The Psychology Lounge (tm)

Hacking Your Next Job Interview: The Real Secret to Getting Hired

Andrew Gottlieb, Ph.D. — Mon, 01 Feb 2010 07:00:44 +0000

This post is for my oldest niece, who told me she had an interview for a job, and wondered if there were any “psychological tricks” for doing well in an interview. I thought about it, and realized she wanted help with some Jobhacks™.

It turns out that there are some tricks. These are written about in a wonderful new book called 59 Seconds: Think a Little, Change a Lot by Richard Wiseman. I’ll be blogging more on the book, which is a concise, science-based set of tips for improving your life, and being happier, healthier, and more productive. I highly recommend the book. It’s a fun, easy read, full of great research and life tips.

(Full Disclosure: If you click on the link, and buy, PsychologyLounge will get a small payment, so you’ll be supporting this blog. If you don’t want to support this blog, just log into your own Amazon account, and search for the book.)

So let’s review conventional wisdom first. Job interviews are based on academic training and work experiences, right? The candidate who gets the job is the one with the best academic credentials and the most impressive work history, correct?

That’s what most people think and they are wrong!

Chad Higgins and Timothy Judge did research looking at factors that influenced interviewers decisions about job candidates. I won’t bore you with the details of their research, but I will tell you what they found. First, they found that the qualifications and work experience of the candidate didn’t matter.

It turns out that the most important predictor of who will be offered the job was a magical and mysterious quality: the pleasantness and likability of the candidate!

So now you’re thinking: “Great, I need a personality transplant in order to become nicer and more likable. Thanks, Gottlieb, years of therapy for that one no doubt!”

No, you don’t need a personality transplant. You just need to follow a simple set of behavioral guidelines.

What were the behaviors that communicated likability? They were very simple:

1. Small talk. Talk about something that interests both you and the interviewer, even if it’s not about work. You notice a picture of them fishing, and you share fishing tales.

2. Praise. Find something you like about the organization they represent and compliment it. Or praise or compliment the interviewer in a genuine way.

3. Enthusiasm. Show your excitement about the job being offered and the company.

4. Connection. Smile and make eye contact.

5. Involvement. Show interest in the person interviewing you. Ask smart questions about the type of person they are looking for, and how the job fits into the organization.

That’s it. Do this and you will greatly increase your likability, and with it, your chance of getting a job. I suspect this would work pretty well in other interview situations too, like blind dates, but that’s more research…

P.S. Two more quick tips from 59 Seconds. If you have weaknesses that will most likely come up, bring them up early in the interview, that increases your credibility, and gives you time to use likability to your advantage. If you have a particular strength, share it later in the interview, in order to look more humble, and end on a strong note.

Holy Cow, Psychology Lounge Got Holy Kawed!

Andrew Gottlieb, Ph.D. — Sun, 24 Jan 2010 07:13:38 +0000

Check it out on Alltop.com!

http://holykaw.alltop.com/depressing-effectiveness-of-anti-depressants

New Study Shows Antidepressant Medication Fails to Help Most Depressed Patients

Andrew Gottlieb, Ph.D. — Sat, 23 Jan 2010 00:52:05 +0000

A very interesting study recently published in the Journal of the American Medical Association (JAMA) demonstrated very clearly that when it comes to antidepressant medication, the Emperor is wearing few if any clothes! The researchers did what is called a meta-study or meta-analysis. They searched the research literature for all studies that were placebo-controlled studies of antidepressants when used for depression. That means the studies had to include random assignment to either a medication group or a placebo (sugar pill) group. They eliminated some studies which use a placebo washout condition. (This means the studies first gave patients a placebo, and then eliminated all patients who had a 20% or greater improvement while taking placebo.) When they eliminated all studies that didn’t meet their criteria, they were left with 6 studies of 738 people.

Based on scores on the Hamilton Depression Rating Scale (HDRS), the researchers divided the patients into mild to moderately depressed, severely depressed, and very severely depressed. This is a 17 item scale that is filled out by a psychologist or psychiatrist, and measures various aspects of depression. It is used in most studies of depression. They then analyzed the response to antidepressant medication based on how severe the initial depression was.

The two antidepressants studied were imipramine and paroxetine (Paxil). Imipramine is an older, tricyclic antidepressant, and Paxil is a more modern SSRI antidepressant.

What did they find? They were looking at the size of the difference between the medication groups and the placebo groups. Rather than do the typical thing of just looking at statistical significance, which is simply a measure of whether the difference could be explained by chance, they looked at clinical significance. They used the definition used by NICE (National Institute of Clinical Excellence in England), which was an effect size of 0.50 or a difference of 3 points on the HDRS. This is defined as a medium effect size.

What they found was very disheartening to those who use antidepressant medications in their practices. They divided the patients into three groups based on their initial HDRS scores: mild to moderate depression (HDRS 18 or less), severe depression (HDRS 19 to 22), and very severe depression (HDRS 23 or greater).

For the mild to moderately depressed patients, the effect size was d=0.11, and for severely depressed patients the effect size was d = 0.17. Both of these effect sizes are below the standard description of a small effect which is 0.20. For the patients in the very severe group, the effect size was 0.47 which is just below the accepted value of 0.50 for a medium effect size.

When they did further statistical analysis, they found that in order to meet the NICE criteria of effect size of a 3 points difference, patients had to have an initial HDRS score of 25 or above. To meet the criteria of an effect size of .50, or medium effect size, they had to have a score of 25 or above, and to have a large effect size, 27 or above.

What does this all mean for patient care? It means that for the vast majority of clinically depressed patients who fall below the very severely depressed range, antidepressant medications most likely won’t help. The sadder news is that even for the very severely depressed, medications have a very modest effect. Looking at the scoring of the HDRS, the normal, undepressed range is 0 to 7. The very severely depressed patients had scores of 25 or above, and a medium effect size was a drop in scores of 3 or more points compared to placebo patients. Looking at the one graph in the paper that show the actual drops in HDRS scores, the medication group had a mean drop of 12 points when their initial score was 25. That means they went from 25 to 13, which is still in the depressed range, although only mildly depressed. Patients who initially were at 38 dropped by roughly 20 points, ending at 18, which is still pretty depressed. And the placebo group had only slightly worse results.

One interesting thing is how strong the placebo effects are in these studies. It seems that for depressions less serious than very severe, placebo pills work as well as antidepressant medication. Is this because antidepressants don’t work very well, or because placebos work too well? It’s hard to know. Maybe doctors should give their patients sugar pills, and call the new drug Eliftimood!

So in summary, here are the main observations I make from this study.

If you are very severely depressed, antidepressants may help, and are worth trying.
If you are mildly, moderately, or even severely depressed, there is little evidence that antidepressants will help better than a placebo. You would be better off with CBT (Cognitive Behavioral Therapy), which has a proven track record with less severe depressions, and which has no side effects.
Interestingly, CBT is less effective for the most severe depressions, so for these kinds of depressions medication treatment makes a lot of sense.
If you are taking antidepressants and having good results, don’t change what you are doing. You may be wired in such a way that you are a good responder to antidepressants.
If you have been taking antidepressants for mild to severe (but not very severe) depression, and not getting very good results, this is consistent with the research, and you might want to discuss alternative treatments such as CBT with your doctor. Don’t just stop the medications, as this can produce withdrawal symptoms, work with your doctor to taper off them.
Even in very severely depressed patients, for whom antidepressants have some effects, they may only get the patient to a state of moderate depression, but not to “cure”. To get to an undepressed, normal state, behavioral therapy may be necessary in addition to medications.
How do you find out how depressed you are? Unfortunately there is no online version of the HDRS for direct comparison. You may want to see a professional psychologist or psychiatrist if you think you might be depressed, and ask them to administer the HDRS to you. There are also online depression tests, such as here and here. If you score in the highest ranges you might want to consider trying antidepressant medications, if you score lower you might want to first try CBT.
The most important thing is not to ignore depression, as it tends to get worse over time. Get some help, talk to a professional.

I’m off to take my Obecalp pills now, as it’s been raining here in Northern California for more than a week, and I need a boost in my mood. (Hint: what does Obecalp spell backwards?)

Does Money Buy Happiness? No, And The Answer Of What Does Buy Happiness May Surprise You

Andrew Gottlieb, Ph.D. — Thu, 03 Dec 2009 03:03:12 +0000

It is often said that money can buy happiness, and as I’ve blogged in earlier articles, this is true, but only up to a basic middle class economic status. Above that, money doesn’t seem to add much happiness. (See my posts here and here.)

So what does buy happiness? We have a surprising answer from our friends across the pond, at the University of Warwick in England. A new study published online Nov. 18 in the journal Health Economics, Policy and Law surveyed thousands of people on their levels of happiness and correlated it with external factors such as a pay raise or winning a lottery prize, and compared this to receiving psychotherapy. Astonishingly, even to me, a psychologist, the increase in happiness from a $1329 course of therapy was so large that to equal it people had to get a pay raise of more than $41,542! That’s a ratio of 32 times! That means a dollar spent on therapy boosts happiness 32 times more than the same dollar received in a pay raise or lottery prize.

As the study author Chris Boyce, of the University of Warwick, summarized: “Often the importance of money for improving our well-being and bringing greater happiness is vastly over-valued in our societies. The benefits of having good mental health, on the other hand, are often not fully appreciated and people do not realize the powerful effect that psychological therapy, such as non-directive counseling, can have on improving our well-being.”

Bravo,Chris! Now when patients ask me whether therapy is worth the money, I can confidently say that research suggests it might be one of the best investments you can make in yourself and your own happiness. (And it’s okay to get a raise, as long as you spend it on therapy!)

The only problem I can see with this article being published is that it may lower MY happiness, as I might get busier, perhaps earning more money, but not having time to see my own therapist!

So to answer the original question, does money buy happiness? Money doesn’t buy happiness; it buys psychotherapy, which yields 32 times more happiness than money!

Link to study: http://www.nlm.nih.gov/medlineplus/news/fullstory_92421.html

New Study Finds the Best Pharmacological Stop Smoking Solution: (Hint, it’s not what you’d think)

Andrew Gottlieb, Ph.D. — Tue, 24 Nov 2009 03:40:02 +0000

A new study at the Center for Tobacco Research and Intervention, School of Medicine and Public Health, University of Wisconsin, Madison, compared all except one of the current drug treatments that help with quitting smoking. They looked at the following treatments and combined treatments:

“bupropion SR (sustained release; Zyban, GlaxoSmithKline), 150 mg twice daily for 1 week before a target quit date and 8 weeks after the quit date;
nicotine lozenge (2 or 4 mg) for 12 weeks after the quit date;
nicotine patch (24-hour, 21, 14, and 7 mg titrated down during 8 weeks after quitting;
nicotine patch plus nicotine lozenge;
bupropion SR plus nicotine lozenge; or
placebo (1 matched to each of the 5 treatments).”

Everyone received six 10- to 20-minute individual counseling sessions, with the first 2 sessions scheduled before quitting.

What were the results?

Three treatments worked better than placebo during the immediate quit period: the patch, bupropion plus lozenge, and patch plus lozenge.

At six months, only one treatment was effective; the nicotine patch plus nicotine lozenge. The exact numbers , as confirmed by carbon monoxide tests, were: “40.1% for the patch plus lozenge, 34.4% for the patch alone, 33.5% for the lozenge alone, 33.2% for bupropion plus lozenge, 31.8% for bupropion alone, and 22.2% for placebo.”

So we see that the combined nicotine substitution therapy worked best, followed closely by either nicotine substitute alone. Zyban or Welbutrin (bupropion) was a bust, no more effective than the simple nicotine lozenge. The only advantage to Zyban would be if one prefers not to use nicotine substitutes.

Now I mentioned that they omitted one drug treatment, which is the drug Chantix (varenicline). This is probably because the drug is a nicotine receptor blocker, so wouldn’t have made sense to combine with nicotine substitutes. Also, there have been some disturbing case reports of people having severe depressive reactions to Chantrix.

Of course, there was one glaring omission that any card-carrying psychologist would spot in a moment–the lack of a behavior therapy component. Giving 6 ten minute sessions is hardly therapy. I would have liked to see true smoking cessation behavior therapy combined with the drug treatments.

So, if you’re trying to quit smoking, combine nicotine patches with nicotine lozenges, sold in any pharmacy. If you do, you have a 40 percent chance of succeeding at 6 months.

Now I am off to have a cigarette….just kidding.

Study: http://cme.medscape.com/viewarticle/712074_print

Why do Most Psychologists Ignore Science Based Therapy? Evidence Based Psychotherapy and the Failure of Practicioners

Andrew Gottlieb, Ph.D. — Sat, 10 Oct 2009 00:16:41 +0000

A new article in Newsweek magazine titled Ignoring the Evidence documents how most psychologists ignore scientific evidence about treatments such as cognitive behavioral therapy which have been proven to be effective.

A two-year study which is going to be published in November in Psychological Science in the Public Interest, found that most psychologists “give more weight to their personal experiences then to science.”

The Newsweek article has a wonderful quote,

“Thanks to clinical trials as rigorous as those for, say, cardiology, we now know that cognitive and cognitive-behavior therapy (teaching patients to think about their thoughts in new, healthier ways and to act on those new ways of thinking) are effective against depression, panic disorder, bulimia nervosa, obsessive-compulsive disorder, and -posttraumatic-stress disorder, with multiple trials showing that these treatments-the tools of psychology-bring more durable benefits with lower relapse rates than drugs, which non-M.D. psychologists cannot prescribe. Studies have also shown that behavioral couples therapy helps alcoholics stay on the wagon, and that family therapy can help schizophrenics function. “

The article documents how most psychologists fail to provide empirically proven treatment approaches and instead use methods which are often ineffective. The truth is there is very little evidence for most of the types of therapy commonly performed in private practices by psychologists and by Masters level therapists. If you are shopping for the most effective types of therapy you need to find a practitioner who is skilled at cognitive behavioral therapy (CBT) which is one of the few psychotherapy approaches that has been proven to work on a variety of problems.

Another interesting article in Newsweek about evidence-based treatment discussed bulimia. Here’s the summary:

“On bulimia (which affects about 1 percent of women) and binge eating disorders (2 to 5 percent), the verdict is more optimistic: psychological treatment can help a lot, and cognitive behavioral therapy (CBT) is the most effective talk therapy. That’s based on 48 studies with 3,054 participants. CBT (typically, 15 to 20 sessions over five months) helps patients understand their patterns of binge eating and purging, recognize and anticipate the triggers for it, and summon the strength to resist them; it stops bingeing in just over one third of patients. Interpersonal therapy produced comparable results, but took months longer; other therapies helped no more than 22 percent of patients. If you or someone you love seeks treatment for bulimia, and is offered something other than CBT first, it’s not unreasonable to ask why. Cynthia Bulik, director of the University of North Carolina Eating Disorders Program, summarized it this way: “Bulimia nervosa is treatable; some treatment is better than no treatment; CBT is associated with the best outcome.”

So the bottom line is this:

1. Most psychologists who don’t practice Cognitive Behavioral Therapy (CBT) are just winging it, using treatments that haven’t been shown to work by scientific studies. It’s as if you went to a regular physician and got treatment with leaches!

2. Many psychologists claim to use CBT but haven’t really trained in the use of CBT, or have taken a weekend workshop. Unless they prescribe weekly homework that involves writing down thoughts, and learning skills to analyze and change your thoughts, then they aren’t really doing CBT, and I recommend you find someone else.

3. If you have an anxiety disorder, depression, bulimia, or obsessive compulsive disorder, and haven’t been offered CBT, then you are not receiving state of the art treatment.

A Better Voicemail Message! (warning, humor!)

Andrew Gottlieb, Ph.D. — Sun, 13 Sep 2009 06:44:48 +0000

Are you tired of all those multiple choice voicemail menus? Press infinity if you’d like more options. I saw this on the web, and had a giggle. Maybe I’ll change my voicemail message to it. (Kidding!)

Welcome to the Psychiatric Hotline.

If you are obsessive-compulsive, please press 1 repeatedly.
If you are co-dependent, please ask someone to press 2 for you.
If you have multiple personalities, please press 3, 4, 5, and 6.
If you are paranoid-delusional, we know who you are and what you want. Just stay on the line so we can trace the call.
If you are schizophrenic, listen carefully and a little voice will tell you which number to press.If you are depressed, it doesn’t matter which number you press. No one will answer.
If you are delusional and occasionally hallucinate, please be aware that the thing you are holding on the side of your head is alive and about to bite off your ear.
If you have an anger management problem, please throw the phone against the wall to select an option.

Anyway, I thought it was funny, and hope I haven’t offended anyone by posting it.

In all seriousness, the real messages that many psychiatrists have are almost as funny. You know, the one that says, “If you have a ‘true’ emergency, please go to the nearest emergency room or call 911.” I’ve always thought this is a stupid message, that is insensitive and uncaring. Like patients don’t know about 911 or the emergency room. I believe a better message is to offer a pager number or cell phone number where a patient can reach me, their psychologist, rather than an impersonal 911 operator. It doesn’t happen often, but when it does, I can usually help the client through crisis quickly and effectively.

Overcoming Social Anxiety and Shyness

Andrew Gottlieb, Ph.D. — Tue, 03 Mar 2009 04:55:47 +0000

I’m often asked about social anxiety and shyness, and how to overcome them. I was lucky enough to be quoted in a Forbes Magazine article about that very topic. And here’s a link to a pdf of the article, which is easier to navigate. Enjoy!

Which Anti-depressant Should You Take? Now We Know

Andrew Gottlieb, Ph.D. — Mon, 02 Mar 2009 20:15:49 +0000

Accepted wisdom for a number of years has been that all modern anti-depressants work equally well, and that drug selection depends more on the side effect profile desired. Thus a lethargic patient might benefit from an activating antidepressant like Prozac, and an anxious patient would be better off with Paxil. Often prescribing practices are based on individual doctors’ preferences and biases. But a newly published study suggests that this may be wrong. There may be antidepressants that not only work better, but are easier for patients to tolerate.

A terrific new study was recently published in the Lancet medical journal. A team of international researchers, led by Andrea Cipriani at the University of Verona in Italy, reviewed 117 studies of antidepressants which included 25928 patients, two-thirds of whom were women. These studies, done all around the world, compared various antidepressants to either placebo or other antidepressants.

The researcher compared the results of 12 new generation antidepressants in terms of efficacy and acceptabiltiy. They defined efficacy as the proportion of patients who improved at least 50% on a depression rating scale by 8 weeks of treatment. They defined acceptability as the proportion of patients who did not drop out of the study. They made an attempt to adjust for dosages, and did very sophisticated statistical analyses to compare all of the drugs. They used fluoxetine (Prozac) as the common comparison drug, since it has been on the market for the longest time.

What were the results? The winners in terms of short term effectiveness were: (drum roll) mirtazapine (Remeron), escitalopram (Lexapro), venlafaxine (Effexor), and sertraline (Zoloft). The winners in terms of acceptability were: escitalopram (Lexapro), sertraline (Zoloft), citalopram (Celexa), and bupropion (Wellbutrin) were better tolerated than other new-generation antidepressants. Note that the overall winners for effectiveness combined with tolerability were escitalopram (Lexapro) and sertraline (Zoloft). Two of the best drugs in terms of effectiveness (mirtazapine (Remeron) and venlafaxine (Effexor)) were not among the best tolerated medicines.

The losers in terms of both effectiveness and tolerability were reboxetine (Edronax), ﬂuvoxamine (Luvox), paroxetine (Paxil), and duloxetine (Cymbalta). The worst drug of all was reboxetine (Edronax).

So what about cost? I’ve developed a spreadsheet of all of the drugs’ costs based on a 30 day supply, paying full retail price at Costco pharmacy, and using generic equivalents when available. Of the winners in terms of effectiveness and tolerability, the clear cost winner was sertraline (Zoloft), at $12 a month. The other winner, escitalopram (Lexapro), was a loser in terms of cost at $88 a month! The other winners in terms of effectiveness were quite cost effective too, with mirtazapine (Remeron) at $14 a month, and venlafaxine (Effexor) at $28 a month.

So what should doctors and patients do? For patients, the two best drugs appear to be escitalopram (Lexapro) and sertraline (Zoloft), with sertraline the clear winner if you pay much for prescription drugs. Doctors might want to consider costs as well, as this can help with overall health care inflation. If you can tolerate the side effects, consider trying mirtazapine (Remeron), or venlafaxine (Effexor).

Now there are of course a few caveats about this study. It is possible that another meta-analysis could find different results. One criticism was that the study only looked at effectiveness over 8 weeks of treatment. It is possible that some drugs work more slowly, and at 12 or 16 weeks might have different results. But most patients want results in two months or less, so this is not a major criticism.

Another issue is funding bias. Although none of the authors of this study were paid by drug companies, many of the studies they analyzed were funded by drug companies, and may have reflected some bias. But for now, this is the best information we have in terms of effectiveness and toleration of antidepressant medications.

So who’s the winner? Sertraline (Zoloft) was the clear winner by effectiveness, tolerability, and cost!

Should you change medications if you are not on one of the winners? No, of course not. If your medication is working, don’t change it. But if it’s not working, then talk with your doctor about switching.

And no, I don’t receive any funding or sponsorship from any drug companies…

Here’s the table of drug price comparisons.
Comparison of Antidepressant Costs for 30 Day Supply (Costco Pharmacy, Generic Equivalents if possible)
Bolded Drugs were most effective

Drug Generic Name Cost Dose(mg)

Celexa             citalopram                   $3                40
Prozac             fluoxetine                    $6                  20
Zoloft             sertraline                       $12             100
Remeron     mirtazapine                    $14               30
Luvox              fluvoxamine               $24             100
Effexor         venlafaxine                    $28                75
Welbutrin      bupropion                   $74             200
Lexapro       escitalopram                 $88                10
Paxil                paroxetine                   $91             37.5
Cymbalta       duloxetine                   $128              60

Does TV Watching Increase the Risk of Depression in Teenagers?

Andrew Gottlieb, Ph.D. — Tue, 17 Feb 2009 01:40:37 +0000

A study published in the February 2009 issue of the Archives of General Psychiatry found that those teenagers who watched more than 9 hours a day of television where more likely to become depressed as young adults.

The researchers used data from a larger study of 4,142 adolescents who were initially not depressed. After seven years of followup, more than 7 percent had symptoms of depression.

But only 6 percent of the children who watched less than three hours a day of TV became depressed, while more than 17 percent of those who watched 9 or more hours a day became depressed.

Interestingly, there was no association with playing video games, or listening to music, or watching videos. The association of TV and depression was stronger for boys than girls, and was constant after the researchers adjusted for age, race, wealth, and educational level.

So what does this mean? First of all, it’s important to put this into context. Nine hours of TV watching is a lot!!!! It means that these kids came home from school at 3pm, and turned on the TV, and kept it on until midnight! Or it means that they spent the entire weekend watching television. So these findings are not so surprising. Basically television was their entire life, and that means that they had no hobbies, no friends, and no sports or extra-curricular activities. All these are a prescription for depression. The kids who watched less than 3 hours of television a day had lives, which is probably why fewer of them got depressed.

So the moral of the story is make sure your children have balanced lives, and limit screen time (which includes video gaming) to 2 or 3 hours a day, or less. One good way to control television time is not to have television sets in children’s bedrooms. Have a main television in the living room, and that allows you to know when and what your children are watching.

Okay, now I am off to watch no more than two hours of my favorite television shows…