Investigation into the relationship between Dark Triad personality traits, Empathy Quotient and the General Susceptibility to Health-Related Misinformation Online.

DISCLAIMER: This paper has not been peer-reviewed by any publication, but only confirmed as valid as part of a university project by my former Open University tutor.

ABSTRACT Increasingly, people are more reliant on social media as the source of their news from platforms such as Facebook and Twitter. But these companies have not yet adequately addressed the lack of moderation of the quality of the news that is shared on them. This lack of action has led to the spread of misinformation at a scale and reach that was not previously possible with traditional media. In particular health-related misinformation can spread unchecked on these platforms and users are left with the responsibility to assess their veracity on their own. It is of particular interest, therefore, to investigate what are the variables that make one susceptible to health-related misinformation online, such as personality traits. To investigate if Dark Triad traits and Empathy Quotient can be predictors of General Susceptibility to Health-Related Misinformation Online (GenSHRMO), I conducted an electronic survey (n=122) where participants have been asked to complete a battery of questionnaires. Responses have been measured with both a 5-points Likert scale for the first 2 personality questionnaires and a 4-points Likert scale for measuring GenSHRMO. The data collected has then been entered into IBM SPSS for multiple regression (1-tailed) and correlation (2-tailed) analysis so that to determine the strength of the relationships between these variables and assess their validity as predictors. The results of this research show that only a weak relationship was observed between Psychopathy and GenSHRMO in the multiple regression analysis, but it was not present in the correlation analysis. No further statistically significant relationship between the other measured personality traits and the values of GenSHRMO was found. Findings, other significant correlations, and conclusions are discussed and explored in more detail in the Discussion section.

  1. Introduction

The widespread adoption of smartphones in the last 10 years coincided with the rise in popularity of social media platforms like Facebook and Twitter all around the world (Ortiz-Ospina, 2019). These platforms, in turn, have become crucial tools for journalists on which to spread and promote their work (Newman, 2011). At the same time, people increasingly are getting their news from these platforms rather than traditional media outlets and hardly pay attention to their source (Sumida, et al., 2019). As the business model of social media platforms is based on user engagement so that to increase exposure to advertisements, they have been reticent historically to moderate the content that is being shared on their platform. The cost of entry that is responsible for the rise in their popularity also leaves the door open to the opportunity of misuse by bad actors and access to less than reputable sources of news. Consequently, social media platforms have been the main medium by which so-called “fake news” have been able to proliferate and spread widely online (Ortutay, 2016). For example, it has been reported recently that Facebook is still, as of the time of this publication, actively profiting from the engagement generated from pages and groups spreading health-related misinformation on vaccines (Graham-Harrison, et al., 2021).

As the responsibility to discern legitimate news from falsehood has been placed on its users, it is of particular interest for Psychology research to investigate what variables would make one susceptible to misinformation online, and which personality traits can be considered as predictors. For the scope of this research, the focus is on health-related misinformation specifically, as its spreading has far-reaching financial and social consequences (McKenna, 2019). Understanding the degree to which personality traits play a role in this could potentially help the development of tools and measures to combat the spread of misinformation on health-related topics.

The role of personality and motivation has been previously investigated, and it was found that the content of the message being shared holds less value than the action and outcome of the act of sharing (Chen, 2012). The author of the research noted that open-mindedness is positively related to susceptibility to misinformation and that “users that are aware of the falseness of misinformation, may still share it”. Chen suggests that this behaviour might be explained by it being motivated by seeking status and recognition within the person’s in-group. He also states that “the action of sharing, rather than the perceived accuracy and characteristics of the information being shared, is what matters most”. The author did not, however, seek to expand in his research on the possibility that Dark Triad personality traits (such as, for example, Narcissism) may play a role in the motivation for intentionally sharing misinformation on social media.

Motivation and personality types do not, however, account for the possibility that other factors may be at play such as the bandwagon effect, trust in the content and its source, fear of missing out and social media fatigue, where people find themselves lacking mental bandwidth to assess the veracity of what is being shared (Talwar, et al., 2019). Indeed, a more nuanced look at the motivation for sharing misinformation that does not require the invocation of personality type as justification has been proposed to explore this. Nonetheless, the role of personality traits cannot be discarded altogether as a personality is linked to motivational patterns of behaviour (Hansel & Visser, 2020). Since high trust in the content is linked to no hesitation from people sharing information that has not been verified, it leaves open the question as to which type of personality is more likely to be sufficiently open-minded to believe in certain kinds of misinformation as well as more prone to taking risks in sharing it and disregard the impact that sharing something that may be false may have on those exposed. After all, people are generally more likely to believe and share information that is consistent with pre-existing beliefs or worldview for both self-validation and confirmation (Lewandowsky, et al., 2012).

Dark Triad personality traits have indeed been found to be positively correlated to the susceptibility to health-related conspiracy theory in recent survey research (Malesza, 2020). The survey’s findings indicate a link between manipulative behaviour and hypersensitivity to being manipulated. These factors are then linked to higher susceptibility to a counter-narrative and consequently to the spread of misinformation to justify and reinforce the pre-existing belief, particularly in participants that scored high in Narcissism. Yet, another research’s finding suggests that highly empathetic individuals might place more importance on, or be more affected by, irrelevant information and thus, be more susceptible to misinformation just as well (Tomes & Katz, 1997). Moreover, findings from other research do suggest that narcissist personalities can take other people’s perspectives into consideration reflecting a potential for intervention (Hepper, et al., 2014). It is thus unclear which of these personality traits may be the most valid in predicting susceptibility to health-related misinformation online.

Based on the findings of previous research, it is possible to conclude that narcissistic personalities who are also susceptible to health-related misinformation online would manifest the following behaviour online: guided by an inflated sense of self and righteousness they would engage in the sharing of health-related misinformation masqueraded as an altruistic gesture that hides the seeking of social status and validation of existing beliefs. It is also possible that such behaviour is unlikely to be guided by malicious intent as people who genuinely hold beliefs that are based on health-related misinformation feel it is their duty to inform others, as it reinforces and validates their own belief. Similarly, people who show high empathy would also be more likely to spread health-related misinformation sharing the same beliefs and justification, and ultimately to the same end. Machiavellian personalities, on the other hand, would engage in similar behaviour knowingly ignoring the veracity of what is being shared for the self-serving purpose of status-seeking and validation, but still, perhaps see themselves as empathetic personalities.  

Thus, the primary goal of this research has been to identify to what extent Dark Triad personality traits would predict participants’ susceptibility to health-related misinformation, alongside how they viewed themselves in relation to others, hence the Empathy Quotient questionnaire. The hypothesis this research is trying to prove is to assess if participants who show susceptibility to health-related misinformation online score highly in Dark Triad traits, in particular, that of Narcissism and Machiavellianism, and will also score highly in the Empathy Quotient test.

  • Methodology

2.1 Sample

There are currently 53 million active social media users in the UK (Tankovska, 2021). To expect a 95% confidence level that the data collected would accurately reflect the general population, with a margin of error of 10%, the recommended sample size is 97 participants (Qualtrics, 2021).  In total, 131 respondents provided consent to participate. However, only 122 fully completed the survey (completion rate: 93.02%). With 122 participants, the margin of error is close to 9%. Participants for this study were recruited primarily via the Open University EPW portal (99 participants, 75.57%), with others from social media platforms such as LinkedIn, Twitter, and Reddit (32 participants, 24.43%). The criteria for participation required participants to be at least 18 years old with no upper age limit; no other restriction prevented participation and participants were assumed to have been exposed to degrees of health-related news on social media platforms.

The majority of participants have identified as female (71.54%). The age of participants ranged from 18 to 63 years old with the majority (30.77%) falling in the 35 to 44 age group. No other demographic data from participants was collected other than gender and age. Participation in the survey was voluntary and the research proposal, alongside ethical considerations, was approved by the Open University D300 tutor.

2.2 Materials and Procedure

The core of the survey is composed of 2 personality questionnaires and 1 questionnaire to measure degrees of general susceptibility to, and the likelihood of spreading, health-related misinformation online.

2.2.1 Survey Administration

All three questionnaires were administered through the online platform Qualtrics (https://qualtrics.com). The survey was designed to be accessible from all known browsers for both mobile and desktop platforms. The survey consisted of a welcome page where participants were briefed on the nature of the project and the research’s goal, as well as provided with all the necessary information needed in order to give an informed consent. Participants were not allowed to proceed with the survey unless consent was confirmed. Participants were then asked for demographic identifiers of age and gender. This was followed by the battery of questionnaires, each on a dedicated page (3 pages in total), comprised of a total of 58 self-reporting items, concluding with a thank you note and a short debrief. The survey took approximately 15 minutes to complete. Participants were permitted to complete the survey without completing all items; they were also permitted to complete the survey up to a week from starting it. All the data for this research was collected over the entire month of March 2021 only.

2.2.2 Questionnaires and Scales

The first personality questionnaire is the “Short Dark Triad” by Paulhus and Jones (2013). It consists of 27 questions divided into 3 groups to measure traits of Machiavellianism, Narcissism, and Psychopathy. Participants are asked about their level of agreement on a 5-point Likert scale (1 = “Strongly Disagree”, 5 = “Strongly Agree”). The scoring of this questionnaire and its procedure have been kept as published at the source. This particular questionnaire was chosen for its concise length and because, according to its authors, “it provides efficient, reliable, and valid measures of the Dark Triad of personalities”. The internal consistency of this scale in the current sample was very good (Cronbach’s alpha = 0.733).

The second personality questionnaire is “The Toronto Empathy Questionnaire” by Sprend et al. (2009). It consists of 16 statements and participants are asked to state the frequency of occurrence for each on a 4-point Likert scale (1 = “Never”, 4 = “Always”). The scoring of this questionnaire has been kept as documented at the source. It aims to measure the Empathy Quotient of participants, and it was chosen for both its length and deemed validity as an instrument for assessing empathy. The internal consistency of this scale was low in the current sample but still valid (Cronbach’s alpha = 0.279).

The third questionnaire was designed specifically for the purpose of this research to measure the degree of susceptibility to health-related misinformation on social media and to assess the behaviour around sharing it. It consists of 15 statements where participants are asked about their level of agreement on a 4-point Likert scale (1 = Strongly Agree”, 4 = “Strongly Disagree”). In particular, statements were designed to measure degrees of critical thinking on beliefs around health, trust in mainstream media messaging about health, trust in the opinion of medical professionals, and trust in the source of information on social media platforms. Examples of items are as follows: “I hold views and beliefs about my health that are ignored by the mainstream media”, “I trust my GP with concerns I have about views and beliefs about my health”, “I always check on the source of the articles I share that support my views and beliefs about my health”, “I do my own research to be informed about my health by reading on blogs of famous people I agree with” (see Appendix A for a full list of statements and scoring). Please note that other questionnaires may be better designed to measure this particular variable, but at the time of research design, none was found that was adequate. The internal consistency for this scale was good (Cronbach’s alpha = 0.643).

2.3 Data Analysis Strategy

As out of the 131 respondents only 122 completed the survey fully, the data from the 9 participants who did not fully complete it were removed from the dataset. The data file was further cleaned from not relevant information columns such as the time of completion and the date of administration.

All answers provided were measured on a Likert scale. For the “Short Dark Triad” and “The Toronto Empathy Questionnaire” personality tests, the value for each answer was kept identical to the source. As to the questionnaire on “susceptibility to, and sharing of, health-related misinformation online”, values were attributed to each statement’s likelihood of matching what is being measured (see Appendix A for details).

The values of the Dark Triad personalities have been grouped into each of the measured traits: Machiavellianism, Narcissism, and Psychopathy. Furthermore, the sum of each personality value has also been grouped as a variable and named “Sum of Dark Triad Traits”. Each Dark Triad trait is considered as an independent variable for the purpose of this research’s data analysis, in addition to the value of the Empathy Quotient. The Sum of Dark Triad Traits variable has only been measured alongside the Empathy Quotient variable. Although the questionnaire on susceptibility to, and sharing of, health-related misinformation contains statements to measure each of its two components, the sum of all values has been summarised to the variable “General Susceptibility to Health-Related Misinformation Online” (GenSHRMO). This value is considered the dependent variable in this research’s statistical analysis.

Analysis of the 6 assumptions needed to proceed with multiple regression was carried out. Two instances of multiple regression analysis (one-tailed test) were carried out: first, to investigate the strength of the relationship between each of the individual Dark Triad traits (Narcissism, Machiavellianism, and Psychopathy), the Empathy Quotient scores and GenSHRMO, and secondly to investigate the strength of the relationship between the total sum of the Dark Triad Traits score, the Empathy Quotient scores and the same GenSHRMO.

Two instances of two-tailed correlation analysis were also carried out so that to provide a complete overview of the strength of relationships between the aforementioned variables and to assure no bias in the data analysis. Furthermore, the distribution of the means responses and related standard deviation values were measured to provide an overview of the participants’ average responses. All statistical analyses were conducted in IBM SPSS V25. Some calculations of averages have been carried out with Microsoft Excel.

2.4 Data validity

To assess whether the dataset collected is valid, 6 assumptions have been tested and confirmed to be met for multiple regression analysis. The scatterplots for linearity between IV and DV for all variables show homoscedasticity as variance along the line of best fit remains similar throughout; on the assumption of multicollinearity, the correlation table for the Pearson’s Correlation values for each IV does not exceed 0.8; the values of Durbin-Watson for each of the 2 models are of 1.88 and 1.89 respectively satisfying the assumption that the values of the residual are independent; the assumption that the variance of the residual is constant has also been met as the scatterplots of both models show equal homoscedasticity; the P-P plots of each model show that the majority of dots do lie close to the diagonal line thus satisfying the assumption that the values of the residuals are normally distributed; lastly, the assumption that no influential cases are biasing the model has also been met as there are no values that are above 1 in the column for Cook’s Distance statistics produced by SPSS onto the data file.

  • Results

3.1 Participants and means with standard deviation distribution

            The total number of participants that provided consent to proceed with the survey questionnaire was 131. Of these, only 122 completed it to 100% (completion rate: 93.02%).

On average, participants scored low on Dark Triad traits and Empathy Quotient but high on GenSHRMO. Here below are the details of each mean and corresponding standard deviation measure.

Figure 1

The mean score for the Dark Triad trait of Machiavellianism is 26.01 (N122, SD 6.29, max score 45. See Figure 1).

Figure 2

The mean score for the Dark Triad trait of Narcissism is 25.20 (N122, SD 3.51, max score 45. See Figure 2).

Figure 3

The mean score for the Dark Triad trait of Psychopathy is 19.04 (N122, SD 3.53, max score 45. See Figure 3).

Figure 4

            The mean score for the Empathy Quotient is 47.65 (N122, SD 3.99, max score 80. See Figure 4).

Figure 5

The mean score for the Sum of the Dark Triad Trait is 70.25 (N122, SD 10.13, max score 135. See Figure 5).

Figure 6

The mean score for the measure of GenSHRMO is 42.53 (N122, SD 5.2, max score 60. See Figure 6).

3.2 Continuous predictors

            Summary of one-tailed and two-tailed Pearson’s correlation coefficient between the sum of the score for GenSHRMO, the Dark Triad personality traits and Empathy Quotient as continuous predictors are provided in Table 1. As shown in the table, there is only 1 statistically significant relationship between the Dark Triad trait of Psychopathy and GenSHRMO (p-value < .05) on the 1-tail test, possibly indicating a negative correlation between the two values. In the two-tailed test, however, the same correlation does not appear (p = .096). There are other statistically significant relationships between personality traits on both 1-tail and 2-tail tests, such as between Narcissism and EQ (p-value < .01) as well as Machiavellianism and EQ (p-value < .01).

            Pearson’s correlation coefficient between the sum of the score for GenSHRMO, Sum of Dark Triad Traits and Empathy Quotient as continuous predictors are provided in Table 2. As the table shows, there is no statistically significant relationship between neither the Sum of Dark Triad Traits nor the Empathy Quotient and the score of GenSHRMO. The only statistically significant relationship that exists is between the Sum of Dark Triad Traits and the Empathy Quotient (p-value < .01) in both 1-tail and 2-tail tests.

3.3 Multiple regression analysis

Two instances of multiple regression analysis were carried out. First, to investigate if the Dark Triad traits of Narcissism, Machiavellianism and Psychopathy, and the Empathy Quotient scores could be valid predictors of scores of “susceptibility to, and sharing of, health-related misinformation online”. The result of the first regression analysis indicates that the model explains 28% of the variance and that it is not a significant predictor of participants’ susceptibility to and sharing of health-related misinformation online, F(4,117) = 0.854, p = 0.494. None of the measured personality traits contributed significantly to the model (Machiavellianism B = 0.42, p = 0.623;Narcissism B = 0.040, p = 0.788; Psychopathy B = -0.256, p = 0.089; Empathy Quotient B = -0.086, p = 0.499).

The second instance was to investigate if the Sum of Dark Triad Traits and the Empathy Quotient scores could be valid predictors of scores of “susceptibility to, and sharing of, health-related misinformation online” as well. The result of the second regression analysis indicates that the model explains only 8% of the variance and that it too is not a significant predictor of participants’ susceptibility to, and sharing of, health-related misinformation online, F(2,119) = 0.460, p = 0.632. Equally, neither the score of the Sum of Dark Triad Traits nor the Empathy Quotient contributed significantly to the model (Sum of Dark Triad Traits B = -0.33, p = 0.496; Empathy Quotient B = -0.56, p = 0.655).

4. Discussion

The average participant of this survey scored slightly above 50% of the scores for both Dark Triad traits of Machiavellianism (65%) and Narcissism (63%) whilst scoring just below 50% on the score of Psychopathy (47.5%). On Empathy Quotient, the average participant scored 58.31% of the total score, whilst on GenSHRMO – 75.88% of the total score.        

In the 1-tail multiple regression analysis carried out to investigate the strength of the relationships between the individual Dark Triad traits of Machiavellianism, Narcissism, Psychopathy, and Empathy Quotient against participant’s susceptibility to, and the likelihood of sharing, health-related misinformation online, the result indicated that the only marginally significant trait that could be a valid predictor is that of Psychopathy with a p-value of .048. However, on the 2-tail correlation analysis test, this statistically significant relationship is no longer present (p= .096). This conflicting result would suggest that although a relationship is present, it is not sufficiently strong to meet the criteria for being statistically valid to be used as a predictor for participants’ susceptibility to health-related misinformation online. Similarly, both the 1-tail and 2-tailed correlation analysis tests carried out to investigate the strength of the relationships between the Sum of Dark Triad Traits, Empathy Quotient and participant’s susceptibility to health-related misinformation online have shown that neither personality traits are valid predictors. With regard to the goal of this research, therefore, the hypothesis that people who scored high in Narcissism, Machiavellianism, and Empathy Quotient would also be more likely to be susceptible to, and be spreading, health-related misinformation is not validated by the survey’s results.

Of note, however, is that data on both 1-tailed and 2-tailed multiple regression and correlation analysis show that there is indeed a statistically significant relationship between the Dark Triad trait of Narcissism and Empathy Quotient with a p-value of .00 for both, and that of Machiavellianism and Empathy Quotient with a p-value of .006 in the 1-tailed and .011 in the 2-tailed test. Similarly, both 1-tail and 2-tailed multiple regression and correlation analysis show a statistically significant relationship between the Sum of Dark Triad Traits and Empathy Quotient with a p-value of .001 for both tests. The Pearson’s Correlation values do indicate it is a negative correlation in both cases, where the higher score of Narcissism and Machiavellianism would be related to lower scores of Empathy Quotient. Interestingly, the results indicate no statistically significant relationship between the trait of Psychopathy and Empathy Quotient in neither 1-tail nor 2-tailed test.

The rationale that guided this research was based on the assumption that participants would respond more truthfully to the Dark Triad personality test and provide more embellished versions of themselves in the Empathy quotient test. The expectation was that the scores of Narcissism and Machiavellianism would positively correlate to the Empathy Quotient and consequently also positively correlated to the scores of GenSHRMO. The hypothesis was that someone with an inflated sense of self, who also has low considerations of and for others, would nonetheless portray themselves as being someone who cares about others. This factor, related to a hypersensitivity to manipulation, higher susceptibility to a counter-narrative consequently leading to the spread of misinformation to justify and reinforce the pre-existing belief, provided the foundation for the research question. The results of this research, however, do not support this model.

There are a few considerations to make that could explain why the result does not support the proposed hypothesis. Firstly, it is the nature of self-reporting of surveys: as participants were aware that the first personality questionnaire pertained to Dark Triad personality traits, there is a possibility that the better-than-average effect may have influenced participants responses. Even though responses are fully anonymous, people could potentially seek to reinforce their self-image in a positive light. Research has shown that people who compare themselves with an average peer would consistently evaluate themselves more favourably than them (Alicke, et al., 1995). Some of the statements in the Short Dark Triad Test may indeed focus the attention of participants on less favourable traits such as the following: “You should wait for the right time to get back at people”, “I know that I am special because everyone keeps telling me so”, “I insist on getting the respect I deserve”, “Payback needs to be quick and nasty”, and “I like to pick on losers”. Thus, it is possible that consequently, participants would rather portray a more likeable version of themselves to themselves and therefore not be able to truthfully assess their level of agreement to such statements. It must be noted, however, that the average score of Empathy Quotient is 58.31%, which does contradict such hypothesis, as for it to be true the average score should have been perhaps higher.

 Secondly, the pool of voluntary participants could have had an unexpected impact on the data collected. As the majority of respondents were recruited from the Open University portal that is only available to its students (n99, 75.57%), it is possible that such a pool of participants may not necessarily adequately represent the segment of the population that would likely fit the criteria of the proposed hypothesis and the general population of social media users at large.

It must be noted, however, that the average score for general susceptibility to, and sharing of, health-related misinformation online is quite high (75.88%), which is a surprising result considering the composition of the majority of participants. As most students that had access to the EPW portal would have been engaged in their own scientific research, a certain degree of critical thinking skills that ought to lead to a lesser susceptibility to misinformation online, specifically health-related, was expected. Of statements that scored surprisingly high, of note are the “Homeopathic Doctors are better informed than Medical Doctors” with a total of 108 participants (88.52%) scoring an average of 3.5, and the “Famous people are better at informing me about my health than scientists” with 106 participants (86.82%) scoring an average of 3.7. This does suggest that the majority of participants do indeed display a degree of susceptibility to health-related misinformation in general. It is possible, however, that the questionnaire used to measure GenSHRMO may not have been sufficiently adequate to measure what it was meant to. Some of the statements may be a reflection of my own beliefs and prejudices about what would make one susceptible to health-related misinformation.

The results of this survey do, nonetheless, challenge the 1997 findings by Tomes & Katz that highly empathetic individuals would be more susceptible to misinformation, as the high score for GenSHRMO did not correlate with a high score of Empathy Quotient. Furthermore, as the previous research conducted by Malesza in 2020 has suggested, a stronger relationship between Dark Triad traits and GenSHRMO should have been present in light of her findings that linked manipulative behaviour to hypersensitivity to being manipulated. Only the data of the 1-tailed test shows a weak link in the relationship between Psychopathy and GenSHRMO, which would give merit to the previous research’s findings. As previously mentioned, however, that statistical significance is not present in the 2-tailed test.

The results of the data collected do show a strong statistically significant relationship between individual Dark Triad traits and Empathy Quotient, as well as the Sum of Dark Triad Traits and EQ, which suggests that the overall results are a fair representation of the participants’ personalities rather than the outcome of subconscious manipulation from their part. Indeed, the Pearson’s coefficient table shows a negative correlation between the variables, as it would be expected by participants answering truthfully. This research, therefore, supports the notion proposed in Talwar et al.’s paper that a more nuanced look, which does not require the invocation of personality type as justification, is required to investigate what makes people susceptible to health-related misinformation in the first place.

Future research into this matter could benefit from a more ample pool of participants, not composed of mainly university students, that is more adequately representing the general makeup of social media users. The low score of Empathy Quotient would suggest that this personality trait is not as important as initially hypothesised to predict people’s GenSHRMO and could be removed from the proposed model. Furthermore, it is possible that a larger and more comprehensive Dark Triad test may help in providing a more accurate assessment of participants’ personalities, for example, by including reverse wording. It would be interesting to confirm which of the three main Dark Triad traits is a more likely predictor of GenSHRMO, as this research did suggest a possibility of correlation between GenSHRMO and Psychopathy. Although, it must be acknowledged that one’s susceptibility to health-related misinformation seems to be more rooted in people’s beliefs and views of the world rather than depending on their personalities and predispositions towards others. Therefore, a qualitative approach may be more appropriate to investigate this subject matter alongside a survey so as to capture the nuances of the subject matter.

5. Conclusion

            In conclusion, guided by previous research, the goal of this project was to prove a positive correlation between Dark Triad personality traits, Empathy Quotient, and people’s general susceptibility to, and the likelihood of spreading, health-related misinformation online. The results of this research do not support the hypothesis that people who scored high in both Dark Triad traits of Narcissism and Machiavellianism would also score high on Empathy Quotient and that these could be used as predictors of the score of GenSHRMO. Instead, the data indicated a small but statistically significant correlation between Psychopathy and GenSHRMO in the 1-tailed test, which was not present, however, in the 2-tailed test. This particular finding should be analysed in future research with a deeper investigation into Dark Triad personality traits, also including a provision for a qualitative perspective for a more nuanced and complete understanding of what makes people susceptible to, and what makes them spread, health-related misinformation online.

References

Alicke, M. D. et al., 1995. Personal contact, individuation, and the better-than-average effect.. APA PsychNet, 68(5), pp. 804-825.

Chen, X., 2012. The Influences of Personality and Motivation on the Sharing of Misinformation on Social Media. s.l., iSchools.

Graham-Harrison, E., Jackson, J. & Heal, A., 2021. Facebook ‘still making money from anti-vax sites’. [Online]
Available at: https://www.theguardian.com/technology/2021/jan/30/facebook-letting-fake-news-spreaders-profit-investigators-claim
[Accessed 16 April 2021].

Hansel, R. & Visser, R., 2020. Does personality influence effectual behaviour?. International Journal of Entrepreneurial Behavior & Research, 26(03), pp. 467-484.

Hepper, E. G., Hart, C. M. & Sedikides, C., 2014. Moving Narcissus: Can Narcissists Be Empathic?. Personality and Social Psychology Bulletin, 40(4), pp. 1079-1091.

Jones, D. N. & Paulhus, D. L., 2013. Introducing the Short Dark Triad (SD3): A Brief Measure of Dark Personality Traits. Assessment, 21(1), pp. 28-41.

Lewandowsky, S. et al., 2012. Misinformation and Its Correction: Continued Influence and Successful Debiasing. Psychological Science in the Public Interest, 13(3), pp. 106-131.

Malesza, M., 2020. The Dark Triad and Beliefs in Conspiracy Theories About the COVID-19, Warsaw: The University of Economics and Human Sciences in Warsaw.

McKenna, M., 2019. The True Dollar Cost of the Anti-Vaccine Movement. [Online]
Available at: https://www.wired.com/story/anti-vaccine-movement-true-cost/
[Accessed 24 April 2021].

Newman, N., 2011. Mainstream Media and the Distribution of News, Oxford: Reuters Institute for the Study of Journalism.

Ortiz-Ospina, E., 2019. The rise of social media. [Online]
Available at: https://ourworldindata.org/rise-of-social-media
[Accessed 16 April 2021].

Ortutay, B., 2016. https://apnews.com/article/1fc42b60a63e49568f0b3707a36c6b23. [Online]
Available at: https://apnews.com/article/1fc42b60a63e49568f0b3707a36c6b23
[Accessed 16 April 2021].

Qualtrics, 2021. Sample Size Calculator. [Online]
Available at: https://www.qualtrics.com/blog/calculating-sample-size/
[Accessed 14 April 2021].

Spreng, N. R., McKinnon, M. C., Mar, R. A. & Levin, B., 2009. The Toronto Empathy Questionnaire: Scale Development and Initial Validation of a Factor-Analytic Solution to Multiple Empathy Measures. Journal of Personality Assessment, 91(1), pp. 62-71.

Sumida, N., Walker, M. & Mitchell, A., 2019. News Media Attitudes in France, Washington: Pew Research Center.

Talwar, S. et al., 2019. Why do people share fake news? Associations between the dark side of social media use and fake news sharing behaviour. Journal of Retailing and Consumer Services, Volume 51, pp. 72-82.

Tankovska, H., 2021. Social media usage in the United Kingdom (UK) – statistics & facts. [Online]
Available at: https://www.statista.com/topics/3236/social-media-usage-in-the-uk/
[Accessed 14 04 2021].

Tomes, J. L. & Katz, A. N., 1997. Habitual Susceptibility to Misinformation and Individual Differences in Eyewitness Memory. Applied Cognitive Psychology, Volume 11, pp. 233-251.

Appendix A

Questionnaire and scoring on General susceptibility to and sharing of health-related misinformation online.

 Susceptibility to (ST) – Sharing of (SO)strongly agreeslightly agreeslightly disagreestrongly disagree  
1I hold views and beliefs about my health that are ignored by the mainstream media. (ST)4321
2Homoeopathic Doctors are better informed than Medical Doctors. (ST)4321
3  I regularly engage with news that discusses in a negative light something that I believe in, about my health. (ST)1234
4I trust my GP with concerns I have about views and beliefs about my health. (ST)1234
5I often disagree with health-related news presented by the mainstream media. (ST)4321
6I am part of one or more groups on social media where I feel free to discuss my views and beliefs about my health. (SO)4321
7I share articles on social media the support my views and beliefs about my health. (SO)4321
8I always check on the source of the articles I share that support my views and beliefs about my health. (SO)1234
9I do my own research to be informed about my health by reviewing peer-reviewed scientific publications. (ST)1234
10I do my own research to be informed about my health by reading blogs of famous people I agree with. (ST)4321
11Famous people are better at informing me about my health than scientists. (ST)4321
12I do remove an article I have published on social media if and when I find it was misleading. (SO)1234
13I search online for information about my health from multiple sources. (ST)1234
14Articles that make me feel a strong emotion about my health are more valid than science articles about the same subject. (ST)4321
15Articles that promote my existing views and beliefs about health from people I know are more valid than articles from scientists that contradict them. (ST)4321

Investigation into the relationship between age groups, Dark Triad personality traits, empathy quotient and the susceptibility to, and spreading of health-related misinformation online: A literary review

Social media has provided a low-cost entry to the opportunity to communicate and create relationships with virtually anyone in the world with access to the internet. Just like in the real world, in-groups and out-groups on social media form out of shared passions, interests, ideology and beliefs about the world, with ideas flowing in and out of them. Which personality type is more or less susceptible to misinformation has been the topic of numerous researches, as well as many investigations were carried out into which age demographic is more likely to share misinformation that agrees with existing beliefs. However, not much research exists that specifically looks at susceptibility to, and the spread of health-related misinformation and its relationship to Dark Triad personality traits, or empathy quotient. Therefore, the goal of the proposed research is to measure these factors and assess their relationship to understand which personality traits within different age groups are more likely to contribute to the susceptibility to, and the spreading of health-related misinformation online. In this essay literature review of five papers, three of which are published researches on personality and misinformation, one has a pending peer-review on Dark Triad traits and conspiracy belief, and another summarises findings on the topic of age and health-related misinformation, will be presented to provide a rationale for the proposed research. The findings of these papers will be briefly described, accompanied by a summary of the methodology and an equally brief discussion on the unresolved questions of their research.

Seeking to investigate the role of personality and motivation in the sharing of misinformation on social media, a survey among university students was conducted in Singapore (Chen, 2012). Chen had identified in his research that the content of the message being shared holds less value than the action and outcome of the act of sharing. He noted that open-mindedness is positively related to susceptibility to misinformation and that “users that are aware of the falseness of misinformation, may still share it”. The author suggests that this behaviour might be explained by it being motivated by seeking status and recognition within the person’s in-group. Chen states that “the action of sharing, rather than the perceived accuracy and characteristics of the information being shared, is what matters most”. His research consisted of a survey questionnaire administered to 171 students across two universities. The questionnaire comprised of the Big Five Inventory to measure personality, an ad-hoc questionnaire to measure motivation based on uses and motivation theory, and six examples of inaccurate news rated for accuracy by the participants. The author acknowledged some limitations of his research, such as the use of convenience sampling as well as the arbitrary choices of examples of misinformation. Although he did not expand on the possibility that Dark Triad personality traits, such as narcissism, may play a role in the motivation for intentionally sharing misinformation on social media. Chen did, however, suggest that future research should focus on various categories of misinformation and target a larger sample size of more varied age groups.

A more recent study also sought to investigate the motivation for sharing fake news and linked several factors to the behaviour, such as trust in the content and its source, fear of missing out (bandwagon effect) and social media fatigue where people find themselves lacking mental bandwidth to assess the veracity of what is being shared (Talwar, et al., 2019). This qualitative research was conducted with an open-ended survey of 88 WhatsApp users, 65 of which were females with a median age of about 21 and a half. The answers were analysed, and factors were extracted from the emerging themes. The main limitation of this research is its sample size and, possibly, the age group of the participants, although the data offers a more detailed perspective on the topic. The findings do indeed propose a more nuanced look at the motivation for sharing misinformation that does not require the invocation of personality type as justification. The factors that emerged provided some context as to what underlying motivations may be related to the susceptibility to, and the sharing of misinformation online, but no indication if age is one of them. High trust in the content is, however, linked to no hesitation from people sharing information that has not been verified, thus leaving open the question as to which type of personality is more likely to be both sufficiently open-minded to believe in certain kinds of misinformation as well as more prone to taking risks in sharing it.

Only one recent yet to be peer-reviewed research aimed to address specifically the relationship between Dark Triad personality traits and beliefs in COVID-19 related conspiracy theories (Malesza, 2020). In her paper, the author identified a positive relationship between Dark Triad traits, such as Machiavellianism, narcissism, psychopathy, and the susceptibility to belief in conspiracy theories about the recent pandemic. This research was conducted with a survey of 564 adults, 298 of which were females and between the age of 18 and 64. It included a short Dark Triad questionnaire and a belief in conspiracy theories inventory. The author’s conclusion on her findings indicates a link between manipulative behaviour and hypersensitivity to being manipulated. These factors are then linked to higher susceptibility to a counter-narrative and consequently to the spread of misinformation to justify and reinforce the pre-existing belief, particularly in participants that scored high in narcissism. However, only towards the end of the discussion section does Malesza note how age is a statistically significant factor influencing belief, with younger people being more susceptible to conspiracy theories, without mentioning specifically how other age groups are impacted. Furthermore, her research leaves open the question as to which personality and age group is more likely to spread misinformation that supports existing belief into any particular conspiracy theory.

To offer different perspectives on who would be more susceptible to health-related misinformation online, a recent editorial brought together the findings of various researches (Scherer & Pennycook, 2020). In the article, the authors surmise concisely several results, for example, those from Brashier and Schacter’s research suggesting that older people may be more prone to share fake news online not because of mental decline but rather due to lack of digital literacy (2020), or, as per Lewandowsky et.al.’s paper (2012), that people are more likely to believe and share misinformation that is consistent with pre-existing belief or worldview. This article is in no way a comprehensive review on the existing literature on the subject but proposes some relevant points for future research, such as that other individual characteristics have not yet been adequately researched concerning susceptibility to health-related misinformation, as well as whether if it is a generalised trait or if it is context-dependent.

The role of empathy in relation to misinformation of any kind and susceptibility to it has not been explored very much in the context of it being a predictive factor to determine their relationship. Tomes and Katz (1997) sought to identify personality traits that would lead to habitual susceptibility to post-event misinformation in eyewitnesses. The authors carried out an experiment focused on a memory recollection task with 183 participants ranging from 17 to 43 years old, by exposing half of them to video clips and questionnaires with misinformation, whilst the other half also watched the same clips but was not exposed to misinformation. The goal was to assess the influence of post-event information. Among their findings, it emerged that highly empathetic individuals might place more importance on, or be more affected by, irrelevant information and thus, be more susceptible to misinformation. The paper does not, however, explain how the empathy of the participants was measured, but only reports that females scored higher than men and clarified that sex is not a predictive factor, but only that cognitive correlates of sex are related to habitual suggestibility. It must be noted that this research only offers a tenuous link to the relationship between empathy and susceptibility to misinformation.  

In conclusion, the papers presented offer an interesting starting point for the research into the relationship between age groups, Dark Triad personality traits, empathy quotient and the susceptibility to, and the spreading of health-related misinformation online. Chen’s research put forward the idea that young people care more about the act of sharing rather than preoccupying themselves with the veracity of the content, motivated by seeking clout in their social groups thus suggesting that narcissism and lack of empathy may be predictive factors. At the same time, however, Talwar et.al’s research points to fear of missing out and social media fatigue as a motivator for taking risks in sharing information that has not been confirmed as true. Tomes and Katz’s findings tenuously suggest that empathy is positively related to being more affected by irrelevant information. Indeed, health-related misinformation goes viral when attached to a story to elicit an emotional reaction on the reader rather than a factual account of medical progress (Xu, 2019). Other research has also looked at the demographics being a predictive factor without exploring common personality traits, whilst only a recent unpublished paper sought to explore Dark Triad traits in relation to belief in specific conspiracy theories. Therefore, the proposed research aims to fill this gap in the current body of work to get a better understanding of the intersection of age groups, personality types and empathy to the susceptibility to, and the spreading of health-related misinformation online.

References

Brashier, N. M. & Schacter, D. L., 2020. Ageing in an Era of Fake News. Current Directions in Psychological Science, 29(3), pp. 316-323.

Chen, X., 2012. The Influences of Personality and Motivation on the Sharing of Misinformation on Social Media. s.l., iSchools.

Lewandowsky, S. et al., 2012. Misinformation and Its Correction: Continued Influence and Successful Debiasing. Psychological Science in the Public Interest, 13(3), pp. 106-131.

Malesza, M., 2020. The Dark Triad and Beliefs in Conspiracy Theories About the COVID-19, Warsaw: The University of Economics and Human Sciences in Warsaw.

Scherer, L. D. & Pennycook, G., 2020. Who Is Susceptible to Online Health Misinformation?. American Journal of Public Health, 110(S3), pp. S276-S277.

Talwar, S. et al., 2019. Why do people share fake news? Associations between the dark side of social media use and fake news sharing behaviour. Journal of Retailing and Consumer Services, Volume 51, pp. 72-82.

Tomes, J. L. & Katz, A. N., 1997. Habitual Susceptibility to Misinformation and Individual Differences in Eyewitness Memory. Applied Cognitive Psychology, Volume 11, pp. 233-251.

Xu, Z., 2019. Personal stories matter: topic evolution and popularity among pro- and anti-vaccine online articles. Journal of Computational Social Science, Volume 2, pp. 207-220.

Do people care more about themselves than others?

Understanding why people do or do not help one another has been a question that involved social scientists, psychologists, anthropologists as well as neuroscientists. As noted by authors Manning and Levine (2017), “helping”, “prosocial” and “altruism” are terms that are often used interchangeably in the scientific literature, often without consistency from the same authors. This is because, although all three behaviours are objectively the same, in that they all describe a form of interpersonal support from one individual to another, they differ in underlying driving motivation for each. Research has shown how social and cultural influences, emotions as well as identity and genetics, all play a role in the manifestation of altruistic behaviour. Thus, in this essay, the extent to which human altruism exist will be critically evaluated, starting from an evolutionary and anthropological overview of its origin, followed by a brief discussion on the biology and neuroscience involved and how it develops from childhood to its morality and social importance.


Evolutionary theory has consistently and accurately predicted how the environmental challenges a species face, shape its gene pool promoting the survival of the fittest. Thus, in an environment of scarce resources, fierce competition and a consequent pursuit of self-interest lead to selfish behaviour so to ensure the passing on of genetic information to the next generation; humans are not exempt from this natural order, as described by Dawkins (1976). However, humans are distinct from other animals in that they will frequently help unrelated strangers as well as people they have never met, without any expectation of a reward or reciprocity (Richerson & Boyd, 2005), a behaviour at odds with most other lifeforms. Among the first ideas that sought to explain altruism from a genetic perspective, was that of inclusive fitness theory where this behaviour is explained as outcome-oriented instead of emerging from inherent motivation (Hamilton, 1964). These theories would suggest, however, that helping behaviour is dependent on the individual’s cost-benefit analysis of any given situation, such as the notion of reciprocal altruism which describes how people may help others with an expectation of being helped back in the future (Trivers, 1971).


As truly altruistic behaviour is understood as the action an individual takes towards another or a group outside that individual’s self-interest, it has been argued that it is impossible to demonstrate pure altruism (Piliavin, et al., 1981). Egoistic or selfish behaviour is indeed distinguished by the fact that it only benefits its actor. However, when one’s personal benefit includes the wellbeing and happiness of one’s tribe or group of belonging, the scope of self-interest extends beyond the self. Thus, altruistic behaviour emerges as an extension of self-interest, as described by Batson’s model (1987), where an overlap occurs between the self and the other. Moreover, the theory of reciprocal altruisms also supports the viewpoint that the motivation driving such behaviour is the expectation that it will be reciprocated in the future. As Hamilton (1964) suggested, natural selection would favour an altruistic gene if the benefit of altruism outweigh its cost, thus ensuring that altruistic behaviour is passed on to the next generation.


More recent research in evolutionary psychology, however, suggest that, has early humans learned to cook, and thus gained a more efficient and less time-consuming method for obtaining calories, the brain had the opportunity to develop its prefrontal cortex by increasing the number of cortical neurons (Gabi, et al., 2016). This development of the brain is significant as the relationship between the feeling of empathy and activity in the prefrontal cortex has been demonstrated both the research conducted with fMRIs (Seitz, et al., 2006), as well as in studies involving patients with brain damage to that region of the brain (Shamay-Tsoory, et al., 2003). As the human ability and capacity to experience empathy increased, the species was better equipped to deal with the evolutionary challenges it encountered on its path, as helping others would have increased the chances of survival through cooperation instead of pursuing rigid competition. Indeed, one crucial and distinctive feature of human empathy is that it is not restricted to interaction with kin, nor does it have to be prompted by the actual perception of distress signal or emotion contagion (Decety, 2011, p. 35).


The claim that truly altruistic behaviour would be impossible to demonstrate, however, was soon disproved by the research conducted by Dovidio et al. in 1990, in which an experiment with the goal to demonstrate purely egoistically motivated helping, as posited by the empathy-altruism hypothesis, showed the opposite, as also noted by Piliavian in 2009. This hypothesis posted that it would be in the individual’s self-interest to minimize emotional distress and thus when in the experimental condition participants were exposed to a person in emotional distress and then given the chance to help, it was thought that altruistic behaviour would decrease. Instead, the opposite was found to be true: participants would consistently help more in relation to the distress perceived. Such finding seems to indicate that the motivation driving altruistic behaviour is the same as the helping behaviour, as in an empathic response from individuals towards one another. The arousal: cost-reward model put forward in the research by Piliavin et al. (1981), does suggest that observing a situation of emergency, raises a state of arousal in bystanders that becomes increasingly unpleasant the longer it continues, thus perhaps explaining what would motivate the helping behaviour in such circumstances. This, however, does not apply when other people are present as, in such a scenario, another effect comes into play: the bystander effect, where the diffusion of responsibility can be observed and the reaction is heavily influenced by social influence (Darley & Latané, 1968).


Is altruistic behaviour, therefore innate or a social construct product of the required cooperation for ensuring survival? Studies have shown that small children display a preference for actors that demonstrate altruistic behaviour, as the research conducted by Hamlin et al. (2011) has shown. Further research has also shown that babies from the age of 14 to 18months, will help others without the expectation of any reward; interestingly, rewarding the behaviour appears to reduce its occurrence (Warneken & Tomasello, 2009). This would suggest, therefore, that altruistic behaviour is not only understood but also sought intuitively from an early age, thus validating, to some extent, Hamilton’s theory on the role of genes in the propagation of altruistic behaviour through the generations of the human species and thus that it is innate in humans.


Yet, the early theory of mind, pioneered by Jean Piaget in the 1920s, acknowledges that one of the states of early childhood development is egocentrism, in that the child is not yet aware that other people have different thoughts and feelings about the world. Although, there is evidence that helping behaviour remains stable throughout childhood, as the research by Zahn et al. (2001) suggests, developmental psychology identifies the achieving of the child recognizing its own mental state, thoughts and belief and, consequently the ability to infer the mental state of others, by the age of five (Hughes & Donaldson, 1979). Moreover, one of the stages of moral development identified by Kolhberg (1969) also shares the quality of altruistic behaviour: stage 3 – The morality of interpersonal concordance “Be considerate, nice and kind: you’ll make friends”. Such stage explicitly indicates the social value of prosocial behaviour as it helps create a new connection with other people using kindness as a currency, indicating, therefore, that altruistic behaviour is an acquired social tool in the developmental stages of childhood. Indeed, in a social world, reputation is as valid as a currency and consequently, altruistic behaviour acquires value to one’s group (Mifune, et al., 2009).


From a social perspective, moral foundation theory (Haidt & Joseph, 2004) suggests that there are fundamental rules to ethical behaviour that are true throughout all cultures as they are the foundation upon which moral behaviour is built upon. Of these foundations, two appear to reflect features of altruistic behaviour: the care/harm foundation, which underlies the virtues of kindness gentleness and nurturance, and the foundation of fairness/cheating from which the principle of reciprocal altruism and justice can be extrapolated. This would indicate, therefore, that altruistic behaviour is both a social construct, as much as it is one of the underpinnings of human cooperation that is innate of the human species on which rules for cooperation have been built upon.


Therefore, considering this body of research, altruistic behaviour could be understood to be both a product of human evolution, as well as the outcome of social reinforcement, as well as people’s empathic reaction towards the world around them. As experiments have shown (Coke, et al., 1978), helping behaviour is driven by one’s empathy, yet social influence also plays a role in the reaction time of the actual helping, if any does indeed occur (Piliavin, et al., 1981). The definition of Prosocial behaviour, however, indicates that it is the kind of behaviour that is generally beneficial to other people and to the ongoing social system (Piliavin, et al., 1981, p. 4). It has indeed been argued that the same emotional and cognitive processes which lead people to display altruistic behaviour towards strangers, constitute an inherent part of the human psychological equipment (Tamas, 2008).


In conclusion, it is undeniable that human altruism does indeed exist. Evolutionary theory and anthropological psychology both describe how it was a natural development of early humans have adapted to a changing environment, particularly stemming from the most important discovery of humankind: cooking, which then led to the ability to experience empathy with far more complexity than any other animal in nature. Consequently, this led to the development of the social structures at the foundations of civilization, from its moral and ethical rules to its cultures. Although innate, it is reinforced through childhood that helping one another is far more beneficial and advantageous than competing against each other.

References

Batson, D. C., 1987. Prosocial Motivation: Is it ever Truly Altruistic?. Advances in Experimental Social Psychology, Volume 20, pp. 65-122.

Coke, J. S., Batson, D. C. & McDavis, K., 1978. Empathic mediation of helping: A two-stage model.. Journal of Personality and Social Psychology, 36(7), pp. 752-766.

Darley, J. M. & Latané, B., 1968. Bystander intervention in emergencies. Journal of Personality and Social Psychology, Volume 8, pp. 377-383.

Dawkins, R., 1976. The Selfish Gene. Oxford and New York: Oxford University Press.

Decety, J., 2011. The neuroevolution of empathy. Annals Of The New York Academy Of Sciences, Volume 1231, pp. 35-45.

Dovidio, J. F., Allen, J. L. & Shroeder, D. A., 1990. Specificity of empathy-induced helping: Evidence for altruistic motivation. Journal of Personality and Social Psychology, 79(2), pp. 249-260.

Gabi, M. et al., 2016. No relative expansion of the number of prefrontal neurons in primate and human evolution. National Academy of Sciences, 8 August.

Haidt, J. & Joseph, C., 2004. Intuitive ethics: How innately prepared intuitions generate culturally variable virtues.. Daedalus, 133(4), pp. 55-66.

Hamilton, W. D., 1964. The Evolution of Social Behaviour. Journal of Theoretical Biology, Volume 7, pp. 1-16.

Hamlin, K. J., Wynn, K., Bloom, P. & Mahajan, N., 2011. How infants and toddlers react to antisocial others. Proceedings of the National Academy of Sciences, 108(50), pp. 19931-19936.

Hughes, M. & Donaldson, M., 1979. The use of hiding games for studying the coordination of viewpoints. Educational Review, 31(2), pp. 133-140.

Kohlberg, L., 1969. Stage and Sequence: the cognitive-developmental approach to socialization. In: D. A. Goslin, ed. Handbook of Socialization Theory and Research. New York: McGraw Hill.

Manning, R. & Levine, M., 2017. Why do we help on another? Helping, altruism and prosocial behaviour. In: R. Capdevilla, J. Dixon & G. Briggs, eds. Investigating Psychology 2 From social to cognitive. London: The Open University, pp. 187-228.

Mifune, N., Hashimoto, H. & Yamagishi, T., 2009. Altruism toward in-group members as a reputation mechanism. Evolution & Human Behaviour, 31(2), pp. 109-117.

Piliavin, J. A., 2009. Altruism and Helping: The evolution of a field: The 2008 Cooley-Mead presentation. Social Psychology Quarterly, 72(3), pp. 209-225.

Piliavin, J. A., Dovido, J. F., Gaertner, S. L. & Clark, R. D. I., 1981. Emergency Intervention. New York: Academic Press.

Richerson, P. J. & Boyd, R., 2005. Not by Genes Alone: How Culture Transformed Human Evolution. Chicago IL: University of Chicago.

Seitz, R. J., Nickel, J. & Azari, N. P., 2006. Functional modularity of the medial prefrontal cortex: involvement in human empathy. Neuropsychology, 20(6), pp. 743-751.

Shamay-Tsoory, S. G., Tomer, R., Berger, B. D. & Aharon-Peretz, J., 2003. Characterization of empathy deficits following prefrontal brain damage: the role of the right ventromedial prefrontal cortex. Journal of Cognitive Neuroscience, 15(3), pp. 324-337.

Tamas, B., 2008. Nature of Virtue: Evolutionary strategies underlying human prosocial behaviour. Hungarian Psychological Review, 63(1), pp. 613-631.

Trivers, R. L., 1971. The Evolution of Reciprocal Altruism. The Quarterly Review of Biology, 46(1), pp. 35-57.

Warneken, F. & Tomasello, M., 2009. The roots of human altruism. British Journal of Psychology, Volume 100, pp. 455-471.

Zahn-Waxler, C. et al., 2001. Empathy and prosocial patterns in young MZ and DZ twins: Development and genetic and environmental influences. In: R. N. Emde & J. K. Hewitt, eds. Infancy to early childhood: Genetic and environmental influences on developmental change. New York: Oxford University Press, pp. 141- 162.

Are Decisions Being Made With Patients’ Best Interests In Mind? Understanding Groupthink


OUTLINE: When making decisions concerning the care of patients, the team must ensure patients’ best interests are kept in mind. To ensure that the best decisions are being made, we will be looking at two psychological theories that consist of the main phenomena observed in the decision-making process and how they can be applied practically.

GROUP POLARISATION THEORY (MOSCOVICI AND ZAVALLONI, 1969)

‣ In 1969, psychologists Moscovici and Zavalloni observed the tendency of members of a group engaged in the decision-making process to shift their initially held views to a more extreme position after a group discussion.

THIS LEADS TO riskier decisions being taken by the group and potentially going against the best interests of patients.

WHY DOES THIS HAPPEN? It has been suggested that this could be the result of a combination of two factors, here described by corresponding theories: social comparison theory, where we compare ourselves against others in order to pursue conformity, and persuasive arguments theory, where arguments brought forward are more likely to reinforce existing views of other members of the group. (Isenberg, 1986).

PLEASE REMEMBER, of course, that taking a more polarised view does not imply that the decision is necessarily wrong.

GROUPTHINK THEORY (JANIS, 1972)

‣ In 1972, Irving Janis identified a phenomenon that was observed in group decision making where members’ desire to reach a unanimous agreement overrides the motivation to pursue a proper and rational decision-making process.

THIS LEADS TO the members having the illusion that the group is “invulnerable, moral and unanimous”, thus encouraging policing of the group to ensure conformity among themselves and others.

WHY DOES THIS HAPPEN? Because not all available options are being properly and fully evaluated by the group whilst also being unaware that discussions and evidence brought forward are more likely to further the dominant view.

ALTHOUGH empirical research on the concept has produced overwhelmingly equivocal support for the groupthink model, it is something to consider when reaching a decision as a team.

HOW CAN THIS BE ADDRESSED?

Methods for overcoming groupthink and group polarisation:

• Be impartial – don’t endorse any specific position.

• Assign a devil’s advocate.

• When possible, subdivide the group occasionally and reunite to air differences.

• Consult outside experts or colleagues.

• Call a ‘second chance’ meeting before implementing decisions.

HOW CAN YOU TRY TO ENSURE THAT DECISIONS ARE MADE IN THE PATIENTSBEST INTERESTS?

The decision-making process must include provisions for ensuring that focus remains on patients’ best interests. As the two theories mentioned above have shown, it is with ease that members of groups may inadvertently fall into the trappings of seeking social conformity, thus leading astray from the desired outcome. A systematic and structured approach to this process is, therefore, recommended when undertaking the tasks of making decisions as a group, ensuring that all options are adequately considered and evaluated so that the patients’ best interests are kept paramountly.

References:

Isenberg, D.J. (1986) ‘Group polarization: a critical review and meta-analysis’, Journal of Personality and Social Psychology, vol. 50, no. 6, pp. 1141–51.

Janis, I.L. (1972) Victims of Groupthink: A Psychological Study of Foreign Policy Decisions and Fiascoes, Boston, MA, Houghton Mifflin.

Janis, I.L. (1982) Groupthink, 2nd edn, Boston, MA, Houghton Mifflin.

Moscovici, S., and Zavalloni, M. (1969) ‘The group as a polarizer of attitudes’, Journal of Personality and Social Psychology, vol. 12, no. 2, pp. 125–35.

Considerations of systemic (family and relationship) issues in a counselling case study

Introduction

The systemic approach to psychotherapy involves drawing from different approaches of therapy and, it is often useful when counselling family groups and/or individual cases within such groups. The key factor of this approach is to acknowledge the individual as a relational being that can only be understood as part of a social system (Vossler, 2016). In this approach, the focus is shifted away from the individual and towards its relationships and social interactions within the family group. As such, there is no ‘right’ way to interpret a situation but, instead, different perspectives to understanding it; conflicts that emerge can often lead family members to be ‘stuck’ in their interactions, thus requiring counsellors to draw from multiple approaches towards the development of multiple hypotheses. In this essay, the fictional case study of Davide and the relationship with his sister Rosa will be discussed to illustrate how a systemic approach to therapy might be more advantageous than any individual approach in resolving their relational conflict. Starting with a description of the case study, a discussion of possible interpretations and a few hypotheses will follow, with a further discussion on how a systemic approach would benefit the resolution of this hypothetical scenario.

Case study

Davide is a 66 years old man originally from Palermo, Italy, and has lived in the suburbs of West London for the past 30 years. He has recently moved in with his sister Rosa following a particularly difficult divorce that separated him from his only son. Davide used to be a restaurant owner for the past 25 years but has been forced to retire as the business did not survive the competition from the high street. Davide and Rosa migrated together to the UK in the 1980s, and they are from a strict catholic upbringing. She is younger by 5 years and has had a history of alcohol and heroin abuse that started after their relocation. Rosa has been relying on Davide for financial support for most of her life as she was never able to hold a job long enough to be independent. They were raised by their single mother and never met their father as he abandoned the family soon after Rosa’s birth. Their mother then passed away when Davide was in his early twenties, and he has looked after his sister ever since. He had been divorced before when he married young, with a local girl from Palermo, and it ended abruptly when he discovered she became pregnant out of an affair entertained with a childhood friend of theirs. This was the single motivator behind their migration. He then remarried a woman of Caribbean origin he met in the UK, and together they had a child. Years later she filed for divorce for unreasonable behaviour due to Davide spending most of his time absorbed by his business and never taking any real-time off; he was working 7 days a week with shifts of 15 hours a day at the time. After moving to the UK, Davide has never developed any real friendships other than with his ex-wife. The closure of his business followed soon after the divorce; he briefly attempted to return to the workforce as a cabbie driver for an online company, but lacked motivation and stopped soon after. Around the same time, he started having heated arguments with Rosa almost daily. According to his GP, Davide has lost significant weight in the past 6 months and has developed irregular sleep patterns often being unable to sleep at all for days in a row. He has also been experiencing episodes of panic attacks whenever outside of the house. Davide also reported being in a depressed mood most of the time and now feels unable to leave his room as moving anywhere requires considerable effort. Moreover, for the past six weeks, Davide has been experiencing suicidal thoughts.

Case study discussion

To understand Davide’s situation, a sociocultural perspective is required as he is originally from a small town in the south of Italy, where certain values about what it means to be a man are instilled from an early age. Qualities such as being hardworking, upholding one’s honour and patriarchy are at the core of Italian masculinity both in Italy and outside of the country’s boundaries (Perrotte, 2000). Thus, his inability to fulfil such standards inherited from his culture would potentially influenced his self-esteem and overall mental well-being. With his manhood in question, Davide may be unable to adequately react and adapt to the adverse circumstances he finds himself in. His age is also a factor to consider as, in combination with his perception of himself as a hard-working man, he is unable to return to the workforce in a way that he sees dignified. Moreover, as both he and Rosa experienced being migrants, being outsiders without speaking the language at first, they would have encountered a degree of difficulty in integrating into communities that could have impacted their ability to develop meaningful social connections. As Rosa was dealing with her own struggle to integrate, her path towards alcohol and heroin abuse could be explained by having made the wrong type of connections within the framing of this forced change of environment. Davide’s relationship with his sister is also affected by the lack of a father figure in their lives. Studies indicate that such absence can impact the economic and social as well as emotional well-being of children throughout their lives (McLanahan, Tach & Schneider, 2013). Moreover, since the death of their mother, Davide would have filled the role of a parent in Rosa’s life, altering their sibling relationship. It must be noted that southern Italy, particularly Sicily, is known to promote a strict hierarchical family structure where women are to ‘know their place’ from an early age (Cucchiari, 1990). Due to having moved to the UK at the cusp of cultural change, Rosa may not have benefited from the shift in perception of her womanhood and change of expectations of her gender. By swapping the familiar role of the caring brother to that of the surrogate father, Davide may have imposed his direction in life to Rosa, limiting her choices. By behaving in an overly protective manner, he removed that level of relationship that exists between accomplice siblings that would have been crucial for the development of her independence. Without that crucial emotional support, replaced by Davide’s role as a guardian in Rosa’s life, she was perhaps unable to fully experience freedom in adulthood (Namyslowska & Siewierska, 2010). Rosa’s path towards alcohol and heroin abuse can be, therefore, seen as the logical adaptation to a circumstance that was not of her choosing. Similarly, Davide might have felt that he had no choice but to help his sister, fuelling further his sense of responsibility towards her. Often, acts of love can be misunderstood as an imposition of control when that love is not communicated adequately, as in the case of Ryan from the documentary analysed in the module material (The Open University, 2016). Ryan’s perception of his mother trying to fulfil her role was perceived as an impediment to his freedom, leading to him aggressively resenting her and thus resulting in their damaged relationship during his teenage years.

Another aspect to consider is Davide’s trust issues that emerged following his first divorce as it would have impacted his ability to build new social relationships and friendships necessary to integrate into any community he would be part of. By developing a self-defence mechanism that did not allow him to trust anyone to get too close to him and his family, he also missed the opportunity to have the support that comes from such relationships. As his reaction to that event was to put literal distance between him and his past, it would have undoubtedly affected his identity in such a way that it influenced his behaviour for the remaining of his life. As a further defence mechanism, Davide would have found comfort in pouring all his energy into his work and becoming a workaholic. As the existential psychotherapist Yalom (1980 ) suggests, placing himself as the ‘ultimate rescuer’ would be a way to overcompensate and take control over his life (Yalom, 1980), albeit in the most dysfunctional manner that jeopardised his second marriage. Davide, therefore, feels he has no choice but to continually `sacrifice` himself for Rosa by providing financial support in the role of parent and elder brother.

Working with this client systematically

The first issue to address is that Davide would fit the diagnosis for ‘major depressive episode’ according to the criteria set in the DSV-IV. It is important to note, however, that these symptoms did not occur in a vacuum. They are the result of the deterioration and alteration of Davide’s social and personal relationships which have significantly impacted his perception of the world and of himself. Losing his business would have impacted his self-esteem, particularly due to how much of his time he spent working in it, as well as the breaking up of his second marriage and the separation from his only child. His recurring heated arguments with his sister, for whom he provides, are also to be considered in understanding the origin of his depressive mood. Therefore, systematically, this case would have to be approached from multiple perspectives.

Approaching this case systematically involves the participation of his sister Rosa, as their relationship is now identified by their arguments rather than by their biological bond and history. Davide and his sister are now `stuck` in a pattern of behaviour that is leading to an increasing conflict and are unable to resolve it on their own. Indeed, families can get `stuck` when unable to adapt to the changing demands of the `family life cycle` (Carter & McGoldrick, 1999). Since moving in with Rosa, Davide, partly due to his patriarchal upbringing and partly out of feeling a lack of control in his life, may have behaved in an increasingly overprotective and controlling manner towards his sister leading to their relationship spiralling outside of their normal roles.

During the course of systemic treatment, they would benefit from the practice of `reframing` both their relationship and their interaction. At present, Davide feels that his sister is being ungrateful towards him whilst she blames him for using her state of helplessness as an excuse for controlling and limiting her freedom. Another tool available to the systemic counsellor is that of engaging in circular questioning during the assessment phase. As Vossler (2016) notes, the answers can have illuminating effects and offer the potential to change their interaction (Vossler, 2016). Moreover, role-playing with the help of a team of counsellors would be beneficial for them as observers, as it would offer them a perspective of how the other feels in regards to their circumstances. As they are both resentful of the circumstance they find themselves in, they perhaps lack the ability to understand or see one another without the filter of their own narrative due to their excessive emotional investment in them. A team of counsellors would help by suggesting alternative narratives to their own. Indeed, as Vossler (2016) notes further, there are no `correct` assumptions about a situation, but there are multiple hypotheses that would be useful to trigger the change necessary for relationships to improve.

Davide and Rosa’s case can also be approached from a humanistic perspective as his depressive mood, loss of motivation and her feeling entrapped in a situation, not of her choosing, would be understood as a state of incongruence. Their idea of themselves is at odds with the reality of the situation they find themselves in, thus leading them to a loop in which the concept of the self is being threatened. This, in turn, leads them to feel increasingly anxious and vulnerable, potentially blocking them from getting ‘unstuck’ as they are incapable of understanding the cause of their pain.  

Conclusion

In conclusion, this fictional case study has illustrated the importance of approaching therapy by acknowledging the relationship of individuals and the social interactions that occur first in the family as well as the social environment surrounding them. Davide and Rosa have both found themselves in circumstances not entirely of their own choosing and were unable to adapt to changing demands of the family life cycle; their interaction deteriorated due to their inability to adequately communicate their intentions leading them to be both ‘stuck’ in their own narratives and, therefore, unable to make the necessary changes towards a resolution on their own. Approaching cases like this systematically allows the counsellor to adequately attend the full sphere of factors that lead individuals like Davide and Rosa towards the deterioration of their mental well-being, as all perspectives are considered as well as offering the benefit from different therapeutic approaches towards a path of improvement and, hopefully, resolution.

2137 words

References

Carter, B., & McGoldrick, M. (1999). “The expanded family lifecycle. Individuals, family and social perspective”. Boston, MA: Allyn and Bacon.

Cucchiari, S. (1990, November). “Between Shame and Sanctification: Patriarchy and Its Transformation in Sicilian Pentecostalism”. American Ethnologist, 17(4), 687-707. Retrieved from http://www.jstor.org/stable/645708. Online, accessed on March 8, 2017.

Langdridge, D. (2016). “Existential psychotherapy”. In The Open University, Understanding counselling and psychotherapy (pp. 125 – 143). London: The Open University.

McLanahan, S., Tach, L., & Schneider, D. (2013, July). “The Causal Effects of Father Absence”. Annual Review of Sociology, 39, 399-427. doi:DOI: 10.1146/annurev-soc-071312-145704. Online, accessed on March 8, 2017.

Namyslowska, I., & Siewierska, A. (2010). “The significance and role of siblings in family therapy”. Archives of Psychiatry and Psychotherapy, 1, 5-13. Retrieved from http://www.webmail.archivespp.pl/uploads/images/2010_12_1/Namyslowska_p5_Archives_1_2010.pdf. Online, accessed March 8, 2017.

Perrotte, G. (2000). “THE PUBLIC SPECTACLE OF ITALIAN MASCULINITY: NONVERBAL DISPLAY OF GENDER IDENTITY”. Orlando, Florida. Retrieved from http://etd.fcla.edu/CF/CFE0001988/Perrotte_Gino_T_200805_MA.pdf. Online. (accessed March 8, 2017)

Salkovskis, P. M. (2016). “Cognitive-behavioural Therapy”. In The Open University, Understanding Counselling and Psychotherapy (pp. 145-166). London: The Open University.

The Open University. (2016). “The process of systemic family therapy – families getting stuck” [Video]. D240 Understanding counselling and psychotherapy. https://learn2.open.ac.uk/mod/oucontent/view.php?id=842445&section=1.4 (accessed March 8, 2017) 

Vossler, A. (2016). “Systemic approaches”. In The Open University, & A. V. Meg Barker (Ed.), Understanding Counselling and Psychotherapy (pp. 191-210). London: The Open University.

Yalom, I. D. (1980). “Existential psychotherapy”. New York: Basic Books.

Working with Fear and Sadness: Existential methodology VS Cognitive-Behavioural approach.

Introduction

Following Freud’s popularisation of psychoanalysis, his successors found that the approach they had been taught did not, fully satisfy the needs they were confronted with. Although psychoanalysis is preoccupied with past events, the subconscious, the intangible which lies below the surface of consciousness, it did not deal with the immediacy of the present, such as those experiences that preoccupy the day-to-day life reality of people seeking therapy. New theories and new approaches to counselling emerged in response, some with philosophical roots such as existential therapy, and others backed by scientific research such as cognitive-behavioural therapy. With an emphasis on the present and the future rather than the past, Existential therapy was developed at the dawn of the 20th century and refined in the last 30 years, stemming from ideas of existential philosophy from the 19th century onwards. Similarly preoccupied with resolving immediate psychological problems, Cognitive-Behavioural Therapy (CBT) focuses on dealing with the management of symptoms. Emerging from theories on cognitive and behavioural approaches, it evolved as a therapy method thanks to the work of Beck (1976) on the cognitive theory of emotion (Beck, 1976). This essay will discuss these two approaches by comparing and contrasting them in relation to understanding fear and sadness, starting with a summary of each and a discussion of their similarities and differences, merits and flaws, concluding with an explanation of why an evidence-based approach, such as CBT, is more adequate in understanding anxiety and depression.

The Existential Approach

Existentialist philosophy focuses on the individual’s responsibility to existence, freedom and choice. When, in the 19th century, Kierkegaard proposed that the responsibility of finding meaning in life lies with the individual, he did so to counter the prevailing thought of the time, dominated by the hierarchical doctrine of Christianity (Stanford University, 2016). This idea on the individual’s responsibility is what led Nietzsche and other philosophers to build upon it and develop it to its current form, highlighting the importance of acknowledging the inevitability of the “human condition” and one’s own fate. These ideas then influenced the development of the existential approach to therapy by Ludwig Binswanger and Medard Boss in the early 20th century as an alternative to the psychoanalytic model, which they both had been trained in, and by the work of Emma Van Deurzen and Ernesto Spinelli in recent years, with their further contribution in refining the method of practice(as cited in Langdridge, 2016). This therapeutic approach focuses on the phenomenological method, which aims to understand the world as it appears to the client, without prejudices. This method engages in a process known as epoché and is divided into four parts, beginning with bracketing where the therapist attempts to better understand the world of the client by setting aside prejudices and preconceptions during an initial assessment. This leads to the building and developing of an understanding of the client’s state of mind from their point of view allowing for an authentic relationship to form during therapy. Following this, the next step is to describe the world as it is, rather than seek reasons and explanations as to why things are the way they are, empathising the experience of the world, rather than its meaning. Once the experience is described, the step that follows is to horizontalize it, so as to avoid placing hierarchical importance when compared to other events. In the mind of the counsellor, during this step, all events and experiences described by the clients are of equal importance. Finally, the counsellor will seek to verify their understanding of the client’s experience to ensure its description accurately reflects their reality by engaging in a conversational approach focusing on the what and how. During the process, the counsellor is highly engaged and entertains a dialogue with the client, where ideas from existential philosophy are occasionally used as tools to bring self-awareness to one’s self, as well as awareness of the world as it is. This awareness, both of the self and the world, can then be directed towards the realisation of the client’s potential and freedom to choose their own path, as existential therapy aims to eradicate what obstacles that lead to it.

The Cognitive-Behavioural Approach

In the 1960s, following the research on behaviourism led by Skinner which built upon the work on conditioning by Pavlov, theories of cognitive and behavioural approaches emerged in response to the dissatisfaction and inadequacy offered by traditional psychoanalysis in the 1960s. However, these ideas on their own did not offer a useful approach method (Salkovskis, 2016). When Arron Beck, a trained psychoanalyst, was conducting research on dreams, he noticed how the thematic content did not reflect the existing notion in psychoanalysis of wish fulfilment (as cited in Salkovskis, 2016). As Salkovskis (2016) notes, those dream accounts involved more of the everyday experience, daily concerns and fears of people, rather than their subconscious desires (Salkovskis, 2016). This led Beck (1976) to develop his theory of cognitive emotion (Beck, 1976). This theory proposes that it is not so much the events causing an emotional response but the meaning attached to it. Beck’s theory suggests that the meaning an individual assigns to any given event is the result of a complex interaction between that person’s mood state, context and personal history. As Salkovskis (2016) notes further, “Often the meanings are conscious, sometimes there are not, but with careful questioning they can be identified” (Salkovskis, 2016). This therapeutic method involves identifying the client’s issues and obstacles so as to find ways to overcome them by offering alternative narratives, often challenging a pre-existing belief. The approach begins with an initial assessment where clients are asked about how their psychological problem or problems are affecting their lives and identifying what coping mechanisms they have devised to overcome them. Outlining the goal sought by the client in terms of short, medium and long term, helps design the trajectory of the therapy sessions as well as provide realistic objectives. The relationship that builds between the counsellor and the client is akin to an alliance, where an emphatic response to the client’s experience helps build the trust necessary throughout the process. Following this, a more specific assessment takes place where the counsellor works with the client to understand how the problem works, identify a recent occurrence, and work through understanding the process by deconstructing it. This leads to a formulation in which the vicious cycle is broken into easily identifiable parts, with an emphasis on the cognitive mechanism which feeds the intrusive or negative thoughts and the safety-seeking behaviour. This formulation is then put forward to the client as a theory to the problem, followed by a discussion leading to an alternative interpretation of the stressful event. Understanding the client’s own coping strategy is key to the process and leads to the development of an alternative theory in an attempt to break the cycle. Throughout the course of the therapy, the client will be encouraged to engage in behavioural experiments so to determine what works and what does not. This offers the client an opportunity to evaluate their own belief and to consider alternative cognitive behaviours to take outside of the therapy.

Existential vs Cognitive-Behavioural Approach

Fear and sadness, respectively an extension of anxiety and depression, are interpreted differently by each approach. Kierkegaard saw anxiety as the price to pay for freedom and Martin Heidegger described it as a fundamental feature of human existence (as cited in Langdridge, 2016). Furthermore, Langdridge (2016) goes on to explain that existential psychotherapy sees fear as a form of anxiety, better understood as a universal aspect of existence rather than a diagnosis (Langdridge, 2016). Similarly, sadness and depression are interpreted in the existential approach, as a consequence of a person’s restricted understanding of the world and thus unable to be truly free. Eugene Minkowski proposed that depression is the manifestation of an unfulfilled or unrealised potential leading to existential guilt. This notion leads to entrenched beliefs which, in turn, work towards reinforcing it. Thus, the phenomenological method helps identify which aspects of the world are being ignored and which are instead being embraced. Whereas in CBT, fear and anxiety are viewed within a cognitive framework, where meaning is attached to what is happening and thus, can be changed by proposing alternative ways of thinking. Similarly, sadness and depression are also viewed as problems to be tackled by behavioural experimentation: a process aimed at breaking the pattern of behaviour that leads to the reinforcement of the psychological problem. Both approaches acknowledge the vicious cycle of negative thought and offer different ways to counter it. As described above, breaking from traditional psychoanalysis, both approaches are not preoccupied with the past in their treatment methods, but instead focus on how to empower the individual to move forward. Albeit in different ways, they both aim at an awareness of the client of how things are so that to help understand how the world works. Existential therapy seeks to help the client by raising self-awareness as a means to cope with the inevitability of existence. CBT, on the other hand, is more concerned with the attributed meaning of events, finding ways to challenge preconceived beliefs in order to alter the self-reinforcing pattern of negative behaviour. In the methodology of existential therapy, all events are dealt with as equally important whereas in CBT the focus is on the most recent occurrence of the problem that is to be resolved. Both approaches aim at empowering the client to choose their own path, thus both approaches can be said to be neither directive nor non-directive but rather directional. Critically, however, CBT is an evidence-based approach where behavioural experiments play a key role during the therapeutic process; on the other hand, existential therapy, although based on a significant body of work, lacks empirical evidence and does not offer reliable methods of quantifying progress during the process. Moreover, the existential approach to therapy relies heavily on the ability of counsellors and their knowledge with a considerable intellectual toll, as philosophical ideas must continuously be engaged with, outside of the therapeutic sessions and developed to fit the client’s needs during the process (Langdridge, 2016). Both approaches do require a level of high engagement with the client, as in both cases the process is based strongly on a relationship built upon trust and understanding. A criticism that both approaches face is the risk that such therapy may resolve in worsening the condition of the client, as the process can potentially feed the pre-conceived notion and negative thought into the intrusive pattern which leads to the psychological problem.

Conclusion

In conclusion, an evidence-based approach is, in my opinion, more equipped, than one lacking empirical evidence on its benefits, to understand how to better deal with fear, sadness, anxiety and depression. Although, there are undeniable merits to the existential approach to therapy, such as when assisting terminally ill patients (Spiegel, 2015), it may lack day-to-day practicality when dealing with issues that a client suffering from anxiety or depression encounters, as it appears too abstract in its interpretation. Furthermore, there is evidence that CBT does alter brain connectivity over time (Liam Mason, et. al 2017). Also, CBT has been proven to be an effective method of treating phobias via the method of graded exposure (Salkovskis, 2016). It is indeed due to the growing amount of empirical evidence that CBT is rapidly evolving, making it an increasingly effective treatment alternative to a pharmacological approach (Kathryn McHugh, et. al 2013). Moreover, it is worth noting that neither approaches are set in stone nor are their methods definitive. Both existential therapy and cognitive-behavioural therapy are still evolving, often one borrowing ideas from another. As discussed, Freud’s psychoanalyst approach was unsatisfactory for the 21st century, leading to the emergence of alternative therapies and approaches, such as the humanist and the more recent mindfulness approach. The tools and technology available to contemporary research are helping, now more than ever to determine which is more effective, but not necessarily excluding one over the other. In my opinion, cognitive-behavioural therapy is a more effective approach because of its roots in the scientific method as well as the growing evidence of its effect on the wiring of the brain, thus leading me to conclude that it is a more efficacious approach in understanding fear and sadness.

References

Beck, A. T. (1976). “Cognitive Therapy and the Emotional Disorders”. New Yotk: International Universities press.

Langdridge, D. (2016). Existential Psychotherapy. In T. O. University, Understanding Counselling and Psychotherapy (pp. 125-143). London: The Open University.

Mason, L. Peters, E.Williams, S.C. and Kumari, V. (2017). “Brain connectivity changes occurring following cognitive”. Translational Psychiatry, 7. doi:doi:10.1038/tp.2016.263. Online, accessed on January 28, 2017. Available at http://www.nature.com/tp/journal/v7/n1/full/tp2016263a.html#aff2

Kathryn McHugh, R. Sarah W. Whitton, Ph.D., Andrew D. Peckham, B.A., Jeffrey A. Welge, Ph.D., and Michael W. Otto, Ph.D (2013). “Patient Preference for Psychological vs. Pharmacological Treatment of Psychiatric Disorders: A Meta-Analytic Review”. The Journal of Clinical Psychiatry, 74(6), 595-602. doi:10.4088/JCP.12r07757. Online, accessed on January 28, 2017. Available at https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4156137/

Salkovskis, P. M. (2016). Cognitive-Behavioural Therapy. In The Open University, “Understanding Counselling and Psychotherapy” (pp. 145-166). London: The Open University.

Spiegel, D. (2015). “Existential Psychotherapy for Patients”. JOURNAL OF CLINICAL ONCOLOGY, 33(24). Online, Accessed on January 28, 2017, from http://ascopubs.org/doi/pdf/10.1200/JCO.2015.62.2365

Stanford University. (2016, July). “Søren Kierkegaard”. Online, accessed on January 28, 2017, from Stanford Encyclopedia of Philosophy: https://plato.stanford.edu/entries/kierkegaard/