An Introduction to Psychology for the Middle East (and Beyond) [1 ed.] 9781527527195, 9781527511828

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An Introduction to Psychology for the Middle East (and Beyond)

An Introduction to Psychology for the Middle East (and Beyond) Edited by

Louise Lambert and Nausheen Pasha-Zaidi

An Introduction to Psychology for the Middle East (and Beyond) Edited by Louise Lambert and Nausheen Pasha-Zaidi This book first published 2018 Cambridge Scholars Publishing Lady Stephenson Library, Newcastle upon Tyne, NE6 2PA, UK British Library Cataloguing in Publication Data A catalogue record for this book is available from the British Library Copyright © 2018 by Louise Lambert, Nausheen Pasha-Zaidi and contributors All rights for this book reserved. No part of this book may be reproduced, stored in a retrieval system, or transmitted, in any form or by any means, electronic, mechanical, photocopying, recording or otherwise, without the prior permission of the copyright owner. ISBN (10): 1-5275-1182-0 ISBN (13): 978-1-5275-1182-8

Disclaimer The information provided in this book is designed to provide helpful information on the subjects discussed. This book is not meant to be used, nor should it be used, to diagnose or treat any psychological, medical or health condition. For diagnosis or treatment of any medical problem, consult a qualified professional. The views and opinions expressed in this book are those of the author(s) and do not necessarily reflect the views and opinions of the editors, their academic institutions, sponsors or publisher. Therefore, the publisher, editors, individual authors, and their organizations are not liable for any damages or negative consequences from any treatment, action, application or preparation, to any person reading or following the information in this book. Any sponsors of the textbook are also exempt from any liability. References are provided for informational purposes only and do not constitute endorsement of any particular sources. Readers should be aware that the websites listed in this book may change. While best efforts have been used in preparing this book, period updates and changes to the information may produce inconsistencies therein. In this event, every attempt shall be made by the editors to update the information in consequent publications.

TABLE OF CONTENTS

Introduction and Welcome .......................................................................... 1 Chapter One: Introduction to Psychology ................................................... 3 Chapter Outline What is Organizational Psychology? by Safiya Salim ........................... 5 What is Educational Psychology? by Dr. Ruba Tabari .......................... 6 What is Clinical Psychology? by Dr. Jacqueline Widmer ..................... 7 What is Health Psychology? by Dr. Melanie Schlatter .......................... 8 What is Neuropsychology? by Dr. Efthymios Papatzikis ...................... 9 Approaches to the Science of Psychology by Dr. Carrie York Al-Karam .............................................................. 10 Cognitive ........................................................................................ 10 Behavioural .................................................................................... 10 Social .............................................................................................. 11 Positive ........................................................................................... 11 Islamic ............................................................................................ 11 Studying Psychology! .......................................................................... 12 Meet Mona Al-Ghamdi, Saudi Arabia ........................................... 12 Meet Meera Al Budoor, United Arab Emirates .............................. 13 Psychology is a Science by Dr. Louise Lambert .................................. 15 Applied and Basic Research ........................................................... 16 The Scientific Method .................................................................... 17 Step 1: Conduct a Literature Review.............................................. 18 Step 2: Develop a Hypothesis ........................................................ 19 Step 3: Choose a Research Design ................................................. 20 Step 4: Collect, Analyze and Interpret Data ................................... 29 Step 5: Publish in Peer Reviewed Journals .................................... 30 Generalizability and Bias ............................................................... 31 Research Ethics by Dr. Katharina A. Azim ......................................... 32 Over to you now… .............................................................................. 34 Chapter Two:Psychology in the Arab and Western Worlds ...................... 36 Chapter Outline What is Indigenous Psychology? by Dr. Nahal Kaivan ....................... 38 A Brief Overview of Islamic Psychology by Dr. Amber Haque.......... 40 The Concept of Al-Fitrah ............................................................... 42

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Nafs: The Nature of the Human Soul ............................................. 43 Qalb and Aql: Significance of the Heart, Intellect and Freewill .... 45 The Concept of Jinn, Satan and Evil Eye ....................................... 47 Perspectives of Early Muslim Scholars .......................................... 49 Six-Step Model for Self-Improvement ........................................... 50 Psychology in the Western World by Reham Al-Taher ....................... 51 Psychoanalytic Psychology ............................................................ 52 Behavioural Psychology ................................................................. 54 Cognitive Psychology .................................................................... 56 Humanistic Psychology .................................................................. 57 Positive Psychology ....................................................................... 59 Topic Box: DSM or the CSV? Know your books! by Dr. Louise Lambert .......................................................................................... 60 Over to you now… .............................................................................. 63 Chapter Three: The Brain and Nervous System ........................................ 64 Chapter Outline The Nervous System ............................................................................ 66 The Sympathetic and Parasympathetic Systems ............................ 66 What are Neurons and How Do They Work? ...................................... 67 Neurotransmitters................................................................................. 68 Brain Parts and Functions .................................................................... 72 The Hindbrain ................................................................................ 73 The Midbrain .................................................................................. 74 The Forebrain ................................................................................. 74 Topic Box: The Split-brain by Malika Narzullaeva ....................... 79 Neurogenesis and Plasticity by Fiza Hameed ...................................... 80 Topic Box: How Does Neuroscience Study the Brain? by Dr. Annie Crookes .......................................................................................... 82 Types of Drugs and their Effects on the Brain by Anum Virani .......... 84 Stimulants ....................................................................................... 84 Depressants .................................................................................... 85 Topic Box: Drug Use in the GCC Region by Dr. Louise Lambert 86 Hallucinogens ................................................................................. 87 Topic Box: How Do Nicotine and Sheesha Affect the Brain? by Dr. Annie Crookes ................................................................................ 89 Over to you now… .............................................................................. 90 Chapter Four: Sleep and the Circadian Rhythm ........................................ 92 Chapter Outline The Circadian Rhythm ......................................................................... 94

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Types of Sleep ..................................................................................... 95 Non-REM Sleep ............................................................................. 95 REM sleep ...................................................................................... 96 Stages of Sleep ..................................................................................... 97 How Much Sleep Do I Need? .............................................................. 98 Topic Box: Sleep and Ramadan by Dr. Melanie Schlatter ........... 101 Dreams: Why do We Dream and What do They Mean? .................... 102 Continuity Hypothesis .................................................................. 103 Reverse Learning Theory ............................................................. 103 Activation-Synthesis Theory ........................................................ 103 AIM Model................................................................................... 104 Sleep Difficulties ............................................................................... 105 Electronics and Blue Light ........................................................... 105 Delayed Sleep Phase Syndrome ................................................... 106 Advanced Sleep Phase Syndrome ................................................ 106 Jet Lag .......................................................................................... 107 Shift Work .................................................................................... 108 Parenting ...................................................................................... 108 Learning and Sleep ............................................................................ 108 Is Lack of Sleep a Big Deal?.............................................................. 109 Sleep Disorders .................................................................................. 110 Insomnia ....................................................................................... 110 Sleep Apnea ................................................................................. 110 Narcolepsy.................................................................................... 111 Restless Legs Syndrome............................................................... 112 Personal Sleep Assessment ................................................................ 112 Over to you now… ............................................................................ 116 Chapter Five: Memory............................................................................. 117 Chapter Outline Topic Box: Supermemory (Mnemonics) ........................................... 119 The Structure of Memory: What makes up the Memory System? ..... 120 Sensory Memory .......................................................................... 120 Short-Term Memory .................................................................... 122 Long-Term Memory ..................................................................... 124 Evaluation and Changes to the Atkinson and Shiffrin Model ...... 128 Topic Box: PTSD and Memory.................................................... 130 Remembering ..................................................................................... 131 Encoding ...................................................................................... 131 Storage ......................................................................................... 133 Forgetting ..................................................................................... 133

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Recall and Recognition ................................................................ 134 Topic Box: Does Obesity Impact Memory? by Dr. Louise Lambert ........................................................................................ 126 Topic Box: Eyewitness Memory .................................................. 135 Forgetting and Memory Failures........................................................ 136 Topic Box: Google May be Quick, But is it Always Good? by Anisha D’Cruz......................................................................... 138 Over to you now… ............................................................................ 140 Chapter Six: Learning.............................................................................. 141 Chapter Outline Some Theory to Get Us Started by Dr. Katharina A. Azim ............... 143 Classical Conditioning by Nicole El Marj ......................................... 143 Pavlov’s Experiment .................................................................... 144 Little Albert Experiment and Emotional Conditioning ................ 147 Unlearning Phobias via Systematic Desensitization by Dr. Louise Lambert .............................................................................................. 148 Operant Conditioning and Reinforcement by Nadia Al Aswad ......... 150 Social Learning by Thoraiya Kanafani .............................................. 153 Learned Helplessness by Dr. Louise Lambert ................................... 154 Topic Box: What’s Best - Reinforcement or Punishment? by Sara Antonucci ........................................................................ 157 Self-Regulation by Isbah Ali Farzan .................................................. 158 Sociocultural Theory by Dr. Katharina A. Azim ............................... 159 Mediated Learning ....................................................................... 160 Zone of Proximal Development (ZPD) ........................................ 160 Egyptian Kindergarteners and the Zone of Proximal Development.. 162 Discovery Learning by Isbah Ali Farzan ........................................... 163 Insight Learning by Dr. Annie Crookes ............................................. 165 Peer-Assisted Learning by Dr. Katharina A. Azim ............................ 167 Learning with Technology by Dr. Katharina A. Azim ...................... 169 Blended Learning ......................................................................... 170 Learning through Social Media .................................................... 171 Experiential Learning and Simulation by Dr. Katharina A. Azim ..... 172 Over to you now… ............................................................................ 175 Chapter Seven: Cognition, Language, and IQ ......................................... 177 Chapter Outline Problem Solving and Decision Making by Dala Kokash ................... 179 Application of Strategies .............................................................. 180 Obstacles to Problem Solving ...................................................... 181

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Decision Making Errors ............................................................... 181 Concepts by Dr. Louise Lambert ....................................................... 185 Creativity by Dr. Louise Lambert ...................................................... 186 Fluid and Crystallized Intelligence by Dr. Louise Lambert ............... 189 Today’s View on Intelligence: What is it & How is it Tested? by Dr. Ruba Tabari........................................................................................ 190 More on IQ ................................................................................... 192 Topic Box: The Flynn Effect by Dr. Annie Crookes.................... 193 Topic Box: Gender and IQ by Dr. Annie Crookes ....................... 195 Multiple Intelligences & Perceptions of Intelligence by Dr. Katharina A. Azim ........................................................................................ 196 Topic Box: What about Social (or Emotional) Intelligence? by Dr. Louise Lambert ............................................................................ 198 Giftedness by Anam Syed .................................................................. 199 Learning Disabilities by Tooba Dilshad ............................................ 201 What to Do if You Have a Learning Disability? by Dr. Norma Kehdi.. 203 Language by Dr. Louise Lambert ...................................................... 205 Psycholinguistics .......................................................................... 205 Language Acquisition .................................................................. 206 Language Acquisition Stages ....................................................... 208 Topic Box: Dialogic Reading and Language Acquisition in Young Children by Dr. Zahir Vally ......................................................... 210 Does What You Speak Affect How You Think? ......................... 211 Multilingualism ............................................................................ 212 Over to you now… ............................................................................ 213 Chapter Eight: Childhood Development.................................................. 215 Chapter Outline Nature versus Nurture by Yasmeen Alhasawi ................................... 217 Topic Box: Fathers and Prenatal Development by Dr. Louise Lambert ........................................................................................ 219 Teratogens and Influences on Fetal Development by Dr. Louise Lambert ........................................................................................ 220 Topic Box: How does Alcohol Affect Prenatal Development? by Reem Deif .................................................................................... 222 Attachment by Yasmeen Al-Hasawi .................................................. 224 Ainsworth and the Strange Situation Experiment ........................ 225 Adult Attachment ......................................................................... 227 Piaget’s Developmental Model by Dr. Nausheen Pasha-Zaidi .......... 229 Vygotsky’s Developmental Model by Dr. Louise Lambert ............... 232 Parenting Styles by Dr. Ruba Tabari ................................................. 234

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Authoritarian Style ....................................................................... 235 Authoritative Style ....................................................................... 235 Permissive Style ........................................................................... 235 ADHD in Children by Reinilda van Heuven-Dernison and Aleksandra Aslani ........................................................................................... 237 Anxiety in Children by Reinilda van Heuven-Dernison .................... 241 Children: Autism by Fiza Hameed..................................................... 245 Children: Down Syndrome by Dr. Louise Lambert ........................... 246 Over to you now… ............................................................................ 249 Chapter Nine: Adolescent and Adult Development................................. 250 Chapter Outline ........................................................................................ Kohlberg’s Model of Moral Development by Dr. Louise Lambert ... 252 Erikson’s Developmental Model by Thoraiya Kanafani.................... 254 Bronfenbrenner’s Ecological Systems Theory by Dr. Louise Lambert .............................................................................................. 263 Gender and Gender Roles by Dr. Jane Bristol-Rhys .......................... 265 Topic Box: Islamic Feminism and Gender by Dr. Manal Al-Fazari ...................................................................................... 267 Later Adulthood: Physical and Cognitive by Dr. Tatiana Rowson .... 269 Physical Changes.......................................................................... 269 Cognitive changes ........................................................................ 270 Emotional growth ......................................................................... 271 The New “Old”: Challenging Age Assumptions by Dr. Katharina A. Azim ........................................................................................ 271 Cultural Differences for Care of the Elderly by Dr. Najma Adam .... 274 Death and Dying ................................................................................ 276 Topic Box: Islamic Views on Death and Grieving by Dr. Najma Adam ........................................................................... 278 Over to you now… ............................................................................ 280 Chapter Ten: Common Disorders ............................................................ 281 How Do We Decide What is a Disorder and What Isn’t? .................. 283 Definition of Psychological Disorders ............................................... 283 Topic Box: Mental Illness: An Islamic Perspective by Carrie York Al-Karam ....................................................................... 287 What Causes Psychological Disorders? ............................................. 288 The Biopsychosocial Model .............................................................. 289 Biological Elements ..................................................................... 290 Psychological Elements................................................................ 291 Social Elements ............................................................................ 291

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Clinician's Approach to Psychological Disorders .............................. 292 How Many Psychological Diagnoses Are There?.............................. 293 “I Am Just Sad, I Don’t Need Medications!” ............................... 294 “They Are Out There to Get Me!” ............................................... 295 “Why Can’t I Stop Washing?” ..................................................... 296 “The War is Not Over in My Mind!” ........................................... 298 Mental Health and Muslims by Dr. Rehman Abdulreham................. 299 Cognitive Behavioural Therapy (CBT) and Islam ....................... 300 Patience and Gradual Change....................................................... 302 Mental Health Problems: A Symbol of Modern Times? .............. 303 Black, White, Right, Wrong, and Everything In Between ........... 305 Topic Box: Cognitive-Behavioural Therapy for Depression by Dr. Louise Lambert ............................................................................ 306 Over to you now… ............................................................................ 309 Chapter Eleven: Health Psychology ........................................................ 310 Chapter Outline What is Stress? ................................................................................... 312 Acute and Chronic Stress ................................................................... 313 The General Adaptation Syndrome .............................................. 313 Significant Life Events and Daily Hassles ......................................... 314 Coping with Life Stressors................................................................. 315 Personality and Psychological Responses .................................... 317 The Immune System .......................................................................... 318 Emotions and Goal-Oriented Behaviours .......................................... 321 Psychosocial Interventions................................................................. 322 Topic Box: Is Stress Contagious? by Dr. Louise Lambert ........... 323 Health Education................................................................................ 324 How Religion plays a Role in Health, Healing and Disease: Islamic Perspectives ....................................................................................... 325 Islam as it Relates to Health Psychology ..................................... 328 Eating Disorders by Dr. Jeremy Alford & The Middle East Eating Disorders Association ........................................................................ 329 Biological Factors ........................................................................ 329 Psychological Factors................................................................... 330 Social Factors ............................................................................... 330 Anorexia Nervosa......................................................................... 331 Bulimia Nervosa........................................................................... 332 Binge Eating Disorder (BED) ...................................................... 332 How Are Eating Disorders Treated? .................................................. 332 Over to you now… ............................................................................ 333

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Chapter Twelve: Motivation and Emotion .............................................. 335 Chapter Outline Introduction to Motivation by Joana Stocker and Jamal AlHaj ......... 337 Drive Reduction Theory ............................................................... 339 Arousal Theory............................................................................. 339 Incentive Theory .......................................................................... 340 Goals ............................................................................................ 342 Goal-Orientation Theory .............................................................. 343 Need for Achievement ................................................................. 344 Maslow’s Hierarchy of Needs ...................................................... 345 Self-Determination Theory........................................................... 348 Motivational Constructs by Joana Stocker & Meera Khalifa............. 350 Implicit Theories of Intelligence (Mindsets) ................................ 352 Attribution Theory........................................................................ 356 Self-Efficacy and Self-Esteem ..................................................... 359 Emotion by Dr. Louise Lambert ........................................................ 361 Emotion Theories ............................................................................... 362 James-Lange Theory .................................................................... 362 Cannon-Bard Theory .................................................................... 362 Schachter-Singer Theory .............................................................. 363 Lazarus theory .............................................................................. 363 What about Aggression? .................................................................... 364 Social Learning Theory ................................................................ 365 General Aggression Model........................................................... 366 Topic Box: Video Games and Aggression by Mehdiyeh Hussain Abidi............................................................................................. 368 Over to you now… ............................................................................ 369 Chapter Thirteen: Social Psychology ...................................................... 371 Chapter Outline Social Identity .................................................................................... 373 Islamic Identity by Dr. Manal Al –Fazari .......................................... 374 Cognitive Dissonance by Dr. Louise Lambert ................................... 375 The Self-Fulfilling Prophecy by Yara Mahmoud Younis .................. 377 Attribution Theory and Attributional Biases by Yara Mahmoud Younis ................................................................................................ 379 Who likes Who? Attraction by Dr. Louise Lambert .......................... 382 Social Influence ................................................................................. 387 Social Loafing .............................................................................. 388 Conformity and Obedience by Homaira Kabir and Yara Mahmoud Younis..................................................................................... 389

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The Bystander Effect and Altruism by Homaira Kabir ................ 392 Ways of Understanding Culture by Anisa Mukhamedova & Mona AlGhamdi ......................................................................................... 394 Acculturation by Mehrdad Fazeli Falavarjani.................................... 398 Discrimination by Aditi Nath............................................................. 399 Tolerance as an Islamic virtue by Dr. Nausheen Pasha-Zaidi ............ 402 Aggression by Reham Al-Taher ........................................................ 403 War, Uprisings, and Social Change by Yasmeen Alhasawi............... 405 Economic Hardship ...................................................................... 406 Psychological Impact ................................................................... 406 Physical Impact ............................................................................ 409 Risk Factors.................................................................................. 409 Displacement and Loss................................................................. 409 Maintaining an Arab Identity ....................................................... 413 Topic Box: Coping with War and Social Unrest by Jeyda Hammad .................................................................. 415 Over to you now… ............................................................................ 417 Chapter Fourteen : Positive Psychology .................................................. 419 Chapter Outline What is Positive Psychology? ............................................................ 421 Topic Box: Aversion to Happiness by Dr. Mohsen Joshanloo ..... 424 Positive Emotions .............................................................................. 425 Joy and Contentment .................................................................... 425 Vitality ......................................................................................... 425 Curiosity ....................................................................................... 426 Pride ............................................................................................. 426 Awe, Elevation, and Inspiration ................................................... 426 Gratitude....................................................................................... 426 Optimism and Hope ..................................................................... 427 Topic Box: Why is Optimism a Good Choice? By Dr. Louise Lambert ........................................................................................ 427 Broaden and Build Model of Positive Emotions................................ 428 Are Positive Emotions Contagious? .................................................. 429 Architecture of Sustainable Happiness .............................................. 430 PERMA Model of Well-Being .......................................................... 432 Pathway of Pleasure/Positive Emotion ......................................... 435 Pathway of Engagement ............................................................... 436 Pathway of Relationships ............................................................. 437 Topic Box: Positive Relationships by Homaira Kabir ................. 438 Pathway of Meaning..................................................................... 440

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Topic Box: Spirituality as a Road to Well-Being by Homaira Kabir ................................................................... 441 Pathway of Accomplishment........................................................ 443 Positive Psychology Interventions ..................................................... 443 Topic Box: When “Just be Happy” Makes You Unhappy by Janine Pinto........................................................................................ 447 Positive Psychology and Culture ....................................................... 448 Over to you now… ............................................................................ 449 Bibliography ............................................................................................ 451 Meet the Editors ...................................................................................... 493 Meet Our Contributors............................................................................. 495

INTRODUCTION AND WELCOME

Welcome! If you are like most students, this Introduction to Psychology class is your first exposure to what is a relatively new field in the region. As your editors and professors of psychology ourselves, we wanted to take a moment to tell you (and your professor) why we undertook this textbook project you are holding in your hands right now. We've both taught this class dozens of times in the UAE, but noticed that many students struggled with the material, terms used, and the level of English. In fact, we were frequently caught off-guard in classes using examples we might have used in the West only to realize they made no sense here! We felt frustrated, just like you, that many of the textbooks used in the region gave a lot of culturally or religiously inappropriate examples, or talked about things that were just not relevant to most students because they were things that didn't exist in this part of the world. Even we could see that the match was terrible. So, we spent a lot of time looking for more appropriate textbooks for you to use and the best that was available are what are called international versions of those same Western textbooks. The only difference is that those have more non-White people and a few things on cultures around the world like China, or Brazil. Better, but not great and most certainly still not "here". We felt very strongly that psychology is meant to be a way for everyone - you included - to learn about yourself and you can't do that if the book is not about you. So, we decided, well, why not write one ourselves? However, we soon realized this was an insane amount of work and we also like our weekends! So, we asked people in psychology to help by writing different parts. We thought this was a good idea, for one, it was easier for us! Two, your professors like to write things and see their names in books (publications are the same as "likes" in our world!). And three, we wanted this book to be about the region and for the region, so that meant it had to be written by people in it or who at least had an attachment to it and understood how things worked here. You’ll see that that is the case from our contributors list. Finally, we know that not all of you reading this book are from here. There are a lot of international students in the GCC region who come from places like Kazakhstan, India, or China who might think, what is Islamic psychology all about? As you are here, we want you to learn about the region as well in the same way we'd learn about you if we were in your

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Introduction and Welcome

country. We hope you'll enjoy it and maybe understand why things are the way they are instead of just wondering about it all the time. That's pretty much it. Make sure to read the chapters and at the end of each one, there are several questions for you to work on and/or think about. Test yourself by answering them on your own and then go back in the text to see whether you got it right. Finally, find us on LinkedIn and if you spot a mistake, tell us. Better yet, if you have an idea for something that should be included in a future updated version of this book, let us know. We'd be pleased to hear it. Tell your professor too. Good luck this semester. Oh, and despite what your professor says, the point of this course is not to get an "A", it's to learn about you. And you're awesome! Sincerely, Dr. Louise & Dr. Nina

CHAPTER ONE INTRODUCTION TO PSYCHOLOGY DR. LOUISE LAMBERT

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Chapter Outline x x x x x

What is Organizational Psychology? by Safiya Salim What is Educational Psychology? by Dr. Ruba Tabari What is Clinical Psychology? by Dr. Jacqueline Widmer What is Health Psychology? by Dr. Melanie Schlatter What is Neuropsychology? by Dr. Efthymios Papatzikis

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x Approaches to the Science of Psychology by Dr. Carrie York AlKaram x Studying Psychology! x Meet Mona Al-Ghamdi, Saudi Arabia x Meet Meera Al Budoor, United Arab Emirates x Psychology is a Science by Dr. Louise Lambert x Research Ethics by Dr. Katharina A. Azim x Over to you now… Psychology is the study of behaviour and mental processes. This includes what people (and sometimes animals) do and how they think, respond, and react to events, other people, external stimuli (like cold temperatures and noise) and to themselves (their motivations and emotions). However, psychology has often been misunderstood: People sometimes think it is a form of mental control, or that psychologists have the ability to read minds! As we progress in this chapter, you will discover that psychology is not any of these things, but that it is, in fact, a science, just like any other field. Psychology is not limited to counselling people who suffer from distress in some way. It’s also used to diagnose, organize, and improve all sorts of human processes and dynamics in a number of professional fields. Read onwards to see where psychology is most commonly found and what types of careers are available in the many branches of psychology. Maybe you’ll find one you like!

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What is Organizational Psychology? by Safiya Salim

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I’m Safiya Salim and I am a business psychologist here in Dubai (UAE). Business Psychology, also known as Industrial and Organisational Psychology or Work Psychology, is a field that involves understanding human behaviour and interaction in a workplace. Although Business Psychology is a well known field in the West, it is quite new and gradually gaining popularity in the Middle East. Students from psychology or business backgrounds can specialise in an area of interest such as leadership, organisational change, diversity management, coaching, and ergonomics. Students who complete the programme may qualify to work in Corporate Psychology or related areas such as Recruitment, Human Resources, Health and Safety, Training, Learning and Development or as an Executive Coach or a Psychometric Assessor. I intend to work in academia as I find it rewarding; I enjoy research, teaching and interacting with young adults and trying to get them engaged and interested in the area of psychology and management!

Chapter One

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What is Educational Psychology? by Dr. Ruba Tabari

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I am Dr. Ruba Tabari, an educational psychologist (EP) living in Dubai. I have been working as an EP for 20 years. My work is diverse. I work with children, parents, schools, other professionals and authorities such as the Ministry of Education to ensure that children aged 2 to 19 years old achieve their potential. The work involves five areas: consultation, assessment, intervention, training and research. Consultation is about giving those concerned the chance to talk. The EP's role is to facilitate the discussion and to use their training in psychological theory and practice to generate strategies that lead to solutions. Assessment involves using many tools and approaches to gather information about students from a number of sources, in a variety of settings and over time in order to inform an intervention plan. These plans are strategies designed to help students with learning and include collaboration with parents, schools and other professionals. Training is provided for staff, parents, children and young people, and other professionals and can be done with the whole school, in small group sessions, and through presentations and workshops. Finally, research is also part of an EP’s job and informs evidence-based psychological practice at the individual, school and ministry level. Research helps EPs get better at their job, increase their knowledge and improve their practice.

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What is Clinical Psychology? by Dr. Jacqueline Widmer

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Ask most people what a psychologist does and they’ll probably say that they treat “crazy” people! Clinical psychology is the branch of psychology that people associate most with the field of psychology as a whole. This was not always the case. When psychology emerged as an independent field in the Western world, psychologists were mostly concerned with the experimental study of thoughts, perceptions, and cognitive processes. The treatment of mental illness was mostly conducted by neurologists and psychiatrists. Clinical psychologists first became known for developing psychological tests that helped to assess people’s cognitive and psychological functioning. In the West, this changed when World War II broke out and there were more psychological wounds to be treated than there were psychiatrists and neurologists available. Clinical psychologists were called to task and thus became recognized as providers of psychotherapy. Today, clinical psychology is recognized as the branch of psychology that studies mental illness in order to prevent, diagnose, and treat it. It is the most popular career choice for psychology students as it is associated with the study and treatment of mental illness.

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What iis Health Psychology? ? by Dr. Meelanie Schlatter

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I’m Dr. Meelanie and I’m m a health psychologist, w which is the study of biological, ppsychologicall, and social contributors to health, illn ness, and health care bbehaviour. Thhe field is div vided into areaas such as behavioural factors thatt influence health (i.e., smoking orr exercise) and a their antecedents (like stress, personality, lack l of suppoort); illness beehaviours (e.g., delayiing seeking help for sympttoms); health--care behaviours (such as proactivve screening); and treatm ment behavioours (i.e., medication m adherence). Health psycchologists are found in accademia, hosp pitals, or private pracctice. We are interested in why some peeople are heallthy; why others get ssick, and how w people manage when ffaced with illlness and treatment. O Our aim is too teach peoplle how to beecome proactiive about health. Thinnk of a groupp of diabetic people. You ’d think they y’d all be prescribed tthe same treattment and theeir conditionss would be co ontrolled. Yet, to ignoore individual differences iss a mistake. T These people may m have different iddeas about diabetes d (e.g.,, embarrassinng disease versus v an illness), its causal factorrs (e.g., evil eye versus ppoor lifestyle)), how it affects them m (e.g., denial or willingnesss to take respoonsibility), how to help themselves (e.g., helplesssness or feeling in controll), and how others o can help them (ee.g., mistrust of doctors orr willingness to learn), which could affect their treatment. Thus, planning client intterventions relates r to symptom m management, psychologicaal adjustmentt, changing unhelpful u illness belieffs, and improvving health beehaviours.

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What is Neuropsychology? by Dr. Efthymios Papatzikis

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I’m Dr. Tim! My studies focus on neuroscience, a field that involves the structure, function and development of the brain and central nervous system using neuroimaging techniques such as electroencephalography (EEG), or functional Magnetic Resonance Imaging (fMRI). When neuroscience tries to understand how conscious and unconscious processes of the brain impact behaviour and cognitive functions, a specialized domain is formed, called neuropsychology or cognitive neuroscience. Changes in the environment, illness, and injuries can affect the way a person feels, thinks, and behaves; thus, a neuropsychologist will study and explain situations like memory difficulties, mood disturbances, learning difficulties and nervous system dysfunctions. Although neuropsychology and cognitive neuroscience are connected, they differ. Cognitive neuroscience focuses on the development of research and knowledge, while neuropsychology is practical and used in clinical settings. Cognitive neuroscientists are the research scientists and neuropsychologists are the people who make you feel better after an unfortunate situation involving your head! Regardless of the field in which you practise psychology, i.e., health, organizational, or clinical, there are many approaches and these refer to

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the framework that is used with which to understand what is being studied and in what way the problem, opportunity, or challenge will be addressed.

Approaches to the Science of Psychology by Dr. Carrie York Al-Karam Suppose you want to understand why one individual is social, outgoing, and likes to spend time with friends whereas another person is quiet and prefers to be alone. How would you try to understand this difference? Is it their personality? Is their behaviour learned from family or culture? Is it controlled by genes and hormones? Psychologists take various approaches to understanding and answering these questions. Depending on the approach, the assumptions, questions, and methods they use to investigate the question will vary, informing the types of interventions or treatments they use. The following are some of the most common approaches psychologists use today.

Cognitive A cognitive psychologist would be interested in how the brain takes in information, creates perception, forms and retrieves memories, processes information, and generates patterns of action; in other words, how our mind deals with incoming information and how we behave in response to it. Cognitive psychologists are interested in mental or “cognitive” abilities such as sensation and perception, learning, memory, thinking, consciousness, intelligence, and creativity. This is different than a biological psychologist who is interested in understanding how the brain as a physical organ affects and is affected by behaviour and mental processes. A cognitive psychologist is interested in the cognitive processes of the brain but a biological psychologist is interested in the workings of the organ itself.

Behavioural Psychologists who take this approach believe that human behaviour is determined by what a person has learned. Built upon the work of John Watson and B. F. Skinner, behavioural psychologists focus on observable behaviour and try to understand how past experiences with rewards and punishments shape a person’s actions. In other words, behaviourists try to understand a person’s learning history. When an individual shows maladaptive habits or problematic behaviour, certain techniques, which are

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based on the principles of learning, are used in order to modify that behaviour.

Social Social psychologists understand how individuals influence one another as well as how people think and behave in groups. It is the study of how and why people think, feel, and do the things they do in the presence of others, real or imagined. In studying how people act in certain situations, we can better understand how stereotypes are formed, why racism and sexism exist, and why people do things in front of others that they wouldn’t ordinarily do elsewhere. Social psychologists study things like group behaviour, leadership, conformity and individuation, prejudice, altruism, attraction, and attitudes.

Positive Positive psychology is a new approach, having developed mainly since the late 1990s. Whereas psychologists have been interested in mental disorders and trying to “fix” what’s wrong with people, positive psychologists are interested in understanding what’s working well. The idea is this: the removal of psychopathology does not necessarily mean an individual will thrive and be happy. Rather, strengths and positive characteristics need to be nurtured. Therefore, interventions that positive psychologists use are designed to help individuals develop the strengths and positive qualities that they possess. This is different than focusing on what’s wrong with someone and trying to fix or remove it.

Islamic An Islamic approach to psychology is holistic, taking into account the spiritual aspect of the human being—the soul. The focus on behaviour and mental processes that modern day psychologists take is not considered wrong; but, incomplete. From an Islamic view, the most important unit of the individual through which all other cognitive functions operate is the soul. Understanding the nature of the soul, therefore, is vital. Hence, the work of an Islamic psychologist would be to understand the nature of the human soul as well as treatments that are designed to ameliorate spiritual distress. As such, when an individual has a mental illness, a psychologist with an Islamic orientation would consider spiritual reasons for the distress, in addition to biological, psychological or environmental factors.

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Because there are so many approaches in psychology, it is important to consider which model is best suited to you! Not all approaches will suit your interests or personality. In therapeutic work, the fit between the psychologist and the client is also an important factor that contributes to treatment success. So, if you need the services of a psychologist, shop around until you find one that’s right for you.

Studying Psychology! Are you interested in pursuing a degree in psychology? Like many fields, psychology is a professional field, which means you will spend many years in university, choose an area of specialization, conduct research of your own and perform the duties of your specialization with real individuals over a period of several months or years to obtain a licence to practise. This knowledge is based in science; thus, you need to be able to read scientific articles and understand what good research is so that you can use the right tools, techniques and latest discoveries in the field. This is what distinguishes psychology from self-help. Further, you need to keep up with developments over time by attending conferences, reading research and other books, getting additional training, and learning about other fields, like medicine, law, and psychiatry to understand what your clients (sometimes also called patients) are experiencing and how new developments impact your work. It’s a lot of work, but there are guidelines and professional associations to help you. Psychology is a satisfying career that gives you the chance to learn a lot about people, events, psychological conditions, culture, religion, and societies – even yourself! Read on to see what these students studied and understand more about what psychology means to them.

Meet Mona Al-Ghamdi, Saudi Arabia “Psychology never crossed my mind as a degree. You could say it was fate that brought me here and once I got here, I knew it was meant to be all along. I was born and raised in the UK where I was hoping to pursue Languages at university; but, I ended up moving to Saudi Arabia and had to base my choice on limited degree options taught in English. I saw psychology and instantly knew this was what I wanted. What interested me in the topic is that it is so relatable and adaptable in everyday life. It was a degree that could be useful to me no matter what results I got, no matter what job I did. It was more than just a university course, it was an opportunity to find answers for questions I always had.

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Being born the youngest and only girl with five older brothers and going through a cross-cultural identity crisis made me realize that psychology was my key to understanding myself and my place in the world. After graduating in 2009, I worked in a non-related field for a few years before going back to pursue further education. This led me to obtaining a Master’s (MA) degree in Counselling from the University of Nottingham in 2014. Psychology is of course, a large umbrella under which are many disciplines and schools of thought. I chose Counseling, because I was drawn to it in an almost spiritual way and felt it was my calling. My need to help and counsel people has existed since primary school days. Without knowing it, I was working my way into counseling throughout my life based on my nature. The MA degree was the most eye-opening experience because I went to a therapist myself and felt what is was like to be in the client’s seat or maybe because the course allowed for a lot self-reflection. I also studied Rogerian philosophies and although I have not officially practised yet, I believe the Person-Centered Approach is my chosen modality since I connected well with its theories and experienced it first-hand. My thesis was focused on the GCC region as throughout my lectures I continuously tried to apply everything I learnt in my courses back to my home and culture to see how and if they fit. Without my Master’s degree, I would not have known the person I wanted to be. That person will be an accredited and certified therapist running her own private practice in the GCC one day. I believe much needs to be addressed in the region, so this is my goal. Until then, I will work and study and use all possible avenues to follow the path that will lead me to my dream.”

Meet Meera Al Budoor, United Arab Emirates “When I first enrolled in Zayed University, I was asked to choose a major from the first semester. I was told that it’s for the sake of getting an approximate number of freshman students interested in each college and that I could change it anytime, so I chose the first major that came to my mind: International Relations. This major was the most interesting to me based on the choices in the course catalog that I saw during orientation. At that time, I didn’t even know that Psychology was offered as a major. On the first day of my third semester (my first official day in the International Relations major), I was told that I needed an elective and was ecstatic when I saw that there were seats available in the Introduction to Psychology course. Leaving my first lesson, I learnt that Zayed University

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would teach me something I’m passionate about. Since the university had opened up a Psychology major, I realized that I had found my calling. As soon as I left the class, I called my parents to let them know I would be changing my major. And that is what I did. Common thoughts that pop into people’s mind when they find out I’m a Psychology student are ‘Can you read me?!’, ‘Can you analyze personalities from a first impression?’, or my personal favourite, ‘Don’t psychologists go mad dealing with crazy people?!’ I’m sure you know the answer to all the questions is ‘No’. There are a lot of stereotypical thoughts regarding psychology major students and 99% aren’t true. Psychology and the Bachelor’s degree in Psychology are very broad. You barely have enough classes to get a glimpse of the vast branches of Psychology as a field of study or work. Personally, I’ve always leaned more towards Clinical Psychology and therapy, but another interesting field was Social Psychology. Clinical Psychology entails a deeper understanding of mental disorders and ways to treat them while Social Psychology focuses more on the effects of society on an individual. Both are very different fields but equally interesting. Another personal favourite was Bio-Psychology and the study of the brain. I remember distinctly what my professor told me at the beginning of that class and after that I was hooked! She said, ‘Is the brain capable of understanding something as complex as the brain itself?’ I want to do a Master’s in Clinical Psychology and if I get the chance, maybe even a Ph.D. The wonderful thing about psychology is that not only do you benefit from it by developing a career, but as an Emirati woman, I think it has given me life skills that I use on a daily basis with my interactions, my responses and relationships with family and friends. It has given me a deeper understanding about human behaviour and development. I’m sure these skills will be put to the test when I become a mother.”

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Psychology is a Science by Dr. Louise Lambert

Photo credit: Pixabay

The scientific method is how psychologists and other scientists test concepts and ideas. Conducting research is vital; without it, we have no way to be sure that what we believe is true. Things are not always what they seem or for the reasons we believe. Further, while something may be true, it may not be true for everyone, all of the time, under all conditions, and everywhere. Imagine knowing that medication ‘A’ worked to reduce high blood pressure in 40-year old men, but what if that same medication didn’t actually work with women or older men, but we thought it did? We could cause death by not testing our assumptions. Everything must be proven; we can’t rely on wishful thinking. And, what may be true today may no longer be true tomorrow because people, social systems, physical environments, and knowledge change too. Sometimes, the technology we use to test our assumptions improves with time and allows us to draw better conclusions about things. The role of research is important in psychology; it helps us make decisions, plan for policy, decide what course of action to take in terms of treatments, as well as evaluate claims of effectiveness. Research is published in academic journals; these are journals specific to each domain (i.e., psychology, sociology, medicine, political science, biology, etc.) and only contain research studies in them. More and more journals are now online and your university library will have access to several databases that hold hundreds, sometimes thousands of journals. Researchers also post their work on personal websites too.

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Photo credit: Louise Lambert

Once you understand how research works, you’ll understand why you sometimes hear that coffee is bad for you and then a few years later, hear that it is good for you. Scientists continue to research things all the time and when facts change, it doesn’t mean the researchers were wrong, but, that the findings were the best answers they had at that time. Scientific knowledge is always changing and considered cumulative, meaning that knowledge builds upon previous knowledge. In this way, science works well in obtaining accurate answers to life’s mysteries. It corrects itself as it advances by disconfirming, accepting, or modifying what is known over time. By the way, coffee, as of today anyway, is good for you in moderation. Drink up; you might need it for the next section!

Applied and Basic Research Psychologists conduct two types of research. The first is called basic research because it refers to the type of knowledge we are seeking. Here, we want to know things like how the brain works, different theories of motivation, or how our emotions influence physiology. We are seeking to discover basic information about how humans think and behave. The type of information we end up with is what you would find in a psychology textbook like this one, a reference book or an encyclopaedia. These studies are usually conducted by people in research laboratories that are interested in answering the question of "what"?

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The second type is called applied research, where we use the information we learned in basic research to solve real problems. For instance, if we know that the emotion of anger has a negative effect on the immune system, we might use this information to develop a cognitive skills program to help people with illness manage their anger to reduce their risk of getting cardiovascular disease. These studies are usually conducted by professionals in the field who deal with real people and use the knowledge generated through research to help, improve, change, or treat conditions in some way.

The Scientific Method The scientific method consists of several steps required to conduct research properly. These steps are useful to know when you read research and assess whether it is a good study or not. Think of the scientific method like a recipe. There's only one dish to cook although it can have a few known variations, but anyone who wants to cook good results must use the scientific method as their recipe. There are benefits to researchers using the scientific method. One, after painstaking years of developing a good recipe, the scientific method is the best way to achieve results with the highest level of robustness and integrity, and which controls for the lowest possibility of error. Not using the recipe is like saying I'm making kebabs but I'm going to use a recipe for hummus! That's just not how you make it. The scientific method also demands honesty and the proper documentation of all steps taken in a study. This documentation allows us to see how well you followed the recipe (there is no sense lying about it as your results will be revealed), and helps readers of your research understand your flow of logic, why you made the decisions you did, and how your results can be understood. As the researcher, it is up to you to make this trail of evidence known—it is not up to readers to guess. This transparency also allows us to replicate your study (repeat the study but on new samples to see if we get the same results), as well as compare results meaningfully. If you followed variation A and the other researcher followed variation B and neither of you reported what you did, it would be hard for readers to know whether we can compare your results to each other. When everyone uses the same recipe for good research, scientific knowledge can move ahead with greater certainty.

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Step 1: Conduct a Literature Review

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The literature review is the most time consuming step, but is one that cannot be overlooked. Reviewing the research literature means reading hundreds - literally - of research studies that may or may not apply to your study for the sole purpose of discovering what is known about the concept and its related ideas, and what is left to know. In other words, we want to know what other researchers have discovered, how they did it, what research design was used, who were their samples, and what were the limits of those studies? Going back in time can help us see how a concept developed and evolved on its own and in relation to similar concepts. This is important if you are trying to develop your own concept. All of this information serves as a roadmap to developing your research question, selecting a research design, and knowing where to look for errors as well as opportunities. The review is useful to know what others have already said and done about your topic. This is important as a junior researcher because you might have a great research question and by going through the literature, you realize, “Oh, everyone already knows that! Or, several researchers have tried to show that idea and it failed repeatedly, so I shouldn’t bother. Or, I could try it this way instead and see if my method works.” Reading the literature saves you time by not repeating something everyone already

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knows when you could be discovering something new! Having said that, many researchers choose to add to knowledge by replicating studies; this is useful as it allows us to see whether what are known as “truths” apply to everyone, all the time, and in all situations. Replication studies use the same or slightly different method or alter the sample (research participant group) age, demographics, settings, and situations to see whether the truth still holds. Finally, in your review, you will see in all studies a section entitled “Future Directions”, which is usually in the Discussion or Limitations area. This is where you get your clues for Step 2 below. These future directions are given to you by researchers who have just finished their studies and have insight as to what went wrong, what could have been improved, what new avenues could be investigated, and what questions were raised in the process of their work. Take their advice; it’s free and often phrased in the format of a research question, which is what you’re looking for next.

Step 2: Develop a Hypothesis Now that you have an idea of the direction in which you need to go, you need a research question with a clear and falsifiable hypothesis. That’s a mouthful! A hypothesis is a fancy word for your “best guess” or prediction; it’s what you think will happen based on the literature review you’ve just done in step 1. The hypothesis is phrased as a statement and not a question, despite the fact that you are seeking to answer an overall question in your study, and is written in way that can be proven correct or false. As such, it involves the determination of your variables (factors or things you want to examine). For example, if I want to test the effects of Medicine A on blood pressure, my variables would be “medicine” and “blood pressure”. A hypothesis defines the variables in measurable terms and includes who the participants will be, the changes expected to be seen, and what the result of those changes may be. “When children are good, mothers love them more” is not a good hypothesis because we don’t know what it means to be “good.” Does it mean to be kind to others, to do one’s chores, to be quiet and not disrupt the dinner table? It’s not clear and we all have different definitions of what it means. “Love” is also unclear; it could mean approval, getting a hug, or being accepted. This would be a tough hypothesis to test. Although it’s interesting, it’s not clear what is meant by these variables, nor how we can measure the variables in this statement. Hypothesis writing is tough!

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Here is a better hypothesis: “When there are more acts of kindness expressed in a household of nuclear family members, children report more parental trust.” This hypothesis is better because it is phrased in such a way that it is testable (we know the direction of the guess and the result can be true or false), defines the participants of the study (family members) as well as the variables (acts of kindness and levels of parental trust), and predicts a result (as kindness increases, levels of parental trust also increase). The variables must be measurable too. Here, we can measure levels of trust via a survey, or ask the parent, child or other family members to report on how many times the child turned to the parent with an issue that required comfort and safety as a response. It would also require the researcher to determine how to measure acts of kindness, i.e., observation of the family unit and recording kind acts done within a specific time period, or having family members fill in a survey every night about others behaviours. What is meant by a “kind act” would also need to be defined so it isn’t confused with normal parenting or family support. Although the hypothesis is clearer, you can already see that it takes some thought to consider each part of the statement. What is being measured, how it will be measured, over what time frame, and on whom, all need to be decided. Finally, the last thing to remember is “size”! Your research question should not try to answer every question under the moon; in fact, the smaller and narrower the focus, the better. That way, you know for certain that your results stem directly from your observations and/or experimentation and not from intervening variables that occurred at the same time. Answering a research question is done through repeated and multiple experiments, each of which has their own hypothesis. Your hypothesis should only relate to one experiment at a time. Others researcher’s studies will add to your research question and the answer will emerge over months and years. You will never answer something 100% entirely.

Step 3: Choose a Research Design The decision of how you will set up the research study depends on the type of question you are asking. Do you already know if your variables go together or are you making an educated guess? What information were you able to find about your topic from the literature review in Step 1? Is your topic so new that no studies or only a few studies have been published on it? There are many ways to get answers and the choice of a design needs to be considered as some phenomena (occurrences or

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events) cannot be studied in certain ways. Also, each design has its pros and cons. Let’s go through the options.

Descriptive Designs There are times when a phenomenon is new, relatively unknown or awkward to study and as a result, we don’t know much about it. Descriptive research designs are used when we are trying to get a better idea of something which we know little about. In these cases, we are not looking to test any assumption, manipulate one variable against another, compare, evaluate claims of effectiveness, or figure out which factor is affected by another. We are basically trying to describe a phenomenon.

Photo credit: Pixabay

This description can be done in many ways. For instance, if we want to know what it is like for an international university student, like you, to travel from her native country and come all the way to the GCC to study, how can we find out? We can interview 15 students about their experiences and see what themes they report. Perhaps they will all say that the experience was exciting at first, but then it got a bit scary and stressful when they realized they had to figure it out on their own. Then, they made friends and the experience became less frightening and a little fun. Interviews are a good way to gather information of this sort and the researcher need only prepare a few questions and then ask more detailed questions based on what the participants say. Of course, interviews take

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time and can be a costly option. We also can’t generalize the information we get from interviews to larger populations. We can give a paper or online survey or questionnaire (i.e., Survey Monkey) and have hundreds of students do it at once. It’s cheap, fast, and can be done anonymously. Survey information isn’t as detailed as interviews because space is limited; so, this reduces the depth of information we get. Further, “Yes” or “No” answers don’t give much insight. You also can’t be sure everyone understands your questions. How many times have you done a survey and thought, “I don’t get it!” and wrote something random to finish? In interviews at least the researcher can say, “I don’t understand” and get more information. When using selfreport, there is always a degree of error between what people report and think or do. The social desirability bias influences results a lot and is when people answer questions in a way that make them seem cool, normal, or acceptable. I ask students to raise their hand if they pick their nose, burp, or snore. Although conventional wisdom would suggest we do these things, no one raises their hand! Are they lying? Yes! Do you blame them? No! Participant demand also happens; this is when participants try to “help” the researcher and give answers they think the researcher wants. Don’t do this; we want to know how you think and feel and there is nothing more disappointing than developing a whole research project and getting responses that conform (become copies of) socially accepted responses. Given that people lie and under or overestimate their responses, how can we get accurate data? We can use something called naturalistic observation. Let’s say you want to know how parents interact with their autistic child. An interview may be helpful but due to social desirability, you might not get honesty, nor might parents remember every event you’re interested in. A researcher could observe them in their natural environment (i.e., not in a laboratory) without them knowing they are being observed or after a relationship has been built so that they feel comfortable during the observation and act more normally. A researcher could join a parenting group and listen to the conversation for what it is like to parent autistic children. The researcher might take on the role of an assistant in a parentchild group where parents bring their children and interact with them during play. A researcher could sit at the playground of a school for autistic children and watch what happens when parents collect their children after school. A researcher could even make friends with parents in a support group and ask them if they could observe them in their home. You see why this method has the word “natural” in it; it is designed to

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really show what happens in the real world as much as possible and this is a huge benefit. On the other hand, it is also filled with misunderstanding! How do you know, as the researcher, if what you are seeing is normal? How do you know you are making the correct interpretation? Real world behaviour is influenced by things like culture, context, time, and other variables we don’t even know about. What if three of the parents are going through a divorce and this is what accounts for their stressed parenting rather than the fact of having an autistic child? What if the parents are rushed after school and have to drop their kids at other appointments and have no time to play? There are invisible variables and by only watching behaviour, you might reach conclusions that are not valid. Hence, this method is useful but it can only help us describe aspects of behaviour, but not explain why it occurs. Finally, we can do a case study. This is kept for situations when there are few people in a category of participants we wish to learn about. For instance, few people worldwide have been kidnapped, gone to the Olympics five times in a row, or suffered from a brain injury. When we want to learn in-depth information about such special people, we do case studies that involve extensive tests, questionnaires, interviews and observations. In case studies, we use every means possible to learn all that we can to understand more about who they are and what they have experienced. Because case studies involve only a few people, it’s hard to know if what you see is due to the fact that this group of people is unique or if there might be a real difference between them and others who have not had the experience. While all of these methods have limits, they remain important. New phenomenon must be unpacked and discovered by descriptive methods first; there is no alternative. All research begins at this level and while some researchers think this stage might be elementary, it cannot be overlooked and remains a fundamental step in knowledge acquisition.

Correlational Designs Most psychology research studies are correlational. Correlation means association or co-relationship; that is, two factors have a relationship of some sort. Thus, in correlational studies, we try to determine the extent to which variables are related, or what factor goes with another. Correlational designs are non-experimental because they do not involve manipulating (changing) the factors; their aim is to determine the relationship between two variables and how strongly these variables relate to each other.

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This is different from what happens in true experiments where researchers try to determine what effect one factor has on another, or what changes in a factor are caused by the other. Thus, experiments are used to predict cause and effect (causation) but a correlation only tells us there is a relationship. If you’re lost, don’t worry! Let’s look at some examples and it will become clearer. There are several types of correlations, positive, negative, curvilinear, and no relationship. Positive correlation: In this case, an increase in one variable is associated with an increase in the other. An example is the more you study, the higher your grades. Both variables increase in the same direction. The variables can also decrease together as well and this is also a positive correlation. An example for this would be the less you eat, the less you weigh. It doesn’t matter if the variables are increasing or decreasing, what makes a positive correlation is that the two variables need to move in the same direction regardless of whether that is up or down. Negative correlation: Here, one variable increases, while the other decreases, the variables move in opposite directions. An example of a negative correlation would be the more you meet new friends, the less time you spend with your family, or, the more homework you do at university, the less time you have to play sports. Negative here doesn’t mean ‘bad’ – it means, moving in the opposite direction. Curvilinear correlation: Here, we have a positive relationship which becomes negative (or vice-versa) over time. Curvilinear is a type of relationship where either an increase or decrease holds true, but only up to a certain point. If you were to graph the relationship, it would look like an upside down “U” or a “U” itself. An example is that between stress and exam performance: as stress increases, performance does too but up to a point. If there is too much stress, performance suffers and decreases over time. Zero correlation (no relationship): This is the case when we discover that two variables are not related at all. An example is drinking Pepsi and reading books or the value of the Euro and loudness of a song. The important thing to keep in mind with correlations is that they do not suggest causation. Even if there is a strong relationship between two variables, it does not mean one caused the other. When you read through research, you will see correlations expressed with a number using the Pearson’s correlation coefficient, usually with the “r” symbol. Correlations vary between +1 and -1. If you see a correlation marked 1.2 for example, it’s wrong, it can never be more than 1. Correlations will be

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either positive or negative as you can see by the positive and negative sign. +1 means a very strong positive relationship whereas a -1 indicates a very strong negative relationship, while r = 0 would mean no relationship. You’ll never see correlations of +1 or -1 though; most relationships are not this strong. What is more likely are correlations like r = .4 (we drop the plus sign for the positive correlation) or r = -.37. The direction of the relationship is also not important when we are determining strength. Which relationship is strongest? r = .56 or r = -.67? If you chose -.67, you’re correct. Whether it’s positive or negative just tells us in what direction the relationship is moving, but the number itself tells us the strength of the relationship. Just because there is a relationship of some sort doesn’t mean the effect is not caused by a third unknown variable or factor. For instance, studying more and getting better grades seems to make sense, but there are loads of people who study more and do worse! There are also loads of people who don’t study at all, but cheat! Some people might receive more help from teachers or have a tutor or might be really smart to begin with. There are many reasons why things happen and a correlation only tells us that two variables go together, not which ones cause the other. Once we know certain variables go together, we must conduct an experiment to determine a cause-and-effect relationship, coming next.

Experimental and Quasi-Experimental Designs Have you ever seen ads for weight loss products or medications advertising what seem to be incredible claims? This pill will make you lose 10kgs in a month or cure your diabetes in three doses! The problem with these claims is that they are based on a small group of people – sometimes only even one or two, but what is not reported is all of the people for whom the product did not work. Yet, some people fall prey to ads like this because they do not understand how science and experiments work. To help you assess claims like these and understand the final research design, we explore randomized, controlled experimental designs, considered the “gold standard” in research. This design is far more difficult than the other designs, yet, it is the best for knowing whether a treatment will work. Let’s look at the elements of a randomized, controlled experiment (The clue is in the words!) There is a treatment group on which we will test a program, medication, procedure, or treatment. There is also a control group on which we will not test the program, medication, procedure, or treatment.

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This group may get nothing at all, or something similar but not quite the actual thing we want to study. Participants in both groups are randomly assigned. The researcher does not purposely decide this; it’s luck. Sometimes, it will be decided that every second person goes in the treatment group, or we can even decide by a flip of a coin, or a computer generated code. It’s decided in some way, but random, meaning everyone has an equal chance of being put into one of the two groups. Randomization is how we ensure that those who get the treatment are similar to those who don’t. If we don’t do this, someone can say at the end of the experiment, “Well, you only got those results because the treatment group was already smarter, or taller, or healthier.” Finally, in a randomized controlled experimental design there is a clear measurable way to determine whether the treatment had a true effect on the treatment group, and whether that result was significantly different from the results of the control group. One of the ways in which the experiment differs from the previous designs is that it is trying to determine whether one factor has an effect on another. From correlational designs, we learned that certain factors did in fact co-vary or have a relationship; now we want to see if one factor has an impact on the other. For this, we determine an Independent and Dependent Variable to study. The independent variable (IV) is the factor that is controlled by the researcher. For instance, if we want to study the effect of energy drinks on sporting performance, the independent variable is energy drinks. One group would get energy drinks (the treatment group) and the other (the control group) would get water to establish what is normal in terms of sports performance. Our dependent variable (DV) is the one that depends on the treatment. In this example, the dependent variable is sporting performance, and this is considered the outcome variable and the one actually getting measured. Remember those ads for weight loss and medication we talked about? Well, the reason we have two groups is to see what would have happened normally. The control group allows us to see what is normal and how the treatment group compares to that. If we have no group to compare our results to, we can’t decide if the result is significant because we have no measure of normal. The control group provides a way to know what is normal under the study conditions. How do you know if the results of a treatment are real when research suggests that people get better depending on the color of medication they take, the size of the pills, and how much a bottle costs regardless of what medication it is? This is called the placebo effect. The placebo effect

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happens when people experience a benefit after taking a treatment of some sort. A placebo is a treatment that we know doesn’t work, like herbs, sugar pills, or sweet water. It’s really a “fake treatment” we give people. In some cases, if people believe in something enough, it can actually produce results. Does this mean that sugar water works? No, it means that sometimes wanting something to work causes you to get better. Typically, we use a placebo in experiments when we must give a treatment to the control group so that they are not aware that they are the control group! If we were testing the effect of anti-depressant medication on people who suffered from depression, we couldn’t just give the treatment group medication and not the other. Why not? The control group would say: “Hey, why are we in this study if we’re not even getting medication?!” They might get even more depressed and angry, whereas the people in the treatment group might get happier only because they received medication and attention from the researchers. To compensate for the treatment/no-treatment difference, we would give the control group a “fake” treatment, i.e., sugar pills that looked just like the real thing. Now, both groups are getting medication and are responding to the “treatment” equally. We don’t tell the control group they are getting a fake because that would defeat the purpose. After a few weeks, we compare the two groups to see which group felt better. If we score both groups at an 8, it means the medication didn’t work any better than sugar pills and you shouldn’t waste your money on it! Thus, the purpose of using a control group is to figure out if a particular treatment has a real effect. If participants taking the actual drug show greater improvement over those taking the placebo, the study can say that the drug seemed to help more than taking nothing. A quasi-experimental design is the same as an experimental design except that we are unable to randomly assign participants to a treatment or control group. For instance, if we want to explore the differences in how young and older married couples respond to a financial problem, we cannot ask 30 people to get married now for our study. We have to use existing individuals who married recently and others who have been married for several years. This isn’t random at all and can limit the validity of our results because people who have been married a longer time might already be different than people who just married a few months ago. This is important because our two groups should be as similar as possible, remember? Thus, in this case young and older marital age is the independent variable and the dependent variable is the time it takes to successfully resolve a financial problem between them.

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Longitudinal and Cross-sectional designs There’s one more way to study phenomenon and that is over time. Here, we aren’t looking to test something or see what goes with what; but, discover how something changes in the same group of people over time, which can be weeks, months, or years. The most famous longitudinal study began in 1921 and is still going. Started by Dr. Lewis Terman, a psychologist interested in learning how 1,521 children from California who scored 135 and more on his intelligence test, fared over their lifetimes. They were contacted by researchers every few years and asked questions about health, careers, relationships, their children and so on.

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Over 100 research articles were written using the data. This type of study allows us to learn more about the relationship of personality or genetic traits or social and environmental influences on development. A limitation is that participants move way, drop out of the study, die, or otherwise lose touch with the researcher and is why the group needs to be enormous. If you don’t have 75 years to wait to collect your data, there is a worthwhile, but slightly less effective option called a cross-sectional design. Rather than follow children every year from grade 1 to grade 12 (which would take you 12 years), we take a short-cut and select 20 children from grade 1, 20 children from grade 2, 20 children from grade 3,

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and so on all the way to grade 12 (which would take one day and be cheaper to do) and take all of the measures we’d like at once. We would still see developmental changes over time, but we just couldn’t attribute them to specific individuals or causes and end up guessing a little as to their specificity. A cross-sectional study is an immediate snapshot of people at different ages or developmental periods versus an extended and repeated photo album taken over time of the same people (longitudinal study).

Step 4: Collect, Analyze and Interpret Data Once you’ve collected your data, it needs to be analyzed. If you read a journal article, this part appears in the Results section. This is where sophisticated mathematical and statistical measures are used. One way of analyzing the data is known as quantitative analysis because it involves numbers and computations. However, you may use other forms of analysis, such as qualitative analysis, where, for example, you might analyze interview records for distinct themes. In some cases, you can use a combination of numerical (numbers) and textual (words) analysis known as a mixed methods analysis. Some designs come with their own methods, whereas you will have options for other designs. In any case, you must select an appropriate method of analysis and the method you choose must have a high level of rigor. Additionally, it must be clearly documented in your study so that other researchers can redo your analysis and assess your results. So, it is important to remember that you need a coherent line of reasoning and justification prior to beginning the study and for every decision taken during it. Finally, we interpret the data. This is found in the Discussion section of an article. As we have presented our statistics (i.e., r=.67) in the Results section of our study, we now explain what these numbers mean and their implications. After having completed the literature review, designed our research study, and analysed our results, we are the expert on this research question. So, based on the methods, analysis, and literature review, we tell the reader how this study is important, what might come of it, and how it adds to the line of evidence on our research question. We must also identify the study’s weaknesses Also, not every study proves what it set out to prove and that’s ok. Isn’t it important to know that medication A showed no effect on blood pressure? This could encourage future researchers to pick up where we left off and examine whether there was something interesting or unique about

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our sample or why this medication failed f to show w effects in this t case. Everything w we discover iss useful to som meone.

Step 5: Pub blish in Peerr Reviewed JJournals

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Now, we wrrite up our stuudy in its entirrety starting w with an abstra act (often a 350 word summary) annd then a full version of ouur study going g through each step w we’ve outlinedd. We include a thorough rreview of the literature emphasizingg what themees were foun nd, developmeents, problem ms and/or gaps in knoowledge. Bassed on this, we w can explaain why and how we developed oour study, which w must follow the sscientific metthod and publishing sstandards set by b each journaal. The jourrnal to whichh we send ou ur study mattters greatly to oo. Some researchers say there is bias in thatt top journalss prefer research that reflects their country of origin o with th he consequencce of research hers from other parts of the worlld having a tough time getting published. In response, m many regional and internatio onal journals have been deeveloped. This is oftenn where a lot of non-Westeern research iss found. An ex xample is the Middle E East Journal of o Positive Pssychology devveloped in thee UAE; it is a specialized journal inn positive psy ychology and oonly for reseaarch from the region. IIt is an exam mple of how th he centre of reesearch can shift s from one region to another.

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Once you submit a paper to be published in a journal, it doesn’t automatically get accepted. In fact, it usually doesn’t because there are thousands of submissions for only seven or eight spots per journal and the peer review process ensures that only the best papers make it in. The peer review process entails the study being sent to three researchers from around the world who are considered experts in your field of study. Reviewers determine whether the study is worthy of publication. The process is anonymous; that is, we never know who the reviewers are and they do not know who did the study. They offer a thorough critique of the literature review, methods used, samples selected, data analysis, conclusions reached, implications, and so forth. This is why we must document everything. If the information is missing, unclear, or incorrect, the paper will be returned with further questions, or rejected on the spot. Most researchers are rejected several times, each time, taking feedback and improving their paper until it gets published. The process can take a year and is not always successful.

Generalizability and Bias As the USA produces the largest share of scientific publications globally, there is concern about the generalizability of research findings (the ability to say that a research finding applies to or represents everyone). In positive psychology for instance, 94% of the research published emerges from the US despite the fact that the US only accounts for 5% of the world's population (Bermant, Talwar, & Rozin, 2011). The danger of this imbalance is that Americans have become substitutes for the whole world. This false representation stands in contrast with the fact that two-thirds of the world’s population is overwhelmingly Asian and non-Christian. Yet, we continue to see what is “normal” from a Western view because that’s where the research is from. Given the numbers of studies coming from the US and the fact that most professors use their students as research participants, we end up with standards of ‘normal’ based on Western, Educated, Industrialized, Rich, and Democratic individuals. Are you a WEIRD participant? This doesn’t always mean that research won’t apply to non-WEIRD people, but always ask; would that finding be true in this area, under these circumstances, or with these people?

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Researchers can be biased or unfair (researcher or experimenter bias) in how they conduct research. We can bias the results of our studies by influencing participants, or choosing certain research methods over others which we know will give us a better result. In short, bias refers to anything the researcher does that influences the study more favorably. Researchers should be concerned about being fair and aiming to reach the highest level of rigor even if it means that their study will come out less favorably. No one wants to be known as a cheater and as your methods must be written in your study, anyone can replicate it and see that there were mistakes, limitations, or purposeful omissions or choices made to skew the results. That can be downright embarrassing and detrimental to researchers’ reputations. An example of a researcher bias involves the selection process of study participants (selection bias). Let’s assume you want to determine who is stronger in science, girls or boys? You select one class from a boy’s school and another from a girl’s school. But, the girls school is in a high socioeconomic area of the city (thus, they are more affluent and have access to better resources at school and home to help them succeed), while the boys are from a poorer area of the city with a lower standard of teaching, few resources and far less parental involvement. You can already guess that the girls will be the ‘smartest’, but is this accurate? Whenever we compare groups, even if they are different (i.e., gender), we must make them as similar as possible. In this case, we should select multiple groups either from the same area of the city (so they are all high or all low socioeconomic classes), or select them from all over the city so there is an equal mix of high and low socioeconomic classes. This way we can be sure that our result is not due to class, money, or other confounding (unknown) variable. When you read research, you should always see who was selected in the participant pool and determine their similarities, differences, and/or how similar they are to you.

Research Ethics by Dr. Katharina A. Azim There are many different research methods in psychology. You may have seen scholars conduct interviews, send out surveys, hold focus groups, or go “into the field” to observe people. No matter the method, an important part of every research project is the concern for ethics. Ethics are norms of acceptable and unacceptable behaviour. We learn at home, in school, through our religion, or at work how we are expected to behave. For example, religious writings like the Hadith help people understand how they can live together in society and act respectfully toward one another.

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We think that our own understanding of what is and is not appropriate is universal and based on common sense, but there are many grey areas depending on a person’s culture, age, gender, religion, and other features. When we speak about ethics in research, there are guidelines on how we can be professional and respectful toward our participants and their experiences. You have probably heard someone mention, “First, do no harm.” Psychologists and many other practitioners, researchers, and scholars around the world who work closely with people hold this as a principle of ethics. It means that we should intend to protect our participants from any potential harm that arises from the research we do with them. We should also ensure that the benefits of our work are greater than the potential risks that come with any research. To protect participants and researchers from ethical concerns, many institutions have ethics committees that put out guidelines on how to protect participant rights. First, every researcher must inform potential participants of their rights before the study begins so they can make an informed decision to take part or not. That includes telling people that their participation is voluntary and telling them about any potential risks and benefits. It is also necessary to explain and remind people that they have the right to withdraw from the study at any time and that they will face no consequences for doing so. Finally, it involves telling them what will be expected from their participation and what they will be asked to do ahead of time. Sometimes, it is difficult for people to decide if they should be part of a study, so researchers must take special precaution when they include what are called, vulnerable populations. These groups of people are at a higher risk of experiencing harm in society. They include people who do not have the same privileges as others in society, like racial and ethnic minorities, people with undocumented or refugee status, people living in homelessness and extreme poverty, and those with a chronic illness or disabilities. Children who are too young to consent also need special care because they cannot assess the risks that come along with research. An important aspect in research studies is privacy. One way of protecting participants’ privacy is by designing the study as either anonymous or confidential. Anonymity means that you do not collect identifying personal information like names, email addresses, and birthdates of your participants, or that you make it impossible to link a participant to their private information by using online surveys for example. Anonymity means the researcher does not even know who answered and how. If this information is important in your study or you

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meet the participant in person, for example in a focus group or an interview, you can make your data confidential. You can do this by using alternative names for your participants, called pseudonyms, or by keeping identifying information separately. Thus, confidentiality means the researcher knows the study participants but makes efforts to disguise who they are in the study itself to protect their identity. We can never promise 100% confidentiality and anonymity, but as researchers we need to try. Imagine if people not involved in the study found personal information on someone who shared their intimate experiences with you. This could be harmful or even dangerous. In the worst case, it could result in humiliation, harassment, or expulsion for their workplace as an example. Besides the harm for the participant, there are also negative consequences for the researcher. Imagine a close friend shared your confidential story with others. This would certainly make it more difficult for you to trust that person in the future. Similarly, in research such events could lead to a person or whole community distrusting researchers. It can even block future researchers from working in that community. Therefore, we need to remember that participants allow us a personal glimpse into their lives, thoughts, and feelings, so we should be the trusting and respectful research partners they expect us to be. A first step to achieve that is by designing our studies along these ethical guidelines.

Over to you now… 1. What does the placebo effect mean? Do a Google search to find three examples of the placebo effect and report it to your class. 2. Given that true experiments are the gold standard in research, when and why might researchers use alternative designs? 3. Come up with three research questions that interest you and propose a design for each question. Discuss with your classmates; would they choose alternative designs? Which ones? 4. When thinking of the different types of psychology; go online and find a study from one branch of psychology and summarize it for the class. Make sure all of the branches are covered between all of you. 5. What do you think of the Western bias in the academic publishing world? What does it mean for the advancement of knowledge in psychology? How do WEIRD samples differ from where you are from?

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6. If you had to choose a branch of psychology in which to work, which one would it be and why? What would you like to investigate or do within that field? 7. If you had to give a brief definition of psychology to a friend who does not know anything about the discipline, what would that definition be? 8. Quickly summarize each approach in the field. Which appeals to you most? If you wanted to see a psychologist, which approach would suit you best? 9. What’s the purpose of a correlational design? 10. What does a Pearson Coefficient r = .33 mean?

CHAPTER TWO PSYCHOLOGY IN THE ARAB AND WESTERN WORLDS

Photo credit: Louise Lambert

Chapter Outline What is Indigenous Psychology? by Dr. Nahal Kaivan Psychology from an Islamic Perspective by Dr. Amber Haque Psychology in the Western World by Reham Al-Taher Topic Box: DSM or the CSV? Know your books! By Dr. Louise Lambert x Over to you now… x x x x

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In the Arab world (and elsewhere for that matter), psychology is not always easily understood. Students often ask whether psychologists can read people's mind and are unsure as to what we do and what psychology is about. But, more than that, there is a lot of stigma attached to people who use psychological services. There is a belief that if you see a psychologist you can't handle life, you need to be medicated, or there is something deeply troubling about you. Yet, psychology is for normal people who have normal problems! You might see a psychologist if you are having problems with your husband or wife, having difficulty disciplining your kids, dealing with an unreasonable boss, or experiencing stress at school. Sometimes you just need to talk to someone who is not a family member or a friend. Sometimes an impartial person can help us look at our problems from a different perspective. In this chapter, we investigate the ways in which psychology is interpreted in Western, Arab, and Islamic contexts.

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What is Indigenous Psychology? by Dr. Nahal Kaivan

Photo credit: Louise Lambert

General psychology was developed in the Western world. Many theories in psychology, such as those of Sigmund Freud, Carl Jung, and Jean Piaget originated in Europe and were later adopted in the United States. North American theorists, such as B.F. Skinner, Albert Bandura, and Carl Rogers also made important theoretical contributions. These theories contributed to the idea of one singular scientific truth, or objective way of understanding the world. What resulted was a universal, or general psychology intended to apply evenly across all cultures. Indigenous psychology in contrast, “advocates examining knowledge, skills, and beliefs people have about themselves and studying these aspects in their natural contexts” (Kim, Yang & Hwang, 2006, p. 6). In indigenous psychology, multiple versus one way of knowing is assumed and one’s context or setting is essential to understand. Rather than applying Western psychologies or ways of knowing to non-Western cultural contexts, indigenous psychologists think that creating a context-specific psychology would be a more helpful and less pathological way of understanding a culture or group. Another way of understanding the difference between Western psychology’s universalist approach to understanding and indigenous psychology’s contextspecific approach to understanding is through -etic and -emic distinctions. Researchers using an etic approach to understanding symptoms of depression might collect data across cultures in Japan, Saudi Arabia, France and the United States. Aiming to understand what manifestations

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of depression are the same across cultures, they would compare and contrast differences in order to discover both differences and similarities with the experience of depression across these cultures. Researchers using an emic approach to understanding depression might conduct their study with one cultural group, such as the Bakhtiari people of Iran. They would aim to understand the behaviours and experiences that one cultural group, the Bakhtiari people, has with depression. The emic researchers may not call depression, “depression”, rather, they might ask the Bakhtiari what their experiences are with a range of emotions seeking to understand Bakhtiari norms, values and customs, and most importantly, not imposing cultural values or assumptions onto them. While discussing the differences between general and indigenous psychologies, it is important to highlight that one is not better than the other; rather, they are equally useful in the appropriate context. However, many Western theories remain dominant ways of understanding human experience and behaviour. Even internationally, Western theories or ways of knowing are commonly used for understanding human experiences, behaviours and conducting therapy (Gallardo, Kaivan, & Gomez, 2012). This has become problematic in the field of psychology in that many religious, ethnic, racial, and other groups have been pathologized (made to seem dysfunctional) through Western or general psychologies that assert a universalist stance that is actually culturally specific to Western ways of understanding the world. Many examples illustrate the dangers of applying a Western frame of understanding universally across cultural groups. For instance, in the United States, African Americans have been overdiagnosed and misdiagnosed with schizophrenia, a severe disorder that is characterized by serious psychological impairment (Robinson & Morris, 2000). Inaccurate diagnosis can lead to detrimental effects, such as loss of employment, or exclusion from certain jobs and social groups, and improper care or treatment. Western theories applied to Arab clients have also led to pathologization. Some examples include the misdiagnosis of Dependent Personality Disorder, Social Phobia, Paranoid Delusions, and Post-Traumatic Stress Disorder (Dwairy, 1998). Middle Eastern/ North African (MENA) researchers in the field of psychology using Indigenous ways of knowing include culture as a factor within one’s context to state that many of the symptoms or criteria for these disorders are not considered pathological or they are simply experienced differently in South/Eastern and North African cultures (Dwairy, 1998; NassarMcMillan, Ajrouch & Hakim-Larson, 2014). This textbook is one example of local and international researchers trying to dispel the dominant way of

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looking at the world by including multiple, or “other” ways of understanding the world.

A Brief Overview of Islamic Psychology by Dr. Amber Haque

Photo credit: Louise Lambert

Psychology that is taught today as a discipline around the world is almost entirely Western; that is, it originated in European countries in the late 19th century and started as an independent science when Wilhelm Wundt established the first experimental lab in Germany in 1879. Modern psychology grew in the West and was imported throughout the 20th century in almost all non-Western countries. Other kinds of lesser-known psychologies have also existed throughout human history but have been overshadowed by Western psychology. These indigenous psychologies include Chinese psychology, Indian psychology, African psychology, and others. A major reason for the development of indigenous psychology is that explanations of human behaviour from a Eurocentric point-of-view are not always relevant for or beneficial to people of non-European based cultures. In order to truly understand people, it is important to know their belief system on various topics. Muslims in the Arab world, for example, belong to a group that may not benefit fully from Western explanations of human behaviour. This may be one reason why psychology never

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established its roots or became fully developed and even accepted in this part of the world: the theories of Western psychology are often incompatible with an Islamic worldview. An indigenous psychology that is rooted in Islam would provide a better alternative. As the name suggests, Islamic psychology is based in Islamic theology and worldview based on the Qur’an and Hadith (traditions of Prophet Muhammad, Peace Be Upon Him). The early Muslim scholars also wrote extensively about human nature and some of their works are introduced here as well.

Photo credit: Pixabay

The term “psyche” refers to soul and “ology” means the study of, so psychology was originally meant to study the soul, but as scientific psychology developed, its subject matter changed. The Arabic equivalent of the term psychology is ilm-an-nafs or knowledge of the soul or self. The key difference between Western and Islamic psychology is that while Western psychology studies the physical aspects of behaviour and mental processes, Islamic psychology concentrates on the spiritual aspects of behaviour and mental processes. The physical and material aspects of behaviours are secondary in Islamic psychology because Islam considers physical matter secondary to spirit. In Islam, human beings are both a body and a soul. Yet, the body is not as important as the soul because the latter consists of inner structures

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of personality that influence the body until it dies. In Islamic psychology, the metaphysical elements that influence human behaviour are the soul (alnafs), the heart (al qalb), the spirit (al-ruh), and the intellect (al-aql). The nafs, aql, ruh and qalb are intertwined and influence human behaviour. The nafs is like the ego that gives rise to reactions to the environment that has been acquired through the lifespan. It may be reflective of an animalistic side of the individual at its lowest untrained level. Many spiritual healers liken the nafs to an animal that if it is untrained may not be pleasant. Yet, if one were to train an animal it can be of service to its master. The nafs is somewhat similar to Freud’s conception of the id (which you’ll read about in the next section). However, from the Islamic perspective, the nafs is not intrinsically bad. Rather, if it learns good habits, it will be of service to the individual, and if it learns bad ones, it can be a barrier to growth. The aql is the rational faculty of human beings and is home to logic, reason, and acquired intellectual beliefs. The ruh is the spirit that, if kept healthy, allows one to live a meaningful and wholesome life. Finally, the qalb is the heart, sometimes used synonymously with “self” and “soul.” Sicknesses of the heart are often indications of sickness of the whole. The heart is where the effects of the other three elements manifest. The heart may also contain hidden blemishes such as jealousy, envy, and pride, that are results of the nafs’ evil inclinations, the aql remaining either dormant to the nafs, or a lack of good reason and malnourishment of the spirit. In order to remove these sicknesses of the heart, one must work toward modifying the inclinations of the nafs toward good, restructuring and acquiring positive/moral thoughts in the aql, and feeding the spirit through remembrance of God.

The Concept of Al-Fitrah The concept of al-fitrah which is knowledge combined with the human soul is the most essential aspect of human behaviour, so it is important that in order to understand psychology from an Islamic view, we must understand the concept of al-fitrah. It is also essential to know that the Islamic creed or aqeedah demands that believers unravel the mysteries of nature not only through science but also through Divine words and wisdom by reflecting on the verses of the Qur’an. Scientific knowledge keeps developing, while the Divine words are final. Knowledge of the self is especially important in Islam as narrated in one of the sayings of the Prophet that “whoever knows himself/herself, knows his/her Lord.” So

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psychology in Islam has great significance if it is studied from Islamic indigenous perspectives. There are at least four interpretations of fitrah, but here, we will discuss only the “positive” interpretation of fitrah, i.e., that human beings are innately good. The notion of fitrah refers to a person’s innate nature, which is not changeable. From a religious perspective, al-fitrah is considered the natural tendency of human beings to accept the Oneness of God (Al-Tawhid). In other words, every human being is born with an innate ability to know God. God created fitrah so humans could acknowledge Him as the One and Only God who has power over everything. The Qur’an testifies that God brought forth from the loins of the children of Adam and made them testify that He is their Lord (Q. 7:172). Islamic psychology stresses that nothing can erase human fitrah and for those who have buried it, it can be revived. Our metaphysical or spiritual fitrah is superior to our earthly existence because the physical is momentary, while the spiritual is permanent. Ibn Khaldun (d. 1406), the Arab philosopher and sociologist, attributed the rise and fall of Arab civilizations to fitrah and maintained that religion alone can bring humans closer to their innate metaphysical nature.

Nafs: The Nature of the Human Soul The Qur’an states that humans are both body and soul. The knowledge of the soul given to human beings is very little, but we can arrive at some knowledge of God as the object of worship (3:81). Based on the Islamic worldview of the Oneness of God (Al-Tawhid), the spirit, soul and the material world, some notable Islamic scholars considered humans as a microcosm of the universe. In other words, our physical and spiritual nature reflects the nature of the universe and once humans realize this, we will come to know the world and its' Creator. The terms heart, soul, spirit and intellect convey two meanings. The first refers to the physical entity and the second to the non-material and spiritual entities of human existence. “Animal instincts” are related to the physical entity and may come into conflict with intellectual and spiritual instincts. Humans as possessors of body and soul have both animal and angelic qualities. The Qur’an states that humans are created in the best of molds but without true faith and good works they can become worse than beasts (94:4-5). It is against these animal instincts that Prophet Muhammad cautioned human beings, asking them to fight against the evil inside oneself, calling it jihad al-akbar or the greater struggle.

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The second meaning of heart, soul, spirit and intellect refers to the ultimate and metaphysical reality of humans and their essence, hence the tradition that “whoever knows himself knows his Lord.” It is said that when the soul inclines towards al-fitrah, peace descends upon it. This state in the Qur’an is called the tranquil soul or nafs al-mutmainnah (89:27). The soul also moves between spiritual qualities affirming loyalty to God and at the same time is drawn towards animal instincts, called the nafs allawwamahh (75:2). It is possible by means of knowledge and good works to tame the animal instincts and attain an angelic nature, but if one cannot, a person may appear human in shape but cut-off from fitrah (a condition called nafs al-ammarah bissu (12:53)). This understanding of the soul is essential to appreciate an Islamic perspective of psychology. Scholars have elaborated on many levels of nafs as follows: 1. Nafs Ammara (the commanding self): the first stage in the development of humans where the rational self and conscience is overtaken by physical desires and expresses itself in selfishness, arrogance, oppression of others, lack of gratitude, stinginess, envy, anger, laziness, etc. 2. Nafs Lawwamah (the blaming self): the second step in human development where one becomes aware of one’s actions and differentiates between right and wrong yet unable to stop oneself from wrong doing. 3. Nafs Mulhima (the inspired self): the third stage in which the good begins to predominate in the constant struggle of the previous two levels but the dangers of reverting back to the earlier stages is possible. 4. Nafs Mutmainnah (the secure self): the fourth stage in development where one has entered the first station of spiritual development and has completed one’s faith and level of self. In this stage, the evil forces of nafs shrink and purity dominates the heart so it becomes the secured self. 5. Nafs Radiyyah (the content self): the fifth stage wherein as the secure self ascends to God, the lights of the heart increase and it is totally content with its Lord. Hardships and ease are same to it as it is happy that every action is from God alone. There is perfect harmony of which he is aware and there are no possibilities of error as he is the master of his nafs. 6. Nafs Mardiyya (the gratified self): the sixth stage where the nafs is not only content with its Lord but gratified by Him.

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Nafs Kamiliya/Nooraniyah (the purified self): This final stage of development of the self wherein a person attains a complete level of servanthood to God.

Qalb and Aql: Significance of the Heart, Intellect and Freewill

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The heart (qalb) in Islamic psychology is the metaphysical entity that is the seat of the true self, the repository of the soul and the core of human personality. It is the heart through which an individual grasps the ultimate knowledge and metaphysical truth; it is our true existential and intellectual center, where contemplation occurs and is therefore, considered more significant than intelligence. Human behaviours reflect the psychospiritual processes taking place in the heart, where sense perception can be supplemented to obtain the true meaning of what we see physically. The object of all sensory observations is to open the eyes of the heart so it can perceive the Oneness of God, hence “there are those who have hearts with which they understand not, eyes with which they see not, and ears with which they hear not” (7:179). In another verse, the Qur’an asks, “Have they never journeyed about the earth, letting their hearts gather wisdom, and causing their ears to hear. Verily it is not their eyes that have become blind—but blind has become their hearts that are in their breasts…”

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(22:46). The Qur’an asserts that it came down upon the “Prophet’s Heart” (2:97) and God reveals Himself to the heart, which knows Him, the spirit which loves him, and the soul that contemplates Him.

Photo credit: Pixabay

There are many terms used in the Qur’an regarding the characteristics of the human heart. Qalb muanun bil-iman (a heart pacified with faith), qalbim-munib (a heart moving towards God), qalbin-saleem (the righteous and the pure heart) are expressions of a healthy heart, and the negative conditions are called amraz al-qalb or diseases of the heart. Humans carry within themselves good and evil tendencies and they are in constant struggle due to opposite dispositions. If the heart is not Godconscious, the evil disposition becomes strong. The complacency of the good and dominance of the evil can destroy the capacity for spirituality and inner vision to realize one’s fitrah and improve one’s self. According to some Muslim scholars, the heart is divided into three types: the healthy heart, the dead heart and the sick heart. A healthy heart is cleansed from passion for all things that God forbids and follows the injunctions given in the Qur’an. The dead heart does not know or worship its Creator in the way it is commanded by Him and the sick heart knows the commandments of its Creator but it suffers from illnesses resulting from a lust for the fleeting pleasures of this world. Thus the Islamic saying “there is a piece of flesh in your body (referring to the heart) that if it is sick, the whole body is sick”. It is said that the intellect (aql) and evil in humans work together to regulate material desires but in opposite directions. The intellect works

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towards the growth and development of the self and if the functions of heart and intellect are compatible with al-fitrah, they will subdue the animal forces within us, but in cases where evil tendencies are stronger, the intellect becomes weak and its functions are paralyzed. In such cases, human intellect is used to fulfill the impulses of the material world and in the end, the heart becomes totally blind, losing sight of the ultimate good for one’s self. Thus, a direct command from the Qur’an is that “…don’t be like those who forgot God and eventually He caused them to forget themselves…” (59:19). The terms used in the Qur’an are ta`aqqul and tadabbur with respect to the heart’s cognitive processes. A heart that does not engage itself in reflective thought is described as one that has “gone blind.” Freewill (iradah) is another concept that refers to the choice of belief and actions in accordance with fitrah and the accountability for not doing so. The purpose of all these concepts and their interplay is to show their existence and relation to human behaviours and mental processes from Islamic perspectives.

The Concept of Jinn, Satan and Evil Eye

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The belief in Jinn, Satan and evil eye is part of Islamic creed and its influence on psychological processes and mental health is seen throughout the Muslim world. Jinn are part of God’s creation, separate from humans

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and the angels, but sharing certain human qualities like intellect, freedom to choose between true and false, right and wrong, good and bad, and so on. Among the Jinn, there are believers and non-believers. According to Islamic belief, Jinn are made of smokeless fire and dwell generally in deserted places, ruins, in the air and fire and possess bodily needs similar to humans. Jinn are mentioned in the Qur’an and the possibility of possession by the Jinn is also mentioned in verse 2:275. The treatment of possession by Jinn is very common in the Muslim world. Satan (Shaitaan) is the Arabic name of Devil, whose work is to incite humans to commit evil through deception, known as “whispering into the hearts.” While all humans are created with a pure soul and in a positive state of fitrah, it is through one’s free will that humans fall prey to Satan. This leads humans to not only deviate from fitrah but invite all sorts of psychological and emotional distress and disorder. Finally, the concept of the evil eye is based on the Islamic doctrine and backed by traditions of the Prophet. The idea of evil eye is that when someone looks at something beautiful and fails to recognize the Creator by offering some form of verbal praise, such as subhanAllah (Glorified is God), or is envious, God can bring harm to that thing. It affects an individual in the same manner as poison or harmful medicine and requires a cure and protection against it. If it does not affect the envied, it is because of the preventive methods taken by the person in reciting the last three chapters of the Qur’an and a verse entitled ayatulkursi prior to bed and after morning prayers.

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Perspectives of Early Muslim Scholars

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Written accounts of human nature by early Muslim scholars can be found as early as 800 AD and onwards until 1100. The key element in Islamic psychology was on finding ways to cure and heal rather than just theorize, and the works of early Muslim scholars underpin many modern techniques. In Islamic perspective, the ability to maintain a positive occupational, familial, and social life may not be equated with positive mental/spiritual health; yet, the presence of positive character traits and behaviours are indicative of positive mental health. Additional symptoms of mental illness that are not equated with mental disorders in Western literature may include addiction to wealth, fame, status, ignorance,

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arrogance, cowardice, cruelty, lust, avarice, deceit, etc. Hence, a large part of an Islamic lifestyle includes the necessity of gaining self-awareness into the internal experiential realities of the self. While many contributed to the debates on the philosophy of the mind and soul, a few names deserve mention and are illustrated below. Al Kindi wrote his books On Sleep and Dreams, First Philosophy, and The Eradication of Sorrow, using cognitive strategies to combat depression. Al Tabari was a pioneer in the field of child development, which he elucidated in his book Firdaus Al-Hikmah. Al Farabi wrote his treatise on social psychology, most renowned of which is his Model City. Ibn Sina, in his book Al Shifa, discussed the mind, mind-body relationship, as well as sensation, perception and other related aspects. He also gave psychological explanations of certain somatic illnesses. Another scholar, Ibn Tufail, gave a unique concept of man as Hayy bin Yaqzam which shows that man has enough powers to reach the ultimate truth with the help of Qur’an and Sunnah. Better known, Al-Ghazzali examined human nature and found that all psychological phenomena originate with the self. He further described the nature of soul and reasons for psychopathology. Yahya Ibn Massawayh, Abu Zayd Hunayn and Ishaq bin Imran, all wrote monographs on melancholia (sadness), emphasizing the benefits of psychotherapy. Al-Razi wrote Kitab al-Hawi discussing different types of melancholia, hypochondria, and effects of temperament on personality, lethargy, madness (junun), schizophrenia (hadhayan), forms of insomnia, mental confusion (iqtitlat), and delirium and described the causes, symptoms and treatment of them. Abul Hasan Ali Ibn Abbas Al Majusi in his book, Kitab al-Malaki, wrote about sleeping sickness, loss of memory, and coma. Abu Bakr Rabi wrote a book named Al Muta’alimuna fi al-Tibb in which he discussed nerves, nature of the brain, its form and functions, symptoms of brain disorders, emotional disorders and sleep disorders. AlBalkhi wrote about rational and cognitive therapies for anxiety, depression, anger, panic, and obsessive disorders.

Six-Step Model for Self-Improvement So while there are consequences of negative effects of the nafs on the heart, what can one do to? Ghazali (1853/1986) suggested the following a six-step method of treatment: x Musharata: make a contract or agreement with oneself toward meeting identified goals. x Muraqabah: guard or reflect over one’s actions.

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Muhasabah: take an ongoing self-account of one’s actions. Muaqabah: give oneself consequences for failing to keep up with the self-agreement or contract. Mujahadah: strive to overcome the desire of the lower nafs. Muataba: show regret for making an error and make a vow to avoid the same mistake(s).

Ghazali’s emphasis is on keeping an eye on one’s thoughts and behaviours to ensure success of the self-contract. He explained that one can view one’s life as a “business,” which can bring gain or loss depending on one’s conduct in relation to the six steps. The more conscious one is and the more one applies these stages in one’s daily life, the more positive gains one can make in one’s thoughts, feelings, and behaviours, thereby improving the overall quality of nafs. One can only hope that with the increasing global interest in indigenous psychologies, supporters of Islamic psychology will continue researching the works of early scholars and Islamic texts and develop a theoretical model for understanding and treating psychological conditions from an Islamic perspective.

Psychology in the Western World by Reham Al-Taher Psychology has a rich history as people have always been interested in what makes us function. The history of psychology from a Western view is important to study as the West has had a large influence on how we understand, experiment and interpret behaviour, emotions and thoughts. Let’s walk through the history of Western psychology.

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Psychoanalytic Psychology

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Up to this point, psychology was interested in the conscious, human experience. An Austrian physician named Sigmund Freud (1856-1939) was interested in unconscious beliefs, secrets our mind keeps to avoid mental anguish and anxiety, as he believed these were the underlying causes of many dysfunctions. Hysteria is a behaviour that interested him, as it involves physiological symptoms in the absence of physiological

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origins, implying that it may be psychological in nature. He applied hypnosis, free association, and dream interpretation to find the origins of disorders and it helped him develop his theory of psychoanalysis (Freud, 1930/1962). Freudian Psychoanalysis emphasizes sexual development as a source of mental health and illness. This had a dramatic influence on psychology as his theory of personality placed great importance on the unconscious mind. As he continued to work with patients, he developed a theory suggesting that early childhood experiences and unconscious desires and fantasies contributed to adult personality and behaviour. According to Freud, human personality is divided into three psychological components (not physical parts of the brain). The id is the primitive component that contains the instincts and operates on the pleasure principle. That means the id wants everything that feels good and wants it now! The superego, on the other hand, is the part that reflects society’s rules and morals; the superego is in constant battle against the desires of the id. The ego is the rational part that tries to find a balance between the id and the superego. In this model, the human mind is a battlefield and psychoanalysis is the way to understand its workings. Because, as the saying goes, “nothing stays buried forever”, our unconscious desires find ways to express themselves. This expression can be done through slips of the tongue, or “Freudian slips”, accidentally saying the wrong word in a sentence that has either a positive or negative connotation behind it. We see it many times with news anchors where, although reading from a teleprompter, they sometimes use swear words in their speech without meaning to. Another way our unconscious expresses itself is through dreams that are filled with symbols and metaphors that, according to Freud, represent our desires that our consciousness is trying to avoid. Freud claimed that psychological disorders were the result of these unconscious conflicts becoming extreme, unbalanced, or neglected. To Freud, these unconscious desires nonetheless operate as part of a person’s personality, but the individual is not totally aware of them and consequently, needs psychotherapy (a form of talk therapy) to uncover them. Having a sense of guilt or shame and not being able to explain why is an example of an unconscious conflict. This was used as the reasoning for the necessity of psychotherapy to help the person become more self-aware, functional, and less anxious. The result of psychoanalysis is to have the individual make conscious choices and have their neuroses healed. The incapability of either one produces “diseases of the personality”. Psychoanalysis had a huge impact on 20th century thought and its theories were heavily influential. The problem with psychoanalysis is that its theories and

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concepts cannot be observed, analyzed, or quantified empirically. Freud never studied patients as an experimental group, but on a case-by-case basis. This makes his theories hard to validate and generalize across the entire population. If everything has to do with the unconscious, something we can’t see or are aware of without the help of someone else, then how can it be known or real? How can others know us better than we know ourselves? As a result, other schools of psychology emerged as a response to this lack of scientific validity.

Behavioural Psychology

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Behaviourism was a response to psychoanalysis and it focused on making psychology a scientific discipline focused purely on observable behaviour. In the early 20th century there was a rise of using animals in experiments. Russian physiologist Ivan Pavlov’s research on dogs led to the classical conditioning theory. He demonstrated that if he could pair food with the sound of a bell enough times, the dogs would salivate to the sound of the bell because they learned to associate these two stimuli. This was generalized to human behaviour, suggesting that humans learn similarly by

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making assoociations. For example, man ny of us like the scent of a perfume more if it is worn by a lovved one becau use of the assoociation we make m with our feelingss for them. Iff we smell th he perfume onn someone ellse it can bring back thhe same feelinngs of nostalg gia and care. Am merican psychologist, John B. B Watson (18878-1958) beccame one of the stronngest advocaates for behaviourism andd argued thatt we are determined by our enviroonment and itt is our enviroonment that creates c or limits our m mental health. If we focus on o fixing behaaviour, then we w can fix internal (em motional) probblems. Behaviourists acknoowledge the power of the mind, bbut since it’s not observable, they chooose not to foccus on it. Watson sugggested that consciousness c is not a usaable concept and goes back to anciient ways of superstition s an nd magical thiinking (Watso on, 1925). The impact of behaviourrism was hug ge and this nnew school off thought dominated thhe field of psyychology for the t next 50 yeears. Psyychologist B.F. Skinner (1904-1990) eexpanded beh haviourist theory with his concept of o operant con nditioning (S kinner, 1953)), the idea that humanss learn througgh punishmen nt and reinforrcement of behaviour. Behaviourissm was accuseed of being reeductionistic;; that is, many y held the view that huumans cannot be reduced to o the level of aanimals in lab boratories and that wee are more complicated c than t productss of the enviironment. Nevertheless, behaviouraal techniques are a still succe ssfully used today t like when we giive stickers too students who do a good jjob in class because b it positively reeinforces them m to keep work king hard.

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Cognitive Psychology

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Psychologist Noam Chomsky (1990) disagreed with the idea that language is learned from reinforcement and punishment and claimed that there must an internal mental structure that helped one learn language. He argued that people generate unique phrases and sentences that nobody had ever taught them before. This is when cognitive psychology began to emerge, which focuses on our mental processes in response to environmental information, to which we then respond. The rise of computers also moved us away from being compared to animals to being compared to information-processing machines, i.e., computers. This was a new way to study the mind scientifically and with the belief in the importance of mental states, cognitive psychology became the dominant model by the late 1970s. Cognitive psychologists have evolved since then, but continue to focus on thoughts as determinants of actions and emotions, and consider

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people to be active participants in their own development seeking out information, experiences, and having an effect on them as well. The field currently studies problem solving, memory, language, decision-making and is very active in the area of depression where researchers like Albert Ellis (1993) and Aaron Beck (1967) developed cognitive models that highlighted errors in thinking, like catastrophizing, all or nothing thinking, and mind reading as reasons for why depressive symptoms develop. Offshoots of cognitive therapy have evolved and combined with previous models to create cognitive-behavioural models, social-learning models and others.

Humanistic Psychology

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Another school of thought known as humanistic psychology emerged emphasizing the totality of human experience. While psychoanalysis focused solely on unconscious beliefs and desires, behaviourism focused on the environment, and cognitive psychology focused on information processing, there was no school focused on the person as a whole. Humanistic psychologists look at human behaviour not only as observers, but by putting themselves in that person’s shoes. Unlike other psychologists

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who choose to play the role of observer, humanistic psychologists empathize with the person and study their subjective experience. This type of psychology became very influential throughout the 1970s and 1980s. American Carl Rogers (1902-1987), the father of humanistic psychology, believed that psychology should not merely focus on behaviour, unconscious forces, or the brain as a physiological machine, but on how individuals perceive, feel, and interpret events. He referred to it as the “study of the self”. Humanism sees people as having a free will, unlike behaviourism and psychoanalysis, which posit that there is no free will and we are under the control of learning associations, unconscious motives, or other pre-determined perspectives. Humanism also sees people as basically good and with a need to make the world a better place. It emphasizes a person’s worth and creativity and is an optimistic approach as it focuses on the human capacity to overcome adversity and grow (Rogers, 1951). As humanists see humans as unique, they reject the study of animals, as these results don’t tell us about human properties, cannot capture the richness of human experience and is dehumanizing. Yet, unlike other schools of thought in psychology, it was difficult to apply humanism to areas like abnormal psychology, the study of mental disorders. A reason why humanism did not find its way in the academic world is because of its non-scientific approach to studying human behaviour. However, its use of qualitative methods and the importance of empathy helped create a more holistic view of human functioning. The term “positive psychology” was first used by psychologist Abraham Maslow (1908-1970), who wrote, “The science of psychology has been far more successful on the negative than on the positive side; it has revealed to us much about man’s shortcomings, his illnesses, his sins, but little about his potentialities, his virtues, his achievable aspirations, or his full psychological height. It is as if psychology had voluntarily restricted itself to only half its rightful jurisdiction, and that the darker, meaner half” (Maslow, 1970, p. 354). The theories emphasizing the importance of emotions, flourishing, and happiness in humanism served to be very influential in developing the fourth force in psychology, called positive psychology.

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Positive Psychology

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Positive psychology began as a new era for psychology in 1998 when Martin Seligman (1942- ), father of positive psychology, chose it as a theme during his time as president of the American Psychological Association. Rather than focusing on what is wrong with a person, which was the dominant school of thought in psychology at the time, Seligman expanded on Maslow and Rogers’s view that we should study people to see how what is right with them and how to nurture that to improve their life (Seligman & Csikszentmihalyi, 2000). The difference between positive psychology and humanism is that positive psychologists use the scientific method to understand human behaviour. Positive psychologists study human behaviour using neuroscience, evolutionary psychology, personality psychology, etc., and have developed theories in analyzing and quantifying happiness, or wellbeing. It is seen as the fourth wave in psychology and the field is currently the most advanced in the United States and Western Europe, although it is currently making inroads into the Middle East/North African region. It studies human behaviour through a scientific lens, but treats the person as a whole being. You should know that while these schools of thought emerged at different times, they are still all used today and all psychologists will be familiar with them and ascribe to one or even more in their practice and

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professional views. Each has its strengths and limitations, but all are designed to help people.

Topic Box: DSM or the CSV? Know your books! by Dr. Louise Lambert

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One of the most important innovations in Western psychology is the development of a classification system from which all mental disorders and illnesses can be diagnosed and accounted for. The classification system has gone through many revisions and will continue to as science, technology, and research continue to advance the knowledge we have about mental health and illness. This is why what we thought were disorders decades ago, we now know are not. Changes are not made lightly; they are done after revisions of the available research literature and made with hundreds of experts and professional organizations around the world who sit on working groups or task forces to do this. It can take years for new revisions to be made as they tend to argue a lot, but also because research evolves and they want to get it just right – until the next revision, that is. So, what is this mysterious book? The Diagnostic and Statistical Manual of Mental Disorders known as the “DSM” is published by the American Psychiatric Association (2013) and is the standard classification of mental disorders used by mental health professionals. It’s like a dictionary of mental disorders used to diagnosis, study, and assist in the treatment of disorders

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used by psychologists and psychiatrists, as well as social workers, nurses, occupational and rehabilitation therapists, counsellors, and other mental health professionals. The DSM includes all mental disorders for adults and kids, as well as their causes, age of onset, prognosis, and research data. The DSM’s indicators help professionals communicate. For example, if two psychologists in Bahrain and Oman are discussing clients, they can use the DSM’s terms and diagnoses to discuss cases and be certain that the behaviours they describe mean the same thing. The DSM also helps in the collection of statistics and allows for the reporting of disorders and rates of how many people have that disorder around the world. If we all had different definitions for disorders we couldn’t do this. By comparing, we learn more about disorders; if a mental illness is high in one place, but not in another, there might be something about genetics or the environment to account for that difference. The DSM has three parts: the diagnostic classification (the code attached to the disorder), criteria sets (what symptoms are needed to be diagnosed with the disorder and for how long [called inclusion criteria], and what symptoms should not be present [called exclusion criteria]), and the descriptive text (research, statistics, etc., about the disorder). The criteria ensure that good diagnoses are made. The DSM has very strict definitions and this helps to limit someone from freely making too many diagnoses and seeing disorder everywhere when it’s not in fact, there. Legally, only a qualified clinician can diagnose a client and every country, emirate, or state, or province will have laws as to who is licenced or qualified to use the DSM. Why so strict? Diagnosing a DSM disorder has consequences. Giving someone a diagnosis of Major Clinical Depression for example, can impair their ability to get health insurance, disability payments, or unfairly punish them from getting custody of their kids. Giving someone a diagnostic label can also have consequences for how other professionals deal with them. If you knew a person was diagnosed with Borderline Personality Disorder, you may treat them differently because of the stigma around mental health many of us have. Diagnosing someone with a DSM diagnosis involves the selection of symptoms from the classification system which describe the symptoms that affect the client the best. The DSM uses a multiaxial or multidimensional view because life events or illnesses influence mental health. The dimensions are:

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Axis I: Clinical Syndromes · This is usually the diagnosis (e.g., depression, schizophrenia, social phobia, etc.) Axis II: Developmental Disorders and Personality Disorders · Developmental disorders first seen in childhood, i.e. autism, ADHD. · Personality disorders: clinical syndromes which have lasting symptoms and involve the client’s way of engaging with the world, i.e., Paranoid, Antisocial, Borderline... Axis III: Physical Conditions · Physical conditions such as brain injury or HIV/AIDS influence Axis I/II Disorders Axis IV: Severity of Psychosocial Stressors · Events such as death of a loved one or unemployment and severity scale. Axis V: Highest Level of Functioning · The client’s level of functioning both at the present time and the highest level within the previous year are scored according to a standardized rating system. Did you know there is another book? This one, however, is not used to diagnose people’s disorders but their strengths. It’s called the Character Strengths and Virtues (CSV) diagnostic manual (Peterson & Seligman, 2004). Clinicians can diagnose clients by identifying which of the 24 known character strengths make up the person’s usual way of seeing and interacting with the world. These strengths are thought to be universal. Building positive states is worthwhile as it leads to upward spirals of growth, but building positive states can also fix and prevent negative states from worsening or occurring at all. The CSV gives clients a direction towards which they can move and the clinician clues as to what needs improving. The best way of diagnosing strengths is to use the VIA questionnaire located at www.viacharacter.org. The long or short version is fine. You can go ahead and try it; it’s free. Character strengths help individuals cultivate a good life for themselves by building and capitalizing on their innate personality charactersitics. This is much easier than spending time trying to correct or use strengths that are weak or absent.

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Over to you now… 1.

2.

3.

You’ve just gone through several psychological models. Would any of these models unfairly categorize individuals as psychologically unhealthy due to their ways of cultural expression? Do they include or refer to culture at all? Who might be best suited for these theories? Who might be at a disadvantage? Consider how counselling is done overall (i.e., a face to face direct conversation about problems that might include an interview, assessment, and various questionnaires), and the assumptions within counselling, such as its focus on the future, the development of goals, and the importance of assertion and active steps to change one’s life. How the might counselling be awkward for certain cultures and/or specific people? Discuss with your classmates. Have you taken the VIA test mentioned in the last Topic Box? Go ahead and take it, then “diagnose” your strengths. What are your top five strengths; when do you use these the most and how?

CHAPTER THREE THE BRAIN AND NERVOUS SYSTEM DR. ANNIE CROOKES

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Chapter Outline x x x x x

The Nervous System What are Neurons and How Do They Work? Neurotransmitters Brain Parts and Functions Topic Box: The Split-Brain by Malika Narzullaeva

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Neurogenesis and Plasticity by Fiza Hameed Topic Box: How Does Neuroscience Study the Brain? by Dr. Annie Crookes Types of Drugs and Their Effects on the Brain by Anum Virani Topic Box: Drug Use in the GCC Region by Dr. Louise Lambert Topic Box: How do Nicotine and Sheesha Affect the Brain? by Dr. Annie Crookes Over to you now…

In our day to day lives we seem to pay little attention to the brain and yet it controls absolutely everything we do. In combination with the rest of the nervous system, it keeps us alive even when we are not in a position to make decisions to save ourselves, i.e., if you are in a coma, the brain continues to take care of its functions. The human brain only weighs around 1.5kg and occupies about 2% of our bodies. This is a relatively small amount in the animal kingdom: for example, rat brains are around 3% and some ant brains occupy almost 15% of their bodies! Despite their smaller relative size, our brains use about 25% of the nutrients we eat as well as 70% of our body’s glucose supply. So if you’re ever feeling like it is hard to focus, try eating a sensible snack and feeding your brain to stay on task. In this chapter, we’ll hopefully address a few brain myths that have somehow made it into popular media. For instance, have you heard people say “I’m a right-brained person” or “we only use 10% of our brains”? People continue to believe that there is such a thing as a left or right-brain person (Dekker, Lee, Howard-Jones, & Jolles, 2012). Yet, you’ll see in this chapter that we use many parts of our brain at once and most of the time the two sides of the brain are working together not independently (even while you read this, your brain is managing your breathing, your eyes on the page, remembering what words mean, and your muscles to keep you upright and sitting in the chair.

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The Nervous System The nervous system is divided into two parts: the Central Nervous System and Peripheral Nervous System. The central nervous system is composed of the brain and spinal cord. The peripheral nervous system includes all the neurons and pathways connecting the spinal cord and brain to the rest of the body’s organs, muscles and glands. The peripheral system supplies the brain with information about the body and incoming sensory information and helps to carry out its instructions for action. The peripheral nervous system is further divided into two parts: the somatic nervous system and the autonomic nervous system. The somatic nervous system involves the transmission of information from our senses (eyes, ears, nose, tongue, and skin) to the central nervous system. This system picks up sensory information from the outside world and sends it to the central nervous system, which allows you to interact and respond to the environment. This is the system responsible for perceiving things like the smell of hot chicken noodle soup, the sound of your neighbours’ music at 2am, or feel too hot in a stuffy room causing you to turn on the AC. This is also the same system which allows you to detect the smell of smoke, the sound of electrical wires snapping, the sight of flames, the sensation of heat, all of which are sent to the central nervous system, where the message “dangerous fire “ is registered. From here, a danger message can trigger the autonomic nervous system to move into action long before you may be aware of what is going on (think of “automatic” when you see the word autonomic). The autonomic nervous system is always either in a resting (parasympathetic) or active (sympathetic) state. So, when a danger message is identified, the system will set your heart, glands, muscles, intestines and other body parts into action.

The Sympathetic and Parasympathetic Systems The sympathetic system is the basis for the “fight or flight” response, where your body’s response to emergencies involves the quick activation of stress hormones (i.e., adrenaline), muscles, increased heart rate, glucose (for energy), blood flow, and respiration, as well as a slowing down of the digestive system (you don’t need to digest lunch during an emergency). These responses allow you to take flight (run away) or to stay and fight (defend yourself). This system also stops you feeling the full effect of injuries and pain while you deal with the immediate situation. (To remember: focus on the word “sympathetic” i.e., being kind. Thus, your body is being nice and trying to help you save your life). The

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parasympathetic system m helps slows down d the hearrt rate, decreaases blood pressure, annd activates thhe digestive system; s in shhort, it works to return you to a restting state after a danger hass subsided andd also controlls activity during norm mal functioninng. These two systems do nnot respond directly d to one another as they are noot connected, but they do w work together closely c to maintain ovverall balancee of body fun nctioning durring the challlenges of daily living. You can thhink of the autonomic sysstem as an ex xtra light switch that iis turned on too keep you alive and safe, aand shut off when w there is no longer a use for it.

Wh hat are Neu urons and How Do Th hey Work? ? Neurons aree the smallestt unit of the brrain. They aree the cells thatt underlie the nervous system and alllow informattion to be trannsmitted throughout the body. Theree are 86 billion neurons in your brain aloone and many y more in the rest of tthe nervous system s and other systems in the body. Neurons communicatte using chem mical and eleectrical signalls. The structture of a neuron inclludes a cell body or soma (the cenntral processing part), dendrites (tthe branches that t link to otther cells and bring informaation into the cell boddy), the axon n (a tunnel ussed to transm mit the electriccal signal from the ceell body to thhe output areea), and the tterminal buttons (the gateway at the end of ann axon where chemicals arre released to send the message to the next cell)). The cell is activated by a chemical messenger m sent from annother neuronn which causees the cell boody to produce a small electrical siggnal that travvels down thee axon to thee cell button. More on what happenns next later! Cell Body (Soma) Axon

Dendrites Photo credit: Adapted from Pixabay P

Teerminal button ns

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Now, let’s look at the three types of neurons so you get an idea of what they do. Sensory neurons take in information from the outside world through your five senses (smell, taste, touch, sight and sound) and transmit this information to the spinal cord and brain (the central nervous system). Once these messages arrive (e.g., ewww, something smells bad!) motor neurons relay impulses away from the brain and spinal cord to the appropriate muscles. In this case, you would move your head away to avoid the smell and remove the bad food from your refrigerator! Finally, interneurons, known as relay neurons, exist in the billions and help make the connections between the motor and sensory neurons. Usually, messages about sensation and movement will be travelling up the central nervous system to the brain (sending information via sensory neurons for the brain to process) or down the central nervous system away from the brain (carrying out planned movements via motor neurons); however, there are times when the information is too life threatening and responses need to happen much more quickly. Suppose you put your hand down on what you think is a cold stove, but ah! – it is not cold but super-hot! Now your response - removing your hand – must happen ASAP and before the message has been processed and planned by the brain. In this case, the skin receptors and sensory neurons have sent the message to the spinal cord; however, the motor response is turned around using a simple sequence within the spinal cord itself. This quick process bypassing the brain is called the reflex arc. This is all fine but you might now be wondering, how then do neurons actually talk to one another?

Neurotransmitters Neurotransmitters are the chemicals responsible for the transmission of messages between neurons (which then activate the electrical signal in the cell body as mentioned above). When you do any action like writing a text to your friends, the message has to travel through a series of neurons working together in “pathways” and “networks” (like a spider web where each neuron connects to lots of others at the same time to increase the brain’s efficiency). These neural networks take the message from a thought, to a plan, and finally, to an action. Neurotransmitters are critical to helping this message travel between neurons and smoothly down the pathway. Neurotransmitters work by what is called neurotransmission. These chemical messengers are found in synaptic vesicles which are little

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storage sackks found in thee cell at the ax xon terminal aand cell button ns. When these vesiclles are stimullated (becausee the cell’s eelectrical pulsse bumps them), theyy release neurotransmitterss in the synaaptic cleft, the t space between thee end of onne neuron an nd the beginnning of anotther. The chemicals trravel across this gap and d lock onto th the next neurron at its dendrites. B But does eveery chemical message acttivate the surrrounding neurons? N No, because neurons n are surrounded s bby thousands of other neurons therre will be lotss of chemicalss travelling aroound at the saame time. It would be too confusinng if neurons activated to eevery chemicaal around them, they would be inn constant overdrive! Thherefore, the chemical messages hitting the neuuron must reeach in orderr for the cell body to activate. Thuus, a neuron will w only “firee” or send a m message if it has h a real reason to doo so. If the neeurons requireed level of stiimulation is reeached, it activates thee next neuron and the next, and the next, and continues sending the messagee on its way.

Photo credit: Pixabay

Neuurotransmitterrs come in different shapees and sizes (literally) and each tyype of neurotrransmitter will influence yyour actions, emotions and mental states in diffferent ways. That is, the message a particular p

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neurotransm mitter sends coould be to “d do something”” (called an excitatory e message, i.ee., increase heart h rate), or o to “stop/sllow down so omething” (called an innhibitory messsage (i.e., do o not increasee heart rate). There T are over 75 diffferent neurotraansmitters, so o, here we desscribe a handfful of the most common: dopaminee, serotonin, acetylcholine, a GABA and glutamate g plus a slighttly different kiind of chemiccal called endoorphins. You may m have heard of theese before ass they are popular in the domain of heealth and sometimes gget mentionedd in the media.. Let’s see whhat each does.

Photo credit: Pixabay

Doopamine is innvolved in what w is calleed our brain’s reward system whicch pushes uss to seek out and repeat aactivities thatt give us pleasure andd is boosted when w we win a competitionn or pass an ex xam. It is also involveed in the devvelopment of addiction to alcohol, nico otine and other drugs (you can readd more on this in the sectioon on “Drugs” below). Drug abuse leading to adddiction is onee example of hhow importan nt it is for the neurotraansmitters in the t brain to be b in a naturall balance – haaving too much or tooo little is not good. g For exaample, too muuch dopamine has been linked to the developmennt of mental disorders d suchh as schizophrrenia and too little doopamine has been b linked to o Parkinson’ss disease, a movement m

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disorder whereby almost 25% of one’s dopamine levels are lost and tremors (shaking), stiffness, and a loss of coordination are experienced as a result (Zhang, Tan, Xu, & Qu, 2016). The specific effect depends on which message pathways in the brain have been put out of balance. Serotonin is one of the most influential neurotransmitters which can be found in many different systems throughout the brain and body. For example it is involved in the regulation of biological processes like sleep and appetite, learning and memory, temperature regulation, impulsivity, aggression, and mood regulation. In fact you have far more serotonin in your gut and digestive system than you do in your central nervous system! Because serotonin is involved in balancing our mood, it is often called the “molecule of happiness” as high levels of serotonin have been linked to positive mental states, while low levels have been related to psychological disorders such as depression, anorexia, obsessive-compulsive disorders and anxiety. However it is not clear how serotonin and other neurotransmitters may be involved in mental illness. The observed links could mean low serotonin is a symptom of depression not a cause (Lacasse & Leo, 2005). Acetylcholine is the main neurotransmitter used by the motor neurons to communicate with the muscles. Acetylcholine “excites” the muscle fibers and allows us to move. In the brain, acetylcholine also helps you focus and is heavily involved in learning and memory. The decrease of this neurotransmitter is thought to be a major cause of Alzheimer’s disease, which primarily affects memory as well as more general thought and language (Chen, Reese, Kim, Rapoport, & Rao, 2011; Easton, Douchamps, Eacott, & Lever, 2012). GABA and Glutamate are two major neurotransmitters which work in partnership to activate or “excite” (Glutamate) and calm down or “inhibit” (GABA) the nervous system. They have an influence in a majority of the message pathways in the nervous system so their effects are pretty widespread. For example, glutamate, alongside acetylcholine, is important for memory and learning processing. However, glutamate must be kept in check by its brother GABA or it can become toxic to the brain. GABA is also an important chemical used to combat disorders of anxiety and fear (the group of medications called Benzodiazepines) as it helps to reset an overactive, over-anxious brain. Endorphins are famous for their role in pain reduction. When you hear stories of people overcoming incredible injury and pain to save themselves or others, it is the endorphin system that has allowed them to keep going. In fact, endorphins are slightly different sorts of chemicals to neurotransmitters, they are known as neuromodulators. So while a

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neurotransmitter is quickly released across a synapse and targets one or two neurons at a time, a neuromodulator is released more slowly and with less specific and larger group of targets (diffusion). As endorphins are stimulated through physical activity, we can say that individuals who engage in a lot of physical activity may experience fewer aches and pains, or at least feel them less than others. This allows them to stick with their exercise. On the other hand, it can also be dangerous as they do not perceive as much pain and can hurt themselves without realizing it. You may have heard of the “runner’s high”? Many people who engage in high levels of physical activity often report a positive mood; so endorphins also affect how we feel (Parikh et al., 2011). Neurotransmitter levels can be affected not just by illicit drugs and prescribed medications but by lifestyle factors such as an unbalanced and unhealthy diet, lack of sleep, use of medications which increase the metabolism of the neurotransmitters causing their rapid burnout, stressful lifestyles, and sensory overload. The good news is that having a healthy lifestyle, engaging in physical activity especially at higher intensity (i.e., cycling versus walking), can increase your levels of norepinephrine and serotonin in particular (Matsui, Soya, Kawanaka, & Soya, 2015; Wipfli, Landers, Nagoshi, & Ringenbach, 2011). While the correct balance of neurotransmitters alongside an active healthy lifestyle can significantly benefit your mental health and maintaining normal functioning, you should be wary of online websites selling “smart drugs” that will apparently increase your brain activity and help you “use all of your brain” given that, as yet, there is no real evidence that any of these have the advertised effect. This means that these marketed chemicals are at best harmless but pointless herbal substances and, at worst, chemicals which could upset the delicate balance of the brain leading to side effects. There is a great interest in the possibility of enhancing our mental capabilities and performance (think of the film Limitless) and this may be something for research to further examine. But, always do some research before buying any of these products and understand that the science of Limitless is a long way off!

Brain Parts and Functions In order to manage all the many complex thinking, planning, decision making, actions and sensations we have and do, the brain seems to have developed with groups of neurons which become specialised for certain actions. This is known as functional localisation in the brain. Although most behaviour is a mix of many individual functions, each of these can

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roughly be mapped to a certain area of the brain. To help us do this, the brain itself has parts that look separate from each other – for example the hemispheres and lobes which are anatomically divided by deep grooves called fissures; or the weird “little brain” (cerebellum) which is stuck onto the bottom of the brain. It’s like the brain is trying to tell us what to look for! To make sense of what the major parts of the brain do and where these are located, we split the brain into the forebrain, midbrain, and hindbrain. In humans, the forebrain has evolved to be by far the largest part; in fact, most of what you see in pictures and drawings of the brain is really just the forebrain. But as you will see below, it is in fact the two smaller hindbrain and midbrain areas that keep you alive. For convenience sake, we’ll start where the spinal cord enters the base of the brain (the hindbrain) and work our way up.

The Hindbrain The hindbrain contains an area of the brain called the brainstem, where the spinal cord enters the brain, as well as the cerebellum. The area called the brainstem is further divided into the medulla, pons, and reticular formation. Together, these areas involve structures that regulate physiological functions like our respiration, heart rate, and blood pressure, critical to our survival and without which we would die. The pons, which in Latin means “bridge”, connects to both sides of the cerebellum and is most known for its contributions in enabling body movement, although it also plays a role in regulating the sleep-wake cycle as well as levels of alertness during the day. The medulla oblongata, also part of the brainstem, is involved in the control of involuntary functions such as breathing, heartbeat, blood pressure, digestion, coughing and swallowing. These are all done automatically and need no input from you to coordinate. Finally, the cerebellum, located in the hindbrain (but not the brainstem), plays a role in monitoring movements such as posture, balance, and coordination of motor skills like learning to hit a golf ball or riding a bike, and the memory for doing these actions. It primary job is to help you to perform smooth and graceful, skilled movements in precise, fluid motions, like figure skating versus jumping off the back of a truck. Damage to this area can result in motor disorders called apraxias, the difficulty of making certain movements, despite the muscle being able to, like being able to lick your lips, or move your tongue.

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The Midbrain The midbrain involves the areas that link the physiological functions of the hindbrain to the cognitive functions of the forebrain (coming below). The midbrain has two main structures known as the tectum and the tegmentum. These structures are mainly involved in coordinating movements towards sensory information; for example, adjusting head and eye movements so you can watch a moving target or focus on a sound or sight to one side of you. In addition, the tegmentum is part of the dopamine pathway for reward and motivation. The dopamine pathway in the midbrain also connects to another area, the substantia nigra, which is involved in coordinating movement as well as learning and motivation.

The Forebrain The forebrain, the largest part of the brain, comprises both the outer cortex layer and some of the key neural structures that lie just beneath it. Therefore, the forebrain is the main part of the brain that is responsible for all our thinking and voluntary behaviours. We can separate the forebrain into four parts for simplification: (1) the thalamus and hypothalamus, (2) the limbic system, (3) the basal ganglia and (4) the cerebral cortex itself. The thalamus is the gateway or relay station where all sensory information (except smell, oddly!) is received and relayed to the appropriate area in the cerebral cortex. Underneath the thalamus is the hypothalamus, which regulates our homeostatic functions like internal body temperature, mood, sexual behaviour, hunger, thirst, and our biological clock (which regulates our sleep/wake cycles as well as up to 100 other timed bodily functions). In order to influence all these functions, the hypothalamus regulates the release of at least eight different hormones (chemicals which travel in the blood to stimulate organs in the body) secreted by the pituitary gland. The limbic system is a set of structures that link together and has as its major role the regulation of emotional expression, memory and motivational states. Two of the areas that make up the limbic system are the amygdala and hippocampus. The amygdala is involved in the regulation of emotions like fear, anger, and sadness and helps us to form memories of emotional events that allow us to avoid dangerous situations. Some people compare the amygdala to our “spidey senses” (after the comic book character Spiderman) – the part of the brain that helps us detect danger. When exposed to what we think is danger, the amygdala modulates our response to fear and prepares our physiological responses

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(e.g., increased heart rate) by turning on the sympathetic nervous system (although if the amygdala is triggered too easily, it can also lead to panic attacks). However, this is also a part of the brain that is significantly affected in post-traumatic stress disorder (PTSD) (Morey et al., 2012), where those same memories are really hard to forget. Because the amygdala is close to the hippocampus, which plays an important role in forming or laying down memory information, these two work together. In the case of PTSD, when life-threatening events trigger such intense fear and emotion the amygdala “stamps” the event to form extra-strong memories that are not easily forgotten. This can lead to the symptom of ‘flashbacks’ or reliving the experience over and over, in people who develop PTSD. There are a few more important things to know about the hippocampus. Because of its role in learning and memory, damage to this area results in a weird situation where you can learn something, you just can’t remember that you ever did (and that’s not to be confused with simply not studying)! The neurons in the hippocampus have a special mechanism called long-term potentiation, which allows them to form stronger bonds than neurons in other areas and retain how often they send signals to other neurons. In general, memories form because neurons that “fire together, wire together” as the saying goes; the more you play tennis or practise algebra, the more you’ll remember those activities compared to that violin you played once. The neural pathways, like a well-used road in the desert, are more frequently used so they simply last longer than the paths that are used less often. The hippocampus finally plays a role in spatial navigation. For example, when you are trying to remember where the theater was during university orientation, your hippocampus helps you to do so! Sleep is especially important in refreshing the ability of the hippocampus to help you remember what you’ve learned on a daily basis; the consolidation of memories (making sure memories “stick” or become stable) is facilitated by sleep (Prince & Abel, 2013), something university students find tough to get.

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Photo credit: Pixabay

Thee basal gangllia control thee voluntary prroduction of movement m and coordinnation. Impairrment can ressult in movem ment disorderss such as Parkinson’s disease (a movement m diso order where iindividuals ex xperience loss of cooordination andd stiffness), Huntington’s H disease (a hereditary h degenerationn of neuronss leading to involuntary jerking actions) and Tourette’s syndrome (a disorder wh here involunt ntary motor (i.e., ( eye twitching, m making facess) and vocal (i.e., grunts,, snorts, or repeating inappropriatte words uncoontrollably) ticcs are experiennced). Thee cerebral corrtex: The cereebral cortex iis actually six layers of cell tissue which can be b thought off as a “coverr” for the un nderlying structures off the brain andd which is dessigned and shaaped into folded curves called gyri ((the upper currves or ridge areas) a and fissuures (lower crrevices of the folds). This “grey matter” m is org ganized into w what appearss to be a squished, foolded pattern that t allows fo or greater surfface area so that t more neurons cann be squeezed into the samee size skull. Itt’s a bit like when w you come back ffrom holidayss and you bou ught a lot of cclothes. You may m have had a tidy suuitcase going,, but to make all the extra cclothes fit, you have to cram it in evvery which way w not caring g much about wrinkles. Thee cerebral cortex is wriinkled for the same reason; it all has to fi fit in one placee. All this surface areaa is called “G Grey matter” because b it com mprises the ceell bodies

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which have a grey appearance. Underneath this grey surface of cell bodies lie all the axons connecting cells into their networks and pathways. Because axons of each cell are covered by a fatty tissue they look white – hence the bundles of axons together make up the brain’s white matter allowing communication around the brain. Finally, the cortex is divided into two hemispheres which are connected by a thick bundle of this white matter (lots and lots of tightly packed axons) called the corpus callosum. Through this and a couple of other “bridges” (known as commissures), information can be transferred across the two halves and movements can be coordinated. In each hemisphere of the cortex, there are four sections (mapped out by clear grooves and divisions on the cortex), or lobes: frontal, temporal, parietal and occipital. The frontal lobes include the motor cortex, Broca’s area and the frontal association area, and are also the largest of the four lobes. They account for almost half of the total brain in humans. The motor cortex helps you to control voluntary movements, like wiggling your toes, tapping your fingers or making faces. The right motor cortex controls movements on the left side of the body, and the left motor cortex controls movements on the right side of the body; called contralateral control. Why the brain is set up this way is still a bit of a mystery, although the latest hypothesis suggests it is to reduce the severity of same side of the brain/same side of the body injuries (Whitehead & Banihani, 2014). Broca’s area in the frontal lobes (named after the researcher who found the area in the course of patient autopsies) is the region linked with speech production and damage to this area can result in the inability to talk, or produce grammatically correct phrases as this requires motor activity like moving the lips and muscles in the mouth and throat. Finally, the frontal association areas are responsible for higher level processing like reasoning, planning, and problem-solving, as well as future planning, impulse control, meaning and memory. In essence, the frontal lobes help us interpret, plan and respond to the people and world around us. Damage to the frontal lobes can result in a loss of spontaneous movement, difficulty controlling impulses, low empathy and flat affect (i.e., flat or dulled emotions), as well as the inability to plan, problem-solve, or switch tasks when required. The parietal lobes involve the somatosensory cortex, responsible for movement, orientation, perception of stimuli like touch, pain, temperature, and pressure. It’s also an area that is sensitive to experience; the more you use your sense of touch for example like playing the piano at a professional level, the greater the area of this cortex is dedicated to those

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of the fingeers (Feldmann & Brecht, 2005). 2 The pparietal lobes are also responsible for proprioceeption, literallly, knowing w where your bo ody parts are. That m may sound oddd, but consid der what happpens when you y learn tennis. Whille you are runnning to makee contact withh the ball, you u need to be aware off where your arm a is (behind d you hopeful ly), at what an ngle (this depends on how your wrist w is turned d), where youur leading sh houlder is pointed, andd how your feet f are positio oned – okay, now hit the ball, and don’t forgett to follow. Thhe parietal lob bes use sensorry information n coming from the muuscles and intternal feedbacck to maintaiin balance and d smooth automatic m movements.

Photo credit: Pixabay

Thee occipital loobes, located at back of tthe brain, inv volve the primary viisual cortex, and are resp ponsible for vvisual processsing and some aspectts of perceptioon in order to make sense oof what you arre seeing. Our visual ccortex has a remarkable r ab bility to take bbasic informattion from the eyes andd build that innto a full 3-dim mensional vissual experiencce. Indeed this happenss even when you y only havee half the infoormation: For example, you only need to see a brroken curved piece p of whitee ceramic to know k that object was pprobably a cooffee cup. Som me people cann suffer from “cortical blindness” oor “scotomas”” where part of their visuual cortex is damaged

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resulting in a “blindspot” of vision they don’t see…even though their eyes are working perfectly well. Some other visual impairments can be “visual form agnosia” or “achromatopsia” where the eyes “see” but the person is still not able to describe the size, shape or color of what is in front of them. The final temporal lobes (near your ears), involve the, hippocampus and the primary auditory cortex, and are responsible for auditory processing (receiving what you hear) and recognition and memory for those sounds. Wernicke’s area, found in the temporal lobe, is associated with language comprehension and damage to this area can result in the inability to speak in a way that others can understand; that is, the phrases, while clear, contain gibberish (nonsensical word salads), inappropriate words, or words that do not exist. The person with damage to Wernicke’s area also does not realize that they make no sense.

Topic Box: The Split-brain by Malika Narzullaeva

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Have you ever heard of a “Split-brain patient?” Split-brain is the term used when the corpus callosum is cut to prevent epileptic seizures. Epilepsy is a neurological disease that involves seizures that may or may not involve physical convulsions (uncontrollable shaking that can last for several seconds or a few minutes). These occur as a result of abnormal and sudden electrical responses in the brain, sometimes on one side of the brain (called focal seizures) or in both sides of the brain

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(called generalized seizures). Cutting the corpus callosum was used to relieve seizures when nothing else works (though improvements in other treatments mean this is rarely done today). The surgery would create the split-brain syndrome where the main communication channel between the two hemispheres is removed and things start to get interesting. In a series of studies over many years, Dr. Michael Gazzaniga (2000) found that patients with a severed corpus callosum showed a strange pattern of deficits in how visual information was processed and responded to. For example, a split brain patient could say the name of an image when it was flashed in their right eye (and processed in the left side of the brain responsible for speech and language), but could only point (with their left hand) to what they saw if the information was flashed only to the left eye (and consequently processed in the right side of the brain with no speech centres). In order to state verbally the object, they had to pick it up and “show” it to the other eye. The two sides of the brain were both able to process visual information but were not communicating with one another for the response. Perhaps the most remarkable discovery though was how relatively few things actually changed in the lives of these patients: split brain patients do not show any changes to their personality, general IQ or day to day functioning as you may expect. This just shows how adaptable the brain is! These discoveries highlight how information processing is a complex mix of messages being sent around the brain and across the hemispheres for different purposes.

Neurogenesis and Plasticity by Fiza Hameed The term brain plasticity refers to the brain’s ability to change and modify itself and occurs following brain damage, during normal brain development, particularly in utero, during childhood and adolescence, throughout the lifespan, and every time you learn or memorize something new. The term plasticity, in and of itself has nothing to do with the material plastic per se, but was derived from the Greek word plastikos, which means molded. The brain is always changing and building new connections between neurons and message pathways as you experience the world and learn. Though we may all be born with the same basic hardware, our experiences (bad and good) shape how these develop which is why we all end up as individuals with our own talents, habits, beliefs and

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personalities. Brain plasticity has also been observed after physical injury to the brain as an adaptive tool to make up for lost functions or to boost remaining ones. The brain’s amazing ability to change in response to damage or injury has served as a gateway towards an understanding of plasticity. Reorganization of brain tissue in response to damage has been observed in some parts of the brain. For example, in young children with a slow-growing tumor in the left hemisphere language area, the right hemisphere will jump in to compensate by mimicking (copying) the function of the left hemisphere to allow for the continued development of language in the child (Thiel et al., 2006). Or, if a finger is lost, the sensory cortex that received its input will begin to pick up signals from neighboring fingers, which then become more sensitive (Fox, 1984). Brain imaging studies examining the cortex of blind individuals have found that the neurons in the visual cortex had been recycled and picked up for use by the auditory and somatosensory systems. Thus, blind people demonstrate skills superior to sighted control subjects on a variety of auditory and somatosensory tasks (Gougoux, Zatorre, Lassonde, Voss, & Lepore, 2005). Although the brain often attempts to repair itself by reorganizing existing tissue, it sometimes tries to fix itself by producing new neurons. Evidence of this process, known as neurogenesis, has been found in adult mice and humans. Prior to the 1980s, brain researchers thought that neuroplasticity was found only during the development of children and young adolescents. Adult brains were considered set or fixed, and incapable of any reorganization and neurogenesis was not thought to be possible in the adult brain; however, new research suggests that it may be possible, but by how much and to what extent is not yet known. We can do a few things to help our brain’s plasticity. Studies have shown that getting adequate sleep helps learning and memory while not sleeping enough reduces the neuronal plasticity necessary for learning and memory. Moreover, research also shows that physical exercise can increase brain plasticity and also help improve learning and memory (Iso, Simoda, & Matsuyama, 2007; Pereira et al., 2007; Stranahan, Khalil, & Gould, 2006).

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Topic Box: How Does Neuroscience Study the Brain? by Dr. Annie Crookes

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It might seem a bit of a mystery to figure out how neuropsychologists know so much about the brain’s functioning; you would expect that they use tools and technology that are pretty technical and specific to the field. Often neuropsychology will use the medical technologies which have been developed to test for damage to the brain or measure brain structure, and modify them to be used to see the brain’s activity during an actual behaviour or psychological task. There are a number of technologies used, some more popular than others and some for specific research questions. Here are the most common. Electroencephalography (EEG). EEG measures electrical activity along a person’s scalp. By attaching small electrodes to a person’s head, the signals produced by neurons in the brain can be measured and results in a printout of a bunch of lines or sideways graphs. The EEG is useful in sleep research, and to observe and measure seizures, the surge of electrical activity often seen in people who have epilepsy. EEG can be adapted to study the brain in action through an experimental technique called “event related potential” where the EEG measures are recorded while a person is doing a cognitive task and comparing these signal patterns to when the person is doing a control task. EEG is a good way to measure the brain’s electrical activity (and therefore the messages being sent through the

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brain) as they happen. However, as the electrodes are recording from all the way on the outside of the person’s head, they are picking up electrical signals from thousands of neurons at the same time and therefore, not very spatially accurate. Positron emission tomography (PET). PET and other imaging techniques are able to look at brain activity at a deeper, more internal level. The PET scan produces an image of brain activity generated as a result of giving a person a small amount of radioactive matter and seeing where it ends up and travels to. As the brain “eats” glucose that is bound to this radioactive matter, we can tell what part of the brain is active during what processes (or which are not and should be). While the radioactive matter is perfectly harmless and biodegrades naturally in the body, it is still somewhat invasive as a technique. However, it does produce some more detailed images of which areas in the brain are most active during a particular cognitive or behavioural task. Finally, neuropsychologists use fMRI, functional magnetic resonance imaging, a modified version of the MRI scans used in hospitals. The fMRI is a similar method to PET but using harmless magnetic waves sent from outside the body instead of radioactive substances. The brain needs oxygen carried by blood cells to feed the neural activity, and blood has a slightly different magnetic charge depending on whether it contains oxygen or not. Therefore, we can use a magnetic pulse to excite the oxygen cells in the blood and observe the blood oxygen levels around the brain to see where the oxygen is being used most (and therefore where brain activity is). fMRI has become highly popular in research because it is non-invasive and provides highly detailed images of the brain. However, measuring blood oxygen levels provides only a delayed measure of neural activity making it less precise. All of these techniques are well used and have advantages and disadvantages. One problem affecting all of these high-tech methods is that they are really only giving us a measure of the brain areas that are active at the same time as a participant completes the task. That is, they are only correlational rather than causational in their approach. Did making the movement lead to the brain activity, or did the brain activity make you do the movement? One very new technique which may resolve this problem and provide a means to causally connect an action to a brain structure is called “Transcranial Magnetic Stimulation”. This uses a handheld magnetic generator which is placed around the head (on the outside) sending a pulse into the head while a person completes a simply task like clapping, speaking, or reading, for example. The magnetic pulse will block

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messages in that specific area of the brain allowing us to directly see how behaviour is upset by this. In this way it gives us a direct, real-time observation of what brain areas are involved. As technology continues to evolve, our methods will become even more precise and direct. It’s no surprise then that we continue to learn new things about the brain as a result.

Types of Drugs and their Effects on the Brain by Anum Virani There are many substances that can affect the brain by influencing neurotransmission. While some of these are illegal and very dangerous such as cocaine and heroin, others may be legal but just as harmful, like alcohol. In fact, other psychoactive substances are far more commonplace; for example caffeine, tobacco (nicotine) and some medications. We will briefly review some of the more dangerous “drugs of abuse” here. These can be classified into three broad categories: stimulants, depressants, and hallucinogens.

Stimulants Stimulant drugs such as cocaine, amphetamine (speed), methamphetamine (crystal meth), and nicotine are among some of the most commonly used drugs due to their desired effects like increased alertness, attention, and energy. Let’s see what happens to Mustafa on stimulants. Mustafa, a 21-year old college student decided to try cocaine without knowing much about how his brain will react to it. Mustafa snorts cocaine, which causes dopamine to be increased in a part of his limbic system called the nucleus accumbens (NAc). Levels of dopamine and norepinephrine increase in his brain contributing to feelings of reward, pleasure and energy. If Mustafa continues to take cocaine regularly, studies have shown that this accumulation of dopamine is much higher than that produced by any other natural source (such as meeting a loved one) which makes the brain put more value on this substance over other things. This is one reason why the drug may lead to addiction in some. Research suggests that when given a simple choice, laboratory animals will ignore food and take cocaine until they starve. And this biological influence on the dopamine systems of reward is much greater for amphetamine and methamphetamines.

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Despite the positive short-term effects, stimulants are considered dangerous because users show poor decision-making skills, impulsivity, aggressive behaviour, paranoia, and psychosis. Users experience physiological changes such as high body temperature, irregular heartbeat and risk of seizures as well.

Depressants Depressants such as alcohol, benzodiazepines, and barbiturates act to slow down the functioning of the central nervous system (CNS) by activating the GABA neurotransmitter pathways. Let’s meet Sarah, an adolescent who has been introduced to drinking alcohol at parties with friends. Sarah drinks alcohol to enhance her mood, feel relaxed, and reduce stress. Recognizing that her drinking may be affecting her personal as well as academic life, she is interested in knowing how her brain responds to alcohol. Sarah learns that alcohol affects her brain chemistry by suppressing the excitatory neurotransmitter glutamate and increasing the levels of inhibitory neurotransmitter gamma-aminobutyric acid (GABA) achieving the desired relaxing effect. What Sarah might not realise is that by artificially influencing the major neurotransmitter systems in the brain while it is still developing, it can change the structure of these pathways for good. Structural abnormalities were found in the hippocampus (responsible for learning and memory) (Risher et al., 2015); simply put, the hippocampus becomes irreversibly immature and does not develop as it should under the influence of alcohol. Other studies showed that significant alcohol use during the teenage and young adult years produced cognitive deficits like poor memory function in later adulthood (Hanson, Medina, Padula, Tapert, & Brown, 2011). If a person continues to use alcohol heavily over a long period of time the brain may become dependent and stop producing GABA and other neurotransmitters on its own. This means that when you stop taking it you experience withdrawal symptoms (like being sick and craving the alcohol to make you feel better) because the brain is not able to continue functioning without the addition of alcohol. In fact, physical dependence to alcohol is much worse than physical dependence to other (even illegal) drugs. Discontinuing use of depressants can result in seizures and other life-threatening side-effects.

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Topic Box: Drug Use in the GCC Region by Dr. Louise Lambert

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In the GCC region, there has been successful control of many drugs of abuse. However, one particular problem was found to be the irresponsible use of prescription pills such as Tramadol (a painkiller) and benzodiazepines (an anxiety medication). It is difficult to get accurate numbers of drug use in the region (Sweileh, Zyoud, Al-Jabi & Sawalha, 2014), but a few studies can give us an idea. Fawzi (2010) conducted a study in Egypt at Ain Shams University Hospital and found that among youth, Tramadol use was an issue. The prescription drug caused respiratory depression, seizures, confusion and dizziness and of the patients admitted to the hospital for overdoses, 77% were young men and 23% were women. In Iran, Tramadol was responsible for 294 deaths in Tehran in 2008 alone, with this number representing a 32 time greater frequency since 2005 (Iravani, Akhgari, Jokar, & Bahmanabadi, 2010). Amont addiction treatment patients in Saudi Arabia, Bassiony (2013) identified amphetamine, heroin, alcohol and cannabis use, with a number of hepatitis infections due to shared needles among users. Likewise, in the UAE, Al Blooshi et al. (2016) recorded Tramadol, alcohol and heroin use among 266 (251 nationals) male patients at the National Rehabilitation Centre in Abu Dhabi. What was significant was the number of patients under the age of 30 who abused prescription

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medication taking up to 14 pills a day. The misuse of prescription medication is an increasing problem and is particularly minimized by youth who think that if the substance is legal, it is neither dangerous nor considered drug abuse (Al Ghaferi, Osman, Matheson, Wanigaratne, & Bond, 2013; Al Marri & Oei, 2009). While these are prescribed drugs, they are nonetheless used improperly, abused in their quantity and are no less dangerous than illegal drugs potentially causing irreversible damage to one’s health and brain. Cocaine is also becoming an issue in the GCC region (Dempsey, 2017). It seems one of the biggest problems to reducing such drug use is not an increase in punishments which does little to deter drug use, but greater awareness of the scope of the problem and a frank discussion about drugs in schools, universities and families so that youth can make better decisions.

Hallucinogens Hallucinogens are substances that affect the sensory systems in the brain causing hallucinations and alterations in a person’s perception of reality such as seeing, hearing, and feeling things that may seem real but are not. The main hallucinogens abused by young people are LSD and the chemical Psilocybin found in some species of fungi (magic mushrooms). In addition, the drug ecstasy (MDMA) is a mix of stimulant and hallucinogen categories. Ahmed tries LSD which targets his prefrontal cortex and the neurotransmitter serotonin, altering his mood, cognition, and perception of the outside world. This change in brain chemistry may lead Ahmed to experience effects such as rapidly changing moods, irrational fears, and visual hallucinations. Although hallucinogens don’t have the same addictive potential as other drugs, some vulnerable LSD users may experience negative mental health effects such as anxiety and depression. You may have heard of marijuana (cannabis, “pot”) and be wondering why it hasn’t been mentioned yet. Well, this drug actually doesn’t quite fit into any of the main categories. Marijuana acts specifically on a neural pathway called the cannabinoid systems which are involved in a range of functions such as appetite, sleep, pain-reduction and memory. The active chemical in marijuana activates these cannabinoid systems leading to some of the reported effects of short-term memory problems, perceptual changes, and feeling hungry. Marijuana does not stimulate the dopamine reward pathways as seen in the previous drugs and it has less potential for physical addiction; however, as it disrupts the

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natural balance of neurotransmission in the brain, it may still lead to feelings of withdrawal and longer term effects in heavy users.

Cannibus Plant Photo credit: Pixabay

Cannibus “Pot” Photo credit: Pixabay Importantly, the effects of smoking marijuana during the teenage and young adult years may be riskier than once thought. Several studies

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point to the relationship between marijuana use and an increased risk of developing schizophrenia as the young brain is still developing. It is unclear whether this link is due to genetics in some individuals, or could affect all users. Either way, marijuana use comes with risks which should be seriously considered by all (Andersen, 2003; Henquet et al., 2010; Raver, Haughwout, & Keller, 2013).

Topic Box: How Do Nicotine and Sheesha Affect the Brain? by Dr. Annie Crookes

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Smoking causes forms of cancer and heart disease and as nicotine is the main chemical in tobacco, it is very addictive with over 70% of people who smoke cigarettes feeling unable to quit. The health problems associated with smoking are caused by chemicals such as carbon monoxide and tar products; yet, it is the nicotine that makes smoking pleasurable and drives smokers to continue despite the risks. When you inhale tobacco, the chemicals enter your bloodstream and the nicotine is carried to the brain. Nicotine molecules have the same shape as the brain neurotransmitter called acetylcholine (ACT), which means it can easily activate brain cells (neurons). By mimicking or copying ACT, nicotine increases alertness and concentration, and stimulates the reward centres in the brain making smoking both pleasurable and addictive.

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In the Gulf, waterpipe smoking (shisha) is a concern. Among younger age groups, shisha smoking is close to double that of cigarettes (9-15% in the GCC nations: Akl et al., 2011). There is confusion about whether shisha is more or less harmful than cigarettes. Research suggests that shisha users inhale as much as 150 times the amount of tobacco smoke (Maziak, 2013) and nearly double the amount of nicotine itself (Eissenberg & Shihadeh, 2009)! Yet, because you cannot smoke shisha endlessly, regular shisha use equates to about 10 cigarettes per day. However, aside from the tobacco itself, shisha uses charcoal as a heat source. This means you may have up to 30 times higher carbon monoxide exposure compared to a cigarette smoker (Schubert et al., 2011) making the risk to your health much higher. Recent attention has turned to dokha smoking, a substance made from dried tobacco mixed with leaves and herbs common in the United Arab Emirates (UAE). Only one study has been done on dokha (Al Houqani, Ali, & Hajat, 2012), which found it to be the second most common form of smoking after cigarettes among UAE nationals. There is little information about dokha so far but reports mention the very high nicotine content, which leads to a rapid increase in heart rate and buzz as the term “dokha” suggests (Shaikh et al., 2012). While it may not have the same health risks as shisha and cigarettes, it is by no means a safe product and likely has a high potential for addiction.

Over to you now… 1. 2. 3. 4. 5. 6. 7. 8. 9.

Look up Tourette’s syndrome and describe it in terms of brain dysfunction. What is a split-brain patient and what happens as a result? What are the three main areas of the brain? Which is the largest and what does it do? Describe the four lobes – what does each do? What technologies are used to study the brain? What are the risks of using marijuana? See what other effects it has on young brains. How does alcohol affect the brain in young adults? How about in older adults? Why are the consequences different? Describe functional magnetic resonance imaging; how does it work and what does it do? What is neuroplasticity and what contributes to it?

The Brain and Nervous System

10. Do you smoke shisha or cigarettes? Have you thought of quitting? Why or why not? If so, how could you go about smoking less? What is the effect it is having on your brain? 11. What sorts of conversations should parents be having with their youth about drugs? Is it enough to just say no?

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CHAPTER FOUR SLEEP AND THE CIRCADIAN RHYTHM DR. LOUISE LAMBERT

Photo Credit Tooba Dilshad

Chapter Outline x x x x x

The Circadian Rhythm Types of Sleep Stages of Sleep How Much Sleep Do I Need? Topic Box: Sleep and Ramadan by Dr. Melanie Schlatter

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Dreams: Why do We Dream and What do They Mean? Sleep difficulties Learning and Sleep Is Lack of Sleep a Big Deal? Sleep Disorders Personal Sleep Assessment Over to you now…

Ah…sleep! What wouldn’t we do for more of it? Most university students report being sleep deprived, while a small group sleep more than is needed. Yet, there is another group for which sleep is problematic and difficult to get. In this chapter, we explore the world of sleep and examine how to get more and what sometimes goes wrong. But, why do we need sleep anyway? There is no one other activity that takes up a third of our lives. So, if this is the case, it must be important beyond making us feel better and more rested, right? The short answer is that being awake takes an enormous amount of energy and sleep is what restores us back to normal like a battery recharge. The long answer is that getting enough sleep can help us think, learn, maintain a healthy body weight, stay young, remember things, and maintain important physiological processes in the body. You can’t function without it and there’s a reason for that. After you read this chapter, see what you can do to get more sleep.

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The Circadian Rhythm

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The circadian system is responsible for changes to our bodily functions over a 24-hour period. It is known for regulating our sleep cycle and can be understood as an internal clock. Its job is similar to the clock on your laptop. Whether your laptop is on or off, recharging, or running multiple programs, the clock always keeps the time and regulates when functions like virus checks and program updates occur. The circadian rhythm does the same for your body by regulating sleep and wake cycles, as well as hormonal changes and digestive enzyme activity. It even regulates things like when you go to the bathroom! Did you know that your body temperature rises and falls by about 1 degree twice in a 24 hour period? This is what signals you to go to sleep and wake up. The circadian rhythm also regulates blood pressure, heart rate, hunger, when we are most cognitively alert (in the morning BTW), and most physically coordinated and energetic (late afternoon to early evening). The circadian rhythm is controlled by the suprachiasmatic nucleus, which is located in the hypothalamus, a portion of your brain that is responsible for homeostatic functions. Yet, the clock is resistant to change; whether jet lagged in Taiwan or pulling an all-nighter for architecture class, the clock is set and there’s little that can change it. To stay “on the clock”as much as possible and

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benefit from its restorative functions, you should aim to go to sleep at the right time. This may vary, but for adults, it’s around 10 to 11pm. If you pay attention, you may notice that you get a small chill run through your body around this time. When your body temperature starts to drop, that’s a signal for you to start preparing for bed as the internal clock is getting ready to start its functions. Think of it like your laptop giving you a popup message informing you that it will start its updates in about an hour – only here, you can’t reschedule. If you ignore that temperature cue, you prevent the brain from performing its scheduled job. Think of it this way: when you’re on your laptop and working on a Word document, streaming live video, and updating Instagram and the virus check kicks in, your laptop slows down and can even freeze. You can’t use so many functions while it’s trying to do its job. The circadian rhythm is the same: it is set to perform certain functions at certain times and if you try to override it with less vital tasks, like being on Instagram at 2am, you make its job much harder to do.

Types of Sleep Have you ever watched a baby or even a puppy sleep and its eyes moved from side to side? Apart from being creepy looking, the eye movement isn’t abnormal, your eyes do the same thing while you sleep and this is a sign that you are in one of the two types of sleep: REM (rapid eye movement) and NREM (non-rapid eye movement).

Non-REM Sleep During Non-REM sleep, your heart rate and respiration are slow and regular, and your blood pressure and brain activity are at their lowest and slowest. Your body also moves little during this time. You could say that there isn’t much going on during NREM sleep; yet, it is nonetheless important as it is the time during which the body repairs tissue, bone and muscle and strengthens the immune system. Higher levels of growth hormone also appear during NREM sleep and allow for greater tissue generation and repair. Thus, NREM seems important for physical restoration.

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REM sleep

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REM sleep happens less regularly (we’re in REM sleep for only about 20% to 25% of the night), but it is called “active” sleep because the brain is quite active during that time. In fact, after only being in REM sleep for 1 to 2 minutes, the brain’s temperature actually increases. REM sleep is also called “deep” sleep because despite all the activity, it is when your muscles move the least. This muscle paralysis prevents us from acting out our dreams. During REM sleep, the brain’s metabolism increases, as well as blood pressure, heart rate and respiration, which become faster and more irregular. Your stomach acid even rises. REM sleep is also when we dream and as you’ll read later, our dreams are the result of this brain activity. In fact, if you wake someone up during REM sleep, they will almost always report being in the middle of a dream, while someone in NREM will not. Much of the activity in REM sleep concerns the brain; this type of sleep is positioned to restore mental capabilities and functions. How do REM and NREM work together? We sleep in cycles of about 90 to 120 minutes and have about four to five cycles a night. In each of these 90 to 120 minute cycles, NREM occurs at least once and maybe even twice and is then followed by REM sleep, which only lasts about 10 to 15 minutes initially, but takes up more and more of the 90 to 120

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minutes in each cycle, with the longest cycle happening before you wake up. So, if your night is cut short for whatever reason, you miss the most important REM cycle, which has the biggest effect on learning and memory. REM sleep is important because of its restorative role as well as for the consolidation of memories. In short, sleep is like your battery charger. It also helps memories “stick”, which helps you learn and remember information. REM sleep is so important that babies in particular have a very high percentage of this type of sleep compared to adults, suggesting that its function helps in the development of the growing brain (Siegel, 2005). Further, studies show that taking naps is not usually very effective; rather it is the length of the nap that seems to make the difference. As REM sleep takes about 90 minutes to appear, naps should be about the same amount of time so that REM sleep occurs and has an impact on the consolidation of memory (especially emotional memories; Wiesner et al., 2015), and hence, learning (Nisida, Pearsall, Buckner, & Walker, 2009). There’s still much to learn about sleep and as new technologies evolve, we are learning that sleep not only allows for mental and physical restoration, but also for the brain to clean itself. One study is worth looking at; Xie et al. (2013) discovered the existence of the glymphatic system, the system designed to carry waste material from the brain. This waste is generated during the day, but as the brain needs its resources during waking hours to process information, its only choice is to use sleep time to clear the waste. The authors found an increase in cerebrospinal fluid during sleep, which was not observed during wakefulness, and that the spaces between brain cells increased by as much as 60% during sleep, allowing more fluid to wash the waste away. Thus, sleep appears to have evolved as a way to allow the brain the time and ability to clean itself so it can be empty, neat and tidy for the next day. This makes sense when you consider that other physiological systems have a means to clean waste (think of urine or sweat) and the brain seems to be similar in this respect. Let’s see what happens in one sleep cycle.

Stages of Sleep NREM Stage 1: Between when our heads hit the pillow and when we finally nod off, we go through what are called Alpha and Theta waves, periods of dreaminess, sort of like daydreaming, although we’re not yet sleeping or fully awake. In this stage, you are quite drowsy and start to see the results of your own thinking and brain activity come together like a film where you sometimes experience the feeling of falling and have

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involuntary muscle jerks. These are called hypnogogic hallucinations. This phase lasts about 5 to 10 minutes, the time it takes most people to fall asleep. NREM Stage 2: In this stage, we are sleeping and our awareness of the outside world fades away. Here, your brain produces short, fast, and rhythmic brain wave activity called Sleep Spindles as well as Kcomplexes designed to block outside stimuli. This is a vital phase of NREM sleep as it is when memory consolidation occurs and where information processing takes place. NREM Stage 2 takes up about 45% to 50% of the night. NREM Stage 3: Your brain is making the switch from light to deep sleep now and begins to produce deep and slow brain wave activity (Delta Waves). Here, you are unaware of outside stimuli. Brain temperature, breathing rate, heart rate, and blood pressure are at their lowest and as you approach REM sleep, you might experience a little dreaming. Sleepwalking might happen here as the body’s muscles are not yet paralyzed and there is some brain activity (dreaming) happening, so it is possible that people act on their dreams and have conversations while sleepwalking. REM sleep (Stage 4): The final stage, REM sleep, is called paradoxical sleep because as the brain and bodily systems become more active (eyes, respiration, brain activity, and dreaming), the muscles actually become less active. If you’ve been keeping track of time, you’ll notice that the stages don’t add up to the 90 minutes we’ve mentioned. Sleep doesn’t follow these stages in a row; instead, sleep begins in Stage 1, then 2, 3, and 4, but then changes thereafter. Stages 4, 3, and then 2 are repeated once more before going into REM sleep. Once this 90 minute cycle is over, it starts over at stage 2 (because you’re already sleeping). Then, 4, 3, and 2 again before going into REM sleep about four to five times a night. If it sounds confusing, don’t worry, your circadian rhythm is designed to keep track of time and sleep functions on your behalf!

How Much Sleep Do I Need? You’ve seen that there are many stages to sleep and we need to sleep for as long as we do to go through each stage and get the benefits for optimal health and daily functioning. Eight hours is about the right amount for

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most adults; yet, you may feel you need a bit more or less. But, if the amount you sleep is consistently less, you may feel normal, but your body and brain suffer as they do not get a chance to recharge and refresh. In contrast, babies can sleep up to 17 hours, young children up to 14, and teenagers, as well as young adults need 1 to 2 more hours of additional sleep as they are still developing. On the other hand, older people tend to sleep a little less. When it comes to teenagers and young adults, between 8 and 10 hours of sleep a night is ideal. However, most schools begin rather early. Researchers have been suggesting that the school day should start later for teenagers to allow them to get more sleep for greater positive outcomes (Morgenthaler et al., 2016). Why not just go to bed earlier? Well, it’s a weird thing, but your circadian rhythm and likely, your personal preference is to stay up later than an adult would. So, at the very time you need more sleep, your circadian rhythm has moved your schedule ahead so you get less! A study by Power, Taylor and Horton (2017) also showed that about 20% of youth wake up in the night to check on social media and these same youth are three times more likely to report feeling daytime drowsiness and less likely to report feeling happy on any given day. This effect was most evident in girls. The authors acknowledge though that it is not clear whether the decrease in happiness was due to less sleep, or more time on social media and the drama that often accompanies it! The point is that young adults are not sleeping enough.

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Wiith an even ann hour less thaan usual, we bbegin to feel th he effects of sleep depprivation. At a low level, yo ou may feel faatigued, a littlee irritable and shaky, aand you might get that weirrd eye twitch happening. You Y might be forgetfull, confused orr have troublee concentratinng and keepin ng focus. Your responnse time will be slower to oo. You mighht even have difficulty controlling yyour emotionns and feel you ur body tempperature rise more m than usual. Somee people get heeadaches. If yyou’re very tirred, you migh ht experience w what are calleed microsleeps, or daytime parah hypnagogia. This happens to students and a adults in long, moonotonous classes or meetiings, or whenn sitting in a less than exciting theaatrical play. Itt’s when yourr eyelids start to get droopy y and you nod off for just two to thhree seconds and suddenlyy wake yourseelf with a jerk of the hhead. Sometim mes, you don’’t even noticee you’ve donee it. Apart from being annoying, theese can be daangerous. Imaagine nodding g off on a busy highw way? In fact, car c insurance companies rreport that miicrosleeps are responsiible for just as a many traffiic accidents aas drunk driviing (Teft, 2016)!

Photo credit: Pixabay

Annother thing that happenss if you doon’t sleep en nough is something ccalled REM Rebound R (Nieelsen et al., 20005). Becausee REM is so vital, if yyou are sleep deprived, you u get a rebounnd effect the next n time you sleep ass your brain will w try to mak ke up for the loss by spend ding more time in REM M. But, this rebound r is no ot without sidde effects; as dreaming occurs duriing REM sleeep, you maay have morre vivid dreeams and nightmares tthe next nightt. Nicotine alsso suppressess REM sleep, so if you

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stop smoking for instance, you might have more vivid and scary dreams for a while afterwards. That seems to be a good enough reason to get more sleep (and not smoke)!

Topic Box: Sleep and Ramadan by Dr. Melanie Schlatter

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Ramadan is the ninth month of the Islamic Calendar, the month in which the Qur’an was revealed, and a time of religious devotion, selfimprovement (including through fasting), social productivity and charity. All Muslims are required to participate, unless they are very young, sick, or elderly. The precise number of fasting hours changes from year to year, but can last anywhere from 9 to 20 hours depending on what region of the world you are located in. In the Middle East, working hours are reduced to accommodate those fasting, but it is still a challenging time, especially if Ramadan occurs during the hot summer months. Indeed, Muslims will often say that it is not the fasting that is difficult, but the tiredness. With proper management however, people can get the same amount of total sleep as they normally would, because it is the sudden change in wake-up times and overall routine that affects the balance. Understanding the sleep cycle is fundamental to proper adjustment.

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Upon going to sleep, we typically begin a 90 to 120 minute cycle ranging from deep to light sleep, as well as a dream phase. Thus it is often recommended to set a wake-up time that is a multiple of approximately 90 minutes. For instance, if you go to bed at 10.30pm, set an alarm for 6am (7.5 hours later). It may seem better to have had 8-8.5 hours of sleep, but physically, you will feel far more tired as you will not have completed an entire sleep cycle. During Ramadan, the same principles can be applied, although it’s a little challenging if you go back to bed after Fajr and want to wake up for work, because your stomach will be busy digesting food! But, as an example, if you go to bed at 10.30pm, set your alarm for 3am and proceed with suhour and then the Fajr prayer. At approximately 4.30am, you can go back to bed. If you are working, it would be best to wake up at 6am or 7.30am to feel as refreshed as possible. As long as one’s Islamic obligations are fulfilled in a timely manner during the day, it is permissible — but not necessarily encouraged — to sleep during the day. And many people do shift their entire sleepwake cycles so that they sleep most of the day and are awake all night. However, for those who are working, short naps — no longer than 20 minutes — are recommended to be taken, but no later than 4pm in the daytime. People who are fasting usually find their energy levels dwindling towards the end of the day, so be extra cautious when driving, operating machinery or if you need to make important decisions. Risk-taking can be higher when people are tired and their blood sugar levels are low. Check with your doctor if you have any doubts about your ability to fast. One should also refrain from excessive eating in the late evening. This leads to extra digestive activity, and it can increase the temperature of the body, which can make it more difficult to fall asleep. It follows that regular socialising into the early hours can also affect one’s sleep cycles. Be sure to make up the time lost as soon as possible.

Dreams: Why do We Dream and What do They Mean? Have you ever dreamed of falling and suddenly woke up with a jump? Or have you had the same dream over and over again? Do you dream of weird things like your teeth falling out? Do certain dreams coincide with moments in your life when you feel insecure about something? There are many hypotheses about why we dream and you may have ideas of your own as culture also plays a role in interpreting what people dream about. Let’s review a few of the more common theories.

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Continuity Hypothesis In the Continuity Hypothesis (Domhoff, 1996), dreams are believed to reflect the continuation of your waking experiences; thus, your dreams may resemble real life because the brain’s manner of processing information while awake merely continues during sleep and all of your preoccupations and thoughts continue. Thus, dreams are only as meaningful as your waking thoughts. One of the criticisms of this theory is that it does not account for or explain why our dreams sometimes are discontinuous with real life, if dreaming is merely an extension of daytime thinking. Domhoff (2007) responded to this criticism by considering that discontinuity was a cognitive defect in dreams.

Reverse Learning Theory In the Reverse Learning Theory (Crick & Mitchison, 1983), dreaming is considered a process that helps you eliminate and forget unnecessary stimuli and information so that your cerebral cortex is not overloaded trying to process new and old accumulated information that you may no longer be using. Think of this as the “delete browser history” or “empty recycle bin” functions of a computer. Every time you open files or websites, storage space is used. Over time, the computer gets slow as too much space is unnecessarily used. Dreaming is the act of deleting unused or old deleted files; pieces that need to be removed to make room for new files. This helps you learn as the cortex is not overloaded and can focus on what’s at hand.

Activation-Synthesis Theory The Activation-Synthesis Theory (Hobson & McCarley, 1977) was one of the first to reject Freud’s idea that dreams had hidden meanings. In the activation-hypothesis theory, dreaming was considered nothing more than the result of random brain activation that “woke-up” certain memories during REM sleep. The processes that took place during REM sleep influenced patterns of dreaming; yet, dreams in themselves were not considered to serve any purpose. Over the years, the theory was redeveloped and went through many changes and is now called the AIM Model.

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AIM Model Hobson noticed that during REM, NREM sleep, and periods of waking, there were several differences which led him to reconsider this theory altogether from one focusing on why we dream to a focus of what and how brain activity relates to consciousness. This new model was called the AIM Model (Hobson, 2009). He noted that during REM sleep, levels of serotonin were low and acetylcholine was high explaining why it was hard to remember dreams as these chemicals are responsible for neural processing and sending chemical messages from one part of the brain to another. He also noted that low levels of serotonin during REM sleep, which limit connections made between parts of the brain, also explained why dreams were weird. In waking life, we make sense of illogical and irrational thoughts, but while we are dreaming, we cannot and reality checks on dreams are not possible. Thus, he considered that REM, NREM and waking were variations of human consciousness instead and were better explained by the AIM Model (Hobson, 2009), which consisted of (1) Activation, (2) Input-output gating, and (3) Modulation, which in turn, reflect three degrees or types of consciousness. Activation: How active is the brain? For instance, in REM sleep, the brain is very active, yet in NREM is it hardly active at all. Differences in states of consciousness involve differences in levels of brain activity. Input-Output Gating: The activation of the brain is also considered, but the source of activation is most important. Is external sensory input (like the sound of a car passing) making its way to consciousness (during REM sleep, it does not); also, is there any motor output (are you responding to the noise by moving your head towards it for instance)? Again, in REM sleep, the answer is no. During REM sleep, the brainstem is actively gatekeeping (blocking) external input from coming in and motor output from going out. During NREM and waking, these gatekeeping functions are less or not active. Modulation: Depending on which neurochemical system is in operation, messages will be sent to remove information that was processed (like in reverse learning above) or to retain and keep information “online” until further notice. Thus, the AIM model maintains that dreaming is meaningless, but explains that we dream as a by-product of the brain switching between different states of consciousness.

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Sleep Difficulties Like everything in the body and brain, sleep doesn’t always go according to plan. Read on to see what habits you are creating that might be making sleep tougher to get.

Electronics and Blue Light

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The brain’s pineal gland is what secretes or produces the hormone melatonin, which helps you to sleep and is secreted for about 9 hours from dusk (early evening) to shortly before daylight (early morning). However, there is a drawback to melatonin; it’s only produced when it’s getting dark. As long as any form of light is reaching the optic nerve through your eyes, the suprachiasmatic nucleus does not signal to the pineal gland to secrete melatonin and you don’t feel as sleepy as you should (Zeitzer, Dijk, Kronauer, Brown, & Czeisler, 2000). What does this mean? When you’re scrolling your Instagram feed at 2am, electronic light called blue light, interferes with the production of melatonin. It’s not only Instagram, but sleeping with the television on, your laptop open, your mobile phone next to your head, streetlights shining through the window, or any type of light, delay the production of melatonin because your eyes

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continue to pick up light and send a signal to your brain that it’s still daytime. While it is tempting to update your status in the middle of the night, you should try to stop all forms of electronics and lower or dim the lights so that you send the signal to your brain that it’s time to produce melatonin so that you can sleep.

Delayed Sleep Phase Syndrome This syndrome is common in university students. “Night owls” are usual in teenagers and young adults and the preference for sleeping late can be brought on by hormonal changes and social pressure to stay up late. Here, the body’s internal clock becomes deregulated and sleep occurs much later than it should even though it might be for the same amount of hours. For example, Salim might be busy doing assignments at first, and then over time, keeps this as a habit and stays up to chat on social media with friends. Next thing you know, he can’t go to sleep before 3am because it’s now what his body is used to. He might still sleep the required amount of hours, but he has missed out on the optimal periods like morning for cognitive efficiency and afternoon for physical strength. Salim can get out of this cycle by gradually shifting back his schedule to waking up earlier by an hour at a time so it’s not such a shock to his system. Going to sleep earlier would help too.

Advanced Sleep Phase Syndrome This syndrome is the opposite and tends to be the pattern we see in the elderly, whereby their sleep patterns shift backwards and they go to sleep early and get up early. You may think this is better than the delayed syndrome, but people who go to sleep and wake too early suffer from the same problem and also miss out on optimal times during which the body and brain are at their best, feeling sleepy at midday and as if they need a nap because they’ve been up longer than the rest of the world by 2pm!

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Jet Lag

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Many of you know what this feels like when you travel at the start and end of the semester. If you fly only a few hours away, it’s not too bad, but if you travel across many times zones, you know how hard this can be for the body and mind. After a few days, the body resets itself. The rule of thumb is for every hour of time zone change, you can expect to allow one day for recovery. This means that if you are 10 hours off your real time, allow up to 10 days for your body to adjust to the new time zone. You can help this process along bef ore you leave by adjusting your sleep or waking times to the new zone a few days prior. This won’t help 100%, but it can make the difference between a good presentation and a bad one if you turn up immediately back at school or work the following day. Finally, if you land at your new destination early in the morning, resist the urge to go to sleep. Try to spend time outside in the sun and get some exercise –even taking a quick walk will help. This will give you energy throughout the day until you can go to bed early and reset your body back on the clock much more quickly than if you give in and sleep for the afternoon.

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Shift Work Hopefully your work schedule won’t involve shift work, but sometimes it will, like it does for police officers, fire fighters, doctors, etc. The key to dealing with shift work that involves working days and then a series of nights is to not frequently alternate the schedule. Rather than work one night and then one day and back to nights, arrange for a series of days in a row and then a series of nights in a row. It’s no fun to work several nights in a row, but this will be easier on your body than changing back and forth, which your body and brain don’t like much. Further, you’ll be less likely to make mistakes or get into car or workplace accidents, so try and be as regular as possible.

Parenting New mothers are prone to exhaustion and fatigue as a result of being the primary caregivers of babies, which often involves getting up several times throughout the night. A study by McBean and Montgomery-Downs (2015) showed that, without surprise, healthy postpartum women had disrupted circadian rhythms as a result of sleeping less and being disrupted in the night as well as sleeping more in the day to match their infant’s sleep cycles. At week 2, they clearly rated high on fatigue, but by week 12, those who had the most disrupted and unpredictable circadian rhythms scored highest on symptoms of anxiety, stress and mood disruptions. Remember that these mothers were not suffering from postpartum depression, they were both healthy samples; what made the difference to their psychological states was a lack of sleep, but more importantly its lack of predictability. The bottom line is that your circadian rhythm will unhappily resist any changes you attempt to make to it.

Learning and Sleep You might not think that a lack of sleep impacts learning beyond feeling tired and not being able to focus in class, but it turns out that certain types of memory and consequently, learning, is affected by a loss of sleep. For instance, procedural memory and motor skill learning (knowing the steps involved for how to do something) depend on the amount of time spent sleeping (Walker, Brakefield, Morgan, Hobson, & Stickgold, 2002), while declarative memory (knowing and understanding content) seems to be more dependent on NREM sleep (Curcio , Ferrara, & De Gennaro, 2006; Hershner & Chervin, 2014). To illustrate, university students who were

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tested on a motor task after 12 hours of forced wakefulness showed no improvement, but for those who slept in between, performance was boosted by almost 20% (Walker et al., 2002)! The need for sleep between periods of learning is important and suggests that the best thing you can do the night before an exam is not pull an all-nighter study session, but rest.

Is Lack of Sleep a Big Deal? In one word, yes! Most people think that not sleeping will only make them tired, which is bad enough, but there are a number of other things that happen when you don’t sleep enough and they’re not good. You get stupid. Yep. A lack of sleep impacts your learning and memory (see above). For one, while you’re tired the next day in class after staying up late playing video games, you can’t focus, concentrate, or think very clearly and you’re probably having a few microsleeps, all of which make it harder for you to take in what is being taught in the first place. Second, not sleeping well, enough or at the right time makes it tough to consolidate memory, which means to “make memories stick”. Whatever you learn during the day requires a good night’s sleep in between to be properly processed and stick in your memory. Not sleeping enough limits that ability and makes the class you sat through pointless as none of it stuck; in fact, research suggests that the quality of your sleep is more important than the quality of your waking hours when it comes to memory (Rasch & Born, 2013). You become miserable. Not sleeping enough can put you at a greater risk for depression, while already being depressed can make your sleep problems worse creating a vicious cycle of no sleep and greater misery, greater misery and less sleep (Nutt, Wilson, & Peterson, 2008; Regestein et al., 2010)! Following the same pattern, not enough sleep can also make anxiety disorders worse as you have more time to worry – due to not sleeping – and this increases anxiety and makes you sleep less (Boland & Ross, 2015). You look (and get) old. After a late night, we have that puffy tired look, but it turns out that not sleeping enough does make us age more quickly. Carroll et al. (2016) suggested that after even one night’s sleep deprivation, cellular damage and deterioration begin to lead to early biological aging. Ugh. You pack on the pounds. When you don’t sleep, the fact is that you’re awake for longer and most of us tend to eat more the longer we are awake. In fact, not sleeping enough made it more likely for people to eat up to 380 more calories a day (Al Khatib, Harding, Darzi, & Pot, 2017);

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do that a few times a week and the kilos increase rather quickly! Further, when you don’t sleep enough, your metabolism slows down thinking there is a problem – remember, your brain can’t tell the difference between you being in real danger or just pulling an all-nighter – so, it responds in the same way by slowing down metabolism so that you can preserve energy by burning fewer calories. This slowing down means it will be harder to burn those calories as your body is holding onto them just in case of a problem. Your body also releases ghrelin, a hormone that stimulates hunger, and decreases leptin, the hormone responsible for feeling full (Motivala, Tomiyama, Ziegler, Khandrika, & Irwin, 2009). Now you really are hungry, don’t feel the effects of fullness and you’re in the refrigerator at 2am! Not a good way to start the academic year.

Sleep Disorders Sleep apnea, insomnia, and narcolepsy are examples of sleep abnormalities. Maybe you know someone who has these or maybe you do; either way, read on – unless you’re sleepy, then go take a nap!

Insomnia Not being able to sleep is a common problem from which many of us suffer a few nights here and there when we’re stressed, but in some cases, irregular sleep patterns, like insomnia, can last weeks, months, or years. Like all sleeping disorders, insomnia, where you frequently wake up in the night, can’t fall asleep and stare at the ceiling, or wake up too early and can’t get back to sleep, has negative consequences for your health. People with insomnia report higher levels of anxiety and physical pain (Kyle, Morgan, & Espie, 2010). Stress and anxiety play a major role in insomnia, but other factors, like traveling, working night shifts, being physically inactive, or not keeping a regular sleep schedule (i.e., staying up too late to watch movies) can also bring it on. For most people, insomnia is transient (lasting for short durations) and will eventually resolve itself, but in others, insomnia can be lifelong. Paying attention to your sleep hygiene (timing, darkness, temperature, physical activity, diet, managing stress, etc.) goes a long way in preventing insomnia and regulating it when it hits.

Sleep Apnea While this is also a common disorder, people confuse it with simple snoring. In fact, sleep apnea is more serious than that. It’s the repeated

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blockage of the upper respiratory passage or, simply, it’s when you stop breathing for a few seconds at least five times an hour in your sleep. Sleeping on your back makes it worse, especially in people who are overweight, because the airway constricts even more as a result of the accumulation of fat and lack of motor tone in the tongue. Worst of all, a person might not even know they have sleep apnea other than the fact that they feel extremely tired despite sleeping for what they think is the whole night. It is present in less than 10% of the normal weight population, but increases tremendously as a person’s weight goes up (Park, Ramar, & Olson, 2011). How is sleep apnea diagnosed? A machine called a polysomnography records brain wave activity, oxygen and breathing levels, heart rate, and movement while you sleep. What’s key to measure is your oxygen levels (or lack thereof) and this is why sleep apnea shouldn’t be ignored. Untreated sleep apnea puts a lot of stress on your cardiovascular system (your heart) as it needs to keep pumping blood without oxygen. This puts people at risk for hypertension (high blood pressure), stroke, insulin resistance and the development of diabetes, and longer postoperative healing times than people who do not suffer from sleep apnea (Park et al., 2011). You can reduce the chances of sleep apnea by losing weight and not smoking. Otherwise, treatment includes the use of a CPAP machine (wearing a medically prescribed oxygen mask while you sleep), surgery, or medication. These don’t reduce the problem completely, but anything to get more oxygen while you sleep is helpful.

Narcolepsy Narcolepsy is a neurological disorder that causes extreme daytime sleepiness and muscle weakness (called cataplexy). Extreme is the key word here, it’s not just feeling tired because you didn’t sleep last night. People with narcolepsy can fall asleep while walking, talking, eating, or even driving, and due to muscle weakness, can drop cups, books, babies, or whatever they are holding. These sleep attacks can last several seconds or up to several minutes, which is why it can be a dangerous disorder. People with narcolepsy sometimes report having hallucinations, really vivid dreams while falling asleep or waking up, and can also experience sleep paralysis (when they can’t move or speak while waking up or falling asleep). It is thought that people who have narcolepsy have low levels of hypocretin, a chemical that promotes wakefulness, but why is not known (Liblau, Vassalli, Seifinejad, & Tafti, 2015).

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Restless Legs Syndrome This syndrome is considered a nervous system disorder as well as a sleeping disorder and is accompanied by a feeling of tingling or pins and needles in the legs which make the person want to move or kick their legs to make it stop. The syndrome can be mild or extreme and can disrupt sleep throughout the night. Not sleeping enough can make it worse or even trigger it, but in reality, no one is sure why it occurs except that it might have a genetic basis as it seems to run in families. It also appears to be more common in women and can start at any time in childhood or as an adult. There are medical solutions; however, all cases benefit from lifestyle changes that by now, you know help many things, like exercise, getting regular sleep, limiting caffeine, and not smoking. That was a quick tour of the world of sleep. Before we end, we include a few self-assessment questions, in addition to the study questions at the end of the chapter, to help you make adjustments to your sleep patterns. These questions will include attention to your timing, duration of sleep, as well as to think about any interference that might get in the way of getting a good night’s sleep and which may also limit your success as a student. Take some notes and do try to make some changes; we often don’t know how bad we feel until we start to feel better. Even regulating your sleep will improve your grades without any other significant changes, so be sure to give it a try.

Personal Sleep Assessment Some people feel tired, but ignore their sleep cues and override their sleep schedules. Read the list below and see what you might be doing to override your sleep system. 1.

2. 3.

Behaviour It’s a time for me to feel bad or just think about my life; it’s quiet, it’s dark, I start to review all of my problems because I was too busy during the day. I eat to stay awake. I don’t know why really. I procrastinate about sleep; I start to check my emails for the next day, I clean, watch just a little more television, I busy myself with nonimportant tasks so that I don’t have to go to sleep so soon.

I do this

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I turn on music, start to get more physically active, I wake myself up. I think of new ideas, chat with people on FB, IM, or other sites, then I’m awake and can’t sleep! I have this feeling that everyone is out there having fun and I’m not. I have a feeling that I might miss something… Other:

The reasons for not sleeping well or long enough may have to do with being too hot, hungry, thirsty, etc. Which of the following get in the way of your sleep? Sleep Issues 1. 2.

My room is too hot and I wake up. I have the A/C vent right on my face (or feet, etc.) 3. There is a lot of street noise. 4. My room is not fully dark; street lights or other sources interfere. 5. I leave laptops and televisions on; my mobile phone is near me and flashes when there is a message. 6. I wake up hungry or thirsty. 7. I am worrying or reviewing the day I had or the one coming up. 8. I sleep with a pet, baby, or small child. 9. I leave the television or music on, even if it is softly. 10. I go to sleep and wake up at different times. 11. I take naps in the day to make up for sleep loss at night. 12. Other…

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In the box below, think of solutions to any of the problems you noted above. If you can’t, ask your classmates for help as they might have solutions to these already. You can also read the following table which has a few solutions already.

Add your own thoughts to this and select some new ideas to try. Sleep Problem 1. My room is too hot and I wake up. 2.

I have the A/C vent right on my face (or feet, etc.)

3.

There is a lot of street noise.

4.

My room is not dark; street lights or other sources interfere.

Sleep Solution A cool room is needed for sleep. A one degree temperature drop needs to occur to signal to the brain that it is time to sleep. If it’s too hot, the signal is not sent. This is uncomfortable and dehydrating! Change the bed’s direction or lower/raise the vents on the A/C. You can also attach a sheet of paper over the vent to push the air away. Ear plugs will work, but an easier option is to get white noise, a small fan pointed away from you will produce a low hum. You can get black out shades or cover the windows with paper; even half the window will do the trick. You can try a sleep mask which blocks out 100% light and is comfortable.

I can do this

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5.

6.

7.

8.

9.

I leave a laptop/ tv on; my phone lights up for a message. I wake up hungry or thirsty. I am worrying or reviewing the day I had or will have. I sleep with a pet or baby.

I leave the TV or music on, even if it is softly.

10. I go to sleep and wake up at different times. 11. I take naps in the day to make up for sleep loss at night.

Turn these off, but if you must leave them on, turn them away from the direction of your face (the same with alarm clocks). Phones should be turned over so the lights are covered. Have 2 large glasses of water about 23 hours before sleep so that you are not dehydrated. A protein-rich snack before bed (i.e., nuts, cheese, milk) will help get you through a night. Write it down to help you reach a conclusion and remember to end with: What does this mean for me now? Or what can I plan to do for tomorrow? Write it down then leave it be. Pets need to be out of the room! Prepare for whimpering until (s)he understands the bed is yours. Babies also need their space, i.e., crib, mattress. They can be in the room if they must, but worrying about rolling over or being kicked is not helpful. Practise over the next few nights turning down the noise more and more until it is finally off. Your brain is processing noise even when asleep and this interferes with it doing its job. Regularity isn’t just for babies; adults need regular sleep timings also. Wake up and go to sleep at the same time, even on weekends, as it takes our bodies time to adjust to change. A nap should only be taken if you can’t function because what you give to the day is taken from the night. The best cure is to stay awake and go to bed earlier. If you need one, you are already sleep deprived.

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Over to you now… 1. 2. 3. 4. 5. 6. 7. 8.

How did you understand dreaming before reading this chapter? Use at least two theories to describe why we dream now to a classmate. Describe the difference between REM and NREM. What does each do? What role does sleep play in your ability to learn and remember? Be specific. What are three functions of sleep/ Discuss the role of the glymphatic system. Are naps good to take? Do we sleep in one continuous stretch of time? Describe the stages of sleep. What changes can you make to your sleep patterns as a result of this chapter? Make sure to explain why you will make those changes by using at least two of the ideas from the chapter.

CHAPTER FIVE MEMORY DR. ANNIE CROOKES

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Chapter Outline x x x x x x

Topic Box: Supermemory (Mnemonics) The Structure of Memory: What makes up the Memory System? Topic Box: PTSD and Memory Remembering Topic Box: Does Obesity Impact Memory? by Dr. Louise Lambert Topic Box: Eyewitness Memory

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x x

x

Forgetting and Memory Failures Topic Box: Google May be Quick, But is it Always Good? by Anisha D’Cruz Over to you now…

We use the term “memory” all the time, but to what are we actually referring? Memory is our brain’s ability to store and recall any type of information over any amount of time. Memories can be for factual words (i.e., Abu Dhabi is the capital of the UAE), for sounds (i.e., music and voices), for movement and action (riding a bicycle), or when you visually replay past experiences in your mind (your last bad day at school). Because of this very broad definition, memory is the basis for almost all of our thinking processes. Remembering information is needed even for having a simple conversation: You have to hold in mind all the words the person is saying, who they are, who others in the conversation are, and the overall theme of the discussion in order to respond. As you’ve seen in previous chapters, memory is involved in so much of our thinking that there is no one single part of the brain that controls it. This incredible ability is a system with multiple components. Psychologists, neuroscientists, philosophers and other researchers have studied the cognitive and neural aspects of the brain and devised models for how it might work. These models are based on experimental evidence of what sort of concepts, centres, and process components must be involved. We will explore all these in this chapter, but first let’s take a look at what is sometimes called, supermemory.

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Topic Box: Supermemory (Mnemonics)

Photo credit: Pixabay

Memory competitions in which contestants show incredible feats of memorization have gained media attention in recent years. In 2014, Arabic memory championships were held in Algeria, Egypt, Sudan and Tunisia and the current Arabic memory champion is Meryem Yezza. Ms. Meryem accurately memorized 640 digits in 15 minutes among many other difficult tasks. Such incredible memory challenges have a long tradition in Islamic societies where Hafiz Muslims memorise the Qur’an in full and recite it back perfectly. On the outside, these seem like impossible tasks that suggest something superior about the memory of the people who complete them. However, there is nothing different about their brains or intelligence. Instead, this kind of supermemory is a result of clever techniques they use to encode and store information. Of course, what these people do share is an uncommon devotion to undertake the effort, time and practice involved in building these abilities. Many of these memory techniques (called mnemonics) have been around for centuries and rely on encoding through visual imagery or spatial location. In particular, the method of loci was made famous by an ancient Greek poet called Simonides who survived a building collapse and

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helped to identify bodies through his memory of who was sitting in each seat. Simonides used visual images to memorise the seating plan of an entire theatre while performing on stage. As noted earlier, the human brain may be hardwired for visual and spatial information so finding a way to link lists of written information into these natural systems can unlock powerful memory abilities.

The Structure of Memory: What makes up the Memory System? The most important model of what the memory system looks like was developed by Atkinson and Shiffrin (1968). They suggested memory was not a single system but a series of linked systems they called The Modal Model. For them, memory could be split into three parts that have different timespans (how long information stays before it is forgotten) and capacities (how much information can be held). You can think of each type of memory like a bucket, some are really large, but have holes in them (sensory memory), while others are small but are watertight and things stay put as long as you swirl the bucket around (working memory), others still yet, are huge and have no holes, but are so big that things something get lost (long-term memory)!

Sensory Memory First, information enters the mind from the outside by taking in external stimuli through one of our senses (i.e., sight, sound, touch, taste, and smell), but not everything that comes through our senses is relevant or useful. You might notice a bird flying by or hear a piece of conversation on the metro in a different language, but for the most part, we don’t pay attention to these things and forget about them immediately. Thus, there must be a sensory memory storage unit that holds the information while the mind decides whether the information is important. This sensory memory capacity is very short, only about 1-3 seconds, but is nonetheless really huge, and is controlled by the cognitive processes of attention and focus. If information in sensory storage is not picked up by our attention, then it is discarded almost immediately. The saying that “what you pay attention to is what gets remembered” couldn’t be truer here; if you don’t think it’s important, your brain quickly moves on to the next thing and has already forgotten the previous.

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Sensory memory was first studied by George Sperling (1960) who briefly showed participants a board of 12 items (letters) for about 50msec and then asked them to recall what they had seen. Generally, participants could only remember 4 of the 12 items. To test if this was because participants did not have enough time to see the rest of the 12 items, Sperling modified the experiment so that the 12 items were arranged as three rows of four letters. Participants would be shown the items followed by a sound which would tell them which row to recall. They would not know ahead of time which row this would be. Sperling found that if the cue came immediately after seeing the items, participants could remember the items from any of the three rows. However, even a small delay and the letters would all be forgotten. Much research has been done either on the visual sensory memory (called iconic, like a physical icon) or on the auditory sensory memory (called echoic, like an echo) as well. In fact, you can test your own iconic memory. Turn on a lighter in the dark and move it around; you’ll notice that you see a trail of light just briefly left behind. What is happening is your eyes capture a series of individual snapshots (or saccades) of information and iconic memory holds onto each until the next snapshot is taken. This information is then linked together to create the sense of a trail of light.

Photo credit: Pixabay

Altogether, these experiments tell us that recall from sensory memory is limited mainly by time and our own attention. That is, the time it takes to name the four items in one row is 0.5-1 second and after this, all other information in the proceeding rows has already faded out.

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Short-Term Memory After sensory storage, information that catches our attention will get moved to a short-term memory store. This part of the system has had a lot of research interest and is central to our information processing. For example, it includes things like listening to the words of a question in order to decide on a response or reading a set of instructions and holding them in mind long enough to complete a task. This is the job of short-term memory and once the task is finished the information is quickly replaced or pushed out by something new. Short-term memory has a slightly longer time limit than sensory memory but not by much! This short timeframe of just a few minutes is the reason that you forget what you’re doing if you get distracted from a task for too long, like when you walk into a room and can’t remember what you went there for! Atkinson and Shiffrin also suggested that short term storage has a limited capacity too. Think of when you do too many things at once and find it hard to keep track of different information. This is one reason why you are told to make notes in classes and prepare your information before attending: trying to hold in memory every word the teacher says during the class is impossible. You will be overloaded within minutes and feel overwhelmed quickly. This is the bucket to which that pertains, it can only hold a few things at once, and as long as you listen, write, or think about that information, it can stay, but look over at your giggling classmate, or follow the teacher into what is already a new section and you’ve dropped the information in the bucket; the information has been pushed out to make way for the new. How do we test short-term memory? We can use a serial recall (a series is a string of items, like 1, 2, 3 or A, B, C) test known as the memory span test. Participants are shown a set of words, letters, numbers or objects one at a time and then asked to recall them in the correct order. Observations from these tests led to a famous observation by George Miller (1956) that memory capacity seems to always be around 7 items (with a range of 5 to 9). This became known as the “magic number 7” rule; that is, most people can handle serial recall lists of 4, 5, and 6 but will start to make mistakes with lists of 8 items or more. Memory span tasks are often included in IQ tests for general intelligence (you’ll learn about this in later chapters) and you may have done one as part of school testing. How good you are at these tests does not come from your intelligence, but has more to do with how familiar you are with the items being tested and how long you can keep the information in mind while you need it. For example, if you were being asked to recall

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in order a list of your favourite TV shows it would be easier than trying to do the same task with a list of unfamiliar foreign language words. George Miller went on to show that the number of items accurately recalled could be extended through chunking – ordering items into meaningful chunks or groups. For example, seeing a series of 12 numbers should be impossible but if you grouped the numbers into sets of four, they would look like years (1978 1956 2011). You could also turn a string of 12 letters (PROMTHENPULL) into word sounds (PROM THEN PULL). Now, it only seems like 3 things to remember. Chunking can be done in many ways – when children learn the alphabet they are often taught it as a song or rhyme that naturally chunks the letters together using rhythm. The same chunking happens when trying to remember phone numbers. Most languages have natural rhythms that we unconsciously use to chunk information. Other research has shown that information is stored in short term memory as sound (known as phonological encoding). Conrad (1964) tested memory span using lists of words. He found that words sounding the same (man, can, mad, mat, cap) were harder to recall, suggesting that the sounds were getting mixed together in the short term storage unit. In contrast, words that had the same meaning but sounded different when spoken (tall, high, big) did not have this problem. The existence of separate short-term and longer term memory processors is observed in patients with memory disorders (known as amnesia). Case studies of patients suffering from amnesia show two distinct patterns of memory loss. A common form of amnesia is when people’s memory for the past is lost, while another involves being unable to hold onto memory of what is happening here and now. An example is Clive Wearing, who was a famous British music conductor until he suffered severe brain damage following a virus. After this, he was able to remember many things about his past but could not follow a conversation, could not complete a task and would not remember he was talking to you if you walked out of the room. Similarly, an early warning sign of the brain disorder known as Alzheimer’s disease are memory slips in everyday tasks, i.e., being forgetful, unable to retain information to complete a task, or losing track of conversations. The distinction between the two storage systems (short and long) is supported by direct evidence from experiments using free recall tests. Unlike serial recall tests noted above, these tests ask participants to recall a longer list of words (10 or more) but in any order. We look for patterns in which words in the list tend to be recalled. For example, people will recall words at the start of the list and at the end, but not the ones in the middle.

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This is known as the primacy (words at the start) effect and recency (words at the end) effect. Participants try to learn the first few words in the list by rehearsing them so they become memorized into long term memory; however, this takes too much space as more words are added. In contrast, the words at the end of the list are remembered because they are still being held in short term memory and are the last ones heard. Neither process works for words in the middle of the list. This also explains why you remember what was said at the start of class (primacy) given that you are focused and fresh, but by the middle of class, you become tired and there’s simply too much information and you lose focus; however, when you know the end is coming, you start to pay attention again and do remember what was said near the end (recency).

Long-Term Memory The final stage of the Atkinson and Shiffrin model is long-term memory (LTM) – the part of memory we are most aware of. We can use selfobservation to learn a lot about long term memory. For example, if you ask a group of your friends to write down as many different answers to the sentence “I remember….” You’ll notice that their answers fall into various categories. Most will answer with facts or knowledge they’ve learnt; some will answer with descriptions of experiences they have had (“I remember when I first learned to swim…”); and some will try to be clever with answers like “I remember I need to feed the cat” or “I remember the taste of my mother’s cooking” or “I remember how to drive my car”. All of these are correct answers and suggest there are several categories of information in long-term memory. Memory for facts and information, the stuff we know, is called semantic memory (Tulving, 1972), and might include the information found in a textbook or learned at school. Memories of past experiences on the other hand, are called episodic memories (think of a television episode). Episodic memory can be further split into experiences of our own past, i.e., autobiographical, or memories for public or other events that have happened around us (like what would be found in your autobiography or book about your life). Together, semantic and episodic memory are also called explicit memory (Squire, 1992) because we “know we know” them and can recall these memories consciously and express them easily. An interesting finding is that episodic memory may develop later in childhood compared to other aspects of long term memory. Of course babies and young children are learning about the world every minute they

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are awake and this shows up in their ability to learn new actions, language and routines. However, if you ask adults to talk about their earliest autobiographical memory, most people can report only as far back as the age of four. Forgetting the memories of our early years is called childhood amnesia. Young children haven’t developed a full sense of themselves yet and without the mental categories in place to make sense of and organise personal experience, the information floats around in storage and is easily lost. Sometimes we think we have memories of being younger but it is likely that these mental images are formed from stories we were told by our parents or photos we saw later on. Since we know it happened to us, our mind rebuilds stories of those experiences from other sources, but not from the actual events themselves. A third type of long-term memory is for the skills we know how to do, called implicit or procedural memory. For example, when you first learned how to drive, every movement and decision was done with conscious effort. You may have done things in the wrong order but over time, those actions became automatic and required little conscious thinking.

Photo credit: Pixabay

Procedural memory is known as implicit because we do not recall the procedures consciously; our muscles and brain just do the activity. If you’re not sure about the conscious part, try to describe out loud to your

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classmates, how to ride a bicycle or how to braid hair. It’s hard to do and we end up using our hands and body to describe the action, our body has memory for it, but these types of actions we no longer think about, we just do, become almost impossible to explain. Conditioned responses (from Pavlov’s classical conditioning) would also be stored here. It’s difficult to test the capacity and limits of long-term memory but most researchers believe it has no set space or time limit. How is this possible? The key for unlimited capacity in LTM is a strict organization of all the information. Think about packing a suitcase – if you pile clothes and items without any organization the case gets full very quickly. But if you fold and plan what goes where you can fit more items in. So too does our LTM organize, file, combine and manage information in a network sometimes called a schema system. This means that all new information and experiences must be fit into an organizational structure of some sort and without it can easily be lost or remembered incorrectly.

Topic Box: Does Obesity Impact Memory? by Dr. Louise Lambert Apart from the obvious health effects, obesity and being overweight can impact memory in ways we are only starting to learn about. While obesity is not a typical factor we look at in memory, it appears to have some effects on our ability to remember and this influence becomes more pronounced as we age. In fact, the hippocampus is what seems to be most affected by obesity and, as you know by now, this is the part of the brain that is directly responsible for learning and memory.

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For instance, a higher body mass index (BMI) seemed to be correlated with lower performance on episodic memory, being able to recall past personal events, with researchers (Cheke, Simons, & Clayton, 2016) finding that obesity not only contributes to dysfunctions in the hippocampus, but to the frontal lobe as well, where the centre for decision-making and problem solving is located. In a similar study in mice this time, Heyward et al. (2016) came to the same conclusion. The researchers induced obesity in mice and at 13 weeks, the obese mice showed no differences in object location on memory tests compared to the non-obese mice, but by the 20th week, their performance was impaired. In these mice at least, it appeared that obesity resulted in altered gene expression in the hippocampal areas of the brain. A third study suggested the same. In that study, researchers (Clark, Xu, Callahan, & Unverzagt, 2016) assessed the effects of a memory training instruction and strategy use program with older adults (sample size of 2800 people with an average age of 74 years) over a ten-year period and found that this training had only one-third the effects on older adults with obesity than on those who were not obese. The authors suggested that obesity, much like the previous studies, was associated with a more rapid loss of hippocampal volume and that it was a risk factor for impairments to memory and other cognitive processes in later life. Indeed, several studies have pointed to a link between obesity and the greater likelihood of dementia and cognitive decline over time (Cournot et al., 2006; Hassing, Dahl, Pedersen, & Johansson, 2010; Kim, Kim, & Park, 2016; Whitmer, Gunderson, Barrett-Connor, Quesenberry, & Yaffe, 2005; Xu et al., 2011). It’s one more reason to be active and mindful of what and how much we eat.

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Evaluation and Changes to the Atkinson and Shiffrin Model

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The Atkinson and Shiffrin model has been highly influential as a foundation for memory research. Yet, it has been modified over time and most researchers now disagree with some of the assumptions made in the original model. For example, the model implies that information must flow in one direction from sensory to short term and then on to long term storage. Yet, this seems unlikely as information travels in both directions at all times. Stored knowledge will influence task processing at the short term stage and we use this knowledge to influence what and how we perceive the external environment, to plan where to shift attention and in effect, pre-programme or pre-decide what will go into sensory memory. Another significant change to the Atkinson and Shiffrin model was made by Baddeley in 1974 (with Graham Hitch). He suggested that short term memory must be much more than just a storage centre and proposed that this part of the system be termed working memory. An example of a working memory test is the counting span task, a variation on the recall tasks noted earlier. In these, participants count the number of items on each screen and maintain a running total of how many items have been shown. Therefore, it is both memory and processing being used at the

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same time. Baddeley’s working memory has two distinct storage centres and a central processing unit. As mentioned earlier, information is likely stored by sound rather than meaning in this part of memory. In the working memory model, this is a storage centre called the phonological loop which mentally encodes sounds and holds onto them by rehearsing them until the information is required. However, information required for day to day tasks is not just verbal but spatial too. For example, when driving you need to hold onto location and geographical information in order to stay on the correct route; thus, in working memory a second storage centre for visuo-spatial information is called the sketchpad. Baddeley and colleagues later suggested there is even a third storage unit called the episodic buffer which holds information drawn from long term memory to be used by the working memory processor. If you start a conversation with someone and need to recall the names of their family in order to ask about them, this information would be drawn into the episodic buffer ready to be used by the working memory processor. The evidence for multiple storage units in working memory comes from dual task experiments where participants are asked to do a visual and auditory task simultaneously. When two simple tasks each use different senses (for example reading and listening), equal performance can be maintained, but if you attempt two different tasks in the same mode (two reading tasks at once), performance decreases. This suggests that each storage unit is limited in its capacity but can still be used at the same time.

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Topic Box: PTSD and Memory

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A cognitive scientist, Alan Tulving (1972), referred to autobiographical memory as mental time travel. Our minds allow us to replay past experiences, travelling back in time in our imagination. This memory ability may have an important function for building our sense of self and using past knowledge to make better decisions in the present. However, this ability to visualize our past may also be problematic and may be at the centre of disorders like PTSD, post-traumatic stress disorder. Sometimes, when children and adults experience traumatic, life threatening events the mind records and stores these memories very close to the surface so that they can be easily recalled and used to avoid danger in the future. The intensity and stress of the event changes the brain structure itself by enhancing or increasing the brain’s stress response and disrupting the normal memory processes of the hippocampus (important in learning and memory). As a result, PTSD sufferers have difficulty differentiating between memories of the past (which should be less emotionally intense) and present experiences. Therefore, unlike our own mental time travel, PTSD brings intense reexperiencing of the memory as if it were happening in the here and now. These are known as flashbacks and can lead to constant feelings

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of anxiety, worry, or even guilt, as well as depression and other emotional problems. Flashbacks can be triggered by even very small cues in the environment, like a sound, smell, or color, and which can lead sufferers to avoid many situations, objects, people and anything else that may trigger them. This can make it very difficult to continue normal life. PTSD is an important mental health problem around the world and is especially high in countries affected by war. For example, studies indicate that the majority of children and young Palestinians in the Gaza Strip show moderate to severe signs of PTSD (Fasfous, PeraltaRamirez, & Perez-Garcia, 2013; Quota & El Sarraj, 2004). The fact that they are so young makes it even more troublesome. Current treatment for PTSD involves medication to help reduce stress, anxiety and/or depressive symptoms. However, these do not change the dysfunctional memory system that underlies these symptoms. Recent research is now investigating ways to potentially remove or change the memory itself using very new neuroscience technologies. However, some people argue that it may be unethical to delete memories even when they are negative and this could have other side effects too.

Remembering It is important to understand the processes that allow information to enter the memory system, move between the structures and come into our conscious mind when needed. These processes are called encoding, storage and recall, and collectively refer to “remembering”.

Encoding Encoding involves taking information and turning it into a format that can be held in memory. When asked to learn information for an assessment at university, you probably start by trying to rehearse it. This may be done by writing it down, saying it over and over, reading it again and again or, practicing it in some way. This process enables the information to move from temporary storage to long term memory. Yet, we’ve all had moments when no matter how much we repeat information, it never quite sticks. An easier way to learn is to assimilate the information into your existing knowledge and hook it into existing schema networks and storage folders

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already in long term memory. We can do this through organization, elaboration, and the use of visual imagery. The simplest form of encoding is organization. Studies of memory and cognitive development in children have found that when a child instinctively tries to group items into sets, their recall is much better than children who just try to learn as it comes. We do this for example when we have a list of jobs to remember or items to buy at the mall. Most likely you will group the list by categories (fruits, meat, dry goods/ or by which shop you can buy from) and it is much easier to remember.

Photo credit: Louise Lambert

The second form of encoding is elaboration. This is useful when we need to remember more complicated information. You may have heard about deep learning, studying for understanding not just for memorization. This means taking the information and thinking about it: how it is used, what else it could apply to, what result is gives, whether you think it works or not. These learning techniques help you to link information into your existing knowledge and become relevant. Finally, it seems encoding works better with visual information. Paivio (1969) showed that concrete words (words of objects) are better remembered than abstract words (i.e., concepts). Visual imagery allows you to create pictures of the information from the memories already in storage. Thus, visualizing (creating pictures in your mind of objects) links the new information to things already in memory. In fact, many memorization techniques (mnemonics) involve adding a visual image to the information in some way. Paivio suggested that adding a visual image

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creates a dual code so that storage is reinforced through two sensory modes. Visual encoding may also boost memory because it is part of our innate survival systems. Memory systems in the brain developed initially for survival: remembering the location of food sources and images of environmental dangers and responding to these effectively. Therefore, prior to any words or numbers, our memory system developed specifically for the purpose of encoding visual or spatial information. Yet, not all information needs to be encoded with conscious effort. Some things seem to go straight to memory as soon as we see or hear them. The memory system gives priority to emotional, personally meaningful or unusual information that will immediately and directly link to your stored knowledge. A good example here is remembering the phone number of someone who might be able to help you with a much needed summer job.

Storage The second process in memory is the active maintenance of information. Unlike storing things we own in cupboards or boxes where they sit untouched and in the same state for as long as needed, storage in memory needs to be much more active or it may be lost. In long term memory, storage is maintained through a network like a spider web where each concept is held together through its links with other things. New information coming into the network is thus continuously activated, modified and updated, effectively keeping the information alive.

Forgetting A fundamental fact of human memory is that we forget and our memories fade over time. Ebbinghaus, one of the first scientists to formally study memory, found a pattern now called the forgetting curve (1913; cited in Schacter et al., 2012). Forgetting happened rapidly at first and then stabilized with time. The fading of memory over time indicates that we have an imperfect storage system. Memory storage is not meant to maintain every detail of an event forever. Details may only be important for the immediate past; over time, the details of your recent Eid celebrations are not important and will blend into a general memory image of “what my family does for Eid”. The purpose of this is to allow the memory system to build general knowledge while losing irrelevant details.

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Recall and Recognition The final process involves the retrieval of correct information from storage efficiently and accurately when needed. This process can be split into recall and recognition. For example, there are times when we “know we know” something but just cannot bring it to consciousness. This is called the tip of the tongue phenomenon and can be very frustrating and often happens when you are set to introduce someone you have known for a long time but suddenly can’t remember their name or where they even come from! Or consider a multiple choice exam: For some questions you read, you immediately know the answer while for other questions, you cannot answer the question immediately but when you see the potential answers you know which one is correct. The written answers provide a cue to unlock the recall process. Similarly, with tip of the tongue if someone gives you the first letter or some other descriptor, the information finally breaks free. Clearly, recognizing information from a cue is much easier than recalling it directly. The reason for this comes back to the network organization of long-term memory. If the relevant information is buried in the network and your mind cannot find it, an external cue such as the first letter or a linked word will be like a light showing your mind where to find the target word. These recall cues don’t have to be external; in fact your mood or the context you are in can bring up memories too. This is known as state dependent memory and context dependent memory and was shown in an experiment by Godden and Baddeley (1975) with a group of deep sea divers. In this study, one set of divers would learn a set of words on dry land and then were tested either on land or in the water. A second group learnt the words underwater. In both cases, performance was best when the learning and testing happened in the same environment (or context). Similarly, studies have shown that memory is aided by being in the same mood or physiological state (for example, being hungry or happy) during recall. These sensations act as cues that were encoded alongside the target information and are now linked to it in the memory network. This explains why you should be more mindful about where you study. An exam room will be quiet and have little stimuli, but if you normally study in a noisy coffee shop, your ability to remember that information during the exam may be impacted as the two contexts differ greatly from one another.

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Topic Box: Eyewitness Memory It is hard to believe that someone could have been a witness to a crime or a victim of it and not be able to remember it and provide a truthful accurate testimony of what happened. However, many years of scientific research has indicated that the reliability of eyewitness testimony is highly questionable.

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As well as the failures of memory described already, there are specific factors in a witness situation that add to this unreliability. In what is now a classic study, Loftus and Palmer (1974) have shown how details of the witness report can be added, substituted and distorted by any information the person hears after the event. In one of her studies, Loftus showed participants a simple car accident and then asked questions about their memory for the event. She found that the wording of the questions would significantly affect what participants reported. For example, asking the question “how fast was the car going when it hit the other car” versus the wording “how fast was the car going when it smashed the other car” would produce higher speed estimates in the second group. These are called leading questions where the wording provides a subtle cue of information about the event that is picked up

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by our memories and included into the memory itself. In 1959, Canadian researcher James Easterbrook also suggested that physiological stress narrowed our attention system. This was known as tunnel vision. When we are in a highly stressful situation and our life may be threatened, all of our cognitive resources will be focused on dealing with the here and now. Indeed, in a violent offence where a weapon is present, our attention is immediately drawn to that object and not the person holding it. In this situation, details of a person’s face, hair, clothes are not noticed. Unfortunately, these are precisely the details we want and rely on eyewitnesses to provide. Despite all this, eyewitnesses tend to have very strong confidence in their memory which is mistaken for accuracy by the police and jury. Psychological research has helped to make important changes to police and court processes around the world. For example, police may now use a cognitive interview technique for eyewitnesses in which they ask questions in a particular way to try and aid the witness to produce the most accurate and detailed memory they can under the circumstances. In addition, in many countries, judges will instruct jurors about the unreliability of eyewitness memory in the hope that they won’t put so much weight on this emotional testimony over other more objective evidence.

Forgetting and Memory Failures There are times when we forget things in daily life. For example, not being able to remember what you studied in the exam, forgetting someone’s name when you have to introduce them, or going into a room and forgetting why you are there. Psychologist Dan Schacter (2001) described seven common ways in which our memory fails and called these the sins of memory. The first failure relates to problems with the encoding process. Transience is the fact that information comes and goes over time and is not necessarily permanent. Similar to the general transience of memory, there are also times when we forget what we went to the kitchen for or what we were saying in the middle of a conversation; this is called absentmindedness, and it is also a failure of working memory. Most of our absent-minded experiences come from failing to monitor, pay attention or focus on our own mind and thoughts; thus, working memory system has been distracted or overloaded and does not hold onto all the information. Have you ever forgotten someone’s name? This is called blocking, and forgetting names, even of loved ones, when we need to

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recall them is so common that studies have been done to determine why names cause us so much trouble. In a study on name-words (Cohen, 1990; Mcweeny et al., 1987) it was shown that using the word ‘Baker’ as a person’s name (i.e., John Baker) was harder to recall than when using it as their occupation (i.e., John Doe who is a baker). It is not about the word but something to do with names in general. One suggestion is that name information is stored separately to other knowledge about a person in long-term memory. As names are labels, the brain encodes them as less important compared to other facts, like an occupation, one’s relationship, or physical features. It may be interesting to study the Baker versus baker phenomenon in languages where names do have specific meanings. This is the case for many names in Arabic where a name provides information about family and community relationships and even where people are from. Perhaps this makes names easier to recall after all. Another way in which encoded and sorted information can be incorrectly recalled is misattribution. This is when we recall a story or fact but forget where the information was learnt. For example, you may recall hearing a fact from your teacher even though you actually saw it on YouTube. Or you re-tell a story of an event happening to a friend only to realize later that the story came from her! Oops. Knowing how or from where we know something – an ability called source monitoring – may not seem like an important aspect of memory but it can be. For example, people who provide eyewitness accounts of a crime may include facts they heard after the event in their testimony not realizing where they heard this news and misattributing it as part of their personal experience. Suggestibility and bias refer to the changeable nature of stored memories. Autobiographical memories are constantly being modified despite these experiences being finished in reality. Autobiographical memory is not an accurate, clean record of what happened but a mix of new and old information. Our memories are naturally biased as they need to fit with our beliefs, knowledge and values. For example, the time you ran a red light despite being a law abiding citizen, you may remember that you were late for an important meeting and that you had checked that it was indeed safe. These elements are included in the memory so that it will fit better with the stored knowledge you have of yourself as a good person. Long term memory works because it is a network of related information, so when something changes, the whole network must shift to accommodate it. That entails a huge upheaval so it’s easier for that one memory event to be changed than the entire network. Finally, the failure of persistence is our inability to stop unwanted memories. There are often parts of our life history that we wish

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we didn’t remember. Persistence may drive us to ruminate or obsessively think about “what may have been” scenarios long after an opportunity or event has passed, which can stop us from moving forward. An example of persistence can also include what is known as “earworms” or songs that stay in our heads like annoying loops we cannot stop. Often these are songs we don’t even enjoy but that are catchy. In the film, Touching the Void (2003), a climber survived a fall and spent seven days climbing back down the Andes mountain range. When the climber came very close to death, he stated that the song “Brown Girl in the Ring" by a band called BoneyM got stuck in his mind. He realized if nothing else he did not want to die listening to that song! So, this annoying earworm actually gave him the drive to go just a little further leading to his being saved.

Topic Box: Google May be Quick, But is it Always Good? by Anisha D’Cruz

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Nowadays, most information can be retrieved with the help of technology. We can save birthdays, medical information and phone numbers and everything is pretty much away just a click or scroll away, but this has had an effect on the way we remember things. If you’re like most people, you turn to Google and look it up instead of relying on your memory. This works for some things, but what effect does relying on technology – instead of remembering things the old-fashioned way - have on memory?

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It seems that increasingly, people are using the internet as a source of cognitive offloading (Sparrow, Liu, & Wegner, 2011). In this sense, the internet serves as the main memory bank rather than our actual brains. This has the effect of reducing the cognitive load on our memory; instead of remembering information itself, we merely need to remember where that information can be found. But, does the availability of the internet change our searching behaviour and preference for using the internet altogether? Storm, Stone and Benjamin (2016) investigated this question asking whether individuals would repeatedly use the internet if their previous searching behaviour involved its use. In their study, participants were given a set of difficult trivia questions where half were asked to answer from memory, while the other half were to use an online search engine. Later, all participants were asked to respond to easy trivia questions and given the option of going online to find the answers. Participants who answered questions with the initial help of the internet were more likely to answer the newer and easier trivia questions using the internet compared to those who had relied on their memory. Why might this be a concern especially given that the answers are right there on the internet? While it’s true, the answers are there on the internet and moreover, they are constantly being updated and probably more accurate than our own memories, it’s that we are getting a little sluggish at working as hard as our grandparents once did. We are becoming less persistent in solving problems and losing the skill of self-reliance as we opt for Google even when we know the answer. Further, as we are only getting immediate on the spot answers, we are not building expertise and an in-depth knowledge relative to our fields of interest. We leave ourselves vulnerable should there be a time when we do not have access to the internet. Imagine your surgeon having to just look up a few things before your surgery, or worse, your boss waiting on your answer during a board meeting and you can’t answer because you have to look it up? How embarrassing. On the other hand, life has become simpler. Can’t remember a math formula, your doctor’s phone number, a grocery list, or where your car is parked at the mall? The internet will help; but, wouldn’t it be nice to give your memory a job to do? You’ve heard the saying, if you don’t use it, you lose it. The same applies to cognitive capacity; the more work you give your brain, the more efficient it becomes and this might keep your cognitive faculties in check for later in life. Go on, challenge yourself by only using your memory. What’s 43 x 6? What’s the capital of the closest five countries? Uh oh, do you even know what the five closest countries are?

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Over to you now… 1. 2. 3. 4. 5. 6. 7. 8. 9.

Describe Alzheimer’s disease and the aspects of memory it impairs; are there any famous people you know with Alzheimer’s disease? What are their symptoms? How can an understanding of how memory works guide you while studying for exams? How can you improve your study habits to ensure that you remember what you need in the exam? Can anyone have a supermemory? How useful would this be? What can we do to make eyewitness testimony more reliable or useful in court? What can cases of memory failure (amnesia or everyday memory fails) tell us about how memory works in general? How does memory link to mental health and ill health? If memory underlies symptoms of PTSD, what can we do to develop treatments for it? What examples can you think of in your own life of the “seven sins” of memory? How is long-term memory used in everyday life? How does it influence everyday tasks? What are the main differences between the sensory, short-term (or working) and long-term memory storage units?

CHAPTER SIX LEARNING DR. LOUISE LAMBERT

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Chapter Outline x x x

Some Theory to Get Us Started by Dr. Katharina A. Azim Classical Conditioning by Nicole El Marj Unlearning Phobias via Systematic Desensitization by Dr. Louise Lambert

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x x x x x x x x x x x x

Operant Conditioning and Reinforcement by Nadia Al Aswad Topic Box: What’s Best - Reinforcement or Punishment? by Sara Antonucci Social Learning by Thoraiya Kanafani Self-Regulation by Isbah Ali Farzan Sociocultural Theory by Dr. Katharina A. Azim Discovery Learning by Isbah Ali Farzan Insight Learning by Dr. Annie Crookes Peer-Assisted Learning by Dr. Katharina A. Azim Learning with Technology by Dr. Katharina A. Azim Experiential Learning and Simulation by Dr. Katharina A. Azim Learned Helplessness by Dr. Louise Lambert Over to you now

When we think about learning, we often picture a classroom with students taking notes of the information a teacher is giving. At the end of the week there may be an exam asking students to demonstrate what they learned. But learning begins even before students enter the classroom and can occur in many ways. Think about your daily routine of waking up when your alarm goes off, preparing breakfast before you leave the house, taking an alternative route to school with less traffic, handing in your assignment early because you know your teacher appreciates it. Learning occurs as a result of experience and can be visible or invisible – we don’t perform or demonstrate everything we learn. That means learning is not necessarily defined by actual and observable changes in behaviour but by relatively lasting changes in the potential for behaviour that comes from experience.

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Some Theory to Get Us Started by Dr. Katharina A. Azim There are different forms of learning just as there are different concepts and models of how a person may learn. These models are also known as paradigms. All paradigms have the same three components –individual (learner), environment (context), interaction – and they can be distinguished by how much they emphasize each component. In the field of learning theories, we differentiate between four paradigms: Behaviourism: The focus is on the environment and the learner’s response to it. Learning occurs either as a reflex or through a learner’s personal experience. This model centres on learned behaviour that is observable. Cognitivism: This model emphasizes the learner’s mental actions and processes, such as problem solving, information processing, reasoning, thinking, and imagining. Thinking is seen as distinct from behaviour. Constructivism: This concept understands the learner as actively constructing knowledge and not as passive recipient, or receiver of information. The learner creates knowledge and builds representations of reality through interaction. Situated Cognition: Learning is seen as interaction between the individual and the environment. A person’s learning is not simply a collection of knowledge but is heavily shaped by the specific situation. Of these, behaviourism is the oldest model while situated cognition is the newest. No model claims to know exactly how we learn but each helps us consider what we mean by learning, in which situations and ways it takes place, what components a person needs to learn, and how it may or may not be expressed in our behaviour. In the following sections, you will see how the paradigms influence the ways we think about learning.

Classical Conditioning by Nicole El Marj Russian scientist, Ivan Pavlov (1849-1936), focused his studies on mammals’ digestive systems and quite by accident discovered classical conditioning, a theory highlighting the learning process that occurs through the repeated association between two stimuli (or things). The explanation of his theory can get a little confusing, so we’ve written the

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terms with their definitions below so you can refer back to them as we discuss his original study. List of Terms and Their Definitions UCS = Unconditioned stimulus UCR = Unconditioned response

NS = Neutral

stimulus

CS = Conditioned stimulus

CR: Conditioned response

A stimulus that triggers a reflexive or automatic response (UCR) A reflexive or automatic response to an unconditioned stimulus (UCS). It is not learned, but rather occurs naturally in response to the UCS. A stimulus that does not produce a reflexive or automatic response A stimulus that begins as a neutral stimulus (NS) and is paired with an unconditioned stimulus (UCS) until it eventually triggers a conditioned response A learned response to a conditioned stimulus (CS)

Table 6-1

Pavlov’s Experiment Pavlov was studying the digestive system of dogs and to do so, kept the dogs in a laboratory where they were fed by a team of researchers. He had a device attached to each dog to measure the amount of saliva secreted from its glands, and like humans, dogs secrete more saliva prior to having food; it is an unconditioned response –unconditioned in the sense that no one teaches a dog to salivate, it just does. Anything that happens on its own in response to an existing stimulus is considered “un” conditioned (no different than when your pupils dilate in the dark, no one teaches you to do that, it just happens, it’s unconditioned). Yet, it didn’t take long for Pavlov to notice that the dogs would begin to salivate whenever he entered the room, even when he was not bringing them food. He discovered that the mere sight of the researchers, their lab coats, or anything associated with food, would trigger the same drooling response. Pavlov realized something was happening here. The dogs were “learning” or associating neutral stimuli (coats, people) with the food itself.

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To test his assum mption, he dev vised a clever experiment. He H used a tuning fork – although for fo our purposses, let’s say it was a bell— —no one uses tuning forks anymore!—to see iff he could creeate a new asssociation for the dogss. Every time he h fed the dog gs, he would rring a bell. Att first, the dogs didn’t notice; after all, a a bell is a neutral stimullus for dogs and a elicits no responsee naturally. Hee continued to o repeatedly ffeed them to the t sound of a bell. Theen, Pavlov atttempted to trry something different. He rang the bell alone w without presennting the dog gs any food. R Remember, th hat a dog typically woould not respoond in any parrticular way too the sound off a bell as it is it a neeutral stimullus. Howeverr, in this casee, the dogs started s to salivate! Thhey had learneed to associatee the bell withh the food and d through those repeatted pairings, the t sound of the bell on its own elicited the same

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response. Earlier, we called their salivation in response to food an unconditioned response. However, now the bell is no longer a neutral stimulus because it elicits a specific response (i.e., salivating) when presented on its own; thus, the bell is now called a conditioned stimulus. The behaviour of salivating in response to the bell is called a conditioned response, because this is a learned behavior. Okay, let’s do this again minus the dogs and using the proper terms. Classical conditioning involves an association between two stimuli, i.e., a conditioned stimulus (CS) and an unconditioned stimulus (UCS). The unconditioned stimulus (UCS) is one that naturally and automatically triggers a response (that’s why we call it “un” conditioned). The unconditioned response (UCR) is a response that occurs naturally in response to the UCS. The UCR is not something that has to be learned per say. For example, when you see your favourite warm chocolate cake with vanilla ice cream on the side you may immediately feel happy and feel your mouth getting watery. In this example, the sight of your favourite dessert is the UCS, and the response of feeling happy and of your mouth getting watery is the UCR. During the learning phase, or the classical conditioning process, a neutral stimulus (NS) is repeatedly paired with the UCS. The NS could be anything essentially, such as an object or place, and the NS alone does not elicit a specific response until it is paired with the UCS. After repeated pairings, an association between the NS and the UCS is made. At this point, the previously NS becomes referred to as the conditioned stimulus (CS). When the once NS, now the CS, becomes associated with the UCS, it gradually starts to trigger a conditioned response (CR). In other words, the CR is the elicited learned response to the presence of the CS alone in the absence of the UCS. Going back to our earlier example, let’s assume that when you saw your favourite dessert you heard some classical music in the background at the restaurant. Although the music is entirely unrelated to the sight of your favourite dessert, if the same song was paired multiple times with the mere sight of the dessert, then hearing that same song alone (without the presence of your favourite dessert) would eventually trigger the response of feeling happy and your mouth getting watery. In this example, the song is the conditioned stimulus and the response of feeling happy and your mouth getting watery is the conditioned response. When the occurrence of a learned response gradually decreases and disappears it is referred to as extinction. This happens when a CS is no longer paired with an UCS. In our earlier example, if the classical music (CS) was repeatedly presented over a period of time without the

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presentation of your favourite dessert (UCS), then the previously conditioned response of feeling happy and your mouth getting watery to the sound of classical music alone would eventually disappear. Spontaneous recovery is the sudden reappearance of the CR after a rest period. For instance, if after a month you walk into a restaurant and you hear the same classical music that you once associated with your favourite food and noticed that you felt happy and your mouth began to get watery again, then that would be referred to as a spontaneous recovery. To sum up classical conditioning, it tends to happen after repeated pairings and typically involves involuntary responses, like blinking, muscle contraction, or salivation. But, are there other types of conditioning?

Little Albert Experiment and Emotional Conditioning

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One of the most famous experiments in conditioning, referred to as the Little Albert Experiment, was conducted by John B. Watson and Rosalie Rayner (1920) wherein they showed that fear can be a learned response. In their experiment, Watson and Rayner exposed Little Albert, a 9-month old child, to a variety of stimuli including a white rat and burning newspaper. They observed Little Albert’s emotional reaction and concluded that he showed no indication of fear to any of the stimuli. Later, they exposed Little Albert to a white rat and made a loud noise using a metal pipe and a hammer. Not surprisingly, the child began to cry. After pairings of the

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white rat with the loud noise, the child eventually began to cry and show signs of fear (CR) when the rat alone was presented (CS). Not only have that, but Little Albert’s fear was generalized to other white fuzzy-looking objects, meaning he became afraid of anything that looked like a white rat. This is referred to as stimulus generalization. This experiment shows how frightening experiences can be formed through conditioning, sometimes called emotional conditioning, and may lead to the development of phobias (fears that don’t quite seem logical, but that have developed through the unnatural pairing of two stimuli, like a fear of birds, heights, or elevators). In cases where the response to stimuli is strong enough, the association is made rapidly and sometimes only takes one experience to elicit the conditioned response thereafter.

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Conditioning can be used to increase or decrease a specific behaviour by allowing individuals to learn new associations, and can be helpful in the treatment of anxiety disorders and fear-based responses.

Unlearning Phobias via Systematic Desensitization by Dr. Louise Lambert As a psychologist, I worked with a woman who had been in a car accident with her daughter. It was winter and they were hit by a truck and stuck in

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the wreckage for a long time before anyone found them. Her daughter died and for hours, the mother was trapped in her seat looking at her. You can imagine the trauma this produced. She developed an intense fear of driving thereafter. Two years later she came to see me and her goal was to drive again as her inability to do so was getting in the way of daily functioning. Her husband was happy to drive her, but this wasn't a good long-term solution. In our first session, we talked about the accident and her feelings about driving, what her thoughts and anxieties were about it, whether she'd tried driving in the past months and how she envisioned this process would go. We decided to use what is called systematic desensitization, a type of therapy whereby the individual is systematically (step by step) desensitized (made less fearful) of a stimulus that generates anxiety or fear. In our next session, we sat in the car and talked about the weather and what she did that day. After a few minutes, I asked if she'd like to sit in the driver's seat. She looked surprised and we both laughed, after all, this is what we were there for! We switched seats and continued to talk, but it was clear she was nervous. I reassured her that we would not drive today; we were a long way from that. I asked her to describe the interior of the vehicle, what she saw outside and other details to ensure she was in the moment and not at the accident in her mind. We put on the radio and I had her take a look in all of the mirrors to describe what she saw.

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A week later, we did the same thing, chatting about the past week and recounting stories to build new memories. This time, we started the motor, but left the vehicle parked. This caused some anxiety but I assured her that we were not driving yet. I asked her to describe what she felt, what she was thinking and focus on the present by describing her present surroundings and breaking the connection between her past memories and present activity. I asked her to practise sitting in a vehicle at home with the engine running. The following week, we got brave and put the car in drive but left a foot on the brake. This provoked much more anxiety, so we stopped the motor, talked it through, gave it a few minutes and then tried again. You see that every time her anxiety went up, we took a pause and tried to get used to the feeling by slowing down the activity, focusing on the present moment, and then taking a break back to safety. She was never pushed beyond her comfort zone and always asked, do you want to proceed or take a break? She used self-talk like, "I can do this, I'm only sitting in a parking lot. There's no danger.... I'm fine....." Eventually, over the weeks, she was able to advance a few feet and then stop, drive to the end of the parking lot and stop, drive out of the parking lot, down the street, and finally around the block. In our last session, she came back to say proudly, I drove here today. This is an example of how people can approach their fears; they break the phobia into small steps and face the smallest to largest one at a time and at a speed that works for them. If they feel too much anxiety, they come down a level, calm themselves and simply try again.

Operant Conditioning and Reinforcement by Nadia Al Aswad Leading psychologist and modern behaviourist, B.F. Skinner, developed operant conditioning, a type of learning, after finding that classical conditioning was too one-dimensional to explain the complexity of human behaviour. Skinner’s work was greatly influenced by the law of effect, which puts forth that rewarded behaviour is more likely to recur than unrewarded behaviour. The creation of what is commonly known as a “Skinner Box” (1938) followed his concept of reinforcement and behavioural control. Skinner’s invention was designed to observe animal behaviour using conditioning; the animal was taught to press a lever in response to either a sound or light signal, and if it correctly performed this behaviour, it was rewarded with food. If the animal responded incorrectly, it was punished with an electric shock. This led Skinner to find that

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shaping behaviour, the gradual moving toward a desired behaviour using rewards or punishments, could be achieved. Thus, operant conditioning was born.

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Although classical conditioning and operant conditioning are both forms of learning, their differences are important. Classical conditioning is concerned with the association formed between the individual and stimuli, while operant conditioning involves individuals associating their own actions with consequences. In classical conditioning (remember Pavlov’s dogs?), an individual’s response is automatic when confronted with a stimulus. However, in the case of operant conditioning, an individual’s behaviour is elicited (brought forward) by the environment they are in; actions rewarded by reinforcers tend to increase, while actions followed by punishers tend to decrease. Behaviour performed to produce either reinforcement or punishment stimuli is called operant behaviour. An important aspect of operant conditioning is reinforcement, which is the term used to refer to any event that increases the strength or frequency of a behaviour as a response. The two major categories of reinforcement are primary and secondary reinforcement. Primary reinforcement is unlearned (e.g., going to sleep when tired). Secondary reinforcement on the other hand, involves a learned association with primary reinforcers (e.g., the link between money and basic rewards, such

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as food). In operant conditioning, there are two different types of secondary reinforcement: positive reinforcement and negative reinforcement. Positive reinforcement involves the addition of a desirable stimulus (e.g., rewarding a child with candy after she finishes her homework), while negative reinforcement involves the removal of an undesirable or aversive stimulus (e.g., turning off a noisy alarm clock). Students often confuse positive and negative reinforcement. The word negative has nothing to do with punishment; it only means removing something bad to increase good behaviour. If your instructor wanted to reward your good grades and study habits, she could remove a quiz from the course; I bet that would make you happy and study harder, yes? Another aspect of reinforcement is reinforcement schedules (Fester & Skinner, 1957). These schedules refer to how and when reinforcement should be delivered as these factors affect the strength and frequency of behaviour as a response. In situations where learning is rapid, continuous reinforcement (non-stop and for every action) is used to ensure behaviour is well learned. Once behaviour is well learned, partial reinforcement (every now and again) is used to ensure the behaviour does not become extinguished (die out). There are four schedules of partial reinforcement, some of which are rigidly fixed and some of which are unpredictably variable. These four schedules are fixed-ratio schedules (the reinforcement of a behaviour after a set number of responses), variable-ratio schedules (the reinforcement of a behaviour after an unpredictable number of responses), fixed-interval schedules (the reinforcement of a behaviour after a fixed time period), and variableinterval schedules (the reinforcement of a behaviour after varying time intervals).

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An example of effective operant conditioning is the token economy, a system commonly used in classroom settings where students are directed towards specific behaviours that are reinforced with tokens (e.g., stickers), and traded for a reward (e.g., candy). Reinforcement ensures that students perform the specific behaviours in order to receive a reward. Reinforcement can be used and observed in everyday life. Let’s use Miriam and her mother as an example: Miriam’s mother tells her at the beginning of the school year that if she receives good grades in her psychology course, she will take her on a shopping spree. That sounds like good motivation for studying! How about you? What reinforcements (positive or negative) do you give yourself in order to regulate your behaviour and reach your goals?

Social Learning by Thoraiya Kanafani Social learning (Bandura, 1977) theory examines the idea that all types of human behaviour are learned, and usually in social settings. Social learning theory believes that learning is both behavioural and involves thinking. It can occur through observing behaviours as well as the consequences of that behaviour. The individual needs to make decisions about what is observed. Reinforcement (strengthening the behaviour) plays a role in the learning process. Also, social learning theory believes that the learner is part of the information processing. Therefore, social learning theory states that behaviour is learned from a situation through the process of observational learning. However, this type of learning does not guarantee a change in behaviour, rather a gaining of new information. Observational learning, also known as vicarious learning, involves the act of observing others to learn new types of behaviour. Let us consider Faisal. In order for Faisal to learn through observation, or modeling, his cognitive, behavioural, and environmental factors must influence each other. Effective modeling must contain four conditions: attention, retention, reproduction, and motivation. Faisal must consider the person he is observing to be powerful, attractive, and similar to himself (attention). Faisal must be able to remember what he paid attention to as either an image or verbal representation in his memory (retention). Faisal must also be able to reproduce (copy and perform) the image in his memory into appropriate actions that match the original behaviour he observed. Finally, Faisal must also have personal reasons to imitate and copy the behaviour (motivation). Reinforcement (strengthening of the behaviour) also plays a part in the social learning theory but is not the deciding factor. Even though

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reinforcement influences behaviour, merely being able to observe the behaviour plays a much bigger role. This shows how important the social factor is in the process of Faisal’s learning and stresses how important it is for Faisal to learn new behaviours and information through observing others. Faisal’s reinforcement can be external (approval from others) or internal (approval of oneself). It can also be positive (rewarding the behaviour with something the individual wants) or negative (the removal of something negative if the behaviour takes place). Many researchers have conducted experiments that demonstrated the influence of social learning. These experiments have looked at the effects of social learning theory within different fields of social situations such as criminology, developmental psychology, business interactions, school psychology, media violence, and therapy. The theory itself looks at how individuals learn social behaviour as well as attitudes through the observation and imitation of others. One of the most famous experiments (Bandura, Ross, & Ross, 1961; 1963) involved adults beating and yelling at a Bobo doll (an inflatable doll that looks like a clown) and then letting children play with the doll. The children who saw the adults mistreating the Bobo doll behaved in aggressive ways towards the Bobo doll. Not only were the children behaving aggressively towards the Bobo doll, but they also used the same behaviours and aggressive words that the adults used. Children who did not see the adults behaved in a much less aggressive manner towards the Bobo doll. The social learning theory can be applied to many areas of life. In therapeutic settings, mental health professionals model the same behaviour within the session that they want clients to learn and model. Modeling certain behaviour increases the chances of individuals putting these to action. For instance, cultural norms or religious traditions are passed on from generation to generation through modeling by others and the observation of these behaviours. The learning of behaviour does not only extend to positive behaviours, but also to negative behaviours such as aggression or socially unacceptable behaviours.

Learned Helplessness by Dr. Louise Lambert Have you ever tried to achieve something over and over again only to fail one more time? Argh! Most of us either eventually achieve our goals or change our strategies towards them; yet, in the face of repeated failure, some people give up altogether. This giving up response is referred to as learned helplessness (Seligman, 1972), and it’s the last type of learning we consider.

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Let’s take a look at how this might apply. You write five New Year’s goals for yourself. The goals are good, reachable and totally realistic. At first, you try hard, get organized, ask for help, get the resources you need and try some more. You face a few setbacks, but no big deal. You carry on, try some more, change your efforts. A few more setbacks and you begin to get frustrated. Sadness sets in. You regroup, try again, reorganize, and start over. Nothing seems to help, not one goal materializes. It’s been four months. You’ve tried every option you can think of. You could think to yourself, “Ok, it’s not the right time. I’ll put these on hold and try again in a few months”. Or you could think, “I’m such an idiot! Everyone reaches their goals; what’s wrong with me?” Or you could think, “Why bother? Goals don’t work for me. In fact, I’m not meant to achieve anything, so why bother anyway?” These reasons are what we call attributions (Weiner, 1986), the reasons we give for why things happen (or don’t happen). We make attributions for good things in life (I got an A because I studied hard) as well as bad things (I failed at Math because I’m a loser!) and the types of attributions we make can lead to learned helplessness. Learned helplessness is the sense of powerlessness that we can feel after repeated failures or unsuccessful attempts, and over time, it can lead to depression. Let’s take a look at the types of attributions people make; they are called internal, stable, and global. An internal attribution is any response you give that has to do with you as a person rather than the situation or other factors that might have contributed to the event happening. So, instead of blaming the fact

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that you had a bad flu for why you failed, you blame the fact that you’re a loser. A stable attribution refers to whether something changes or not. If you believe you failed the test because you’re stupid, that’s stable – it won’t change – but if you believe the reason for your failure has to do with an unstable reason, like you didn’t study, that can be changed. Finally, a global attribution refers to how often this thing happens; all the time or only sometimes? Some students believe they fail all the time (so, why bother?), while others believe they fail only sometimes (so, maybe try for this exam, right?). Why are these important? Holding negative stable, global and internal attributions, called a pessimistic explanatory style, increases the risk of depression (Pryce et al., 2011). But, it’s not only depression; it’s also failing to help ourselves in more serious situations. For example, individuals who experience learned helplessness tend to do worse with health recovery and illness (Peterson, Seligman, & Vaillant, 1988) and getting out of financial debt (Dixon & Frolova, 2011). Mind what you say to yourself as it seems to end up being what you believe over time and impacts what you do as a result.

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Topic Box: What’s Best - Reinforcement or Punishment? by Sara Antonucci

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Have you thought about how you might raise your children and which approach might be more useful for their learning? When we discuss reinforcement and punishment, we often think of shaping behaviour and this necessarily brings up discussions about parenting strategies. Although this section discusses which strategy might be best in obtaining optimal results in children, these same principles apply in daily life, like workplaces, school, relationships, and even sports. In studies, both positive and negative reinforcement is considered to be more useful than punishment in educating and shaping children’s behaviour, as well as in avoiding the presence of more severe behavioural issues (Bouxsein, Roane & Harper, 2011). Positive reinforcement boosts children’s self-esteem when an action is appreciated and improves their motivation to adopt similar positive behaviours due to their expectation of receiving material (i.e., candy), behavioural (i.e., free time) or emotional (i.e., praise or a compliment) rewards. Punishing children or young adults is not always useful due to the difficulty of changing their unwanted behaviour as they often

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continue the same bad actions once the threat is removed. A good example is to think about children playing with their siblings. When the parents are in the room, they play nicely, but once parents leave, they resume their bad behaviour because no one is there to watch. It’s the same reason you don’t speed in front of a police officer, but once they’ve moved on, watch out! More importantly, punishment often results in children and teens threatening to punish the parents in return by adopting aggressive or vengeful behaviour (Weinblatt & Omer, 2008). Using punishment or attempting to achieve discipline in the form of physical force has also been shown to lead to maladjustment and deviancy (for example, teens might run away and become trouble makers that can lead to lifelong consequences), and unhealthy relationships between themselves and their parents and with other teens or children too (Smith & Mosby, 2003). Finally, using only punishment as a form of behavioural control can be damaging to children’s selfesteem as it sends the message that children are “bad” and are only to be noticed when they behave poorly. This can sometimes encourage bad behaviour as it’s the only way children get attention from their parents. Thus, only using punishment is not helpful in encouraging better behaviour as it only shows what is unacceptable and not what is good to do as an alternative. For this reason, punishment, if it is to be used, should also be combined with reinforcement. For instance, parents can punish a child for misconduct (e.g., clean your room!), but should also reward them when good behaviour has occurred (i.e., extra television time!). Think about the times you were punished by your parents or teachers. What did it feel like? Did you learn better behaviour or only to be afraid? How would you have preferred to have been dealt with? What do you think would be best to use with your children in the future? This decision may also have to do with what type of parenting you find attractive.

Self-Regulation by Isbah Ali Farzan While working on a task you make decisions such as why and when to work on it, how much effort to put in, and how best it can be done. These decisions influence the effort on the task, meaning they play a vital role in the quality of learning and performance. These decisions are defined as self-regulation (Zimmerman, 1998) and are rooted in Bandura’s (1986)

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Social Cognitive Theory. This theory assumes that person, behaviour, and environment influence each other simultaneously. Thus, the decisions for regulation are influenced by cognition and motivation processes, actions of the learner, as well as the models available. Being reciprocal, selfregulation guides cognitive and motivation processes involved in making choices for learning. Self-regulation develops in four stages. A learner first observes the models, uses the skills observed in the model, internalizes the skills, and finally, uses the internalized skills appropriately. In this way, adult learners can self-regulate their learning. Self-regulation is guided by a process involving observation, judgement, and alteration of self. In the first step, the learner observes his/her behaviour in terms of frequency, intensity, and quality. In the second step, he/she compares the behaviour with the set goals. In the third step, he/she uses the judgement to alter behaviour, cognition, and motivation. Taken correctly, these steps lead to effective strategies to work on a task. These steps occur all the time during a task, so the learner can accommodate changes taking place in personal, behavioural, and environmental factors. On one hand, self-regulation improves motivation, cognition, and behaviour; on the other, it does safe-guard learning and performance against the changes taking place inside and outside a learner. Thus, regulation strategies are a key to the quality of learning and performance.

Sociocultural Theory by Dr. Katharina A. Azim The environment is an important influence on how we learn; that means it can shape the way we pick up information but also the way learners influence it. Lev Vygotsky (1930/1978) was one of the first scholars to point this out in his work, when he explained that learning and acquiring knowledge can only take place when learners interact with their environment and share their learning processes with others. Maybe you remember the first time you played with a ball. You probably saw other children rolling it back and forth, then learned that you can throw it, and maybe someone showed you how to kick it with your foot. Not only did you learn your ball play from others, but others also observed how you were playing, and probably learned something from you! According to Vygotsky, our learning takes places when we use language, psychological tools, and social interaction, which he calls mediated learning.

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Mediated Learning In this concept, there are three components that help people interact and learn together: material tools, psychological tools, and other people (Presseisen & Kozulin, 1994). Material tools are objects like the ball we used for playing, while psychological tools are the cognitive processes that take place when we learn. The most important psychological tool is language. Other people are necessary for interactions to take place and we use language, cultural symbols, and discourse for these interactive processes. Because learning, and particularly the type of learning that involves higher cognitive functioning, requires both the individual person and someone else, these two processes are described as interpsychological (between people) and intrapsychological (within the learner). The learner is thus not just a recipient of information but experiences it through active participation and reasoning with the environment.

Zone of Proximal Development (ZPD)

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Imagine Zeina, a 10-year old girl who wants to learn to ride a bike. She has seen her older sister Rawya enjoy cycling around in the street and is eager to try it herself. Many times Zeina observed her sister hold the handlebars, put one foot on the pedal, push herself forward with the other,

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and sit back onto the saddle. As the more competent cyclist, Rawya holds Zeina’s bike from behind during the first couple of trials, but slowly let’s go so she can ride on her own. Although Zeina falls off her bike a few times, she listens to her sister's instructions to get back on the saddle. This type of learning is called scaffolding. Learners are guided through a task by someone more experienced so that their skills and understanding become progressively stronger and require less dependence on the expert. You can find these kinds of relationships between students and teachers, novices and experts, children and adults, as well as tutees and tutors. Scaffolding and the gray zone in which the learner can accomplish a task with guidance is described by Vygotsky (1930/1978) as the Zone of Proximal Development (ZPD). (You can read more about Vygotsky’s model in Chapter 8). More specifically, that gray zone lies between what a person cannot do at all even with help and what a person can do completely independently without assistance. When Zeina learns to ride the bike, the task isn’t too difficult for her to begin with her sister’ help; yet, without that help from a more advanced peer, she would have had difficulty. Functions within the ZPD are on their way of being developed but they have not yet reached their full potential. Returning to our example, just because Zeina knows how to balance herself on the bike now, doesn’t mean she has learned how to comfortably use the front brakes yet. The ZPD concept focuses on the potential of what the learner can soon achieve with guided learning and scaffolding. Within a more formal educational setting, a scaffolding approach could be a task-based learning exercise or problem-based task posed by the teacher, in which students are initially given instructions on how to start the assignment. As the students progress, the teacher offers less help until the students learn enough to manage the work on their own. Two researchers (Tharp & Gallimore, 1988) explained the internal and external processes that occur when people develop through the ZPD. x First, the learners rely on assistance from more capable others, like parents, teachers, and more competent peers. In this stage, learners narrate what they are doing, but speech takes place mostly within the learner. This is referred to as interpersonal speech. x Then, learners rely on a little less assistance they get from others and themselves. Here, they also narrate what they are doing step by step but out loud and to no one in particular. This is called egocentric speech or private speech. x After that, learners develop their own performance and no longer rely on other’s assistance. The learning is internalized, which is called

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automatization. Internal dialogs and egocentric speech are also not used anymore. Finally, learners fall back into earlier stages because they forgot what they learned. This is called de-automatization and happens with a lack of practice. When learners “re-learn” the skill, they tend to personalize it.

Egyptian Kindergarteners and the Zone of Proximal Development

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In a kindergarten in Ismailia, Egypt, Elmonayer (2013) conducted a study with 67 young children and the way they learn to use and manipulate sounds in Arabic, helpful in learning to read and spell. In the experiment, the teacher used 28 stories with pictures, one for each letter of the alphabet. As the sounds were embedded in these short stories and with a visual aid, the task became more meaningful and interesting to students. While the teacher showed the children the digital pictures with a projector, the students asked questions and discussed what they saw. This is where the ZPD approach occurred: The teacher engaged the children in dialog, helping them verbalize their questions and comments more proficiently so they could practise the Arabic sounds. This was done with prompts (cues that helped students recall specific information) or by expanding on

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children’s responses giving them slightly more difficult information to work with each time. The teacher also used physical prompts, objects like blocks and chips, to help the children elaborate on their responses. The teacher engaged them in dialog that was neither completely outside the range of their verbalizing abilities nor on the same level. The researcher noticed that the dialogs motivated the children to become more proficient in their Arabic sounds and to interact with each other. Sometimes the children used peer-to-peer scaffolding, when children learn together with prompts from the teacher and switched between being a novice and expert during a task. At other times, the children used tutor-learner scaffolding, when one child assumed a helping role to assist other children to gain the same knowledge. It’s remarkable how learners, even five- and six-yearolds, help each other along so that both can complete a task together and share the same knowledge.

Discovery Learning by Isbah Ali Farzan

Photo credit: Pixabay

Saba teaches math to Grade One students. One day she comes to class and offers blocks to students to play with. They are asked to subtract two blocks from three and share the answer. Students who solve the sum are

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given another, more complex task. Saba sits with those students who did not solve the task correctly and does the subtraction herself to show it as an example. After this activity, Saba describes what subtraction is by comparing it to the concept of addition, which she taught her students the week before. In this class, students have done hands-on practice to learn the concept of subtraction. Those who failed are offered modeling. Saba relates the new information of subtraction to the old knowledge of addition, which the students already have. This method of instruction is known as Discovery Learning (Bruner, 1961) and is rooted in Piaget’s Cognitive Constructivist Theory. The discovery learning method aims to provide freedom to students to become behaviourally and cognitively active and make sense of new information. This freedom is facilitated by the teacher guiding students in their learning process. Activities are designed to promote exploration and discovery such as puzzles and role-plays. Students are offered learning material to interact with the environment. With these attributes, the discovery method of instruction offers students the opportunity to generate learning all by themselves. They actively construct knowledge and make sense of new information by linking it to other related existing knowledge. Because of this, students make better sense of information and are in a stronger position to use it for problem-solving and other higher-order cognitive functions. Compared to other methods of instruction like lecturing, discovery learning is tougher to implement in the classroom but has advantages for students’ in-depth and complex learning.

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Insight Learning by Dr. Annie Crookes

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Have you ever been stuck on a problem at school or in life and felt that your mind was just going around in circles? Or maybe you have experienced having the solution suddenly flash into your mind? These situations have been termed “impasse” and “Aha!” moments and may be the foundations of what is called insight problem solving and learning. Insight Learning was originally reported by Wolfgang Kohler and colleagues in the 1920s while observing different animals learning to use tools to get food or other rewards. For example, chimpanzees trying to get a banana hanging from the ceiling would first show random behaviour and frustration, then a moment of stopping or looking around the room before using boxes or other toys to successfully reach the banana. Kohler argued that this was different from conditioning learning because the chimpanzees had used cognition and planning to find the correct strategy. Similarly, in human cognition, psychologists have differentiated between problem solving processes which are logical, analytical and use prior experience; to those which are creative, sudden, and need new solutions. For example, how would you solve the following problem?

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Most students will make some incorrect guesses and go in circles trying to work it out. However for some, you may have realized that the simple solution is to take the pins out of their box, pin the box to the wall and stick the candle on it. The key to this problem is insight – realizing that the box itself is one of your available objects as well. It’s usually obvious once you know the answer! Ohlsson (1992) described insight problem solving as three stages: a state of impasse where you have reach a standstill; then a process of changing the problem by elaborating more on the options or seeing it in new terms; and finally a release of new solutions. The final stage is often linked to positive feelings of “getting warmer” or being close to the solution (Metcalfe, 1986). The ability to see problems in new ways or think “outside the box” is therefore the key to finding insight – and it seems some people may be better at this than others. For example, studies show that people from multi-lingual backgrounds may have better cognitive flexibility and task switching abilities which could lead to better insight problem solving (Cushen & Wiley, 2011). Also, training in mindfulness helps people let go of past knowledge and automatic thinking, thus making space for new creative ideas (Ostafin & Kassman, 2012). Similarly, meditation has been used for many centuries in Buddhist and East Asian traditions to find insight (see Ren et al., 2011 for experimental evidence). Despite all these observations of insight learning, there is ongoing debate about the actual cognitive and neural mechanisms and whether this should be seen as a special cognitive process or not (see Fleck & Weisberg, 2013; Weisberg, 2015 for review of this debate). Either way, it seems that if you find yourself stuck on a problem, the best solutions may come from taking a break and thinking less, not more.

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Peer-Assisted Learning by Dr. Katharina A. Azim

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Have you ever wondered how you, as students, can learn from one another through actual teaching techniques? Peer-assisted learning is a form of collaborative or tutoring learning that takes place among students. It’s an approach that accommodates for students’ individual differences. Within this approach, different techniques can be used to meet learning needs, like cooperative learning (CL), peer tutoring (PT), and specific peerassisted learning strategies (PALS). Let’s have a look at these three learning techniques. Cooperative learning is an approach in which peers communicate and learn collaboratively and actively. They use feedback and debate to find solutions and motivate each other in their work. This allows them to generate new ideas and creative ways of thinking, and further their knowledge (Slavin, 1996). Learners can but do not necessarily have different levels of knowledge; regardless, they are instructed through the teacher on how to solve the posed problem or task. Cooperation between peers ensures that they don’t just learn together but that they help each other achieve learning goals. This approach is good for higher-order thinking skills. An example of cooperative learning is a task in which a group of students is asked to find information on behaviourism in psychology and create an experiment fitting the theory. The group splits

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up, Nora looks up classical conditioning, Adham investigates operant conditioning, while Nevine digs into behaviourist experiments, and Hatem searches for famous theorists. Once they have collected this information, they return to the group and discuss together what they have learned individually. Then they solve the problem of their own experiment by debating and deciding how to go about it. At the end, the teacher assesses the students on their understanding of the topic and their application of the new information. In 2005, Turkish educators were encouraged to improve their educational system by focusing more on student-centered learning and less on teacher-centered approaches (Dirlikli, AydÕn, & Akgün, 2016). They found that there was a noticeable increase in educators using cooperative learning strategies after this call to reform. This technique helped increase students’ academic achievement, encourage their interest and active participation, create a positive perception of the course, and develop students’ social skills. Peer tutoring is a little different and refers to the technique in which students of equal educational and social standing educate each other. In peer tutoring, one learner has a stronger knowledge base or expertise in a specific area than other learners. This form of teaching can take place in a classroom or informal learning environment outside of school. By sharing information, they acquire learning and study skills, give each other feedback on their work, work on problem-solving tasks, and motivate each other to learn together and alone (Colvin, 2007). Peer tutoring can positively contribute to peer-peer-interaction, improve learners’ motivation, and help solidify new information that learners encounter. A problem can occur though when the student that is being taught perceives the tutor as unknowledgeable, unqualified, or lacking teaching skills. A scenario in which peer tutoring could be set is when students who show thorough competence or knowledge in a specific area help peers acquire that knowledge or skill. You might want to see if your university offers peer tutoring and if not, how you might take up the challenge of introducing the idea. Peer-assisted learning strategies (PALS) are teaching methods that are often found in tasks that promote skill development. In literacy, for example, students work in pairs during reading activities and alternate reading and listening while giving each other feedback. Topping (2005) created a theoretical model and notes five processes that influence the effectiveness of student learning: (1) organization and engagement, (2) cognitive conflict, (3) scaffolding and error management, (4) communication, and (5) affect (emotion). To make this concept effective,

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teachers must instruct students first on the techniques of scaffolding, organizing, communicating, etc. They must also continuously supervise the students during their pair-work. Especially in practices of scaffolding, there is intensive collaboration between the learners and students need to be instructed and guided in the specific techniques they use. Learning takes place by one student adding to the knowledge of another and is essentially what we know as the Zone of Proximal Development (see above and Chapter 8). PALS is applied in literacy and language education, mathematics and accounting, nursing and medicine. For example, when 30 experts in medical education from different Iranian universities were asked what they would consider priorities in medical teaching, most responded with problem-based learning and peer-assisted learning strategies (Amini, Kojuri, Lotfi, Karimian, & Abadi, 2012).

Learning with Technology by Dr. Katharina A. Azim

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In the last decade, much of our lives have shifted from our physical reality to a virtual one. Many people of all ages spend hours scrolling through Facebook posts and Tweets, checking their friends’ photos on Instagram, adding videos on Snapchat, or calling family members on Skype or FaceTime. Our lives have become almost unimaginable without Social Software. Some people refer to the first generation that hasn’t experienced

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a time without social media as Digital Natives or iGeneration – a reference to the popular Apple products. Online communities are not only useful for communication between people, they can also be used to store, share, and co-create knowledge. While schools are always a little behind new technological trends, there is a growing number of teachers, tutors, schools, and universities that recognize these tools as useful and supportive for students’ learning. Learning can effectively be offered anywhere any time. In the following sections, you will be introduced to forms of social software, social media, and simulation learning.

Blended Learning Blended Learning is a learning approach that is a mix between personal or face-to-face instruction and electronic learning. An example of blended learning could be an elementary school teacher instructing students to read a text on different types of trees in class, then letting students search pictures of those trees online, and having them add their findings to online portfolios. This type of learning can motivate students to engage in collaborative work, because they can receive additional information that is not present in classroom materials and make use of different forms of media (photos, video clips, podcasts, and blog posts) that can enrich their learning. So, why not just learn online then? Because having a real-life person in front of you has benefits that cannot be provided by an online community. Personal face-to-face interaction can foster students’ motivation to work on tasks, encourage feelings of belonging and sense of community, and provide learners with immediate guidance from a real-life instructor. The integration of both forms of communication can bring students together, provide more diverse learning approaches, tap into a variety of cognitive processes, and encourage personal exchanges using synchronous and asynchronous methods. These factors can have a positive impact on collaborative learning. According to Bold (2006), students rate the possibility of flexible collaborative use of multimedia programs as particularly stimulating and as easily adaptable and user-friendly. Researchers conducted a study with 427 students in the School of Information Technology at the University of Jordan (Obiedat et al., 2014). They surveyed the participants to investigate how blended learning impacts students’ academic achievement. The school used Blackboard, a virtual learning environment and students as well as faculty were familiar with the website. In such a virtual environment, courses can be structured for online use (online teaching) or the site can be used as additional

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support for traditional face-to-face teaching (blended learning). The results showed that a blended learning approach had a positive impact on students’ academic achievement and participants enjoyed the opportunity to access course materials anywhere at any time.

Learning through Social Media

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There are many computer-mediated technologies that can be used to further people’s learning in and out of the classroom. For example, blogs encourage people to exchange their thoughts and knowledge, which may differ from the initial blogger and expose them to more nuanced views. Because blogs are often used as a form of online journal or diary, they allow the writers to engage in self-reflective processes. In educational settings, blogs increase students’ feelings of belonging to a learning community and give introverted students an opportunity to actively take part in class discussions. In blogs, just like in forums and Wikis, learners co-create knowledge and connect theoretical knowledge with practical application. Forums, online discussion boards, are similar in their collaborative functions, with the difference that individual discussions, called threads, are generated around a common topic to which forum members respond. While the thread is initiated by one person, the forum itself does not belong to a specific user, as is the case in blogs. Forums are supervised by moderators who can move off-topic responses to other threads, close threads for inactivity, or remove users who do not follow community rules. Research has shown that interactions in online forums has various

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benefits, such as promoting well-being in marginalized and stigmatized users and motivating users to engage in civic and political projects to help others in their communities (Pendry & Salvatore, 2015). Finally, Wikis, websites that provide users with the opportunity to create content collaboratively, are also useful for learning. One of the oldest and most well-known sites is Wikipedia, which has millions of wiki entries on thousands of topics. Users add their knowledge to an entry, supply sources to back up their information, and provide feedback on other’s contributions. This co-creation of content can challenge learners in their higher-order thinking when they negotiate, evaluate, and connect their contributions to those of others. Between 2011 and 2013, a researcher in anatomy at the University of Sharjah (UAE) used Facebook, Twitter, and YouTube to support his classroom instruction with digital material (Jaffar, 2014). Most of the students used Facebook and other social networking services anyway, so forming the Human Anatomy Education Page was easy and much appreciated. Results showed that students found the Facebook site interesting, challenging, and contributing to their learning. The majority found posts with test questions, multiple-choice assessment, and quizzes beneficial. One of the benefits of communicating online from a psychological view is the potential increase in motivation to view educational materials and interact. It also positively relates to affective learning when students interact with peers and faculty outside the classroom and in a less formal setting. .

Experiential Learning and Simulation by Dr. Katharina A. Azim Have you ever heard someone say, “If you want to learn it, you have to experience it?” This type of learning can be classified as experiential learning in a real-time and real-life setting. Kolb (1984) developed the Experiential Learning Model, in which learners go through four steps when they are learning: (1) Abstract conceptualization – learning by thinking; (2) Active experimentation – learning by doing; (3) Concrete experience – learning by feeling and being part of an experience; and (4) Reflective observation – learning by reflecting, listening, and watching. To help learners, feedback, prompts and modeling from experts can provide guidance to the learner and help with deeper critical reflection.

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How does this connect to simulation learning? Simulation is an imitation or model of a real or imaginary situation, circumstance, or process. Think of pilots learning to fly for the first time; they don’t practise in a real plane –that would be dangerous; instead, they practise in what are called simulators. In simulation-based learning, learners experience a realistic situation and are prompted to act as they were taught in theory. Simulation can involve computer software, objects and props, or other people. In education, this type of learning approach relies heavily on the interaction between learners and the environment and on scaffolding. Here are examples of types of educational simulation: x Construction games: learners simulate building objects or environments, e.g., a house, a rollercoaster, a liveable community, or functional train tracks. x Role playing: learners act out the behaviour of a specific person or professional in a specific scenario, for example a psychiatrist using a technique on a patient. x Problem-solving simulation: learners work together to find a solution to a difficult problem, e.g., an exercise in which student groups make a plan to leave a deserted island with limited tools. x Case-study simulation: learners apply their knowledge to deal with a specific instance, e.g., nursing students helping a person having a heart attack.

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Process simulation: learners design, build, used, and analyse technical procedures, e.g., in a flight simulation or when tracing chemical processes in an experiment. Researchers state that simulation learning is more effective than traditional classroom instruction in which students are simply the recipients of information. Just because you’ve read and been told how to give someone an injection, doesn’t mean you would know how to do it in practice the first time. It takes knowledge, observation, practice, feedback, and then more practice, and maybe your first trials would be on an orange or in a skills lab with fake skin. Learning in a simulated or self-contained artificial situation is also referred to as immersive learning. The benefits are that simulation learning can be enjoyable, motivating, and help build memory networks because it combines knowledge, cognitive processes, and physical practice. Because simulations are often modeled on real-life situations, the tasks are often content-rich and meaningful, two aspects that are necessary in effective learning. Simulations can also range in complexity, so that lower- and higher-order thinking, problem-solving skills, and collaborative skills can be practised at the same time. Think about medical students who are learning techniques to tend to and interact with patients and vulnerable people. As you can imagine, the area of medical education greatly benefits from simulation learning, because there is not much room for error. Medical professionals need to ensure well-being and safety on the one hand, and new doctors and students need to be exposed to actual practices on the other. That practice requires knowledge, skill competence, and confidence. Simulation helps reduce error because new medical professionals can practise as much as they need until they master a skill. But Lateef (2010) pointed out that even seasoned nurses and doctors benefit from simulation, because they can refine procedures and skills they already have. x

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Over to you now… 1. 2.

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How do you deal with setbacks? Have you experienced learned helplessness? Do you know someone who has? What did you do about it? Think of a situation in which you learned something through social learning? Can you think of examples in society where social learning could lead to negative effects? What might be done to reverse those effects? Describe phobias using the correct classical conditioning terminology to a classmate. Then, describe how you might unlearn that phobia using desensitization. Think about a person who has a phobia of birds called ornithophobia; create a plan for how you could help them using this technique. Explain what the Zone of Proximal Development is. Describe a situation in which you have learned a new skill using scaffolding. What was your role and how did you acquire the skill from the expert? Scaffolding can be used in many different learning scenarios. What kind of roles between someone less proficient and someone more proficient can you think of? Explain how prompts can be used for learning in these situations.

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Choose a type of educational simulation and explain what you find appealing about it. Have you used it before to learn a new skill? How does it help you interact with your peers? What could be the limitations of this simulation type? Use the principles of operant conditioning to change one of your problematic behaviours, or increase a positive behaviour that you want to do more of. Illustrate all four ways of using the stated methods.

CHAPTER SEVEN COGNITION, LANGUAGE, AND IQ DR. LOUISE LAMBERT

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Chapter Outline x x x x

Problem Solving and Decision Making by Dala Kokash Concepts by Dr. Louise Lambert Creativity by Dr. Louise Lambert Fluid and Crystalized Intelligence by Dr. Louise Lambert

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x x x x x x x x x x

Today’s View on Intelligence: What is it, how is it tested? by Dr. Ruba Tabari Topic Box: The Flynn Effect by Dr. Annie Crookes Topic Box: Gender and IQ by Dr. Annie Crookes Multiple intelligences and perceptions of intelligence by Dr. Katharina A. Azim Topic Box: What about Social (or Emotional) Intelligence? by Dr. Louise Lambert Giftedness by Anam Syed Learning Disabilities by Tooba Dilshad What to Do if You Have a Learning Disability? by Dr. Norma Kehdi Language by Dr. Louise Lambert Over to you now…

What does the word “cognition” mean? That’s a good question and if we had to answer it in one word, it would be “thinking.” But, for a more sophisticated answer, cognition refers to all the mental processing that we do, such as problem solving, using language, mathematical skills, critical thinking - even daydreaming – including the sense-making in which we engage to understand the world, our own thoughts, and daily experiences. These processes are grouped together and known as cognitive psychology, the study of mental processes. In this chapter, you’ll earn more about your own cognitive processes, which also include attention to language and intelligence, or IQ.

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Problem Solving and Decision Making by Dala Kokash You’ve surely faced a problem before, whether it’s what to wear in the morning, or what major to choose. A problem is a situation that requires a response, only which response (if indeed there are any) is not obvious at the time. One thing is certain: how a problem is defined, understood, and perceived will vary between individuals and determine how easy or difficult a solution can be or even if one is possible. This is called problem representation, how a problem is defined.

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Differences among problems also exist – there are well-defined and ill-defined problems. Well-defined problems are those with specific problem representations, set goals, and clear solutions, like when you are solving a math problem. You might not know the answer just by looking at the question, but apply a formula, do the calculation, and in a few seconds, you’ll have the answer. Meanwhile, ill-defined problems are those with unclear goals, solutions, and a less specified problem representation. These are more like the problems we encounter in daily life. For example, your friend Mona is really cool, but she acts weird around your friend Aisha and denies any ill-feelings towards her. You have a party coming up and want them both there, but now Aisha says she won’t go if Mona attends. Ugh.

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Application of Strategies Once a problem is defined, the next step involves finding a strategy; here are a few. Trial and Error is used when all options seem just as good as the other and there is no way to tell which option might result in a better solution. For example, in a choice of three remote controls, trial and error is the best way to discover which one turns on the television. This strategy responds most closely to a “try and see what happens” approach as it removes much deliberation (overthinking) and planning. Algorithms are a step-by-step process that provides a correct solution to a problem every time. For example, dividing 700 by 35; if you follow the process correctly, the answer will always be 20. Algorithms work well when there is a clear and available answer; however, sometimes, they lead to a correct answer, but if emotions are involved, it might not be the answer you want! Imagine you create a flow-chart plotting your choice of major. If you get over 60%, you’ll go into engineering, but if you get less, you’ll go with architecture. But what if you want to do aviation and your parents disagree? Your “solution” worked, but it still wasn’t the solution you wanted, because it wasn’t the real problem. Heuristics or rules based on personal experience provide solutions although they are sometimes less than optimal as they lead us to be biased or overlook better solutions in favor of habits. For instance, if you know that a street is always blocked with traffic from 7:30 to 9:00am, you might opt for a longer, but less congested road without considering new options. You do this for months until someone says, “Why don’t you use the main road; they’ve added three extra lanes?!” Oh. While heuristics act as mental shortcuts, it doesn’t mean they are right! A means-ends analysis involves developing a picture of where you’d like to be and filling in the steps starting from today to get there. An example is a class project due at the end of term. By December, you should have a finished paper and presentation, but you can’t have a presentation until the paper is done. That means the presentation will be done last. The paper needs to have a list of references, a conclusion, sound arguments and counter-arguments, a literature review, and introduction, as well as a cover page, and obviously, a good topic. Where to start? By laying out all that is needed, we then plot the steps needed to get there on a timeline and follow it; thus, by creating sub-goals, smaller and more manageable goals, we can meet our larger end goal.

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Obstacles to Problem Solving While there are many strategies to help solve problems, there are factors that interfere with the process. Our mental sets, the tendency to approach problems in the same ways we’ve always done can limit us. This happens when there is a perfectly good and new solution to a typical problem, but because we are familiar with the old solution, or don’t know the new one, we stick with it and persist even if it’s clear it’s not working! An example is learning to do multiplication, i.e., 10 x 3. Early on, a child will draw out 3 groups of 10 dots and then count them all. This works, but over time, the child needs to learn to use the proper multiplication formula because calculating 17 x 134 by drawing dots would take forever! Sometimes new solutions require learning or getting used to and the effort needed to overcome it seems harder than using the old solution which might take longer, but is at least well-known. Functional fixedness is similar, only here, we get stuck on the function of an object rather than its possibilities. For instance, think of a compact disk (CD) and try to come up with 10 uses for it. How many of your answers were related to its actual purpose; that is, storing documents, photos, music, other types of data? Did you also consider that it might be useful as a hanging decoration, a Frisbee, a coaster, a tracing object for circles, and a mirror for applying lipstick? When we look at a CD as a circular piece of plastic with a reflective surface, suddenly we can see many more uses for this object.

Decision Making Errors Decision making differs from problem solving in the sense that we do not need to identify solutions, but we must choose the best available solution for our problem. We’d like to think that we make the best decisions and that we take time to think through our options, but the truth is, we are misers. Just like we don’t want to spend too much money and our friends might call us “cheap,” we also don’t want to do much thinking. Hence, a cognitive miser (Fiske & Taylor, 1984) is someone who doesn’t put much thought where they should and relies on mental short-cuts. Yet, it seems we’re all cognitive misers! It’s not that we’re lazy; it’s that our brain defaults to the easiest way of arriving at a decision. As we are bombarded by so many decisions to make every day, we use shortcuts because we have little time to think everything through. Take driving home. You always take the first road out of the university because it’s the simplest; but today, they announce there

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is an accident and while you can take the same road, there will be delays. You can take other roads but this requires you to mentally take a few seconds and consider each in your head. Should you go right or left? Which will have the least traffic? How much further will they take you? By the time you consider these options, there are seven cars honking behind you to move; plus, it is rush hour and you’re hungry. You end up taking the same route as usual and simply wait in traffic. Making a different decision takes too much processing time; you go with the flow.

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This is an example of where our thinking goes into default mode; we are not the scientists psychologists once thought we were, taking time to consider the pros and cons of each decision. In fact, by being “cheap” with our thinking and using mental short-cuts (called heuristics; Tversky & Kahneman, 1974), we avoid wasting time and energy better used elsewhere and for more important decisions like what university major to take. On the other hand, it also means we’re not very logical and make bad decisions now and again. For the most part, this might mean sitting in traffic for longer than usual, but at other times, it might mean electing a president that really is the worst choice (you know exactly who I am

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talking about!), but it’s the easiest choice because learning about all the issues takes effort (Lau & Redlawsk, 2001). There are several heuristics. For instance, the representativeness heuristic involves basing a new situation to a previous stereotyped model, which may be untrue and lead to errors in decisions. An example is when we have an experience with a specific cultural group, good or bad, and we then assume the next person we meet from this group will be the same; that is, they will represent the whole group. This can impact hiring decisions in the workplace and how professors treat students in the classroom. Another heuristic is availability, where we judge the likelihood of events happening by how fast their examples come to mind. In essence, we use the information that is right in front of us instead of considering all possibilities. A good example is rain in the GCC region. It rarely rains and once a year is not enough to make us think of bringing an umbrella. We fail to take precautions simply because it hasn’t recently rained. If we lived in the UK, we’d have no problems remembering an umbrella; in fact, it’s likely it would have rained that morning. There are other decision-making barriers. The confirmation bias, the tendency to seek out information that supports our beliefs and equally, ignore information that disproves our beliefs can be seen in our selection of news sources. There is a reason some people listen to Al Arabiya, versus CNN or the BBC. By watching a news source with the same set of values, we confirm our beliefs about the world and are never exposed to beliefs that might contradict them and get to feel good about ourselves as a result. Yet, this is an error, because we base decisions on our desire to feel acceptable and not necessarily on facts. Further, we limit our exposure to alternative ideas and don’t challenge ourselves to see the world otherwise and can lead to belief perseverance, clinging to beliefs even after evidence disproves them. Framing, the way information is presented, can also influence decisions. Think of a painted picture and imagine the types of frames we can put on it; renaissance cherub babies in gold leaf or a simple, sleek modern frame of brushed steel. Whichever frame we choose alters how the picture looks. It is the same with decisions, only emotions are the frame. For example, insurance sales people only need to present one tragic story that elicits fear to get people to buy insurance which may not be of any use to them. Medical representatives do the same; by presenting individuals with their likelihood of attracting serious diseases, they are more likely to sell vitamins.

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Anchoring, the tendency to focus on one detail or factor in a decision and give it more weight than necessary, impacts decisions too. Say you want to buy a car. One is blue, your favourite color, brand and make; you love it! But, the other possibility is on sale and more reasonably priced. The savings could be useful for your parents as your sister is getting married next month. It will be hard to overlook the fact that the car is on sale; that one fact will act as an anchor and keep you coming back to it and possibly overlooking other factors, like safety ratings or fuel economy.

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There are a few more ways in which we make mistakes and you certainly will have experienced some of these. Our intuition or gut feeling about a decision carries importance. Sometimes, you can’t really explain why or how, but one solution will feel better than the rest. We might also experience the ostrich effect, the tendency to ignore dangerous or negative information. It’s called the ostrich effect because like the bird, we keep our heads in the sand not wanting to see reality. At last, you may have experienced what is called the blind-spot bias, the inability to recognize any of the errors just described! We have a blind spot for our own cognitive errors and this is perhaps the most dangerous one of all, not even thinking for one second that you are capable of even making a mistake!

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Concepts by Dr. Louise Lambert One of the ways in which we make sense of the world and understand what we see and experience is to categorize events, people, and things mentally. We do this automatically (although sometimes when you’re learning something new, you may do it on purpose) and in order to save time. A concept, then, is easier to understand if you use the word “idea” instead; in essence, a concept is a group of objects, events, or ideas that have something in common. These groupings help us understand situations, events, and ideas more quickly. There are two ways we can think of concepts.

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A formal concept is when a group of ideas or related smaller ones are neatly and clearly defined by a set of defining characteristics, or rules. For instance, a formal concept might be something simple like a triangle. All triangles, no matter what, have 3 sides and in total, the sum of the angles comes out to 180 degrees. If anything has 3 sides and sums up to 180 degrees, then by definition, it’s a triangle. If something has 4 sides, or if the sum of its angles comes out to 272 degrees, it is not. Formal concepts like these are composed of features known to everyone and do not change. But, who cares about a triangle? Exactly. The point is that a set of rules that define a formal concept help us determine what something is and

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by default, what to do about it or how to respond, as it fits (or not) a category of ideas with which we are already familiar. Let’s pretend you move to some far away land where everything is weird and new and someone hands you a brown, hairy, sea-urchin looking like object, you might think, “What is this?!”; and drop it in disgust. Yet, someone only has to say, it’s a “vegetable” (concept) and you might ask questions about how to prepare it. A more complex example might involve someone telling you the new country you are in is in fact, a plutocracy. Is that an island, you might ask? No, it’s a system of governance, like democracy, aristocracy, or monarchy. These are all examples of “systems of governance.” A natural concept, on the other hand is a concept defined by our experiences and perceptions of how the world works. Unlike formal concepts, natural concepts differ between people and are made up of different principles, characteristics or rules. For example, a natural concept might include “potential wife or husband” – and there will be great variety as to what defining features should make up the category. You may say kindness, intelligence, and humour, while another may say good looks, loyalty, and emotional intelligence. There is no right or wrong; we define natural concepts for ourselves. The next time you meet someone who fits the defining characteristics of your concept, you may consider them as a future partner. Thus, concepts help us make sense of the world and take action accordingly. Sometimes, it can be too complicated to define or list all of the characteristics that make up a concept. As we like to take short-cuts in our thinking, we can come up with best examples to quickly convey the features. Let’s say you are trying to describe the defining characteristics of a good parent to your friends. You might start by giving them a list, like nice, supportive, funny, patient and so on, but finally, you say, oh, you know, like Dr. Mohammed who teaches Math! Ah, now they all understand what you are talking about. Your good example, in this case, an exemplar, fits most of the defining features of your category and comes from your own experience. But, what if someone in your group has never taken Math? Then, you’ll have to use a prototype, a fictitious (made-up) model describing the features of your concept instead.

Creativity by Dr. Louise Lambert See the drawing below and take a few minutes to complete it. Don’t think too hard. When you are done, share your drawing and compare the range of ideas.

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Did you find that easy? Did you start on the drawing immediately and without thinking too much? If you did, you might be a creative person who can easily see options, ideas, and possibilities. On the other hand, did you find that difficult? Were you one of those students who stared at the box for a while and did not know what to do? Did you wonder what the right answer might be before you began? There are two types of thinking related to creativity. Divergent thinking (Guilford, 1967) is the type we think about when it comes to creativity and refers to the ability to think of many new and diverse ways to achieve a goal in which there is a wide degree of freedom and few rules, like in the arts, along with the ability to carry this idea through to its completion (and not just think about it). Convergent thinking on the other hand also involves creativity, but in this case, it is the ability to come up with one correct answer within a limited scope of possibilities and by following a certain number of rules, like in the sciences, and also carry it through to completion. What helps creativity? Think back to your drawing task. To be creative, you have to have permission to make mistakes and the freedom to try alternatives. Think about this. Do universities give students the freedom to try things out and make mistakes? In some classes, maybe, but

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generally, this has been a complaint of the education system for some time. By expecting students to get the one right answer, we limit their creativity to think in different ways and expand what they know. You may not have given yourself permission to be creative either and perhaps thought, what does the professor want to see? Keep this is mind as you go through your career and in life; there are many ways to do things. How else can you become more creative? By not trying too hard to be creative! Wallas (1926) developed a model that is still referenced today suggesting that thinking too hard about a solution prevents creativity from emerging. He outlined four stages to creativity. Stage 1: Preparation: Here is where the problem or challenge is considered and may include what to do draw, paint, or design, or how to solve a mathematical problem or engineering challenge. The person merely thinks about the problem, its context, rules, needs, and limits. Stage 2: Incubation: Here, the person stops thinking of the problem and moves to other issues or activities and lets the problem “incubate” or brew like coffee. Your brain is still thinking of the issue, but passively and doesn't require any further input. Advice like "sleep on it" probably comes from here. Stage 3: Illumination: Have you ever had a good idea while in the shower? Illumination refers to when people are suddenly hit with a solution seemingly out of nowhere. The idea has come on its own; ta-da! Stage 4: Verification: Does it work? Sometimes, it'll be a great idea but it still needs a little refinement or direction. Usually, it's a good start and you can take it from there and finish the rest. The point is that too much conscious thought gets in the way of creativity or even problem solving for that matter. Once you know enough about the problem, then you can think about it, leave it alone, go do something else, and see what happens. There's one more thing you can do to boost your creativity. Go for a walk, preferably outside (Oppezzo & Schwartz, 2014); it gives you a break from trying too hard to solve your problem, allows you to be distracted and increases your oxygen levels and blood flow allowing you to think more clearly and creatively. So, think, stop, and walk for greater creativity!

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Fluid and Crystallized Intelligence by Dr. Louise Lambert Before we look at how intelligence is understood today, it is helpful to look at two concepts that help us understand to what it refers. Cattell (1963) distinguished between what is called Fluid Intelligence and Crystallized Intelligence. This theory was later developed into what is now called the Cattell–Horn–Carroll theory, based on the work of Cattell, and later Horn (1965) and Carroll (1993). Everyone has both crystallized and fluid intelligence and they refer to the difference between your thinking skills and abilities and the knowledge you gain and accumulate as a result.

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Fluid intelligence is culture-free, meaning it is not based on where you live or what you learn in school, although you do practise it and use it in school, and involves your cognitive processes; in sum, how you think and not what you know. This includes skills like memory, abstraction, reasoning, communication, analysis, using logic and other abilities. Fluid intelligence usually increases from birth to adolescence because we are using processes, our inborn or innate processes to learn things, throughout this period to learn. Good schools develop and use your thinking skills.

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Fluid intelligence in turn, helps develop crystallized intelligence. These are the learned skills, facts and content you accumulate over time, like formulas, dates, events, concepts, and theories, in other words, “stuff”, what you actually know (versus how you got to know it). This type of intelligence increases throughout adulthood (provided that you keep learning). So, think of fluid intelligence as the foundation you need to build so that you can then put crystallized knowledge (stuff) on top of it. Universities assume students have a basic level of fluid intelligence. This makes it far easier to grasp aspects and features of knowledge that depend on crystallized intelligence. However, in some places primary and secondary schools rely on memorization and this explains why some students have difficulty learning in university—they lack the basic fluid intelligence skills and consequently, the foundation for learning is not properly developed, so anything added on top is not stable or well understood. Skills and abilities, while innate, must nonetheless be developed, practised and perfected, and good schools will accomplish this task well.

Today’s View on Intelligence: What is it & How is it Tested? by Dr. Ruba Tabari Have you ever gone online to try and find out how clever you are? Many online intelligence tests usually only test one aspect of intelligence, nonverbal reasoning, and this is why they are not very accurate. Furthermore, a real IQ test can only be administered by a licensed psychologist who has training in this area and it is usually done in person and can take a few hours to complete. So, what is intelligence and how is it tested? There are many people who think intelligence is about what they know (like crystallized intelligence), something they can study or prepare for like a test at school. It is not! Intelligence is about the skills that we have, your fluid intelligence. It is about how we learn and not what we learn. Skills like reading a road map upside-down, remembering directions, completing a Sudoku puzzle or a crossword all test different aspects of intelligence. But each of these activities relates to different aspect of intelligence; such as our ability to problem solve; our spatial awareness and language skills. Thus, an IQ test does not measure what you learn at school (i.e. dates, formulas, events) as these tests would be biased against individuals who have never gone to school. Rather, they test for thinking skills that do not rely on education.

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Scientists generally agree that intelligence can be measured by psychometric tests. These tests (called IQ tests for Intelligence Quotient) look at four areas of ability: verbal reasoning which relies on language skills; nonverbal reasoning which assesses reasoning through pictures and practical tasks such as manipulating blocks. The tests also assess working memory and processing speed skills. The term working memory refers to a brain system that provides temporary storage and manipulation of the information necessary for such complex cognitive tasks as language comprehension, learning, and reasoning. Processing speed assesses our ability to focus our attention and quickly scan, discriminate between, and sequentially order visual information. Research tells us that working memory and processing speed have a large effect on our ability to be successful learners. So, if you cannot study for an IQ test, how can you increase your score or improve your intelligence? In the past, we used to believe that everyone was born with a certain level of ability, a ceiling or limit, and that our environment could determine how close we got to that limit. For example, if I go to a good school and have good teachers then I am more likely to reach my pre-determined limit. Yet, today science has shown that our brain is not fixed and that it can develop and change. What this tells us is that if you are not good at Sudoku but keep practising and trying to understand how it works, you can and very likely will get better at it.

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More on IQ You may have heard some people report their IQ scores and wondered what these meant. The average for the IQ test is 100 points. But, just like the average height is 170 centimeters, few people measure exactly 170. The average person is perhaps 173, or 168, and as these are close to 170, they are considered within the normal range. IQ is the same: 100 is the average, but the range of normal is 15 points either way (this is called the standard deviation, that is, the average degree to which scores deviate – move away – from the average). Thus, scores between 85 and 115 are considered normal. So, if someone tries to impress you with a score of 107, it’s still average and nothing to get crazy over. In fact, 50% of the population scores between 90 and 110 points, while 70% score between 85 and 115. This means that 7 out of 10 people won’t benefit much from knowing their scores as the chances are good that they are normal.

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So, if most people are normal, why do we test? Most IQ testing is done to determine whether any individuals are on the lower or higher end of the IQ scale. Individuals who score below 70 are considered to have a severe to moderate disability of some sort and may need a dedicated tutor to help them in school, or a special form of schooling altogether. In more severe cases, these individuals might not be able to take care of themselves

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and require care. At the higher end of the IQ scale are “gifted” individuals (more on them below). These individuals also need attention as they have the capacity to achieve more and specialized instruction can help them make use of their skills. What determines IQ and are there groups with a higher IQ than others? Not really. Remember that IQ tests thinking skills and everyone has these regardless of education. However, there are environments that support the development of thinking skills more than others and this may result in slightly higher scores in some places. But, definitely, some individuals have higher IQs than others. Further, while genetics and heritability play a large role in IQ, there are environmental factors that can boost scores. The nutrition you get as a baby has a role to play in the growth and development of the brain. This isn’t an issue for most people but consider babies and infants who grow up in conditions of war or famine and are severely malnourished. Their brains and bodies do not develop as they should and this impacts their cognitive skills as well as their ability to focus and learn. Second, as kids grow older, they need a stimulating environment, one that provides for learning, challenge, interest, and exploration. Parents who don’t support their children’s exploration and consequent mistakes can limit their ability to reason and learn. Thus, parental encouragement is vital. Reading to children, letting them figure out problems, challenging them with cognitive and physical tasks, and encouraging them to offer solutions goes a long way. Finally, good schooling helps. While IQ doesn’t test for content, good schools can provide environments for children to practise their reasoning skills and stretch themselves intellectually. Schools that rely on simple memorization will not achieve boosts in children’s IQ or much learning for that matter.

Topic Box: The Flynn Effect by Dr. Annie Crookes In 1984, James Flynn reviewed IQ scores published in the US from 1932 to 1978 and found that every 10 years the scores had gone up by approximately 3 points on the tests. This meant, each generation was getting smarter than the one before! This became known as the Flynn Effect, although several other people had previously noticed the same effect both in the US and other countries. Since then, the Flynn Effect has been found in over 30 countries, in different age groups, and on lots of different types of intelligence test (see Trahan, Stuebing, Fletcher, & Hiscock, 2014 for review). Recent reviews have suggested that the largest effect is seen in fluid intelligence and less in crystallised intelligence, as well as for non-verbal, abstract thinking.

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Photo credit: Pixabay

While universal patterns such as this may sound like some sort of genetic or biological change, in fact the most likely explanations are socio-economic, like changes in access to education, improved nutrition making mothers and babies healthier, and children growing up with more enriched technological environments. Another suggestion is that children today are just more familiar with test taking and tend to know how to approach IQ tests themselves better than older generations did (for review see Pietsching & Voracek, 2015; Williams, 2013). As intelligence itself is influenced by multiple factors, it is likely that in different countries and groups there are different reasons for the Flynn Effect. Finally, there has been some recent evidence for a reverse Flynn Effect that on some aspects of intelligence children may be starting to show worse performance (Dutton, Van Der Linden, & Lynn, 2016). Clearly, this effect is an important part of the psychology of intelligence that will be continue to be studied for many years to come. James Flynn himself gave a TEDTalk on this subject in 2013 which can be viewed online at: https://www.ted.com/talks

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Topic Box: Gender and IQ by Dr. Annie Crookes It’s easy to assume the genes that create physical differences between men and women must also influence brain and cognition. Unfortunately, this interest is often biased and aims to show “better” abilities in males over females. For example, you may have heard people say that girls are more emotional and verbal, boys more practical and analytical; men prevail in science and technology while women are better at “care” jobs like nursing and teaching. Even with all of our modern science and psychology research, there is a longstanding belief that men’s brains are naturally better at math and spatial tasks while women’s brains develop better verbal abilities. According to the belief, this is not only “proven” by evidence but biologically determined.

Photo credit: Pixabay

But, what does the data actually tell us about gender differences in intelligence? It started with scientific publications in the US around the 1970’s that reported strong gender differences in maths, verbal and spatial abilities (see Hyde, 2016 for a review). These fit nicely with the social differences in gender roles and so became accepted without question. However, the data has never actually proven anything. In fact, findings from different studies have always been mixed and review papers of the past 30 years have repeatedly shown there are no overall significant differences between girls and boys or men and women on measures of general IQ, maths or verbal ability (Ardila, Rosselli, Matute, & Inozemtseva, 2011; Hyde, 2016). Even countries with strong traditional

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gender roles in society, such as Saudi Arabia, show no gender differences on IQ measures (Hein, Tan, AlJughaiman, & Grigorenko, 2015). The only enduring evidence seems to be for a small male preference on tasks of mental rotation. So why the prevailing stereotypes and confusion? In most cases where differences have been shown historically, these can be explained more by social factors than by underlying cognitive or intelligence functioning. For example, the Flynn Effect has a greater rise in IQ scores for women than men over the 20th century but this is linked more to the efforts made in reducing social inequalities during this time. Nowadays, in countries where gender equality is better, findings show no further gender differences in IQ scores (Flynn & Rossi-Case, 2011). Even the small effect shown in mental rotation can be explained by differences in practice where boys are encouraged to play with action toys while girls are encouraged to play social games. In addition, test performance is also influenced by psychological factors such as confidence and self belief. Recent studies have shown that, compared to women, most men still rate themselves as higher on maths, spatial and practical intelligence and assume they will perform well on these tests (Storek & Furnham, 2014). Women may be more anxious on tests or simply not put themselves forward for exams if they don’t believe they can do well. This is known as stereotype threat and is seen in a number of intelligence and academic measures. Clearly, changing gender inequality, providing access to education for all, and fighting false stereotypes will impact the intelligence measures of everyone in a society. In fact, Salahodjaev and Sardor (2015) report that reducing gender inequalities in a country can raise the overall national IQ measure by 10 points. Many governments in the GCC understand the need to educate women and to encourage more women to enter science and technology. Innovation and scientific growth will come from ensuring the most intelligent and motivated individuals are utilized irrespective of their genetic make-up.

Multiple Intelligences & Perceptions of Intelligence by Dr. Katharina A. Azim Some critics argue that only seeing human intelligence as one thing (like IQ) limits a view of people’s abilities and suggest that instead, we should consider the presence of multiple, distinct intelligences. Howard Gardner developed a Theory of Multiple Intelligences (1983) and proposed seven

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types of intelligences: logical-mathematical, linguistic, musical, spatial, body-kinaesthetic, interpersonal, and intrapersonal. Later, he added three more to the list: naturalistic, existential, and moral. While he did not develop a method to test these, Gardner said any fair testing methods needs to include activities that are culturally meaningful. That means the person who takes the test should be familiar with the activity and the task should be considered relevant in their culture. His theory however, has been critiqued as some researchers feel these “intelligences” are nothing more than talents or skills and one’s “intelligence” in sports for instance, shouldn’t be given the same importance as critical thinking skills. Perhaps it might be better to think of these intelligences as ways of knowing or understanding the world instead. Sternberg’s triarchic intelligence theory (1985), includes three types of intelligence, componential (mental abilities like those on the IQ test, i.e., verbal ability, abstraction, planning), experiential (creative thinking, coming up with new ideas, problem solving), and contextual (practical intelligence, being able to use and apply what you know, as well as take advantage of situations to your benefit). To him, intelligence is not only about having mental abilities or skills, it’s about knowing what to do with those skills and being able to see them in various contexts and at the right time and in a beneficial way, and explains why some smart people can be so stupid (the title of one of his books by the way)! Thus, successful intelligence has four parts: (1) achieving success in life depends on a person’s personal standards and their cultural context; (2) the person can make use of their strengths and correct their weaknesses; (3) there is a balance between analytical, creative, and practical abilities; and (4) a person can choose, change, and adapt to an environment that suits them. You can see that we have not come to a conclusion about whether people have multiple intelligences and, if so, which ones they have. Another interesting question that gives us an insight into people’s minds is how they perceive their own intelligence. How would you rate your intelligence if someone asked you? Higher or lower than your parents? Would you make a difference between your mother and your father? What about your siblings’ intelligence? How we think about our abilities can influence how motivated we are at school, what major we choose at university, and what kind of tasks we pick up at our job. In one study, researchers (Furnham & Mottabu, 2004) compared how university students from Cairo and London rated their own and their parents’ intelligence. They found that British male students rated themselves and their mothers’ general intelligence much higher than anyone else. On the other hand, Egyptian female students rated their father’s intelligence much

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higher than their own or their mother’s. An interesting result was that Egyptian women estimated their reasoning and spatial abilities higher than the British women or the Egyptian men, even though these intelligence types are often seen as “male intelligences” in Western countries. Another study compared Lebanese and Indian high school graduates (Nasser, Singhal, & Abouchedid, 2008) and found that Lebanese male students’ rated their intelligence a little higher than the Lebanese female students while the Indian students did not. Learning about selfestimates of intelligence and how people perceive themselves and others can give us insight into the social and cultural context in which the person lives in. The researchers in the second study caution us, though that the participants in Lebanon and India came from a higher social class – those that graduated from high school and will go to university – so the results cannot be generalized to everyone in the country. Remember from earlier that environments influence how we develop our thinking skills and abilities. The same counts for how we rate our intelligence.

Topic Box: What about Social (or Emotional) Intelligence? by Dr. Louise Lambert

Photo credit: Pixabay

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IQ is important, but it appears there is another type of intelligence that is also critical to life success—social intelligence. Consider a really intelligent manager who can solve technical problems and balance budgets, but cannot communicate, deal with interpersonal issues, or manage change or challenge during a business meeting. It is a real skill that matters in the workplace as well as in our personal lives. Social intelligence is the ability to properly manage one’s own emotions, understand and respect those of others, know and effectively do what is needed to fit in, while responsibly accomplishing tasks (Albrecht, 2004). Fitting in is more important than you realize. People like to know that they can trust you and that you are like them in some way. Thus, social intelligence is about showing people that this is the case without losing the essence of yourself along the way either. In workplaces, the socially intelligent are rated as more socially skilled and effective, able to read others emotions and determine what is required to satisfy, solve, appease, or otherwise meet the needs of others. They also tend to earn more money suggesting that navigating a workplace environment and its social hierarchy is an important skill for your career (Momm et al., 2015). Those with high social intelligence also show greater levels of life satisfaction, selfesteem, and well-being too (Mayer, Roberts, & Barsade, 2008). You should know that social intelligence is not about manipulation or advancing your goals at the expense of others, but it involves empathy, kindness, goodwill and respect to create meaningful connections with others.

Giftedness by Anam Syed You may have listened to or at least heard of the most famous classical music composer ever to live, Amadeus Mozart. At the age of 3, he could play the piano and violin and could hear a complex piece of music and replay it perfectly. He claimed to see musical notes in his head and this seemed to be true as he was able to compose pieces for multiple instruments at the same time, often composing musical scores while in conversation with people! By the age of 6, he wrote his first concerto and went on to write over 1000 musical works in his lifetime, and note that he only lived to the age of 35. Mozart is considered to have been gifted, a term given to individuals who have superior intellectual, physical, artistic, or creative abilities, beyond that which is considered normal. Giftedness is usually spotted in childhood and nurtured throughout one’s development

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as gifted individuals are considered to have a lot of potential to offer society and often make lasting contributions in their field. There are many characteristics that suggest a child might be gifted. Here are a few signs: x Language skills, such as easily learning new words even before entering school, speaking at a faster speed, speaking in more complex phrases and with sophisticated words, constantly asking questions when hearing or seeing something new. x Gifted children quickly absorb new information. They have good memory, connect new information to previously learned material, and carry on mature adult conversations. They spend a lot of time in activities in which they are interested, showing creativity and solving tough problems. They might also spend a lot of time reading or investigating a specific topic, and practicing their skills. x They may also show strong physical co-ordination and skill in physical activities such as soccer or tennis far beyond the capacities of other children. How can you tell if your child is gifted? While everyone likes to think their child is gifted, most are not. But, you can start by looking at your child compared to other children of the same age to know whether the child is excelling beyond the level of others. Parents can spot clues even where teachers don’t. In fact, many gifted children are mistakenly identified as slow or learning delayed as gifted children do not always come across as geniuses, but clumsy, socially awkward, and dull in some subjects. It’s tougher than you think to identify giftedness in some cases, while in other situations it will be obvious, like in the case of Mozart. Professionally qualified individuals trained to make this determination, like educational psychologists, can make a formal diagnosis of whether a child is gifted. They will test the child’s IQ, watch the child in his/her environment and ask parents and teachers for feedback. Identified gifted children can be made to skip grades, or put into advanced classes, enrichment programs, or different schools where they can be given more specialized education and training to achieve higher levels of performance and not get bored. These strategies are effective in boosting gifted kids’ achievements (Kim, 2016; Steenbergen-Hu & Moon, 2011) and for the fact that teachers don’t always recognize the need for more attention assuming the gifted need none in class (Brighton, Hertberg, Moon, Tomlinson, & Callahan, 2005).

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You might think that being gifted is great, but it’s not always so. The gifted may be bullied or ridiculed and might have a hard time fitting in. Parents and teachers hold high expectations for them and the pressure might result in depression and anxiety. Yet, research suggests that these concerns are exaggerated and what matters in the social and emotional adjustment of the gifted is their fit with the environment (Wiley & Hébert, 2014). Are parents supportive or pushy? Does the student have friends and activities outside of their talent? Is the student happy otherwise? The gifted often take pleasure in their talent and may spend hours developing it, playing the piano for hours as an example and do not necessarily suffer from more psychological problems than the average child (Wiley & Hébert, 2014). What is certain is that giftedness is an understudied area of psychology and there is a long way to go in understanding how it occurs, how diverse types of giftedness (e.g., athletic, musical, mathematical, etc.) can be nurtured, and how many gifted people there really are (Plucker & Callahan, 2014).

Learning Disabilities by Tooba Dilshad The term learning disability (LD) was coined by Samuel Kirk in 1963 and while there is no one definition of learning disabilities, the Diagnostic and Statistical Manual of Mental Disorders 5 (DSM-V) defines them as a “neurodevelopmental disorder with a biological origin that is the basis for abnormalities at a cognitive level that are associated with the behavioural signs of the disorder. The biological origin includes an interaction of genetic, epigenetic, and environmental factors, which affect the brain's ability to perceive or process verbal or non- verbal information efficiently and accurately” (p. 68). Disabilities vary in severity and play a role in an individual’s ability in oral (listening, understanding, speaking) and written language (spelling, written expression), reading (decoding comprehension), mathematics (computation, problem solving), attention, and the coordination of movement. Yet, learning disabilities should not be confused with learning problems. LDs are neurological disorders in the brain whereas learning problems are the result of motor, hearing and sight handicaps, mental retardation, emotional disturbance, as well as environmental, cultural or economic disadvantages. There are no known causes of learning disabilities but research shows that biological risk factors can lead to their development, such as genetic mutations and chromosome abnormalities in individuals. It is also common for such individuals’ parents or relatives to present with the same

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disabilities, suggesting a hereditary or genetic link for LDs. Certain factors that affect the unborn embryo or fetus also play a role in the development of LDs. Mothers who drink alcohol during their pregnancy have children with Fetal Alcohol Syndrome (FAS), which lead to signs of learning disabilities. Premature or prolonged labor, diabetes, contact with radiation (e.g., cancer treatments), and meningitis are also risk factors that lead to children developing LDs. These are often complicated by environmental factors such as malnutrition, poor prenatal healthcare, neglect by parents, and a lack of mental stimulation in early childhood. Here are some common learning disabilities: Auditory Processing Disorder (APD), also known as Central Auditory Processing Disorder (CAPD), affects how sound is processed and interpreted by the brain. Individuals with APD have difficulty making sense of sounds they hear, but not the meaning of what is heard. The direction or source of the sound is also confusing for people with APD. For example, if Maryam has APD, the phrase “tell me how a couch and a chair are alike” may sound like “tell me how a cow and a hair are like”. She may also have difficulty in processing sharp sounds like “k”, “s”, “sh” and “th.” Language Processing Disorder (LPD) is a type of APD that affects processing expressive and receptive language. In other words, individuals have extreme difficulty in expressing what they want to say as well as understanding what is being said to them. Using the example of Maryam again, if she has LPD, she may often need things repeated to her, such as jokes or instructions, to help her process language. Individuals with dyscalculia struggle with comprehending, organizing, and memorizing numerical symbols, mathematics, and/or time. For example, they may be unable to count backwards, remember basic mathematical facts, and have difficulty comprehending that “five apples” is the same numerical value as “five cats”. Dyslexic individuals struggle with the ability to read and decode information. They sometimes have difficulty with speech and writing as well. If Ahmed has dyslexia, he may confuse the letter “b” with “d” while writing. He may also confuse the sounds “ba” and “da” while reading. Individuals with dysgraphia struggle with poor handwriting, spacing, spatial planning on paper and spelling, composition of writing, and writing and thinking simultaneously. The individual’s handwriting may look a lot like preschoolers handwriting. Finally, individuals who present with nonverbal learning disabilities (NVLD) are often confused with having Asperger’s syndrome as the two disorders have similar symptoms. However, Asperger’s

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Syndrome is more severe. Individuals with NVLDs show differences between verbal skills and weaker motor, as well as social and visualspatial skills. These individuals struggle with accurately understanding facial expressions, body language, and vocal tones. They may have messy handwriting, poor physical coordination, poor social skills, or a fear of new situations, among other things. There are a few disorders that are not classified as LDs; yet, they are still important. Attention deficit hyperactivity disorder (ADHD), dyspraxia, and poor executive functioning exist alongside LDs like dyslexia and dyscalculia. In general, individuals with specific learning disabilities and/or ADHD show signs of poor executive functioning, such that they have difficulty with processes such as organization, strategizing, paying attention and focusing, remembering details, planning, and managing time and space. For example, Fatima is a high school student who has ADHD and tends to appear restless and has trouble focusing on a task. Ibrahim is a high school student who has poor executive functioning and while he also appears restless in class, he can maintain focus but has trouble recalling things, and often finds himself asking for information to be repeated multiple times. Just because someone has a learning disability does not mean they won’t be successful in school, work, or life. There are ways that psychology and educational psychologists especially, can help individuals to focus, read, write, understand, and achieve learning like everyone else. Read on to see how.

What to Do if You Have a Learning Disability? by Dr. Norma Kehdi Acknowledging that you struggle in school can be hard and the thought of having a learning disability (LD) may be even harder. The term “disability” is often associated with being different or “less than” others. There are stigmas, or feelings of shame or embarrassment attached to disabilities that we internalize from society, institutions, and even families. In the Middle East/North Africa (MENA) region, this fear of stigmatization keeps people who learn differently from seeking, accessing, or demanding the support they need. A learning disability is an “invisible disability” because it can’t be seen and you might be tempted to want to keep it that way. Yet, when you spend your life feeling different in classes because of your performance, always work harder than peers and have little to show for it, or have been told that you are not “performing to your potential,” getting assessed for a learning disability can be a relief.

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Common signs of a learning disability include difficulties: x with memory x focusing on details x working at a fast work pace x approaching reading or writing tasks x understanding new concepts x comprehending reading material These are just a few signs. Do some research about different types of LDs. If you experience any of the above signs, get evaluated! Psychologists do these types of assessments, and they can be found in universities, hospitals, or in private practice. Students with LDs are often afraid to ask for assistance in university. Students tell me, “I’ve felt different my whole life, I don’t want to feel different here,” or “I don’t want to be judged for having a learning disability, so I can’t tell anyone.” At the same time, students said they wished they had sought support sooner because of their struggles. Societal taboos can creating fear and prevent people with LDs from seeking the help they deserve, but things are slowly starting to change. A researcher (Abu-Hamour, 2013) found that the majority of faculty members at a university in Jordan had very positive attitudes toward the inclusion of students with disabilities in higher education. Additionally, some universities in the MENA region have made efforts to create a more inclusive school environment; examples include Birzeit University, Lebanese American University, and the American University of Cairo. See what your university can offer for academic support. If you have been evaluated for and have a learning disability, depending on where you live and what type of school you attend, it may be tough to find good resources. Know your rights and ask for what supports exist! Educational accommodations include things like electronic-text, notetaking support, taking tests in separate rooms, and extra time on tests. As a student who learns differently, it will be important to advocate for yourself within the school system to get these accommodations. You might have to do some research about your LD and what services can help you. This might mean finding learning specialists, disability counselors, or psychologists at the university who can help you. These people are usually found in Student Affairs, a Disability Services Center, or Health/ Counseling Center. Keep in mind that when seeking accommodations or support due to a LD, you are not asking for anything extra. The purpose is to create an equal playing field in an educational system that privileges certain ways of learning over others. I challenge you to expand your view

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of “normal” to include all learning styles and be empowered to find your voice in getting the support you need.

Language by Dr. Louise Lambert

Photo credit: Pixabay

We might have one or many languages; yet, speaking, signing, and thinking about language is a bit like brushing your teeth; we all do it, but rarely think about. Consider the following questions in your group: how is language produced? How does language differ between cultures or within a culture? How does language use differ between genders? Do you think differently when you speak another language? How did you learn your first language? Did someone have to teach it to you or did you pick it up naturally? What are the benefits of speaking more than one language; what are the drawbacks?

Psycholinguistics The questions you were just thinking about are those that preoccupy psycholinguists, psychologists who study language. Psycholinguistics is the study of language from a psychological view and includes how we get

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language in the first place, create language on a daily basis, and understand it. Psycholinguistics also involves the study of the brain mechanisms involved in doing so and problems that may emerge. These problems might be those that occur after you’ve had a brain injury, stroke, tumor, infection, or even cancer, which affect parts of the brain that in turn, affect your ability to use (speak) or comprehend language. For instance, if the Broca’s area of the brain was affected in a stroke, the area responsible for speech production might make it impossible for you to produce words even though you understand what is being said and can read easily. Or, if the Wernicke’s area, responsible for language comprehension is affected, the individual wouldn’t understand the meaning of words and be unable to make meaningful sentences, despite being able to produce words. Reading and writing are also affected. Imagine how tough it would be for the person affected by these language disorders, or types of aphasia that prevent them from producing or understanding language.

Language Acquisition When we’re talking about the first language a person learns (and not other languages you learn later), we are referring to language acquisition, the unconscious and instinctual language that is obtained in the first six to seven years of life. This acquisition does not depend on intelligence, but needs the input of others to be successful. That is, when your mother spoke to you as a child or repeated back the sounds you made like “ba, ba, ba”, this helped you hear what the sounds of your language were supposed to be, what those sounds meant over time, and the order in which they were meant to go. This is why reading and speaking to children – even if they can’t yet understand – is important. Language acquisition is quick compared to later language learning that can take years to fully and properly learn and even then, we make grammatical mistakes and keep an accent. In first language learning, once we acquire the general rules, the system becomes natural to us. Thus, language acquisition is considered unconscious learning. This is different from second (and subsequent) language learning, which is known as conscious learning and which requires significant effort, remains imperfect, and is unfortunately, quick to be forgotten. How do we “get” language? You’ve seen that babies seem to pick up language easily. Adults speaking to them, a necessary ingredient in the acquisition of language, and the fact that we are neurologically hardwired to pick up language, is the basis for the theory for how we acquire

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language developed by Dr. Noam Chomsky (1955/1975), who suggested that the only thing we need to learn our first language is the presence of language versus instruction and reinforcement. Further, the ability to acquire language is facilitated by the Language Acquisition Device, which holds the rules for all languages and is composed of hundreds of brain processes working together to produce and understand language. Chomsky added that the evidence for this system came from the fact that children do not acquire language based on learning theory as adults cannot possibly use all of the existing language combinations in front of children for them to learn them all. Further, the fact that children try to make sense of grammatical rules (e.g. I drew versus I drawed) suggests that they are learning a system of rules and not random words or specific phrases. As language is innate to all humans, something more important than social learning or cognitive development has to explain this. Thus, Chomsky proposed that language is an instinct, like walking, and requires no teaching. Chomsky’s theory received much criticism over time, but neurological studies are proving him correct (Ding, Melloni, Zhang, Tian, & Poeppel, 2016). Chomsky further developed the idea of Universal Grammar; that children can interpret sentences and meaning without ever having heard those exact phrases suggests that we have a pre-determined tendency for understanding language based on a universal system of grammar. Different languages are understood to reflect only one particular organization of words, meanings, and rules; however, while every language has its own combinations, they all share the same rules and we are genetically predisposed to learn such a system early in life. Language is accordingly pre-organized in the brain and the environment shapes this neuronal network into a language. Thus, language happens to us. But, is there a time after which it becomes tougher to learn another language or a first language altogether if it wasn’t done appropriately? Yes. One line of evidence comes from children who have hearing impairments. A study conducted in Palestine showed that compared to hearing children, children with hearing impairments had significant difficulties in understanding subject-verb order and object questions and these persisted difficulties over time (Friedmann & HaddadHanna, 2014), suggesting that the required language input is necessary for properly acquiring language. Second language learning is also problematic after puberty, although this commonly cited critical period is debated and the more accurate age after which it becomes more difficult to learn a first or subsequent language seems to be the age of 6 (Friedmann & Rusou, 2015;

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Krashen, 1973). Regardless of the time, before puberty there are a number of hormonal changes and brain lateralization which occurs that seems to reduce the receptivity and ability for unconscious learning making further languages tough to learn. There is also a loss of plasticity around this time period (Lenneberg, 1967), although some argue this loss occurs as a result of the first language being acquired altogether (Pallier, 2013). As an adult, you might attend language classes for five hours a week, which is a lot when you’re learning additional languages but not much compared to when you were a kid and spent 24/7 getting the first one. Further, making the sounds required of different languages becomes tougher over time. While you’re learning language to begin with, you create all sorts of sounds and move your mouth and throat in strange ways with regular practise, but over time, it’s tough to create sounds your throat and mouth are not used to making – just ask non-Arabic speakers to make the “ayn” sound and you’ll understand! Around the world, and regardless of the language spoken, there is a pattern to how people acquire language, which is also why language acquisition (and not the language itself) is considered genetically predetermined. Here are the stages we go through in acquiring language.

Language Acquisition Stages Crying: It might not seem like language, but it is. Babies make noise to communicate needs, wants, and emotions. If you’re around babies a lot, you can differentiate between a cry of hunger or a wet diaper. Cooing: Babies become more sophisticated over time and begin to make little noises, ah, oh, eeh (and a few giggles too). They don’t spend a lot of time in this stage because they quickly learn to babble. Babbling: Babies vocalizations are more defined and clear uses of consonants and vowels can be heard, like da da, ma ma, they struggle to make meaningful phrases, but they are trying to get the sounds right. Holophrastic stage: Here, children by about the age of one begin to use one word to symbolize a lot. They might point at their father and say Baba and look back at you, which really means something like, “Oh, look, Baba just walked in the door from work and he’s right here in front of me!”

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First sentences: Now, sentences are becoming more complex still and two words are coming together: Baba bye, Mama go. Baby no. A subject and an action are coming together. And so on from here… There are interesting speech features that occur in this time that show that children are learning grammatical and conceptual rules. Overextension is when they use one term to refer to anything that shares one feature of the class of objects to which they are referring, like calling a goat a “cat” because it has four legs and is not human. In the other direction, they also use under-extension, when a pet is a brown cat gets called a cat, but the neighbor’s cat which is black, is not considered a cat. Finally, kids show over-regularization, where they use grammatical rules inappropriately, yet, use them showing that they are aware of language rules. They say things like, “I breaked a toy” versus “I broke a toy”. By age 3, children know hundreds of words and by age 5, the syntactical rules (how sentences are constructed) are learned; because this learning takes place unconsciously (without the realization of learning), the rules and syntax of a language are internalized versus explicitly learned. What this means is that if you ask a native Arabic speaker about a specific grammatical rule, she might not be able to give you an answer – she knows it exists, but why or how is hard to describe. In contrast, someone learning Arabic as an adult may be able to answer because they’ve had to consciously learn it and just last week.

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Topic Box: Dialogic Reading & Language Acquisition in Young Children by Dr. Zahir Vally

Photo credit: Pixabay

We know that for many children across the world the acquisition of language, learning to speak and eventually to read, happens naturally, because of instruction (being directly taught) or through exposure to daily life experiences. But for others, especially children who are raised in environments of poverty and deprivation, turbulent family circumstances, or who have parents that are illiterate, language development does not progress smoothly. In fact, many show severely delayed language skills in comparison to children of a similar age who are raised in more stimulating and well-resourced families. A reading technique that appears to be very effective for these children is called dialogic reading (DR). DR is a style of interactive adult-child joint reading. During DR, adults and children swap traditional roles and with the support and encouragement of the adult, the child learns to tell the story. When most adults share a book with a child, they read while the child listens with little interaction between them. In DR, the adult listens to the child and asks the child questions about the content of the book in an attempt to actively engage them. They support the child’s learning by giving them opportunities to talk, asking questions, explaining unknown words and

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repeating and expanding on their responses. The primary reading technique in DR is the PEER sequence of behaviours (prompt, evaluate, expand, and repeat). The adult points to pictures in the book and tells the child the name for it or acts out the behaviour if possible (for example, pretends to brush the child’s hair). Later, once the child has received sufficient exposure to the names of objects in the book, the adult checks their understanding of the new knowledge. First, the child is prompted to talk about a depiction in the book, then the child’s response is evaluated, the adult rephrases and expands the child’s response by adding information to it, and finally the prompt is repeated to ensure the child has learned from the expansion. For example, if a parent and child are looking at the page of a book that has a picture of a camel on it, the parent says, “What is this?” (prompt) while pointing to the camel. The child says, camel, and the parent follows with “That’s right (evaluation); it’s a camel, like the one we saw at the zoo (expansion); can you say camel?” (repetition). Research tells us those children who are read to at least three times per week or more show better development during later childhood than children do who are read to less than three times per week. Further, when parents read to their children using this technique, they show substantially better language and attention skills than children whose parents read to them in the traditional way (Cooper et al., 2014; Vally, 2012; Vally, Murray, Tomlinson, & Cooper, 2015

Does What You Speak Affect How You Think? Some research suggests that the language in which you speak shapes your view of the world and this may be more noticeable for those who speak many languages. Some would say that the language you speak makes you feel like a different person as language contains memories, scripts for acceptable behaviours and expected situations, as well as emotions (Pavlenko, 2006). The thought that language influences how we see the world stems from the Linguistic Relativity Hypothesis (or Sapir-Whorf Hypothesis; Brown & Lenneberg, 1954), suggesting that there are certain concepts or thoughts inherent to some languages and not to others. Thus, those that speak language A will see the world slightly differently than those who speak language B. Further, this hypothesis suggests that our understanding and interpretation of the world is constrained (limited) by the words at our disposal and specific to our language. Over the years, this hypothesis has failed to gather enough evidence; yet, every now and again, a study pops up to give it support.

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Doogan and Warren (2016) found that changing the linguistic habits of rehabilitating prisoners may be helpful in keeping them out of trouble once they leave prison. In their study, they analyzed the written notes prisoners sent to one another as part of a support program that served to increase positive behaviours (“I noticed you were patient with Prisoner A”) and decrease negative behaviours (“That joke about punching Prisoner B wasn’t funny”). These messages had all been approved by team leaders before being read aloud in group meetings. Over the course of two to seven years (depending on the group), researchers tracked whether the messages changed at all, or became less negative or more positive. They proposed that, just like we choose our social networks because we share certain values, activities, preferences, and behaviours, so too do we choose our selection of words and phrases to match our views of the world. These linguistic preferences (or schemas) reflect our beliefs about the world (i.e., believing that people are good or evil; or, that you can trust society or need to defend yourself against it) and the authors added, previous research suggests that these schemas influence the likelihood of criminal activity. So, if the schemas were changed somehow, would that affect what these prisoners did once they were released back into the real world? Rates of recidivism (re-offending) were higher in the prisoners who showed no changes to their linguistic habits, while rates of recidivism were lower in the groups who decreased their negative schemas or increased their positive ones. These changes to recidivism were observed up to one year after release. Hmmm… Maybe this theory has some merit after all.

Multilingualism Like many of your peers, you probably speak more than one language. In fact, most people around the world speak many languages and while there are a few drawbacks (i.e., it sometimes take longer to find the right word in the right language), there are overwhelming benefits to being bilingual (speaking two languages) or multilingual (speaking more than two languages). Most benefits are obvious. Speaking more than one language allows you to connect with all sorts of people from diverse backgrounds and travel easily. Perfecting your grammar and speaking in more than one language can make you a better job candidate in several nations around the world. But other benefits are perhaps less obvious. Knowing more than one language puts a greater cognitive load or strain on your brain, which acts as a form of exercise for your brain. Switching between languages, understanding when rules of grammar are

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used in one language but not in another, searching through vocabulary and ideas that might exist in one language but not elsewhere is a lot of work and explains why learning a new language is exhausting! Yet, this extra work pays off. Bilinguals (as well as multilinguals) show greater executive functioning (Bialystok, Craik, Klein, & Viswanathan, 2004); that is, we are better at coping with tasks that involve memory, attention and concentration. This greater flexibility helps future learning. The most important advantage involves the protection this type of brain exercise offers. As a result of the extra effort, the brain, like other muscles, becomes stronger, building a cognitive reserve, which protects against future forms of cognitive decline that are useful in postponing the onset of dementia (Bialystok, Craik, & Luk, 2012). It seems the advantages of learning many languages exist in the present moment, but more so as we age over time. You might want to pull out that Italian dictionary you’ve been meaning to work on!

Over to you now… 1. 2. 3. 4. 5.

6.

What are some things which contribute to boosting IQ scores? Do a quick Google search and find two more things that were not discussed. Consider the role of cultural expectations. How should someone with a learning disability organize themselves to be more successful in classes? Offer three pieces of concrete, practical advice. Do a quick Google search of someone with an IQ of over 132. Don’t just look up Einstein – find someone new who did something really awesome – preferably someone in the region. Do you know anyone who is gifted? In what? Remember, it’s not just being good at something or famous, it’s being really exceptional in one’s field. Can you find 3 more decision making errors and come up with a local example of your own to illustrate and present it to the class? Which of the decision making errors have you made? How can you be more careful making decisions from now on? Talk about creativity and some of the myths that surround it. You can look this up online. Who is really creative? And who only pretends to be?! Are you creative? How and when, doing what? If you’re not, what stops you from being more creative? Remember, it’s not a must and not all professions encourage creativity, so don’t feel you must be creative despite it being a popular thing.

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What are your thoughts on the linguistic relativity hypothesis? How does speaking many languages influence you? 8. With respect to social intelligence, are you good at reading others? How do you know? Describe the skills you use to read others effectively and consider the actions you take to fit into groups and respond to others with kindness while getting the job done. 9. If you were to test yourself using Gardner’s theory of multiple intelligences, on which would you score high and low? Look them up to see what the details are about each type of intelligence. 10. What might be some reasons for the reverse Flynn Effect? Look it up – oh, wait, is that the problem?!

CHAPTER EIGHT CHILDHOOD DEVELOPMENT DR. LOUISE LAMBERT

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Chapter Outline x x

Nature versus Nurture by Yasmeen AlHasawi Teratogens and Other Influences on Fetal Development by Dr. Louise Lambert

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x x x x x x x x x x x

Topic Box: Fathers and Prenatal Development by Dr. Louise Lambert Topic Box: How does Alcohol Affect Prenatal Development? by Reem Deif Attachment by Yasmeen Al-Hasawi Piaget’s Developmental Model by Dr. Nausheen Pasha-Zaidi Vygotsky’s Developmental Model by Dr. Louise Lambert Parenting Styles by Dr. Ruba Tabari ADHD in Children by Reinilda van Heuven-Dernison Anxiety in Children by Reinilda van Heuven-Dernison Children: Autism by Fiza Hameed Children: Down Syndrome by Dr. Louise Lambert Over to you now…

When we talk about development, we refer to the changes humans go through from the point of inception all the way to death. These changes are biological, but also include the cognitive, social, emotional, and moral changes we experience. Development is predictable and orderly in that it follows a pattern or expected course, such that we all babble and cry at the beginning of life. However, there are always individual differences due in part to our environments (the families and societies in which we grow up as well as the physical environment, i.e., abundant food versus famine), as well as differences in genetics, and unpredictable events, like war. All of these things affect us. In this chapter, we look at many theories which explain how we develop across the lifespan.

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Nature versus Nurture by Yasmeen Alhasawi

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Have you ever considered whether we are products of our genetic material, such that our personalities and behavioural characteristics are predetermined for us (a position known in developmental psychology as “nature”) or whether our environment and social setting influences our personalities and behaviours, (a position known as “nurture”)? Have you wondered why girls are often seen playing with dolls or cooking sets, while boys usually play with toy automobiles? Have you questioned why college men are traditionally enrolled in science, computer, and engineering majors, while college women pursue arts, language and education majors? Are these these gender roles determined by our personal environmental experiences or by predisposed genetic material found in our DNA? Are we attracted to certain things based on our biological drives or are these determined by our experiences growing up, including our family, hometown, and the society in which we live? These questions have elicited the curiosity of many psychologists. To this day, the issue of nature versus nurture continues to be debated in psychology and other disciplines. Some psychologists and scientists argue that development is determined by our genetic material, while others argue

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that environmental experiences account for the differences in developmental outcomes. Urie Bronfenbrenner is a developmental psychologist who proposed the Bioecological Theory of Human Development (Bronfenbrenner, 1977). Bronfenbrenner’s theory states that human development occurs as a result of the interaction between our biological makeup and the environment, including the events and observations a person experiences. Thus, it is not the environmental experiences or genetic materials alone that determine development, but a combination or interaction between the two. A situation that supports Bronfenbrenner’s theory is our body shape, which is believed by many to be an inherited or biological trait. Yet, we can change our body’s appearance by engaging in exercise. Further, our environment influences our body type. This is based on the kind of foods that are readily available to us and the amount of activity required to live in our current environment. In both cases, genetic factors and environmental aspects play a role in determining body shape. Twin studies also illustrate the bioecological theory of development. Think of one twin growing up in a Middle Eastern country, such as Qatar and the other twin grows up in America. Despite similar genetic materials and sharing similar facial features, there is no doubt that each twin will have different personality characteristics. One sister may be interested in American music, whereas the other sister has an interest in traditional Arabic music. Differences may also be observed in terms of food preferences, as well as behavioural patterns and characteristics. These examples help us better understand how nature and nurture work together to produce developmental outcomes. A key area of debate in the nature versus nurture issue is human cognitive ability. Are we born with certain cognitive capabilities or does our environment and schooling influence them? Research on intelligence abilities in humans has supported both biological and environmental factors in influencing human cognitive abilities further supporting Bronfenbrenner’s theory (Plomin & Spinath, 2004). Much research has been conducted in this area and is likely to continue to be a source of psychological study for many years as psychologists and scientists continue to debate whether or not nature or nurture is more influential in development. Now that we have had time to reflect, what do you think about human development? Is it nature, nurture, or both? Can you name situations where genetics play a larger role than the environment and where the environment is more influential than genetics?

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Topic Box: Fathers and Prenatal Development by Dr. Louise Lambert

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When it comes to babies, pregnancy, parenting and anything in between, it’s very often the mother who gets blamed should anything go wrong. While the mother’s hormones, nutrition quality, and psychological and physical environment play a role in prenatal development, the father’s role is just as important. A review by Day et al. (2016) reported on the role of paternal influence and is worth a read if you have the time. Here are a few highlights of that review. Across the literature, a positive correlation was found between the advanced age of the father and autism, schizophrenia and birth defects independently of the mother’s genetic influence (Malaspina et al., 2001; Reichenberg et al., 2006). Further, a father’s level of obesity was also linked to changes in metabolic regulation and a higher likelihood of obesity in offspring (Soubry et al., 2015). Alcohol use in fathers was found to increase the likelihood of children being diagnosed with Fetal Alcohol Syndrome (symptoms include low birth weight, impaired cognitive functioning affecting behaviour, decision-making, as well as neuropsychological

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impairments in visual-spatial learning, all of which are irreversible), even when the mother herself had never consumed alcohol before or during her pregnancy (Abel, 2004; Ouko, 2009). Smoking is of interest and shows that what fathers do prior to conception matters in that the father’s smoking damages their sperm’s DNA and causes genetic alterations in their children (Linshcooten, 2009; Marczylo, Amoako, Konje, Gant, & Macrzylo, 2012). Men, take care of your lifestyle as it clearly has an impact. What you do today (e.g., exercise, smoking, no sleep, etc.) can have an impact on your baby and certainly, you as well.

Teratogens and Influences on Fetal Development by Dr. Louise Lambert The word teratogen refers to anything in the environment to which the mother is exposed that can cause a birth defect in her developing baby (fetus) and includes things like alcohol, street drugs, prescription medication, environmental toxins like lead and radiation, pesticides in food, sexually transmitted diseases, or other infections or illnesses like diabetes. Teratogens can have different effects at different times during a mother's pregnancy and can have negative effects during what are considered critical periods, times during which the fetus is more vulnerable due to certain organs and systems developing. The critical period for brain growth for instance is between 3 and 16 weeks. Teratogens are sometimes only harmful when paired with other harmful substances but not on their own, or in large doses and at high levels of exposure, but not at smaller or lower doses. Some teratogens will be harmful to some fetuses because of existing genetic predispositions, but not in others. Timing is also an issue. As the fetus is at its most vulnerable in the first 10 to 60 days, it may be spontaneously aborted if it is affected by teratogens in serious enough ways. By the time of birth, only about 35% of babies will be born with birth defects and another 3-5% of defects will only appear later in life. While this number is small, most teratogens can easily be avoided. For example, a common teratogen, cigarette smoking, doesn't cause defects in itself, but causes low birth weight that in turn, increases the risk of health problems at birth and throughout life, not to mention the health of the parents too. Further, even if you have a medical condition that requires you to take medication, check with your doctor about its necessity before and during pregnancy. Things like retinoic acid used to

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treat acne, diet pills, or antibiotics can be toxic for fetuses as these medicines are adjusted for your size and condition and not your baby’s, so remind your doctor of the medications you are taking but do not stop taking them until told to do so, especially if they are necessary for you.

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What has recently attracted attention in the research literature are the effects of stress, depression, and anxiety on the fetus. Talge, Neal and Glover’s review (2007) showed that pregnant women’s exposure to traumatic events like death, war, or earthquakes resulted in neurodevelopmental changes in their babies increasing the risk for autism and cognitive disabilities. A later review by Field (2011) found that mother's depression while pregnant was also associated with fetal prematurity and low birth weight, as well as attentional, emotional and behavioural problems during childhood. Studies (Kingbury et al., 2016; Plante, Pariante, Sharp, & Pawlby, 2015) showed that maternal stressful life events, like a terrorist attack, the death of a child or parent, divorce, financial strain, racism, or several events in a short time predicted depressive symptoms, major depression and other negative events like abuse in childhood and teenage years. The likelihood of transmitting depression in this way is thought to be

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caused by the increased level of stress hormones in the shared environment between a mother and her fetus. Thinking of depression and stress as teratogens may be helpful in encouraging governments to spend money on preventative health care in order to reduce costs later and support pregnant women so that they can protect their babies in later life and improve their own quality of life. In sum, teratogens present a number of problems that can have important effects on babies over the course of their lifetime. This doesn't mean you should be worried about every little event that happens while you are pregnant, your body and mind are also resilient, but it does mean you should pay attention to stress and other harmful substances in your environment and do what you can to keep these at a minimum.

Topic Box: How does Alcohol Affect Prenatal Development? by Reem Deif

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Prenatal alcohol exposure (PAE) refers to a condition resulting from alcohol use by either parent that can harm normal fetal development. Depending on how much alcohol is taken and when, PAE contributes to defects ranging from nothing to perinatal death. Different motor and

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intellectual disabilities make up the Fetal Alcohol Spectrum Disorders (FASD); this includes Fetal Alcohol Syndrome (FAS), Alcohol-Related Neurodevelopmental Disorders and Alcohol-Related Birth Defects. Alcohol-related disabilities are estimated to be about 9.1 per 1000 babies (O’Learey, 2002). Fetal alcohol syndrome (FAS) is still one of the leading causes of birth defects worldwide (Welch-Carre, 2005). Symptoms are categorized into three groups; growth retardation, central nervous system abnormalities and facial defects. How does alcohol reach the fetus? Ethanol (an ingredient in alcohol) enters the fetus without being metabolized in the placenta and goes onto the liver to be used up at a rate that is only 5-10% of the adult rate (Pikkarainen, 1971)! This means the fetus has a tough time getting rid of alcohol in its system because of its smaller metabolic capacity. As a result, ethanol builds up in the amniotic fluid, the protective environment for the fetus, and is recycled back to the fetus. Effects of higher alcohol exposure can be seen in brain imaging, which show reduced brain volume in individuals with FAS especially in the hippocampus and cerebellum, as well as less gray and white brain matter (Lebel, Roussotee, & Sowell, 2011). Further, the corpus callosum responsible for the coordination between the right and left brain hemispheres can be altered by alcohol. Alcohol also delays the development and rate of neuronal generation (Kumada, Jiang, Cameron, & Komuro, 2007). Individuals with FAS show low socio-emotional development in terms of reduced responsiveness and a tendency to emotionally withdraw (Molteno, Jacobson, Carter, Dodge, & Jacobson, 2014). This can include higher irritability, greater sensory sensitivity in infancy (Wittenberg, 2001) and poor attachment to the mother (Kelly, Day, & Streissguth, 2000). Early neurocognitive problems during infancy also affect learning (O’Connor & Paley, 2009). Understanding language and expressing language are also problems for FAS children. For example, Autti-Ramo and colleagues (1992) suggest that articulation, word comprehension and naming are impacted by prenatal alcohol exposure. Other studies found a link between fetal alcohol exposure and attention-deficit hyperactivity disorder (ADHD) (O’Malley & Nanson, 2002), limitations in attention, planning and working memory (Green et al., 2009), as well as difficulty shifting attention, or little cognitive flexibility (Schonfeld, Mattson, Lang, Delis, & Riley, 2001). As you might have guessed, kids with heavy PAE can have poor academic success. Since no safe dose of alcohol has been identified, total abstinence is the best choice during pregnancy.

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Attachment by Yasmeen Al-Hasawi

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Human beings have a remarkable ability to connect, interact, and form close relationships with others. Our relationships with one another are influenced by many factors. The most important factor influencing the quality of our relationships with others is attachment theory. John Bowlby, a developmental child psychiatrist, proposed an attachment theory that discusses the impact that a child’s first relationship has on later development. He believed that the quality of a child’s first relationship with their primary caregiver influences later social development (Bowlby, 1973). This unique relationship between a child and his caregiver is referred to as the attachment bond, an intense, enduring, and affectionate social relationship. Attachment relationships are social in nature and the emphasis is on creating and maintaining attachment bonds, through which children establish social rules, expectations and beliefs about themselves. This attachment relationship with the caregiver serves as security and protection for the child. When infants are born, they rely completely on their caregiver to fulfill their basic needs. Thus, the attachment relationship that a child forms with his caregiver provides protection, as the caregiver helps the child learn to care for his basic needs and regulate

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his feelings and behaviours. The child also learns to trust others and feel that the world is a safe place or at least, there is a safe place for them. Attachment also protects infants from predators and dangerous situations. It is instinctive and helps infants achieve goals, such as when an infant cries to get his mother to return. These goals are achieved through engaging in attachment behaviours in order to bring proximity (closeness) and contact with the primary caregiver (Ainsworth & Bell, 1970) and include crying, clinging, and smiling. Attachment has been described as a biological necessity as this bond is what allows infants to feel safe enough to explore the world. Bowlby also looked at infants’ basic needs and discussed how separation, deprivation, and bereavement can change the developmental process (Bowlby, 1973). A disrupted relationship between the parent and infant often leads to protests, usually characterized by the child crying upon the parent leaving and later characterized by happiness and smiling when the parent returns.

Ainsworth and the Strange Situation Experiment Mary Ainsworth, a developmental psychologist, expanded on Bowlby’s theory (Ainsworth & Bell, 1970). She and her colleagues developed the Strange Situation experiment, which measured attachment security between the infant and caretaker in one-year-olds. The experiment was conducted in a laboratory playroom, where a child is left in the playroom and observed reacting to the presence and absence of the caregiver along with their reaction to a stranger. Children responded in many ways and differences were observed in terms of the quality of attachment relationship when presented in a stressful situation. In other words, how the child responded to the mother’s (or primary caregiver) absence and her return in particular, reflected the quality of their attachment with her. Two categories of attachment style were observed: secure and insecure attachment (Ainsworth & Bell, 1970). Infants with a secure attachment style were able to freely explore the playroom while in with the caretaker’s presence, check in with the caregiver from time to time, and limit activities in the caretaker’s absence. Children with an insecure attachment style focused their attention directly on the caregiver’s departure or reacted indirectly by avoiding or dismissing the attachment figure. Based on these observations, two sub-categories of the insecure attachment style were added: insecure-resistant/anxious and insecureavoidant. Insecure-anxious is described as the child showing a lot of

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distress over the caregiver’s absence, engaging in little activity in their absence, being hard to settle or calm him or herself at reunion, and displaying resistance or anger toward the caregiver. Insecure-avoidant attachment style is described as showing little distress when separated from the attachment figure. An insecure disorganized/disoriented category for attachment style was later identified by Main and Solomon (1986). Infants in this stage do not have effective coping mechanisms to help them deal with the caregiver’s absence or return and are reported to not approach the caregiver upon return, possibly due to fear or confusion.

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According to Bowlby’s attachment theory, an individual’s attachment style greatly influences his or her later social development. Generally, individuals who fall into the broader insecure attachment category tend to be less social with other peers than securely attached individuals, and have difficulty establishing close relationships, as well as maintaining them. Securely attached individuals on the other hand, tend to have more positive relational outcomes as they are able to form more secure relationships with peers and maintain these relationships. They also

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tend to have better self-esteem and better coping styles too (Kim, 2005; Shaver & Mikulincer, 2007). Reflecting back on the different attachment styles, can you match the attachment style resembled in the following scenario? Hamad, a 6-year old boy, starts to cry and cling to his mother’s feet as she leaves for the grocery store. When his mother returns from the store, Hamad does not approach her. What type of attachment style does Hamad most likely resemble? What are some of the attachment behaviours that Hamad has engaged in? Think of reasons for why Hamad might be responding in this way? How might his mother have responded to him in the past to create his response style?

Adult Attachment

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How many people are securely, insecurely or avoidant attached? Studies have examined this question and there are some consistent patterns. Despite cultural differences, as well as social and environmental factors that shape attachment (Agishtein & Brumbaugh, 2013), about 60% of the population can be considered securely attached, 20% anxious, and 20% avoidant (van Ijzendoorn & Bakermans-Kranenburg, 1996; van Ijzendoorn & Sagi-Schwartz, 2008). Before you ask why secure attachment isn’t higher, think of factors present in the attachment period; that is, socio-

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cultural factors going on in the first year of the child’s life or mother’s life which may prevent her from consistently responding to her child’s needs. She may be seriously ill or depressed. She may be living in poverty and has a number of other stressors to consider like housing, work, and bills. Perhaps an older sibling has died, or she is going through a divorce. Her husband may have disappeared in the midst of war and she has no support in raising the infant in addition to her other children. The infant may be ill and has to stay in hospital for several months. There are many reasons for which a mother (or primary caregiver) cannot establish a bond with her infant, so it is important to always consider the context in which people find themselves. Your attachment style generally remains stable from childhood to adulthood (Shaver & Mikulincer, 2007), meaning that the attachment style you develop with your primary caregiver tends to be same style used in your adult intimate relationships. Yet, this can be changed – to a degree. Let’s take a look at what the attachment styles look like in adulthood and you can consider what your relationships look like with your friends or significant others in your life. Secure Attachment: In this attachment style, individuals are able to love easily and be close to their partners without worrying about the relationship. They accept their partners for who they are and offer love and respect. They are able to communicate their needs directly and also able to share their feelings – good or bad – and are receptive to those of their partners too. People with secure attachment tend to have good self-esteem and don’t become defensive, or take things personally. They seek solutions to problems that will benefit both partners. Anxious Attachment: Individuals with an anxious attachment style want to be close to their partner, but feel the need to always accommodate the partner and their needs out of fear that they won’t be loved. They tend to worry about whether the partner really cares, means what they say, and whether they will leave. As a result, they focus on their partner too much and perhaps overlook their own needs. They may worry about negative things happening and project these onto the relationship when they haven’t happened at all. The anxiously attached person may threaten to leave, withdraw emotionally, or otherwise manipulate their partner into showing love and attention. Their anxiety drives them to do this, but if they are not careful, their need for closeness can backfire and send the partner running away. If anxiously attached individuals can identify that the problem is their anxiety and their management of it, they may be able to redress their

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attachment style. A patient, securely attached partner who can provide reassurance that their emotional connection is not lost and respond with love to the anxious person’s worry may, over time, help decrease the anxious attachment. Avoidant Attachment: In this type of attachment, individuals tend to avoid relationships and closeness. They may enter relationships, but not be fully emotionally available. These people are less comfortable sharing or showing their feelings with others and keep a mental distance as a way to reduce the need to get close. They might engage in behaviours to create even more distance, like frequent travel, working late, or ignoring a partner’s needs although, this can create the very situation they don’t want as the more they attempt to distance themselves, the more the other partner becomes needy for closeness, making them uncomfortable with the demands of intimacy. What type of attachment do you have? How does that show in your relationships? Can you identify the different attachment types in your friends or family members? How do you manage your needs for closeness and independence in relationships?

Piaget’s Developmental Model by Dr. Nausheen Pasha-Zaidi The pioneer of child development is Jean Piaget (1896-1980), a Swiss psychologist who argued that children have a different way of understanding the world than adults. According to Piaget (1972), children organize their thoughts and actions based on the schemas they learn. Schemas are mental models that we have of the world around us. Schemata (the plural of schema) can be thought of as index cards filed in the brain, each telling us how to react to incoming information. A simple behaviour like shopping is based on what you’ve learned about the actions associated with “shopping”. You pick something from the store that you would like. You take it to the sales counter. You pay for it with your card and wait for the cashier to pack the item in a bag. Then you walk out of the store. This is the schema for “shopping”. The next time you go shopping, you follow the same steps; it’s stored in memory. Sometimes, the stimuli you receive may not fit with your existing schema. So, what then? According to Piaget, you have options to help you adapt. These adaptations are known as assimilation or accommodation. In assimilation, you reuse existing schema to fit the new situation. For example, let’s say you’re shopping and you follow your normal schema,

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but this time when you get to the sales counter, the cashier says that the credit card machine is not working. You assimilate to this change by giving the cashier cash instead. The schema of shopping has not changed; you have just changed the way you pay. In accommodation, however, the change in the environment may be so different to your experience that you can’t fit it into an existing schema. This causes disequilibrium, an uncomfortable feeling you get when you don’t know how to act in a situation because it does not fit your schema. To get back to a feeling of calm or equilibrium, you accommodate the new information by changing your schema to include the unexpected stimuli. Back to shopping: you are at the store, you get to the counter with your item and the salesperson says that the counter is closed. Now, what? This is not part of your original schema so you have to change your schema to fit the new information. Child development, according to Piaget, follows a pattern of developing and adapting schemas. He believed that children go through four stages of development as they construct mental models of their environment.

Stage 1: Sensorimotor (Birth to 2 years of age) The sensorimotor stage gives us a hint as to how babies learn about the environment; in this case, through their senses (sight, touch, smell, hearing, and taste) and motor activity, movement. By wiggling around in their crib, they might kick themselves and over time, begin to learn that their foot is indeed attached to them, pain hurts, and the world begins where their feet and fingers end. Because their cognitive ability is not yet developed, they can only rely on their senses to learn about the world around them. Thus, everything goes in their mouth and over time, they start to inspect things in great detail, bang toys against the floor, and babble and squeal incessantly; all of this helps them make sense of the world around them and promotes their cognitive development. An important concept that babies learn in this stage is object permanence. For example, you show your baby brother, Abdul, a toy. You then take it away and hide it behind your back. Once Abdul has developed object permanence, he understands that the toy has not disappeared forever. It’s just out of sight, but a baby who has not yet learned this skill won’t even turn his head to look behind your back; he’s already forgotten the toy exists!

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Stage 2: Preoperational Stage (2-7 years) In this stage, children learn to think about things symbolically and begin to develop mental models. Here, Abdul plays pretend games and may talk to a make-believe friend or play drums with the housemaid’s pots. This stage is also characterized by egocentrism, which means that Abdul can’t understand anyone else’s point of view. Everything revolves around him and if the housemaid needs the pot to make dinner, Abdul is not going to let her have it and might scream to let her know he is serious! Parents often refer to this stage as the terrible two’s, when children want everything their way.

Stage 3: Concrete Operational Stage (7-11 years) Piaget considered this stage to be the turning point in a child’s development. Here, Abdul begins to learn logical or operational thought. When he studies maths, he can now add and subtract in his head. Once he has developed operational thought, he won’t need counters to find out that 6+4=10. Abdul also learns a concept called conservation, an understanding that the quantity of something stays the same even if the shape changes. Before this stage, you could trick Abdul when you poured a tall glass of water into a short wide one because he would think that the tall glass had more water in it. But, now that he has developed an understanding of conservation, he understands that the amount of water does not change just because it went from a tall glass to a short wide one.

Stage 4: Formal Operational Stage (Adolescence to adulthood) This is the final stage of cognitive development in Piaget’s theory. In this stage, a child learns how to think about abstract concepts. Abstract ideas are those that we can’t see, hear, touch, smell, or taste. They are ideas like morality – what is right and what is wrong, as well as hypothetical situations that are possible only in one’s mind and not in reality. This stage continues to develop into adulthood, so Abdul may be trying to understand new abstract ideas even when he is fifty years old! Another interesting thing happens in this stage and that is the return of egocentrism, for teenagers at least. This might explain why it’s tough for teenagers to understand their parent’s point of view; they tend to be focused on their own thoughts, desires and wants and while they don’t necessarily throw temper tantrums, they do tend to act out in ways that adults do not!

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This was a brief outline of Piaget’s theory and it is more detailed than what is offered here. You can look up more details about it as a learning activity. While this theory is a useful guide to development, it is not without criticism. Piaget's theory is criticized for not considering the role of culture and other people on cognitive development. All of the stages seem to suggest that the child develops these skills and abilities in the absence of people altogether and there is a strong focus on autonomy in contrast with Vygotsky’s theory below that is more focused on the interaction of children with their culture and society (Lourenço, 2012). Read on to contrast the two theories and see what you think.

Vygotsky’s Developmental Model by Dr. Louise Lambert Lev Vygotsky (1896-1936), a Soviet psychologist, was also interested in children’s development. His views differ from Piaget’s in that he put more importance on the effects of the social environment and children’s interactions in it. Vygotsky did not develop stages to describe development and much of his work had to be translated from Russian so it didn’t appear until later. In fact, Vygotsky died early in life from tuberculosis and as a result, his theory may seem incomplete. Yet, the ideas are still valid today so we include him here. Piaget believed that children’s brains developed first and this is what then allowed their cognitive development to proceed, but Vygotsky’s idea was that biological growth was not the first ingredient in learning. Rather, learning from others and interacting with them was what started development. Take an example like building a bridge out of toy blocks and you quickly realize that someone has to show you what a bridge looks like first and then someone has to show you how blocks work and what you can do with them, and then build a few things in your presence so you get an idea of what is possible for you to begin building that bridge yourself. Thus, children develop with the help of a few things. A More Knowledgeable Other. We learn from teachers, parents, siblings, and authorities. We watch what they do or they explain things to us, but their presence is needed to learn first and develop second. A Zone of Proximal Development. This refers to the space in which we have active learning interactions we those who teach us. In this learning zone, you might teach your nephew to tie his shoes or your niece how to braid hair. It’s a practice space where individuals learn small skills that together, make up larger learning. To learn these smaller pieces, scaffolding is used. Scaffolding refers to the temporary structures used by workers when constructing a building. When they need to get to the roof

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but the stairs aren’t yet built, they make scaffolding to bring themselves and their materials upwards. We learn in the same way. We learn in small pieces until we can put it all together and undertake the entire range of skills or competencies required. A zone of proximal development is also created during play, a way for children to develop cognitively and socially as that is where they learn to take the perspective of others. This happens with imaginary friends and the development of characters, like mommy and daddy. Children learn to think about situations from others points of view and develop empathy in the process. They develop vocabulary for the situations they create and learn to regulate their emotions and thoughts in response to the stories they build in their heads. When playing with others, children also learn new behaviours. For instance, “mommy” might choose not to cook in today’s game and go to work instead. Play helps children learn about the outside world; far from wasting time, play is a form of learning about the self and others. Private speech also occurs in the zone until learning is internalized. Private speech is indeed talking to yourself, but it’s specific to learning and we use this type of speech to regulate learning. When you’re playing tennis, for the first few times you’ll be talking to yourself a lot and saying things like, slow down, left foot first, quicker, keep a 90 degree angle on the racket and so on. You’ll say these things to yourself until you put all of the actions together and don’t need to think of them anymore. Thus, private speech involves the guidance we give ourselves, mimicking or copying others like when you’re learning a new language, you literally copy the sounds others make, and thinking through required steps. Children use private speech a lot – because they have so much to learn – but the difference with them is that they do it out loud and by age 9 or 10 realize this is something to do privately and internalize their speech thereafter like adults. Vygotsky put a lot of importance on language, and like Chomsky, believed that children’s language abilities were innate and critical for learning and cognitive development. Vygotsky also put a focus on the use of tools. These are the symbols, signs, images, logos, shared jokes, body language, expressions, technologies, and language itself that transmit meaning and from which we make sense of the world. Take “OMG!” for example. You and I share an understanding of what this means, but someone from Tonga might not. We share ideas through tools like “OMG” and create new ideas and meanings through these tools. Children learn problem-solving, meaning making, and communication from these tools. You can think of tools as

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aspects of culture as well. Thus, other people and culture help children’s social and cognitive development a lot.

Photo credit: Pixabay

Finally, Vygotsky believed that we develop cognitively through a process called co-construction. Both you and I influence one another simply by exchanging ideas and even being around one another. I watch the way you act, what you say, and you do the same with me. This forces a change in both of us, positively or negatively; we can’t help but influence one another. The idea is that we build a mental reality – even if for one minute – between us. We co-construct, or build a temporary reality together, and this is how we mutually influence one another through behaviours, ideas and even emotions. Is development necessary first for us to then act on our environments, like Piaget believed? Or do we develop through our interactions with the environment and other people, like Vygotsky proposed?

Parenting Styles by Dr. Ruba Tabari Parenting styles are psychological approaches used to describe how parents raise their children. Baumrind (1966) described three types: authoritarian, authoritative and permissive. They fall on a continuum with authoritarian parenting at one end and permissive parenting on the other; authoritative parenting falling in the middle. Let’s look at the some of the features of each of them.

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Authoritarian Style x x x x x x x x

Believes in discipline. Is strict about rules. Has a distant relationship with the children. Tells children off or is mean to them without worrying about their self-esteem or how they feel. Takes all the decisions for children. Wants children to be instantly obedient. Criticizes, labels and calls children names like “stupid”. Puts his/ her needs ahead of the children’s.

Authoritative Style x x x x x x x x

Believes all family members should have a say in making rules. Has good nurturing skills Teaches the child to be independent and to make healthy decisions. Has a close relationship with the children. Believes in everyone winning. Is a good listener. Uses constructive and helpful criticism and gives feedback that is useful and informative. Uses encouragement and discussion to guide children.

Permissive Style x x x x x x x

Has no clear rules or boundaries. Frequently gives in or allows the children to take control of situations. Is often surprised that children are out of control. Makes no attempt to be assertive. Always loses or gives in. Allows children to make all the decisions even when they are not good for them. Motivated by wanting the children to like them or be their friend.

These parenting styles are the most commonly discussed. Yet, crosscultural studies show that while many parents in the Western world use authoritative styles, this is not the case in the Arab world. How does it work in this part of the Arab world? Dwairy et al., (2006) found that the three styles overlapped creating different parenting patterns:

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x x x

Controlling-oriented parenting is a combination of authoritarian and authoritative styles. Flexible parenting combines authoritative and permissive parenting. Inconsistent parenting consists of permissive and authoritarian styles, two opposite styles.

In looking at the Arab world, Dwairy et al. (2006) found that the social and political influences in different countries affected parenting patterns in that country. For example, in Lebanon, Algeria, and Jordan, there was more flexible parenting. Stricter cultures such as Saudi Arabia had more controlling parenting patterns. Other differences found were with the first born who was normally brought up with a more permissive parenting style. Jaradat (2012) also found differences in parenting styles based on a family's socioeconomic status, education levels, and number of co-wives. Although it was a small research sample from Yarmouk, Syria, he found that the more income and the more education parents had, the more likely they were to use authoritative styles. Yet, when fathers had more than one wife, the tendency went from being more permissive (delegating parenting to mothers) or more authoritarian (emphasizing obedience and punishment as a result of weak emotional bonds with his children).

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In another study (Feldman & Masalha, 2010) comparing Palestinian Arabs and Israelis, father control at 5 months had opposite effects in both societies when the child was again retested at 33 months. The social competence (ability to join in group activities, form friendships, and cooperate with other children) of Palestinian toddlers whose fathers who took more control increased over time, whereas the control of fathers had the opposite effect in Israeli children whose social development was hindered by it. The researchers explained this difference by pre-existing cultural values. Palestinian society, they stated, was more oriented towards compliance and respect for elders and thus, more open to parental control, guidance and encouragement, whereas Israeli parents were more focused on the child’s autonomy and feelings, and thus, children were perhaps less open to parental control as it limited their feelings of independence. The main point of this study is that culture influences not only how parents interact with their children, but also the outcomes of that parenting. Thus, culture matters and what works in one culture may not work in another because of the prevailing values that exist.

ADHD in Children by Reinilda van Heuven-Dernison and Aleksandra Aslani Have you ever been to a kid’s birthday party? Noisy and chaotic, right?! Children are normally active, loud, impatient, and spontaneous; but, for some kids, these characteristics are so excessive that they interfere with daily functioning and become problematic. What is ADHD? Attention deficit hyperactivity disorder (ADHD) is a neurodevelopmental disorder seen in kids that affects attention, activity and impulsivity. While every child has problems in these areas, in kids with ADHD, the levels of inattention, hyperactivity and impulsiveness is far greater compared to their peers and difficult to control and manage. This causes problems for the child in settings like home, school, in peer groups and leisure activities and creates distress for everyone. What are the symptoms of ADHD? Inattentiveness is when children find it difficult to stay focused on one task for long and seem disorganised and get distracted easily. They may be forgetful, lose things and avoid activities that require planning. Imagine being 7 years old and playing a board game when you can’t pay attention, forget the rules, can’t keep track of who is doing what; you’d become tired quickly and want to quit! Overactivity is an excess of movement where children find it difficult to be seated or remain still. They squirm, play with objects, and

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get up oftenn in the classrroom or at thee dinner tablee. They switch h quickly from activitty to activity. Parents say that t they are all over the place p and teachers struuggle to reguulate them. Im mpulsivity m means they act without thinking of tthe consequennces and find it i hard to conttrol themselvees leading for the poteential to get innto dangerous activities. P Parents worry for their safety and teeachers compllain about the disruptions.

Photo credit: Pixabay

Whhat are the different d typees of ADHD?? Three subttypes are recognised aand this depennds on the sym mptom that iss the most dom minant in each case. W We recognise the combined d type in whicch both inatten ntion and hyperactivityy/impulsivity are present, the inattentiive type in which w the symptom off inattention is apparent an nd the hyperacctive/impulsiv ve type in which the hhyperactive/im mpulsive sym mptoms are m mostly display yed. The specialist caan also say if the t case of AD DHD is mild, m moderate or severe. Hoow do you diiagnose a chiild with ADH HD? Accordin ng to the DSM-V, thee symptoms shhould be pressent for at leasst 6 months. The T child should show w the symptom ms in two or more m settings and not only at school or at home.. It is also reeported that th he child is nnot able to function as expected at home, at schhool and in so ocial interactioons and the symptoms s cannot be eexplained by other conditions. Sometim mes parents minimize

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symptoms and then a teacher, school psychologist or doctor will recommend an evaluation be done. A clinical psychologist or child psychiatrist will make the diagnosis with the child, parents and teachers through clinical interviews, observations, questionnaires and other methods. How common is it? About 3%-5% of children are affected and it is three times more common in boys. What other problems do children with ADHD usually face? Children with ADHD have problems in relationships with peers and social interactions. They are usually rejected by other children due to their disruptive and impulsive behaviour and this can lead to low self-esteem and aggression. Children with ADHD can also have poor academic skills even when their cognitive ability falls in the normal range. It’s tough for these kids to meet the obligations of the classroom. Learning problems in reading, spelling and writing often exist. Problems in attention and concentration make it difficult to do well. There is also a likelihood of other behavioural disorders when a child with ADHD is aggressive, stubborn and oppositional and shows antisocial behaviour. ADHD is also related to emotional problems like depression and anxiety (Daviss, 2008).

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Does it look like ADHD when it might not be? Yes! Keep in mind that there are cases when a parent or a teacher complains about a child who might have a difficult temperament and only need understanding, boundaries and empathy. Some children are hyperactive, inattentive or impulsive in only one setting and this is not ADHD either. It might be bad parenting or lack of teacher control in the classroom! Also, when a child goes through a difficult phase in life, like a divorce, separation from a friend, loss of a loved one, change in school environment, or relocation, they can become restless or irritable. These symptoms may be temporary signs of stress and the child will settle over time. What causes ADHD? We don’t really know, but a review (Thapar, Cooper, Eyre, & Langley, 2013) offered a few possibilities. Genetic factors seem to play a role. Family, adoption and twin studies show that ADHD runs in families and is heritable and different genes are under investigation. From another view, neurochemical imbalances have been found and are supported by the fact that ADHD can be regulated with medication. Another theory suggests that ADHD is a result of brain abnormalities in regions responsible for executive functioning. Environmental factors may also be a cause: parental smoking, substance abuse, exposure to medication and stress may contribute. Perinatal circumstances also involve low birth weight and birth complications, while postnatal factors involve exposure to lead, consumption of artificial food additives, family environment and parenting styles. How do you treat ADHD? A management plan should be developed to educate the child’s caregivers, school personnel, and the child themselves about the diagnosis, what it is, how it affects the child, what they need to know and understand and what they can do to help. Medication is effective although it has side-effects. There are three medications for ADHD; Methylphenidate, Atomoxetine and Dexamphetamine decrease the severity of the symptoms of inattention, impulsivity, and hyperactivity. Medication is better than behavioural therapy alone especially when the child suffers from ADHD-combined type (Santosh et al., 2005), but attention should be paid to dosage (how much is given). Parent training programs are the most commonly used intervention and change the way parents interact with their children by applying techniques such as operant conditioning and modeling. While there are many variations, generally parents learn to recognize the antecedents (what comes before the symptoms) and the consequences of a behaviour and how to use reinforcements effectively. Cognitive behavioural therapy can also be used to improve the child’s social skills

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and teach mood regulation and anger management strategies. The principle behind the treatment is that behaviour, emotions and thoughts are linked. The thoughts made about a situation influence the way we feel about it and our resulting actions. Thus, a change in thinking can result in a change of actions and feelings. Other treatments include special education, occupational therapy, physical activity, and diet changes but all need to be chosen with caution and after a discussion with a clinician. Several studies show improvements in ADHD when children engage in greater physical activity (Pontifex, Saliba, Raine, Picchietti, & Hillman, 2013; Silva et al. 2015), as well as spending time in nature (Faber Taylor & Kuo, 2011; Wells, 2000) suggesting that having outlets in which to release stress and physiological activation where there is little distraction or competing stimuli may be beneficial. Children with ADHD also benefit from a well-organized home and consistent school routine where tasks can be broken down into steps and benefit from positive reinforcement, praise, setting goals and the use of logical consequences for behaving inappropriately, as well as compassion and love.

Anxiety in Children by Reinilda van Heuven-Dernison

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Were you afraid of the monsters under your bed as a kid? Me too! Anxiety, fear and worries are pretty common in kids; but, when normal worries turn to real anxiety, children’s development and daily functioning can be affected. What’s anxiety anyway? Anxiety is the feeling of worry or nervousness that is felt physically, such that an individual experiences an increase in heart rate and body temperature, sweaty palms, dry mouth, dizziness, ringing ears, or like they can’t sit still, have too much nervous energy, or have to use the bathroom. Anxiety is also experienced mentally and results in racing thoughts, a feeling that something bad is coming or even that they are going to die, a concern that everyone is looking at them, they won’t be able to cope with any stress at all. While that might sound awful, anxiety is a basic emotion and can still be adaptive. It’s the same feeling that happens when we are faced with an emergency of some type. You’ve heard of the fight or flight response, that’s basically what anxiety is. When someone is chasing you down the street, you get symptoms of anxiety and it is designed to alert you to a problem and provide you with the resources necessary to deal with that problem. So, if anxiety is very similar to the fight or flight response, why do we classify it as a disorder and if it’s a disorder, is it really that common and troublesome? Anxiety becomes a problem when it interferes with functioning. For example, in children, having anxiety can mean that they are afraid to make friends, go to school or join sports activities. Anxiety can also result in avoidance behaviour, actions taken to avoid the source of anxiety or settings that are likely to trigger anxiety in general. For example, anxious children may avoid presenting papers in front of their teacher and classmates or going to a busy mall. When the level of anxiety is too high it can become a problem in daily life and interfere with daily activities. Anxious children may feel so uncomfortable that they cannot talk to the teacher, are too anxious to sleep alone or cannot join a school trip. Anxiety disorders are common in adults, but they are also the most common mental health disorder amongst children (CartwrightHatton, McNicol, & Doubleday, 2006) and teens (Higa-McMillan, Francis, Rith-Najarian, & Chorpita, 2016; Merikangas et al., 2010). It can be tough to distinguish between normal and abnormal anxiety because children are fearful of many things anyway, like the first day at school or petting an animal. Further, they usually aren’t very good at communicating their feelings and thoughts and what they are fearful of. They might throw a tantrum instead or wet the bed. We also can’t give them a questionnaire like we do with adults. This is why a careful

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diagnosis is needed and the help of parents is useful as they know what is normal for their child. A good psychologist will always speak to parents to see how family events might contribute to the anxiety. In other cases, a school psychologist will make the diagnosis and include the observations of the child’s teacher too. It’s worth mentioning that stressors, like war or social unrest can also contribute to anxiety disorders in children and adults as well. Types of Childhood Anxiety Disorders Generalised Anxiety Disorder An excessive worry about multiple things, but none specifically. These children strive for perfection and seek constant assurance and validation from others. Panic Disorder

Panic or anxiety attacks come on suddenly and for no reason, and are followed by a fear of having another, losing control or “going crazy.” During panic attacks, children experience intensive fear, accelerated hearthbeath, shortness of breath, sweating, shaking or feelings of choking.

Social Anxiety Disorder

This disorder, also called social phobia, is marked by an intense fear of social and performance situations such as being publicly questioned in class, or starting a conversation with a peer.

Separation Anxiety Disorder

An excessive fear of being away from home and separated from parents or caregivers. They miss home and loves ones a lot when they are away even for a short time and fear being separated.

Obsessive Compulsive Disorder

Unwanted and intrusive thoughts (obsessions), feeling compelled to repeatedly perform rituals and routines (compulsions) to ease anxiety, like hand washing, or turning off lights.

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A refusal to speak in situations where talking is expected and that interferes with school and making friends. Instead, they chew/twirl their hair, stand motionless, avoid eye contact, or withdraw. Yet, they may be talkative in other settings. Parents are surprised to learn that their child doesn’t speak at school. The average age of diagnosis is around 5 years old, or when a child enters school.

Table 8-1

There are different types of anxiety and a psychologist has to determine which the child is showing. Here are common types of anxiety in children. Think about whether you’ve ever seen these behaviours in children and how it might affect their learning, social life, and health. There are many ways to treat anxiety. Children may benefit from simply knowing more about what anxiety is and what it does so that they can recognize their symptoms and not think there is something wrong with them. Otherwise, about 60 to 65% of youth with anxiety disorders who are treated with cognitive-behavioural therapy (CBT) show a reduction in anxiety symptoms following treatment (e.g., Kendall, Hudson, Gosch, Flannery-Schroeder & Suveg, 2008; Storch et al., 2013; Walkup et al., 2008). In this type of treatment, the psychologist will educate the child about anxiety and use exposure, a type of therapy whereby children learn to face their fears instead of avoiding the fearful situation or object. The psychologist will also provide a variety of techniques and skills to teach the child to recognize and challenge their irrational beliefs about the feared situation or object. Parents can be a big help when it comes to anxiety and psychologists will consider whether and how changes in parent behaviour can help in treating their child’s anxiety given that parental factors influence both the development and maintenance of anxiety in youth. For instance, when children are anxious about leaving home for the afternoon, parents shouldn’t be nervous for their child as this signals to the child that something bad may in fact happen, that there is a need to be anxious or worse, that the child should stay home to reduce the anxiety. Sometimes, parents try to protect their children and prevent them from feeling anxious, but this may in fact, strengthen the anxiety as it teaches the child to avoid what is stressful and robs them of the opportunity to challenge their anxiety. Parents should model confidence in a gentle and understanding

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way, but let the child know that it is normal to make social visits and anxiety can be tolerated even though it doesn’t feel good. Treatment for children with anxiety who have one parent with anxiety themselves often do worse (Bodden et al., 2008; Kendall et al., 2008) as the anxious parent models anxious behaviour on a daily basis and projects their anxiety onto the child. You know how your parents get when they worry about you, imagine what that would be like for one of them to have a real anxiety disorder, they’d be worried all the time, excessively, and perhaps try to limit your independence and freedom to make themselves feel better. Beyond a parent having anxiety themselves, many other issues influence a child’s anxiety. Parental overprotection, intrusiveness or controlling behaviour, a lack of acceptance or support, criticism and rejection, promotion of avoidance behaviour, how parents interpret situations (is it unsafe or risky when in fact, it’s fine), lack of attachment, marital conflict, and parental psychopathology all play a role in affecting children. In families in particular, what happens to one person affects everyone.

Children: Autism by Fiza Hameed Autism, a neurobiological developmental disorder, has its onset in the first three years of life and includes deficiencies in social relationships, speech and language delays, abnormalities in communication, and restricted, repetitive, and stereotyped patterns of behaviour. Children with autism have difficulty developing a theory of mind, especially in understanding other’s beliefs, perspectives and emotions. A recent review (Salhia, Al-Nasser, Taher, Al-Khathaami, & ElMetwally, 2014) found only three prevalence studies in the region for Oman, the UAE and Bahrain. Prevalence rates for Autism Spectrum Disorder (ASD) was 1.4 per 10,000 in Oman and 4.3 per 10,000 in Bahrain. The UAE study took a broader approach and looked at Pervasive Developmental Disorders (a bigger category of disorders that would include Autism among other disorders) and noted 29 cases per 10,000. Many causes are thought to underlie autism. There is some consensus in the research literature to suggest that autism is a brain dysfunction with abnormalities in brain structure and neurotransmitters (Anderson et al., 2009). Genetic factors also likely play a role in the development of autism (El-Fishawy & State, 2010; Shen et al., 2010) and there is increased risk when parents are related (Al-Salehi, Al-Hifthy, & Ghaziuddin, 2009), a finding not uncommon in the Middle Eastern region.

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Indeed, a separate study conducted in Saudi Arabia found that consanguinity (marrying a blood relative) was noted in 28.6% of ASD patients Saudi patients. This same study cited reasons behind autism rates and included the delay of breastfeeding (and no resulting colostrum intake, a nutrient in breast milk), while breastfeeding for up to 24 months seemed to reduce the risk of autism. High levels of lead, maternal or paternal age above 30 years at time of birth, and caesarian deliveries also seemed to increase the rate. Children with autism benefit from a well-structured environment, individualized instruction, behavioural therapy and small group instruction. Research and clinical experience show improved outcomes when intervention is applied at an early age, so there are annual regional initiatives to emphasize the importance of parental education and awareness, early diagnosis and intervention. Pediatricians have to be vigilant in detecting signs and symptoms as early as 6 months of age and instruct parents on early intervention and monitoring siblings at risk. They also have a crucial role to act as a child’s advocate in obtaining the appropriate therapy and education.

Children: Down Syndrome by Dr. Louise Lambert You may have heard of the term Down Syndrome and seen local organizations that serve individuals that have the syndrome (and their families). The UAE Down Syndrome Association is one group that helps to improve standards and quality of life for people affected by Down Syndrome by offering rehabilitation skills for their greater inclusion in society. But, what exactly is Down Syndrome? Where does the name come from, and why are the rates so high in this region? Down Syndrome was discovered by Dr. Langdon Down; hence, the name. He discovered the syndrome in 1866, so it’s not new, but it is more frequently diagnosed now. The word syndrome refers to a set of physical and mental traits that together create a diagnosis. Thus, a child born with only one symptom would not be considered affected by Down Syndrome—many symptoms must be present. In the case of Down Syndrome, the set of symptoms is caused by extra genetic material and explains why it is also known as Trisomy 21, which refers to the number of the chromosome that is affected. Every human has 23 pairs of chromosomes that split apart into 46. In the case of Trisomy 21, the 21st chromosome does not separate or split apart, and when the fertilized egg starts to divide, there remains an extra chromosome. Why it occurs is unclear. Although there are two other

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types of Down Syndrome, Trisomy 21 is the most common type, accounting for about 90% of cases.

Photo credit: Pixabay The extra genetic material causes many abnormalities. Babies with Down Syndrome tend to have distinct facial features with eyes that

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slant upwards, small ears, and small mouths. They also have poor muscle tone, called hypotonia, which makes coordination and muscle control difficult. They tend to have heart defects that occur in about 50% of cases, and eye defects. Sometimes, there are hearing defects that affect speech and language development and which require speech therapy. There also developmental delays (slower development progression than in other babies), that include intellectual disabilities of a mild or more serious nature. These health conditions often lead to other problems, such as respiratory infections or hearing loss. However, many of these problems can be treated. There are two types of tests to determine whether the syndrome will appear. The first is a screening test, such as an ultrasound or a blood test during the first or second month of pregnancy. This test can show if the fetus is at risk for the syndrome. The second is a diagnostic test, which shows if a baby actually has the syndrome. Diagnostic tests are done if there were abnormal results during the screening test. In the absence of these, a baby can also be diagnosed after birth based on their features and the results of a physical exam and blood tests. As it is genetic, there is nothing parents do to make this occur. Yet, the rates seem to increase as women approach their late 30s and 40s, although women have babies with Down Syndrome before this age too. The Center for Arab Genomic Studies (2013) suggests there is a higher incidence of Down’s in Arab countries which may be explained by consanguineous marriages (marrying a blood relative, which increases the risk significantly), having babies at an increased maternal age and having many children. In contrast with other countries where couples can get prenatal tests to detect whether the baby is affected, many countries in the region do not offer these and parents often do not realize their child has the syndrome until later, causing them to lose out on resources and supports that could have helped the child’s physical, intellectual and language development at an earlier age and reduced parental stress had they been made aware of the issue and better prepared. Rates of Down Syndrome in developed countries are about 1 in 1000 babies. Regionally, the rate is higher in the United Arab Emirates and stands at 1 in 319 babies, while in Oman it is 1 in every 500, and Qatar is 1 in every 546.

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Over to you now… 1. 2.

3.

4. 5.

6.

Do you know any children with anxiety? How do their parents respond? How would you respond differently if you were a parent? Were you an anxious child? Are you an anxious adult? What could you do in class for example, to handle your anxiety? What might a child do in a classroom to deal with anxiety and function properly? Discuss in your class groups. Do you have ADHD? Many adults do as they had it as children. Do you know children with ADHD? What are their issues? What does the family do about it? What is being done to help? If you had a child with ADHD, what would you do? What would you do as a teacher; what problems might teachers face in dealing with children with ADHD? Do you know any children with Down Syndrome? Can you describe their symptoms? What are they like as adults? Do you think there are cultural differences in attachment styles, such that some attachment styles may be more prevalent in some cultures than others, such as in the Middle East? Why or Why Not? Do you feel that one attachment style is more predominant in today’s world than other styles or do you feel that attachment styles vary greatly from region to region? Do an online search and find: Agishtein, P., & Brumbaugh, C. (2013). Cultural variation in adult attachment: The impact of ethnicity, collectivism, and country of origin. Journal of Social, Evolutionary, and Cultural Psychology, 7(4), 384-405. While it doesn’t directly address findings from the MENA region, it does suggest cultural differences about attachment related to honorbased collectivism. Read the article and take your best guess about what the findings would say if these studies were done in the GCC region. Discuss in small groups and consider your own attachment style and how it is affected by culture.

CHAPTER NINE ADOLESCENT AND ADULT DEVELOPMENT DR. LOUISE LAMBERT

Photo credit: Louise Lambert

Chapter Outline x x x x

Kohlberg’s Model of Moral Development by Dr. Louise Lambert Erikson’s Developmental Model by Thoraiya Kanafani Bronfenbrenner’s Ecological Systems Theory by Dr. Louise Lambert Gender and Gender Roles by Dr. Jane Bristol-Rhys

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Topic Box: Islamic Feminism and Gender by Dr. Manal AlFazari Later Adulthood: Physical and Cognitive by Dr. Tatiana Rowson The New “Old”: Challenging Assumptions about Age by Dr. Katharina A. Azim Cultural Differences for Care of the Elderly by Dr. Najma Adam Death and Dying Topic Box: Islamic Views on Death and Grieving by Dr. Najma Adam Over to you now…

In this chapter, we continue with development, only we focus on the concerns of adults. You’ll notice that the needs in this period focus more on social and relational issues, as well as work and career. As we conclude with development in this chapter, we also focus on death as dying is also a part of living and an important part of life concerns. We also explore sexuality, gender roles and everything to do with being an adult, like ageing. Read on and see how similar your concerns are for this period of your life and consider what theorists have had to say. Kohlberg, our first theorist, may help you to think about the role you’d like to take in society and why.

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Kohlberg’s Model of Moral Development by Dr. Louise Lambert Have you ever wondered how people decide what is right or wrong? Regardless of family or religious upbringing, the decisions we make often have a lot to do with what others around us are doing and sometimes, simply depend upon what we are most focused at that time. Lawrence Kohlberg (1984) developed his theory of moral development to explain these differences. As you read about the stages, determine in which you find yourself. It’s not always the one you think you’re at! Level Pre-conventional Conventional Post-conventional

Stage 1 2 3 4 5 6

Social Orientation Obedience and Punishment Instrumental Exchange Good boy/girl Law and order Social contract Principled Conscience

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There are three categories, or orientations in the model with 2 smaller levels in each. The major categories determine where people are most focused, that is on themselves, on others, or on values. These are called Pre-Conventional, Conventional and Post-Conventional. Let’s take a look at each. At the Pre-Conventional level, people make decisions based on what is best for themselves. They are not that concerned about what others think or higher abstract values. It’s the lowest level, and generally, most children can be located here. Although, some children can be quite mature in their moral reasoning and likewise, adults can be rather immature, so age is not a guarantee of where people will find themselves in these stages. In short, their reasoning is based on the consequences of their actions. In Stage 1, Obedience and Punishment, they obey the rules in an effort to either avoid being punished or to get a reward. You might think of little Omar not stealing a biscuit from the kitchen counter only to avoid being punished by his parents. He’s not avoiding stealing because he truly believes it is wrong, he just doesn’t want to get into trouble. It’s the same reason you don’t speed when you see a police officer, you don’t want to be punished with a fine. On the other hand, Sarah cleans her room not because she thinks it’s a good idea, but because she was promised a

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reward for doing it. In this stage, individuals are motivated by what they can avoid or what they can get by performing certain behaviours. In Stage 2, Instrumental Exchange, individuals will be a little craftier and recognize that different individuals have different needs. They try to satisfy the needs of others but only if theirs are met too. In essence, they follow a “you scratch my back and I'll scratch yours" mentality. Individuals cooperate with others if there is benefit from doing so. At the Conventional level, the regard and esteem of others becomes important and moral behaviour is influenced by what others think of us, like parents, friends, colleagues, employers, or authority figures. It’s not that decisions are taken out of fear of punishment; instead, they are taken because of a fear of people thinking we’re not worthy or acceptable, or that a decision might disappoint others. In fact, Stage 3 called Good Girl or Good Boy orientation is about wanting to please people and be seen as good. This is where the majority of people find themselves as we depend on the opinions of others for social belonging. Thus, you might not cheat on an exam not because you feel it is wrong or that you might get caught, but for the simple reason that if your parents found out, they would be ashamed and that would be the worst punishment of all. In Stage 4, Law and Order, individuals are also concerned about others but follow the rules in order for society to run smoothly. They believe it is their job to obey the rules in order for society to function properly. An example might be following the speed limit not because you are fearful of getting a fine, but because you don’t want to cause an accident, hurt others or cause delays that will affect everyone. Finally, the Post-Conventional level is where people make decisions based on values. According to Kohlberg, few people make it here probably because the pressures at this stage are strong. For example, people will not engage in certain behaviours, even when others do and when it is considered normal to do so, because it is against their values. They might be ridiculed as a result. Stage 5, Social Contract, is the level where people are aware of the rules and follow them for the sake of social harmony. They believe that if everyone followed the rules, it would be in everyone’s best interest and society would be able to grow and prosper and not only avoid problems. Finally, Stage 6, Principled Conscience, involves making decisions according to one’s own moral standards and personal values, which may contrast with those accepted in the broader society, like speaking up against the discrimination of a widely prosecuted group which no one seems to find a problem.

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Erikson’s Developmental Model by Thoraiya Kanafani Erik Erikson (1902-1994) was a German psychoanalyst who put forward a psychosocial theory that explains how individuals develop through life. He proposed eight stages across the entire lifespan wherein the individual confronts and surpasses new challenges. If these are not successfully completed, individuals can be forced to deal with them again later in life. For example, events like a divorce can force us to redo stages, while a career move or setback can result in going back to university as a late adult. Therefore, the successful completion of each stage depends on overcoming the previous ones. One thing is certain from Erikson’s (1968) model is that we are constantly changing and facing new challenges and these never stop throughout life. Continual growth is important throughout life and these challenges start right from infancy and follow us well into late adulthood. The eight stages are: 1. 2. 3. 4. 5. 6. 7. 8.

Trust versus mistrust Autonomy versus shame and doubt Initiative versus guilt Industry versus inferiority Identity versus role confusion Intimacy versus isolation Generativity versus stagnation Ego integrity versus despair.

Let’s see how Sara works through each stage and how the unsuccessful completion of each stage affects her. Erikson’s first stage begins in the first year and a half of life and is called trust versus mistrust. During this time, Sara is a baby and confused and unsure of the world around her. She looks to her parents for a sense of security and trust. When Sara’s parents provide consistent care and respond to her in a warm and caring manner all the time, she develops a sense of trust in current as well as future relationships. If this does not happen, Sara learns to mistrust and can begin to see the world as an unsafe place where no one can be relied upon. This will have consequences on her future relationships of all kinds. To help Sara develop trust, her parents can be consistent in her routine, spend time with her sharing stories and playing games, show her care and love. When Sara cries, both parents share the responsibility of making her feel safe and comfort her.

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Stage 1: Trust versus Mistrust Photo credit: Pixabay

The next stage, autonomy versus shame and doubt, begins at 18 months and continues until Sara is about three years old. In this time, Sara begins to assert her independence through physical development and mobility. The more she moves around, the more likely she is to move away from her parents and develop her skills and abilities. To help cultivate her independence, parents can give Sara space to be active while providing encouragement. For example, when she is learning to take her first steps, parents can encourage and make her feel happy that she accomplished something new. When Sara develops control over her physical skills and abilities, she gains a sense of independence. If not, she develops feelings of shame and doubt and is unsure as to whether she can master her environment.

Stage 2: Autonomy versus Shame & Doubt Photo credit: Pixabay

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Erikson’s third stage, initiative versus guilt, occurs during the ages of three to five. In these years, Sara begins to behave and speak in a confident manner more frequently through play and interactions with other children. When she learns to initiate or take the lead in her interactions with others, she learns to become more assertive and in control of her environment which leads to a sense of initiative and purpose. However, if Sara exerts too much control and power, she experiences disapproval from others which leads to feelings of guilt. Sarah’s parents can help her with this stage by encouraging a sense of exploration and discovery and encouraging her to take the lead and not trying to do everything for her.

Stage 3: Initiative versus Guilt Photo credit: Pixabay

The next stage, industry versus inferiority, occurs during the ages of five to twelve. Since Sara is at school now, she looks to her peers and teachers for approval and acknowledgment of her competencies and accomplishments. When she is able to cope with social and academic demands, Sara develops a sense of industry (i.e. feeling like she can accomplish tasks on her own in a successful way). If not, she develops feelings of inferiority and may feel less worthy than others. This is an important stage for children as it is the first time they will be away from home and forced to make friends on their own and take charge of themselves at school, like bringing homework to school, counting, reading and writing, as well as asking the teacher for assistance. School becomes an important source of confidence.

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Stage 4: Industry versus Inferiority Photo credit: Pixabay

Erikson’s fifth stage, identity versus role confusion, occurs during adolescence. During this stage, Sara wants to belong in society and needs to understand what her role is in her environment based on who she is, who she wants to be, and what is appropriate for her gender. If Sara develops an effective sense of self and personal identity, she can avoid many pitfalls in life and make better choices for herself. If not, Sara develops role confusion and a weak sense of self and this can lead to negative consequences. The important factor during this stage is social relationships.

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Stage 5: Identity versus Role Confusion Photo credit: Pixabay

Marcia (1966) further developed Erikson’s theory and proposed four types of identity development: identity foreclosure, identity diffusion, identity moratorium, and identity achievement. x

x

Identity foreclosure refers to the stage when people think they know who they are, yet have done so without exploration. In effect, they close the door before thinking about identity at all. An example might be in Sara’s career choice. Sara’s parents might have said to her at an early age, you’ll be the family’s engineer! Sara grows up hearing this repeatedly and does not question the decision made for her. She may decide this is what she wants to be only to discover later – after an expensive degree - that engineering is not for her and she only agreed because it was what her parents wanted. Choosing too early has consequences for happiness later. Identity diffusion is when a person does not have an established identity and is not actively searching for one. These individuals may be more likely to go along with others and conform to their views and behaviours in an effort to fit in. They do not have a clear sense of who they are and while they may not be concerned about it, they are not actively trying to figure out who they are either. Not knowing who one is can lead to bad decision making as friends have an influence in determining who you will be and what you’ll do.

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Identity moratorium occurs when a person explores and progresses towards identity achievement. An example of this happens when Sara spends lots of time exploring her own occupational choices, different interests, and talks to others to form her own ideas. She might still change her identity frequently, goth one week, nerdy the next, or sporty the one thereafter, but this exploration leads her to understand who she is, what she likes and dislikes and ultimately, what are her own values. This exploration can at times frighten parents, but in the end, leads teens to understand who they are and “achieve” a sense of self, like in the next stage. Identity achievement refers to when a person makes a commitment to a sense of identity. An example of this happens after Sara has actively explored a wide variety of options available and has gone through identity moratorium. Individuals who have achieved their identity tend to have better outcomes in life by knowing who they are, what works for them and what reflects their values best. They tend to pick careers that suit them, relationships that bring out the best in them, and have a healthy sense of self-esteem.

Conflicting roles may complicate the successful completion of these stages. For instance, if Sara has differing views from her culture or her familial traditions, she may struggle with developing her own identity without feeling guilty or she might feel as though she is betraying others. As this stage already occurs during an emotionally unstable period of Sara’s life (teenage years), it can become more difficult to handle such pressure. Erikson’s next stage is intimacy versus isolation, which occurs during young adulthood (18-40). During this time, relationships outside the family are explored and formed. When comfortable relationships are formed and a sense of commitment and safety within a relationship is felt, Sara forms intimate, loving, and strong relationships with others. If not, she may feel lonely and isolated. The important aspect in this stage is relationships and includes not only an intimate relationship and life partner, but relationships with friends too. As we get older, we become more selective about friends as we have greater control in choosing them, whereas in school, we choose friends out of availability.

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Stage 6: Intimacy versus Isolation Photo credit: Pixabay

The seventh stage, generativity versus stagnation, occurs during middle adulthood (ages 40-65). During this stage, Sara aims to feel like she is a productive part of society. She looks at the bigger picture in terms of work, family, and her contributions to society as a whole. When Sara is able to create and nurture aspects of her life, she feels a sense of usefulness and accomplishment. If not, she feels a sense of stagnation like she’s not progressing or moving ahead and experiences a shallow involvement in the world. The important aspects in this stage are work and parenthood.

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Stage 7: Generativity versus Stagnation Photo credit: Pixabay

The final stage in Erikson’s psychosocial development stages is ego integrity versus despair which occurs in mature adults (65 years +). During this time, Sara looks back and reflects upon her life, contributions, and accomplishments. When Sara is able to see her life as productive and fulfilled, she feels a sense of integrity and satisfaction. However, if Sara feels she was unproductive, or feels a sense of guilt over past actions, or regret for things she did not do or accomplish like life goals, she may feel dissatisfied, bitter and feel a sense of despair. The important aspect in this stage is reflection on life.

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Stage 8: Ego Integrity versus Despair Photo credit: Pixabay

How about you? What stage(s) are you at in your life right now? Write a few sentences about it in the box below. Think about your parents. What stage are they in?

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Bronfenbrenner’s Ecological Systems Theory by Dr. Louise Lambert

Photo credit: Louise Lambert Have you ever wondered whether your culture, religion, government or neighborhood had an impact on how you grew up? Changes are good that they did. In fact, social, cultural, structural and even physical influences are powerful in shaping how we think, what we do, and how we physically develop. Many developmental models are criticized for not taking into account environmental or social influences, but the next theory does. Developed by Urie Bronfenbrenner, the Ecological Systems theory (1979) takes these influences into account and focuses on individual, as well as environmental and social conditions. This model suggests that we are affected by everything around us and that we too, have an influence on those same contributors. He categorizes these influences as “systems.” Let’s begin with the microsystem, in which various people have the greatest influence on a child, like parents, siblings, grandparents and cousins. But, we also pay attention to the child too and determine how their physiological influences influence their development. For instance, if the child is male or female, has a disability, or disease of some sort. These things impact the entire life course of that child’s development. How the child’s parents use discipline, what type of parenting philosophy they

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ascribe to, how old they themselves are (old parents versus young parents do different things), and whether there are other children in the home and in what order the child was born (parents treat first born children differently than last born children) are also variables. So many things influence development. It is in this microsystem that interactions called proximal processes occur. These are activities where new skills are learned and include interactions like parents talking to their babies, siblings teaching younger siblings to use manners, grandparents teaching children to share. Proximal processes (proximal means “close” or in tight relationships) are a good example of a child learning from the environment and at the same time, parents and other siblings learning from the child too. These processes also suggest that close relationships are designed for learning skills, so who is in the microsystem is vital. As proximal processes occur in these relationships, one should consider the impact of children being looked after by nannies. Children in these situations may take on behaviours, accents, and worldviews that are not like those of their parents. Whoever is close to the children ends up invariably having an influence on them. As the child grows older, there are more interactions with the outside world, called the mesosystem, that include the child’s school and teachers, nursery, close neighbors, family friends, or other environments and people with and in which the child spends a lot of time.

Photo credit: Pixabay

The exosystem (“exo” means outside) involves the influence and interaction of other systems not directly related to the individual. The exosystem is a lot like the mesosystem in that it refers to the interactions versus the factors which have an influence.

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The macrosystem includes things like the socioeconomic system in which the child lives, high, middle, or lower class (i.e., how much money the parents make and in which social group they find themselves as a result). It involves government institutions and other organizations within society. It also includes a person’s race and/or culture, whether the country is highly developed and what type of government it has (i.e., a democracy, autocracy, or dictatorship as examples). These are perhaps not things that have such a direct identifiable influence but that do influence your chances in life and how others interact and respond to you. If your country is poor and undeveloped, you will have fewer job opportunities, be exposed to more crime and corruption, and find yourself with even fewer opportunities or rights, and less so, if are part of a cultural (or other) minority. This system changes over time as people in power change, resources are developed, technology advances, and political systems evolve. Your grandparent’s macrosystem will have been a very different one to yours and your child’s will also be different too. Finally, the chronosystem emphasizes social changes, trends, as well as stable influences over time. Examples here are the changes and stable features of the GCC countries. Many more girls graduate from university than ever today; in fact, it’s considered a normal thing for them to graduate at a higher rate than men. Yet, some things remain the same such as the emphasis on the separation of genders in many public places, and arranged marriages (although this is changing too). The chronosystem then can be thought of as the cultural ideas that persist or change over time. Another example would be divorce. Years ago, this was unheard of the region, but with the years, it has become more common. Think about how your ecology influenced your development. Compare yourself to a classmate from an entirely different background and together, explore how you are different and similar by going through the levels in this model. What did you discover about yourself? Does it make more sense now why you see the world and act the way you do? The environment in which we grow up plays a big role in life.

Gender and Gender Roles by Dr. Jane Bristol-Rhys A person’s sex is physical. You are either a male or a female because “sex” refers to the biological and reproductive differences between the two. Gender, on the other hand, is a more complicated concept that refers to the way a culture recognizes and acknowledges male and female behaviours and accompanying markers, like clothing, speech, temperament, jewelry, and hairstyle, which are used to culturally distinguish a man from a

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woman. These markers are not used only to distinguish a male from a female; they represent what are expected and acceptable behaviours. What is “expected” is what we are accustomed to seeing or hearing and is often thought of as being normal. Acceptable means that most people will agree that clothes or hair is within our definition of expected and, therefore normal. There is a lot of variation across cultures on what dress and behaviour is acceptable and the differences can sometimes make us uncomfortable when we travel to new places, or when an individual begins to act outside of the accepted rules or expectations we have for them. Along with behaviour, cultures and societies also distinguish between what are called gender roles. Like gender, gender roles refer to the accepted and expected functions (social roles) that men and women play in society. Accepted roles are those that are considered to be culturally normal, usually meaning that they are similar, if not identical, to the ways in which our parents and grandparents lived and the type of work they did. While acceptable gender roles vary from society to society, the most commonly accepted one is that men work outside of the home while women work inside, taking care of children and the home itself. This difference is often referred to as men being in the public sphere and women in the private. Since the 1960s and with the rapid development of the world, the distinction between public and private spheres is less rigid and now it is accepted for a woman to have a job outside of the home, to socialize with relatives and friends in public spaces and in some cases, to have a career that requires travel, public speaking, and social contact with others. This is the case in many of the GCC countries, where local women, a high proportion of whom are university educated, are working in government ministries, institutions and organizations, as well as running their own companies. This goes to show that gender roles can and do change over time.

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T Topic Box: Islamic Feminism an d Gender byy Dr. Manal Al-Fazarii

Photo credit: Pixabay

In order too discuss gennder from Isslamic feminiist perspectiv ves, it is important too understand how Islam viiews this conccept and distiinguish it from how it is culturally viewed v and misunderstood. m . Islamic Femiinism is a spiritual and social movvement that challenges thhe patriarchall idea of inequality annd discriminaation between men and woomen (Prado, 2006). In this regard, the two conncepts that arre related to gender and culturally c misunderstoood are equalitty and qawam ma; that is, pow wer and contro ol. In Islam, equaliity is assured d in men andd women's rellationship with each oother. The Prophet of Allaah says that ““Women are the twin halves of men” (Islamic Women‘s Weelfare Counciil of Victoria,, 1995, p. 3). Both men and women are treated d equally as both have riights and responsibilitties. Women’s rights havee been enshrinned in the Qur’an Q for 1400 years! Both men and a women have h the samee religious du uties, and Islam grantts women thee rights to be b respected as a mother, wife, a daughter andd a sister. A woman w has the right to keepp her own ideentity and individualityy after gettinng married by y keeping herr own family y’s name.

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Women also have the right to an education and to participate in trades and financial work, own property, and run businesses (Jawad, 1998). All of these rights are asserted and emphasized by Islamic feminism. These rights are reflected in many areas nowadays. Girls and boys both go to school and university, study the same courses, and have the same opportunities to join students’ societies and participate in social and cultural activities. Besides working at home as housewives, Muslim women have jobs that suit their nature and abilities such as in the areas of teaching, health, law, engineer, technology, and so on. Women also participate in different workshops, charity work and community services. In some cultures, there have been misapplications of Islamic rights as gender inequality is reflected in men’s power and dominance over women, and in women’s traditional roles in the society. That is because Islamic religious texts have been misinterpreted to encourage such discriminatory practices and attitudes towards women (Andren, 2007). Islamic feminism emphasizes the importance of women’s rights and obligations to society and to the family, and critiques the inequality and power differential between men and women (Sadain, 2009). Qawamah in Islam is defined as one of men's rights as they are the head of the household and their wives and children should respect and obey them. So, they have the qawamah over their wives. Allah says in the Holy Qur’an: “Men are the protectors and maintainers of women (qawamun), because Allah has given the one more (strength) than the other, and because they support them from their means” (Qur’an 3:34). In this regard, some men misunderstand the meaning of this concept and use it as power to control their wives and mistreat them because they believe that they have social and legal right to control women (Bedar & El Matrah, 2005). This belief comes from patriarchal and cultural beliefs that both men and women are not equal and men have authority and control over women. In Islam, marriage is the legal, social and holy relationship between men and women, based on love and mercy. In Islam, women are half of the society and must be treated with care and love. The Prophet Mohammed (PBUH) demonstrated a good example in respecting women by dealing with his wives with kindness and mercy. Nowadays, women in Arab and Muslim countries are increasingly being given their rights as they are achieving higher positions and jobs alongside men, but more work is needed. From Islamic feminist perspectives, cultural and traditional beliefs about women as well as misinterpretations of Qur’anic texts create many of the gender issues that we see around us. This is reflected in areas

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like wife abuse and the contradiction between beliefs and practices. Correcting people’s misunderstandings about male power and control over women is important so that people understand the rights that have been given to women by the Qu’ran and the Sunnah. This understanding can help societies demonstrate the essence of Islam in their dealing with women.

Later Adulthood: Physical and Cognitive by Dr. Tatiana Rowson The study of aging involves the study of longevity, the quantity of years lived, as well as one’s quality of life, how age-related changes affect daily functioning. This domain includes various fields such as biology, psychology and sociology. Longevity can be divided into life span and life expectancy. The human life span, the maximum longevity of humans, is about 120 years (you thought you were old!), while life expectancy refers to the average number of years individuals are expected to live. This varies according to geographic location, gender, ethnicity, and biology. Age-related changes involve physical and cognitive aging; cognitive aging includes both gains and losses, while physical aging typically involves a gradual decline that develops over time up to the point of death. There are two other terms worth understanding. Primary aging refers to processes that are unavoidable and universal, even in the context of good health (Busse, 1995). This type of aging is experienced by all of us and includes greying hair, a decline in hearing, wrinkles, loss of muscle tone and so forth. You have no control over these changes. On the other hand, secondary aging refers to the biological processes that happen as a result of environmental and lifestyle factors, such as a lack of exercise, poor diet, smoking and stress (Busse, 1995). In this section, we look at primary aging.

Physical Changes The musculoskeletal system changes over time. Loss of bone density causes stature decrease where older adults appear shorter than they were in younger age. Severe loss of bone density is associated with osteoporosis, a bone disease that occurs in both women and men when bones lose density (mass/weight), become weak and easily break in the course of regular movement like walking, bumping into a table or even sneezing. Sarcopenia, the technical term for the loss of muscle mass and strength

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that occurs with age, also means that longer recovery time from physical effort is needed with advancing age (Evans, 2010). In fact, the loss of muscle mass is estimated to be about 1% to 2% per year starting around the age of 50 (Hiona & Leeuwenburgh, 2008; Marzetti & Leeuwenburgh, 2006). Joints also degenerate with age and some individuals develop arthritis, swelling, stiffness and decreased range of motion of the joints that can cause pain and an inability to engage in daily activities like walking or climbing a few stairs. It tends to be more common in women, but men get it too, and while there are over 100 types of arthritis, the most typical become more common as age progresses. Cardiovascular and respiratory systems also become less efficient with the muscles of the heart more rigid than before. Also, due to hardening and shrinking of blood vessels, the heart's capacity to pump blood through the circulatory system slows down. The lungs also lose elasticity and capacity. These changes are worse for people who are sedentary (those who have little physical activity). The brain is also an organ of the body and it changes too. While it gains in volume until the age of 40 to 50 years, it begins to lose a little each year until it really begins to shrink around the age of 70 (Scahill et al., 2003; Terribilli et al., 2011). By the time we die, our brain volume is equivalent to what we had around the age of 7 years (Yeatman, Wandell & Mezer, 2014).

Cognitive changes The cognitive ageing process is not all about decline as stereotypes lead us to believe. For instance, fluid intelligence (Horn & Cattell, 1967), the ability to be flexible, adaptive and respond to novel situations increases in adolescence and then plateaus for a while, finally decreasing around 50 to 60 years of age and is thus, a good predictor of cognitive decline (Salthouse, 2012) as it has a physiological basis. Crystallized intelligence involves the knowledge learned and acquired through school, increases, or at least remains steady into one’s 70s and 80s (Park & Reuter-Lorenz, 2009). Further, information is not processed as fast in older adulthood, impacting memory and recall. Studies suggest that implicit memory (automatic, without conscious awareness) deteriorates with age, but not as much as explicit memory (deliberate, with conscious effort to recall) (Ward, Berry, & Shanks, 2013). Associative memory, associated with making connections between bits of information is affected by aging (Naveh-Benjamin, 2000), while autobiographical memory, memories of one’s experience, is not (Erber, 2013).

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Cognitive decline that naturally occurs over time and with age should not be confused with the type of decline seen in dementia, a severe and long-lasting disorder of mental processes caused by brain disease and characterized by problems with memory, changes to one’s personality, and impaired reasoning. Dementia tends to occur with age and is considered a disorder, while normal aging and its consequences is not. Further, while the total number of people suffering from dementia is increasing as more people are living longer, the actual percentage of individuals suffering from dementia is low. While there is no official data, it can be expected that in the Gulf region, the incidence of dementia is similar to that of other countries due to people living longer than before.

Emotional growth Studies on emotional aging suggest that age brings emotional growth and that older adults enjoy high levels of life satisfaction and emotional wellbeing (Scheibe & Carstensen, 2009). Older adults minimize negative emotions and tend to focus more on positive emotional memories (Charles, Mather, & Carstensen, 2003), making them less likely to suffer from mood disorders. They tend to have a better emotional adjustment as they age which is a component of successful aging. Other studies show that adults tend to experience greater meaning in life as they grow older, while the search for meaning in life tends to decline (Steger, Oishi, & Kashdan, 2009). Further, life satisfaction and positive emotion, which tend to decline in early to middle adulthood, increase as individuals reach the age of 50 and onwards (Blanchflower & Oswald, 2008). What are your thoughts on aging? Is it something you welcome or are nervous about? What about your parents? Are they aging successfully? How do you cope with their aging?

The New “Old”: Challenging Age Assumptions by Dr. Katharina A. Azim When I was 21, one friend after another got engaged. Soon after, I received wedding invitations and then photos of my friends’ babies started pouring in. On my wedding day I was 28 and I felt old. When I whined to my family about my age, my 40-year-old cousin confided she felt ancient, and my parents in their 50s complained they were treated as elderly. Who do we think of, though, when we call someone old, senior, elderly, or aged?

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Every culture has expectations of when certain life events should take place. We call these celebrations milestones or rites of passage when we change from one phase in life to another. At first glance it seems that everything important happens in the first three decades, like our first steps, the first school day, puberty, first love, marriage, and childbirth. With so much focus on the transitions of younger people, we forget that the lives of older adults are continuously changing. Even in psychology, you may have noticed that many popular Western theories on human development focus on children, adolescents, and young adults, and not much on adults above 40 or 60. Of course, if we do not really consider later life in our conversations, we can have misunderstandings and myths about adulthood and aging.

Photo credit: Louise Lambert

For example, when you watch TV or skim through the news, how are older adults represented? One myth is that all older adults become senile and frail. While certain cognitive or physical tasks may require more completion time, most older adults perform everyday tasks normally, like household chores, driving, working, and doing groceries. As the previous section explained, it is also a myth that every older person will inevitably suffer from Alzheimer’s or dementia. The World Health Organization estimates that about 6% of people above the age of 60 in the Middle East have dementia (Abyad, 2015). It is not clear if this number is accurate as there are no major studies that have recorded numbers for Alzheimer’s and dementia in the region. Part of this problem lies with the

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social stigma and the taboo of talking about mental diseases. Interestingly, one of the first physicians who wrote about gerontology – the study of aging – was Ibn al Jazzar in his work on the physical and mental wellness of older adults. Another prevailing myth is that older people are conservative in their views and cannot relate to youth. Especially during the Arab Spring, young adults felt misunderstood and thought their parents’ and grandparents’ generations were stuck in the past with inflexible attitudes. It is important to know that people from a certain social generation who are born within the same time range, also called a cohort, share specific historical events and cultural experiences with each other. Going through life-changing events with your peers like a revolution or a social movement can shape your perceptions on life. Despite this, there is a variety of opinions within any cohort and people’s views continue to shift throughout life. In fact, one study from the United States that compared generational cohorts found that changes in attitudes of people aged 60 and above were just as common as those among younger people and that older age did not necessarily hold conservative views (Danigelis, Hardy, & Cutler, 2007). Attitudes toward older persons can depend on the structures and values of society. For example, religious practices that are deeply ingrained in Arab cultures emphasize the respect older people in our lives should receive. Researchers found that in 26 different cultures on six continents, people perceived older persons as wiser and more knowledgeable (Löckenhoff et al., 2009). While older adults have had more years of life experience, it is nonetheless a myth that wisdom comes with progressive age. Wisdom itself is a complex concept that entails a person’s development of reflective judgment, insight, affect, responsibility, and humility among others (Marchand, 2003). With progressing age, we have more opportunity to practise these skills; however, not everyone gets a chance to use these opportunities. Supportive environments seem to hold the key to whether people develop and express wisdom. Finally, while we often speak about the physical, mental, and spiritual aspects in older age, there is one conversation that is generally avoided: intimacy and romantic relationships. In love and affection, older people are not all that different from younger ones. Emotional and physical closeness are human needs that do not disappear with older age. Yet, we do not think about our parents and grandparents in that way, so we avoid the topic altogether. The problem is particularly difficult for women. Their life expectancy can be up to 5 years longer than men in the MENA region and elsewhere. In cultures where we think about love and marriage

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belonging to a young age, it means that people who outlive their partners or those who are not in a partnership in old age may face social challenges in meeting new partners. In order to tackle this myth, we should not think of older age and intimacy as inappropriate but rather as a part of life.

Cultural Differences for Care of the Elderly by Dr. Najma Adam In order to understand cultural differences in caregiving for older adults, it is important to make an artificial separation by splitting the world into “East” and “West”. Asian, Arab, Mediterranean and Latin and African (among other) societies can be categorized as representing “Eastern” worldviews while European societies can be classified as “Western”. It is also important to understand that religious teachings, cultural socialization and familial practices impact caregiving for older adults. How people practise what they are taught can be further divided into socio-economic classes, geographic location, gender and personality factors. As you understand cultural differences in caring for adults, it is important to keep in mind that this discussion is a generalization; nonetheless, it is true that Easterners revere and value their older adults significantly as a result of having a collective orientation (placing themselves within their social group) while Westerners tend to be individualistic (placing themselves at a distance from their social group).

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In Eastern frameworks, older adults are considered the head of the unit, a valued and prized member whose life experiences and age are to be honored. For example, did you know that China passed the Elderly Rights Law, which demands that children visit their parents frequently or be fined or jailed? The Japanese are taught to be dutiful and respectful to their older adults as part of their cultural norms. Koreans have large feasts to celebrate their older adult’s birthdays. Arab, Asian and Latino families often live with their older adult members and will care for them rather than place them in nursing homes or live alone. It is generally understood that those from the Eastern cultural framework often have children as insurance, so someone can care for them as they age. Interestingly, in 2004, France passed laws similar to China’s Elderly Rights Law requiring children to maintain contact with their parents. Unfortunately, the law was necessary for two reasons. One, France has experienced a very high rate of suicide amongst its older population. Two, during one of France’s heat waves thousands of people were found dead, and most of them were older adults who were found days later. In the Western framework, given the emphasis on individuality, older adults generally live alone so long as they can care for themselves. When self-care becomes challenging, professional caregivers are hired to care for them in their own homes. Other options that allow for semiindependent living include assisted or semi-retirement facilities. When health limits the ability to live independently, nursing homes are available though they can be expensive and sometimes risky. Increasingly, as Easterners experience the challenges of a demanding lifestyle where all members of the household work to pay the bills, caring for older adults is no longer an option; thus, in the last two decades in the United States, a few cultural and religious retirement and assisted living facilities have emerged serving Asians and Hindus. From an Islamic view, it is a religious mandate to care for older parents and to respect and care for the elderly to earn good deeds. In fact, it is considered an honor and a great blessing to care for parents and an opportunity to repay them for their kindness in caring for you when you were young. The Qur’an (17:23-23) declares: “Thy Lord hath decreed, that ye worship none save Him, and (that ye show) kindness to parents. If one of them or both of them attain old age with thee, say not "uff" unto them nor repulse them, but speak unto them a gracious word. And lower unto them the wing of submission through mercy, and say: My Lord! Have mercy on them both as they did care for me when I was little.”

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Death and Dying

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Death is a sensitive topic and avoided as much as possible. There’s no doubt that death is stressful for the dying, but it is also stressful for their loved ones. Elisabeth Kubler-Ross (1969), a Swiss-American psychiatrist, developed five stages of grief that accompany the process of death that include the emotional, mental and spiritual experiences faced by survivors and those facing death themselves. Dr. Elisabeth visited and interviewed patients who were facing death since that was the only effective way to figure out how the process occurs and develops. If you remember from the chapter on research methods, sometimes interviewing people is the most effective method we have of gathering information. But don’t worry, Dr. Elisabeth didn’t sit there with a clipboard asking a bunch of impersonal survey questions, she would hold their hand and pass the afternoon listening to their thoughts and spent many weeks developing a relationship with each patient. Finally, she developed five stages from these experiences: denial and isolation, anger, bargaining, depression and acceptance. People are used to denying the idea of dying or suffering from a severe illness. We say that there’s no way it is going to happen, and the person is going to be fine in a couple of days, months or perhaps a couple of years. We respond with shock and denial and refuse to accept the facts.

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We may socially withdraw and stop talking to people or pretend nothing is wrong. This is the first stage that Dr. Elisabeth found. After patients or family members realize that nothing will be normal again, they become angry, frustrated, short-tempered and even demanding of doctors and medical staff. Anger can be expressed differently; patients could become emotionally upset with God, themselves or others. These patients can be difficult to handle and everyone around them may want to distance themselves from the negativity. Getting through anger, patients can feel a sense of self-pity asking questions like “Why me?! What did I do to deserve this?” This third stage also involves a little bit of optimism where patients begin to secretly bargain or negotiate between themselves and God. It is as if they’re asking for extra time before it’s over. Parents may ask for more time to see their children graduate and get married. In this stage, they’ve realised that they are the chosen ones and there’s no way out, but they still seek something extra, a spark of hope to avoid the reality of the upcoming grief. During the fourth stage, depression, individuals lose hope and say things like “Why bother with anything? I might as well give up and stay sad till I die” or “My life is in shambles, no point of it anymore”. Patients worry about the wrongs they’ve done and how much the situation is overwhelming everyone around them and may deprive themselves of spending time with others. They may become withdrawn, depressed and trapped in their thoughts, although not expressing their feelings can make it worse. These patients need to feel comfortable to express what they’re going through and it might not always be family as family members are too close and become emotionally reactive themselves. Once patients or family members come to terms with the situation, they gradually achieve acceptance. It doesn’t mean they are happy, but rather, they accept what is happening and try to make the most of the time they have left. If patients and their family members can make it to this stage, they can go through what is called a good death, a positive, supportive end for the person in question and a positive experience for those left behind who were able to say their last goodbyes and end the relationship by wishing the person well into the next world. Keep in mind that not everyone passes these five stages; some don’t even make it halfway, since death can be sudden, inevitable and uncontrollable. Others get stuck in certain stages like anger and so, they fight death all the way. While this model was put forward as “common stages of grief”, there may be cultural and personal variations depending on one’s beliefs, religion, and relationship with the person (your mother dying of old age versus a neighbor you haven’t seen for months). In the

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Arab world, there is less anger as people believe both life and death are written or determined by God, so this makes death more acceptable, whereas Western cultures might look at death (i.e., car accident by texting) as a person’s stupidity and be really mad. Coping with loss is a very deeply subjective experience, because no one will fully understand what you’re going through other than you. No one will be able to make it easier as it is indeed a loss, but there are things you can do to make it better. Sometimes we get too caught up in the moment and decide to give in when we lose someone dear to us, but have you thought of ways to make it easier on yourself? Give yourself the chance to feel as sad as you need to. It’s okay to feel sad because it would be inhumane to not feel anything. Your grief can last for a day or a month, but remember that time really does make the pain lighter. You can also find ways to remember your loved one and the good times you shared together. You can think of ways to celebrate or honour their memory by planting a garden or keeping certain belongings and cherishing them as a reminder of that person.

Topic Box: Islamic Views on Death and Grieving by Dr. Najma Adam

Photo credit: Louise Lambert

Muslims are required to believe in the hereafter, or afterlife, as a tenet of their faith. In addressing death and dying in Islam, it is important to understand that physical death is connected to three interrelated lives of mankind. First, life in this dunya (world), which is physical and limited in scope; second, intermediate life (in the grave) which is another

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dimension and also limited; and third, the eternal life (akhirah) which is the final state of existence for all souls. Muslims believe that life on this earth (dunya) is temporary and consists of trials intended to separate the faithful believers from the disbelievers and those who followed Iblis or Satan (because remember, the agreement between Iblis and God was that Iblis would turn souls toward him and away from Allah). Since conduct in this life determines whether the believer will go to heaven or hell, both permanent and eternal, it is critical that Muslims strive to please Allah and follow His commandments. In other words, pass the trials through sabr, or patience, with the understanding that the benefits will be delivered in this dunya and/or akhirah (hereafter.) Islamically, death is not to be feared if one has lived a righteous life, consistently repents to Allah and strives to serve only Him. In this regard, death is only a passage to a beautiful abode, richly described in the Qur’an as a place where one can partake in all the pleasures known and unknown in this world. In fact, one of the oftrepeated hadith (sayings of the Prophet Mohammed) states that a child enters the world crying while those around him smile. Yet, when he dies, he will smile (assuming he led a righteous life), while those around him will cry. The belief in the hereafter should provide Muslims with the incentive to use their free will to choose the path as dictated by the Qur’an and the Sunnah (Prophet Mohammed’s living example). If, however, a Muslim chooses to disbelieve in the basic Islamic tenets and leads a life of sin then surely hellfire awaits. This too is described in the Qur’an. Muslims believe that physical body ceases to exist through death, but the soul, or nafs, does not die. Thus, the departure from this world leads to an intermediate world in the grave (al-barzakh), where the soul begins to benefit or suffer from the deeds performed on earth. In the grave, the soul will be asked three questions: 1) Who is your Lord? (Allah) 2) What was your religion? (Islam) 3) Who was your messenger? (Prophet Mohammed) Once the questions are answered correctly, the gate of paradise will be opened so that she can see where she is destined. The gate to hell will also be opened to show what was avoided by leading a righteous life. The disbeliever will also have the gate to hell opened so that she can see where she is destined while the gate of heaven is shown to demonstrate what could have resulted had she made different choices. Finally, akirah is the permanent hereafter and is the final abode of all souls and has two outcomes – heaven (jannah) or hell (jahannam).

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Allah decides the soul’s final fate based on her deeds, accounted for on judgment day when all souls are gathered before the Almighty and a scale will measure their actions on earth. The Qur’an reminds Muslims that not an atom’s weight of good or bad will be overlooked (Qur’an 99:6-8). The soul will see, as if she’s watching a movie of her own life, how she lived and the consequences of her actions. If she followed her Islamic teachings and pleased Allah, she will enter heaven, but if she has not, then hell awaits her. From an Islamic view, it is not just Muslims who are heaven bound. Muslims believe that Allah is the final judge of one’s deeds and, more importantly, the intention behind such deeds. Thus, it is important to focus on one’s own relationship with Allah and not be critical or judgmental of others. Death and dying in Islam signify an end to earthly life and the trails associated with it, but do not indicate an end to one’s existence. Instead, death is a passageway to the next realm of existence. For the believer, death is one step closer to the beatification vision – when the pleasure of all pleasures will be provided to those in heaven: that of seeing Allah’s face (Qur’an 75: 22-23).

Over to you now… 1.

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In what level did you find yourself in Kohlberg’s moral reasoning model? Do you take decisions based on your values or on what others are doing? Or, do you take decisions based on what you think would make your parents proud? Have you taken decisions based on your values even when it wasn’t popular and you were ridiculed for it? What level would you say most people in society tend to rely on for their decisions? What would happen if more people were at the personal values level? Would society be a better or worse place? How have gender roles changed where you are from? How are they changing now? Consider what was acceptable for your grandparents and parents, and finally yourself. For what gender are roles changing the most? Why do you think this is the case? What result are these changes having in society overall? Discuss with your classmates. What are your thoughts on caregiving for older adults? Who will care for your parents? Think critically about this question; you will likely be working and perhaps your spouse too. How will you manage this event when the time comes?

CHAPTER TEN COMMON DISORDERS DR. KHALID ELZAMZAMY

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Chapter Outline x x x x

How Do We Decide What is a Disorder and What Isn’t? Definition of Psychological Disorders What Causes Psychological Disorders? Topic Box: Mental Illness: An Islamic Perspective by Carrie York Al-Karam

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x x x x x x

The Biopsychosocial Model Clinician's Approach to Psychological Disorders How Many Psychological Diagnoses Are There? Mental Health and Muslims by Dr. Rehman Abdulreham Topic Box: Cognitive-Behavioural Therapy for Depression by Dr. Louise Lambert Over to you now…

During my psychiatry rotation in medical school, we were scheduled to have a case presentation. A patient was brought in, a well-groomed man in his mid-twenties and our professor started interviewing him asking questions like, “Why are you here?”, “How are you feeling?” and “Is anything bothering you?” The patient was listening quietly and I could see that he was suspicious of us. Suddenly and aggressively, the patient said, “You all are oblivious of my special status. All of you are jealous of what God has given me. You all are trying to stop and resist me. All the prophets have been fought against!” The professor asked: “What do you mean by special status?” “I am not a Prophet, but God speaks to me. I hear the Adhan (Call to Muslim prayer) in my ear all the time” the patient responded. He also added, “I hear a message from God so that I can warn people about the Day of Judgment that is about to start.” I was startled at what I was seeing, especially given the religious nature of what this person was saying. At the end, he was deemed psychologically disturbed and admitted to the psychiatric hospital to start receiving treatment which, in his case, included medication. He was discharged from the hospital a few weeks later and his behaviour returned to normal. This event brought to memory the story of some Prophets sent by God, when they first declared that they were receiving revelations and were accused by their people of being insane, possessed by spirits (Jinn) or afflicted by magic. What is it about this person that made the professor decide he needed treatment? What was his diagnosis? This person suffered from a psychological disorder called “schizophrenia” in which a person experiences disturbances in their thinking process, perception, emotions and behaviour. We’ll talk about schizophrenia later, but this is one example where people present themselves or are brought in to psychiatric clinics, mental health settings and behavioural health departments. Others suffer from obsessive-compulsive disorder, major depression, phobias, posttraumatic stress disorder, anxiety or other disorders we’ll review in this chapter.

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How Do We Decide What is a Disorder and What Isn’t? For you to understand the importance of this question, reflect on the following cases: A woman feels sad after her divorce. Everyone is concerned as she hasn’t been seeing her friends for the last two months, or eating well. Does she need medication, psychotherapy for depression, or time to feel better? A man committed a crime and as the case is brought to court. He claims that he was not in his full mental capacity at the time. Therefore, he argues, he shouldn’t be held accountable. How do we decide whether he should be sent to prison or a mental hospital? A Muslim child with an intellectual disability has reached the age of puberty. His mother is concerned that he should start performing his five daily prayers. She knows that a person who is insane is not obliged to pray, but she is not sure if her child’s intellectual disability is severe enough to excuse him from his religious obligation. As you can see, the answers are not always clear and depend on many things, like the psychological diagnosis for one, but also the law, culture, religious factors, age, and circumstances. Psychological disorders have a wide range of medical, personal, social, legal, cultural and religious implications and are never determined with a narrow focus on symptoms alone. Context matters greatly.

Definition of Psychological Disorders You’ve already studied different psychological functions such as emotions, learning, thinking, memory, sleep and consciousness. What do you think the definition of a psychological disorder might be? If you think about what you’ve learnt about normal psychological functions, you may have guessed that a psychological disorder is any disturbance in one of those normal psychological functions. A disturbance in someone’s emotions and mood can take the form of depression. An intense feeling of worry might be anxiety. A disturbed perception and bizarre thinking can be psychosis (as in the case of schizophrenia). An abnormal social communication, social interaction and behaviour in a child may be autism spectrum disorder. Therefore, abnormal psychology (other terms are also used including psychological disorders, mental disorders and psychopathology) is the study of abnormal behaviour and mental processes. A line needs to be drawn between normal and abnormal. In order to do that, mental health experts have established three main criteria to

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define a mental disorder. Take a look at this definition set forth by the Diagnostic and Statistical Manual of Mental Disorders - Fifth Edition (also known as the DSM-V), which by the way, is the book that is used by psychologists, psychiatrists and other healthcare workers to evaluate and diagnose mental health patients. According to the DSM-V (2013): A mental disorder is a syndrome characterized by a clinically significant disturbance in an individual’s cognition, emotion regulation, or behaviour that reflects a dysfunction in the psychological, biological, or developmental processes underlying mental functioning. Mental disorders are usually associated with significant distress or disability in social, occupational, or other important activities. An expectable or culturally approved response to a common stressor or loss, such as the death of a loved one, is not a mental disorder. Socially deviant behaviour (e.g., political, religious, or sexual) and conflicts that are primarily between the individual and society are not mental disorders unless the deviance or conflict results from a dysfunction in the individual, as described above. (p. 20) Here are three elements worth highlighting in this definition: 1- Clinical Syndrome: “A mental disorder is a syndrome characterized by clinically significant disturbance in an individual’s cognition, emotion regulation, or behaviour that reflects a dysfunction in the psychological, biological, or developmental processes underlying mental functioning.” Syndrome refers to a cluster or group of signs and symptoms that occur together and characterize a specific abnormality or condition. Thus, an important element to determine (diagnose) a psychological disorder is to be able to identify and recognize the characteristic group of symptoms and disturbances for each disorder. For example, while Amna follows a strict diet to lose weight, she is not necessarily diagnosed with an eating disorder that is common among young females and known as anorexia nervosa, unless her restriction of food leads to significant weight loss (1), with an intense fear of gaining weight or of becoming fat (2) and associated with a disturbance in the way she views her body weight and shape (3). These three signs make up the “syndrome” and will include a time frame because it is not enough to feel like this for a few days as that would include most people. Each disorder has specific criteria and each is found in the DSM-V. 2- Impact on Quality of Life: “Mental disorders are usually associated with significant distress or disability in social, occupational, or other important activities.”

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A further criterion between normal and abnormal is that mental disorders are maladaptive and harmful to one’s physical and psychological well-being, meaning the behaviours and thoughts do not serve the person well and negatively impact their quality of life and daily functioning. Again, you don’t qualify for a mental disorder just because you’re a bit odd; that would include most of us, it has to interfere with life in an important way. But, how do we determine how much interference is normal? The global burden of disease is a measure developed by the World Health Organization (WHO) to assess how much a disease weighs in importance. It measures the years of life lost due to premature death and years of life lived in poor health or disability due to an illness or disorder. This is measured in a unit called “disability-adjusted life years” (DALY). If we take smoking for example, it causes health problems including respiratory problems, cardiovascular problems and cancers. Smokers may suffer premature death or struggle for years because one of these conditions affects their daily activity and quality of life. In the year 2000, smoking was responsible for about five million deaths and 59 million DALYs in the world which accounts for 4% of the total global burden of disease (Rodgers et al., 2004). This means that in the year 2000, smokers around the globe lost 59 million years due to premature death or disability.

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The WHO estimates that 7.4% of global DALYs are caused by mental and behavioural disorders. Major depressive disorder carries the heaviest burden, accounting for 2.54% of all global DALYs. You might be unclear as to how a mental disorder can remove years of life; after all, it’s not a physical disease. Take Ammar who has struggled with depression for

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some time. Ammar frequently doesn’t feel well and doesn’t show up to work. He has used all his sick leave and now taking unpaid leave. He doesn’t feel like getting out of bed and is uninterested to meet people at work and is not as productive as before. This situation has led him to lose his previous job and he is near losing this one too. This has led to conflict between him and his wife as he no longer earns enough money to support the family. Ammar is feeling that life is not worth living. He hasn’t thought of committing suicide, but he’s been feeling worthless. Ammar’s case as well as those of others who suffer from major depression shows that mental distress can have a substantial impact on many aspects of a person’s life. Depression can decrease a person’s productivity at work and increase absenteeism resulting in lowered income or unemployment. It can negatively impact social interactions and close relationships. People who suffer from major depression are more likely to commit suicide (Lépine & Briley, 2011). Mental health matters. 3- Cultural Acceptance: “An expectable or culturally approved response to a common stressor or loss, such as the death of a loved one, is not a mental disorder.” Culture is the behaviours, ideas, attitudes, values, and traditions (including religion) shared by a group of people and transmitted from one generation to the next. Accordingly, the DSM-V has expanded the section on culture to encourage mental health clinicians to appreciate its impact while dealing with psychological and mental disorders. According to the DSM-V, the boundaries between normality and pathology vary across cultures for specific behaviours. Culture has a big impact on all levels of dealing with psychological disorders starting with the expression of symptoms, signs, and behaviours that are criteria for diagnosis, coping strategies and endorsements of certain help seeking attitudes, behaviours and options including alternative and complementary health systems (which may include faith healing using “Islamic Ruqya” for example). Culture may also influence acceptance or rejection of a diagnosis and adherence to treatments, affecting the course of illness and recovery. For example, according to Islamic traditions, after the death of her husband, a widow is expected to spend a period of mourning that may extend up to 4 months and 10 days, during which she is not expected to go out of her house except for necessities. This may be interpreted as social isolation in non-Muslim contexts and may be viewed as a component of major depressive disorder. However, in Islamic cultural and religious contexts, it is a normal and acceptable practice. Knowing the cultural and religious expectations, an informed clinician should not interpret this as dysfunctional unless it extends far beyond this timeframe and even then,

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we would have to consider other circumstances in this person’s life which may explain her behaviour. As noted in the previous two elements for diagnosing a mental disorder, unless the person’s symptoms meet the clinical criteria for major depressive disorder and unless it has an impact on her functioning, it wouldn’t (or shouldn’t) be diagnosed as a mental disorder.

Topic Box: Mental Illness: An Islamic Perspective by Dr. Carrie York Al-Karam

Photo credit: Pixabay

Psychology from an Islamic perspective is holistic, taking into account all aspects of the human being – the physical body including the brain, cognitive and behavioural processes, as well as the soul. When there is a problem with any aspect of human behaviour (i.e., a malfunction in the brain, a hormonal imbalance, disturbed perceptions, or spiritual disease), an individual can develop psychological distress. Whereas mental illness within a mainstream psychology framework is understood to be a distressful way of thinking, feeling, or acting, an Islamic framework further includes spiritual disease. Fitrah - The Nature of the Human Soul. The Islamic belief is that all human beings are born in a pure spiritual state called fitrah, which is the belief in the oneness of God (tawhid). When one’s fitrah has been tarnished or corrupted, a person can become distressed, which sometimes

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presents as mental illness. That’s not to say that all individuals who have mental health issues have a spiritual problem; rather, a spiritual cause must be considered as part of the equation. It is within this holistic Islamic framework that mental illness can be understood, diagnosed, and treated. Diseases of the Heart. Prophet Mohammed has said “Beware! There is a piece of flesh in the body, if it becomes good, the whole body becomes good, but if it gets spoilt, the whole body gets spoilt, and that is the heart” (Bukhari, book 1, volume 2, hadith 49). This hadith not only highlights an interrelationship between the physical, psychological, and spiritual dimensions of the human being, but it also brings attention to a central concept that goes hand in hand with psychopathology - diseases of the heart. Whereas modern psychology understands mental illness as a problem with brain function or environmental factors (the nature versus nurture question), Islamic psychologists look to diseases of the heart, harmful beliefs and behaviours that corrupt the soul, harden the heart, and can present as psychological distress. Disbelief in God, forgetting God, or engaging in behaviours that are unlawful in Islam all contribute to corrupting the heart, which is the physical and spiritual organ in which the soul resides. Spiritual disease affects behaviour and thought processes and vice versa. Many practices are believed to rid or purify the heart of disease and promote spiritual and psychological wellbeing. Practises like dhikr (remembrance), salat (formal prayer), duaa (supplications), ruqya (Qur’anic healing) and even fasting and giving charity are believed to have healing properties. Research on these and other spiritual practices seems to support the idea that when an individual engages in such activities, they have better mental health outcomes and less psychological distress.

What Causes Psychological Disorders? You now have an idea about how psychological disorders are defined and how to distinguish between what is normal and what is pathological. But, you may wonder, why do people develop psychological disorders? What makes one person get a psychological disorder, while another won’t? Throughout history, people have searched for answers to this question. The Greek physician Hippocrates (c. 460 – c. 370 BC) incorporated the four humors model into his medical theories and believed that certain emotions and behaviours were caused by too much or too little body fluids (called "humors"): blood, yellow bile, black bile, and phlegm. This theory was adopted and modified by Arab and Muslim

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philosophers. Ishaq Ibn Imran, a Jewish Arab philosopher of the 10th century believed that melancholy (sadness) could be hereditary, passed on to children through malfunctions of the sperm or uterus, or acquired independently from biological influences due to certain imbalances. Avicenna (980–1037 AD) in his Canon of Medicine reintroduced some of the previous theories with modifications and presented new concepts for understanding psychological disturbances. Many philosophers and scholars who lived during the Islamic civilization proposed explanations for puzzling behaviours and conditions. Imam Abu Zayd Al-Balkhi who lived in the late 9th century wrote a famous psychological treatise titled Masalih al-Abdan wa al-Anfus, which translates into “Sustenance of the Body and Soul”. In it, he classified three types of depression: everyday normal sadness, endogenous depression (originating within the body, i.e., biological) and reactive depression (originating from outside, i.e., situational), which is near to how we understand depression today. A popular belief across many cultures and historical time periods is to attribute psychological disorders (as well as some physical disorders and other ailments) to supernatural occurrences and beings such as spirit possession “Al-mass bil-Jinn”, the evil eye “Al-Ayn” and black magic. People who hold this belief would seek help to cure their psychological ailments including faith healing. However, the current scientific frameworks for mental disorders, psychology and medicine are focused on evidence-based practices, and since supernatural phenomena can’t be explained by science, they are not considered as causes for mental or physical disorders in the field of psychology.

The Biopsychosocial Model Many models and frameworks have been proposed to provide an understanding of how and why psychological disorders occur. The biomedical model and the biopsychosocial model are most popular. The biomedical model emphasizes biological factors being the causes of disorders that include genes, microorganisms, chemical imbalances and functional (organic) disturbances. The biopsychosocial model emphasizes that an interaction and dynamic relationship between biological, psychological and socials factors determines psychological well-being and illness. The model proposes that it is not one factor which causes psychological disorders but interactions between many.

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Biological Elements Many connections between psychological disorders and biological elements have been established and genetic predispositions, neurotransmitter imbalances, brain functions, infections and the effect of trauma have all been researched. Let’s look at a few examples of these categories.

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Genetic evidence: There is evidence that identical twins may develop similar phobias even when raised separately (Carey, 1990), giving weight to the impact of genetics. Mood disorders run in families, such that the risk of major depression increases if you have a parent or sibling with the disorder (Sullivan et al., 2000), while the nearly 1-in-100 odds of any person being diagnosed with schizophrenia drops drastically to about 1-in10 among those whose sibling or parent has the disorder, and close to 1 in 2 if the affected sibling is an identical twin (cited by Myers, D., 2010). Brain and neurotransmitter evidence: According to Mataix-Cols et al. (2004), the brain scans of people with Obsessive Compulsive Disorder (a disorder characterized by obsessions, intrusive thoughts or unwanted urges, and compulsions, repetitive actions and behaviours the individual feels forced to do in response to an obsession) show higher activity in certain brain areas during behaviours such as compulsive hand washing, checking, ordering, or hoarding (a need to save items and resulting distress in the face of getting rid of them). Norepinephrine and serotonin are neurotransmitter systems that play a role in mood disorders. Norepinephrine, which increases arousal and boosts mood, is low during depression and too high during manic episodes. Serotonin is also low in

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depression. Drugs that help depression increase norepinephrine or serotonin supplies by blocking their reuptake or chemical breakdown. These are just a few studies that highlight the role of the brain’s chemistry in contributing to mental disorders.

Psychological Elements A person’s personality, negative thinking, emotional responses, and cognitive processing contribute to how we deal with life stressors and consequently, make us prone to certain disorders. Psychological evidence: Self-defeating beliefs and a negative explanatory style tend to increase depression (Metalsky, Halberstadt, & Abramson, 1987). A negative explanatory style is the tendency to interpret life events in a way that includes blaming oneself for mishaps and believing that bad events will always exist. People with negative assumptions about themselves, their situation and future tend to exaggerate bad experiences and minimize good ones. According to Nolen-Hoeksema, Wisco and Lyubomirsky (2008), depression may be related to overthinking. Alloy et al. (2000) monitored university students every 6 weeks for 2.5 years. Among those with a pessimistic thinking style, 17% had a first episode of major depression, compared to only 1% of those with an optimistic thinking style.

Social Elements A person’s sociocultural environment plays a role and includes early childhood experiences, parenting styles, socioeconomic status, culture, religion, social support, and gender roles among other things. Seligman (1990) suggests that depression is common among young Westerners due to the rise of individualism and the decline of commitment to religion and family which have forced young people to take personal responsibility for failures and rejections. In non-Western cultures, where close-knit relationships and cooperation are the norm, major depression is less common and less tied to self-blame over personal failure (WHO, 2004). Stressful events related to work, marriage, and close relationships often precede depression, while a family member’s death, job loss, marital crisis, or physical assault also increase the risk. Kendler (1998) tracked rates of depression in 2000 people and the risk ranged from less than 1% among those who had experienced no stressful life event in the preceding month to 24% among those who had experienced three events in that month.

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Clinician's Approach to Psychological Disorders Imagine a person going to their doctor complaining that they are coughing blood. What does she do? She starts asking questions to figure out what is causing them to cough up blood. The problem might be as simple as a bacterial bronchitis or as serious as cancer. The physician will ask questions, examine the patient, run blood tests and order some radiologic imaging (like x-ray) to put a name to the problem. Once the doctor diagnoses the problem, things will shift from finding out what the problem is to managing the problem and explaining the management plan to the patient as well as managing the patient’s expectations for recovery. Once a diagnosis is reached, doctors communicate with other doctors about the patient with the use of one word that describes the diagnosis instead of explaining all the symptoms, examinations, blood tests and x-ray results. A diagnosis provides a common language between clinicians that is understood all over the world and facilitates communication greatly. So, when a clinician writes in their notes that a patient has “Bulimia Nervosa”, all professionals understand what it means: recurrent episodes of binge eating, self-induced vomiting at least once a week for 3 months, misuse of laxatives, and their body shape and weight is extremely important for their self-esteem. Mental health clinicians such as clinical psychologists and psychiatrists go through a similar process with patients. They spend a long time with them and ask questions about all aspects of their lives including their current situation in an attempt to determine whether their problem meets the criteria for any of the psychological disorders. They have to assess the quality, duration, and severity of the symptoms as well as their impact on the person's functioning and quality of life. They might be able to put a name to the problem after the first visit or two, or longer. There are no blood tests or x-rays available for clinicians and psychiatrists to utilize in determining a diagnosis; it’s all about their skills in talking to patients and obtaining information pertinent to the problem. A diagnosis is vital and clinicians spend much time making, confirming, and even changing diagnoses as treatment plans depend on the label we give. For example, major depressive disorder is treated differently from schizophrenia, although some disorders may have overlapping symptoms. Having an incorrect diagnosis can result in incorrect treatment with negative results for the patient, as well as their loved ones who will have to deal with the effects of an incorrect diagnosis.

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How Many Psychological Diagnoses Are There? The DSM-V has organized mental disorders into 22 categories that include 152 disorders*. As mentioned earlier, it is published by the American Psychiatric Association (APA) and is a classification system of mental disorders that provides standard criteria for diagnosing each disorder as well as a common language to use between clinicians, researchers, health insurance companies, and others in the mental health field. The Roman numeral “V” means “5”, which indicates that it is the fifth edition in a series of multiple of manuals that have been published since 1952 and used in many parts of the world.

Categories of Mental Disorders (DSM-V) 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. 12. 13. 14. 15. 16. 17. 18. 19. 20. 21.

Neurodevelopmental Disorders Schizophrenia Spectrum and Other Psychotic Disorders Bipolar and Related Disorders Depressive Disorders Anxiety Disorders Obsessive-Compulsive and Related Disorders Trauma- and Stressor-Related Disorders Dissociative Disorders Somatic Symptom and Related Disorders Feeding and Eating Disorders Elimination Disorders Sleep-Wake Disorders Sexual Dysfunctions Gender Dysphoria Disruptive, Impulse-Control, and Conduct Disorders Substance-Related and Addictive Disorders Neurocognitive Disorders Personality Disorders Paraphilic Disorders Other Mental Disorders Medication-Induced Movement Disorders and Other Adverse Effects of Medication 22. Other Conditions That May Be a Focus of Clinical Attention The following section will offer a synopsis of four common psychological disorders, namely: Depression, Schizophrenia, ObsessiveCompulsive Disorder and Posttraumatic Stress Disorder. This section is

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not meant to be a comprehensive review of all psychological disorders nor of the four disorders. Each section includes a scenario, some MENA regional statistics, symptoms and main treatment approaches.

“I Am Just Sad, I Don’t Need Medications!” Ali is a 65 year old male from Kuwait who was advised to meet with a mental health clinician. He states that over the last two months he’s been having crying episodes and sleeping excessively. It doesn't seem like he’s taking care of his personal hygiene. He lost 15 kilograms of weight. He says that all these changes have started following his wife’s death. He cannot enjoy his time with his grandchildren anymore. He hasn’t had any thoughts of committing suicide as he believes it is religiously unacceptable; however, he feels that life is not worth living without his wife. x In the US, the 12-month prevalence of major depressive disorder is approximately 7% with marked differences by age group such that the prevalence in 18 to 29 year-old individuals is three times higher than the prevalence in individuals age 60 years or older (DSM-V, 2013). x In the UAE, rates of depression were 2.5% for males and 9.5% for females in a sample of 1,390 individuals from the general population in Al-Ain (Daradkeh, Ghubash, & AbouSaleh, 2002). x In a Saudi sample of primary care attendees, the prevalence rate of depression was 17%, with females showing higher indices (ElǦRufaie, Albar, & AlǦDabal, 1988). x In Qatar, 18.31% of participants (1475 participants) had major depressive disorders (Bener, Abou-Saleh, Dafeeah, & Bhugra, 2015). Depressive disorders are a group of disorders characterized by a sad mood accompanied by physical and behavioural changes that impact an individual's capacity to function. You might remember feelings of sadness after the loss of a loved one, failing an exam, or ending a relationship. These are all forms of sadness or grief that don’t raise clinical concerns, but are normal human feelings and reactions to sad events. It is mentioned that Prophet Yaqoub “Jacob” experienced sorrow and grief over the loss of his beloved sons Yousuf “Joseph” and Binyamin “Benjamin”. After losses, people need time to grieve and recover, but

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some people don’t recover and develop depressive disorders. Others go into depression without even a known trigger or incident. Major Depression is a more severe sadness that is accompanied by severe disruption of life. In addition to feeling sad or down, a person may lose interest or pleasure in almost all activities, experience changes in weight and appetite, disturbance of sleep, fatigue, feelings of guilt and worthlessness and a decreased ability to think and concentrate. One reason why depression is concerning to professionals is that in addition to the disturbed quality of life and impairment of daily activity, depression may lead to thinking of and committing suicide. Most adults with depression see an improvement in their symptoms when treated with antidepressant drugs, psychotherapy or a combination of both. However, there is a 50% chance of recurrence once a person has an episode of depression.

“They Are Out There to Get Me!” Mohsen is a 23 year-old medical student from Iran. His family and close friends have noticed increasingly abnormal behaviours over the last few weeks. They’ve overheard him talking in a harsh agitated voice, even though there is no one nearby. Lately, he has refused to answer or make calls on his mobile, for concerns of being spied on. He has refused to see a psychiatrist. He has stopped attending classes and is on the verge of failing. x According to the WHO, schizophrenia affects 21 million people worldwide. The lifetime prevalence of schizophrenia is about 0.3%-0.7%, but, this varies across countries and by race and ethnicity (DSM-V, 2013). x In Bahrain, an average annual incidence rate of schizophrenia of 1.29 per 10,000 for all ages and 2.13 for the 15 to 54 age group was reported (Abdul Karim, & Al Haddad, 1998). x In the UAE, the total lifetime prevalence rate for schizophrenia was found to be 0.7% in a community psychiatric survey study done in Al-Ain (Abou-Saleh, Ghubash, & Daradkeh, 2001). When we hear the word “schizophrenia” many say, “Yes, I know this, it is the multiple personality disorder that I saw in a movie”. This is not schizophrenia. We often confuse schizophrenia with “Dissociative Identity Disorder” (formerly called multiple personality disorder). The reason for this confusion is the origin of the word schizophrenia in Greek

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that means “skhízǀ (to split) + phrখn (mind)”, so when translated, it is misleading. In Arabic, the translation of schizophrenia gives this misleading connotation “Fusam or Infisam Al-shakhseya”. Remember the case study at the beginning of the chapter about the patient who thought he was receiving messages from God? This is common for patients with schizophrenia. Schizophrenia, a feature of which is a disturbance in a person’s thinking that can take the form of delusions, false fixed beliefs. Fixed means that it is not changeable and you can’t convince the person they are wrong. The disturbances in thinking or delusions take many forms and are often around a theme, i.e., persecutory (a belief that everyone is against them or out to harm them) or grandiose (believing a superior importance for oneself that doesn’t match reality). People with schizophrenia can have a disturbed perception in the form of hallucinations, the perception of stimuli that do not exist, i.e., seeing or hearing something that is not there. People with schizophrenia may also report hearing voices. These voices may be reported to be God speaking to them or voices that commands them to kill or hurt oneself or others. People with schizophrenia also present with disordered speech that reflects a disturbed thinking process and can switch from one topic to another (flight of thoughts), give answers that are not unrelated to questions, go on tangents and use word salads, unrelated words and sentences. Schizophrenia is a devastating psychological disorder to deal with especially for the family of the affected person. Some people may recover from schizophrenia with treatment and some continue to have relapses despite treatment. Treatment focuses on eliminating the symptoms by using antipsychotic medications, which are necessary for this type of disorder. Patients with schizophrenia need to learn and use coping skills to be able to pursue their life goals. Psychosocial treatment may help achieve this.

“Why Can’t I Stop Washing?” “I can’t touch the floor barefoot and I can’t touch anything that fell on the ground because I am afraid it is dirty. After I do my ritual ablution “Wudu” or take a shower, I try not to touch the ground, the sink, a wall or person for the fear that they might be not pure and may result in nullifying my ablution. If I touch anything accidently, I repeat my shower or ablution again and again. When I use the bathroom to relieve myself, I sit there for a long time to make sure that every impurity has come out of my body.”

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According to the DSM-V, the 12-month prevalence of Obsessive-Compulsive Disorder (OCD) internationally is 1.1%-1.8% (DSM-V, 2013). In Iran, the prevalence of OCD is 1.8% (Mohammadi et al., 2004). In Egypt, in a sample of 900 high school and university students, showed approximately 8% prevalence of OCD (Okasha et al., 2000).

Obsessive Compulsive Disorder (OCD) is known to cause high levels of anxiety and characterized by two components. First are obsessions, intrusive thoughts or urges that are unwanted and a person can’t get rid of and that are marked by distress and anxiety. In order to relieve them, a person engages in compulsions, repetitive actions and behaviours the individual feels forced to do in response. Obsessions and compulsions are time-consuming and affect not only the person but their family members as well. Imagine a sibling who has an OCD using the only bathroom in the house every day for hours and hours taking repeated showers. This can lead to impairments in social and occupational performance. Applied Examples: Obsessions Hand is not clean enough The door of the house is not locked My ablution “Wudu” is not complete Needing things to be even or lined up My intention for my prayer “Salah” is not valid

Æ Æ Æ Æ Æ

Compulsions frequent washing frequent checking on the door repeating the wudu over and over again repeatedly rearranging objects to reach symmetry repeating the prayer over and over again

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The Arabic name for this disorder causes confusion. OCD is called in Arabic: “Al-Waswas Al-Qahry”. Due to the use of the word “Waswas”, used to indicate Satanic whispers (Waswas Al-Shaytan) in Arab cultures and the frequent manifestation of OCD in religious practice such as prayer, people think that OCD is caused by satanic whispers and by instructing the person with OCD to seek refuge in God from Satan

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“shaytan”, can relieve the symptoms. OCD is an example of several disorders that need better understanding and collaboration among mental health professionals and religious scholars. People with OCD can benefit from the use of medication and psychotherapy. Cognitive behavioural therapy (CBT) and related therapies such as habit reversal training can work. A type of CBT called exposure and response prevention is effective in reducing compulsive behaviours.

“The War is Not Over in My Mind!” Laila is 38 year-old female who recently moved to the USA as a refugee from Syria. Her husband was kidnapped and killed. She and her daughters were attacked and threatened multiple times. She vividly remembers the horrific scene of her husband being taken and killed in front of her. She was screaming, crying, trying to pull him back and embrace him. No matter how hard she tries to forget, she finds herself reliving the event as if it was happening now. Since, Laila has experienced nightmares more nights than not. Before moving to the USA, she had to leave her house and move with a friend to avoid reminding herself about the incident. Laila has become increasingly withdrawn and irritable. x In the US, projected lifetime risk for Posttraumatic Stress Disorder (PTSD) using DSM-IV criteria at age 75 years is 8.7%; the 12-month prevalence among US adults is 3.5% (DSM-V, 2013). x In Lebanon, Karam et al. (2008) found a 3.4% lifetime prevalence rate of PTSD in a national sample of adult Lebanese civilians. x Researchers reported that the lifetime prevalence of PTSD among adults was 17.8% in the Gaza strip (post Intifada) and 37.4% in Algeria (post 1991 violence) (De Jong et al., 2001). x In Iraq, a 10.5% prevalence rate of PTSD was reported in a group of children and adolescents aged 1 to 15 years attending primary healthcare centers in Mosul (Al-Jawadi & Abdul-Rhman, 2007). Posttraumatic Stress Disorder (PTSD) is a disorder that is getting more attention and is of critical importance in the Middle East and North Africa because civilians in the region have been subjected to frequent episodes of violence, conflicts, and natural disaster. People exposed to war trauma, accidents, rape, and violence are susceptible to PTSD. However, a person doesn’t have to be directly exposed to the

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trauma to develop PTSD. It can happen by witnessing trauma happen to others or learning that a violent trauma or accident has happened to a relative or friend. According to the DSM-V, rates of PTSD are higher among people in vocations with higher risk of traumatic exposures such as police and fire fighters. One-third to more than one half of survivors of rape, military combat and war-related traumas may experience PTSD (DSM-V, 2013). PTSD is also common among survivors of natural disasters. People with PTSD experience flashbacks and nightmares in which they frequently see or relive the experience. They may have feelings of guilt regarding the trauma (like not being able to save a loved one from death) and become easily physiologically aroused, irritated and agitated. People with PTSD avoid any experience that reminds them of the trauma like a scene and objects. Symptoms of PTSD can improve with medication and many symptoms require long-term therapy. CBT that focuses on exposure therapy and cognitive restructuring may be helpful. This was a brief journey into the world of psychopathology. We explored the definition, criteria, classification and diagnosis of mental disorders and studied some of them in greater depth getting an idea of their prevalence in the region. We also mentioned some unique aspects of culture and how it may affect people’s mental health. Take a look at the following sections for more on mental health and make sure to think about the questions at the end of the chapter to review your understanding.

Mental Health and Muslims by Dr. Rehman Abdulreham Language is an important tool for psychologists. It is how we relay ideas, encourage a restructuring of dysfunctional beliefs, and motivate change. So it makes sense that we use a language that is understood by the client. In cross-cultural therapy, including therapy with Muslim clients, this means understanding the language of their life experience and speaking to people at their level of understanding. Interestingly, a well-known Muslim scholar of hadith, Bukhari reported that the Prophet Mohammed (PBUH) said, “Speak to people at their level of understanding”. If the client does not understand technical terms, we avoid it and use understandable ones, but if the client wants a scientific understanding of mental health, we provide it. We cannot assume that all Muslims have similar understandings of life, religion, the world and mental health. Although Muslims share a core set of beliefs, there is great variation in their life experience. Muslims can be devout in their beliefs, or struggle with faith. Some may want a religious perspective on mental health, others may not.

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Let’s use an example. A client, a man of Iranian descent, was raised as a Muslim and seeing a Muslim psychologist. Although he identified as a Muslim, he did not choose to practise the faith. He drank alcohol, was agnostic about any faith, but yet found it helpful to explore the role of religion and Islam specifically with respect to the development of who he was as a person. The reason for his visits involved a social anxiety disorder, and for this, treatment could have been cognitive behavioural therapy. Yet for him, understanding the role of Islam in mental health was important and he consistently returned to this in conversation. It was very much part of who he felt he was at one point in his life, a part of his identity, and thus part of something he wanted to gain a better understanding about regardless of the fact that he chose not to practise the faith. Culture often accounts for variation in what many believe are religious beliefs. Take for example the hijab (head scarf). Some Muslims argue that this practice should be observed by all Muslim women. Although this has been the classic interpretation of many Islamic scholars, there exists great diversity in practice and, as an example, many Muslim women in different parts of the world do not wear the hijab. In the GCC region, hijab is part of the national dress and the majority of women wear it. So, even in what may appear to be clear-cut cases, there remains a difference in opinion and practice. A Muslim woman who wears the hijab might not be as religious as she looks while a Muslim woman who does not wear the hijab might not have abandoned her beliefs either. Given the cultural differences between Muslims from different parts of the world, there is variation in views on mental health too. For some Muslims, culture influences their view on mental health more than religion. In my work with Imams, they often remark that people come to them and say they are dealing with anxiety or sadness due to a lack of faith in God. It is also common to hear from Muslim clients who approach their Imams for help that solutions to their problems lie in having "more faith", or needing to "make dua" (say prayers). It is not that Imams are unwilling to help, but it may be the only tool they have to offer; hence, the need to train religious leaders in working with mental health issues. But, passively trying to have more faith in God does not fit with psychological practice or Islamic faith for that matter.

Cognitive Behavioural Therapy (CBT) and Islam CBT works on the principle that life experience is a result of three components; our feelings, thoughts (cognitions) and actions (behaviours).

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While our feelings are important, they merely reflect our beliefs and thoughts, as well as our behavioural interactions and life experiences. By adjusting our behaviour in line with new ways of seeing and thinking, we can change how we feel. Psychologists who practise CBT say that in order for our beliefs to have an impact on how we feel, it is critical that we put them into action. And that clinically or otherwise, it is in the behavioural component of CBT that change lies. In my clinical experience, it is not enough for people to know what to do, but why it would help. With regards to Islam and CBT, the suggestion to have "more faith" would imply that one simply needs to adjust their feelings. This is like telling someone who is depressed to "get over it", or a person who is anxious to just "stop worrying". If only it were that easy! Changing feelings without adjusting one's beliefs or actions is not effective and can sound very insensitive. Much of Islamic practice is based on what would appear to be principles of cognitive behavioural therapy (Thomas & Ashraf, 2011). Take for example the core set of beliefs that Muslims hold to, the five pillars of Islam. They include the Shahada (declaration of faith), prayer (the physical ritual and meditation of the five daily prayers), charity, fasting (during Ramadan) and lastly, Hajj (Pilgrimage). The first, and most critical for Muslims, is the Shahada. It is the proclamation of beliefs, and what must be uttered, privately or around others, for one to declare them a Muslim. It is the key element upon which the Islamic faith is based. Without this belief, or cognitive framework, the remaining behavioural practices would have no meaning and a Muslim would have little motivation to engage in practices that require a great deal of energy and commitment. The purpose of these pillars is to bring forward an emotional response of "faith". But that emotional response is based on (1) a belief - new or changed, followed by (2) a series of behaviours. I encourage Muslims to look at the pillars as a metaphor for their practice in life. Rather than take a passive approach to their problems by simply having faith, they need to first review their beliefs, and then once adjusted, engage in behavioural change as a result. I also point them toward the importance of active change, versus passive belief. This is noted in the Qur’an as an example: "Verily Allah does not change men's condition unless they change their inner selves" (Qur’an 13: 11). Another example, is that of the following authentically narrated hadith, as noted below, clearly stating that in order to have God come toward you, you must first take an initial action. Go to him walking and he comes to you running.

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Narrated / Authority of: Abu Dhar Allah's Messenger said that Allah said: He who comes with a good deed, its reward will be ten like that or even more. And he who comes with vice, his reward will be only one like that, or I can forgive him. He who draws close to Me a hand's span, I will draw close to him an arm's length. And whoever draws near Me an arm's length, I will draw near him a fathom's length. And whoever comes to Me walking, I will go to him running. And whoever faces Me with sins nearly as great as the earth, I will meet him with forgiveness nearly as great as that, provided he does not worship something with me. (This Hadith is sound and reported by Muslim, Ibn Majah and Ahmad in his Musnad). (Muslim) This hadith reflects a behavioural intervention known as behavioural activation, often used with depression. To help overcome this passive belief in faith, or passive waiting for change (common to many people), whereby people wait to feel better before engaging in change, this hadith is a good metaphor that would encourage Muslims to be active first before expecting some form of "divine intervention" or change. That change starts with oneself. I believe it also provides a hierarchy for behaviour, where by one walks before one can run, suggesting an implicit need for gradual change.

Patience and Gradual Change The need for gradual change is noted in Islamic history. When Islam was first introduced, behavioural ritual and restrictions were gradually placed upon Muslims. Take for example the restriction of alcohol. Interestingly, it was not entirely prohibited at one point. The prohibition of it came gradually, initially with people not allowed to drink prior to prayer (so that they could be mindful during it). Then, Muslims were informed by divine decree that they must be always mindful and that alcohol consumption at any time was prohibited. This balance was also seen in an account where a man started to urinate inside the prayer hall in front of others. The initial reaction of one companion of the Prophet Mohammed was to respond angrily. Mohammed's response was to "let him finish" and then wash the area where he urinated, and gently corrected the man. The Prophet understood that this "new Muslim" required time to understand the principles of Islam and was patient with him in his acculturation. This patience with gradual change is a belief that is critical to the therapeutic process.

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Mental Health Problems: A Symbol of Modern Times?

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A myth held by Muslims is that mental health problems are a sign of the times and that mental health problems may not have been present at a time when spirituality was more practised. I have found it helpful to refer people to a comparison between the current rates of common mental illness and to see if this directly is reflected to dua (prayers) that were offered by the Prophet Mohammed nearly 1400 years ago. Statistics noted by the Canadian Psychological Association (CPA) (2013) that 1 in 5 individuals struggle with a mental disorder. International research denotes that for anxiety disorders alone, 19% of the global population struggle with an anxiety disorder at any given year, and 9% with a depressive disorder (Kessler, Chiu, Demler, Waters, 2005). Projections from the World Health Organization (WHO), based on current rates of mental illness, suggest that depression will become the second leading cause of illness and disability by 2020 (WHO, 2001) and the leading cause in disability and illness by 2030 (WHO, 2008). Furthermore both anxiety and mood disorders are the most common forms of mental illness at present (Kessler et al., 2005). In fact, difficulties with mental health are 1.5 times that of all cancers combined, and 7 times that of all infectious diseases (CPA, 2013). There are several prayers mentioned in hadith that date back to ancient times, which ask for solace from anxiety and depression. “O, Allah, I take refuge in you from anxiety and sorrow, weakness and laziness, miserliness and cowardice, the burden of debts, and from being overpowered by men.” “O, Allah, I am Your servant, son of Your servant, son of Your maidservant, my forelock is in Your hand, Your command over me is forever executed and Your decree over me is just. I ask You by every name belonging to You which You named Yourself with, or revealed in Your book, or You taught to any of Your creation, or You have preserved in the knowledge of the unseen with You, that You make the Qur’an the life of my heart and the light of my breast, and a departure for my sorrow and a release for my anxiety.” This is evidence that faith does not ignore mental health, nor does it suggest it is a Western problem, or endemic to modern times. This can often help realign the thoughts and beliefs that might previously have made people reluctant to accept the concept of mental health.

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Black, White, Right, Wrong, and Everything In Between

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Although Islam has made comments on many aspects of practical life, there are matters clearly delineated as halal (permissible) or haram (impermissible). Some Muslims may get caught up in what is halal or haram and focus too much on the prescriptive elements of the faith. But there are many elements of Islam that suggest cognitive flexibility, understanding things in their context. In fact, Islam will often promote cognitive flexibility as a sign of spirituality. Furthermore, cognitive flexibility is a good characteristic for effective coping during times of stress. I point Muslim clients to this hadith: What Allah has made lawful in His Book is halal and what He has forbidden is haram, and that concerning which He is silent is allowed as His favor. So accept from Allah His favor, for Allah is not forgetful of anything. He then recited, "And thy Lord is not forgetful." (19:64) (This hadith was reported by al-Hakim, classified as sahih (sound), and quoted by al-Bazzar.) I encourage Muslims to see that even in what seem like clear rulings, there is room for cognitive flexibility. Take for example the concept of consuming alcohol or pork. In almost all situations, Muslim’s core beliefs would disallow these. Yet, in situations of emergency or medicinal purposes, this changes. The study of Islamic theology is even split into four primary schools of thought, again suggesting variability in interpretation. Helping Muslims understand this about their tradition can allow them to be more flexible in their thinking. Adding to this is a hadith

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in which there were different points of view and both persons were considered to be correct. This hadith is only one of many that promote the view that different perspectives be accepted instead of clinging to rigid thinking. Abu Sa’eed Al-Khudri reported: Two men went out for travel when the time of prayer arrived and they did not have water with them, so they performed ablution with dust (taymmum) with clean earth and prayed, then they later found water. One of the repeated his ablution and prayer, while the other did not repeat them. They came to the Messenger of Allah, peace and blessings be upon him, and mentioned that to him. The Prophet said to the one who did not repeat the prayer, “You followed the prophetic tradition (Sunnah) correctly and you will be rewarded for your prayer,” and the Prophet said to the one who repeated the prayer, “You will have a double reward.” (Sunan Abu Dawud 338, Grade: Sahih (authentic) according to Al-Albani). It is not uncommon for Muslims to struggle with what the “right” thing is to do, nor uncommon when they see a Muslim therapist to look for the correct answer versus the usual response of therapists encouraging their clients to make their own decisions. In response, I offer the saying of a prominent companion of the Prophet Mohammed, Ali Ibn Talib, who said “the basis of my religion is logic”.

Topic Box: Cognitive-Behavioural Therapy for Depression by Dr. Louise Lambert

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You’ve been learning about various disorders as well as different ways psychologists help their clients. Here, we will see how psychologists use Cognitive-Behavioural Therapy, or CBT, to deal with one of the most common disorders that you or someone you know may have experienced: depression. CBT focuses on thoughts and behaviour, hence the name cognitive-behavioural. It does not pay attention to emotions as the assumption is that how we think and behave impacts our feelings. Feelings are caused by thoughts and actions and on their own, cannot be changed. Thus, there is no point in targeting emotions for change. As such, CBT believes that much of our distress is caused by our own biased or negatively skewed view of the world and the behaviours in which we engage as a response. If you were to go to a CBT therapist, you can expect them to practise the same way as the treatment is highly standardized. CBT targets specific thoughts. This means you will not be talking about your past or a bunch of problems – although you will likely talk about a specific problem long enough to identify the problematic thinking in it. CBT is time-limited and brief, taking about 4-6 sessions or less. You would also be taught the tools to challenge your own thoughts in the future too. Once you can effectively challenge and change your own thoughts, counseling ends even though there are still problems. The idea is that once you learn the CBT skills, you can do it yourself. CBT is very directive. You will be talking about your dysfunctional thinking (and not necessarily the problem) and how to change it. You would be given homework where you challenge your own thinking, or, your homework might be behavioural, where you introduce yourself to a person during the course of a week and engage in conversation to get you thinking of other things and practising social skills. Homework is needed as CBT therapists believe change takes place in the real world and not in the safety of an office where you talk and don’t take action! CBT therapists won’t tell you how to think, but will help you generate alternative thoughts which might be possible in a situation. By changing thoughts about a situation, you don’t change the situation but you remove or reduce the distress in it. CBT is great for depression and the skills can be used for other disorders like phobias and anger. Many of the skills CBT therapists use are based on helping clients get a better grasp on real facts. For instance, if you feel like everyone is talking about you behind your back because of a mistake you made at work, the therapist would ask, "How do you really know those people are laughing at you?" "What is your evidence for that?” “Did

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someone say anything?” “Is it possible they were laughing at something else?" Unless you have real facts for an event you consider to be true, a CBT therapist will not allow you to think it because it will cause you to feel negatively as a result. There are many cognitive errors CBT therapists look for. Can you spot them? Saeed organizes a hunting trip and invites several close friends three days early. A few confirmed, but on the day of the hunt, none showed! Saeed wondered whether they didn’t all get together and decide to not show up because they really don’t like him. He also considered that they all lied by confirming they were coming but really had no plans for it. What cognitive errors can you spot? For one, he jumped to conclusions by assuming they didn’t like him. He also didn’t give anyone the benefit of the doubt that perhaps something happened to them on the way and that’s why they couldn’t come. He also personalized the action of his friends thinking it had to mean something about him. How do you think Saeed felt after having these thoughts? Probably upset, but more than anything, he likely felt really bad about himself because he assumed it was a personal attack or reflection of himself. What are some alternative thoughts? He could have thought maybe there was a road washout and no one could make it to his place. He could have considered that there was a family emergency and two of his friends, brothers, couldn’t come for that reason. His friends may also have forgotten, an innocent mistake, or there might be other reasons why they did not show and none at all to do with Saeed. Other examples of cognitive errors include: Selective Abstraction: We focus on one detail to form an overall picture of an event and discount the rest, especially the positives. For example, you might go to an afternoon tea and have a great time eating, laughing and meeting people you haven’t seen for ages. But one person, whom you don’t even know, gave you a mean look. You focus on that the rest of the day. Overgeneralization: We focus on one bad event but generalize it to everyone or everything in that category. For instance, a boy you like ignored you and now you think all boys are ridiculous. Personalization: We think we are the center of all that can and will happen! If someone didn’t show up to your sister’s party, it’s probably because of what you said to their friend two weeks ago. Thomas and Ashraf (2011) showed that CBT works well with Islamic traditions. In CBT, clients are asked to alter their view of a problem in line with Husn al-Dhun (having a good opinion) and to hold a

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positive view of the world and a good opinion of God, people, and the future.

Over to you now… 1. 2.

3. 4.

The region is going through social and political challenges. How do you think these affect mental health? Many people are fleeing and seeking refuge in other safer countries. Some refugees suffer from mental and emotional problems as a result of exposure to trauma. These refugees need help from clinicians who may have a completely different culture, language or religion. How do you see this affecting the relationship between the patient and the clinician and how can it affect the services clinicians provide? Religion plays an important role in the life of people in the region. What areas of conflict can you see between the fields of psychology, mental health and religion? Have you ever tried to challenge your thoughts? Did it make a difference to how you felt afterwards?

CHAPTER ELEVEN HEALTH PSYCHOLOGY DR. MELANIE SCHLATTER

Photo credit: Louise Lambert

Chapter Outline x x x x x

What is Stress? Acute and Chronic Stress Significant Life Events and Daily Hassles Coping with Life Stressors The Immune System

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Emotions and Goal-Oriented Behaviours Psychosocial Interventions Topic Box: Is Stress Contagious? by Dr. Louise Lambert Health Education How Religion plays a Role in Health, Healing and Disease: Islamic Perspectives Eating Disorders by Dr. Jeremy Alford & The Middle East Eating Disorders Association How Are Eating Disorders Treated? Over to you now…

We don’t often think of our health until we don’t feel well. But, health is so much more than not feeling sick. It’s also about coping with stress, understanding what happens to our bodies under the effects of stress, and how our emotions and personality contribute to both wellness and illness. It’s also about understanding what you can do to make sure you are at your best by using health information to your advantage. In this chapter, we look at those issues as well as eating disorders, an unfortunate problem that affects both males and females and that involves concerns around body weight and body image that is increasing worldwide and strongly influenced by media. By the end of this chapter, the hope is that you will appreciate the contributors to good health and think of ways to strengthen your health so it can work for you throughout the years and not against you.

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What is Stress?

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The word stress elicits different things to different people. It is used to describe times when an individual is faced with difficulties that surpass their perceived ability to cope (Lazarus, 1984). How do you view stress? It's very personal; think of exam times. Some people see exams as a threat and feel anxious, worried and agitated; others see them as a challenge, feeling a little on edge, but still in control and a bit excited to show what they can do. But what if you were also moving house at exam time? Or if a loved one passed away at the same time? And you had a fight with a friend over the weekend? How do you think these events and feelings of control affect a person’s ability to cope? Do you think people would be more likely to get sick if they were feeling this stressed and overwhelmed?

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In health psychology, the study of biological, psychological, and social contributors to health, illness, and health care behaviour, an area of great interest is the correlation between stress and illness / disease, and the direct and indirect effects of stress (Weinmann, & Petrie, 2000). If you feel overwhelmed by the demands placed on you, whether they are the ones you put on yourself, or those put on you by parents, teachers, culture, or peer pressure, chores and tough exams, there will be indirect effects of stress. For instance, your chances of taking up risky behaviour may increase and you may decide to smoke, drive fast, or drink alcohol to feel better. The direct effects would be the consequences of stress on your blood pressure or heart rate, which may eventually affect your immune system and resistance to disease.

Acute and Chronic Stress Stress is often defined in terms of its duration. We refer to acute stress as lasting less than 6 months, and chronic stress, as lasting longer than 6 months. Exams were mentioned and these would be considered an acute stressor; as is the stress of dental work (the stress of anticipation!), going for a job interview, driving test, or making a presentation in public. But what if you received a diagnosis of illness and then had to embark on many months’ worth of treatment? Or what if your sibling or parent was seriously ill and you had to help and become a primary caregiver? These situations would instigate new and ongoing triggers of stress and would be viewed as chronic stress or stressors.

The General Adaptation Syndrome

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Stress can also be defined in terms of our biological adaptation to it. Selye (1936, 1978) described the General Adaptation Syndrome, a model describing three phases of adaptation to stress on the body. His belief was that your ability to cope with stress can decline over time and with more exposure to the stressor. In the first Alarm stage, your body responds to stress with the typical “fight or flight” response. This is the response you need when you see a lion or car heading towards you. It involves the immediate surge of adrenaline and stress hormones, such as cortisol (Eisenberger, Taylor, Gable, Hilmert, & Lieberman, 2007), which enable you to address the stressor immediately with a huge surge of energy. You've heard of people lifting cars off children for example - this is that stage. When the stressor is no longer there, or the situation has been dealt with, the body tries to reach a state of homeostasis where it can restore hormonal imbalances, but your defences will be low and you’ll have less energy in this second Resistance stage. If you continue to be triggered by stress, your body continues trying to resist and exhausts itself unless something stops the stressor. The third stage, Exhaustion, is when the stressor is ongoing and people describe themselves as being burned out, reaching overload, or having adrenal fatigue, they no longer have energy, and this is a dangerous stage for health problems and an increased risk of psychological illness like depression and anxiety. You can see how important it is to reduce stress in your life and learn ways to cope with stressors when they arise. As you know, a lot of your stress response involves your perception of stress, i.e., how you see or understand a situation. If you think of exams as the lions and cars in your life, then you are teaching your brain to be on high alert at exam time (and even at the very mention of exams), and you would be more likely to get sick quickly. While the fight or flight response is a great resource for dealing with stress, we have to be careful not to kick off or initiate the process ourselves.

Significant Life Events and Daily Hassles The Social Readjustment Rating Scale (SRRS; also known as the Life Events Scale) (Holmes & Rahe, 1967) is designed to measure the impact of significant life changes over the duration of the past year and investigate the relationship between stress and subsequent illness. There are 43 events, all assigned a ranking and impact score, and it's a good place to start if you want to learn about the major stressors likely to affect people’s health. For instance, “death of a spouse” rates as number 1 on the scale and is given a corresponding score of 100. “Outstanding personal

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achievement” is ranked at 25 on the list with a score of 28, while “minor violations of the law” is ranked last at 43 with a score of 11. This test is available online and if you score between 11—150, the authors state that there is only a low to moderate chance of becoming ill in the near future, but if you score over 300, you may have a very high risk of becoming ill. Yet, we have to be cautious in interpreting scores, particularly when dealing with different cultures, like here in the Middle East. Some cultures believe that death is a part of life and not the end of it and may feel less distressed about it as a result, while others might feel angry and devastated by it. Some cultures see violations of the law, no matter how small, as far more shameful than others. As such, everything has to be interpreted within a context, and culture is one of those contexts. In life, we are also more likely to be subjected to continual but minor daily hassles (e.g. losing keys or internet connection, traffic jams, forgetting your phone, arguing with a friend, or having someone close a door in your face at the mall) than to constant major changes or life events; yet, the small things add up! Kanner, Coyne, Schaefer and Lazarus (1981) developed a measure of daily hassles and compared it to major life events, such as those described in the SRRS, and found that hassles were a more accurate predictor of stress related difficulties, such as anxiety and depression, than the bigger life events that tend to happen less frequently. Stress is not all bad though. Interestingly, there is such a thing as eustress (Lazarus, 1966), or positive stress, examples of which might be preparing for a new baby, graduating from university, starting a new career, or planning your wedding. Eustress can often be motivational, enabling you to keep planning and moving forwards, whilst generally positively affecting your emotional wellbeing! The trick is perhaps seeing whether you can turn actual stress into eustress by changing your thinking about the events you encounter; it might be possible for some events and not for others, but it is something to think about as our perception of stress does have an impact on our body’s responses.

Coping with Life Stressors “It is a truism that ‘every one copes all the time’. The question is ‘how much’, ‘in what way’, ‘to what end’?” (Heim, Augustiny, Schaffner, & Valach, 1993, p.537).

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As a health psychologist, it is important to take into account the kind of stress and the amount of stress clients have been exposed to in their lives, and how they have coped as a result. Take the example of cancer. Being diagnosed with or having cancer is not a single stressful event, but rather a complex chain of interconnected events, and the experience has the potential to endanger survival and consistency in one’s self-perception (how you see yourself) (Cameron & Leventhal, 2003). Typically, there is an ongoing need to cope with anxiety, fear, depression, and anger during the cancer experience. Further, women with seemingly comparable breast cancer tumours, for example, still vary in terms of disease progression and survival outcomes, and it is possible that these differences can be accounted for, in part, by psychological and social variables (Graham, Ramirez, Love, Richards, & Burgess, 2002). In fact, it has been assumed that psychological factors may influence tumour development, progression and survival, and a relationship between personality and cancer was hypothesised as far back as the second century AD when Galen, a physician and philosopher, observed a greater incidence of cancer in “melancholic” (sad) as opposed to “sanguine” (optimistic and positive) women (Edwards et al., 1990).

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Personality and Psychological Responses Have you ever heard about the highly strung Type A personality (competitive, time-pressured, hostile), or the laidback Type B (moderate ambition, easy going, calm) personality (Friedman & Rosenman, 1959)? Well, there is also a Type C or cancer prone personality (Temeshok & Dreher, 1992). Characteristics include the suppression of emotion (often of anger) in order to appease or avoid conflict, passivity, high social conformity, self-sacrificing behaviour, and being overly cooperative and compliant (Nyklicek, Vingerhoets, & Denollet, 2002). Which gender do you think fits Type C behaviours most? This is a good example of where gender roles play a contributing factor in illness. Other psychological responses have also been investigated; specifically, the roles of fighting spirit, denial, help/hopelessness, fatalism, anxious preoccupation, and emotional control / suppression. These behavioural patterns were discovered in relation to cancer (Greer & Watson, 1987; Watson, 1998), but the terms are also relevant for other chronic illnesses and diseases. Fighting spirit is conceptualized as a tendency to be optimistic, with resoluteness to battle disease and an eagerness to participate in treatment decisions, whilst remaining accepting of the diagnosis. Denial is defined as the minimization and even rejection of the severity of a diagnosis, while help/hopelessness refers to being significantly overwhelmed by the diagnosis and feeling negative, hopeless, and wanting to give up. Similarly with fatalism, also called stoic acceptance, there is an acceptance of the diagnosis, but a fatalistic, even proud resigned attitude, while in anxious preoccupation, much time is spent thinking about the cancer and its recurrence. Lastly, emotional control, noted from the Type C personality, is the conscious effort of an individual to inhibit one's emotional response (e.g., putting on a brave face when one feels like crying; being quiet and polite when one would rather speak up); while emotional repression is similar but where the individual is not conscious of deliberately inhibiting his/her responses. Emotional control, while adaptive in the short term (not crying at a dinner party; saying you feel fine to stop further questioning), may result in poor adjustment in the long term (Reynolds et al., 2000). Why? As you know from the General Adaptation Syndrome, chronic stress is maintained when the individual continues to ignore or suppress cues about stressful circumstances, rather than trying to resolve the issues. As a result, emotional control or emotional suppression has been associated with the onset and progression of cancer (and hypertension) in a meta-analysis of

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22 studies on a total of over 6000 patients (Mund & Mitte, 2012). But, what about positive emotions; do they have any effect? Read on.

The Immune System

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Although the immune system was thought to be an independent system in its defence against foreign substances, research over the past 50 years has changed this idea and it is now accepted that the immune system has a close relationship with the nervous and endocrine systems (DeKeyser, 2003). This has led to exploration about the relationship between psychological variables and immune function in a new field called psychoneuroimmunology (PNI). In PNI research, there is evidence to show that personality characteristics (like those above), positive and negative emotions, as well as coping styles affect immune and endocrine function (Kiecolt-Glaser, McGuire, Robles, & Glaser, 2002). It has also been hypothesised that the immune system is a mechanism responsible for the relationship between emotional control and cancer progression. In fact, the immune system is considered to be a critical defence against the onset and progression of cancer and other diseases. Emotions play a role in the immune and inflammation response. A simple example, you get a paper cut on your finger. In response to and to repair that cut, the body sends an inflammation response, which also lights up the hypothalamic–pituitary–adrenal (HPA) axis, a stress response pathway which in turn, produces cortisol, a stress hormone. Under normal circumstances, like when you have a cut or bigger injury, the inflammation response forces the body into “repair” mode and that’s exactly what you

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want. But, it turns out that negative emotions, like depression and anxiety, also light up the HPA axis, the inflammatory and immune response (Dowlati et al., 2010; Setiawan et al. 2015), only in this case, there is nothing to fix. It’s like leaving the car engine running in the driveway for nothing and using resources that could be better used elsewhere. Regularly lighting up the HPA axis has been implicated in the onset of diabetes and cardiovascular disease (Dowlati et al., 2010; Wellen & Hotamisligil, 2005). How do positive emotions factor in this? Positive emotions like awe, joy, contentment, and pride seem to be able to reduce this inflammation response by decreasing levels of proinflammatory cytokines (Stellar, John-Henderson, Anderson, Gordan, McNeil, & Keltner, 2015). And to show that emotions are indeed involved in the HPA response, another study (Janicki-Deverts, Cohen, Doyle, Turner, & Treanor, 2007) was able to show that inducing (forcing) the inflammatory response was associated with less positive affect (a mood versus discrete emotion). While researchers are still working out the details, it appears that in reviews, positive emotions were associated with reduced levels of cardiovascular events (Boehm & Lyubomirsky, 2012), lower morbidity, decreased symptoms of pain and greater longevity (Cohen & Pressman, 2006), and quicker blood pressure recovery after stress and lower inflammatory responses (Bostock, Hamer, Wawrzyniak, Mitchell, & Steptoe, 2011); but, keep in mind that these are correlational studies, which mean there is a relationship, but not causation, between positive emotions and health outcomes. Alternatively, negative emotions and states like pessimism and high levels of stress were associated with shorter telomere length, which sped up aging (Epel et al., 2004; Hawkley & Cacioppo, 2007; Ikeda et al., 2014), and higher blood pressure (Hawkley, Thisted, Masi, & Cacioppo, 2010).

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Does this mean that we should strive to be happy and experience positive emotions all the time? Not really and anyone who tells you that will be exaggerating the effects of positive emotions greatly (Coyne & Tennen, 2010). In fact, there is a line of research that shows that positive emotions can actually delay healing from illness and cause worse outcomes. For one, optimism does not keep you alive longer in the face of disease (Veenhoven, 2008); it’s more the case that negative emotions seem to decrease positive health outcomes, but positive emotions don’t necessarily add any. In fact, studies show that optimism, when not used at the right time, can be counterproductive to illness, or at best have no impact on disease progression (Coifman, Flynn, & Pinto, 2016; Hurt et al., 2014; Schofield et al., 2004) such that individuals who are too optimistic may not take seriously the advice of doctors, preferring to rely on wishful (although optimistic) thinking and thus, failing to take the precautions and necessary behaviours that would have an impact on their disease progression. The fact that positive emotions can fail to have any effect on disease progression is important because in this era of “positive thinking”, there is a lot of pressure to be and act happy and this can make people feel like they have failed if they aren’t as happy as could be. In many cases, this has led to victim blaming, or in this case, patient blaming, for contracting an illness. You need to remember that people get sick for many reasons. Some illnesses are environmental, genetic, or even caused by another pre-existing disease, so blaming people for causing their illnesses is not scientifically justified (or cool); so, resist the urge to blame yourself, your emotions, stress, inability to cope or other people for that

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matter. Sure, stress doesn’t help and can make things tougher by affecting how you cope with illness, but positive emotions have never “cured” illness either, they just make it easier to cope with.

Emotions and Goal-Oriented Behaviours Emotions are a reflection of conscious or unconscious appraisals and cognitive processes (Schwartz, 2000). If individuals perceive themselves to be progressing well towards a goal, they experience more positive emotions such as interest and joy, which motivate them to proceed with favourable actions. If their progress is unfavourable, they may experience negative emotions such as anger, depression or frustration (Schwartz, 2000), and feel less excited about trying harder or moving ahead.

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We divide behaviours into those that are approach-oriented or avoidance-oriented (Carver & Scheier, 1999). Emotional expression, seeking and getting social support, positive reappraisal, and active problem solving are examples of approach-oriented coping strategies, some of which have been shown to improve quality of life, survival and a reduced response to stressors altogether (e.g., Compas, Jaser, Dunn, & Rodriguez, 2012; Taylor, Burklund, Lehman, Hilmert, & Lieberman, 2008; Taylor & Stanton, 2007). There is evidence to show that approachoriented emotion regulation strategies used in the context of health can result in an increased chance of survival as well as positive adjustment when confronted with stressful encounters and health related stressors (Reynolds et al., 2000; Stanton, Kirk, Cameron, & Danoff-Burg, 2000). As such, the management and expression of emotions is a goal of many psychosocial intervention programs (Aspinwall, 2001). Individuals with avoidance-oriented goals on the other hand, may disengage effort or withdraw socially, alienating themselves from potential support (e.g., Spencer, Carver, & Price, 1998). Moreover, they may lack the ability to express their emotions and may exhibit help/hopelessness, fatalistic attitudes or an anxious disposition (Servaes et al., 1999). Emotional control has been shown to be used frequently as an avoidant coping strategy and individuals who utilize avoidance strategies may harm their long-term physical and psychological health, not only because they are decreasing their chances of learning how to cope with stressors, but also because they are exhausting their physiological resources through constant hypervigilance and reactivity (Aspinwall, 2001). Nonetheless, other studies have shown that temporarily disengaging from goals (not abandoning them, but putting them aside for a time) while one is ill might be a good strategy as it reduces the pressure one may feel to excel in life while coping with serious illness, which may be more important at that time (Jobin, & Wrosch, 2016; Neter, Litvak, & Miller, 2009).

Psychosocial Interventions Evidence supports the role of psychosocial group interventions, which focus on educating people, setting goals, and implementing adaptive coping strategies, particularly strategies which encourage emotional expression for limiting the responsiveness of the immune system and improving psychosocial and physical outcomes. Interventions have been developed for use in medical populations, such as cancer, diabetes, heart disease, and chronic pain. The goal of such interventions is to enhance an individual’s ability to select and efficiently use problem-solving strategies

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and methods of emotion regulation to manage problems and emotions that arise from their illness experience.

Topic Box: Is Stress Contagious? by Dr. Louise Lambert

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We’ve all had the experience of watching a friend go through a tough time; but, have you wondered whether watching friends or family go through difficulties has an effect on you? It turns out that stress might actually be contagious. A recent study (Engert, Plessow, Miller, Kirschbaum, & Singer, 2014) showed that empathic stress, the response experienced by observing another individual undergo a stressful experience, was more than just feeling bad for someone. Individuals watching someone they knew well experiencing a stressor experienced the highest physiological response with an increase in cortisol themselves. What was interesting was that this cortisol response was also seen when subjects watched strangers experience a stressor. Our ability to feel empathy for others may help us understand how they feel and enable us to respond more appropriately, but it also exposes us to the real effects of second-hand stress just as if we ourselves were experiencing the actual stressor. While we cannot avoid empathizing with others, the study raises an important question: might it be a good idea to avoid or limit the suffering of others to reduce an unnecessary stress response on our own bodies?

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Health Education Health professionals always need to update themselves in the latest advances in health promotion and disease in order to be aware of the conditions with which their clients present to understand the client’s experiences and provide appropriate guidance. However, some medical and psychological conditions are seen with scepticism, indifference, even disgust, often because of societal beliefs or a lack of education. Examples are infertility, post-natal depression, and breast and prostate cancers. Another example is the subject of HIV and AIDS. A glance at the local literature shows several trends in the region indicating a significant lack of awareness, knowledge, appropriate care and accurate data; stories of patients who are considered unemployable and rejected by their families; and fears surrounding the threat of deportation for expatriates who are diagnosed with the disease. The picture is sad and under these conditions, patients would not readily present themselves to health professionals and may put their health at risk even further. A recent study (Abolfotouh, Al Saleh, Mahfouz, Abolfotouh, & Al Fozan, 2013) examined the attitudes of Saudi nursing students towards AIDS and the predictors of their willingness to provide care for AIDS patients in the Kingdom. Although they agreed that patients needed treatment, there were misconceptions about AIDS transmission and the students’ knowledge was the lowest regarding the treatment and control of AIDS. The results indicated that students believed transmission could occur through swimming pools and coughing / sneezing (53.7% and 49.6% respectively); 83% believed that AIDS patients should be kept in isolation from other patients; 73% did not know there was no vaccine for the prevention of AIDS contraction; and nearly 25% stated that people living with AIDS deserve it. This research is concerning and shows the need for thorough and comprehensive education in order to develop positive attitudes and willingness to care for patients with stigmatised illnesses and diseases. It also shows how strongly religious and cultural beliefs in the region influence health and its care. Several studies point to the lack of sexual education in the region (Makhlouf Obermeyer, 2015) and the study we just saw about HIV is evidence of that. When medical students are unaware of these issues, it is difficult for the average person to become knowledgeable about important sexual health information. Indeed, in a study of Saudi male college students (31% of which admitted to having premarital sex at least once), only 51% reported knowing that condom use could prevent sexually transmitted diseases (Raheel, Mahmood, & BinSaeed, 2013), while a

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second study in Saudi Arabia, this time among girls aged 11-21, found that fewer than 40% knew sexually transmitted diseases were in fact transmitted sexually (Alquaiz, Almuneef, & Minhas, 2012)! When significant gaps are missing in knowledge, be it sexual, mental, or otherwise physical, this puts everyone at risk of attracting and transmitting the very diseases and issues we should be trying to prevent with damaging and sometimes fatal results. No knowledge is a bad thing, but good knowledge can help you make proper decisions and respect yourself.

How Religion plays a Role in Health, Healing and Disease: Islamic Perspectives For many, Islam is as a way of life. The faith encompasses guidance on spiritual, emotional and physical health matters, while being understanding of human needs and desires. Good health, and how to cope with illness and disease, are emphasised in many sections of the Qur’an (the Islamic sacred book) and the Sunnah (teachings and practices of Prophet Muhammad). The Qur’an itself is viewed as a source of peace, healing and solace away from the problems of everyday life.

Photo credit: Pixabay “And we send down from the Qur’an that which is a healing and a mercy to those who believe …” (Qur’an 17:82)

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Muslims believe that spiritual health is important if they are to cope with everyday problems. Indeed, if spiritual health is carefully tended to, this can benefit physical and emotional health also. Islam guides Muslims to accept, be patient towards, and even find gratitude for illness and disease. Further, accepting these trials does not mean that nothing can be done to cope outside the spiritual realm; rather, Muslims are encouraged to be proactive (such as going to a doctor) and learn from the experience in order to move forward. They are also encouraged to treat their body with respect: eat in moderation, exercise, and keep clean. In fact, Muslims are expected to practise their faith on a daily basis without fail and their commitment is thought to positively influence the prevention of psychological disorders, illness, and even enhance healing and recovery (Matthews, 2000).

Photo credit: Pixabay “Eat of what is lawful and wholesome on the earth” (Qur’an 2:168).

Muslims are guided to eat a nutritious “halal” (permissible) wholesome diet from the foods of the land (such as honey, fish, fruit, vegetables, legumes, nut and grains), and they are encouraged to stay away from several items or methods deemed “haram” (forbidden), such as meat from swine (e.g., pork) and byproducts (e.g., gelatine), blood, intoxicants

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(e.g., alcohool), and anim mals killed im mproperly. S Scientific reseearch has confirmed m many benefits of the halaal diet, and theree is no strong evidence to support thhe benefits off ingesting any ything on the haraam list. Further, F if Muslims eatt in moderatioon, which is beelieved to be m more adaptivee for their religious com mmitments, thhey will be ph hysically stronnger in body, heart and mind. This will enable thhem to fulfil other obligattions in Islam m, such as fasting in thhe holy monnth of Ramad dan, and makking the pilgrrimage to Mecca. “And eat and drink but waste w not by extravagance…” (Qur’an 7:31)

Thee practice of five f daily obliigatory prayerrs in Islam is actually a a form of exeercise as all the muscles and joints aree used. Anytthing that results in a cclear mind andd physical reju uvenation is eencouraged (w with a few exceptions),, including reaading, studyin ng and workinng, rising befo ore dawn, and even looking after peeople in need d. Socialising with close friiends and family couldd even be connsidered an ex xercise for thee mind and heart, as it encourages deeper bondds and feeling gs of happineess, contentm ment, and security.

Photo credit: Pixabay

Cleeanliness is paaramount in Isslam, and washhing the hand ds, mouth, nostrils, facee, arms and feeet thoroughly y with water inn a prescribed d manner, five times a day before prayer p is obligatory. Brushhing and flosssing teeth

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was also recommended by Prophet Muhammad, although it is not obligatory for prayer.

Islam as it Relates to Health Psychology Muslims are expected to do as much as possible for their health that is within their control—adhering to a good diet and eating in moderation; exercising and living an active lifestyle that benefits body, mind, and soul; keeping up with fulfilments to God to strengthen faith (such as worship and charity, acts of maturity, responsibility, and accountability); and keeping clean. These facets of Islam are all validated and encouraged in the scientific literature, as well as in the general health psychology approach. If you recall from the introduction to this book: “health psychology in an integration of biological, psychological, and social (‘biopsychosocial’) contributions to health, illness, and health care behaviours”… with the goal of “teach(ing) people how to become proactive about their health and / or illness and to maximise one’s quality of life”. Given the health problems of society, such as cancer, diabetes, obesity, heart disease, and respiratory ailments and the fact that many people suffer from emotional disharmony in the form of anxiety, depression, eating disorders and the like, it would be remiss for a health psychologist not to warn against specific and unhelpful features of everyday life. For example, late-night exposure to televisions and cellphones which can disrupt melatonin and thus the ability to sleep, wake, and receive adequate restoration; bad eating habits and lack of exercise due to stress and lack of time; uptake of harmful substances or risky behaviours which can affect the mind or body, just for immediate gratification; over-working at the expense of family, children, and peace of mind; lack of fun and relaxation; or the general pulling away from personal values where one can lose a sense of who they are and of what is important in life. It is the pulling away from recommended positive habits which is discouraged in Islam and practicing Muslims generally feel weakened when they “lose their way”. Contrary to the recommendations in Islam, some Muslims won’t seek medical help as soon as they need it, preferring to put their faith in God before they seek external support. Visiting a psychologist is an especially difficult concept to grasp, because it might suggest they are losing their mind! What becomes an even more difficult problem is when a client is suffering from a health condition or disease such as breast or prostate cancer, infertility, HIV or stress incontinence. Although it does

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not matter who you are or where you are from, these illnesses are filled with stigma and shame, and anxiety and depression are almost expected as a result of diagnosis. The ramifications on partnerships and family can be tough. To only receive medical help (if one eventually seeks it) is not addressing the complex nature of health, including the culture and / or religion with which a person identifies. Our role as health psychologists is thus to educate people about various ailments and normalise the typical psychological consequences of challenges to physical health in the context of each individual’s situation. Then we can provide strategies to cope. As noted earlier, seeking help is advised in the Qur’an and where applicable, that might help people retain or regain their sense of conviction towards God and the role of religion in their life. When this emotional and psychological balance is achieved, it is believed that any medical treatment may have a chance of being more successful.

Eating Disorders by Dr. Jeremy Alford & The Middle East Eating Disorders Association An eating disorder occurs when our relationship with food goes further than just satisfying hunger towards becoming a source of emotional and psychological comfort and control. Food and eating turn into an obsession and impact the way we relate to the world, daily life and ourselves as it leaves no room for anything else like friendships, studies, family interaction and clear self- perceptions. Clinicians often refer to one of two diagnostic manuals (i.e., the Diagnostic and Statistical Manual of Mental Disorders (DSM-V) published by the American Psychiatric Association and the International Statistical Classification of Diseases and Related Health Problems (ICD-10) by the World Health Organisation) to identify and treat people suffering with eating disorders. There many types of eating disorders. The biopsychosocial model suggests that eating disorders can be the result of multiple interacting factors which include biological, psychological/emotional and social/cultural issues.

Biological Factors Research suggests that there are genetic links to developing an eating disorder. We inherit a body type from our parents: we are tall, or short or medium in height. We may tend to be lean and muscular or heavy and overweight. This is known as our Set Point. While we cannot change our set point, we can work towards developing or maintaining the healthiest

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body within that type. Further, binging (excessive overeating), purging (vomiting), severe fasting (not eating for long periods of time), or excessive exercise as ways to lose calories disrupt the body's ability to maintain a healthy weight. These forms of malnutrition affect how different parts of our bodies function that are essential for physical and emotional regulation. Finally, certain chemicals in the brain that control hunger, appetite and digestion have been found to be unbalanced in some people with eating disorders.

Psychological Factors There are psychological feelings that underlie eating disorders. Individuals who struggle with feelings of inadequacy or lack of control, as well as poor self-esteem and a sense of perfectionism may be at greater risk for eating disorders. Depression, anxiety, anger, stress, loneliness, disappointment, sudden loss or death in one’s surroundings may also predispose individuals to develop such disorders. One's personal history may make disorders more likely, such as being bullied or made fun of with respect to their body image and a history of physical or verbal abuse. Finally, troubled personal relations, difficulty managing or regulating ones emotions make the management of such disorders more difficult.

Social Factors The Middle East’s exposure to a more Westernized way of living influenced by the media and people having more access to the Internet seems to play an important role in the gradual increase of eating disorders in the region. The stigma around mental health in Middle Eastern culture which has traditionally valued “saving face” (keeping problems and their resolution within the family unit to avoid shame) may contribute to worsening eating disorders. Further, standards of beauty change over time and culture. For example, in the 18th century, the healthy person in Western countries would be round and plump whereas in the 21st century, they apparently need a six pack as a man and zero percent fat as a woman. The pressure of living in a culture that encourages photo-shopped perfection in magazines may trigger a distorted image of our body. This narrow portrayal of beauty with specific body types can affect the way individuals see themselves. Cultural norms that value people based on their physical attributes and not their personalities, as well as stress related to ethnic, racial, weight and other aspects of prejudice and discrimination can fuel eating disorders.

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Basic Facts Eating disorders develop over time and affect both men and women. Almost 1 in 5 people suffer from any kind of disordered eating and to date, 70 million people worldwide suffer from an eating disorder. In our culture, dieting has become the norm and severe dieting is the number one risk factor for eating disorders as dieters are 8 times more likely to suffer from an eating disorder than non-dieters. Most alarming is that between 5 and 20% of anorexics die as a result of physical complications of the disorder and between all of the mental health disorders, eating disorders are the deadliest of all. An eating disorder or disordered eating (not fulfilling all of the criteria for eating disorders) leads to secrecy and isolation, guilt and shame, and negative feelings about oneself. So far, there is no accurate data on eating disorders in the Middle East, but studies suggest that eating disorders are increasing.

Anorexia Nervosa Anorexia nervosa is the deadliest of all and there are two types: 1) restrictive and 2) purging. The restrictive type will lose weight through strict diets, fasting, and excessive exercise, whereas the purging type will lose weight through the use of laxatives, diet pills or other diuretics. Anorexia affects men and women, but is most common in women between the ages of 14 and 25. Symptoms vary, but may include the following: individuals limit the amount of food and drink consumed, fear gaining weight, focus on thinness, and have a distorted body image (feeling fat even if not) and subject themselves to weight loss beyond what is healthy and engage in excessive exercising. Doing this may result in a loss of menstruation, dry skin, hair loss, and tooth decay. Over time, the physical and psychological side effects include an irregular heartbeat, low blood pressure, dehydration, brittle bones, kidney problems, extreme fatigue, chemical changes in the brain affecting thoughts, as well as depression, anxiety and suicidal thoughts. They can lead to infertility in women, osteoporosis, epilepsy, cancer, diabetes and death. Excessive weight loss for an extended period of time, combined with self-induced starvation will affect your ability to think clearly which in turn will lead to a chain reaction of physiological complications. When our Body Mass Index (BMI) is lower than what is considered healthy, we risk having to go to hospital. A healthy BMI for an adult is between 20 and 25. However, if it is less than 17.5 then it is likely you could be anorexic if other physical illnesses have been ruled out.

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Bulimia Nervosa Bulimia is an eating disorder characterized by episodes of binging and purging (i.e., eating large amount in a short space of time followed by selfinduced vomiting) as a way to control weight gain. The use of laxatives and diuretics are common. Anyone can develop bulimia and at any age. Most affected appear to be young women between the ages of 14 to 25. Symptoms will vary and can go completely unnoticed. However, the following are quite common: the individual constantly thinks of food and counts calorie, eats excessive amounts in a very short space of time followed by purging, dislikes their physical appearance, goes to the toilet frequently, especially after meals, and struggles with feelings of guilt, and perhaps anxiety, depression, or other obsessive compulsive disorders. The frequency of binges can vary. Episodes can range from several times a day to a few times per months. The long-term effects of these include: irregular heartbeats, low blood pressure, feeling faint, being constipated, tooth decay, a sore throat, rupture of the oesophagus, facial swelling, bloating, damage to the kidneys, haemorrhoids and infertility. Effects can also trigger epilepsy or result in death.

Binge Eating Disorder (BED) Binge Eating Disorder (BED) is an eating disorder characterized by excessive eating in a short space of time even when not hungry. However, binging episodes do not follow with purging (i.e. self-induced vomiting), nor are laxatives or diuretics used. Both men and women can suffer for this condition. Most common age range is between 20 and 40. Most people with BED are overweight or obese; however, others might be at a regular weight. Symptoms will vary and can go completely unnoticed. However, the following are quite common: eats excessive amounts in a short space of time even when not hungry, feels out of control, eats until uncomfortably full, frequent dieting with poor progress resulting in weight gain, prefers eating alone or in secret, and often feels guilty and/or ashamed. The effects of BED also include weight gain, malnutrition, heart disease, high blood pressure, high cholesterol, mood swings or depression, diabetes, stress, anxiety, poor confidence and social withdrawal.

How Are Eating Disorders Treated? Different eating disorders require specialized treatment plans. The practitioner must be specialized to help treat both the psychological causes

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and physical side effects. This is a process that can take many years to resolve depending on the type and severity of the condition. A multidisciplinary team composed of a clinical psychologist, a psychiatrist, a general practitioner, a clinical nutritionist among others is usually required. Some people might benefit from only outpatient treatment, whereas others may need inpatient treatment in a specialised eating disorder facility. If you think you’re at risk for disordered eating, there are things you can do. First, ask to speak to an eating disorders specialist and seek professional advice regarding food and your body. Make sure that the psychologist, nutritionist, psychiatrist, medical doctor or other healthcare provider is specialized in eating disorders. You can also get professional guidance through eating disorder associations such as the Middle East Eating Disorders Association (www.meeda.me) that can help confirm whether you have an eating disorder and guide you accordingly. If you do have an eating disorder, know that recovery is possible. You can join an eating disorders support group if there is one in your community.

You can begin by ignoring society’s expectations about physical appearance and eating habits and think of food as natural medicine. It is there to allow your body to function. Become aware of your emotions; they are there to tell you something. Avoid managing them with food and learn to distinguish between real hunger, for energy and physical function versus emotional hunger, eating when you are full. Writing a list of alternative strategies (like calling a friend, listening to music, going for a walk, writing) when you want to avoid eating or on the contrary, might want to binge, or purge may also be helpful.

Over to you now… 1. 2.

When would eustress become stress? Why is marriage high up at Number 7 on the SRRS with a score of 50? Take the SRRS test (just google it online to find one). What score did you achieve; what strategies can you use to reduce the impact

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3. 4. 5. 6. 7.



of these stressors on your life? Find at least 5 ways to reduce your stress level; if you can’t find that many, pair up with someone and find them together. Do you have any tips for stress you can share with your classmates? What effect does watching stressful scenes on television have on your body and emotions? What can you do to reduce the effects on your body as a result? What role do positive emotions play in health; are they always good? When are they useful and when might they not be? Describe two of the most common eating disorders and then do a search for their prevalence in the Middle East and see what additional information you can find. What is psychoneuroimmunology? Give a definition in your own words. Do a search and find the top 5 most common health issues in the MENA region. Which are you at risk of possibly getting? What can you do now to start preventing these issues?

CHAPTER TWELVE MOTIVATION AND EMOTION DR. LOUISE LAMBERT

Photo credit: Louise Lambert

Chapter Outline x x x x x

Introduction to Motivation by Joana Stocker and Jamal AlHaj Motivation: Major Theories Motivational Constructs by Joana Stocker and Meera Khalifa Self-concepts Implicit Theories of Intelligence

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x x x x x x x

Attribution Theory Self-efficacy and Self-esteem Emotion by Dr. Louise Lambert Emotion Theories What about Aggression? Media and aggression Over to you now…

Do you ever wonder why you do things? Or why you might set a New Year’s resolution and your new goals or actions only last for one week, while other people always seem to reach their goals without fail? You might be wondering then about motivation, the why of how and why we do things. In this chapter, we’ll review a number of theories and related motivational concepts to help you understand more of your behaviour. We’ll also take a look at emotions, why we have them, and what purpose they serve.

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Introduction to Motivation by Joana Stocker and Jamal AlHaj

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Motivation has been an important domain throughout the history of psychology (Bernard, Mills, Swenson, & Walsh, 2005), and evolved during the 19th century with the biological and behaviourists theories (like Thorndike, Watson, Pavlov, and Skinner) which considered motivation an automatic process or reflex, and even a biological need (Hull, 1943). The humanists took a turn at describing motivation and this is exemplified by Maslow’s (1943) famous pyramid of needs. Later, it was considered a cognitive process with Weiner (1966), in which expectations and interpretations influenced behaviour by causal attributions (discussed later). Finally, the social learning theories with Bandura (1977) posited that observation, imitation, and modeling guide human behaviour. All of these theories were isolated from each other, until researchers realized that all of these factors (automatic processes, cognition, and social interaction) play a role in motivation and from here grew the social-cognitive approach to motivation, still the most important motivational theory to date (Bandura, 1989; Dweck, 1999; Dweck & Leggett, 1988). The socialcognitive approach proposes that motivation is a concept that combines behavioural, social, affective, cognitive, as well as environmental dimensions.

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For example, your motivation to study may vary depending on your mood (personal/biological), how much you like a course (affective), how you think it will be useful and your expectations for it (cognitive), as well as the materials and resources with which you have to study (environment). Overall, most theories agree that motivation is the concept that describes the stimulation that acts on an individual, either from within or from the surrounding environment, initiating, directing and maintaining goal-oriented behaviours (Petri & Govern, 2013). It is what leads you to grab a snack to reduce hunger or to enroll in university (Cherry, 2010). In simple terms, motivation is the factor that drives one to take action whether it is due to internal or external factors. Motivation can be divided into two and include intrinsic and extrinsic motivation. Intrinsic motivation is the natural and spontaneous motivation that develops from people’s psychological needs and stems from a desire for growth (as intellectual challenge, sense of achievement, learning enjoyment, curiosity, interest) that is inherent to all human beings (Reeve, 2015). Extrinsic motivation, on the other hand, is the motivation that results from external stimuli such as incentives (i.e., grades), material or tangible rewards (i.e., money), or social recognition and praise (i.e., “you are so smart!”). It is important to encourage intrinsic motivation in individuals because research has repeatedly shown that it leads to greater benefits. In fact, being intrinsically motivated is a crucial element in cognitive, social and physical development because those who are intrinsically motivated engage in tasks voluntarily and for the activity itself, which creates opportunities to gain knowledge and skills. In fact, having intrinsic ambitions such as the desire for growth, autonomy, learning, among others, leads to greater well-being, while extrinsic rewards and outside reinforcement can reduce interests and motivation in performing a given task. In 1973, Lepper, Greene, and Nisbett conducted a study on nursery children who were divided into three groups and had to complete a drawing. The first group of children was the “expected reward” group, who was offered a “good-player award”. The second group of children was the “unexpected reward” group who received an award that was not promised beforehand. The third group was the “no-reward” subjects who had to perform the task with no reinforcement. The result was that the “expected-reward” subjects spent less time doing the task and showed less interest in it! This often happens when individuals are promised a reward and feel they only need to perform that task to get the reward.

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In educational settings, intrinsic motivation is the drive that leads a student to engage in academic activities like studying for exams, doing homework, actively participating in group discussion and work, and other actions that lead to successful academic achievement. Intrinsically motivated students often show a preference for challenging tasks, are usually more curious, more likely to commit to and persist in tasks as well (Pintrich, 2003). In fact, it has been observed that students who are intrinsically motivated tend to perform better than their peers (Ryan & Deci, 2000). Other psychological constructs are closely related to human motivation influencing and directing our behaviour such as the selfconcept, self-efficacy, personal conceptions of intelligence, and causal attributions. We’ll discuss each of these in this chapter.

Drive Reduction Theory Drive reduction theory (Hull, 1943) was one of the first to propose that motivation is a function of physiological (biological) needs. We have primary drives that are innate and include thirst, hunger, the need to get warm, or go to the bathroom, and secondary drives, not innate, but learned, and include the drive to make money, or achieve goals. The theory is basic, suggesting that primary needs take priority in order for our bodies to return to a state of homeostasis (balance). In other words, we will be driven to reduce needs and those actions will become habit forming. When you are hungry and sitting in class, your first action at break time will be to head for food. This theory can explain that, but it can’t explain why we sing, are interested in science, or run marathons. So much of what we do has nothing to do with biology. It also doesn’t explain why we continue to pursue things like money even after it has met needs like food. These critiques gave rise to theories focused on psychological needs instead.

Arousal Theory Arousal theory focuses on psychological activation. People vary in the amount of arousal they can handle and need; some skydive, others read, others go for a walk, and other take a nap. We are nonetheless motivated to keep an optimal level of physical and mental activation. When arousal is low, we try to increase it by playing with our phones or getting up to walk even if it’s to go nowhere. When arousal is too high, we try to reduce it, like when you’re anxious during an exam, or stressed during a business

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meeting. You might try to take deep breaths or sneak out of the room for a minute.

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We need arousal to function, but it needs to be just right. The Yerkes & Dodson Law (1908) examines the relationship between stress and performance following this idea. If you’re not aroused or stressed enough, performance suffers; yet, if you are too worked up, your performance also suffers! For best performance, we need a moderate level of stimulation, some anxiety and stress to keep us focused and prioritizing activity, but not so much that we can’t think or so little that we’re bored.

Incentive Theory Incentive theory (Young, 1959), a behavioural view, states that motivation can be affected by incentives or external rewards, which stimulate us to act. What rewards motivate you? For many students, this includes getting an instructor’s approval, or high grades. In this sense, external incentives pull us to action. Incentives can maintain behaviour (i.e., keep your GPA high over the year and your parents give you a car), or stop it (i.e., win money for not smoking 30 days); yet, incentives are only good insofar as they are valued by the person who gets them. As an instructor, I can invite a great guest speaker to class, but if you don’t care about the subject, you

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might leave no matter who is there. Incentives need to be valued by the person receiving them and not the one necessarily giving them.

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Rewards are effective but, not all the time. Accepting a job for extra pay – even a lot – might not be worth it if it means seeing your family less or being tired and stressed all the time - sometimes what looks like an incentive has a cost attached. Also, rewards can decrease our intrinsic motivation by devaluing a liked activity and increasing our dependence on rewards (Deci, Koestner, & Ryan, 2001; Murayama, Matsumoto, Izuma, & Matsumoto, 2010). If you paid your child to clean their room, they probably would, but the moment you stopped paying, they’d stop cleaning. Or, you love to paint and do it for the art itself, but now, someone wants to pay you for it - cool! But in time, you may wonder whether your painting is worth the money you’re given (too little or too much?), feel pressured to paint when you don’t want to, and enjoy it less as it’s become a job. Some researchers reject the idea that external rewards decrease intrinsic motivation (Cameron, Banko, & Pierce, 2001), but what ends up accounting for differences is the degree to which rewards are used, in what context and what the orientation was to begin with (intrinsic or extrinsic).

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Goals Goals (Fishbach & Ferguson, 2007), are the mental pictures of a desired future we’d like for ourselves and compared to the present, leave a gap between what we want and where we are. Closing the gap becomes a motivating factor. Yet, just because someone suggests you become a professional musician and you do play well, you may still only choose it if it’s something you want, see as possible, and have time for. Not all dreams become goals, but reaching life goals adds to life satisfaction (Headey, 2008) and striving towards tough goals makes people enjoy and work harder at them (Abuhamdeh & Csikszentmihalyi, 2012), especially when they get feedback about their efforts. For example, employees do better when they are told to reach 80% of their targets versus only “doing their best” (Latham & Pinder, 2005). Having clear targets lets us know what we need to do and how hard we need to work.

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You might think dreaming up a goal is enough to achieve it, but goals are more likely to succeed when they are realistic (you won’t be a basketball star if you’re 145 centimeters), achievable with effort that you are willing to put in over time (over 80% of people give up on their New

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Year’s resolutions within days!), include a plan and reasonable expectations (some plans are complex and take years to reach), and support (if no one cares for your goal, you may give up). Goals help us in many ways (Rheinberg, 2008; Weinberg & Gould, 2007). They direct our attention and give us something on which to focus that is future directed and keep us from overthinking about the past or present. They inform us about where to spend efforts, by how much, and when. They increase our persistence (we work harder with goals than without), and help us develop strategies and skills we wouldn’t otherwise. Goals are also useful when things go wrong as they offer a safe place in which to escape.

Goal-Orientation Theory

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How we approach goals matters and goal orientation theory (Wolters, 2004) suggests that individuals tend to do it in four ways. In Mastery/Approach Goal, people set mastery goals and are motivated by the desire to improve their skills and learn. These goals focus on developing ability and “mastering” (becoming good) a task. Achievement here means making progress, even if the person does not become the best or finish first. An example includes a person spending time practicing their piano skills to master a difficult piece by Mozart. In Mastery/Avoidance Goal, it’s the opposite: people will do whatever they can to not learn in

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case they cannot and feel bad about themselves as a result. A person may say, “I’m not interested in playing the piano”, but very much wants to. They just doubt having the ability to learn and as a result, don’t. The categories above involve making a personal assessment of whether one can master new knowledge and skills. Now, the focus changes to whether the person can perform the action and involves an assessment of how confident a person is in front of others. In Performance/Approach Goal, goals are used to show competence and ability, especially in front of others. Achievement here means doing better than others. Yet, it’s not always about showing off, sometimes this approach can help us excel and involves the times you work harder in class only to beat a score held by the top student in your program. Others help us excel without knowing it. Finally, in Performance/Avoidance Goal, goals involve the desire to show one is not incompetent in front of others. People avoid showing their low ability and achievement means not doing worse than others. This type of goal can increase anxiety and make performances worse as the person gets no practice in performing the exact thing in which they need confidence! An example might include a classmate suddenly being “sick” on presentation day for no other reason than they were worried about not being competent and having that show in front of others.

Need for Achievement

Photo credit: Pixabay

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We can look at individual’s needs for achievement (McClelland, Atkinson, Clark, & Lowell, 1953) (written as n Ach), power and affiliation to also understand motivation. High n ACH people are self-motivated to do well by choosing goals that are difficult but not impossible. They value hard work and are not afraid to put in effort and use determination and persistence. They do not expect goals to be fulfilled by others or wait to see if they will happen. Their goals are realistic and attainable, but difficult enough to keep them interested. They want feedback to know how and where to make changes; they also take responsibility for those changes. In sum, they have a deep need to achieve. People with a low n ACH avoid taking risks because they are afraid to fail. As a result, it’s hard to grow. They choose easy goals (or none) as they are more concerned with saving face, feeling comfortable, or not being embarrassed. If they do choose, they pick easy ones that can be reached by anyone or aim so high than no one could reach them. This way, they don’t feel like a failure when they don’t reach them. People have two other needs; that is, power and affiliation. People with a high need for power want to have an influence on, or direct others, or even control situations and events. They tend to put a lot of importance on leader-follower relationships and may have difficulty with relationships as a result of their forwardness. Not everyone likes to be lead; some people respond better to simple friendly requests. In contrast, people with a high need for affiliation have a strong desire for the acceptance and approval of others, be it friends, instructors, or colleagues. They value others feelings and are warm and friendly, yet they may conform to the wishes of others in order to be accepted when it isn’t what they want. Let’s look at two other theories; one, a classic and the other, much newer.

Maslow’s Hierarchy of Needs Maslow’s theory (1943) is a popular theory that can help us understand why some people are motivated by wanting to do something great and important, while others are happy hanging out with friends. But first, what life goals are you currently working on? Write them out. Now, think of other people, a university cleaner, earthquake victim, or athlete. What goals are they pursuing? You might say things like getting a new home and ensuring there is food and safety for the earthquake victim, or working towards achieving

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excellence or fame for the athlete, or making enough money to one’s parents. This is what Maslow’s theory is about; our needs motivate our behaviour and we are focused on meeting needs of the moment, and once they are met, move on to higher needs. Yet, Maslow agreed that there could be overlap between the levels given that our needs depend on what is occurring and we may accomplish several at once. What are our physiological and psychological needs?

Figure 12-1: Maslow’s Hierarchy of Needs

Physiological needs are our basic needs (like food, sleep, shelter, clothing, etc.). If they are not met and until they are, we cannot function. Think of this level as the starting point before anything else can happen. Countries experiencing strife or war struggle to get these needs met. Without necessities like a roof over your head, food, clothing and the ability to get a good night’s sleep, nothing else matters much. Security and Safety needs: This level can coincide with the first. Not feeling safe and not being able to meet physiological needs is a terrible situation. Feeling frightened, running for one’s life, not knowing who to trust or where to turn leaves people feeling psychologically and

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physically insecure and helpless. Not being able to protect one’s body, property, or family makes us vulnerable. Until safety and protection are permanently ensured, these needs interfere with the ability to do other things or present major difficulties in doing so. Social needs of belonging and love: We don’t always think of this as a need as most of us have good relationships with family and friends, but the need to belong, be loved and accepted becomes a pressing need when that is not the case. We feel social isolation strongly and separation is emotionally painful. Further, when we don’t belong, we miss information, resources, support and others help. While we are motivated to connect with others, we need to be careful. When we don’t have relationships or good ones, it’s hard to make the right choice as to who we let into our lives. The need to be with someone and the desire to be with anyone can make us vulnerable to accepting poor treatment from others. Self-esteem needs: This is where Maslow’s theory has been criticized as it doesn’t consider cultural differences. While it is important for individuals to like themselves and feel a sense of confidence, as well as have respect and recognition from others, placing the individual as the basis upon which this theory is centred is not always a priority in some cultures. In collectivist cultures for instance, the emphasis is not totally on feeling good about yourself and developing a sense of pride about who you are and what you do; rather, it may be more important that a person behaves in accordance with what the group to which he/she belongs values and fulfills their social obligations towards others in order to achieve a sense of self. Thus, one doesn’t achieve a sense of self by one’s self, but through others. Self-actualization and fulfillment needs: Not everyone gets here. This is where we develop a sense of purpose and meaning and value personal growth and the realization of our potential. People here might say things like, “I want to be a doctor and dedicate my life to helping others”, or “I want to become an important writer and challenge people to think about issues.” People set difficult goals and work hard to reach them while becoming their best selves, not for money but for more altruistic reasons. One criticism of Maslow’s theory is that it doesn’t take into consideration major life upheavals and realities like war, which many people live with (Gambrel & Cianci, 2003). In fact, the theory was developed using the top 1% of high college student achievers in the USA in the 1950s, a stable time in history and a very privileged sample! Another criticism involves the order of these needs: a study done across 123 countries (Tay & Diener, 2011) showed that people often pursue the needs out of order, that is, when they can and when possible, versus in

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order and one by one. To be fair, all theories get criticized, change over time and always reflect the researcher’s worldview and sociocultural context. It’s impossible not to.

Self-Determination Theory Self-determination theory (SDT) (Deci & Ryan, 2000; Ryan & Deci, 2000), our final theory, is relatively new and has a lot of support. It too is based on needs, but considers social and cultural contexts, which can limit or support individuals in their growth, development, goal strivings, and wellbeing. SDT proposes that individuals have three needs; autonomy, competence, and relatedness, and these help us understand why certain goals are chosen and how they are reached.

Photo credit: Adeel Zaidi

Competence relates to feelings of effectiveness and efficiency in the completion of tasks. We feel competent when we are able to do things and do them well. Relatedness refers to the feeling of belongingness one has with others and is based on our need to care for and love others, as well as be cared for and loved by others. Finally, autonomy includes our want to have and organize our own experiences by using choice and control over our behaviour and thoughts while moving toward chosen goals. As individuals meet these needs through goal pursuits, wellbeing

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increases such that persistence, psychological health, and better performance emerges and increases motivation. Researchers Ryan and Deci (2000) considered these needs to be innate (natural) and dependent upon each other. For instance, a sense of competence, being able to do things, relates to autonomy such that you can only do things well if you are allowed to do things at all. Further, competence also depends on our degree of relatedness. To be competent in something, one has to be supported and encouraged by others. When parents show interest in their child’s academic or sporting success, they are more motivated to continue in those activities to make themselves and their parents proud. We still engage in behaviour in the absence of other’s support (i.e., you might be motivated to improve your photography skills and no one cares about it but you), but others’ interest and encouragement does boost motivation. There are also two types of goals: autonomous and controlled. Under controlled goals, individuals engage in goal pursuits for reasons other than their own—they are controlled or regulated by others to a degree. Under external regulation, an individual’s behaviour is controlled by others such that they are acting to avoid a punishment or get a reward. People’s response is “I don’t want to do this, but if there’s a reward or a way to avoid punishment, then I will”. This form of regulation results in a lack of follow-through, no maintenance and undermines intrinsic motivation. This is like the paying your child to clean their room example. In the introjection regulation condition, people are less resistant, but only engage in the behaviour to save face, make others happy or proud, avoid guilt and shame, or avoid feeling self-conscious. It’s like saying, “I don’t want to do this, but I will only because….” There is an inner conflict between what others want and what they believe despite the fact that they pursue the goal anyway. The behaviour is more likely to be maintained than in the previous example, but if the expectation changes, the behaviour will too. Under autonomous goals, individuals also engage in behaviours or expectations given by others, but they agree with them at least. Under identification regulation, there is little inner conflict and the behaviour is “owned” to a greater degree. Individuals recognize and accept the value of a behaviour and understand why it is good for them to do so. Nonetheless, it is still done for a reason. They might say, “I’ll exercise, because I know it is good for my heart.” Finally, in the integration regulation condition, individuals recognize, accept, and integrate the behaviour into aspects of themselves. The behaviour is fully determined by them. In this situation, they say, “I want to go for a swim today because I like it” and not “I have to” or “I should.”

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We naturally internalize society’s expectations to a degree; in part, because we want to fit in and in part, because normally societies have good expectations for us. However, researchers noticed that in conditions where there is strong influence, control or excessive pressure to take on behaviours (in other words, when someone is trying to motivate you when you aren’t in agreement with the choice in question), it backfires and has the opposite effect. Individuals need to come to realizations on their own and supporting their autonomy (the ability to think and reason for themselves) facilitates, or makes the internalization of that behaviour more likely (Grolnick & Ryan, 1989; Grolnick, Ryan, & Deci, 1991). Remember that when you become a parent! Don’t push; but, teach, model and wait. What about amotivated people, lacking all form of motivation? Ryan and Deci (2000) determined that these people lack either selfefficacy (the personal belief that one can make a change to one’s circumstances) or lack control over their own behaviours, decisions and thoughts. In this case, we can say that amotivated people lack both intrinsic motivation and extrinsic motivation. We’ve covered many theories and models to explain motivation, but there are a few more independent constructs to review that contribute to motivation even though they can also be included in other areas of human behaviour. These include our self-concept, self-efficacy, mindsets, and attributions. Ready?

Motivational Constructs by Joana Stocker & Meera Khalifa We define self-concept as the perception we have of ourselves and specifically, the attitudes, feelings and knowledge we have about our abilities, skills, physical appearance and social acceptability. According to authors (Marsh & Hattie, 1996; Marsh & Shavelson, 1985; Rawlinson, 2005), perceptions about one’s self as well as one’s self-awareness are based on the experiences we have across contexts like family, school and peer group. Cognitively, one’s self-concept also depends on the interpretations we make of those experiences as well as the causal explanations or attributions we make for these events (i.e. asking “why did this happen?”). Although there are many theories about the self-concept, the most recognized is the multidimensional and hierarchical model developed by Shavelson, Hubner and Stanton (1976) (revised by Marsh, 1990; Marsh, Byrne, & Shavelson, 1988; Marsh & Shavelson, 1985). The self-concept is

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organized in different dimensions or categories about the individual and authors conceptualize the self-concept in different areas such as spiritual self-concept, academic self-concept, social self-concept, physical selfconcept, among others. In each, we find sub-dimensions. For example, the academic self-concept relates to a student’s beliefs about their skills, academic potential and limitations, habits, preferences and interests in school. Students, beyond an academic self-concept, also hold selfperceptions in specific academic domains developing the Math selfconcept, the Arabic self-concept, the English self-concept, etc. (Marsh et al., 1988; Schunk & Pajares, 2002). The self-concept changes throughout our development becoming more specific and multifaceted with more subdimensions. Generally, upper dimensions (general facets) are more stable than specific ones. In fact, as one descends in the self-concept hierarchy, the dimensions become more situation-specific and less stable. For example, the academic self-concept is more stable across time than the Math self-concept (Marsh & Shavelson, 1985). Finally, the self-concept can be both descriptive and evaluative, being used to describe oneself, such as I am a spiritual/religious person, and/or to make self-evaluations, such as I am a good athlete. See the Table below for examples of dimensions and sub-dimensions.

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Why is the self-concept considered a motivational construct? Well, think about your motivation levels when you are about to do something you don't like, feel comfortable with, or aren’t good at. Are you

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highly motivated to do it? If Majid thinks he has weak reading skills, will he be motivated to read for the whole class? Now, think about a situation where you really like an activity and in which you feel very competent: how is your motivation? For example, Bodoor likes archery and she usually doesn't miss the target: will she be motivated to participate in a school tournament? For sure! Examples of Self-Concept Dimensions and Respective Self-perceptions: Dimension Academic Math Verbal

Physical Ability Physical Appearance Spiritual Values Emotional Stability

Self-perception (positive and negative) I learn quickly in most academic subjects. I hate studying for many academic subjects. I am quite good at mathematics. Mathematics makes me feel inadequate. I can write effectively. I do not do well on tests that require a lot of verbal reasoning ability. I have a high energy level in sports and physical activities. I am poor at most sports and physical activities. I am good looking. I am ugly. My spiritual/religious beliefs provide the guidelines by which I live my life. I rarely if ever spend time in spiritual meditation or religious prayer. I am usually pretty calm and relaxed. I worry a lot.

Table 12-1 Adapted from Self-Description Questionnaire III (Marsh & O'Niell, 1984)

Implicit Theories of Intelligence (Mindsets) Let’s move on to what are called implicit theories of intelligence. Carol Dweck is considered the founder of the implicit theories of intelligence. “They are called ‘implicit’ because they are rarely made explicit, and they are called ‘theories’ because, like a scientific theory, they create a framework for making predictions and judging the meaning of events in one's world” (Yeagera & Dweck, 2012, p. 303). These personal theories, which each of us have, are developed based on our common sense, the

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way we were raised, cultural values, and the schema through which we see the world. While we have personal theories about different personal attributes (such as personality), the ones about our intellectual capacity influence the way we organize our goals, behaviours, emotions, cognitions; the way we react to challenges, adversities, success and failure.

Photo credit: Nausheen Pasha-Zaidi

There are two types of intelligence beliefs and we are guided by one of them. They are incremental (growth mindset) or entity theories (fixed mindset). Individuals with a growth mindset (who see intelligence as incremental) view intelligence as a set of dynamic capabilities and skills that can be further developed and improved through personal effort and work, and which are controllable. Individuals who choose a growth mindset focus more on personal growth and development (Dweck & Molden, 2005) and consider challenges, setbacks, and adversities as opportunities to improve. They develop high levels of persistence and resilience, which can be of help when things at school, work or in life don’t work out (Elliot & Dweck, 2005; Yeagera & Dweck, 2012). In contrast, individuals with a fixed mindset (who see intelligence as an innate, limited, fixed and stable trait), believe that challenges, tasks, and evaluations of all sorts reflects a measure of their intelligence level and how smart (or dumb) they are. Their goal is not learning per se, but showing how smart they are and their good results. As a result, these

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individuals choose easy tasks in which they feel safe and know they will succeed, looking for positive appraisals, avoiding negative judgments, and protecting their image. Challenging situations are avoided and seen as a threat (Dweck & Leggett, 2000). Given the difference between incremental (growth) and entity (fixed) theories, it is expected that individuals adopt different goals and behaviours as a result (see Table below).

Intelligence perception Effort perception

Incremental (growth) Developable, improvable Key to success

Goals

Learn

Value of help Response to challenge Resilience and persistence levels

Low Work harder High

Entity (fixed) Fixed, unchangeable Lack of intelligence Look smart and avoid negative judgments High Give up (don't want to look “dumb”) Low

Table 12-2 Adapted from Yeagera & Dweck (2012)

Dweck undertook many experiments to test her theory. In one of them, she took children from the 5th grade and gave them puzzles to solve. The children were divided in two different groups: one was praised for intelligence (“You did really well, you must be very smart”); the other was praised for effort (“You did really well; you must have tried very hard”). The first puzzles were easy and every time a child successfully completed it, they were praised either by intelligence or effort. After, they were given a harder set of puzzles. What happened to their confidence and motivation? Did they think “I’m struggling so it means I’m not good at this”? Or, “I just need more effort and a better strategy”? To understand, children were asked in the end if they would prefer to continue with the last puzzles, in which they struggled, or go back to the easy ones. They found that children who were praised for their intelligence wanted to go back to the easy ones. This is a sign of a fixed mindset and for them, the difficulty meant that they weren’t smart. In contrast, children who were praised for their effort wanted to continue with the more challenging ones. This is a sign of a growth mindset and for them, challenge meant a learning opportunity (i.e., “There’s a mistake I can learn from” or “I feel good when I do something difficult”). How educators,

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parents, peers, among others, praise and reinforce children has an impact on their theories of intelligence and motivation. Studies show that how people view their ability to change and the ability of others to change even has implications for inter-group conflict and race relations. Holding a fixed mindset about a group of people, that is, believing that a group of people have fixed traits that cannot be changed, promoted and maintained hatred against the group (Halperin, Russell, Trzesniewski, Gross, & Dweck, 2011). Having a fixed mindset and believing that another group is evil, aggressive, or stupid and will always be like that, can lead you and the group to which you belong to justify your dislike and act on that aggression. Dweck (2012) conducted a study with Arab and Jewish Israelis, and Palestinians with interesting results. First, the more Jewish Israelis held a fixed mindset about groups overall, the more they held negative attitudes about Palestinians. Second, when primed to have a more open and flexible mindset by reading an article on how societies in general can and do change, both Jews and Arabs (in or out of Israel) were more likely to support political compromise for the sake of peace. Arabs and Palestinians with a more flexible mindset were more open to interacting with Jewish individuals if the chance arose. Finally, whether Palestinian or Israeli, individuals with a growth mindset were less likely to respond with hatred and a want for vengeance than those with a fixed mindset and a want for retaliation.

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What might the implications of this research be for these groups and others around the world who find themselves in conflict? What are some real life activities that people can do to change their minds about others?

Attribution Theory

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In this theory, researcher Bernard Weiner (1966) thought that people behave in certain ways because of the way they interpret or explain what is happening to them by asking, why, or what’s the reason for? These are questions that consciously or not, we ask ourselves after an event, especially if the outcome is unexpected. People have a need to understand their environment, to analyze successful strategies and identify unsuccessful ones, to predict results, in other words, to make causal attributions. This means that very often, if not always, we try to identify (attribute) reasons (causes) for what happens and these interpretations influence our future behaviours. To what can I attribute a bad grade? Why wasn't I chosen to play this match? Why wasn't I invited to the gathering? There are an unlimited number of possible causes for successes and failures. Some of the most common are luck/chance, effort, knowledge, interest, attention, preparation, task characteristics, ability, and self-confidence (Eccles & Wigfield, 2002; Weiner, 1985). In Arab countries, we can identify other important causes, such as wasta, Rizq (blessing), and Qadar (destiny/fate). Are there times when you attributed a good grade to luck or when something that happened to you due to Qadar?

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These causes can be organized along three different continuums – causal dimensions (Weiner, 1994), which include: locus (which means location/place in Latin), stability, and controllability.

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Locus, or locus of control, refers to whether the individual attributes the situation to something internal or external to him/herself, effectively deciding where the responsibility for that event or things lies. For example, effort, ability, mood, preparation, would be considered causes that are within the individual. On the other hand, luck, wasta, Rizq, and Qadar, would be causes that are beyond the person and considered as having an external locus. Example of internal causes: Ak’lak - Although Ahmed’s parents don't behave in a high manner, Ahmed is very well mannered (has Ak’lak). This could be due to the fact that Ak’lak is internal to each person. Example of external causes: wasta - Meera just graduated and got hired at a prestigious institution right away. All her friends assume: “She was only able to get this job because of her wasta, not her talent”.

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Stability refers to the endurance of the cause, as some causes may be stable and constant over time (such as Rizq and Qadar), while others may change over time (like luck, mood, wasta, faith, and attention). Example of stable causes: smartness – In high school, Saif got high grades because he was a smart student. He is likely to continue to get high grades in the university due to his smartness. How smart a person is seems to be stable throughout his/her life. Example of unstable causes: popularity – In high school, Sarah was popular and had lots of friends, which made her feel self-confident. However, once she entered university, a new environment, she lost her popularity, became socially withdrawn, and her self-confidence decreased significantly. Finally, controllability (controllable vs. uncontrollable) refers to the individual’s control over the situation/task and degree of responsibility. Some causes cannot be controlled by the person, such as luck, mood, other people’s behaviour, task characteristics, Rizq, Qadar; while other causes may be controlled by the individual, such as effort, manners, and faith. Example of controllable causes: effort – Maryam is participating in a writing competition. She spends a lot of time editing and improving the text. The amount of effort Maryam puts on this task to have a wellwritten paper is under her control. Example of uncontrollable causes: other’s people behaviour – Mohammed went to pay his electricity bills and the employee in charge was very rude. The employee’s behaviour was out of Mohammed’s control. Each cause can be internal or external, stable or unstable, and controllable or uncontrollable. How can we classify other causes also common in Arab countries in these dimensions? Can we assume that faith is internal, unstable, and controllable? Well, there are no exact answers as research looking at these concepts is sparse. So, which types of attributions are more adaptive and benefit the individual most? Well, it depends on whether it is a situation of success or failure. Western literature suggests that attributing the reasons of success to internal, stable and controllable causes is more adaptive and promotes self-confidence and motivation. In this case, individuals interpret that the causes that led them to success are within themselves and under their control, as well as constant, which means that in a future similar situation, they should be successful once again. If Hessa gets promoted at work and attributes it to her competence (internal, stable and controllable cause), it implies that this success depends only on her and is constant, so she may be successful again in the future.

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On the other hand, in the case of failure, it seems to be more adaptive to attribute the results to external, unstable and uncontrollable causes (Weiner, 1985, 1986). Seen this way, the failure did not depend on the individual and he or she cannot be totally held responsible for the negative outcomes. If Abdullah isn’t chosen for being a Research Assistant and attributes it to the fact that the teacher doesn't like him (external, unstable and uncontrollable cause), it suggests that this negative event didn't depend on him, so in the future he still might be chosen for another job. According to Walker (2004), children growing up within a traditional Arab worldview tend to not develop internal self-control as much, given that parents are the ones who have ultimate control over their behavioural choices. In Arab societies, when children question parents’ decisions, expressions such as “haram” and “aib” are given, which means that this behaviour is “forbidden by God” and brings shame. In fact, Almajali (2012) found that Arab students who came from authoritarian homes tended to have an external locus of control and obtain lower scores on creativity tests. What do you think? What type of causes and attributions do you develop in cases of success or failure? Are they adaptive or not much? To end this segment on motivation, we review two more concepts: self-esteem and self-efficacy. Meet Hamdan. It’s his first day with a trainer at the gym. He is nervous and certain that he cannot do what the trainer asks, so he does not even try. As a result of not doing anything to disprove whether he can do push-ups, his belief remains. His trainer tells him that if he thinks he can’t, then he’s right. As Hamdan believes he can’t do push-ups, he doesn’t try and as a result, his belief and ability stay the same. We stop ourselves from trying new things or getting better at old ones because we don’t believe we can; yet, without trying, we never learn otherwise. In this example, self-efficacy is highlighted.

Self-Efficacy and Self-Esteem Self-efficacy (Bandura, 2009) involves a personal belief about whether you can successfully perform an activity, like stair-climbing at the gym or completing a university degree. Self-efficacy is important because how successful you think you can be influences what you do. Self-esteem, on the other hand, refers to how you feel about yourself, whether you are worthy or likeable. Self-esteem can be high or low, change over time, and be influenced by social contexts and experiences (Baumeister, 1998; Crocker & Park, 2004). How we feel about ourselves depends on what we

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do and believe about ourselves, which is why self-esteem and self-efficacy affect one another. But, how we see ourselves also depends on the opinions of others. These opinions, joined to our own create a lens through which we see ourselves and influence what we think we can do.

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People with high self-efficacy approach difficult tasks as challenges. They set difficult goals for themselves and see these as interesting long-term projects to do over time. If they fail, they think it is because they didn’t try hard enough or don’t have information or skills. They see opportunities and focus on what is possible. As a result, they are not afraid of challenge; they face it with confidence and have positive mental images of themselves succeeding. They also tend to be happier over time and feel they can control or at least deal with whatever comes their way. (I hope you are seeing a trend by now)! People with low self-efficacy, that is, a low belief in their ability to perform, avoid difficult things. They set easy goals or none at all. When faced with tough stuff, they focus on what they don’t have, or the problem instead of what they can do to solve it. As a result, they reduce their effort, give up, or don’t bother trying. When they fail, they think it is because they have low ability making it more difficult to try the next time. As a

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result, low self-efficacy can lead to stress and depression. If you think you can’t do anything, life is stressful; you see yourself failing even before you begin.

Emotion by Dr. Louise Lambert

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If you were to research emotions specific to your culture, which would you choose to know more ab out? Now, think about how that emotion is expressed in your culture and how it might be expressed differently in another? Come to think of it, are there some cultures that show their emotions freely, while others might be more likely to mask or hide their emotions? What you are thinking of are called display rules (Ekman & Friesen, 1969, 1971), the social guidelines for emotional expression learned in childhood that can be based on gender (men can show anger, but not women), age (children can have temper tantrums, not university students), or context (anger may be justified to show dominance in a parking lot with a stranger, but not with one’s father), and meaning (burping is a sign of respect for the cook in some cultures, while in others, burping is well, … burping). While emotions are universal and we all experience them, how they get shown is a different story. Researchers have also noted that individuals modify the expression of their emotions for many reasons. Have you ever felt so sad, but ended up saying, “Oh, I’m fine” with a weak smile, to hide it from others? That’s called expression management (Ekman & Friesen, 1969, 1971) and we do it for many reasons. Of course, we do show our emotions honestly without any attempt to disguise what we feel in some situations

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and with certain people and at certain times (still according to the display rules). But, we can also amplify (exaggerate) or deamplify (minimize) our emotions by perhaps showing excessive sadness at a funeral (to indicate love and devotion), while minimizing sadness at a wedding everyone knows is a terrible match and that has been characterized by ongoing fighting between the families. We can also mask or hide emotions, like nurses or doctors do when dealing with terminally ill patients by pretending that is all fine, or even air stewards who deal with what are sometimes unreasonable demanding people – all with a smile! Sometimes people neutralize their emotions altogether and show a flat face, not happy or sad, but not showing anything at all. This could be a sign of depression of course, but in some cultures, showing nothing is a sign of mature selfcontrol and wisdom. (By the way, this is also why psychologists get annoyed with people who think we can accurately “read” body language! With all of these variations and rules on emotional expression, it becomes very difficult, if not impossible, to know exactly who is feeling what, especially if you’re from outside that culture).

Emotion Theories While research is advancing quickly, we are still uncovering the pieces as to how we experience emotion. We cover some of the standard theories of emotion now and include some new ideas in emotion research, as well as a section on aggression.

James-Lange Theory This was one of the first theories by Lange and James (1922) to suggest that our emotions are a reflection of our physiological arousal, which we first experience and then perceive as an emotion. From the pattern of arousal (you can think of them as symptoms), we then identify which emotion we are feeling. Imagine you are in class and a friend you’ve had a fight with walks in late and bumps your desk on the way by. Your face might feel red, your body temperature may rise, your face may harden, and your heart starts to race. Your feel these sensations and realize you are upset. Yet, not all researchers agreed with this theory.

Cannon-Bard Theory The Cannon-Bard theory (Bard, 1934; Cannon, 1927) rejects the Lange and James theory stating there are not enough combinations of

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physiological arousal to go around for each emotion; how can we identify all of them in this way? Instead, they proposed that individuals get a physiological sensation and at the same time, perceive or identify the emotion. It’s close but the difference is that the physiological sensation does not inform what emotion you have; they happen together.

Schachter-Singer Theory Schachter and Singer (1962) suggests another variation. We have a physiological response, but for it to become an emotion, we must provide an attribution (reason) for it. An example is that you’re in class and suddenly feel hot, flushed and anxious (physiological response), but decide that it’s because you took cold medication this morning and nothing more. This sensation does not get interpreted further and is not perceived as an emotion. Thus, not every sensation is an emotion and that shouldn’t be the only criteria as there are examples of when we feel sensations without emotion, like when you go to the gym, you feel energized, but this isn’t an emotion, it’s your body’s response to increased blood flow and the release of endorphins. The same when you get a cold and feel chills, sore muscles, and tired. These aren’t emotions but physiological responses. While there are distinct physiological patterns to the six basic emotions (Levensen, Ekman, & Friesen, 1990), i.e., anger, disgust, fear, joy, sadness and surprise, there are not necessarily for smaller emotions, like curiosity or confusion.

Lazarus theory And finally, the Lazarus theory (Lazarus, 1991) suggests the opposite. We cognitively appraise a situation first (we decide we are angry about the friend bumping into our desk) and then we feel a physiological response. This theory also has merit: you see someone you don’t like but decide that you’ll ignore them and feel no emotion as a result. You chose the emotion first and the physiological response (or lack thereof in this case) follows. While these are the main emotion theories, there are new ones being developed. In particular, Prinz (2004) took up the work of James and Lange stating that a bodily change indicates a situation in the environment that should concern us in some way. Sometimes, we get a weird feeling that we can’t explain, and while we can’t find the words for it or identify it, it nonetheless signals a change that our body registered although our minds did not. When we pay attention to this feeling, we then work to identify it as an emotion. Thus, according to Prinz, emotions are

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physiological feelings, which do not always or necessarily involve the causes or effects of that emotion. Prinz also posits that we are limited by physiology; we can only feel the emotions that our bodies create such as the six basic emotions in this theory of fear (including worry and panic), happiness (including sensory pleasures, satisfaction and joy), despair, romantic love, jealousy, and finally, our homeostatic emotions, which include feeling hungry, tired, dehydrated and so forth (although we don’t normally consider these emotions within the other theories). Prinz’s model relates to embodiment (Niedenthal, 2007), the idea that our emotions are related, tied to, and located within (embodied) the body. For instance, individuals who get BOTOX® injections show a decrease in the overall strength of their emotional experience caused by the restraint of the facial muscles (Davis, Senghas, Brandt, & Ochsner, 2010; Neal & Chartrand, 2011). They tend to feel happier because they cannot frown; if the body cannot create the response of an emotion, it is experienced to a far lesser degree. Research is also looking at the role of gut microbiota in understanding anxiety (Diaz Heijtz et al., 2011; Neufeld, Kang, Bienenstock, & Forster, 2011), Alzheimer’s disease (Hu, Wang, & Jin, 2016) and the stress response (Moloney, Desbonnet, Clarke, Dinan, & Cryan, 2014) as our naturally occurring and present at birth microorganisms affect behaviour, mood and brain development. Gut microbiota is influenced by diet, especially Western high-fat and low fiber diets (Dash, Clarke, Berk, & Jacka, 2015), with differences in diet showing rapid changed to gut profiles in as few as five days (David et al., 2014). High-fat diets promote intestinal permeability (called “leaky gut"), increasing the circulation of microbiota, which triggers an inflammatory response and influences the development of depression (Berk et al., 2013). In contrast, specific probiotic diets have shown promise in alleviating depression and regulating mood (Bravo et al., 2011; Desbonnet et al., 2010). These limited but growing studies lend support to the relationship between the body and emotions as both seem to influence one another and time will tell what interesting treatments will emerge as a result.

What about Aggression? Aggression and violence are words we use interchangeably; yet, they differ. Aggression is the physical and verbal behaviour used to threaten or cause pain or harm to another person, while violence refers to the quality of that aggression. In other words, not all aggression is violent. There are

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also two ways to understand aggression. Hostile aggression is unplanned, impulsive and involves anger, usually in response to a provocation. On the other hand, instrumental aggression refers to behaviours that are organized, planned with a goal in mind, which could still be to harm someone, or obtain a material goal, such as aggression used in the course of a store robbery. But, where does aggression come from? Are we hard-wired to be mean or are we good people at heart? Well, the answer seems to be yes to both of those questions. It seems that culture, environmental cues, situational factors, and personality play a big role in aggression.

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Social Learning Theory The social learning theory (Bandura, 2001) states that what we see we imitate and this becomes learned behaviour, especially if the role model who shows aggressive behaviour is rewarded. Think of how violence becomes acceptable when it is done by a popular singer, actor, or sports figure, especially if they receive no punishment. This model successfully explains aggression, but doesn’t explain why some people don’t become

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aggressive. Many children grow up in families where there is violence and aggression and turn out to be non-violent, and in contrast, there are many families where children are not exposed to aggression yet behave aggressively.

General Aggression Model The General Aggression Model (GAM) (Anderson & Bushman, 2002) includes cognitive and emotional factors, paying attention to three types of knowledge frameworks that involve (1), perceptual schemata, one’s ability to identify what is happening (2), personal schemata, beliefs about people or groups and (3), behavioural scripts, information about how people act under particular circumstances. These frameworks each involve emotions too. We examine those factors now: (a) situational cues and individual differences; (b) levels of emotion, arousal and cognitions; (c) appraisals (determining what is needed in a situation) and coping; (d) aggressive or non-aggressive behaviours. Aggressive cues (things in the environment that encourage violence) shape our responses a lot, such as the presence of guns, violent video games or movies. In fact, studies (Anderson, Carnegey, & Eubanks, 2003) show that violent songs and lyrics increased levels of state hostility through an increase in aggression related cognitions (thoughts). Interpersonal provocation like insults, verbal aggression and bullying can also lead to a change in one’s emotions. Frustrations that block our ability to reach goals, especially when there is an identifiable person responsible for it influence appraisals as well as how we understand a situation and think we should react. Drugs also increase aggression as people who are under the influence seem to react more strongly to provocation. Finally, incentives may influence the decision to use violence, i.e., using instrumental aggression to kill one’s partner for insurance money. All of the factors that make up one’s personality, including one’s attitudes and genetic predisposition influence aggression. Males are more likely to be aggressive and respond to provocation than women and their preferred styles of aggression also vary. Beliefs, attitudes, values and scripts also contribute to making appraisals. Beliefs such as self-efficacy and outcome efficacy are related to an increased use of aggressive acts. If you believe you will be successful using violence, the greater the chance you will. Attitudes towards one’s self and violence also contribute to the shaping of beliefs. For example, a study conducted in Jordan showed that cultural and social norms are accepting of using violence with children or

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women as a kind of diiscipline, desspite the factt that violencce is not acceptable inn Islam (Al-B Badayneh, 201 12). Thus, valuues (social or cultural), influence agggression form mation in that if i aggression is seen as the right and correct thingg to do, it is more m likely to be b used. Ann increase in arousal a (excitaation, physioloogical energy)) can also strengthen aand activate ann aggressive tendency. t Thiink of what haappens at an outing w with your frieends and therre’s just beenn a fight with h another group. Som me of you migght be anxiou us and upset, but others might m feel pumped up and full of ennergy, looking g to fight som me more. If a person is provoked w while in a statte of increaseed arousal, thee tendency to o become aggressive ccan increase.

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Apppraisals (reasoon for a decision) are sponttaneous, taken n quickly, lack cognitivve effort, andd can occur without w awarenness. All of th he factors above influeence the apprraisals we make, i.e., cultture, situation n, beliefs, gender. Thuus, the same acction can prod duce differentt responses in n different people depeending on thheir history, personality, p aand which kn nowledge frameworks are availablee. Yet, a reap ppraisal (recoonsidering a decision) can occur if the circumsstances are no ot right for aaggression. You might think twicee of using aggression a iff you hear police sirenss in the background.. Yet, somettimes there is i no opportuunity to reap ppraise a situation, thhere may be little l time to think, no resoources, or no way out even if the pperson decidess violence is not n the best soolution after alll.

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The GAM ends at this stage where the individual decides whether or not to use aggression based on the above. This model explains why some people use violence and why they don’t and takes into account a person’s social and cultural background and values, present day context (what people expect of you and what you expect of yourself and the situation), and the future (what you want to achieve over time). The model also accounts for many motivations suggesting there are also many ways to intervene to reduce violence, such that beliefs about violence and gender in one’s culture can be addressed or environmental cues can be changed.

Topic Box: Video Games and Aggression by Mehdiyeh Hussain Abidi

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Mass media (television, films, radio, and videogames) and the effect it has on human behavior is an extensively researched topic in psychology. Studies on aggression and violent videogames suggest that video gaming can increase aggressive behaviors in individuals while also decreasing an individual’s sensitivity towards violence. Bandura’s Social Learning Theory (1971) provides a possible explanation regarding the effects of videogames. It suggests that people learn behaviors through observing others in their environment. This leads to the imitation and modeling of violent behavior displayed by popular videogame characters. Anderson

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(Anderson et al., 2003; Bushman & Anderson, 2002) also conducted several studies on the negative effects of video gaming and found that action games can desensitize individuals and reduce their level of emotional response and cause them to attribute hostility towards the actions of others, even in the absence of aggression. For example, Yousef enjoys playing Resident Evil every day. One day Yousef was walking back home from school and noticed a boy running towards him. He felt threatened and moved towards the boy preparing to defend himself but, the boy ran past Yousef in order to catch a taxi which was heading the other way. Yousef’s aggressive and defensive behavior can be attributed to him playing Resident Evil, which may have influenced him to become suspicious of strangers and view them as possible enemies. However, other media violence researchers (Ferguson, 2013; Ferguson et al., 2008) scrutinized Anderson’s findings and suggested that mass media does play a role in teaching and influencing the behaviors of individuals but it is not the only factor to be considered. Ferguson argued that factors such as genetics, personality, and history of family violence also influence human behavior. Behavior is not only learned through observation and modelling. It is also a product of a person’s genetic predisposition and an individual’s temperament and personality without influences from social factors such as mass media. For example, Aisha was at a café in Dubai Mall when suddenly a man bumped into her causing her to spill her coffee. She lost her temper and demanded an apology. Her friends tried to calm her down but Aisha refused to cooperate. Aisha’s tendency to lose her temper very quickly can be attributed to her genetic disposition and her family’s history of short temperedness, not to her playing Call of Duty every day.

Over to you now… 1.

2.

Can you think of a situation in which you were intrinsically motivated and another where you were extrinsically motivated? How did that work? In which activity did you work harder and how do you explain that? Which types of goals do you normally select? Or do you even set goals for yourself? If not, can you explain why by using other concepts in this chapter? Goal orientation theory suggests there are four ways in which we can approach goals. Which do you think is the most successful? Do a quick search and find out who does the best

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3.

4. 5.

6.

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and why, but also in which circumstances that might stop being true. Maslow proposes a number of needs that individuals need or strive to meet over their lifetimes. Is the theory a good way of beginning to understand why we do the things we do and what it is that we need to accomplish? Would you add anything else to the theory? What else is important in life? Might there be some cultures that spend more time attaining certain levels over others? Where and why? Is this a guess or do you see consistent differences in people’s behaviour? Explain and discuss with your classmates. How do you think we experience emotions? What is the main question researchers seem to be confused about and trying to figure out in all of theories? Are you able to describe physiological patterns for the emotions? Try it with a list of 10; it will require you to think of when you felt that emotion and what your physiological response was. How do you explain aggression and violence? If you were to come up with a theory to explain why some people are aggressive and use violence and why others do not, what would it be? Find a PDF copy of Al-Badayneh’s (2012) article (look in the references) and use it as a case study. Consider the reasons for violence against women from the perspective of men and women too. Then, consider solutions for reducing gender-based violence in Jordan (consider the context) and then extend and/or modify these solutions to your own country. Would the same solutions work there? Why/why not? How are people different? How do the culture and/or beliefs about violence and aggression differ? Consider these questions on your own first and then discuss with your classmates.

CHAPTER THIRTEEN SOCIAL PSYCHOLOGY DR. NAUSHEEN PASHA-ZAIDI

Photo credit: Louise Lambert

Chapter Outline x x x x

Social Identity Islamic Identity by Dr. Manal Al –Fazari Cognitive Dissonance by Dr. Louise Lambert The Self-Fulfilling Prophecy by Yara Mahmoud Younis

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x x x x x x x x x x x x x x

Attribution Theory and Attributional Biases by Yara Mahmoud Younis Who likes who? Attraction by Dr. Louise Lambert Social Influence Social Loafing Conformity and Obedience by Homaira Kabir and Yara Mahmoud Younis The Bystander Effect and Altruism by Homaira Kabir Ways of Understanding Culture by Anisa Mukhamedova & Mona Al-Ghamdi Acculturation by Mehrdad Fazeli Falavarjani Discrimination by Aditi Nath Tolerance as an Islamic virtue by Dr. Nausheen Pasha-Zaidi Aggression by Reham Al-Taher War, Uprisings, and Social Change by Yasmeen Al Hasawi Topic Box: Coping with War and Social Unrest by Jeyda Hammad Over to you now…

In this chapter, we look at how individuals are influenced by other people, groups, or society, as well as how they behave, think, and feel in groups; this novel way of examining people is what happens in the field of social psychology. The basic assumption here is that human beings are social creatures and our behaviour occurs in a social context, even when we’re alone. Think about it. When we are by ourselves, we might scratch our armpits, but would never dare in front of others! We think things but would never say them out loud to others. We feel certain things when we are alone, but as soon as there are others around, we shift our attention to them and our feelings change instantaneously. We are indeed influenced by the presence of others and in this chapter, we will see how, when, and why. And to do that, we will look at a number of social psychology concepts that have been collected for this chapter.

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Social Identity

Photo credit: Pixabay

Have you ever heard the phrase, “you are what you eat”? Well, in social psychology you are who you spend your time with. Henri Tajfel (1979) noted that we base our sense of self, our social identity, on the groups to which we belong. Groups provide us with self-esteem and pride. We often view our group as being better than other groups, and so when our group is successful, we feel successful. Are you a Real Madrid fan or Manchester United all the way? Whatever side you are on, your team is the best and everyone else is second-rate. To this end, we characterize people as “us” (those who belong in our group) and “them” (those who are outsiders). This categorization is known as in-group and out-group and is based on the how much similarity there is between group members. By grouping things together, people have an easier time processing the information. Doing so, however, leads to an exaggeration in the similarities within each group and an exaggerated view of the differences between groups. Keep in mind that we all belong to many groups. Groups can be based on gender, nationality, religion, age, class, and a host of other things. Sometimes, these groups overlap and other times, they may be completely different from each other. Let’s say you enjoy camping in the desert while your brother prefers to play videogames online. Both of you belong to the same family group, but because you have different interests, you may end up going camping with a group of friends on Saturday (your group) while your brother stays at home and plays Call of Duty with his online multiplayer team (his group). If one of your camping buddies also enjoys online gaming, you may find that he belongs in both your group and your brother’s group.

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Let’s try it out. Get into groups based on the type of shoes you are wearing today. Once you are in your shoe group, find out each group member’s favourite color. Do you all have the same favourite color? Compare the favourite colors listed in your group with the colors listed in the other groups. Now, rearrange your groups based on your favourite color. Look at the people in your color group. Are these people the same as the ones in your shoe group? You can do this with other descriptors as well. How many different groups are in your class? What do you talk about when you are with each group? These are all facets of your social identity.

Islamic Identity by Dr. Manal Al –Fazari

Photo credit: Louise Lambert

Developmental psychologist Eric Erikson (1968) noted that social identity develops throughout one’s lifetime from infancy to adulthood, but adolescence is the peak time when individuals think about who they are and where they belong in the world. When we talk about Islamic identity, it is important to note that such an identity is framed from childhood by

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learning the principles, values, and behaviours laid out by the Qur’an and the Sunnah. In Muslim countries, people follow Sharia’a law that is based on these two important sources. In developing an Islamic identity, Muslims strive to follow these laws and use the Prophet Mohammed (Peace Be Upon Him) as a role model for how to behave and deal with others. For Muslims, Islam is more than a religion; it is a way of life that organizes and guides social and moral behaviours through its system of beliefs, duties, principles, values, and history. Islam is based on five pillars of faith: (1) (2) (3) (4) (5)

The Shahada, the proclamation and belief in Allah and that there is no God but Allah and Mohammed (Peace Be Upon Him) is his prophet Prayer (five times a day), Charity (zakah or tithe), Fasting (during the holy month of Ramadan), and Hajj (pilgrimage).

These pillars impact Muslim lives and societies in many positive ways. For instance, they can make people feel closer to Allah, enhance an individual’s character, and strengthen personality traits such as honesty, patience, confidence, and humility. Good behaviours are an important form of worship that shape each Muslim’s identity. Prophet Mohammed (Peace Be Upon Him) said: “I was sent only to complete the best behaviour and best characters”. Some examples of ideal Muslims’ behaviours include caring for others, including ageing parents and orphans, kindness to Muslim and nonMuslim neighbors, visiting the sick, helping people who are in need, and expressing generosity. Thus, an Islamic society expects Muslims to grow up with a strong identity that will make an important and positive impact on society. This expectation can shape Muslim identities in unique ways, but the challenge in maintaining an Islamic identity is the contradiction between belief and practice; it’s not always easy to practise what one believes.

Cognitive Dissonance by Dr. Louise Lambert Consider this situation. You really would like to act in an environmentally responsible manner by driving an eco-friendly car that uses less petrol and doesn’t pollute the environment. You’ve looked into a few brands, but the

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car you have been dreaming about ever since you were old enough to drive was just made available to you. In fact, your father has agreed to buy it for you. Sweet!! The only problem is that the dream car is not at all ecofriendly and consumes a lot of petrol. Furthermore, you’ve just signed up for an environmental science class and everyone is sharing how they’ve taken on recycling, or started taking the metro and other forms of public transportation. You’re feeling a bit red-faced. On the one hand, you believe in your responsibility towards the environment, but you also love this dream car and it can be waiting in the driveway just for you. This conflict is called cognitive dissonance (Festinger, 1962) and refers to the mental stress or discomfort an individual experiences when they have two or more conflicting beliefs, or inconsistencies between a belief and an action. We don’t like to be inconsistent by saying one thing and doing another and are motivated to align these beliefs and/or actions to be the same in order to reduce the emotional discomfort we feel. It is especially worse when others notice the inconsistency! Imagine if the environmental science class knew you got the car! Not only would you feel uncomfortable about going against your values, but now, you run the risk of others judging you for it. In this example, you have a few options that would help you to not feel like a hypocrite. You could reject your environmental beliefs (change your beliefs) and go with the car; this way, your belief now matches your actions. The only problem is that you do believe in environmental responsibility, so that wouldn’t work. You could say no to the car and take the metro (change your actions) or find a car that is a good compromise and doesn’t take so much petrol. This might work although now you’d feel sad that you don’t have the car, plus, you might upset your father! Or you might do what many people do and justify your actions by minimizing the situation by saying something like, “I know it takes a lot of petrol, but compared to a Land Rover which takes much more, it’s not the worst”. You might also criticize others in the hopes that they won’t notice your inconsistency: “I know it’s a petrol-waster, but it’s not more than taking an airplane, and Mohammed, you fly away every weekend, don’t you!?” Think about some typical examples of cognitive dissonance you have faced in your life. Discuss an example with your classmate and apply the tension-reducing options to see what options might have been available to you. Then, discuss the following as a case study: You are against smoking and organize an anti-smoking campaign at the university. You were on television to talk about your work against smoking last week. You even said that no one in your family smokes and

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you would not hang around smokers. It’s a month later: you are leaving the university and notice your best friend smoking with a group of people! Everyone knows the two of you are best friends. You hang around together all the time. You will be presenting again this afternoon at the university about implementing university-wide no-smoking policies. What do you do now? Take a look at the photo below. How might cognitive dissonance be reflected in this image?

Photo credit: Louise Lambert

The Self-Fulfilling Prophecy by Yara Mahmoud Younis Do you remember the last time you told yourself it was going to be a bad day and when it ended badly, you wondered why you ever got out of bed? It might have seemed like the world was against you on those days but, it was your own expectations and attitudes for that day that increased the chances of it becoming a bad day. Yes, you may in fact have influenced the bad day all by yourself! The expectations that we hold for events and situations that end up creating those very events and situations are known

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as the self-fulfilling prophecy (Merton, 1948). A formal definition is when people develop negative or positive expectations about a certain person, subject, or event, their behaviour changes in a way that causes those expectations to become real. It is important that you understand how your attitude can shape your behaviour in everyday situations and how you can have better control on your outlook by holding more positive expectations. Let’s take a look at Maryam. She has to take a statistics course at university and feels that statistics is difficult, and as a result, expects that she will not get a good grade. Maryam shows a change in behaviour as she does not put any extra effort in this course as she would for other courses. This in turn causes Maryam to get a bad grade, reinforcing her original expectation that she would not do well. But what happens when we use self-fulfilling prophecies to positively motivate people? That is what Rosenthal and Jacobson (1968) investigated in an elementary school classroom. They informed teachers that some students were more intelligent than others based on a test. In fact, those students were randomly chosen and there was no test, but the teachers didn’t know that. The purpose of this experiment was to find out if changes in teacher expectations could produce greater achievements in students. They concluded from this experiment that one person's expectations of another's behaviour may act as a self-fulfilling prophecy. When those teachers expected the more intelligent students to get better results on an IQ test, they did because their teacher’s attitudes changed towards them. This is known as the Pygmalion effect, which is a type of self-fulfilling prophecy that explains higher performance by people when greater expectations are placed on them. Knowing this, let’s go back to Maryam. Her statistics professor gives her extra feedback and help with class exercises, showing Maryam that he expects her to improve. In turn, Maryam feels motivated to work harder to reach his expectation. In this case, the professor's attitude towards Maryam motivated her and changed her attitude towards the class. This, in turn, resulted in her getting a better grade. Let’s look at one more example where the self-fulfilling prophecy can have bad results. Imagine Yasser, a young man of 19 years. He has been spending a lot of time on the Internet watching videos about the need to protect himself against acts of violence from newcomers in his village. He is certain he will be attacked by these new inhabitants; they seem to be causing so much trouble. He decides to take matters into his own hands and begins to act aggressively and defensively against any person he perceives is insulting him. As a result, his behaviour is inviting violence,

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rather than preventing it, which reinforces his expectations of violence. We can even extend this scenario on a national level where states, in a bid to protect themselves against acts of terror, end up engaging in acts of violence themselves (Zulaika, 2009). Where can you see the self-fulfilling prophecy in your daily life? Remember that self-fulfilling prophecies have an impact on how you see events or other people. Your expectations of these change your behaviour and produce the result you wanted (or didn’t). Understanding this can help you improve your studies, work, and social relationships. So, the next time you expect something to go badly, remember that an optimistic attitude can have a lot of influence on avoiding negative consequences.

Attribution Theory and Attributional Biases by Yara Mahmoud Younis In previous chapters, we looked at how people make cognitive judgements about others. Here, we look at the same processes but consider how these judgements shape our behaviour and the views we have of other people. Let’s briefly review. Attributions refer to the process of interpreting the causes for a specific event or behaviour; it’s our explanation for why something happened or why someone engaged in a specific action. Attributions are attempts to understand our own experience and the behaviour of others in life. Fritz Heider (1958) is well known for developing attribution theory. It is concerned with how people perceive, interpret, and understand events by assigning (giving) causal explanations to them, and how this can influence the way people think and behave (Kelley, 1973). Every time you interact with another person, you make judgments about them and try to understand the reasons for why that person acts in a certain way, allowing you to make sense of these interactions by determining your own meaning of it. For instance, Fatima has a group project with two of her classmates. This would be the first time she has ever worked with, or even spoken to her partners, so she does not know them very well. They all split their work and each has their own part, but towards the deadline Fatima finds out that one of her partners did not complete the work. She begins to wonder if her partner is just lazy or might have other problems going on that she isn't aware of. If Fatima finds out her partner is intentionally not completing the work, she would assign a dispositional attribution. Dispositional attribution refers to a person’s characteristics and is considered to be an internal factor that drives the motives and intentions of

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the actor. In other words, Fatima’s colleague is just plain lazy! On the other hand, if there were external factors involved that prevented her partner from completing the work, Fatima would assign a situational attribution. A situational attribution is when we decide or know of external factors in the environment that can provoke an individual to act in a certain manner, such as having trouble at home (Heider, 1958).

Photo credit: Pixabay

Attribution theory can also be applied to journalism and the media. There is a particular focus on how attribution theory forms stereotypes of Arabs and Muslims in the eyes of the Western world (Gregg, 2005). When Western media sources always show the Middle East negatively, the audience begins to assign dispositional attributions to the entire society. As this view is shared by a huge portion of the audience, it creates stereotypes, and can turn to hatred. This becomes dangerous over time and influences how people and even countries respond to one another. Have you ever been in a situation where you were quick to judge and blame others, but not yourself? If so, then you faced an attributional bias (Heider, 1958). While attributions are assigned to explain the cause of people’s behaviour, an attributional bias is a subjective causal explanation based on personal perceptions held by individuals. This normally leads to inaccurate explanations of the behaviour and the situation (Heider, 1958).

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Attribution bias is common when individuals attribute others’ behaviour to personal factors rather than the situation they were in. When individuals focus on dispositional factors and minimize the impact of social situations, they engage in the fundamental attribution error (Ross, 1977). For example, Amina is waiting in line to pay for her items in a shop; the customer in front of her suddenly starts yelling at the cashier because the cash register is lagging, and the customer is getting impatient. Amina immediately thinks that this person is impolite as the cashier is just doing their job. But Amina does not consider that the person could have had a death in the family that day and really did not intend to be impolite. There are times where a person is quick to blame their failures on external factors while attributing successes to themselves. This is called a self-serving bias and it helps people see themselves positively and raise their self-esteem (Shepperd, Malone, & Sweeny, 2008). Let’s look at Aliya, who is part of a creative team at work. Every time they win a new client for the company, she gives herself most of the credit in that success. But when the client is not happy with their work, or a mistake has been made, Aliya blames her colleagues. The just-world bias also places too much blame on the individual. This is the tendency to make attributions on the belief that the world is fair or just, meaning that people deserve what happens to them and if they are in a difficult situation, it is their fault (Hafer & Bègue, 2005). By blaming the person, others believe that they will not be in similar situations by simply avoiding those behaviours. Imagine that Tareq was in a car accident, and on the news it says that it was due to reckless driving. Others read the news and blame Tareq for the accident because he was driving badly, but actually there was another driver that came out of nowhere and caused Tareq to swerve into another lane and crash. Another bias is called the false-consensus effect. This is a type of bias in which you overestimate the degree to which people who have common opinions, attitudes, and beliefs similar to your own, so that you are quite sure that others think and feel the same way as you do (Ross, Greene, & House, 1977). For example, Haneen goes out for dinner with a group of her friends. When they are ordering food, Haneen orders lamb instead of chicken for everyone at the table as she prefers lamb, and assumes everyone else does too. After Haneen places the order, she finds out that most of the group prefers chicken. Oops. These biases can be an obstacle to understanding others and you may not even be aware it is happening. Think of the last time you had an experience where you judged a person too quickly; was their behaviour

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situational or dispositional? Write down some attributions about your own behaviour to help you decide. The next time you talk to or hear about a person who is behaving unusually, think about all of the factors in a situation, such as environmental factors, societal norms and cultural expectations. Doing this can help you understand people in a more positive light.

Who likes Who? Attraction by Dr. Louise Lambert Have you ever met someone new and decided you liked them just because they wore red pants? Or have you sat next to a classmate you barely noticed at first but over the course of a semester, ended up being friends just because you sat next to each other? A lot of our attraction to people is quite nonsensical. Let’s talk more about why people like each other in the first place. Affiliation refers to the motivation to seek out relationships with other people and this need can be explained by the fact that throughout evolution, humans have survived and flourished best in groups. In fact, we depend on one another for almost everything, such as protection, childrearing and intimacy, obtaining resources (like money, food, and employment), sharing confidences and emotional support, attention, good conversation, fun, and the opportunity to compare one’s self to others to see how we are doing in life (Hill, 1987). We can affiliate rather loosely and have a network marked by weak ties that would include connections we have with neighbors, people at your mosque, professors, the cashier at your favourite store, or we can affiliate very closely in networks marked by strong ties, like the ones you have with family members and your best friends (Granovetter, 1973). In our desire for connection, the Social Affiliation Model (Latané & Werner, 1978) suggests that we try to maintain an optimal range of social contact and any movement away from our usual levels motivates us to re-establish a balance. Thus, when we experience too much solitude, we are motivated to seek others, but when we experience too much contact, we are motivated to seek solitude and quiet. But, who do we seek out and why? While affiliation describes our natural need to connect with others, the desire to move towards certain people in particular is called attraction. Many things influence attraction. For example, we tend to like people that make us feel good and dislike them if they make us feel bad (Shapiro, Baumeister & Kessler, 1991). Further, anything or anyone present when we feel good is also likely to be liked too (Johnston & Short, 1993). For example, on days when you are hungry and tired, your

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classmate becomes almost too much to bear, but on days when you yourself are in a good mood, you like her a lot better despite the fact that her behaviour hasn’t changed a bit. Emotions influence our attraction or repulsion towards others to a much greater degree than the qualities of the person in question, which means if you want to be liked by someone make sure they are in a good mood before and while you meet them! Let’s go back to our red pants. Red pants are a little zany and take confidence to wear. That confidence alone is what often attracts us to people – even without them uttering a word in our direction. In fact, we make first impressions in less than 1 second (Willis & Todorov, 2011)! That means, in literally no time, someone creates an idea about you in their head. Wow! That hardly seems fair, but keep in mind that first impressions change; this is only the initial red or green light towards further contact and a lot more information is needed from that point onwards to decide if we will carry on a relationship or not.

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In 6 seconds, on what do we base our judgments? The first thing we notice (whether it be the red pants, beautiful hair, or a funny laugh) is involved in making a judgment of someone. This is called the primacy effect – the effect (usually positive) of seeing that ‘first thing” and using it to interpret everything else about the person afterwards. The funny thing is, we often pre-pick the “first thing” and decide who we like even before we meet them. Let’s take height, for example. Most people are drawn to taller men. Height in men, signals authority, maturity, or leadership - it commands respect (Batres, Re, & Perrett, 2015). If these characteristics matter to you, the next time you meet a tall man, you will already have a favorable impression of him without him even glancing your way! Simply as a result of this, we are more likely to positively interpret his comments and actions even when there might be nothing special about them at all. Our first impressions tend to be quite accurate though. Think back to when you’ve first met people, it’s more likely that you were correct in your judgment of them than not. Humans are good at detecting good people and are also forgiving of good people who are not so great at making good impressions. This means that if you mess up a first meeting, but you’re genuine (not trying to be someone you’re not), people will spot your goodness anyway. The Halo Effect (Dion, Berscheid, & Walster, 1972; Nisbett & Wilson, 1977), the belief that what is beautiful must surely be beautiful, healthy, smart, or popular, can also explain why we are drawn to some people over others. In fact, this effect is even more pronounced when we are in a good mood ourselves (Forgas, 2011). Think of Kim Kardashian, beautiful for sure, but skilled or talented? I leave that to you to decide, but be aware of the halo effect and you’ll see it everywhere, i.e., who gets job interviews, better performance reviews, social invitations, or help from strangers. It’s not fair that we judge so quickly and on things so superficial, but consider what first impressions people make of you in job interviews or online (i.e., LinkedIn or Facebook). Yet, be aware that beauty can backfire; if you focus too much on your own beauty, or if a focus on beauty is not appropriate for the context in which you are trying to accomplish something, i.e., in a job interview, your beauty can lead to less successful appraisals (Agthe, Spörrle, & Maner, 2010).

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Whhat else leadds to attractio on? Laughingg, repeated exposure, e proximity ((being physicaally close), an nd similarity. JJust sitting orr standing near others – especiallyy over time - greatly influ luences our attraction. a Repeated eexposure (Zajjonc, 2001), like seeing a classmate ev very day, increases our familiarityy and sense of comfort causing us to more positively evvaluate the peerson (Morelaand & Beach,, 1992). Yet, this does not apply iff you already dislike someo one, in fact, thhe more you see s them, the more yoou will dislikee them! How about laughinng? Laughing g requires two people tto be in closee contact with one another and once it occcurs, we discover thaat we have at a least one id dea in comm mon – the onee we just laughed aboout. Laughterr also createes positive em motion, whicch boosts attraction, aand establishees intimacy as a it marks tthe boundary between those who laaugh and those kept outsidee the joke creaating a temporrary “we” group of bellonging. Sim milarity plays a role as well; w the moore similar we w are or perceive ourrselves to be with others, the t more the ppotential for attraction as we tend to befriend those t who look, think, annd act like uss. In fact, through con nsensual valid dation (Festin nger, 1954), inndividuals tend d to think that when otthers agree with w them, it co onfirms that thhey are in facct, correct or intelligennt. In this casse, why wouldn’t we like them - we get to feel good about ourselves evvery day. Thus, the moree people sharre similar attitudes, thhe more they tend to like each other. B But, similaritty is also important w when it comess to level of attractiveness, a , communication style, culture, sociio-economic level, life valu ues and goals, and activities. Thee matching hypothesis explains e our cchoice of parrtner: we seek out othhers who mattch us – equaally - on manny dimensionss; that is, people who score more or o less the sam me on attractivveness (or oth her social characteristiics, i.e., popuularity, activitty levels, socciability, etc.)) will be more likelyy to get togeether than th hose who do not match (Walster, Aronson, A Abrahams, & Rottman, R 196 66). While wee don’t need someone

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who is 100% like us, we do need enough things in common to be able to understand one another, but we also need to be different enough so the relationship remains interesting.

Photo credit: Pixabay

What about the idea that “opposites attract?” Well, they might for a while but it’s tough to maintain a relationship over time with an opposite. Instead, we seek complementarity (Winch, 1958). For example, if one likes to lead, the other likes to follow, or if one likes to support and offer care, while the other needs to feel a sense of emotional security, then one characteristic complements the other. One’s behaviour fills a space in the other’s life. Even in other contexts, complementarity is important. For example, three friends want to go into business together, one likes to do public relations and market the product, the other likes to develop the product, the other enjoys taking care of administrative details and organization. Perfect! Together, while all different, they create a good whole. In this model, difference is fine as long as the differences still lead people to move in the same direction.

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What initially attracts you to someone – their looks, manners, culture, or something else? Think about arranged marriage. How do two people who might not know each other well eventually come to love one another?

Social Influence

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Studies in social psychology have identified an interesting principle surrounding group interaction. By analyzing the way people make

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decisions in their everyday lives, as well as across schools, organizations, communities and even on the internet, researchers have found that when people come together in groups, discussion typically moves towards the extremes. This phenomenon is called group polarization (Moscovici & Zavalloni, 1969), the tendency for group opinions to become more similar and pronounced than would be the case for any one individual making the same decision. That is, the opinions expressed can become more risky and extreme if the group is heading in that direction, or more cautious and riskaverse. The power of groups can influence our thoughts and opinions a lot. While group polarization does have benefits, such as when hard working students gather together and collaborate towards excellence or when like-minded people find support for their shared concerns or interests, the negative effects of polarization cannot be overlooked. The most pervasive of these is groupthink, the tendency of those in power to discourage or suppress dissent in the interests of group harmony. Psychologist Irving Janis (1982) believed that groupthink is more common in cohesive groups that are isolated from other viewpoints and have a directive leader who has the decision-making authority.

Social Loafing Have you ever been asked to do teamwork? When you work on a team, you share the responsibility for the effort that is needed to complete your tasks. One major issue that comes up in work groups is the tendency of some people to do less than others. This is known as social loafing. One of the earliest experiments to test this phenomenon was done by a French engineer named Max Ringelmann in 1913. Ringelmann asked participants to pull a rope individually and in a group. What do you think he found? Well, he discovered that when people were in a group, they put in less effort to pull the rope than when they did the task by themselves. Another experiment looked at how effort decreased as the number of people in a group went up. Latane, Williams and Harkins (1979) asked participants to yell and clap individually, in pairs, in groups of four and in groups of six. The people who worked in pairs performed at only 71% of their individual performance. The four-person group performed at 51% of their individual performance level and the six-person group performed at only 40%. In other words, the more people in your team, the less effort seems to be put into the work. Remember to tell your teacher that next time she assigns you to do teamwork!

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Conformity and Obedience by Homaira Kabir and Yara Mahmoud Younis

Photo credit: Adeel Zaidi

Your beliefs, attitudes and actions are never isolated from your social surroundings. In fact, many of your choices and decisions are influenced by them. When you were younger, you probably tried to change something about yourself to fit in, whether it was your hair, the way you dress, or even your interests and hobbies. At some point in every person’s life, they have changed an aspect of their behaviour in the hopes of being accepted by a group of people. This behaviour reflects a form of social influence called conformity. Usually a response to group/peer pressure, conformity involves a change in attitude or behaviour in order to fit in with an accepted set of social norms within a given group (Asch, 1951). When an individual conforms, it is most likely due to a fear of social disapproval from others, and conformity can vary from compliance to internalising and identifying with those social norms (Asch, 1951). We can see how conformity would lead to obedience (Milgram, 1963). It is important to distinguish between scenarios where obedience leads to positive results and those that become a source of evil. For example, teachers who require their students to be obedient during lecture time, do so in order to facilitate optimal learning in the classroom. Thus, obedience is when an individual receives a direct order, typically from a higher authority figure, and must obey orders as there is a perceived difference in status (Milgram, 1963). Regardless of whether an individual

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personally wants to follow orders or not, and even if orders go against personal morals, values, and beliefs, that person is likely to do what a higher authority orders. In one famous study known as the Stanford Experiment, participants were randomly assigned the role of a prisoner or a guard as part of a simulation resembling a prison environment. After being taken to a university basement that had been converted for the project, the “prisoners” quickly learned how actual prisoners are treated when they were unexpectedly arrested, given a uniform and an ID number. In this way, the prisoners were deindividuated, meaning that they were no longer seen as separate human beings, but rather as one group, in this case a group of prisoners. Although the simulation was supposed to last two weeks, it was stopped after six days. Philip Zimbardo, the lead investigator in the study had this to say, “Our planned two-week investigation into the psychology of prison life had to be ended after only six days because of what the situation was doing to the college students who participated. In only a few days, our guards became sadistic and our prisoners became depressed and showed signs of extreme stress.” Because conformity to social roles occurs as part of social interaction and expected behaviours of the people in those roles, it quickly became clear that the prisoners were becoming passive, whilst the guards were becoming increasingly cruel. When leaders take advantage of their position of authority to enforce behaviours that are detrimental to the larger good, we need to question our tendency to obey. Another famous experiment was conducted by Milgram (1974). In this experiment, the extent of obedient responses was measured to understand how far regular people would go in harming others when given orders. Milgram was interested in how people could be influenced to commit very inhumane acts such as the Nazis in Germany during World War II. In the experiment, volunteers were recruited and asked to “randomly” choose to be a teacher or a learner. But the choice was fixed without their knowledge, and all of them were selected as teachers. The teacher was instructed to activate an electric shock whenever the learner made a mistake, increasing the shock voltage each time. The learner would purposefully answer wrongly, and when the teacher would refuse to administer a shock, the experimenter would give a series of orders to make them continue. Milgram found that ordinary people were in fact likely to follow orders given by an authority figure, even if they thought it was fatally harming or killing an innocent person. You might think that these experiments are extreme examples (which they are!) and this phenomenon couldn’t possibly affect you, but

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consider the ways in which you respond to peer pressure, for example. Do you ever find yourself going along with your friends, even though you may not want to? Are you ever afraid of saying something because you fear that people will make fun of you, leave you out or unfriend you? It would be fair to mention that in a partial replication of the Milgram experiments, participants were less likely to follow orders to give electric shocks when they saw another person refuse to do so. You may have experienced this in your own life where you kept your ideas to yourself until someone ventured forward with: “Actually, I don’t completely agree…” Often, this is all we need to take a stand for what we believe in. There is a lot you can do to prevent the adverse effects of group polarization. Awareness is key. Ask yourself whether your group is: x x x x x

Relatively isolated from dissenting viewpoints Ridicules those who raise doubts or disagree Has a stereotyped view of those outside the group Rationalizes their behaviours with a belief in their morality Rewards those who agree with the “leader”

This makes it difficult to separate right from wrong when the authority is perceived as legitimate. Thus, there are ethical implications as people justify wrongdoing and mass atrocities as they consider themselves to be “following orders”. This is especially true when obedience to authority is embedded into all of us from childhood. Do you think you would behave differently in these situations?

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The Bystander Effect and Altruism by Homaira Kabir

Photo credit: Pixabay

Helping is part of human nature. If you think of your own life, you can likely identify many situations where you went out of your way to help others. Although many theories explain our impulse to help, from selfish reasons like expecting something in return, to selfless ones like simply wishing the best for the other person, the benefits of helping are clear – we feel good when we help. Social psychologists have studied people to understand the internal characteristics and external circumstances that lead to helping in order to increase the chances that people will help others. In their study of altruism – the desire to help even when no benefits are expected in return – they have found that certain factors lead people to help others in nonemergencies. They found that acts of comfort, caring and compassion are common in people who are: x x x

In a good mood and want to spread the cheer Deeply religious and want to help as a way of feeling closer to the divine Feeling guilty and use helping to calm their guilt

They also found that certain situations increase the chances of helping such as:

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Observing a helpful act which fuels our own urge to help Being relaxed and not under time pressure The person who needs help appears to be needy The person who needs help appears to be similar or like us in some way We are the only one who can offer help

In emergencies though, reaching out to help others is an instinctive human reaction that is inhibited by a single situational factor – the presence of other bystanders. This bystander effect brings to light an essential concept in the field of social psychology, and suggests that when there are other bystanders in an emergency, we are less likely to intervene with offers of help (Latane & Darley, 1968). Why would this be the case? The presence of other people alters the situation in small ways, such as: x x

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We are less likely to notice the person in distress. Often we are immersed in our own private thoughts and do not pay attention to the environment. We are less likely to interpret a situation as an emergency. This is because of the normative influence (Festinger, 1954), where we want to blend in with other people’s reactions and do what everybody else is doing. We are less likely to assume responsibility for taking action. When we know that others can provide the help needed, we feel that the burden of responsibility is no longer on us and pass off the responsibility to other bystanders.

As a result of this, the irony is that sometimes victims are less likely to get help when more people are around. Yet, knowing how the bystander effect can inhibit helping is often enough to make people more helpful. Think about this in your own life. Have there been situations where you have refrained from helping because you felt that others could do so? Will the knowledge of the bystander effect affect your actions in the future? Were there times when you’ve not stopped to help simply because you were rushed, distracted or upset? What can you do to become more attentive to the needs of others when you are in large groups of people? Discuss this with your peers in class. We, in the Middle East, are part of a culture that is grounded in religious beliefs where we place great importance on relationships, and where the pace of life is slower and more conducive to helpful behaviours.

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As the research shows, this leads to upward spirals of helping because we are more likely to help when we observe helpful acts. So, notice the kind caring acts of family, friends and strangers so that you can nurture your helping muscle and benefit from the happiness that comes with it!

Ways of Understanding Culture by Anisa Mukhamedova & Mona Al-Ghamdi There are many ways to understand cultures and the following sections will give you clues as to why your friends might act and think the way they do and why you too, engage in certain behaviours and hold certain values. Remember that these classifications are just a guide and do not mean that everyone in a given culture will behave or think in this way. Culture influences us tremendously and often implicitly (without us realizing it), but with social media, extensive travel, and education, we are just as likely to be influenced by Brittany Spears and eating McDonald’s! While there are differences between cultures, remember that there are just as many differences between individuals of the same culture and just as many similarities between individuals of different cultures. Geert Hofstede (2001) is a pioneer in this line of research and we explore the themes he found studying cultures around the world, namely individualism/collectivism, power distance, comfort with uncertainty, orientation to time, and femininity/masculinity as ways to understand culture. The Power Distance dimension deals with the fact that power is not distributed equally among all individuals in society and reflects the cultural and individual attitudes towards these inequalities. A higher power distance reflects a higher acceptance of a hierarchical order in society and resulting inequality amongst members of that society. Societies that do not accept an unequal power distribution and where power is shared and widely distributed instead, tend to have a low power distance index. In the United Arab Emirates, people accept a hierarchical order and some degree of inequality which explains its High PDI score of 90. Canada in contrast scored only 39, reflecting its value on a lack of class distinction and hierarchical order. The table below provides a summary of some of the characteristics of high and low PDI.

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x x x x x

High Power Distance Index Power is not distributed equally Centralized power; not shared No shared social rewards nor shared social responsibilities Hierarchical distribution of positions Generally not acceptable to oppose, disagree, or question higher positioned or more powerful individuals

x x x x x x

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Low Power Distance Index Power distribution is equal and fair Democratic relations, everyone as considered to be part of one group Less or no hierarchy Rewards are shared and a focus on social development and group success Shared and distributed responsibilities Considered acceptable to disagree, question, and express ideas

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The dimension Uncertainty Avoidance expresses how society deals with the uncertainty and the fact that the future can never be known. Different cultures have learned to deal with it in different ways, some may rely more on rules, belief and traditions, while others may be more relaxed, open to the new and unknown, and tolerant of ideas that do not fit mainstream beliefs. The United Arab Emirates and Saudi Arabia both score high on Uncertainty Avoidance (scores of 80), which means that it maintains rigid codes of beliefs and behaviour and prefers to avoid uncertainty, while China and the UK score much lower (30 and 35), being more comfortable not knowing where things are especially headed at all times. The Orientation to Time (Long-Term Orientation or Short-Term Orientation) dimension refers to how a society prioritizes and maintains links between its past and faces the challenges of the present and future. Some societies are suspicious of societal changes and prefer to focus on tradition and norms (socially acceptable rules) thus, scoring low on this dimension, while other societies are more open to the future and focus on education, saving money, and taking a practical approach to upcoming change, scoring much higher as a result. Germany scores high (83) on this dimension, which according to the Hofstede's measurements, indicates an ability to adapt to social change and be persistent in achieving desired results compared to Iran, scoring 14, or Saudi Arabia with a score of 36 reflecting their strong normative cultures.

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The Femininity and Masculinity (MAS) dimensions refer to how competitive or cooperative societies can be. More competitive societies have a preference for achievement, assertiveness and heroism reflecting the Masculinity side of the dimension, whereas social preferences for cooperation, caring for the weak, showing modesty and pursuing quality of life (versus quantity of things) reflects the Feminine side. The United Arab Emirates is neither considered Masculine nor Feminine by scoring 50 on this dimension, while Kuwait scores 40 and Saudi Arabia scores 60. Countries like Japan and Austria scored high (Japan; 95 and Austria; 75) which indicates Masculine values and behaviours both in men and women, unlike Sweden, which only scored a 5 in this dimension reflecting its Feminine values of cooperation, the pursuit of quality of life and modesty. The table below provides some characteristics of high and low MAS dimensions.

x x x x

High MAS Strong ego Feelings of pride; Importance of status Value of money and achievement Competition and winning

x x x

Low MAS Relationship oriented Focused on quality of life Managing through discussion, negotiation and compromise

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Many cultures in the world can be understood based on a continuum with “collective” at one end and “individualistic” at the other. The major distinction between these revolves around the interaction between the individual and the social group to which he or she belongs and how much (or little) the group is prioritized, as well as the degree to which the individual sees themselves as part of this group. On Hofstede's scale, Middle East countries score as follows on Individualism: Morocco (46), Egypt (25), Syria (35), Iraq (30), Jordan (30), Libya (38), UAE (25), while countries like Canada (80), Australia (90), Denmark (74), Italy (76) and the UK (89) score higher on that scale. Remember that these are not good or bad, they are just different dimensions of culture we can use to understand one another. Triandis et al. (1988) outlines some of the major differences between individualism and collectivism. The general characteristics of each are summarized in the table below.

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Collectivist Personal goals are put aside for the collective goals of the group 2. If demands towards the group are inconvenient, it does not hinder the individual and they remain within it 3. Conformity 4. Traditional culture, individuals exchange love, status and service 5. Vertical relationships are of most value (parents, grandparents, children) 6. Parent-child relationship fosters inter-dependence and involves frequent guidance, consultation into child’s private life 7. Emphasis on person (i.e. prioritizing a family’s needs over personal tasks) 8. Social relations are enduring, take part in large groups and involuntary 9. Social control is governed by the use of shame by others 10. Individuals share personal information to in-group members (i.e., family) but out-group individuals are considered strangers with no vested interest in the individual. 1.

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Individualistic Personal goals are highlighted and prioritized 2. If demands have a high price attached to them, the individual can and will leave the group 3. Anti-conformity 4. Modern culture: individuals exchange money, information and goods 5. Horizontal relationships of most value (spouse, coworkers, friends) 6. Parent-child relationship fosters emotional detachment, independence and privacy 7. Emphasis on task (i.e. prioritizing personal tasks over group’s needs) 8. Social relations are temporary, take part in smaller groups that make entry/exit easier and voluntary 9. Internal control is governed by one’s own guilt 10. Individuals share personal information to in-group members defined by same social class, race, religion, allowing for easier interaction with more people. Familiarity is based on similarity. 1.

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Aree you more of o a collectiv vist or an inddividualist? Circle C the numbers froom each colum mn that most closely c corressponds to how w you act, think, and feel. Now, think t about your y country;; would it mostly m be considered a collectivist nation n or an in ndividualistic nnation? Has itt changed over time? W What are somee typical actio ons or ways off thinking thatt lead you to this answ wer? What are some benefitss and drawbaccks an individu ual might experience lliving in eachh type of sociiety? Certainly ly, there are individual differences among peoplle, as well as people who will differ frrom their nation. But, do you thinkk these dimen nsions reflect a nation welll? Would you add otheer ways to meeasure or undeerstand culturees? Seee the websitee (https://geeert-hofstede.coom/countries.h html) for Hofstede’s ddimension andd look up you ur country to uunderstand it better. Is it accurate?? Now, comppare your country to a cclassmate’s. Does D this explain som me of the differrences betweeen the two of yyou?

Accculturation n by Mehrd dad Fazeli F Falavarjan ni

Photo credit: Pixabay

Acculturatiion refers to the t cultural an nd psychologiical changes caused c by the interacttions betweenn people of varied cultuures. An exaample of acculturationn is how youu changed when you moveed to this coun ntry or if you live herre, how otherss changed you ur culture andd you! Culturee consists of shared noorms, values, beliefs, b inform mation, and skkills among peeople and these are nooticeable acrosss our everyday behaviourss, physical acctions and social system ms which creaate varied gro oups and comm munities with h different

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languages, religions, laws, gender roles, manners, foods, clothing, styles of architecture, and so forth. We don’t notice most aspects of culture since we are so immersed in it and it’s not until we exit our cultures that we realize we do things in ways that others might call “a national way” (Koomen & Dijker, 1997; Ward & Kagitcibasi, 2010). Migrants everywhere experience cultural changes that require adaptation. For example, Iran has over 15 cultural groups and 75 languages. This multicultural setting makes big cities culturally different from rural areas even in the same country. Rural migrants must acculturate to cities where people practise different lifestyles and must learn new social norms and values and often suffer discrimination and are labeled by urban people as backwards and uncultured because of how they dress, speak, and what they do (Baharan, 2010). As a result, they live in districts with people of their own culture. When people have difficulty acculturating, it creates problems of integration and discrimination. These issues are not unique to Iran. Think about where you come from. Which groups have difficulty acculturating? What has your experience been like adjusting and living with other cultures? Most studies on how minorities acculturate come from cultures like the United States, Australia and Canada as these countries have usually hosted immigrants. Thus, theories of acculturation have portrayed other cultures as primitive or inferior, and research is limited to studies of how powerless immigrants and racial minorities adopt to majority cultures. What is less known is what happens when equally powerful, confident cultures interact or when a powerful minority and powerless dominant culture interact (Rudmin, Wang, & Joaquim, 2015). In the Middle East, we find a variety of these culture and power combinations which provide a good context in which to study acculturation. The UAE and other GCC nations (Bahrain, Kuwait, Oman, Saudi Arabia, etc.) make good test cases as they have majority-minorities; that is, larger numbers of expatriates than the national population which raises the question; who acculturates to whom, exactly? The development and application of theories in the region by Middle Eastern scholars may help Western scholars realize how their historical and cultural backgrounds have limited the study of this growing worldwide phenomenon.

Discrimination by Aditi Nath Discrimination refers to the negative treatment of an individual or a group, based on factors such as gender, age, religion, race, social class, etc. It is mostly expressed in the form of damaging behaviour or unjust

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practices that disadvantage a particular person or group. For example, it has been reported that workers from the Philippines are paid less in comparison to workers from Romania for the same job, regardless of higher experience. This kind of discrimination is called institutional discrimination, which refers to discriminatory practices fixed in organizational structures which cannot be directly observed. On the other hand, interpersonal discrimination refers to discriminatory interactions between individuals, which can be perceived directly. For example, interpersonal discrimination would occur when the management in an organization favors the promotion of Ahmed over Khadija based solely on gender, disregarding Khadija’s higher level of experience or equal qualification. There are two reasons which explain discriminatory behaviour; the first is that discriminatory behaviour is learned and the second is that discriminatory behaviour occurs due to conformity.

Photo credit: Pixabay

Hatred or dislike towards others is said to be learned early in life, even before children consciously realize the characteristics of a target group. For instance, it has been found that English children, between the ages of 5 and 10, tend to prefer playing with children from other European

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countries rather than those of Non-European countries, indicating an early onset of discriminatory treatment (Barrett & Short, 1992). This early learning can be attributed to witnessing discriminatory behaviour from parents, specifically through parental modelling (e.g., parents expressing racial hatred), classic conditioning (e.g., White child gets scolded for playing with an Asian child) and operant conditioning (e.g., parental approval for racist behaviour and disapproval for non-racist behaviour). Another explanation for discriminatory behaviour is conformity. As mentioned earlier in this chapter, conformity is the tendency for people to adopt a set of behaviours believed to be normal by their group or society. Consider the case where Faisal is part of a society which does not practise or advocate friendship with members from other cultural backgrounds. Faisal’s social environment may lead him to be less likely to befriend Michael simply because he is fearful of going against his societal norms. An essential aspect to understanding discrimination is the notion of tolerance. Simply, tolerance is the ability of individuals to not act on their disapproval towards a group from a different race, religion, social class, etc. For example, Fatima and Kimberly come from different cultural backgrounds; yet, they can still work together on a project because they are tolerant of one another. As this kind of tolerance represents a fair and objective attitude towards other groups, it can reduce discriminatory practices in a diverse society. However, tolerance also has the potential to promote discriminatory practices. People who directly or frequently witness acts of discrimination can become tolerant of the individual conducting the act. For example, even after witnessing Yusuf being racially discriminative against Steve, Abdullah is tolerant towards Yusuf and continues working with him without voicing his objection. In fact, Abdullah’s response to Yusuf may encourage Yusuf in sustaining his racially discriminative acts.

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Toleraance as an Islamic virrtue by Drr. Nausheen n Pasha-Zaaidi

Photo credit: Pixabay

Tolerance iss the key to ovvercoming preejudice and diiscrimination. As noted above, disccrimination can c be seen n through acctions and practices. p Prejudice, on the other hand, is mucch harder to detect becausse it is a negative attiitude against a group of people based oon limited or incorrect knowledge about that group. Preju udice is the feeling or opinion; discrimination is the acttion. Words that t have an “-ism” at thee end are sometimes uused to descrribe differentt types of pre rejudice. For example, ageism is prrejudice basedd on age and raacism is prejuudice based on n race. Preejudice has alw ways been a part p of humann history and the cause of much paiin and sufferinng in the worlld. It is often tthe result of fear fe of the unknown, pperceived threeats, and a deesire to preveent others fro om taking away the reesources we have h (Stephan & Stephann, 2000). Stud dies have shown that pprejudice incrreases when th here is compeetition for exissting jobs (Esses, Jacckson, & Arrmstrong, 1998; Esses, JJackson, Dov vidio, & Hodgson, 20005). This may explain wh hy prejudice tends to go up u during periods of economic annd social unreest. The Syriian refugee crisis, c for example, thhat has displaaced millionss of people ffrom their ho omes has resulted in waves of industrialized i d countries cclosing their borders. Although m most of the Syrian S refugeees have beenn taken in by y Muslim majority couuntries in thee Middle East, the crisis hhas spurred in ncreasing levels of preejudice in many Western countries resullting in anti-im mmigrant and anti-Muuslim policiess that are bein ng enacted in countries likee the UK and the Unnited States. Ironically, Muslim M culturees are often the ones displayed inn Western meddia as being in ntolerant and bbackwards! Onn the contraryy, tolerance is one of the principles of Islamic morality. Inn fact, the onlyy things that Islam I does noot tolerate aree injustice

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and oppression! The word tolerance comes from Latin, meaning “to bear” and is usually associated with respecting other cultures, religions, and ways of life, even when we don’t agree with them. Islam promotes the establishment of societies built on justice – something that cannot be done without some level of tolerance. The Quran states, "There is no compulsion in religion" (Al-Baqarah: 256). Other verses reiterate that commandment, emphasizing that it is up to the individual to follow Islam or not. "And say, 'The truth is from your Lord, so whosoever wants let him believe and whosoever wants let him deny” (An-Nahl: 29). If Muslims are enjoined tolerance in religion, then it goes by implication that Muslims are expected to be tolerant in all aspects of life. The Qur'an says very clearly: "To every People have We appointed rites and ceremonies which they must follow, let them not then dispute with you on the matter, but do invite (them) to your Lord: for you are assuredly on the Right Way. If they do wrangle with you, say, 'Allah knows best what it is you are doing.' 'Allah will judge between you on the Day of Judgment concerning the matters in which you differ.'” (Al-Hajj: 76-69). Thus, tolerance is the mechanism that upholds human rights because, according to Islamic beliefs, the pluralism we see in societies around the world is a part of God’s creation.

Aggression by Reham Al-Taher According to Freud’s theory of Psychoanalysis, our basic drives come in two forms: sex and aggression (Mahruqi, 2013). This means that we have a natural tendency to be in conflict. Conflict occurs when there is an incompatibility in reaching our goals, which results in our “acting out”. One way to act it out is through aggressive behaviour. Social psychologists define aggression as behaviour with the immediate intention to hurt someone (Coon & Mitterer, 2014). While conflict often leads to aggression, aggression can sometimes originate from negative emotions or frustration. As much as I would like to claim that the positive thinking gurus from self-help books and programs are correct in claiming that feeling negative only hurts us, the opposite is usually true. Researchers Kashdan and Biswas-Diener (2015) believe there is a purpose and even necessity in having a sense of aggression, feeling negative emotions, and experiencing conflict in life. Modern evolutionary psychology views each and every single emotion we have to be an important mechanism and motive for survival. Seeing something to be unfair, disrespectful, and unjust can have empowering results. For instance, the Arab Spring would not have been

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possible if it wasn’t for a deep sense of injustice and aggression towards what people believed to be corrupt social and governing systems. There is a purpose in being aggressive; it’s there to help you survive as aggression is a technique people use to strive for material recourses and gain respect from others. How aggression is expressed depends on the individual’s goals, thoughts, social influences and environments. Some act out impulsively, others calculate the right time to express themselves, and others act out aggression based on what is appropriate within their social norms. Aggression often breeds more aggression, causing more conflicts than it can resolve. It’s important to keep in mind that this is a natural tendency and a struggle to restrain; that’s why restraint of negative emotions is praised in most societies and acting out is punished harshly. Our natural tendencies in society are translated as being “barbaric”. They are seen as something toxic that infects others and makes them aggressive too. Evidence for this has come from media studies which show that violence in the media breeds more violence (Mares & Woodward, 2005). One of the reasons punishment doesn’t work is because it doesn’t teach the aggressor prosocial forms of behaviour. Instead it teaches behaviours based on predicted consequences, regardless of insight or understanding. Prosocial behaviour is voluntary behaviour that benefits others or society as a whole. While aggression originated from adaptive behaviour for many of our ancestors (e.g., using aggression to gain access to shelter, food, and so on), it has become less acceptable behaviour over time as humans became more social and have access to more of what they need in terms of resources. As humans socialized more, aggression was seen as maladaptive and destructive and prosociality became the more acceptable behaviour to act out when trying to reach goals (Warburton, & Anderson, 2015). It is easy to act out aggressive behaviour, but being prosocial requires thoughtful and considerate behaviour that doesn’t come as naturally. It needs to be taught. One way to increase prosocial behaviours is expose the aggressor to positive role models behaving in a way we want the aggressor to. We learn the more we observe and as we act out the role model’s actions, we receive positive reinforcement, and the behaviour hopefully continues. It is how children and adults learn. In fact, research on prosocial role models in the media has been promising (Mares & Woodward, 2005) and suggests that just as exposure to violence and aggression can increase violence in viewers, prosocial models can decrease aggression and increase cooperation in society.

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Photo credit: Pixabay

War, Uprisings, and Social Change by Yasmeen Alhasawi In recent years, the Middle East has witnessed a wave of Arab uprisings that has led to wars and regional conflicts. This has rocked the core of many Arab nations and caught the world by surprise. As world leaders come together to discuss a conflict resolution for the Middle East crisis, the fate of those affected by the conflicts remains in their hands. The number of casualities and lives affected by war and conflict is staggering. Aside from the physical hardship of surviving a war, a number of psychological issues arise. There are both short- and long-term challenges facing each and every survivor. Yet, little, if any, mental health services have been provided to alleviate the suffering of individuals affected. Thus, we will look at psychological and social impact of war on the wellbeing of those affected.

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Photo credit: Louise Lambert

Economic Hardship So, what leads to the war and conflicts in the first place? There is one incident that is said to have begun the conflict. The Arab uprising began when a 26-year-old street vendor Mohammad Bouazizi set fire to himself in Tunisia in protest of the economic hardships and corruption present there. For years, Arabs in Middle Eastern countries, such as Tunisia, Libya, Yemen, and Egypt, had struggled to make a living given the current economic situation in the Middle East. Many people dealt with a shortage of food and tried to make a living under autocratic rule. Bouazizi’s action became a flashpoint for the war in Tunisia as many citizens began protesting and taking to the streets. Similarly, individuals in other Arab countries took this as an example and began protests demanding greater freedom and an end to corruption in hopes of social change.

Psychological Impact We know that war is a traumatic and life-changing event that has the potential to shatter a person’s worldview, whether permanently or for a specified period of time. There are many psychological effects of war. The

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effects experienced include depressive disorders (such as Major Depressive Disorder), anxiety disorders (such as Generalized Anxiety Disorder), and Post Traumatic Stress Disorder (PTSD). Historically, psychological injury as a result of war was commonly known as “shell shock,” a response to prolonged exposure to trauma and war. Today, one of the most predominant psychological effects of war is PTSD. According to the Diagnostic and Statistical Manual of Disorders (DSM-V, 2013), PTSD is a psychological response to: 1. 2. 3. 4.

directly experiencing the traumatic event(s), witnessing, in person, the event(s) as it occurred to others, learning that the traumatic event(s) occurred to a close family member or close friend, or experiencing repeated or extreme exposure to aversive details of the traumatic event(s) (p. 271).

The affected individual further experiences symptoms related to invasive thoughts pertaining to the traumatic event(s), constant avoidance of stimuli or negative changes in mood or thoughts linked with the traumatic event(s), and changes in arousal and reactivity related to the traumatic events(s) (DSM-V, 2013). Depression is also a common psychological result of war given the violence witnessed, displacement from home, and separation from and loss of loved ones. Individuals in war-torn countries often experience symptoms of depression, such as feelings of sadness, hopelessness, guilt, worthlessness, as well as difficulty thinking, concentrating, and making decisions. Symptoms may also include changes in appetite and weight, sleep disturbances (such as insomnia), and slowed thinking. Given the instability, daily fears, and worry, anxiety is another psychological effect of war that is dealt with by survivors. Symptoms may also include muscle tension, fatigue, and restlessness. How common do you think mental health disorders are in individuals exposed to trauma and or war, whether directly or indirectly? A number of studies have investigated the prevalence of such disorders. A study by Cardozo et al. (2004) assessed the impact of war in Afghanistan on mental health in a sample of 799 household members. Out of these participants (age 15 years or older), 100 were reported to have some type of disability. Participants were administered a national mental health survey and results showed that symptoms of depression to be prevalent in 67% of nondisabled respondents and 71% of respondents with disabilities. Regarding symptoms of PTSD, there was a prevalence rate of 42% in both

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nondisabled respondents and respondents with disabilities. Symptoms of anxiety were present in 72% and 84% of nondisabled respondents and respondents with disabilities, respectively. Scholte et al., (2004) also found symptoms in a sample of people from Afghanistan: 38% experienced depression, 20% reported PTSD symptoms, and 52% had anxiety symptoms. Similarly, a study by Ahmad, Sofi, Sundelin-Wahlsten and von Knorring (2000) assessed the impact of conflict on the mental health of Iraqi Kurdish families. Many children and caregivers in Iraq experienced PTSD, found in 87% of children and 60% of their guardians.

Photo credit: Pixabay

Poor social support during conflict and war is a contributing factor to the mental health illnesses experienced by individuals in times of conflict. Families are torn apart as a result of the conflict, as some family members may be imprisoned for an undetermined amount of time, while other family members have died or had to move away from one another. The decrease in social support negatively contributes to mental health of individuals who have experienced the trauma associated with war.

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Physical Impact Prolonged war stress may lead to catastrophic effects on one’s physical health. These effects include starvation and malnutrition, which are experienced due to limited access to essential resources, such as food and clean water. This is due to the environmental effects of war and loss in productivity, including the loss of crop production. There is also a rise in number of physical disabilities as a result of war. According to Murthy and Lakshiminarayana (2006), studies show that “conflict situations cause more mortality and disability than any major disease” (p. 25).

Risk Factors Men and women are both affected by war. Studies assessing risk factors associated with war have found women in the military to be more vulnerable than men to psychosocial impact of war and conflict. The psychosocial impacts include suicide risk, PTSD, depression, and decreased social support as a result of the breakdown in social networks (Murdoch et al., 2006). According to Murthy and Lakshiminarayana (2006), “Despite their vulnerability, women’s resilience under stress and its role in sustaining their families has been recognized” (p. 28). Given that women may take on more responsibilities with home and family during times of war, this is also a risk factor in increased stress and vulnerability. Also, women’s stress and depression can influence their children’s prenatal or post-natal development.

Displacement and Loss Economic and social decline also occur in war-torn countries. Such conflict has long- and short-term impacts on the environment and on social development, as there is a decrease in maintainable development, a breakdown in societal cohesion, a disruption of local government, and environmental degradation. There is also a decrease in one’s quality of life as a result of the trauma and loss, as it is difficult to maintain valued lifestyles. Further, there are diminished (if any) choices, limited access to life sustaining resources such as clean water and food, and a loss of basic human rights. Moreover, social decline is further impacted by increased incidences of illness in war times, given the limited access to critical resources including proper medical care. Economically, there is a daily decline with production losses, particularly in agriculture.

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What happens to all the people who are impacted by war and lose their homes? Millions of lives are displaced and torn apart during conflict and war and many refugees struggle to find shelter elsewhere. In Syria alone, there are at least 2.8 million refugees that have been displaced amid rising conflicts within the country; they are struggling to flee the war and seek asylum elsewhere. There are an overwhelmingly large number of refugees displaced from their home countries and as a result with neighboring countries facing a massive influx of immigrants. Those countries struggle to plan for the financial demands related to providing resources such as food, water, shelter, and daily necessities for incoming refugees, as well as social supports related to employment, housing, and education. At the same time, they need to ensure tightened security to prevent potential security breaches given the threat of terrorism amid plots of corruption and disruption from Daesh and other terrorist groups and rebels.

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Even the small numbers of refugees who successfully seek asylum in foreign countries still face a myriad of challenges. Among the challenges facing refugees is the concern and constant worry about their unstable future. The future remains a mystery and each day is a struggle. They have already witnessed so much and experienced the loss of loved ones. Some face the possibility of a loved one being taken as a prisoner of war and worry about their fate. Refugees also experience homesickness. Many refugees also experience acculturation. Recall that acculturation is a psychological process that occurs when an individual from one culture adapts over time to that of a second culture. Immigrants who move to another country experience cultural change as a result of exposure to one or more cultures. Psychological changes occur as a result of this process; the individual undergoes a process of reconstruction in cultural identity and cultural variables. Acculturative stress or culture shock may be experienced if the individual’s adaptive resources are insufficient to support adjustment to the new cultural environment or if an individual cannot adapt to those changes, such as the daily demands of life in a foreign country and language barriers. Another challenge relates to poverty and unemployment, as people struggle to make ends meet. Even those that take on new jobs do not enjoy the same level of employment that they were once accustomed to. For example, a father who worked as a

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physician in Syria might now take on the role of a fast food worker in another country. This is a stressful process for many. Children also face unique obstacles. As previously noted, environmental influences can greatly impact lives. Dealing with war has the potential to greatly influence children’s development as they witness so much and parents can only keep so much hidden from their children during war. The daily challenges facing families has implications for development and the well-being of children, which can lead to psychosocial disorders, such as attachment, anxiety, and depressive disorders. During the developmental years, children look to adults for affection, love, and attention, and depend on them for fulfilling their basic needs. When these needs are met and a child forms a positive relationship with his or her primary caregiver, a strong attachment is formed. However, during times of war, the primary caregiver may be unable to fulfill these needs. The child may experience the loss of the caregiver, separation due to displacement, or imprisonment of a family member. Additionally, primary care may not be readily available given adults pre-occupation with the ongoing conflict and the struggle for the family’s survival. Caregivers may become distracted or emotionally unavailable and this has damaging implications for attachment relationships and further development. The child could potentially develop a psychosocial issue related to changes in parenting roles.

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Children may also become victims of political war. Given children’s susceptibility during times of war, they may become vulnerable to becoming child soldiers themselves. This is due to the rise in radicalism and the spread of Daesh and other terrorist tribes and organizations in wartorn countries. How would you feel like if your friend became a victim to radicalization?

Maintaining an Arab Identity In addition to war and conflict, there remains the issue of radicalization in the Middle East. Radicalization is the process by which a person takes on very extreme religious, political, or social beliefs and principles that threaten or reject social structure and values. Given the misperceptions of individuals of these terrorist groups who call themselves Islamic militants, there has been a challenge for Arabs and other Middle Easterners to maintain their Arab or Muslim identity in the face of the images portrayed by the media. Perhaps you or a classmate has had a similar experience related to Arab identity or discrimination? If you have not yet experienced this, how would you go about facing someone with misconceptions and biases about Middle Eastern individuals? Education is the key to demystifying biases and stereotypes. It is important to remember that the actions of a few do not represent those of the majority. Unfortunately, war appears to be a daily reality in today’s society; many people are suffering as they try to survive daily social and economic hardships. War not only takes many lives, but also destroys neighborhoods. War has detrimental impacts on individual’s well-being and mental health, as well as a damaging effect on the environment and society. Individuals exposed to war often face mental health challenges related to experiencing symptoms of PTSD, depressive disorders, and anxiety disorders. Thus far, mental health services for survivors have been limited and there is a growing need for services geared towards refugees and the treatment of trauma. Potential services should take into account unique cultural factors and potential challenges in terms of identity, such as challenge of maintaining cultural identity in the face of conflict.

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There is also an increased need for research in the field to better understand the depth and nature of the effects of war on special populations, particularly children and the geriatric or elderly population. A potential area of research to explore is whether or not prolonged exposure to war has an effect on the lifespan of the geriatric population. Another area of study would be to explore the long-term effects of war on the mental health of adult survivors who had been exposed to war during childhood. What are your thoughts about the recent Arab Uprising? Do you think that these conflicts will end? How? Have you been affected by the changes? How did/do you cope? What do you think will be the long-term consequences on the region?

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Topic Box: Coping with War and Social Unrest by Jeyda Hammad

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War and social unrest create a difficult environment to live in because our need to feel safe and secure is not met. Our basic needs for food and shelter can be compromised. War and social unrest can create problems concerning day to day living, including work and education. War and social unrest can impact on people in different ways; people may vary in their responses and their responses can change over time. People who learn of what has happened, for example through friends, family and the media can similarly be affected. When faced with life-endangering circumstances, or where there is the potential of harm, this can feel incredibly frightening and anxiety provoking. Some people may feel upset, panicked, helpless, powerless, shocked, angry, sad, fearful, worried, guilty, or emotionally numb. Ibrahim is a young man who fled war in the Middle East. Although Ibrahim now safely lives in London, he continues to scan his surroundings for any potential dangers. He often feels scared and on edge. He avoids things that remind him of the war. Ibrahim has nightmares, flashbacks, and unwanted memories of the war, which he

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finds frightening because he forgets he is now safe and away from the war. Re-experiencing involves involuntarily and vividly reliving traumatic events as though they are happening in the present, which can occur in the form of nightmares, flashbacks, or distressing images and sensations. Re-experiencing occurs because during a traumatic event, our body can shut down thinking processes that help us process and understand what is happening, in order to concentrate on surviving. Reexperiencing is typically triggered by reminders of the trauma, and is an indication that the traumatic memory has not been processed and filed away properly as a memory. For example, when Ibrahim heard the sound of fireworks going off, it immediately reminded him of the sound of explosions during the war; he forgot where he was and thought he was back in the war again. He became frightened and found it difficult to breathe properly. When this happens, Ibrahim finds it helpful to look around and remind himself of where he is and that he is safe now; he concentrates on his surroundings, such as counting the number of items in the room, which helps him to feel calmer. He also finds it helpful to smell something with a strong scent (e.g., perfume, coffee beans) to help orientate himself to the present. Dina, a teenager who escaped persecution and war, feels emotionally numb and disconnected from her body. This is another way our bodies cope with overwhelming and painful experiences. Dina experiences low mood, disturbed sleep, and negative thoughts. Dina often feels really stressed and finds it hard to concentrate. She often has headaches and aches and pains in her body. Ahmed, a young man from the Middle East witnessed social unrest and violence in his home town. He felt so scared that he went into shock and did not know what to do when he saw people being assaulted. He wanted to run but felt frozen to the spot. His body felt like jelly and he could not think clearly. Since the violence in his hometown, Ahmed is wary of who to trust, he feels angry about what has happened and he feels hopeless about the future. It is important to remember that in the context of war, behaviours that may be classified as trauma should be considered normal responses to abnormal circumstances. Ahmed, Ibrahim, and Dina’s experiences are normal, common responses to war and unrest. When faced with danger, we naturally respond in a way to help maximise survival, and although these responses may be helpful during times of danger, they are not so helpful once we are safe. There are many different coping strategies that people use when affected by war and social unrest. Dina tried to find ways to reduce potential threats of

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harm, such as seeking shelter in areas that were less likely to be attacked. During the war Ibrahim helped others, problem solved and found ways to adapt to difficulty. He found it helpful to create structure and return to a daily routine where possible. Social support and cultural and religious strategies are also commonly used to help people cope. Ahmed found that his family and religion helped him to cope with the traumatic events he witnessed. The family and community can offer emotional and practical support, much as engaging in religious and spiritual practices, like prayer, and cultural traditions and rituals can support people too. The meaning people give their experiences can also help people make sense of what is happening. Coping strategies vary depending on the duration and severity of the conflict. However, despite adverse life circumstances caused by conflict, resilience, community spirit, and compassion can be found. People can find that they often feel better able to deal with other life challenges with confidence because they have had previous experiences of coping with war or social unrest. People may find that such experiences facilitate a greater appreciation of life and affirms their values, which guide their life.

Over to you now… 1.

2. 3. 4. 5. 6.

Have you ever stopped to think about your social identity? Does your identity become more or less important when you are a minority or a majority? How does your behaviour change when you are in an in-group versus an out-group? Explain cognitive dissonance in your own words and talk about a time when you recently experienced it? Have you ever recognized the self-fulfilling prophecy in your friends? How does it work? Have you ever seen it at work? What attributions do you make for your positive and negative outcomes? What attributions do you make for the positive and negative outcomes of strangers? Why do these usually differ? Look at your friends here at university/ How can you explain the fact that you are friends with them and not with others? Use the principles of attraction to explain your friend choices. What is the formula for a good marriage? Use the concepts you have learned in this chapter to develop a questionnaire that can help identify the characteristics of a good marriage.

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What is your favourite brand of clothing? Think about the marketing strategies that are used to promote that brand. How do the advertisements reflect social psychology principles? 8. Peer pressure can be difficult. Think of a time that you went along with others even though you didn’t want to. How did you feel? What were some of the thoughts that crossed your mind? If you were in a similar situation again, would you behave the same way? Why or why not? 9. What makes you angry? What do you do when you get angry? In your opinion, what is the best way to deal with anger? Work with a partner to come up with a 5-step plan to cope with anger. Then share your ideas with the class. 10. Describe your culture using Hofstede’s cultural dimensions? Would you add any? Change the score? To what and how? 11. Have you seen discrimination or experienced it? Can you explain it using the in-group/out-group concept?

CHAPTER FOURTEEN POSITIVE PSYCHOLOGY DR. LOUISE LAMBERT

Photo credit: Louise Lambert

Chapter Outline x x x x x

What is Positive Psychology? Topic Box: Aversion to Happiness by Dr. Mohsen Joshanloo Positive Emotions Topic Box: Why is Optimism a Good Choice? By Dr. Louise Lambert Broaden and Build Model of Positive Emotions

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x x x x x x x x

Are Positive Emotions Contagious? Architecture of Sustainable Happiness PERMA Model of Well-Being Topic Box: Spirituality as a Road to Well-Being by Homaira Kabir Positive Psychology Interventions Topic Box: When “Just be Happy” Makes You Unhappy by Janine Pinto Positive Psychology and Culture Over to you now…

You might be wondering what is actually good about people after reading this textbook! After all, we’ve talked a lot about what can go wrong with people’s brains, bodies, emotions, relationships, kids, and so forth and it paints a negative picture. If you feel that way, you’re not alone. Other psychologists have felt the same way too, wondering where the good qualities of people can be found in psychology, if at all. As a result of this, a new school of psychology evolved in the late 1990’s and made an official entrance to the field in the year 2000. It is called positive psychology and entirely dedicated to discovering the “other half” of human experience, like altruism, positive emotions, engagement, meaning, positive relationships, and giving as examples. We hope you’ll feel better about psychology after reading this chapter and that it will inspire you to do great things with your life!

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What is Positive Psychology?

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Positive psychology is the new kid on the block in psychology. The newest branch in the field, it is an approach that focuses on the creation of positive states of mind, positive emotions, and positive experiences. It focuses on what is good with people instead of what is wrong with them and aims to develop strategies and interventions to help everyday people, like you, become greater versions of themselves. Its primary goal is to discover the processes and conditions that contribute to human growth or flourishing. It developed as a field when it started to become clear that many of the approaches taken in traditional psychology were focused on the negative things about people and didn’t have much to say about how to improve life (Seligman & Csikszentmihalyi, 2000). This meant that traditional psychology wasn’t especially relevant to people who just

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wanted to be happier and who had no mental disorder or distress of any kind to warrant attention by psychologists. Positive psychology has grown into a broad field and its influence can be found in education, medicine, sports, and organizations. Beyond a focus on the individual, studies in positive psychology also focus on positive traits, which involve genetics and personality characteristics, as well as institutions, groups, and communities. Because the field is new, researchers get to ask novel questions. For example, research has repeatedly shown that once our basic needs are met, money doesn’t contribute much to happiness. In fact, over the past 50 years across many countries, material lives have greatly increased, yet, measures of happiness have not changed much. This begs the question, why do we continue to focus so much on material goods such as iPhones, shoes, and cars to make us happy when they don’t? In some cases, objects make us more materialistic, less focused on relationships, and lead to fragile states of happiness that are dependent on material worth rather than personal character. It is these sorts of questions that preoccupy positive psychologists. Just to be clear: a lot of people think positive psychology ignores negative emotions or minimizes their importance. This is not true. Positive psychologists recognize that negative emotions can help us grow and have value in themselves, but what they insist upon is that we pay equal attention to positive emotions and positive states as these are also growth inducing and in some cases, more important to our survival and performance in everyday life. Thus, positive psychology isn’t about thinking positively or just wishing and hoping for good things to happen; it is the scientific study of positive emotions, positive experiences and positive interventions that lead to more productive, satisfying, and healthy states, whereby happiness or well-being is taken just as seriously as illbeing and unhappiness. Here are additional ways in which positive psychology differs from other fields in psychology.

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Mainstream Psychology Discussing problems is curative and eases symptoms (Repair what is wrong) People are broken, need to be changed, victims of biological/psychological forces, need help with disorder Focus on negatives (trivializes the positives, assumes only negatives are worth analysis and attention) Goal is to reduce symptoms and make life less miserable Assumes that an absence of illness and problems equals happiness Not very appealing to clients; hard to motivate to focus on problems, potentially feel worse first Skill: accept, deconstruct, remediate, “deal” with the past (and present) Past is required to make change; people revisit the past because there is something there to do or learn

Positive Psychology Building strengths and generating positive emotion is curative (Build what is strong) People are self-motivated, autonomous, growth-oriented, need skills to help grow Focus on positives to repair, promote, and prevent; positives are worthy of attention, just like the negatives Goal is to reduce symptoms, promote happiness, and prevent future problems; make life more worthwhile Assumes absence of problems is not happiness but vulnerability for future problems and empty present Highly appealing to clients: can save face, move forward, feel better quickly Skill: re-educate attention and memory to the positives, build future and be led by it, enhance present moments Past is not required to change today, but people revisit the past because as is nothing to look at now or later

Table 14-1 Adapted from Rashid, T. (2008). Positive psychotherapy. In S. J. Lopez (Ed.), Positive psychology: Discovering human strengths (pp. 187-217). ABC-CLIO

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Topic Box: Aversion to Happiness by Dr. Mohsen Joshanloo Not everyone embraces happiness though. Aversion to happiness (also known as the fear of happiness) involves a hesitation towards the experience and/or expression of happiness. This hesitation can be due to beliefs that being happy may be wrong, sinful, or unnecessary. The hesitation towards happiness can also be caused by expectations that being happy can have bad consequences. These feared consequences are diverse. For example, people may avoid being happy because happiness can cause an individual to become rude, irresponsible, careless, superficial, or selfish. Some people may also expect adverse consequences for being happy, including being punished or rejected by others, physical harm, and loss of properties or relationships (Joshanloo & Weijers, 2014).

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It is important to note that there are numerous definitions of happiness and these definitions do not have equal chances of being feared. Happiness in the sense of experiencing positive emotions and pleasures (especially very active ones such as excitement, ecstasy, and elation) and happiness in the sense of having runs of very good luck are more likely to be feared by people. Happiness in the sense of exercising moral and psychological virtues (e.g., having meaning in life or a strong faith), on the other hand, is hardly, if ever, feared by individuals.

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Moderate levels of aversion to happiness may be adaptive in collectivistic cultures (like those found in the Middle East) that value group harmony or certain religious ideals. In such cultures, being happy may indicate selfishness or moral decline, and thus it is important to keep these cultural norms in mind. However, happiness is increasingly valued worldwide, and there is room for more favorable attitudes towards happiness. As suggested by research, a strong aversion to happiness may come to harm the individual’s emotional health or real-life functioning (Joshanloo et al., 2014). Hence, individuals with a strong aversion to happiness can benefit from a re-evaluation of their philosophy of happiness.

Positive Emotions An important focus of positive psychology is the study of positive emotions. Dr. Barbara Fredrickson (2006) has spent much of her life studying this question and developed the Broaden and Build model to illustrate how positive emotions benefit us in the short and long term. But, before we move forward, what positive emotions do you know of? Which do you experience most frequently? Write them down. If that was tough, you’re not alone! We spend so much time thinking about our negative emotions, like sadness, fear, anger, loneliness, etc., that it’s hard to even think of what positive emotions there are and what they even do for us. Here’s a list of many positive emotions you should know about so that when you feel them, you’ll be able to identify them more easily. It will also help the theories and ideas below make more sense.

Joy and Contentment When we feel joy, we want to play, push limits, tease, and express our creativity across our social, physical, and intellectual activities (Fredrickson, 2000, 2004). Contentment is a deeper, but less excitable feeling, which makes savoring life quite easy; it signals all is well with the world and we are satisfied with the state of things (Fredrickson, 2000).

Vitality Vitality is defined as feeling physically and psychologically alive and energized, along with a sense of purpose and meaning (Ryan & Deci,

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2008). It’s the feeling you get when training for a marathon and you begin to feel stronger, vital, enthusiastic, and like you have a reason to get up every day.

Curiosity Curiosity is the feeling we get when we recognize something of interest, pursue it, and regulate our motivation in response to it. Curiosity generates new behaviour, attention to novelty or new stimuli, exploration, interest, and the incorporation of new experiences into our sense of identity (Kashdan & Fincham, 2004)

Pride Pride is experienced when we consider our successes to be the result of our inner strengths and effort and place admiration and worth on ourselves as a result. For instance, if you consider yourself a good person and so do others; you will be motivated to continue acting in this way. As a result, pride leads us to persist on tasks and towards goals we have chosen especially when others acknowledge our efforts (Tracy & Robbins, 2007).

Awe, Elevation, and Inspiration Inspiration involves transcendence, turning to something bigger than our usual life concerns; evocation, meaning inspiration happens and can’t be planned; and motivation, the desire to do something (Burleson, Leach & Harrington, 2005). Slightly different, awe includes anything experienced as larger than one’s self that causes us to adjust our response to what was unknown until then (Haidt & Seder, 2009). Finally, elevation helps us be better people; as a result of seeing selfless and kind acts, we are emotionally uplifted and engage in more pro-social actions (Algoe & Haidt, 2009).

Gratitude Feeling a sense of gratitude is the awareness of others’ benevolence. By attributing positive events to the kindness of others, we see ourselves as receivers of generosity and feel more hope and life satisfaction (Algoe, Haidt, & Gable, 2008).

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Optimism and Hope Optimism can be big or little. It can be concerned with our overall outlook on life, (i.e., human nature is good), or be concerned with a belief about a current challenge (i.e., how long will I wait in line at the bank?) (Schueller & Seligman, 2008). Hope, on the other hand, concerns the mental pictures of actions required to achieve our goals (Snyder, 2002).

Topic Box: Why is Optimism a Good Choice? By Dr. Louise Lambert

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Optimism is an expectation of the best and refers to our ability to look to the positive side of life. It is a way to see the world, (i.e., holding favourable beliefs about the future), as well as a way to explain certain events (an attribution). Optimists tend to explain positive events as conditions that are not likely to change and caused by the individual’s actions. Pessimists on the other hand tend to also see that situations are unlikely to change, but these situations are considered negative ones caused by others. Optimism can also involve your general outlook on life (i.e., life is wonderful), or be more specific and focused on a present challenge (i.e., will I pass my Finance quiz today?) (Peterson, 2000). But, keep in mind that optimism is not wishful thinking, which is simply hoping for the best without putting in the effort to make it true (Oettingen

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& Mayer, 2002). Why is it better to be an optimist? Overall, optimists have more adaptive coping strategies and persist harder and with greater efficiency at their pursuits (Schueller & Seligman, 2008). They are more realistic and rational than pessimists who see the world in a negative light and limit their pursuits by the very beliefs they hold for themselves. Thus, optimism is a thinking style that leads to more future-oriented actions as well as a more positive emotional state. We can become more optimistic by managing our expectations and thoughts and questioning the assumptions we hold about events and our abilities. For example, purposefully coming up with positive thoughts about future events and writing about them every day across varied areas of life such as family, relationships, and work has been shown to increase happiness over a six month period and decrease depression over a three month period (Shapira & Mongrain, 2010). By consistently becoming aware of automatic and often negative expectations for the future and implementing a more positive mindset, you can become more optimistic. A word of caution! Use realistic optimism (Schneider, 2001) for the best results. If there are high risks and few rewards, optimism should be decreased; but, if there are high gains and not many risks, you can afford to be more optimistic. Never use optimism as a substitute for reality where real and imminent risks are disregarded because this could land you in trouble. But, never abandon optimism entirely, no matter how bad the situation. In sum, optimism involves thoughts, feelings, and a sense of motivation which helps people move forward with life challenges.

Broaden and Build Model of Positive Emotions When we are under the influence of positive emotions, like those described above, we undergo broadening and building (Fredrickson, 2006). Broadening refers to the increase of our visual range towards more positive stimuli and the consequent perception, focus, and attention as a result of being under the influence of positive emotions. In other words, positive emotions allow us to track and pay greater attention to positive stimuli (things) in our environment, which help us grasp and take advantage of immediate opportunities. This shift in focus helps us to think and behave in ways that help us in the moment, but also allow us to build long lasting resources over time in the categories below.

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Physical: Positive emotions undo the physiological effects of negative emotions (like stress and anger) and help to reset the body back to normal by reducing stress hormones and lessening the strain placed on our immune, cardiovascular, and lymphatic systems. This helps to keep us healthy. But, positive emotions also help us indirectly too. People who experience more positive emotions are more likely to take better care of their health by exercising and being active, not smoking, getting enough sleep, and taking their doctor’s advice when it comes to weight control. Cognition: Positive emotions help us to think more broadly, be more creative, focus on opportunities, and pursue more goals. These emotions allow us to learn about the world, be curious, ask more questions, and pursue interesting things. As a result of doing so, we gain knowledge, become more open to the world and interact with it in increasingly complex ways. Psychological: When under the influence of positive emotions, we are more likely to take risks and manage and negotiate challenge. These risks boost our self-esteem, resilience (the ability to bounce back from obstacles), self-efficacy (the belief that we can have a positive impact on our lives), and confidence. Social: When under the influence of positive emotions, we tend to trust others more and take social risks by introducing ourselves, making eye contact, and starting conversations. People who experience greater positive emotions tend to become more knowledgeable as a result of their social connections; they know who is hiring for jobs or selling a car. They gain information and favors in this way. As a result of this broadening and building process, we grow and become better versions of ourselves. Positive emotions are cool, huh?

Are Positive Emotions Contagious? Fowler and Christakis (2007, 2008, 2010) are interested in social networks and conducted a number of studies showing that obesity, for instance, tends to run in social circles. If you are obese yourself, it's likely that your friends are too and that overeating and/or lack of exercise are activities shared through common norms. What the studies showed was not just the network effect of our first degree friends, but that the impact of smoking and obesity can spread by up to three degrees of separation, meaning it's not only your friends, but the friends of your friends who have an

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influence on how you feel, what you eat, and whether or not you smoke. This network effect applies to happiness too (Fowler & Christakis, 2008). How? Through mimicry, or unintentionally copying others’ moods, behaviours, attitudes, and preferences, as well as our desire to be around people who make us feel good about ourselves, we can boost our happiness. You've probably had this happen to you already. You’re in a fabulous mood, you look great, and your favourite song was on the radio on your drive in this morning. You got an "A" on your midterm and you suddenly love all your friends. Their mood suddenly improves because yours is happier. They will go on to be happier during the course of the day and interact with their own friends and families more positively and the friends of those people will too. Yet, it’s not only direct contagion that occurs; this relationship was also observed through Facebook networks (Kramer, Guillory, & Hancock, 2014). Yet, the reverse is also true. One of your friends meets you for lunch and it’s all depressing. It's not their fault, life is just bad, but you end up taking on their emotions. You feel your smile slide away, your posture drop, your energy vanish and you become irritated. You’re suddenly emptied of positivity and upset that your happiness was stolen. It's difficult to shield ourselves from negativity, but we can protect it - and change it by hanging around more positive people or at least limiting our contact with more negative ones. Further, by being positive yourself - even if your friends are too - you can still boost the positivity of others much further into their network, including your own. We can’t help it; we catch emotions in the same way we pick up the flu or a cold. Our neurons mirror other people’s emotions and behaviours (Vacharkulksemsuk & Fredrickson, 2012) and this involuntarily produces the same emotions within ourselves. So, use this to your advantage but also be careful about who infects you first!

Architecture of Sustainable Happiness The sustainable happiness model (Lyubomirsky, Sheldon, & Schkade, 2005) suggests that happiness is influenced by three factors; our genetic set point, life circumstances, and personal choices. Let's see what each means. Genetics are unfortunately not things we can change. This involves things like our personality (difficult to modify) and our set points. A set point refers to the usual level of happiness (or unhappiness) you normally experience in the absence of bad and great days. In spite of life's usual ups and downs, the set point is the state or mood to which we usually return over time; it's how people would generally describe your positivity level.

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This is genetically determined and explains why some people are just born more optimistic or pessimistic than others. Most people think our genetic set point has little influence on our happiness but it turns out that it carries the greatest importance! In fact, 50% of our happiness is influenced by our genes! But don't worry, even if your parents and grandparents were less happy than you would have liked, it doesn't mean you are destined to be miserable. See it as a risk factor like diabetes. Even if diabetes runs in the family, you can lower your risk by paying attention to your diet, exercise, stress levels and so on - you'll just have to work a little harder than others.

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Life circumstances are where people tend to place a lot of blame or responsibility for happiness. They think if they just had more money, were married, were a little skinnier, or smarter, happiness would increase. In fact, our circumstances account for very little of our happiness. If that's hard to believe, consider this - our circumstances (all of the things that happen to us on a daily basis including those big events in life that get us down) account for no more than 10% of our happiness - really. Now, before you say, "that's impossible", this is 10% over a lifetime! What that means is that at any given moment, bad events can occupy 100% of our thoughts, existence and take control of our feelings, but because we have the ability to adapt, (that is, we get used to things), the effects of circumstances, good and bad, fade over time. That's good news for bad events as it means if you just hang in there long enough, eventually time will heal sadness and pain will lessen. On the other hand, adaptation is bad news for good events, because we adapt to those too, meaning that a raise at work or even a promotion will eventually lose its excitement and you'll feel right back to normal in no time.

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So, we have 50% for genetics, 10% for circumstances, which leaves 40% for personal control. These are the purposeful things that we do, think, perceive and interpret about situations, events, and ourselves. It includes the choices we make about how we respond to events and deal with our feelings. Although this is only 40%, it is the thing we have the most control over, and it is enough to increase our happiness almost every day. Being in control doesn't mean bad things won't happen, but it does mean you can control how you react to those things making events either go more smoothly or much worse than they need to go. Thus, being happy involves making a decision to see events as opportunities for growth and not a reason to lay on the bed and never get up again! These three things influence our happiness (i.e., genetics, circumstances, and personal choice). Will you blame your circumstances or will you be an active person who chooses to respond to your life's events positively, constructively, and with growth in mind? If so, you will be a lot happier over time.

PERMA Model of Well-Being

Photo credit: Louise Lambert

Another area in which positive psychology is active is the development of models and theories to explain happiness; yet, you’ll rarely hear positive psychologists talk about happiness – they use the word wellbeing instead. Happiness doesn’t really have a clear definition and it tends to be associated with smiling a lot. That’s not really what we mean by happiness; it’s a lot more than that.

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The PERMA (Seligman, 2011) model was developed as a model of wellbeing that is composed of five different pathways to happiness; that means, there are at least five different ways in which we can reach a state of wellbeing. We can choose to use all five at once, however, most of us tend to favor some over the others. When we use all five pathways, we are said to lead a full life and this is the best representation of happiness. When we barely use any of them, we are said to lead an empty life and this is closest to a state of depression. Each of the letters in the PERMA model (P-E-R-M-A) corresponds to the pathways below. See the chart below to see which pathway describes you best and indicate what types of activities you do in each of the pathways. We’ll talk more about the pathways later. PERMA Pathways

Pleasure and Positive emotions

Engagement & Flow

I love enjoying myself and delighting in pleasures on a daily basis whether it’s laughing, enjoying a good meal, savoring my kid’s laughter, buying myself shoes, or listening to music, watching the sunset. I often and easily lose myself in difficult activities like scrap booking, playing tennis, doing research, solving cross-words, collecting stamps or in activities that others think I spend much time doing.

Rate 1-10. 10=very much like me, 1=not at all like me)

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I care deeply about my family and friends. I call them often and spend as much time with them as I can. If they are sad or need help, I try to help or just sit with them. My social circle means everything to me; I would choose them every day over activities. I find my happiness in others. My values, beliefs, or religion matters. When I decide to spend time doing something, I consider how it fits my purpose. I do the right thing. Morals are vital. I think about how I live my life; what it means. I know what I am here to do. I always set goals and see how much I can achieve and what I can make happen for myself. I like to see how far I can push myself and what I am made of. I love the feeling of succeeding, meeting my goals and immediately setting new targets!

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You can measure how you rate on each pathway by going to www. authentichappiness.org and check the full range of questionnaires there. 1. 2.

Which was your strongest pathway? Which is your least preferred pathway?

Although we can rely on many or all of the pathways, there is one pathway that is weaker than the rest. Pleasure is the pathway upon which we should not depend too much or in isolation as it tends to include short-term forms of instant gratification, like shopping, listening to music, or eating chocolate. While these are not terrible for us, they could become bad if that’s all we have in life (i.e., dependence, overspending, overeating, addiction, etc.). On the other hand, we need little boosts of happiness every day to help us attain long-term goals; otherwise we burn out, become fatigued and give up if there is no pleasure. A good balance of multiple pathways is the best combination. Let’s look at each pathway now.

Pathway of Pleasure/Positive Emotion

Photo credit: Pixabay

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This pathway focuses on pleasures and positive emotions from the past, present, and future. Examples from the past might be pride: “I was so proud when I finished my first marathon,” while example from the future might be anticipation: “I can’t wait to go to the Seychelles!” Finally, an example of a present gratification might be satisfaction or contentment: “I love the smell and taste of this chai tea!” Anything that makes us feel good in the immediate moment would fit into the pathway of pleasure.

Pathway of Engagement

Photo credit: Adeel Zaidi

Engagement involves the feelings we have about the activities in which we spend time, such as feeling involved, interested and attached. These activities can include sports, hobbies and passions like art work, or anything difficult in which we use our skills and talents and spend a lot of time. As a reward for spending time and committing ourselves to our activities, we create a state of mind called flow (Csikszentmihalyi, 1990). Flow is the feeling you get when you lose yourself or “zone out” in chosen difficult and enjoyable activities and you barely see the time go by.

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Pathway of Relationships

Photo credit: Pixabay

Social support helps us maintain happiness as we grow through our connections with others. Our relationships do not only include those we have with close individuals, but even include our group interactions and our acts of kindness, charity, and cooperation in society too. Further, simply being around others helps us maintain more realistic thoughts and distract ourselves from our own problems.

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Topic Box: Positive Relationships by Homaira Kabir

Photo credit: Pixabay

Positive psychology identifies five main pathways to wellbeing and of living a life of flourishing. One of these is by nurturing positive relationships. It is interesting that the word “positive” has been added to “relationships” – but not so surprising after all. Negative relationships, such as envy and conflict in families and friends can lead to mental turmoil and regretful behaviours that do not benefit anyone. In Middle Eastern societies, we are fortunate to have a strong network of relationships that keep us grounded. Large and close-knit families and long-lasting friendships are part of our social fabric. This is because we belong to collective cultures that are based on respect, consideration and cooperation to help us thrive. Research shows that this has many advantages for our wellbeing. Relationships help us in times of need and provide us with emotional support to get over our fears and disappointments and find the courage to go out and do the right thing. Relationships also provide us with moments of laughter and connection that release us of stresses and bring us together in meaningful ways. It is well documented that one of the reasons for the rise in depression in the West is the lack of close relationships. People feel isolated, insecure and unable to share their joys and sorrows. The reasons

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for this are many, such as hurried lives and individualized cultures, but there is one reason that we all have to be careful about. Technology, for all its wonderful benefits, has the potential to isolate us into our own worlds and distance us from others. Social media can make us believe that we are connecting with friends and being a part of their lives. But research shows that this form of connection has no impact on building the strengths of empathy, kindness and compassion— strengths that are necessary for positive relationships. It is only by spending real time with others, by being with them through thick and thin, and by sometimes sacrificing our own needs that we build relationships of trust and mutual caring. This has benefits not just for others. Positive relationships are a two-way street. Research shows that when we take care of others and make them feel an important part of our lives, we build our own resilience and find deep inner happiness. We have all experienced those feelings of joy that come from helping someone else, as well as the feelings of gratitude that emerge when we are offered help. The good news is that it does not take much to spread positive emotions. By being conscious of our actions and remembering the power we have to bring happiness to others, we can exercise more empathy, listen, smile more often and nurture positive relationships that benefit others and ourselves.

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Pathway of Meaning

Photo credit: Pixabay

Meaning also comes from engagement and involves the use of our strengths, talents and skills towards something larger than our own selfinterest or present concerns and can include actions such as volunteering, belonging to a community or civic group, religion, or any action taken based on our personal, family, or group values. Meaning involves the determination of our purpose, the reason we give ourselves for why we do what we do and what is important to us.

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Topic Box: Spirituality as a Road to Well-Being by Homaira Kabir

Photo credit: Pixabay

In positive psychology, one of the five pathways to wellbeing is to cultivate more meaning in our lives. Meaning answers the call of something deeper within us, the desire to belong to something larger than the self. It could be a subjective state – which means we can feel we are pursuing something meaningful when in the act, such as having a great night out with friends. But it can also be an objective one, when years later, or in the eyes of someone else, we find that our actions made a difference. This means that meaning is not felt simply through our bodily and emotional experiences, but through something deeper within us. Some people call it the spirit or the soul – the part of us that judges our actions and holds us accountable for them. Spirituality is about recognizing this part of us as an essential part of existence and thus seeing ourselves as more than mere robots going through life. This is especially important in our current day and age, because we tend to place a lot of emphasis on what is analytical and material at the expense of the wholeness and transcendence of the soul. There are multiple ways of nurturing spirituality through experiences, practices and perspectives. Spiritual experiences are those that give rise to feelings of being alive and feelings of elevation. They are

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often embedded in relationships, such as when we feel deeply connected with someone or when we come together for a common cause. Similarly our work, whether it is a job or our education, can become a spiritual experience when we engage our passions and love what we do. Spending time in nature or with little kids (and even older ones!) can all be spiritual experiences if they take us beyond our world and give rise to feelings of awe and wonder. Spiritual practices are those that we engage in to find a connection to our deeper core. In the Islamic world, religion is a strong source of this connection that gives us faith, brings us hope and keeps us committed to something larger than the self. This brings a deep sense of peace and belonging. Lastly, a spiritual perspective on life is simply thinking about who we are and what it means to be here in this world. People who take time out to reflect about this not only consider life, but also their inevitable death. Even Prophet Mohammed (PBUH) urged us to spend a few moments thinking about death every day. Nothing keeps us as committed to making a positive difference to the world as the awareness that one day we will die. No wonder spirituality can bring out the best in us.

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Pathway of Accomplishment

Photo credit: Adeel Zaidi

Achievements involve the activities we do to feel efficacious, successful, and for the simple pleasure of saying, “YES! I did it!” Competition can be used to bring out the best in individuals by using our skills and effort towards chosen goals. Pursuing mastery and success are means to happiness. When we pursue mastery we become an expert at something by spending an incredible amount of time practicing and amassing knowledge about that one area. Setting difficult long-term goals and realistic plans that involve effort and ways to deal with failure and setbacks would fall into this category.

Positive Psychology Interventions Positive psychology researchers are also interested in the development of positive psychology interventions or PPIs for short. PPIs promote the building of positive emotions and experiences and differ from traditional strategies that only reduce negative emotions and experiences (Sin & Lyubomirsky, 2009). Building positive states has better results than just

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trying to remove negative states. In other words, being happy (the presence of positive emotions and experiences) is far better than just not being depressed. Studies show that not being happy (a condition called languishing – kind of like stuck in neutral, going through the motions, being bored, not being happy nor sad) is just as bad for us as being depressed. Languishing individuals are at risk of becoming depressed over time if they stay that way too long! Several large studies concluded that PPIs reliably decreased rates of depression and improved well-being. In both depressed and nondepressed groups of people, PPIs (such as writing a gratitude letter and envisioning ourselves at our best) improved positive mood between one and six months. Let’s try the gratitude letter (Seligman, Steen, Park, & Peterson, 2005) Writing a gratitude letter and making a gratitude visit are effective strategies against depression and help to boost positive emotions. Gratitude also promotes the savouring of positive experiences because we must attend to them and remember them to be appreciative. Gratitude increases our feelings of self-worth and is incompatible (can’t happen together) with negative emotions like anger. What this means is that if you’re having a tough time in life or are feeling pretty good but want to boost your mood even more, write someone a gratitude letter and then call them to read it, or better yet, deliver it. Ready? Select a person who has had a positive influence in your life and write them a letter of gratitude. Let them know what they did that meant so much to you and how it makes you feel to think of it. Focus on their good deed in particular. The letter should be handwritten so that the recipient has a lasting memory of your thoughts. Once written, deliver it in person and read it to them. If you cannot meet, call them and read it. If that is not possible, you can post it. If the person has passed on, you may still write a letter and read it to them as though they were listening. When you've done it, write about what the experience was like and share it with your classmates. Would you like to try one more PPI? In the Best Self Exercise (Layous, Nelson, & Lyubomirsky, 2013), we imagine our best possible self, which helps us think about our life goals and desires and who we really aspire to become. Proposing our best self prompts us to plan and see ourselves and visualize our goals. Developing plans and desires for our best self further increases our motivation and generate a sense of purpose. Part 1: Write about your best self. This is how you see yourself at your very best in the future. The future can be any time. Think about this in great detail. How will you look? How will you interact with others?

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How will your thoughts be different? How will your actions be different? How will your daily activities differ? How will you present yourself differently to the world? Write freely about how you see yourself at your very best in as much detail as possible. When you are finished, move on to part two. Part 2: Now, comes the planning and setting your best self into motion! We can do this by setting goals and intentions for ourselves as these provide purpose, direction and structure our time. Without goals, we have no reason to act, and with them, we try harder. Make sure to choose goals to approach (I will do ABC) instead of goals to avoid (i.e., I won’t do ABC). Choose one aspect of your best self and consider the actions you could do to make it happen. It might be several steps; break it down into as many steps that are required. Now, select the first and easiest step and begin to do it this week. It’s never too early to start being your best self as it is a long process to reach our best selves. Once you’ve been able to accomplish this step or habit successfully for a time, develop more goals and continue to move forward. You can use the table below and break up your goals into several categories. Remember to fill in your current resources; these are things and people in your life that are helpful and can provide support, ideas, motivation and the will to become your best self. Good luck!

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Best Possible Self Goals Family

Work

Social/Friends

Community

Health/Fitness

Environment

Religion/ Spirituality

Education

Recreation/ Hobbies

Finances

Travel/Learning

Contribution to world

Other My current resources (friends, skills, health, money, smarts, family, time, beliefs, etc.)

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Topic Box: When “Just be Happy” Makes You Unhappy by Janine Pinto

Photo credit: Pixabay

“Just be happy” is a phrase that’s casually thrown around as though it’s supposed to be second nature to us all. It’s probably safe to say that this phrase is the epitome of something that’s easier said than done. If you’ve tried to make “be happy” your New Year’s resolution, you’ll probably know that trying hard to be happy actually makes you unhappier. Don’t worry though, you’re not bad at being happy, it’s merely that being happy is harder than it seems. I’ll summarize Ford and Mauss’ (2014) chapter for you and explain why trying to be happy can sometimes make us unhappy. Firstly, our standards of happiness are way too high. If you set unreasonably high standards of happiness and expect to be happy even when it makes no sense to be happy, you’re not going to be happy. Imagine you plan this incredible party that you expect will make you super popular because for some reason, you think “super popular = super happy” - obviously. You plan for months and pull an unhealthy amount of allnighters trying to make sure you have the best party in the country. After the party, you end up extremely disappointed because your incredible party didn’t make you super popular. Because you set really high standards for yourself, you end up feeling worse than how you felt before you had this brilliant idea. Happiness works the same way. More often than not, we set ridiculous standards for happiness which makes us feel a whole lot worse compared to when we had no standards at all. Best thing to do is to set more reasonable standards and accept that you can’t (and

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shouldn’t) be happy all the time. Sad vibes aren’t always bad vibes. Secondly, we don’t always know what will make us happy and overestimate the effects of positive events. Have you ever been so excited for something like driving your first car or living alone for the first time? You may think that these events would make you super happy but when it actually happens, you’re not as happy as you thought you’d be. The same goes for negative events. We overestimate the effects of those too. We think if we fail a class, life will never be the same and we will be impacted forever. But in reality, we get over things pretty quickly and even bad stuff tends to hurt less over time and is eventually forgotten. These overestimations cause us to focus too much on positive events (creating disappointment when they don’t meet our expectations) and to avoid negative events (which could lead us to grow) or focus on how bad we think they should make us feel and then surprise, surprise, we end up feeling bad because we think we should! Lastly, we monitor, or analyse our happiness too much. Imagine someone told you a funny joke. If you didn’t monitor it, you’d laugh hysterically. But, if you were asked to analyse the joke and write a 500 word essay on its meaning, you’d not find the joke so funny anymore. The more you think about your happiness, the harder it is to experience. Instead, when you hear your favourite song on the radio or eat that chocolate bar you’ve been craving, just enjoy it and don’t think so much about it. The same goes for when an amazing thing happens to you; don’t analyse it, just enjoy the surprise and go with it. Finding happiness is not easy, but perhaps the best advice is just not to try so hard.

Positive Psychology and Culture A more recent development in positive psychology is the consideration of happiness from a cultural point of view. Studies have shown that the definition of happiness differs depending on culture. For instance, a study by Uchida and Ogihara (2012) found differences in perceptions of happiness between European-American cultures and East Asian cultures. Individuals from European-American cultures felt that happiness involved a sense of personal autonomy and independence, individual achievement, and self-esteem. These descriptors tend to reflect how happiness is understood in more individualistic nations. Recall that individualistic nations are those where the desires and wishes of the individual take greater importance than those of the group or family. In contrast, East Asian cultures felt that happiness involved inter-dependence with family

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members, relationship harmony, and the value of social support. These descriptors tend to reflect the priorities of collectivist nations. As it turns out, culture has a big influence on how we understand happiness. Studies (Lambert D’raven & Pasha-Zaidi, 2015) showed that Emirati as well as other Arab university students in the UAE tended to describe happiness as something they obtained through others. They mentioned activities like sitting with their parents, sharing Friday lunches with their families, spending time with extended family like cousins, and giving and receiving mutual emotional and material support to their friends. The word "I" was absent in describing activities that brought them happiness, reflecting the importance of other people in their lives as well as their culture's collective orientation (see previous chapter). Both groups also felt that happiness included the fulfilment of social, family, and religious obligations, such as helping siblings, engaging in good deeds and ensuring parents were well taken care of. Fulfilling these obligations were considered to be helpful in maintaining society's balance and order and allowed individuals to gain the respect, regard and acceptance of others. Finally, both also expressed positive emotions like pride, a sense of recognition and belonging, and self-esteem when parents were satisfied with how they lived their lives, such that things like graduating from university, getting a new job, or any type of good news was considered a group achievement that brought everyone pride and not just something from which the individual alone gained happiness.

Over to you now… 1. 2. 3. 4. 5. 6.

What is the major difference between positive psychology and mainstream psychology? Describe the Architecture of Sustainable Happiness. What are the 3 components of happiness? What does PERMA signify? In which pathway did you score highest? How might you engage in activities to boost your other pathways? What are examples of positive emotions? Talk about the Broaden and Build theory: what is the purpose of positive emotions? What is meant by an aversion to happiness? Where have you seen this before? How is happiness viewed in your culture? How many of positive emotions do you experience every day? Do you reach the 3 to 1 positivity ratio? What could you do to reach that ratio of more of positive emotions?

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7.

8.

9.

What is happiness in your mind? What brings you happiness? Write down as many sources of happiness that reflect your beliefs and personal/family activities. Once finished with your list, decide if it reflects a collective or individualistic orientation? You might also want to ask your parents and a few friends; what is happiness for them? Interview your parents and at least two friends (preferably from another culture) and write down their answers here. Are their responses different from yours? Why do you think that is so? What did they not mention? Are you as optimistic as you could be? Want to practise? Why don’t you come up with three optimistic beliefs about a tough situation you are facing now or that is coming in the future? Write them out and see whether you can practise reminding yourself of these?

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MEET THE EDITORS

Dr. Louise Lambert, PhD, teaches Psychology at the United Arab Emirates University (UAEU) in Al Ain (UAE) and was also formerly Associate Professor at the Canadian University Dubai (UAE), teaching in psychology, positive psychology in the workplace, ethical reasoning, and business ethics. She is a Canadian Registered Psychologist with over 15 years of counselling practise in the non-profit, mental health and primary healthcare sectors. She is also Editor-inChief and founder of the Middle East Journal of Positive Psychology. A published researcher in happiness research, she also works to teach individuals, and in particular university students, how to increase their well-being by teaching the skills of happiness through her Happiness 101 series, as well as character strengths development so they can be best prepared for the workplace and function as competent, ethical and productive citizens of the world. Watch for her latest edited book on developing a regional brand of positive psychology in the GCC this year. Dr. Nausheen Pasha-Zaidi, PhD, has degrees in Communications, Education, and Psychology. She has worked as an international educator for almost 20 years focusing on language development and cultural studies with an emphasis on Muslim populations. Her articles have appeared in a number of professional journals including the Middle East Journal of Positive Psychology, Ethnicities and The Journal of International Women’s Studies. She is the author of The Colour of Mehndi, a novel that explores acculturation, family values and mental illness within the Pakistani-American community

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and the lead editor of Mirror on the Veil: A Collection of Personal Narratives on Hijab and Veiling. Dr. Louise and Dr. “Nina” have been friends since both arrived in the UAE and have worked hard to support one another academically, professionally and personally in order to reach their very best levels of excellence. This book project was one of many to see the light of day while chatting over weekly lunch at the Dubai Mall fountains. We hope you enjoy it as much as we have enjoyed putting it together and that it will inspire you and your colleagues to do the same for other topics in psychology in the region. We look forward to seeing your next steps.

MEET OUR CONTRIBUTORS

Photo Credit Daniel Crump

Dr. Rehman Abdulreham, Ph.D., C. Psych., is the director of Clinic Psychology Manitoba and Assistant Professor with the Department of Clinical Health Psychology at the University of Manitoba (Canada). He has interests in crosscultural and international psychology, working as a clinician and consultant with hospitals, political parties, and cultural communities. His work includes program development to increase access to psychological treatment in low resource settings, while his international work in Tanzania included developing the first CBT treatment group for anxiety disorders in the country, and providing mental health services to orphans who were formerly street children. Recently, he participated in developing a free resource for any individual working with Syrian refugees and others from the Middle East region. Dr. Rehman was also the past chair of the Committee on International Relations in Psychology for the American Psychological Association. Mehdiyeh Hussain Abidi received her degree in Psychology and Human Resource Management from Middlesex University Dubai. She is currently working at Human Resources Institutes and Clinics Dubai, under the supervision of Dr. Thoraiya Kanafani. Mehdiyeh plans on pursuing a Master’s Degree in Clinical Psychology and Criminology. She was nominated to attend the Global Young Leaders Conference (US) and has interests in political science and archeology. Mehdiyeh hopes to study and work with criminals suffering from psychiatric disorders.

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Najma Adam, Ph.D., L.C.S.W. is currently Assistant Professor at United Arab Emirates University (UAEU) in Al Ain. With years of clinical and administrative experience, Dr. Najma served as executive director of a domestic violence agency, provided services to death row inmates, coordinated programs for children and families, and worked with homeless adults. Her teaching areas include domestic violence, research methods, social policy, and cross-cultural courses. A second generation Ugandan Indian, she migrated to the USA with her family at the age of seven and since received a B.S.W from Bloomsburg University (USA), an A.M. from the School of Social Service Administration, University of Chicago, and a Ph.D. from Jane Addams College of Social Work in Chicago, USA. She is also currently an Associate Professor in Social Work and Women’s Studies. Meera Khalifa Al Agroobi is a 21-year old Emirati graduate from Zayed University (UAE) with a major in both Communications and Psychology. As an undergraduate, Meera was chosen to be in the Sheikh Mohammed bin Zayed Scholar program developed by New York University Abu Dhabi for outstanding students in UAE national universities. She was also a speaker at Tedxnyuad where she spoke about high school bullying. Meera is passionate about learning and aspires to improve the education system in the UAE and advocate for social issues. She currently works at the Minstry of Education and aspires to become an author and filmmaker.

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Nadia Al Aswad is a graduate of Middlesex University Dubai, where she obtained a BSc in Psychology with Human Resource Management. She participated in the Board of Studies as a student representative and received a certificate of participation at The Third National Conference of Applied Psychological Research in the UAE. Nadia interned at the Human Relations Institute & Clinics (Dubai) under the supervision of Dr. Thoraiya Kanafani. From there, she moved on to the UK to continue her studies and acquire a master’s degree in clinical psychology. Meera AlBudoor is a Zayed University 2015 graduate who majored in Psychology and Human Services. During her last few semesters, she was both on the Dean's list and on the Zayed Scholar list. Meera's senior project was a detailed research that focused on Emirati's perception towards mental health in the UAE. Following her internship, she started her career in The Executive Council of Dubai in the Socioeconomic Strategy Management and Governance department working mainly with social policies related to social cohesion, education, and early childhood. Manal Khasib Hamdan Al Fazari is an assistant professor in the department of Psychology, College of Education at Sultan Qaboos University (SQU) in Oman and current deputy director of the student counselling centre. She finished her Masters and PhD degrees in counselling from the University of Queensland in Australia. Her research interests include counselling, counselling and domestic violence, Islamic Feminist Theory, school counselling, and qualitative research. Since 2005, she has taught undergraduate and postgraduate university students, and

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participated in various coonferences and d symposium ms in Oman, A Australia, Malaaysia and the UAE. She S is founderr of the first aw wareness campaign on o the “Imporrtance of Coun nseling Psychology y” at SQU thiss past year. Jeremy Alford, A PhD., iis a Clinical Psycholog gist and Foundder and Presid dent of MEEDA, the Middle Eaast Eating Dissorders Associatio on. Founded inn 2009, MEED DA is a non-profitt organisation that works to raise awarenesss, prevent eatinng disorders, conduct research, and a offer suppport. It has a free fr online hottline to providde assistance to o anyone in the Mid ddle East seekking help. Info ormation can be fou und at www.m meeda.me. ME EEDA provides workshops w in sschools for stu udents, teachers an nd parents andd workshops to t healthcaree professionalss to improve diagnosis d and treatm ment support. M MEEDA work ks with other institutions to provvide accrediteed trainings. For more infoormation, visitt www.meeeda.org. Mona Al-Ghamdi is a S Saudi MA Counsellin ng Graduate frrom the Univeersity of Nottingham m (UK). She hhas worked in n fields such as salles, hospitalityy, PR, and hum man resources; however, herr passion lies in i counselling and psychottherapy. Born n and raised in UK, U and then m moving to Sau udi Arabia in 2005, 2 Mona iss well acquain nted with multi-cultu ural issues froom both a perssonal and profession nal mind framee. It is in this duald cultural ex xistence that shhe produced research r to reflect the needs of thhe community y. Mona has a brigh ht future aheadd in the counsselling and psycho otherapeutic w world; we look k forward to o seeing more of her.

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Jamal Alhaj currently works at Dubai Media Incorporated as a translator and news publisher. He majored in International Affairs at Zayed University (Dubai, UAE), where he was also an undergraduate researcher and part of the Undergraduate Research Scholars Program where he studied advanced research methods towards his research in motivation and self-perception. He worked in ZU’s Peer tutor/mentor and leadership program as a peer tutor—or—PAL (Peer Assistance Leader) where he was an ambassador to the university and the program, and taught courses related to anthropology, sociology, history, philosophy and political science. His research interests includes: Self-theories and Motivation, Morality, Altruism, Symbolic Interactionism, and Transculturation. Yasmeen Alhasawi received her Bachelor’s degree in Psychology at Purdue University and Master’s degree in Psychology with a specialization in Clinical Psychology at Gallaudet University. She completed a research fellowship in molecular genetics and otolaryngology at the Harvard Medical School and was a visiting research scholar at the Neuroethics Studies Program at the Center for Clinical Bioethics at Georgetown University. Her research interests are in audio-visual integration and long-term auditory memory in late-deafened adults, and the neuroethical considerations of cochlear implantation. She is completing her doctoral degree in Clinical Psychology at Nova Southeastern University.

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Dr. Carrie York Al-Karam is a professor at the University of Iowa (USA) and Director of Al-Karam Center for Islamic Psychology. She conducts research, publishes, and teaches on the Psychology of Religion, Islamic Psychology, and Spiritually Integrated Psychotherapy. She has a PhD in Psychology (Sofia University, 2011), MA in Middle East Studies (American University of Beirut, 2003), and a BA in International Studies (State University of New York, 1998). From the USA, she lived for nearly 17 years in the United Arab Emirates, Lebanon, Turkey, France, Russia, Latvia, and Singapore. Her most recent co-edited book is Mental Health and Psychological Practice in the United Arab Emirates (2015). She is working on Islamically Integrated Psychotherapy: Processes and Outcomes of Muslim Clinicians (Templeton Press, 2018) and Islamic Psychology: Defining a Discipline (Brill, 2019). Hamed Al-Refaei is a 15 year old self-taught artist from Kuwait. He is the eldest of 5 siblings and started painting at the age of 5. Hamed has donated 15 paintings to Bayt Abdullah, which is a local hospice for kids with terminal cancer and another to Q8 Bookstore whose funds go to charitable organisations in Africa. Hamed also has a painting in a Finnish Museum representing Kuwait in children's art from around the world. He has given free art classes to kids in ArtSpace Cafe and at NBK Hospital for children with cancer. He also painted live for "The Love of Kuwait" anti-terrorism campaign at Al-Hamra Mall. Hamed is currently working on his second solo exhibition. See the work of this non-commercial artist who seeks to make a life a better place through art at hamedrsgallery on Instagram.

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Reham Al-Taher is an aspiring clinical psychologist with an ardent interest in positive psychology. She wants to pursue a PhD in Psychology and open a practice in Saudi Arabia, where she hopes to revolutionize mental health and remove its stigma so everyone can feel safe to ask for and accept help. She recently authored, The relationship between drug use and impulsiveness and emotional dysregulation, available on Amazon soon. She is the Editor in Chief and International Relations and Content Manager of the Positive Psychology Program website in the Netherlands. Aleksandra Aslani is a psychologist and a trained cognitive behavioural therapist. She obtained her degree in Philosophy-Pedagogics and Psychology, a BSc in Psychology from the University of Athens, and MSc in Child and Adolescent Mental Health at the Institute of Psychiatry of the King’s College London, where she worked as a research assistant at the Department of Child and Adolescent Psychiatry and assistant psychologist at the Child and Adolescent Mental Health Services. She has worked in the field of special education undertaking children with cognitive, educational and developmental difficulties and disorders. She has co-authored papers on the development of new psychometric tools and is a member of the British Psychological Society.

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Sara Antonucci is an Italian university student living in Dubai with her family. “It took me a while before feeling integrated in such a multi-cultural and diverse environment, but after making friends and improving my English, I decided to join the Canadian University Dubai, where I had the possibility to meet people and experience a stimulating university atmosphere. My major is marketing and by living in a city like Dubai, I find it interesting to study its market and customer behaviour. I like drawing, reading, writing and sports, as well as travelling and learning about different cultures. I love meeting and learning from new people.” Dr. Katharina A. Azim holds a Ph.D. in educational psychology from the University of Memphis (USA) and now a lecturer at the University of Buffalo (USA). Her dissertation examined the conceptualization of ethnic identity in Saudi female graduate students in the U.S. She has a master’s degree in German language and literature at Fontys University Tilburg, a master’s degree in English language and education at Utrecht University, and a master’s degree in education and media at FernUniversität in Hagen, Germany. Her research focuses on ethnicity, ethnic identity development, and enculturation processes with MENA, Arab, and Muslim women and on women’s reproductive health, agency, and rights. She is German-Russian, Muslim, and married to an Egyptian, dividing her time between the U.S., Netherlands, Egypt, and Germany.

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Dr. Jane Bristol-Rhys is a cultural anthropologist who writes about Emirati society from Zayed University in Abu Dhabi (UAE). She is the author of Emirati Women: Generations of Change, and many articles about Emirati history and heritage. She has lived in the Middle East for more than 25 years and spent part of her childhood in Nigeria and Kenya. She earned a BA in sociocultural anthropology from The American University in Cairo and a Ph.D. from the University of Washington in Seattle in 1987. Jane’s next books are Future Perfect/Present Tense: Host and Migrants, and Monitor Lizards, Snakes and the Juju Man: Growing up Wild in Nigeria, a humorous memoir of Nigeria in the 60s. Dr. Annie E. Crookes, MSc., PhD, PGCertHE, has been based in Dubai, UAE for 11 years as a lecturer and department leader in Psychology for two British institutions. She is now Academic Head of Psychology for Heriot-Watt University (Dubai campus), developing and managing the psychology programmes at BSc and MSc level and overseeing student support. She works with professional psychologists in the UAE and helps organise the annual International Psychology Conference Dubai. Her main areas of teaching are cognitive psychology (memory, learning and perception), biopsychology and advanced courses in consciousness and mental health studies. Following a recent sabbatical year in which she gained an MSc in International Addiction Studies, she has a research interest in substance use among young people based in Dubai.

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Anisha D’Cruz obtained her Bachelor’s degree in Psychology with Human Resource Management and her Master’s degree in Psychology from Nottingham Trent University (UK) with a specialization in MSc Health Psychology from University of Nottingham (UK). She has worked in a Special Needs School and has volunteered working with autistic children. However, she is keen to work in the UAE in the field of health psychology at hospitals or clinics. She aspires to work with patients or individuals with chronic illnesses to help them cope better and improve. Reem Deif is an Egyptian graduate of The American University in Cairo (AUC) and is currently a graduate student of MA in Counseling Psychology. She has been a teaching assistant in psychology classes including social psychology, narrative psychology and the psychology of gender in AUC and is a remedial trainer for children with cognitive and learning disabilities. Previously, she worked as a Freelance APA style editor for the "Handbook of Arab American Psychology" and has presented in many conferences about the effects of prenatal alcohol exposure and parent-focused interventions. Tooba Dilshad is the Marketing Communications and Research Associate at the Human Relations Institute and Clinics. She handles PR and marketing, and is part of the clinical psychology research team. Tooba holds a B.A. in Strategic Communications from Seattle University and has a background in health and social impact PR. She has researched international and cross-cultural styles of communication and provided support

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for citizenship and immigration services for elderly clients in the USA. Tooba is interested in the power of digital reach in increasing access to healthcare resources for underserved, minority, and refugee communities. Nicole El Marj obtained her Bachelors in Psychology from the University of Ottawa and Masters in Educational Neuroscience from the University of London. She has worked in research and clinical settings at the Royal Ottawa Institute of Mental Health Research and the Centre for Research in Autism in London. Her expertise lies in psycho-educational and neuropsychological testing as well as remediation for children, adolescents and adults with neurodevelopmental disorders. Nicole works with children through play therapy and behavioural modification, and is trained on the Lindamood-Bell programs. She has worked with adolescents and adults with depression and anxiety and facilitates support groups. Nicole is now completing her Doctoral studies in Clinical Psychology at the University of Birmingham, UK. Khalid Elzamzamy is a psychiatry resident at Hamad Medical Corporation in Doha, Qatar. He received his medical degree from Ain Shams University, Egypt and served as a research assistant in neurology and psychiatry at Yale University. He also served in the Departments of Refugee Health and Mental Health at Caring Health Center in Springfield, Massachusetts. Khalid acts as a research fellow at the Family and Youth Institute (www.thefyi.org). His interests include investigating the history and current practice of Muslim mental health, developing an Islamic framework for psychology and

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mental health, and raising the public's awareness about mental health issues.In addition, Khalid has a special interest in studying Islamic sciences and Arabic literature which he continues to pursue under many scholars in the Middle East. Isbah Ali Farzan is from Pakistan and a PhD candidate in Educational Psychology at the University of Memphis, USA. Her area of interest is achievement motivation. She is particularly interested in cross-country differences in academic motivation and performance of middle and high school students. She uses a cultural lens to understand these differences. By profession, she belongs to the field of educational assessment. She has worked on classroom assessment, achievement tests, standardized tests, and evaluation studies. She has worked for UNESCO, American Institutes for Research, Queensland Curriculum and Assessment Authority, and The Aga Khan University-Examination Board, Pakistan. She is a recipient of Commonwealth Distance Learning Scholarship, Endeavour Executive Award, and the Fulbright Scholarship. Mehrdad Fazeli Falavarjani is a researcher in the field of social psychology from Iran. He graduated from Universiti Putra Malaysia specializing in Iranian acculturation in Jan 2014. He was mentored by Prof. Floyd Webster Rudmin, through his dissertation and has held several training workshops on statistics and research tools in universities of Malaysia and Iran. Further, he extends his research area into Peace Studies. Currently, he is a researcher at University of Isfahan, Iran. Fiza Hameed, an applied professional in Paediatric Neuropsychology, is an instructor at Zayed University (UAE) since 2012 teaching undergraduate psychology courses in the College of Education and College of Sustainability Sciences and Humanities. Her research interests are child psychology, special needs, developmental neuro-cognitive processes, and early intervention. Fiza is a member of the University Institutional Teaching and Learning committee working on innovative teaching strategies and tools, and has served on the Student Affairs committee being an advocate of student engagement and collaborative

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inter-collegiate initiatives. Prior to academia, Fiza trained in psychometric testing and clinical assessment for children and teens. Jeyda Hammad (DPsych candidate) is a Psychotherapist and Counselling Psychologist in training. She trained as a Psychotherapist at the University of East London (UEL), England and is currently completing her Professional Doctorate in Counselling Psychology at UEL. Jeyda is a practising Psychotherapist who specialises in working with complex trauma and survivors of human rights violations. Jeyda works therapeutically with client groups including refugees and asylum seekers, survivors of torture, domestic abuse, childhood sexual abuse and sexual violence and in adult mental health. Jeyda’s clinical and research interests are trauma, how people cope with war and trauma, community psychology, culture and spirituality in counselling and psychotherapy. Dr. Amber Haque is Professor of Psychology at UAE University in Al Ain (United Arab Emirates), where he has worked for several years, directing the Master’s Program in Clinical Psychology. Dr. Haque practised psychology in Michigan from 1983 to 1996 and taught psychology in Malaysia from 1996 to 2004. He has published extensively in the areas of mental health and Islamic Psychology and served on the editorial boards of numerous international refereed journals. Dr. Mohsen Joshanloo holds a PhD from Victoria University of Wellington, New Zealand (2013). He did his postdoctoral work at Chungbuk National University, South Korea, and is now an assistant professor at Keimyung University, South Korea. His main research interests are well-being, culture, value, religion, and emotion. He advocates for culturally inclusive research into these variables and has been conducting research in both Western and non-Western populations (including Muslim cultures).

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Homaira Kabir is a Leadership Coach and a Cognitive Behavioural Therapist whose practice is founded on the science of positive psychology. She empowers women and teens to become leaders of their own selves in order to become leaders in life, relationships, and at work. She lives in Muscat, Oman and is one of the few positive psychology practitioners in the Middle East. As part of her commitment to enabling clients to reach their full potential, she conducts research on the role of passions in driving engagement and achievement. Her strength lies in her ability to take both head and heart together in the journey towards change. She is a writer, artist and mother of four children, the inspiration for her work. Read more about her at www.homairakabir.com. Nahal Kaivan, M.A., is an Iranian-American and Doctoral Candidate in Counseling Psychology at Washington State University (USA). Her research interests focus primarily on Middle Eastern/North African populations (MENA) in North America, Europe and the Middle East and North Africa. She uses Liberation Psychology to understand trauma and resilience, gender and sexuality and the process of identity development for MENAs. After the completion of her doctoral program in 2017, she will continue researching, teaching and providing therapy.

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Dr. Thoraiya Kanafani holds a PhD in clinical psychology, Master’s degree in Educational Psychology, Master’s degree in Counseling Psychology, and a Bachelor’s degree in Psychology. After working and completing her education in Canada, she moved to the Middle East, working in Bahrain, Lebanon, Saudi Arabia, and now the UAE. She has worked with couples, assessing children with learning disabilities, and providing therapy for individuals suffering from more clinically based disorders. Her expertise lies in working with adolescents and early adults, however, has experience working with older adults and couples too. She is now working as a clinical psychologist at the Human Relations Institute and Clinics in Dubai and is adjunct psychology professor at Middlesex University in Dubai. Dr. Norma Kehdi received her Doctorate in Clinical Psychology from Pacific University (USA) in 2015. She is a Learning Disability Specialist in California and has worked in university settings conducting psychotherapy and learning disability assessments, as well as student workshops. Dr. Kehdi is completing her Postdoctoral Fellowship at the University of Southern California working with university students with disabilities and conducting psycho-educational assessments for ADHD and learning disabilities. She is passionate about working with ethnic and racial minorities and college students with disabilities, and conducting research related to Arab American mental health.

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Meet Our Contributors

Dala Kokash is a graduate from the Canadian University Dubai, holding a Bachelor’s Degree in Communications with a major in Public Relations. Dala is originally from Damascus, Syria and that is where her passion for knowledge began. Dala had taken part in many research courses revolving around psychology and the way the mind functions. Dala now holds the role of community engager, responsible for social media customer care and content with a regional start-up. Anisa Mukhamedova is from Tajikistan and moved to Dubai to continue her studies in the Canadian University Dubai’s School of Environment and Health Sciences. She works as a customer service representative in one of the biggest department stores of Dubai and speaks fluent Tajik, Russian, English and Turkish. She has recently begun to learn Arabic and German too. At 9 years of age, she joined a professional traditional dancing group and continues today. She enjoys drawing, sketching and creating new art concepts and is now working on two still-life paintings with a mix of acrylic paint and traditional patterned cloth. Malika Narzullaeva was born in Dushanbe, Tajikistan, and is a senior student at Canadian University Dubai (UAE), taking a BBA in Accounting and Finance. She will graduate in Spring 2016 and thereafter, will complete an MBA degree. During university, Malika’s activities were many. She was an active member of the Student Council, and outside of university, Malika enjoys drawing, playing tennis and volleyball, and is passionate about creating presentations and short videos.

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Aditi Nath graduated from Middlesex University with a Bachelor of Science, majoring in Psychology. At University, she was the President of the Debate Society and an independent researcher in the Department of Social Sciences. Her research on the impact of luck on mood gained high acclaim at the 3rd Undergraduate Research Competition, Abu Dhabi. She has had experience as a Psychology intern at an advanced learning center for children and as a Research and Development officer for a commercial photography organization. She interned at the Human Relations Institute and Clinics in Dubai under the supervision of Dr. Thoraiya Kanafani. Dr. Efthymios Papatzikis is an Assistant Professor in Educational Neuroscience. He has trained in and worked on neuroscience and music education in Harvard University (PostDoc in the Mind, Brain and Education program), the University of East Anglia (PhD in Music Psychology), the UCL, Institute of Education, University of London and its centre of Educational Neuroscience (PostDoc lectureship), and the International Brain Research Organisation (PostDoc training in applied neuroscience/neuroimaging). His research interests are in educational neuroscience, infants and children’s neurobehavioural development through music, educational development and special needs. Dr. Tim is a member of the International Brain Research Organisation, the Society for Education, Music and Psychology Research, and the International Society for Music Education. He is also a Fellow of the Higher Education Academy, UK, and holds Qualified Teacher Status with the National College for Teaching and Leadership, UK, and the Ministry of Education, Greece.

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Meet Our Contributors

Janine Ronda Pinto is a Dubai-raised university student who developed a passion for harmonizing public speaking and wanderlust. She studies at the Canadian University Dubai where she majors in Communications and Media studies with a concentration in Advertising. Janine’s speaking savvy unlocked the latches of one of the top international advertising agencies in the Middle East, Memac Ogilvy, for an internship. Her passion for humanitarian issues flew her to Vietnam after being chosen as a delegate at the 2016 University Scholars Leadership Symposium. She is currently the university’s Student Council President and hopes to continue pursuing her passions in public speaking, humanity, travelling and photography to live the life she’s always wanted. Anam Syed is a 20-year old student in Business Administration with a major in Marketing at the Canadian University Dubai. While born and raised in Dubai, her parents are from India and Pakistan. Anam is passionate about gaining knowledge, meeting new people, giving advice to loved ones, and observing others mannerisms! In the future, she wants to pursue an MBA in marketing and general management and perhaps a PhD. Her interests are reading, creative writing, fashion, beauty, personal styling and collecting designer pieces. She is thinking of becoming a marketing professor, have a part time footwear and clothing line, and be an entrepreneur for an image consultancy firm.

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Dr. Tatiana S. Rowson is a Business and Coaching Psychologist interested in life and career transitions throughout the life course, with a particular focus on aging, identity and work. She has a PhD in Gerontology from Keele University, UK, where her research explored the psychological aspects of the transition and adjustment to retirement. She has previously published on issues related to the adjustment to retirement and has participated in conferences discussing the psychology of ageing and adjustment. Dr. Rowson lived in the United Arab Emirates where she worked as a consultant and academic for 10 years before returning to the UK, where she is a Senior Lecturer in Business Psychology at the University of Westminster, London. Safiya Salim is completing her PhD in International Human Resource Management at Heriot-Watt University Dubai, as well as her Level A & B certification (British Psychological Society accredited) in psychometric assessment, coaching and mentoring qualifications (ILM Level 5). Previously, she worked with business psychologists at Emirates’ corporate psychology department and now teaches part-time at the undergraduate level in organisational behaviour, management in a global context, and business skills. Her Masters’ dissertation topic was ‘A crosscultural study on the role of core selfevaluations and job factors on occupational stress.’ In it, 103 participants from 28 countries showed that personality factors were an indicator of job stress in collectivist and individualist samples.

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Dr. Melanie Schlatter (PhD) is a New Zealander and a Dubai licensed Health Psychologist who has lived in Dubai for over a decade. With a background in psychoneuroimmunology, she is trained in helping adults to overcome health-related psychological issues, and she has a special interest in cancer and HIV / AIDs. She also helps healthy people who are simply struggling with issues of daily life, as well as delivering general motivation and stress management programmes, which include a focus on self-care and development. She has published in six international journals, is a board member of several local organisations and magazines, has taught psychology and health psychology at university level, and was on Dubai radio weekly for three years discussing health related topics. See www.healthpsychuae.com for more. Dr. Joana Stocker, Assistant Professor at Zayed University (Dubai) since 2013, teaches courses in counselling, psychological assessment, and research methods. With a PhD in psychology (College of Psychology and Sciences of Education of University of Porto, Portugal), her research focuses on Educational Psychology, i.e., motivational factors related to the learning process and academic success. Constructs related to selftheories, such as the self-concept, personal conceptions of intelligence, causal attributions, self-efficacy, and emotional competence form the core of her investigations. She is involved in research projects such as computational approaches to analyze eye tracking data to diagnose early autism spectrum disorder in children in the UAE, and academic self-concept and high school academic success in Emirati students.

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Dr. Ruba Tabari is an educational psychologist (UCL, 1994) and teacher with over 25 years of experience. She has worked with institutions and schools in the UK and Gulf region covering all aspects of school development work. She has contributed to working groups on matters like child protection and has extensive experience in assessing and diagnosing children and implementing remedial and developmental programs for children and families. Her interests are parenting solutions, Special Educational Needs, working with teens, policy work and school improvement. She has also been involved in community outreach work through professional teacher training initiatives and voluntary organizations. For 3 years, Dr. Ruba had a program on Dubai TV (Elayki) about child development issues. Now, Dr. Ruba practises as an educational psychologist in the UAE. Reinilda van Heuven-Dernison is a chartered (Neuro) Health Psychologist/Cognitive Behavioural Therapist with over 20 years experience in child and adolescent psychiatry. She has published about memory disorders, ADHD and severe dyslexia and has participated in post graduate courses on neuropsychology and cognitive behavioural therapy in the Netherlands. She has been working for six years in the MENA region as chair of the DPR group and has also worked as a consultant for several universities and introduced courses of positive psychology and mindful parenting. She has recently moved to Oman, from Qatar, where she is now an affiliate of Al Harub Medical Centre.

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Dr. Zahir Vally is a British-trained clinical psychologist. Most of his clinical career has been spent working in acute psychiatric settings with psychotic-spectrum disorders in both South Africa and the United Kingdom. He trained in child development at the Winnicott Research Unit at the University of Reading (UK) and has published in the areas of neuropsychiatry, mother-infant mental health, language acquisition in children, and the implementation of psychotherapy interventions in the developing world. His current research focuses on mental health help-seeking behaviour, social media and distorted body image, and the neuropsychological correlates of creativity. He is currently an Assistant Professor at the United Arab Emirates University in Al Ain, UAE. From Pakistan, Anum Virani received her degree in Psychology from Carleton University, Canada. After graduation, she worked as a research assistant at the Children’s Hospital of Eastern Ontario and volunteered as a crisis line specialist at the Distress Centre in Ottawa. Now in Dubai, she is an intern at the Human Relations Institute and Clinics (UAE) and supervised by Dr. Thoraiya Kanafani. She also works as a therapist with autistic kids at Kids in Motion Therapy Services, and has also worked with toddlers, adolescents, adults, and victims of domestic abuse.

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Dr. Jacqueline Widmer (Psy.D. Clinical Psychology, Long Island University (USA); B.A. Psychology from University of Geneva, Switzerland), is an Assistant Professor in the College of Sustainability Sciences and Humanities at Zayed University (UAE). She teaches students in the Psychology and Human Services program and conducts research on the assessment and clinical correlates of emotion regulation strategies. She is a Clinical Psychologist and has worked in psychiatric clinics in the USA and Switzerland and owned and operated a private practice in Cyprus. Yara Mahmoud Younis was born and raised in Dubai, but nonetheless feels detached from her ‘home’ in the Gaza Strip. Now, having spent years contemplating ‘traditional’ Arab society, she questions the meaning of modern Arab identity. Yara graduated from Canadian University Dubai with a BA (hons) in media and communication studies. She now works at the Delma Institute in Abu Dhabi as a research associate. Prior to that, she interned for Alsayegh Media as a market researcher, worked as a customer relations co-ordinator for bookshop Kinokuniya, and, most recently was a content producer at Sail Publishing. Yara constantly looks to increase her knowledge on anything and everything, and uses writing as a creative outlet.