The work of Langer & Rodin

To explore the effects of decision-making and responsibility on residents in a nursing home, Langer and Rodin gave residents a houseplant. Residents were to make all the decisions about when and how much to water and how much sun to give their plant. Resident in the experimental group were also given other choices such as where they would prefer to receive visitors, whether they wanted see the weekly movie and which evening they wanted to attend (a movie was played on Thursdays and replayed on Fridays), etc. A comparison (control) group were also given plants but told that the nurses would take care of them. Those in this group were not encouraged to make decisions for themselves but were told that staff was there to help them. Issues were as similar as possible with the experimental and comparison groups except for the distinctions about who was in control and responsible for decisions. The researchers used various behavioural and emotional measures to judge the effect of the encouragement, for example, participation in activities at the nursing home, how happy the residents felt and how alert and active the residents were. Clear and dramatic improvement was made in the group given more responsibility. Eighteen months after the study the researchers returned and again performed the outcome measures. The residents who had been given more responsibility were still significantly more active, vigorous and sociable than those in the comparison group. The experimental group also asked more questions during a lecture that Judith Rodin gave. During this return trip physical health was measured. Prior to the study the two groups had been in similar health based on their medical records. However, eighteen months later the health of the experimental group had improved while that of the comparison group had worsened. The most striking discovery was mortality rate. Only seven of the 47 residents in the experimental group had died whereas 13 of the 44 residents in the comparison group had died (15% versus 30%). These results have been confirmed by much research since the time of the original experiment. To improve this experiment they could have looked for other areas where choice can be given back to residents such as dining, bathing, and placement of personal items in their room. Record the outcomes. Watch to see if over time there are changes in activity participation, alertness and affect of residents. As this experiment proceeds it would be good for staff to discuss amongst themselves how to change their own perspective to maximize residents' sense of independence, freedom and involvement. The relation between health and a sense of control may grow stronger in old age. This could occur through three types of processes: experiences particularly relevant to control may increase markedly in old age; the association between control and some aspect of health may be altered by age; and age may influence the association between control and health-related behaviours or the seeking of medical care. Studies show that there are detrimental effects on the health of older people when their control of their activities is restricted; in contrast, interventions that enhance options for control by nursing home patients promote health. With increasing age, however, variability in preferred amounts of control also increases, and sometimes greater control over activities, circumstances, or health has negative consequences including stress, worry, and self-blame. Mechanisms mediating the control-health relation include feelings of stress, symptom labelling, changes in the neuroendocrine an d immune systems, and behaviour relevant to health maintenance. * Work which very clearly supports Langer & Rodin is that of Marmot et al (1997) and the study of civil service office workers: – Marmot et al (1997) Marmot and his co-workers devised an experiment to determine the association between adverse psychosocial characteristics at work and risk of coronary heart disease among male and female civil servants. There were self-report questionnaires provided for information on psychosocial factors of the work environment and coronary heart disease. Independent assessments of the work environment were obtained from personnel managers. Setting: London based office staff in 20 civil service departments. Subjects: 10308 civil servants aged 35-55 were examined-6895 men (67%) and 3413 women (33%). Results: Men and women with low job control, either self reported or independently assessed, have a higher risk of newly reported coronary heart disease during the follow up. Job control was assessed on two occasions three years apart, although intercorrelated, had cumulative effects in newly reported disease. Subjects with low job control on both occasions have an odds ratio for any coronary event of 95% compared with subjects with high job control at both occasions. This association could not be explained by employment grade, negative affectivity, or classic coronary risk factors. Job demands and social support at work were not related to the risk of coronary heart disease. Conclusion: Low control in the work environment is associated with an increased risk of future coronary heart disease among men and women employed in government offices. The cumulative effect of low job control assessed on two occasions indicates that giving employees more variety in tasks and a stronger say in decisions about work may decrease the risk of coronary heart disease. * Whereas the work done by Brady (1958) in the ‘Executive Monkey' experiment completely goes against Langer, Rodin and Marmot: – Brady tested groups of monkeys to determine which were the quickest learners; they would then be chosen to take the place of the ‘Executive Monkey'. The executive monkey is then sat in a harness with its feet touching the floor allowing almost complete mobility, the non-executive monkey is sat in the other harness so that it cannot touch the floor, both harnesses are connected to a bar that in turn is attached to a pivot. A bell would sound and the exec. Monkey would have 20 seconds to get to a switch, if he did not manage to get to the switch in time, both monkeys would be given an electric shock. Brady discovered that the best way to conduct this experiment was to put the monkeys 6 hours in then 6 hours off, this was found to be the best way to stress them. Around 23 days into the experiment the executive monkey would die from stomach ulcers, due to the stress. > We could argue that the monkey had the control over whether they got shocked or not and yet it still got stressed and died, which would then completely dis-prove Langer & Rodin. > But you could also argue that the exec. monkey got stressed from having to get to the switch and its also possible to say that the executive monkey didn't have complete control, i.e. they couldn't turn the electric shocks off completely, and so got stressed from having to continuously press the switch. * Weiss (1972) repeated Brady et al's experiment but with rats this time: – He found that giving feedback on successful shock avoidance (by sounding a tone) reduced ulceration in executives to below that of the non-executive rats. The feedback tells the animal it has avoided shocks and increases its ‘sense of control' over the situation. The non-executive animal cannot respond and lacks any control at all over what's going on, this leads to more ulceration. ==> By comparing Brady and Weiss' experiments it's very clear to see that the idea of a ‘sense of control' separates the two. Not as many animals will die in Weiss' as in Brady's, the rats don't feel as stressed as the monkeys because they feel more ‘in control'. These studies also show the importance of control and feedback on successful coping in reducing levels of stress.