Category: SOS Blog

Psychology & Climate change: Risk perception

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Note: This article is my once-in-a-while exploration of human behavior and climate change. While it is in no way related to health care, it may be directly related to health.

The cold temperatures across the nation this week have had some individuals scoffing at the notion of global warming. On the other hand, most scientists explain that extremes of weather are part of the whole pattern of global warming; these freezing temperatures are the other side of the extreme heat we experienced this summer and fall.

The American Psychological Association’s (APA) report on global climate change is a thorough examination of our current understanding of human attitudes, emotions and behavior relevant to climate change. Whether or not you have seen the movie “An Inconvenient Truth“, you might benefit from reading the introductory section (pages 24-30) of the APA report which does an excellent job of reviewing the background of the intersection of human systems and earth systems, and how human behavior impacts earth systems.

Section 1 of the report explores how people understand the risks presented by climate change. One of the primary challenges in changing behavior is to understand the perspective of the person whose behavior we are trying to change. Any psychotherapist worth his or her salt will tell you that a good assessment of the individual with whom one is proposing to work is essential to effective therapy. The nature of the assessment is less important than its outcome…an understanding of the experiences and motivations of the potential consumer of services, along with a sense of their strengths and limitations.  The beliefs and points of view of that person, about their problems and about their power to impact those problems, is crucial in designing a treatment plan.

So before we design a climate behavior treatment plan for our families, our neighbors and our communities, we must understand how they perceive the potential risks of global climate change. Psychological research leads us to believe that the impacts of distant or rare events tend to be underestimated. From pages 6 and 7 of the APA report, we learn that

…small probability events tend to be underestimated in decisions based on personal experience, unless they have recently occurred, in which case they are vastly overestimated. Many think of climate change risks (and thus of the benefits of mitigating them) as both considerably uncertain and also as being mostly in the future and geographically distant, all factors that lead people to discount them. The costs of mitigation, on the other hand, will be incurred with certainty in the present or near future…. Yet, emotional reactions to climate change risks are likely to be conflicted and muted because climate change can be seen as a natural process and global environmental systems perceived as beyond the control of individuals, communities, and quite possibly, science and technology.

Accordingly, when we communicate about the potential risks to humans of global climate change, we must recognize that different human responses will result based upon the individual’s perception of the risk to them and theirs posed by climate change. If the risk is seen as low and completely outside their control, no change to current behavior will occur. Even if the danger is seen as high, if it is seen as outside the ability of the individual to have an impact, there will still be no change in behavior.

Based on this understanding of how people behave in the face of risk, we must assure that our interventions allow people to experience a sense of efficacy and empowerment. We need to believe that the things we are doing to affect climate change can possibly have the effect we seek. Without such a belief, we will not likely take action.

For most of us, the source of information about climate change has been media reports of the observations of climate scientists. Few of us have personally seen melting glaciers or arctic ice. Psychological research on risk communication is important in this regard. What is the most effective way to communicate about climate change to inform individuals and communities and to empower them to take action? Just how should we be communicating the reports and projections of climate scientists to maximize change in human behavior? Will we be successful in enlisting the media as educators rather than as sensationalists or naysayers?

The summary of section 1 of the APA report (p 48-49) clearly states these issues.

Feeling (or not feeling) vulnerable and at risk in the face of climate change seems to be instrumental in moving (or not moving) people to action (see section 4), and thus the sources of these feelings are in need of further study. Research in cognitive psychology suggests that certain perceived characteristics of climate change (e.g., that it is “natural,” not new, and in principle controllable) may lead citizens as well as policy makers to underestimate the magnitude of the risks. Other psychological research provides additional hypotheses related to emotional reactions to climate change such that the absence of feeling at risk may be a psychodynamic reaction (see section 3), the result of psychic numbing or denial in the face of overwhelming and uncontrollable risk (see section 4 and 5). These explanations are not necessarily mutually exclusive, though sometimes contradictory in elements of their hypotheses (e.g., is climate change seen as a controllable or uncontrollable risk?). Such contradictions need to be resolved by empirical investigations.

The ability of different educational interventions in shaping perceptions, attitudes, and action related to climate change should also be a topic of empirical research (see section 6). Existing knowledge about the relative impact of direct personal experience vs. more abstract statistical information on the perceptions of risk in domains like financial decisions or with the relative effectiveness of emotional vs. analytic processes in prompting protective action can guide the design of different educational interventions about likely climate change scenarios and their repercussions and about the pros and cons of different courses of adaptation to climate change and/or mitigation of greenhouse gas emissions.

If you have not yet taken a look at the APA report, you should do so. Set aside some time to focus on the issues facing us as behavioral and psychological experts, then share your perspectives here. To enter your comments, just click on the title of this article and type in the box at the bottom of the post.

Evidence Based Treatment and Psychology

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As a psychologist trained 30 years ago in a Boulder-model scientist practitioner training program in clinical psychology, the ability to critically evaluate research and to determine its application to the treatment of my patients was an essential part of my practice and of my outlook on clinical psychology. That initial training fed my early interest in Cognitive Behavioral Therapy. I still have vivid recollection of attendance at my first two-day workshop conducted by Jeff Young (Jeffrey E. Young, Ph.D.) on Beck-style Cognitive Therapy of Depression, a workshop that had profound impact on the treatment I provided. Even my later identification as a Feminist Therapist and my questioning of programmed, patriarchal methods that elevated the therapist above the patient was always tempered by the need to use the scientific method in my practice and in my life. (I’ll credit George Kelly’s ‘man, the scientist’ and Franz Epting, Ph.D. for that.)

As I have mentioned previously, I have been retired from active practice since 1993. Imagine my surprise to learn this past November that clinical psychologists value their own experience and the guidance of their colleagues more than they do the dictates of science. In fact, according to the authors of Current Status and Future Prospects of Clinical Psychology: Toward a Scientifically Principled Approach to Mental and Behavioral Health Care by Timothy B. Baker, Richard M. McFall, and Varda Shoham, some clinical psychology training programs are downright anti-scientific. They believe the solution to this ‘problem’ is a new system of accreditation for training programs. NPR’s Science Friday aired an episode on this topic on December 4, 2009. The show, entitled The Science of Clinical Psychology, is a quick way to get a sense of the much longer paper.

This paper and the PR blitz surrounding it including an article in The Washington Post by the authors, has received strong reaction from practicing psychologists, directors of training programs in clinical psychology and divisions of the American Psychological Association (APA).

While some would describe the Baker, McFall, Shoham article as politically motivated and an attempt to wrest accreditation away from the APA, it seems to me that focusing in a defensive fashion on political motivations accomplishes little. Perpetuation of the ad hominem arguments used in the paper will not get us very far. Perhaps we should focus instead on the notion of scientific support for mental health and behavioral treatments, how clinical research might be encouraged, how evidence-based treatments (EBTs) might be most effectively promulgated, and whether psychologists are alone in their hesitance to adopt EBTs.

In his December editorial in Current Psychiatry Online, Henry A. Nasrallah, M.D. suggests that psychiatrists also could benefit from self-evaluation regarding their use of EBTs. Below is an excerpt from Dr. Nasrallah’s article:

PSYCHIATRISTS’ TRACK RECORD

 The Schizophrenia Patient Outcomes Research Team5 assessed how the treatment of 719 patients with schizophrenia conformed to 12 evidence-based treatment recommendations. Overall, <50% of treatments conformed to the recommendations, with higher conformance rates seen for rural than urban patients and for Caucasian patients than minorities.

A study using data from the National Comorbidity Survey6 found that only 40% of respondents with serious psychiatric disorders had received treatment in the previous 12 months, and only 15% received care considered at least minimally adequate. Four predictors of not receiving minimally adequate treatment included being a young adult or African-American, living in the South, suffering from a psychotic disorder, and being treated by physicians other than psychiatrists.

Finally, a recent survey of psychiatrists’ adherence to evidence-based antipsychotic treatment in schizophrenia7 showed: 1) mid-career psychiatrists more adherent than early or late-career counterparts; 2) male psychiatrists more adherent than female; 3) those carrying a large workload of schizophrenia patients more likely to adhere to scientific literature.

It would appear that psychologists and psychiatrists all need a stronger push toward use of EBTs.

In the world of community behavioral health, Medicaid and Medicare are pushing providers of care to the chronically mentally ill toward use of EBTs. SAMHSA has an entire section of its web site dedicated to EBTs. SAMHSA’s National Registry of Evidence-based Programs and Practices (NREPP) contains a searchable database of interventions for the prevention and treatment of mental and substance use disorders. The database currently contains 150 entries along with a method for submitting programs for review and inclusion in the database. The NREPP has the potential for becoming a clearinghouse for effective behavioral health treatment interventions.

How does your organization approach the issue of evidence-based treatments? What is your take on the current controversy in the field of clinical psychology? How do you imagine we ought to move forward in advancing scientifically-tested approaches to mental health treatment? Given the costs of health care, this seems like an extremely important issue for all providers of behavioral health services to address.

Please enter your comment by clicking on the title of the article and typing in the box at the bottom of the page.

Remote Conversations: How do you do it?

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I’ve mentioned here pretty often than I am not a technology sophisticate. I use technology every day in my work life, but I am a slow-adopter. For some of you, this article may be so old-hat that you will ask “Kathy, where have you been?” But I know there are others out there like me, so here goes anyway.

My mother-in-law had back surgery in Miami early this month. Since my 89-year-old mother lives with us, it has been impossible for me to go down to see her since the surgery. This past weekend, we arranged to skype a conversation so she could talk to me and my mom and we could “see” how she is doing. That word I just used…”skype” did not exist as a verb until August 2003 when a group of Estonia-based developers released the first version of what became Skype.

So what in the world is a skype? It is a company that created a technology that allows one computer to make voice and video calls to another computer free of charge. It also allows one to make phone calls from your computer to land lines and cell phones for a very low charge. Of course, it is the free-of-charge calls to other computers, especially video calls, that makes it so exciting. The process of doing this has become “to skype” or “we skyped.”

The technology allows high quality computer connections without going through a telephone service. As long as you have a high-speed internet connection, there are no voice/video delays. As long as your web cams are decent quality, picture and voice quality are excellent…and Skype has built-in tools to help you improve quality if you are having any difficulty.

But here’s the rub…Skype has become so popular that our Sunday morning attempt to connect was unsuccessful. The servers were all busy! So what’s a computer video newbie to do? Well, use Google Chat instead, of course.

SOS has recently switched all of our email to a Google corporate account. This gives us access to a number of other tools…Google Chat is one that we have used in-house for instant messaging. While I only learned about this through our Google account (I told you I am technology-impaired), this tool is also available to anyone who wants to use it…just check out the link above. I had not input the settings correctly before this weekend, so we combined old-fashioned cell phone technology with Google Chat computer video. There was a lack of synchronization between our cell phone service and the video, but now that I have my webcam microphone set up as the sound source it will be synced on future calls.

Yahoo! Messenger has provided similar service and functionality for years, and for Microsoft fans, Windows Live Messenger also allows these same capabilities. Ichat is a similar service used by Apple aficionados.

I must tell you that I do not have much interest in using this technology for work, but for personal contacts with family members who live far away, these are wonderful tools. My assessment of this may change over time. For many of you, the time may be now. Video conferencing is a wonderful way for scholars and far-flung colleagues to work together. It is also a fantastic way to provide behavioral health services to remote and home bound clients.

Several months ago, a Florida psychology listserv to which I belong was the setting for considerable discussion about remote provision of services. While some of the practitioners were hesitant to consider providing psychotherapy via computer video, some have already begun doing so. Community behavioral health organizations are actively considering such services for rural clients and others who require case management but are not readily available for visits. Over time, providing low-income, seriously mentally ill individuals with an inexpensive computer, internet service and webcam could save thousands of dollars in case manager travel and time costs, not to speak of hospitalization costs when deterioration not noticed on a telephone call but readily apparent on a video conference, is beginning.

The biggest push for these services may come from Medicare, Medicaid and other payers. A December 2008 article from the American Telemedicine Association details Medicare’s authorization for payment for remote services. These are provider and location-of-recipient dependent, so check out the details before you decide to start billing Medicare for such services. Since psychotherapy is a covered service for the purposes of telehealth, I expect more practitioners will begin to provide these services. I hope more abundant research on comparative efficacy will follow.

Has your organization begun providing any services remotely using video conferencing? What methods do you use? What benefits and limitations do you experience? If you are not already providing services in this fashion, what might it take to move you to do so?

Please share your comments by clicking on the title of this article and entering your comments in the box at the bottom of the page. Thanks for participating in the discussion!

APA & Climate Change: What psychology can do

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I sat down Monday morning to write this week’s blog post. I was intent upon writing about American Psychological Association’s (APA) recent report on climate change and what the psychology community can do about it. I had previously glanced at the executive summary of the report and was excited to learn what the entire report recommended. Unfortunately, I must have been a bit too tired when I started out in my reading. I was only on page three when my eyes glazed over.

I do have a history with APA; I have been a member for 30 years. I joined as soon as I was eligible after completing my Ph.D. In the early 1990’s I served on two different committees within APA—the Public Information Committee and the Committee for the Advancement of Professional Practice. I have read more than my share of scholarly papers and APA organizational documents. Since retiring from the practice of psychology in 1993 and moving to full-time involvement in the business of psychology billing and clinical record software, I have become more removed from scholarly work and more involved in the action orientation of the business world.

Psychology and Global Climate Change: Addressing a Multi-faceted Phenomenon and Set of Challenges, while perhaps intended to be a call to action, is actually a carefully written and documented organizational treatise on the psychological phenomena involved in this crisis, the psychological research and knowledge which are applicable to these events, and recommendations for the role APA as an organization and psychologists as professionals and individuals can and should play as this crisis unfolds. It is what I should have expected, but not what I hoped it would be.

In order to make this document useful, I believe it needs to be broken down into parts and digested in that fashion. Accordingly, over the next few months, I am going to take each section of the report and tell you about what is in that section. I hope this will have the result of helping us glean the recommendations of the APA and determining what constructive actions individual mental health professionals and behavioral health community organizations can take.

The APA Climate Change Task Force considered six questions:

  1. How do people understand the risks imposed by climate change?
  2. What are the human behavioral contributions to climate change and the psychological and contextual drivers of these contributions?
  3. What are the psychosocial impacts of climate change?
  4. How do people adapt to and cope with the perceived threat and unfolding impacts of climate change?
  5. Which psychological barriers limit climate change action?
  6. How can psychologists assist in limiting climate change?

In examining these questions, they reviewed the psychological literature to focus areas in which additional research might be useful and in which current data might enhance the work of climate scientists.  By way of this report, the task force attempted to create bridges between the climate science community and the psychological community.

It is also clear from these questions that the authors were considerably concerned about what the psychosocial effects of climate change might be. Since those of us who work with individuals, families and communities about various emotional and behavioral health concerns will undoubtedly need to address these impacts, it behooves us to be prepared…at least with knowledge.

Finally, the task force recommended that specialists in behavioral and psychological research adopt the following principles in an attempt to maximize the value and use of psychological principles in climate change work:

  1. Use the shared language and concepts of the climate research community where possible and explain differences in use of language between psychology and this community.
  2. Make connections to research and concepts from other social, engineering, and natural science fields.
  3. Present psychological insights in terms of missing pieces in climate change analysis.
  4. Present the contributions of psychology in relation [to] important challenges to climate change and climate response.
  5. Prioritize issues and behaviors recognized as important climate changes causes, consequences, or responses. 
  6. Be cognizant of the possibility that psychological phenomena are context dependent.
  7. Be explicit about whether psychological principles and best practices have been established in climate-relevant contexts.
  8. Be mindful of social disparities and ethical and justice issues that interface with climate change.

If climate change continues and has even some of the potential impacts that are predicted, mental health and behavioral specialists will be deluged with people caught in and reacting to those impacts. What can you and your organization do to prepare for addressing the fallout of some of these impacts? What would be the result of a Katrina-equivalent in your community? What knowledge and expertise do you need to gain?

Please share you comments by clicking on the title of this article and entering your comment in the box at the bottom of the page.

Stress: APA’s 2009 Survey

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In early November 2009, the American Psychological Association released the results of their 2009 Stress in America Survey. The executive summary is an excellent way to review the results of the survey in 20 pages. The survey was conducted by Harris Interactive and included 1,568 adults aged 18 and older who reside in the United States. The report also includes the results of a YouthQuery survey conducted among 1,206 youths aged 8-17 years of age. Those who provide mental health services to either or both adults and children should take a look at the outcome of this survey. The data are distressing and worrisome to those of us with interest in the effects of stress on our physical health.

According to the survey, parents think their own stress does not affect their children and that their children are not stessed. It appears that parents do not see the worries and stress-related symptoms of their children accurately; and while three-quarters of young people say they can talk to their parents about things they worry about, they also indicate that worry is a real problem for them. Either they are not telling their parents about their stress or worry, or their parents are not hearing them when they communicate. As a result, children may not be getting the family support they need to manage stress. Parents also seem to underestimate the severity of the stress teens and tweens experience.

42% of adults indicate that their stress has increased in 2009. This is 7% fewer than those reporting an increase in stress during 2008 (49%) but is still almost half of the adults surveyed. While it is somewhat comforting to know that only 42% of adults said that their stress has increased in the past year, it is difficult to tell from this report whether the 49% who reported an increase last year are now experiencing less stress or whether it is merely the same as in 2008. The summary indicates that “this could be a precursor to serious health consequesces related to chronic stress.”

While 44% indicate they exercise or walk to manage their stress, 49% indicate they rely on sedentary means of managing stress. 43% reported eating too much or eating unhealthy foods because of stress. Only 4% indicate that they see a mental health professional to deal with stress.

Money, work and the economy are still the most important sources of stress for adults.

Two-thirds of U.S. adults have been told by a health care provider that they have chronic health condition(s) and 70% have received recommendations for lifestyle and behavior changes….exercise more (48%), lose weight (38%) and eat healthier (36%). Few were offered or received support to make these changes; half did not even get an explanation for the recommendation. Women seem to be bearing the brunt of the stress…or are more likely to report it. They are also more likely to report physical symptoms along with the stress.

The potential physical effects of stress has long been studied by mental health and medical professionals. Back in 1967 Holmes and Rahe developed their Life Changes questionnaire also known at the Social Readjustment Rating Scale. This simple questionnaire has been used in a multitude of studies and scores correlated with the occurrence of serious physical illness within the next year. Let’s hope that those who become ill following these two years of significant stress will have access to the health care services they need.

A 2008 study detailed a physiological explanation, and an article in Gizmag does a nice, brief discussion, of how stress affects the immune system. Under stress, the body produces cortisol to facilitate the “fight or flight” response. Under chronic stress, there is an overabundance of cortisol, so the body remains on alert long after that is necessary and the immune system is affected. The mechanism at work seems to be the shortening of chromosomal end caps called telomeres which produce telomerase, an enzyme that keeps immune cells “young”. Cortisol diminishes the production of telomerase thus shortening the healthy life of protective T lymphocytes.

Of course, there is a perfect opportunity for development of a drug to reduce cortisol or increase telomerase. As specialists in behavioral change, I would think it incumbent upon mental health professionals to be doing more education about stress management rather than waiting for yet another drug to make us healthy. There are certainly online resources to facilitate such education. If only 4% of adults indicate that they consult with a mental health professional to help them manage stress, it would appear that the opportunities in this area are wide open.

What does your organization do to help your clients and your community better manage stress? Do you believe there are ways that behavioral health providers might more effectively attract the severely stressed into treatment? Should the practice of psychotherapy also include community education in stress inoculation techniques? How do you manage your own stress?

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