The 14th European Congress of Psychology

The 'nowness' of PTSD

Receiving the Wilhelm Wundt-William James award for her extensive and internationally-recognised work in developing therapy for people suffering with Post Traumatic Stress Disorder (PTSD), Professor Anke Elhers (University of Oxford) spoke about the rationale behind the treatment.

Following a traumatic event people who develop PTSD will often re-experience brief parts of the event. These episodes are more than mere memories and are usually accompanied by very strong emotions, as well as a feeling that the event is happening again – they have a sense of 'nowness' which is absent from normal memories. Ehlers also explained that these intrusive memories can be triggered by a wide range of stimuli and, although rare, some people experience dissociative flashbacks where they feel as if they are actually re-living an event and lose all sense of current reality.

Ehlers and her colleague Professor David Clark proposed a model of PTSD, where people with persistent PTSD symptoms perceive a power threat accompanied by strong emotions and arousal symptoms. The two sources of this threat are negative appraisals of the trauma and the nature of the memory.

Compared with survivors of trauma who don't develop PTSD, those who do tend to find their intrusive memories are triggered more easily and they have a sense of 'nowness' rather than simply a similarity to a usual remembered event. Ehlers explained that triggers of these memories do not often have a meaningful association with the trauma.

Parts of therapy for PTSD are based on the idea that certain memory processes may be involved. There may be a strong perceptual priming during a traumatic event, making seemingly neutral stimuli an eventual trigger for intrusive memories. Ehlers gave the example of one patient who was stabbed in an assault. His intrusive memories were once triggered while attending an art exhibition by a certain quality of light playing over glass.

Ehlers tested this idea and found when pictures of neutral objects are presented during a traumatic story (in the form of a slide show of pictures), these are more easy to recognise when participants are later presented with blurred images of these objects. The therapeutic technique which emerged from this and similar findings is to conduct 'stimuli discrimination training' with PTSD sufferers. A therapist will work through a person's triggers and train people to focus on the difference between that trigger, for example a neutral object or even sensory event, and the actual trauma itself.

Ehlers and her team also hypothesised that the autobiographical memory which comes back to be re-experienced by someone with PTSD is disjointed from other autobiographical memories: they are retrieved without context. She gave the example that many people during a traumatic event feel like they are about to die, and although they did not die, when re-experiencing event they again feel very strongly they will die. She suggested that these re-lived moments remain threatening because the meaning of the event hasn't been updated.

Therefore another part of therapy for PTSD is to update these trauma memories. A therapist will identify the worst moments of a trauma and the idiosyncratic meaning attached to these (e.g. the thought a person is going to die or was to blame for the trauma) and then look for information which updates the meaning of these memories.

Ehlers concluded her talk by presenting data which demonstrated the effectiveness of such therapeutic techniques for people with PTSD. She said very few people drop out from such therapy and it can be used for adults, children and people who have experienced multiple traumas. Ehlers hopes to expand her work to deliver her treatments over the internet, thus helping people globally.

Beating tax aversion takes trust

What role do power and trust play in how we could tackle tax avoidance and the roles of power and trust? Erich Kirchler (University of Vienna) argued that tax avoidance – large corporations using loopholes in laws of certain countries to shift profit – is a far larger problem than tax evasion. 'We need more to educate and empower people to establish a sense of wrongdoing,' he said.

Professor Kirchler added that despite large benefits to tax avoidance it comes with reputational costs and can be associated with a decline in a company's stock market value. While audits and fines have their place in motivating compliance, there are other factors – including the psychological – at play.

Kirchler pointed to studies of attitudes towards tax revealing that if people are asked whether they would drive for 30 minutes to purchase a television with an 8 per cent tax discount compared with if they are asked if they would drive 30 minutes to purchase a television with a 9 per cent non-tax-related discount, a majority will say yes to the former option but no to the latter.

Kirchler said: 'Something is going wrong here, audits and fines might be necessary but they're not the whole story.' He suggested that since we live in a social system a better way to encourage positive interactions between people and institutions was to look at the roles of trust and power.

In his Slippery Slope Framework Kirchler distinguishes between voluntary compliance with taxes or compliance which is forced and looked at how the perceived power of and trust in institutions affects compliance. He said an authority's power comes from its capacity to punish tax evaders while trust in an institution is related to transparency.

In a cross-cultural study Kirchler and his colleagues asked more than 14,000 people in 44 countries whether trust or power were more important in their intended compliance to pay taxes. He found that high levels of both power and trust together lead to higher intended compliance with taxes across countries.

With this main finding aside, Kirchler and his colleagues found a second surprising effect. When comparing countries; he saw that in some, e.g. India, Iran and Pakistan, high trust and low power leads to more intended compliance where in countries such as South Korea, Japan and the UK, high power and low trust leads to more compliance.

Kirchler said he was initially puzzled by this effect and speculated that in many European countries trust in institutions is quite high and people would accept it if they manifested more power. He said we could learn from social psychology, which suggests that it is important for institutions to build trust first followed by power. Whereas in other countries trust is lacking in institutions and this could be why people in these countries would comply more if trust was higher.

Kirchler concluded that though audits and fines are needed, they should be carefully applied. Both power and trust are needed to encourage compliance but power needs a legitimate and trustworthy basis to be effective. 'We should invest in people's representations of the public, the state and taxes and we might think about changing the paradigm which emphasises cooperative relationships.'

Evil and heroism explained

Professor Philip Zimbardo (Harvard University) the researcher behind the infamous Stanford prison experiment of the early 1970s, gave the closing keynote of the conference around the themes of evil and heroism. He began by admitting that growing up in the Bronx he had friends who got in with the wrong crowd, giving into temptation and carrying out 'evil deeds' for money while others resisted.

He said this experience led him to ask questions about the nature of evil, and what separated those who took the different routes. Professor Zimbardo outlined the psychological definition of evil, which involves exercising power to hurt people psychologically. At the level of nations, this involves committing crimes against humanity; in corporations it comes from allowing fraud, corruption and bullying. Although psychologists began by exploring the nature of evil at an individual level, Zimbardo said it took psychologists like himself to point out that people are always in a social context and always have an audience. He concluded that psychologists must take into account an individual and their situation.

So what is the recipe for turning ordinary people evil? The biggest factor, according to Zimbardo, is dehumanisation – thinking of others as less than human. He also pointed to diffusion of responsibility, obedience to authority, group pressure, moral disengagement and anonymity as factors.

After a brief summary of his (in)famous Stanford prison experiment, where college students were assigned as guards or prisoners in a fake prison setting with many guards then treating the prisoners inhumanely, Zimbardo said he had concluded that anyone is capable of good or bad if a situation induces it.

On the flip side, Zimbardo asked, what are the conditions necessary for ordinary people to do good things? Although there is little research in this area, he suggested courage mindfulness, empathy, morality and compassion – but said sometimes these don't lead to action. Therefore Zimbardo refers to heroism as the part of compassion that causes people to act.

He outlined two types of 'hero'; those who are heroic when immediately reacting to a situation and those who are heroic after reflection (e.g. the Enron whistleblowers). He suggested that while many children are exposed to superheroes as a role-model for doing good, a better role model would be ordinary people carrying out heroic acts.

Zimbardo then spoke of the creation of his Heroic Imagination Project – a non-profit educational programme which is run in schools to teach children how to take heroic action and act in a pro-social way. The lessons taught are based on challenging mindsets, situation blindness, bystander effect, peer pressure/conformity/adaptive attributions and stereotype threat, prejudice and intergroup conflict.

There are activities around each theme, all of which end with the suggestion that the children spread the word about what the have learned. The project is now being taught in around 1,000 schools in Hungary alone to change attitudes and encourage prosocial behaviour.

Does religion breed personal values?

'Does it matter if you're a Protestant, a Catholic, a Jew or a Muslim? Is religion enough to account for individual differences?' So began Professor Shalom Schwartz (University of Jerusalem) in his fascinating talk, aimed at convincing the audience that religion doesn't matter for individuals' personal values. Schwartz added: 'I'm talking about religion as a cause in leading to people having one set of value priorities – not about religiosity. That does matter; people who are highly religious have different values than those who are secular. '

In his investigations Schwartz used data from the European Social Survey which was conducted between 2002 and 2012 over 36 countries and involved face-to-face interviews with more than 250,000 people between 15 and 102 years old. The survey included 21 questions which intended to measure 10 values, and Schwartz condensed these into six categories, including self conformity and tradition, self-direction and need for stimulation.

Schwartz found some marked differences between religions and their values, including high levels of conformity and tradition within Muslim people but low levels in the non-religious and Jews. The highest levels of hedonism were found in Jewish people and the non-religious, with the lowest levels seen in that Eastern Orthodoxy.

Schwartz said that almost every possible between-group comparison he found was significant, but was religion actually the main factor in these personal values differences? Schwartz said when looking at each group individually we see some large differences: for example the Protestant group were much older on average, the Jewish people had comparatively higher levels of education and the Eastern Orthodox group contained more females.

Schwartz said it was vital to control for these variables and when doing so almost all of the variance in personal values seems to be due to individual characteristics. Another potential confounding variable is a person's country of origin: religious groups within the same country are much more similar to each other, and Schwartz suggested being of a certain religion in a country where that religion is in the minority could impact on personal values. For example, Muslim people's values stood out most when they were in a minority and were 'grounded in anxiety and self-protection'.

Schwartz concluded: 'People say without religion people tend to be self-interested. But that doesn't seem to be terribly important for what people are. Non-religious people were just as high as protestants in concern for others and just as low in concern for the self and taking advantage of others.' He also pointed out that identifying with a religion was not important for benevolence and that religion accounts for very little variance in individual values.

Schwartz did point out that his study was limited by its focus on Western monotheistic religions and only looked at European countries. He also said that we should consider that each religious group would probably differ in its values and it may be that certain people with certain values are drawn to particular religions or being non-religious. He added that many psychologists had completely ignored the fact that most people in Europe identify as non-religious. In the future, Schwartz said, he hoped to look at the values of people who were once religious but no longer are.

The psychobiology of stress

Some fascinating insights into stress and the potential for later illness, as well as stress in stimulated life-threatening situations, were discussed at a British Psychological Society funded symposium. Members of the Psychobiology Section drew in scores on a hot and humid day.

Dr Mark Wetherell (Northumbria University) started the talks with his work on the effects of anticipation of a forthcoming demanding situation on cortisol. He began by explaining the role of cortisol in maintaining the fight or flight response, and its role in the longer term on sleep-wake regulation and glucose metabolism.

He explained that cortisol has an immediate peak after waking up, the cortisol awakening response (CAR). This response, if reduced, is related to burnout and exhaustion and if exaggerated can be the result of increased job and life stress. If a person has a demanding event ahead of them, this anticipation (even if the event is positive) can lead to an exaggerated CAR.

In his own work at the Northumbria Centre for Sleep Research, which is laid out to look like a comfortable two-bedroom apartment in an attempt to increase ecological validty, Dr Wetherell has looked to assess the effects of anticipated demand on cortisol. In one study participants either entered into a sleep or stress study and measured their cortisol, general wellbeing, wake-sleep patterns over a 14-day baseline assessment before attending the lab.

In the stress condition they were told that the following day they would do a range of demanding tests each hour throughout the day until bedtime. In the sleep study they were told they could spend the day in the lab and watch TV and relax. He found those in the stress study were more tense and physically aroused compared to their 14-day baseline. The stress group also had greater secretion of cortisol during CAR and a greater CAR peak.

Angela Clow (University of Westminster) continued by speaking about the individual difference of attachment style in predicting cortisol responses. She explained that the stress and cortisol systems could become dysregulated over time if a person is repeatedly exposed to stress, and that our responses or evaluation of stressful situations have a bearing on how we cope with them.

Professor Clow said that just as exaggerated stress responses can predict morbidity in later life, having close attachments can also predict life-course morbidity. The insecure-anxious attachment style, which manifests itself in a fear of rejection and high desire of company, is associated generally with more health problems across the lifespan.

With this as a starting point Clow looked into the stress responses of undergraduate students to a modified version of the Trier Social Stress Test, where six participants were confronted with a non-empathetic and powerful panel of people and asked to give a two-minute speech and then do mental arithmetic. She took cortisol samples prior to and at several intervals after the session. Cortisol has a delayed response and thus peaks around 30 minutes after the task. Clow found those with secure attachment style had around a two-point peak in cortisol levels while those with an anxious style peaked at around six points.

Clow concluded that it was quite surprising that young women with no other ill health could have an indicator of vulnerability for future ill health and that an anxious attachment style could be a significant individual difference factor predicting future vulnerability to ill health.

Dr Michael Smith (Northumbria University) has been looking into the sometimes controversial link between Type D personalities, physiological symptoms and dysregulated reactions to stress. He began by explaining a Type D personality is categorised as a person having high levels of negative affectivity (being worried, irritable or unhappy) and social inhibition (high levels of inhibition, being closed and reserved). Early studies in this area have found people with this personality type are more likely to have recurrent heart attacks after an initial heart attack. However the area has been heavily criticised, with many studies failing to be replicated. Smith pointed out that some have argued abandoning Type D research would be premature, as it can be useful in predicting cardiovascular outcomes. In one study Smith and his colleagues worked with 77 people who were asked to carry out a multi-tasking stressor experiment where four tasks must be completed at the same time, each requiring a different response while blood pressure and heart rate are monitored.

He found, surprisingly, that at most points during the task Type D people showed reduced blood pressure reactivity. He explained, though, that blunted cardiovascular activity is related to poor health outcomes too. A further study found a similar blunted response in Type D people to mental arithmetic.

Another psychobiological reaction seen in Type D personalities, Smith explained, is cortisol levels. Previous research has found Type D coronary patients have an elevated CAR and a greater cortisol secretion throughout the day. In his own work Smith found no relationship between this personality type and cortisol levels, but in Type D participants aged 26 to 44 he observed higher social inhibition and higher levels of cortisol during CAR than in other age groups, along with higher levels of cortisol throughout the day. He concluded: 'With repeated stresses physical systems become stressed and respond in an aberrant way. Personality might be another individual difference factor that's important in terms of demands on the physiological system.'

Finally Sarita Robinson (University of Central Lancashire) spoke about her research looking into the psychobiology of facing simulated life-threatening situations, its impact on cognition and the potential for nutritional interventions to help dampen these effects. Dr Robinson has carried out work at a nautical college where participants have to escape from a helicopter cockpit which is submerged underwater and rotated 180 degrees. She said there is a peak in cortisol around 30 minutes following the exercise, although participants feel relaxed by this point. In terms of cognition participants have no working memory problems before the exercise but straight after do show some problems with this.

Some of Robinson's participants are also tested for cortisol levels and cognition after completing a simulated fire fighting search and rescue. During this work she came across the idea of 'cognitive collapse', where survivors of an emergency feel cognitively capable during the event but following a stressful event cognitive ability seems to fall away. Robinson began to look at whether drinking an energy drink prior to the fire search and rescue exercise would help prevent this cognitive collapse. She found a high glucose drink before the event did help with memory performance and mood, while both high caffeine and high glucose drinks helped with information processing. A further study looked to asses whether chewing gum, either regular gum or that containing caffeine or L-Theanine (an amino acid found in tea and thought to aid relaxation), would help with cognitive collapse. No effect was found of chewing gum on stress or cortisol levels, while caffeine gum had some effect on visual declarative memory.

She concluded that some interventions should be considered for the time after an emergency or life-endangering situation, and that interventions such as chewing gum – which have had good effects in the lab – may not be useful in real-life stressful situations.

Being together apart

Three researchers who have looked into the use of forums in supporting people with a chronic illness gave talks about the challenges of psychologists working with technology, the difficulty of being a forum moderator and the use of forums more generally as support networks.

Jeff Gavin (University of Bath) began the discussion by explaining that, with the NHS under intense strain, more research is being aimed at how technology may help people self-manage their own chronic conditions. While much work looking into forums is done retrospectively the researchers wanted to create a forum from scratch aimed at people with Complex Regional Pain Syndrome (CRPS).

Dr Gavin explained that CRPS is an incurable disorder which leaves sufferers with debilitating pain. It is a difficult condition to diagnose and can be extremely isolating. The study aimed not only to create a conventional forum but, following this, to encourage users of that forum to contribute to a Wiki page on CRPS to give a patient perspective of the condition – this unique idea would allow the researchers to see discussions among the authors who were creating the page.

The original forum was set up and monitored for six months and in that time there were 62 members and more than 200 posts. However, Gavin said there had been some key challenges within the study. These included working with web developers to produce a user-friendly and attractive site, and regaining momentum after a hacker created several fake profiles on the site causing it to be shut for several days. Gavin also outlined an interesting ethical dilemma faced when one of the forum users seemed to be struggling with symptoms of depression. One researcher wondered whether it would be ethical to intervene, a second suggested setting up a fake profile on the forum to offer help that way, the third researcher disagreed with the ethics of this and suggested asking another of the group members to offer some support. Eventually it turned out this person had received much support on other social networks.

Finally Gavin said there was an issue with the lack of participant engagement, particularly with the intended Wiki task. None of the forum users wanted to write about their condition publically. As a result the research team created a series of leaflets about CRPS from what they thought was the forum users' point of view. He said this should perhaps tell researchers to stick to studying existing technology and familiar mediums for communication.

Neil Coulson (University of Nottingham) gave an interesting talk into his work with forum moderators, those who help to run and offer support to people using the sites. Dr Coulson said moderators, who are usually also patients themselves, were an incredibly important group who have been under-studied, and he asked what psychologists could do to support them.

One study looked into 59 moderators across six online communities (all for physical and mental health problems) to see what they do. Two thirds of messages sent by moderators in this study were aimed to support other members, doing things with a supportive intention, offering advice, validating feelings and telling them not to feel alone.

Coulson and his team also conducted extensive face-to-face interviews with 33 moderators across 24 online support groups. He found three major themes; emergence, empowerment and nurturing. Emergence is the first step of most moderators – in setting up online communities due to a lack of support outside of the internet, he found a want to care for others as a big drive for this. Empowerment, Coulson explained, involved a moderator's experience of learning and growth and turning the challenging experience of having a medical condition into something positive. He pointed out the difficulty of serving that dual function of helping others while helping the self and said engaging with an online group helped people to learn more about their conditions as well as accessing a 'communal brain' or resource hub that's available for everyone to use. Finally Coulson explained nurturing, and asked what it takes to nurture a forum and be a moderator. He said there was some tension between living with a disease but devoting a lot of attention to helping others, and that moderators felt a strong need to set clear boundaries. Around this theme the notion of self-care also came out: moderators spoke about having 'armour' to deal with spam and trolls. Coulson concluded that we need moderators but that there was an argument for moderator training to develop the skills and resilience needed to carry out the role.

Finally Professor Karen Rodham (Staffordshire University) described examining a forum from its birth. She said this gives researchers much scope to assess how themes, cultures and quirks develop. When first using the CRPS forum, Rodham found that people tended to use their real names and speak about their journey to diagnosis, contact with health professionals, and their hobbies. There is much misdiagnosis with CRPS, treatment is often simply aimed at alleviating symptoms, and people have much trial and error in finding the right medication for them. Rodham therefore suggested this standard introductory format served to establish an individual's credentials as an authentic member of the community and someone with a right to join.

Moving on to more troubling forum use, Rodham has examined the type of language used on pro-anorexia websites. On these sites, she found, many of the troubling symptoms of anorexia (such as hair loss) are framed in a positive light. Rodham also found some members encouraging others to actively hide the fact they were anorexic, using sinister language that suggested telling others would lead to disaster.

Across forums generally common themes occur, with sites often starting with a positive outlook but over time turning negative. Rodham said that although venting can be helpful and positive, there is a danger that forums turn into a collective rant. The growing feeling on some forums that only a person with a particular condition could understand their pain, can lead to greater isolation in the real world.

Rodham concluded that health professionals should be armed with quality sites and good information to point patients towards. She added that professionals should harness the positivity of forums to compliment, but not replace, face-to-face interactions.

Grasping the organisation of the brain

How are objects represented in the brain? Eminent cognitive neuroscientist Alfonso Caramazza (Harvard University) argued that it is on the basis of both 'domains' and 'attributes', and he backed up this view with neuropsychological evidence.

Professor Caramazza described patients with agnosia, a difficulty in recognising objects, and apraxia, who have trouble with actions related to objects. Patients with selective impairments of certain parts of cognition about objects give some proof that the brain must be organised in a certain way.

For example some patients struggle with identifying an object's attributes; Caramazza pointed to patient WC who performed only at chance when asked which two objects (out of a piano, pen and typewriter) matched in the manner in which one uses them (piano and typewriter). They were able, however, to say which matched in function (pen and typewriter): Caramazza said this shows we have separate object knowledge in the brain, part dealing with function and part dealing with the manipulation of objects.

Some patients are impaired in their knowledge of object domains; for example patient EW showed a selective difficulty in naming animals (animate objects) but performed normally naming inanimate objects. The visual system within the brain, Caramazza pointed out, is organised by categories; there is an area for faces, animals, bodies, body parts and trees and buildings. However the major organisation of the brain is complex and is seemingly split into three domains; animate, inanimate, and big vs small objects. There are peaks of preference for each of these in certain areas of the brain. Caramazza suggested that this organisation by size serves a vital function – small things are graspable while things that are large can be used for navigational purposes.

In terms of the development of highly specialised areas for objects, size and function, Caramazza asked how these develop and whether they are truly 'visual' areas. It seems, thanks to recent research, that even the congenitally blind have brains organised for inanimate, animate, small and large objects. Caramazza concluded that brain organisation does not arise due to visual experience but must be a result of evolutionary pressures to organise the brain.