Chapter 4

Question 1

Basic components of a ReseaRch study

Answer 1

The basic research process is very simple. You start with an educated guess, called a hypothesis, about what you expect to find. When you decide how you want to test this hypothesis, you have a research design. This includes the aspects you want to measure in the people you are studying (the dependent variable) and the influences on their behaviours (the independent variable). For example, a researcher interested in understanding the rela- tionship between panic attacks and alcohol abuse might choose to study the effects of anxiety induction in the lab (the independent variable) on how much alcohol research participants choose to drink (the dependent variable). Finally, two forms of validity are specific to research studies: internal and external validity. Internal validity is the extent to which we can be confident that the inde- pendent variable is causing the dependent variable to change. External validity refers to how well the results relate to things outside your study, in other words, how well your findings describe similar individuals or processes outside the laboratory.

Question 2

Hypothesis

Answer 2

Human beings look for order and purpose. We want to know why the world works as it does, and why people behave the way they do. Robert Kegan (cited in Lefrancois, 1990) describes us as “meaning-making” organisms, constantly striving to make sense of what is going on around us. In fact, fascinating research from social psychology tells us that we may have a heightened motiva- tion to make sense of the world, especially if we experience situ- ations that seem to threaten our sense of order and meaning (Heintzelman & King, 2014).

The familiar search for meaning and order also characterizes the field of abnormal behaviour. Almost by definition, abnormal behaviour defies the regularity and predictability we desire. It is this departure from the norm that makes the study of abnormal behaviour so intriguing. In an attempt to make sense of these phenomena, behavioural scientists construct hypotheses and then test them. Hypotheses are nothing more than educated guesses about the world, often informed from previous research. You may believe that watching violent television programs will cause children to be more aggressive. You may think that bulimia is influenced by media depictions of supposedly ideal female body types. You may suspect that someone abused as a child is likely to abuse his or her significant other or child. These concerns are all testable hypotheses.

Once a scientist decides what to study, the next step is to put it in words that are unambiguous and in a form that is testable. Consider a study of how self-esteem (how you feel about your- self) affects depression. Ulrich Orth from the University of California–Davis and his colleagues from around the world gathered information from more than 4000 people over several years (Orth et al., 2009). They knew from previous research that at least over a short period, having feelings of low self-esteem seems to put people at risk for later depression. The researchers posed the following hypothesis: Prior low self-esteem will be a predictor of later depression across all age groups of partici- pants. The way the hypothesis is stated suggests the researchers already know the answer to their question. They won’t know what they will find until the study is completed, but phrasing the hypothesis in this way makes it testable. If, for example, people with high self-esteem are at equal risk for later depression, then other influences must be studied. This concept of testability (the ability to confirm or refute the hypothesis) is important for science because it allows us to say that in this case, either (1) low self-esteem signals later depression, so maybe we can use this information for prevention efforts, or (2) there is no relationship between self-esteem and depression, so let’s look for other early signs that might predict who will become depressed. The
researchers did find a strong relationship between self-esteem and later depression for people in all age groups, which may prove useful for detecting people at risk for this debilitating disorder.

When they develop a hypothesis, researchers also specify the dependent and independent variables. A dependent variable is what is expected to change or be influenced by the study. Psychol- ogists studying abnormal behaviour typically measure an aspect of the disorder, such as overt behaviours, thoughts, and feelings, or biological symptoms. In the study by Orth and colleagues (2009), the main dependent variable (level of depression) was measured using the person’s responses on a questionnaire about his or her depression (Center for Epidemiologic Studies Depres- sion Scale). Independent variables are those factors thought to affect the dependent variables. The independent variable in the study was measured using responses on a questionnaire on self-esteem (the Rosenberg Self-Esteem Scale). In other words, self-esteem was thought to influence later levels of depression. When possible, the independent variable is manipulated by the researcher, to provide a better test of its influence on the depen- dent variable. In the case of the Orth and colleagues’ study, the independent variable was not manipulated but simply observed.

Question 3

Internal and External Validity

Answer 3

The researchers in the study on self-esteem and depression used responses on the questionnaires collected from two very large studies conducted in the United States and Germany. Suppose they found that, unknown to them, most people who agree to participate in these types of studies have higher self-esteem than people who do not participate. This would have affected the data in a way that would limit what they could conclude about self- esteem and depression and would change the meaning of their results. This situation, which relates to internal validity, is called a confound (or confounding variable), defined as any factor occurring in a study that makes the results uninterpretable because a variable (in this instance, the type of population being studied) other than the independent variable (having high or low self-esteem) may also affect the dependent variable (depression).

Scientists use many strategies to ensure internal validity in their studies, three of which we discuss here: control groups, randomization, and analogue models. In a control group, people are similar to the experimental group in every way except that members of the experimental group are exposed to the indepen- dent variable and those in the control group are not. Because researchers can’t prevent people from being exposed to many things around them that could affect the outcomes of the study, they try to compare people who receive the treatment with people who go through similar experiences except for the treatment (control group). Control groups help rule out alternative explana- tions for results, thereby strengthening internal validity.

Randomization is the process of assigning people to different research groups in such a way that each person has an equal chance of being placed in any group. Researchers can, for exam- ple, randomly place people in groups but still end up with more of certain people (e.g., people with more severe depression) in one group than another. Placing people in groups by flipping a coin or using a random number table helps improve internal valid- ity by eliminating any systematic bias in assignment. You will see later that people sometimes put themselves in groups, and this self-selection can affect study results. Perhaps a researcher treat- ing people with depression offers them the choice of being either in the treatment group, which requires coming into the clinic twice a week for two months, or in a wait-list control group, which means waiting until some later time to be treated. The most severely depressed individuals may not be motivated to come to frequent treatment sessions and so will choose the wait-list group. If members of the treated group are less depressed after several months, it could be because of the treatment or because group members were less depressed to begin with. Groups assembled randomly avoid these problems.

Analogue models create in the controlled conditions of the laboratory aspects that are comparable (analogous) to the phenom- enon under study. Bulimia researchers could ask volunteers to binge eat in the laboratory, questioning them before they ate, while they were eating, and after they finished to learn whether eating in this way made them feel more or less anxious, guilty, and so on. Such “artificial” studies help improve internal validity.

In a research study, internal and external validity often seem to be in opposition. On the one hand, we want to be able to control as many things as possible to conclude that the independent vari- able (the aspect of the study we manipulated) was responsible for the changes in the dependent variables (the aspects of the study we expected to change). On the other hand, we want the results to apply to people other than the participants of the study and in other settings; this is generalizability, the extent to which results apply to everyone with a particular disorder. If we control all aspects of a study so that only the independent variable changes, the result may not be relevant to the real world. For example, if you reduce the influence of gender issues by studying only males, and if you reduce age variables by selecting only people from 25 to 30 years of age, and finally, if you limit your study to those with university degrees so that education level isn’t an issue— then what you study (in this case, 25- to 30-year-old male univer- sity graduates) may not be relevant to many other populations. Internal and external validity are in this way often inversely related. Researchers constantly try to balance these two concerns and, as you will see later in this chapter, the best solution for achieving both internal and external validity is to conduct several different studies on the same research question.

Question 4

statistical veRsus clinical significance

Answer 4

The introduction of statistics is part of psychology’s evolution from a prescientific to a scientific discipline. Statisticians gather, analyze, and interpret data from research. As an example, consider a study evaluating whether a drug (naltrexone)—when added to a psychological intervention—helps those with alcohol addiction stay sober longer (Anton et al., 2006). The study found that the combination of medication and psychotherapy helped people stay abstinent 77 days on average and those receiving a placebo stayed abstinent 75 days on average. This difference was statistically significant. But is it an important difference? The difficulty is in the distinction between statistical significance (a mathematical calculation about the difference between groups) and clinical significance (whether or not the difference was meaningful for those affected) (Thirthalli & Rajkumar, 2009).

Closer examination of the results leads to concern about the size of the effect. Because this research studied a large group of people dependent on alcohol (1383 volunteers), even this small difference (75 versus 77 days) was statistically different. Few of us, however, would say staying sober for two extra days was worth taking medication and participating in extensive therapy—in other words, the difference may not be clinically significant.

Fortunately, concern for the clinical significance of results has led researchers to develop statistical methods that address not just that groups are different but also how large these differences are, or effect size. Calculating the actual statistical measures involves fairly sophisticated procedures that take into account how much each treated and untreated person in a research study improves or worsens. Some researchers have used more subjective ways of determining whether truly important change has resulted from treatment. The late behavioural scientist Montrose Wolf (1978) advocated the assessment of what he called social validity. This technique involves obtaining input from the person being treated, as well as from significant others, about the importance of the changes that have occurred. In the example here, we might ask the participants and family members if they thought the treatment led to truly important improvements in alcohol abstinence. If the effect of the treatment is large enough to impress those who are directly involved, the treatment effect is clinically significant. Statistical techniques of measuring effect size and assessing subjective judgments of change will let us better evaluate the results of our treatments.

Question 5

the aveRage client

Answer 5

Too often we look at results from studies and make generaliza- tions about the group, ignoring individual differences. Kiesler (1966) labelled the tendency to see all participants as one homo- geneous group the patient uniformity myth. Comparing groups according to their mean scores (“Group A improved by 50 percent over Group B”) hides important differences in individual reac- tions to our interventions.

The patient uniformity myth leads researchers to make inac- curate generalizations about disorders and their treatments. To continue with our previous example, what if the researchers studying the treatment of alcoholism concluded that the treatment was a good approach? And suppose we found that, although some participants improved with treatment, others worsened. Such differences would be averaged out in the analysis of the group as a whole, but for the person whose drinking increased with the treatment, it would make little difference that, on average, people improved. Because people differ in such ways as age, cognitive abilities, gender, and history of treatment, a simple group compar- ison may be misleading. Practitioners who deal with all types of disorders understand the heterogeneity of their clients and there- fore do not know whether treatments that are statistically signifi- cant will be effective for a given individual. In our discussions of various disorders, we return to this issue.

Question 6

STuDyInG InDIvIDual CaSES

Answer 6

One method is to use the case study method, investigating inten- sively one or more individuals who display the behavioural and physical patterns

One way to describe the case study method is by noting what it is not. It does not use the scientific method. Few efforts are made to ensure internal validity and, typically, many confounding variables are present that can interfere with conclusions. Instead, the case study method relies on a clinician’s observations of differences among one person or one group with a disorder, people with other disorders, and people with no psychological disorders. The clinician usually collects as much information as possible to obtain a detailed description of the person. Interview- ing the person under study yields a great deal of information on personal and family background, education, health, and work history, as well as the person’s opinions about the nature and causes of the problems being studied.

Case studies are important in the history of psychology. Sigmund Freud developed psychoanalytic theory and the methods of psychoanalysis on the basis of his observations of dozens of cases. Freud and Josef Breuer’s description of Anna O. (see Chapter 1) led to development of the clinical technique known as free association. Sexuality researchers Virginia Johnson and William Masters based their work on many case studies and helped shed light on numerous myths regarding sexual behaviour (Masters & Johnson, 1966). Joseph Wolpe, author of the land- mark book Psychotherapy by Reciprocal Inhibition (1958), based his work with systematic desensitization on more than 200 cases. As our knowledge of psychological disorders has grown, psycho- logical researchers’ reliance on the case study method has gradu- ally decreased.

One difficulty with depending heavily on individual cases is that sometimes coincidences occur that are irrelevant to the condition under study. Unfortunately, coincidences in people’s lives often lead to mistaken conclusions about what causes certain conditions and what treatment appears to be effective. Because a case study does not have the controls of an experimental study, the results may be unique to a particular person without the researcher realizing it or may derive from a special combination of factors that are not obvious. Complicating our efforts to understand abnormal behaviour is the portrayal of sensational cases in the media. For example, on April 16, 2007, a shooter on the campus of Virginia Tech University took the lives of 32 faculty members and students. Immediately after this horrific mass killing there was speculation about the shooter, including early bullying, descriptions of him being a “loner,” and depictions of notes he wrote against “rich kids,” “deceitful charlatans,” and “debauchery” (Kellner, 2008). Attempts have been made to discover childhood experiences that could possibly explain this later behaviour. We must be careful, however, about concluding anything from such sensational portrayals, since many people are bullied as children, for example, but do not go on to kill dozens of innocent people.

As another illustration of both the limits and potential of the case study method, Canadian researcher Earls and Lalumière (2002) described the case of a man who showed a preference for sex with a horse over sex with humans (or any other species for that matter). The man in question had been convicted of animal cruelty, had received a diagnosis of antisocial personality disor- der, and scored below average on a measure of IQ (80). The authors noted that the finding of low IQ was consistent with previ- ous research and discussions linking low intelligence to acts of bestiality and to zoophilia (a sexual preference for animals). Later, the authors were contacted by a man who suggested that some high-functioning men also have a strong preference for animals, using himself as an example: “You published one case study and I am another one. Who determines which one is typi- cal?” Earls and Lalumière (2009) later published a case report on this occupationally successful man: He had a long-standing sexual interest in horses (one that preceded his actual contact with horses), was a published medical doctor, and was married with children; he eventually left his wife to live on a farm alone with two horses, which he called his “mare-wives.”

Researchers in cognitive psychology point out that the public and researchers themselves are often, unfortunately, more highly influ- enced by dramatic accounts than by scientific evidence (Nisbett & Ross, 1980). Remembering our tendency to ignore this fact, we highlight research findings in this book. To advance our under- standing of the nature, causes, and treatment of abnormal behav- iour, we must guard against premature and inaccurate conclusions.

Question 7

RESEaRCh By CoRRElaTIon

Answer 7

One of the fundamental questions posed by scientists is whether two variables are related to each other. A statistical relationship between two variables is called a correlation. For example, is schizophrenia related to the size of ventricles (spaces) in the brain? Are people with depression more likely to have negative attributions (negative explanations for their own and others’ behaviour)? Is the frequency of hallucinations higher among older people? The answers depend on determining how one vari- able (e.g., number of hallucinations) is related to another (e.g., age). Unlike experimental designs, which involve manipulating or changing conditions, correlational designs are used to study phenomena just as they occur. The result of a correlational study—whether variables occur together—is important to the ongoing search for knowledge about abnormal behaviour.

One of the clichés of science is that correlation does not imply causation. In other words, two things occurring together does not necessarily mean that one caused the other. For example, the occurrence of marital problems in families is correlated with behaviour problems in children (e.g., Yoo & Huang, 2012). If you conduct a correlational study in this area, you will find that in families with marital problems you tend to see children with behaviour problems; in families with fewer marital problems, you are likely to find children with fewer behaviour problems. The most obvious conclusion is that having marital problems will cause children to misbehave. If only it were as simple as that! The nature of the relationship between marital discord and childhood behaviour problems can be explained in a number of ways. It may be that problems in a marriage cause disruptive behaviour in the children. Some evidence suggests, however, the opposite may be true as well: The disruptive behaviour of children may cause marital problems (Rutter & Giller, 1984). In addition, evidence suggests genetic influences may play a role in conduct disorders and in marital discord (D’Onofrio et al., 2006; Lynch et al., 2006), so parents who are genetically more inclined to argue pass on those genes to children who then have an increased tendency to misbehave.

This example points out the challenges in interpreting the results of a correlational study. We know that variable A (marital problems) is correlated with variable B (child behaviour prob- lems). We do not know from these studies whether A causes B (marital problems cause child problems), whether B causes A (child problems cause marital problems), or whether some third variable, C, causes both (genes influence both marital and child problems).

The association between marital discord and child problems represents a positive correlation. This means that higher scores in one variable (a great deal of marital distress) is associated with higher scores in the other variable (more child disruptive behav- iour). At the same time, lower scores in one variable (less marital distress) is associated with lower scores in the other (less disrup- tive behaviour). When there is a negative correlation, the rela- tionship between the two variables is reversed. That is, higher scores in one variable are associated with lower scores in the other, and vice versa. The correlation coefficient can vary from –1.0 (a perfect negative correlation) to 0.0 (no correlation) to +1.0 (a perfect positive correlation). See ■ Figure 4.1 for an illustra- tion of positive and negative correlations.

Marital problems in families and behaviour problems in chil- dren have a relatively strong positive correlation represented by a number around +0.50. Schizophrenia and height are not related, so the correlation is likely close to 0.00. We used an example of a negative correlation in Chapter 2, when we discussed social supports and illness. The more social supports that are present, the less likely it is that a person will become ill. The negative relationship between social supports and illness could be repre- sented by a number such as –0.40.

Question 8

Epidemiological ReseaRch

Answer 8

Scientists often think of themselves as detectives, searching for the truth by studying clues. One type of correlational research that is very much like the efforts of detectives is called epidemiology, the study of the incidence, distribution, and consequences of a particular problem or set of problems in a population. Epidemi- ologists expect that by tracking a disorder among many people, they will find important clues to why the disorder exists. One strategy is to determine the incidence of a disorder—the esti- mated number of new cases during a specific period. For example, as we see in Chapter 12, the incidence of new cases of cocaine use has been decreasing over the past decade among most age groups in Canada. A related strategy involves determining prevalence, the number of people with a disorder at any one time. For exam- ple, the prevalence of alcohol dependence among Canadian adults is about 3 percent (Statistics Canada, 2002a). Epidemiologists study the incidence and prevalence of disorders among different groups of people. For instance, data from epidemiological research conducted by Statistics Canada indicate that the preva- lence of alcohol dependence among women is substantially lower than among men (Statistics Canada, 2002a).

Although the primary goal of epidemiology is to determine the extent of medical problems, it is also useful in the study of psychological disorders. In the early 20th century, many people displayed symptoms of a strange mental disorder. Its symptoms were similar to those of organic psychosis, which is often caused by mind-altering drugs or great quantities of alcohol. Many patients appeared catatonic (immobile for long periods) or exhibited symptoms similar to those of paranoid schizophrenia. Victims were likely to be poor, which led to speculation about class inferiority. Using the methods of epidemiological research, however, researcher Joseph Goldberger found correlations between the disorder and diet, and he identified the cause of the disorder as a deficiency of the B vitamin niacin among people with poor diets. The symptoms were successfully eliminated by niacin therapy and improved diets. A long-term, widespread benefit of Goldberger’s findings was the introduction of vitamin- enriched bread in the 1940s (Colp, 2009).

Researchers have used epidemiological techniques to study the effects of stress on psychological disorders. For example, researchers have examined the psychological effects of the September 11, 2001, terrorist attacks on the U.S. World Trade Center and the American Pentagon. Following those events, Blanchard et al. (2004) examined rates of two anxiety disorders— acute stress disorder and post-traumatic stress disorder—in three samples of university students: those attending the University of Albany in New York state, those attending North Dakota State University in North Dakota, and those attending Augusta State University in Georgia. They found significantly greater rates of both acute stress disorder (28 percent versus 10 percent versus 19 percent, respectively) and post-traumatic stress disorder (11 percent versus 3 percent versus 7 percent, respectively) in the New York students.

A similar study conducted in Saskatchewan by Gordon Asmundson and his colleagues showed rates of disorder compa- rable to those obtained by Blanchard and colleagues (2004) in the students from North Dakota and Georgia. More specifically, about 4 percent of the Canadian sample met the criteria for full or partial post-traumatic stress disorder following the events of September 11, 2001 (Asmundson et al., 2004).

Taken together, these findings suggest a relationship between geographical proximity and impact of the trauma, with those living closer to the site of the terrorist attacks showing the greatest levels of distress. The studies by Blanchard et al. (2004) and Asmundson et al. (2004) are correlational studies because the investigators did not manipulate the independent variable. Like other types of correlational research, epidemiological research can’t tell us conclusively what causes a particular phenomenon. Knowledge about the prevalence and course of psychological disorders is extremely valuable to our understanding, however, because it points researchers in the right direction.

Question 9

RESEaRCh By ExPERImEnT

Answer 9

An experiment involves the manipulation of an independent variable and the observation of its effects. We manipulate the independent variable to answer the question of causality. If we observe a correlation between social supports and psychological disorders, we can’t conclude which of these factors influenced the other. We can, however, change the extent of social supports and see whether it triggers an accompanying change in the prevalence of psychological disorders—in other words, do an experiment.

What will this experiment tell us about the relationship between these two variables? If we increase the number of social supports and find no change in the frequency of psychological disorders, it may mean that the lack of such supports does not cause psychological problems. However, if we find that psycho- logical disorders diminish with increased social support, we can be more confident that lack of support does contribute to disor- ders. However, because we are never 100 percent confident that our experiments are internally valid—that no other explanations are possible—we are cautious about interpreting our results. In the following section, we describe different ways researchers conduct experiments and consider how each one brings us closer to understanding abnormal behaviour.

Question 10

ExpeRimental designs

Answer 10

With correlational designs, researchers observe people to see how different variables are associated. In experimental designs, researchers are more active. They actually change an independent variable to see how the behaviour of the people is affected. Suppose researchers design an intervention to help reduce insom- nia in older adults, who are particularly affected by the condition (Ancoli-Israel & Ayalon, 2009). They treat a number of individu- als and follow them for 10 years to learn whether their sleep patterns improve. The treatment is the independent variable; that is, it would not have occurred naturally. They then assess the treated group to learn whether their behaviour changed as a func- tion of what the researchers did. Introducing or withdrawing a variable in a way that would not have occurred naturally is called manipulating a variable.

Unfortunately, a decade later the researchers find that the older adults treated for sleep problems still, as a group, sleep less than eight hours per night. Is the treatment a failure? Maybe not. The question that can’t be answered in this study is what would have happened to group members if they hadn’t been treated. Perhaps their sleep patterns would have been worse. Fortunately, research- ers have devised ingenious methods to help sort out these chal- lenging questions.

A special type of experimental design is used more and more frequently in the treatment of psychological disorders and is referred to as a clinical trial (Durand & Wang, 2011; Pocock, 2013). A clinical trial is an experiment used to determine the effectiveness and safety of a treatment. The term clinical trial implies a level of formality with regard to how it is conducted. As a result, a clinical trial is not a design by itself but rather a method of evaluation that follows a number of generally accepted rules. For example, these rules cover how you should select the research participants, how many individuals should be included in the study, how they should be assigned to groups, and how the data should be analyzed—and this represents only a partial list. Also, treatments are usually applied using formal protocols to ensure that everyone is treated the same. The terms used to describe these experiments can be confus- ing. “Clinical trials” is the overarching term used to describe the general category of studies that follow the standards described previously. Within the “clinical trial” category are “randomized clinical trials,” which are experiments that employ randomization of participants into each group. Another subset of clinical trials is “controlled clinical trials,” which are used to describe experi- ments that rely on control conditions to be used for comparison purposes. Finally, the preferred method of conducting a clinical trial, which uses both randomization and one or more control conditions, is referred to as a “randomized controlled trial.” We next describe the nature of control groups and randomization, and discuss their importance in treatment outcome research.

Question 11

Control Groups

Answer 11

One answer to the what-if dilemma is to use a control group— people who are similar to the experimental group in every way except they are not exposed to the independent variable. In the previous study looking at sleep in older adults, suppose another group who didn’t receive treatment was selected. Further suppose that the researchers also follow this group of people, assess them 10 years later, and look at their sleep patterns over this period. They probably observe that, without intervention, people tend to sleep fewer hours as they get older (Cho et al., 2008). Members of the control group, then, might sleep less than people in the treated group, who might themselves sleep somewhat less than they did 10 years earlier. Using a control group allows the researchers to see that their treatment did help the treated partici- pants keep their sleep time from decreasing further.

Ideally, a control group is nearly identical to the treatment group in such factors as age, gender, socioeconomic backgrounds, and the problems they are reporting. Furthermore, a researcher would do the same assessments before and after the independent variable manipulation (e.g., a treatment) to people in both groups. Any later differences between the groups after the change would, therefore, be attributable only to what was changed.

People in a treatment group often expect to get better. When behaviour changes as a result of a person’s expectation of change rather than as a result of any manipulation by an experimenter, the phenomenon is known as a placebo effect (from the Latin word placebo, which means “I shall please”). Conversely, people in the control group may be disappointed that they are not receiving treatment (analogously, we could label this a frustro effect, from the Latin word meaning “to disappoint”). Depending on the type of disorder they experience (e.g., depression), disappointment may make them worse. This phenomenon would also make the treatment group look better by comparison.

One way researchers address the expectation concern is through placebo control groups. The placebo is given to members of the control group to make them believe they are getting treatment. A placebo control in a medication study can be carried out with relative ease because people in the untreated group receive something that looks like the medication administered to the treatment group (e.g., a sugar pill). In psychological treatments, however, it is not always easy to devise something that people believe may help them but does not include the component the researcher believes is effective. Clients in these types of control groups are often given part of the actual therapy—for example, the same homework as the treated group—but not the portions the researchers believe are responsible for improvements.

Note that you can look at the placebo effect as one portion of any treatment. If someone you provide with a treatment improves, you may attribute the improvement to a combination of your treatment and the client’s expectation of improving. Therapists want their clients to expect improvement; this helps strengthen the treatment. However, when researchers conduct an experiment to determine what portion of a particular treatment is responsible for the observed changes, the placebo effect is a confound that can dilute the validity of the research. Thus, researchers use a placebo control group to help distinguish the results of positive expectations from the results of the active treatment ingredients.

The double-blind control is a variant of the placebo control group procedure. As the name suggests, not only are the partici- pants in the study “blind,” or unaware of what group they are in or what treatment they are given (single blind), but so are the researchers or therapists providing treatment (double blind). This type of control eliminates the possibility that an investigator might bias the outcome. For example, a researcher comparing two treatments who expected one to be more effective than the other might try harder if the preferred treatment wasn’t working as well as expected. On the other hand, if the treatment that wasn’t expected to work seemed to be failing, the researcher might not push as hard to see it succeed. This reaction might not be deliberate, but it does happen. This phenomenon is referred to as an allegiance effect (Dragioti et al., 2015). If, however, both the participants and the researchers or therapists are blind, there is less chance that bias will affect the results.

A double-blind placebo control does not work perfectly in all cases. If medication is part of the treatment, participants and researchers may be able to tell whether or not they have received it by the presence or absence of physical reactions (side effects). Even with purely psychological interventions, participants often know whether or not they are receiving a powerful treatment, and they may alter their expectations for improvement accordingly.

As an alternative to using no-treatment control groups to help evaluate results, some researchers compare different treatments. In this design, the researcher gives different treatments to two or more comparable groups of people with a particular disorder and can then assess how or whether each treatment helped the people who received it. This is called comparative treatment research. In the sleep study we discussed, two groups of older adults could be selected, with one group given medication for insomnia, the other given a cognitive-behavioural intervention, and the results compared.

Question 12

pRocess and outcome of tReatment

Answer 12

The process and outcome of treatment are two important issues to be considered when different approaches are studied. Process research focuses on the mechanisms responsible for behaviour change, or “why does it work?” In an old joke, someone goes to a physician for a new miracle cure for the common cold. The physician prescribes the new drug and tells the patient the cold will be gone in seven to ten days. As most of us know, colds typi- cally improve in seven to ten days without treatment. The new drug probably does nothing to further the improvement of the patient’s cold. The process aspect of testing medical interven- tions involves evaluating biological mechanisms responsible for change. Does the medication cause lower serotonin levels, for example, and does this account for the changes we observe? Similarly, in looking at psychological interventions, we deter- mine what is “causing” the observed changes. This is important for several reasons. First, if we understand what the “active ingredients” of our treatment are, we can often eliminate aspects that are not important, thereby saving clients’ time and money. For example, one study of insomnia found that adding a relax- ation training component to a treatment package provided no additional benefit—allowing clinicians to reduce the amount of training and focus on only those aspects that really improve sleep (e.g., cognitive-behavioural therapy) (Harvey et al., 2002). In addition, knowing what is important about our interventions can help us create more powerful, newer versions that may be more effective.

Outcome research focuses on the positive and negative effects (results) of the treatment. In other words, does it work? Remember, treatment process involves finding out why or how your treatment works.

Question 13

SInGlE-CaSE ExPERImEnTal DESIGnS

Answer 13

B. F. Skinner’s innovations in scientific methodology were among his most important contributions to psychopathology. Skinner formalized the concept of single-case experimental designs. This method involves the systematic study of individu- als under a variety of experimental conditions. Skinner thought it was much better to know a lot about the behaviour of one individual than to make only a few observations of a large group for the sake of presenting the “average” response. Psychopathol- ogy is concerned with the suffering of specific people, and this methodology has greatly helped us understand the factors involved in individual psychopathology (Barlow et al., 2009; Kazdin, 2011). Many applications throughout this book reflect Skinnerian methods.

Single-case experimental designs differ from case studies in their use of various strategies to improve internal validity, thereby reducing the number of confounding variables. As you will see, these strategies have strengths and weaknesses in comparison with traditional group designs. Although we use examples from treatment research to illustrate the single-case experimental designs, they, like other research strategies, can help explain why people engage in abnormal behaviour, as well as how to treat them.

Question 14

Repeated measuRements

Answer 14

One of the more important strategies used in single-case experi- mental design is repeated measurement, in which a behaviour is measured several times instead of only once before you change the independent variable and once afterward.

Question 15

Withdrawal design

Answer 15

a researcher tries to determine whether the independent variable is responsible for changes in behaviour.

Question 16

multiple Baselines

Answer 16

Another single-case experimental design strategy used often that doesn’t have some of the drawbacks of a withdrawal design is the multiple baseline. Rather than stopping the intervention to see whether it is effective, the researcher starts treatment at different times across settings (home versus school), behaviours (yelling at spouse/partner or boss), or people. As an example of treatment across settings, suppose that after waiting for a while and taking repeated measures of Wendy’s anxiety both at home and at her office (the baseline), the clinician treats her first at home. When the treatment begins to be effective, intervention could begin at work. If she improves only at home after begin- ning treatment but improves at work after treatment is used there also, we could conclude the treatment was effective. This is an example of using a multiple baseline across settings. Does inter- nal validity improve with a multiple baseline? Yes. Any time other explanations for results can be ruled out, internal validity is improved. Wendy’s anxiety improved only in the settings where it was treated, which rules out competing explanations for her anxiety reduction. If she had won the lottery at the same time treatment started and her anxiety decreased in all situations, however, we couldn’t conclude her condition was affected by treatment.

Suppose a researcher wanted to assess the effectiveness of a treatment for a child’s problem behaviours. Treatment could focus first on the child’s crying, and then on a second problem, such as fighting with siblings. If the treatment was first effective only in reducing crying, and effective for reducing fighting only after the second intervention, the researcher could conclude that the treatment, not something else, accounted for the improve- ments. This is a multiple baseline conducted across behaviours.

Single-case experimental designs are sometimes criticized because they tend to involve only a small number of cases, leaving their external validity in doubt. In other words, we can’t say the results we saw with a few people would be the same for everyone. However, although they are called single-case designs, researchers can and often do use them with several people at once, in part to address the issue of external validity. One of us studied the effectiveness of a treatment for the severe behaviour problems of children with autism (Durand, 1999) (see ■ Figure 4.3). We taught the children to communicate instead of misbehaving, using a procedure known as functional communica- tion training. Using a multiple baseline, we introduced this treat- ment to a group of five children. Our dependent variables were the incidence of the children’s behaviour problems and their newly acquired communication skills. As shows, only when we began treatment did each child’s behaviour problems improve and communication begin. This multiple baseline design let us rule out coincidence or some other change in the children’s lives as explanations for the improvements.

Among the advantages of the multiple baseline design in evaluating treatments is that it does not require withdrawal of treatment and, as you’ve seen, withdrawing treatment is some- times difficult or impossible. Furthermore, the multiple baseline typically resembles the way treatment would naturally be implemented. A clinician can’t help a client with numerous problems simultaneously but can take repeated measures of the relevant behaviours and observe when they change. A clinician who sees predictable and orderly changes related to where and when the treatment is used can conclude the treatment is caus- ing the change.

Question 17

STuDyInG GEnETICS

Answer 17

We tend to think of genetics in terms of what we inherit from our parents: “He’s got his mother’s eyes.” “She’s thin just like her dad.” “She’s stubborn like her mother.” This simple view of how we become the people we are suggests that how we look, think, feel, and behave is predetermined. Yet, as you saw in Chapter 2, we now know that the interaction between our genetic makeup and our experiences is what determines how we will develop. The goal of behavioural geneticists (people who study the genet- ics of behaviour) is to tease out the role of genetics in these interactions.

Genetic researchers examine phenotypes, the observable characteristics or behaviour of the individual, and genotypes, the unique genetic makeup of individual people. For example, a person with Down syndrome typically has some level of intel- lectual disability and a variety of other physical characteristics, such as slanted eyes and a thick tongue. These characteristics are the phenotype. The genotype is the extra 21st chromosome that causes Down syndrome.

Our knowledge of the phenotypes of different psychological disorders exceeds our knowledge of the genotypes, but that may soon change. Ever since the discovery of the double helix in 1953 by James Watson and Francis Crick, scientists have aimed to map the structure and location of every gene on all 46 chromo- somes to fully understand our genetic endowment. Beginning in 1990, scientists around the world, in a coordinated effort, began the human genome project (genome means “all the genes of an organism”). Using the latest advances in molecular biology, scientists working on this project completed a rough draft of the mapping of the approximately 25000 human genes. This work identified hundreds of genes that contribute to inherited diseases. These exciting findings represent truly astounding progress in deciphering the nature of genetic endowment and its role in psychological disorders.

With the rapid advance of the science of genes, a new concept is now the focus of intense study—endophenotypes. Endophe- notypes are the genetic mechanisms that ultimately contribute to the underlying prob- lems causing the symptoms and difficulties experienced by people with psychological disorders. In the case of schizophrenia, for example, researchers are not looking for a “schizophrenia gene”; instead, they are searching for the gene or genes responsible for the working memory problems character- istic of people with this disorder (endophe-
notype), as well as the genes responsible for other problems experienced by people with this disorder. What follows is a brief review of the research strategies that scientists use as they study the interaction between envi- ronment and genetics in psychological disorders.

Question 18

family studies

Answer 18

In family studies, scientists simply examine a behavioural pattern or emotional trait in the context of the family. The family member with the trait singled out for study is called the proband. If there is a genetic influence, presumably the trait should occur more often in first-degree relatives (parents, siblings, or offspring) than in second-degree or more distant relatives. The presence of the trait in distant relatives, in turn, should be some- what greater than in the population as a whole. In Chapter 1 you met Jody, the adoles- cent with blood-injury-injection phobia who fainted at the sight of blood. The tendency of a trait to run in families, or familial aggre- gation, is as high as 60 percent for this disor- der; that is, 60 percent of the first-degree relatives of someone with blood-injury- injection phobia have the same reaction to at least some degree. This is one of the highest rates of familial aggregation for any psychological disorder we have studied.

The complication with family studies is that family members tend to live together and there might be something in their shared environment that causes the high familial aggregation.

For example, Mom might have developed a bad reaction to blood as a young girl after witnessing a serious accident. Every time she sees blood she has a strong emotional response. Because emotions are contagious, the young children watching Mom probably react similarly. In adulthood, they
pass it on, in turn, to their own children.

Question 19

adoption studies

Answer 19

How do we separate environ- mental from genetic influences in families? One way is through adoption studies. Scientists identify adoptees who have a particular behavioural pattern or psychological disorder and attempt to locate first-degree relatives who were raised in different family settings. Supp- ose a young man has a disorder and scientists discover his brother was adopted as a baby and brought up in a different home.

If the siblings raised with different families have the disorder more often than would be expected by chance, the researchers can infer that genetic endowment is a contributor.

Question 20

tWin studies

Answer 20

Nature presents an elegant experiment that gives behavioural geneticists their closest possible look at the role of genes in devel- opment: identical (monozygotic) twins. These twins not only look a lot alike but also have identical genes. Some changes do occur in chemical markers (called epigenetic markers) in the womb, which explains the subtle differences even in identical twins (van Dongen et al., 2014). Fraternal (dizygotic) twins, conversely, come from different eggs and have only about 50 percent of their genes in common, as do all first-degree relatives. In twin studies, the obvious scientific question is whether identical twins share the same trait—say, fainting at the sight of blood—more often than fraternal twins. Determining whether a trait is shared is easy with some physical traits, such as height. As Robert Plomin from the Institute of Psychiatry in London, England, points out, correla- tions in height for both first-degree relatives and fraternal twins are +0.45, and +0.90 for identical twins (Plomin, 1990). These findings show that heritability of height is about 90 percent (twice the difference between the two correlations), so approximately 10 percent of the variance is due to environmental factors. However, remember that this 90 percent heritability estimate is only an estimate of the contribution of genetic factors to individ- ual differences in height. An identical twin who was severely physically abused or selectively deprived of proper foods during development might be substantially different in height from the other twin, showing how environmental factors can have an impact on a given trait even for traits that have high heritability.

Behaviour genetics researchers Murray Stein, Kerry Jang, and John Livesley (2002) conducted a study on the heritability of social anxiety–related concerns. The variable of interest was fear of negative evaluation—a cognitive factor central to social phobia. The individuals in the study were 437 twin pairs in the University of British Columbia’s twin database. The investigators found that monozygotic twins had a greater degree of resemblance for fear of negative evaluation than did dizygotic twins, suggesting a significant heritable component. However, this way of studying genetics isn’t perfect. You can assume monozygotic twins have the same genetic makeup and dizygotic twins do not. A compli- cating concern, however, is whether monozygotic twins have the same experiences or environment as dizygotic twins. Some iden- tical twins are dressed alike and are even given similar names. And the twins themselves influence each other’s behaviour, and in some cases, monozygotic twins may affect each other more than dizygotic twins (Carey, 1992).

One way to address this problem is by combining the adoption study and twin study methods. If you can find identical twins, one or both of whom were adopted as an infant, you can better esti- mate the relative roles of genes and the environment in the devel- opment of individual differences in behavioural patterns.

Question 21

genetic linkage analysis and association studies

Answer 21

The results of a series of family, twin, and adoption studies may suggest that a particular disorder has a genetic component, but they can’t provide the location of the implicated gene or genes. To locate a gene, there are two general strategies: genetic linkage analysis and association studies (Fears et al., 2009; Zheng et al., 2012).

The basic principle of genetic linkage analysis is simple. When a family disorder is studied, other inherited characteristics are assessed at the same time. These other characteristics—called genetic markers—are selected because we know their exact location. If a match or link is discovered between the inheritance of the disorder and the inheritance of a genetic marker, the genes for the disorder and the genetic marker are probably close together on the same chromosome. For example, bipolar disorder was studied in a large Amish family (Egeland et al., 1987). Researchers found that two markers on chromosome 11—genes for insulin and a known cancer gene—were linked to the presence of mood disorder in this family, suggesting that a gene for bipolar disorder might be on chromosome 11. Unfortunately, although this is a good example of a genetic linkage study, it also illustrates the danger of drawing premature conclusions from research. This linkage study and a second study that purported to find a linkage between bipolar disorder and the X chromosome (Baron et al., 1987) have yet to be replicated; that is, different researchers have not been able to show similar linkages in other families (Merikangas & Risch, 2014).

The inability to replicate findings in these studies is quite common (Fears et al., 2009; Zheng et al., 2012). This type of failure casts doubt on conclusions that only one gene is respon- sible for such complex disorders. Be mindful of such limitations the next time you read in a newspaper or hear on television that a gene has been identified as causing some disorder.

The second strategy for locating specific genes, association studies, also uses genetic markers. Association studies compare markers in a large group of people with a particular disorder to people without the disorder. If certain markers occur significantly more often in the people with the disorder, it is assumed the mark- ers are close to the genes involved with the disorder. This type of comparison makes association studies better able to identify genes that may only be weakly associated with a disorder, but it is also plagued by failure to replicate, at least in our field. Nevertheless, both strategies for locating specific genes shed new light on the origins of specific disorders and may eventually inspire new approaches to treatment (Fears et al., 2009; Zheng et al., 2012)

Question 22

STuDyInG BEhavIouR ovER TImE

Answer 22

Sometimes we want to ask, “How will a disorder or behaviour pattern change (or remain the same) over time?” This question is important for several reasons. First, the answer helps us decide whether to treat a particular person. For example, should we begin an expensive and time-consuming program for a young adult who is depressed over the loss of a grandparent? You might not if you knew that with normal social support the depression is likely to diminish over the next few months without treatment. On the other hand, if you have reason to believe a problem isn’t likely to go away on its own, you might decide to begin treatment. For example, as you will see later, aggression among young children often does not go away naturally and should be dealt with as early as possible.

It is also important to understand the developmental changes in abnormal behaviour because sometimes these can provide insight into how problems are created and how they become more serious. For example, some researchers identify newborns who are at risk for autism spectrum disorder because they are siblings of a child with the disorder and then follow them through infancy until some develop the disorder themselves. This type of study is showing us that the pattern of the onset of this disorder is actually much different than parents report after the fact—they tend to remember drastic changes in the child’s behaviour when, in fact, the changes occur gradually (Zwaigenbaum et al., 2013). Prospec- tive studies (which record changes over time as they occur) some- times reveal dramatic differences in the development of psychological disorders or their treatment compared with the information discovered through retrospective studies (which ask people to remember what happened in the past).

Question 23

pRevention ReseaRch

Answer 23

An additional reason for studying clinical problems over time is that we may be able to design interventions and services to prevent these problems. Clearly, preventing mental health diffi- culties would save countless families significant emotional distress, and the financial savings could be substantial. Prevention research has expanded over the years to include a broad range of approaches. These different methods can be viewed in four broad categories: positive development strategies (health promotion), universal prevention strategies, selective prevention strategies, and indicated prevention strategies (Kalra et al., 2012). Health promotion or positive development strategies involve efforts to blanket entire populations of people—even those who may not be at risk—to prevent later problems and promote protective behav- iours. The intervention is not designed to fix existing problems but, instead, focuses on skill building, for example, to keep prob- lems from developing. For example, the Seattle Social Develop- ment Program targets young children in public elementary schools in the Seattle school system that are in high-crime areas, providing intervention with teachers and parents to engage the children in learning and positive behaviours. Although this approach does not target one particular problem (e.g., drug use), long-term follow- up of these children suggests multiple positive effects in achieve- ment, reductions in delinquency, and lower odds of contracting a sexually transmitted infection by age 30 (Bailey, 2009; Hill et al., 2014; Lonczak et al., 2002). Universal prevention strategies focus on entire populations and target certain risk factors (e.g., behav- iour problems in inner-city class-rooms) without focusing on specific individuals. The third approach to prevention interven- tion—selective prevention—specifically targets whole groups at risk (e.g., children who have parents who have died) and designs specific interventions aimed at helping them avoid future prob- lems. Finally, indicated prevention is a strategy for those indi- viduals who are beginning to show signs of problems (e.g., depressive symptoms) but do not yet have a psychological disorder.

To evaluate the effectiveness of each of these approaches, the research strategies used in prevention research for examining psychopathology across time combine individual and group research methods, including both correlational and experimental designs. We look next at two of the most often used designs: cross-sectional and longitudinal.

Question 24

cRoss-sectional designs

Answer 24

A variation of correlation research is to compare different people at different ages. For a cross-sectional design, researchers take a cross section of a population across the different age groups and compare them on some characteristic. For example, if they were
trying to understand the development of alcohol abuse and dependence, they could take groups of adolescents at 12, 15, and 17 years of age and assess their beliefs about alcohol use. In an early comparison, Brown and Finn (1982) made some interesting discoveries. They found that 36 percent of the 12-year-olds thought the primary purpose of drinking was to get drunk. This percentage increased to 64 percent with 15-year-olds, but dropped again to 42 percent for the 17-year-old students. The researchers also found that 28 percent of the 12-year-olds reported drinking with their friends at least sometimes, a rate that increased to 80 percent for the 15-year-olds and to 88 percent for the 17-year- olds. Brown and Finn used this information to develop the hypothesis that the reason for excessive drinking among teens is a deliberate attempt to get drunk rather than a mistake in judg- ment once they are under the influence of alcohol. In other words, teenagers do not, as a group, appear to drink too much because once they’ve had a drink or two they show poor judgment and drink excessively. Instead, their attitudes before drinking seem to influence how much they drink later.

In cross-sectional designs, the participants in each age group are called cohorts; Brown and Finn studied three cohorts: 12-year-olds, 15-year-olds, and 17-year-olds. The members of each cohort are the same age at the same time and thus have all been exposed to similar experiences. Members of one cohort differ from members of other cohorts in age and in their exposure to cultural and historical experiences. You would expect a group of 12-year-olds in the early 1980s to have received a great deal of education about drug and alcohol use, whereas the 17-year-olds may not have. Differences among cohorts in their opinions about alcohol use may be related to their respective cognitive and emotional development at these different ages and to their dissim- ilar experiences. This cohort effect, the confounding of age and experience, is a limitation of the cross-sectional design.

Researchers prefer cross-sectional designs to study changes over time partly because they are easier to use than longitudinal designs (discussed next). In addition, some phenomena are less likely to be influenced by different cultural and historical experi- ences and therefore are less susceptible to cohort effects. For example, the prevalence of Alzheimer’s disease among people at ages 60 and 70—assumed to be strongly influenced by biology— is not likely to be greatly affected by different experiences among the study participants.

One question not answered by cross-sectional designs is how problems develop in individuals. For example, do children who refuse to go to school grow up to have anxiety disorders? Researchers cannot answer this question simply by comparing adults with anxiety problems and children who refuse to go to school. They could ask the adults whether they were anxious about school when they were children, but this retrospective information (looking back) is usually less than accurate. To get a better picture of how individuals develop over the years, research- ers use longitudinal designs.

Question 25

longitudinal designs

Answer 25

Rather than looking at different groups of people of differing ages, researchers may follow one group over time and assess change in its members directly. The advantage of longitudinal designs is that they do not suffer from cohort effect problems and they allow the researchers to assess individual change. (■ Figure 4.4 illus- trates both longitudinal and cross-sectional designs.)

Nagin and Tremblay (1999) conducted a longitudinal study on physical aggression in boys. They followed more than 1000 boys from low-socioeconomic neighbourhoods in Montréal from age 6 in kindergarten to age 15 in high school, examining their levels of physical aggression over this period. Using this method, Nagin and Tremblay were able to identify four distinct groups of boys based on their levels and stability of aggression over this period. The first group was a chronic physical aggression group comprising boys who displayed persistently high levels of aggression over the nine years of the study. The second group was a high but declining group comprising boys who displayed a high level of aggression in kindergarten but showed a decrease thereafter. A third group was a moderate but declining group whose members showed moderate levels of aggression in kinder- garten but showed a decrease thereafter. The final group was a low group whose members rarely displayed aggression during the study.

In addition to measuring levels of physical aggression, the researchers also measured parental and early childhood variables that might help explain which boys would show persistently high aggression from childhood to adolescence. The researchers found that boys who displayed high hyperactivity or high oppo- sitional behaviour in kindergarten were each about three times as likely as other boys to be a
member of either the chronic
physical aggression or the high
but declining group.

Imagine conducting a major longitudinal study. Not only must the researcher persevere over months and years but so must the people who participate in the study. They must remain willing to continue in the project, and the researcher must hope they will not move away, or worse, die! Longitudinal research is costly and time-consuming; it is also subject to the distinct possibility that the research question will have become irrelevant by the time the study is complete. Lastly, longitudinal designs can suffer from a phenomenon similar to the cohort effect on cross- sectional designs: The cross-generational effect involves trying to generalize the findings to groups whose experiences are very different from those of the study participants. For example, the drug use histories of people who were young adults in the 1960s and early 1970s are vastly different from those of people born in the 1990s.

Sometimes psychopathologists combine longitudinal and cross-sectional designs in a strategy called the sequential design, which involves repeated study of different cohorts over time. Marvin Krank of the University of British Columbia, Okanagan, in Kelowna and his colleagues studied the development of alcohol and drug use among British Columbia youth (e.g., Krank et al., 2011; Krank & Wall, 2006; Krank et al., 2005; Nealis et al., 2016). They used the sequential design to learn whether and how differ- ent forms of substance use and other risk behaviours changed over time among these youth. Their ambitious project, labelled the Project on Adolescent Trajectories and Health (PATH), involved collecting survey data from more than 1300 students in a large school district in Western Canada.

Question 26

STuDyInG BEhavIouR aCRoSS CulTuRES

Answer 26

Just as we can become narrowly focused when we study people only at a certain age, we can also miss important aspects by studying people from only one culture. Studying the differences in behaviour of people from different cultures can tell us a great deal about the origins and possible treatments of abnormal behaviours. Unfortunately, most research literature originates in Western cultures, producing an ethnocentric view of psychopa- thology that can limit our understanding of disorders in general and can restrict the way we approach treatment (Christopher et al., 2014). Researchers in Malaysia—where psychological disorders are commonly believed to have supernatural origins— have described a disorder they call sakit gila, which has some features of schizophrenia but differs in important ways (Csordas, 2015). Could we learn more about schizophrenia (and sakit gila) by comparing the disorders themselves and the cultures in which they are found? Increasing awareness of the limited cultural scope of our research is creating a corresponding increase in cross-cultural research on psychopathology.

The designs we have described are adapted for studying abnor- mal behaviour across cultures. Some researchers view the effects of different cultures as though they were different treatments (López & Guarnaccia, 2012). In other words, the independent variable is the effect of different cultures on behaviour, rather than, say, the effect of cognitive therapy versus simple exposure for the treatment of fears. The difference between looking at culture as a treatment and our typical design, however, is impor- tant. In cross-cultural research, we can’t randomly assign infants to different cultures and observe how they develop. People from varying cultures can differ in any number of important ways— their genetic backgrounds, for one—that could explain variations in their behaviour for reasons other than culture.
The characteristics of different cultures can also complicate research efforts. Symptoms, or descriptions of symptoms, can be dissimilar in different societies (Paniagua & Yamada, 2013). Nigerians who are depressed complain of heaviness or heat in the head, crawling sensations in the head or legs, burning sensations in the body, and a feeling that the belly is bloated with water

In contrast, people in North America report feeling worthless, being unable to start or finish anything, losing interest in usual activities, and thinking of suicide. Natives of China, on the other hand, are less likely to report feeling depressed or losing interest in favourite things but may have thoughts of suicide or worthlessness (Yu et al., 2012). These few examples illustrate that applying a standard definition of depres- sion across different cultures will result in vastly different outcomes (Corrigan et al., 2014).
An additional complicating factor is varying tolerances, or thresholds, for abnormal behaviour. If people in different cultures see the same behaviours very differently, researchers will have trouble comparing incidence and prevalence rates. For example, traditional Chinese customs include talking to deceased relatives and local deities—behaviours that might be character- istic of schizophrenia in other cultures (Fuji et al., 2014). Under- standing cultural attitudes and customs is essential to such research (Paniagua & Yamada, 2013).

Finally, treatment research is also complicated by cross- cultural differences. Cultures develop treatment models that reflect their own values. In Japan, psychiatric hospitalization is organized in terms of a family model, with caregivers assuming parental roles. A family model was common in psychiatric insti- tutions in 19th-century North America, until it was replaced with the medical model common today (Colp, 2009). In Saudi Arabia, women are veiled when outside the home, which
prevents them from uncovering their faces in the presence of therapists; custom thus complicates efforts to establish a trust- ing and intimate therapeutic client–therapist relationship and may also prevent the therapist from gathering information about a patient’s affective state from her facial expression (Ali et al., 2004; Mistry et al., 2009). Because in the Islamic perspective medicine and religion are inseparable, medical and religious treatments are combined (Tober & Budiani, 2014). As you can see, something as basic as comparing treatment outcomes is highly complex in a cross-cultural context.

Question 27

ThE PowER of a PRoGRam of RESEaRCh

Answer 27

When we examine different research strategies independently, as we have done here, we often have the impression that some approaches are better than others. It is important to understand that this is not true. Depending on the type of question you are asking and the practical limitations inherent in the inquiry, any of the research techniques would be appropriate. Significant issues often are resolved not by one perfectly designed study but rather by a series of studies that examine different aspects of the problem—in a program of research. The research of one of this book’s authors will be used to illustrate how complex research questions are answered with a variety of different research designs.
One of us studies why children with autism spectrum disorders display seemingly irrational behaviours, such as self-injury (hitting or biting oneself) or aggression. The expectation is that the more we understand why these behaviours occur, the better the chances of designing an effective treatment. In an early study we used a single-subject design (withdrawal design) to test the influence of adult attention and escaping from unpleasant educational tasks on these problem behaviours (Carr & Durand, 1985). We found that some children hit themselves more when people ignore them, and others will hit themselves to get out of school assignments that are too difficult, showing that these disturbing behaviours can be understood by looking at them as primitive forms of communication (e.g., “Please come here” or “This is too hard”). This led us to consider what would happen if we taught these children to communicate with us more appropri- ately (Durand, 1990). The next series of studies again used single- subject designs and demonstrated that teaching more acceptable ways of getting attention or help from others did significantly reduce these challenging behaviours (e.g., Durand & Carr, 1992). Several decades of research on this treatment (called functional communication training) demonstrates its value in significantly improving the lives of people with these once severe behaviour problems by reducing the severity of the misbehaviour through improving communication skills.
One of the questions that face researchers in this area is why some children develop severe forms of these behaviour problems, while others do not. To begin to answer this question, we conducted a three-year prospective longitudinal study on more than 100 children with autism to see what factors might cause more problems (Durand, 2001). We studied the children at age three and later at age six to determine what about the child or the family led to more severe problems. We found the following two factors to be the most important indicators of severe behaviour problems in the children: (1) the parents were pessimistic about their ability to help their child or (2) the parents were doubtful about their child’s ability to change. These parents would give up and allow their child to dictate many of the routines around the house (e.g., eating dinner in the living room, or not going out to the movies because it would cause tantrums) (Durand, 2001).

This important finding then led to the next question: Could we make pessimistic parents more optimistic, and would this help prevent their children from developing severe behaviour prob- lems? To answer this question, we next relied on a randomized clinical trial to see if adding a cognitive behaviour intervention would help make pessimistic parents more optimistic. We wanted to teach these parents to examine their own pessimistic thoughts (e.g., “I have no control of my child” or “My child won’t improve because of his/her autism”) and replace them with more hopeful views of their world (e.g., “I can help my child” or “My child can improve his/her behaviour”). We hypothesized that this cognitive intervention would help them carry out the parenting strategies we offer them and in turn improve the outcomes of our behav- ioural interventions. We randomly assigned groups of pessimistic parents who also had a child with very severe behaviour problems to either a group that taught them how to work with their child or a group that used the same techniques but also helped them explore their pessimistic thinking and helped them view them- selves and their child in a better light. The treatments were applied very formally, using written protocols to make sure that each group received the treatment as designed (Durand & Hieneman, 2008). What we found was that addition of the cognitive-behavioural intervention had the expected effect— improving optimism and also improving child outcomes (Durand et al., 2009; Durand et al., 2013).

Question 28

REPlICaTIon

Answer 28

Scientists in general, and behavioural scientists in particular, are never really convinced something is true. They are very skeptical when it comes to claims about causes or treatment outcomes. Replicating findings is what makes researchers confident that what they are observing isn’t a coincidence. We noted when we described the case study method that if we look at a disorder in only one person, no matter how carefully we describe and docu- ment what we observe, we cannot draw strong conclusions.
The strength of a research program is in its ability to replicate findings in different ways to build confidence in the results. If you look back at the research strategies we have described, you will find that replication is one of the most important aspects of each. The more times a researcher repeats a process (and the behaviour he or she is studying changes as expected) the more sure he or she is about what caused the changes.
Many areas of science have experienced a replication crisis, in which findings were not duplicated when careful replication stud- ies were conducted. Psychology is not exempt from this crisis (e.g., Open Science Collaboration, 2015), and we mentioned earlier the difficulties in replicating molecular genetic findings for mental disorders, for example. One recommendation we have for the consumer of science, and for you, the reader, is to be more impressed and influenced by findings that have been repeated by different scientific teams and to be a bit skeptical of findings that are based on single studies. Most of the information we present in this textbook is based on replicated findings.

Question 29

RESEaRCh EThICS

Answer 29

An important final issue involves the ethics of doing research in abnormal psychology. For example, the appropriateness of a clinician’s delaying treatment to people who need it, just to satisfy the requirements of an experimental design, is often questioned. One single-case experimental design, the with- drawal design, can involve removing treatment for some time. Treatment is also withheld when placebo control groups are used in group experimental designs. Researchers continue to discuss and caution others about just when it is appropriate to use placebo-controlled trials (Boot et al., 2013). The fundamen- tal question is this: When does a scientist’s interest in preserving the internal validity of a study outweigh a client’s right to treatment?
One important aspect of this question involves informed consent—a research participant’s formal agreement to cooperate in a study following full disclosure of the nature of the research and the participant’s role in it. The concept of informed consent was derived from the war trials after World War II. Revelations that the Nazis had forced prisoners into so-called medical experi- ments helped establish the informed consent guidelines that are still used today. The ethical requirement of informed consent helps to prevent tragedies, such as the psychic driving experi- ments conducted by Dr. Ewan Cameron on vulnerable psychiatric patients (without their consent) at the Allan Memorial Institute in Montréal from 1957 to 1964 (see Chapter 17). Today, because of ethical requirements of informed consent, in studies using some form of treatment delay or withdrawal, the participant is told about why it will occur and the risks and benefits, and permission to proceed is then obtained. In placebo control studies, partici- pants are told they may not receive an active treatment (all partici- pants are blind to or unaware of which group they are placed in), but they are usually given the option of receiving treatment after the study ends.
True informed consent is at times elusive. The basic compo- nents are competence, voluntarism, full information, and compre- hension on the part of the participant (Snyder, 2012). In other words, research participants must be capable of consenting to participation in the research, they must volunteer and not be coerced into participating, they must have all the information they need to make the decision, and they must understand what their participation will involve. In some circumstances, all these condi- tions are difficult to attain. Children, for example, often do not fully appreciate what will occur during research. Similarly, indi- viduals with cognitive impairments, such as intellectual disability or schizophrenia, may not understand their role or their rights as participants. In institutional settings, participants should not feel coerced into taking part in research. And individuals from differ- ent cultures can have different perspectives about what is impor- tant in informed consent.

Certain general protections help ensure that these concerns are properly addressed. First, according to the Tri-Council Policy Statement for the Ethical Conduct for Research Involving Humans, research in Canadian university and medical settings must be approved by a research ethics board (REB; Government of Canada, 2014). These are committees made up of university faculty and nonacademic people from the community. Each committee is made up of five members (including both men and women): Two members must have expertise in the methods or areas of research covered by the particular REB, one member must be an expert in ethics, a fourth member should be an expert in relevant law (this type of member is required for a biomedical REB and suggested for other REBs), and the final member is a layperson from outside the institution. The purpose of the REB is to see that the rights of research participants are protected. The committee structure allows people other than the researcher to look at the research procedures to determine whether sufficient care is being taken to protect the welfare and dignity of the participants.
Psychological harm is difficult to define, but its definition remains the responsibility of the investigator. Researchers must hold in confidence all information obtained from participants, who have the right to conceal their identity on all data, either written or informal. Whenever deception is considered essential to research, the investigator must satisfy the REB that this judg- ment is correct. If deception is used, participants must be debriefed—that is, told in language they can understand the true purpose of the study and why it was necessary to deceive them.
The Society for Research in Child Development (2007) has endorsed ethical guidelines for research that address some issues unique to research on children. For example, these guidelines not only call for confidentiality, protection from harm, and debriefing but also require informed consent from children’s caregivers and from the children themselves if they are age seven or older. These guidelines specify that the research must be explained to children in language they can understand so that they can decide whether they want to participate. Many other ethical issues extend beyond protection of the participants, including how researchers deal with errors in their research, fraud in science, and the proper way to give credit to others. Doing a study involves more than select- ing the appropriate design. Researchers must be aware of numer- ous concerns that involve the rights of the people in the experiment, as well as their own conduct.
A final and important development in the field that will help to “keep the face” on psychological disorders is the involvement of consumers in important aspects of this research. The concern over not only how people are treated in research studies but also how the information is interpreted and used has resulted in many government agencies providing guidance on how the people who are the targets of the research (e.g., those with schizophrenia, depression, or anxiety disorders) should be involved in the process. The hope is that if people who experience these disorders are partners in selecting research questions, as well as designing, running, and interpreting this research, the relevance of the research, as well as the treatment of the participants in these stud- ies, will be markedly improved.