Month: March 2012

Nature has an important article on why virtually no-one is trying to develop treatments to prevent suicide because research with such high-risk patients is almost impossible to get approved.

Most psychiatric drug trials today—the majority of which are industry sponsored—exclude anyone expressing thoughts of suicide. This is for ethical as well as practical reasons: physicians consider it taboo to give people on the brink of suicide an experimental drug, let alone a placebo, if other options are available, and many additional safety precautions are required to run trials in this vulnerable population. To complicate matters, few mental health experts are trained in how to conduct suicide research, and those who do are often afraid of lawsuits.

As a result, institutional review boards aren’t always so amenable to this kind of high-risk research. “It takes forever to get anything approved to do suicide prevention research, and it’s incredibly frustrating,” says Marjan Holloway, a clinical psychologist who is running clinical trials with suicidal military personnel at the Uniformed Services University of the Health Sciences in Bethesda, Maryland. Kate Comtois, a psychologist at the University of Washington in Seattle who has run psychotherapy trials in people with borderline personality disorder (BPD), expresses a similar concern. “I hear many stories from other institutions where people have basically given up recruiting high-risk patients because their institutional review boards are so cautious that they throw up roadblocks,” she says.

Suicide research also suffers from a practical problem related to the development of risk-assessments.

Normally, if I want to develop a way of predicting who will develop depression or not, I can assess a group of people and I can return later and see whether my predictions were right or not.

If I do the same with a suicide assessment and it suggests that several people are at high-risk of suicide, I have a moral duty to intervene and help them.

What complicates the issue is that this often applies regardless of the quality of my assessment. In other words, imagine that my suicide assessment is useless but I don’t know it – I will still intervene.

This means it’s often hard to get the assessment ‘off the ground’ in terms of its testing and development and this is why most scales are based on research looking at less serious outcomes, like having suicidal thoughts, that aren’t a very good predictor of whether someone will actually try to kill themselves or not.

This is also one reason why ethical review boards, and indeed researchers, are reluctant to get involved in this research.

Who wants to be known as someone who had several patients kill themselves during a trial to test an experimental form of suicide prediction? Despite the fact that, actually, virtually all the established scales are equally as ‘experimental’ due to lack of data.

The Nature article does a fantastic job of tackling these delicate issues and highlighting the need for better research on a crucial issue.
 

Link to Nature article ‘The Ultimate Endpoint’ (via @Neuro_Skeptic)

The New York Times has an extended article that uncritically dicusses a $125 million US Military programme currently designed to increase resilience against mental illness.

If you’re interested in the effects and treatment of psychological trauma, it’s always worth keeping tabs on what the military are doing. The concept of trauma has largely been driven by the military and they are usually pioneers in developing treatments and interventions.

The Comprehensive Soldier Fitness programme is a US Army programme based on positive psychology and was developed with the help of the field’s guru Martin Seligman.

Rather than aim to treat mental health problems, it aims to prevent them by improving the psychological strength of individual soldiers. Owing to the fact that the US Military has surprisingly high levels of PTSD, it is clearly designed with this in mind.

It involves completing a 110 item questionnaire called the ‘Global Assessment Tool’ that gives scores based on the four domains of programme: emotional fitness, social fitness, family fitness and spiritual fitness (it would be interesting to see how atheists score on this last part).

The idea is that the programme can then be tailored to the GAT profile of each soldier to strengthen vulnerabilities and build on existing strengths.

If you were going to base your programme on a psychometric assessment, most importantly, you would want to know that your assessment predicted problems or coping in particular soldiers.

For example, if a particular soldier had a low score on, let’s say, the emotional fitness part of the scale, it would be important to know that tells us about what sort of problems the soldier is likely to have in real life and during his or her service.

You would also want to know that the assessment told us about the likelihood of the solider getting mental illness. It makes sense, right? If you’ve designed a programme intended to prevent mental illness based on an assessment, the assessment should tell us which soldiers are at higher risk for psychiatric difficulties so we can help with skills and abilities that mitigate the risk.

In psychological jargon, this is known as predictive validity and it can be tested statistically.

It is not known whether the Global Assessment Tool does actually predicts anything useful about US soldiers’ problems because this was never tested.

We know this because the GAT and the other aspects of the Comprehensive Soldier Fitness Programme were the subject of the special issue of American Psychologist that had numerous articles on the development and evidence for the programme by the programme’s creators, including an article on the GAT.

As a whole, it seems the Army implemented the programme wholesale and has since been evaluating it in retrospect, which seems a little bit of an odd way of going about it.

By the way, the New York Times article is really focused on ‘posttraumatic growth’ – the psychological benefits that surviving trauma can bring. In places it seems to imply a sort of split view of the phenomenon where you either are traumatised or experience growth – when in reality, it’s possible to be both disabled in some aspects of life while growing in others.

One of the best things I read on this recently was Stephen Joseph’s book What Doesn’t Kill Us: The Psychology of Post-Traumatic Growth (note: I’m blurbed on the back but I don’t make any money from it) that, as a level-headed look at the concept, comes highly recommended.
 

Link to NYT article on post-traumatic growth.

Slate has an article covering the growing research on post-sex behaviour – what we do after we’ve got it on and what it might mean.

To be honest, I had no idea that anyone was studying what people do after sex but it sounds like the science is well underway.

Counter to popular opinion, a dated study, and the great wisdom of many lady mags, researchers have not found that men fall asleep faster than women after sex. In fact, according to a recent study [pdf] of heterosexual pairings by Kruger and Hughes, a woman is just as likely as a man to be out first. But — and here’s the interesting part — regardless of gender, the partner who stayed awake longer reported that they weren’t getting enough post-sex hugging, kissing or talking – what evolutionary psychologists call “pair bonding” activities…

And what about the other activities people move on to after sex, like hanging out in bed, ordering Chinese food, or smoking a cigarette? Earlier in 2011 Kruger and Hughes published a report in the Journal of Sex Research, considering a wider range of after-sex impulses. In that case they found that our post-coital behaviors – again considering only heterosexual sex – tend to split along gender lines. Eating, fixing yourself a drink, smoking and asking your partner for favors – all activities that sound pretty good to me – were more likely to be taken on by the men. The women, in this case, placed greater importance on behaviors related to intimacy, like cuddling and “professing their love.”

From reading the article though it’s clearly a fascinating area, even if the research seems only to have looked at heterosexual sex so far.

Apparently though, my preferred behaviour, apologising, seems barely to feature at all.
 

Link to ‘After the Climax’ from Salon (via @QMUPsychology)

I’ve just found a disappointing study from the European Journal of Psychology that found that physically attractive people are more likely to be psychologically balanced and accepting than the rest of us.

The study asked 119 participants to complete the Personal Orientation Inventory, a measure of psychological characteristics such as self-acceptance, spontaneity and self-actualisation, while a photo of each was also rated on physical attractiveness by a six person panel.

The study revealed that participants in the high attractiveness group scored significantly higher on 7 of the 12 POI scales in comparison to the participants in the low attractiveness group: Inner-Directed, Self-Actualising Value, Feeling Reactivity, Spontaneity, Self-Regard, Self-Acceptance, and Capacity for Intimate Contact.

The researchers debate why more attractive people might, on average, end up being more psychologically accepting of themselves and others.

They suggest that it could be due to a self-fulfilling prophecy effect. Previous research has shown that good looking people are stereotyped as being more confident, warm, dominant, stable and socially skilled, among other things, and being treated this way could enourage exactly these sorts of behaviours and attitudes.

Personally, I have been trying to cultivate a shallow and empty persona in the hope that it would make me seem more physically attractive but I now realise I should have been saving to enhance my rack as a form of personal development.
 

Link to study.