson is evident in their campaign script: “Some people think if you have a really bad headache, you should take extra medicine.” The term “some people” is referring to the party suing the company. The commercial also used the Vice President of Sales for Tylenol to deliver a message, who may be considered a credible source.

In 1995, Burgoon and colleagues published empirical findings on issue/advocacy advertising campaigns. Most, if not all, of these types of advertising campaigns utilize inoculation to create the messages. They posited that inoculation strategies should be used for these campaigns to enhance the credibility of the corporation, and to aid in maintain existing consumer attitudes (but not to change consumer attitudes). Based on the analysis of previous research they concluded issue/advocacy advertising is most effective for reinforcing support and avoid potential slippage in the attitudes of supporters. They used Mobil Oil’s issue/advocacy campaign message. They found that issue/advocacy adverts did work to inoculate against counter-attitudinal attacks. They also found that issue/advocacy adverts work to protect the source credibility. The results also indicated that political views play a role in the effectiveness of the campaigns. Thus, conservatives are easier to inoculate than moderates or liberals. They also concluded that females are more likely to be inoculated with these types of campaigns. An additional observation was that the type of content used in these campaigns contributed to the campaigns success. The further the advertisement was from “direct self-benefit” the greater the inoculation effect was on the audience.

Compton and Pfau (2004) extended inoculation theory into the realm of credit card marketing targeting college students. They wondered if inoculation could help protect college students against dangerous levels of credit card debt and/or help convince them to increase their efforts to pay down any existing debt. Inoculation seemed to reinforce students’ wanted attitudes to debt, as well as some of their behavioural intentions. Further, they found some evidence that those who received the inoculation treatment were more likely to talk to their friends and family about issues of credit card debt.

Deception

Inoculation theory plays a role in deception detection research. Deception detection research has largely yielded little predictable support for nonverbal cues, and rather indicates that most liars are revealed through verbal content inconsistencies. These inconsistencies can be revealed through a form of inoculation theory that exposes the subject to a distorted version of the suspected action to observe inconsistencies in their responses.

Journalism

Breen and Matusitz (2009) suggest a method through which inoculation theory can be used to prevent pack journalism, a practice in which a large quantity of journalists and news outlets swarm a person, place, thing, or idea in a way that is distressing and harmful. It also lends itself to plagiarism. Through this framework derived from Pfau and Dillard (2000), journalists are inoculated against news practices of other journalists and instead directed towards uniqueness and originality, thus avoiding pack journalism.

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An Overview of the Einstellung Effect

Published on 12/10/2024 by Andrew Marshall1 Comment

Introduction

Einstellung is the development of a mechanised state of mind. Often called a problem solving set, Einstellung refers to a person’s predisposition to solve a given problem in a specific manner even though better or more appropriate methods of solving the problem exist.

The Einstellung effect is the negative effect of previous experience when solving new problems. The Einstellung effect has been tested experimentally in many different contexts.

The example which led to the coining of the term by Abraham S. Luchins and Edith Hirsch Luchins is the Luchins water jar experiment, in which subjects were asked to solve a series of water jar problems. After solving many problems which had the same solution, subjects applied the same solution to later problems even though a simpler solution existed (Luchins, 1942). Other experiments on the Einstellung effect can be found in The Effect of Einstellung on Compositional Processes and Rigidity of Behaviour, A Variational Approach to the Effect of Einstellung.

Background

Einstellung literally means “setting” or “installation” as well as a person’s “attitude” in German. Related to Einstellung is what is referred to as an Aufgabe (“task” in German). The Aufgabe is the situation which could potentially invoke the Einstellung effect. It is a task which creates a tendency to execute a previously applicable behavior. In the Luchins and Luchins experiment a water jar problem served as the Aufgabe, or task.

The Einstellung effect occurs when a person is presented with a problem or situation that is similar to problems they have worked through in the past. If the solution (or appropriate behaviour) to the problem/situation has been the same in each past experience, the person will likely provide that same response, without giving the problem too much thought, even though a more appropriate response might be available. Essentially, the Einstellung effect is one of the human brain’s ways of finding an appropriate solution/behaviour as efficiently as possible. The detail is that though finding the solution is efficient, the solution itself is not or might not be. (This is consistent with the famous remark of Blaise Pascal: “I would have written a shorter letter, but I didn’t have the time.”)

Another phenomenon similar to Einstellung is functional fixedness (Duncker 1945). Functional fixedness is an impaired ability to discover a new use for an object, owing to the subject’s previous use of the object in a functionally dissimilar context. It can also be deemed a cognitive bias that limits a person to using an object only in the way it is traditionally used. Duncker also pointed out that the phenomenon occurs not only with physical objects, but also with mental objects or concepts (a point which lends itself nicely to the phenomenon of Einstellung effect).

Luchins and Luchins Water Jar Experiment

The water jar test, first described in Abraham S. Luchins’ 1942 classic experiment, is a commonly cited example of an Einstellung situation. The experiment’s participants were given the following problem: there are 3 water jars, each with the capacity to hold a different, fixed amount of water; the subject must figure out how to measure a certain amount of water using these jars. It was found that subjects used methods that they had used previously to find the solution even though there were quicker and more efficient methods available. The experiment shines light on how mental sets can hinder the solving of novel problems.

In the Luchins’ experiment, subjects were divided into two groups. The experimental group was given five practice problems, followed by four critical test problems. The control group did not have the five practice problems. All of the practice problems and some of the critical problems had only one solution, which was “B minus A minus 2⋅C.” For example, one is given jar A capable of holding 21 units of water, B capable of holding 127, and C capable of holding 3. If an amount of 100 units must be measured out, the solution is to fill up jar B and pour out enough water to fill A once and C twice.

One of the critical problems was called the extinction problem. The extinction problem was a problem that could not be solved using the previous solution B − A − 2C. In order to answer the extinction problem correctly, one had to solve the problem directly and generate a novel solution. An incorrect solution to the extinction problem indicated the presence of the Einstellung effect. The problems after the extinction problem again had two possible solutions. These post-extinction problems helped determine the recovery of the subjects from the Einstellung effect.

The critical problems could be solved using this solution (B − A − 2C) or a shorter solution (A − C or A + C). For example, subjects were instructed to get 18 units of water from jars with capacities 15, 39, and 3. Despite the presence of a simpler solution (A + C), subjects in the experimental group tended to give the lengthier solution in lieu of the shorter one. Instead of simply filling up Jars A and C, most subjects from the experimental group preferred the previous method of B − A − 2C, whereas virtually all of the control group used the simpler solution. When Luchins and Luchins gave experimental group subjects the warning, “Don’t be blind”, over half of them used the simplest solution to the remaining problems.

Explanations and Interpretations

The Einstellung effect can be supported by theories of inductive reasoning. In a nutshell, inductive reasoning is the act of inferring a rule based on a finite number of instances. Most experiments on human inductive reasoning involve showing subjects a card with an object (or multiple objects, or letters, etc.) on it. The objects can vary in number, shape, size, colour, etc., and the subject’s job is to answer (initially by guessing) “yes” or “no” whether (or not) the card is a positive instance of the rule (which must be inferred by the subject). Over time, the subjects do tend to learn the rule, but the question is how? Kendler and Kendler (1962) proposed that older children and adults tend to exhibit noncontinuity theory; that is, the subjects tend to pick a reasonable rule and assume it to be true until it proves false.

Regarding the Einstellung effect, one can view noncontinuity theory as a way of explaining the tendency to maintain a specific behaviour until it fails to work. In the water-jar problem, subjects generated a specific rule because it seemed to work in all situations; when they were given problems for which the same solution worked, but a better solution was possible, they still gave their ‘tried and true’ response. Where theories of inductive reasoning tend to diverge from the idea of the Einstellung effect is when analysing the fact that, even after an instance where the Einstellung rule failed to work, many subjects reverted to the old solution when later presented with a problem for which it did work (again, this problem also had a better solution). One way to explain this observation is that in actuality subjects know (consciously) that the same solution might not always work, yet since they were presented with so many instances where it did work, they still tend to test that solution before any other (and so if it works, it will be the first solution found).

Neurologically, the idea of synaptic plasticity, which is an important neurochemical explanation of memory, can help to understand the Einstellung effect. Specifically, Hebbian theory (which in many regards is the neuroscience equivalent of original associationist theories) is one explanation of synaptic plasticity (Hebb, 1949). It states that when two associated neurons frequently fire together – while infrequently firing apart from one another – the strength of their association tends to become stronger (making future stimulation of one neuron even more likely to stimulate the other).

Since the frontal lobe is most often attributed with the roles of planning and problem solving, if there is a neurological pathway which is fundamental to the understanding of the Einstellung effect, the majority of it most likely falls within the frontal lobe. Essentially, a Hebbian explanation of Einstellung could be as follows: stimuli are presented in such a way that the subject recognises themself as being in a situation which they have been in before. That is, the subject sees, hears, smells, etc., an environment which is akin to an environment which they have been in before. The subject then must process the stimuli which are presented in such a way that they exhibit a behaviour which is appropriate for the situation (be it run, throw, eat, etc.).

Because neural growth is, at least in part, due to the associations between two events/ideas, it follows that the more a given stimulus is followed by a specific response, the more likely in the future that stimulus will invoke the same response. Regarding the Luchins’ experiment, the stimulus presented was a water-jar problem (or to be more technical, the stimulus was a piece of paper which had words and numbers on it which, when interpreted correctly, portray a water-jar problem) and the invoked response was B − A − 2C. While it is a bit of a stretch to assume that there is a direct connection between a water-jar problem and B − A − 2C within the brain, it is not unreasonable to assume that the specific neural connections which are active during a water-jar problem-state and those that are active when one thinks “take the second term, subtract the first term, then subtract two of the third term” tend to increase in the amount of overlap as more and more instances where B − A − 2C works are presented.

Other Einstellung Research

Psychological Stress

The following experiments were designed to gauge the effect of different stressful situations on the Einstellung effect. Overall, these experiments show that stressful situations increase the prevalence of the Einstellung effect.

The Speed Test

Luchins gave an elementary-school class a set of water jar problems. In order to create a stressful situation, experimenters told the students that the test would be timed, that the speed and accuracy of the test would be reviewed by their principal and teachers, and that the test would affect their grades. To further agitate the students during the test, experimenters were instructed to comment on how much slower the children were compared to children in lower grades. The experimenters observed anxious, stressed, and sometimes tearful faces during the experiment. (Note that while such methods were common in the 1950s, today it violates ethical practices in research.)

The results of the experiment indicated that the stressful speed test situation increased rigidity. Luchins found that only three of the ninety-eight students tested were able to solve the extinction problem, and only two students used the direct method for the critical problems. The same experiment conducted under non-stress conditions showed 70% rigidity during the test problems and 58% failure of the extinction problem, while the anxiety-inducing situation showed 98% and 97% respectively.

The speed test was performed with college students as well, which yielded similar results. Even when college students were told ahead of time to use the direct method in order to avoid mistakes made by children, the college students continued to exhibit rigidity under time pressure. The results of these studies showed that the emphasis on speed increased the Einstellung effect on the water jar problems.

Maze Tracing

Luchins also instructed subjects to draw a solution through a maze without crossing any of the maze’s lines. The maze was either traced normally or traced using the mirror reflection of the maze. If the subject drew over the lines of the figure, they had to start at the beginning, which was disadvantageous since the subject was told that their score depended on the time and smoothness of the solution. The mirror-tracing situation was the stressful situation, and the normal tracing was the non-stressful, control situation. Experimenters observed that the mirror-tracing task caused more drawing outside the boundaries, increased overt signs of stress and anxiety, and required more time to accurately complete. The mirror-tracing situation produced 89% Einstellung solution on the first two criticals instead of the 71% observed for normal tracing. In addition, 55% of the subjects failed with the mirror while only 18% failed without the mirror.

Hidden Word Test for Stutterers

In 1951, Solomon gave both stutterers and fluent speakers a hidden word test, an arithmetical test, and a mirror maze test. Experimenters called the hidden word test a “speech test” to increase stutterer anxiety. There were no marked differences between the stutterers and the fluent speakers for the arithmetical and mirror maze tests. However, the results reveal a significant difference between the performance of the stutterers and the fluent speakers on the “speech test”. On the first two critical problems, 58 percent of the stutterers gave Einstellung solutions whereas only 4 percent of the fluent speakers showed Einstellung effects.

Age

The original Luchins and Luchins experiment tested nine-, ten-, eleven-, and twelve-year-olds for the Einstellung effect. The older groups showed more Einstellung effects than the younger groups in general. However, this initial study did not control for differences in educational level and intelligence.

To remedy this problem, Ross (1952) conducted a study on middle-aged (mean 37.3 years) and older adults (mean 60.8 years). The adults were grouped according to the I.Q., years of schooling, and occupation. Ross administered five Einstellung tests including the arithmetical (water jar) test, the maze test, the hidden word test, and two other tests. For every test, the middle-aged group performed better than the older group. For example, 65% of the older adults failed the extinction task of the arithmetical test, whereas only 29% of the middle-aged adults failed the extinction problem.

Luchins devised another experiment to determine the difference between Einstellung effects in children and in adults. In this study, 140 fifth-graders (mean 10.5 years) were compared to 79 college students (mean 21 years) and 21 adults (mean 43 years). Einstellung effects prior to the extinction task increased with age: the observed Einstellung effects for the extinction task were 56, 68, and 69 percent for young adults, children, and older adults respectively. This implies that there exists a curvilinear relationship between age and the recovery from the Einstellung effect. A similar experiment conducted by Heglin in 1955, also found this relationship when the three age groups were equated for IQ.

Therefore, the initial manifestation of the Einstellung effect on the arithmetic test increases with age. However, the recovery from the Einstellung effect is greatest for young adults (average age 21 years) and decreases as the subject moves away from this age.

Gender

In Luchins and Luchins’ original experiment with 483 children, they found that boys demonstrated less of an Einstellung effect than girls. The experimental difference was only significant for the group that was instructed to write “Don’t be blind” on their papers after the sixth problem (the DBB group). “Don’t be blind” was meant as a reminder to pay attention and guard against rigidity for the sixth problem. However, this message was interpreted in many different ways including thinking of the message as just some more words to remember. The alternative interpretations occurred more frequently in girls and increased with IQ score within the female group. This difference in interpretation of “don’t be blind” may account for the fact that the male DBB group showed more direct solutions than their female counterparts.

To determine sex differences in adults, Luchins gave college students the maze Einstellung test. The female group showed slightly more (although not statistically significant) Einstellung effects than the male group. Other studies have provided conflicting data about the sex differences in the Einstellung effect.

Intelligence

Luchins and Luchins looked at the relationship between the intelligence quotient (IQ) and the Einstellung effects for the children in their original experiment. They found that there was a statistically insignificant negative relationship between the Einstellung effect and intelligence. In general, large Einstellung effects were observed for all subject groups regardless of IQ score. When Luchins and Luchins looked at the IQ range for children who did and did not demonstrate Einstellung effects, they spanned from 51 to 160 and from 75 to 155 respectively. These ranges show a slight negative correlation between intelligence and Einstellung effects.

This page is based on the copyrighted Wikipedia article < https://en.wikipedia.org/wiki/Einstellung_effect >; it is used under the Creative Commons Attribution-ShareAlike 3.0 Unported License (CC-BY-SA). You may redistribute it, verbatim or modified, providing that you comply with the terms of the CC-BY-SA.

An Overview of Antiprocess

Published on 12/09/2024 by Andrew MarshallLeave a comment

Introduction

Antiprocess is the pre-emptive recognition and marginalisation of undesired information by the interplay of mental defence mechanisms: the subconscious compromises information that would cause cognitive dissonance. It is often used to describe a difficulty encountered when people with sharply contrasting viewpoints are attempting (and failing) to discuss a topic.

In other words, when one is debating with another, there may be a baffling disconnect despite one’s apparent understanding of the argument. Despite the apparently sufficient understanding to formulate counter-arguments, the mind of the debater does not allow him to be swayed by that knowledge.

There are many instances on the Internet where antiprocess can be observed, but the prime location to see it is in Usenet discussion groups, where discussions tend to be highly polarised. In such debates, both sides appear to have a highly sophisticated understanding of the other position, yet neither side is swayed. As a result, the debate can continue for years without any progress being made.

Dynamics

Antiprocess occurs because:

The mind is capable of multitasking;
The mind has the innate capability to evaluate and select information at a preconscious level so that we are not overwhelmed with the processing requirements;
It is not feasible to maintain two contradictory beliefs at the same time;
It is not possible for people to be aware of every factor leading up to decisions they make;
People learn argumentatively effective but logically invalid defensive strategies (such as rhetorical fallacies);
People tend to favour strategies of thinking that have served them well in the past; and
The truth is just too unpalatable to the mind to accept.

The ramifications of these factors are that people can be engaged in a debate sincerely, yet the appearances suggest that they are not. This can lead to acrimony if neither party is aware of antiprocess and does not adjust his or her debating style accordingly.

This page is based on the copyrighted Wikipedia article < https://en.wikipedia.org/wiki/Antiprocess >; it is used under the Creative Commons Attribution-ShareAlike 3.0 Unported License (CC-BY-SA). You may redistribute it, verbatim or modified, providing that you comply with the terms of the CC-BY-SA.

An Overview of Cognitive Inertia

Published on 12/04/2024 by Andrew MarshallLeave a comment

Introduction

Cognitive inertia is the tendency for a particular orientation in how an individual thinks about an issue, belief, or strategy to resist change. Clinical and neuroscientific literature often defines it as a lack of motivation to generate distinct cognitive processes needed to attend to a problem or issue. The physics term inertia emphasizes the rigidity and resistance to change in the method of cognitive processing that has been used for a significant amount of time. Commonly confused with belief perseverance, cognitive inertia is the perseverance of how one interprets information, not the perseverance of the belief itself.

Cognitive inertia has been causally implicated in disregarding impending threats to one’s health or environment, enduring political values and deficits in task switching. Interest in the phenomenon was primarily taken up by economic and industrial psychologists to explain resistance to change in brand loyalty, group brainstorming, and business strategies. In the clinical setting, cognitive inertia has been used as a diagnostic tool for neurodegenerative diseases, depression, and anxiety. Critics have stated that the term oversimplifies resistant thought processes and suggests a more integrative approach that involves motivation, emotion, and developmental factors.

Brief History and Methods

Early History

The idea of cognitive inertia has its roots in philosophical epistemology. Early allusions to a reduction of cognitive inertia can be found in the Socratic dialogues written by Plato. Socrates builds his argument by using the detractor’s beliefs as the premise of his argument’s conclusions. In doing so, Socrates reveals the detractor’s fallacy of thought, inducing the detractor to change their mind or face the reality that their thought processes are contradictory. Ways to combat persistence of cognitive style are also seen in Aristotle’s syllogistic method which employs logical consistency of the premises to convince an individual of the conclusion’s validity.

At the beginning of the twentieth century, two of the earliest experimental psychologists, Müller and Pilzecker, defined perseveration of thought to be “the tendency of ideas, after once having entered consciousness, to rise freely again in consciousness”. Müller described perseveration by illustrating his own inability to inhibit old cognitive strategies with a syllable-switching task, while his wife easily switched from one strategy to the next. One of the earliest personality researchers, W. Lankes, more broadly defined perseveration as “being confined to the cognitive side” and possibly “counteracted by strong will”. These early ideas of perseveration were the precursor to how the term cognitive inertia would be used to study certain symptoms in patients with neurodegenerative disorders, rumination and depression.

Cognitive Psychology

Originally proposed by William J. McGuire in 1960, the theory of cognitive inertia was built upon emergent theories in social psychology and cognitive psychology that centred around cognitive consistency, including Fritz Heider’s balance theory and Leon Festinger’s cognitive dissonance. McGuire used the term cognitive inertia to account for an initial resistance to change how an idea was processed after new information, that conflicted with the idea, had been acquired.

In McGuire’s initial study involving cognitive inertia, participants gave their opinions of how probable they believed various topics to be. A week later, they returned to read messages related to the topics they had given their opinions on. The messages were presented as factual and were targeted to change the participants’ belief in how probable the topics were. Immediately after reading the messages, and one week later, the participants were again assessed on how probable they believed the topics to be. Discomforted by the inconsistency of the related information from the messages and their initial ratings on the topics, McGuire believed the participants would be motivated to shift their probability ratings to be more consistent with the factual messages. However, the participants’ opinions did not immediately shift toward the information presented in the messages. Instead, a shift towards consistency of thought on the information from the messages and topics grew stronger as time passed, often referred to as “seepage” of information. The lack of change was reasoned to be due to persistence in the individual’s existing thought processes which inhibited their ability to re-evaluate their initial opinion properly, or as McGuire called it, cognitive inertia.

Probabilistic Model

Although cognitive inertia was related to many of the consistency theories at the time of its conception, McGuire used a unique method of probability theory and logic to support his hypotheses on change and persistence in cognition. Utilising a syllogistic framework, McGuire proposed that if three issues (a, b and c) were so interrelated that an individual’s opinion were in complete support of issues a and b then it would follow their opinion on issue c would be supported as a logical conclusion. Furthermore, McGuire proposed if an individual’s belief in the probability (p) of the supporting issues (a or b) was changed, then not only would the issue (c) explicitly stated change, but a related implicit issue (d) could be changed as well.

This formula was used by McGuire to show that the effect of a persuasive message on a related, but unmentioned, topic (d) took time to sink in. The assumption was that topic d was predicated on issues a and b, similar to issue c, so if the individual agreed with issue c then so too should they agree with issue d. However, in McGuire’s initial study immediate measurement on issue d, after agreement on issues a, b and c, had only shifted half the amount that would be expected to be logically consistent. Follow-up a week later showed that shift in opinion on issue d had shifted enough to be logically consistent with issues a, b, and c, which not only supported the theory of cognitive consistency, but also the initial hurdle of cognitive inertia.

The model was based on probability to account for the idea that individuals do not necessarily assume every issue is 100% likely to happen, but instead there is a likelihood of an issue occurring and the individual’s opinion on that likelihood will rest on the likelihood of other interrelated issues.

Examples

Public Health

Historical

Group (cognitive) inertia, how a subset of individuals view and process an issue, can have detrimental effects on how emergent and existing issues are handled. In an effort to describe the almost lackadaisical attitude from a large majority of US citizens toward the insurgence of the Spanish flu in 1918, historian Tom Dicke has proposed that cognitive inertia explains why many individuals did not take the flu seriously. At the time, most US citizens were familiar with the seasonal flu. They viewed it as an irritation that was often easy to treat, infected few, and passed quickly with few complications and hardly ever a death. However, this way of thinking about the flu was detrimental to the need for preparation, prevention, and treatment of the Spanish flu due to its quick spread and virulent form until it was much too late, and it became one of the most deadly pandemics in history.

Contemporary

In the more modern period, there is an emerging position that anthropogenic climate change denial is a kind of cognitive inertia. Despite the evidence provided by scientific discovery, there are still those – including nations – who deny its incidence in favour of existing patterns of development.

Geography

To better understand how individuals store and integrate new knowledge with existing knowledge, Friedman and Brown tested participants on where they believed countries and cities to be located latitudinally and then, after giving them the correct information, tested them again on different cities and countries. The majority of participants were able to use the correct information to update their cognitive understanding of geographical locations and place the new locations closer to their correct latitudinal location, which supported the idea that new knowledge affects not only the direct information but also related information. However, there was a small effect of cognitive inertia as some areas were unaffected by the correct information, which the researchers suggested was due to a lack of knowledge linkage in the correct information and new locations presented.

Group Membership

Politics

The persistence of political group membership and ideology is suggested to be due to the inertia of how the individual has perceived the grouping of ideas over time. The individual may accept that something counter to their perspective is true, but it may not be enough to tip the balance of how they process the entirety of the subject.

Governmental organisations can often be resistant or glacially slow to change along with social and technological transformation. Even when evidence of malfunction is clear, institutional inertia can persist. Political scientist Francis Fukuyama has asserted that humans imbue intrinsic value on the rules they enact and follow, especially in the larger societal institutions that create order and stability. Despite rapid social change and increasing institutional problems, the value placed on an institution and its rules can mask how well an institution is functioning as well as how that institution could be improved. The inability to change an institutional mindset is supported by the theory of punctuated equilibrium, long periods of deleterious governmental policies punctuated by moments of civil unrest. After decades of economic decline, the United Kingdom’s referendum to leave the EU was seen as an example of the dramatic movement after a long period of governmental inertia.

Interpersonal Roles

The unwavering views of the roles people play in our lives have been suggested as a form of cognitive inertia. When asked how they would feel about a classmate marrying their mother or father, many students said they could not view their classmate as a step-father/mother. Some students went so far as to say that the hypothetical relationship felt like incest.

Role inertia has also been implicated in marriage and the likelihood of divorce. Research on couples who cohabit together before marriage shows they are more likely to get divorced than those who do not. The effect is most seen in a subset of couples who cohabit without first being transparent about future expectations of marriage. Over time, cognitive role inertia takes over, and the couple marries without fully processing the decision, often with one or both of the partners not fully committed to the idea. The lack of deliberative processing of existing problems and levels of commitment in the relationship can lead to increased stress, arguments, dissatisfaction, and divorce.

In Business

Cognitive inertia is regularly referenced in business and management to refer to consumers’ continued use of products, a lack of novel ideas in group brainstorming sessions, and lack of change in competitive strategies.

Brand Loyalty

Gaining and retaining new customers is essential to whether a business succeeds early on. To assess a service, product, or likelihood of customer retention, many companies will invite their customers to complete satisfaction surveys immediately after purchasing a product or service. However, unless the satisfaction survey is completed immediately after the point of purchase, the customer response is often based on an existing mindset about the company, not the actual quality of experience. Unless the product or service is extremely negative or positive, cognitive inertia related to how the customer feels about the company will not be inhibited, even when the product or service is substandard. These satisfaction surveys can lack the information businesses need to improve a service or product that will allow them to survive against the competition.

Brainstorming

Cognitive inertia plays a role in why a lack of ideas is generated during group brainstorming sessions. Individuals in a group will often follow an idea trajectory, in which they continue to narrow in on ideas based on the very first idea proposed in the brainstorming session. This idea trajectory inhibits the creation of new ideas central to the group’s initial formation.

In an effort to combat cognitive inertia in group brainstorming, researchers had business students either use a single-dialogue or multiple-dialogue approach to brainstorming. In the single dialogue version, the business students all listed their ideas. They created a dialogue around the list, whereas, in the multi-dialogue version, ideas were placed in subgroups that individuals could choose to enter and talk about and then freely move to another subgroup. The multi-dialogue approach was able to combat cognitive inertia by allowing different ideas to be generated in sub-groups simultaneously and each time an individual switched to a different sub-group, they had to change how they were processing the ideas, which led to more novel and high-quality ideas.

Competitive Strategies

Adapting cognitive strategies to changing business climates is often integral to whether or not a business succeeds or fails during economic stress. In the late 1980s in the UK, real estate agents’ cognitive competitive strategies did not shift with signs of an increasingly depressed real estate market, despite their ability to acknowledge the signs of decline. This cognitive inertia at the individual and corporate level has been proposed as reasons to why companies do not adopt new strategies to combat the ever-increasing decline in the business or take advantage of the potential. General Mills’ continued operation of mills long after they were no longer necessary is an example of when companies refuse to change the mindset of how they should operate.

More famously, cognitive inertia in upper management at Polaroid was proposed as one of the main contributing factors to the company’s outdated competitive strategy. Management strongly held that consumers wanted high-quality physical copies of their photos, where the company would make their money. Despite Polaroid’s extensive research and development into the digital market, their inability to refocus their strategy to hardware sales instead of film eventually led to their collapse.

Scenario planning has been one suggestion to combat cognitive inertia when making strategic decisions to improve business. Individuals develop different strategies and outline how the scenario could play out, considering different ways it could go. Scenario planning allows for diverse ideas to be heard and the breadth of each scenario, which can help combat relying on existing methods and thinking alternatives is unrealistic.

Management

In a recent review of company archetypes that lead to corporate failure, Habersang, Küberling, Reihlen, and Seckler defined “the laggard” as one who rests on the laurels of the company, believing past success and recognition will shield them from failure. Instead of adapting to changes in the market, “the laggard” assumes that the same strategies that won the company success in the past will do the same in the future. This lag in changing how they think about the company can lead to rigidity in company identity, like Polaroid, conflict in adapting when the sales plummet, and resource rigidity. In the case of Kodak, instead of reallocating money to a new product or service strategy, they cut production costs and imitation of competitors, both leading to poorer quality products and eventually bankruptcy.

A review of 27 firms integrating the use of big data analytics found cognitive inertia to hamper the widespread implementation, with managers from sectors that did not focus on digital technology seeing the change as unnecessary and cost prohibitive.

Managers with high cognitive flexibility that can change the type of cognitive processing based on the situation at hand are often the most successful in solving novel problems and keeping up with changing circumstances. Interestingly, shifts in mental models (disrupting cognitive inertia) during a company crisis are frequently at the lower group level, with leaders coming to a consensus with the rest of the workforce in how to process and deal with the crisis, instead of vice versa. It is proposed that leaders can be blinded by their authority and too easily disregard those at the front-line of the problem causing them to reject remunerative ideas.

Applications

Therapy

An inability to change how one thinks about a situation has been implicated as one of the causes of depression. Rumination, or the perseverance of negative thoughts, is often correlated with the severity of depression and anxiety. Individuals with high levels of rumination test low on scales of cognitive flexibility and have trouble shifting how they think about a problem or issue even when presented with facts that counter their thinking process.

In a review paper that outlined strategies that are effective for combating depression, the Socratic method was suggested to overcome cognitive inertia. By presenting the patient’s incoherent beliefs close together and evaluating with the patient their thought processes behind those beliefs, the therapist is able to help them understand things from a different perspective.

Clinical Diagnostics

In nosological literature relating to the symptom or disorder of apathy, clinicians have used cognitive inertia as one of the three main criteria for diagnosis. The description of cognitive inertia differs from its use in cognitive and industrial psychology in that lack of motivation plays a key role. As a clinical diagnostic criterion, Thant and Yager described it as “impaired abilities to elaborate and sustain goals and plans of actions, to shift mental sets, and to use working memory”. This definition of apathy is frequently applied to onset of apathy due to neurodegenerative disorders such as Alzheimer’s and Parkinson’s disease but has also been applied to individuals who have gone through extreme trauma or abuse.

Neural Anatomy and Correlates

Cortical

Cognitive inertia has been linked to decreased use of executive function, primarily in the prefrontal cortex, which aids in the flexibility of cognitive processes when switching tasks. Delayed response on the implicit associations task (IAT) and Stroop task have been related to an inability to combat cognitive inertia, as participants struggle to switch from one cognitive rule to the next to get the questions right.

Before taking part in an electronic brainstorming session, participants were primed with pictures that motivated achievement to combat cognitive inertia. In the achievement-primed condition, subjects were able to produce more novel, high-quality ideas. They used more right frontal cortical areas related to decision-making and creativity.

Cognitive inertia is a critical dimension of clinical apathy, described as a lack of motivation to elaborate plans for goal-directed behaviour or automated processing. Parkinson’s patients whose apathy was measured using the cognitive inertia dimension showed less executive function control than Parkinson’s patients without apathy, possibly suggesting more damage to the frontal cortex. Additionally, more damage to the basal ganglia in Parkinson’s, Huntington’s and other neurodegenerative disorders have been found with patients exhibiting cognitive inertia in relation to apathy when compared to those who do not exhibit apathy. Patients with lesions to the dorsolateral prefrontal cortex have shown reduced motivation to change cognitive strategies and how they view situations, similar to individuals who experience apathy and cognitive inertia after severe or long-term trauma.

Functional Connectivity

Nursing home patients who have dementia have been found to have larger reductions in functional brain connectivity, primarily in the corpus callosum, important for communication between hemispheres. Cognitive inertia in neurodegenerative patients has also been associated with a decrease in the connection of the dorsolateral prefrontal cortex and posterior parietal area with subcortical areas, including the anterior cingulate cortex and basal ganglia. Both findings are suggested to decrease motivation to change one’s thought processes or create new goal-directed behaviour.

Alternative Theories

Some researchers have refuted the cognitive perspective of cognitive inertia and suggest a more holistic approach that considers the motivations, emotions, and attitudes that fortify the existing frame of reference.

Alternative Paradigms

Motivated Reasoning

The theory of motivated reasoning is proposed to be driven by the individual’s motivation to think a certain way, often to avoid thinking negatively about oneself. The individual’s own cognitive and emotional biases are commonly used to justify a thought, belief, or behaviour. Unlike cognitive inertia, where an individual’s orientation in processing information remains unchanged either due to new information not being fully absorbed or being blocked by a cognitive bias, motivated reasoning may change the orientation or keep it the same depending on whether that orientation benefits the individual.

In an extensive online study, participant opinions were acquired after two readings about various political issues to assess the role of cognitive inertia. The participants gave their opinions after the first reading and were then assigned a second reading with new information; after being assigned to read more information on the issue that either confirmed or disconfirmed their initial opinion, the majority of participants’ opinions did not change. When asked about the information in the second reading, those who did not change their opinion evaluated the information that supported their initial opinion as stronger than information that disconfirmed their initial opinion. The persistence in how the participants viewed the incoming information was based on their motivation to be correct in their initial opinion, not the persistence of an existing cognitive perspective.

Socio-Cognitive Inflexibility

From a social psychology perspective, individuals continually shape beliefs and attitudes about the world based on interaction with others. What information the individual attends to is based on prior experience and knowledge of the world. Cognitive inertia is seen not just as a malfunction in updating how information is being processed but as the assumptions about the world and how it works can impede cognitive flexibility. The persistence of the idea of the nuclear family has been proposed as a socio-cognitive inertia. Despite the changing trends in family structure, including multi-generational, single-parent, blended, and same-sex parent families, the normative idea of a family has centred around the mid-twentieth century idea of a nuclear family (i.e. mother, father, and children). Various social influences are proposed to maintain the inertia of this viewpoint, including media portrayals, the persistence of working-class gender roles, unchanged domestic roles despite working mothers, and familial pressure to conform.

The phenomenon of cognitive inertia in brainstorming groups has been argued to be due to other psychological effects such as fear of disagreeing with an authority figure in the group, fear of new ideas being rejected and the majority of speech being attributed to the minority group members. Internet-based brainstorming groups have been found to produce more ideas of high-quality because it overcomes the problem of speaking up and fear of idea rejection.

This page is based on the copyrighted Wikipedia article < https://en.wikipedia.org/wiki/Cognitive_inertia >; it is used under the Creative Commons Attribution-ShareAlike 3.0 Unported License (CC-BY-SA). You may redistribute it, verbatim or modified, providing that you comply with the terms of the CC-BY-SA.

What is Double Depression?

Published on 12/03/2024 by Andrew Marshall1 Comment

Introduction

Double depression refers to the co-existence of major depressive disorder (MDD) and persistent depressive disorder (PDD), the latter previously referred to as dysthymia. Research has shown that double depression tends to be more severe than either MDD or PDD alone and that individuals with double depression experience relapse more often than those with either MDD or PDD alone. However, there is some research that indicates few differences exist between double depression, MDD, and PDD; as a result, those researchers conclude that double depression is not a distinct disorder.

The literature that details the pharmaceutical treatment of double depression is sparse. Although there are studies that demonstrate that certain medications, such as selective serotonin reuptake inhibitors (SSRIs), are effective methods of treatment, those studies lack placebo controls; therefore, the studies’ conclusions are questionable.

Research has found that, as is the case with other depressive disorders, pharmaceutical and therapeutic treatments combined are more effective than the use of either form of treatment alone. Individuals with double depression tend to experience more functional impairment than those with either MDD or PDD alone. As a result, researchers emphasize the need for unique treatments for double depression to be developed and implemented.

Presentation

Individuals with double depression meet the DSM-5 classification criteria for both MDD and PDD. Goldney and Fisher (2004) determined that, in a sample of 3,010 individuals from southern portions of Australia calculated a prevalence rate of double depression of 2.2%. Jonas et al. (2003) reported a prevalence rate of double depression in the United States of 3.4%—based upon an assessment of 7,667 Americans. The prevalence rate of double depression can be compared to rates of PDD at 6.2%, major depressive episode (MDE) at 8.6%, and major depressive episode with severity (MDE-s) at 7.7%. Keller and Shapiro (1982) found that 26% of patients within a sample of 101 met the criteria for both MDD and PDD; however, the aforementioned sample is much smaller—and much more inclined to inaccuracies—than the samples (3,010 and 7,667) described above. Thus, double depression is less common than other forms of depression, but it is still a form of depression that warrants medical attention in the form of behavioral therapies; pharmaceutical treatments; or, both (Miller, Norman, and Keitner, 1999).

The characteristics of those with double depression tend to be more severe in nature than those associated with those who have either MDD or PDD. Levitt, Joffe, and MacDonald (1991) found that those with double depression experience fluctuations in mood at an earlier point in life, a more substantial number of depressive episodes, as well as co-morbid disorders of anxieties more often than their MDD-alone counterparts. Goldney and Fisher (2004) reported that individuals with double depression seek medical attention more often than those with either MDD or PDD alone. Leader and Klein (1996) found that individuals with double depression experience a more substantial level of social impairment, which includes factors such as leisure pursuits and relationship characteristics, than those with either MDD or PDD. Dixon and Thyer (1998) concluded that individuals with double depression experiences recoveries on a more frequent basis than their counterparts who have MDD alone (88% to 69%); however, individuals with double depression experience the most substantial rates of relapse of all of those who suffer from chronic depression. In addition, remission from MDD tends to happen faster than remission from PDD (Dixon & Thyer, 1998).

Miller, Norman, and Dow (1986) reported that individuals with double depression endure a more severe path of illness, but experience few differences with respect to social impairment compared to their MDD-alone counterparts. In addition, McCullough et al. (2000) found that, with the exception that patients with double depression tended to experience of more severe illness, few differences were apparent. Therefore, the conclusions drawn in previous research that are associated with the nature of the clinical presentation of double depression are mixed. Multiple scientists emphasize the need for additional research to determine adequate treatments for those with double depression, as depression is a disease that places a considerable burden upon communities and societies; furthermore, those researchers predict depression will be, in an economic sense, the second-most burdensome disease on societies come 2020.

Treatment

Research on pharmaceutical treatment of double depression in particular is sparse. Certain medications, such as fluoxetine, were found in numerous studies to be effective at reducing symptom severity; however, these studies involved open-label trials, double-blind randomised trials that lack placebo conditions, and small sample sizes. Thus, placebo-controlled trials are needed in order to determine adequate and unique treatments for double depression. In addition, the considerable burden depression places upon communities and societies (Goldney & Fisher, 2004) emphasizes the need for additional research into the treatment of chronic depression.

Hellerstein et al. (1994) theorised that antidepressant medications could be used to ameliorate both MDD and PDD; a pharmaceutical trial found that fluoxetine facilitated remission in 57.1% of patients after five months of treatment. In addition, Miller, Norman, and Keitner (1999) conducted an intervention in which one cohort received pharmaceutical treatment while another cohort received both pharmaceutical and therapeutic treatment. Their results indicated that those who received the combined intervention were more functional—in a social sense—as well as relieved of their depression than those who received the pharmaceutical intervention alone (Miller, Norman, & Keitner, 1999). However, the researchers found that the effect disappeared at both the 6 and 12-month follow-up assessments.

Vasile et al. (2012) conducted a pharmaceutical trial with 16 patients with double depression (who had comorbid alcohol dependence) who were treated and monitored for six months. Results showed that three antidepressants – venlafaxine, duloxetine, and milnacipran – were associated with substantial improvement; venlafaxine was the most effective of the three antidepressants.

Koran, Aboujaoude, and Gamel (2007) conducted a pharmaceutical trial with 24 adults who received duloxetine over the course of a 12-week period. Results showed that duloxetine was successful in the treatment of both PDD as well as double depression. However, the researchers’ trial was an open-label trial; as a result, the researchers called for a double-blind and placebo-controlled trial to be conducted in order to further validate the benefits the medication seems to provide.

In addition, Waslick et al. (1999) used duloxetine to treat 19 children and adolescents with either PDD or double depression; after eight weeks of pharmaceutical treatment, 11 of the patients failed to meet the classification criteria for one of the two disorders, which led to the conclusion that duloxetine was a medication that appeared to provide relief from PDD and double depression in children and adolescents. However, the aforementioned trial (in addition to Koran et al.’s (2007) trial) was an open-label trial, which the authors noted as a limitation.

Hirschfield et al. (1998) conducted a 12-week randomised controlled trial (RCT) that involved the administration of sertraline or imipramine, after which 324 of 623 patients either qualified for remission or experienced a substantive improvement in clinical presentation. In a double-blind, fixed-dose trial that involved the use of either the monoamine oxidase inhibitor (MAOI) moclobemide or the SSRI fluoxetine, Duarte, Mikkelsen, and DeliniStula (1996) were able to facilitate a minimum of a 50% score reduction on the Hamilton Depression Rating Scale (HDRS). 71% of cases that involved moclobemide – versus 38% of cases that involved fluoxetine – were determined to achieve the aforementioned desired outcome. As a result, the researchers concluded that both antidepressants were similar in their abilities to treat double depression in an effective fashion. However, the lack of a placebo control undermines the extent to which the results can be applied.

Marin, Kocsis, Frances, and Parides (1994) conducted an eight-week open trial that entailed the administration of desipramine to 42 individuals with double depression and 33 individuals with PDD. The researchers found that 70% of the PDD patients experienced a substantial improvement in clinical presentation; the proportion associated with the double depression-cohort was said to be similar. However, the lack of blindness as well as a placebo control notes a considerable limitation of the aforementioned research.

Goldney and Bain (2006) found that those who have double depression receive some form of treatment on a more substantial basis than their MDD-alone and PDD-alone counterparts. To elaborate, the authors measured that, in Australia, 41.4% of those evaluated with double depression received treatment three or more times over the course of the previous month, whereas 34.5% of those with MDD alone; 23.2% of those with PDD alone; and 10.3% of those who were not depressed received treatment three or more times over the course of the previous month (Goldney & Bain, 2006). In addition, the researchers concluded that those with double depression acquire a more substantial number of treatment visits per month (a mean of 4.3) when compared to their MDD-alone counterparts (a mean of 3.0); their PDD-alone counterparts (a mean of 2.6); and their non-depressed counterparts (a mean of 1.5).

Prognosis

Although double depression is less prevalent than either MDD or PDD, it is still a form of depression that warrants medical attention in the form of behavioural therapies; pharmaceutical treatments; or, both. Miller, Norman, and Keitner (1999) found that the use of both behavioural and pharmaceutical treatments was more effective on a short-term basis in the reduction of depression than the use of pharmaceutical treatments alone.

Klein, Shankman, and Rose (2008) determined that poor maternal-child relationship, histories of sexual abuse, co-morbid disorders of anxieties, and lower educational attainment predicted an increased HAM-D score after a decade; the researchers also determined that those same factors predicted, after a decade, increased functional impairment. In addition, the results showed that the life course of depression did not differ to a substantial extent between individuals with MDD-alone and double depression.

Hirschfield et al. (1998) conducted a 12-week RCT that involved the administration of sertraline or imipramine, in which the most notable predictors of treatment response were educational attainment and relationship status; in addition, the authors noted the apparent influence of intrinsic personal traits. However, Hirschfield et al. noted the limitation of a lack of a placebo control.

Klein, Taylor, Harding, and Dickstein (1988) reported that, via their assessment of clinical, familial, and socio-environmental characteristics of those with chronic depression, at a six-month follow-up, individuals with double depression experienced decreased rates of remission, increased manifestations of clinical depressive phenomena, increased functional impairment, and increased likelihood of the development and onset of a hypomanic episode than their MDD-alone counterparts; as a result, the authors underscore the importance of the creation of a distinct classification of double depression due to its unique episodic path.

Controversies

Previous research on the clinical presentation of double depression tends to be mixed. Numerous studies indicate that the course of double depression tends to be more severe in nature. In addition, numerous studies demonstrate that individuals with double depression seek medical attention to a more substantial extent than those with either MDD or PDD. However, Miller, Norman, and Dow (1986) determined that individuals with MDD or PDD versus individuals with double depression experienced similar levels of social impairment. In addition, McCullough and colleagues found that there were few additional differences overall between the characteristics of those with double depression versus those with either MDD or PDD.

Research on the course of double depression is also mixed. Klein, Taylor, Harding, and Dickstein (1988) found that remission in individuals with double depression is less probable than it is in individuals with either MDD or PDD; the researchers also noted that those with double depression are more prone to the development and onset of a hypomanic episode than those with either MDD or PDD. In addition, Klein, Shankman, and Rose (2008) and Hirschfield et al. (1998) both concluded that educational status predicted treatment outcome. However, Levitt, Joffe, and MacDonald (1991) demonstrated that the courses of the respective depressive disorders did not differ to a substantial extent. While Klein, Shankman, and Rose (2008) advocate for the creation of a distinct classification of double depression in the future edition(s) of the DSM, Levitt and colleagues (as well as McCullough and colleagues) seem to indicate that, due to the numerous similarities as well as limited differences between double depression and either MDD or PDD, the creation of such a classification would be inappropriate and incorrect. Remick, Sadovnick, Lam, Zis, and Yee (1996) determine that the heritable bases of MDD, PDD, and double depression are similar and that, as a result, the three disorders are unable to be differentiated.

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An Overview of Externalising Disorders

Published on 12/02/2024 by Andrew MarshallLeave a comment

Introduction

Externalising disorders are mental disorders characterised by externalising behaviours, maladaptive behaviours directed toward an individual’s environment, which cause impairment or interference in life functioning. In contrast to individuals with internalising disorders who internalise (keep inside) their maladaptive emotions and cognitions, such feelings and thoughts are externalised (manifested outside) in behaviour in individuals with externalising disorders. Externalising disorders are often specifically referred to as disruptive behaviour disorders (attention-deficit/hyperactivity disorder, oppositional defiant disorder, and conduct disorder) or conduct problems which occur in childhood. Externalising disorders, however, are also manifested in adulthood. For example, alcohol- and substance-related disorders and antisocial personality disorder are adult externalising disorders. Externalising psychopathology is associated with antisocial behaviour, which is different from and often confused for asociality.

Brief History

The classification for several externalising disorders changed from DSM-IV to DSM-5. ADHD, ODD, and CD were previously classified in the Attention-deficit and Disruptive Behaviour Disorders section in DSM-IV. Pyromania, kleptomania, and IED were previously classified in the Impulse-Control Disorders Not Otherwise Specified Section of DSM-IV. ADHD is now categorised in the Neurodevelopmental Disorders section in DSM-5. ODD, CD, pyromania, kleptomania, and IED are now categorised in the new Disruptive, Impulse-Control, and Conduct Disorders chapter of DSM-5. Overall, there were many changes made to the DSM from the transition of DSM-IV-TR to DSM-5, which was somewhat controversial.

Signs and Symptoms

Externalising disorders often involve emotion dysregulation problems and impulsivity that are manifested as antisocial behaviour and aggression in opposition to authority, societal norms, and often violate the rights of others. Some examples of externalising disorder symptoms include, often losing one’s temper, excessive verbal aggression, physical aggression to people and animals, destruction of property, theft, and deliberate fire setting. As with all DSM-5 mental disorders, an individual must have functional impairment in at least one domain (e.g. academic, occupational, social relationships, or family functioning) in order to meet diagnostic criteria for an externalising disorder. Moreover, an individual’s symptoms should be atypical for their cultural and environmental context and physical medical conditions should be ruled out before an externalising disorder diagnosis is considered. Diagnoses must be made by qualified mental health professionals. DSM-5 classifications of externalising disorders are listed herein, however, ICD-10 can also be used to classify externalising disorders. More specific criteria and examples of symptoms for various externalising disorders can be found in the DSM-5.

DSM-5 Classification

There are no specific criteria for “externalising behaviour” or “externalising disorders”. Thus, there is no clear classification of what constitutes an externalizing disorder in the DSM-5. Attention-deficit/hyperactivity disorder (ADHD), oppositional defiant disorder (ODD), conduct disorder (CD), antisocial personality disorder (ASPD), pyromania, kleptomania, intermittent explosive disorder (IED), and substance-related disorders are frequently referred to as externalising disorders. Disruptive mood dysregulation disorder has also been posited as an externalising disorder, but little research has examined and validated it to date given its recent addition to the DSM-5, and thus, it is not included further herein.

Attention-Deficit/Hyperactivity Disorder

Inattention ADHD symptoms include: “often fails to give close attention to details or makes careless mistakes in schoolwork, at work, or during other activities,” “often has difficulty sustaining attention in tasks or play activities,” “often does not seem to listen when spoken to directly,” “often does not follow through on instructions and fails to finish schoolwork, chores, or duties in the workplace,” “often has difficulty organizing tasks and activities,” “often avoids, dislikes, or is reluctant to engage in tasks that require sustained mental effort,” “often loses things necessary for tasks or activities,” “is often easily distracted by extraneous stimuli (for older adolescents and adults, may include unrelated thoughts),” and “is often forgetful in daily activities.”

Hyperactivity and impulsivity ADHD symptoms include: “often fidgets with or taps hands or feet or squirms in seat,” “often leaves seat in situations when remaining seated is expected,” “often runs about or climbs in situations where it is inappropriate,” “is often unable to play or engage in leisure activities quietly,” “is often “on the go,” acting as if “driven by a motor,” “often talks excessively,” “often blurts out an answer before a question has been completed,” “often has difficulty waiting his or her turn,” and “often interrupts or intrudes on others.”

In order to meet criteria for an ADHD diagnosis, an individual must have at least six symptoms of inattention and/or hyperactivity/impulsivity, have an onset of several symptoms prior to age 12 years, have symptoms present in at least two settings, have functional impairment, and have symptoms that are not better explained by another mental disorder.

Oppositional Defiant Disorder

ODD symptoms include: “often loses temper,” “is often touchy or easily annoyed,” “is often angry and resentful,” “often argues with authority figures, or for children and adolescents, with adults,” “often actively defies or refuses to comply with requests from authority figures or with rules,” “often deliberately annoys others,” and “often blames others for his or her mistakes or misbehavior.” In order to receive an ODD diagnosis, individuals must have at least four symptoms from above for at least six months (most days for youth younger than five years) with at least one individual who is not a sibling, which causes impairment in at least one setting. Rule outs for a diagnosis include symptoms occurring concurrently during an episode of another disorder.

Conduct Disorder

CD symptoms include “often bullies, threatens, or intimidates others,” “often initiates physical fights,” “has used a weapon that can cause serious physical harm to others,” “has been physically cruel to people,” “has been physically cruel to animals,” “has stolen while confronting a victim,” “has forced someone into sexual activity,” “has deliberately engaged in fire setting with the intention of causing serious damage,” “has deliberately destroyed others’ property (other than by fire setting),” “has broken into someone else’s house, building, or car,” “often lies to obtain goods or favors or to avoid obligations,” “has stolen items of nontrivial value without confronting a victim,” “often stays out at night despite parental prohibitions, beginning before age 13 years,” “has run away from home overnight at least twice while living in the parental or parental surrogate home, or once without returning for a lengthy period,” and “is often truant from school, beginning before age 13 years.” In order to receive a CD diagnosis, individuals must have three of these symptoms for at least one year, at least two symptoms for at least six months, be impaired in at least one setting, and not have an antisocial personality disorder diagnosis if 18 years or older

Antisocial Personality Disorder

ASPD symptoms include: “failure to conform to social norms with respect to lawful behaviors, as indicated by repeatedly performing acts that are grounds for arrest,” “deceitfulness, as indicated by repeated lying, use of aliases, or conning others for personal profit or pleasure,” “impulsivity or failure to plan ahead,” “irritability and aggressiveness, as indicated by repeated physical fights or assaults,” “reckless disregard for safety of self or others,” “consistent irresponsibility, as indicated by repeated failure to sustain consistent work behavior or honor financial obligations,” and “lack of remorse, as indicated by being indifferent to or rationalizing having hurt, mistreated, or stolen from another.” In order to meet diagnostic criteria for ASPD, an individual must have “a pervasive pattern of disregard for and violation of the rights of others, occurring since age 15 years,” three or more of the above symptoms, be at least age 18 years, have a conduct disorder onset before age 15 years, and not have antisocial behaviour exclusively during schizophrenia or bipolar disorder.

Pyromania

Pyromania symptoms include: “deliberate and purposeful fire setting on more than one occasion,” “tension or affective arousal before the act,” “fascination with, interest in, curiosity about, or attraction to fire and its situational contexts,” and “pleasure, gratification, or relief when setting fires or when witnessing or participating in their aftermath.” In order to receive a pyromania diagnosis, “the fire setting is not done for monetary gain, as an expression of sociopolitical ideology, to conceal criminal activity, to express anger or vengeance, to improve one’s living circumstances, in response to a delusion or hallucination, or as a result of impaired judgment.” A conduct disorder diagnosis, manic episode, or antisocial personality disorder diagnosis must not better account for the fire setting in order to receive a pyromania diagnosis.

Kleptomania

Kleptomania symptoms include: “recurrent failure to resist impulses to steal objects that are not needed for personal use or for their monetary value,” “increasing sense of tension immediately before committing the theft,” and “pleasure, gratification, or relief at the time of committing the theft.” In order to receive a kleptomania diagnosis, “the stealing is not committed to express anger or vengeance and is not in response to a delusion or a hallucination.” Additionally, in order to receive a diagnosis, “the stealing is not better explained by conduct disorder, a manic episode, or antisocial personality disorder.”

Intermittent Explosive Disorder

IED symptoms include:

“recurrent behavioral outbursts representing a failure to control aggressive impulses as manifested by either of the following: 1) Verbal aggression (e.g., temper tantrums, tirades, verbal arguments or fights) or physical aggression toward property, animals, or other individuals, occurring twice weekly, on average, for a period of 3 months. The physical aggression does not result in damage or destruction of property and does not result in physical injury to animals or other individuals. 2) Three behavioral outbursts involving damage or destruction of property and/or physical assault involving physical injury against animals or other individuals occurring within a 12-month period.”

In order to receive an IED diagnosis, “the magnitude of aggressiveness expressed during the recurrent outbursts is grossly out of proportion to the provocation or to any precipitating psychosocial stressors,” “the recurrent aggressive outbursts are not premeditated” and “are not committed to achieve some tangible objective.” Additionally, to receive an IED diagnosis, an individual must be six years or older (chronologically or developmentally), have functional impairment, and not have symptoms better explained by another mental disorder, medical condition, or substance.

Substance Use Disorders

According to the DSM-5, “the essential feature of a substance use disorder is a cluster of cognitive, behavioral, and physiological symptoms indicating that the individual continues using the substance despite significant substance-related problems.” Given that at least 10 separate classes of drugs are covered in the DSM-5 Substance-Related and Addictive Disorders section, it is outside the scope of this article. Refer to the DSM-5 for more information on signs and symptoms.

Comorbidity

Externalising disorders are frequently comorbid or co-occurring with other disorders. Individuals who have the co-occurrence of more than one externalising disorder have homotypic comorbidity, whereas individuals who have co-occurring externalising and internalising disorders have heterotypic comorbidity. It is not uncommon for children with early externalising problems to develop both internalising and further externalising problems across the lifespan. Additionally, the complex interplay between externalising and internalising symptoms across development could explain the association between these problems and other risk behaviours, that typically initiate in adolescence (such as antisocial behaviours and substance use).

Stigma

Consistent with many mental disorders, individuals with externalising disorders are subject to significant implicit and explicit forms of stigma. Because externalising behaviours are salient and difficult to conceal, individuals with externalising disorders may be more susceptible to stigmatisation relative to individuals with other disorders. Parents of youth with childhood mental disorders, such as ADHD and ODD, are frequently stigmatised when parenting practices are strongly implicated in the aetiology or cause of the disorder. Educational and policy-related initiatives have been proposed as potential mechanisms to reduce stigmatisation of mental disorders.

Psychopathic Traits

Individuals with psychopathic traits, including callous-unemotional (CU) traits, represent a phenomenologically and etiologically distinct group with severe externalising problems. Psychopathic traits have been measured in children as young as two-years-old, are moderately stable, are heritable, and associated with atypical affective, cognitive, personality, and social characteristics. Individuals with psychopathic traits are at risk for poor response to treatment, however, some data suggest that parent management training interventions for youth with psychopathic traits early in development may have promise.

Developmental Course

ADHD often precedes the onset of ODD, and approximately half of children with ADHD, combined type also have ODD. ODD is a risk factor for CD and frequently precedes the onset of CD symptoms. Children with an early onset of CD symptoms, with at least one symptom before age 10 years, are at risk for more severe and persistent antisocial behaviour continuing into adulthood. Youth with early-onset conduct problems are particularly at risk for ASPD (note that an onset of CD prior to age 15 is part of the diagnostic criteria for ASPD), whereas CD is typically limited to adolescence when youth’s CD symptoms begin during adolescence.

Treatment

Despite recent initiatives to study psychopathology along dimensions of behaviour and neurobiological indices, which would help refine a clearer picture of the development and treatment of externalising disorders, the majority of research has examined specific mental disorders. Thus, best practices for many externalising disorders are disorder-specific. For example, substance use disorders themselves are very heterogeneous and their best-evidenced treatment typically includes cognitive behavioural therapy, motivational interviewing, and a substance disorder-specific detoxification or psychotropic medication treatment component. The best-evidenced treatment for childhood conduct and externalising problems more broadly, including youth with ADHD, ODD, and CD, is parent management training, a form of cognitive behavioural therapy. Additionally, individuals with ADHD, both youth and adults, are frequently treated with stimulant medications (or alternative psychotropic medications), especially if psychotherapy alone has not been effective in managing symptoms and impairment. Psychotherapy and medication interventions for individuals with severe, adult forms of antisocial behaviour, such as antisocial personality disorder, have been mostly ineffective. An individual’s comorbid psychopathology may also influences the course of treatment for an individual.

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What is Milnacipran?

Published on 11/27/2024 by Andrew Marshall2 Comments

Introduction

Milnacipran (trade names Ixel, Savella, Dalcipran, Toledomin) is a serotonin–norepinephrine reuptake inhibitor (SNRI) used in the clinical treatment of fibromyalgia. It is not approved for the clinical treatment of major depressive disorder in the US, but it is in other countries.

Brief History

Milnacipran was first approved for the treatment of major depressive episodes in France in December 1996. It is currently marketed (as Ixel) for this indication in over 45 countries worldwide including several European countries such as Austria, Bulgaria, Finland, France, Portugal, and Russia. It is also available in Japan (as Toledomin) and Mexico (as Dalcipran). Cypress Bioscience bought the exclusive rights for approval and marketing of the drug for any purpose in the United States and Canada in 2003 from the manufacturer Laboratoires Pierre Fabre.

In January 2009 the US Food and Drug Administration (FDA) approved milnacipran (under the brand name Savella) only for the treatment of fibromyalgia, making it the third medication approved for this purpose in the United States. In July and November 2009, the European Medicines Agency refused marketing authorisation for a milnacipran product (under the brand name Impulsor) for the treatment of fibromyalgia.

Medical Uses

Depression

In a pooled analysis of 7 comparative trials with imipramine, milnacipran and imipramine were shown to have comparable efficacy while milnacipran was significantly better tolerated. A pooled analysis of studies comparing milnacipran and SSRIs concluded a superior efficacy for milnacipran with similar tolerability for milnacipran and SSRIs. A more recent meta-analysis of 6 studies involving more than 1,000 patients showed no distinction between milnacipran and SSRIs in efficacy or discontinuation rates, including discontinuation for side effects or lack of efficacy. A meta-analysis of a total of 16 randomised controlled trials with more than 2200 patients concluded that there were no statistically significant differences in efficacy, acceptability and tolerability when comparing milnacipran with other antidepressant agents. However, compared with TCAs, significantly fewer patients taking milnacipran dropped out due to adverse events. As with other antidepressants, 1 to 3 weeks may elapse before significant antidepressant action becomes clinically evident.

Impulse Control

Milnacipran was found to improve impulse control in rats, which has been linked to its activation of D₁-like receptors in the infralimbic cortex. However, high doses of milnacipran did not show this effect, likely because of increased dopamine in the nucleus accumbens. Depression has been associated with increased impulsivity.

Fibromyalgia

During its development for fibromyalgia, milnacipran was evaluated utilizing a composite responder approach. To be considered as a responder for the composite ‘treatment of fibromyalgia’ endpoint, each patient had to show concurrent and clinically meaningful improvements in pain, physical function, and global impression of disease status. A systematic review in 2015 showed moderate relief for a minority of people with fibromyalgia. Milnacipran was associated with increased adverse events when discontinuing use of the drug.

Social Anxiety

There is some evidence that milnacipran may be effective for social anxiety.

Contraindications

Administration of milnacipran should be avoided in individuals with the following:

Known hypersensitivity to milnacipran (absolute contraindication)
Patients under 15 years of age (no sufficient clinical data)
Concomitant treatment with irreversible MAO inhibitors (e.g. tranylcypromine (Parnate), phenelzine (Nardil), >10 mg selegiline) or digitalis glycosides is an absolute contraindication.

Administration of milnacipran should be done with caution in individuals with the following:

Concomitant treatment with parenteral epinephrine, norepinephrine, with clonidine, reversible MAO-A Inhibitors (such as moclobemide, toloxatone) or 5-HT_1D-agonists (e.g. triptan migraine drugs)
Advanced renal disease (decreased dosage required)
Hypertrophy of the prostate gland (possibly urination hesitancy induced), with hypertension and heart disease (tachycardia may be a problem) as well as with open angle glaucoma.

Milnacipran should not be used during pregnancy because it may cross the placenta barrier and no clinical data exists on harmful effects in humans and animal studies. Milnacipran is contraindicated during lactation because it is excreted in the milk, and it is not known if it is harmful to the newborn.

Side Effects

The most frequently occurring adverse reactions (≥ 5% and greater than placebo) were nausea, headache, constipation, dizziness, insomnia, hot flush, hyperhydrosis, vomiting, palpitations, heart rate increase, dry mouth, and hypertension [FDA Savella prescribing information]. Milnacipran can have a significant impact on sexual functions, including both a decrease in sexual desire and ability. Milnacipran can cause pain of the testicles in men. The incidence of cardiovascular and anticholinergic side effects was significantly lower compared to TCAs as a controlled study with over 3,300 patients revealed. Elevation of liver enzymes without signs of symptomatic liver disease has been infrequent. Mood swing to mania has also been seen and dictates termination of treatment. In psychotic patients emergence of delirium has been noticed. Milnacipran has a low incidence of sedation but improves sleep (both duration and quality) in depressed patients. In agitated patients or those with suicidal thoughts additive sedative/anxiolytic treatment is usually indicated. However, several studies found that there seems to be no “activation syndrome” and no increased risk of suicidality in milnacipran therapy; instead it is said to reduce suicidality along with depressive symptoms.

Interactions

MAOIs — hyperserotonergia (serotonin syndrome), potentially lethal hypertensive crisis.
5-HT1 receptor agonists — coronary vasoconstriction with risk of angina pectoris and myocardial infarction.
Epinephrine, norepinephrine (also in local anaesthesia) — hypertensive crisis and/or possible cardiac arrhythmia.
Clonidine — antihypertensive action of clonidine may be antagonised
Digitalis — haemodynamic actions increased.
Triptans — there have been rare postmarketing reports of hyperserotonergia (serotonin syndrome). If concomitant treatment of milnacipran with a triptan is clinically warranted, careful observation of patient is advised when starting or increasing dosages.
Alcohol — no interactions known; however, because milnacipran can cause mild elevation of liver enzymes, caution is recommended; the FDA advises against the concomitant use of alcohol and milnacipran.

Pharmacology

Pharmacodynamics

Milnacipran inhibits the reuptake of serotonin and norepinephrine in an approximately 2:1 ratio, respectively. Milnacipran exerts no significant actions on H₁, α₁, D₁, D₂, and mACh receptors, nor on benzodiazepine and opioid binding sites.

Recently, levomilnacipran, the levorotatory enantiomer of milnacipran, has been found to act as an inhibitor of beta-site amyloid precursor protein cleaving enzyme-1 (BACE-1), which is responsible for β-amyloid plaque formation, and hence may be a potentially useful drug in the treatment of Alzheimer’s disease. Other BACE-1 inhibitors, such as CTS-21166 (ASP1720), MK-8931, and AZD3293 were in clinical trials for the treatment of Alzheimer’s disease, but in both cases clinical trials were halted due to a lack of positive evidence of a favourable benefit to risk ratio and both were considered unlikely to return satisfactory results.

Pharmacokinetics

Milnacipran is well absorbed after oral dosing and has a bioavailability of 85%. Meals do not have an influence on the rapidity and extent of absorption. Peak plasma concentrations are reached 2 hours after oral dosing. The elimination half-life of 8 hours is not increased by liver impairment and old age, but by significant renal disease. Milnacipran is conjugated to the inactive glucuronide and excreted in the urine as unchanged drug and conjugate. Only traces of active metabolites are found.

This page is based on the copyrighted Wikipedia article < https://en.wikipedia.org/wiki/Milnacipran >; it is used under the Creative Commons Attribution-ShareAlike 3.0 Unported License (CC-BY-SA). You may redistribute it, verbatim or modified, providing that you comply with the terms of the CC-BY-SA.

An Overview of Normalisation

Published on 11/26/2024 by Andrew MarshallLeave a comment

Introduction

“The normalization principle means making available to all people with disabilities patterns of life and conditions of everyday living which are as close as possible to the regular circumstances and ways of life or society.” (Nirje, 1982).

Normalisation is a rigorous theory of human services that can be applied to disability services. Normalisation theory arose in the early 1970s, towards the end of the institutionalisation period in the US; it is one of the strongest and long lasting integration theories for people with severe disabilities.

Definition

Normalisation involves the acceptance of some people with disabilities, with their disabilities, offering them the same conditions as are offered to other citizens. It involves an awareness of the normal rhythm of life – including the normal rhythm of a day, a week, a year, and the life-cycle itself (e.g. celebration of holidays; workday and weekends). It involves the normal conditions of life – housing, schooling, employment, exercise, recreation and freedom of choice previously denied to individuals with severe, profound, or significant disabilities.

Wolf Wolfensberger’s definition is based on a concept of cultural normativeness: “Utilization of a means which are as culturally normative as possible, in order to establish and/or maintain personal behaviours and characteristics that are as culturally normative as possible.” Thus, for example, “medical procedures” such as shock treatment or restraints, are not just punitive, but also not “culturally normative” in society. His principle is based upon social and physical integration, which later became popularised, implemented and studied in services as community integration encompassing areas from work to recreation and living arrangement.

Theoretical Foundations

This theory includes “the dignity of risk”, rather than an emphasis on “protection” and is based upon the concept of integration in community life. The theory is one of the first to examine comprehensively both the individual and the service systems, similar to theories of human ecology which were competitive in the same period.

The theory undergirds the deinstitutionalisation and community integration movements, and forms the legal basis for affirming rights to education, work, community living, medical care and citizenship. In addition, self-determination theory could not develop without this conceptual academic base to build upon and critique.

The theory of social role valorisation is closely related to the principle of normalisation having been developed with normalisation as a foundation. This theory retains most aspects of normalisation concentrating on socially valued roles and means, in socially valued contexts to achieve integration and other core quality of life values.

Brief History

The principle of normalisation was developed in Scandinavia during the sixties and articulated by Bengt Nirje of the Swedish Association for Retarded Children with the US human service system a product of Wolf Wolfensberger formulation of normalisation and evaluations of the early 1970s. According to the history taught in the 1970s, although the “exact origins are not clear”, the names Bank-Mikkelson (who moved the principle to Danish law), Grunewald, and Nirje from Scandinavia (later Ministry of Community and Social Services in Toronto, Canada) are associated with early work on this principle. Wolfensberger is credited with authoring the first textbook as a “well-known scholar, leader, and scientist” and Rutherford H. (Rud) Turnbull III reports that integration principles are incorporated in US laws.

Academe

The principle was developed and taught at the university level and in field education during the seventies, especially by Wolf Wolfensberger of the United States, one of the first clinical psychologists in the field of mental retardation, through the support of Canada and the National Institute on Mental Retardation (NIMR) and Syracuse University in New York State. PASS and PASSING marked the quantification of service evaluations based on normalisation, and in 1991 a report was issued on the quality of institutional and community programmes in the US and Canada based on a sample of 213 programmes in the US, Canada and the United Kingdom.

Significance in Structuring Service Systems

Normalisation has had a significant effect on the way services for people with disabilities have been structured throughout the UK, Europe, especially Scandinavia, North America, Israel, Australasia (e.g. New Zealand) and increasingly, other parts of the world. It has led to a new conceptualisation of disability as not simply being a medical issue (the medical model which saw the person as indistinguishable from the disorder, though Wolfensberger continued to use the term into the 2000s, but as a social situation as described in social role valorisation.

Government reports began from the 1970s to reflect this changing view of disability (Wolfensberger uses the term devalued people), e.g. the NSW Anti-Discrimination Board report of 1981 made recommendations on:

“the rights of people with intellectual handicaps to receive appropriate services, to assert their rights to independent living so far as this is possible, and to pursue the principle of normalization.”

The New York State Quality of Care Commission also recommended education based upon principles of normalisation and social role valorisation addressing “deep-seated negative beliefs of and about people with disabilities”. Wolfensberger’s work was part of a major systems reform in the US and Europe of how individuals with disabilities would be served, resulting in the growth in community services in support of homes, families and community living.

Critical Ideology of Human Services

Normalisation is often described in articles and education texts that reflect deinstitutionalisation, family care or community living as the ideology of human services. Its roots are European-American, and as discussed in education fields in the 1990s, reflect a traditional gender relationship-position (Racino, 2000), among similar diversity critiques of the period (i.e. multiculturalism). Normalisation has undergone extensive reviews and critiques, thus increasing its stature through the decades often equating it with school mainstreaming, life success and normalisation, and deinstitutionalisation.

In Contemporary Society

In the United States, large public institutions housing adults with developmental disabilities began to be phased out as a primary means of delivering services in the early 1970s and the statistics have been documented until the present day (2015) by David Braddock and his colleagues. As early as the late 1960s, the normalisation principle was described to change the pattern of residential services, as exposes occurred in the US and reform initiatives began in Europe. These proposed changes were described in the leading text by the President’s Committee on Mental Retardation (PCMR) titled: “Changing Patterns in Residential Services for the Mentally Retarded” with leaders Burton Blatt, Wolf Wolfensberger, Bengt Nirje, Bank-Mikkelson, Jack Tizard, Seymour Sarason, Gunnar Dybwad, Karl Gruenwald, Robert Kugel, and lesser known colleagues Earl Butterfield, Robert E. Cooke, David Norris, H. Michael Klaber, and Lloyd Dunn.

Deinstitutionalisation and Community Development

The impetus for this mass deinstitutionalisation was typically complaints of systematic abuse of the patients by staff and others responsible for the care and treatment of this traditionally vulnerable population with media and political exposes and hearings. These complaints, accompanied by judicial oversight and legislative reform, resulted in major changes in the education of personnel and the development of principles for conversion models from institutions to communities, known later as the community paradigms. In many states the recent process of deinstitutionalisation has taken 10–15 years due to a lack of community supports in place to assist individuals in achieving the greatest degree of independence and community integration as possible. Yet, many early recommendations from 1969 still hold such as financial aid to keep children at home, establishment of foster care services, leisure and recreation, and opportunities for adults to leave home and attain employment (Bank-Mikkelsen, p.234-236, in Kugel & Wolfensberger, 1969).

Community Supports and Community Integration

A significant obstacle in developing community supports has been ignorance and resistance on the part of “typically developed” community members who have been taught by contemporary culture that “those people” are somehow fundamentally different and flawed and it is in everyone’s best interest if they are removed from society (this developing out of 19th Century ideas about health, morality, and contagion). Part of the normalization process has been returning people to the community and supporting them in attaining as “normal” as life as possible, but another part has been broadening the category of “normal” (sometimes taught as “regular” in community integration, or below as “typical”) to include all human beings. In part, the word “normal” continues to be used in contrast to “abnormal”, a term also for differentness or out of the norm or accepted routine (e.g. middle class).

Contemporary Services and Workforces

In 2015, public views and attitudes continue to be critical both because personnel are sought from the broader society for fields such as mental health and contemporary community services continue to include models such as the international “emblem of the group home” for individuals with significant disabilities moving to the community. Today, the US direct support workforce, associated with the University of Minnesota, School of Education, Institute on Community Integration can trace its roots to a normalisation base which reflected their own education and training at the next generation levels.

People with disabilities are not to be viewed as sick, ill, abnormal, subhuman, or unformed, but as people who require significant supports in certain (but not all) areas of their life from daily routines in the home to participation in local community life. With this comes an understanding that all people require supports at certain times or in certain areas of their life, but that most people acquire these supports informally or through socially acceptable avenues. The key issue of support typically comes down to productivity and self-sufficiency, two values that are central to society’s definition of self-worth. If we as a society were able to broaden this concept of self-worth perhaps fewer people would be labelled as “disabled.”

Contemporary Views on Disability

During the mid to late 20th century, people with disabilities were met with fear, stigma, and pity. Their opportunities for a full productive life were minimal at best and often emphasis was placed more on personal characterises that could be enhanced so the attention was taken from their disability. Linkowski developed the Acceptance of Disability Scale (ADS) during this time to help measure a person’s struggle to accept disability. He developed the ADS to reflect the value change process associated with the acceptance of loss theory. In contrast to later trends, the current trend shows great improvement in the quality of life for those with disabilities. Sociopolitical definitions of disability, the independent living movement, improved media and social messages, observation and consideration of situational and environmental barriers, passage of the Americans with Disabilities Act of 1990 have all come together to help a person with disability define their acceptance of what living with a disability means.

Bogdan and Taylor’s (1993) acceptance of sociology, which states that a person need not be defined by personal characterises alone, has become influential in helping persons with disabilities to refuse to accept exclusion from mainstream society. According to some disability scholars, disabilities are created by oppressive relations with society, this has been called the social creationist view of disability. In this view, it is important to grasp the difference between physical impairment and disability. In the article The Mountain written by Eli Clare, Michael Oliver defines impairment as lacking part of or all of a limb, or having a defective limb, organism or mechanism of the body and the societal construct of disability; Oliver defines disability as the disadvantage or restriction of activity caused by a contemporary social organisation which takes no or little account of people who have physical (and/or cognitive/developmental/mental) impairments and thus excludes them from the mainstream of society. In society, language helps to construct reality, for instance, societies way of defining disability which implies that a disabled person lacks a certain ability, or possibility, that could contribute to her personal well-being and enable her to be a contributing member of society versus abilities and possibilities that are considered to be good and useful.

Personal Wounds, Quality of Life and Social Role Valorisation

However, the perspective of Wolfensberger, who served as associated faculty with the Rehabilitation Research and Training Centre on Community Integration (despite concerns of federal funds), is that people he has known in institutions have “suffered deep wounds”. This view, reflected in his early overheads of PASS ratings, is similar to other literature that has reflected the need for hope in situations where aspirations and expectations for quality of life had previously been very low (e.g. brain injury, independent living). Normalisation advocates were among the first to develop models of residential services, and to support contemporary practices in recognising families and supporting employment. Wolfensberger himself found the new term social role valorisation to better convey his theories (and his German Professorial temperament, family life and beliefs) than the constant “misunderstandings” of the term normalisation!

Related Theories and Development

Related theories on integration in the subsequent decades have been termed community integration, self-determination or empowerment theory, support and empowerment paradigms, community building, functional-competency, family support, often not independent living (supportive living),and in 2015, the principle of inclusion which also has roots in service fields in the 1980s.

Misconceptions

Normalisation is so common in the fields of disability, especially intellectual and developmental disabilities, that articles will critique normalisation without ever referencing one of three international leaders: Wolfensberger, Nirje, and Bank Mikkelson or any of the women educators (e.g. Wolfensberger’s Susan Thomas; Syracuse University colleagues Taylor, Biklen or Bogdan; established women academics (e.g. Sari Biklen); or emerging women academics, Traustadottir, Shoultz or Racino in national research and education centres (e.g. Hillyer, 1993). In particular, this may be because Racino (with Taylor) leads an international field on community integration, a neighbouring related concept to the principle of normalisation, and was pleased to have Dr. Wolf Wolfensberger among Centre Associates. Thus it is important to discuss common misconceptions about the principle of normalisation and its implications among the provider-academic sectors:

a) Normalisation does not mean making people normal – forcing them to conform to societal norms.

Wolfensberger himself, in 1980, suggested “Normalizing measures can be offered in some circumstances, and imposed in others.” This view is not accepted by most people in the field, including Nirje. Advocates emphasize that the environment, not the person, is what is normalized, or as known for decades a person-environment interaction.

Normalization is very complex theoretically, and Wolf Wolfensberger’s educators explain his positions such as the conservatism corollary, deviancy unmaking, the developmental model (see below) and social competency, and relevance of social imagery, among others.

b) Normalisation does not support “dumping” people into the community or into schools without support.

Normalisation has been blamed for the closure of services (such as institutions) leading to a lack of support for children and adults with disabilities. Indeed, normalisation personnel are often affiliated with human rights groups. Normalisation is not deinstitutionalisation, though institutions have been found to not “pass” in service evaluations and to be the subject of exposes. Normalisation was described early as alternative special education by leaders of the deinstitutionalisation movement.

However support services which facilitate normal life opportunities for people with disabilities – such as special education services, housing support, employment support and advocacy – are not incompatible with normalization, although some particular services (such as special schools) may actually detract from rather than enhance normal living bearing in mind the concept of normal ‘rhythms’ of life.

c) Normalisation supports community integration, but the principles vary significantly on matters such as gender and disability with community integration directly tackling services in the context of race, ethnicity, class, income and gender.

Some misconceptions and confusions about normalisation are removed by understanding a context for this principle. There has been a general belief that ‘special’ people are best served if society keeps them apart, puts them together with ‘their own kind, and keep them occupied. The principle of normalisation is intended to refute this idea, rather than to deal with subtlety around the question of ‘what is normal?’ The principle of normalisation is congruent in many of its features with “community integration” and has been described by educators as supporting early mainstreaming in community life.

d) Normalisation supports adult services by age range, not “mental age”, and appropriate services across the lifespan.

Arguments about choice and individuality, in connection with normalisation, should also take into account whether society, perhaps through paid support staff, has encouraged them into certain behaviours. For example, in referring to normalisation, a discussion about an adult’s choice to carry a doll with them must be influenced by a recognition that they have previously been encouraged in childish behaviours, and that society currently expects them to behave childishly. Most people who find normalisation to be a useful principle would hope to find a middle way – in this case, an adult’s interest in dolls being valued, but with them being actively encouraged to express it in an age-appropriate way (e.g. viewing museums and doll collections), with awareness of gender in toy selection (e.g. see cars and motorsports), and discouraged from behaving childishly and thus accorded the rights and routines only of a “perpetual child”. However, the principle of normalisation is intended also to refer to the means by which a person is supported, so that (in this example) any encouragement or discouragement offered in a patronising or directive manner is itself seen to be inappropriate.

e) Normalisation is a set of values, and early on (1970s) was validated through quantitative measures (PASS, PASSING).

Normalisation principles were designed to be measured and ranked on all aspects through the development of measures related to homes, facilities, programmes, location (i.e. community development), service activities, and life routines, among others. These service evaluations have been used for training community services personnel, both in institutions and in the community.

Normalisation as the basis for education of community personnel in Great Britain is reflected in a 1990s reader, highlighting Wolf Wolfensberger’s moral concerns as a Christian, right activist, side-by-side (“How to Function with Personal Model Coherency in a Dysfunctional (Human Service) World”) with the common form of normalisation training for evaluations of programmes. Community educators and leaders in Great Britain and the US of different political persuasions include John O’Brien and Connie Lyle O’Brien, Paul Williams and Alan Tyne, Guy Caruso and Joe Osborn, Jim Mansell and Linda Ward, among many others.

References

Nirje, B. (1982) The basis and logic of the normalisatioprinciple, Bengt Nirje, Sixth International Congress of IASSMD, Toronto.

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