What is the Paddington Alcohol Test?

Introduction

The Paddington alcohol test (PAT) was first published in the Journal of Accident and Emergency Medicine in 1996.

Background

It was designed to identify alcohol-related problems amongst those attending accident and emergency departments. It concords well with the Alcohol Use Disorders Identification Test (AUDIT) questionnaire but is administered in a fifth of the time.

When 40-70% of the patients in an accident and emergency department (AED) are there because of alcohol-related issues, it is useful for the staff of the AED to determine which of them are hazardous drinkers so that they can treat the underlying cause and offer brief advice which may reduce the health impact of alcohol for that patient. In accident and emergency departments it is also important to triage incoming patients as quickly as possible, to reduce staff size and cost. In one study, it took an average of 73 seconds to administer the AUDIT questionnaire but only 20 seconds for the PAT.

The working version of the PAT is reviewed at St Mary’s Hospital based on feedback from frontline doctors in the emergency department (A&E). There is also a modified version in use for an English multi-site programme research (Screening and Intervention Programme for Sensible Drinking, SIPS).

The latest version of the PAT is available on the UK Department of Health website, the Alcohol Learning Centre (now part of Public Health England).

What is the CAGE Questionnaire?

Introduction

The CAGE questionnaire, the name of which is an acronym of its four questions, is a widely used screening test for problem drinking and potential alcohol problems.

The questionnaire takes less than one minute to administer, and is often used in primary care or other general settings as a quick screening tool rather than as an in-depth interview for those who have alcoholism. The CAGE questionnaire does not have a specific intended population, and is meant to find those who drink excessively and need treatment. The CAGE questionnaire is reliable and valid; however, it is not valid for diagnosis of other substance use disorders, although somewhat modified versions of the CAGE questionnaire have been frequently implemented for such a purpose.

Overview

The CAGE questionnaire asks the following questions:

  1. Have you ever felt you needed to Cut down on your drinking?
  2. Have people Annoyed you by criticising your drinking?
  3. Have you ever felt Guilty about drinking?
  4. Have you ever felt you needed a drink first thing in the morning (Eye-opener) to steady your nerves or to get rid of a hangover?

Two “yes” responses indicate that the possibility of alcoholism should be investigated further.

The CAGE questionnaire, among other methods, has been extensively validated for use in identifying alcoholism. CAGE is considered a validated screening technique with high levels of sensitivity and specificity. It has been validated via receiver operating characteristic analysis, establishing its ability to screen for problem drinking behaviours.

Brief History

The CAGE questionnaire was developed in 1968 at North Carolina Memorial Hospital to combat the paucity of screening measures to detect problem drinking behaviours. The original study, conducted in a general hospital population where 130 patients were randomly selected to partake in an in-depth interview, successfully isolated four questions that make up the questionnaire today due to their ability to detect the sixteen alcoholics from the rest of the patients.

Reliability

Reliability refers to whether the scores are reproducible. Not all of the different types of reliability apply to the way that the CAGE is typically used. Internal consistency (whether all of the items measure the same construct) is not usually reported in studies of the CAGE; nor is inter-rater reliability (which would measure how similar peoples’ responses were if the interviews were repeated again, or different raters listened to the same interview).

Rubric for Evaluating Norms and Reliability for the CAGE Questionnaire

CriterionRating [1]Explanation
NormsN/ANormative data are not gathered for screening measures of this sort.
Internal ConsistencyNot ReportedA meta-analysis of 22 studies reported the median internal consistency was
α= 0.74.
Inter-Rater ReliabilityNot Usually Reported1. Inter-rater reliability studies examine whether people’s responses are scored the same by different raters, or whether people disclose the same information to different interviewers.
2. These may not have been done yet with the CAGE; however, other research has shown that interviewer characteristics can change people’s tendencies to disclose information about sensitive or stigmatised behaviours, such as alcohol or drug use.
Test-Retest Reliability (Stability)Not Usually ReportedRetest reliability studies help measure whether things behave more as a state or trait; they are rarely done with screening measures.
RepeatabilityNot ReportedRepeatability studies would examine whether scores tend to shift over time; these are rarely done with screening tests.

Validity

Validity describes the evidence that an assessment tool measures what it was supposed to measure. There are many different ways of checking validity. For screening measures such as the CAGE, diagnostic accuracy and discriminative validity are probably the most useful ways of looking at validity.

Evaluation of Validity and Utility for the CAGE Questionnaire

CriterionRating [1]Explanation
Content ValidityAdequateItems are face valid; not clear that they comprehensively cover all aspects of problem drinking.
Construct Validity [2]GoodMultiple studies show screening and predictive value across a range of age groups and samples.
Discriminative ValidityExcellentStudies not usually reporting AUCs, but combined sensitivity and specificity often excellent.
Validity GeneralisationExcellentMultiple studies show screening and predictive value across a range of age groups and samples.
Treatment SensitivityN/ACAGE not intended for use as an outcome measure.
Clinical UtilityGoodFree (public domain), extensive research base, brief.

Notes:

  1. Ratings = Adequate, Good, Excellent, Too Good.
  2. For example: predictive, concurrent, convergent, and discriminant validity.

Limitations

The CAGE is designed as a self-report questionnaire. It is obvious to the person what the questions are about. Because talking about drinking behaviour can be uncomfortable or stigmatized, people’s responses may be subject to social desirability bias. The honesty and accuracy of responses may improve if the person trusts the person doing the interview or interpreting the score. Responses also may be more honest when the form is completed online, on a computer, or in other anonymous formats.

Alternatives

Some alternatives to the CAGE include:

TestDescription
TWEAKA 5-item questionnaire that was originally developed for pregnant women at risk for drinking problems.
Michigan Alcoholism Screening Test (MAST)A 25-item scale designed to assess lifetime symptoms of alcoholism with a focus on late-stage symptoms.
Brief MASTShortened 10-item version of the MAST.
Short MASTA second shortened version of the MAST that does not include questions pertaining physical symptoms of drinking.
Veterans Alcoholism Screening Test (VAST)A 25-item questionnaire similar to the MAST that distinguishes between current and past symptoms.
Alcohol Use Disorders Identification Test (AUDIT)A 10-item scale that focuses on symptoms experienced within the past year.
Adolescent Drinking IndexA 24-item scale developed specifically to assess the degree of an adolescent (age 12-17) individual’s drinking problem.

On This Day … 08 August

People (Births)

  • 1879 – Bob Smith, American physician and surgeon, co-founded Alcoholics Anonymous (d. 1950).

Bob Smith

Robert Holbrook Smith (08 August 1879 to 16 November 1950), also known as Dr. Bob, was an American physician and surgeon who founded Alcoholics Anonymous with Bill Wilson (more commonly known as Bill W.).

Smith began drinking at college attending Dartmouth College in Hanover, New Hampshire. Early on he noticed that he could recover from drinking bouts quicker and easier than his classmates and that he never had headaches, which caused him to believe he was an alcoholic from the time he began drinking. Smith was a member of Kappa Kappa Kappa fraternity at Dartmouth. After graduation in 1902, he worked for three years selling hardware in Boston, Chicago, and Montreal and continued drinking heavily. He then returned to school to study medicine at the University of Michigan. By this time drinking had begun to affect him to the point where he began missing classes. His drinking caused him to leave school, but he returned and passed his examinations for his sophomore year. He transferred to Rush Medical College, but his alcoholism worsened to the point that his father was summoned to try to halt his downward trajectory. But his drinking increased and after a dismal showing during final examinations, the university required that he remain for two extra quarters and remain sober during that time as a condition of graduating.

After graduation, Smith became a hospital intern, and for two years he was able to stay busy enough to refrain from heavy drinking. He married Anne Robinson Ripley on 25 January 1915, and opened up his own office in Akron, Ohio, specialising in colorectal surgery and returned to heavy drinking. Recognising his problem, he checked himself into more than a dozen hospitals and sanitariums in an effort to stop his drinking. He was encouraged by the passage of Prohibition in 1919, but soon discovered that the exemption for medicinal alcohol, and bootleggers, could supply more than enough to continue his excessive drinking. For the next 17 years his life revolved around how to subvert his wife’s efforts to stop his drinking and obtain the alcohol he craved while trying to hold together a medical practice in order to support his family and his drinking.

Meeting Bill Wilson

In January 1933, Anne Smith attended a lecture by Frank Buchman, the founder of the Oxford Group. For the next two years he and Smith attended local meetings of the group in an effort to solve his alcoholism, but recovery eluded him until he met Bill Wilson on 12 May 1935. Wilson was an alcoholic who had learned how to stay sober, thus far only for some limited amounts of time, through the Oxford Group in New York, and was close to discovering long-term sobriety by helping other alcoholics. Wilson was in Akron on business that had proven unsuccessful and he was in fear of relapsing. Recognising the danger, he made inquiries about any local alcoholics he could talk to and was referred to Smith by Henrietta Seiberling, one of the leaders of the Akron Oxford Group. After talking to Wilson, Smith stopped drinking and invited Wilson to stay at his home. He relapsed almost a month later while attending a professional convention in Atlantic City. Returning to Akron on 09 June, he was given a few drinks by Wilson to avoid delirium tremens. He drank one beer the next morning to settle his nerves so he could perform an operation, which proved to be the last alcoholic drink he would ever have. The date, 10 June 1935, is celebrated as the anniversary of the founding of Alcoholics Anonymous.

Final Years

Smith was called the “Prince of Twelfth Steppers” by Wilson because he helped more than 5000 alcoholics before his death. He was able to stay sober from 10 June 1935, until his death in 1950 from colon cancer. He is buried at the Mount Peace Cemetery in Akron, Ohio.

What is the Alcohol Use Disorders Identification Test?

Introduction

The Alcohol Use Disorders Identification Test (AUDIT) is a ten-item questionnaire approved by the World Health Organisation (WHO) to screen patients for hazardous (risky) and harmful alcohol consumption.

Background

It was developed from a WHO multi-country collaborative study, the items being selected for the AUDIT being the best performing of approximately 150 items including in the original survey. It is widely used as a summary measure of alcohol use and related problems. It has application in primary health care, medical clinics, and hospital units and performs well in these settings. Using different cut-off points, it can also screen for Alcohol Use Disorder (DSM-5) and Alcohol Dependence. Guidelines for the use of the AUDIT have been published by WHO and are available in several languages. It has become a widely used instrument and has been translated into approximately fifty languages.

The AUDIT consists of ten questions, all of which ask explicitly about alcohol:

  • Questions 1 to 3 ask about consumption of alcohol (frequency, quantity or typical drinking occasions, and consumption likely to cause impairment);
  • Possible dependence on alcohol (Questions 4 to 6); and
  • Harmful alcohol use, including concern expressed by others (Questions 7 to 10).

Each question is scored between 0 and 4 depending on the response and so the total score ranges between 0 and 40. Based on responses in the original WHO multi-centre study a score of 8 or more is the threshold for identifying hazardous or harmful alcohol consumption with a score of 15 or more indicating likely alcohol dependence, and 20 or more indicating likely severe dependence and harm. Using the cut-off point of 8, its performance in the original collaborative WHO study indicated a sensitivity of 92% and a specificity of 94% for the diagnoses of hazardous and harmful alcohol consumption.

The AUDIT was designed to be used internationally, and was derived from a WHO collaborative study drawing patients from six countries, representing different regions of the world and different political and economic systems. More than 300 studies have been undertaken to examine its usefulness and validity in various settings. Multiple studies have found that the AUDIT is a reliable and valid measure in identifying alcohol abuse, hazardous consumption and harmful alcohol use (consumption leading to actual harm) and it has also been found to be a valid indicator for severity of alcohol dependence. There is some evidence that the AUDIT works in adolescents and young adults; it appears less accurate in older adults. It appears well-suited for use with college students, and also with women and members of minority groups. There has also been significant evidence for its use in the trauma patient population to screen for possible alcohol use disorders. In the trauma patient population, AUDIT has been shown to be more effective at identifying possible alcohol abuse than physician judgement and the blood alcohol content (BAC) test.

A shorter version of the Alcohol Use Disorders Identification Test (AUDIT-C) has been created for rapid use, and is composed of the first 3-question of the full length AUDIT pertaining specifically to quantity of alcohol consumed. It is appropriate for screening for problem drinking in a doctor’s office.

On This Day … 10 June

Events

  • 1935 – Dr. Robert Smith takes his last drink, and Alcoholics Anonymous is founded in Akron, Ohio, United States, by him and Bill Wilson.

Dr. Robert Smith

Robert Holbrook Smith (08 August 1879 to 16 November 1950), also known as Dr. Bob, was an American physician and surgeon who founded Alcoholics Anonymous with Bill Wilson (more commonly known as Bill W.).

Family and Early Life

Smith was born in St. Johnsbury, Vermont, where he was raised, to Susan A. (Holbrook) and Walter Perrin Smith. His parents took him to religious services four times a week, and in response he determined he would never attend religious services when he grew up. He graduated from St Johnsbury Academy in 1898, having met his future wife Anne Robinson Ripley at a dance there.

Education, Marriage, Work, and Alcoholism

Smith began drinking at college attending Dartmouth College in Hanover, New Hampshire. Early on he noticed that he could recover from drinking bouts quicker and easier than his classmates and that he never had headaches, which caused him to believe he was an alcoholic from the time he began drinking. Smith was a member of Kappa Kappa Kappa fraternity at Dartmouth. After graduation in 1902, he worked for three years selling hardware in Boston, Chicago, and Montreal and continued drinking heavily. He then returned to school to study medicine at the University of Michigan. By this time drinking had begun to affect him to the point where he began missing classes. His drinking caused him to leave school, but he returned and passed his examinations for his sophomore year. He transferred to Rush Medical College, but his alcoholism worsened to the point that his father was summoned to try to halt his downward trajectory. But his drinking increased and after a dismal showing during final examinations, the university required that he remain for two extra quarters and remain sober during that time as a condition of graduating.

After graduation, Smith became a hospital intern, and for two years he was able to stay busy enough to refrain from heavy drinking. He married Anne Robinson Ripley on January 25, 1915, and opened up his own office in Akron, Ohio, specialising in colorectal surgery and returned to heavy drinking. Recognising his problem, he checked himself into more than a dozen hospitals and sanitariums in an effort to stop his drinking. He was encouraged by the passage of Prohibition in 1919, but soon discovered that the exemption for medicinal alcohol, and bootleggers, could supply more than enough to continue his excessive drinking. For the next 17 years his life revolved around how to subvert his wife’s efforts to stop his drinking and obtain the alcohol he craved while trying to hold together a medical practice in order to support his family and his drinking.

Meeting Bill Wilson

In January 1933, Anne Smith attended a lecture by Frank Buchman, the founder of the Oxford Group. For the next two years she and Smith attended local meetings of the group in an effort to solve his alcoholism, but recovery eluded him until he met Bill Wilson on 12 May 1935. Wilson was an alcoholic who had learned how to stay sober, thus far only for some limited amounts of time, through the Oxford Group in New York, and was close to discovering long-term sobriety by helping other alcoholics. Wilson was in Akron on business that had proven unsuccessful and he was in fear of relapsing. Recognising the danger, he made inquiries about any local alcoholics he could talk to and was referred to Smith by Henrietta Seiberling, one of the leaders of the Akron Oxford Group. After talking to Wilson, Smith stopped drinking and invited Wilson to stay at his home. He relapsed almost a month later while attending a professional convention in Atlantic City. Returning to Akron on 09 June, he was given a few drinks by Wilson to avoid delirium tremens. He drank one beer the next morning to settle his nerves so he could perform an operation, which proved to be the last alcoholic drink he would ever have. The date, 10 June 1935, is celebrated as the anniversary of the founding of Alcoholics Anonymous.

Final Years

Smith was called the “Prince of Twelfth Steppers” by Wilson because he helped more than 5000 alcoholics before his death. He was able to stay sober from 10 June 1935, until his death in 1950 from colon cancer. He is buried at the Mount Peace Cemetery in Akron, Ohio.

Alcoholics Anonymous

Alcoholics Anonymous (AA) is an international mutual aid fellowship with the stated purpose of enabling its members to “stay sober and help other alcoholics achieve sobriety.” AA is nonprofessional, non-denominational, self-supporting, and apolitical. Its only membership requirement is a desire to stop drinking. The AA programme of recovery is set forth in the Twelve Steps.

AA was founded in 1935 in Akron, Ohio, when one alcoholic, Bill Wilson, talked to another alcoholic, Bob Smith, about the nature of alcoholism and a possible solution. With the help of other early members, the book Alcoholics Anonymous: The Story of How More Than One Hundred Men Have Recovered From Alcoholism was written in 1939. Its title became the name of the organisation and is today commonly referred to as “The Big Book”. AA’s initial Twelve Traditions were introduced in 1946 to help the fellowship be stable and unified while disengaged from “outside issues” and influences.

The Traditions recommend that members remain anonymous in public media, altruistically help other alcoholics, and that AA groups avoid official affiliations with other organisations. They also advise against dogma and coercive hierarchies. Subsequent fellowships such as Narcotics Anonymous have adapted the Twelve Steps and the Twelve Traditions to their respective primary purposes.

AA membership has since spread internationally “across diverse cultures holding different beliefs and values”, including geopolitical areas resistant to grassroots movements. As of 2016, close to two million people worldwide are estimated to be members of AA.

Are There Sex Differences in Comorbidity Between Substance Use & Mental Health in Adolescents?

Research Paper Title

Sex Differences in Comorbidity Between Substance Use and Mental Health in Adolescents: Two Sides of the Same Coin.

Background

This study aims to evaluate sex differences in alcohol and cannabis use and mental health disorders (MHD) in adolescents, and to evaluate the predictive role of mental health disorders for alcohol and cannabis use disorders (AUD and CUD respectively).

Method

A sample of 863 adolescents from the general population (53.7% girls, Mage = 16.62, SD = 0.85) completed a computerised battery including questions on substance use frequency, the Brief Symptom Inventory, the Cannabis Problems Questionnaire for Adolescents – Short version, the Rutgers Alcohol Problem Index and the DSM-IV-TR criteria for AUD and CUD. Bivariate analyses and binary logistic regressions were performed.

Results

Girls presented significantly more mental health problems and a higher prevalence of comorbidity between SUD and MHD. Obsessive-compulsive symptoms and phobic anxiety indicated a higher risk of AUD, whereas depression and interaction between hostility and obsessive-compulsive disorder indicated a higher risk of CUD.

Conclusions

Comorbidity between SUD and MHD is high among adolescents, and significantly higher among girls.

Reference

Fernandez-Artamendi, S. Martinez-Loredo, V. & Lopez-Nunez, C. (2021) Sex Differences in Comorbidity Between Substance Use and Mental Health in Adolescents: Two Sides of the Same Coin. Psicotherma. 33(1), pp.36-43. doi: 10.7334/psicothema2020.297.

Age at First Drink & Severity of Alcohol Dependence in Military Personnel

Research Paper Title

Age at first drink and severity of alcohol dependence.

Background

Early age at first drink (AFD) has been linked to early onset and increased severity of alcohol dependence in various studies. Few Indian studies on AFD have shown a negative correlation between AFD and severity of alcohol dependence. The study aimed to explore this relationship in patients with alcohol dependence syndrome (ADS) diagnosed using ICD-10 criteria.

Methods

One hundred fifty-one consecutive patients freshly diagnosed with ADS were included in the study, which was conducted at the psychiatry unit of a tertiary care, multispecialty hospital. The Addiction Severity Index (ASI) was used to assess severity of alcohol dependence.

Results

Mean AFD was 24.85 years (range = 13-40 years). Median ASI score was 36 (range = 21 to 57). The study yielded a weak negative correlation (ρ = -.105) between AFD and ASI, which was statistically not significant.

Conclusions

The researchers found no correlation between AFD and severity of alcohol dependence at detection in Indian Armed Forces personnel, which is contrary to what has been reported worldwide and in previous Indian studies. Delayed initiation of alcohol use among those enrolling in the Indian Armed Forces and early detection of alcohol dependence within the military environment are possible explanations.

Reference

Chatterjee, K., Dwivedi, A.K. & Singh, R. (2021) Age at first drink and severity of alcohol dependence. Medical Journal, Armed Forces India. 77(1), pp.70-74. doi: 10.1016/j.mjafi.2019.05.003. Epub 2019 Oct 16.

Linking Anxiety, AUD & GABAB

Research Paper Title

The influence of anxiety symptoms on clinical outcomes during baclofen treatment of alcohol use disorder: A systematic review and meta-analysis.

Background

Given the high coexistence of anxiety symptoms in people with alcohol use disorder (AUD), the researchers aimed to determine the influence of anxiety symptoms on outcomes in patients with AUD treated with GABAB receptor agonist baclofen.

Methods

A meta-analysis of 13 comparisons (published 2010-2020) including baseline and outcome data on alcohol consumption and anxiety after 12 weeks was undertaken.

Results

There were significantly higher rates of abstinent days in patients treated with baclofen compared to placebo (p = 0.004; high certainty evidence); specifically in those with higher baseline anxiety levels (p < 0.00001; high certainty evidence) compared to those with lower baseline anxiety levels (p = 0.20; moderate certainty evidence). The change in anxiety ratings over 12 weeks did not differ between those treated with baclofen or placebo (p = 0.84; moderate certainty evidence).

Conclusions

This may be due to different anxiety constructs being measured by scales not validated in this patient group, or that anxiety is not a biobehavioural mechanism by which baclofen may reduce alcohol drinking. Given the prevalence of anxiety symptoms in AUD all these factors warrant further research.

Reference

Agabio, R., Baldwin, D.S., Amaro, H., Leggio, L. & Sinclair, J.M.A. (2021) The influence of anxiety symptoms on clinical outcomes during baclofen treatment of alcohol use disorder: A systematic review and meta-analysis. Neuroscience and Biobehavioural Reviews. doi: 10.1016/j.neubiorev.2020.12.030. Online ahead of print.

On This Day … 01 January

People (Births)

  • 1946 – Claude Steele, American social psychologist and academic.

Claude Steele

Claude Mason Steele (born January 1, 1946) is a social psychologist and emeritus professor at Stanford University, where he is the I. James Quillen Endowed Dean, Emeritus at the Stanford Graduate School of Education, and Lucie Stern Professor in the Social Sciences, Emeritus.

Formerly he was the executive vice chancellor and provost at the University of California, Berkeley. He also served as the 21st provost of Columbia University for two years. Before that, he had been a professor of psychology at various institutions for almost 40 years.

He is best known for his work on stereotype threat and its application to minority student academic performance. His earlier work dealt with research on the self (like self-image and self-affirmation) as well as the role of self-regulation in addictive behaviours.

In 2010, he released his book, Whistling Vivaldi and Other Clues to How Stereotypes Affect Us, summarising years of research on stereotype threat and the underperformance of minority students in higher education.

Education

He enrolled at Hiram College in Hiram, Ohio, where he earned a B.A. in psychology in 1967.

At Hiram College, Steele’s passion for reading novels led to an interest in how the individual faces the social world. After being fully immersed in the Civil Rights Movement and the issues of racial equality, rights, and the nature of prejudice as a child, Steele formed a desire to study the topics in a scientific manner. He was especially keen to discover their effects on social relationships and quality of life. Steele was inspired by African-American social psychologist Kenneth Clark’s TV appearance discussing the psychological implications of the 1964 race riots in Harlem, New York City, which led to doing behavioural research. Steele conducted early experimental research at Hiram College in physiological psychology (looking at behavioural motives in Siamese fighting fish) and social psychology (studying how African-American dialect among kids maintains ethnic/racial identity), where he worked under the mentorship of social psychologist, Ralph Cebulla.

In graduate school, he studied social psychology, earning an M.A. in 1969 and a Ph.D. in 1971 at Ohio State University, with a minor in statistical psychology. His dissertation work, with faculty adviser Tom Ostrom at Ohio State, focused on attitude measurement and attitude change.

Research

Throughout his academic career, his work fell into three main domains of research under the broad subject area of social psychology: stereotype threat, self-affirmation, and addictive behaviours. Although separate and distinct, the three lines of research are linked by their shared focus on self-evaluation and how people cope with threats to their self-image and self-identities.

  • Addictive Behaviours:
    • Although many people primarily associate Steele with his significant contributions in the development of stereotype threat research, the 14 years of his post-doctoral academic career that he spent at the University of Washington were focused on addictive behaviours and the social psychology behind alcohol use and addiction.
    • He was interested in the role of alcohol and drug use in self-regulation processes and social behaviour.
    • Among his major findings were that alcohol myopia, the cognitive impairment by alcohol use, reduces cognitive dissonance, leads to more extreme social responses, increases helping behaviour, reduces anxiety when it is combined with a distracting activity, and enhances important self-evaluations.
  • Self-Affirmation:
    • While studying the effects of alcohol use on social behaviour, Steele was formulating a theory about the effects of self-affirmation.
    • Developed in the 1980s, self-affirmational processes referred to the ability to reduce threats to self-image by stepping back and affirming a value that is important to self-concept.
    • Steele often uses the example of smokers who are told that smoking will lead to significant negative health outcomes.
    • The perception that they may be evaluated negatively by their willingness to engage in negative behaviours threatens their self-image.
    • However, affirming a value in a domain completely unrelated to smoking but important to one’s self-concept: joining a valued cause, or accomplishing more at work, will counter the negative effects of the self-image threat and re-establish self-integrity.
    • Self-affirmation theory was originally formulated as an alternative motivational explanation for cognitive dissonance theory that threats to the self led to a change in attitudes rather than psychologically inconsistent ideas, and self-affirmational strategies can reduce dissonance as effectively as attitude change.
    • His research on self-affirmation and its effects demonstrated the power of self-affirmation to reduce biased attitudes, lead to positive health behaviours, and even improve the academic performance of minority students.
  • Stereotype Threat:
    • Steele is best known for his work on stereotype threat and its application to explain real-world problems such as the underperformance of female students in mathematics and science classes as well as Black students in academic contexts.
    • Steele first began to explore the issues surrounding stereotype threat at the University of Michigan, when his membership on a university committee called for him to tackle the problem of academic underachievement of minority students at the university.
    • He discovered that the dropout rate for Black students was much higher than for their white peers even though they were good students and had received excellent SAT scores.
    • That led him to form a hypothesis involving stereotype threat.
    • Stereotype threat refers to the threat felt in particular situations in which stereotypes relevant to one’s collective identity exist, and the mere knowledge of the stereotypes can be distracting enough to negatively affect performance in a domain related to the stereotype.
    • Steele has demonstrated the far-reaching implications of stereotype threat by showing that it is more likely to undermine the performance of individuals highly invested in the domain being threatened and that stereotype threat can even lead to Black people having significant negative health outcomes.
    • The theories of stereotype threat can be applied for better understanding group differences in performance not only in intellectual situations but also in athletics.
    • Steele has spearheaded many successful interventions aimed at reducing the negative effects of stereotype threat, including how to provide critical feedback effectively to a student under the effects of stereotype threat, inspired by the motivating style of feedback of his graduate school adviser, Ostrom, and how teacher practices can foster a feeling of identity safety.
    • That would improve performance outcomes by elementary school minority students.

On This Day … 11 November

Events

  • 1934 – Bill Wilson, co-founder of Alcoholics Anonymous, takes his last drink and enters treatment for the final time.

People (Deaths)

  • 1966 – Augusta Fox Bronner, American psychologist, specialist in juvenile psychology (b. 1881).
  • 1979 – James J. Gibson, American psychologist and author (b. 1904).

Bill Wilson

You can find an outline of Bill Wilson here.

Augusta Fox Bronner

Augusta Fox Bronner (22 July 1881 to 11 December 1966) was an American psychologist, best known for her work in juvenile psychology. She co-directed the first child guidance clinic, and her research shaped psychological theories about the causes behind child delinquency, emphasizing the need to focus on social and environmental factors over inherited traits.

James J. Gibson

James Jerome Gibson (27 January 1904 to 11 December 1979), was an American psychologist and one of the most important contributors to the field of visual perception. Gibson challenged the idea that the nervous system actively constructs conscious visual perception, and instead promoted ecological psychology, in which the mind directly perceives environmental stimuli without additional cognitive construction or processing.

A Review of General Psychology survey, published in 2002, ranked him as the 88th most cited psychologist of the 20th century, tied with John Garcia, David Rumelhart, Louis Leon Thurstone, Margaret Floy Washburn, and Robert S. Woodworth.