News, June 2006

Who's the greatest? 

AT this Royal Institution debate, four men proposed four other men as the greatest minds to have changed our minds. 'Two of the advocates are psychiatrists and two are psychologists,' explained the chair, Professor Robin Murray, in his introduction. 'If you want to know the difference – psychologists tend to be more intelligent, but psychiatrists are better paid.'

Freud
'We can stop this debate now,' said Dr Jeremy Holmes, the consultant psychiatrist and psychotherapist who happened to be proposing Sigmund Freud just days before the 150th anniversary of his birth. 'It's never great to be the favourite,' he continued, 'but if you consider what the world would be like without any of the four candidates, then Freud has to be the winner.'
Yes, Freud got a lot wrong, Holmes argued, but he got a hell of a lot right too – the importance of dreams; the basic techniques of therapy, what we recognise today as the common factors of effective therapy; the subconscious; and he was a pioneer of developmental psychopathology.
'Psychoanalysis is one of the few proven treatments that works for severe personality disorder when compared against "treatment as usual" – in other words, what you get at the Maudsley,' he quipped. 'So psychoanalysis certainly isn't a luxury, it's helped us understand our world and will continue to do so.'

Jaspers
But Professor Paul Bebbington, head of the Department of Mental Health Sciences at UCL, who was proposing Karl Jaspers, said that it was important to distinguish between fame and legacy. 'Jasper's influence is enormous, but hidden,' he argued. 'His web is everywhere, he's a universal spider.'
Bebbington explained how, in diagnosis, Jaspers advocated observing the form of symptoms, rather than their content; he distinguished between the psychology of explanation and of understanding; recognised that there can be physical explanations for psychiatric conditions; and he introduced the idea of a 'symptom complex', what's known today as a syndrome. His two-volume text General Psychopathology became a classic and later editions were massively influential in the UK in the 1960s. Halfway through his career Jaspers turned to philosophy and became one of the founders of existentialism. 'He's really better known as a philosopher' Bebbington said.

Eysenck
Hans Eysenck's influence was all about the 'appliance of science', argued Dr Glenn Wilson, Reader in Personality at the Institute of Psychiatry. 'Before 1940, psychiatry was based on authoritative pronouncements, – "Freud says this…", "Jung says that…", but Eysenck argued that without evidence, these were no more important than what Aunt Sally says. Eysenck's answer was the evidence-based scientific approach.'
Wilson described how Eysenck authored 79 books and 1078 scientific papers, and at the time of his death was the most widely cited psychologist in the world. He founded two journals that are still going strong today – Behaviour Research and Therapy, and Personality and Individual Differences, and his PhD students head psychology departments in all parts of the world. He was also responsible for outlining the key elements of behaviour therapy, including the idea that symptoms are acquired by learning and that treatments must be evaluated against placebo and no-treatment controls. He initiated modern behavioural genetics, and was involved in some of the earliest twin studies.
'His legacy is demonstrated by the fact that evidence-based psychotherapy is today accepted everywhere,' Wilson concluded, 'except in isolated pockets, such as Hampstead.'

Beck
Aaron T. Beck, the psychiatrist who developed cognitive behaviour therapy (CBT), and the only candidate still alive today, was proposed by Professor David Clark, head of psychology at the Institute of Psychiatry.
Clark described how Beck – 'still outrageously productive today' – started out as a psychoanalyst, with an initial research grant to study the interpretation of dreams. 'But he listened to his own data', Clark said, 'and changed his mind. He observed that when it comes to experiences, it's not the event per se that matters, but our interpretation. He noted how people with mental problems have cognitive distortions, and inspired by Eysenck, he also recognised the role of genetic predisposition.'
Clark argued that randomly controlled trials have demonstrated the efficacy of CBT for a wide range of conditions from personality disorder to schizophrenia and bipolar disorder. CBT can work alone, has been found to enhance the effect of medication, and help prevent relapse. Beck's diagnostic scales are also used routinely around the world.
'Thanks to Beck's CBT, people now recognise that psychological therapies can work for serious mental problems,' Clark said, 'and in fact, thanks largely to NICE guidelines recommending CBT as the treatment of choice for many disorders, the Labour manifesto actually made a commitment to increase access to psychological treatment.'
In the end, with 62 votes, the audience named Aaron T. Beck to be the greatest mind to have changed our mind. Freud earned 49 votes, Jaspers 12 and Eysenck 58.    CJ
- Look out for our report on the Royal Institution's follow-up to this event, 'From bad to worse: The worst ideas on the mind', to be held on 18 July. See tinyurl.com/z334e to book.

BEHAVIOURAL THERAPIES  IN COCHRANE COLLABORATION

A NEW Behavioral Medicine Field has been established within the Cochrane Collaboration (www.cochrane.org), an international organisation that has conducted and disseminated systematic reviews of health interventions for more than 10 years. The Behavioral Medicine Field focuses on 'interventions that improve health outcomes through behavioral mechanisms alone or in combination with other therapies'. The aim is to increase access to the evidence base in behavioural medicine as well as to create increased expertise in the use of systematic review methodology.

RESEARCH INTEGRITY

THE UK Research Integrity Office is to develop a code of practice for staff working in the NHS, universities and the health industry. It will also offer support to whistleblowers, and provide experts to boost the quality of future research. However, it will remain the responsibility of employers or sponsors to investigate individual allegations of fraud or unethical working. The move will help to bring the UK into line with other similar initiatives in the US and parts of Europe, including Scandinavia.

Prizes for mind-altering research

A TOP prize of £6000 is being offered by business consultancy The Mind Gym Ltd for research 'that helps people use their minds better in daily life'. Two runners-up will receive £2000 each.
Sebastian Bailey, co-director of The Mind Gym told us 'The idea behind the prize is to close the gap between academic research and practice…We want to bring the great work that is being done in academic psychology to people as quickly as possible.' The focus will be on research findings with practical implications. 'We're all about helping people get better at things, while at the same time making sure the topics we cover are based on sound science,' Bailey said.
Entries will be judged by The Mind Gym's academic board, made up of four Fellows of the Society, including former BPS President Ingrid Lunt.
Academic board member Guy Claxton, visiting professor of psychology and learning at Bristol University, told The Psychologist: 'What we are looking for are experimental pieces of work that could underpin smart ways of helping ordinary adults get the most out of their minds – at work, at play and in relationships.'
The winner will be announced at a ceremony hosted by the Royal Society of Arts and their research will be translated so as to directly impact people's lives. Anyone can enter, and submissions from new researchers are particularly welcome. The deadline for entries is 1 March each year, starting in 2007.     CJ

- See tinyurl.com/zazx4 for more information and how to apply.

Electrosensitivity - all in the mind?

The Swedes recognise electrosensitivity as a physical illness, and two million people in the UK, according to the consumer group Powerwatch, suffer from headaches and dizziness when they use mobile phones, computer screens and other electrical devices (see www.powerwatch.org.uk/ gen/sensitiv.asp). But a study published in BMJ suggests electrosensitivity is entirely psychological in origin.
Dr James Rubin and colleagues at the Mobile Phones Unit at King's College London subjected 60 self-proclaimed electrosensitive people, and 60 controls, to 50 minutes exposure to a real mobile phone and 50 minutes exposure to a 'sham' mobile phone that heated up like a normal phone but had a greatly attenuated signal. Although the 'sensitive' participants reported more unpleasant symptoms than the controls, they reported the same amount of symptoms whether they were exposed to the sham phone or the real phone. Moreover, more of the sensitive participants (63 per cent vs. 60 per cent) thought the sham phone was giving off a harmful signal than thought the real phone was.
'We think electrosensitivity symptoms are caused by the "nocebo" effect,' Dr Rubin told us. 'This is the flipside of placebo, in which people's expectation that something will hurt them becomes a self-fulfilling prophecy caused by their anxiety.'
But Alasdair Philips, the former electronics engineer who heads Powerwatch, remains unconvinced. He said the design of the sham mobile phone was flawed because it leaked a residual signal at a level 20 times higher than the level at which electrosensitive people have previously reported symptoms. 'Electrosensitivity is very much a real thing,' he told us. 'For people who experience symptoms, it is likely to get worse, reaching a critical stage at which all sorts of equipment cause problems, making life very miserable.'
However, Rubin said the residual signal leaked by the sham phone was non-pulsing (whereas it is pulsed signals that are thought to cause symptoms) and 700 times weaker than that emitted by the real mobile phone. 'Given that previous observational research has documented a dose-response effect of wave signals on electrosensitive people, any physical/biological process should have led to far worse symptoms during exposure to the real phone compared with the sham phone,' he said.
'Sufferers of "electrosensitivity" have argued they're the "canaries down the mine shaft", the early warning of things to come from the ubiquitous use of mobile phones and other wireless technologies, but our research suggests this simply isn't the case, that electrosensitivity is a psychological problem caused by anxiety about using mobiles and other devices,' Rubin told us. He said the media might have played a part in this with the widespread use of headlines such as 'Mobiles may fry your brain' and newspaper reports linking mobiles with cancer.
His latest findings come after his team published a systematic review last year that found cognitive behaviour therapy was the only effective treatment for electrosensitivity.     CJ
- Rapid responses to this research: http://bmj.bmjjournals.com/cgi/eletters/
332/7546/886;
Mobile Telecommunications and Health Research: www.mthr.org.uk.

Feedback help for people with autism

NEURAL feedback training could be used to help children with autism, according to preliminary research presented at the annual meeting of the Cognitive Neuroscience Society in San Francisco.
Dr Jaime Pineda and colleagues at the University of California's Cognitive Neuroscience Lab attached electrodes to the heads of eight autistic children while they played a video game. The more the children increased their µ rhythm brain activity, the faster their car travelled around a race track. The researchers focused on this brain-wave pattern because they believe it to be associated with mirror neuron activity – the brain cells involved in our ability to understand other people's intentions, a capability that is impaired in autism. 'We reasoned that if these kids have a deficit in mirror neuron functioning, then maybe we could enhance their functioning using neural feedback,' Pineda told us.
The children weren't given explicit instructions on how to control their µ rhythm brain activity, but earlier research with healthy adult controls found they were able to do so by thinking about movement, speed and racing.
The children soon improved on the video game, and after the training they performed better on a test of sustained attention – they were more focused, and better able to sit still for longer periods. The researchers also found EEG coherence between the children's two hemispheres had decreased following the training. 'We think this is related to increased information processing,' Pineda explained. 'Increased coherence is associated with an idle state whereas information processing leads to more random firing and less EEG coherence between the hemispheres.'
Pilot work has suggested the benefits of neural feedback training last just two months before autistic children revert back to their previous behaviour. 'We're planning on following up this research with 20 more children, and we want to find out how long the training has to be to produce more permanent benefits,' Dr Pineda told us.
In a separate development, scientists at the MIT Media Research Lab have developed an 'Emotional-Social Intelligence Prosthesis' that aims to help autistic people interpret the emotional responses of the person they're talking to (see tinyurl.com/pvjwf). A small video camera connected to a computer will use head, eyebrow, lip and nose movements to tell the wearer, via vibrations or audio, whether the person they're talking to is agreeing, disagreeing, concentrating, thinking, unsure or interested. Researcher Rana El Kaliouby presented the device to the Body Sensory Network conference in April. 'People keep asking me if it can detect flirting,' she joked. 'I could program it to do that. Maybe it could be used for dating'.     CJ

Can anger management courses make offenders more dangerous?

ACCORDING to new recommendations issued by the National Probation Service, offenders who have a history of using premeditated violence to get what they want should not be enrolled on anger management courses. The new guidance states: 'For offenders indicating such behaviour…anger management interventions that seek to improve the offender's capacity to control their behaviour are considered to be wholly inappropriate and have the potential to equip the offender with additional control mechanisms and increase his/her capacity to manipulate a situation to their advantage and power.'
The guidelines stem from the report published by Her Majesty's Chief Inspector of Probation into the murder in 2004 of the London banker John Monckton by Damien Hanson and Elliot White. At the time, Hanson was on probation having served just half his 12-year sentence for attempted murder. According to the report, his completion of 24 courses of the CALM programme (controlling anger and learning to manage it) played a part in the parole board's decision to release him early.
Dr Gareth Hughes is head of psychological services at Kneesworth House Hospital, which provides psychological treatment to offenders detained under the Mental Health Act. He told us the idea that psycho-educational programmes can do more harm than good when applied to patients who score high on measures of psychopathy is hardly new, with research on this dating back to the late 1980s.
'For psychopathic offenders who are not riven by anger, but who use violence instrumentally, or who simply enjoy hurting people, anger control courses are obviously a complete waste of time,' Dr Hughes said. 'It sounds like there has been indiscriminate use of these anger management courses caused by the bureaucratisation of therapy. This is what happens when psychology loses control to bureaucrats whose performance is measured by how many of these courses they deliver, and how many people receive them. Yet the whole emphasis of the "what works" literature is on the importance of providing appropriate treatment.'
However, writing to The Guardian, Dr William Winogron, co-author of the CALM programme, challenged the recommendation that offenders who use violence instrumentally should always be excluded from anger management courses. 'Is it appropriate to treat explosive anger in someone who also shows instrumental aggression? It is – but treating the former doesn't do much to alter the latter,' he wrote. And he defended the CALM programme against the charge that it had helped Hanson manipulate the parole board: 'CALM did no such thing – nothing in the programme teaches persuasiveness or any related skills or tactics.'
- The Monckton Inquiry report: tinyurl.com/h23pb; Probation service guidelines for practitioners, arising from the Monckton Inquiry: tinyurl.com/grryj.

World Cup – winning advice

Sandy Wolfson and David Lavallee with 10 tips from psychology for the England squad, ahead of this month's football tournament.

Create a home away from home
FIFA's (2006) analysis of 6679 international matches not played on neutral territory showed 49 per cent home wins, 26 per cent draws, and 25 per cent away wins. Teams are clearly disadvantaged when they play on foreign territory. Even within one country, teams from the Premier League down obtain significantly more wins at home than away. Preparation for away visits is thus imperative, and all team personnel need to be aware of the risks of travelling to and competing in foreign places. Deviations from normal routines should be minimised by adapting early to the new surroundings and making them as home-like as possible through familiar foods, activities, home colours and logos, and music. The press might express amusement at imported baked beans and beds, but such attention to detail can reduce fatigue, disorientation and insomnia (Neave & Wolfson, 2004).

Treat players as individuals
A manager at international level doesn't get to see players' daily behaviours and idiosyncrasies, but mainly witnesses 'best behaviour' from footballers at training camps who are desperate to be selected to play. Yet knowledge of players' typical and atypical responses is vital. An awareness of individual footballers' personal patterns and reactions to competition can be vital, as players vary considerably in their responses to being ahead or behind in a match, becoming the butt of jokes from teammates, receiving criticism from coaches, and being provoked by opponents. In addition, research (Neave & Wolfson, 2004) shows that footballers' testosterone levels are significantly lower away from home overall, some being dramatically affected, others less so. Shouting at Player A might be motivating, while Player B could react negatively, so gathering information about players' predispositions can be extremely helpful in providing the ideal preparation for each individual.

Deal with the crowd
Responding to the influence of crowds is an important part of performing well. The mere presence of a single, even impartial, observer is known to have an arousing effect on performers; a stadium full of chanting, hostile rival fans can be extremely distracting. Impaired decision making, narrowed focus of attention, poor execution of complex tasks, and the inability to perform recently acquired skills are associated with high levels of arousal. Psychological skills related to maintaining concentration and attentional focus are therefore critical, even with fervent supporter from the crowd. Indeed, Butler and Baumeister (1998) found impaired performance in front of a supportive as opposed to unsupportive audience, even though the performers incorrectly believed that the audience had benefited them! Exercises designed to improve concentration and attention (see Moran, 1996) can be highly useful in coping with the demands of crowds, particularly for players like surprise inclusion Theo Walcott, a 17-year-old who has never played a top-flight game. It might also help to remember Alan Shearer's observation that rival crowds don't normally boo poor players!

Enjoy the experience
Footballers should be encouraged to trust all the hard training they have done and enjoy their experience. The input of the coach and manager is of particular importance here. Confidence can be instilled by frequently reminding the players that they have been selected for good reason and that they should cherish this time of their lives. It is also important to stress that arousal (such as increases in heart rate, perspiration and butterflies in the stomach) should be interpreted as natural and positive in competition, rather than a sign of worry and anxiety. Embracing the exhilaration and excitement of the tournament can then be seen as part of pre-match preparation (Higham et al., 2005). This can help to enhance positive expectations, focus attention, and inoculate against anxiety about making errors or about the strength of an opponent – especially important in the first match (or, indeed, the first half of the first match), which can often make or break a player's tournament.

Prepare for penalties
Some of England's most dramatic and memorable defeats have been a result of heartbreaking penalty shoot-outs. While some managers and players contend that practising penalties is futile because simulating the pressures of a competition, is impossible, the evidence is that well-rehearsed, automatic manoeuvres are more successfully executed when performers are aroused or fatigued. Thus it is critical to include penalties in training sessions, and an effort can be made to add in some incentives (e.g. asking each player to put in £500, with the best penalty taker winning the lot). This also helps the goalkeeper to sharpen his skills and decision making (Lavallee et al., 2004). Research has also found that keepers can extract relevant information from an opponent's posture: penalties tend to go to the right or left according to the orientation of the taker's hips to the goalkeeper (Williams, 2000).

Foster team spirit
Positive relationships, feelings of belongingness, trust in the group and pride in membership of a team are important ingredients of team cohesion. The more team spirit, the more motivated individual members of the group are to feel personal responsibility in the team's success and give their all for the team. Without cohesion, 'social loafing' may occur wherein players put in reduced effort or try to avoid feeling exploited by teammates. Team cohesion has also been associated with increased self-disclosure (Carron et al., 2002), which can be helpful if a player needs to share a personal concern. Another product of cohesion is an ingroup mentality leading to bonding against external threats, such as opponents and the ever-negative British media. Cohesion has been enhanced and demonstrated in the sharing of in-jokes, such as when the England team integrated Beatles and Abba song titles into their media interviews. Research suggests that cohesion can also be enhanced when members have a strong leader who makes fair, understandable decisions, and when clear roles are perceived by members, not only in terms of their position on the pitch but also their social role (such as the joker; the arbitrator; the agony aunt). Although it might seem inconceivable that a World Cup team could be characterised by disharmony and conflict, it should be noted that many players will have been archrivals at club-level only weeks before. An abrupt context change is not always straightforward.

Stay in the present
The players will not be able to control many aspects of the future, and certainly not the past, so thinking about these can cause feelings of helplessness, anxiety and stress – and, in turn, have a negative impact on performance. Yet, some individuals will place themselves in the past by dwelling on a mistake they have made, particularly if it had a dramatically negative outcome. Others will be too preoccupied with the future, evoking images of how wonderful it would be if they won the World Cup, or how terrible to be knocked out early. Although past mistakes can be seen as opportunities for improvement, and thinking about the future can assist in setting appropriate goals, good performances on the pitch are normally accompanied by self-talk that is positive and instructional (Lavallee et al., 2004). This can help players stay in the present and enhance their self-esteem.

Keep faith in injured stars
One of the few benefits players enjoy after being injured is to be seen as heroic to have returned to competition through their commitment and focused training (Walker et al., 2004). The pressure is off because fans and the media have high hopes but do not expect optimal performance as from a player who has had a normal build-up to the competition. Yet some players have demonstrated excellent performances after injury. Having suffered serious injuries while at Blackburn Rovers during the 1995/6 season, Alan Shearer became the top scorer in Euro96. England's first-choice strikeforce of Michael Owen and Wayne Rooney, still not playing a few weeks before the tournament, should take heart from this and from support from the media and fans ('Pray for Wayne', etc.).

Please the crowd-pleasers
We all feel that referees are biased against our team. Observe the comments of managers, players and supporters after a disappointing result: the referee's unfair decisions or lack of expertise are nearly always implicated. Yet if we calm down and think objectively about them, we just might conclude that officials are highly motivated to do well, being constantly under scrutiny by people who make decisions about their futures. Referees also feel a good deal of pride in their objectivity (Wolfson & Neave, 2002), so it's not surprising that they feel aggrieved.