child throwing tantrum

How to Deal with Your Child’s Tantrums

Tantrums are sudden outburst of childish rage or temper. They involve intense emotions like that of anger, loss, frustration, and disappointment which can result in a child crying loudly, throwing things, biting, kicking, or head banging. Interestingly, they are quite common among children of 1-4 years of age, and almost every child goes through them. Tantrums are actually a child’s way of dealing with an unpleasant or frustrating situation. Temper tantrums in toddlers are often a result of frustration. Since a child of 2-3 years has limited vocabulary to express how he or she is exactly feeling and often have difficulty in finding a solution to a problem that he or she encounters; this leads to a feeling of frustration  and anger and is often expressed in the form of tantrums. No matter how common tantrums are, they can pose a huge challenge for parents and often cause great distress to them. However, if dealt properly tantrums can very well be prevented and managed when they happen. Knowing the reason behind your child’s tantrums can help you prevent the sudden outbursts. Some kids are naturally more prone to temper tantrums due to temperamental issues; they are more sensitive and get easily upset; also, stress, hunger, and tiredness can also lead the kids to throw tantrums. Additionally, sometimes kids find themselves in situations that are beyond their coping levels, situations that can be emotionally overwhelming. Here are a few ways to deal with and manage your child’s tantrums:

  1. Stay calm: It may be easier said than done, to remain calm when you find yourself in the middle of your child’s emotional outburst—when he or she start crying loudly, kicking, biting, throwing things at you. You are bound to react, but the key to managing tantrums, being a parent, is remaining as calm as possible. Reacting with an angry outburst will only make the situation worse. Speak slowly in a calm composed manner. As a thumb rule, if you see your child yelling or crying loudly, speak as softly and in a voice as low as possible. Do not try to reason with child as it is very late once a tantrum has started.
  2. Acknowledge the emotions: Very small children throwing tantrum mostly don’t know how to express their emotions and they don’t even know how to label each and every emotion they go through. When your children throw a tantrum help them acknowledge their emotions. If you see that your child is throwing tantrum as a way to express anger, tell him or her, “I know you are angry or upset.”
  3. Allow them to choose: Most of the time a toddler throws a tantrum over things that involve a sense of control. In situations where your child wants to assert his or her own choice especially over issues such as what to eat or wear, it is better to allow your child a little bit of control. Let your child decide what he or she wants to eat or wear or which toy he or she wants to bring along. Give them a chance to decide by giving them two or more options. Don’t make a big deal out of your child’s choice of a weird food combination or if he or she decides to wear some bizarre clothing.
  4. Appreciate good behavior: Find instances when your child behaves in a calm manner in a situation that would have normally caused a tantrum and praise your child effusively—give a pat on their back or hug. Tell him or her “you did wonderful!” This will help your child understand the behavior that is appreciated.
  5. Maintain a routine: It is important to follow a routine. Sudden change in activity sometimes makes children upset and restless. Play-time, lunch/dinner-time, sleep, everything should follow a routine. If you are about to introduce a change in the routine activity or schedule, let your child know five to ten minutes in advance. Say for example, your child is playing, and suddenly you realize that you have guests coming in half an hour, tell your child that he/she has five minutes of more play-time left today as you are expecting guests. Also ensure, especially in case the child is a toddler, that he or she is getting appropriate rest and sleep and is well fed. Sometimes hunger, fatigue, and sleeplessness may make little kids irritable and ultimately trigger a tantrum.
  6. Be consistent with rules: You need to establish some rules early on and follow them consistently. Rules work as a guide to what behavior is accepted and what is not.
  7. Build emotional vocabulary: Toddlers often have limited vocabulary especially when it comes to communicating their feelings. Help them learn emotional vocabulary by finding situations where you label their emotions. You can even engage in role-play of emotions with your child to build his or her emotional vocabulary.
  8. Whether to ignore or not: While many suggest that ignoring a tantrum will stop it. But this is a tricky matter. Imagine you are upset or feeling low and everyone around you starts ignoring you, how would you feel. Same is the case with children. A tantrum, as we know, is an emotional outburst. Suppose your child is upset because his or her sibling took away his or her favorite toy, and you, instead of addressing the issue, ignore his or her displeasure—imagine how frustrating it can be for the child. In a long run, this tactic of ignoring will not only be futile but is also going to set up a bad example as far as the child’s responsiveness to other’s plight is concerned. Your child will learn that whenever people are upset it is better to ignore them. Or, if you feel upset don’t reach out to the loved ones as they are going to ignore you. Thus, when your child throws a tantrum, it is better to go to your child, give him/her a hug and acknowledge his or her feelings.

In cases when you are not able to reach out to your child right away, wait till your child calms down and then hug the child and tell him/her that you were aware of their emotional outburst and now that they are calm, you can help them or comfort them. Most importantly, if you do feel that, in a certain situation, responding to your child’s tantrum will only encourage the child for worse, make sure, while ignoring the tantrum, that your child is safe and well within your visibility so that you can observe his or her reaction.

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Compassionate nurse

Where Is the Compassion in Psychiatric Care?

“There is nothing weak about kindness and compassion,” former President Barack Obama said in his eulogy of Elijah Cummings, the Democratic Congressman who died last week. “There is nothing weak about looking out for others. There is nothing weak about being honorable. You are not a sucker to have integrity and to treat others with respect.”

While President Obama was speaking about a man working in the highly polarized world of partisan politics, I heard his message as a psychiatrist, working in a field that too often views compassion as unnecessary and even as a professional weakness.

One local hospital’s psychiatric services website states of its mission:

“To provide our patients with the best care, we depend on the compassion, expertise, and strength of one another. We come to work knowing that our patients need us and that our colleagues support us and this allows us to strive daily to be the best health care providers — and people — that we can be.”

Frankly, talk is cheap. Too many hospitals fail to live up to the mission statements they proudly display.

I know many excellent psychiatrists and psychiatric nurses whom I would confidently recommend to someone I love. To me, this is the greatest mark of professional respect. However, a few of my colleagues disgrace their profession and blemish the work of the compassionate, enlightened majority who strive to maintain their patients’ dignity.

Sadly, I have learned from too many of my own patients about unprofessional, demeaning, abusive treatment they suffered at the hands of both doctors and nurses at psychiatric clinics and hospitals across the country. I have witnessed this offensive behavior first-hand since I was in medical school.

Most of my patients who have been admitted to a psychiatric unit describe the experience as traumatic, terrifying, or both. One went directly from my office, accompanied by a parent, to the hospital. Within a few hours, her clothing had been forcibly removed by a group of security personnel, including men, one of whom groped her breasts. She was so traumatized by the abusive treatment she endured that she refused to return to the hospital when she needed help. Instead, she took her own life.

Other patients have recounted being held down and forcibly injected when they were not being aggressive or combative. Another was humiliated by the taunts of a nurse and a ward clerk. (I witnessed this myself.)

Due to the cruelty my patients have encountered, and through many years of experience, I fear for the safety of patients when they become acutely ill. Of course, I worry about the harm their brains and bodies may sustain due to their illness, but I also fear how they will be treated by the staff they will encounter if admitted.

Those admitted to a psychiatric unit are usually very ill, sometimes disruptive, and potentially violent. Due to the severity of their symptoms, they might lack insight regarding the nature of their illness and their need for treatment, yet they are still human beings worthy of respect.

Some staff on psychiatric units excuse their hostile, dehumanizing patient interactions as a necessary response to a dangerous working environment. Their appalling behavior is not about the safety of staff or patients; it reflects a desire, whether by an individual or the entire clinical team, to exercise power over a vulnerable individual. If their behavior is acceptable, reasonable, and appropriate, why do they always deny it occurred? Invariably, the patient is blamed or accused of dishonesty.

Psychiatrists and their clinical teams are given extraordinary power to limit a patient’s freedom and to treat an ill person who lacks insight, sometimes against their will. Patients and families trust us to use that power responsibly.

We are judged as a society by how we treat our most vulnerable members. The abuse of power and the use of humiliation and violence demonstrated by some staff on psychiatric units have no place in a just and civilized society, much less in a medical setting, which is meant to be both safe and settling.

Those individuals who abuse patients, or fail to protect them, must be held accountable by colleagues, professional licensing bodies, and patients and their families. Regrettably, a complaint from one doctor is easy for a hospital to ignore. To provoke meaningful change, we all need to speak up.

I urge anyone who experiences or witnesses a dehumanizing, threatening, traumatizing or humiliating psychiatric clinic or hospital interaction to speak out. Write to the hospital, health authority, or professional college where the event occurred. Then, perhaps the hospitals and licensing bodies will demand that mental health professionals do what they’re supposed to do — care.

Source link: https://www.psychologytoday.com/intl/blog/psyched/201910/where-is-the-compassion-in-psychiatric-care

man looking at tiger

The Most Subtle Yet Insidious Forms of Passive Aggression

Microaggressions that should not go unchecked.

Overtly aggressive people may be hard to stay clear off, but they are not hard to miss. Passive-aggressive people, by contrast, use much more subtle tactics to aggress against you. But passive aggression can be just as insidious and hurtful as its overt sibling.

Passive aggression can be extremely upsetting because we are very good at picking up on even the most subtle forms of hostile behavior, even though we are not always consciously aware of what it is we are picking up on.

Your unconscious brain can detect barely noticeable changes in facial expression, body language, body posture and direction, and changes in behavioral patterns. Once your unconscious brain detects hostility in another person, it activates the amygdala—an area of the brain that processes fear—or other brain regions associated with a fight-or-flight response. This physiological change can make you feel anxious, fearful, worried, stressed out, or just ill at ease.

The special problem that passive aggression poses is that you often cannot put your finger on what is wrong. Your unconscious brain is telling you that the other person has negative feelings toward you. Yet because of the subtly of how the aggression is manifested, it’s easy to write it off as normal behavior, especially if the other person insists that nothing is wrong. For example, you feel that your partner is acting more distant toward you than they normally would. When you ask them, they say nothing is wrong. But the feeling that something is off doesn’t go away.

If you are continually exposed to passive-aggressive behavior from the same person, and they keep denying that anything is wrong, you may start to question your own judgment and ultimately your own sanity. However, the truth is that if you repeatedly feel that something is wrong, probably something is wrong. Although we are unusually adept at detecting passive aggression unconsciously, it takes more careful attention to consciously spot it. The following are a few examples of fairly common but exceptionally subtle forms of passive aggression.

Diminished Eye Contact

If a person you know fairly well isn’t making as much eye contact with you as they usually do over an extended period of time, then that’s a signal that something is wrong but that they are unwilling to tell you for whatever reason. Instead of talking to you, they choose to deal with their negative feelings by distancing themselves from you, which can manifest itself in subtle ways, such as diminished eye contact.

Diminished eye contact isn’t necessarily deliberate. Nor does it always imply that the other person is angry with you. They could be feeling guilty about something they have done to you. Or they could be dealing with problems that have nothing to do with you. But if it’s your business to know what’s going on, and they deliberately don’t tell you, then it’s passive aggression.

Persistent Forgetting

Continually forgetting to do something is another sign of passive aggression to watch out for. Some people are generally forgetful, disorganized, or easily distracted, but there are limits to how much forgetting you should put up with if people are otherwise mentally healthy.

The reason people deliberately forget, or deliberately do something that they know will make them forget, is that they really don’t want to do what they have promised you or what is expected of them. Yet they also don’t want to tell you that they don’t want to do what they promised or what’s expected. For example, if you have a standing agreement with your live-in partner that you put dirty dishes in the dishwasher immediately after using them instead of letting them pile up on the counter, but your partner frequently leaves dirty dishes behind, then it’s probably a sign of deliberate forgetting—or at least that’s a reasonable conclusion if you have confronted them, and it keeps happening.

Ignoring You During a Group Conversation

If a person is ignoring you when you pass them on the street or in the hallway, this could just be a sign that they are not very perceptive or that they need a new eyeglass prescription. But when there doesn’t seem to be any other rational explanation for why another person would ignore you, then they are most likely acting passive-aggressively.

This form of passive aggression may happen during a group conversation. Suppose you and your friend Sid from college are talking to the speaker after his or her talk, yet the speaker immediately direct their attention to Sid and begins asking him questions about his research interests, mostly ignoring you, that’s a very good sign that they probably think less of you or don’t like you for whatever reason. Their subtle behavior gives it away.

When people ignore you in a conversation, it can be somewhat less deliberate. For example, the speaker in the above scenario might have an implicit bias against you. Let’s suppose you are a woman and that the speaker implicitly thinks that Sid is smarter than you by virtue of being a man. In this case, the speaker’s subtly rude behavior is a form of bias-driven microaggression. But this does not rule out that the aggressor should be held accountable, because not all implicit biases are created equal.

If an outsider—call them Pat— had observed your group conversation and had noticed the speaker’s subtly hostile behavior toward you, Pat could have asked the speaker: “What were you just doing?” The speaker might answer: “I was asking Sid questions about his research interests.” But if questioned a bit further, perhaps they will eventually admit: “Yes, it’s true that I didn’t ask Sally about her work but I didn’t mean to act biased against her.” But in terms of the quality of the excuse, this is on a par with a murderer saying: “Yes, I stabbed her with a knife but I didn’t mean to harm her.”

Source link: https://www.psychologytoday.com/intl/blog/the-mysteries-love/201910/the-most-subtle-yet-insidious-forms-passive-aggression

The movie Dark Knight's Joker doll

Are Psychopaths Sexy?

Psychopaths exert a strange allure. The fictional psychopath has been a staple of film and television for decades, and the popularity of true-crime podcasts and streaming-service documentary series suggests that our fascination with psychopathy is on the increase.

A curiosity about the psychological precursors of manipulative or violent behavior can be laudable: If we understand psychopathy we will be better able to address its negative consequences. However, interest in psychopaths often appears to be motivated less by a desire to learn than by a desire for the psychopaths themselves.

In the wake of Netflix’s Ted Bundy Tapes, viewers flooded social media to declare that Bundy — a convicted serial killer — was hot. Cinema, too, is littered with portrayals of sexy psychopaths, played by actors such as Christian Bale (American Psycho), Zac Efron (Extremely Wicked, Shockingly Evil and Vile), Rosamund Pike (Gone Girl), and Sharon Stone (Basic Instinct).

Why do we find psychopaths so interesting and, in some cases, attractive?

According to new research, it shouldn’t be surprising. A pair of psychologists from Ontario, Canada have suggested that psychopathy may, in fact, be a tactic for attracting sexual partners.

Fake It Till You Make It

Kristopher Brazil of Brock University and Adelle Forth of Carleton University point out that success in relationships is influenced by a person’s attractiveness. A person is judged more attractive if they possess qualities in demand within their pool of potential partners. These qualities can include physical appearance, but also sincerity, honesty, success, and access to resources such as money. People who do not possess these qualities are at a disadvantage in the mating market. Brazil and Forth hypothesize that psychopaths may be motivated to fake attractive qualities in an effort to secure access to partners who would otherwise not be interested.

This hypothesis is bolstered by past research indicating that people high in psychopathy tend to be egocentric, promiscuous, and sexually opportunistic; to be more willing to lie and cheat; and to exhibit a superficial charm and an ability to inhibit emotional “leakage” (giving away one’s true feelings).

To test their theory, Brazil and Forth recruited around 50 young men from a Canadian university. Each man was introduced to a female volunteer (actually a confederate of the researchers). The pair was prompted to discuss what each liked to do on a first date or what they thought was important in a relationship. The conversations were video recorded. Afterward, the men completed a psychopathy survey.

An independent group of around 100 women viewed these videos and rated each man on his desirability as a dating partner. The women were also asked to imagine that each man had expressed a desire to meet up with them, and to record a voicemail for him to arrange a date. Of course, these voicemails were never delivered to the men. Instead, the scientists analyzed the voice for pitch.

Desirable Psychopaths

Brazil and Forth found that men who scored higher on the psychopathy questionnaire were rated more desirable by women. But why were the psychopaths more attractive? It’s possible they were physically more alluring that the men who scored lower on psychopathy. That’s why the psychologists statistically controlled for the physical attractiveness of the men. Even after discounting the effect of appearance, more psychopathic men were more desirable, which suggests that their greater appeal stems from their non-verbal behavior.

Brazil and Forth also expected that women would raise the pitch of their voices when recording voicemails for men higher in psychopathy, because previous research has indicated that women increase the frequency of their voice pitch (whether consciously or unconsciously) when conversing with attractive men. This hypothesis was not supported, although exploratory analyses suggested that women’s vocal changes might depend on a man’s pattern of psychopathic traits. Women tended to increase the pitch of their voices when recording a message for a man higher in the affective component of psychopathy (shallow emotions, callousness, lack of concern for others) and to lower their pitch in response to men higher in the antisocial component (disregard for authority, poor anger controls). It seems that not all psychopaths are equal, nor equally attractive.

Although it is unlikely that psychopathy is a tactic in the sense that it is a consciously enacted plan—people who exhibit psychopathic tendencies are not able to shed or adopt personality traits at will—Brazil and Forth conclude that their results “suggest that psychopathy in men may enable them to ‘enact’ the desirable qualities women prefer in social and dating encounters.”

It should be noted that psychopathy is a spectrum and that the type of psychopath who ends up as the subject of a Netflix true-crime series is an extreme example. The allure of the everyday garden-variety psychopath of the sort one might find studying at a Canadian university, for instance, may not be all that surprising, especially if such men are are able to simulate a marginally more appealing personality than that which comes naturally.

Brazil and Forth are also at pains to point out that their study only speaks to a possible evolutionary function of psychopathy, but does not seek to excuse or justify the negative behavior of psychopaths.

References:

Brazil, K. J., & Forth, A. E. (in press). Psychopathy and the induction of desire: formulating and testing an evolutionary hypothesis. Evolutionary Psychological Science. doi:10.1007/s40806–019–00213–0

Source link: https://www.psychologytoday.com/intl/blog/attraction-evolved/201910/are-psychopaths-sexy

Reducing the Stigma of Mental Illness in Middle School — Free Spirit Publishing Blog

As educators, we believe that the educational environment should be inclusive and welcoming to all students. We can celebrate vibrant cultures, recognize boundless gender roles, and identify shifting home lives. But the more we evolve, the more we see that there are also hidden characteristics and more discrete inclusions to consider. Students…

via Reducing the Stigma of Mental Illness in Middle School — Free Spirit Publishing Blog

Banner carrying Constructive feedback as text

How to Master the Art of Constructive Feedback

There are instances when you genuinely want to help a person improve or give suggestions for his/her betterment while there are also times when you simply need to evaluate a person’s performance in an organizational set-up. However, very often you find that, instead of being taken in a positive light your feedback is either ignored altogether or not well received, making the target person rather angry or defensive. This could be because you have not yet realized that giving constructive feedback is an art which needs to be mastered.

Feedback forms an important part of communication process and serves to convey how a person is functioning or how his or her behavior is affecting us and others around him or her. This feedback can be positive or negative.

Positive feedback is generally used to point out to the person, what he/she has been doing right and encourage the person to continue with the behavior. Whereas, negative feedback is used to point out the shortcomings and bring about an improvement in that person’s behavior. Positive feedback is much easier to give, as it is readily accepted by the receiver; however, giving negative feedback requires special skills, so that the receiver doesn’t get defensive and remains open to your criticism or suggestions. Negative feedback should be helpful and so, merely pointing out the faults should not be the sole purpose of this feedback. We must bear in mind that the purpose of this feedback is much more crucial, that is, to help the receiver be better than before and make him/her work on his/her shortcomings. Therefore, we choose the word constructive feedback.

Having the ability to give constructive feedback can help managers enhance their team performance or can help teachers mold the behavior of their students. This skill can also come in handy in personal relationships where you want your spouse, children, friend, or loved ones, to correct a few things in order to  be a better version of themselves. After all, we all have some weaknesses and shortcomings, and constructive feedback, if given carefully, can be of great help in overcoming those. Following are some tips to make your feedback more constructive, helpful and receiver-friendly:

1. Descriptive: Try to make your feedback as descriptive as possible. It should also be clear and specific about the behavior you want to encourage or change. Saying “you are not doing well” is not enough. It is too vague and leaves the person wondering about what needs to be done. Therefore, describe completely what the concerned person should do or improved.

2. Appropriate time: Make sure you give your feedback at the earliest and at the most appropriate time. If you take too long to give your feedback, you may forget about the specifics of the situation and behavior and it is likely that the receiver too does not remember the situation. Moreover, taking too long to give feedback may give a wrong impression to the receiver that what he or she has been doing is acceptable, and then, when you finally give your feedback, he or she may not be as open to it.

3. Constructive ideas: Especially when feedback is negative, it is important to include constructive ideas about how to improve. Offer assistance in the process of improvement and betterment. Saying “your performance was terrible” connotes that the person already knows for sure what went wrong and how to correct it, whereas in reality, this might not be the case. Hence, for a constructive feedback, it is important that the person giving the feedback must also help the receiver in finding the solution.

4. Consistency: Be consistent with giving constructive feedback. Especially in the professional world, consistency in giving feedback has been found to be much more effective and credible. Make it a part of your regular interaction with your juniors and co-workers for maximum impact.

5. Don’t get personal: While giving negative feedback, never get personal and do not target the person. Rather, focus on the behavior or action that needs to be changed. Never criticize the person or make personal attacks. For example, while judging your friend’s singing skills, commenting upon his pitch, notes and song choice etc, can help him improve his performance as a singer, but telling that he has a bad voice quality is something that is not much helpful because, he can’t change his voice. Here, the former makes your criticism constructive, while the latter may just hurt the person and make him feel bad.

6. Never demean: Never use negative feedback as a tool to demean the other person. Never bring your personal agenda to the equation and refrain from using negative feedback as a means to make the other person feel inferior or to take revenge.

7. Positive feedback: Don’t use feedback for pointing out only the faults or shortcomings of a person. Instead focus on giving positive feedback as well. Point out the strengths of the person and appreciate his or her positives as well. Some people think that feedback is just to point out the negatives, but the fact is that a balanced feedback that focuses on positives as well as on negatives is much more readily accepted and considered credible.

8. Purpose: Never forget that the purpose of a feedback is to bring change and improvement and not to hurt the feelings of the person.

9. Listen: While giving your feedback, make sure you give the person a chance to respond too. Do listen to his or her viewpoint and interpretations patiently, and give them a chance to defend their view.

Also read:
8 Ways to Build a Positive and Healthy Body Image
8 Powerful Ways to Boost Your Self-Esteem

a man taking a peldge while lying

Study Explains Why People Lie

We all were probably taught to never lie but there would be rarely anyone who can truthfully claim that he or she doesn’t lie or hasn’t lied in life, ever. Depending upon the demands of the situation, we might tell a lie for harmless reasons like to avoid awkward situations, protect others, or avoid hurting others’ feelings, or, for some other reasons that are much serious and can potentially wreak havoc on our lives. However, there are some people who lie out of habit. And, the more they lie, the easier and more frequent this behaviour becomes. Scientists have now discovered why liars lie.

Psychologists believe that children start lying at the age of two. Since lying involves paying attention to the environment, complex planning, and the ability to manipulate a situation, it is actually considered a crucial milestone in children’s development. While growing up, they keep on learning how to use this skill for their own benefit, and by the time they reach adulthood, their lies become much more clever, harder to catch, and easier to get away with.

Cognitive neuroscientist Joshua Greene from Harvard University investigated the physical process of lying during an experiment. Participants were given the opportunity to win money by lying. While some of them still stuck to being honest and told the truth, others resorted to deception. The MRI of the participants was performed to examine their brain activity during the study. The MRI reports revealed that there was an increased activity in the frontal parietal control network of the group of liars because deciding between honesty and lying requires hard and intricate thinking. Since the neural reward centers of the participants who won money by telling lies were more active, it can be assumed that lying may be a result of the inability to resist temptation.

However, there is still no scientific explanation as to why people tend to avoid lying and whether it is a result of conflict in their brains or an understanding of morality and self-control, or simply following the social norm. According to Dan Ariely, a behavioral psychologist at Duke, “We are our own judge about our own honesty. And that internal judge is what differentiates psychopaths and non-psychopaths.”

Apparently, despite that the urge to lie comes from within, external factors can influence the frequency too. Research has shown that people tend to be dishonest when they are suffering from stress or lack of sleep, or when they see others lying. “We as a society need to understand that when we don’t punish lying, we increase the probability it will happen again,” Ariely added.

Ariely and his colleagues conducted a study to show the change in participants’ brain while they are being dishonest. The study revealed that there was an increased activity in their amygdala, a part of the brain responsible for producing fear, anxiety and emotions. This change made lying or being dishonest easier for those participants. The signals from the amygdala reduced when they expected no consequences for being dishonest, such as when playing a game. Cognitive neuroscientist at University College London, Tali Sharot, who led the research said, “If you give people multiple opportunities to lie for their own benefit, they start with little lies and get bigger and bigger over time.”

Self-Fulfilling Prophecy

Self-fulfilling prophecy refers to a prediction that becomes true as a consequence of having been made. In other words, the expectancy becomes a cause, so that what is expected comes true because it was expected. A self-fulfilling prophecy can be directed at oneself, another person, a group, or even inanimate objects. The process involves three steps:

1. An individual forms an expectation of a situation or target person

2. That individual’s expectations affect how he or she behaves in the situation or treats the target person

3. The situation or the target person is affected by that individual’s behavior in a way that validates the individual’s initial expectation

Therefore, if a teacher of a class predicts a fall in the students’ grades, then the prediction is likely to bring about a fall in the students’ grades irrespective of any other factors, because students will be more likely to perform poorly in the assessments. Hence, expecting a particular outcome from somebody will bring change in the behavior, and this, in turn, will influence other’s response which will ultimately reinforce the former’s behavior and that’s how self-fulfilling prophecy works.

a woman undergoing ct scan in front of a doctor

Peer Pressure Influences CT Scan Use for Dizziness/Vertigo Patients

It is usually believed that peer pressure ends when a person becomes an adult. But this is, unfortunately, not the case. Adults are just as much subject to peer pressure as children and youth. Peer pressure is when a person or group of people attempts to cause another person to conform to some type of uniform code. Peer pressure among adults can happen anywhere, even at workplace and in general work practices.

A new study published in the journal Medicine has shown that peer pressure among emergency physicians (EPs) plays an important role in the use of computed tomography (CT) imaging, also known as CT scan, for dizziness or vertigo patients. A team comprising researchers from Kaohsiung Chang Gung Memorial Hospital, Niao-Sung, Taiwan and Chang Gung University College of Medicine, Taoyuan City, Taiwan evaluated the effect of peer pressure on decision making in EPs to use CT scan for patients with dizziness/vertigo.

Dizziness is a common complaint in the emergency department (ED), accounting for 2.5% of all ED visits in the United States. While the most common causes of dizziness/vertigo are benign, a potentially serious underlying disease, such as cerebellar or brain stem stroke, may go unnoticed. Due to the uncertainty and cost of a misdiagnosis, EPs may reduce the testing threshold for brain imaging in handling these low-probability, high-morbidity situations. But unnecessary head CT examination may lead to prolonged ED stay, increased medical costs, and exposure to radiation (a potential carcinogen).

The use of CT imaging to examine patients presenting with dizziness has increased exceedingly, from 9.4% to 37.4% in the United States between 1995 and 2009. A previous study had showed that EPs vary in their respective decisions to either admit or discharge general ED patients. Senior EPs were found to have lower discharge rates compared with their junior colleagues.

The purpose of this study was, therefore, to evaluate the peer-pressure effect on the decisions of CT use for dizziness/vertigo patients by EPs with varying seniority. The EPs were categorized into 3 groups according to seniority. Group “>V12” consisted of 10 senior physicians with more than 12 years of work experience. Group “V7-V12” consisted of 9 physicians with 7 to 12 years of work experience (intermediate seniority). Group “<V7” consisted of 10 junior physicians with <7 years of work experience.

The study intervention used a behavior modifying measure by creating a “team norm” that imposed an unspoken peer pressure effect by announcing the CT-use rate of each EP by monthly e-mail reminders. Norms are the rules that the team agrees to follow and designate a standard for average performance by the whole team. Once developed, team norms are used to guide and shape team members’ behavior.

The authors explained, “To evaluate the effectiveness of peer pressure on changing EP decisions concerning CT use for dizziness/vertigo patients, we created a ‘team norm’ imposed peer-pressure effect by announcing the CT use rate of each EP through monthly e-mail reminders. We also conducted a before-and-after retrospective case review of patients who visited the ED.”

The study was conducted in a tertiary academic medical center in Southern Taiwan with over 2500 acute beds and an average of 72,000 adult ED visits per year. The medical records of nontraumatic patients who were older than 17 years of age and visited the ED with a principal diagnosis of dizziness and vertigo were extracted from the ED administrative database using the International Classifications of Diseases Tenth Revision coding system.

“Our study group consisted of 3165 patients; 1657 were enrolled in pre-intervention group while 1508 were enrolled in post-intervention group. Patients were assessed by the 29 EPs in the department,” the authors said.

The intervention strategy presented herein applied peer pressure through e-mail reminders. The findings of the study revealed a decrease in CT use for patients with isolated dizziness/vertigo, particularly among junior EPs and in younger patients. Although the study has a few limitations pertaining to the generalizability of its conclusions to other ED settings, the method used in this study offers a promising option that can effectively decrease CT use and unnecessary medical costs in ED.

Also read 10 Techniques to Help Your Child Resist Peer Pressure