What works and who benefits: Treating behavioral problems in kids on the Autism Spectrum

Sometimes kids can be challenging. They forget rules they've learned, and don't listen to their parents. These types of problems happen with all children, all over the world, but can be even more challenging for parents with kids on the Autism Spectrum. Luckily, this is a problem that psychology is very good at solving. For decades, leaders in the field of behavioral science have been developing and perfecting intervention programs for children with Autism Spectrum Disorders. 

In clinical psychology and medicine, the best way to show that an intervention works is by conducting a randomized controlled trial (RCT). In this type of clinical trial, a team of researchers recruit a sample of individuals in their target population and randomly assign them to one of two or more interventions. Using this scientific approach is the only way of knowing at the end of the intervention whether the improvements you observed were due to the intervention, rather than differences between the individuals in the treatment groups. 

Very recently,  Karen Bearss, Emory University, and her research team published the results of the largest RCT ever conducted looking at the effectiveness of two active treatment programs for disruptive behavior in children on the Autism Spectrum. They compared Parent Training (PT) and a Parent Education Program (PEP) to determine which program resulted in the greatest improvements in disruptive behaviors. Parent Training is described as follows: 

"The first session taught parents to identify the function of a behavior by analyzing its antecedents (events occurring before the behavior) and consequences (events following the behavior). Subsequent sessions presented strategies for preventing disruptive behavior (eg, visual schedules for routine events), positive reinforcement for appropriate behavior, planned ignoring of inappropriate behavior, and techniques to promote compliance. In the last few sessions, the therapist instructed parents on teaching new skills (eg, communication or daily living skills) and how to maintain improvements over time. This sequence was intended to reduce the child’s disruptive behaviors and foster skill acquisition. The treatment sessions used direct instruction, video examples, practice activities, and rehearsal (role play) with feedback to promote parental skill acquisition. In homework assignments between sessions, parents applied new techniques to specific behaviors. 

The other treatment arm, Parent Education Program, involved having a trained therapist provide "useful information on young children with ASD, including the essentials of evaluation, developmental changes in ASD, educational planning, advocacy, and current treatment options." Each intervention arm included 11 or 12 sessions, and sessions in both treatment arms were 12 60-90 minute sessions. They measured improvements in child defiant behaviors, aggression, irritability, social withdrawal, stereotypy, hyperactivity, and inappropriate speech 24 and 48 weeks after starting the treatment program.  Each of these are core behavioral problems that children on the Autism Spectrum and their families commonly deal with on a daily basis. 

The trial ultimately randomized 180 children (ages 3-7, 158 boys, 22 girls) on the Autism Spectrum to one of the two treatments. Twenty four weeks after starting the treatment program, kids assigned to the PEP showed a 31.8-34.2% decline in behavior problems, depending on the behavior examined. Kids assigned to PT showed a 47.7-55% decline in behavior problems. In other words, both treatments worked in reducing problem behaviors, but the Parent Training program worked much better. Further, the benefit of these treatment programs were still visible at the 48 week follow-up. The research team concluded that Parent Training is an effective program for addressing disruptive behaviors in families with children on the Autism Spectrum. 

More recently, this research team published a study of the moderators of treatment response. Moderators are factors that influence how well the treatment program works. In this study, Luc Lecavalier, Ohio State University, looked at whether the Parent Training intervention works better or worse in kids with different individual or family characteristics. For example, they looked at whether IQ of the child, severity of Autism, presence of another co-occurring disorder such as ADHD or anxiety,  living in a single parent family, or parent income and education were related to treatment outcomes. 

They found that the kids who improved the most from Parent Training were the ones without co-occurring ADHD, low anxiety symptoms, and living in families with a family income above $40,000 per year. In other words, there was no difference in benefit from PT or PEP for kids in the study with ADHD, high symptoms of anxiety, or in low-income families. That being said, the PEP was still associated with a 31-34% decline in disruptive behaviors, so treatment was still somewhat effective. 

To their surprise, the research team did not find that IQ or severity of Autism symptoms were associated with differences in treatment benefits from Parent Training. This is important because many people believe that IQ and symptom severity automatically mean that treatments won't work for them. Here, we see that kids in the study with a range of IQ and symptom severity showed improvements in disruptive behaviors, particularly those enrolled in Parent Training. 

So what does this mean? If you have a child on the Autism Spectrum, Parent Training may significantly improve your and your child's quality of life. In fact, Parent Training is a well-established and effective way of dealing with disruptive behaviors for kids (up to around age 12), regardless of being on the Autism Spectrum. The strategies taught to parents in Parent Training are based in basic behavioral science and apply to all behavior, and in these treatment programs the principles of behavioral theory are simply tailored to the most commonly observed problems in specific populations. 

A final thought on the name "Parent Training." In my work, I've found many parents resistant to going through training in parenting. In many ways, it seems as though parenting should be intuitive and not, yet another, thing that requires a degree or certification. In many ways that's very true. Loving and caring for a child is innate. Teaching a child to regulate their impulses and emotions is something entirely different, and often at odds with the immense loving and caring you feel for them. Think about how often you, as a parent or caregiver, feel conflicted between the short-term relief of "peace and quiet" that is almost immediately gained from giving in to a toddlers request for something at the grocery store and the long-term benefit of not hearing these requests every time you go to the store until the end of time. Behavioral science is an immense field of study that resulted in the training of the modern generation of clinical psychologists who can provide Parent Training that will help reduce the impact of these little moments in your daily life. 

If you're interested in learning more, some Parent Training books I highly recommend for parents looking for behavioral strategies that work: 

For all parents: 

The Everyday Parenting Toolkit: The Kazdin Method for Easy, Step-by-Step, Lasting Change for You and Your Child by Alan E. Kazdin and Carlo Rotella

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For the over-achievers out there, Alan Kazdin has also just completed a course on parenting in Coursera called "Everyday Parenting" which I highly recommend for anyone who has or will ever have kids.   Click here to learn more about that course. 

For parents struggling with child defiance: 

The Kazdin Method for Parenting the Defiant Child by Alan E. Kazdin

Your Defiant Child, Second Edition: Eight Steps to Better Behavior by Russell A. Barkley and Christine M. Benton



References 
Bearss, K., Johnson, C., Smith, T., Lecavalier, L., Swiezy, N., Aman, M., ... & Sukhodolsky, D. G. (2015). Effect of parent training vs parent education on behavioral problems in children with autism spectrum disorder: a randomized clinical trial. Jama, 313(15), 1524-1533.

Lecavalier, L., Smith, T., Johnson, C., Bearss, K., Swiezy, N., Aman, M. G., ... & Scahill, L. (2017). Moderators of parent training for disruptive behaviors in young children with autism spectrum disorder. Journal of abnormal child psychology, 45(6), 1235-1245.

Many thanks to unsplash.com for the lovely photos! 

What your beliefs about failure are teaching your child.

A self-fulfilling prophecy describes when a person believes something will happen so they engage in behaviors that increase the likelihood of the expected outcome. There are few more important examples of this than children's learning. Children can either have a fixed or a growth mindset about intelligence. Kids with a fixed mindset believe that intelligence is, well, fixed. Kids with a growth mindset believe that intelligence is something malleable. Whether a child has a fixed or growth mindset predicts how hard that child will try when given a hard problem. Children with a fixed mindset get frustrated easily and give up. Kids with a growth mindset spend longer working on problems and demonstrate more effort while trying to solve it. As you can imagine, this phenomenon snowballs over the years, and indeed, children with fixed mindsets go on to under-perform children with growth mindsets in almost every domain compared to their growth mindset peers. But where do kids get these fixed and growth mindsets? If we know where these mindsets originate, we can begin to cultivate growth mindsets in more and more kids.

Now, the obvious answer is usually the right one. Parents. However, whether or not a child has a fixed or growth mindset is NOT related to whether their parent has a fixed or growth mindset. So,
Kyla Haimovitz and Dr. Carol Dweck, Stanford University, conducted four studies to understanding exactly how parents influence their children's beliefs about intelligence.

To do this, they first conducted a study to answer the question: Do parents' beliefs about failure relate to their child's beliefs about intelligence? They recruited 73 parents and their 4th and 5th grade students. Parents completed surveys measuring their intelligence mindset, failure mindset, and perceptions of their child's competence in math, science, social studies, and English. Failure mindsets were assessed with questions like "Experiencing failure facilitates learning and growth" and participants indicated how much they agreed. Children completed surveys measuring their intelligence mindset and their parents orientation to learning and performance using questions such as "My parents want me to understand homework problems, not just memorize how to do them". 

Parents fixed vs growth mindsets were unrelated to their child's fixed vs. growth mindset, whereas the degree to which the parent believed that failure was a hindrance rather than an opportunity for learning predicted a child's fixed intelligence mindset. They also found that children's perceptions of their parents' orientation to learning and performance  explained how parents beliefs about failure led to children's intelligence mindsets. 

Next, Haimovitz and Dweck conducted a study to answer the question: Do parents who believe failure is debilitating parent their children differently? They recruited 160 parents for an online study who completed questions about their intelligence mindset, failure mindset, and their reactions to a scenario in which their child came home with a failing grade on a quiz. Questions in reaction to the scenario were "I might worry (at least for a moment) that my child isn't good at this subject" or "I'd encourage my child to tell me what she learned from doing poorly on the quiz."

Parents who held a failure-is-debilitating mindset were more likely to endorse reactions to the scenario consistent with worry about their child's abilities, instead of opportunities for growth and learning. 

In a 3rd study, the researchers sought to understand whether a parent's failure mindset is more visible or obvious to their child than their intelligence mindset. To answer this question, 102 parents completed surveys about their intelligence and failure mindsets, while their children completed surveys about their perceptions of their parents intelligence and failure mindsets. Lo and behold, kids were more accurate about their parents' failure mindsets than their intelligence mindsets. 

Finally, they tackled the ultimate question: Do parents beliefs about failure cause their reactions to their child's failures? To do this, they recruited 132 parents for an online study where parents reported their perceptions of their child's competence and then were randomly assigned to 1 of 2 conditions. In one condition, parents were induced into thinking that "failure is debilitating", while the other condition induced a "failure is enhancing" mindset.  Then parents were asked to explain what they would think, feel, and do if their child came home with a failing grade on their math quiz. 

Indeed, parents randomized to the "failure is debilitating" condition were more likely to see the failure as a hindrance to learning and express worry about their child's abilities. Most importantly, this was true regardless of how competent the parent thought the child was at the outset of the study. 

To review, this is how kids develop a fixed or growth intelligence mindset. Parents either view failure as debilitating or an opportunity for learning. A failure is debilitating mindset is apparent to children because the parent rewards them for performance instead of learning. Parents react to their child's failures by questioning the child's abilities and competence. Then the child develops a sense that their abilities are either fixed or can be cultivated through learning and hard work. 

With all of this laid out, the fix is pretty simple. Do you see failure as an opportunity for learning or as a sign of incompetence? If it's the latter, changing that mindset will help your child learn that their intelligence can be cultivated and the self-fulfilling prophecy will snowball in their favor. 

If you think this is interesting work, you will love watching Carol Dweck's TED Talk!

Thanks to unsplash for the lovely images!

Haimovitz, K., & Dweck, C. S. (2016). What predicts children’s fixed and growth intelligence mind-sets? Not their parents’ views of intelligence but their parents’ views of failure. Psychological science, 0956797616639727.

Who does the cleaning in your house? And why it matters.

With all of the #LeanIn and #HeForShe movements going on lately, division of housework has become a common topic of conversation. The typical family in the United States is comprised of two working adults, averaging about 91 paid hours (combined) per week. So, at the end of the work day, both adults are tasked with recovering from the work day, managing their home, and often caring for their children. Moreso than for any other generation, the division of housework matters. 

In 1965, women spent 30 hours per week devoted to housework while men spent about 5 hours per week. In the year 2000, the National Survey of Families and Households found that women spent about 18 hours per week doing housework while men spend about 10. This suggests a lot of things. First, the amount of hours the average family is spending on housework has declined by 20% since 1965, perhaps due to the introduction of time-saving technology such as microwaves, dishwashers, and washing machines into most American homes. It also says that as women have increasingly joined the work-force, men have increasingly participated in more housework. Yet, among households where both adults work full-time, men still report spending significantly more time "relaxing" and doing leisure activities after work, while women report spending more time doing housework and care-giving.  

Unfortunately, I find conversations about the division of housework to be mostly limited to issues of who does what and seldom about the potential consequences for health, wealth, and well-being. To me, the fact that men and women spend their time doing different activities is obvious and not very interesting. Whether the activities men and women engage in after work have implications for physical and psychological well-being interests me very much. Luckily these are empirical questions that psychologists care about and are actively trying to answer. 

In particular, Dr. Darby Saxbe, University of Southern California, and her colleagues asked the question: 

Does the division of labor in a household have implications for physical health in either partner? 

To answer this question, the research team recruited 30 healthy couples, both members working full-time, who own their own home, have a mortgage, and have at least one child between 8-10 years of age. With these participants, the research team tried to capture a "week in the life" of these couples by tracking their behaviors for 4 days from around 6:30-8:30am and then again from about 4pm to whenever the participants went to bed. Their goal was to capture what participants did before work, and after work. Tracking in this study constituted a research staff member recording each member of the household's location (e.g., kitchen, living room) and activity (e.g., cooking, watching TV) every 10 minutes into a handheld computer. Compared with previous studies that had used self-report assessments of how people spend their time at home, these observations allowed the research team to have a more objective measure of what participants' time at home looked like. 

Participants in this study also provided saliva samples on 3 days at waking, in the late morning (at work before lunch), afternoon (before leaving work), and right before bed. Saliva samples were used to measure the concentration of cortisol. Cortisol is final product of the body's physiological stress response system.* Cortisol in the body should be high in the morning and decline throughout the day. Not showing a steep decline in cortisol throughout the evening has been associated with poor sleep, several diseases, and is a predictor of mortality. In fact, many researchers see dysregulated cortisol as a pathway through which chronic stress leads to illness. The research team was interested in understanding whether the day-to-day activities of men and women at home were related to their body's ability to down-regulate this stress hormone in the evenings. 

They found that women were doing housework in 30.5% of observations, whereas men were doing housework in 20% of observations. In contrast, women were engaging in leisure activity in 10.6% of observations, whereas men were engaging in leisure activities in 19.4% of observations. Surprisingly, perhaps only for me, men and women were both engaging in communication in about 18% of observations. 

They then looked at whether activities at home predicted physiological stress in the evening. They found that both men and women who spend more time doing housework, have higher cortisol in the evenings. Perhaps more interesting, the amount of housework a wife does had no association with their husband's cortisol in the evening. In contrast, husbands observed doing more housework had wives with lower cortisol in the evening. 

When it came to leisure, husbands had lower cortisol in the evening when they spent more time doing leisure activities, especially when their wives were NOT engaging in leisure. In contrast, how much time women spent doing leisure activities was not related to their cortisol in the evening. 

So what does it all mean? The research team concluded creating a true division of labor at home may have real physiological benefits for wives, and suggested that these benefits (or the lack of them) can add up over time.         

So what's the solution? Perhaps it's that wives should make an executive decision to do less housework. A lot of households can accomplish this by making a decision to invest in their health by outsourcing housework to robots and third parties. My favorite examples of this are Roomba and Fluff-and-Fold laundry services. Perhaps it's that husbands need to make an effort to jump in when they see their wife doing housework. This includes, but is not limited to, cooking, vacuuming, doing laundry, dishes, changing sheets, and regularly scanning the house for stray belongings (read: socks). The good news is that many of these solutions are small but still make a big difference. 

This research study definitely doesn't provide all of the answers, and probably introduces more questions than it answers (as all good research does). For example, this study focused on heterosexual couples and therefore the role of "wife" vs "husband" is somewhat confounded with "male" vs "female." It's possible that women have higher physiological stress in the evenings than men, independent of housework. More studies looking at a more diverse sample of couples that include homosexual couples would help us understand how to disentangle the male-female differences from the role of housework-leisure behaviors. Also, this study only included couples where both parent works full-time. While this represents the average American family today, this study doesn't tell us much families with stay-at-home moms or dads.   

*Click here for past articles about/related to cortisol. 

Saxbe, D. E., Repetti, R. L., & Graesch, A. P. (2011). Time spent in housework and leisure: links with parents' physiological recovery from work. Journal of Family Psychology, 25(2), 271.

Many thanks to unsplash for the photos!

How Dogs Highjack Your Brain with Love Hormones

A little over 3 years ago, we rescued this puppy and named him Tolstoi. I have had dogs most of my life, so I have always taken for granted that special bond one has with a pet. However, Tolstoi is my husband's first dog, and watching that bond develop so quickly and so deeply was quite a special experience.

Dogs are wonderful in so many ways, and I've written about some of the ways dogs can enhance your health here. This week I thought I would share some recent #justplaincool research on the neuroscience behind the human-dog bond. 

There is a hormone in all mammal brains called oxytocin. Oxytocin is thought to play an important role in relationships. For example, oxytocin surges during cuddling and other intimate activities, in mothers when meeting their new infant for the first time, and while breastfeeding. I won't pretend that we fully understand the ins and out of oxytocin yet, but that's what makes science so exciting. 

Anyway, we have a pretty good understanding that the amount of oxytocin in your system fluctuates in ways that are salient to relationships, but so far those relationships have always been within the same species; human-human, rodent-rodent. Wouldn't it be cool if the neuroscience of how humans bonded with their dogs was dependent on the same processes through which humans bonded with other humans? Well, apparently that's exactly what happens. 

Dr. Miho Nagasawa, Azabu University, and her colleagues were interested in whether oxytocin in the body changes in humans and dogs when interacting with one another. To understand this, they recruited 55 healthy individuals and their dogs. All participants provided a urine sample and then were randomized to one of two conditions. Urine is one place you can measure oxytocin. In the first condition, participants were told to play with their dog for 30 minutes. In the other condition, participants were told not to look directly at their dog for 30 minutes. At the end of the 30 minute experimental condition, participants provided another urine sample. 

They found that the owners and their dogs that interacted during the 30 minutes showed large increases in oxytocin before and after the experiment. They also found that the largest increases in oxytocin occurred in owners who dogs initiated "gazes" with them frequently. This likely means that humans experience a similar neurochemical signal  when bonding with their dogs as with other humans, but that this signalling varies based on how much time owners and their dogs spend looking at eachother. 

My first thought when reading this finding was, well sure. Humans are very bonded with their dogs, and maybe surges of oxytocin just occur with humans interact with anything they are bonded with. Then I wondered whether the dogs experience this same surge in oxytocin. Luckily, Dr. Nagasawa has also conducted that study. 

In the 2nd study, they use the same procedure only this time they included a comparison group of hand-raised wolves and measured oxytocin in the urine of the canines in addition to their owners. They found that the increase in oxytocin after 30 minutes of interacting with their owner occurred in dogs but not wolves, and that the magnitude of oxytocin change was directly related to the length of time the owner and dog gazed at one another. 

Gazing is interesting for several reasons. We tend to take it for granted as a form of communication, but mutual gazing is considered the most fundamental manifestation of social attachment, especially between a mother and infant. Dogs and humans can't communicate verbally, so they rely on engaging socially with humans in other ways that tend to mirror how humans interact with their infant offspring. Another fun fact I learned from these articles was that dogs are apparently more skilled at using human social communicative behaviors than their will counterparts, wolves, but also chimpanzees. This suggests that dogs are uniquely capable of bonding with humans in ways no other species can.  

So basically, the next time Tolstoi stares at me, he communicating with me in a way that send natural "love drugs" throughout my brain to ensure I will keep taking care of him. Sneaky puppy, but man is it powerful. 

Unfortunately, some dogs havent been lucky enough to get rescued yet. If you want your brain highjacked with love hormones, some of these guys are up for the job. 

Nagasawa, M., Kikusui, T., Onaka, T., & Ohta, M. (2009). Dog's gaze at its owner increases owner's urinary oxytocin during social interaction. Hormones and Behavior, 55(3), 434-441.

Nagasawa, M., Mitsui, S., En, S., Ohtani, N., Ohta, M., Sakuma, Y., ... & Kikusui, T. (2015). Oxytocin-gaze positive loop and the coevolution of human-dog bonds. Science, 348(6232), 333-336.

Mama Bear: Ever wonder whether breastfeeding changed your behavior?

This week’s article highlights many of the fun things we do in psychology research. Of course, it started with a question:

Does breastfeeding increase aggression?

Many lactating animals (e.g., mice, rats, prairie voles, hamsters, lions, domestic cats, rabbits, squirrels, and domestic sheep) are more aggressive than their non-lactating peers. In animals, lactation increases aggressive behavior, and reduces physiological responses to stress. This makes sense because for many animal, and even humans until 100 years ago, many infants didn't survive. Lactation is a way for the mother's body to know that there is an infant to still take care of. However, humans have built societies and homes, invented seatbelts, and established food protection standards. So, it remains to be documented whether human women become more aggressive after having a baby, and what physiological processes support this change in behavior.

To answer this question, Dr. Jennifer Hahn-Holbrook, now a professor at Chapman University, and her colleagues conducted a very cool experiment to understand whether breastfeeding women are more aggressive, and whether that aggression is accounted for by reduced physiological responses to stress.

To do this, they recruited three groups of women: 20 women with infants between 3-6 months who were exclusively breast-feeding, 20 women with infants between 3-6 months who were feeding their infant a mix of breast milk and formula, and 20 women who had never had a baby. The women came to the laboratory and met what we call a “confederate.” A confederate is a person introduced to the participants as another participant, but in actuality is part of the experiment. The confederate was trained to be rude. Rude behavior involved ignoring the actual participant, chewing gum, and checking their cell phone during the experiment instructions. This was intended to cause the actual participants to make what psychologists call fundamental attribution error, or the tendency to place an undue emphasis on internal characteristics (personality) to explain someone else’s behavior in a given situation rather than considering the situation’s external factors. For example, when you cut someone off you know it’s because you are late and would otherwise miss your exit. When someone else cuts you off, it’s because they are a jerk.

The participants were then instructed to play a game against the other “participant” that involved reaction time. Fastest person to respond wins. The winner of each round got to push a button that released a loud sound at the loser. The participant controlled the volume (up to 150 decibels) and duration (up to 5 seconds) of the sound with their button push. After 8 rounds of the game, participants fed their babies (breastfed, formula fed) or took a break if they were in the non-mother control group. Then, the participants played the game again for another 8 rounds. The mothers’ blood pressure was monitored and recorded throughout the entire procedure.

They found that breastfeeding mothers delivered longer and louder aversive sounds to their rude competitors, compared to both the mixed-feeding mothers and the non-mothers. They also found that breastfeeding women had smaller increases in blood pressure (a measure of stress) while playing the competitive game than women in either of the other groups.

The research team concluded by saying that women who are breastfeeding, not just new moms, were more likely to be aggressive than women who are not. Supporting this idea, they found that there was a significant positive correlation between aggression during the game and the percent of the infant’s diet that was breastmilk (as a measure of how much the mother is lactating). Therefore, they believe that the physiology that supports lactation in new moms supports aggressive behavior that is protective to the infant. And further, lactating mothers show a reduced response to stress, which likely helps facilitate aggression in times of threat and competition.

So, what can we take away from this? I think on a very basic level, knowledge is power. If you or someone you know is breastfeeding, they are likely to be more aggressive than they are usually, and more aggressive than other people. This is normal and adaptive. Don’t hold it against them or yourself. Aggression has many different dimensions. In this study it was the force with which women delivered aversive sounds to competitors, like a punishment. But what might this behavior look like outside of the laboratory? Potentially, it’s perceiving other people as a threat, competing with other moms for no apparent reason, delivering unusually harsh punishments to your partner or older children for potential threats to the new baby. Just remember, increases in aggression are normal, and being driven by the many, many changes to your physiology that allowed you to have the baby and care for it in the first place.

In these modern times, we take for granted all of the physiological changes that come with being able to sustain a pregnancy, have a baby, and breastfeed that have been promoting human survival for thousands of years. As a result, many women don’t learn about these physiological changes until they are going through it, and society doesn’t do much to support them. Don’t be part of that problem.

Hahn-Holbrook, J., Holt-Lunstad, J., Holbrook, C., Coyne, S.M., & Lawson, E.T. (2011). Maternal defense: Breast feeding increases aggression by reducing stress. Psychological Science. DOI: 10.1177/0956797611420729

"Spotlight" reminds us that preventing child sexual abuse starts at home

I had the extraordinary pleasure of viewing the new film, Spotlight, this weekend. The critical acclaim of this masterpiece has been loud and unanimous, but more importantly, well-deserved. The film recounts the efforts of the investigative team, Spotlight, at The Boston Globe back in 2001 as they scrupulously uncovered systemic protection of Catholic priests who had repeatedly molested and raped children in their parishes with this article. This isn't a film blog, so I will simply leave you with a strong recommendation to see the film and get straight to the science. 

Children exposed to sexual abuse sustain psychological injuries that persist throughout their lives. In fact, I became a clinical psychologist because my first experience in clinical psychology research was in treating adults who continued to suffer from Post-traumatic Stress Disorder (PTSD) from severe sexual abuse as children. For the most part, a child who is sexually abused will have more physical illnesses, be less educated, have poorer and fewer close relationships, more problems with depression and anxiety, and more likely to attempt suicide than their peers for the rest of their lives. In fact, the World Health Organization (WHO) ranks child sexual abuse as equivalent to other well-known health concerns such as lead exposure and urban air pollution. 

This occurs for a lot of reasons, some of which we understand and some of which we don't yet. As a scientist, I am often more interested in the how and why of psychological phenomenon, but in the case of childhood sexual abuse, the negative consequences are so horrifying that our attentions should be solely focused on intervention and treatment. In the service of that goal, I have identified an article published this year that begins to explain how child sexual abuse prevention can start in the home. 

The main argument of this article is aimed at intervention researchers and emphasizes that child sexual abuse prevention should occur through parenting programs which still need to be developed. And further, these programs should target the parents of young children (ages 3-5). The rationale and evidence for this argument is what I want to share with you and your loved ones.

Currently, there are a number of preventive efforts in place that serve to protect children from sexual abuse. They are: 

1)Punishing offenders with incarceration, required public registration as a sex offender, and restrictions to where they can live and work. 
2)Advocacy and media campaigns that combat the "bystander effect" which basically encourage members of the community to take a "if i don't help, who will?" approach to protecting members of their community and neighborhood. 
3) Treating sexual offenders to prevent future victimizations
4) Treating victims to prevent future victimization

While each of these preventive strategies has been effective in some ways, they argue that more can be done to educate children and families to protect themselves. For example, we know that parenting intervention programs can reduce other types of abuse to children, such as physical abuse, but also that these parenting intervention programs can increase different parenting skills and practices that will help to prevent a child's risk for being sexually abused. 

The most important parenting predictors of positive child outcomes are warmth and control. Parents who are high in both warmth and control have children that grow up to be healthy, happy, and accomplished. This is obviously an over-generalization of what we know in developmental psychology, but either way, a child almost always benefits from their parent exhibiting mutual increases in warmth and control in their daily lives. The good news is that warmth and control can be taught, and child and adolescent psychologists know how to teach it! 


How to use Warmth and Control as a parent to prevent sexual abuse: 

Warmth: Sounds simple, but talk to your young child about sex and everything else. Parents who provide a safe environment for their children to talk about sexual behavior are more likely to delay the onset of having sex and end up more effectively using contraceptives. The authors of the article argue that these benefits could also be extended to helping children understand what type of touching is and is not ok. The truth is that children, especially young children, often do not know they are being victimized. They often believe they are just doing what they are told, or are playing a game. As a parent, your job is to learn as much as possible about the world they live in from their perspective and from there you will learn about their experiences, both good and bad. Also, kids know when something is "taboo" but often misread the signals as they are "in trouble." In fact, the children and adults I have treated who have a history of sexual abuse failed to tell an adult because they were worried they would get in trouble. Create a safe and supportive place for them to talk to you. This starts early. The peak age for sexual abuse exposure is in the early teen years (ages 12-14) but the number jumps from 3% among 0-2 year olds to 14% among 3-5 year olds. If you start the conversation early, you are the most likely to be effective in teaching your child what is and is not ok. 

Control: The highest risk populations for child sexual abuse are single parent families, families who live in poverty, children with disabilities, and families with domestic violence. The common denominator here is parent supervision. Basically, children who spend time with more adults who are not their parents are at highest risk. So, watch your kids, and when you can't watch your kids make sure they are with adults that you know and trust. Not to make you paranoid, but perpetrators are actually less likely to be strangers than your child's friends, their friends' older siblings, and babysitters. 

A scandal like this, and a film like Spotlight can often turn into a dramatized smear campaign against the Catholic Church and everything it stands for. However, perhaps most brilliant and much appreciated about the film was the attempt at an honest portrayal of an entire community that was guilty of negligence. We are all vulnerable to valuing belonging to a group over protecting individuals. From an evolutionary standpoint, that serves us well more often than it hurts us. We live in complex social systems made up of families, and neighborhoods, and cities, and states, and nations, and cultures. When it come to sexual abuse of a child, what we have to remember is that it is not enough to simply separate the perpetrator from the victim. It is not enough to remove the perpetrator from other potential victims. In the anticipation of Spotlight's release, The Boston Globe released an article highlighting the reformed Catholic Church on all issues related to child molestation and handling of church officials suspected of this behavior. Archbishop Michael Jackels in Iowa said it well, "The story told by the movie bears repeating until all of us get all of it right."

Mendelson, T., & Letourneau, E. J. (2015). Parent-Focused Prevention of Child Sexual Abuse. Prevention Science, 1-9.

Are you a parent with math anxiety?

Math is a very important skill. Regardless of whether you became an engineer, basic math skills are essential to modern daily life. At the very least, we all have budgets to manage and we all have to calculate the amount of time it will take us to get to and from the places we do and don't want to go. Despite the ubiquity of numbers and math in daily life, there is always a spike in anxiety when the bill needs to be divided up after a large dinner with friends because lots of people get anxious when they have to do math. Some psychologists are interested in where that anxiety comes from, and how to prevent it. 

In particular, Dr. Erin Maloney at the University of Chicago recently conducted a large study to discern whether parents' math anxiety contributes to developing math anxiety in kids. This is important for us to consider because math performance early in grade school is a robust predictor of long-term education outcomes. 

To do this, she and her colleagues recruited 438 1st and 2nd graders and their parents from 90 classrooms and 29 public and private schools in the Midwest. During the first 12 weeks and the final 8 weeks of the school year, the kids completed standardized math and reading tests, and questionnaires about math anxiety. Questions about math anxiety included items such as how nervous they would feel doing mental math problems or solving a math problem on the board in front of their teacher and peers. During the middle of the school year, the children's parents also completed questions about math anxiety, including items about how nervous they feel when "reading a cash register receipt after you buy something." Parents were also asked to report how often they help their child with math homework on a 7-point scale (1 = never  to 7 = more than once a day). 

They found that parents with high math anxiety who also reported helping their kids with math homework most often had kids with lower math achievement scores at the end of the year. This effect was independent of kids' math scores at the beginning of the year, gender, grade, school- and teacher-related factors. The same association was not found between parent math anxiety and reading scores, suggesting that the effect is specific to math skills. What was also interesting, was that this association between high parent math anxiety, more homework help and math achievement scores predicted increases in the child's math anxiety between the beginning and end of the school year. 

So, what does this mean? It potentially means that children develop math anxiety partially through exposure to their parents' math anxiety while helping them with homework. A dangerous conclusion that could be drawn from this is that parents with math anxiety should not help their children with math homework. While it used to be common for school to explicitly prohibit parents from providing extra instruction on coursework at home (click here to learn some more about history of education in the U.S), this custom has lang since changed. Instead, this may be just one more way untreated problems with anxiety can have unnecessarily long-term consequences. There are very effective ways of treating anxiety, such as CBT. More importantly, avoiding anxiety is the worst possible way to deal with anxiety. It is also prudent to consider the potential third variables that contribute to these findings. Perhaps genetic vulnerability to anxiety is playing a role in both the math anxiety of the parent and the child. Perhaps intelligence, also genetically heritable, is playing a role. Perhaps parents who have time to help their children with their homework also spend more time with their kids in general, and factors that contribute to a parent being more available to the child in general are driving these effects, for example income, occupation, personality. 

Needless to say, this study gives us some guidance about which children may be at risk for early problems with math, and therefore a place to start preventing those problems. 

Maloney, E. A., Ramirez, G., Gunderson, E. A., Levine, S. C., & Beilock, S. L. (2015). Intergenerational effects of parents’ math anxiety on children’s math achievement and anxiety. Psychological Science, 0956797615592630.

The Halo Effect

I've just finished reading Thinking Fast and Slow by Daniel Kahneman. Not exactly light summer reading, but still an engaging account of Dr. Kahneman's mental journey from wondering why humans are so bad at estimating the likelihood of events, to the development of some of the most important theories that explain human behavior. So important were these theories, in fact, that they won Dr. Kahneman a Nobel Prize, despite that it had never been awarded to a psychologist. As a psychologist, I was familiar with many of the principles explained in the book, but had never considered the cross-cutting value of them for marketing, law, medicine, public health, and beyond until I consumed them through his narrative.

What Kahneman does particularly well in this book is provide the research context under which his ideas developed. For example, he described the ideas and experiments put forth by his colleagues in psychology and economics departments around the world. One of those experiments was published by Richard Nisbett and Timothy DeCamp Wilson in 1977 at the University of Michigan (GO BLUE!) and is well known in psychology as the Halo Effect.

The Halo Effect has been around since 1920 when Thorndike coined the term, however until 1977 there was little empirical evidence to help us understand the effect. Simply, the Halo Effect describes how global evaluations of something influence our evaluations of specific attributes of that thing. So like good psychological scientists, Nisbett and Wilson sought to understand whether people are aware of Halo Effect when it is happening to them and the potential implications.

To do this, they recruited 118 undergraduate students. Half of the students saw a video-interview of a professor who presented himself as "as a likable teacher, respectful of his students' intelligence and motives, flexible in his approach to teaching, and enthusiastic about his subject matter." The other half of the participants saw a video-interview of the same professor who presented himself as, "quite unlikable, cold and distrustful toward his students, rigid and doctrinaire in his teaching style." After viewing the videotaped interview, the subjects rated the instructor's likability, as well as the attractiveness of his physical appearance, his mannerisms, and his accent from "extremely irritating" to "extremely appealing." In order to explore the question of subject awareness, some subjects were then asked whether the instructor's likability had affected their ratings of his appearance, mannerisms, and accent. Finally, participants were asked whether their rating of the professor on likeability influenced their ratings on his appearance, mannerisms, and accent.

They found that 70% of participants who saw the "warm and likeable" interview rated the professor's physical attractiveness as "appealing," while 70% of participants who saw the "cold and uninviting" interview rated the professors physical attractiveness as "irritating." A similar pattern was observed for ratings if his mannerisms, such that if he was warm and likeable, his mannerisms were perceived as appealing, while if he was cold, his mannerisms were irritating. This reminds me of the rose-colored glasses we wear when falling in love. Of course, it's endearing when someone you are falling for has cute little quirks, like saying "supposably," even though it drives your friends and family nuts. Even more interesting was that the professor in the interview had a thick, French accent. Participants who saw the video of the "warm" professor were equally likely to say the accent was appealing vs irritating, while participants who viewed the "cold" interview almost exclusively found the accent irritating. Important to note is that each of these attributes, physical attractiveness, mannerisms, and accent, were the same in both videos, what varied was the global impression of the individual as warm vs cold.

They also found that the Halo Effect depended upon a lack of awareness. Most people in the study reported that their global impression of the professor did not influence their ratings of his attributes, despite that it overwhelmingly did. This is good news though. The practical application of this important work is the knowledge that we will make global evaluations of others, and they will make them of us. The direct application of these findings to daily life are that if we are warm and friendly, people will find us more attractive and less irritating. So be warm and friendly, or at least try to be. The indirect application would be to recognize your global evaluations of people and things in the world, and practice interfering with your brain's tendency to spread those evaluations to other attributes incorrectly. For example, you can dislike a person, but they can still be good at their job.

At the center of Daniel Kahneman's work is the discrepancy between how economists believe rational people "should" behave, and how humans actually behave. The Halo Effect is alive and well in all of us, costs most of us a great deal of money, and likely prevents us from fostering relationships with great people in favor of not-so-great people.

Nisbett, R. E., & Wilson, T. D. (1977). The halo effect: Evidence for unconscious alteration of judgments. Journal of personality and social psychology, 35(4), 250.

We can’t really smell fear, but our brains can.

The brain is such a fascinating organ. Despite having spent a decade studying it, I learn more about the brain, its capabilities, and complexities every day. For example, I recently went to a fascinating talk where I learned that the brain recognizes others’ fear through chemicals in sweat. This post is about how we learned that. 

Dr. Lilliane Mujica-Parodi, a professor at Stony Brook University, is interested in how emotions are communicated between individuals. We have 5 senses: visual (sight), tactile (touch), auditory (sound), gustatory (taste), and olfactory (smell). In particular, Dr. Mujica-Parodi is interested in how emotions are communicated through smell. We know that facial expressions help us visually communicate with one another and language helps us communicate with auditory information, but what communicative purpose does smell have?

To answer this question she collected two different types of sweat: fear-induced sweat and physical exertion induced sweat. The fear-induced sweat was collected from 144 individuals who went tandem skydiving for the first time, including a 1 minute free fall from 13,000 feet.. The physical exertion induced sweat was collected while these individuals ran on a treadmill. Their hypothesis was that the fear-induced sweat would contain different olfactory information

They then recruited a group of 16 individuals (50% female) and had them smell 40 different sweat samples (20 of each type) for 2.5 seconds each. Participants smelled each of these samples from inside an fMRI scanner, while the research team recorded activation of their amygdala, the fear recognition center of the brain. They found that participants had great activation in the amygdala when they were smelling the samples taken from people while sky-diving compared with when smelling the samples taken during exercise.

They then recruited 16 new participants (50% female), and repeated the experiment with 40 new sweat samples, half collected during skydiving and the other half during exercise. They found the same thing: participants demonstrated greater amygdala activation, or recognition of fear, when smelling the sweat collected from people while skydiving.

But were the participants aware that they were exposed to two different types of sweat? It doesn’t appear that way.

To test whether the two types of sweat were noticeably different to the participants, they recruited 16 more participants (50% female), and asked them to smell 16 pairs of sweat samples. After smelling each pair of samples, they were asked to decide whether the samples were both the same or different from one another. The results of this experiment suggest that the participants were unable to accurately report any differences between the two types of sweat.

Finally, they conducted a 4th experiment to test whether exposure to fear sweat influenced perception of emotions in others. Because, after all, what good would it be for our brains to recognize fear in others through chemical signaling, if that different give us any behavioral or perceptual benefits? To do this, they recruited 14 more participants and had them complete a computer task where they saw faces with different expressions ranging from neutral to angry and had to report whether the face was “neutral” or “threatening.” The participants completed half of the trials while smelling the fear-induced sweat and half while smelling the exercise-induced threat. They found that after smelling the fear-induced sweat, participants were more accurate at identifying whether a face was threatening or neutral than when they smelled the exercise induced threat.

I am always impressed by all of the things our brain is constantly doing outside of our awareness, and these findings are no exception. Basically, this study demonstrates that while we aren’t aware of it, we can smell fear in others, the fear circuits in our brain are activated, and that activation leads us to more accurately perceive threat in our environment. 

As a person who would never go skydiving, and who barely rides the kiddie-roller coaster at amusement parks, this makes me wonder about the role of these olfactory signals in amusement parks and haunted houses. Part of our anticipation of the ride could be driven by our brains picking up on sensory information that people have been scared here before. But what about other emotions? Might there be chemical signals for happiness, desire, sadness that communicate our experiences with people who will come after us? Are some people more sensitive to olfactory emotional signals? Is that a strength or a vulnerability? This study controlled for potential differences between men and women, but I would imagine that men and women differ quite meaningfully in how receptive they are to olfactory signals of emotions in others.

As is the case with many studies using brain imaging, there were very few people in each of the experiments I described so the findings warrant replication. As is the case with all cutting edge research, we are left with more questions than answers, but that’s what is so exciting about the field of psychological science. Stay tuned!


Mujica-Parodi, L. R., Strey, H. H., Frederick, B., Savoy, R., Cox, D., Botanov, Y., ... & Weber, J. (2009). Chemosensory cues to conspecific emotional stress activate amygdala in humans. PLoS One, 4(7), e6415.

The pervasive influence of stress on your relationship

Stress occurs when the perceived demands of the environment exceed the individual’s perceived resources. So for example, when you have to finish a report for work in one day when it should take a week. Stress takes a toll on the mind and the body. We've already talked about that here and here and here. But people don’t live in a vacuum, we live inside relationships and families and societies. Thus, there is a growing interest in understanding how an individual’s process of experiencing stress influences other people in their lives. Rather than thinking about how having too little time to prepare the report will influence your health, relationship scientists are interested in how having too little time to prepare the report will influence your partner’s health and the health of the relationship.

In other words, How does stress outside the relationship influence stress and satisfaction inside the relationship?

In particular, Mariana Falconier of Virginia Polytechnic Institute and State University and her international colleagues was interested in testing the Systemic-Transactional Stress Model (STM) which posits that stress from daily hassles can have a negative impact on psychological and physical health of the individual as well as the health of the relationship. According to STM, one partner’s stress depends on the other partner’s stress and coping.

To address these questions, they conducted a study of 110 couples, most of whom were in their 40s, had been in their committed relationship for 18 years, and just over 54% had children. Each member of the couple answered questionnaires about stress they experience outside of their relationship, such as financial troubles, stress at work, and conflict with their friends. Then they answered questions regarding stress they experience within their relationship, such as feeling neglected or disturbing habits of their partner. The participants also filled out questionnaires about their current symptoms of depression, anxiety, and physical health. Finally, all participants completed a measure of relationship satisfaction.

Their findings were quite interesting, but also quite complicated. Overall, they were interested in describing whether each member of the couple’s stress outside the relationship influence their partner’s relationship satisfaction. Overall, they found what everyone would expect. When an individual experiences more stress outside of the relationship, they will also report more stress inside the relationship and poorer relationship satisfaction. However, their findings are more interesting when you look at how stress outside the relationship influences their partner, and how those patterns differ for men and women. When women in the sample reported more daily hassles, their partners reported more stress within the relationship, more depression symptoms, and poorer relationship satisfaction. However, men’s daily hassles did not influence women’s reports of stress in the relationship, women’s mental health, or women’s relationship satisfaction.

The next step in this research is to understand how women’s daily hassles are affecting men, and why men’s daily hassles aren’t affecting women in the same way. For example, do men not talk about their stress and thus there is less spill-over of stress from work to home? Do women require more support from their partner when experiencing daily hassles, thus increasing the demands placed on the relationship? Do men not know how to support their female partner’s through stress, and thus experience hopelessness at watching their loved one struggle? We really don’t know yet.

The authors brought up that a past study followed couples for an extended period of time and recorded men and women’s responses to one another in times of stress. They found that on days men experienced stress, women provided more support. In contrast, when women were stressed, their male partners provided support but also responded to the partner’s stress with blame, criticism, or inconsiderate advice. Now we understand that the costs of failed support result in the deteriorating health of both partners and their relationship. Maybe it’s just a matter of appraisal. When your partner is grumpy do you automatically think, “They must be under a lot of stress right now” or is it “What a %&*$!!” If it’s the latter, how is that helping either of you?

Until we know more, perhaps it’s enough for men to be more aware of when their female partner is experiencing stress. Awareness is the first step to providing support to prevent the cascading effects. Alternatively, women can also be more aware of when they are letting daily hassles at work “spill over” into their relationship in a negative way.  

One idea to keep in your toolkit is a clinical exercise called “Opposite Action” where individuals practice smiling even though they are angry, reaching out to someone when you feel like being alone, or providing more love and support to a person even though they are particularly irritable and ornery. This concept can be helpful in couples, where you often feel compelled to draw away from someone when they are being unreasonable or difficult. That may be exactly when they need “just because” flowers or date night. We are here to care for one another and your relationships are your greatest resource. Protect them, nurture them, invest in them.

Falconier, M. K., Nussbeck, F., Bodenmann, G., Schneider, H., & Bradbury, T. (2014). Stress From Daily Hassles in Couples: Its Effects on Intradyadic Stress, Relationship Satisfaction, and Physical and Psychological Well‐Being. Journal of marital and family therapy. DOI: 10.1111/jmft.12073

Go hug someone. Here's why.

Having social support is great for your mental and physical health. We have good research showing that people who have supportive relationships live longer, get sick less often, and recover from illness faster than people who don’t. In particular, the immune system is vulnerable during times of stress, and social support buffers the effects of stress on the immune system, thus reducing your body’s vulnerability to illness. However, social support is a pretty ambiguous construct. Does social support mean people remember your birthday, bring you yogurt when you had your wisdom teeth out (instrumental support), come to your grandfather’s funeral (emotional support)? This seems to be an important question because as a clinician, part of my job is to help young people identify reliable sources of social support, ask for help when they need it, and take care of those relationships by showing their support to others. In order to do that, I want to identify actual behaviors that account for why social support benefits health.

One behavior that is a likely candidate is hugging. Hugging is a likely candidate because nonsexual physical contact is a communication of reassurance, care, and empathy. This type of behavior is linked with better immune functioning within both human and non-human primate families and communities. So, the question that emerges is:

Does hugging protect your health? 

To answer this question, an interdisciplinary group of researchers, led by Dr. Sheldon Cohen at Carnegie Mellon University conducted a study on 404 healthy adults (age 33). In this study, each participant completed a questionnaire about their perceived social support and participated in a physical exam that included a blood test for antibodies and measurement of their mucus to assure they were not sick. Each participant then completed an interview every day for 2 weeks where they reported on what they did that day, who they interacted with, whether they experienced any conflicts, and whether they received any hugs from anyone. At the end of the two weeks, they completed another physical exam and blood test to measure the presence of antibodies. Then each participant received nasal drops of the common cold (rhinovirus 39) or the flu (influenza A/Texas/39/91). For up to 6 days following exposure to the cold or flu, participants were assessed for the development of cold and flu symptoms, and then were assessed again 4 weeks after exposure to the illness.

Cohen and his team found that 78% of participants in this study contracted the illness they were exposed to (as measured by developing some symptoms), and that 31% developed a clinically significant illness of either the flu or the cold. They also found that people in this study were exposed to hugs 67% of the 14 days, while conflict was only reported on about 7% of the 14 days. The main finding of the study was that participants who reported more conflict during the 14 days preceding exposure to the flu/cold were more likely to develop an infection, however receiving more hugs served as a buffer to that effect. Thus, they found that hugs were an effective, protective experience that prevented the cold/flu.

In particular, their findings suggest that hugs are more helpful in improving immunity to the cold, rather than the flu. This may have to do with the rate that the flu replicates in the body. They also found that hugs were protective in whether or not the participant would get sick, not necessarily how sick they would get. Remember, they drew a distinction between people who developed symptoms (78%) and people who had clinically significant syndromes (31%). Hugs were effective in buffering the link between having conflict and developing symptoms, but were not necessarily effective in preventing the severity of the illness if you do contract the infection. To me, this suggests that, not surprisingly, there is more to immunity than hugs, and there are still individual differences in the ways our bodies respond to exposure to germs and viruses.

Of course, this research doesn’t suggest that we should just go around hugging one another instead of going to the doctor to get a flu shot. Rather, giving hugs to our loved ones frequently, especially if they are going through stress is an effective way to provide social support that may boost immunity.

Despite this important and fascinating potential benefit, there are several questions that emerge from this study about application and potential explanation. For example, do people who give and get hugs frequently simply have more efficient immune systems because they consistently have more exposure to germs and bacteria? I wonder whether we could test that question by comparing immunity across cultures who vary in their typical greetings, for example bowing (no physical contact), shaking hands, kissing on both cheeks. Or, is there something special about a hug that improves immunity through psychological well-being like optimism that people care about you?

Another potential limitation of this study was that conflict was reported fairly infrequently in this sample, only 7% of days (less than 1 day on average). I wonder whether these effects would be stronger or weaker among a sample with more frequent exposure to conflict, such as people exposed to domestic violence, or who deal with conflict as part of their job, such as attorneys.

To conclude, this article is just one more example for me of how we can benefit from taking care of ourselves by showing that we care for one another. I’ve always been a bit reluctant around those enthusiastic groups of people around town squares waving FREE HUGS signs. Now, I have a greater appreciation for the work that they do for public health. More free hugs for everyone!

Cohen, S., Janicki-Deverts, D., Turner, R. B., & Doyle, W. J. (2014). Does Hugging Provide Stress-Buffering Social Support? A Study of Susceptibility to Upper Respiratory Infection and Illness. Psychological science, 0956797614559284.

Photo credit: http://coffeeandwhinelife.com/five-in-less-than-5-minutes-fitness-wellness-tips/

Is there something in your medicine cabinet for hurt feelings?

If you haven’t noticed, I have a great deal of interest in the relationship between the mind and the body. Luckily, I am living and conducting research during a time when this is of interest to a multitude of disciplines, from molecular biology to politics. Every so often, I come across studies that really get to the heart of the mind-body connection and make me really appreciate how completely integrated all of these systems are. In a conversation with my new mentor recently, one of these studies was brought to my attention.

The study was about pain. Not, “Ouch, I stubbed my toe!” pain, but rather “that wasn’t a very nice thing to say” sort of pain. In psychology, what most people call “hurt feelings” is called social pain. Anecdotally, we use the same language to refer to physical pain as social pain, and only recently have we had the technology to investigate whether the two concepts overlap actually, or just metaphorically.

About 4 years ago, Dr. C. Nathan DeWall of the University of Kentucky and his colleagues published a study on social pain. In this study, he asked the very simple question:

Do existing remedies for treating physical pain help reduce social pain as well?

To answer this question, he conducted 2 experiments. In the first experiment, he recruited 62 undergraduate students. These participants were randomly assigned to receive either 1000 mg of acetaminophen per day (500 mg in the morning, and 500 mg before bed) or a placebo pill. The participants were prescribed their respective pills for 3 weeks. During these 3 weeks, the participants also completed daily reports of their “social pain.” These included items such as, “Today being teased hurt my feelings.”

At the end of the three weeks, they found that participants taking acetaminophen experienced declining reports of “hurt feelings” throughout the study. In comparison, the participants taking the placebo demonstrated no change in their reports of daily hurt feelings. Since the participants were randomly assigned to either receive the acetaminophen or the placebo, the reduction in hurt feelings over the course of the three weeks was likely caused by the effects of acetaminophen on the central nervous system’s recognition of pain.

Dr. DeWall then asked whether the effects of acetaminophen on social pain corresponded to neural networks in the brain. What we know from the past 2 decades of neuroimaging research, is that people who have lesions in the anterior insula and the dorsal anterior cingulate cortex report not being bothered by physical pain, and are less sensitive to social rejection and loss. Thus, Dr. DeWall was interested in whether acetaminophen use would result in differences in neural activity in response to social rejection in these two areas.

To answer this question, he recruited another 25 undergraduate students and randomly assigned them to receive either acetaminophen or a placebo. Participants took their assigned pill every day, morning and night, for 3 weeks. At the end of the 3 weeks, the participants came to the lab to participate in an fMRI, or brain imaging session. While in the scanner they played a ball toss game that, unbeknownst to them, was designed to make them feel socially rejected.

The ball toss game had 2 parts. In the first part, the participant and two other players virtually played catch with each other. In the second part, the two other players stopped throwing the ball to the participant after 3 possessions. This is likely to prime the participant to think and feel socially rejected.

Dr. DeWall and his colleagues found that participants who had been taking acetaminophen for the past three weeks demonstrated less activity in the areas of the brain that are responsible for experiencing pain, anterior insula and the dorsal anterior cingulate cortex, compared with the placebo group. Thus, taking a daily dose of acetaminophen caused their brain to be less sensitive to social rejection.

So, am I telling you to start taking acetaminophen every day to feel less sensitive? NO, absolutely not. These studies were conducted with a very small number of young and healthy people, and taking any medication should be a decision made with the advice of your personal physician. Furthermore, I'm not convinced that not having hurt feelings would be a good thing. Experiencing hurt feelings may be a good thing in the long run, as those experiences will teach you who in your life is a reliable and supportive friend, and who is not. Evidence to support this notion is that Dr. DeWall also collected information on positive emotions throughout the study, and the participants in the acetaminophen group didn't report more positive emotions, even though they had fewer experiences of hurt feelings.

What this study should remind you of is the importance of feelings and their relevance to development and well-being. Given that humans are dependent on adults for a relatively long period of childhood, being able to express “hurt feelings” at separation from a caregiver would have been adaptive. It completely makes sense that physical and social pain would be neurobiologically intertwined. Given that we now have a wealth of information to support that the brain responds similarly to physical and social pain, I would like to challenge the notion that fault can only be placed on people who inflict physical pain on others. Put another way, every time a person says something hurtful to another person, the brain might as well be getting punched. This has implications that we don’t necessarily understand yet. People who are physically abused or live in conditions of chronic pain have long term negative repercussions, but very few people understand the long term consequences of living in an environment filled with hurtful and rejecting social interactions. If these experiences act on the central nervous system in a similar way, ought the long term negative consequences overlap as well? In light of this reminder, I leave you with a quote from my favorite book:

“Shall we make a new rule of life from tonight: always to try to be a little kinder than is necessary?” ~ J.M. Barrie, Peter & Wendy

Dewall, C. N., Macdonald, G., Webster, G. D., Masten, C. L., Baumeister, R. F., Powell, C., ... & Eisenberger, N. I. (2010). Acetaminophen reduces social pain: behavioral and neural evidence. Psychological Science, 21(7), 931-937.