Category: Togetherness

A recent study has found that EMDR, a once suspect therapy that involves recalling traumatic memories while moving your eyes, is one of the most effective treatments for post-traumatic stress disorder (PTSD).

EMDR stands for Eye Movement Desensitization and Reprocessing. It’s a type of psychotherapy that, among other things, involves thinking about the traumatic event while attending to bodily reactions and moving your eyes left and right, usually following a light or the therapist’s finger.

It sounds bizarre and caused a great deal of suspicion when it first emerged, largely it was pretty much just ‘thought up’ by Dr Francine Shapiro and no-one really knows quite how it works.

However, several studies have found it to be one of the most effective treatments for post-traumatic stress disorder, and this new study, one of best to date, has repeated the finding.

This new study, led by Dutch psychiatrist Dr Bessel van der Kolk, compared EMDR, with SSRI drug fluoxetine (aka Prozac) and a pill placebo in a group of patients diagnosed with PTSD.

After the eight week treatment block, fluoextine and EMDR were equally effective,

However, six months later, 75% who had been traumatised in adulthood and were treated with EMDR reported having no symptoms. For people traumatised during childhood, a third treated by EMDR were symptom free by the same point.

In contrast, none of the people in either group treated with fluoxetine managed to free themselves from symptoms.

Most clinicians looking at the study might suspect that eight weeks of drug treatment wouldn’t be long enough as prescriptions are often recommended for six months to a year after stabilisation.

Nevertheless, it’s an impressive result, not least because of the short 8-week treatment time for EMDR and the strong recovery rate.

One of the criticisms of EMDR is that it’s still not clear what part the eye-movement aspect plays in the therapy and exactly how it works.

What this trial didn’t do is compare EMDR to cognitive behavioural therapy (CBT), a type of recently devised psychotherapy that is known to be one of the most effective treatments for anxiety disorders.

Both of these therapies focus on ‘reprocessing’ the trauma memories – essentially remembering and ‘reliving’ them, which seems to play a major role in preventing the uncontrolled memories and flashbacks that are part of the disorder.

This is also the focus of a recently devised combined drug and ‘reprocessing’ therapy we reported on earlier, which seems to work by dampening down bodily arousal when the memories are recalled due to the action of the drug propranolol.

Link to abstract of clinical trial.

Singapore art collective A Dose of Light exhibited some poignant and beautiful photographs by Wu Xiao Kang, a 26 year-old man with schizophrenia who later killed himself.

The show gained international acclaim and only later was it revealed that Kang was fictional, a creation of the collective who had taken the photos themselves.

The project consisted of 36 photos supposedly taken by Kang of an abandoned psychiatric hospital in which he was previously treated.

A Dose of Light designed the whole project as a conceptual artwork to portray the breakdown of reality that sometimes occurs in schizophrenia.

Several galleries and events hosted the exhibition in good faith, and one gallery has now pulled the exhibition in protest.

According to one newspaper report, the group decided to come clean on July 1st when a mental health charity wanted to use the images to promote awareness of mental illness in Singapore.

However, I first saw the photos at Bonkers Fest, an art and music event held in Camberwell, London on June 2nd, that also promotes awareness of mental health issues and is organised by a number of mental health charities.

In this case, there was no admission that the Kang was fictional and the photos were presented as genuine.

One member of the collective, Robert Zhao is a fine art student at Camberwell College of Arts, who were also partly involved in organising the festival.

Link to online ‘Wu Xiao Kang’ exhibition.
Link to Metafilter on the controversy.

The New York Times magazine has a great article on Williams Syndrome, the genetic disorder which leads to cognitive impairment, but with normal language and an outgoing and ‘chatty’ personality.

The article investigates the impact of this condition, but also explores what it tells us about the genetics of sociability.

Williams Syndrome results from the deletion of region q11.2 (section 11.2 of the ‘q’ or long arm) of chromosome 7. This causes 20 or so normally present genes to be missing.

The syndrome is associated with learning difficulties, slight facial differences and heart problems (not unlike several other genetic syndromes that affect the brain).

However, people with the syndrome are notable for their interest in language and conversation. They will often have a surprising vocabulary and delight in unusual words.

They also have what has been described as a ‘cocktail party personality’, meaning that they are outgoing, gregarious but often aren’t capable of dealing with deeper social issues because of their lower IQ.

The online article also has a video interview with someone with the syndrome who explains how it affects them and their family.

If you’re interested in hearing more about Williams Syndrome, NPR had an excellent radio show about it last year that’s well worth listening to.

Link to NYT article ‘The Gregarious Brain’.
Link to NPR programme ‘Williams Syndrome: It’s Not a Fairy Tale’.

National Geographic has just published an article on swarm behaviour in animals and how this is being applied to understanding human behaviour and improving complex systems.

The article looks at how whole groups of animals seem to have intelligence, while individually they only seem to be able to perform very simple actions.

One of the big discoveries in this area is that complex problem solving behaviours can emerge from a group of individuals who each follow simple rules.

The article also mentions Craig Reynolds, a computer scientist who has been working on computer simulations of flocking behaviour.

He has a fantastic page with animated demonstrations and explanations of his work if you want to see how it all fits together.

This technology was used to simulate flocks in Hollywood movies like Batman Begins but is also being used by everyone from the military to internet technology companies in an attempt to develop distributed but efficient problem solving systems.

Link to National Geographic article ‘Swarm theory’.
Link to Craig Reynolds ‘boids’ page.

A brief article published in the Journal of the Royal Society of Medicine in 2001 reported the case of a young man who suffered delusions that he was a player inside a computer game.

The game isn’t mentioned by name, but it seems to be Grand Theft Auto.

The authors of the case study point out that they’re not suggesting that computer games cause psychosis, but they comment on how it’s a somewhat unusual illustration of how ideas from a person’s life get incorporated into the themes of psychosis.

A young man was admitted from prison to a psychiatric facility after reports that he had been acting in a bizarre manner. He had been arrested for stealing motor vehicles and assaults with weapons. At interview he was found to be experiencing the delusion that he was a player inside a computer game (adult-certificate game, widely available) in which points are scored for stealing cars, killing assailants and avoiding police vehicles.

Psychotic symptoms had emerged slowly over two years. His family had noticed him becoming increasingly withdrawn and isolated from social activities. He developed delusions that strangers were planning to kill him and also experienced auditory hallucinations, constantly hearing an abusive and derogatory voice. Previously a computer enthusiast, he began to play computer games incessantly. He felt that the games were communicating with him via the headphones.

In a complex delusional system he came to believe he was inside one of these games and had to steal a car to start scoring points. He broke into a car and drove off at speed, believing he had `invulnerable’ fuel and so could not run out of petrol. To gain points he chose to steal increasingly powerful vehicles, threatening and assaulting the owners with weapons. Later he said he would have had no regrets if he had killed someone, since this would have increased his score.

After arrest and while in prison he continued to believe he was in the game, despite initial medication. When he was admitted to hospital six weeks later, part of ward management was to deny him access to computer games. Nothing abnormal was found on physical examination, blood investigations, drug screen, electroencephalography or a computed tomographic brain scan. Paranoid schizophrenia was diagnosed and he responded well to further treatment with antipsychotic medication.

Similarly, ‘rock and roll delusions’ have occasionally been reported in the medical literature (David Bowie seems to be a favourite).

Link to JRSM full-text article ‘Computer Game Delusions’.

The New York Times reports on a new study that examined how doctors disclose information about themselves during patient consultations. The study found that disclosures are usually for the benefit of the doctor and rarely help the patient.

The study recorded 113 doctor-patient interactions and analysed the conversation for themes, timing, effect and number of self-disclosures.

Self-disclosure is usually specifically covered in clinical training and, if done carefully, is thought to enhance the relationship with the patient and make them feel more at ease.

In this case, the research team found that none of the self-disclosures were primarily focused on patient concerns and only 4% were useful, providing education, support, explanation, or acknowledgment, or prompting some indication from the patient that it had been helpful.

The study also contains a few transcripts, including this gem:

Physician: No partners recently?

Patient: I was dating for a while and that one just didn’t work out. . . . about a year ago.

Physician: So you’re single now.

Patient: Yeah. It’s all right.

Physician: [laughing] It gets tough. I‚Äôm single as well. I don’t know. We’re not at the right age to be dating, I guess. So, let’s see. No trouble urinating or anything like that?

As was found in a previous study, it was also found that the longer the doctor talked about themselves, the less likely it was to be useful.

We tend to think of medical diagnosis as a scientific process, but so much of it relies on conversation, with patients – to get their experience of symptoms, and colleagues – to get their opinions and advice. In other words, it relies as much on negotiation as diagnostic tests.

Another key element is how the doctor transforms the patient’s personal problem into a medical one, so he or she can apply medical knowledge and problem-solving techniques to it.

As found by a key study in medical sociology, doctors use various non-scientific strategies to interpret the objective medical symptoms while making a diagnosis.

When medicine is discussed as ‘part art, part science’, the art seems to be in how doctors interact with their patients and interpret their concerns, which seems to be equally as important as medical tests.

Link to NYT article ‘Study Says Chatty Doctors Forget Patients’.
Link to abstract of study.

Childhood stress can interfere with the development of the teeth to the extent that a traumatic experience leaves a recognisable line in the tooth enamel that remains as a record of past traumas.

I discovered this when reading about a study published in the Annals of the New York Academy of Sciences [pdf] that used these lines to compare the number of childhood traumatic experiences that occured in people diagnosed with schizophrenia and healthy controls.

New approaches to the problem of estimating stress during early brain development are required. In this regard, human enamel has promise as accessible repositories of indelible information on stress between gestation and the age of 13. Stressful experiences induce long-term activation of the sympatho-adrenal system, slowing of tropic [growth-related] parasympathetic functions, and they then induce disrupted secretion of the enamel matrix.

During the brain development (in infancy, childhood and preadolescence), ameloblast activity in human enamel is slowed during 1 to 2 days of extreme stress, and the segment of enamel rods is smaller and often misshapen, making a particular dark line seen by the use of a microscope (we referred this line to Pathological Stress Line, PSL in short). Retzius reported that this line is incremental lines reflecting the layered apposition of enamel during amelogenesis (Retzius, 1937), and after that this line is termed the Retzius line. The line is conceptually akin to tree rings which are markers of environmental adversity in the tree’s life.

Schizophrenia was once thought to be largely caused by genetic factors, but in the last decade a number of studies have shown that childhood trauma contributes to the chance of developing the disorder.

One difficulty with this type of research is that it often relies on people remembering back to their childhood after the onset of psychosis, which could mean that the memories aren’t perfectly reliable in some cases.

Stress-induced lines in tooth enamel are one way of looking at the link between trauma and schizophrenia that doesn’t rely on potentially hazy memories of the past.

Link to abstract of study.
pdf of scientific paper.

Science has just published a study of almost a quarter-of-million people providing strong evidence that oldest children have slightly higher IQs, and, most interestingly, the evidence suggests that this isn’t a biological effect – it’s likely to do with family environment and upbringing.

In fact, first-born children are known to have a number of psychological differences. For example, they are less likely to be gay, show differences in autistic-like traits, and are typically less severely affected by schizophrenia if it occurs.

These differences have often been explained by a theory that argues that the mother adapts her immune system during the first pregnancy and it might not be fully attuned to later children and this might affect the brain development of subsequent children.

In order to test this idea the Science study looked at the records of almost 250,000 Norwegian army recruits, all of which have routine IQ tests and full medical and family histories.

It turned out, as has been found many times before, that first-born children had higher IQs by about 3 points on average.

Crucially, it also turned out that some second-born children who had an older sibling who had died young also had higher IQs.

In other words, although they were second-born biologically, they were brought up as the oldest child after their sibling passed away.

Being brought up as the oldest child seems to be the crucial factor: family-rank, not birth order affects IQ. This suggests that the immune system theory is unlikely to explain this effect.

This has generated a great deal of discussion and many parents are interested in whether they can provide the ‘first child advantage’ to their younger children as well.

The New York Times featured the study and just published a follow-up article discussing the role of family-dynamics in the development of intelligence after all the interest it generated.

Some psychologists are suggesting that the effect might be because older children get the chance to coach the junior family members which may help them consolidate knowledge and provide practice in manipulating information.

It’s also interesting that a recent study on birth-order in Thai medical students found exactly the reverse pattern. Younger siblings were found to be more intelligent and have more positive personality factors.

All of these studies suggest that culture and environment are crucial factors during childhood, both for mental and emotional development.

Link to abstract of Science study (thanks Laurie!).
Link to NYT write-up.
Link to NYT on intelligence and family dynamics.

The New York Times has an interesting opinion piece on using genetic tests to determine which psychiatric drugs will be most effective and least problematic.

It is starting to become known that people with certain genes or sets of genes react to drugs differently.

These could be genes related to aspects of brain function, or, just as importantly, liver function, because many psychiatric drugs are broken down by enzymes in the liver.

For example, enzyme CYP2D6 metabolises a whole range of psychiatric drugs including antidepressants and antipsychotics.

Some people have certain versions of the CYP2D6 gene which means they have much less of the enzyme and so break these drugs down at a much slower rate.

This means the same dose of the drug in these people will have a much stronger effect, which can lead to increased side-effects.

There are many more examples of how genes influence the effects of drugs, and doctors would ideally like to be able to test people beforehand to see which drugs might be better.

Like most mass-market industries, the drug industry prefers a ‘one size fits all’ approach, advertising their pill as suitable for anyone with a particular condition.

The idea of genetically testing people for drug suitability is causing them a bit of a headache at the moment, as they’re desperately trying to think of ways to make money out of it.

The New York Times article is quite positive about the effect this will have on the relationship between medicine and industry:

Aside from the potential to transform clinical psychiatric practice, these new developments will surely change the relationship between doctors and the drug industry and between the industry and the public. Direct-to-consumer advertising will become nearly irrelevant because the drugs will no longer be interchangeable, but will be prescribed based on an individual’s biological profile. Likewise, doctors will have little reason to meet with drug company representatives because they won’t be able to give doctors the single most important piece of information: which drug for which patient. For that doctors will need a genetic test, not a salesman.

Of course, it could just lead to people with common genes being prescribed cheap, widely available treatments, while those with rarer genetic profiles having to pay more for expensive, niche medicines.

Almost certainly, it will lead to the drug industry getting into the genetic testing market, probably with equally as many advantages and drawbacks as exist with their current marketing strategies.

Link to NYT on ‘On the Horizon, Personalized Depression Drugs’.

Today’s Washington Post has an article on the psychology of rejection in children’s social circles and its possible long-term effects on behaviour and mental health.

It comes in the wake of the Virginia Tech massacre and it aims to make sense of bullying and rejection by looking at scientific studies in the area.

These have uncovered which things make a child more likely to be rejected, and what is likely to occur when it happens.

One key finding is that early rejection means that children are less likely to develop social skills, meaning continued rejection is more likely.

This has led to a focus on ‘early intervention’ for troubled children to try and prevent them from getting caught up in the vicious circle of social exclusion.

This is a valuable project because rejection is known to be associated with depression, behaviour problems and chance of becoming involved in criminal activities.

The article looks at some of the recent studies that have focused on this area, and talks to some of the professionals involved in trying to make a difference with vulnerable young people.

Link to article ‘A Better Response to Rejection’.

Both Time and Slate have just run articles on the often neglected field of fatherhood, where they report on the significant brain changes and unique psychological processes linked to male parenthood.

I sometimes think you can’t blame fathers for feeling like they’re unimportant when science has relegated them to a footnote in the parenting process.

This is slowly beginning to change and increasingly research is showing that fatherhood and impending-fatherhood has a unique effect on the mind and brain.

For example, fathers have unique hormonal changes during their partner’s pregnancy and when interacting with their child that significantly affects their brain.

And yet despite these findings, few scientists treat the physiology of fathers as a serious subject in its own right. Researchers have been investigating some of the hormonal swings in humans for almost a decade, and longer in other species; still, most of this work remains on the fringe. Between 2000 and 2006, the journal Hormones and Behavior published nearly three times as many studies of mothers as of fathers, and this year the count so far is 16 to three. A 2000 review framed research into physiological fatherhood as “an opportunity to better understand maternal behavior, by studying parental behavior in the absence of pregnancy and lactation.” Interest in how men’s bodies prepare themselves for fatherhood only seems to matter to the extent it sheds light on mothers. Meanwhile, the ways in which dads screw up their kids is a thriving area of research.

It’s also interesting how stories on fatherhood are presented.

BBC News recently reported on a new study (which I haven’t been able to track down yet, except as a press release) that looked at couvade syndrome – where fathers experience physical symptoms as their partners go through pregnancy.

This is entirely explained in terms of ‘anxiety’ and being ‘attuned’ to their partners.

This is despite the fact that researchers have been arguing for over a decade that the syndrome is equally as influenced by the biological changes brought on by fatherhood.

In contrast, the popular reporting on pregnancy and women is awash with the effects of hormones on behaviour and often ignores the psychological aspect.

In other words, women who experience changes in thinking or behaviour are described if they’re slaves to their hormones whereas symptoms in men are due to anxiety and over-identification.

It’s an interesting twist on how our stereotypes about sex roles and parenting play out in science and popular culture.

The Time and Slate articles attempt to redress the balance by examining research on the role of fathers and how their body and brains react to pregnancy and childcare.

Link to Slate article on what fatherhood does to the body and the brain.
Link to Time on the psychology of fatherhood.

This week’s Science News has an article on transference, originally a Freudian concept of how feelings from one relationship can affect another if the two people share similarities.

In its simplest sense, transference is taking out your feelings of frustration on your partner when you’ve just had an argument with the bus driver. You’ve just transferred them from one person to another.

More commonly, it’s used to describe the idea that you re-experience certain feelings and relationship patterns you developed with important people in your childhood when you meet new people who share similarities with the original person.

In other words, if you didn’t trust your father, you’re less likely to trust people who remind you of your father.

Transference is key in Freudian psychotherapy, where the therapist attempts to be a ‘blank screen’ onto which the patient can project and transfer their feelings through the therapeutic relationship.

This allows the therapist to see the process in action and make the patient aware of it, so they can change and improve their relationship patterns.

This is one Freudian concept that has remained quite popular in modern psychology, although it’s rarely been subjected to controlled research.

This is beginning to change, however, as some researchers are starting to test the idea experimentally, and finding that the effects seem to be measurable in the lab.

The Science News article looks at some of the research being conducted by Profs Susan Andersen and Glen Gabbard that has been exploring this interesting interpersonal effect.

Link to Science News article ‘Past Impressions’.

The Washington Post published an interesting article last week on research suggesting that human traits like generosity and altruism may be innate.

It describes a number of experiments which are tackling the relatively new field of ‘moral neuroscience’, which aims to understand how the brain is involved in moral decision-making.

What is interesting is that some of the brain areas found to be associated with this form of reasoning are those thought to be quite ‘old’ in evolutionary terms.

In one 2004 brain-imaging experiment [pdf], Greene asked volunteers to imagine that they were hiding in a cellar of a village as enemy soldiers came looking to kill all the inhabitants. If a baby was crying in the cellar, Greene asked, was it right to smother the child to keep the soldiers from discovering the cellar and killing everyone?

The reason people are slow to answer such an awful question, the study indicated, is that emotion-linked circuits automatically signaling that killing a baby is wrong clash with areas of the brain that involve cooler aspects of cognition. One brain region activated when people process such difficult choices is the inferior parietal lobe, which has been shown to be active in more impersonal decision-making. This part of the brain, in essence, was “arguing” with brain networks that reacted with visceral horror.

Such studies point to a pattern, Greene said, showing “competing forces that may have come online at different points in our evolutionary history. A basic emotional response is probably much older than the ability to evaluate costs and benefits.”

Link to Washington Post article.
pdf of paper mentioned in excerpt.

A poem from the book Uncut Confetti by the brilliant John Hegley:

For Therapeutic Purposes

I have not been quite right in the head
Like a balding tyre, I’ve been losing my grip
I have been given various medications
to help me cope
anti-depressants
anti-psychotics
And my brother has given me
a skipping rope.

Hegley’s poems move effortlessly between the comic and the achingly poignant, and often touch upon the more curious aspects of human nature.

American TV discussion host Charlie Rose has a series of programmes available online where some of the world’s leading researchers discuss Freud, neurobiology and the latest in psychological treatments for mental illness.

The first programme is a discussion of the legacy of Freud, with neurobiologist Eric Kandel, Freudian psychotherapist Peter Fonagy, inventor of cognitive therapy Aaron Beck and psychiatrist Charlie Roose.

It is a great guide to the differences between Freudian and cognitive approaches to psychotherapy, as well as how it relates to brain function and modern neuroscience.

A second programme looks at a similar topic, but expands the discussion to include cognitive psychological research and also includes psychologists Nancy Kanwisher, Nora Volkow, Rebecca Saxe and Liz Phelps.

Finally, one is a special interview with Eric Kandel, which is guest hosted by fellow Novel Prize winner Harold Varmus, who, incidentally co-founded PLoS – the organisation behind some of the world’s finest open-access science journals.

The BPS Research Digest covers a simple yet fascinating study on the power on lightly touching someone’s arm when trying to persuade them.

In this case, the psychology study involved a man asking women to dance or for their phone numbers.

A good-looking man approached 120 women in a night club over a period of three weeks, and asked them to dance. It was in the name of science – the man was an assistant to the psychologist Nicolas Guegen. Remarkably, of the 60 women who he touched lightly on the arm, 65 per cent agreed to a dance, compared with just 43 per cent of the 60 women who he asked without making any physical contact.

A second study involved three male research assistants approaching 240 women in the street and asking them for their phone numbers. Among those 120 women who the researchers touched lightly on the arm, 19 per cent agreed to share their number, compared with 10 per cent of the women with whom no physical contact was made.

Christian has a fantastic talent for finding really intriguing studies and this is a particularly good example.

Have a look at his article for more on why this effect might occur.

Link to BPSRD on ‘The power of a light touch on the arm’.