As Ebola Concerns Mount, Psychology Offers Guidance on Health-Risks Communication



What science reveals about importance of preparatory communication in large-scale incidents

October 8, 2014 -- The possibility of a catastrophic incident, such as a pandemic, severe weather or a terrorist attack, creates unease for many people. Psychologists who study risk perception and people’s potential reactions to unpredictable threats say that people can prepare themselves psychologically and therefore feel more in control if such an event were to occur.

Psychology’s understanding of communications science — particularly how health and risk messaging should be done — will be particularly useful in light of the current outbreak of Ebola, not only out of concern for people in West Africa but because there are now cases being treated in the United States.

What the Public Needs to Know

Q. What scares people the most about a threat from a natural disaster, contagious disease or terrorist attack? Are fear and anxiety a normal response?

A. Experts on public health and risk perception say that fear about catastrophic incidents often originates from a feeling of lack of control and a perceived inability to prevent the problem or threat. Some level of anxiety is constructive in that it motivates people to take appropriate action (assuming such actions are available and recommended). But without any recommended course of action, anxiety around these threats has the potential to become debilitating.

Psychologists who study people’s reactions to health, safety and environmental risks say fear is a normal response to an unpredictable threat. Anxiety is also a normal response to ambiguous situations over which one has little or no control. Anxiety about the future and fears of terrorism were quite normal after 9/11, and some people continue to feel anxious about the future.

Q. What can people do to lessen their anxiety about a health risk or environmental threat?

A. People can keep the actual degree of risk they are facing in its proper perspective and create a plan just in case. Psychologists who specialize in managing stress and anxiety say that people who feel some sense of control while dealing with a scary, unknown situation handle the unexpected better.

Q. How can parents communicate serious health threats to children?

A. According to developmental psychologists, parents should explain clearly what is known about the situation. They should present strategies for eliminating or preventing the feared situation. This should include education and discussion that increase a sense of feeling of control and knowing that actions will lead to certain results.

Child and adolescent experts also say that older children can help their younger siblings and peers feel less anxiety by reassuring them that they are not alone in the situation.

Psychologists who researched responses after 9/11 found that if parents were distressed about terrorism, they conveyed that information directly and indirectly to their children, which in turn raised the distress levels of their offspring. Adolescents’ distress following 9/11 was also associated with perceived parental unavailability to discuss the attacks, suggesting that a key to understanding parents’ influences on adolescents’ adjustment may lie in parents’ ability to manage their own distress and voice their concerns appropriately. Psychologists and other mental health professionals can play a role in helping parents manage their own distress and providing guidance on how best to respond to their children.

Q. When does a person’s fear over this kind of threat become a problem that may need treatment?

A. If a person is having trouble with daily functioning and regular routines, then a visit to a credentialed mental health care provider is advisable. A clinician will assess the duration of the problem and the array and severity of symptoms, etc. Anxiety about an ambiguous future is a natural and normal emotion, and mental health experts say that it is important not to pathologize normal responses to potentially traumatic experiences. But when such anxiety interferes with a person’s normal day-to-day functioning, that person should seek help from a qualified mental health professional.

There will not be one universal reaction to a catastrophic event. But it is important to recognize that an individual’s degree of emotional response will not necessarily be proportional to the degree of exposure, amount of loss or proximity to an illness. As noted above, mental health professionals can help individuals manage their own distress and provide guidance on how best to respond to their children.

How Government and Health Officials Can Prepare

Misinformation Can Create Unnecessary Fear

Some experts say that misinformation (in large part disseminated via the media and from uninformed “experts”) is likely to be responsible for unjustified fear. It is critical that a trusted communicator (with appropriate credentials) provide clear, easy-to-understand messages that clarify what we know, what we don’t know and what is still being studied.

Q. What is the best way public health officials can communicate warnings about a health threat without starting mass panic?

A. The evidence shows that panic is an unlikely response and only occurs when people lose connection with their entire social network. A summary of research on collective behavior by Kathleen Tierney, PhD, (Department of Sociology and Natural Hazards Research and Applications Information Center — University of Colorado at Boulder) shows that even during conditions of severe threat, “panic only occurs when individuals feel completely isolated and when pre-existing social bonds break down to such a degree that those who are in danger feel totally on their own in seeking safety.” Other research on social behavior shows that panic is more likely when those entrusted with managing disasters fail to provide accurate information about what to do and where to go during impending threats.

Credible Expert Spokespeople are Needed

Experts on trauma reactions also say that panic is a rare and preventable response with credible communication of accurate information. According to experts who study crisis communications, it is important that the message be clear, concise and truthful (including ambiguous elements if they are present), and delivered repeatedly. It is critical that coordination of services and agencies be conducted prior to any health emergency in the United States. The agency responsible for communicating with the public and the agency’s lead spokesperson should be clearly identified, and a clear chain of command should be established. Health communications research further points to the need for identifying evidence-based strategies for delivering the message, and identifying an organization that is responsible for mental health response and recovery. In addition, public health officials need to provide clear information on possible preparation and safety actions and provide concrete recommendations about what to do. Public health officials must avoid multiple authorities with differing political and policy agendas who provide inconsistent or conflicting messages. Finally, it is important to recognize that with repeated false alarms, many will acclimate to the threat and may fail to notice genuine danger.

Those communicating an emergency need to understand that fear and other emotions may interfere with people’s decision-making and judgment. In addition, because people in crisis management often have not had to communicate about health threats of this magnitude before, it is important that they evaluate and test the messages before releasing them to the public. Lastly, social scientists should be part of emergency planning teams to assist in formulating messages and communications strategies that will achieve the desired outcomes.

Warnings are best administered in the context of concrete advice for what people can actually do to protect themselves. Information in the absence of concrete action is far less effective.

Experts on risk and decision-making can identify what is critical to convey to the different audiences. Young people have different information needs than do older people. Those with children or those taking care of elderly parents, those with health problems, and those who are away from home at the time of the emergency all have different information needs. Psychologists and other behavioral scientists can identify these different groups’ belief systems and aid in designing comprehensible messages and evaluate their success.

Furthermore, research shows that people listen to messages more often when they come from professional experts rather than when they come from politicians, particularly when the messages are emergency messages and the audiences are racial/ethnic minority groups. Also, the “public” is not a monolithic entity; some individuals are more vulnerable than others (e.g., individuals with prior mental health difficulties, the infirm, refugees, etc.), and therefore it is important to target services to those who need them the most.

Researchers who have studied communication find that certain ways of presenting information increase the perception of risk and thus fear. Specifically, people are more fearful when they see individuals or case studies similar to themselves, rather than statistics. And the greater the lack of perceived control associated with the fear message, the greater the fear and discomfort. Thus, it is important to communicate a reason for concern, but it is also important to explain clearly how to prevent what is feared by including tactics or strategies for controlling the feared situation. Also important is reminding people of the degree of risk presented by the situation, e.g., the odds of the event’s occurrence based on their life circumstances.

Psychologists who specialize in how the design of warnings affects human behavior have learned that people want easy-to-comprehend information and access to more information if they want it. The news media will play a critical role if a health emergency occurs. Information flow to the public about very bad news should not be controlled in the name of trying to avoid an outbreak of mass panic. The public should be armed with information.

The information from this advisory was compiled from the following experts:

· Michael Wogalter, PhD, professor, Ergonomics and Experimental Psychology Program and director, Cognitive Ergonomics Laboratory, North Carolina State University

· Kathleen Tierny, PhD, professor of sociology, Department of Sociology and Natural Hazards Research and Applications Information Center — University of Colorado at Boulder

· Roxane Cohen Silver, PhD, professor of psychology, Department of Psychology and Social Behavior and Department of Medicine, University of California, Irvine

· Vicki Mays, PhD, MSPh, professor of psychology, University of California, Los Angeles

· Laura Kubzansky, PhD, assistant professor, Department of Society, Human Development and Health, Harvard School of Public Health

· Toni Vaughn Heineman, DMH, clinical associate professor of pediatrics and psychiatry, University of California, San Francisco, private practice

· Margaret Gibbs, PhD, professor of psychology, School of Psychology, Fairleigh Dickinson University, private practitioner

· Scott Geller, PhD, director for applied behavior systems, Department of Psychology, professor of psychology, Virginia Polytechnic Institute and State University

The American Psychological Association, in Washington, D.C., is the largest scientific and professional organization representing psychology in the United States. APA's membership includes nearly 130,000 researchers, educators, clinicians, consultants and students. Through its divisions in 54 subfields of psychology and affiliations with 60 state, territorial and Canadian provincial associations, APA works to advance the creation, communication and application of psychological knowledge to benefit society and improve people's lives.

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