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When Private Optimism meets Public Despair: People adapt to threats like Covid-19 by maintaining positive and protective biases while reducing negative perceptions and emotions

Maria Thomas29 June 2020

This blog was written by PhD Student Laura K. Globig from the Department of Experimental Psychology, UCL. 

woman wearing face mask

Humans tend to be optimistic. They overestimate their financial prosperity and marriage longevity, while underestimating their risk of disease, such as cancer or suffering other hardships, like being burgled (Sharot, 2011, Weinstein, 1980).

What is surprising about such observations is that anecdotally, people also often express pessimism regarding the state of society as a whole. Following the financial collapse of 2008, polls showed that people were extremely pessimistic about the financial future of their country. By contrast, they were optimistic about their own financial prospects (Ipsos MORI, 2008).

Now these seemingly opposing but coexisting beliefs integrate to shape a person’s response becomes especially relevant when danger faces the self and others. How someone estimates their own vulnerability will likely affect their well-being and the choices they make. Simultaneously, someone’s predictions about the vulnerability of society at large could also affect their personal well-being and behavior. The latter is particularly pertinent, when one’s own behavior can affect others’ well-being.

As COVID-19 swept the globe and stay at home orders were issued we surveyed a representative sample of 1145 Americans in 30 states across two timepoints. Our aim was two-fold: 1) To investigate how people perceived the danger COVID-19 posed to themselves and to their fellow citizens. 2) To determine how these perceived risks influenced their own well-being and behavior.

We found that people believed they were at lower risk of getting COVID-19 relative to others their age and gender. We refer to this as private optimism. At the same time, people also believed that COVID-19 posed a tremendous danger to the health of the human population as whole. We refer to this as public pessimism.

We found that private optimism can be explained by people’s sense of control. People believe their fate is in their own hands, and thus they believe they can avoid negative outcomes (Zakay, 1984). During the pandemic, this may relate to people believing they are in control over being exposed to the virus. This then leads them to believe they are less likely than others to catch the virus. But because this sense of control does not extend to society, they are less optimistic about global issues. We cannot control how others behave during the pandemic.

Those who were optimistic about their own chances of being infected were also happier and less anxious compared to those who were not. How people estimated the danger posed by COVID-19 to society as a whole however did not influence personal happiness, but did affect anxiety. Those who were pessimistic about the danger to society, were more anxious. Thus, our perception of our own vulnerability can influence both positive and negative aspects of well-being, while how vulnerable we perceive others relates specifically to anxiety.

When it comes to slowing the spread of COVID-19, to what extent we adopt preventative measures, such as social distancing, not only mitigates our own risk of getting infected, but also that of others. It enables us to protect those who are particularly vulnerable.

Our study shows that public pessimism predicted how likely people were to adhere to public health advice to slow the spread. That is, people who believed the virus posed a great danger to society as a whole reported putting greater effort in social distancing, hand washing and avoiding touching their faces. How people considered the risk to the self, however, did not affect compliance. This suggests that people predominantly engage in protective behaviors for the benefit of others.

Finally, we also observed that people adapted well to the restrictions imposed by the pandemic. Their well-being increased as lockdown progressed. Compared to the start of lockdown, people were less anxious and reported an increased sense of control. They considered the danger of COVID-19 to humanity as less than they did at the beginning of lockdown. Private optimism and happiness remained stable throughout. This suggests that humans adapt to threats by maintaining positive and protective biases while reducing negative perceptions and emotions.

We surveyed Americans across 30 US states, thereby allowing us to sample a diverse representation of US citizens. Notably, we did not observe an effect of state or number of COVID-19 cases or COVID-19 related fatalities at the time of testing. It is therefore likely that our findings will also apply to other countries, such as the United Kingdom.

Rather than an effect of location, we did find that political orientation, age, gender and socioeconomic status had a differential effect on well-being and behavior. Older individuals and females were more like to comply with government advice related to COVID-19 mitigation. Moreover, those with high income were happier. Finally, males and republicans were more likely to express private and public optimism. Additionally, younger individuals were also more likely to express private optimism. Future research is needed to explore how government policies in response to COVID-19 influence well-being and behavior. There may well be differential effects on an international scale.

Given the recent decline in COVID-19 cases and easing restrictions, it is possible that risk perception in general will decrease, due to the actual risk of infection being reduced. Nevertheless, some preliminary data we collected indicates that people still consider the risk of getting infected themselves as low, relative to others of same age and gender. More work is needed to explore how this optimistic tendency relates to reports of an increasing number of people believing they have already contracted the virus and are thereby immune. As official statistics indicate the true percentage of the population that has actually tested positive for COVID-19 is still relatively small. Therefore, it is in fact possible that the belief to have had COVID-19 already is in itself, also a form of private optimism in which people falsely believe they are immune, and thereby no longer at risk of infection.

One might believe that private optimism may deter individuals from getting vaccinated against COVID-19 once a vaccine becomes available. However, vaccinations rely on the concept of herd immunity and thereby only work to prevent the spread of infectious diseases if the majority of the population is vaccinated. They could therefore be considered a form of behavioral compliance to protect those who are vulnerable and thus one’s willingness to get vaccinated likely relies more on how we estimate the danger to the human population. Of course, this relies on effective communication and education of the public.

There is reason to believe, that the paradoxical existence of private optimism and public pessimism generalizes to other threats such as war, financial collapse and climate change. For example, we speculate that people’s tendency to make “green choices” is linked to the belief that climate change poses a threat to humanity, regardless of whether they believe that they are themselves at risk. Such knowledge can be useful for advocates and policy makers in framing information to encourage individuals to select actions that protect themselves and others from natural and man-made threats. In the future we also hope to explore the mechanistic link between sense of control, private optimism and well-being further. If we can strengthen people’s sense of control, we might be able to harness the positive effects on personal well-being in times of crisis.

 

References

Globig, L. K., Blain, B., & Sharot, T. (2020, May 29). When Private Optimism meets Public Despair: Dissociable effects on behavior and well-being. https://doi.org/10.31234/osf.io/gbdn8

Ipsos MORI. (2008). Political Monitor, March 2008, [UK]. [Data set].  Retrieved from: https://www.ipsos.com/ipsos-mori/en-uk/ipsos-mori-political-monitor-march-2008

Sharot, T. (2011). The optimism bias. Current Biology, 21(23), R941–R945. https://doi.org/10.1016/j.cub.2011.10.030

Weinstein, N. D. (1980). Unrealistic optimism about future life events. Journal of Personality and Social Psychology, 39(5), 806–820. https://doi.org/10.1037//0022-3514.39.5.806

Zakay, D. (1984). The Influence of Perceived Event’s Controllability on Its Subjective Occurrence Probability. The Psychological Record, 34(2), 233–240. https://doi.org/10.1007/BF03394867

Researching student mental health during the pandemic: a PhD student tries to remain objective

Maria Thomas4 May 2020

This blog has been guest written by PhD Student Tayla McCloud, UCL Division of Psychiatry.

Woman anxious at desk with laptop

It is difficult to think of anyone who is unaffected in some way by the current coronavirus pandemic and resulting UK lockdown. Whilst practical adjustments and physical health concerns spring to mind, there are myriad mental health implications, too.

Results from two early online surveys conducted by the mental health charity MQ and the Academy of Medical Sciences (AMS) showed that the main concerns among people with lived experience of a mental illness and others in the general population were the impact of the pandemic on anxiety, isolation, and access to support. These are likely to affect everyone to differing degrees throughout the lockdown.

On April 15th, a team of prominent psychiatric researchers published a piece in Lancet Psychiatry calling for high-quality research monitoring the mental health impact on the general population overall and in specific vulnerable groups. These are defined as including children and young people affected by school closures, older adults who may be isolated, and frontline healthcare workers. This is undoubtedly of utmost importance.

One group also experiencing a lot of disruption, though, is university students. Universities have been forced to close physically, meaning that this year’s exam and graduation season has been upended. Teaching is being conducted remotely and assessments have mostly been moved to different formats online. Like primary and secondary education students, university students will be adjusting to a completely new routine and way of learning.

Unlike primary and secondary students, though, for university students studying ‘at home’ may mean moving back in with parents in a completely different city, town or even country to where they usually study. This is likely to be a considerable upheaval at an already difficult time, with concerns around when it will be safe to return, but students who do not go back to where they lived before university risk being left to live alone without their usual support networks as many others leave.

Most university courses are attempting to continue as close to normal as possible, delivering teaching remotely, which means assessments are still largely going ahead. This means that students are under a lot of pressure to be as productive and focused as usual during what is a very tough time psychologically. Without access to libraries and equipment, they also may not have the resources or study spaces they usually have in which to complete their work. Under-performance, as well as the pandemic itself, could negatively impact their future career.

For these reasons, among others, university students may be at increased risk of experiencing negative mental health consequences of the coronavirus pandemic. It is, however, difficult to know this without relevant data.

SENSE Study Logo

This is where my PhD project, the SENSE study, comes in. SENSE is a longitudinal survey of the mental health of UCL students, conducted online beginning in October 2019. The last wave was in February 2020 and the next wave will begin shortly, in May. It covers such areas as students’ demographics, accommodation, financial situation and social lives, and we are adding new questions relating to the pandemic. This means that we will be able to compare UCL students’ mental health before and during the UK coronavirus outbreak. This could help us to understand more about which groups are more vulnerable to the impact of UCL’s closure and the UK lockdown, potentially highlighting areas for intervention. Follow @SENSEstudy on Twitter for updates, or visit our website www.sensestudy.co.uk.

I am also involved in a new study, You-COPE, which aims to measure the mental health of young people aged 16-24 in the UK throughout the lockdown and public health response and in the months afterwards. Follow me on Twitter (@TaylaMcCloud) for updates on this when it launches. This will include university students as well as non-students, and as such will complement the SENSE data findings and allow comparisons between these two groups.

I am attempting to continue this PhD work as usual, whilst conscious that I am a university student living through the coronavirus pandemic researching the mental health of university students during the coronavirus pandemic. It can be difficult to continue work as a “professional” when your work involves focusing on how students are being negatively affected.

Being a student who is researching student mental health is often quite odd like this. I talk about ‘university students’ in the third person, making hypotheses about this abstract group that it is easy to forget I am part of. I often bring my own university experience into the conversation as an example, as do my supervisors, but I am usually referring to a (somewhat) far away undergraduate version of myself and not my present experience. PhD students occupy a confusing space somewhere between staff and student that means we never quite feel like either.

The current coronavirus pandemic, and the resulting UK lockdown and UCL closure, has undoubtedly impacted my PhD work, as well as seemingly every other aspect of my life. I am trying to use this as an advantage; considering how I can use my experience as a UCL student during this time to inform my research, and my interpretation of the findings of this research. I hope that this will add value to the research I am conducting, and that SENSE and You-COPE will be able to shed new light on our understanding of the mental health of university students at a time when they may be particularly vulnerable.

Psychiatry needs a(nother) dose of wellbeing

Maria Thomas24 February 2020

This blog has been guest written by Rochelle Burgess from UCL Institute for Global Health – prompted by our previous blogs from Prof Tony David (Insight and Psychosis: the next 30 years and What is mental health?)

Group of people holding hands in the air

 

 

 

 

 

Earlier this month, the New York Times published an obituary for Dr. Bonnie Burstow, feminist therapist, professor and anti-psychiatrist. Once discovered, I promptly fell through a rabbit hole of Twitter feeds and debates reflecting on her career, most notably her critiques of a psychiatric care system that situates women’s (and everyone’s) mental health problems in the brain, instead of the problematic worlds where these brains and bodies live. This critique has always resonated deeply with me on many levels – as a mental health service user but also more systematically in my research, studying the mental health needs and treatment experiences of marginalised groups exposed to poverty, oppression and various forms of violence, in high-income and low-income settings. That day’s rabbit hole was full of people confirming the ongoing relevance of her work, viewing mental health sciences as disciplines still grappling with some pretty old problems and a rage that is as robust today as it was in the early days of Burstow’s work.

There are probably many reasons to explain this persistence. But they all converge around a long standing critique of the psy-disciplines, well-articulated by Foucault, R.D.Laing, and more recently, Thomas and Bracken’s Post-psychiatry framework, and some critical spaces of the global mental health world. Essentially, patients don’t feel seen. Not fully. Service users are seen in a partial sense – a way that prioritises diagnosis, biological and neurological mechanisms, over what it means to be in the world with a condition, and to the full range of needs of a person.

This is not for a lack of trying. Social and community psychiatry have embraced recovery paradigms and more recently, responding to calls for social interventions. Each in their own way complicates our approach to supporting a process of being ‘in’ the world and experiencing mental distress. But even in this, mental health feels a little stuck in the idea that a person is primarily their diagnosis (see – recovery in the bin movement), and what counts as treatment remains fairly narrow. We still forget the world where bodies live – in spite of the wealth of evidence we have that highlights the structural drivers of mental illness, the impacts of those drivers on treatment outcomes. But we just can’t seem to shift things, probably because the way we define the problem still doesn’t give enough space to the complex needs of people.

We need a new way. Anti-psychiatry doesn’t feel right, as that in its own way removes complexity – ignoring that there are places, spaces and people who will benefit tremendously from access to diagnostics and medications.

This is where wellbeing paradigms have something to offer. Though seen as a hot new topic popularised (and arguably distilled) by ‘happiness’ studies and indexes, wellbeing paradigms are rooted in classical philosophical concepts of Eudaimonia and hedonia – and reflect our earliest attempts to understand the roots of happiness wellbeing. For me, Hedonic perspectives, focused largely on pleasure, are less helpful here. But Eudaimonic perspectives, which looks at meaning, self-actualisation and the ‘full functioning’ of a person, provide the foundations for more holistic, meaningful and potentially radical mental health spaces – where all kinds of care are on the table.

Sociologist Corey Keys, and psychologist Carol Ryff have made considerable contributions to our understandings of how wellbeing principles relate to mental health and mental illness. Importantly, their analyses place mental health and mental illness as two separate but related spectrums, rather than the opposite ends of a single spectrum. Using a framework of ‘complete mental health’ they suggest that the absence of mental illness doesn’t automatically lead to mental health (though they are often co-related), and for this to occur, we need the presence of social, psychological and emotional wellbeing – defined as the ability to flourish. Most importantly for marginalised groups, flourishing encapsulates social wellbeing concerns beyond our relationships, demanding attention be paid to socio-political structures and the world where we live. It’s a model of person-centred care where addressing social-structural realities is as important as psychological and relational ones.

Imagine a field where this is our dominant framing? Where minds, bodies and the places they live are treated as one? Lately, I feel like we’re getting there. Daisy Fancourt is doing amazing things to push forward an evidence base for the importance of social prescribing and community networks to positive mental health, and for the biological dimensions of wellbeing. In communities where I work in the global south, a wellbeing perspective has driven the exploration and testing of intervention models that combine, within treatment programmes, psychological and community development support. Early findings from my recent pilot study of collective narrative therapy for women with complex trauma in South Africa suggests there is a positive booster effect when a focus on how to tackle problematic social environments is included in the intervention.

Burstow wanted a psychiatry/psychology that was as much about the brain, as it was about the world. This is entirely possible – all we need is a healthy dose of wellbeing.

Photo credit: MARCH network – Groups

Insight and Psychosis: The next 30 years

tonydavid25 October 2019

I published my first paper on the topic of insight in relation to psychosis about 30 years ago in the British Journal of Psychiatry. An anonymous Lancet editorialist commented at the time that studying insight was, “academically nourishing but clinically sterile”. Torn between feeling flattered by the attention and insulted by the judgement, I persisted. Now seems a good time to take stock and look forward to the next 30 years. We can now say that we have some ‘facts’ about insight in psychosis: first that it is possible to measure in ways that are at least as valid and reliable as any other psychopathological phenomenon. Next, that there are some very well replicated associations: poorer insight, worse psychopathology; lower IQ, lower insight; and lower mood, better insight. Finally there is the obvious and clinically relevant relationship between insight and treatment adherence and hence outcome.

The relation between insight and adherence, or rather poor insight and coercive treatment is, naturally, where critics of the insight concept converge. ‘Insight’ they say is mere agreeing with the doctor. But where a patient’s self-appraisal as not being unwell or needing help is at odds with their peers and family, might this not be regarded as a lack of insight? The interface between insight and capacity to decide upon treatment is where current ethical debate is concentrated and is seen most vividly in the ability to a ‘use and weigh’ information, a key criterion for mental capacity used in the Mental Capacity Act (2005) definition. It is hard to see how the benefits and harms of a proposed treatment can be weighed in the balance if you don’t believe you are ill in the first place.

Metacognition is a relatively new area of psychology examining people’s ability to reflect upon their own cognition and appears to be related to insight as used in psychiatry. The cognitive neuroscience of metacognition is beginning to make important contributions to psychopathology. Lack of metacognitive awareness – not reflecting on whether a decision is correct – underpins much thinking in say, depression, while excessive metacognition can inhibit decision making as in obsessive compulsive disorder. The lack of ability to change one’s mind in the light of new evidence is a core feature of delusions. Paradigms that build on advances in metacognitive research and make use of computational modelling also promise much in this regard.

For insight in psychiatry, the metacognitive challenge posed is to reflect on one’s own mental and interpersonal functioning. It involves an attempt to see one’s thinking and behaviour ‘objectively’ as if through another person’s eyes and then comparing it to some representation of mental health. There is just one fundamental question asked in relation to clinical insight (after Aubrey Lewis): do I have an illness and is the Illness mental? It includes the moment-to-moment evaluation of mental activity (e.g., was someone speaking to me or was it my imagination?) as well as more enduring ‘semantic’ evaluations such as whether my beliefs are true and shared by others. Note that while that representation of mental health will be the amalgam of received opinion and experience, there is no judging doctor, as it were, in sight.

Cognitive insight is a new construct put forward by pioneer of cognitive therapy, Aaron (Tim) Beck. It refers to a cognitive style or propensity to question one’s ideas, beliefs and behaviour. One advantage it affords research is that it enables insight to be studied in healthy individuals without confounders such as stigma and the effects of treatment, and thus linked to normal psychological processes. An early area of interest is the relationship between cognitive and clinical insight – which surprisingly, turns about to be rather weak. We still do not know if poor cognitive insight in a vulnerable individual may be a risk factor for later psychosis per se.

Can insight be fostered?

Restoring or improving insight is a worthwhile psychotherapeutic aim.  It should be in the form of acknowledging difficulties as a first step in gaining mastery over them. Then, encouraging openness to taking up an effective treatment for those symptoms that cause distress at least as a start, and not at all the forced acceptance of some abstract illness model. This was the aim of the now retro-sounding ‘Compliance Therapy’ trials back in the 1990s. Talking therapies designed to improve metacognition (Metacognitive Therapy and Metacognitive Training) across a range of mental disorders have been developed and tested in small clinical trials and subjected to meta-analysis – and the results are promising. To some extent the success of all these therapies depends on the closeness of the link between metacognition and insight which, as discussed is itself a topic of ongoing enquiry.

Apart from medication, which if effective at relieving symptoms is correspondingly effective at improving insight – a new area of therapeutic research is neuromodulation. Transcranial direct current stimulation (tDCS) is a simple, safe and non-invasive method for selectively modulating cortical excitability. Of interest, tDCS over the dorso-lateral prefrontal cortex has been reported to significantly increase awareness of errors on attention tasks in the elderly. Also, a pilot study showed that tDCS to same region increased insight in patients with schizophrenia – replication with a control condition is obviously required.

In conclusion, the study of insight has proved to be both academically simulating and clinically fertile. It is a biopsychosocial construct par excellence.  I am looking forward to what new insights the next 30 years will bring.

A fuller version of this blog will be published soon as a comment piece in the British Journal of Psychiatry. *The full comment can be found at https://doi.org/10.1192/bjp.2019.217

 

A.S.David, Director, UCL Institute of Mental Health

October 17th 2019

Further Reading

  1. David AS. Insight and psychosis. Br J Psychiatry 1990; 156: 798-808. https://doi.org/10.1192/bjp.156.6.798
  2. Amador XF, David AS. (Eds). Insight and psychosis: awareness of illness in schizophrenia and related disorders. 2nd edn. Oxford: Oxford University Press, 2004.
  3. Beck AT, Baruch E, Balter JM, Steer RA, Warman DM. A new instrument for measuring insight: the Beck Cognitive Insight Scale. Schizophr Res 2004; 68: 319-329.
  4. Philipp R, Kriston L, Lanio J, Kühne F, Härter M, Moritz S, Meistert R. Effectiveness of metacognitive interventions for mental disorders in adults—A systematic review and meta‐analysis (METACOG). Clin Psychol Psychother 2019; 26: 227– 240. https://doi.org/10.1002/cpp.2345
  5. De Jong S, van Donkersgoed R, Timmerman M, Aan het Rot M, Wunderink L, Arends J, Pijnenborg G. Metacognitive reflection and insight therapy (MERIT) for patients with schizophrenia. Psychological Medicine 2019; 49: 303-313
  6. Harty S, Robertson IH, Miniussi C, Sheehy OC, Devine CA, McCreery S, O’Connell RG. Transcranial direct current stimulation over right dorsolateral prefrontal cortex enhances error awareness in older age. J Neurosci 2010; 34:3646 –3652.

Bose A, Shivakumar V, Narayanaswamy JC, Nawani H, Subramaniam A, Agarwal SM, Chhabra H, Kalmady SV, Venkatasubramanian G. Insight facilitation with add-on tDCS in schizophrenia. Schizophr Res 2014; 156:63-65.