Want to eat less? Try using your non-dominant hand

Much of our eating behaviour is habitual. Many of us eat biscuits with tea, nibbles before dinner, popcorn at the cinema and so on. A new study by David Neal and his colleagues has put these habits under the microscope and shown just how entrenched they can become and how they can be broken.

One hundred and fifty-eight participants were recruited to either watch movie trailers at a cinema or music videos in a university department meeting room. In both settings they were given popcorn to eat, which was either stale or fresh. Now, some of the participants were habitual popcorn eaters at the movies, others weren't. The notable finding was that in the cinema setting the habitual popcorn eaters ate just as much of the popcorn when it was stale as when it was fresh. This they did even though they said they liked it less (just as the non-habitual popcorn eaters did), and regardless of whether they were hungry or not. Neal's team said this highlights how habits are driven by context (the cinema) and are immune to attitudes (i.e. liking) and motivation (i.e. hunger). By contrast, when in the department meeting room (not the usual setting for eating popcorn), the habitual popcorn eaters ate less of the stale popcorn and their consumption was influenced by hunger. This shows that if you escape the context that usually drives a habit then its power weakens and motives and intentions can take over.

A second study was similar to the first except this time half the participants were told to eat the popcorn with their non-dominant hand (i.e. right-handers had to eat with their left). This manipulation, which obstructs the automatic execution of a habit, had a similar effect to changing the environmental context. Habitual popcorn eaters allowed to use their dominant hand again ate just as much stale popcorn as fresh, in spite of liking it less, and regardless of their hunger levels. But those instructed to use their non-dominant hand were freed of their usual habit - they ate less of the stale popcorn and their consumption was driven more by hunger and liking.

"Habit change may ... require impeding habit activation [by contexts] or interrupting fluid habit execution," the researchers said. "Although our findings suggest that both avenues are effective, it is not always possible for dieters to avoid or alter the environments in which they typically overeat. More feasible, perhaps, is for dieters to actively disrupt the execution of the activated eating sequence by simple manipulations such as eating with the non-dominant hand and, in so doing, bring their eating under their personal control."
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Neal, D., Wood, W., Wu, M., and Kurlander, D. (2011). The Pull of the Past: When Do Habits Persist Despite Conflict With Motives? Personality and Social Psychology Bulletin DOI: 10.1177/0146167211419863

Further reading: How to form a habit.
Seven ways to be good.

Post written by Christian Jarrett for the BPS Research Digest.

The woman misdiagnosed with Alzheimer's, and how we can all be affected by the suggestion that we have psychological problems

Psychologists in the Netherlands have documented the case of a 58-year-old woman who was misdiagnosed with Alzheimer's Disease. The would-be patient consulted a neurologist at a stressful time in her life, in the knowledge that her mother had had the illness. A brain scan indicated reduced activity at the front of her brain ("hypofrontality"), and the neurologist also estimated her performance on a test of cognitive impairment as poor (though no formal test was conducted). On this basis he diagnosed Alzheimer's*.

The woman was devastated and thereafter her condition deteriorated significantly, to the point that she was permanently confused and, at one point, suicidal. Some months later, after receiving advice from an Alzheimer's helpline, the woman consulted a different neurologist for a second opinion. She completed comprehensive memory tests and undertook a further brain scan. All results were normal. This neurologist surmised that her earlier hypofrontality was associated with depression. He also went to great lengths to explain the good news about her results and the misinterpretation of her earlier scan, but it proved extremely difficult to assuage her concerns.

Years later, Harald Merckelbach and his team have interviewed the woman and they report that she continues to experience intrusive thoughts about the misdiagnosis and to catastrophise her memory lapses. Merckelbach's group believe the effect of a misdiagnosis has parallels with the implantation of false memories. Just as false memories are difficult to reverse, so too are mistaken diagnoses. "Conferring a diagnostic label is far from a neutral act," they said. "Many diagnostic labels have strong stereotypical connotations and sometimes, these will automatically shape the experiences and behaviour of patients, a phenomenon called 'diagnoses threat'."

To test these ideas further, Merckelbach, with colleagues Marko Jelicic and Maarten Pieters, gave 78 undergrads a psychological symptoms questionnaire to complete. Afterwards the students performed Suduko puzzles as a distraction. Next, the researchers went through some of the students' answers with them. During this review, the researchers inflated two of the answers they'd given to anxiety items. For example, imagine a student had originally indicated that she never had trouble concentrating. The researcher would inflate that answer by two points on the scale, as if she'd said that she sometimes had trouble concentrating, and they then asked the student to explain why she'd given that answer. Remarkably, 63 per cent of the participants failed to notice that their answers had been altered, and they proceeded to describe their experience of the symptoms (readers may notice parallels here with a phenomenon known as "choice blindness", in which people seem to have little insight into a recent choice they made).

Ten minutes later, and again after one week, all the students re-took the psychological symptoms questionnaire. At both time points, students who'd earlier failed to notice that two of their answers had been altered, now gave higher ratings to those two items, as if they considered themselves to have those symptoms. Such an effect was not observed among the minority of students who'd earlier noticed that their answers had been altered. An analysis of all the students' original baseline answers uncovered higher average baseline symptoms among those who would fail to notice the inflation of their answers. "Apparently a non-zero symptom intensity level introduces ambiguity; thereby raising the probability that misinformation is accepted," the researchers said. However, it's not the case that the influenced participants were simply more keen to give answers that the researchers wanted - they scored just the same on a test of social desirability.

The results from this study are consistent with past research showing how misinformation about physical symptoms can shape how people feel: for example, false feedback about asthmatic wheezing can trigger breathlessness in children with asthma.

Harald Merckelbach and his colleagues said their findings had particular significance for the way medical professionals interact with patients with unexplained symptoms, including those labelled with chronic fatigue, fibromyalgia, irritable bowel syndrome, and chronic pain. "... Expressing concern about the possibility of an underlying illness and, related to this, excessive investigation and attending patient support groups may all contribute to symptom escalation. What these interventions have in common is that they convey the message to the patient that his or her symptoms might be more intense and severe than he/she thinks they are. Our study suggests that blindness to unintended misinformation about the severity of the symptoms may underlie escalation of symptoms."

The researchers recommend that medics avoid mentioning the whole spectrum of possible symptoms when interviewing patients with medically unexplained symptoms. They also pointed to interesting avenues for future research. For example, notwithstanding the ethical issues involved, could patients benefit from receiving misinformation that lowered their symptom ratings? Also, is the inflated self-reporting of symptoms observed here based purely on exaggerated report, or is it grounded in an altered experience of symptoms?
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Merckelbach, H., Jelicic, M., and Jonker, C. (2011). Planting a misdiagnosis of Alzheimer's disease in a person's mind. Acta Neuropsychiatrica DOI: 10.1111/j.1601-5215.2011.00586.x

Harald Merckelbach, Marko Jelicic and Maarten Pieters (In Press). Misinformation increases symptom reporting – a test – retest experiment. J R Soc Med Sh Rep.

*Many years later, the neurologist was found guilty of having misdiagnosed several patients with Alzheimer's and 26 malpractice suits were filed against him (the woman featured in this case study was not part of that litigation).

This post was written by Christian Jarrett for the BPS Research Digest.

Take vitamin pill, eat cake. How supplements can encourage unhealthy behaviour

Have you ever had that feeling, after an energetic gym session, or perhaps a long walk, that you've earned the right to a mountainous slice of cake, or to lounge lazily in front of the telly? Psychologists call these licensing effects and a new study has documented a similar phenomenon following the simple act of taking a vitamin pill. The researchers say the finding could help explain why the explosive rise in the consumption of dietary supplements (approximately half the US population take them, according to recent data) has not led to a commensurate improvement in public health.

Wen-Bin Chiou and his colleagues gave an inert pill to 82 participants recruited via posters in the Taiwanese city of Kaohsiung. Half the participants were told it was a placebo; the other half were told it was a vitamin pill. They were instructed to suspend their usual intake of supplements, if any, for the duration of the study.

Afterwards, compared with placebo participants, the participants who thought they'd taken a vitamin pill rated indulgent but harmful activities like casual sex and excessive drinking as more desirable; healthy activities like yoga as less desirable; and they were more likely to choose a free coupon for a buffet meal, as opposed to a free coupon for a healthy organic meal (these associations held even after controlling for participants' usual intake of vitamin pills. Participants also said at the end that they hadn't guessed the purpose of the study).

The vitamin-takers also felt more invulnerable than the placebo participants, as revealed by their agreement with statements like "Nothing can harm me". Further analysis suggested that it was these feelings of invulnerability that mediated the association between taking a postulated vitamin pill and the unhealthy attitudes and decisions.

A second study with student recruits was similar to the first, but this time, participants who'd taken what they thought was a vitamin pill opted to walk a shorter distance to return a pedometer to a researcher located elsewhere on campus (even though they'd just been reminded of the health benefits of walking). Again, this association, between the vitamin pill and behaviour, was mediated by feelings of invulnerability.

"People who rely on dietary supplements for health protection may pay a hidden price: the curse of licensed self-indulgence," the researchers said. "Policy interventions that remind individuals to monitor the licensing effect may help translate the increased use of dietary supplements into improved public health."
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Chiou, W., Yang, C., and Wan, C. (2011). Ironic Effects of Dietary Supplementation: Illusory Invulnerability Created by Taking Dietary Supplements Licenses Health-Risk Behaviors. Psychological Science DOI: 10.1177/0956797611416253

This post was written by Christian Jarrett for the BPS Research Digest.

The dark side of swearing - it may deter emotional support from others

Each culture has its agreed-upon list of taboo words and it doesn't matter how many times these words are repeated, they still seem to retain their power to shock. Scan a human brain, swear at it, and you'll see its emotional centres jangle away.

Recent research has shown that this emotional impact can have an analgesic effect, and there's other evidence that strategically deployed swear words can make a speech more memorable. But it's not all positive. A new study suggests that swear words have a dark side. Megan Robbins and her team recorded snippets of speech from middle-aged women with rheumatoid arthritis, and others with breast cancer, and found those who swore more in the company of other people also experienced increased depression and a perceived loss of social support.

The sample sizes were small (13 women with rheumatoid arthritis and 21 women with breast cancer), but the technology was neat. The women wore "an electronically activated recorder" that periodically sampled ambient sounds, including speech. A lapel microphone recorded 50s every 18 minutes over two weekends for the arthritis sample and 50s every 9 minutes over one weekend for the breast cancer patients. Two months or four months after baseline the women repeated measures of their depression and perceived social support - the latter measured by agreement with statements like "I get sympathy and understanding from someone". The key finding is that higher rates of swearing in someone else's company, but not solitary swearing, were associated with an increase in depression symptoms and a drop in perceived social support. Moreover, statistical analysis suggested the effect of swearing on depression was mediated by the lost social support.

"This is one of the first studies to provide evidence of how swearing is implicated in the coping process," the researchers concluded. "It highlights a potential cost of swearing - that it can undermine psychological adjustment, possibly via repelling emotional support."

The study has its limitations, as the researchers acknowledged. For example, the methodology doesn't allow an alternative causal direction to be ruled out. Perhaps diminishing support or increasing depression provoked some of the women into swearing more. In that sense it was a shame the researchers weren't able to look for changes in rates of swearing. Another important limitation is the sample - perhaps swearing by middle-aged women has an adverse effect on their social support because of society norms, which dictate that women, especially of a certain age, shouldn't swear. The same study performed with young men may have produced a different result. "Swearing may even serve a bonding function among men, or younger people, and in different contexts," the researchers said.
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Robbins, M., Focella, E., Kasle, S., López, A., Weihs, K., and Mehl, M. (2011). Naturalistically observed swearing, emotional support, and depressive symptoms in women coping with illness. Health Psychology DOI: 10.1037/a0023431

This post was written by Christian Jarrett for the BPS Research Digest.

Good news and bad for a popular willpower-enhancing strategy

In rich countries, temptation is never far and many of us struggle to achieve our long-term aims of moderation, dedication and fidelity. An increasingly popular strategy for regaining control is to form so-called implementation intentions. Rather than having the vague goal to eat less or exercise more, you spell out when, where and how you will perform a given activity, and rehearse that thought regularly. For example, "when in the cafeteria at lunch I will buy orange juice rather than cola". A more specific variant is to form an 'if-then' plan, as in "if it is a Tuesday morning, then I will go for a run," and again, this is rehearsed mentally on a regular basis.

Past research has found these plans to be successful, helping people to live more healthily. There's even evidence that they are particularly beneficial to those who have had their willpower compromised by brain damage or by taxing laboratory tasks. Two new studies add to this literature, one of them cautionary, the other more hopeful.

Sue Churchill and Donna Jessop studied 323 students tasked with eating more fruit and vegetables. They found that implementation intentions helped students achieve this task over a 7-day period, but only if they scored low on a measure of "urgency", as revealed by their agreement or not with statements like "When I am upset, I often act without thinking." The researchers said this suggests implementation intentions may not be a panacea: "Ironically, people who possess poor self-regulatory skills insofar as they tend to act on impulse when distressed, who are arguably most in need of assistance in achieving their goals, may benefit least from behaviour change interventions based on implementation intention formation."

Why the contradiction with earlier research showing implementation intentions are most helpful to those with compromised willpower? Churchill and Jessop can't be sure, but they said one possibility could be because their task of eating more fruit and veg is more complex than some of the lab tasks studied previously.

That's the cautionary news. The good news comes from a study by Barbel Knauper and her colleagues who found that using mental imagery boosted the benefit of implementation intentions for students attempting to increase their fruit consumption over seven days. Rather than merely forming an if-then plan, such as "If I see orange juice at lunch, then I will buy it", they also imagined themselves performing this act, with as much sensory detail as possible. A promising result, and the researchers expressed their surprised that no-one had thought to investigate the combination of these two strategies before.

Here's a curious observation across both studies. Knauper's team failed to find the usual benefit of forming simple implementation intentions (without the addition of mental imagery) and her team said one possible explanation for this was the simplicity of their task of eating more fruit. Recall that Churchill and Jessop thought the same task (admittedly, also including vegetables) was relatively complicated compared with tasks used in earlier research. It just shows how much room there is for interpretation.

Both studies suffered from a reliance on retrospective self-report - the students told the researchers whether they'd managed to eat more fruit and veg or not over the preceding week. They also had short study durations - we need our newfound healthy habits to last longer than a week. But together the studies point to some interesting avenues for future research. Perhaps implementation intentions plus imagery will prove to be effective for people who have particularly weak willpower?
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S Churchill, and D Jessop (2011). Too impulsive for implementation intentions? Evidence that impulsivity moderates the effectiveness of an implementation intention intervention. Psychology and Health DOI: 10.1080/08870441003611536

B Knauper, A McCollam, A Rosen-Brown, J Lacaille, E Kelso, and M Roseman (2011). Fruitful plans: Adding targeted mental imagery to implementation intentions increases fruit consumption. Psychology and Health DOI: 10.1080/08870441003

This post was written by Christian Jarrett for the BPS Research Digest.

More serious brain injuries associated with more life satisfaction

Psychologists investigating the well-being of patients with an acquired brain injury (ABI) have documented a curious phenomenon, whereby the more serious a person's brain injury, the higher their self-reported life-satisfaction.

With the help of the charity Headway UK, Janelle Jones and her colleagues recruited 630 people (aged 9 to 81) with an acquired brain injury. Most had sustained their injuries from road accidents, with other causes including stroke and falls. Based on the time they'd spent in a coma, the majority of the participants' injuries were judged to be moderate to severe.

The participants answered a brief, 20-item questionnaire about their sense of identity (e.g. 'I think of myself as someone who has survived a brain injury'), their social support, relationship changes since their injury, and their life-satisfaction.

Having a strong sense of identity, seeing oneself as a survivor, having plenty of social support and improved relationships were all independently related to higher life satisfaction. These different factors also influenced each other. '...[I]t is likely that personal identity and social network support factors operate in a cyclical way,' the researchers said, 'whereby becoming personally stronger from effectively relying on social support also makes individuals more likely to continue to seek out social support and, in that way, to develop social capital.'

Perhaps the most curious finding was that participants who'd sustained more serious injuries tended to report being more satisfied with their lives. This association was mediated by the social and identity factors - that is, participants who'd sustained a more serious injury also tended to identify more strongly as a survivor, and to have more social support and improved relationships.

An obvious suggestion is that the more seriously injured participants might not have complete insight into their lives. Jones and her colleagues doubt this is the case, in part because of the logic of the results, with identity and social support mediating the higher life satisfaction among these participants.

'Sustaining a head injury does not always lead to a deterioration in one's quality of life,' the researchers concluded. '...[D]ata from this study serves to tell a coherent story about the way in which the quality of life of those who experience ABIs can be enhanced by the personal and social "identity work" that these injuries require them to perform. ... Nietzsche, then, was correct to observe that that which does not kill us can make us stronger.'
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Jones, J., Haslam, S., Jetten, J., Williams, W., Morris, R., and Saroyan, S. (2011). That which doesn't kill us can make us stronger (and more satisfied with life): The contribution of personal and social changes to well-being after acquired brain injury. Psychology and Health, 26 (3), 353-369 DOI: 10.1080/08870440903440699

Bribing kids to eat their greens really does work

Try bribing him with a sticker

Some experts have warned that bribing children to eat healthy foods can be counter-productive, undermining their intrinsic motivation and actually increasing disliking. Lucy Cooke and colleagues have found no evidence for this in their new large-scale investigation of the issue. They conclude that rewards could be an effective way for parents to improve their children's diet. '...rewarding children for tasting an initially disliked food produced sustained increases in acceptance, with no negative effects on liking,' they said.

Over four hundred four- to six-year-olds tasted six vegetables, rated them for taste and then ranked them in order of liking. Whichever was their fourth-ranked choice became their target vegetable. Twelve times over the next two weeks, most of these children were presented with a small sample of their target vegetable and encouraged to eat it. Some of them were encouraged with the reward of a sticker, others with the reward of verbal praise, while the remainder received no reward (a mere exposure condition). A minority of the children formed a control group and didn't go through an intervention of any kind.

After the two-week period, all the intervention children showed equal increases in their liking of their target vegetable compared with the control children. However, when given the chance to eat as much of it as they wanted (knowing there was no chance of reward), the kids who had previously earned stickers chose to eat more than the kids who'd just been repeatedly exposed to the vegetable without reward.

At one- and three-month follow-up, the intervention children's increased liking of their target vegetable was sustained regardless of the specific condition they'd been in. However, in terms of increased consumption (when given the opportunity to eat their target vegetable, knowing no reward would be forthcoming), only the sticker and verbal praise children showed sustained increases.

So, how come previous studies have claimed that bribery can undermine children's intrinsic motivation, actually leading to increases in disliking of foods? Cooke and her colleagues think this may be because past lab studies have often targeted foods that children already rather liked. Consistent with this explanation, it's notable that past community studies that reported the successful use of rewards targeted unpopular vegetables just as this study did.

An important detail of the current study is that verbal praise was almost as effective as tangible reward. 'Social reward might be particularly valuable in the home,' the researchers said, 'because it may help parents avoid being accused of unfairness in offering incentives to a fussy child but not to the child's siblings.'
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Cooke, L., Chambers, L., Anez, E., Croker, H., Boniface, D., Yeomans, M., and Wardle, J. (2011). Eating for Pleasure or Profit: The Effect of Incentives on Children's Enjoyment of Vegetables. Psychological Science DOI: 10.1177/0956797610394662

Can psychology help combat pseudoscience?

From homeopathy to dodgy nutritional supplements, support for pseudoscience and quackery thrives on people believing falsely that one thing causes another, when in fact it doesn't. Meanwhile, psychologists study belief formation, and specifically illusions of control (see earlier), whereby people wrongly believe that they're controlling something when they're not. In a new paper, three psychologists at Deusto University in Bilbao argue that the psychological literature can be mined for ways to help combat pseudoscience, and they've performed a small study to test the principle.

One of the psychological findings that Helena Matute and her colleagues focus on is that people are particularly likely to form an illusion of control when: (1) a desired outcome occurs frequently and (2) they, or someone else, perform some ineffectual action lots of times. In the context of health, this would be akin to having a condition from which recovery occurs frequently without intervention (e.g. back pain), whilst at the same time receiving a frequent, but ineffectual, treatment. This leads to the inevitable pairing of the desired outcome with the ineffectual intervention, thus giving rise to the false belief that the intervention is causing the positive outcome.

Matute's team tested this in a fictional scenario. One hundred and eight participants (recruited online) read about a fictional medicine 'Batarim' that could potentially cure the pain caused by a fictitious disease 'Lindsay Syndrome'. They were told about 100 patients, one at a time, in each case learning whether the patient had been given Batarim and whether their pain had subsided.

Crucially, half the participants heard about 80 patients who'd taken the drug and 20 who hadn't, whilst the other participants heard about 20 patients who'd taken the drug and 80 who hadn't. For both groups, the rates of recovery, at 80 per cent, were the same regardless of whether patients had taken Batarim or not - in other words, on this evidence, the drug doesn't make any difference to recovery rates.

Next, the participants were asked to rate the drug's effectiveness. All of them believed the drug had had some effect, thus showing how easily confused people are about issues of cause and effect. The key finding, however, is that those participants in the group who'd heard about just 20 patients who'd taken Batarim were far more accurate in their appraisals. Presumably this is because they'd had the opportunity to see that recovery often occurred without the drug, whereas participants in the other group were blinded by the more frequent pairing of drug with recovery (even though they too witnessed recovery occurring at just the same rate without the drug).

Matute and her colleagues said this suggests a simple way for pseudoscience claims to be challenged on TV and in news reports: '...simply showing participants the actual proportion of patients that felt better without following the target treatment helps them detect the absence of contingency for themselves. This should counteract the effect of all those miracle-products advertisements that focus their strategies on presenting confirmatory cases.'

Another finding from the psychological literature that Matute's team focused on relates to the wording used in questions about cause and effect. They predicted that people are more likely to endorse pseudoscientific beliefs when asked how effective a given treatment is, compared with when asked whether it caused the desired outcome. The latter should focus people's minds on the probabilities involved. That's exactly what was found in the current study - participants gave the fictional drug more realistic ratings when asked whether it had been 'the cause of the healings' compared with when asked how 'effective' it had been.

The main point of this study was to demonstrate, in principle, that findings in psychology can be exploited to help combat the ubiquity of pseudoscientific belief, and Matute's team feel they've done that. 'Our research proves that developing evidence-based educational programmes should be effective in helping people detect and reduce their own illusions,' they said.
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Matute, H., Yarritu, I., and Vadillo, M. (2010). Illusions of causality at the heart of pseudoscience. British Journal of Psychology DOI: 10.1348/000712610X532210

If-then plans help protect us from the 'to hell with it' effect

You're probably familiar with what could be called the 'to hell with it' effect. It's when (as demonstrated by lots of research) a bad mood causes us to take risky decisions or engage in risky behaviour. Like when you're feeling down and you drive home dangerously fast or go out and get drunk. Now a team led by Thomas Webb at the University of Sheffield says that we can protect ourselves from this effect by forming 'if-then' implementation decisions in advance. These are self-made plans which state that if a certain situation occurs, then I will respond in a pre-specified way.

A first study used a trick anagram task to put some students in a bad mood. They were told the task was easy and should only take them five minutes when in fact three of the anagrams were insoluble (pilot work had shown that this puts students in a grump). Other students were told the truth, so the task wasn't expected to put them in a bad mood. Next, all the students said how they would behave in three imaginary scenarios - whether to drive an old car with brake problems, whether to disclose a secret to a room-mate, and whether to return deliberately damaged shoes to a shop for a refund.

Would being provoked into a bad mood encourage riskier behaviour? It depended whether the students had formed if-then plans in advance. During the previous week, ostensibly as part of a separate study, the students had been asked to keep a mood diary and to try to stay in as positive a mood as possible. Half the students (the control group) followed the simple instruction 'I will try to stay in a positive mood', which they were asked to repeat to themselves three times during the week. The others followed the if-then plan: 'If I am in a negative mood, then I will ... breathe deeply / think only positive thoughts / think how I've dealt successfully with previous situations' (they could choose which ending to use). Again they had to repeat this three times during the week. The key finding was the being provoked into a bad mood by the impossible anagrams led the control students to make riskier decisions (the 'to hell with it effect' in action) but not the students who'd made the if-then implementation plans during the prior week. They seemed to have been inoculated.

This pattern of results was replicated in second study in the context of arousal and a gambling task. Like being in a bad mood, being more aroused is also associated with taking more risks. In this case, Bach's Brandenberg concerto no. 3 was used to increase greater arousal in half the participants (the others listened to Beethoven's moonlight sonata). The gambling task involved betting points on whether a token was hidden inside blue or red boxes on a computer screen. After the arousal induction but before the task, half the students formed the if-then plan 'If I am asked to make a bet, then I will pay close attention to the number of red versus blue boxes'. The control students were simply told to end the game with as many points as they could. Consonant with the first study, increased arousal led the control students to play more riskily, but not the students who'd formed a protective if-then plan.

'Taken together,' the researchers said, 'the findings of the two experiments suggest that people can strategically avoid the detrimental effect of unpleasant mood and arousal on risk taking by forming implementation intentions directed at controlling either the experience of mood or risky behaviour.'

How do if-then plans exert their protective effects? Webb and his colleagues can't be sure, but they think they help form strong links between specific circumstances (e.g. when in a bad mood) and responses (e.g. breathe deeply) thereby making those responses easier to enact. 'Future studies will need to confirm that these processes ... explain how implementation intentions shield behaviour from the deleterious effects of mood,' they said.
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Webb TL, Sheeran P, Totterdell P, Miles E, Mansell W, and Baker S (2010). Using implementation intentions to overcome the effect of mood on risky behaviour. The British journal of social psychology / the British Psychological Society PMID: 21050527

How to form a habit

This has nothing to do with nuns' clothing. Habits are those behaviours that have become automatic, triggered by a cue in the environment rather than by conscious will. Health psychologists are interested for obvious reasons - they want to assist people in breaking unhealthy habits, while helping them adopt healthy ones. Remarkably, although there are plenty of habit-formation theories, before now, no-one had actually studied habits systematically as they are formed.

Phillippa Lally and her team recruited 96 undergrads (mean age 27) and asked them to adopt a new health-related behaviour, to be repeated once a day for the next 84 days. The new behaviour had to be linked to a daily cue. Examples chosen by the participants included going for a 15 minute run before dinner; eating a piece of fruit with lunch; and doing 50 sit-ups after morning coffee. The participants also logged onto a website each day, to report whether they'd performed the behaviour on the previous day, and to fill out a self-report measure of the behaviour's automaticity. Example items included 'I do it automatically', 'I do it without thinking' and 'I'd find it hard not to do'.

Of the 82 participants who saw the study through to the end, the most common pattern of habit formation was for early repetitions of the chosen behaviour to produce the largest increases in its automaticity. Over time, further increases in automaticity dwindled until a plateau was reached beyond which extra repetitions made no difference to the automaticity achieved.

The average time to reach maximum automaticity was 66 days, although this varied greatly between participants from 18 days to a predicted 254 days (assuming the still rising rate of change in automaticity at the study end were to be continued beyond the study's 84 days). This is much longer than most previous estimates of the time taken to acquire a new habit - for example a 1988 book claimed a behaviour is habitual once it's been performed at least twice a month, at least ten times. In fact, even after 84 days, about half of the current study participants had failed to achieve a high enough automaticity score for their new behaviour to be considered a habit.

Unsurprisingly perhaps, more complex behaviours were found to take longer to become habits. Participants who'd chosen an exercise behaviour took about one and a half times as long to reach their automaticity plateau compared with the participants who adopted new eating or drinking behaviours.

What about the effect of having a day off from the behaviour? Writing in 1890, William James said that a behaviour must be repeated without omission for it to become a habit. The new results found that a single missed day had little impact on later automaticity gains, either early in the study or later on, suggesting James may have overestimated the effect of a missed repetition. However, there was some evidence that too many missed repeats of the behaviour, even if spread out over time, had a cumulative effect, reducing the maximum automaticity level that was ultimately reached.

It seems the message of this research for those seeking to establish a new habit is to repeat the behaviour every day if you can, but don't worry excessively if you miss a day or two. Also be prepared for the long haul - remember the average time to reach peak automaticity was 66 days.

This research has a serious shortcoming, acknowledged by the researchers, which is that it depended entirely on participants' ability to report the automaticity of their own behaviour. Also, the amount of data made it hard to form clear conclusions about the need for consistency in building a habit. However, the study provides an exciting new approach for exploring habit formation and future research could easily remedy these shortcomings.
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Lally, P., van Jaarsveld, C., Potts, H., and Wardle, J. (2010). How are habits formed: Modelling habit formation in the real world. European Journal of Social Psychology DOI: 10.1002/ejsp.674

Video protects girls from the negative effects of looking at ultra-thin models

'No wonder our perception of beauty is distorted' - that's the concluding catchphrase of a one-minute video called 'evolution' made by Dove a few years ago to show how cosmetics and computer trickery are used to create the unrealistic portrayals of female models on advertising billboards. Now a team of researchers at the University of the West of England, led by Emma Halliwell, have tested whether viewing this short video can buffer young girls against the negative effects of looking at images of ultra-thin female models. Past research found such a benefit when adult women viewed a similar video but this is the first time the idea has been investigated with young girls.

One hundred and twenty-seven girls, aged ten to thirteen, from two schools in the South of England, were recruited for what they thought was an evaluation of 'attitudes to health, appearance and magazines'. In keeping with the cover story, tests of body satisfaction and esteem were embedded among other questionnaires to try to conceal the true purpose of the study.

Consistent with past research, girls who looked at thin models subsequently reported lower body satisfaction and confidence compared with girls who looked at pictures of landscapes (in turn, prior research has linked lower body self-esteem with increased risk of developing an eating disorder). The key finding was that this negative effect was not seen among the girls who watched the Dove video first, before looking at the ultra-thin models. The body self-esteem and confidence of these girls was just the same as among girls who watched the video and then looked at pictures of landscapes.

'Theoretically, we assume that the intervention disrupted the upward social comparisons that many young girls make when viewing idealised media images,' the researchers concluded. 'Moreover, we propose that the comparison is avoided because the media models have been construed as artificial and, therefore, an inappropriate comparison target.' Halliwell and her team added that future research will be needed to test the truth of this reasoning and whether the benefits of watching the evolution video, or others like it, can be sustained over time.
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Halliwell E, Easun A, & Harcourt D (2010). Body dissatisfaction: Can a short media literacy message reduce negative media exposure effects amongst adolescent girls? British journal of health psychology PMID: 20687976

Link to Dove's Evolution video.

Say Cheese! Big smilers in photos are likely to live longer

Look at a person's photo and it's tempting to think you can see their personality written all over it: stony-faced individuals appear sombre; others flashing a big, toothy grin seem more genial. An intriguing new study claims that these smiles are a reliable marker of underlying positive emotion and as such are predictive of a person's longevity.

Ernest Abel and Michael Kruger had five people rate the smile intensity of 230 baseball players according to photos featured in the 1952 Baseball Register. The researchers used a three-point smile scale: no smile, half smile (mouth only), and genuine 'Duchenne' smile (muscles contracted around the mouth and corners of the eyes).

Focusing on the 150 players who'd died by the time of the study and controlling for extraneous factors such as BMI and marital status, the researchers found that those who were flashing a genuine 'Duchenne Smile' were half as likely to die in any given year compared with non-smilers. Indeed, the average life-span of the 63 deceased non-smilers was 72.9 years compared with 75 years for the 64 partial smilers and 79.9 years for the 23 Duchenne smilers.

A follow-up study was similar to the first but observers rated the attractiveness of the same players rather than their smile intensity. Unlike smile intensity, attractiveness bore no relation to longevity.

'To the extent that smile intensity reflects an underlying emotional disposition, the results of this study are congruent with those of other studies demonstrating that emotions have a positive relationship with mental health, physical health, and longevity,' the researchers said.
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Abel, E., & Kruger, M. (2010). Smile Intensity in Photographs Predicts Longevity. Psychological Science DOI: 10.1177/0956797610363775

The psychological barriers facing MMR promotion campaigns

A focus group study of parents' attitudes towards interventions promoting uptake of the MMR vaccine suggests it is better for health advice to be seen as independent from government.

The findings come after the General Medical Council ruled yesterday that Andrew Wakefield, the doctor who first suggested a link between the MMR vaccine and autism, was guilty of serious professional misconduct.

The MMR vaccine protects children against measles, mumps and rubella. Unfortunately the number of UK parents vaccinating their children plummeted in the wake of Wakefield's 1998 Lancet study, since discredited and un-replicated, which purported to show a link between the MMR vaccine and autism. Today vaccination rates remain at around 85 per cent, compared with the desired rate of 90 to 95 per cent required for herd immunity (whereby even the unvaccinated are safe).

For the new study, Benjamin Gardner and colleagues analysed five focus group interviews they held with 28 parents in London. The parents were asked for their responses to three 'motivation-based' interventions (a website; an information pack; and parent-led group discussions) and three 'organisational interventions' (health care workers acting as immunisation champions; mobile vaccination units; legislation to penalise non-compliers).

Five key themes emerged. Parents felt they didn't have enough information, especially in relation to the dangers associated with not vaccinating. Government sources were not trusted. By contrast, other parents were trusted: 'Parents trust advice from other parents,' one mother said. '[You] take it on board. You listen to them.' Parents also revealed they were biased towards risk-related information. And they misunderstood balance, believing that pro- and anti-MMR arguments should be given equal weight even though the scientific evidence overwhelming favours MMR vaccination.

Gardner's team said a number of practical implications emerged from their findings. In particular, promotional MMR campaigns are likely to be better received if they appear to be independent of government and if they are fronted by parents. More information is needed about the risks of non-vaccination. And care should be taken when highlighting the small risks associated with vaccination - parents are likely to zoom in on these.

The researchers acknowledged their study has some limitations, most notably that the majority of the parents involved had actually vaccinated their children. Nonetheless, they said their results 'highlight important psychological barriers and facilitators that may determine whether MMR promotion interventions are effective.'
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Gardner B, Davies A, McAteer J, & Michie S (2010). Beliefs underlying UK parents' views towards MMR promotion interventions: a qualitative study. Psychology, health & medicine, 15 (2), 220-30 PMID: 20391239

Also on the Digest: How to promote the MMR vaccine.

Scary health messages can backfire

A short while ago there was a shocking advert on British TV that used slow motion to illustrate the bloody, crunching effects of a car crash. The driver had been drinking. Using these kind of scare tactics for anti drink-driving and other health issues makes intuitive sense. The campaigners want to grab your attention and demonstrate the seriousness of the consequences if their message is not heeded. However, a new study makes the surprising finding that for a portion of the population, scare tactics can back-fire, actually undermining a message's efficacy.

Steffen Nestler and Boris Egloff had 297 participants, 229 of them female, average age 35, read one of two versions of a fictional news report from a professional medical journal. The report referred to a study showing links between caffeine consumption and a fictional gastro-intestinal disease 'Xyelinenteritis'. One version was extra-scary, highlighting a link between Xyelinenteritis and cancer and saying that the participant's age group was particularly vulnerable. The other version was lower-key and lacked these two details. Both versions of the article concluded by recommending that readers reduce their caffeine consumption.

Before gauging the participants' reaction to the article and its advice, the researchers tested them on a measure of 'cognitive avoidance'. People who score highly on this personality dimension respond to threats with avoidance tactics such as distracting themselves, denying the threat or persuading themselves that they aren't vulnerable.

The key finding is that participants who scored high on cognitive avoidance actually rated the threat from Xyelinenteritis as less severe after reading the scary version of the report compared with the low-key version. Moreover, after reading the scary version, they were less impressed by the advice to reduce caffeine consumption and less likely to say that they planned to reduce their caffeine intake.

On the other hand, highly cognitive avoidant participants were more responsive to the low-key report than were the low cognitive avoidant participants. In other words, for people who are cognitively avoidant, scary health messages can actually back-fire.

'Practically, our results suggest that instead of giving all individuals the same threat communications, messages should be given that are concordant with their individual characteristics,' Nestler and Egloff said. 'Thus, the present findings are in line with the growing literature on tailoring intentions to individual characteristics, and they highlight the role of individual differences when scary messages are used.'
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Nestler, S., & Egloff, B. (2010). When scary messages backfire: Influence of dispositional cognitive avoidance on the effectiveness of threat communications Journal of Research in Personality, 44 (1), 137-141 DOI: 10.1016/j.jrp.2009.10.007

Also on the Digest:
-Morbid warnings on cigarette packs could encourage some people to smoke.
-How to promote the MMR Vaccine.
-Public health leaflets ignore findings from health psychology.

Video-game exercise bikes - not just a gimmick

Exercise is going techno. People are playing Wii fit sports games in their homes and gyms are full of ever more interactive exercise machines. But is this trend anything more than gimmickry? Yes, according to a new study by Ryan Rhodes at the Behavioural Medicine Lab at the University of Victoria, and his colleagues.

Rhodes' team had 29 previously inactive young men embark on an exercise regime, involving three half-hour cycling sessions a week for six weeks. Crucially, half the men trained on GameBikes wired up to a Playstation, such that their peddling speed and steering interacted with in-game events. The remaining participants trained on standard low-tech exercise bikes, although they were allowed to enjoy their own choice of music over an ipod. Exercise intensity was equalised across the two groups.

The bottom-line: the men who trained on the GameBikes were more likely to stick to the exercise regime. They attended an average of 77 per cent of the sessions compared with 42 per cent of participants in the low-tech control condition.

Rhodes' team also took some psychological measures in line with the well-established theory of planned of behaviour. Only 'affective attitudes' were found to differ between the two exercise groups. That is, men in the GameBike condition expected the exercise regime to be more enjoyable, pleasant and exciting than control participants, partly explaining their greater adherence. Attitudes in both groups had declined by the end of the six-week period, but they remained more positive in the GameBike group than the controls.

The researchers said more research was needed with other participant groups (the men in the current study all had personal experience of video games), over a longer duration, and with different control conditions - for example, how does video-game based exercise compare with low tech outdoors exercise?

'In summary, exercise videogaming appears to have potential efficacy as a physical activity intervention,' the researchers concluded.
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Rhodes, R., Warburton, D., & Bredin, S. (2009). Predicting the effect of interactive video bikes on exercise adherence: An efficacy trial Psychology, Health & Medicine, 14 (6), 631-640 DOI: 10.1080/13548500903281088

Morbid warnings on cigarette packs could encourage some people to smoke

Every now and again a finding comes along that provides perfect ammunition for psychologists confronted by the tiresome claim that psychology is all 'common sense'. Researchers have found that death-related health warnings on cigarette packs are likely to encourage some people to smoke. The surprising result is actually consistent with 'Terror-management Theory', according to which thoughts of mortality cause us to cling more strongly to our cultural beliefs and to pursue ego-boosting activities.

Jochim Hansen and colleagues first measured how important smoking was to the self-esteem of 39 student smokers. Example questionnaire items included 'smoking allows me to feel valued by others'. Next, the smokers were divided into two groups: one group looked at two cigarette packs that featured death-related warnings, such as 'Smokers die earlier'. The other group looked at cigarette packs that featured death-neutral warnings, such as 'Smoking makes you unattractive.'

Fifteen minutes later all the students reported their attitudes to smoking; the questionnaire included items such as 'Do you intend to quit smoking?'. Among the students for whom smoking was important to their self-esteem, those who looked at packets with death-related warnings subsequently reported more positive attitudes to smoking compared with those who looked at death-neutral packets. The exact opposite pattern was found for students for whom smoking was not important for their self-esteem.

In other words, for smokers who derive a self-esteem boost from smoking - perhaps they see it as a key part of their identity or they think it makes them look cool - a death-related cigarette packet warning can have the ironic effect of making them want to smoke more, so as to buffer themselves against the depressing reminder of their own mortality. The findings suggest that for these kinds of smokers, packet warnings that target positive beliefs about smoking (e.g. 'Smoking makes you look unattractive') could well be more effective.

'To succeed with anti-smoking messages on cigarette packs one thus has to take into account that considering death may make some people smoke,' the researchers concluded.
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Hansen, J., Winzeler, S., & Topolinski, S. (2010). When the death makes you smoke: A terror management perspective on the effectiveness of cigarette on-pack warnings. Journal of Experimental Social Psychology, 46 (1), 226-228 DOI: 10.1016/j.jesp.2009.09.007

Hospital staff make better decisions using textual information rather than medical charts

Whether from first-hand experience or from TV and film, we've probably all seen those medical charts that hang at the bottom of hospital beds. A new study makes the surprising claim that it might be better if these graphical charts were replaced or complemented with short passages of text conveying the same information. Marian Van Der Meulen and colleagues say that graphs are prone to misinterpretation by inexperienced, distracted staff and text leads to more accurate courses of action. Of course translation of medical charts into text-based summaries is labour intensive to an impractical degree, as the researchers freely acknowledge. But they say new software that can automatically translate data into text-based summaries could potentially solve this problem.

Van Der Meulen's team presented 35 nurses and doctors from the neonatal intensive care unit (ICU) at the Royal Infirmary of Edinburgh with real data from 24 infant patients. The participants' task was to scrutinise the data and decide on what the next course of action should be. The data, which provided information on factors like blood pressure and temperature, as well as previous actions taken by staff, was either presented via time series graphs, in the conventional manner; as text-based summaries translated from the graphs by medical experts; or as computer-generated text. It's important to note that both forms of text summary provided no clinical interpretation, they merely summarised the salient information in the graphical data.

Remarkably, the participating nurses and doctors chose significantly more appropriate courses of action after looking at the textual summaries written by an expert as compared with looking at the standard time-series graphs. Decisions made after looking at the computer-generated text were poorer than decisions taken after the human-generated text but were just as accurate as decisions made from the graphs.

'Overall, these results confirm that in a neonatal ICU, human generated descriptions of time series physiological measures are better able to support medical decision-making than graphs with trend lines,' the researchers said.

These findings will only have relevance to real-life hospital settings if a way can be found to make the computer-generated text as effective as the text written by a human expert. The researchers are confident that this can be achieved. A research paper they have in press has compared the two types of text to look for differences that could help improve the BT-45 software that was used in this study. Such differences include the human text having a more coherent grammatical structure and narrative and a tendency to group physiological measures together.

'...[F]urther development of this technology is likely to be extremely fruitful in supporting complex real-world cognition,' the researchers concluded.
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van der Meulen, M., Logie, R., Freer, Y., Sykes, C., McIntosh, N., & Hunter, J. (2010). When a graph is poorer than 100 words: A comparison of computerised natural language generation, human generated descriptions and graphical displays in neonatal intensive care. Applied Cognitive Psychology, 24 (1), 77-89 DOI: 10.1002/acp.1545