Concerned About Unconventional Mental Health Interventions?

Concerned About Unconventional Mental Health Interventions?
Alternative Psychotherapies: Evaluating Unconventional Mental Health Treatments

Tuesday, April 19, 2016

Time-Outs, Time-Ins: Good, Bad, and Badly Misunderstood

A brief article published a couple of years ago in Time magazine is still getting a lot of attention. This piece, written by Daniel Siegel and Tina Payne Bryson, was entitled “ ‘Time-Outs’ Are Hurting Your Child” ( ). Siegel and Bryson began with the statement that painful experiences can “change the structure of the brain”  (though they did not follow up by saying what behavioral or mood changes might result, if any). They noted that emotional pain activates the same brain areas as physical pain, commented that isolation can be emotionally painful, and concluded that children who were temporarily isolated in “time-out” may be damaged by the experience. They advised that “time-out” should give way to “time-in” to give increased experience of warm affection.

Members of the Society of Clinical Child and Adolescent Psychology, Division 53 of the American Psychological Association, have been quite concerned about the inaccuracies in these statements. In a press release headed “Outrageous claims regarding the appropriateness of Time Out have no basis in science”, members of the division pointed out the highly selective cherry-picking of neurological evidence that Siegel and Bryson made use of, and noted that there were decades of research supporting the safety and efficacy of “time out”, and little or none supporting “time in”.

The efforts of Siegel and Bryson to argue that “time outs” or harmful were characterized by a common theme among pitchers of woo--  that when the brain is “changed” by events, that the outcome is of necessity a bad one. This ignores the fact that the brain is constantly changing in structure and function because of maturational factors, and is simultaneously being changed as memories of experiences of all kinds are formed. The outcomes of these changes are generally positive, so it is absurd to present “changes in the brain” as evidence of harm. The first problem is to show that an experience (“time out”, for instance) is regularly followed by undesirable behavioral or attitudinal changes; if this had been accomplished, which it has not, the next step would be to trace the brain events that cause the connection between the experience and the bad outcome.

Like all other organisms, children change their behavior in response to reinforcing events that follow behaviors. If something nice happens after you do something, you become more likely to repeat that action. Unfortunately, sometimes behaviors that other people do not want or like get reinforced by accident. For example, most children will cut back on a behavior that gets them scolded and yelled at, but a child who gets very little attention may find that being focused on by an angry adult has reinforcing power. It’s not the yelling itself, but the attention, that reinforces the behavior. Similarly, a preschool child who acts up may find that although the teacher does not reinforce the behavior, all the other kids are excited and interested and attentive--  that reinforces the behavior and makes it more likely to be repeated.  

If children are “being bad” because an undesirable behavior has been reinforced in the past, the unwanted behavior can be reduced by making sure that it does not get reinforced.  The purpose of “time out” is to prevent reinforcement by removing the child temporarily from a potentially reinforcing situation. If done consistently, this is an effective approach--- but ONLY if the unwanted behavior has reached its present frequency because it was reinforced in some way by the social environment.

If a behavior is self-reinforcing, like eating when hungry, scratching an itch, or masturbating, unless it has also been socially reinforced, “time-out” will not affect its frequency. Neither will “time-out” reduce seizures or periods of inattentiveness due to neurological disorders, or fearful behavior stemming from previous traumatic experiences, or attention-getting behavior resulting from the absence of normal adult attention. The reason to choose a method other than “time-out” is that a specific behavior may not have developed as a result of reinforcement, and it will not diminish as a result of non-reinforcement. Under those circumstances, “time-in” and increased interaction with an adult may be helpful to a child who needs social support in order to do his or her best.

“Time-out” is not always the best choice--  but this is not because it “changes the brain” in some mysterious but threatening way.

P.S. Then there’s my two-year-old granddaughter, who when sent to “time-out” trots off looking very pleased with herself as she does just what her older brother is sent to do! Is this experiencing actually reinforcing for her? Maybe, but after all she wasn’t so very naughty to begin with…

Saturday, April 9, 2016

How Kids Enlist in the Culture Wars

Anyone who has been watching American political events this year will be aware of the reasons for the term “culture wars”. We’re not just watching groups of people who happen to agree with each other and not with their opposite numbers; we’re watching groups each bound together by beliefs and practices, and each disapproving strongly of the other’s positions. The beliefs and practices of each group are defined as cultures because they are taught and learned by members whose group shares them. The “war” part is unfortunately pretty obvious these days.

Although the United States is fortunately multicultural, there are two broad groups (each a coalition of smaller groups) that form the cultures now struggling in the political arena. The first of these is a modernist, progressive, liberal group,  consisting of the mainstream religious bodies combined with the secular humanists, whose beliefs and practices are not very different from those of the liberal churches. The second group is traditionalist, fundamentalist, and conservative. As adults, the two groups display strong differences in attitudes and preferred behaviors associated with a variety of issues. For examples of differences in the beliefs of these two groups, we can look at attitudes toward contraception and abortion, toward same-sex marriage, and toward reports of global warming.

Not surprisingly, the modernist and traditionalist groups each do their best to inculcate their beliefs and practices into children growing up in their groups. But how do they do this? When do the children begin to share the adult attitudes? Are modernist 5-year-olds and fundamentalist 5-year-olds already very different in their thinking? Or does it take years of teaching and cognitive development before differences are evident? Gilbert and Sullivan claimed that “Every boy and every gal that’s born into this world alive/ Is either a little liberAL or else a little conservaTIVE”. Were they right?

These are not easy questions to answer, but some help has been provided in a recent article (Jensen, L.E., & McKenzie, J. [2016]. The moral reasoning of U.S. evangelical and mainline Protestant children, adolescents, and adults: A cultural-developmental study. Child Development, 87[2], 446-464; N.B., if you look at this paper—I think the captions to figures 2 and 3 are reversed). Jensen and McKenzie compared moral reasoning in members of two Presbyterian groups, the modernist Presbyterian Church (USA) and the fundamentalist Presbyterian Church in America (PCA). The first is a member of the National Council of Churches, the second a member of the National Association of Evangelicals. (Although I mentioned earlier that secular humanists might share a good deal with the modernist churches, I want to point out that no secular humanists were included here, and the results of this study may not apply to them as well.) Interviews about moral judgments and reasoning were carried out with 60 members of each church, the groups divided evenly into 7-12-year-olds, 13-18-year-olds, and adults ages 36-57. For example, at one point, interviewees were asked whether they could tell about a time when they had an important experience involving a moral issue—this might be a situation where they now think their actions were morally right, or they may now seem morally wrong. 

Of course most people find it difficult to explain all the details of their moral reasoning and judgment, whether they think an action is right or whether they think it’s wrong. Jensen and McKenzie worked out some details of the interviewees’ thinking by analyzing issues and answers on three dimensions. One was the age of the participant, a piece of information that would help establish developmental change in moral reasoning. A second was whether the moral issue being discussed was a private experience (like drug use, behavior toward friends, theft, or volunteering) or had to do with public sphere (like giving money to panhandlers, divorce, or capital punishment). The third dimension had to do with the ethical perspective taken. The authors referred to the three possibilities as follows: The Ethic of Autonomy focuses on harm to the self and the interests of the self and the needs of other individuals (as unique persons, not simply as group members). These moral decisions attempt to protect the self and other individuals, and this type of moral reasoning begins in early childhood and persists into adulthood. The Ethic of Community makes moral decisions on the basis of duties toward group needs, initially the family and later schools and even broader social organizations, whose harmony is seen as important. This type of moral reasoning is minimal in early childhood and may gradually increase through adolescence and into adulthood. Finally, the Ethic of Divinity stresses the role of spiritual or religious entities, with moral decisions involving obedience to a god’s authority, natural law, or spiritual purity. The last ethic has received much less research attention than the others.

Jensen and McKenzie’s interviewees used the Ethic of Autonomy most as children and decreased this perspective somewhat through adolescence and into adulthood. The Community perspective increased for everyone from childhood into adulthood.

The great difference between the groups was in the use of the Ethic of Divinity—rare even among evangelical children, almost nonexistent among modernist children, and increasing with age through adolescence, but by far most common among fundamentalist adults thinking about public moral issues (e.g., same-sex marriage).  Mainline adults, though less likely to use the Ethic of Divinity at all, applied it more often in the private than in the public sphere. A major difference between modernist and fundamentalist adults was in the appeal to scriptural authority, with Bibles being used and on display in fundamentalist households but rarely referenced by modernists.

 Jensen and McKenzie pointed out that the two “armies” in the current culture wars are not committed to the same “moral lingua franca” and therefore find themselves unable to carry out any real discussion of their differences. This is not so much a problem in childhood, when evangelical and mainline children tend to share the Ethic of Autonomy, but looms large after adolescence, when evangelicals emphasize the Ethic of Divinity, a perspective rarely taken by modernists.

That such different moral languages are spoken by the two major  groups may be one of the reasons for the current intense emphasis on angry emotion in politics. Neither understands what the other is saying, and the discussion is regrettably reduced to mime. Can we generalize this view to an explanation of world-wide conflicts? I think that’s possible—but such thinking is only a baby step toward  resolution on any stage.