Category: Mental Health

What is Vicarious Traumatisation?

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Introduction

Vicarious trauma (VT) was a term coined by McCann and Pearlman that is used to describe how working with traumatised clients and the effect it has on trauma therapists.

Previously, the phenomenon was referred to as secondary traumatic stress coined by Dr. Charles Figley. The theory behind VT is that the therapist has a profound world change and is permanently altered by the interaction of empathetic bonding with a client. This change is thought to have three conditional requirements: empathic engagement and exposure to graphic and traumatising material, the therapist being exposed to human cruelty, and re-enactment of trauma within the therapy process. This change can produce changes in a therapist’s sense of spirituality, worldview, and self-identity.

VT is still a subject of debate by theorists, with some saying it is based on the concept of countertransference (refer to transference), burnout, and compassion fatigue. McCann and Pearlman argue, however, that there is probably a relationship between these constructs, but VT is unique and distinct.

As time has progressed, the term VT has expanded to more than just indirect trauma experienced by trauma therapists and has come to include many more populations, although the phenomenon is still evolving.

Signs and Symptoms

The symptoms of vicarious trauma align with the symptoms of primary, actual trauma. When helping professionals attempt to connect with their clients/victims emotionally, the symptoms of VT can create emotional disturbance such as feelings of sadness, grief, irritability and mood swings. The signs and symptoms of VT parallel those of direct trauma, although they tend to be less intense. Workers who have personal trauma histories may be more vulnerable to VT, although the research findings on this point are mixed.

Common signs and symptoms include, but are not limited to:

  • Social withdrawal;
  • Mood swings;
  • Aggression;
  • Greater sensitivity to violence;
  • Somatic symptoms;
  • Sleep difficulties;
  • Intrusive imagery;
  • Cynicism;
  • Sexual difficulties;
  • Difficulty managing boundaries with clients; and
  • Core beliefs and resulting difficulty in relationships reflecting problems with security, trust, esteem, intimacy, and control.

Contributing Factors

VT, conceptually based in constructivist self-development theory, arises from an interaction between individuals and their situations. This means that the individual helper’s personal history (including prior traumatic experiences), coping strategies, and support network, among other things, all interact with his or her situation (including work setting, the nature of the work s/he does, the specific clientele served, etc.), to give rise to individual expressions of vicarious trauma. This in turn implies the individual nature of responses or adaptations to VT as well as individual ways of coping with and transforming it. Some have postulated that this traumatisation occurs when one’s view of the world or a feeling of safety is shattered by hearing about the experiences of their clients. This exposure to trauma, however indirectly, can cause an interruption to the daily functioning of the clinician reducing their effectiveness.

Anything that interferes with the helper’s ability to fulfil their responsibility to assist traumatised clients can contribute to vicarious trauma. Many human service workers report that administrative and bureaucratic factors that impediment to their effectiveness influence work satisfaction. Negative aspects of the organisation as a whole, such as reorganisation, downsizing in the name of change management and a lack of resources in the name of lean management, contribute to burned-out workers.

Vicarious trauma has also been attributed to the stigmatisation of mental health care among service providers. Stigma leads to an inability to engage in self care and eventually the service provider may reach burnout, and become more likely to experience VT. The research has also begun to show that vicarious trauma is more prominent in those with a prior history of trauma and adversity. Research indicates that a mental health provider’s defence style might pose as a risk factor for VT. Mental health providers with self-sacrificing defence styles have been found to experience increased VT.

Research has demonstrated that females are more likely to develop secondary traumatic stress than males and counsellors not in private practice are more likely to develop secondary traumatic stress. Those with stronger counsellor professional identity (CPI) experience less secondary traumatic stress as well.

Specifically, in emergency medical service (EMS) personnel, previous veteran status increased likelihood of experiencing VT.

While the term “vicarious trauma” has been used interchangeably with “compassion fatigue”, “secondary traumatic stress disorder,” “burnout,” “countertransference,” and “work-related stress,” there are important differences. These include the following:

  • Unlike compassion fatigue, VT is a theory-based construct. This means that observable symptoms can serve as the starting for a process of discovering contributing factors and related signs, symptoms, and adaptations. VT also specifies psychological domains that can be affected, rather than specific symptoms that may arise. This specificity may more accurately guide preventive measures and interventions, and allow for the accurate development of interventions for multiple domains (such as changes in the balance between psychotherapy and other work-related tasks and changes in self-care practices).
  • Countertransference is the psychotherapist’s response to a particular client. VT refers to responses across clients, across time.
  • Unlike burnout, countertransference, and work-related stress, VT is specific to trauma workers. This means that the helper will experience trauma-specific difficulties, such as intrusive imagery, that are not part of burnout or countertransference. The burnout and VT constructs overlap, specifically regarding emotional exhaustion. A worker may experience both VT and burnout, and each has its own remedies. VT and countertransference may also co-occur, intensifying each other.
  • Unlike VT, countertransference can be a very useful tool for psychotherapists, providing them with important information about their clients.
  • Work-related stress is a generic term without a theoretical basis, specific signs and symptoms or contributing factors, or remedies. Burnout and VT can co-exist. Countertransference responses may potentiate VT.
  • Vicarious post-traumatic growth, unlike VT, is not a theory-based construct but rather is based on self-reported signs.
  • Body-centred countertransference.

Mechanism

The posited mechanism for VT is empathy. Different forms of empathy may result in different effects on helpers. Batson and colleagues have conducted research that might inform trauma helpers about ways to manage empathic connection constructively. If helpers identify with their trauma survivor clients and immerse themselves in thinking about what it would be like if these events happened to them, they are likely to experience personal distress, feeling upset, worried, distressed. On the other hand, if helpers instead imagine what the client experienced, they may be more likely to feel compassion and moved to help.

Measurement

Over the years, VT has been measured in a wide variety of ways. VT is a multifaceted construct requiring a multifaceted assessment. More specifically, the aspects of VT that would need to be measured for a complete assessment include self capacities, ego resources, frame of reference (identity, world view, and spirituality), psychological needs, and trauma symptoms. Measuring of some of these elements of VT exist, including the following:

  • Psychological needs, using the Trauma and Attachment Belief Scale.
  • Self capacities, using the Inner Experience Questionnaire and/or the Inventory of Altered Self-Capacities.
  • Trauma symptoms, using the PTSD Checklist, Impact of Events Scale, Impact of Events Scale-Revised, children’s revised Impact of Events Scale (Arabic Version), Trauma Symptom Inventory, Detailed Assessment of Posttraumatic Stress, and/or the World Assumptions Scale.
  • Secondary Traumatic Stress Scale is a 17 item, 5-point Likert scale that distinguishes between PTSD measures by framing the questions as stressors from exposure to clients.
  • The Professional Quality of Life (ProQol) version 5. This assessment has 30 questions on a 5-point Likert scale and measures compassion fatigue and secondary trauma.

Addressing

VT is not the responsibility of clients or systems, although institutions that provide trauma-related services bear a responsibility to create policies and work settings that facilitate staff (and therefore client) well-being. Each trauma worker is responsible for self-care, working reflectively, and engaging in regular, frequent, trauma-informed professional confidential consultation.

There are many ways of addressing VT. All involve awareness, balance, and connection. One set of approaches can be grouped together as coping strategies. These include, for example, self-care, rest, escape, and play. A second set of approaches can be grouped as transforming strategies. Transforming strategies aim to help workers create community and find meaning through the work. Within each category, strategies may be applied in one’s personal life and professional life. Organisations that provide trauma services can also play a role in mitigating VT.

Research shows that many simple things increase happiness and this aids to lessen the impact of VT. People who are more socially connected tend to be happier. People who consciously practice gratitude are also shown happier. Creative endeavours that are completely detached with work also increase happiness. Self-care practices like yoga, qigong, and sitting meditation are found to be helpful for those who practice. The Harvard Business Review in a case study regarding to traumatisation stated that it is essential to create an organisational culture in which it is cool to be a social worker or a counsellor, where these professionals are empowered to influence the workplace issues, the strategy of human services in both corporate and care services. Additionally, research indicates clinicians who are exposed to VT are in need of targeted interventions that will boost their resilience. Findings have show interventions such as respite, increasing self efficacy, and having appropriate professional support buffer against the effects of vicarious trauma.

Individuals Found to Experience Vicarious Trauma

Children

Children have been found to experience VT from the traumas experienced by their caregivers and peers. In children the following factors have been found to predict vicarious trauma symptoms:

  • Socioeconomic status.
  • Gender (girls more than boys).
  • Race.
  • Witnessing the trauma directly.
  • Caregiver warmth and hostility.

Foster Parents

Foster parents have been found to experience VT related to the trauma of those they care for. Several studies have found that foster parents experience vicarious trauma, burnout, and compassion fatigue and report that emotional disengagement (a common symptom of VT) is a coping strategy.

Counsellors and Other Mental Health Providers

Counsellors and other mental health professional have been found to experience vicarious trauma when working with veterans and others that have experienced trauma. Some of the factors that predict vicarious trauma severity include:

  • Professional trauma.
  • Level of peer supervision.
  • Social support availability.
  • Emotional coping strategies.
  • Long hours and high caseloads.
  • Population served by the clinician.
  • Defensc mechanisms of the therapist.

American Muslims

After the terrorist attack on the World Trade Centre in the United States, many Muslims were relegated with terrorists and attacks of violence were perpetrated against them. This caused many individuals in this community to experience VT and added to a feeling of worry and being unsafe. Those feeling a stronger sense of religious identity were more likely to experience VT.

What is Transportation Theory (Psychology)?

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Introduction

Narrative transportation theory proposes that when people lose themselves in a story, their attitudes and intentions change to reflect that story.

The mental state of narrative transportation can explain the persuasive effect of stories on people, who may experience narrative transportation when certain contextual and personal preconditions are met, as Green and Brock postulate for the transportation-imagery model. As Van Laer, de Ruyter, Visconti, and Wetzels elaborate further, narrative transportation occurs whenever the story receiver experiences a feeling of entering a world evoked by the narrative because of empathy for the story characters and imagination of the story plot.

Defining the Field

Deighton, Romer, and McQueen  anticipate the construct of narrative transportation by arguing that a story invites story receivers into the action it portrays and, as a result, makes them lose themselves in the story. Gerrig was the first to coin the notion of narrative transportation within the context of novels. Using travel as a metaphor for reading, he conceptualizes narrative transportation as a state of detachment from the world of origin that the story receiver – in his words, the traveller – experiences because of his or her engrossment in the story, a condition that Green and Brock later describe as the story receiver’s experience of being carried away by the story. Notably, the state of narrative transportation makes the world of origin partially inaccessible to the story receiver, thus marking a clear separation in terms of here/there and now/before, or narrative world/world of origin.

Relevant Features

Most research on narrative transportation follows the original definition of the construct. Scholars in the field constantly reaffirm the relevance of three features.

  1. Narrative transportation requires that people process stories – the acts of receiving and interpreting.
  2. Story receivers become transported through two main components: empathy and mental imagery. Empathy implies that story receivers try to understand the experience of a story character, that is, to know and feel the world in the same way. Thus, empathy offers an explanation for the state of detachment from the world of origin that is narrative transportation. In mental imagery, story receivers generate vivid images of the story plot, such that they feel as though they are experiencing the events themselves.
  3. When transported, story receivers lose track of reality in a physiological sense.

In accordance with these features, Van Laer et al.  define narrative transportation as the extent to which:

  • An individual empathizes with the story characters; and
  • The story plot activates their imagination,

Which leads them to experience suspended reality during story reception.

Similar Constructs

Narrative transportation is a form of experiential response to narratives and thus is similar to other constructs, such as absorption, narrative involvement, identification, optimal experience or flow, and immersion. Yet several subtle, critical differences exist. Absorption refers to a personality trait or general tendency to be immersed in life experiences; transportation is an engrossing temporary experience. Flow is a more general construct (i.e. people can experience flow in a variety of activities), whereas transportation specifically entails empathy and mental imagery, which do not occur in flow experiences. Phillips and McQuarrie demonstrate that immersion is primarily an experiential response to aesthetic and visual elements of images, whereas narrative transportation relies on a story with plot and characters, features that are not present in immersion. Identification emphasizes the involvement with story characters, while narrative transportation is concerned with the involvement with the narrative as a whole.

Narrative Persuasion

Since narrative transportation’s conceptualisation, research has demonstrated that the transported “traveller” can return changed by the journey. Subsequent studies have confirmed that a story can engross the story receiver in a transformational experience, whose effects are strong and long-lasting. The transformation that narrative transportation achieves is persuasion of the story receiver. More specifically, Van Laer et al.’s literature review reveals that narrative transportation can cause affective and cognitive responses, beliefs, and attitude and intention changes. However, the processing pattern of narrative transportation is markedly different from that in well-established models of persuasion.

A 2016 meta-analysis found significant, positive narrative persuasion (i.e. narrative-consistent) effects for attitudes, beliefs, intentions and behaviours.

Rival Models

Before 2000, dual-process models of persuasion, especially the elaboration likelihood model and heuristic-systematic model, dominated persuasion research. These models attempt to explain why people accept or reject message claims. According to these models, the determination of a claim’s acceptability can result from careful evaluation of the arguments presented or from reliance on superficial cues, such as the presence of an expert. Whether receivers scrutinise a message depends on the extent to which they are able and motivated to process it systematically. As important variables, these models include empathy, familiarity, involvement, and the number and nature of thoughts the message evokes. If these variables are mainly positive, the receiver’s attitudes and intentions tend to be more positive; if the variables are predominantly negative, the resulting attitudes and intentions are more negative. These variables also exist in narrative persuasion.

Differences between Analytical and Narrative Persuasion

Analytical persuasion and narrative persuasion differ depending on the role of involvement. In analytical persuasion, involvement depends on the extent to which the message has personally relevant consequences for a receiver’s money, time, or other resources. If these consequences are sufficiently severe, receivers evaluate the arguments carefully and generate thoughts related to the arguments. Yet, as Slater notes, even though severe consequences for stories are relatively rare, “viewers or readers of an entertainment narrative typically appear to be far more engrossed in the message.” This type of involvement, or narrative transportation, is arguably the crucial determinant of narrative persuasion.

Though the dual-process models provide a valid description of analytical persuasion, they do not encompass narrative persuasion. Analytical persuasion refers to attitudes and intentions developed from processing messages that are overtly persuasive, such as most lessons in science books, news reports, and speeches. However, narrative persuasion refers to attitudes and intentions developed from processing narrative messages that are not overtly persuasive, such as novels, movies, or video games. Addressing the strength and duration of the persuasive effects of processing stories, narrative transportation is a mental state that produces enduring persuasive effects without careful evaluation of arguments. Transported story receivers are engrossed in a story in a way that neither is inherently critical nor involves great scrutiny.

Sleeper Effect

Narrative transportation seems to be more unintentionally affective than intentionally cognitive in nature. This way of processing leads to potentially increasing and long-lasting persuasive effects. Appel and Richter use the term “Sleeper effect” to describe this paradoxical property of narrative transportation over time, which consists of a more pronounced change in attitudes and intentions and a greater certainty that these attitudes and intentions are correct.

Plausible explanations for the sleeper effect are twofold:

  1. According to post-structural research, language’s articulation in narrative format is capable not only of mirroring reality but also of constructing it. As such, stories could cause profound and durable persuasion of the transported story receiver as a result of his or her progressive internalization. When stories transport story receivers, not only do they present a narrative world but, by reframing the story receiver’s language, they also durably change the world to which the story receiver returns after the transportation experience.
  2. Research demonstrates that people analyse and retain stories differently from other information formats. For example, Deighton et al. show that analytical advertisements stimulate cognitive responses whereas narrative advertisements are more likely to stimulate affective responses.

Following this line of reasoning, Van Laer et al. define narrative persuasion as:

the effect of narrative transportation, which manifests itself in story receivers’ affective and cognitive responses, beliefs, attitudes, and intentions from being swept away by a story and transported into a narrative world that modifies their perception of their world of origin.

The conceptual distinction between analytical persuasion and narrative persuasion and the theoretical framework of sound interpretation of narrative persuasion both ground the extended transportation-imagery model (ETIM).

Moderators

ETIM contains three methodological factors that moderate the overall effect of narrative transportation, as van Laer, Feiereisen, and Visconti detail. The narrative transportation effect is stronger for stories:

  • In the commercial (vs. non-commercial) domain;
  • By users (vs. professionals); and
  • Received alone (vs. with others).

What is Negative Transference?

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Introduction

Negative transference is the psychoanalytic term for the transference of negative and hostile feelings, rather than positive ones, onto a therapist (or other emotional object).

Refer to Narcissistic Neurosis and Transference Neurosis.

Freud’s Preference

In his pioneering studies of transference phenomena, Freud noted the existence of both positive and negative transferences, while expressing a preference for the former, which he initially saw as a prerequisite for analytic work. Freud considered that “The hostile feelings make their appearance as a rule later than the affectionate ones and behind them”; and more frequently in same-sex than in mixed-sex analytic pairings.

Otto Fenichel pointed out that whereas neurotic aggravations can follow the emergence of a negative transference, so too (paradoxically) can improvements: the patient gets better to spite the therapist for emphasising the patient’s problems.

Later Formulations

Melanie Klein in her disputes with Anna Freud laid much greater emphasis than her opponent on the constructive role to be played by interpreting the negative transference. Jacques Lacan followed her theoretical lead in seeing “the projection of what Melanie Klein calls bad internal objects” as key to “the negative transference that is the initial knot of the analytic drama” – though he himself would face criticism for glossing over the negative transference in training analyses, to keep his analysands in dependence.

W.R.D. Fairbairn was also more interested in the negative than the positive transference, which he saw as a key to the repetition and exposure of unconscious attachments to internalised bad objects. In his wake, object relations theorists have tended to stress the positive results that can emerge from working with the negative transference.

Technical Blocks

  • Fritz Wittels considered the brevity of Wilhelm Stekel’s analyses to be due to his narcissism being unable to endure the emergence of the negative transference.
  • Rollo May saw the flaw in person-centred therapy as a pervasive reluctance to deal with the negative transference.

Literary Analogues

Describing the process of becoming the focus of a paranoid’s hostility, C.P. Snow wrote:

“No one likes being hated: most of us are afraid of it: it jars to the bone when we meet hatred face to face.”

What is Narcissistic Neurosis?

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Introduction

Narcissistic neurosis is a term introduced by Sigmund Freud to distinguish the class of neuroses characterised by their lack of object relations and their fixation upon the early stage of libidinal narcissism.

The term is less current in contemporary psychoanalysis, but still a focus for analytic controversy.

Freud considered such neurosis as impervious to psychoanalytic treatment, as opposed to the transference neurosis where an emotional connection to the analyst was by contrast possible.

Freud’s Changing Ideas

Freud originally applied the term “narcissistic neurosis” to a range of disorders, including perversion, depression, and psychosis. In the 1920s, however, he came to single out “illnesses which are based on a conflict between the ego and the super-ego… we would set aside the name of ‘narcissistic psycho-neuroses’ for disorders of that kind” – melancholia being the outstanding example.

About the same time, in the wake of the work of Karl Abraham, he began to modify to a degree his view on the inaccessibility of narcissistic neurosis to analytic treatment. However his late lectures from the thirties confirmed his opinion of the unsuitability of narcissistic and psychotic conditions for treatment “to a greater or less extent”; as did his posthumous ‘Outline of Psychoanalysis’.

Later Developments

From the twenties onwards, Freud’s views of the inaccessibility of the narcissistic neuroses to analytic influence had been challenged, first by Melanie Klein, and then by object relations theorists more broadly.

While classical analysts like Robert Waelder would maintain Freud’s delimiting standpoint into the sixties, eventually even within ego psychology challenges to the ‘off-limits’ view of what were increasingly seen as borderline disorders emerged.

Relational psychoanalysis, like Heinz Kohut, would also take a more positive approach to narcissistic neurosis, emphasising the need for a partial or initial participation in the narcissistic illusions.

In retrospect, Freud’s caution may be seen as a result of his unwillingness to work with the negative transference, unlike the post-Kleinians.

What is Transference Neurosis?

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Introduction

Transference neurosis is a term that Sigmund Freud introduced in 1914 to describe a new form of the analysand’s infantile neurosis that develops during the psychoanalytic process.

Based on Dora’s case history, Freud suggested that during therapy the creation of new symptoms stops, but new versions of the patient’s fantasies and impulses are generated. He called these newer versions “transferences” and characterised them as the substitution of the analyst for a person from the patient’s past. According to Freud’s description: “a whole series of psychological experiences are revived not as belonging to the past, but as applying to the person of the analyst at the present moment”. When transference neurosis develops, the relationship with the therapist becomes the most important one for the patient, who directs strong infantile feelings and conflicts towards the therapist, e.g. the patient may react as if the analyst is his/her father.

Refer to Narcissistic Neurosis and Negative Transference.

Basic Characteristics

Transference neurosis can be distinguished from other kinds of transference because:

  1. It is very vivid and it rekindles the infantile neurosis.
  2. It is generated by the feelings of frustration that the analysand inevitably experiences during sessions, since the analyst does not fulfil the analysand’s longings.
  3. In transference neurosis the symptoms are not stable, but they are transformed.
  4. Regression and repetition play a key role in the creation of transference neurosis.
  5. Transference neurosis reveals the particular meanings that the analysand has given to current infantile relationships and events, which generate internal conflicts between wishes and particular defences formed to strive against them. These meanings are united and create several transference patterns.

Resolution

Once transference neurosis has developed, it leads to a form of resistance, called “transference resistance”. At this point, the analysis of the transference becomes difficult since new obstacles arise in therapy, e.g. the analysand may insist on fulfilling the infantile wishes that emerged in transference, or may refuse to acknowledge that the current experience is, in fact, a reproduction of a past experience. However, the successful resolution of transference neurosis through interpretation will lead to the lifting of repression and will enable the Ego to solve the infantile conflicts in new ways. Furthermore, it will allow the analysand to recognize that the current relationship with the analyst is based on repetition of childhood experiences, leading to the detachment of the patient from the analyst.

The replacement of the infantile neurosis by transference neurosis and its resolution through interpretation remains the main focus of the classical psychoanalytic therapy. In other types of therapy, either the transference neurosis does not develop at all, or it does not play a central role in the therapy process. Although it is more likely for transference neurosis to develop in psychoanalysis, where the sessions are more frequent, it may also appear during psychotherapy.

What is Depressive Realism?

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Introduction

Depressive realism is the hypothesis developed by Lauren Alloy and Lyn Yvonne Abramson that depressed individuals make more realistic inferences than non-depressed individuals.

Although depressed individuals are thought to have a negative cognitive bias that results in recurrent, negative automatic thoughts, maladaptive behaviours, and dysfunctional world beliefs, depressive realism argues not only that this negativity may reflect a more accurate appraisal of the world but also that non-depressed individuals’ appraisals are positively biased.

Refer to Defensive Pessimism.

Evidence (For)

When participants were asked to press a button and rate the control they perceived they had over whether or not a light turned on, depressed individuals made more accurate ratings of control than non-depressed individuals. Among participants asked to complete a task and rate their performance without any feedback, depressed individuals made more accurate self-ratings than non-depressed individuals. For participants asked to complete a series of tasks, given feedback on their performance after each task, and who self-rated their overall performance after completing all the tasks, depressed individuals were again more likely to give an accurate self-rating than non-depressed individuals. When asked to evaluate their performance both immediately and some time after completing a task, depressed individuals made accurate appraisals both immediately before and after time had passed.

In a functional magnetic resonance imaging (fMRI) study of the brain, depressed patients were shown to be more accurate in their causal attributions of positive and negative social events than non-depressed participants, who demonstrated a positive bias. This difference was also reflected in the differential activation of the fronto-temporal network, higher activation for non self-serving attributions in non-depressed participants and for self-serving attributions in depressed patients, and reduced coupling of the dorsomedial prefrontal cortex seed region and the limbic areas when depressed patients made self-serving attributions.

Evidence (Against)

When asked to rate both their performance and the performance of others, non-depressed individuals demonstrated positive bias when rating themselves but no bias when rating others. Depressed individuals conversely showed no bias when rating themselves but a positive bias when rating others.

When assessing participant thoughts in public versus private settings, the thoughts of non-depressed individuals were more optimistic in public than private, while depressed individuals were less optimistic in public.

When asked to rate their performance immediately after a task and after some time had passed, depressed individuals were more accurate when they rated themselves immediately after the task but were more negative after time had passed whereas non-depressed individuals were positive immediately after and some time after.

Although depressed individuals make accurate judgments about having no control in situations where they in fact have no control, this appraisal also carries over to situations where they do have control, suggesting that the depressed perspective is not more accurate overall. Note, however, that this finding alone does not imply depression as a cause; researchers did not control for philosophical factors such as determinism which could affect responses.

One study suggested that in real-world settings, depressed individuals are actually less accurate and more overconfident in their predictions than their non-depressed peers. Participants’ attributional accuracy may also be more related to their overall attributional style rather than the presence and severity of their depressive symptoms.

Criticism of the Evidence

Some have argued that the evidence is not more conclusive because no standard for reality exists, the diagnoses are dubious, and the results may not apply to the real world. Because many studies rely on self-report of depressive symptoms and self-reports are known to be biased, the diagnosis of depression in these studies may not be valid, necessitating the use of other objective measures. Due to most of these studies using designs that do not necessarily approximate real-world phenomena, the external validity of the depressive realism hypothesis is unclear. There is also concern that the depressive realism effect is merely a byproduct of the depressed person being in a situation that agrees with their negative bias.

What is Defensive Pessimism?

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Introduction

Defensive pessimism is a cognitive strategy identified by Nancy Cantor and her students in the mid-1980s.

Individuals use defensive pessimism as a strategy to prepare for anxiety-provoking events or performances. When implementing defensive pessimism, individuals set low expectations for their performance, regardless of how well they have done in the past. Defensive pessimists then think through specific negative events and setbacks that could adversely influence their goal pursuits. By envisioning possible negative outcomes, defensive pessimists can take action to avoid or prepare for them. Using this strategy, defensive pessimists can advantageously harness anxiety that might otherwise harm their performance.

Defensive pessimism is utilised in a variety of domains, and public speaking provides a good example of the process involved in this strategy. Defensive pessimists could alleviate their anxiety over public speaking by imagining possible obstacles such as forgetting the speech, being thirsty, or staining their shirts before the event. Because defensive pessimists have thought of these problems, they can appropriately prepare to face the challenges ahead. The speaker could, for instance, create note cards with cues about the speech, place a cup of water on the podium to alleviate thirst, and bring a bleach pen to remove shirt stains. These preventive actions both reduce anxiety and promote superior performance.

Refer to Depressive Realism.

Strategy Effectiveness

Though defensive pessimists are less satisfied with their performances and rate themselves higher in “need for improvement,” they do not actually perform worse than people with a more optimistic strategy. Norem and Cantor (1986) investigated whether encouraging defensive pessimists, and thereby interfering with their typical negative thinking, would result in worse performances. Participants in the study were in either encouragement or non-encouragement scenarios as they prepared to complete anagram and puzzle tasks. In the encouragement condition, the defensive pessimists were told that, based on their GPA, they should expect to do well. Defensive pessimists performed worse when encouraged than the defensive pessimists whose strategy was not manipulated. Defensive pessimism is an adaptive strategy for those who struggle with anxiety: their performance decreases if they are unable to appropriately manage and counteract their anxiety.

Key Components

Prefactual Thinking

Prefactual (i.e. “before the fact”) thinking is an essential component of defensive pessimism. Synonymous with anticipation, it denotes a cognitive strategy in which people imagine possible outcomes of a future scenario. The term prefactual was specifically coined by Lawrence J. Sanna, in 1998, to denote those activities that speculate on possible future outcomes, given the present, and ask “What will be the outcome if event E occurs?”

The imagined outcomes are either positive/desirable, negative/undesirable, or neutral. Prefactual thinking can be advantageous because it allows the individual to prepare for possible outcomes of a scenario.

For defensive pessimists, prefactual thinking offers the primary and critical method to alleviate anxiety. Usually, this prefactual thinking is paired with a pessimistic outlook, resulting in negative/undesirable imagined scenarios. With regard to the earlier example, the public speaking defensive pessimist anticipates forgetting the speech or becoming thirsty as opposed to giving an amazing speech and receiving a standing ovation.

Anxiety

As defensive pessimism is motivated by a need to manage anxiety, it is unsurprisingly also correlated with trait anxiety and neuroticism. Negative mood states promote defensive pessimists’ goal attainment strategy by facilitating the generation of potential setbacks and negative outcomes that could arise during goal pursuit, which can then be anticipated and prevented. When defensive pessimists are encouraged into positive or even just neutral mood states, they perform worse on experimental tasks than when in a negative mood state. They are more anxious because they are prevented from properly implementing their preferred cognitive strategy for goal attainment.

Self-Esteem

Defensive pessimism is generally related to lower self-esteem since the strategy involves self-criticism, pessimism, and discounting previous successful performances. Indeed, Norem and Burdzovic Andreas (2006) found that, compared to optimists, defensive pessimists had lower self-esteem entering college. At the end of four years of college, however, the self-esteem of the defensive pessimists had increased to nearly equal levels as optimists. The self-esteem of optimists had not changed, and the self-esteem of pessimists who did not employ defensive pessimism had fallen slightly by the end of college. While defensive pessimism may have implications for self-esteem, it appears that these effects lessen over time.

Compared to Pessimism

Unlike pessimism, defensive pessimism is not an internal, global, and stable attribution style, but rather a cognitive strategy utilised within the context of certain goals. Pessimism involves rumination about possible negative outcomes of a situation without proactive behaviour to counteract these outcomes. Defensive pessimism, on the other hand, utilizes the foresight of negative situations in order to prepare against them. The negative possible outcomes of a situation often motivate defensive pessimists to work harder for success. Since defensive pessimists are anxious, but not certain, that negative situations will arise, they still feel that they can control their outcomes. For example, a defensive pessimist would not avoid all job interviews for fear of failing one. Instead, a defensive pessimist would anticipate possible challenges that could come in an upcoming job interview – such as dress code, stubborn interviewers, and tough questions – and prepare rigorously to face them. Defensive pessimism is not a reaction to stressful events nor does it entail ruminating on events of the past, and should therefore be distinguished from pessimism as a trait or a more general negative outlook. Instead, defensive pessimists are able to stop using this strategy once it is no longer beneficial (i.e. does not serve a preparatory role).

Compared to Other Cognitive Strategies

Self-Handicapping

Elliot and Church (2003) determined that people adopt defensive pessimism or self-handicapping strategies for the same reason: to deal with anxiety-provoking situations. Self-handicapping is a cognitive strategy in which people construct obstacles to their own success to keep failure from damaging their self-esteem. The difference between self-handicapping and defensive pessimism lies in the motivation behind the strategies. Beyond managing anxiety, defensive pessimism is further motivated by a desire for high achievement. Self-handicappers, however, feel no such need. Elliot and Church found that the self-handicapping strategy undermined goal achievement while defensive pessimism aided achievement. People who self-handicapped were high in avoidance motivation and low in approach motivation. They wanted to avoid anxiety but were not motivated to approach success. Defensive pessimists, on the other hand, were motivated to approach success and goal attainment while simultaneously avoiding the anxiety associated with performance. Although it was found that defensive pessimism was positively correlated with goals related to both performance-avoidance and anxiety-avoidance, it was not found to be a predictor of one’s mastery of goals.

Strategic Optimism

In research, defensive pessimism is frequently contrasted with strategic optimism, another cognitive strategy. When facing performance situations, strategic optimists feel that they will end well. Therefore, though they plan ahead, they plan only minimally because they do not have any anxiety to face. While defensive pessimists set low expectations, feel anxious, and rehearse possible negative outcomes of situations, strategic optimists set high expectations, feel calm, and do not reflect on the situation any more than absolutely necessary. Strategic optimists start out with different motivations and obstacles: unlike defensive pessimists, strategic optimists do not have any anxiety to surmount. In spite of their differences in motivation, strategic optimists and defensive pessimists have similar objective performance outcomes. For both strategic optimists and defensive pessimists, their respective cognitive strategies are adaptive and promote success.

What is Self-Handicapping?

Published on by Andrew Marshall2 Comments

Introduction

Self-handicapping is a cognitive strategy by which people avoid effort in the hopes of keeping potential failure from hurting self-esteem.

It was first theorised by Edward E. Jones and Steven Berglas, according to whom self-handicaps are obstacles created, or claimed, by the individual in anticipation of failing performance.

Self-handicapping can be seen as a method of preserving self-esteem but it can also be used for self-enhancement and to manage the impressions of others. This conservation or augmentation of self-esteem is due to changes in causal attributions or the attributions for success and failure that self-handicapping affords. There are two methods that people use to self-handicap: behavioural and claimed self-handicaps. People withdraw effort or create obstacles to successes so they can maintain public and private self-images of competence.

Self-handicapping is a widespread behaviour amongst humans that has been observed in a variety of cultures and geographic areas. For instance, students frequently participate in self-handicapping behaviour to avoid feeling bad about themselves if they do not perform well in class. Self-handicapping behaviour has also been observed in the business world. The effects of self-handicapping can be both large and small and found in virtually any environment wherein people are expected to perform.

Refer to Self-Defeating Personality Disorder and Defensive Pessimism.

Overview and Relevance

The first method people use to self-handicap is when they make a task harder for themselves in fear of not successfully completing that task, so that if they do in fact fail, they can simply place the blame on the obstacles rather than placing the blame on themselves. This is known to researchers as behavioural handicapping, in which the individual actually creates obstacles to performance. Examples of behavioural handicaps include alcohol consumption, the selection of unattainable goals, and refusal to practise a task or technique (especially in sports and the fine arts).

The second way that people self-handicap is by coming up with justifications for their potential failures, so that if they do not succeed in the task, they can point to their excuses as the reasons for their failures. This is known as claimed self-handicapping, in which the individual merely states that an obstacle to performance exists. Examples of claimed self-handicaps include declarations that one is experiencing physical symptoms.

Self-handicapping behaviour allows individuals to externalise failures but internalise success, accepting credit for achievements but allowing excuses for failings. An example of self-handicapping is the student who spends the night before an important exam partying rather than studying. The student fears failing his exam and appearing incapable. In partying the night before the exam the student has engaged in self-defeating behaviour and increased the likelihood of poor exam performance. However, in the event of failure, the student can offer fatigue and a hangover, rather than lack of ability, as plausible explanations. Furthermore, should the student receive positive feedback about his exam, his achievement is enhanced by the fact that he succeeded, despite the handicap.

Individual Differences

People differ in the extent to which they self-handicap and most research on individual differences has used the Self-Handicapping Scale (SHS). The SHS was developed as a means of measuring individuals’ tendency to employ excuses or create handicaps as a means to protect one’s self-esteem. Research to date shows that SHS has adequate construct validity. For example, individuals who score high on the SHS put in less effort and practice less when concerned about their ability to perform well in a given task. They are also more likely than those rated low self-handicappers (LSH) to mention obstacles or external factors that may hinder their success, prior to performing.

A number of characteristics have been related to self-handicapping (e.g. hypochondriasis) and research suggests that those more prone to self-handicapping may differ motivationally compared to those that do not rely on such defensive strategies. For example, fear of failure, a heightened sensitivity to shame and embarrassment upon failure, motivates self-handicapping behaviour. Students who fear failure are more likely to adopt performance goals in the classroom or goals focused on the demonstration of competence or avoidance of demonstrating incompetence; goals that heighten one’s sensitivity to failure.

A student, for example, may approach course exams with the goal of not performing poorly as this would suggest a lack of ability. To avoid ability attributions and the shame of failure, the student fails to adequately prepare for an exam. While this may provide temporary relief, it renders one’s ability conceptions more uncertain, resulting in further self-handicapping.

Gender Differences

While research suggests that claimed self-handicaps are used by men and women alike, several studies have reported significant differences. While research assessing differences in reported self-handicapping have revealed no gender differences or greater self-handicapping among females, the vast majority of research suggests that males are more inclined to behaviourally self-handicap. These differences are further explained by the different value men and women ascribe to the concept of effort.

Major Theoretical Approaches

The root of research on the act of self-handicapping can be traced back to Adler’s studies about self-esteem. In the late 1950s, Goffman and Heider published research concerning the manipulation of outward behaviour for the purpose of impression management. It was not until 30 years later that self-handicapping behaviour was attributed to internal factors. Until this point, self-handicapping only encompassed the usage of external factors, such as alcohol and drugs. Self-handicapping is usually studied in an experimental setting, but is sometimes studied in an observational environment.

Previous research has established that self-handicapping is motivated by uncertainty about one’s ability or, more generally, anticipated threats to self-esteem. Self-handicapping can be exacerbated by self-presentational concerns but also occurs in situations where such concerns are at a minimum.

Major Empirical Findings

Experiments on self-handicapping have depicted the reasons why people self-handicap and the effects that it has on those people. Self-handicapping has been observed in both laboratory and real world settings. Studying the psychological and physical effects of self-handicapping has allowed researchers to witness the dramatic effects that it has on attitude and performance.

Jones and Berglas gave people positive feedback following a problem-solving test, regardless of actual performance. Half the participants had been given fairly easy problems, while the others were given difficult problems. Participants were then given the choice between a “performance-enhancing drug” and a drug that would inhibit it. Those participants who received the difficult problems were more likely to choose the impairing drug, and participants who faced easy problems were more likely to choose the enhancing drug. It is argued that the participants presented with hard problems, believing that their success had been due to chance, chose the impairing drug because they were looking for an external attribution (what might be called an “excuse”) for expected poor performance in the future, as opposed to an internal attribution.

More recent research finds that, generally, people are willing to use handicaps to protect their self-esteem (e.g. discounting failings) but are more reluctant to employ them for self-enhancement. (e.g. to further credit their success). Rhodewalt, Morf, Hazlett, and Fairfield (1991) selected participants who scored high or low on the Self-Handicapping Scale (SHS) and who had high or low self-esteem. They presented participants with a handicap and then with success or failure feedback and asked participants to make attributions for their performance. The results showed that both self-protection and self-enhancement occurred, but only as a function of levels of self-esteem and the level of tendency to self-handicap. Participants who were high self-handicappers, regardless of their level of self-esteem, used the handicap as a means of self-protection but only those participants with high self-esteem used the handicap to self-enhance.

In a further study, Rhodewalt (1991) presented the handicap to only half of the participants and gave success and failure feedback. The results provided evidence for self-protection but not for self-enhancement. Participants in the failure feedback, handicap absent group, attributed their failures to their own lack of ability and reported lower self-esteem to the handicap-present, failure-feedback condition. Furthermore, the handicap-present failure group reported levels of self-esteem equal to that of the successful group. This evidence highlights the importance of self-handicaps in self-protection although it offers no support for the handicap acting to self-enhance.

Another experiment, by Martin Seligman and colleagues, examined whether there was a correlation between explanatory styles and the performance of swimmers. After being given false bad times on their preliminary events, the swimmers who justified their poor performance to themselves in a pessimistic way did worse on subsequent performances. In contrast, the subsequent performances of those swimmers who had more optimistic attributions concerning their poor swimming times were not affected. Those who had positive attributions were more likely to succeed after given false times because they were self-handicapping. They attributed their failure to an external force rather than blaming themselves. Therefore, their self-esteem remained intact, which led to their success in subsequent events. This experiment demonstrates the positive effects that self-handicapping can have on an individual because when they attributed the failure to an external factor, they did not internalise the failure and let it psychologically affect them.

Previous research has looked at the consequences of self-handicapping and have suggested that self-handicapping leads to a more positive mood (at least in the short term) or at least guards against a drop in positive mood after failure. Thus, self-handicapping may serve as a means of regulating one’s emotions in the course of protecting one’s self-esteem. However, based on past evidence that positive mood motivates self-protective attributions for success and failure and increases the avoidance of negative feedback, recent research has focused on mood as an antecedent to self-handicapping; expecting positive mood to increase self-handicapping behaviour. Results have shown that people who are in positive mood are more likely to engage in self-handicapping, even at the cost of jeopardising future performance.

Research suggests that among those who self-handicap, self-imposed obstacles may relieve the pressure of a performance and allow one to become more engaged in a task. While this may enhance performance in some situations for some individuals, in general, research indicates that self-handicapping is negatively associated with performance, self-regulated learning, persistence and intrinsic motivation. Additional long-term costs of self-handicapping include worse health and well-being, more frequent negative moods and higher use of various substances.

Zuckerman and Tsai assessed self-handicapping, well-being, and coping among college students on two occasions over several months. Self-handicapping assessed on the first occasion predicted coping with problems by denial, blaming others and criticising oneself as well as depression and somatic complaints. Depression and somatic complaints also predicted subsequent self-handicapping. Thus, the use of self-handicapping may lead to not only uncertainty as to one’s ability but also ill-being, which in turn may lead to further reliance on self-handicapping.

Applications

There are many real world applications for this concept. For example, if people predict they are going to perform poorly on tasks, they create obstacles, such as taking drugs and consuming alcohol, so that they feel that they have diverted the blame from themselves if they actually do fail. In addition, another way that people self-handicap is by creating already-made excuses just in case they fail. For example, if a student feels that they are going to perform badly on a test, then they might make up an excuse for their potential failure, such as telling their friends that they do not feel well the morning of the test.

Occurrence in Sports

Previous research has suggested that because in Physical Education (PE) students are required to overtly display their physical abilities and incompetence could be readily observed by others, PE is an ideal setting to observe self-handicapping. Because of its prevalence in the sporting world, self-handicapping behaviour has become of interest to sports psychologists who are interested in increasing sports performance. Recent research has examined the relationship between behavioural and claimed self-handicaps and athletic performance as well as the effects self-handicapping has on anxiety and fear of failure before athletic performance.

Controversies

One controversy was revealed in a study done at the University of Wyoming. Previous research indicated a negative correlation between self-handicapping behaviours and boosting one’s self-esteem; it was also shown that people who focus on the positive attributes of themselves are less likely to self-handicap. This study, however, demonstrates that this claim is only partially accurate because the reduction of self-handicapping is only apparent in an area unrelated to the present self-esteem risk. As a result, the attempt to protect self-esteem becomes a detriment to future success in that area.

What is Self-Injury Awareness Day?

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Introduction

The orange ribbon of self-harm awareness.

Self-injury Awareness Day (SIAD) (also known as Self-Harm Awareness Day) is a grassroots annual global awareness event/campaign on 01 March, where on this day, and in the weeks leading up to it and after, some people choose to be more open about their own self-harm, and awareness organisations make special efforts to raise awareness about self-harm and self-injury.

Some people wear an orange awareness ribbon, write “LOVE” on their arms, draw a butterfly on their wrists in awareness of “the Butterfly Project” wristband or beaded bracelet to encourage awareness of self-harm. The goal of the people who observe SIAD is to break down the common stereotypes surrounding self-harm and to educate medical professionals about the condition.

Background

Depression and self-harm often go hand-in-hand, though there are many other reasons people self-harm. As many as two million Americans currently engage in self-harm, with methods like cutting, burning, scratching, bruising, and hitting themselves, along with other more harmful methods. It’s said that these behaviours promote feelings of control and help relieve tension, while helping the person express their emotions and escape the numbness that accompanies depression.

SIAD was created to spread awareness and understanding of self-injury, which is often misrepresented and misunderstood in the mainstream. Those who self-harm are often left feeling alone and afraid to reach out for help because they fear they will be seen as “crazy”.

Participating Organisations

Organisations involved in SIAD include:

  • Sociedad Internacional de Autolesión.
  • LifeSIGNS (Self-Injury Guidance & Network Support).
  • Self-Injury Foundation.
  • YoungMinds.
  • ChildLine.
  • The Mix (a UK digital charity).
  • Adolescent Self-Injury Foundation.
  • Cars for hope.

What is Relapse Prevention?

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Introduction

Relapse prevention (RP) is a cognitive-behavioural approach to relapse with the goal of identifying and preventing high-risk situations such as unhealthy substance use, obsessive-compulsive behaviour, sexual offending, obesity, and depression.

It is an important component in the treatment process for alcohol use disorder, or alcohol dependence.

Underlying Assumptions

Relapse is seen as both an outcome and a transgression in the process of behaviour change. An initial setback or lapse may translate into either a return to the previous problematic behaviour, known as relapse, or the individual turning again towards positive change, called prolapse. A relapse often occurs in the following stages: emotional relapse, mental relapse, and finally, physical relapse. Each stage is characterised by feelings, thoughts, and actions that ultimately lead to the individual’s returning to their old behaviour.

Relapse is thought to be multi-determined, especially by self-efficacy, outcome expectancies, craving, motivation, coping, emotional states, and interpersonal factors. In particular, high self-efficacy, negative outcome expectancies, potent availability of coping skills following treatment, positive affect, and functional social support are expected to predict positive outcome. Craving has not historically been shown to serve as a strong predictor of relapse.

Efficacy and Effectiveness

Carroll et al. conducted a review of 24 other trials and concluded that RP was more effective than no treatment and was equally effective as other active treatments such as supportive psychotherapy and interpersonal therapy in improving substance use outcomes. Irvin and colleagues also conducted a meta-analysis of RP techniques in the treatment of alcohol, tobacco, cocaine, and polysubstance use, and upon reviewing 26 studies, concluded that RP was successful in reducing substance use and improving psychosocial adjustment. RP seemed to be most effective for individuals with alcohol problems, suggesting that certain characteristics of alcohol use are amenable to the RP. Miller et al. (1996) found the GORSKI/CENAPS relapse warning signs to be a good predictor of the occurrence of relapse on the AWARE scale (r = .42, p < .001).

Prevention Approaches

General Prevention Theories

Some theorists, including Katie Witkiewitz and G. Alan Marlatt, borrowing ideas from systems theory, conceptualize relapse as a multidimensional, complex system. Such a nonlinear dynamical system is believed to be able to best predict the data witnessed, which commonly includes cases where small changes introduced into the equation seem to have large effects. The model also introduces concepts of self-organisation, feedback loops, timing/context effects, and the interplay between tonic and phasic processes.

Rami Jumnoodoo and Dr. Patrick Coyne, in London UK, have been working with National Health Service users and carers over the past ten years to transfer RP theory into the field of adult mental health. The uniqueness of the model is the sustainment of change by developing service users and carers as ‘experts’ – following RP as an educational process and graduating as Relapse Prevention Practitioners. The work has won many national awards, been presented at many conferences, and has resulted in many publications.

Terence Gorski MA has developed the CENAPS (Centre for Applied Science) model for relapse prevention including Relapse Prevention Counselling (Gorski, Counselling For Relapse Prevention, 1983) and a system for certification of Relapse Prevention Specialists (CRPS).

Depression

For the prevention of relapse in Major Depressive Disorder (MDD), several approaches and intervention programmes have been proposed. Mindfulness-based Cognitive Therapy is commonly used and was found to be effective in preventing relapse especially in patients with more pronounced residual symptoms. Another approach often used in patients who wish to taper down antidepressant medication is Preventive Cognitive Therapy, an 8-weeks lasting psychological intervention programme delivered in individual or group sessions that focuses on changing dysfunctional attitudes, enhancing memories of positive experiences and helping patients to develop personal relapse prevention strategies. Preventive Cognitive Therapy has been found to be equally effective in preventing a return of depressive symptoms as antidepressant medication use alone in the long-term treatment of MDD. In combination with pharmaceuticals, it was found to be even more effective than antidepressant use alone.