Answers to general behavioral science/mental health questions are provided by David Aboussafy, Ph.D. Manager of Content Development and Research.
Q: What is the point of trying to do psychology on the web?
A: In short, empirically supported psychological interventions are very effective in treating a variety of psychological disorders and reducing health care costs at the individual and group level. Unfortunately, not very many people have access to such services. By offering psychoeducational information and online programs such as multi-session behavioral health courses (e.g., stress management, etc.) supported by online counseling, UCounsel can reach more people than conventional face-to-face individual or group treatment. If, as we hope to demonstrate, online interventions are effective, providing these services on the web may positively impact many more lives than we could reach on a face-to-face basis and generate significant savings to both our individual and institutional clients. See the UCounsel About Us section for more information.
Q: Is internet addiction a real disorder? If so, what is it and how can it be treated?
A: "Internet addiction" is not a diagnosis found in the DSM-IV, the current diagnostic and statistical manual of mental disorders. However, it may be an increasing behavior problem and may appear in future diagnostic manuals. With the internet playing an increasingly large role in our business, professional and personal lives, the question of how much time on the internet is too much may be quite subjective. Generally, internet usage may be seen to be problematic if it comes to impair social, physical, and/or occupational functioning. For example, staying up late at night on the web at the expense of adequate sleep or family interaction; or excessive inappropriate internet usage at work. Using the term "addiction" in this way is controversial, as addiction in the traditional sense refers to physiological addiction to a specific drug, rather than a compulsive habit like internet overuse. A number of psychologists have written on internet "addiction" and generally suggest treating it behaviorally as they would other troublesome habits (such as compulsive gambling, etc.). Behavioral treatments such as stimulus control involve strictly limiting access (e.g., to a maximum of one hour a day for non-work related internet surfing/chatting, etc.) and developing new behaviors in situations where the compulsive overuse occurred. Alternatively, treatment for the internet "addict" may address any underlying problem (such as anxiety, depression, relationship difficulties or reaction to triggering stressor) that preceded the problematic internet overuse. For more information, see the UCounsel course on habit control (currently in development).
Q: My brother keeps gambling even though he should be smart enough to know that he is going to keep losing money. Why do people make such dumb decisions?
A: The propensity toward poor decision making may be a human trait. For example, studies have repeatedly shown that, in general, people tend to be shortsighted in their decision making, choosing short term gain over long term consequences. More relevant to the case you mention, may be what psychologists call the "Polyanna principle," the tendency of people to view positive outcomes as more likely to happen to them, and conversely, to believe that negative outcomes are less likely. Gamblers, in particular, may believe that they are personally more likely to win than to lose, despite what they may know about the odds of their particular game. How many of us would continue to buy lottery tickets if we really felt that the actual odds of winning - 14 million to 1 (about the same chance as finding a winning lottery ticket on the street) - applied equally to us as they did to everybody else? In short, it is easy to imagine ourselves winning so our perception of the odds is skewed. Gambling behavior may be further reinforced by what psychologists refer to as its schedule of reinforcement (reward). Behaviorally, occasional, unpredictable payouts (called a variable interval rate of reinforcement), i.e, getting rewarded once in awhile after an unpredictable number of responses, produces the highest rate of responding in everything from rats pressing a lever in their cages to get food, to humans working a slot machine. These occasional rewards keep gamblers hooked. Chronic gamblers may also develop particular dysfunctional thoughts - such as "I'm due to win it all back" - that do not reflect an accurate assessment of the odds. One chronic gambler I treated had lost over $200,000 to gambling debts and believed that he was "due" and would earn it back if he kept gambling. Stimulus control - avoiding gambling situations - and challenging such irrational thoughts are typically part of treatment programs for gambling. A UCounsel program for chronic gambling is in development.
Q: Why am I more likely to want to clean my room when I have a lot of homework to do? I don't normally want to do either.
A: Basically, this is an application of the Premack principle which suggests that how pleasant or unpleasant we find a particular activity (and therefore how likely we are to do it) is dependent on what other things are happening relative to the other activity. So, in short, you don't enjoy cleaning your room and you don't like doing your homework. However, you dislike cleaning your room less than you dislike your homework so when put in the position when you have to do them both, suddenly cleaning your room doesn't seem so bad. The same holds true for positive events. You might normally like to shoot baskets (especially compared with homework or room cleaning), but if given the chance of going to a movie, shooting hoops may seem less attractive. This may be a case of psychologists coming up with a name for something that is pretty obvious.
Q: I diet a lot, cutting out sweets and high fat snacks totally for periods of time. I find that I completely "give in" to my cravings and goodies if I slip up and have a little first. Why is that? How can this be prevented?
A: Abandoning a restriction after having a small slip is something psychologists call the "abstinence violation effect." This principle suggests that people are more likely to consume a lot of what they had been denying themselves if they have a small amount first. Research found that dieters would consume more of a restricted substance (milkshakes) if they were first allowed to have a sip. The problem, however, wasn't the slip, it was having a total ban in the first place. Prohibiting something completely can make the abstinence violation effect more likely. Prohibitions may make things extra attractive - the forbidden fruit being seen as the sweetest. In addition, "slipping up" and having some may increase the tendency to think: "well I broke my diet anyway…" or that they have failed and that there is no point in not eating as much as they like. A better plan may be to allow small amounts of your favorite goodies as part of your regular pattern of healthy eating (one or two cookies, a few chips). Sometimes people are extremely responsive to external cues - if its there they'll eat it. So keep only the small portions you are allowing yourself handy - one cookie or a few chips in a bowl instead of the whole bag. A lifestyle of healthy eating - which includes the occasional treat - is much better in the long run than restrictive on-again and off-again diets. See the UCounsel Course on Healthy Eating for more information.
Q: Why do people keep doing things that are bad for them? Why isn't knowing that something is bad for you enough to make someone stop?
A: Changing any behavior is difficult. Risky health behavior - smoking, unprotected sex, etc., occur despite people being aware of the risks - they may "know better" but continue anyway. First, their perception of risk may be skewed - as discussed previously, people have a tendency to underestimate the chance that something bad will happen to them personally. This tendency may be even more marked among young people. Lecturing on the risks may have little effect other than to promote resentment. In addition to having good information and an accurate perception of the risks, a belief in the ability to successfully do something about it may be required for someone to seriously consider changing the behavior. People may simply not be ready for change at a given moment and may require education and preparation before being able to decide for themselves whether they will attempt to change the behavior. Other factors (e.g., nicotine addiction in smokers) may make specific changes especially difficult.
UCounsel has a number of articles and programs that may be relevant from Stop Smoking to Habit Control.
Q: On the TV show ER, I heard them mention the "DMS" when talking about looking up psychiatric problems. What is the DMS?
A: ER got it a bit wrong. It's actually the DSM - which stands for the Diagnostic and Statistical Manual of mental disorders put out by the American Psychiatric Association. Basically, the DSM is a classification system for psychiatric disorders which ensures psychologists, physicians and other health professionals in North America are all talking about the same thing when they refer to a specific psychiatric diagnosis (e.g., "Schizophrenia, Paranoid Type," or "Adjustment Disorder, with Depressed Mood"). DSM-IV assessments are multiaxial, which means that they assess individuals in different domains, roughly: Axis I: clinical disorders, Axis II: personality disorders, Axis III: general medical conditions, Axis IV: psychosocial problems, & Axis V: global functioning. The current version is the fourth edition (DSM-IV), published in 1994, which has evolved considerably from the original 1952 edition (with many additions and removals of diagnostic categories, changes in criteria, etc.). Outside North America, other diagnostic classification schemes may be used, such as the International Classification of Diseases - 9th Edition (ICD-9).
Q: What alternative health techniques are useful for psychological problems?
A: "Alternative" health methods have become increasingly popular in recent years. Contributing to this popularity may be impressive claims many such treatments make, usually without solid evidence of effectiveness. They may rely on unverified testimonials or simply the claims and charisma of practitioners (mesmerism is a historical example). Some temporary conditions are self-limiting (meaning they get better on there own). Furthermore, the placebo effect is quite strong, suggesting that improvement may occur simply if someone expects to get better regardless of the specific effectiveness of the particular treatment. It may be argued that there are no "alternative" methods, there are only proven, evidence-based techniques supported by solid placebo-controlled studies or unproven methods. What sets alternative techniques apart is that they have not been scientifically tested and their advocates usually deny the need for such testing (e.g., psychics, "energy transfer" or "rebirthing" methods). These unsupported techniques do not include relaxation training, physiotherapy or empirically supported psychological interventions such as cognitive behavior therapy that may complement conventional treatment and do not make extraordinary, untestable claims. Be cautious, especially where your money and well-being are at stake. Ask to see evidence, if none can be produced, think twice. When in doubt, talk to your physician or a licensed psychologist. See the UCounsel article on Alternative Health techniques for more information. www.quackwatch.com also contains detailed evaluations of many "alternative" treatments.
Q: In the past few years, mass suicides in various cults (Heaven's Gate, Solar Temple, etc.) made me to wonder: what makes people believe so strongly in such weird things, even to the point of doing themselves in?
A: Nobody ever said people were rational. History is full of examples of people believing things others find to be pretty strange, even to the point of suicide or death (Jonestown and Waco may be other examples). Psychologists have made a number of attempts to explain their actions, looking at both individual factors and group processes. In short, there is a tendency for people to want to belong to and identify with a group. In addition, people also tend to want answers to their most troubling questions, in particular, they like simple answers that make them feel special. At the group level, groups can increase adherence by using isolation and giving new members strenuous or difficult assignments. Research has shown that attitudes and beliefs tend to follow behavior, not the other way around (one social psychologist has written that the first thing he would do to improve group cohesion is have them move heavy furniture). The more effort people put into something, the more likely they are to believe in it. This may reflect cognitive dissonance - the group must be good or true if I've worked so hard for it. Some people may be especially susceptible: young people, those with few strong connections to others, the highly suggestible, and those with low self-esteem. It may well be that some cult/group leaders are delusional, however the content of the beliefs (comet, sun worship, aliens, etc.) does not appear to make much difference. Basically, many people want to belong, and want easy answers that make them feel special. When these are provided, along with groups processes that facilitate strong adherence to beliefs (however strange the beliefs are) belief in the group can, in extreme cases, exceed thoughts of self-preservation.
Q: A survey in my local paper had readers rate the "best food in town" in a number of categories. Somehow, fast food outlets tended to top the list. What could possibly explain these results?
A: Opinions of fast food aside, surveys of large groups can be problematic for a number of reasons. Open-ended questions, especially those like in the "best of" survey you describe, may actually tap into what psychologists call the availability heuristic. In the absence of expert knowledge on a topic surveyed (in this case, familiarity with the food at all the restaurants in town) people may fall back on responding with what comes most readily to mind. Thus, the survey you describe may be a better measure of advertising and marketing success than anything else.
Q: Why can't homicidal behavior, such as was seen in the Columbine school shooting, be predicted more accurately?
A: In brief, behavior with a very low base rate of occurrence are nearly impossible to predict accurately. Unfortunately, the best researchers and mental health professionals can do is identify risk factors shared by those who commit the behavior. Unfortunately, these risk factors may not set them a part from a much larger number of people who may share many of the same characteristics. For example, with reference to recent school shootings in the US, there may be hundreds of thousands of boys who share some of the characteristics of the shooters but almost none of them will go on to commit similar crimes. See www.apa.org for more information on this topic.
Q: I've been reading a lot about "road rage" lately. What causes road rage and how can it be prevented?
A: Road rage refers to a number of dangerous physical, emotional and/or behavioral responses triggered by driving situations such as heavy traffic. In short, road rage is an example of the "fight or flight" response. When we perceive an event as threatening we are prepared physically and emotionally to run away or attack - our heart rate and blood pressure increase, our muscles tense, adrenalin enters our bloodstream and we become primed to respond to any sign of an attack. This response helped our ancestors survive in a difficult environment where physical threats had to be dealt with immediately. Today, however, the fight or flight response usually does us more harm than good. Repeated exposure to the same stressors - being stuck in traffic - may make behavioral responses such as aggressive driving more likely. In the short term, road rage can lead to dangerous driving behavior and even physical fights between motorists. In the long term, repeated activation of the stress response can lead to a number of serious health problems such as cardiovascular disease. Minimizing exposure to the triggering situation (such as avoiding peak traffic hours), practicing relaxation techniques, or reducing the perceived threat by interpreting events more rationally (e.g., giving other drivers the benefit of the doubt and not viewing their behavior as intentional attacks) can help prevent or reduce "road rage" and its consequences. See the UCounsel article: Understanding the Stress Response [link] or the UCounsel Stress Management course [link] for more information.
Q: Why is quitting smoking so difficult?
A: Changing any behavior is difficult. Quitting smoking is especially challenging for a number of reasons. First and foremost, nicotine is a highly addictive drug - withdrawal symptoms are experienced when nicotine levels drop. Second, smoking behavior is habit forming. Lighting up, puffing, etc are habits that have been done so many times that they are "overlearned" and may become almost automatic. Furthermore, smoking is often associated with positive events such as coffee breaks and socialization. This pairing with positive events, in addition to ending withdrawal symptoms, can make smoking seem very rewarding to the smoker. For some, smoking may also be seen as part of their identity and even almost as a source of emotional support. Typically, it takes a number of attempts before someone quits for good. Behavioral programs, alone or in combination with other methods, can improve your chance of quitting successfully. Remember, the only failure in quitting smoking is to stop trying. See the UCounsel article: Stopping Smoking: Benefits, Challenges and Techniques [link] or the UCounsel Stop Smoking course [link] for more information.
Q: What are the differences between psychologists, psychiatrists and psychotherapists?
A: A psychiatrist is a Medical Doctor (MD) who has specialized in psychiatry and can prescribe medication. Clinical psychologists are typically PhDs who can conduct assessments and psychological interventions. In most states and provinces, licensed clinical psychologists have earned a PhD from accredited programs, completed supervised internships and postdoctoral work, and passed licensing exams. Experimental psychologists may conduct research and teach at universities but are not licensed to conduct clinical work. The term "psycho- therapist" is not a legally protected name nor does it refer to a regulated profession. See the American Psychological Association www.apa.org for more information.
Q: Why might pain persist even after an injury has healed?
A: Normally, when you hurt yourself, pain causes you to stop what you are doing, leave the situation, and rest. This aids healing. Where pain experienced is chronic and variable and no clear physical explanation for it is evident (as in phantom limb pain), the relationship between injury or disease (if any) and the pain is complex. Pain experienced is not strictly a function of physical changes. Many clinicians and scientists now see pain as the result of a gate-like mechanism that controls how nerve impulses reach the brain and are interpreted. When the pain is chronic, your emotional and behavioral reactions may make it worse and may keep the pain "gate" open. With chronic pain, withdrawal from activities may lead to boredom, depression, and decreased fitness. A vicious cycle may develop whereby isolation and inactivity contribute to anxiety, depression and muscle tension, which leads to increases in perceived pain, which in turn leads to more inactivity and so on. Undistracted by other activities, you may focus more on your pain and perceive it to be more intense as your tolerance for it decreases. Medication may work less well over time (after awhile medication may inhibit or even stop your own production of natural endorphins - morphine-like substances that help reduce your awareness of pain). Cognitive behavioral pain management programs are designed to teach alternative ways of dealing with pain that help "close the gate" and reduce distress, anxiety and depression by increasing understanding and control over the problem, encouraging activation, and breaking the cycle of factors which may maintain pain at high levels. See the UCounsel article: Understanding and Managing Chronic Pain [link] or the UCounsel Pain Management course [link] for more information.
Q: The more I try and fall asleep, the more difficult falling asleep becomes. What can I do to help myself fall asleep faster?
A: Most minor sleep problems respond well to simple behavioral interventions. First, good sleep hygiene is important. Where you sleep should be comfortable (good mattress, temperature, noise level) and should not be used for activities such as work, study or eating. Once sleep problems have started, usually during a stressful period, they may be maintained by anxiety associated with trying to fall asleep or clockwatching. For people dealing with occasional insomnia, bedtime may become somewhat anxiety provoking, as you start to worry about not being able to fall asleep. This type of anxiety promotes wakefulness, as the more you "try" to fall asleep, the more restless you become. If you are not able to fall asleep within 30 minutes, you should get up out of bed and do something (such as quiet reading) until you feel sleepy again. Staying in bed any longer, tossing and turning, associates your sleeping environment with wakefulness and anxiety. Realizing that you will eventually feel sleepy, not getting too worried by it, and doing something else allows sleepiness to return. If it helps, think of sleepiness as a cycle that will return on its own. If you miss it once, be assured that it will return again and enjoy the extra time you have for yourself to do something else. Since caffeine is a powerful stimulant, you may also want to try eliminating or cutting back on any caffeine intake, especially in the evening. In some cases, simply not trying to fall asleep or paradoxical intention can also help reduce insomnia. Since the more you try to force yourself to sleep, the more difficult falling asleep becomes, not trying, or doing the opposite - trying to stay awake - may remove the anxiety and promote sleep in some cases. Taking the focus off trying to sleep by engaging in an activity like leisure reading or a relaxation exercise can also be helpful. For more information, see the UCounsel article: Improving Sleep [link] or the UCounsel Better Sleep course [link] for more information.
Q: What causes the symptoms of a panic attack?
A: Panic symptoms include heart palpitations, dizziness, stiff muscles, tremulousness, cold hands and feet and shortness of breath. Assuming you have been cleared medically by your physician after a thorough physical evaluation, these symptoms may simply be signs that your body is directing energy to self-protection. When in an anxiety provoking situation, your brain sends messages to your body that cause an increase in heart rate and increased strength of the heart beat (which causes blood pressure to go up). By speeding blood flow it improves oxygen delivery to muscles and which helps prepare for activity. This is why a pounding heart is usually experienced during a panic attack. Blood also moves to the large muscle groups (in your arms and legs), helping prepare you for action. Blood is also taken away from the skin, fingers and toes (this makes it less likely for a cut in extremities to cause severe blood loss). This is why your hands, feet and skin may feel cold and you may experience some numbness and tingling during a panic attack. Panic is also associated with an increase in the speed and depth of breathing which allows more oxygen to be taken in. Overbreathing can lead to increasing levels of oxygen in the blood and decreasing carbon dioxide. This can create symptoms such as breathlessness and even pain and tightening in the chest. Certain blood vessels constrict and hemoglobin increases its attachment to oxygen. As a result, less blood reaches certain areas of the body and oxygen that reaches these areas are less likely to be released to these tissues. Thus, while overbreathing results in more oxygen being taken in, less reaches certain parts of the brain and body. This can cause symptoms such as: dizziness, light headedness, and breathlessness. Remember, panic symptoms simply indicate energy and attention are being directed toward self-protection; if you have been cleared medically they are NOT a sign of illness, impending death or insanity as many people experiencing panic symptoms fear. For more information, see the
UCounsel article: Don't Panic or the UCounsel Overcoming Panic course for more information.
Do you have a general interest behavioral health or psychology question for UCounsel? Send your request to [email protected]. Dr. Aboussafy does not provide personal responses but questions of general interest may be answered here.
