Psychotherapy has drug-like effect on the brain

There is now widespread evidence that successful psychological therapies induce changes to brain function, often in a way comparable to drug treatments. That’s according to a new review by Veena Kumari at the Institute of Psychiatry.

Take the example of depression: a recent brain imaging study found recovery was associated with decreased metabolism in the ventrolateral prefrontal cortex, both in patients who had improved after taking Seroxat, and in patients who had undergone successful cognitive behavioural therapy (CBT). Successful CBT was also associated with brain changes not seen with Seroxat, including increased activity in the cingulate, frontal and hippocampus regions, probably reflecting a cortical ‘top down’ mechanism of action.

Or consider the treatment of obsessive compulsive disorder: another brain imaging study found recovery was associated with similar changes in the right caudate metabolic rate, following either behavioural therapy or Prozac.

Elsewhere, more research is needed. CBT is often beneficial to schizophrenia patients who don’t respond to antipsychotic medication but no research has yet been published on the neural correlates of this benefit.

“The reviewed studies clearly demonstrate that psychological interventions, such as CBT, are able to modify activity in dysfunctional neural circuitries linked to the development of various psychopathological conditions” Kumari concluded.

In fact, she added that psychotherapy may provide a clearer insight into the brain changes associated with recovery from mental illness because “it has minimal side-effects (if any) and [unlike drugs] lacks direct pharmaceutical actions to obscure brain changes directly related to behavioural change…”.
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Kumari, V. (2006). Do psychotherapies produce neurobiological effects? Acta Neuropsychiatrica, 18, 61-70.

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Educational TV must overcome young children's 'video deficit'

Designers of educational television for young children face a major stumbling block: two-year-old children tend to ignore information presented to them on a TV screen.

For example, in an initial study by Georgene Troseth and colleagues, two-year-olds told face-to-face where a toy was going to be hidden went and found it in the first place they looked 77 per cent of the time, whereas those told by the same researcher via a video-recording found the toy in the first place they looked just 27 per cent of the time.

Troseth’s team think this ‘video deficit’ is caused by the fact young children quickly learn to distinguish between video and reality, predisposing them to ignore information presented by someone on TV.

One way to overcome this could be to encourage children to see the person on TV as socially relevant. To test this, some two-year-olds interacted with a researcher over a live video-link for five minutes, playing games, chatting and singing songs. Later on, when the researcher appeared on a pre-recorded video telling the same children where she had hidden a toy, they went and found it in the first place they looked 69 per cent of the time. In contrast, a control group of children who hadn't interacted with the researcher over the live video-link earlier on, found the toy just 35 per cent of the time.

“Learning that a person on video was a social partner who could share relevant information eliminated the typical deficiency in two-year-olds’ acquisition and use of information from video”, the researchers said.

The finding has implications for the design of educational TV. “If social cues suggest that people on television are serving as conversational partners, children will be more likely to pay attention and learn” the researchers concluded, pointing to the example of Blues Clues as a programme that is “on the right track”.
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Troseth, G.L., Saylor, M.M. & Archer, A.H. (2006). Young children’s use of video as a source of socially relevant information. Child Development, 77, 786-799.

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Caring for learning-disabled clients with challenging behaviour

Care staff working with learning-disabled clients who also exhibit challenging behaviours – for example, throwing objects, screaming and hoarding things – could be particularly prone to making the ‘fundamental attribution error’, that is believing the client is behaving that way deliberately because of who they are, rather than because of their circumstances. That’s according to a study by Luise Weigel and colleagues at the University of East Anglia.

Fifteen care staff were asked to recall two recent negative events, one involving a client of theirs who had intellectual disabilities and displayed challenging behaviours, and another involving a client who had intellectual disabilities but who did not exhibit challenging behaviour.

Unlike their view of negative events involving the learning-disabled client who didn't have behavioural problems, the staff tended to describe the negative events involving the client with challenging behaviour as being more within that client’s control, and they believed such events had less to do with environmental circumstances and more to do with the client. Moreover, when asked to comment for five minutes on the two clients, the staff were more critical, hostile and overly emotionally involved when talking about the client with challenging behaviour.

To help care staff working with people with intellectual disabilities and challenging behaviour, Dr. Peter Langdon, a co-researcher on the study, told The Digest that he and a colleague were attempting to adapt a family intervention programme used with families who have a relative with psychosis (previously developed by Elizabeth Kuipers and colleagues). The new intervention for care staff would involve “psycho-education, and a cognitive component” he said.
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Weigel, L., Langdon, P.E., Collins, S. & O’Brien, Y. (2006). Challenging behaviour and learning disabilities: The relationship between expressed emotion and staff attributions. British Journal of Clinical Psychology, 45, 205-216.

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The misrepresentation of coma in films

The unrealistic portrayal of coma in films could be misleading the general public at a time when society has been so bitterly divided by the ethical issues raised by high-profile cases like that of Terri Schiavo. She died last year after her feeding tube was removed, following 15 years living in a persistent vegetative state.

Eelco and Coen Wijdicks at the Mayo Clinic College of Medicine analysed the portrayal of coma in thirty popular films, including Kill Bill and Regarding Henry. In all the films bar one, coma patients were seen to remain well-groomed with a normal, muscular tanned appearance. In 18 of the films, the coma patient awoke, usually in a sudden fashion and without any noticeable cognitive deficits.

The authors said that not showing the muscle atrophy, bed sores, incontinence and feeding tubes associated with coma “may be a conscious decision to maximise entertainment but is a disservice to the viewer”.

"To imply full physical and cognitive recovery after prolonged coma is gratuitous", they added.

Indeed, a survey of 72 lay viewers who were shown 22 scenes taken from the analysed films revealed more than a third would use the fictional scenes to inform decisions that could potentially face them in real life.

“We are concerned that the comatose states depicted in these movies often can be misinterpreted as realistic representations” the authors concluded. However, they pointed to one film ‘Dream Life of Angels’ “…that was truly able to convey the complexities of care surrounding a loved one in a coma”.
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Wijdicks, E.F.M. & Wijdicks, C.A. (2006). The portrayal of coma in contemporary motion pictures. Neurology, 66, 1300-1303.

Link to Hollywood coverage of mental disorders, from The Psychologist magazine.

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Three-person groups best for problem-solving

Individuals may outperform groups when it comes to brainstorming for ideas (see earlier post), but for logic-based problem solving, it seems three-person groups work best.

That’s according to Patrick Laughlin and colleagues who tested 760 students on a series of letters-to-numbers problems. Such problems involve the numbers 1 to 10 being allocated to the letters A to J, and the task is to find out which letters refer to which numbers in as few trials as possible. On each trial, equations (e.g. A + B = ?) are put to the researchers who will provide the answer in letter form, and the students can then make a guess for what that letter stands for, with the researchers saying whether the guess is true or false.

For each of 40 letter-to-number problems, the performance of students working alone was compared with the performance of a two-, three-, four- and five-person group working on the same problem.

The two-person groups didn’t tend to perform any better than the best of two students who were working alone on the same problem. However, the three, four and five-person groups consistently outperformed the best of three, four or five individuals working alone on the same task as them. The groups solved the problem more quickly and used more sophisticated equations.

However, the four- and five-person groups were no better than the three-person groups, suggesting a team of three is the optimum group size for logic-based problem solving.

“If groups of three perform as well as groups of larger size, it is obviously a more efficient use of human and logistic resources to use three-person groups”, the researchers concluded. “Further research should be conducted to determine whether three persons are necessary and sufficient for groups to perform better than the best of an equivalent number of individuals on other problem solving tasks”.
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Laughlin, P.R., Hatch, E.C., Silver, J.S. & Boh, L. (2006). Groups perform better than the best individuals on letters-to-numbers problems: Effects of group size. Journal of Personality and Social Psychology, 90, 644-651.

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Brain dread

It makes time slow down when you want it to go fast, and it keeps turning your mind back to the very thing you want to forget – dread is a most unpleasant emotion. Now Gregory Berns (pictured) and colleagues at Emory University School of Medicine think they’ve found where dread is represented in the brain.

Berns’ team scanned the brains of 32 participants while applying electric shocks to their feet. Dread was induced in the participants by giving them information before each shock that told them how powerful it would be and how long until it would be applied (e.g. “60 per cent strength in 27 seconds”).

Compared with the 23 participants classified as mild dreaders, the researchers found the nine participants classified as extreme dreaders exhibited more activity in their caudal anterior cingulate cortex, a part of the brain’s pain ‘matrix’ that is known to be involved in paying attention to the location of pain. However, levels of activity in the amygdala, a region associated with fear and anxiety, did not differ between the two groups.

“Taken together, the anatomical locations of dread responses suggest that the subjective experience of dread that ultimately drives an individual’s behaviour comes from the attention devoted to the expected physical response and not simply a fear or anxiety response”, the researchers wrote. In other words, dread can probably be reduced by distracting yourself from what it is you're dreading.

The participants were classified as mild or extreme dreaders based on their pattern of behaviour in a different part of the experiment in which they had to choose between more pain sooner versus less pain later (i.e. after a longer period of dread). The extreme dreaders sometimes chose more pain sooner, and they also reported finding the longer waits more unpleasant than trials in which the electric shock came sooner.

“The neurobiological mechanisms governing dreading behaviour may hold clues for both better pain management and improvements in public health”, the researchers concluded.
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Berns, G.S., Chappelow, J., Cekic, M., Zink, C.F., Pagnoni, G. & Martin-Skurski, M.E. (2006). Neurobiological substrates of dread. Science, 312, 754-758.

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Extras

Studies that didn't make the final cut this fortnight:

Does the detrimental effect of early deprivation on children's cognition last into adolescence?

Improving the labelling of medicines to reduce patient confusion.

The psychological and health effects of disasters on firefighters.

Neurons in the orbitofrontal cortex encode the value of offered and chosen goods.

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Spread the word

Please help us spread the word about our free Research Digest service.

As well as the Blog, the Digest is also available as a fortnightly email, which includes pointers on how the research fits into the Psychology A-level syllabus here in the UK, plus a link for downloading the latest Digest as a printable PDF.

It would also be great if you could print off our free posters (pictured above and below, and downloadable here and here) and put them up wherever you think people might be interested in reading about new psychology research.

If you write or host a psychology-related blog, please do get in touch so that we can swap links.

Many thanks to Marginal Revolution and Mind Hacks and all the other sites who have already sent readers this way!

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Introducing the Super Shrink

From 'the archives', first published in the Digest 19/1/2004

When it comes to client recovery, it's not the type of therapy that matters so much as the individual therapist who's giving it - that's the message from a study by researchers at Brigham Young and Ohio universities in America.

John Okiishi and a team of colleagues examined real-life data from 1,841 student clients with problems ranging from homesickness to personality disorder, who between them saw 56 therapists at a large university counselling centre. Before each therapy session, clients completed an outcome questionnaire designed to track their progress and recovery.

The researchers found no effect of therapists' sex, level/type of training, or their theoretical orientation (cognitive behavioural, humanistic or psychodynamic) on clients' recovery. There were, however, massive differences between therapists in the typical outcome of their clients and the duration of therapy. A client seeing one of the top three therapists(on average) could expect to feel dramatically better after a few weeks treatment. By contrast, a client seen by one of the bottom three therapists could expect, on average, to feel the same, possibly worse, after three times as much treatment. The range of severity of clients' problems at treatment onset was similar for the different therapists.

The authors concluded "something about these (more successful) therapists and the way they work, independent of the amount of time spent with clients, has a significant impact. . . There is an urgent need to take account of the effectiveness of the individual therapist and it is time for clinicians to welcome such research".
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Okishi, J., Lambert, M.J., Nielsen, S.L. & Ogles, B.M. (2003). Waiting for supershrink: an empirical analysis of therapist effects. Clinical Psychology and Psychotherapy, 10, 361-373.

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Recognising the sacrifice of organ donation

Eight thousand people in the UK are waiting for donated organs to become available; over 90,000 are waiting in the USA. This chronic shortage will continue while pro-donation activists continue to oversimplify the issue by focusing on the idea of organ donation as a ‘gift of life’. So argue Magi Sque and colleagues, who believe greater recognition should be given to the sacrifice made by the relatives of deceased donors, from whom consent is often needed before a donation can proceed.

Sque and her collaborators analysed data collected in the UK and the USA from interviews with the relatives of deceased donors, and from letters written by donors’ families to donor recipients and to the National Donor Family Council.

While it was clear that relatives were motivated by the idea of their loss leading to the chance of life for others, it was also apparent that many struggled to “relinquish guardianship” of their loved one’s body, and to accept the idea of them being operated on. Many found it difficult to overcome the feeling that their deceased relative had already suffered enough.

A particular source of pain and distress came from the situation of ‘neurological death’, in which loved ones’ bodies appeared to still be alive because of a ventilator, even though they had been certified as neurologically dead. “She looked so beautiful, she wasn’t marked in anyway, can’t cut these eyes out you know, that’s how I sort of visualised it then”, one father said.

The researchers concluded: “Although the gift of life discourse may remain useful for heightening public awareness about the benefits of donation, this is not an adequate framework for understanding what is important for the family at the bedside faced with a donation decision…Such decisions are more closely related to sacrifice”.
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Sque, M., Payne, S. & Clark, J.M. (2006). Gift of life or sacrifice?: key discourses for understanding of organ donors’ decision-making by families. Mortality, 11, 117-132.

Link to UK Transplant, where you can add your name to the organ donor register.

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Why you should add a bit of Grrrrr to your negotiations…

Past research has shown it’s disadvantageous to feel down or angry when you’re negotiating. But now Marwan Sinaceur and Larissa Tiedens argue that pretending you’re angry can be beneficial, especially when dealing with someone who has few options, because it gives the impression you are “dominant, strong and tough”.

First they asked 157 students to imagine they were a salesman for a technology company, and to read a fictional account of a negotiation between themselves and a buyer. Afterwards, the students who read a version in which the buyer got angry agreed to more concessions than the students who read a version in which he stayed calm, but only if they were told beforehand that their business was struggling at the moment.

In a second experiment, 142 students role-played in pairs, with half of them acting as a an employer and half as a job candidate. The students playing the role of ‘employer’ were given negotiation advice beforehand. Compared with the ‘employers’ advised to hide their emotions, the ‘employers’ who were told it was good to look angry (plus tips on feigning anger by frowning or banging the table) managed to negotiate better terms on salary, holiday, work location and equipment, but only if they were negotiating with a ‘candidate’ who thought there were no other jobs available.

“Whereas feeling angry has been shown to lead to bad negotiation outcomes, we showed that expressing anger can lead to good negotiation outcomes”, the researchers concluded. However, they advised that the strategy be treated with caution in light of earlier work showing that expressing an emotion can cause you to feel that emotion, and because you could put people off negotiating with you in the future. “As such, the expression of anger may be a strategy best suited for relatively short single-shot negotiations”, they said.
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Sinaceur, M. & Tiedens, L.Z. (2006). Get mad and get more than even: When and why anger expression is effective in negotiations. Journal of Experimental Social Psychology, 42, 314-322.

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…And how testosterone can fuel entrepreneurship

I'm not sure what this says about the finalists of The Apprentice but a new study argues that, among men at least, entrepreneurs have more testosterone than usual. Using saliva swabs, Roderick White and colleagues found 31 male business students who’d previously invested and managed their own ventures had significantly higher testosterone levels than 79 of their male class mates who’d never led their own business venture.

“A specific heritable characteristic of each individual, their testosterone level, explains something about the likelihood of that individual being significantly involved in creating a new venture”, the researchers said. “Entrepreneurs may not be born; but what one is born with affects the likelihood of that person engaging in entrepreneurial activities”.

The researchers said that, if replicated, the finding could raise ethical dilemmas. “Should venture capitalists be allowed to test the testosterone levels of would-be-entrepreneurs requesting new venture funding?”, they asked.
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White, R.E., Thornhill, S. & Hampson, E. (2006). Entrepreneurs and evolutionary biology: The relationship between testosterone and new venture creation. Organisational Behaviour and Human Decision Processes, 100, 21-34.

Link to testosterone-themed boxer shorts (thanks Mind Hacks).

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Face-recognition problems more common than previously thought

Problems recognising faces, brought on by brain injury, could be more prevalent than previously thought. That’s according to Tim Valentine and colleagues who argue there’s been an over-reliance on ‘pure’ cases, and that “it is easy to dismiss a problem with face recognition as uninteresting if it is ‘just’ part of a generalised memory impairment, or ‘secondary’ to poor attention and concentration”.

Valentine’s team recruited 91 patients who had suffered brain injury either through an accident, a stroke or illness, and asked them to complete a raft of face recognition tests and general mental performance tests.

They found 50 per cent of the patients thought they would have trouble recognising people they had met only a few times. And 77 per cent scored significantly worse than the healthy population average when this ability was tested. This was done by presenting them with a large number of unfamiliar faces from which they had to distinguish those that had been shown to them once already from those that were entirely new.

On an easier version of the test that involved fewer faces, or more chances to view some faces, 20 per cent of the patients performed particularly poorly. Those patients who had difficulty learning to recognise new faces also often had general visual processing deficits, and general problems with recognition memory.

The researchers also noted how much variation there was in the sensitivity of the different face-recognition tests they used. “The likelihood of detecting a face recognition impairment in someone with brain injury therefore clearly depends on the particular test which is used” they said, before suggesting possible interventions for affected patients such as “verbally encoding particular facial features” and “using caricatures to accentuate structural properties of to-be-learned faces”.
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Valentine, T., Powell, J., Davidoff, J., Letson, S. & Greenwood, R. (2006). Prevalence and correlates of face recognition impairments after acquired brain injury. Neuropsychological Rehabilitation, 16, 272-297.

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Reasons to do your maths homework

People who are good with numbers make better decision-makers. That’s according to Ellen Peters and colleagues at Decision Research who found the less numerate among 100 students were more likely to be influenced by so-called ‘framing effects’.

For example, less numerate students tended to rate a student’s exam performance as better on a 7-point scale if they were told she had answered 74 per cent of items correctly in her exam, than if they were told she had answered 26 per cent incorrectly. By contrast, more numerate students were less affected by the way such information was presented. (Numeracy was tested with 11 maths questions on probability).

In another experiment, students were given the chance to win cash if they picked a red bean from a jar. Less numerate students were more likely than numerate students (33 per cent vs. 5 per cent, respectively) to choose to take their chances with a jar that had 9 red beans out of 100, than with a jar that had 1 red bean among 10, probably because they were swayed by the sight of more red beans in the first case, even though the odds were poorer.

The differences in performance between the more and less numerate students couldn’t be explained by differences in their general intelligence, which was also measured.

“We believe that low-numeracy decision makers are left with information that is less complete and less understood, lacking the complexity and richness available to the more numerate”, the researchers concluded.
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Peters, E., Vastfjall, D., Slovic, P., Mertz, C.K., Mazzocco, K. & Dickert, S. (2006). Numeracy and decision making. Psychological Science, 407-413.

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Could prayers be harmful?

An American study has suggested prayer could sometimes do more harm than good.

Herbert Benson and colleagues followed the fortunes of nearly 2000 heart surgery patients between 1998 and 2000, some of whom they arranged to be prayed for by three Christian groups.

Among those patients who didn’t know whether or not they were being prayed for, 52 per cent of those prayed for suffered medical complications after their surgery, compared with 51 per cent of the patients who weren’t prayed for. Some of the patients were told they were definitely being prayed for by the Christian groups – they fared worse than the others, with 59 per cent experiencing post-operative complications. There was no difference between the groups on measures of survival.

“Our findings are not consistent with prior studies showing that intercessory prayer had a beneficial effect on outcomes in cardiac patients”, the researchers said.

However, like other studies in this area, the current project was fraught with methodological limitations. For example, the researchers could not rule out that any of the patients may have prayed for themselves or have been prayed for by their families. Moreover, the Christian groups were only sent the first name and last initial of the to-be-prayed-for patients, and were not allowed any communication with patients or their families, nor were they given any feedback on their condition. They were also given the specific wording to pray with, rather than being allowed to choose their own prayers.

“Private or family prayer is widely believed to influence recovery from illness, and the results of this study do not challenge this belief”, the researchers concluded.
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Benson, H., Dusek, J.A., Sherwood, J.B., Lam, P., Bethea, C.F., Carpenter, W., Levitsky, S., Hill, P.C., Clem Jr, D.W., Jain, M.K., Drumel, D., Kopecky, S.L., Mueller, P.S, Marek, D., Rollins, S. & Hibberd, P.L. (2006). Study of the therapeutic effects of intercessory prayer (STEP) in cardiac bypass patients: A multicentre randomised trial of uncertainty and certainty of receiving intercessory prayer. American Heart Journal, 151, 934-942.

Link to earlier, related Digest item.
Link to related Cochrane review.
Link to commentary on studies of prayer by social psychologist David G Myers.

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Did you see what just happened?

Say someone’s mugged outside the office window – you know what happens next, everyone starts talking about it. The problem for police investigators is that the witnesses start contaminating each other’s memories. But do you think a witness’s memory would be most prone to distortion following a big group chat about the event, or following a one-on-one conversation?

Andrea Dalton and Meredyth Daneman have found our memories are most susceptible to misinformation following a one-on-one conversation, and whereas previous research has focused on peripheral information that’s not that relevant, Dalton and Daneman have shown how easily people’s memories can be distorted for information central to what just happened.

In their study, 89 students watched a five-minute clip from the film Inner Space. They then discussed the clip, either alone with one other student who was actually an accomplice of the researchers, or in a four to six-person group that included the accomplice. In both cases the accomplice said some true things about the clip but also mentioned some deliberately inaccurate things – these were either central to what happened (e.g. that the main character had avoided colliding with a car, when in fact he had hit it), or were peripheral (e.g. he got the name of the shopping mall that was featured wrong).

Afterwards the participants read 16 statements about the clip, including some of the false statements made by the researchers’ accomplice. Crucially, participants who’d discussed the clip one-on-one with the accomplice said his false statements were true 68 per cent of time whereas participants who’d had a group discussion accepted his statements 49 per cent of the time.

This sometimes included the misremembering of central events – participants accepted false statements about central events made by the accomplice 35 per cent of time (versus 82 per cent for peripheral events, and 10 per cent for false statements about central events not mentioned by the accomplice).

“A thorough investigation of the extent to which eyewitnesses’ memories can be altered may contribute to greater acknowledgements within the justice system that absolute reliance on even the most convincing of testimonials may be dangerous”, the researchers said.
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Dalton, A.L. & Daneman, M. (2006). Social suggestibility to central and peripheral misinformation. Memory, 14, 486-501.

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Extras

Studies that didn't make the final cut this fortnight:

The 'implicit association test', used to measure people's inherent biases, might not be as pure a measure as some would suggest. And see this on Mind Hacks.

Can false memories recover spontaneously?

Black defendants judged by participants to be more stereotypically black in appearance were more likely to have been sentenced to death following their conviction for murdering a white victim. The same trend was not found among black defendants convicted of murdering a black victim.

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Tattooing as self-harm?

"From the Archives", first published in the Digest 05.01.04.

Psychologists in America have documented what they believe to be the first report of tattooing used as a form of emotional self-regulation. Michael Anderson (Wright State University, USA) and Randy Sansone (Kettering Medical Centre, USA) reported the case of Mr. B, a 19-yr-old who was hospitalised voluntarily following acute suicidal thoughts. Diagnosed with major depressive disorder, Mr. B explained to the clinicians that he had dealt with his emotional pain in the past through acquiring tattoos. "Physical pain helps to take my mind of it" he said. He had considered cutting himself but "people would see the cuts and it would be pretty embarrassing". The greater his emotional pain at a given time, the more sensitive the body area he selected for tattooing.

Anderson and Sansone interpreted this behaviour as a form of mood regulation, distracting Mr. B from his intolerably depressive feelings. Physiologically, the pain of the tattoos might have resulted in the release of naturally occurring opioids in the brain and had a therapeutic effect that way. The authors concluded that the question of how often tattooing is used in this way "warrants further investigation".
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Anderson, M. & Sansone, R.A. (2003). Tattooing as a means of acute affect regulation. Clinical Psychology and Psychotherapy, 10, 316-318.

Link to BPS leaflet on self-harm.

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