Tag Archives: economists

Therapist-free therapy

Looks like psychologist will be out of work soon and they will be replaced by computer programs. I never trust those talk therapy anyways, the couch only works in the movies.

Mar 3rd 2011, The Economist
Cognitive-bias modification may put the psychiatrist’s couch out of business

THE treatment, in the early 1880s, of an Austrian hysteric called Anna O is generally regarded as the beginning of talking-it-through as a form of therapy. But psychoanalysis, as this version of talk therapy became known, is an expensive procedure. Anna’s doctor, Josef Breuer, is estimated to have spent over 1,000 hours with her.

Since then, things have improved. A typical course of a modern talk therapy, such as cognitive behavioural therapy, consists of 12-16 hour-long sessions and is a reasonably efficient way of treating conditions like depression and anxiety (hysteria is no longer a recognised diagnosis). Medication, too, can bring rapid change. Nevertheless, treating disorders of the psyche is still a hit-and-miss affair, and not everyone wishes to bare his soul or take mind-altering drugs to deal with his problems. A new kind of treatment may, though, mean he does not have to. Cognitive-bias modification (CBM) appears to be effective after only a few 15-minute sessions, and involves neither drugs nor the discussion of feelings. It does not even need a therapist. All it requires is sitting in front of a computer and using a program that subtly alters harmful thought patterns.

This simple approach has already been shown to work for anxiety and addictions, and is now being tested for alcohol abuse, post-traumatic-stress disorder and several other disturbances of the mind. It is causing great excitement among researchers. As Yair Bar-Haim, a psychologist at Tel Aviv University who has been experimenting with it on patients as diverse as children and soldiers, puts it, “It’s not often that a new evidence-based treatment for a major psychopathology comes around.”

CBM is based on the idea that many psychological problems are caused by automatic, unconscious biases in thinking. People suffering from anxiety, for instance, may have what is known as an attentional bias towards threats: they are drawn irresistibly to things they perceive to be dangerous. Similar biases may affect memory and the interpretation of events. For example, if an acquaintance walks past without saying hello, it might mean either that he has ignored you or that he has not seen you. The anxious, according to the theory behind CBM, have a bias towards assuming the former and reacting accordingly.

The goal of CBM is to alter such biases, and doing so has proved surprisingly easy. A common way of debiasing attention is to show someone two words or pictures—one neutral and the other threatening—on a computer screen. In the case of social anxiety these might be a neutral face and a disgusted face. Presented with this choice, an anxious person instinctively focuses on the disgusted visage. The program, however, prods him to complete tasks involving the neutral picture, such as identifying letters that appear in its place on the screen. Repeating the procedure around a thousand times, over a total of two hours, changes the user’s tendency to focus on the anxious face. That change is then carried into the wider world.

Emily Holmes of Oxford University, who studies the use of CBM for depression, describes the process as like administering a cognitive vaccine. When challenged by reality in the form of, say, the unobservant friend, the recipient of the vaccine finds he is inoculated against inappropriate anxiety.

In a recent study of social anxiety by Norman Schmidt of Florida State University and his colleagues, which involved 36 volunteers who had been diagnosed with anxiety, half underwent eight short sessions of CBM and the rest were put in a control group and had no treatment. At the end of the study, a majority of the CBM volunteers no longer seemed anxious, whereas in the control group only 11% had shed their anxiety. Although it was only a small trial, these results compare favourably with those of existing treatments. An examination of standard talk therapy carried out in 2004, for instance, found that half of patients had a clinically significant reduction in symptoms. Trials of medications have similar success rates.

The latest research, which is on a larger scale and is due to be published this month in Psychological Science, tackles alcohol addiction. Past work has shown that many addicts have an approach bias for alcohol—in other words, they experience a physical pull towards it. (Arachnophobia, a form of this bias that is familiar to many people, works in the opposite way: if they encounter a spider, they recoil.)

This study, conducted by Reinout Wiers of the University of Amsterdam and his colleagues, attempted to correct the approach bias to alcohol with CBM. The 214 participants received either a standard addiction treatment—a form of talk therapy—or the standard treatment plus four 15-minute sessions of CBM. In the first group, 41% of participants were abstinent a year later; in the second, 54%. That is not a cure for alcoholism, but it is a significant improvement on talk therapy alone.

Many other researchers are now exploring CBM. A team at Harvard, led by Richard McNally, is seeking volunteers for a month-long programme that will use smart-phones to assess the technique’s effect on anxiety. And Dr Bar-Haim and his team are examining possible connections between cognitive biases and post-traumatic-stress disorder in the American and Israeli armies.

Not all disorders are amenable to CBM. One study, by Hannah Reese (also at Harvard) and her colleagues, showed that it is ineffective in countering arachnophobia (perhaps not surprising, since this may be an evolved response, rather than an acquired one). Moreover, Dr Wiers found that the approach bias towards alcohol is present in only about half of the drinkers he studies. He hypothesises that for the others, drinking is less about automatic impulses and more about making a conscious decision. In such cases CBM is unlikely to work.

Colin MacLeod of the University of Western Australia, one of the pioneers of the technique, thinks CBM is not quite ready for general use. He would like to see it go through some large, long-term, randomised clinical trials of the sort that would be needed if it were a drug, rather than a behavioural therapy. Nevertheless, CBM does look extremely promising, if only because it offers a way out for those whose answer to the question, “Do you want to talk about it?” is a resounding “No”

Driven to distraction

Mr. Pink is dead wrong. Intrinsic rewards and the pleasure gain from doing a job well only comes if the job is paid well. You will simply feel ripped off if you are not rewarded accordingly.

Jan 14th 2010, The Economist
Two and a half cheers for sticks and carrots

THIS is bonus season in the financial world. That means, of course, that it is bonus-bashing season everywhere else. The righteously outraged have no shortage of arguments on their side, from the mind-boggling size of the bonuses to the fact that the banks were recently rescued with public money. But if they want to mix a bit of theory with their spleen they now have a book to help them: Daniel Pink’s “Drive: The Surprising Truth About What Motivates Us”. It seems that bankers are not just slaves to greed. They are also slaves to a discredited management theory: the idea that the best way to motivate people is to use performance-related rewards.

Mr Pink’s argument is hardly new. Eminent management theorists have been dismissing payment-by-results as simplistic and mechanical ever since Frederick Taylor tried to turn it into the cornerstone of scientific management in the early 20th century. But Mr Pink’s book is nevertheless well-timed. The widespread fury about bonuses is sparking a wider debate about the way bankers and other lavishly remunerated people are paid. “Drive” is a decent summary of the anti-Taylorist school of thinking. And Mr Pink, once Al Gore’s chief speechwriter and now a prolific management writer, is a highly motivated self-publicist.

Mr Pink argues that the rich world is in the middle of a management revolution, from “motivation 2.0” to “motivation 3.0” (1.0 in this schema was prehistoric times, when people were motivated mainly by the fear of being eaten by wild animals). In the age of routine production it made sense for organisations to rely on sticks and carrots or “extrinsic motivators”, as he calls them. But today, with routine jobs being outsourced or automated, it makes more sense to rely on “intrinsic rewards”, or the pleasure we gain from doing a job well. Look at the success of collaborative marvels such as Wikipedia, Firefox or Linux, which were created by volunteers. Or look at the rise of social entrepreneurs or the movement to promote “low-profit” limited-liability firms.

Mr Pink argues that carrots and sticks are not only outdated, but can also be counterproductive—motivation killers and creativity dampeners. Paying people to give blood actually reduces the number who are willing to do so. Providing managers with financial rewards can encourage them to game the system or, even worse, to engage in reckless behaviour.

So how should firms motivate people? Mr Pink argues that the answer is to give them more control over their own lives and thus allow them to draw on their deep inner wells of diligence and drive. Software companies such as Atlassian and—of course—Google are giving workers time to pursue their own projects. Even low-tech firms such as Whole Foods and Best Buy are giving people more control over how and with whom they work.

How convincing is all this? Mr Pink insists that all he is doing is bringing the light of science to bear on management: “There’s been a mismatch between what science knows and what business does.” But this argument depends on a highly selective reading of the academic literature. Four reviews of research on the subject from the 1980s onwards have all come to the same conclusion: that pay-for-performance can increase productivity dramatically. A study of an American glass-installation company, for example, found that shifting from salaries to individual incentives increased productivity by 44%. More recent research on workers at a Chinese electronics factory also confirms that performance-related pay (especially the threat of losing income) is an excellent motivator (see article).

Linking pay to performance does not just increase motivation. It also helps to recruit and retain the most talented. The world’s brightest students are overwhelmingly attracted to organisations that make extensive use of performance-related rewards such as partnerships and share options. Firms are adept at using these rewards to encourage long-term loyalty: people work in the salt mines for years in the hope of becoming partners or senior managers. Companies that eschew extrinsic rewards risk lumbering themselves with sluggish dullards.
Self-determined to do better

What about Mr Pink’s other worries, about creativity and “self-determination”? It is certainly true that creative people value the intrinsic things in life. But an enthusiasm for intrinsic rewards can go hand in hand with a taste for extrinsic gain. American universities attract star professors from all around the world by the simple expedient of paying them lots of money. Successful writers employ agents to get the highest possible advances (Mr Pink himself probably hopes to make some money from his book). Creative centres such as Hollywood and Silicon Valley are also hotbeds of payment-by-results. It is true that some of the world’s best companies are putting more emphasis on “purpose”. But it is quite possible to mix this with pay-for-performance; indeed, companies that Mr Pink lauds, such as Google and Whole Foods, are highly skilled at using sticks and carrots.

All this suggests that Mr Pink has it backwards: far from abandoning sticks and carrots organisations are making ever more use of them. Companies are keener than ever on holding bosses’ feet to the fire by linking their pay to performance through stock options and the like and on firing them if they fail. But they are also trying to widen pay differentials further down the organisation: about 90% of American firms use merit pay, for example.

There is no doubt that sticks and carrots can be badly used. They can encourage risky behaviour, as they have in the banking system, or persuade policemen to focus on minor traffic infractions rather than violent criminals, as they have in Britain. But properly managed they can be immensely powerful tools for boosting productivity and attracting the right people. For all the battering he has taken over the past hundred years, Frederick Taylor still has the edge over his critics.