News, January 2008

Cancer care concerns 

Psychologists have broadly welcomed the government's new five-year NHS Cancer Reform Strategy (see tinyurl.com/3bd8zw), although there is some concern that the role of psychologists in cancer care has not been made more explicit.
Professor Sheila Payne, a health psychologist and Chair in Hospice Studies at Lancaster University, told us that the new strategy 'provides a number of opportunities for psychologists', including: in the design and delivery of health promotion and cancer prevention interventions; understanding people's 'models of illness', to reduce the time people wait before reporting symptoms to their doctor; helping improve the presentation of information; and understanding inequalities in care – how and why survival rates are affected by factors like social demographics.
'It is also very important that this new strategy has again highlighted the need for psychological support at all stages of cancer,' Professor Payne added. 'And it is also welcome that cancer survivorship has been recognised as an important issue. Psychologists need to be encouraged to direct greater attention clinically and in research to the long-term impact of cancer.'
Christine Kalus, Macmillan Consultant Clinical Psychologist at the Rowans Hospice in Hampshire, also welcomed the strategy and praised the requirement for all cancer professionals to complete communications skills training. However, Kalus noted that neither clinical nor health psychologists are explicitly mentioned in the 144-page document. 'It's a missed opportunity. There is a robust literature on the importance of psychological support, yet the new strategy is not strong enough to encourage commissioners to beef up psychological services, certainly not in hospitals where they're often very weak.'
In particular, Kalus said there is too little attention given to the needs of carers, even though 'we know that if the carers collapse then the care for the patient does too'. There is also no mention of bereavement.
Dr Elaine McWilliams, who also works at the Rowans Hospice, called for a clear policy on the minimum levels of psychological support. Without that, 'change will be slow or even in some cases regressive, and will be dependent on local commissioning priorities rather than a true understanding of psychological need'.
According to Kalus, there are pockets of good practice, yet other areas struggle to recruit a single psychologist. 'We need to ask what more can we be doing to get out there and make health commissioners aware of best practice in psychological care,' she said. cj

No more clowning around

What makes a hospital 'child- friendly'? According to a University of Sheffield team, sending in the clowns is not the answer, and the first step is to cast aside adult assumptions and actually listen to what the children themselves say.
In research reported in Built Environment, Jo Birch, Penny Curtis and Allison James used a variety of methods (such as interviews, photo elicitation, participant observation and mapping of movements and activities) to elicit the views of 255 inpatient and outpatient children aged between 4 and 16. According to the government's National Service Framework, children and young people should experience hospitals differently according to age. But the team found that children still feel that they are lumped together with babies and young infants in an environment that is decorated and furnished with only the youngest in mind.
'A therapeutic environment for children and young people – that which promotes healing – needs to be one that acknowledges their sense and sensibilities as children and young people,' say the authors. 'Thus, for example, it is one which might endow children with the "sense" to be able to decide for themselves when to have the light on or off and just how much light they need, how warm their cubicle should be and when to watch television and when to rest.'
Other recommendations included the segregation of 'babies' from older children; spaces away from the bed (but not necessarily outdoors); and making the controls for lights and air circulation devices more easily accessible to, and operable by, children. As for the clowns, Penny Curtis told The Psychologist that 'even the older children found them creepy'. js

Attitudes to the environment

New survey results published by the Department for the Environment Food and Rural Affairs in November show that being 'green', or environmentally conscious, is beginning to be seen as the social norm. In the sixth survey of its kind published since 1986, only 30 per cent of 3618 people surveyed in England said they agreed that 'Being green is an alternative lifestyle, it's not for the majority'. By contrast, 44 per cent said they disagreed with this statement, while 24 per cent were unsure. Those people who said they had already made environmentally friendly changes to their behaviour tended to be aged over 65, to live in rural areas or to
be of higher socio-economic status. cj
I    For the full results see tinyurl.com/ypzenk

Talking mats

One of the most distressing aspects of dementia is the detrimental effect it has on patients' ability to communicate with their carers and loved ones.
Now psychologists at the University of Stirling have reported that a low-tech aid, the 'Talking Mat' (www.talkingmats.com), significantly improves the ability of people with dementia to express themselves to others.
The Talking Mat consists of a textured, rectangular space onto which symbols can be placed. The space can be arranged so that symbols placed along the top create a scale ranging from happy to unsure to unhappy. Users can then place activity symbols or other types of symbol in a corresponding location lower down the mat to express how they feel or felt about that activity.
Psychologists Joan Murphy and Cindy Gray, together with social worker Sylvia Cox, videoed 31 people with dementia talking about activities, people, their environment and themselves, using either an ordinary, unstructured conversation, a structured conversation (with topics subdivided), or the Talking Mat.
Compared with structured or unstructured conversation, coding of the videos revealed use of a Talking Mat significantly improved communication by the people with dementia, in terms of their understanding, engagement, their ability to remain on track, and how much the person they were talking to understood them. This was especially the case for people with moderate to late-stage dementia.
In their Joseph Rowntree Foundation report (tinyurl.com/3y4gkp), the researchers concluded: 'Talking Mats that have been designed to address precise topics, questions or issues could extend the period during which people with dementia can play an active role in making decisions about their lives.' cj

Women's gait - an evolving hypothesis

A study into changes across the menstrual cycle in the way women walk caught the media's attention in November, and led to questions about evolutionary psychology.
Meghan Provost and colleagues, at Queen's University, Kingston, Ontario, filmed the gait of 20 women when they were at the high-fertile, late follicular phase of their menstrual cycle, and then again when they were at the low-fertility, luteal phase. Using motion-capture technology (deployed by film makers and video game creators), the researchers asked the women to don ballet outfits, placed reflective markers on their joints and recorded their walking movements with 12 cameras.
A mathematical analysis of the women's joint movements was able to classify the women according to fertility with 71 per cent accuracy, confirming that the women were walking differently at different times in their menstrual cycle, particularly in relation to the movement of their hips and the positioning of their knees.
But it was the results from a second experiment that made headlines such as the BBC's 'Sexy walks keep men off scent'. Provost's team played the videos, showing only the lights on the women' s key joints, to 43 male students who were asked to rate the attractiveness of the walkers. Crucially, women at the less fertile stage of their menstrual cycle received higher attractiveness ratings, a finding that has since been replicated with two further independent samples of men.
The finding appears to contradict earlier research showing, for example, that women take more care over their hair and clothing when they are at their most fertile. But in their report of the research published in Archives of Sexual Behaviour, Provost and colleagues said this could have to do with the intimacy of the different signals – gait can be viewed from afar, whereas cues like body odour and facial attractiveness can only be detected at close range. Therefore, it's possible that at times of peak fertility, women enhance their close-up attractiveness, but alter their walking pattern to avoid the sexual interest of unfavourable men and possible sexual assault.
'If women are interacting with men to the point that the men can see their faces, then I am assuming that women would choose to be in that situation,' Dr Provost explained to The Psychologist. 'However, people cannot generally choose the recipients of distance cues like gait.
Of course, there are a lot of unanswered questions: How prevalent was sexual assault in our ancestral past? What's causing the difference in gait patterns? Is there a relationship between a man's use of sexual assault and how he views the walks of women? All of these questions still need to be answered.'
However, the psychologists' explanation of the findings drew scepticism from some quarters: Ben Goldacre's Bad Science website characterised the research as 'more ludicrous teleology from evolutionary psychologists' and claimed that they had found their 'hypothesis in their results'.
Is there any truth to these accusations? Evolutionary psychologist Dr Lynda Boothroyd (University of Durham) told us the results were interesting, although she would have liked more discussion of the fact that the men had only seen motion capture videos of the women, rather than full view of their body shape, which may have impacted the results. But ultimately, she continued, 'the authors did only what any author should do – suggested an alternative explanation for unusual results and elaborated further hypotheses based upon it.'
Indeed, Dr Provost added: 'I did not set out to prove why men rate women differently on attractiveness across the menstrual cycle. I only wanted to investigate if they did. Yes, my concluding hypothesis came from the data. I have made no compunctions about that fact.
I found results contrary to what was expected from previous research, and suggested one reason why it may be so. I do not see why the same would not happen in any other type of research.' cj

IN BRIEF

From the Society for Neuroscience 37th Annual Meeting, San Diego, November 2007

I The brain chemical serotonin is central to how rewarding we find cooperative behaviour to be. That's according to Robert Rogers of the University of Oxford who investigated the effect of serotonin levels on players' performance in the 'Prisoner's Dilemma' game. Rogers blocked levels of l-tryptophan, a precursor to serotonin, in certain players, which lowered their serotonin levels and caused them to play less cooperatively.

I Children with autism were able to complete a task that involved interpreting other people's intentions, but unlike non-autistic controls, they appeared to do so without engaging their brain's mirror neuron system. That's according to Jaime Pineda of the University of California, San Diego who used the suppression of mu rhythm activity, as recorded by EEG recordings, as an indicator of mirror neuron engagement. Pineda said the mirror neuron system is not absent in children with autism but is abnormally responsive, thus pointing to a target for future interventions.

I In research that might one day benefit paralysed humans, a macaque monkey has been trained to use thought power alone to control a robotic arm and gripper tool. The monkey did not move its own hand or fingers, but was able to use mind power to pick up pieces of food and feed itself using the robot arm. 'The monkey developed a great deal of skill using this physical device,' said Meel Velliste at the University of Pittsburgh. 'We are in the process of extending this type of control to a more sophisticated wrist and hand for the performance of dexterous tasks.'

I New research on rats is confirming the profound protective role that diet can play against age-related cognitive decline. James Joseph and colleagues at Tufts University fed rats a diet consisting of 2, 6 or 9 per cent walnuts. Compared with controls these rats showed reversals in several measures of brain ageing, as well as differences in age-related motor and cognitive deficits. In humans a 6 per cent diet of walnuts would be equivalent to eating one ounce of walnuts a day. Joseph said: 'Coupled with our previous studies, this shows that the addition of walnuts, berries and grape juice to the diet may increase health span in ageing.'

I A brain-scanning study suggests smoking cannabis causes the teenage brain to have to work harder to produce the same results. Gerry Jager and colleagues at the Rudolf Magnus Institute of Neuroscience at the University Medical Center Utrecht, in the Netherlands, scanned the brains of 10 cannabis-using teenage boys, aged 15 to 18 years, while they performed a memory task. Compared with nine abstinent controls, the cannabis users displayed brain activity in the same regions and performed the task equally well, but their neural activity was exaggerated. This was the case even though they had abstained from cannabis for a week before the experiment.

I Researchers have identified a 'biomarker' for PTSD. Thirty-three war veterans were presented with pairs of yellow/green lights or blue/green lights. The former pair was followed by a blast of air to the throat, whereas nothing happened after the blue/green pair – thus the blue light was a kind of safety signal. Michael Davis and colleagues at Emory University School of Medicine were interested in what happened when blue and yellow were presented together. Veterans with PTSD, but not healthy veterans, showed the same startle response to blue/yellow as they did to yellow/green, revealing an attenuated response to safety signals. cj

Placebo in sport

We've all heard about the relevance of the placebo effect in clinical settings but what about its place in sport? Fabrizio Benedetti and colleagues at the University of Turin Medical School and National Institute of Neuroscience have thrust the issue into the spotlight with a dramatic demonstration of the effects of 'morphine pre-conditioning'.
Forty participants were divided into four teams prior to a test of pain endurance. During three training sessions, held a week apart prior to the actual competition, two of the teams received injections of morphine.
On the day of the actual competition, one of the morphine teams, unbeknown to them, received saline solution instead (i.e. a placebo), while the other morphine team received naloxone, a chemical that blocks the effect of opioids.
Crucially, the team that received morphine during training and then a saline injection on competition day, showed the greatest pain endurance. This included superior performance to one of the teams not given morphine during training, but only given a placebo injection of saline on competition day, thus showing the added benefit of pharmacological pre-conditioning during the training sessions.
The team given morphine during training but naloxone on competition day did not show any greater pain endurance than other teams, thus showing the placebo effect enjoyed by the most superior team was opioid-based.
The finding has profound ethical implications in sport where certain drugs, like morphine, are banned during competition but not during training. Writing in the Journal of Neuroscience (tinyurl.com/yps86y) the researchers said '..the increase in pain endurance after placebo is real and robust and has key attributes relevant to situations encountered in sport competitions.' cj

 

Event report

Hazel Stevenson reports on Professor Martin Seligman's talk on 'Positive Psychology and Positive Interventions', Friends House, London, 6 November 2007

The atmosphere was electrifying; 1100 people crowded into Friends House in London for this stimulating event, organised by the London and Home Counties Branch of the British Psychological Society. Professor Seligman explored the power of happiness. He acknowledges that understanding negative emotions can add value, but he asserts that the exploration and use of 'the positive side of life' can enable us all and provide growth. He outlined the impact on productivity, growth and health that can be achieved by maximising positive emotions, and in particular engagement and meaning. Professor Seligman suggested that positive emotions jolt us into a different mode of thought and thus enable us to be more successful in terms of top-down thinking and creativity. He provided research to show that happier and more optimistic people are less likely to be divorced and are more likely to have a higher salary.
Compelling research data covered a wide range of psychological applications in the clinical, social, occupational and educational fields. How we treat depression, how to make school life a positive experience, the best ways to coach and develop work teams – all can benefit from the positive approach. For example, Professor Seligman provided clear data to illustrate the short- and longer-term benefits of treating depression, including through engagement exercises and 'gratitude visits' – writing a 300-word testimonial to someone who is alive and who did something good for you in your past.
Professor Seligman provided a word of caution about the danger of over-promising without sufficient research and delivery. There is a need to build on the growing body of data available in the field.
His thinking has now developed to identify four core pillars: Positive Emotions and Engagement; Positive Relationships; Meaning and Purpose; and Positive Accomplishment. Professor Seligman believes that we are at the forefront of a political change, a review of the social science implications, and the need to build on 'what is right'. He sees wider implications for positive psychology, including its impact on physical health and neuroscience.
As an occupational psychologist, I recognised many applications that could expand the quality of interventions within business psychology. I could tell from the audience that psychologists in academia, educational, social and clinical fields could view the same possibilities. However, one of the most interesting aspects of the evening for me was that, unusually, there was a unity and convergence across the psychological disciplines. People were reacting, not so much from their specialist area, but across the self-imposed boundaries and barriers.
In a sense, this evening became an exercise in positive psychology itself. Positive psychology fits neatly with our desire as psychologists to 'do good' and to make a difference. In my view, positive psychology should not stand alone: it should be one of many concepts, ideas and theories that transcend psychology across the specialism and beyond, into the wider scientific, social and political arenas. We need to stop thinking in a narrow domain and to start to drive the broader agenda.
Whilst positive psychology will undoubtedly have many applications and will enhance and inform our research, interventions and applications, I hope that one of its greatest legacies will be to help us to take stock and to think as a profession about our direction and our potential impact.

I    Hazel H. Stevenson is a chartered occupational psychologist
E-mail: [email protected]

ADHD - drugs not a long term fix

Psychological approaches to treating ADHD look set to be given greater prominence following new research suggesting that, in the longer term, drug treatments for the condition are no more effective than behavioural treatments.
The Multimodal Treatment Study of Children With ADHD (MTA), an investigation of 579 US children, earlier reported short-term advantages of drug treatments like Ritalin over psychological interventions. However, a 36-months follow-up showed no advantage of drugs, and even some evidence of harm to children's growth.
The new findings formed the basis of a BBC Panorama programme in November, in which one of the co-authors of the MTA study, Professor William Pelham Junior, said of Ritalin, 'In the short run it will help children behave better, in the long run it won't. That information should be made very clear to parents.' Anxious headlines followed, and in the Lords, Professor Susan Greenfield called for an inquiry into the diagnosis and treatment of ADHD.
The MTA findings were published in the Journal of the American Academy of Child and Adolescent Psychiatry. Originally, children with ADHD were allocated to one
of four treatment groups for a year: behavioural, drug,
a combination, or routine community care. The new data is from 485 members of the original sample, two years after the controlled treatment was ended. This means that the study had effectively become observational in nature because many of the children in the behavioural group began taking drugs, and children in the drug group stopped their medication. Controlling for these changes, the study concluded that although all groups showed sustained improvements in their ADHD symptoms, the short-term advantages of prior drug treatment over behavioural therapy had disappeared by 36 months.
Following Panorama, the Department of Health said that the National Institute for Health and Clinical Excellence (who are drafting new guidelines on treatment) had 'advised that drug therapy should only be part of a comprehensive treatment programme that includes a range of social, psychological and behavioural interventions.'
Chartered Educational Psychologist Sean McLaughlin told us: 'The most important issue to emerge is that when medication is prescribed it will almost certainly be for a set time. This gives us a window of opportunity to put in place a coherent programme of management. Drugs will no longer be perceived as a panacea. Parents will no longer be able to pressurise medics to prescribe medication without a multidisciplinary assessment involving parents, teachers and psychologists.'
McLaughlin said that the implications for resources and training are enormous. 'We have got to make psychology and our psychological skills much more explicit. We must work with young people and their families on emotional intelligence, social skills training and cognitive behaviour techniques and
do so in a way that does not negate the sinister impact of the underlying condition.' cj

Speak your weight

All parents in England are to be sent information on the height and weight of their children, together with healthy living advice, according to plans outlined in the government's new Health and Social Care Bill. Part of a drive to help reduce childhood obesity, the move comes after a government Foresight report, published in October, which warned that nearly 60 per cent of the UK population will be obese in 2050 if nothing is done to halt current trends.
Health Minister Ben Bradshaw said: 'Tackling obesity is a top priority for the government, and this change is part of our commitment to make the NHS a service that prevents ill health, as well as treating it.'
Parents of children in Reception and Year 6 already have the option of receiving information about their children's weight, but following the planned changes all such parents will receive this information unless they specifically request not to.
Andrew Hill, Professor of Medical Psychology at the University of Leeds, told us the plan had the potential to help: 'Research shows that parents often fail to recognise overweight and obesity in their children, especially if they are boys,' he said. 'There is still a residual, post-war belief that a fat baby and child is a healthy baby and child. Perhaps most importantly, being fatter than average is not seen as important by parents as other things in their children's life. And it's not seen as easy to fix.'
However, Hill warned that raising parents' awareness of their children's weight will only be beneficial if they are also alerted to services that will be effective in helping their children lose weight. 'While Foresight describes some of these, for example "Watch-it" and "Carnegie Weight Loss", these interventions are not widely available and indeed are only in the early stages of showing their effectiveness.'
Hill also told us that families should be offered help with parenting skills and children's general well-being 'because it is important to recognise the complexity of family life and the way that weight can just be one of several problems that families are struggling with'. cj