News and Media, April 2009

Psychologists excluded from NHS workforce consultation

The government has failed to include psychologists working in the NHS in its 'Future of the Healthcare Science Workforce' consultation, which ended in March.

In the Society's response, Professor Graham Turpin from the Division of Clinical Psychology said: 'The Future of the Healthcare Science Workforce consultation is aimed only at physical health care and largely ignores mental health and well-being. In doing so, practitioners of psychological science such as neuropsychologists, applied psychologists and psychological therapists working within the NHS are explicitly excluded.'

Psychologists and psychological therapists were also effectively excluded from the last major NHS workforce report, published by Lord Darzi last summer. Professor Turpin told The Psychologist that 'a lot of guidance and training is following this influential report, and psychology is being left out in the cold. That's an inappropriate thing to do. The psychological workforce is one the NHS should be nurturing, particularly in our present economic situation when we can expect greater numbers of the public experiencing emotional distress and psychological disorders.'

The Society's response states that the omission would be more understandable if neuroscience and psychology were well represented elsewhere. However, the four groups recognised and supported by the Department of Health are currently doctors/dentists, nurses, healthcare scientists and allied health professions. The Society's response recommends that 'a project is established to promote a review and modernisation of the careers of psychologists and psychological therapists'. It also notes that some members of the profession have suggested the appointment of a Chief Psychologist to advise the government. It concludes that 'only by commissioning a specific review of the psychological NHS workforce will psychologists and psychological therapists working in the NHS receive the recognition and career support they need and deserve.'

Personality disorder guidelines

The National Institute for Health and Clinical Excellence (NICE) has called on mental health trusts to establish specialist, multidisciplinary personality disorder services. The recommendation is one of many to be found in two new guidelines on the treatment and management of borderline personality disorder (BPD) and antisocial personality disorder (ASPD).

People with BPD show instability in their relationships, self-image and mood and are at high risk of impulsive behaviour including self-harm. The new NICE guidelines for BPD emphasise that treatment sessions should be conducted in an atmosphere of optimism and hope, conveying the fact that recovery is possible.

Dr Tim Kendall, Joint Director of the National Collaborating Centre for Mental Health (NCCMH; of which the Society is a partner), said: 'We want attitudes to change inside the health profession and amongst the public – borderline personality disorder is a real condition that can be treated effectively to the benefit of the person with BPD, their families and the wider community.'

The BPD guidelines suggest twice weekly treatment sessions should be considered; that therapists should receive appropriate supervision; that comprehensive care plans should be established; and that care should be taken when ending treatment or services as BPD clients may be particularly vulnerable at such times.

Dialectical behaviour therapy is recommended for women with BPD who are self-harming, while the guidelines advise that drug treatments are not to be used for treating the symptoms or behaviours associated with BPD (except when used cautiously during crisis periods).

People with ASPD show impulsive, reckless and irresponsible behaviour with a marked lack of concern for other people's feelings. As with BPD, the new guidelines advise that a positive rewarding treatment approach is more likely to be successful than a punitive style.

For young children displaying conduct problems, the new guidelines advise offering parents group-based parenting skills training. For children exhibiting callous traits, cognitive problem-solving training is also recommended, while multisystemic therapy is recommended for teenagers showing signs of ASPD. For adults with ASPD, group-based cognitive and behavioural interventions are the approach of choice, while pharmaceutical treatments are specifically advised against.

Dr Stephen Pilling, Joint Director of NCCMH, said: 'Many people do not realise that ASPD is preventable: working with children who are at risk of developing conduct disorder and their families could prevent them from developing ASPD as adults.

It is important that we make these investments early on to realise the future benefits to these families and society.'

I    The guidelines can be found at tinyurl.com/c6p27u and tinyurl.com/da4xmy. 

HPC register set for July opening

Legislation to enable psychologists to be taken into statutory regulation was tabled in March at Westminster and Holyrood. The Department of Health (DH) and the Health Professions Council (HPC) will proceed on the basis that the legislation will be passed, and are working towards 1 July 2009 as the date that the register will open.

The statutory instrument (Section 60 Order) Health Care and Associated Professions (Miscellaneous Amendments & Practitioner Psychologists) Order 2009 is very similar to earlier drafts the Society has seen and commented on. It will now be scrutinised by the appropriate committees in both London and Edinburgh, who will report to their respective parliaments. There will then be a vote in both Houses of Parliament at Westminster and in the Scottish Parliament.

The Society's Board of Trustees remains concerned that the legislation excludes a significant number of practitioner Chartered Psychologists (those without an adjectival title), and that the public will therefore not receive full protection. 'We believe this is a failing in the legislation and hope the committees scrutinising the statutory instrument will agree.'

Blogging benefits

logging can have a beneficial effect on students' social relations (CyberPsychology and Behavior: tinyurl.com/bwsyqw). That's according to a study by Taiwanese researchers, published in the same month that neuroscientist Susan Greenfield and psychologist Aric Sigman were widely criticised for inciting unfounded fears about web-based social tools like Facebook.

Hsiu-Chia Ko and Feng-Yang Kuo surveyed 692 university students who blogged and found that those who used their blogs more to share information about their feelings, emotions and experiences also tended to report a greater sense of social belonging and superior well-being. The study is limited by its cross-sectional design, but Ko and Kuo further noted that the audiences for the students' blogs were largely made up of their real-life friends and class-mates. 'Blogging does not diminish substantial relations in real life but, on the contrary, helps to enhance bloggers' existing relations through social bonding,' they said.

On a related note, a Which report led by neuroscientist Chris Baird of UCL has concluded that so-called brain-training games, such as MindFit (endorsed by Baroness Greenfield), Lumosity and Nintendo's brain training are supported by a weak evidence base. 'People who buy brain trainers to keep their minds in shape may be just as well off leading active social lives or surfing the internet,' Which says on its website.

IN BRIEF

Christian Jarrett reports from the Annual Meeting of the Association for the Advancement of Science, 12–16 February, Chicago
 

In the absence of formal tuition, deaf children invent their own signs. 'I have been able to follow children in Nicaragua who are not near a special education school and accordingly continue developing their homesigns independently,' said Marie Coppola (University of Chicago). Coppola thinks the spontaneous signing she's observed in children is what underlay the development of Nicaraguan Sign Language. This system was developed independently in the 1970s by children at a school for the deaf in the country's capital after they were encouraged to read lips and speak rather than use sign.
Brain scans of 23 undergraduate students have pointed to the possibility that abnormal brain activity can contribute to feelings of loneliness. The students were shown images of people in either pleasant or unpleasant settings. Relative to non-lonely students, those students who were lonely showed reduced reward-related activation in the ventral striatum in response to the positive images, and reduced empathy-related activity in the temporal-parietal junction in response to the unpleasant images. Whilst loneliness may cause these differences, John Cacioppo (University of Chicago) and colleagues said it's also possible that the direction of causation is the other way around.
 
Players of internet-based fantasy games like Everquest II can play with other gamers across the globe and yet they mostly choose to play with people who live nearby. 'It's not creating new networks. It's reinforcing existing networks,' said Noshir Contractor (Northwestern University). 'Individuals 10 kilometres away from each other are five times more likely to be partners than those who are 100 kilometres away from each other.' Other findings to emerge from the study, which involved 60 tetrabytes of data and 7000 participants, were that players underestimated the time they spent playing and were more likely than average to suffer from depression.

A walk in the park can improve the concentration of children with ADHD with the benefit being of the same magnitude as that reported for drug treatments. Frances Kuo (University of Illinois at Urbana-Champaign) and colleagues tested children with ADHD on a concentration task after either a walk in the park or in an urban environment. Kuo said this was just the latest in a series of studies pointing to the psychological benefits of natural environments. 'So when people say: "As a scientist, would you say that we now know nature is essential to optimal functioning in humans?" I say: "As a scientist I can't tell you. I'm not ready to say that",' Kuo admitted. 'But as a mother who knows the scientific literature, I would say, "Yes".'

Baboons and even pigeons are able to perform a cognitive feat that was previously considered a uniquely human ability – that is, to think about the relations between relations. This is the ability, when comparing A with A, to recognise that they are the same and that their relation to each other is therefore different from the relation shared between A and B, which are different from each other. 'What we're really trying to understand is the extent to which cognition is general throughout the animal kingdom,' Ed Wasserman (University of Iowa) explained. 'The evidence that we collect constantly surprises us, suggesting that we're not alone in many of these cognitive abilities.'

Women and science careers

The under-representation of women in science is not caused by their having inferior maths abilities compared with men. That's the conclusion of a comprehensive review by psychologists Stephen Ceci, Wendy Williams and Susan Barnett at Cornell University in New York, covering more than 400 journal articles and book chapters on the topic (Psychological Bulletin: see http://tinyurl.com/bmbbte).

Instead, the group found that the principal factor affecting the presence of women in science is the life choices they make, especially in relation to having children, and the impact this has on their careers. On a positive note, Ceci's team also found little evidence that discrimination is a factor.

The question of why women are a rare sight in the upper echelons of science and technology has proved a sensitive issue. In 2005, Lawrence Summers, then President of Harvard University and now head of President Obama's National Economic Council, caused a storm after he suggested that a key reason related to biological differences in women's mental abilities compared with men's.

The new review does find that more men than women tend to score at the extreme high end of spatial and maths ability tests, possibly reflecting biological differences in ability or sociocultural factors (some countries show the opposite pattern).

However, regardless of its cause, the size of this difference in ability fails to account for just how few women are in science and technology careers, especially at more senior levels.

'The one research finding related to the under-representation of women in all academic careers, not just those that are mathintensive, that is robust, incontrovertible, and based on up-to-date information, is that women's fertility choices, and the timing of when to have children, are powerful predictors of career success, as are sex differences in lifestyle preferences and career choices,' the authors concluded.Indeed, among women with superior maths skills, the research shows, for example, that they are less likely than their male peers to opt for science careers, perhaps because they are more likely than men to also have superior verbal abilities, thus inclining them towards alternative careers in law or medicine, which may be more accommodating when it comes to family concerns.Ceci's team said their findings have implications for how best to address the relative dearth of women in science and technology careers. 'Universities and institutes could accommodate family responsibilities by giving faculty part-time work that segues to full-time tenure track,' the authors advised. 'Other family-friendly work policies could also be implemented to make it easier for mothers to remain in STEM [science, technology, engineering and maths] careers and to juggle work and family demands.'

IAPT for kids

A document has appeared on the website of the LSE's Centre for Economic Performance in which the chief architect of the government's Improving Access to Psychological Therapies (IAPT) programme – the economist Lord Richard Layard – recommends a similar expansion and modification of services for children and adolescents (see tinyurl.com/c2kp7q). In the paper entitled 'Child mental health: Key to a healthier society' (currently unaccompanied by any official announcement or press release), Layard calls for Child and Adolescent Mental Health Services (CAMHS) to be upgraded, including the training of an extra 1000 psychological therapists and the creation of a dedicated research fund to support research into therapies for children. 'I suggest that any serious attempt to improve CAMHS should ... include such an IAPT-like strategy,' Layard writes.

Creating more peaceful schools

A bullying intervention that focuses  on school ethos as a whole rather than targeting problematic individual children has shown superior outcomes relative to an intervention that offered individual pupil counselling (Journal of Child Psychology and Psychiatry).

Psychologist Peter Fonagy of UCL and colleagues compared levels of pupil-reported bullying and aggression at three schools participating in the CAPSLE (Creating a Peaceful School Learning Environment) programme with the levels reported at three schools allocated to the School Psychiatric Consultation programme and three schools that received no intervention.

'CAPSLE is a psychodynamic approach that addresses the co-created relationship between bully, victim and bystanders, assuming that all members of the school community, including teachers, play a role in bullying,' Fonagy explained. 'It aims to improve the capacity of all community members to mentalise...'.

Over a three-year period – two involving intervention and one follow-up year – levels of aggression and bullying actually increased across all the schools. Crucially, however, schools following the CAPSLE programme showed less of a reduction in empathy than did the SPC and no intervention schools and a smaller increase in levels of victimisation. They also showed improved outcomes in terms of teacher ratings of in-class behaviour, whereas the SPC and no intervention schools did not. Moreover, at the end of the follow-up year, the CAPSLE schools, but not the SPC schools, showed better outcomes across a range of measures including levels of aggression. Effect sizes across the measures used were small to moderate.

'We have shown that a programme that is not focused on aggressive children but rather on other aspects of social relationships has significant effects that may have theoretical as well as practical importance,' the researchers concluded.

Although the results are encouraging, the study has a number of shortcomings, many of which were acknowledged by the researchers. For example, there were no objective measures of school discipline, and sample sizes were small with significant drop-out rates. Furthermore, the CAPSLE programme is multifaceted. As well as numerous student tasks, including poster design and classroom discussions, it actually has embedded in it the so-called Gentle Warrior programme of self-defence classes inspired by Bushido. This makes it difficult to establish what the active ingredients of the programme are.

Synaesthesia surprises

Two new studies have significantly advanced our understanding of synaesthesia, in which people experience a blending of the senses. In the first, Julia Simner and her colleagues at the University of Edinburgh provide the first ever data on the childhood prevalence of the condition. They found that 1.3 per cent of 615 schoolchildren, aged six to seven years, experienced grapheme–colour synaesthesia, in which certain letters or numbers are always experienced in the same colour (Brain: tinyurl.com/blb9rj).

'[This] implicates over 170,000 children age 0–17 in the UK alone,' Simner's group said, 'and suggests that the average primary school in England and Scotland (N = 168 pupils) contains 2.2 grapheme-colour synaesthetes at any time.' Inevitably, the prevalence for synaesthesia as a whole, considering all the subtypes, would be even higher.

A hallmark of grapheme–colour synaesthesia is that the colour triggered by a given letter or number is always the same – a fact the researchers exploited to identify the condition in schoolchildren. Indeed, when asked to associate letters with colours, the children identified as synaesthetes showed more consistency over a 12-month period than the other children did over a 10-second period.

The study also showed how synaesthetic associations develop over time. The children with synaesthesia had an average of 10.5 reliable grapheme– colour associations when first tested aged six to seven, compared with 16.9 when tested a year later. Simner's team plans to observe how this rate of acquisition develops as the children get older.

Meanwhile, an international team of researchers led by Roi Kadosh of UCL has cast doubt on the hyperconnectivity hypothesis of synaesthesia by showing that the grapheme–colour form of the condition can be induced by hypnosis (Psychological Science).

Kadosh's team gave suggestible students the following instructions under hypnosis: 'Look at that colour; this is the colour of the digit _, and whenever you see, think, or imagine that digit, you will always perceive it in that colour,' thus inducing synaesthetic-like symptoms post-hypnosis in the majority of the students. This was demonstrated both phenomenologically, via the student's self-report, and by showing that the students had difficulty perceiving a digit when it appeared against a background of the same colour that they'd been instructed to associate it with.

'Our findings cannot be explained by the creation of abnormal neuronal connections because such new anatomical connections could not arise, become functional, and suddenly degenerate in the short time scale of this experiment,' the researchers explained. Instead, they favour an account of synaesthesia based on the degree of inhibition between brain areas. 'This idea requires further examination in studies that combine an approach similar to that of the present study with electrophysiological and neuroimaging techniques,' they said.

Illusion help for amputees?

A well-known sensory illusion could help amputees acquire a sense of touch in, and ownership over, their prosthesis (Brain: tinyurl.com/d5b79f). Henrik Ehrsson (Karolinska Institute, Sweden) and colleagues showed that six out of 18 amputees experienced a strong sensation of touch from a rubber prosthesis during a version of the rubber-hand illusion. This is the effect whereby a rubber hand is placed where a participant's hand might be and is stroked in time with the stroking of the real but concealed hand, and observing this provokes a sensation of touch in the rubber hand.

The researchers demonstrated the illusion in amputees by stroking their stump in synchrony with stroking a rubber hand. The effects were measured by questionnaire and a pointing task, which required the participants to indicate where in space they experienced sensation from the stroking. The researchers also demonstrated the participants' sweat levels increased when the rubber hand was stabbed with a needle.

The strength of the illusion wasn't as great as has been shown with people without an amputation, but this is likely to be due to unavoidable constraints on the way the illusion was performed. For example, the illusion in its classic form is typically strongest when the rubber hand and real hand are stroked in the exact same areas – an impossibility with the amputee participants (although the researchers did exploit the fact some participants experienced sensations in a 'phantom' hand when specific parts of their stump were touched).

Ehrsson's team say it should be possible 'to design prosthesis equipped with tactile sensors in the fingertips that can be connected to an array of tactile simulators on the stump that would reproduce the present illusion in everyday usage… Every time the finger of the prosthesis touched an object a tactile stimulation would be delivered instantaneously to the stump, thereby tricking the multisensory brain into experiencing the sensation of touch from the artificial finger.' The researchers added that the illusion could also have psychological value by provoking a sense of ownership over the false limb.

The precise mechanism by which the illusion worked is not known. One possibility is that the correlation of visual information from the rubber hand with somatosensory information from the stump leads to re-mapping in multisensory areas of the brain, similar to the somatotopic reorganisation postulated to underlie the experience of the illusion in healthy people.

CBT and CFS

Researchers at Stony Brook University in New York have questioned a key assumption underlying cognitive behavioural approaches to chronic fatigue syndrome (CFS). Patients treated with CBT tend to report feeling better, a benefit that is thought to come about via a gradual increase in their activity levels. In turn, this activity increase is postulated to help assuage patient fears of symptom flare-ups and to reverse the physical de-conditioning associated with CFS. However, in their study of 11 people with CFS who were treated with CBT, Fred Friedberg and Stephanie Sohl found a mismatch between self-report and objective outcome measures (Journal of Clinical Psychology).

Many of the participants reported feeling better, consistent with previous trials of CBT, but an actigraph attached to their waist, which measures movement, and a six-minute walking test revealed that some of these 'improved' participants were actually less or only equally active after treatment compared with before. One possible explanation is that CBT is effective not through increasing activity levels per se, but rather by helping people achieve a healthier balance between activity and rest – for example performing mild exercise in the place of activity  that is more work-related. 

Mapping the way to drug rehabilitation

The National Treatment Agency for Substance Misuse (NTA) has given its seal of approval to a mapping technique designed to help drug-dependent clients visualise and work through their problems with a drug worker or therapist. The mapping approach, which involves identifying problems and solutions with the aid of a series of interconnected boxes, was developed by Professor Dwayne Simpson of Texas Christian University
(e.g. see www.ncbi.nlm.nih.gov/pubmed/9243339).

The NTA sponsored trials of the mapping approach at sites in Manchester, London and Birmingham, alongside implementing organisational changes designed to foster strong leadership, a learning culture and clarity of purpose. Compared with control sites following standard counselling practices, clients at the sites using mapping demonstrated superior outcomes, including improved psychological functioning and better rapport with their key workers.

Speaking at a British Psychological Society conference on new developments in the psychology of addiction held in February, Annette Dale-Perera, the NTA Director of Quality, said: 'These pilot schemes demonstrate that the combination of mapping and management significantly contribute to an individual's progression to recovery, and put psychosocial interventions at the heart of the delivery of drug treatment.'