0a~e&y4sKo Y0Professor Paul Bloom: Welcome to the last class. Before starting the lecture I just want to do some final procedural issues. Again, your reading responses have been completed. Your essays have been all completed and the grades will be available sometime next week. The teaching fellows are currently grading them like crazy. Your experimental participation requirement is up until May 7th. Please finish it by then. If not--just please finish it by then. Your exam's on Monday. Last class--somebody asked me whether I was going to post an old exam and I said, "Well, you don't need it because you--I already posted a midterm and it looks like the Midterm," and one of the teaching fellows e-mailed me and essentially said, "Why are you so damn lazy?" [laughter] So, I posted the old final.
0d |\?C%~0Some of you require special accommodations for the Final. The arrangements will be precisely the same as for the Midterm and Judy York should be contacting you to set up the arrangements. If there are any problems with that, definitely contact me as soon as possible but you should be hearing from Judy York concerning special arrangements.心理学空间d*KW!]K-v
Finally, the review sessions are going to be held tomorrow and on Friday. Please note: It turns out the original class schedule for the Thursday review session is booked. The review session will be held in this room from 6 o'clock to 8 o'clock and once again, the teaching fellows have graciously agreed to run these review sessions.心理学空间Tq:K9j)l
Okay. 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.
r2@-pDhWI:zs n0And 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.心理学空间%M{ G:f)a6n^6D2eq
lT;t*p7TL0In 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.心理学空间5~b^P&W#]
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.心理学空间w!k;J"h;YIK$]PxV
5Vj!h+vefe,nG0Finally, 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.
G ]d~4N K;zQ@N0Also 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.
:`j A,cH;U0Student:[inaudible]
4EM|M4h5e8T\0Professor 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.心理学空间 ~mbgm1U
Student:[inaudible]心理学空间/},~Nf Q"Bj#D
3[+p A#K:W;^#s0Professor 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.
O Vv1t V0Okay. 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 calledDSM-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.