Albert Ellis has left the building

Albert Ellis, one of the co-founders of cognitive therapy, died yesterday at his home in New York. The Boston Herald has an obituary that captures some of his work and eccentric spirit.

Ellis created ‘rational emotive behavior therapy’ (REBT) that stressed a rational approach to dealing with distressing cognitive distortions – a significant break from the largely Freudian therapy he was trained in.

It was an early version of cognitive behaviour therapy (CBT), now one of the most extensively tested, empirically validated and widely used psychological treatments for mental disorder.

Ellis was a prolific writer, producing a small library of books, papers and articles, did weekly seminars for most of his life and founded the Albert Ellis Institute.

Apart from his extensive writing he was known for his boundless energy and his approach to therapy and teaching which was variously described as no nonsense / assertive / confrontational (take your pick).

He was voted sixth in Psychotherapy Networker’s list of ‘top ten’ influential therapists of all time earlier this year.

Link to Boston Herald obituary for Albert Ellis.
Link to Psychotherapy Networker on Ellis.

Epilepsy: fighting myths and saving lives

BBC News reports on a recently published study that found that myths about epilepsy and its treatment are still widely believed, possibly putting people at risk. This post will tell you how to help someone having a seizure.

The research project, led by Dr Sallie Baxendale, used the internet to survey over 4,500 people concerning their knowledge of the effects of epilepsy, and what to do if someone has a seizure.

The study found that myths about the effects are widespread, many people still believe that epilepsy commonly causes ‘foaming at the mouth’ and is strongly linked to violence, neither of which are the case.

More worringly, a third of people thought they should put something in the mouth of a person having a seizure to stop them ‘swallowing their tongue’ and two-thirds would always call an ambulance.

Never put anything in the mouth of someone having a seizure (they could choke) and you only need to call an ambulance if it’s the person’s first seizure, if the seizure has been going on for more than five minutes, if they don’t regain consciousness between seizures, or if they’re physically injured.

This is the advice from Epilepsy Action about how to help someone who is having a tonic-clonic seizure.

These are what are sometimes called ‘fits’ and used to be called ‘grand-mal’ seizures. ‘Grand mal’ literally means ‘great evil’, and so understandably, isn’t used by the medical profession, although it still is used in day-to-day language by some people not familiar with the proper name.

Tonic-Clonic seizures

The person loses consciousness, the body stiffens, then falls to the ground. This is followed by jerking movements. A blue tinge around the mouth is likely. This is due to irregular breathing. Loss of bladder and/or bowel control may occur. After a minute or two the jerking movements should stop and consciousness may slowly return.

* Protect the person from injury – (remove harmful objects from nearby)
* Cushion their head
* Look for an epilepsy identity card or identity jewellery
* Aid breathing by gently placing them in the recovery position [pictured] once the seizure has finished
* Be calmly reassuring
* Stay with the person until recovery is complete

* Restrain the person
* Put anything in the person’s mouth
* Try to move the person unless they are in danger
* Give the person anything to eat or drink until they are fully recovered
* Attempt to bring them round

Call for an ambulance if…
* You know it is the person’s first seizure
* The seizure continues for more than five minutes
* One tonic-clonic seizure follows another without the person regaining consciousness between seizures
* The person is injured during the seizure
* You believe the person needs urgent medical attention

Obviously, if no-one knows whether it’s the person’s first seizure and they are unable to tell you, or no-one knows when the seizure started, call an ambulance.

Also, some people who have seizures will have strong emotional reactions when they come round owing to the brain disturbance.

The person might regain consciousness and seem terrified, traumatised, confused or very anxious (not always the case, some people feel elated).

This may cause onlookers to get equally anxious and panicky. Stay calm and just reassure the person (and everyone else if necessary!), gently letting them know what’s happened.

The Epilepsy Action first aid page also has information on dealing with other types of seizure.

Take the opportunity to read through the information – the next five minutes of your life could save someone else’s.

Link to Epilepsy Action first aid information.
Link to BBC News story ‘Many ‘believe myths’ on epilepsy’.
Link to abstract of research report.

Cognitive reserves and staying sharp

SharpBrains has a great interview with neuropsychologist Prof Yaakov Stern who discusses his research on maintaining a healthy brain and gives plenty of great advice for keeping your edge throughout life.

Stern talks about the cognitive and neural ‘reserve theories’ which argue that the mind and brain have a certain tolerance to decline and damage before they go into the freefall of dementia.

It’s sort of a threshold theory, suggesting that if the strain on the brain reaches past a certain point, the system starts to break down rapidly.

The amount of ‘reserve’ or the threshold varies between individuals, so some people are more likely to get dementia than others.

We know that genetics is one component, but what Stern’s research has also shown is that we can play an active part in boosting our reserve and raising our dementia threshold.

In other words, by changing our lifestyle we can maintain our mental sharpness for longer and reduce the chances of getting a degenerative brain disease.

Healthy diet, exercise and nutrition are key, but education, keeping mentally active and having a varied social life might also be important.

AF: Can you give us some examples of those leisure activities that seem to have the most positive effects?

YS: For our 2001 study we evaluated the effect of 13 activities, combining intellectual, physical, and social elements. Some of the activities with the most effect were reading, visiting friends or relatives, going to movies or restaurants, and walking for pleasure or going on an excursion. As you can see, a variety. We saw that the group with high level of leisure activities presented 38% less risk (controlling for other factors) of developing Alzheimer’s symptoms. And that, for each additional type of activity, the risk got reduced by 8%.

There is an additional element that we are starting to see more clearly. Physical exercise, by itself, also has a very beneficial impact on cognition. Only a few months ago researchers were able to show for the first time how physical activity promotes neurogenesis in the human brain. So, we need both mental and physical exercise. The not-so-good news is that, as of today, there no clear recipe for success. More research is needed before we prepare a systematic set of interventions that can help maximize our protection.

The interview also has plenty more practical advice, links to the original scientific papers, and a video, which I can’t watch because it’s blocked at work. Grrrr!

Link to SharpBrains interview with Prof Yaakov Stern.

Renaissance advice on mind and mood

A couple of quotes from the 16th and 17th centuries that still hold true today. The first from Leonardo da Vinci’s Notebooks, dated 1508:

Irons rusts from disuse, stagnant water loses its purity and in cold weather becomes frozen; even so does inaction sap the vigor of the mind.

Which reminded me of Robert Burton’s advice for combating depression, given in his landmark 17th century book, The Anatomy of Melancholy:

Observe this short precept — Be not solitary; be not idle.

Both sets of advice hold true today. Modern studies have shown that exercise boosts mood and prevents cognitive decline.

Are attention and consciousness the same thing?

Psychologists have often wondered whether attention and consciousness are the same thing. Can we only be conscious of things we pay attention to? And can we attend to things we’re not conscious of?

A paper [pdf] published last year suggests that they are, in fact, separate mental processes.

William James, one of the founder of modern psychology, wrote that “everyone knows what attention is” when trying to define it.

Similarly, as neuroscientist Susan Greenfield has pointed out, scientists often rely on a ‘we all know what we’re talking about, don’t we?’ definition of consciousness.

It turns out that attention is easier to define that consciousness, and in psychology it generally refers to the preferential processing of one source of information over another.

This can be measured experimentally because it’s possible to see how experience of one thing affects performance on another task, even if the person isn’t aware of experiencing anything in the first place.

We described an example of this last week, in a study that found that people could make accurate beauty judgements for faces presented so quickly they didn’t consciously recognise them.

This study, and many others on ‘implicit’ or ‘subliminal’ perception, demonstrate that people can attend to something without being conscious of it.

Being conscious of something we haven’t attended to, and where attention is nearly absent, is a bit more tricky.

The paper, by cognitive scientists Christof Koch and Naotsugu Tsuchiya, suggests that getting ‘gist’ impressions might be one example.

Experiments show that when photographs are unexpectedly flashed up in front of participants for no more than 30ms, they don’t have time to focus on any part of it, but can report a general gist or summary of the image.

Consciousness and attention have also been shown to have opposite effects in some instances.

When participants try to find two embedded images within a rapidly flashed stream of pictures, they often fail to see the second image – an effect known as ‘attentional blink‘.

However, one study [pdf] found that distracting people during this task, actually made them better at it, they were more likely to consciously detect the second image.

Reducing their attention to the task seemed to increase their conscious awareness.

The Koch and Tsuchiya paper has many more examples if you’re interested in trying to untangle these closely related processes.

pdf of ‘Attention and Consciousness: Two Distinct Brain Processes’ (via SciCon).

Autism, honesty and the capacity to deceive

Online magazine InCharacter has an article on what autism can tell us about honesty and deception, by autism researcher Prof Simon Baron-Cohen.

People with autism or related conditions are often poor at both deception and recognising deception in others. It’s not always the case, but it’s quite a common attribute.

Baron-Cohen’s article explores what we know about some of the differences in autistic thinking, and what might be so different that an effective understanding of deception becomes almost impossible.

He argues that a key skill is ‘meta-representation’, the ability to think about other thoughts, imaginary scenarios or abstract principles in yourself or others.

The key is that it’s not just thinking or imagining, it’s being able to think about thinking or imagining.

When this specifically involves thinking about what other people are thinking, understanding their perspective, it is often called ‘theory of mind‘.

You can see why this is a key skill in deception. You need to have a theory or understanding of what the other person is thinking or is likely to think, to work out how to hide the real state of the world from them.

As people with autism often perform poorly on tasks that test ‘theory of mind’ (despite some debate about whether the experiments are suitable) it has been suggested that a poor understanding of deception is a result of this difficulty.

Baron-Cohen’s article examines some of the research behind these ideas, but also looks at why the human race might have generally evolved to be good deceivers, with some notable exceptions in people who are nowadays likely to be diagnosed with autism.

In other autism news, Bad Science has been doing a fantastic job of tackling dodgy news stories that regularly hit the press, particularly a recent front-page Observer article that seemed to have little trouble deceiving people about autism research.

Link to InCharacter autism and deception article.
Link to Bad Science on another type of autism and deception story.

Lying on the Couch with Masud Khan

I’m currently reading Irvin Yalom’s novel about psychoanalysts, Lying on the Couch (ISBN 0060928514), and have noticed that a key character bears a striking resemblance to one of the most controversial people in the history of psychoanalysis, Masud Khan.

Psychoanalysis is both the talking therapy and the set of theories about the human mind that were originally created by Freud. Both have a colourful history owing to the controversial ideas and the eccentric people involved.

In Yalom’s book, Seth Pande is introduced as a senior Indian psychoanalyst who is dying of lung cancer and is being censured by the psychoanalytic society for bringing the profession into disrepute, owing to unethical conduct such as sleeping with patients, financial irregularities and, worst of all, writing about what he does!

Perhaps the real-life inspiration for Pande, Masud Khan, is discussed in an eye-opening article from the Boston Review that looks at his life and also gives an insight into the turbulent world of 20th century psychoanalysis.

Initially a student when he came to the UK, he ended up training with some of the leading psychoanalysts of the time, notably being analysed by Donald Winnicott.

Khan was known for his brilliant writing, but also slept with his patients, insulted them and largely lacked ‘therapeutic boundaries’ (i.e. a responsible doctor-patient relationship) even with those patients whom he didn’t so obviously abuse.

Later in his life, Khan wrote a book called The Long Wait which detailed his anti-Semitic views and outrageous behaviour with a number of patients.

Although it has been suggested that the case studies in his book are fake, it is now well established that Khan was regularly drunk and abusive with his patients, and was kicked out of the British Psycho-Analytical Society. He later died of lung cancer.

A famous 2001 article and subsequent letters published in the London Review of Books ‘outed’ Khan to the general public, who were mostly unaware of his previous misdeeds.

Interestingly, both the fictional Pande and the real-life Khan inspired considerable devotion in some of their patients and trainees. It’s been noted in recent biographies that Khan seemed to behave more responsibly with some people, whom he reportedly genuinely helped.

One of the most interesting things about both Yalom’s enormously fun novel and the Boston Review article is that they give a fascinating insight into the world of psychoanalysis past and present.

One of the great ironies is that for a profession that prides itself in resolving conflicts, psychoanalysts have a long history of stabbing each other in the back.

Link to great Boston Review article on Masud Khan.
Link to (closed access) LRB article on Khan by former patient.
Link to LRB post-article letters page.