Taking a situated approach to assessment and intervention in trichotillomania and social connection

Trichotillomania (hair pulling disorder) can be a debilitating mental health condition, but current interventions are not without their flaws. Central to developing an effective intervention is to first accurately measure it. Thus, this thesis’ first aim was to develop an assessment instrument for trichotillomania, with the intention to build an intervention. Traditional assessment measures for trichotillomania ignore the importance of the situation, can lead to inaccuracies, and may not give a complete picture of pulling for each individual. Chapter 2 addresses these concerns and builds a novel assessment instrument for trichotillomania, based on the theory of grounded cognition. Our results created a detailed pulling profile for each individual that was situation specific and presented promising areas for interventions to focus on. The second aim of this thesis was to develop an intervention for trichotillomania. As part of this intervention, we were interested in social connectedness and social support and what role they may play in hair pulling, given their association with mental health in general. Chapters 3 and 4 therefore develop an assessment instrument for social connectedness and social support, again building from the theory of grounded cognition. Findings from these studies helped to develop our understanding of influential processes for social connectedness and social support, and situational effects. Finally, the Discussion chapter introduces a trichotillomania intervention developed from the previous studies and the wider literature and further discussed the implication of the findings within Chapters 2-4

Developing and evaluating a situated assessment instrument for trichotillomania: The SAM2 TAI

Measuring trichotillomania is essential for understanding and treating it effectively. Using the Situated Assessment Method (SAM2), we developed a psychometric instrument to assess hair pulling in situations where it occurs. In two studies, pullers evaluated their pulling in relevant situations, along with how much they experience factors that potentially influence it (e.g., external triggers, reduction in negative emotion, negative self-thoughts). Individual measures of pulling, averaged across situations, exhibited high test reliability, construct validity, and content validity. Large differences between situations in pulling were observed, along with large individual-situation interactions (with limited evidence distinguishing focused versus automatic pulling subtypes). In linear regressions for individual participants, factors that influence pulling tended to correlate with pulling as predicted, explaining a median 74%–83% of its variance. By identifying factors that predict pulling for each individual across situations, the SAM2 Trichotillomania Assessment Instrument (TAI) offers a rich understanding of an individual’s pulling experience, potentially supporting individualized pulling interventions

Cohort profile : The 'Children's Health in Care in Scotland' (CHiCS) study-a longitudinal dataset to compare health outcomes for care experienced children and general population children

Purpose: The Children’s Health in Care in Scotland Cohorts were set up to provide first population-wide evidence on the health outcomes of care experienced children (CEC) compared with children in the general population (CGP). To date, there are no data on how objective health outcomes, mortality and pregnancies for CEC are different from CGP in Scotland. Participants: The CEC cohort includes school-aged children who were on the 2009/2010 Scottish Government’s Children Looked After Statistics (CLAS) return and on the 2009 Pupil Census (PC). The children in the general population cohort includes those who were on the 2009 PC and not on any of the CLAS returns between 1 April 2007 and 31 July 2016. Findings to date: Data on a variety of health outcomes, including mortality, prescriptions, hospitalisations, pregnancies, and Accident & Emergency attendances, were obtained for the period 1 August 2009 to 31 July 2016 for both cohorts. Data on socioeconomic status (SES) for both cohorts were available from the Birth Registrations and a small area deprivation measure was available from the PC. CEC have, on average, lower SES at birth and live in areas of higher deprivation compared with CGP. A higher proportion of CEC have recorded events across all health data sets, and they experienced higher average rates of mortality, prescriptions and hospitalisations during the study period. The reasons for contacting health services vary between cohorts. Future plans: Age-standardised rates for the two cohorts by sex and area deprivation will be calculated to provide evidence on population-wide prevalence of main causes of death, reasons for hospitalisation and types of prescription. Event history analysis will be used on matched cohorts to investigate the impact of placement histories and socioeconomic factors on health

Virtuous opinion change in structured groups

Although the individual has been the focus of most research into judgment and decision-making (JDM), important decisions in the real world are often made collectively rather than individually, a tendency that has increased in recent times with the opportunities for easy information exchange through the Internet. From this perspective, JDM research that factors in this social context has increased generalizability and mundane realism relative to that which ignores it. We delineate a problem-space for research within which we locate protocols that are used to study or support collective JDM, identify a common research question posed by all of these protocols—‘What are the factors leading to opinion change for the better (‘virtuous opinion change’) in individual JDM agents?’—and propose a modeling approach and research paradigm using structured groups (i.e., groups with some constraints on their interaction), for answering this question. This paradigm, based on that used in studies of judge-adviser systems, avoids the need for real interacting groups and their attendant logistical problems, lack of power, and poor experimental control. We report an experiment using our paradigm on the effects of group size and opinion diversity on judgmental forecasting performance to illustrate our approach. The study found a U-shaped effect of group size on the probability of opinion change, but no effect on the amount of virtuous opinion change. Implications of our approach for development of more externally valid empirical studies and theories of JDM, and for the design of structured-group techniques to support collective JDM, are discussed

Structured groups make more accurate veracity judgements than individuals

Groups often make better judgements than individuals, and recent research suggests that this phenomenon extends to the deception detection domain. The present research investigated whether the influence of groups enhances the accuracy of judgements, and whether group size influences deception detection accuracy. Two-hundred fifty participants evaluated written statements with a pre-established detection accuracy rate of 60% in terms of veracity before viewing either the judgements and rationales of several other group members or a short summary of the written statement and revising or restating their own judgements accordingly. Participants' second responses were significantly more accurate than their first, suggesting a small positive effect of structured groups on deception detection accuracy. Group size did not have a significant effect on detection accuracy. The present work extends our understanding of the utility of group deception detection, suggesting that asynchronous, structured groups outperform individuals at detecting deception

Virtuous opinion change in structured groups

Although the individual has been the focus of most research into judgment and decision-making (JDM), important decisions in the real world are often made collectively rather than individually, a tendency that has increased in recent times with the opportunities for easy information exchange through the Internet. From this perspective, JDM research that factors in this social context has increased generalizability and mundane realism relative to that which ignores it. We delineate a problem-space for research within which we locate protocols that are used to study or support collective JDM, identify a common research question posed by all of these protocols—‘What are the factors leading to opinion change for the better (‘virtuous opinion change’) in individual JDM agents?’—and propose a modeling approach and research paradigm using structured groups (i.e., groups with some constraints on their interaction), for answering this question. This paradigm, based on that used in studies of judge-adviser systems, avoids the need for real interacting groups and their attendant logistical problems, lack of power, and poor experimental control. We report an experiment using our paradigm on the effects of group size and opinion diversity on judgmental forecasting performance to illustrate our approach. The study found a U-shaped effect of group size on the probability of opinion change, but no effect on the amount of virtuous opinion change. Implications of our approach for development of more externally valid empirical studies and theories of JDM, and for the design of structured-group techniques to support collective JDM, are discussed

Using the Situated Assessment Method (SAM²) to measure social connectedness, social support, and loneliness before and during COVID-19

Increased levels of social connectedness and social support, together with decreased levels of loneliness, have been consistently linked with good mental and physical health. To better understand these constructs, it is important to measure them accurately. In previous work, we used the Situated Assessment Method (SAM²) to develop a situated psychometric instrument for measuring social connectedness and social support. The current work extended this instrument to also assess loneliness, and to assess all three constructs before and during COVID-19. As expected, we observed large individual differences, large situational variance, and large situation by individual interactions in social connectedness, social support, and loneliness. We also established underlying processes that explained high levels of variance in these constructs. Surprisingly, loneliness was unrelated to social connectedness and social support, but was explained well by underlying processes assessed with the SAM2 instrument. Interesting patterns emerged for all three constructs over the course of COVID-19

Developing the Situated Assessment Method (SAM²) to assess social connectedness and social support

Social connectedness and social support play central roles in human cultures and have consistently been linked to mental and physical health. Accurately measuring these constructs is essential for understanding them and for developing interventions to increase them. Most current assessment instruments are unsituated, given that they ask an individual to assess their social connectedness and social support by abstracting across unspecified life situations to establish general impressions. To include situations in the assessment process, we developed a situated psychometric instrument based on the Situated Assessment Method (SAM²) to assess social connectedness and social support. Using this instrument, 189 individuals evaluated 24 different situations for social connectedness and social support, and also evaluated 8 predictors of these constructs established in the scientific and clinical literatures. As expected, we observed large reliable individual differences in both social connectedness and social support, along with substantial situational effects and situation by individual interactions. Additionally, we established high construct and content validity for both measures, demonstrating that they offer meaningful assessments of their underlying constructs. Interestingly, both SAM2 measures were only moderately related to well-established unsituated measures of social connectedness and social support, indicating that situated and unsituated measures capture different information

Developing and Evaluating a Situated Assessment Instrument for Trichotillomania: The SAM² TAI

Trichotillomania (hair pulling disorder) is characterized by the recurrent and repetitive pulling of one’s own hair, often resulting in distress for the individual. Being able to accurately measure trichotillomania is essential for understanding hair pulling and developing interventions to decrease pulling. Most current assessment measures are unsituated, asking an individual to assess their pulling by abstracting across unspecified life situations to construct overarching impressions. This abstraction process can potentially lead to inaccurate judgements that ignore important sources of situational variance. We used the Situated Assessment Method (SAM²) to develop a situated psychometric instrument for assessing trichotillomania: the SAM2 Trichotillomania Assessment Instrument (SAM2 TAI). Using the SAM2 TAI, participants in two studies (n = 117 and n = 99) evaluated 52 situations for pulling frequency and urge strength, along with a set of processes known to influence pulling (e.g., external triggers, reduction of negative emotion, situational control, emotion regulation). As expected, large reliable individual differences emerged across these measures of trichotillomania, together with substantial situational effects and situation by individual interactions. High levels of construct and content validity were also observed, demonstrating that the SAM2 TAI provides meaningful assessments of constructs associated with trichotillomania. Prediction of trichotillomania at both the group and individual levels supported theoretical models of trichotillomania in the literature, while establishing individual prediction profiles that varied widely. Interestingly, the SAM2 TAI was only moderately related to a well-established unsituated measure of trichotillomania, the MGH-HPS, indicating that situated and unsituated measures capture different information