In psychology, alogia (from Greek ἀ-, “without”, and λόγος, “speech” + New Latin -ia) is poor thinking inferred from speech and language usage.
There may be a general lack of additional, unprompted content seen in normal speech, so replies to questions may be brief and concrete, with less spontaneous speech. This is termed poverty of speech or laconic speech. The amount of speech may be normal but conveys little information because it is vague, empty, stereotyped, overconcrete, overabstract, or repetitive. This is termed poverty of content or poverty of content of speech. Under Scale for the Assessment of Negative Symptoms (SANS) used in clinical research, thought blocking is considered a part of alogia, and so is increased latency in response.
This condition is associated with schizophrenia, dementia, severe depression, and autism. As a symptom, it is commonly seen in patients suffering from schizophrenia and schizotypal personality disorder, and is traditionally considered a negative symptom. It can complicate psychotherapy severely because of the considerable difficulty in holding a fluent conversation.
The alternative meaning of alogia is inability to speak because of dysfunction in the central nervous system, found in mental deficiency and dementia. In this sense, the word is synonymous with aphasia, and in less severe form, it is sometimes called dyslogia.
Characteristics
Alogia may be on a continuum with normal behaviours. People without mental illness may have it occasionally including when fatigued or disinhibited, when writers use language creatively, when people in certain disciplines – such as politicians, administrators, philosophers, ministers, and scientists – use language pedantically, or in people with intelligence or little education. Hence, deciding if an individual has alogia depends on contextual clues. Is the person in control? Can the person moderate the effect if asked to be specific or concise? Is it better with another topic? Are there other significant symptoms?
Alogia is characterised by a lack of speech, often caused by a disruption in the thought process. Usually, an injury to the left side of the brain may cause alogia to appear in an individual. While in conversation, alogic patients will reply very sparsely and their answers to questions will lack spontaneous content; sometimes, they will even fail to answer at all. Their responses will be brief, generally only appearing as a response to a question or prompt.
Apart from the lack of content in a reply, the manner in which the person delivers the reply is affected as well. Patients affected by alogia will often slur their responses, and not pronounce the consonants as clearly as usual. The few words spoken usually trail off into a whisper, or are just ended by the second syllable. Studies have shown a correlation between alogic ratings in individuals and the amount and duration of pauses in their speech when responding to a series of questions posed by the researcher. The inability to speak stems from a deeper mental inability that causes alogic patients to have difficulty grasping the right words mentally, as well as formulating their thoughts. A study investigating alogiacs and their results on the category fluency task showed that people with schizophrenia who exhibit alogia display a more disorganised semantic memory than controls. While both groups produced the same number of words, the words produced by people with schizophrenia were much more disorderly and the results of cluster analysis revealed bizarre coherence in the alogiac group.
If the condition is assessed using a language other than the individual’s primary language, the medical professional needs to make sure that the problem is not from language barriers.
This condition is associated with schizophrenia, dementia, and severe depression.
Example
The following table shows an example of “poverty of speech” which shows replies to questions that are brief and concrete, with a reduction in spontaneous speech:
Poverty of Speech
Normal Speech
Q: Do you have any children? A: Yes.
Q: Do you have any children? A: Yes, a boy and a girl.
Q: How many? A: Two.
Q: How old are they? A: Edmond is sixteen and Alice is six.
Q: How old are they? A: Six and sixteen.
Q: Are they boys or girls? A: One of each.
Q: Who is the sixteen-year-old? A: The boy.
Q: What is his name? A: Edmond.
Q: And the girl’s? A: Alice.
The following example of “poverty of content of speech” is a response from a patient when asked why he was in a hospital. Speech is vague, conveys little information, but is not grossly incoherent and the amount of speech is not reduced. “I often contemplate—it is a general stance of the world—it is a tendency which varies from time to time—it defines things more than others—it is in the nature of habit—this is what I would like to say to explain everything.”
Causes
Alogia can be brought on by frontostriatal dysfunction which causes degradation of the semantic store, the centre located in the temporal lobe that processes meaning in language. A subgroup of chronic schizophrenia patients in a word generation experiment generated fewer words than the unaffected subjects and had limited lexicons, evidence of the weakening of the semantic store. Another study found that when given the task of naming items in a category, schizophrenia patients displayed a great struggle but improved significantly when experimenters employed a second stimulus to guide behaviour unconsciously. This conclusion was similar to results produced from patients with Huntington’s and Parkinson’s disease, ailments which also involve frontostriatal dysfunction.
Treatment
Medical studies conclude that certain adjunctive drugs effectively palliate the negative symptoms of schizophrenia, mainly alogia. In one study, Maprotiline produced the greatest reduction in alogia symptoms with severity reduction in 50% of patients (out of 10). Of the negative symptoms of schizophrenia, alogia had the second best responsiveness to the drugs, surpassed only by attention deficiency. D-amphetamine is another drug that has been tested on people with schizophrenia and found success in alleviating negative symptoms. This treatment, however, has not been developed greatly as it seems to have adverse effects on other aspects of schizophrenia such as increasing the severity of positive symptoms.
Relation to Schizophrenia
Although alogia is found as a symptom in a variety of health disorders, it is most commonly found as a negative symptom of schizophrenia.
Previous studies and analyses conclude that at least three factors are needed to cover both the positive and negative symptoms of schizophrenia; the three are: psychotic, disorganization, and negative symptom factors. Studies suggest that an inappropriate affect is strongly associated with bizarre behaviour and positive formal thought disorder on a disorganisation factor; attention impairment correlates significantly with psychotic, disorganization, and negative symptom factors. Alogia contains both positive and negative symptoms, with the poverty of content of speech as the disorganization factor, and poverty of speech, response latency, and thought blocking as the negative symptom factors.
Alogia is a major diagnostic sign of schizophrenia, when organic mental disorders have been excluded.
In schizophrenia, negative symptoms including flattening of affect, avolition, and alogia are responsible for the considerable morbidity of the disease compared with other psychotic disorders. Negative symptoms are common in the prodromal and residual phases of the disease and can be severe. During the first year, negative symptoms can progress, especially alogia, which may start off from a relatively low rate. Within 2 years, up to 25% of patients will have significant negative symptoms. Psychotic symptoms tend to diminish as the individuals age, but negative symptoms tend to persist. Prominent negative symptoms at disease onset, including alogia, are good predictors of worse outcomes.
Negative symptoms can arise in the presence of other psychiatric symptoms. Positive symptoms are a common cause of apathy, social withdrawal, and alogia. Secondary causes of negative symptoms, such as depression and demoralisation, often remit within a year, which helps distinguishing them from primary negative symptoms. Symptoms that don’t diminish over a year with medications should be reconsidered as possible primary negative symptoms.
Allostatic load is “the wear and tear on the body” which accumulates as an individual is exposed to repeated or chronic stress.
The term was coined by Bruce McEwen and Stellar in 1993. It represents the physiological consequences of chronic exposure to fluctuating or heightened neural or neuroendocrine response which results from repeated or prolonged chronic stress.
Regulatory Model
The term allostatic load is “the wear and tear on the body” which accumulates as an individual is exposed to repeated or chronic stress. It was coined by McEwen and Stellar in 1993.
The term is part of the regulatory model of allostasis, where the predictive regulation or stabilisation of internal sensations in response to stimuli is ascribed to the brain. Allostasis involves the regulation of homeostasis in the body to decrease physiological consequences on the body. Predictive regulation refers to the brain’s ability to anticipate needs and prepare to fulfil them before they arise.
Part of efficient regulation is the reduction of uncertainty. Humans naturally do not like feeling as if surprise is inevitable. Because of this, we constantly strive to reduce the uncertainty of future outcomes, and allostasis helps us do this by anticipating needs and planning how to satisfy them ahead of time. But it takes a considerable amount of the brain’s energy to do this, and if it fails to resolve the uncertainty, the situation may become chronic and result in the accumulation of allostatic load.
The concept of allostatic load provides that:
“the neuroendocrine, cardiovascular, neuroenergetic, and emotional responses become persistently activated so that blood flow turbulences in the coronary and cerebral arteries, high blood pressure, atherogenesis, cognitive dysfunction and depressed mood accelerate disease progression.”
All long-standing effects of continuously activated stress responses are referred to as allostatic load. Allostatic load can result in permanently altered brain architecture and systemic pathophysiology.
Allostatic load minimises an organism’s ability to cope with and reduce uncertainty in the future.
Types
McEwen and Wingfield propose two types of allostatic load with different aetiologies and distinct consequences:
Type 1 allostatic load occurs when energy demand exceeds supply, resulting in activation of the emergency life history stage. This serves to direct the animal away from normal life history stages into a survival mode that decreases allostatic load and regains positive energy balance. The normal life cycle can be resumed when the perturbation has passed. Typical situations ending up in type 1 allostasis are starvation, hibernation and critical illness. Of note, the life-threatening consequences of critical illness may be both cause and consequences of allostatic load.
Type 2 allostatic load results from sufficient or even excess energy consumption being accompanied by social conflict or other types of social dysfunction. The latter is the case in human society and certain situations affecting animals in captivity. In all cases, secretion of glucocorticosteroids and activity of other mediators of allostasis such as the autonomic nervous system, CNS neurotransmitters, and inflammatory cytokines wax and wane with allostatic load. If allostatic load is chronically high, then pathologies may develop. Type 2 allostatic overload does not trigger an escape response, and can only be counteracted through learning and changes in the social structure.
Whereas both types of allostatic load are associated with increased release of cortisol and catecholamines, they differentially affect thyroid homeostasis: Concentrations of the thyroid hormone triiodothyronine are decreased in type 1 allostasis, but elevated in type 2 allostasis. This may result from an interaction of type 2 allostatic load with the set point of thyroid function.
Measurement
Allostatic load is generally measured through a composite index of indicators of cumulative strain on several organs and tissues, primarily biomarkers associated with the neuroendocrine, cardiovascular, immune and metabolic systems.
Indices of allostatic load are diverse across studies and are frequently assessed differently, using different biomarkers and different methods of assembling an allostatic load index. Allostatic load is not unique to humans and may be used to evaluate the physiological effects of chronic or frequent stress in non-human primates as well.
In the endocrine system, the increase or repeated levels of stress results in the increased levels of the hormone Corticotropin-Releasing Factor (CRH), which is associated with activation of hypothalamic-pituitary-adrenal (HPA) axis. The HPA axis is the central stress response system responsible for modulating inflammatory responses throughout the body. Prolonged stress levels can lead to decreased levels of cortisol in the morning and increased levels in the afternoon, leading to greater daily output of cortisol which in the long term increases blood sugar levels.
In the nervous system, structural and functional abnormalities are a result of chronic prolonged stress. The increase of stress levels causes a shortening of dendrites in a neuron. Therefore, the shortening of dendrites causes the decrease in attention. Chronic stress also causes greater response to fear of the unlearned in the nervous system, and fear conditioning.
In the immune system, the increase in levels of chronic stress results in the elevation of inflammation. The increase in inflammation levels is caused by the ongoing activation of the sympathetic nervous system. The impairment of cell-mediated acquired immunity is also a factor resulting in the immune system due to chronic stress.
Relationship to Allostasis and Homeostasis
The largest contribution to the allostatic load is the effect of stress on the brain. Allostasis is the system which helps to achieve homeostasis. Homeostasis is the regulation of physiological processes, whereby systems in the body respond to the state of the body and to the external environment. The relationship between allostasis and allostatic load is the concept of anticipation. Anticipation can drive the output of mediators. Examples of mediators include hormones and cortisol. Excess amounts of such mediators will result in an increase in allostatic load, contributing to anxiety and anticipation.
Allostasis and allostatic load are related to the amount of health-promoting and health-damaging behaviours like for example cigarette smoking, consumption of alcohol, poor diet and physical inactivity.
Three physiological processes cause an increase in allostatic load:
Frequent stress: the magnitude and frequency of response to stress is what determines the level of allostatic load which affects the body.
Failed shut-down: the inability of the body to shut off while stress accelerates and levels in the body exceed normal levels, for example, elevated blood pressure.
Inadequate response: the failure of the body systems to respond to challenge, for example, excess levels of inflammation due to inadequate endogenous glucocorticoid responses.
The importance of homeostasis is to regulate the stress levels encountered on the body to reduce allostatic load.
Dysfunctional allostasis causes allostatic load to increase which may, over time, lead to disease, sometimes with decompensation of the allostatically controlled problem. Allostatic load effects can be measured in the body. When tabulated in the form of allostatic load indices using sophisticated analytical methods, it gives an indication of cumulative lifetime effects of all types of stress on the body.
Causes of Allostatic Load
Type 1 allostatic load represents the adaptive response to an absolute lack in energy, glutathione and several macronutrients. It also includes predictive responses, e.g. in hibernation, infection and depression.
Type 2 allostatic load results from an expected mismatch of energy demand and supply. It is triggered by psychosocial stress, e.g. due to low socioeconomic status, major life events and environmental stressors. This association explains the increased risk for cardiovascular disease and chronic conditions like obesity, diabetes, hypertension and psychotic conditions in subjects that were exposed to psychosocial trauma, social disadvantage and discrimination. Socio-cultural mechanisms tend to augment this relation by perpetuating disparity even in the quality of health care, which tends to be inferior in socially disadvantaged population strata.
Implications of Allostatic Load on Health
Increased allostatic load constitutes a significant health hazard. Several studies documented a strong association of allostatic load to the incidence of coronary heart disease, to surrogate markers of cardiovascular health and to hard endpoints, including cause-specific and all-cause mortality. Mediators connecting allostatic load to morbidity and mortality include the function of the autonomic nervous system, cytokines and stress hormones, e.g. catecholamines, cortisol and thyroid hormones.
Reducing Risk
To reduce and manage high allostatic load, an individual should pay attention to structural and behavioural factors. Structural factors include the social environment, and access to health services. Behavioural factors include diet, physical health and tobacco smoking, which can lead to chronic disease. Actions such as tobacco smoking are brought about from the stress levels that an individual experiences. Therefore, controlling stress levels from the beginning, for example by not leading to tobacco smoking, will reduce the chance of chronic disease development and high allostatic load.
Low socio-economic status (SES) affects allostatic load and therefore, focusing on the causes of low SES will reduce allostatic load levels. Reducing societal polarisation, material deprivation, and psychological demands on health helps to manage allostatic load. Support from the community and the social environment can manage high allostatic load. In addition, healthy lifestyle that encompasses a broad array of lifestyle change including healthy eating and regular physical exercise may reduce allostatic load. Empowering financial help from the government allows people to gain control and improve their psychological health. Improving inequalities in health decreases the stress levels and improves health by reducing high allostatic load on the body.
Interventions can include encouraging sleep quality and quantity, social support, self-esteem and wellbeing, improving diet, avoiding alcohol or drug consumption and participating in physical activity. Providing cleaner and safer environments and the incentive towards a higher education will reduce the chance of stress and improve mental health significantly, therefore, reducing the onset of high allostatic load.
Allostatic load differs by sex and age, and the social status of an individual. Protective factors could, at various times of an individual’s life span, be implemented to reduce stress and, in the long run, eliminate the onset of allostatic load. Protective factors include parental bonding, education, social support, healthy workplaces, a sense of meaning towards life and choices being made, and positive feelings in general.
1900 – Erich Fromm, German psychologist and sociologist (d. 1980).
1933 – Philip Zimbardo, American psychologist and academic.
People (Deaths)
2008 – Vaino Vahing, Estonian psychiatrist, author, and playwright (b. 1940).
Erich Fromm
Erich Seligmann Fromm (23 March 1900 to 18 March 1980) was a German social psychologist, psychoanalyst, sociologist, humanistic philosopher, and democratic socialist.
He was a German Jew who fled the Nazi regime and settled in the US. He was one of the founders of The William Alanson White Institute of Psychiatry, Psychoanalysis and Psychology in New York City and was associated with the Frankfurt School of critical theory.
Philip Zimbado
Philip George Zimbardo (23 March 1933) is an American psychologist and a professor emeritus at Stanford University.
He became known for his 1971 Stanford prison experiment, which was later severely criticized for both ethical and scientific reasons. He has authored various introductory psychology textbooks for college students, and other notable works, including The Lucifer Effect, The Time Paradox, and The Time Cure. He is also the founder and president of the Heroic Imagination Project.
Vaino Vahing
Vaino Vahing (15 February 1940 to 23 March 2008, in Tartu), was an Estonian writer, prosaist, psychiatrist and playwright. Starting from 1973, he was a member of the Estonian Writers Union.
A trauma trigger is a psychological stimulus that prompts involuntary recall of a previous traumatic experience.
The stimulus itself need not be frightening or traumatic and may be only indirectly or superficially reminiscent of an earlier traumatic incident, such as a scent or a piece of clothing. Triggers can be subtle and difficult to anticipate. A trauma trigger may also be called a trauma stimulus, a trauma stressor or a trauma reminder.
The process of connecting a traumatic experience to a trauma trigger is called traumatic coupling. When trauma is “triggered”, the involuntary response goes far beyond feeling uncomfortable and can feel overwhelming and uncontrollable, such as a panic attack or a strong impulse to flee to a safe place. Avoiding a trauma trigger, and therefore the potentially extreme reaction it provokes, is a common behavioural symptom of posttraumatic stress disorder (PTSD), a treatable and usually temporary condition in which people sometimes experience overwhelming emotional or physical symptoms when something reminds them of, or “triggers” the memory of, a traumatic event. Long-term avoidance of triggers increases the likelihood that the affected person will develop a disabling level of PTSD. Identifying and addressing trauma triggers is an important part of treating PTSD.
A trigger warning is a message presented to an audience about the contents of a piece of media, to warn them that it contains potentially distressing content.
Brief History
Trauma triggers have been recognised by medical professionals since the 19th century.
Triggers
The trigger can be anything that provokes fear or distressing memories in the affected person, and which the affected person associates with a traumatic experience. Some common triggers are:
A particular smell: Such as freshly mown grass, the fragrance of an aftershave product, or perfume. The sense of smell, olfaction, has been claimed as more closely connected to traumatic reminders than other sensory experience, given the proximity of the olfactory bulb to the limbic system..
A particular taste: Such as the food eaten during or shortly before a traumatic experience.
A particular sound: Such as a helicopter or a song.
A particular texture.
Certain times of day: For example, sunset or sunrise.
Certain times of year or specific dates: For example, autumn weather that resembles the affected person’s experience of the weather during the September 11 attacks, or the anniversary of a traumatic experience.
Sights (real, photo, film or video): For examples, a fallen tree or a light shining at a particular angle.
Places: For example, a bathroom, or all bathrooms.
A person: Especially a person who was present during a traumatic event or resembles someone involved in that event in some respect.
An argument.
A sensation on the skin: Such as the feeling of a wristwatch resembling the feeling of handcuffs, or sexual touching for victims of sexual assault.
The position of the body.
Physical pain.
Emotions – such as feeling overwhelmed, vulnerable, or not in control.
A particular situation – for example, being in a crowded place.
The trigger is usually personal and specific. However, it need not be closely related to the actual experience. For example, after the Gulf War, some Israelis experienced the sound of an accelerating motorbike as a trigger, which they associated with the sound of sirens they heard during the war, even though the resemblance between the two sounds is limited.
The realistic portrayal of graphic violence in visual media may expose some affected people to triggers while watching movies or television.
Experiences
People who have experienced trauma and who have developed trauma triggers may panic when the trigger is experienced, especially if it is unexpected. For example, the noise of fireworks may seem unbearable to a combat veteran whose trauma is coupled with sudden, loud noises as the trigger.
Trigger Warnings
Trigger warnings, sometimes called content warnings, are warnings that a work contains writing, images, or concepts that may be distressing to some people. Content warnings have been widely used in mass media without any connection to trauma, such as the US TV Parental Guidelines, which indicate that a show includes content that some families may find inappropriate for their children. The term trigger warning, with its trauma-specific context, originated at feminist websites that were discussing violence against women, and then spread to other areas, such as print media and university courses. Although it is widely recognised that any sight, sound, smell, taste, touch, feeling or sensation could be a trigger, trigger warnings are most commonly presented on a relatively narrow range of material, especially content about sexual abuse and mental illness (such as suicide, eating disorders, and self-injury).
Although the subject has generated political controversy, research suggests that trigger warnings are neither harmful nor especially helpful. Among people without traumatic experiences, “trigger warnings did not affect anxiety responses to potentially distressing material in general.” Studies disagree on whether trigger warning cause transient increases in anxiety in those without traumatic experiences. For participants who self-reported a posttraumatic stress disorder (PTSD) diagnosis, or for participants who qualified for probable PTSD, trigger warnings had little statistically significant effect. Effect sizes on feelings of avoidance, decreased resilience, or other negative outcomes have been “trivial” in controlled research environments.
Controversy in Higher Education
The idea of giving content warnings to university students about their coursework has been disputed and politicised. Much of the dispute centres around content warnings given to all students about the presence of generally uncomfortable subjects in the curriculum, such as racism and misogyny. There is no significant dispute over providing reasonable accommodations to the small number of students (usually current and former military personnel and sexual assault survivors) who qualify as having a disabling level of post-traumatic stress disorder and whose ability to learn the normal curriculum can be improved, for example, by mentioning in advance that the next reading assignment contains a detailed description of a violent event or that an upcoming ballistic pendulum demonstration will produce loud sounds.
In 2014, the American Association of University Professors criticised the use of general content warnings in university contexts, stating:
“The presumption that students need to be protected rather than challenged in a classroom is at once infantilizing and anti-intellectual. It makes comfort a higher priority than intellectual engagement and…it singles out politically controversial topics like sex, race, class, capitalism, and colonialism for attention.”
This view is supported by some professors such as Richard McNally, professor of psychology at Harvard, and some psychiatric medical practitioners, such as Metin Basoglu and Edna Foa. They believe that trigger warnings increase avoidance behaviours by those with PTSD which makes it harder to overcome the PTSD, create a culture that decreases resilience, and more geared towards political virtue signalling, and are “counterproductive to the educational process”.
Since the publication of the American Association of University Professors’ report, other professors, such as Angus Johnston, have supported trigger warnings as a part of “sound pedagogy”. Other supportive professors have stated that “the purpose of trigger warnings is not to cause students to avoid traumatic content, but to prepare them for it, and in extreme circumstances to provide alternate modes of learning.”
Universities have taken different stances on the issue of trigger warnings. In a letter welcoming new undergraduates, the University of Chicago wrote that the college’s “commitment to academic freedom means we do not support so-called ‘trigger warnings’,” do not cancel controversial speakers, and do not “condone the creation of intellectual ‘safe spaces’ where individuals can retreat from thoughts and ideas at odds with their own”. Students at UC Santa Barbara took the opposite position in 2014, passing a non-binding resolution in support of mandatory trigger warnings for classes that could contain potentially upsetting material. Professors were encouraged to alert students of such material and allow them to skip classes that could make them feel uncomfortable.
While trigger warnings have garnered significant debate, few studies have investigated how students typically respond to potentially triggering material. In a 2021 study, three hundred and fifty-five undergraduate students from four universities read a passage describing incidences of both physical and sexual assault. Longitudinal measures of subjective distress, PTSD symptoms, and emotional reactivity were taken. Greater than 96% of participants read the triggering passage even when given a non-triggering alternative to read. Of those who read the triggering passage, those with triggering traumas did not report more distress although those with higher PTSD scores did. Two weeks later, those with trigger traumas and/or PTSD did not report an increase in trauma symptoms as a result of reading the triggering passage. Students with relevant traumas do not avoid triggering material and the effects appear to be brief. Students with PTSD do not report an exacerbation of symptoms two weeks later as a function of reading the passage. In 2021, a study of the effects of trigger warnings, published in the Chronicle of Higher Education, announced that “Trigger warnings don’t help”.
Thought suppression is a psychological defence mechanism. It is a type of motivated forgetting in which an individual consciously attempts to stop thinking about a particular thought.
It is often associated with obsessive-compulsive disorder (OCD). OCD is when a person will repeatedly (usually unsuccessfully) attempt to prevent or “neutralise” intrusive distressing thoughts centred on one or more obsessions. It is also thought to be a cause of memory inhibition, as shown by research using the think/no think paradigm. Thought suppression is relevant to both mental and behavioural levels, possibly leading to ironic effects that are contrary to intention. Ironic process theory is one cognitive model that can explain the paradoxical effect.
When an individual tries to suppress thoughts under a high cognitive load, the frequency of those thoughts increases and becomes more accessible than before. Evidence shows that people can prevent their thoughts from being translated into behaviour when self-monitoring is high; this does not apply to automatic behaviours though, and may result in latent, unconscious actions. This phenomenon is made paradoxically worse by increasing the amount of distractions a person has, although the experiments in this area can be criticised for using impersonal concurrent tasks, which may or may not properly reflect natural processes or individual differences.
Empirical Work (1980s)
In order for thought suppression and its effectiveness to be studied, researchers have had to find methods of recording the processes going on in the mind. One experiment designed with this purpose was performed by Wegner, Schneider, Carter & White. They asked participants to avoid thinking of a specific target (e.g. a white bear) for five minutes, but if they did, they were told then to ring a bell. After this, participants were told that for the next five minutes they were to think about the target. There was evidence that unwanted thoughts occurred more frequently in those who used thought suppression compared to those who were not. Furthermore, there was also evidence that during the second stage, those who had used thought suppression had a higher frequency of target thoughts than did those who had not used thought suppression; later coined the rebound effect. This effect has been replicated and can even be done with implausible targets, such as the thought of a “green rabbit”. From these implications, Wegner eventually developed the “ironic process theory”.
Improved Methodology (1990s)
To better elucidate the findings of thought suppression, several studies have changed the target thought. Roemer and Borkovec found that participants who suppressed anxious or depressing thoughts showed a significant rebound effect. Furthermore, Wenzlaff, Wegner, & Roper demonstrated that anxious or depressed subjects were less likely to suppress negative, unwanted thoughts. Despite Rassin, Merkelbach and Muris reporting that this finding is moderately robust in the literature, some studies were unable to replicate results. However, this may be explained by a consideration of individual differences.
Recent research found that for individuals with low anxiety and high desirability traits (repressors), suppressed anxious autobiographical events initially intruded fewer times than in other groups (low, high, and high defensive anxious groups), but intruded more often after one week. This difference in coping style may account for the disparities within the literature. That said, the problem remains that the cause of the paradoxical effect may be in the thought tapping measures used (e.g. bell ringing). Evidence from Brown (1990) that showed participants were very sensitive to frequency information prompted Clarke, Ball and Pape to obtain participants’ aposterio estimates of the number of intrusive target thoughts and found the same pattern of paradoxical results. However, even though such a method appears to overcome the problem, it and all the other methodologies use self-report as the primary form of data-collection. This may be problematic because of response distortion or inaccuracy in self-reporting.
Behavioural Domain
Thought suppression also has the capability to change human behaviour. Macrae, Bodenhausen, Milne, and Jetten found that when people were asked not to think about the stereotypes of a certain group (e.g. a “skinhead”), their written descriptions about a group member’s typical day contained less stereotypical thoughts. However, when they were told they were going to meet an individual they had just written about, those in the suppression group sat significantly farther away from the “skinhead” (just by virtue of his clothes being present). These results show that even though there may have been an initial enhancement of the stereotype, participants were able to prevent this from being communicated in their writing; this was not true for their behaviour though.
Further experiments have documented similar findings. In one study from 1993, when participants were given cognitively demanding concurrent tasks, the results showed a paradoxical higher frequency of target thoughts than controls. However other controlled studies have not shown such effects. For example, Wenzlaff and Bates found that subjects concentrating on a positive task experienced neither paradoxical effects nor rebound effects – even when challenged with cognitive load. Wenzlaff and Bates also note that the beneficiality of concentration in their study participants was optimised when the subjects employed positive thoughts.
Some studies have shown that when test subjects are under what Wegner refers to as a “cognitive load” (for instance, using multiple external distractions to try to suppress a target thought), the effectiveness of thought suppression appears to be reduced. However, in other studies in which focused distraction is used, long term effectiveness may improve. That is, successful suppression may involve less distractors. For example, in 1987 Wegner, Schneider, Carter & White found that a single, pre-determined distracter (e.g. a red Volkswagen) was sufficient to eliminate the paradoxical effect post-testing. Evidence from Bowers and Woody in 1996 is supportive of the finding that hypnotised individuals produce no paradoxical effects. This rests on the assumption that deliberate “distracter activity” is bypassed in such an activity.
Cognitive Dynamics
When the cognitive load is increased, thought suppression typically becomes less effective. For example, in the white bear experiment, many general distractions in the environment (for instance a lamp, a light bulb, a desk etc.) might later serve as reminders of the object being suppressed (these are also referred to as “free distraction”). Some studies, however, are unable to find this effect for emotional thoughts in hypnotized individuals when one focused distraction is provided. In an attempt to account for these findings, a number of theorists have produced cognitive models of thought suppression. Wegner suggested in 1989 that individuals distract themselves using environmental items. Later, these items become retrieval cues for the thought attempting to be suppressed. This iterative process leaves the individual surrounded by retrieval cues, ultimately causing the rebound effect. Wegner hypothesized that multiple retrieval cues not being forged explains, in part, the effectiveness of focused distraction (i.e. a reduction of mental load). This is because there may be an ideal balance between the two processes; if the cognitive demand that is not too heavy, then the monitoring processes will not supersede it.
Individual differences may also play a role in regards to the ironic thought process.
Thought suppression has been seen as a form of “experiential avoidance”. Experiential avoidance is when an individual attempts to suppress, change, or control unwanted internal experiences (thoughts, feelings, bodily sensations, memories, etc.). This line of thinking supports relational frame theory.
Other Methodologies
Thought suppression has been shown to be a cause of inhibition in several ways. Two commonly-used methods to study this relationship are the list method and the item method. In this list method, participants study two lists of words, one after the other. After studying the first list, some participants are told to forget everything that they have just learned, while others are not given this instruction. After studying both lists, participants are asked to recall the words on both lists. These experiments typically find that participants who were told to forget the first list do not remember as many words from that list, suggesting that they have been suppressed due to the instruction to forget. In the item method, participants study individual words rather than lists. After each word is shown, participants are told to either remember or forget the word. As in experiments using the list method, the words followed by the instruction to forget are more poorly remembered. Some researchers believe that these two methods result in different types of forgetting. According to these researchers, the list method results in inhibition of the forgotten words, but the item method results in some words being remembered better than the others, without a specific relation to forgetting.
Think/No Think Paradigm
A paradigm from 2009 to study how suppression relates to inhibition is the think/no think paradigm. In these experiments, participants study pairs of words. An example of a possible word pair is roach-ordeal. After all the word pairs are learned, the participants see the first word of the pair and are either told to think about the second word (think phase) or not to think about the second word (no think phase). The no think phase is when suppression occurs. Some pairs were never presented after the initial study portion of the study, and these trials serve as the control group. At the end of the experiment, the participants try to remember all of the word pairs based on the first word. Studies could also use the “independent probe” method, which gives the category and first letter of the second word of the pair. Typically, regardless of the method used, results show that the no-think trials result in worse memory than the think trials, which supports the idea that suppression leads to inhibition in memory. Although this methodology was first done using word pairs, experiments have been conducted using pictures and autobiographical memories as stimuli, with the same results.
Research has also shown that doing difficult counting tasks at the same time as a think/no think task leads to less forgetting in the no think condition, which suggests that suppression takes active mental energy to be successful. Furthermore, the most forgetting during the no think phase occurs when there is a medium amount of brain activation while learning the words. The words are never learned if there is too little activation, and the association between the two words is too strong to be suppressed during the no think phase if there is too much activation. However, with medium activation, the word pairs are learned but able to be suppressed during the no think phase.
fMRI studies have shown two distinct patterns of brain activity during suppression tasks. The first is that there is less activity in the hippocampus, the brain area responsible for forming memories. The second is an increase of brain activity in the dorsolateral prefrontal cortex, especially in cases where suppression is harder. Researchers think that this region works to prevent memory formation by preventing the hippocampus from working.
This methodology can also be used to study thought substitution by adding an instruction during the no think phase for participants to think of a different word rather than the word being suppressed. This research shows that thought substitution can lead to increased levels of forgetting compared to suppression without a thought substitution instruction. This research also suggests that thought substitution, while used as a suppression strategy during the no think phase, may work differently than suppression. Some researchers argue that thinking of something different during the no think phase forms a new association with the first word than the original word pair, which results in interference when using this strategy, which is different than the inhibition that results from simply not thinking about something.
Dream Influence
Dreams occur mainly during the rapid eye movement (REM) sleep and are composed of images, ideas, emotions, and sensations. Although more research needs to be done on this subject, dreams are said to be linked to the unconscious mind. Thought suppression has an influence on the subject matter of the unconscious mind and by trying to restrain particular thoughts, there is a high chance of them showing up in one’s dreams.
Ironic Control Theory
Ironic control theory, also known as “ironic process theory”, states that thought suppression “leads to an increased occurrence of the suppressed content in waking states”. The irony lies in the fact that although people try not to think about a particular subject, there is a high probability that it will appear in one’s dreams regardless. There is a difference for individuals who have a higher tendency of suppression; they are more prone to psychopathological responses such as “intrusive thoughts, including depression, anxiety and obsessional thinking”. Due to these individuals having higher instances of thought suppression, they experience dream rebound more often.
Cognitive load also plays a role in ironic control theory. Studies have shown that a greater cognitive load results in an increased possibility of dream rebound occurring. In other words, when one tries to retain a heavy load of information before going to sleep, there is a high chance of that information manifesting itself within the dream. There is a greater degree of dream rebound in those with a higher cognitive load opposed to those whose load was absent. With the enhancement of a high cognitive load, ironic control theory states thought suppression is more likely to occur and lead to dream rebound.
Dream Rebound
Dream rebound is when suppressed thoughts manifest themselves in one’s dreams. Self-control is a form of thought suppression and when one dreams, that suppressed item has a higher chance of appearing in the dream. For example, when an individual is attempting to quit smoking, they may dream about themselves smoking a cigarette. Emotion suppression has also been found to trigger dream rebound. Recurrence of emotional experiences act as pre-sleep suggestions, ultimately leading to the suppressed thoughts presenting themselves within the dream. One effecting factor of dream rebound is the changes in the prefrontal lobes during rapid-eye movement sleep. Suppressed thoughts are more accessible during REM sleep, as a result of operating processes having a diminished effectiveness. This leads to pre-sleep thoughts becoming more available “with an increased activity of searching for these suppressed thought[s]”. There are other hypotheses regarding REM sleep and dream rebound. For instance, weak semantic associations, post REM sleep, are more accessible than any other time due to weak ironic monitoring processes becoming stronger. More research is needed to further understand what exactly causes dream rebound.
Narrative transportation theory (or simply 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 conceptualises 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.
Narrative transportation requires that people process stories – the acts of receiving and interpreting.
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.
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;
The story plot activates their imagination; and
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 scrutinize 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.
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 internalisation. 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.
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;
In the family triangulation system, the third person can either be used as a substitute for direct communication or can be used as a messenger to carry the communication to the main party. Usually, this communication is an expressed dissatisfaction with the main party. For example, in a dysfunctional family in which there is alcoholism present, the non-drinking parent will go to a child and express dissatisfaction with the drinking parent. This includes the child in the discussion of how to solve the problem of the alcoholic parent. Sometimes the child can engage in the relationship with the parent, filling the role of the third party, and thereby being “triangulated” into the relationship. Alternatively, the child may then go to the alcoholic parent, relaying what they were told. In instances when this occurs, the child may be forced into a role of a “surrogate spouse” The reason that this occurs is that both parties are dysfunctional. Rather than communicating directly with each other, they utilise a third party. Sometimes this is because it is unsafe to go directly to the person and discuss the concerns, particularly if they are alcoholic and/or abusive.
In a triangular family relationship, the two who have aligned risk forming an enmeshed relationship.
Good versus Bad Triangulation
Triangulation can be a constructive and stabilising factor. Triangulation can also be a destructive and destabilising factor. Destabilising or “bad triangulation” can polarise communications and escalate conflict. Understanding the difference between stabilising triangulation and destabilising triangulation is helpful in avoiding destabilising situations. Triangulation may be overt, which is more commonly seen in high-conflict families, or covert.
A 2016 longitudinal study of adolescent relationship skills found that teens who were triangulated into parental conflicts more frequently used positive conflict resolution techniques with their own dating partner, but were also more likely to engage in verbally abusive behaviours.
The Perverse Triangle
The Perverse Triangle was first described in 1977 by Jay Haley as a triangle where two people who are on different hierarchical or generational levels form a coalition against a third person (e.g. “a covert alliance between a parent and a child, who band together to undermine the other parent’s power and authority”). The perverse triangle concept has been widely discussed in professional literature. Bowen called it the pathological triangle, while Minuchin called it the rigid triangle. For example, a parent and child can align against the other parent but not admit to it, to form a cross-generational coalition. These are harmful to children.
Child Development
In the field of psychology, triangulations are necessary steps in the child’s development. When a two-party relationship is opened up by a third party, a new form of relationship emerges and the child gains new mental abilities. The concept was introduced in 1971 by the Swiss psychiatrist Dr. Ernst L. Abelin, especially as ‘early triangulation’, to describe the transitions in psychoanalytic object relations theory and parent-child relationship in the age of 18 months. In this presentation, the mother is the early caregiver with a nearly “symbiotic” relationship to the child, and the father lures the child away to the outside world, resulting in the father being the third party. Abelin later developed an ‘organiser- and triangulation-model’, in which he based the whole human mental and psychic development on several steps of triangulation.
Some earlier related work, published in a 1951 paper, had been done by the German psychoanalyst Hans Loewald in the area of pre-Oedipal behaviour and dynamics. In a 1978 paper, the child psychoanalyst Dr. Selma Kramer wrote that Loewald postulated the role of the father as a positive supporting force for the pre-Oedipal child against the threat of re-engulfment by the mother which leads to an early identification with the father, preceding that of the classical Oedipus complex. This was also related to the work in Separation-Individuation theory of child development by the psychoanalyst Margaret Mahler.
Destabilising Triangulation
Destabilising triangulation occurs when a person attempts to control the flow, interpretation, and nuances of communication between two separate actors or groups of actors, thus ensuring communications flow through, and constantly relate back to them. Examples include a parent attempting to control communication between two children, or a relationship partner attempting to control communication between the other partner and the other partner’s friends and family. Another example is to put a third actor between them and someone with whom they are commonly in conflict. Rather than communicating directly with the actor with whom they are in conflict, they will send communication supporting his or her case through a third actor in an attempt to make the communication more credible.
Self-objectification is when people view themselves as objects for use instead of as human beings.
Self-objectification is a result of objectification, and is commonly discussed in the topic of sex and gender. Both men and women struggle with self-objectification, but it is most commonly seen among women. According to Calogero, self-objectification explains the psychological process by which women internalise people’s objectification of their bodies, resulting in them constantly criticising their own bodies.
Relationship to Objectification
Objectification and self-objectification are two different topics, but are closely intertwined. Objectification looks at how society views people (in this case, women) as bodies for someone else’s pleasure. This occurs in advertisements where the body but not the face of a woman is shown. These messages put an unrealistic standard on women’s bodies, dehumanising them to an object of visual pleasure, and self-objectification occurs in response. Women start to internalise the message that they are not individual human beings, but objects of beauty, pleasure, and play for men or women, and they start to look at themselves and their bodies as such.
The perpetuation of self-objectification can be described as a cycle. Objectification causes self-objectification which perpetuates objectification, and the cycle goes on. Both media and social interaction factor into that cycle as well. Media is everywhere, plastering seemingly perfect women across billboards, in music videos, and on covers of magazines. These ideals cause people to put on an unrealistic lens, thinking that they should look and act like the women in the media are portrayed, perpetuating the cycle of self-objectification. Social interactions affect this cycle as well, as the way people communicate with each other subconsciously furthers objectification as well. This type of talk is known as appearance related communication. Two types of appearance-related communication that have had an effect on the existence of self-objectification are fat talk and old talk.
Appearance-Related Communication
Fat talk, a term coined by Mimi Nichter, refers to women making comments about their own weight, dieting, or justifications of one’s eating or exercising habits. It includes comments such as, “I’m out of shape”, or “I’m just eating everything today”. Women who engage in fat talk are more likely to struggle with body dissatisfaction, self-objectification, depression, anorexia, bulimia, and other eating disorders.
Old talk refers to negative statements about wrinkles, skin tone, yellowing teeth, and other physical aspects of the natural aging process. Women who engage in old talk are more likely to be dissatisfied with their bodies, engage in self-objectification, suffer from depression and anxiety, and it may even decrease their quality of life and actual lifespan. Both fat and old talk result in higher self-objectification, as women measure themselves against and attempt to reach an unrealistic standard.
In Different Generations
One period of time in a woman’s life where self-objectification happens excessively is during pregnancy. Magazines offer pictures of pregnant celebrities with golden skin, toned legs, and a perfectly rounded, “cute” pregnant belly. The photo-editing makes it seem real, and people start to think that is how they ought to look when they are pregnant. Looking at these perfect pictures results in pregnant women feeling worse about themselves and being incredibly self-conscious about their weight even though their weight gain is normal and necessary. They see themselves as not good enough, again, objectifying their identity to a body that needs to be perfect. Studies have also been done on adolescent girls, and what heightens self-objectification at an early age. With the amount of over-sexualised media that children are exposed to, young girls start to identify themselves as a “prize” to be used and given away at an early age. This objectification is fuelled heavily by media and the fact that it is highly sexualised. The more a young girl is exposed to media that sexually objectifies women, the more they will internalise those beliefs and ideals and objectify themselves.
Self-regulation theory (SRT) is a system of conscious personal management that involves the process of guiding one’s own thoughts, behaviours and feelings to reach goals.
Self-regulation consists of several stages and individuals must function as contributors to their own motivation, behaviour and development within a network of reciprocally interacting influences.
Background
Roy Baumeister, one of the leading social psychologists who have studied self-regulation, claims it has four components:
Standards of desirable behaviour;
Motivation to meet standards;
Monitoring of situations and thoughts that precede breaking said standards; and
Willpower.
Baumeister along with other colleagues developed three models of self-regulation designed to explain its cognitive accessibility: self-regulation as a knowledge structure, strength, or skill. Studies have been done to determine that the strength model is generally supported, because it is a limited resource in the brain and only a given amount of self-regulation can occur until that resource is depleted.
SRT can be applied to:
Impulse control, the management of short-term desires.
People with low impulse control are prone to acting on immediate desires.
This is one route for such people to find their way to jail as many criminal acts occur in the heat of the moment.
For non-violent people it can lead to losing friends through careless outbursts, or financial problems caused by making too many impulsive purchases.
The cognitive bias known as illusion of control.
To the extent that people are driven by internal goals concerned with the exercise of control over their environment, they will seek to reassert control in conditions of chaos, uncertainty or stress.
Failing genuine control, one coping strategy will be to fall back on defensive attributions of control – leading to illusions of control (Fenton-O’Creevy et al., 2003).
Goal attainment and motivation.
Sickness behaviour.
SRT consists of several stages. First, the patient deliberately monitors one’s own behaviour and evaluates how this behaviour affects one’s health. If the desired effect is not realised, the patient changes personal behaviour. If the desired effect is realised, the patient reinforces the effect by continuing the behaviour (Kanfer, 1970; 1971; 1980).
Another approach is for the patient to realise a personal health issue and understand the factors involved in that issue. The patient must decide upon an action plan for resolving the health issue. The patient will need to deliberately monitor the results in order to appraise the effects, checking for any necessary changes in the action plan (Leventhal & Nerenz, 1984).
Another factor that can help the patient reach their own goal of personal health is to relate to the patient the following:
Help them figure out the personal/community views of the illness;
Appraise the risks involved; and
Give them potential problem-solving/coping skills.
Four components of self-regulation described by Baumeister et al. (2007) are:
Standards: Of desirable behaviour.
Motivation: To meet standards.
Monitoring: Of situations and thoughts that precede breaking standards.
Willpower: Internal strength to control urges.
Brief History and Contributors
Albert Bandura
There have been numerous researchers, psychologists and scientists who have studied self-regulatory processes. Albert Bandura, a cognitive psychologist had significant contributions focusing on the acquisition of behaviours that led to the social cognitive theory and social learning theory. His work brought together behavioural and cognitive components in which he concluded that “humans are able to control their behaviour through a process known as self-regulation.” This led to his known process that contained: self observation, judgment and self response. Self observation (also known as introspection) is a process involving assessing one’s own thoughts and feelings in order to inform and motivate the individual to work towards goal setting and become influenced by behavioural changes. Judgement involves an individual comparing his or her performance to their personal or created standards. Lastly, self-response is applied, in which an individual may reward or punish his or herself for success or failure in meeting standard(s). An example of self-response would be rewarding oneself with an extra slice of pie for doing well on an exam.
Dale Schunk
According to Schunk (2012), Lev Vygotsky who was a Russian psychologist and was a major influence on the rise of constructivism, believed that self-regulation involves the coordination of cognitive processes such as planning, synthesizing and formulating concepts (Henderson & Cunningham, 1994); however, such coordination does not proceed independently of the individual’s social environment and culture. In fact, self-regulation is inclusive of the gradual internalisation of language and concepts.
Roy Baumeister
As a widely studied theory, SRT was also greatly impacted by the well-known social psychologist Roy Baumeister. He described the ability to self-regulate as limited in capacity and through this he coined the term ego depletion. The four components of self-regulation theory described by Roy Baumeister are standards of desirable behaviour, motivation to meet standards, monitoring of situations and thoughts that precede breaking standards and willpower, or the internal strength to control urges. In Baumeister’s paper titled Self-Regulation Failure: An Overview, he express that self-regulation is complex and multifaceted. Baumeister lays out his “three ingredients” of self-regulation as a case for self-regulation failure.
Research
Many studies have been done to test different variables regarding self-regulation. Albert Bandura studied self-regulation before, after and during the response. He created the triangle of reciprocal determinism that includes behaviour, environment and the person (cognitive, emotional and physical factors) that all influence one another. Bandura concluded that the processes of goal attainment and motivation stem from an equal interaction of self-observation, self-reaction, self-evaluation and self-efficacy.
In addition to Bandura’s work, psychologists Muraven, Tice and Baumeister conducted a study for self control as a limited resource. They suggested there were three competing models to self-regulation: self-regulation as a strength, knowledge structure and a skill. In the strength model, they indicated it is possible self-regulation could be considered a strength because it requires willpower and thus is a limited resource. Failure to self-regulate could then be explained by depletion of this resource. For self-regulation as a knowledge structure, they theorised it involves a certain amount of knowledge to exert self control, so as with any learned technique, failure to self-regulate could be explained by insufficient knowledge. Lastly, the model involving self-regulation as a skill referred to self-regulation being built up over time and unable to be diminished; therefore, failure to exert would be explained by a lack of skill. They found that self-regulation as a strength is the most feasible model due to studies that have suggested self-regulation is a limited resource.
Dewall, Baumeister, Gailliot and Maner performed a series of experiments instructing participants to perform ego depletion tasks to diminish the self-regulatory resource in the brain, that they theorized to be glucose. This included tasks that required participants to break a familiar habit, where they read an essay and circled words containing the letter ‘e’ for the first task, then were asked to break that habit by performing a second task where they circled words containing ‘e’ and/or ‘a’. Following this trial, participants were randomly assigned to either the glucose category, where they drank a glass of lemonade made with sugar, or the control group, with lemonade made from Splenda. They were then asked their individual likelihoods of helping certain people in hypothetical situations, for both kin and non-kin and found that excluding kin, people were much less likely to help a person in need if they were in the control group (with Splenda) than if they had replenished their brain glucose supply with the lemonade containing real sugar. This study also supports the model for self-regulation as a strength because it confirms it is a limited resource.
Baumeister and colleagues expanded on this and determined the four components to self-regulation. Those include standards of desirable behaviour, motivation to meet these standards, monitoring of situations and thoughts that precede breaking standards and willpower.
Applications and Examples
Impulse control in self-regulation involves the separation of our immediate impulses and long-term desires. We can plan, evaluate our actions and refrain from doing things we will regret. Research shows that self-regulation is a strength necessary for emotional well-being. Violation of one’s deepest values results in feelings of guilt, which will undermine well-being. The illusion of control involves people overestimating their own ability to control events. Such as, when an event occurs an individual may feel greater a sense of control over the outcome that they demonstrably do not influence. This emphasizes the importance of perception of control over life events.
The self-regulated learning is the process of taking control and evaluating one’s own learning and behaviour. This emphasizes control by the individual who monitors, directs and regulates actions toward goals of information. In goal attainment self-regulation it is generally described in these four components of self-regulation. Standards, which is the desirable behaviour. Motivation, to meet the standards. Monitoring, situations and thoughts that precede breaking standards. Willpower, internal strength to control urges.
Illness behaviour in self-regulation deals with issues of tension that arise between holding on and letting go of important values and goals as those are threatened by disease processes. Also people who have poor self-regulatory skills do not succeed in relationships or cannot hold jobs. Sayette (2004) describes failures in self-regulation as in two categories: under regulation and misregulation. Under regulation is when people fail to control oneself whereas misregulation deals with having control but does not bring up the desired goal (Sayette, 2004).
Criticisms/Challenges
One challenge of self-regulation is that researchers often struggle with conceptualising and operationalising self-regulation (Carver & Scheier, 1990). The system of self-regulation comprises a complex set of functions, including research cognition, problem solving, decision making and meta cognition.
Ego depletion refers to self control or willpower drawing from a limited pool of mental resources. If an individual has low mental activity, self control is typically impaired, which may lead to ego depletion. Self control plays a valuable role in the functioning of self in people. The illusion of control involves the overestimation of an individual’s ability to control certain events. It occurs when someone feels a sense of control over outcomes although they may not possess this control. Psychologists have consistently emphasized the importance of perceptions of control over life events. Heider proposed that humans have a strong motive to control their environment.
Reciprocal determinism is a theory proposed by Albert Bandura, stating that a person’s behaviour is influenced both by personal factors and the social environment. Bandura acknowledges the possibility that individual’s behaviour and personal factors may impact the environment. These can involve skills that are either under or overcompensating the ego and will not benefit the outcome of the situation.
Recently, Baumeister’s strength model of ego depletion has been criticised in multiple ways. Meta-analyses found little evidence for the strength model of self-regulation and for glucose as the limited resource that is depleted. A pre-registered trial did not find any evidence for ego depletion. Several commentaries have raised criticism on this particular study. In summary, many central assumptions of the strength model of self-regulation seem to be in need of revision, especially the view of self-regulation as a limited resource that can be depleted and glucose as the fuel that is depleted seems to be hardly defensible without major revisions.
Conclusion
Self-regulation can be applied to many aspects of everyday life, including social situations, personal health management, impulse control and more. Since the strength model is generally supported, ego depletion tasks can be performed to temporarily tax the amount of self-regulatory capabilities in a person’s brain. It is theorised that self-regulation depletion is associated with willingness to help people in need, excluding members of an individual’s kin. Many researchers have contributed to these findings, including Albert Bandura, Roy Baumeister and Robert Wood.
Self-help groups for mental health are voluntary associations of people who share a common desire to overcome mental illness or otherwise increase their level of cognitive or emotional wellbeing.
This article focuses on groups for which members do not need to share a common diagnosis or aetiology of their mental illness. Improving mental health and wellbeing is also a desired outcome of groups like, for example, Alcoholics Anonymous and Survivors Network of those Abused by Priests. In those cases, for example, members share the trait of alcoholism or traumatic experiences of abuse by priests and those groups focus on improving the mental health and wellbeing of members while acknowledging their shared circumstances.
Despite the different approaches, many of the psychosocial processes in the groups are the same. Self-help groups have had varying relationships with mental health professionals. Due to the nature of these groups, self-help groups can help defray the costs of mental health treatment and implementation into the existing mental health system could help provide treatment to a greater number of the mentally ill population.
Types
Mutual Support and Self-Help
Mutual support or peer support is a process by which people voluntarily come together to help each other address common problems. Mutual support is social, emotional or instrumental support that is mutually offered or provided by persons with similar mental health conditions where there is some mutual agreement on what is helpful.
Mutual support may include many other mental health consumer non-profits and social groups. Such groups are further distinguished as either Individual Therapy (inner-focused) or Social Reform (outer-focused) groups. The former is where members seek to improve themselves, where as the latter set encompasses advocacy organisations such as the National Alliance on Mental Illness and Psychiatric Rehabilitation Association.
Self-help groups are subsets of mutual support and peer support groups, and have a specific purpose for mutual aid in satisfying a common need, overcoming a shared handicap or life-disrupting problem. Self-help groups are less bureaucratic and work on a more grassroots level. Self-help Organisations are national affiliates of local self-help groups or mental health consumer groups that finance research, maintain public relations or lobby for legislation in favour of those affected.
Behaviour Control or Stress Coping Groups
Of individual therapy groups, researchers distinguish between Behaviour Control groups (such as Alcoholics Anonymous and TOPS) and Stress Coping groups (such as mental health support groups, cancer patient support groups, and groups of single parents). German researchers refer to Stress Coping groups as Conversation Circles.
Significant differences exist between Behavioural Control groups and Stress Coping groups. Meetings of Behaviour Control groups tend to be significantly larger than Stress Coping counterparts (by more than a factor of two). Behaviour Control group members have a longer average group tenure than members of Stress Coping groups (45 months compared to 11 months) and are less likely to consider their membership as temporary. While very few members of either set saw professionals concurrently while being active in their group, Stress Coping members were more likely to have previously seen professionals than Behaviour Control group members. Similarly, Stress Coping groups worked closer with mental health professionals.
Member vs Professional Leadership
Member Leadership
In Germany, a specific subset of Conversation Circles are categorised as Talking Groups (Gesprächsselbsthilfegruppen). In Talking Groups all members of the group have the same rights, each member is responsible only for themselves (group members do not make decisions for other group members), each group is autonomous, everyone attends the group on account of their own problems, whatever is discussed in the group remains confidential, and participation is free of charge.
Professionally Led Group Psychotherapy
Self-help groups are not intended to provide “deep” psychotherapy. Nevertheless, their emphasis on psychosocial processes and the understanding shared by those with the same or similar mental illnesses does achieve constructive treatment goals.
Interpersonal learning, which is done through processes such as feedback and confrontation, is generally deemphasized in self-help groups. This is largely because it can be threatening, and requires training and understanding of small group processes. Similarly, reality testing is also deemphasized. Reality testing relies on consensual validation, offering feedback, seeking feedback and confrontation. These processes seldom occur in self-help groups, though they frequently occur in professionally directed groups.
Professional Affiliation and Group Lifespan
If self-help groups are not affiliated with a national organisation, professional involvement increases their life expectancy. Conversely, if particular groups are affiliated with a national organisation professional involvement decreases their life expectancy. Rules enforcing self-regulation in Talking Groups are essential for the group’s effectiveness.
Typology of Self-Help Groups
In 1991 researchers Marsha A. Schubert and Thomasina Borkman created five conceptual categorizations for self-help groups.
Unaffiliated Groups
Unaffiliated groups are defined as self-help groups that function independently from any control at state or national levels, and from any other group or professionals. These groups accept all potential members, and everyone has an equal opportunity to volunteer or be elected. Leaders serve to help the groups function by collecting donations not through controlling the members. Experiential knowledge is mostly found, and there is a high emphasis on sharing. An example of an unaffiliated group includes Wildflowers’ Movement in Los Angeles.
Federated Groups
Federated groups have superordinate levels of their own self-help organisation at state or national levels which makes publicity and literature available. The local unit of the federated self-help group retains full control of its decisions. These groups tend to rely on experiential knowledge, and professionals rarely directly interact. The leaders of these groups would be any members comfortable with the format and willing to accept responsibilities. Leaders do not need to have formal training to gain their title. Examples of a federated self-help group would be Depression and Bipolar Support Alliance (DBSA) and Recovery International.
Affiliated Groups
Affiliated groups are subordinate to another group, a regional or national level of their own organisation. Local groups conform to the guidelines of the regional/national groups. Leaders are self-helpers not professional caregivers, and meetings included educational activities and sharing, supplemented by research and professionals. Examples of an affiliated self-help group would be the National Alliance on Mental Illness (NAMI).
Managed Groups
Managed groups are based on a combination of self-help and professional techniques. These groups are populated generally through referrals and group activities are led by group members. Managed groups do not meet all the criteria for self-help groups, and so should be designated professionally controlled support groups. Examples of managed groups are common with support groups in hospitals, such as those with breast cancer survivors and patients that may be managed by a nurse or therapist in some professional fashion.
Hybrid Groups
The hybrid group has characteristics of the affiliated and managed groups. Like affiliated groups, hybrid groups are organised by another level of their own organisation. To participate in specialised roles, training is developed by a higher level and enforced through trained leaders or facilitators. Like a managed group, a hybrid group cooperates and interacts with professionals, and that knowledge is highly valued alongside experiential knowledge.
Group Processes
No two self-help group are exactly alike, the make-up and attitudes are influenced by the group ideology and environment. In most cases, the group becomes a miniature society that can function like a buffer between the members and the rest of the world. The most essential processes are those that meet personal and social needs in an environment of safety and simplicity. Elegant theoretical formulations, systematic behavioural techniques, and complicated cognitive-restructuring methods are not necessary.
Despite the differences, researchers have identified many psychosocial processes occurring in self-help groups related to their effectiveness. This list includes, but is not limited to: acceptance, behavioural rehearsal, changing member’s perspectives of themselves, changing member’s perspectives of the world, catharsis, extinction, role modelling, learning new coping strategies, mutual affirmation, personal goal setting, instilling hope, justification, normalisation, positive reinforcement, reducing social isolation, reducing stigma, self-disclosure, sharing (or “opening up”), and showing empathy.
Five theoretical frameworks have been used in attempts to explain the effectiveness of self-help groups.
Theory
Outline
Social Support
Having a community of people to give physical and emotional comfort, people who love and care, is a moderating factor in the development of psychological and physical disease.
Experiential Knowledge
Members obtain specialised information and perspectives that other members have obtained through living with severe mental illness. Validation of their approaches to problems increases their confidence.
Social Learning Theory
Members with experience become credible role models.
Social Comparison Theory
Individuals with similar mental illness are attracted to each other in order to establish a sense of normalcy for themselves. Comparing one another to each other is considered to provide other peers with an incentive to change for the better either through upward comparison (looking up to someone as a role model) or downward comparison (seeing an example of how debilitating mental illness can be).
Helper Theory
Those helping each other feel greater interpersonal competence from changing other’s lives for the better. The helpers feel they have gained as much as they have given to others. The helpers receive “personalized learning” from working with helpees. The helpers’ self-esteem improves with the social approval received from those they have helped, putting them in a more advantageous position to help others.
A framework derived from common themes in empirical data describes recovery as a contextual nonlinear process, a trend of general improvement with unavoidable paroxysms while negotiating environmental, socioeconomic and internal forces, motivated by a drive to move forward in one’s life. The framework identified several negotiation strategies, some designed to accommodate illnesses and others designed to change thinking and behaviour. The former category includes strategies such as acceptance and balancing activities. The latter includes positive thinking, increasing one’s own personal agency/control and activism within the mental health system.
Relationship with Mental Health Professionals
A 1978 survey of mental health professionals in the United States found they had a relatively favourable opinion of self-help groups and there was a hospitable climate for integration and cooperation with self-help groups in the mental health delivery system. The role of self-help groups in instilling hope, facilitating coping, and improving the quality of life of their members is now widely accepted in many areas both inside and outside of the general medical community.
The 1987 Surgeon’s General Workshop marked a publicised call for egalitarian relationships with self-help groups. Surgeon General C. Everett Koop presented at this workshop, advocating for relationships that are not superordinate-subordinate, but rather emphasizing respectful, equal relations.
A survey of psychotherapists in Germany found that 50% of the respondents reported a high or very high acceptance of self-help groups and 43.2% rated their acceptance of self-help groups as moderate. Only 6.8% of respondents rated their acceptance of self-help groups as low or very low.
Surveys of self-help groups have shown very little evidence of antagonism towards mental health professionals. The maxim of self-help groups in the United States is “Doctors know better than we do how sickness can be treated. We know better than doctors how sick people can be treated as humans.”
Referrals
A large majority of self-help users use professional services as a gateway to self-help services, or concurrently with professional service or the aftercare following professional service. Professional referrals to self-help groups thus can be a cost-effective method of continuing mental health services and the two can co-exist within their own fields. While twelve-step groups, such as Alcoholics Anonymous, make an indispensable contribution to the mental and/or substance use (M/SU) professional services system, a vast number of non-twelve-step groups remain underutilised within that system.
Professional referrals to self-help groups for mental health are less effective than arranging for prospective self-help members to meet with veterans of the self-help group. This is true even when compared to referrals from professionals familiar with the self-help group when referring clients to it. Referrals mostly come from informal sources (e.g. family, friends, word of mouth, self). Those attending groups as a result of professional referrals account for only one fifth to one-third of the population. One survey found 54% of members learned about their self-help group from the media, 40% learned about their group from friends and relatives, and relatively few learned about them from professional referrals.
Effectiveness
Self-help groups are effective for helping people cope with, and recover from, a wide variety of problems. German Talking Groups have been shown to be as effective as psychoanalytically oriented group therapy. Participation in self-help groups for mental health is correlated with reductions in psychiatric hospitalisations, and shorter hospitalisations if they occur. Members demonstrate improved coping skills, greater acceptance of their illness, improved medication adherence, decreased levels of worry, higher satisfaction with their health, improved daily functioning and improved illness management. Participation in self-help groups for mental health encourages more appropriate use of professional services, making the time spent in care more efficient. The amount of time spent in the programmes, and how proactive the members are in them, has also been correlated with increased benefits. Decreased hospitalisation and shorter durations of hospitalisation indicate that self-help groups result in financial savings for the health care system, as hospitalisation is one of the most expensive mental health services. Similarly, reduced utilisation of other mental health services may translate into additional savings for the system.
While self-help groups for mental health increase self-esteem, reduce stigma, accelerate rehabilitation, improve decision-making, decrease tendency to decompensate under stress, and improve social functioning, they are not always shown to reduce psychiatric symptomatology. The therapeutic effects are attributed to the increased social support, sense of community, education and personal empowerment.
Members of self-help groups for mental health rated their perception of the group’s effectiveness on average at 4.3 on a 5-point Likert scale.
Social support, in general, can lead to added benefits in managing stress, a factor that can exacerbate mental illness.
Select List of Organisations
Depressed Anonymous
Depressed Anonymous (DA) is based on the model pioneered by Alcoholics Anonymous and open to anyone who wants to stop saddening themselves.
Emotions Anonymous
Emotions Anonymous (EA) is a derivative programme of Neurotics Anonymous and open to anyone who wants to achieve emotional well-being. Following the Twelve Traditions, EA groups cannot accept outside contributions.
GROW
GROW was founded in Sydney, Australia, in 1957 by a Roman Catholic priest, Father Cornelius Keogh, and people who had sought help with their mental illness at Alcoholics Anonymous (AA) meetings. After its inception, GROW members learned of Recovery, Inc. (the organisation now known as Recovery International, see below) and integrated its processes into their programme. GROW’s original literature includes the Twelve Stages of Decline, which state that emotional illness begins with self-centeredness, and the Twelve Steps of Recovery and Personal Growth, a blend of AA’s Twelve Steps and will-training methods from Recovery International. GROW groups are open to anyone who would like to join, though they specifically recruit people who have been in psychiatric hospitals or are socioeconomically disadvantaged. GROW does not operate with funding restrictions and have received state and outside funding in the past.
Neurotics Anonymous
Neurotics Anonymous is a twelve-step programme open to anyone with a desire to become emotionally well. According to the Twelve Traditions followed in the programme, Neurotics Anonymous is unable to accept outside contributions. The term “neurotics” or “neuroses” has since fallen out of favour with mental health professionals, with the movement away from the psychoanalytic principles of a DSM-II. Branches of Neurotics Anonymous have since changed their name to Emotions Anonymous, which is currently the name in favour with the Minnesota Groups. Groups in Mexico, however, called Neuróticos Anónimos still are referred to by the same name, due to the term “neuroticos” having a less pejorative connotation in Spanish. This branch continues to flourish in Mexico City as well as largely Spanish-speaking cities in the United States, such as Los Angeles.
Recovery International
Recovery, Inc. was founded in Chicago, Illinois, in 1937 by psychiatrist Abraham Low using principles in contrast to those popularised by psychoanalysis. During the organisation’s annual meeting in June 2007 it was announced that Recovery, Inc. would thereafter be known as Recovery International. Recovery International is open to anyone identifying as “nervous” (a compromise between the loaded term neurotic and the colloquial phrase “nervous breakdown”); strictly encourages members to follow their physician’s, social worker’s, psychologist’s or psychiatrist’s orders; and does not operate with funding restrictions.
Fundamentally, Low believes “Adult life is not driven by instincts but guided by Will,” using a definition of will opposite of Arthur Schopenhauer’s. Low’s programme is based on increasing determination to act, self-control, and self-confidence. Edward Sagarin compared it to a modern, reasonable, and rational implementation of Émile Coué’s psychotherapy. Recovery International is “twelve-step friendly.” Members of any twelve-step group are encouraged to attend Recovery International meetings in addition to their twelve-step group participation.
Criticism
There are several limitations of self-help groups for mental health, including but not limited to their inability to keep detailed records, lack of formal procedures to follow up with members, absence of formal screening procedures for new members, lack formal leadership training, and likely inability of members to recognise a “newcomer” presenting with a serious illness requiring immediate treatment. Additionally, there is a lack of professional or legal regulatory constraints determining how such groups can operate, there is a danger that members may disregard the advice of mental health professionals, and there can be an anti-therapeutic suppression of ambivalence and hostility. Researchers have also elaborated specific criticisms regarding self-help groups’ formulaic approach, attrition rates, over-generalisation, and “panacea complex”.
Formulaic Approach
Researchers have questioned whether formulaic approaches to self-help group therapy, like the Twelve Steps, could stifle creativity or if adherence to them may prevent the group from making useful or necessary changes. Similarly others have criticised self-help group structure as being too rigid.
High Attrition Rates
There is not a universal appeal of self-help groups; as few as 17% of people invited to attend a self-help group will do so. Of those, only one third will stay for longer than four months. Those who continue are people who value the meetings and the self-help group experience.
Overgeneralisation
Since these groups are not specifically diagnosis-related, but rather for anyone seeking mental and emotional health, they may not provide the necessary sense of community to evoke feelings of oneness required for recovery in self-help groups. Referent power is only one factor contributing to group effectiveness. A study of Schizophrenics Anonymous found expert power to be more influential in measurements of perceived group helpfulness.
Panacea Complex
There is a risk that self-help group members may come to believe that group participation is a panacea – that the group’s processes can remedy any problem.
Sexual Predation and Opportunism
Often membership of non-associated self-help groups is run by volunteers. Monitoring of relationships and standards of conduct are seldom formalised within a group and are done on a self-regulating basis. This can mean undesirable and unethical initiation of sexual and intimate encounters are facilitated in these settings. Predatory and opportunistic behaviour in these environments which by association involve divulging volatile mental states, medication changes and life circumstances mean opportunities by those willing to leverage information that is often normally guarded and deeply personal, is a risk more-so than in other social meetup settings or professionally governed bodies.
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