Spontaneous public response to a marauding knife attack on the London underground: Sociality, coordination and a repertoire of actions evidenced by CCTV footage

Across a range of recent terrorist attacks in the United Kingdom, the question of how crowds behave in confined public space is an important concern. Classical theoretical assumptions are that human behaviour in such contexts is relatively uniform, self-interested and pathological. We contest these assumptions by reporting on a study of public response to a marauding knife attack that occurred on London's underground rail network in 2015. The analysis draws primarily upon footage from 27 CCTV cameras positioned across the station footprint supplemented by social media, news footage, radio logs and incident reports. Using an innovative methodology, we topographically and chronologically mapped behaviours during the incident. The analysis demonstrates that while rapid egressions occurred as the threat escalated, at every phase of the incident members of the public intervened spontaneously with coordinated, purposeful, socially oriented actions. This behavioural pattern contrasts with classical assumptions of a chaotic and apathetic crowd in emergencies. We highlight eight complementary categories of actions in the public response that appeared functional for the collective safety of the crowd during the short period before the police arrived. The policy implications for emergency planning, and the methodological innovations involving the use of video data are discussed.

Beyond normative and non-normative: A systematic review on predictors of confrontational collective action

This paper critically examines the normative versus non-normative distinction commonly used in collective action research. To explore the similarities and differences between antecedents of normative versus non-normative actions, we conducted a systematic review on diverse predictors of non-normative, radical and violent collective actions. We examined 37 social and political psychology studies published after 2010 and identified five recurring themes: identity, efficacy, injustice, emotions and norms. Findings exhibited significant overlaps with those predictors associated with normative collective action. Thus, a reconceptualization is needed to undermine the rigid boundaries between these action types, highlighting the intricate interplay of factors that transcend the conventional binary. Aiming to avoid conceptual ambiguity and challenge the perspective that associating particular collective actions with unwarranted violence using social norms as fixed and a priori, we propose the term 'confrontational collective action' to separate out form of action from societal approval. Through this reconceptualization, we discussed the main limitations in the literature, focusing on how studies approach normativity and efficacy and addressing the issue of decontextualization in the literature. This paper calls for a contextually informed understanding of confrontational collective action that recognizes what is seen as 'normative' can change over time through intra- and intergroup interactions.

Beyond 'stampedes': Towards a new psychology of crowd crush disasters

The Bethnal Green tube shelter disaster, in which 173 people died, is a significant event in both history and psychology. While notions of 'panic' and 'stampede' have been discredited in contemporary psychology and disaster research as explanations for crowd crushes, Bethnal Green has been put forward as the exception that proves the rule. Alternative explanations for crushing disasters focus on mismanagement and physical factors, and lack a psychology. We analysed 85 witness statements from the Bethnal Green tragedy to develop a new psychological account of crowd disasters. Contrary to the established view of the Bethnal Green disaster as caused by widespread public overreaction to the sound of rockets, our analysis suggests that public perceptions were contextually calibrated to a situation of genuine threat; that only a small minority misperceived the sound; and that therefore, this cannot account for the surge behaviour in the majority. We develop a new model, in which crowd flight behaviour in response to threat is normatively structured rather than uncontrolled, and in which crowd density combines with both limited information on obstruction and normatively expected ingress behaviour to create a crushing disaster.

Trajectories of distress and recovery, secondary stressors and social cure processes in people who used the resilience hub after the Manchester Arena bombing

BACKGROUND

Terrorist incidents lead to a range of mental health outcomes for people affected, sometimes extending years after the event. Secondary stressors can exacerbate them, and social support can provide mitigation and aid recovery. There is a need to better understand distress and mitigating factors among survivors of the Manchester Arena attack in 2017.

AIMS

We explored three questions. First, what experiences of distress did participants report? Second, how might secondary stressors have influenced participants' psychosocial recoveries? Third, what part has social support played in the relationships between distress and participants' recovery trajectories?

METHOD

We conducted a cross-sectional online survey of a convenience sample of survivors of the Manchester Arena bombing (N = 84) in January 2021 (3 years 8 months post-incident), and a longitudinal study of the same participants' scores on mental health measures over 3 years from September 2017.

RESULTS

Survivors' mental well-being scores in early 2021 were significantly lower than general population norms. Longitudinal follow-up provided evidence of enduring distress. Secondary stressors, specifically disruptions to close relationships, were associated with greater post-event distress and slower recovery. We found an indirect relationship between identifying with, and receiving support from, others present at the event and mental well-being >3 years later.

CONCLUSIONS

The Arena attack has had an enduring impact on mental health, even in survivors who had a mild response to the event. The quality of close relationships is pivotal to long-term outcome. Constructive support from family and friends, and people with shared experiences, are key to social cure processes that facilitate coping and recovery.

When social movements fail or succeed: social psychological consequences of a collective action's outcome

Collective actions occur all around the world and, in the last few years, even more frequently. Previous literature has mainly focused on the antecedents of collective actions, but less attention has been given to the consequences of participating in collective action. Moreover, it is still an open question how the consequences of collective action might differ, depending on whether the actions are perceived to succeed or fail. In two studies we seek to address this gap using innovative experimental studies. In Study 1 (N = 368) we manipulated the perceptions of success and failure of a collective action in the context of a real social movement, the Chilean student movement from last decade. In Study 2 (N = 169), in addition to manipulating the outcome, we manipulated actual participation, using a mock environmental organization aiming to create awareness in authorities, to test the causal effect of both participation and success/failure on empowerment, group efficacy, and intentions of future involvement in normative and non-normative collective actions. Results show that current and past participation predict overall participation in the future, however, in Study 2 the manipulated participation was associated with having less intentions of participating in the future. In both studies, perception of success increases group efficacy. In Study 1, we found that when facing failure, participants increase their willingness to participate more in the future as opposed to non-participants that actually decrease theirs. In Study 2, however, failure increases the perception of efficacy for those with a history of non-normative participation. Altogether these results highlight the moderating role of the outcome of collective action to understand the effect of participation on future participation. We discuss these results in light of the methodological innovation and the real world setting in which our studies were conducted.

Public decisions about COVID-19 vaccines: A UK-based qualitative study

OBJECTIVE

To explore UK public decisions around whether or not to get COVID-19 vaccines, and the facilitators and barriers behind participants' decisions.

DESIGN

This qualitative study consisted of six online focus groups conducted between 15th March and 22nd April 2021. Data were analysed using a framework approach.

SETTING

Focus groups took place via online videoconferencing (Zoom).

PARTICIPANTS

Participants (n = 29) were a diverse group (by ethnicity, age and gender) UK residents aged 18 years and older.

RESULTS

We used the World Health Organization's vaccine hesitancy continuum model to look for, and explore, three main types of decisions related to COVID-19 vaccines: vaccine acceptance, vaccine refusal and vaccine hesitancy (or vaccine delay). Two reasons for vaccine delay were identified: delay due to a perceived need for more information and delay until vaccine was "required" in the future. Nine themes were identified: three main facilitators (Vaccination as a social norm; Vaccination as a necessity; Trust in science) and six main barriers (Preference for "natural immunity"; Concerns over possible side effects; Perceived lack of information; Distrust in government;; Conspiracy theories; "Covid echo chambers") to vaccine uptake.

CONCLUSION

In order to address vaccine uptake and vaccine hesitancy, it is useful to understand the reasons behind people's decisions to accept or refuse an offer of a vaccine, and to listen to them and engage with, rather than dismiss, these reasons. Those working in public health or health communication around vaccines, including COVID-19 vaccines, in and beyond the UK, might benefit from incorporating the facilitators and barriers found in this study.

Survivors' experiences of informal social support in coping and recovering after the 2017 Manchester Arena bombing

BACKGROUND

Much of the psychosocial care people receive after major incidents and disasters is informal and is provided by families, friends, peer groups and wider social networks. Terrorist attacks have increased in recent years. Therefore, there is a need to better understand and facilitate the informal social support given to survivors.

AIMS

We addressed three questions. First, what is the nature of any informal support-seeking and provision for people who experienced the 2017 Manchester Arena terrorist attack? Second, who provided support, and what makes it helpful? Third, to what extent do support groups based on shared experience of the attack operate as springboards to recovery?

METHOD

Semi-structured interviews were carried out with a purposive sample of 18 physically non-injured survivors of the Manchester Arena bombing, registered at the NHS Manchester Resilience Hub. Interview transcripts were thematically analysed.

RESULTS

Participants often felt constrained from sharing their feelings with friends and families, who were perceived as unable to understand their experiences. They described a variety of forms of helpful informal social support, including social validation, which was a feature of support provided by others based on shared experience. For many participants, accessing groups based on shared experience was an important factor in their coping and recovery, and was a springboard to personal growth.

CONCLUSIONS

We recommend that people who respond to survivors' psychosocial and mental healthcare needs after emergencies and major incidents should facilitate interventions for survivors and their social networks that maximise the benefits of shared experience and social validation.

Advancing a social identity perspective on interoperability in the emergency services: Evidence from the Pandemic Multi-Agency Response Teams during the UK COVID-19 response

Previous research shows there are persistent challenges with multi-agency response centring on problems of communication and coordination. The Social Identity Approach provides an important psychological framework for analysing relations within and between groups which can be used to understand why challenges in multi-agency response occur, and what can be done to prevent them re-occurring in the future. To explore this issue, we conducted semi-structured interviews with 14 responders from the Police, and Fire and Rescue Services who were involved in Pandemic Multi-Agency Response Teams (PMART) during the initial months of the COVID-19. These teams responded to suspected COVID-19 deaths in the community. Interviews were analysed using thematic analysis. Results show that responders appeared to share the pre-existing superordinate identity of all being members of the blue-light service. This identity was made salient as a result of responders experiencing positive contact with each other. Responders also shared the situational superordinate identity of PMART which was both created, and then made salient, through positive contact with each other, as well as responders sharing difficult experiences. At the same time though, structural factors such as inequalities in building access and different shift patterns increased the salience of sub-group identities in ways that created conflict between these identities, as well as operational challenges for joint working. This research advances our understanding of multi-agency working from a social identity perspective by providing evidence of a shared social identity at an operational level of emergency response. Practical implications of this research are discussed.

P-375 Optimising vaginal biospecimen collection

Study question

Are menstrual tampons an acceptable and comparable method to lower vaginal swabs (LVS) for analysing the vaginal microbiome in non-pregnant women?

Summary answer

Tampons capture a higher bacterial load, volunteers are familiar with them, thus are well-accepted, and can be efficiently frozen at -20 °C prior to analysis.

What is known already

The vaginal microbiome plays a key role in women’s reproductive health. The application of investigating this niche allows a greater understanding of the impact of the vaginal microbiota in diverse reproductive disorders including infertility, recurrent miscarriage, spontaneous preterm birth and sexually transmitted infections. Fear and embarrassment related to physicians taking a traditional vaginal swab using a speculum results in many female genitourinary health appointments to be missed in the UK and recruitment challenges into vaginal microbiota research studies. Growing evidence suggests a menstrual tampon to be a superior alternative biospecimen collection device to a vaginal swab.

Study design, size, duration

This was a prospective, cross-sectional observational study. Twenty-one healthy volunteers (average age 30 years) were recruited over a period of 6 weeks at the Centre for Women's Health Research, University of Liverpool, an academic, tertiary referral centre.

Participants/materials, setting, methods

The volunteers consented to wearing a tampon for 20 minutes, taking 2 LVS and completing an acceptability questionnaire. Samples were halved for immediate processing and freezing at -20 °C for 2-4 weeks. Real-time PCR using Femoflor-16 was carried out to identify microorganisms present in vaginal microbiota. Microbiota was classified by total bacterial mass and relative abundance of lactobacillus species. Statistical analysis was carried out using GraphPad PRISM 5, Microsoft Excel 2019 and IBM SPSS Statistics 27.

Main results and the role of chance

Of the 84 samples, four had insufficient material for the purpose of analysis. Three of these were LVS samples and the fourth was a frozen tampon sample.

Mean tampon total bacterial mass was higher for fresh and frozen samples versus the mean LVS total bacterial mass.

The Femoflor algorithm gave identical vaginal microbiota characterisation between the fresh tampon and fresh LVS in 68.4% (13/19) of cases. 92% (12/13) samples with over 80% relative abundance of lactobacillus in the LVS also had over 80% relative abundance in the tampon. More discrepancy was seen between samples within the 20-80% and <20% relative abundance groups of lactobacillus in the LVS with 50% and 75% different classifications respectively. Importantly, only one case showed an LVS with lactobacillus >80% (normal) and a tampon with non-dominance of lactobacillus (<80%, dysbiosis).

The questionnaires revealed that 90.5% of the volunteers highly rated using tampons (3 or more out of 5 on a Likert scale), with 52.4% rating tampon-use at 5/5. All participants (100%) stated that they would be happy to provide a tampon sample for clinical/research testing purposes in the future.

Limitations, reasons for caution

This study included 21 healthy volunteers; this is not necessarily representative of the entire UK population, but the tampon and LVS from the same volunteer were consistently comparable before and after freezing. We used a multiplex PCR assay to target common vaginal bacteria, inevitably some bacteria have not been characterised.

Wider implications of the findings

Self-collected tampons are suitable, well accepted biospecimen collection devices that may reduce barriers posed due to embarrassment, improve attendance in genitourinary medicine clinics and encourage participation in vaginal microbiota research. Freezing before processing reduces time and costs. A large study is necessary to ensure reproducibility and acceptability to patient population.

Trial registration number

Not Applicable

Tracking the nature and trajectory of social support in Facebook mutual aid groups during the COVID-19 pandemic

At the onset of the COVID-19 pandemic, thousands of mutual aid groups were established on social media and operated as platforms through which people could offer or request social support. Considering the importance of Facebook mutual aid groups during the early stages of the COVID-19 pandemic in the United Kingdom but also the lack of empirical research regarding the trajectories and types of social support rendered available through the groups, our aims in this paper are threefold; first, to examine the trajectory of social support-related activity during the period between March-December 2020; second, to compare offers and requests of support during the peaks of the first and second waves; third to provide a rich analysis of the types of social support that were offered or requested through the online mutual aid groups. Quantitative findings suggest that online social support activity declined soon after the peak of the first pandemic wave and, at least in Facebook mutual aid groups, did not reach the levels observed during the first wave. Also, the number of offers of support during the first wave was higher compared to offers during the second wave, and similar was the case for requests for support. Additionally, offers for support were higher compared to requests for support during both the first and second waves. Finally, qualitative analysis showed that people used the Facebook mutual aid groups to offer and request various types of practical, emotional, and informational support. Limitations as well as implications of our study are considered.

Interventions to promote physical distancing behaviour during infectious disease pandemics or epidemics: A systematic review

OBJECTIVES

Physical distancing, defined as keeping 1-2m apart when co-located, can prevent cases of droplet or aerosol transmitted infectious diseases such as SARS-CoV2. During the COVID-19 pandemic, distancing was a recommendation or a requirement in many countries. This systematic review aimed to determine which interventions and behavior change techniques (BCTs) are effective in promoting adherence to distancing and through which potential mechanisms of action (MOAs).

METHODS

Six databases were searched. The review included studies that were (a) conducted on humans, (b) reported physical distancing interventions, (c) included any comparator (e.g., pre-intervention versus post-intervention; randomized controlled trial), and (d) reported actual distancing or predictors of distancing behavior. Risk of bias was assessed using the Mixed Methods Appraisal Tool. BCTs and potential MoAs were identified in each intervention.

RESULTS

Six articles (with seven studies and 19 comparisons) indicated that distancing interventions could successfully change MoAs and behavior. Successful BCTs (MoAs) included feedback on behavior (e.g., motivation); information about health consequences, salience of health consequences (e.g., beliefs about consequences), demonstration (e.g., beliefs about capabilities), and restructuring the physical environment (e.g., environmental context and resources). The most promising interventions were proximity buzzers, directional systems, and posters with loss-framed messages that demonstrated the behaviors.

CONCLUSIONS

The evidence indicates several BCTs and potential MoAs that should be targeted in interventions and highlights gaps that should be the focus of future research.

Is it really "panic buying"? Public perceptions and experiences of extra buying at the onset of the COVID-19 pandemic

Shopping behaviour in response to extreme events is often characterized as "panic buying" which connotes irrationality and loss of control. However, "panic buying" has been criticized for attributing shopping behaviour to people's alleged psychological frailty while ignoring other psychological and structural factors that might be at play. We report a qualitative exploration of the experiences and understandings of shopping behaviour of members of the public at the onset of the COVID-19 pandemic. Through a thematic analysis of semi-structured interviews with 23 participants, we developed three themes. The first theme addresses people's understandings of "panic buying". When participants referred to "panic buying" they meant observed product shortages (rather than the underlying psychological processes that can lead to such behaviours), preparedness behaviours, or emotions such as fear and worry. The second theme focuses on the influence of the media and other people's behaviour in shaping subsequent shopping behaviours. The third theme addresses the meaningful motivations behind increased shopping, which participants described in terms of preparedness; some participants reported increased shopping behaviours as a response to other people stockpiling, to reduce their trips to supermarkets, or to prepare for product shortages and longer stays at home. Overall, despite frequently using the term 'panic', the irrationalist connotations of "panic buying" were largely absent from participants' accounts. Thus, "panic buying" is not a useful concept and should not be used as it constructs expected responses to threat as irrational or pathological. It can also facilitate such behaviours, creating a self-fulfilling prophecy.

People's experiences of distress and psychosocial care following a terrorist attack: interviews with survivors of the Manchester Arena bombing in 2017

BACKGROUND

Distress after major incidents is widespread among survivors. The great majority do not meet the criteria for mental health disorders and rely on psychosocial care provided by their informal networks and official response services. There is a need to better understand their experiences of distress and psychosocial care needs.

AIMS

The aims of our study were to enhance understanding of the experience of distress among people present at the Manchester Arena bombing in 2017, identify their experiences of psychosocial care after the incident and learn how to better deliver and target effective psychosocial care following major incidents.

METHOD

We conducted a thematic analysis of semi-structured interviews with 18 physically non-injured survivors of the Manchester Arena attack, who registered with the NHS Manchester Resilience Hub.

RESULTS

Distress was ubiquitous, with long-lasting health and social consequences. Initial reluctance to seek help from services was also common. Early and open access to authoritative sources of information and emotional support, and organised events for survivors, were viewed as helpful interventions. Inappropriate forms of psychosocial and mental healthcare were common and potent stressors that affected coping and recovery.

CONCLUSIONS

This paper extends our understanding of how people react to major events. Provision for the large group of people who are distressed and require psychosocial care may be inadequate after many incidents. There is a substantial agenda for developing awareness of people's needs for psychosocial interventions, and training practitioners to deliver them. The findings have substantial implications for policy and service design.

Open science communication: the first year of the UK's Independent Scientific Advisory Group for Emergencies

The COVID-19 pandemic has shone a light on the complex relationship between science and policy. Policymakers have had to make decisions at speed in conditions of uncertainty, implementing policies that have had profound consequences for people's lives. Yet this process has sometimes been characterised by fragmentation, opacity and a disconnect between evidence and policy. In the United Kingdom, concerns about the secrecy that initially surrounded this process led to the creation of Independent SAGE, an unofficial group of scientists from different disciplines that came together to ask policy-relevant questions, review the evolving evidence, and make evidence-based recommendations. The group took a public health approach with a population perspective, worked in a holistic transdisciplinary way, and were committed to public engagement. In this paper, we review the lessons learned during its first year. These include the importance of learning from local expertise, the value of learning from other countries, the role of civil society as a critical friend to government, finding appropriate relationships between science and policy, and recognising the necessity of viewing issues through an equity lens.

The effect of pre-analytical variables on downstream application and data analysis of human endometrial biopsies

STUDY QUESTION

What are the effects of pre-analytical variables on the downstream analysis of patient-derived endometrial biopsies?

SUMMARY ANSWER

There are distinct differences in the protein levels of the master regulator of oxygen homeostasis, hypoxia-inducible factor-1-alpha (HIF1α), and the protein and mRNA levels of three related genes, carbonic anhydrase 9 (CA9), vascular endothelial growth factor A (VEGFA) and progesterone receptor (PR) in human endometrial biopsies, depending on the pre-analytical variables: disease status (cancer vs benign), timing of biopsy (pre- vs post-hysterectomy) and type of biopsy (pipelle vs full-thickness).

WHAT IS KNOWN ALREADY

Patient-derived biopsies are vital to endometrial research, but pre-analytical variables relating to their collection may affect downstream analysis, as is evident in other tissues.

STUDY DESIGN SIZE DURATION

A prospective observational study including patients undergoing hysterectomy for endometrial cancer (EC) or benign indications was conducted at a large tertiary gynaecological unit in the UK. Endometrial biopsies were obtained at different time points (pre- or post-hysterectomy) using either a pipelle endometrial sampler or as a full-thickness wedge biopsy.

PARTICIPANTS/MATERIALS SETTING METHODS

The changes in HIF1α, CA9, VEGFA and PR protein levels were measured by semi-quantitative analysis of immunostaining, and the expression levels of three genes (CA9, VEGFA and PR) were investigated by quantitative real-time PCR, in endometrial biopsies from 43 patients undergoing hysterectomy for EC (n = 22) or benign gynaecological indications (n = 21).

MAIN RESULTS AND THE ROLE OF CHANCE

An increase in HIF1α immunostaining was observed in EC versus benign endometrium (functionalis glands) obtained pre-hysterectomy (P < 0.001). An increase in CA9 immunostaining was observed in EC versus benign endometrial functionalis glands at both pre- and post-hysterectomy time points (P = 0.03 and P = 0.003, respectively). Compared with benign endometrial pipelle samples, EC samples demonstrated increased mRNA expression of CA9 (pre-hysterectomy P < 0.001, post-hysterectomy P = 0.008) and VEGFA (pre-hysterectomy P = 0.004, post-hysterectomy P = 0.002). In benign uteri, HIF1α immunoscores (functionalis glands, P = 0.03 and stroma, P = 0.009), VEGFA immunoscores (functionalis glands, P = 0.03 and stroma, P = 0.01) and VEGFA mRNA levels (P = 0.008) were increased in matched post-hysterectomy versus pre-hysterectomy samples. Similarly, in EC, an increase in VEGFA immunoscores (epithelial and stromal) and VEGFA mRNA expression was observed in the matched post-hysterectomy versus pre-hysterectomy biopsies (P = 0.008, P = 0.004 and P = 0.018, respectively). Full-thickness benign post-hysterectomy endometrial biopsies displayed increased VEGFA (P = 0.011) and PR (P = 0.006) mRNA expression compared with time-matched pipelle biopsies.

LARGE SCALE DATA

N/A.

LIMITATIONS REASONS FOR CAUTION

This descriptive study explores the effect of pre-analytical variables on the expression of four proteins and three hypoxia-related genes in a limited number of endometrial biopsies from patients with EC and benign controls. Due to the small number, it was not possible to investigate other potential variables such as menstrual cycle phase, region-specific differences within the endometrium, grade and stage of cancer, and surgical technicalities.

WIDER IMPLICATIONS OF THE FINDINGS

Careful consideration of the effects of these pre-analytical variables is essential when interpreting data relating to human endometrial biopsies. A standardized approach to endometrial tissue collection is essential to ensure accurate and clinically transferrable data.

STUDY FUNDING/COMPETING INTERESTS

The authors have no conflicts of interest to declare. The work included in this manuscript was funded by Wellbeing of Women project grants RG1073 and RG2137 (D.K.H.), Wellbeing of Women Entry-Level Scholarship ELS706 and Medical Research Council MR/V007238/1 (A.M./D.K.H.), Liverpool Women's Hospital Cancer Charity (M.A.) and University of Liverpool (L.B., L.R. and E.N.).

The interactional production and breach of new norms in the time of COVID-19: Achieving physical distancing in public spaces

A key requirement of COVID-19 pandemic behavioural regulations in many countries was for people to 'physically distance' from one another, which meant departing radically from established norms of everyday human sociality. Previous research on new norms has been retrospective or prospective, focusing on reported levels of adherence to regulations or the intention to do so. In this paper, we take an observational approach to study the embodied and spoken interactional practices through which people produce or breach the new norm. The dataset comprises 20 'self-ethnographic' fieldnotes collected immediately following walks and runs in public spaces between March and September 2020, and these were analysed in the ethnomethodological tradition. We show that and how the new norm emerged through the mutual embodied and spoken conduct of strangers in public spaces. Orientations to the new norm were observed as people torqued their bodies away from each other in situations where there was insufficient space to create physical distance. We also describe how physical distance was produced unilaterally or was aggressively resisted by some people. Finally, we discuss the practical and policy implications of our observations both for deciding what counts as physical distancing and how to support the public to achieve it.

How participation in Covid-19 mutual aid groups affects subjective well-being and how political identity moderates these effects

Mutual aid groups have flourished during the Covid-19 pandemic. However, a major challenge is sustaining such groups, which tend to decline following the initial upsurge immediately after emergencies. The present study investigates one possible motivation for continued participation: the well-being benefits associated with psychological membership of groups, as suggested by the "social cure" approach. Interviews were conducted with 11 volunteers in a mutual aid group organized by ACORN, a community union and anti-poverty campaigning organization. Through qualitative analysis, we show that participation provided well-being in different ways: positive emotional experiences, increased engagement in life, improved social relationships, and greater sense of control. Participants also reported some negative emotional experiences. While all interviewees experienced benefits from participation, those who viewed their participation through a political lens were able to experience additional benefits such as feelings of empowerment. Moreover, the benefits conferred by a shared political identity appeared to be qualitatively different from the benefits conferred by other forms of shared identity. The interview data is used to hypothesize an overall process by which participants may come to attain a political identity via mutual aid. These findings have implications for how such groups retain their members and how authorities support these groups.

More Than a COVID-19 Response: Sustaining Mutual Aid Groups During and Beyond the Pandemic

Mutual aid groups have been an indispensable part of the public response to the COVID-19 pandemic. They have provided many forms of support, in particular grocery shopping which has enabled people to self-isolate if required. While community solidarity during emergencies and disasters is common, previous studies have shown that such solidarity behaviors tend to decline over time, even when needs remain high. In this study, we address how mutual aid groups can be sustained over time in the context of the COVID-19 pandemic. We conducted 32 interviews with organizers of COVID-19 mutual aid and community support groups in the United Kingdom between September 2020 and January 2021. Based on a reflexive thematic analysis, we identified several community and group level experiences and strategies that were related to sustained participation in COVID-19 mutual aid groups. Meeting community needs over time with localized action and resources and building trust and community-based alliances were foundational elements in the COVID-19 mutual aid groups. Group processes strategies, such as a culture of care and support and regular group meetings, were used to help to sustain involvement. Some experiences resulting from participation in COVID-19 mutual aid groups were also related to sustained participation, including positive emotions (e.g., joy, pride), well-being and sense of efficacy, and an increasing sense of local community belonging and cohesion. Based on these findings, we propose four practical recommendations for sustaining mutual aid groups to assist public engagement with protective behaviors in the COVID-19 pandemic and beyond. We recommend providing practical and financial support to COVID-19 mutual aid groups; to mobilize the knowledge and the experiences acquired by COVID-19 mutual aid groups for developing programs and interventions for addressing the medium and long-term impacts of COVID-19; to prioritize community-level interventions; and to recognize the role of group processes as these have the potential to lead to long-term community responses. These approaches will be key for ensuring that communities effectively recover from the COVID-19 pandemic.

More Than a COVID-19 Response: Sustaining Mutual Aid Groups During and Beyond the Pandemic

Mutual aid groups have been an indispensable part of the public response to the COVID-19 pandemic. They have provided many forms of support, in particular grocery shopping which has enabled people to self-isolate if required. While community solidarity during emergencies and disasters is common, previous studies have shown that such solidarity behaviors tend to decline over time, even when needs remain high. In this study, we address how mutual aid groups can be sustained over time in the context of the COVID-19 pandemic. We conducted 32 interviews with organizers of COVID-19 mutual aid and community support groups in the United Kingdom between September 2020 and January 2021. Based on a reflexive thematic analysis, we identified several community and group level experiences and strategies that were related to sustained participation in COVID-19 mutual aid groups. Meeting community needs over time with localized action and resources and building trust and community-based alliances were foundational elements in the COVID-19 mutual aid groups. Group processes strategies, such as a culture of care and support and regular group meetings, were used to help to sustain involvement. Some experiences resulting from participation in COVID-19 mutual aid groups were also related to sustained participation, including positive emotions (e.g., joy, pride), well-being and sense of efficacy, and an increasing sense of local community belonging and cohesion. Based on these findings, we propose four practical recommendations for sustaining mutual aid groups to assist public engagement with protective behaviors in the COVID-19 pandemic and beyond. We recommend providing practical and financial support to COVID-19 mutual aid groups; to mobilize the knowledge and the experiences acquired by COVID-19 mutual aid groups for developing programs and interventions for addressing the medium and long-term impacts of COVID-19; to prioritize community-level interventions; and to recognize the role of group processes as these have the potential to lead to long-term community responses. These approaches will be key for ensuring that communities effectively recover from the COVID-19 pandemic.

Collectively coping with coronavirus: Local community identification predicts giving support and lockdown adherence during the COVID-19 pandemic

The role of shared identity in predicting both ingroup helping behaviour and adherence to protective norms during COVID-19 has been extensively theorized, but remains largely under-investigated. We build upon previous Social Identity research into community resilience by testing the role of pre-existing local community (or 'neighbourhood') identity as a predictor of these outcomes, via the mediator of perceived social support. Community residents in the UK completed a longitudinal online survey four months before lockdown (T1; N = 253), one month before lockdown (T2; N = 217), and two months into lockdown (T3; N = 149). The cross-lagged panel analysis shows that T1 community identification predicts T3 giving and receiving of pandemic-related support, and that these effects occur via the perception of community support at the second time point (while the alternative pathway from T1 support via T2 identification is non-significant). Moreover, we show that T1 community identification also directly predicts lockdown adherence at T3. Our findings point to the pivotal role played by community identity in effective behavioural responses to the pandemic, and the need to support and foster community development to facilitate local community resilience as the crisis continues to unfold.

Template for Rapid Iterative Consensus of Experts (TRICE)

BACKGROUND

Public health emergencies require rapid responses from experts. Differing viewpoints are common in science, however, "mixed messaging" of varied perspectives can undermine credibility of experts; reduce trust in guidance; and act as a barrier to changing public health behaviours. Collation of a unified voice for effective knowledge creation and translation can be challenging. This work aimed to create a method for rapid psychologically-informed expert guidance during the COVID-19 response.

METHOD

TRICE (Template for Rapid Iterative Consensus of Experts) brings structure, peer-review and consensus to the rapid generation of expert advice. It was developed and trialled with 15 core members of the British Psychological Society COVID-19 Behavioural Science and Disease Prevention Taskforce.

RESULTS

Using TRICE; we have produced 18 peer-reviewed COVID-19 guidance documents; based on rapid systematic reviews; co-created by experts in behavioural science and public health; taking 4-156 days to produce; with approximately 18 experts and a median of 7 drafts per output. We provide worked-examples and key considerations; including a shared ethos and theoretical/methodological framework; in this case; the Behaviour Change Wheel and COM-B.

CONCLUSION

TRICE extends existing consensus methodologies and has supported public health collaboration; co-creation of guidance and translation of behavioural science to practice through explicit processes in generating expert advice for public health emergencies.

P–365 Altered endometrial oestrogen-responsiveness and aberrant expression of cell-fate markers may contribute to the aetiology of recurrent pregnancy loss

Study question

Do women with recurrent pregnancy loss (RPL) have an aberrant expression of oestrogen receptor-β(ERβ) and cell-fate markers during the window of implantation (WOI) endometrium?

Summary answer

Women with RPL are found to have significantly altered levels of ER βand Ki–67 in the WOI endometrium, possibly resulting in anti-proliferative and anti-angiogenic effects.

What is known already

RPL affects 1% of all women and has been associated with altered endometrial angiogenesis and proliferation when compared with the endometrium of healthy fertile women. RPL can be subcategorised into recurrent loss of anembryonic pregnancy, fetal loss (following evidence of a fetal heartbeat) and recurrent implantation failure (RIF). ERβis the only oestrogen-receptor (ER) known to be expressed in the vascular endothelium of the endometrium and is the dominant ER during the WOI. It has an important role in endometrial regeneration and is proposed to regulate the angiogenic and vascular changes that occur in embryo implantation. Study design, size, duration: This pilot case-control study took place at the Liverpool Women’s Hospital and included 38 women; 29 who suffered RPL and 9 controls with proven fertility (≥2 healthy pregnancies). Of the RPL group, 9 had recurrent loss of anembryonic pregnancy, 10 had recurrent fetal loss and 10 had RIF. Endometrial samples were collected during the WOI (cycle day 22+/–2).

Participants/materials, setting, methods

To determine whether markers of endometrial cell proliferation and oestrogen-responsiveness are associated with RPL, we assessed the immuno-staining for ER β, progesterone receptor (PR) and cell-fate marker Ki–67 in endometrial biopsies during the WOI using immunohistochemistry. A semi-quantitative immuno-staining score was used to assess the endometrial glands, stroma, luminal epithelium, perivascular and vascular endothelium compartments separately. Statistical differences between groups were calculated by non-parametric tests and significance level set at p &lt; 0.05.

Main results and the role of chance

During the WOI, the endometrial epithelium of women with RIF and recurrent anembryonic pregnancy loss showed significantly higher levels of ER βwhen compared with fertile controls (p = 0.01 and p = 0.01, respectively). This may indicate an anti-proliferative process occurring at the site of implantation with very early pregnancy losses. In contrast, with women with recurrent fetal loss, a significantly lower level of ERβwas found within the vascular endothelium when compared with the fertile controls (p &lt; 0.01). This supports the theory that increased oxygen levels may compromise trophoblastic invasion, thereby leading to fetal loss. The presence of Ki–67 (a marker of proliferation) was significantly lower within the vascular endothelium of all types of RPL: recurrent anembryonic loss (p = 0.02), RIF (p = 0.02) and recurrent fetal loss (p &lt; 0.01). These findings suggest ineffective endometrial angiogenesis in RPL, resulting in a suboptimal endometrial microenvironment.

PR was found to be significantly reduced (p &lt; 0.01) in the perivascular area of women with RIF versus fertile controls. Since decidualisation and preparation of the endometrium for a successful implantation is controlled by critical target genes downstream of PR, this alteration in PR may be an important feature of their defective endometrial phenotype.

Limitations, reasons for caution

Samples analysed were taken from the functional endometrium and therefore the results do not reflect the basalis. The WOI was identified using history and histological appearance, rather than timing with ovulation. Although we detected statistical significance, generalisation of the results requires further studies with larger sample size.

Wider implications of the findings: This data provides novel insight into the biological correlates of clinical types of RPL and suggests that specific alterations in the regulation of endometrial cell fate and oestrogen- responsiveness are associated with different types of RPL. This highlights possible new therapies for RPL, such as selective oestrogen receptor modulators (SERMs).

Trial registration number

Not applicable

P-365 Pre-selected for an award: Altered endometrial oestrogen-responsiveness and aberrant expression of cell-fate markers may contribute to the aetiology of recurrent pregnancy loss

Study question

Do women with recurrent pregnancy loss (RPL) have an aberrant expression of oestrogen receptor-β (ERβ) and cell-fate markers during the window of implantation (WOI) endometrium?

Summary answer

Women with RPL are found to have significantly altered levels of ERβ and Ki-67 in the WOI endometrium, possibly resulting in anti-proliferative and anti-angiogenic effects.

What is known already

RPL affects 1% of all women and has been associated with altered endometrial angiogenesis and proliferation when compared with the endometrium of healthy fertile women. RPL can be subcategorised into recurrent loss of anembryonic pregnancy, fetal loss (following evidence of a fetal heartbeat) and recurrent implantation failure (RIF). ERβ is the only oestrogen-receptor (ER) known to be expressed in the vascular endothelium of the endometrium and is the dominant ER during the WOI. It has an important role in endometrial regeneration and is proposed to regulate the angiogenic and vascular changes that occur in embryo implantation. 

Study design, size, duration

This pilot case-control study took place at the Liverpool Women’s Hospital and included 38 women; 29 who suffered RPL and 9 controls with proven fertility (≥2 healthy pregnancies). Of the RPL group, 9 had recurrent loss of anembryonic pregnancy, 10 had recurrent fetal loss and 10 had RIF. Endometrial samples were collected during the WOI (cycle day 22+/-2).

Participants/materials, setting, methods

To determine whether markers of endometrial cell proliferation and oestrogen-responsiveness are associated with RPL, we assessed the immuno-staining for ERβ, progesterone receptor (PR) and cell-fate marker Ki-67 in endometrial biopsies during the WOI using immunohistochemistry. A semi-quantitative immuno-staining score was used to assess the endometrial glands, stroma, luminal epithelium, perivascular and vascular endothelium compartments separately. Statistical differences between groups were calculated by non-parametric tests and significance level set at p &lt; 0.05.

Main results and the role of chance

During the WOI, the endometrial epithelium of women with RIF and recurrent anembryonic pregnancy loss showed significantly higher levels of ERβ when compared with fertile controls (p = 0.01 and p = 0.01, respectively). This may indicate an anti-proliferative process occurring at the site of implantation with very early pregnancy losses. In contrast, with women with recurrent fetal loss, a significantly lower level of ERβ was found within the vascular endothelium when compared with the fertile controls (p &lt; 0.01). This supports the theory that increased oxygen levels may compromise trophoblastic invasion, thereby leading to fetal loss. 

The presence of Ki-67 (a marker of proliferation) was significantly lower within the vascular endothelium of all types of RPL

recurrent anembryonic loss (p = 0.02), RIF (p = 0.02) and recurrent fetal loss (p &lt; 0.01). These findings suggest ineffective endometrial angiogenesis in RPL, resulting in a suboptimal endometrial microenvironment.

PR was found to be significantly reduced (p &lt; 0.01) in the perivascular area of women with RIF versus fertile controls. Since decidualisation and preparation of the endometrium for a successful implantation is controlled by critical target genes downstream of PR, this alteration in PR may be an important feature of their defective endometrial phenotype.

Limitations, reasons for caution

Samples analysed were taken from the functional endometrium and therefore the results do not reflect the basalis. The WOI was identified using history and histological appearance, rather than timing with ovulation. Although we detected statistical significance, generalisation of the results requires further studies with larger sample size.

Wider implications of the findings

This data provides novel insight into the biological correlates of clinical types of RPL and suggests that specific alterations in the regulation of endometrial cell fate and oestrogen- responsiveness are associated with different types of RPL. This highlights possible new therapies for RPL, such as selective oestrogen receptor modulators (SERMs).

Trial registration number

Not applicable

What have we learned about COVID-19 volunteering in the UK? A rapid review of the literature

BACKGROUND

Community engagement and volunteering are essential for the public response to COVID-19. Since March 2020 a large number of people in the UK have been regularly doing unpaid activities to benefit others besides their close relatives. Although most mutual aid groups emerged from local neighbourhoods and communities, official public institutions also fostered community volunteering, namely through the community champions scheme. By considering a broad definition of COVID-19 volunteering, this article describes a systematic review of the literature focused on one broad question: What have we learned about COVID-19 volunteering both at the UK national level and the more local community level?

METHODS

A rapid review of the literature in peer-reviewed databases and grey literature was applied in our search, following the PRISMA principles. The search was conducted from 10 to 16 of October 2020, and sources were included on the basis of having been published between January and October 2020, focusing on COVID-19 and addressing community groups, volunteering groups, volunteers, or community champions in the UK.

RESULTS

After initial screening, a total of 40 relevant sources were identified. From these, 27 were considered eligible. Findings suggest that food shopping and emotional support were the most common activities, but there were diverse models of organisation and coordination in COVID-19 volunteering. Additionally, community support groups seem to be adjusting their activities and scope of action to current needs and challenges. Volunteers were mostly women, middle-class, highly educated, and working-age people. Social networks and connections, local knowledge, and social trust were key dimensions associated with community organising and volunteering. Furthermore, despite the efforts of a few official public institutions and councils, there has been limited community engagement and collaboration with volunteering groups and other community-based organisations.

CONCLUSIONS

We identified important factors for fostering community engagement and COVID-19 volunteering as well as gaps in the current literature. We suggest that future research should be directed towards deepening knowledge on sustaining community engagement, collaboration and community participation over time, during and beyond this pandemic.

Re-opening live events and large venues after Covid-19 'lockdown': Behavioural risks and their mitigations

This article reviews the behavioural risks and possible mitigations for re-opening large venues for sports and music events when Covid-19 infection rates and hospitalizations begin to decline. We describe the key variables that we suggest will affect public behaviour relevant to the spread of the virus, drawing upon four sources: (1) relevant evidence and recommendations from the Scientific Pandemic Influenza Group on Behaviours produced for the Scientific Advisory Group for Emergencies (SAGE); (2) research evidence from non-pandemic conditions; (3) research on behaviour during the pandemic; and (4) relevant theory. We first outline some basic risks and a framework for understanding collective behaviour at live events. We then survey some trends in UK public behaviour observed over 2020 and how these might interact with the opening of live events and venues. We present a range of mitigation strategies, based on the framework for collective behaviour and on what is known about non-pharmaceutical (i.e. behavioural) interventions in relation to Covid-19.

Behavioural responses to Covid-19 health certification: a rapid review

BACKGROUND

Covid-status certification - certificates for those who test negative for the SARS-CoV-2 virus, test positive for antibodies, or who have been vaccinated against SARS-CoV-2 - has been proposed to enable safer access to a range of activities. Realising these benefits will depend in part upon the behavioural and social impacts of certification. The aim of this rapid review was to describe public attitudes towards certification, and its possible impact on uptake of testing and vaccination, protective behaviours, and crime.

METHOD

A search was undertaken in peer-reviewed databases, pre-print databases, and the grey literature, from 2000 to December 2020. Studies were included if they measured attitudes towards or behavioural consequences of health certificates based on one of three indices of Covid-19 status: test-negative result for current infectiousness, test-positive for antibodies conferring natural immunity, or vaccination(s) conferring immunity.

RESULTS

Thirty-three papers met the inclusion criteria, only three of which were rated as low risk of bias. Public attitudes were generally favourable towards the use of immunity certificates for international travel, but unfavourable towards their use for access to work and other activities. A significant minority was strongly opposed to the use of certificates of immunity for any purpose. The limited evidence suggested that intention to get vaccinated varied with the activity enabled by certification or vaccination (e.g., international travel). Where vaccination is seen as compulsory this could lead to unwillingness to accept a subsequent vaccination. There was some evidence that restricting access to settings and activities to those with antibody test certificates may lead to deliberate exposure to infection in a minority. Behaviours that reduce transmission may decrease upon health certificates based on any of the three indices of Covid-19 status, including physical distancing and handwashing.

CONCLUSIONS

The limited evidence suggests that health certification in relation to COVID-19 - outside of the context of international travel - has the potential for harm as well as benefit. Realising the benefits while minimising the harms will require real-time evaluations allowing modifications to maximise the potential contribution of certification to enable safer access to a range of activities.

Collectively coping with coronavirus: Local community identification predicts giving support and lockdown adherence during the COVID-19 pandemic

The role of shared identity in predicting both ingroup helping behaviour and adherence to protective norms during COVID-19 has been extensively theorized, but remains largely under-investigated. We build upon previous Social Identity research into community resilience by testing the role of pre-existing local community (or 'neighbourhood') identity as a predictor of these outcomes, via the mediator of perceived social support. Community residents in the UK completed a longitudinal online survey four months before lockdown (T1; N = 253), one month before lockdown (T2; N = 217), and two months into lockdown (T3; N = 149). The cross-lagged panel analysis shows that T1 community identification predicts T3 giving and receiving of pandemic-related support, and that these effects occur via the perception of community support at the second time point (while the alternative pathway from T1 support via T2 identification is non-significant). Moreover, we show that T1 community identification also directly predicts lockdown adherence at T3. Our findings point to the pivotal role played by community identity in effective behavioural responses to the pandemic, and the need to support and foster community development to facilitate local community resilience as the crisis continues to unfold.

Public behaviour in response to the COVID-19 pandemic: understanding the role of group processes

BACKGROUND

In the absence of a vaccine, behaviour by the public is key to the response to the COVID-19 pandemic. Yet, as with other types of crises and emergencies, there have been doubts about the extent to which the public are able to engage effectively with the required behaviour. These doubts are based on outdated models of group psychology.

AIMS AND ARGUMENT

We analyse the role of group processes in the COVID-19 pandemic in three domains: recognition of threat, adherence by the public to the required public health behaviours (and the factors that increase such adherence) and actions of the many community mutual aid groups that arose during lockdown. In each case, we draw upon the accumulated research on behaviour in emergencies and disasters, as well as the latest findings in relation to the COVID-19 pandemic, to show that explanations in terms of social identity processes make better sense of the patterns of evidence than alternative explanations.

CONCLUSIONS

If behaviour in the pandemic is a function of mutable group processes rather than fixed tendencies, then behavioural change is possible. There was evidence of significant change in behaviour from the public, particularly in the early days of the pandemic. Understanding the role of group processes means we can help design more effective interventions to support collective resilience in the public in the face of the pandemic and other threats. We draw out from the evidence a set of recommendations on facilitating the public response to COVID-19 by harnessing group processes.

Self-categorization as a basis of behavioural mimicry: Experiments in The Hive

INTRODUCTION

Do we always do what others do, and, if not, when and under what conditions do we do so? In this paper we test the hypothesis that mimicry is moderated by the mere knowledge of whether the source is a member of the same social category as ourselves.

METHODS

We investigated group influence on mimicry using three tasks on a software platform which interfaces with mobile computing devices to allow the controlled study of collective behaviour in an everyday environment.

RESULTS

Overall, participants (N = 965) were influenced by the movements of confederates (represented as dots on a screen) who belonged to their own category in both purposive and incidental tasks.

CONCLUSION

Our results are compatible with collective level explanations of social influence premised on shared social identification. This includes both a heuristic of unintended mimicry (the acts of group members are diagnostic of how one should act), and communication of affiliation (based on a desire to make one's group cohesive). The results are incompatible with traditional 'contagion' accounts which suggest mimicry is automatic and inevitable. The results have practical implications for designing behavioural interventions which can harness the power of copying behaviour, for example in emergency evacuations.

Agent-based simulation of collective cooperation: from experiment to model

Simulation models of pedestrian dynamics have become an invaluable tool for evacuation planning. Typically, crowds are assumed to stream unidirectionally towards a safe area. Simulated agents avoid collisions through mechanisms that belong to each individual, such as being repelled from each other by imaginary forces. But classic locomotion models fail when collective cooperation is called for, notably when an agent, say a first-aid attendant, needs to forge a path through a densely packed group. We present a controlled experiment to observe what happens when humans pass through a dense static crowd. We formulate and test hypotheses on salient phenomena. We discuss our observations in a psychological framework. We derive a model that incorporates: agents’ perception and cognitive processing of a situation that needs cooperation; selection from a portfolio of behaviours, such as being cooperative; and a suitable action, such as swapping places. Agents’ ability to successfully get through a dense crowd emerges as an effect of the psychological model.

Risk-Taking That Signals Trust Increases Social Identification

Abstract. Social identification predicts many important phenomena; however, its determinants have received comparably little research attention. We argue that people are more likely to socially identify with others who engage in risky behavior that implies trust than with those who act cautiously, and test this in four experiments with over 900 participants. The experiments found support for the hypotheses across diverse risk contexts – specifically, risk of physical injury, disease risk, and financial risk. These findings indicate that others’ risk taking can strengthen shared psychological group membership.

Shared social identity transforms social relations in imaginary crowds

In this paper we present three studies that address the difference between physical and psychological groups, the conditions that create a transformation from the one into the other, and the psychological processes underlying this transformation. In Study 1 we demonstrate correlations between shared social identity, desired physical proximity to others, and positive emotions in the company of others. Study 2, employing a between-subjects design, finds that an event that creates shared fate, such as the breakdown of a train, leads to greater comfort in social interactions (e.g., ease of conversation) and comfort in sensual interactions (e.g., tolerance of physical touch) with other passengers, and that this occurs through an increase in shared social identity but not through social identification. Study 3 obtains similar findings using a within-subjects design. In combination, these studies provide consistent evidence for the role of shared social identity in the emergence of psychological groups from physical groups.

Collective resilience in times of crisis: Lessons from the literature for socially effective responses to the pandemic

Most countries worldwide have taken restrictive measures and called on their population to adopt social distancing behaviours to contain the spread of the COVID-19 pandemic. At a time when several European countries are releasing their lockdown measures, new uncertainties arise regarding the further evolution of a crisis becoming multifaceted, as well as the durability of public determination to face and contain it. In this context, the sustained social efficacy of public health measures will depend more than ever on the level of acceptance across populations called on to temporarily sacrifice daily freedoms, while economic insecurity grows and social inequalities become more blatant. We seek to develop a framework for analysing how the requirements of 'social distancing' can be reconciled with the conditions that allow for the maintaining, or even strengthening, of social cohesion, mutual solidarity, and a sense of collective efficacy, throughout the crisis. To reach this goal, we propose a summary of relevant findings and pragmatic policy principles derived from them.

COVID-19 in context: Why do people die in emergencies? It's probably not because of collective psychology

Notions of psychological frailty have been at the forefront of debates around the public response to the COVID-19 pandemic. In particular, there is the argument that collective selfishness, thoughtless behaviour, and over-reaction would make the effects of COVID-19 much worse. The same kinds of claims have been made in relation to other kinds of emergencies, such as fires, earthquakes, and sinking ships. We argue that in these cases as well as in the case of the COVID-19 pandemic, other factors are better explanations for fatalities - namely under-reaction to threat, systemic or structural factors, and mismanagement. Psychologizing disasters serves to distract from the real causes and thus from who might be held responsible. Far from being the problem, collective behaviour in emergencies - including the solidarity and cooperation so commonly witnessed among survivors - is the solution, one that should be harnessed more effectively in policy and practice.