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  • This lecture will be a some slightly shorter lecture than

  • usual. What I first want to do is

  • finish off the discussion of clinical psychology from last

  • lecture and then have a little brief discussion about some very

  • interesting research on happiness.

  • We talked--we ended last lecture with a discussion of

  • some early--some of the history of treating mental illness and

  • we saw that it was rather gruesome,

  • unsuccessful, and arbitrary. For the most part,

  • we do better now, and Dr.

  • Nolen-Hoeksema reviewed some of the therapies with focus on

  • therapies for depression. The textbook talks in detail

  • about therapies for different disorders including

  • schizophrenia, anxiety disorders,

  • and so on. The question which everyone is

  • interested in is, "Does therapy work?"

  • And this proves to be surprisingly difficult to tell.

  • Part of the problem is if you ask people who go into therapy,

  • "Did you get better after therapy?"

  • for the most part they'll tell you that they did but the

  • problem is this could be a statistical byproduct of what's

  • called "regression to the mean." So, the idea looks like this.

  • This line plots how you feel from great through okay to awful

  • and it goes up and down and in fact in everyday life you're

  • going to--some days are going to be average,

  • some days will be better than average, some days worse than

  • average. You could plot your semester.

  • You could do a plot every morning when you wake up or

  • every night before you go to bed.

  • You could put yourself on a graph and it'll come out to some

  • sort of wiggly thing. Statistically,

  • if something is above average or below average it's going to

  • trend towards average just because that's a statistical

  • inevitability. When do people go to therapy?

  • Well, they go to therapy when they're feeling really crappy.

  • They go to therapy when they're feeling unusually bad.

  • Even if therapy then has no effect at all,

  • if it's true that people's moods tend to go up and down

  • after you feel really bad you'll probably improve rather than get

  • worse. And so this could happen--the

  • normal flow could happen just even if therapy has no effect at

  • all. And so, simply getting better

  • after therapy doesn't tell you anything.

  • On the worst day of your life you could do naked jumping jacks

  • on the roof of your college for ten minutes.

  • I guarantee you your next day would probably be better.

  • That doesn't mean naked jumping jacks are helping you.

  • Rather, it just means that the day after the worst day of your

  • life usually is not as bad as the worst day of your life.

  • It can get worse, but usually it just trends to

  • average. What you've got to do then is

  • you have to take people at the same point who would get

  • treatment and compare them to people who do not get treatment

  • or what we call a "control group."

  • And this is an example of this. So, this is for people who are

  • depressed. This is statistically equal.

  • They start off pre-therapy. They all go for therapy but

  • because in this example there's a limited number of therapists,

  • some of them are put on a waiting list and others get a

  • therapist. It's arbitrary.

  • It's random, which is--which--making it a

  • very good experiment. And in this example,

  • you could see those who received cognitive training were

  • better off. They had lower depression

  • scores than those that received no therapy at all.

  • In general, in fact, we could make some general

  • conclusions about therapy. Therapy by and large works.

  • People in treatment do better than those who are not in

  • treatment and that's not merely because they choose to go into

  • treatment. Rather, it's people who are in

  • desperate straits who seek out help.

  • Those who get help are likely to be better off than those that

  • don't get help. Therapy for the most part works.

  • We can't cure a lot of things but we can often make them

  • better. Different sorts of therapy

  • works best for different problems, and again,

  • depression proves to be an illustrative example.

  • If you have everyday unipolar depression, that is,

  • you feel very sad and you show other symptoms associated with

  • depression, an excellent treatment for you

  • is some combination of cognitive behavioral therapy and possibly

  • antidepressant medications like SSRIs.

  • If you have bipolar depression, the cognitive behavioral

  • therapy is useless but medication is your best bet and

  • so on for all of the other disorders.

  • Each disorder has some sort of optimal mode of treatment.

  • If you suffer from an anxiety disorder, cognitive behavioral

  • therapy can be of help. If you're a schizophrenic it's

  • probably not going to be of much help at all.

  • And so, different disorders go best with different sorts of

  • therapies. Finally, some therapists do

  • better than others. So, for reasons that nobody

  • fully understands, there are good therapists and

  • then there are better therapists and there are bad therapists.

  • And there's great individual differences in the efficacy of

  • an individual therapist. Finally, putting aside then the

  • difference in therapies and the difference in therapists,

  • does it make sense to say that therapy, in general,

  • works? And the answer is "yes."

  • And this is in large part because of what clinical

  • psychologists describe as "nonspecific factors."

  • And what this just is a term meaning properties that all

  • therapies, or virtually all therapies, share and I've listed

  • two of them here. One of them is "support."

  • No matter what sort of therapy you're getting involved in,

  • be it a psychoanalyst or a behavior therapist or a

  • cognitive therapist or a psychiatrist who prescribes you

  • medication or someone who makes you go through different

  • exercises or keeps a journal, you have some sense of support,

  • some acceptance, empathy, encouragement,

  • guidance. You have a human touch.

  • You have somebody who for at least some of the day really

  • cares about you and wants you to be better and that could make a

  • huge difference. Also you have hope.

  • Typically, there's an enthusiasm behind therapy.

  • There's a sense that this might really make me get better and

  • that hope could be powerful. Sometimes this is viewed under

  • the rubric of a placebo effect, which is that maybe the

  • benefits you get from therapy aren't due to anything in

  • particular the therapist does to you but rather to the belief

  • that things are going to get better,

  • something is being done that will help you.

  • And this belief can be a self-fulfilling prophecy.

  • "Placebo effect" is often used sort of in a dismissive way,

  • "Oh, it's just a placebo," but placebos can be powerful

  • and even if it's useless from a real point--from a psychological

  • theory point of view, even if the therapist runs

  • around and dances while you – I have dancing on my mind now

  • – while you sit in the chair and watch him dance;

  • if you believe the dancing is going to make you better,

  • it may well help. Okay.

  • That's all I'm going to say about therapy.

  • Any questions about therapy? Yes.

  • Student: [inaudible] Professor Paul Bloom:

  • Fair enough. The question is the assumption

  • of regression to the mean seems sort of arbitrary because it

  • depends what the mean is. Always after the fact you can

  • apply an average to it and say, "Look.

  • This is the average," but how do you know beforehand?

  • It's a good point. When you talk about regression

  • to the mean, it adopts certain assumptions.

  • The assumption is there really is an average throughout much of

  • your life and things go up and down within that average and for

  • the most part that's true for things like mood.

  • For most of us, we have an average mood and we

  • have bad days and we have good days.

  • It's always possible that you have a bad day and then from

  • there on in it's just going to go down and down and down but

  • statistically the best bet is if you have a bad day you're going

  • to go back up to the mean. It's--in some way you don't

  • even have to see it from a clinical point of view.

  • You could map it out yourself. Map out your moods and the days

  • where you're most depressed sooner or later you're likely to

  • go up. Similarly, on the happiest day

  • of your life odds are the next day you're going to go down and

  • there's nothing magical about this.

  • This is just because under the assumption that there really is

  • an average in--built into one--each of us.

  • If human behavior was arbitrary, it would be like a

  • random walk but it's not. We seem to have sort of set

  • points and aspects of us that we fall back to that make the idea

  • of a mean a psychologically plausible claim.

  • Yes. Student: [inaudible]

  • Professor Paul Bloom: That's a good question.

  • Yes. In that study it's a perfectly

  • good hypothesis that the sort of anxiety of being told,

  • "I see you've come here for help.

  • We can't give it to you. Congratulations.

  • You're a control group" [laughs]

  • causes anxiety. In other studies the control

  • group doesn't know they are the control group.

  • So sometimes you can do an intervention where you say,

  • "Congratulations, everybody in Intro Psych who

  • did very low on the depression inventory,"

  • which many of you filled out, "We're going to do something to

  • you." And then the rest of the people

  • don't even know that they haven't been chosen.

  • So, you're right. It's a perfectly good point.

  • Knowing you're not chosen could have a deleterious effect and

  • the way to respond to that is you have other studies that

  • don't use that same method.

  • Okay. I want to end with happiness

  • and it's a strange thing to talk about in psychology.

  • Most of psychology focuses on human misery,

  • most of clinical psychology. There is the psychology we

  • spoke about through most of the semester on vision and language

  • and social behavior, but typically when people think

  • about interventions what they think about is people having

  • problems and then we figure out how to make them better.

  • They are schizophrenic, they are depressed or anxious,

  • they are just not making it in life,

  • and psychologists try to figure out how to make things improve.

  • And in fact, a lot of the information I gave

  • you at the beginning of the lecture last class where I

  • reviewed all of the disorders is in this wonderful book called

  • DSM-IV, The Diagnostic and Statistical

  • Manual of Mental Disorders. If you ever really want to

  • get--If you really [laughs] want to diagnose people and

  • come to have a belief in your own mental instability,

  • browsing through that book is a treat.

  • Everything that can go wrong in mental life from Aspergers

  • syndrome to fetishes to paranoid schizophrenia is all in that

  • wonderful book and--but a lot of psychologists have been

  • disturbed by the focus of our field on taking bad people,

  • people who are broken, people who are sad,

  • and bringing them up to normal. And they've started to ask can

  • psychology give us any insight into human flourishing,

  • how to take people who are--who--how to study people

  • who are psychological successes, how to take people who are

  • psychologically okay and make them better.

  • And this is the movement known as "positive psychology."

  • And it has its own handbook now, The Handbook of Positive

  • Psychology, listing psychological strengths,

  • listing virtues, ways--what psychology tells us

  • about how we can be at our best. Some of this work in positive

  • psychology is, in my mind, real crap.

  • A lot of it is some combination of new age banalities by people

  • who are striving to get more grant funds and end up on

  • Time magazine. On the other hand--and so,

  • some of it is really bad. You could imagine this attracts

  • every self-help huckster you could imagine.

  • On the other hand, a lot of this work is quite

  • neat, quite interesting and quite promising.

  • And what I want to do is tell you what I think is the most

  • interesting research from this movement concerning happiness.

  • Now, there are a lot of good books on this and I'm going to

  • recommend books, which I haven't been doing much

  • in this class. Marty Seligman is the pioneer

  • of positive psychology and he's written an excellent book called

  • Authentic Happiness. Jonathan Haidt is a brilliant

  • young scholar who's done--also done a lot of work on disgust

  • and morality. He did the "sex with dead

  • chicken study" we discussed earlier.

  • This is one of my favorite books by – Happiness by

  • Nettle, because it's smart, it's beautifully written and

  • it's extremely short. And Dan Gilbert's book,

  • Stumbling on Happiness, is a very, very funny book and

  • very smart book and is now on The New York Times