News, September 2006

Statutory regulation - more delay, more consultation

The long-awaited Donaldson Report and Foster Report, government reviews attempting to produce an integrated regulatory system covering medical and non-medical professions, were published at the end of July. Both reports were published as consultation exercises rather than statements of government policy, with a deadline of 10 November for responses.
Despite numerous rumours earlier in the year the government has still not published its response to last year's public consultation exercise on the regulation of applied psychology. 'So', as British Psychological Society President Ray Miller said: 'we are no wiser as to the government's position in regard to us.'
However, the Foster Report does conclude that 'any new profession coming into statutory regulation should be regulated by one of the existing regulatory bodies, probably the Health Professions Council'. The report notes 'some aspirant groups' have argued that 'new bodies should be set up to regulate their professions', but that approach is rejected.
The commitment to the HPC and the medical emphasis are bad news, according to Ray Miller. 'The report is wholly written about those who work within the National Health Service. This is deeply unhelpful to us, and the public, as so many of the members work in other settings – prisons, education, business and commerce – and it is extremely hard to see how the proposals would fit in a non-NHS setting. For instance, the review discusses CPD assessment being carried out by employers as part of annual appraisal processes – but unless all the systems were integrated across employers this would lead to a serious consistency and quality issue. It also discusses the resolution of 'less serious' fitness to practise complaints at local, employer level – again systems would have to be integrated across both public and private sector employers. The burden on small- and medium-size private sector companies could be enormous.'
Other concerns are also ignored. For example, the Society has argued that the profession must have an input into setting its own standards, something the HPC model does not accommodate. The Foster Report said that this issue 'did not appear to give cause for concern'.
The UK Council for Psychotherapy described the Foster Report as a 'damp squib', although it also noted that 'the HPC now seems set to move towards a more social care model, appropriate to the regulation of mental health care professionals'.
Nicola Barden, chair of the British Association for Counselling and Psychotherapy, said: 'Although BACP remains strongly committed to the principle of regulation, the Donaldson and Foster reports were disappointing in terms of furthering this aim. While there is a logic to simplifying regulatory structures and encouraging a "light touch", this can all too easily translate into inflexible mechanisms and minimal standards, which will not in the end protect the public. HPC remains the only regulator on offer, yet in its present form cannot secure the confidence of the profession.
It is to be hoped that the next consultation round will meet the concerns expressed by the psychological therapies field in a more realistic way.'
The British Psychological Society remains committed to the principle of statutory regulation to protect the public. 'But it has to be a system that would be fit for purpose,' said Ray Miller. 'That is why we shall continue to argue for a new regulatory council, which could cover not only us but also counselling and psychotherapy.'

A Society response is being prepared and members will be invited to comment in due course: keep an eye on the website for information. 
See also the President's column, on p.515.

PATIENT INCIDENTS

THE National Patient Safety Agency has published the first analysis of mental health patient safety incidents.
Covering almost 45,000 mental health incidents, it found most were associated with no or low harm, but 2 per cent reported severe harm or death – usually as a result of suicide. The four most common incident types, accounting for over 84 per cent were: patient accidents, disruptive/aggressive behaviour, self-harming behaviour, and absconding or missing patients.
 

INTERNATIONAL AWARD

DR Jacky Boivin is the 2006 winner of the Society for Reproductive and Infant Psychology Award for her 'outstanding contribution to research and scholarship in the area of reproductive psychology'.
The Cardiff University lecturer's research helped establish the idea that stress can have an effect on fertility in both sexes. She has also helped bring better psychosocial services for people having difficulty conceiving.
The Society for Reproductive and Infant Psychology is an international organisation promoting the scientific study of all psychological and behavioural matters related to human reproduction.

ART AND THE EGO

MANCHESTER'S Castlefield Gallery is holding a psychoanalysis-inspired exhibition exploring the ego within contemporary art practice.
Making Love to My Ego examines the realm of self-image and alter ego, connecting the pioneering work of Freud and Lacan, whose theories offer an interpreting language for the work on display.
- For more information contact the the gallery on 0161 832 8034 or view their website at www.castlefieldgallery.co.uk.

Autism 'rise' - changes in diagnosis, or something more?

MORE than one in a hundred children are affected by autistic spectrum disorders (ASDs), according to a new study. But although the estimate grabbed the headlines, experts in the field are unsurprised.
The researchers at Guy's and St Thomas' hospitals studied all children currently resident within 12 districts in South Thames who were born between 1 July 1990 and 31 December 1991. They used a screening procedure in a high-risk group, followed by a comprehensive diagnostic assessment with a sub-sample of 255. Their results, published in The Lancet, put the prevalence of childhood autism at 38.9 per 10,000, and 77.2 per 10,000 for other ASDs, making a combined prevalence of 116.1 per 10,000. Studies this century have estimated prevalence at between 30 and 90 cases per 10,000: older figures were as low as 4.  
Uta Frith, professor of cognitive development at University College London and the Institute of Cognitive Neuroscience, described it as a 'landmark study', saying it is further proof of how the UK is leading research into ASDs, and predicted that it would have a tremendous impact.
She told The Psychologist: 'This figure is not unexpected to people working within the field of autism. As a scientist, you have to keep the question open, but there is still no justification to demand a study into whether it is increasing. What's not been done in this particular study is look at children who are not statemented: who have a good IQ, are doing reasonably well in school, but may still have communication problems.'
Dr Stella Acquarone, an Adult and Child Psychotherapist and founder of the Parent Infant Clinic and School of Infant Mental Health, told us that since the 1980s she has been 'telling people there are more of these children than the figures suggest'. By studying home videos of those diagnosed with autism at the age of three, she identifies early signs.
Professor Simon Baron-Cohen agrees that rising prevalence might be due to both better recognition and the widening of the category to recognise a spectrum. But he argues there may also be a genetic factor – 'assortative mating' of two 'high systemisers' – that may be becoming more common (see tinyurl.com/pe7rc).
The authors of the The Lancet study conclude: 'Prevalence of autism and related ASDs is substantially greater than previously recognised. Whether the increase is due to better ascertainment, broadening diagnostic criteria, or increased incidence is unclear. Services in health, education, and social care will need to recognise the needs of children with some form of ASD, who constitute one per cent of the child population.'    CB

In brief
A round-up of research from the latest BPS journals

Is skin-cutting a particularly female phenomenon? Not according to a new study by Mark Marchetto (London Metropolitan University), which found no significant gender differences among a large sample of 516 skin-cutters. He argues that previous studies may have found this association due to the use of small and biased samples. Marchetto also found a significant association between skin-cutting and both high parental overprotection and low maternal care. (PAPTRAP, September)

Research over the past two decades has demonstrated that adults are better at recognising and discriminating faces of their own race versus other races. Now Pamela Walker and Miles Hewstone (University of Oxford) have conducted the first study to find this effect across three age-groups – primary school, secondary school and university – with an ingenious and subtle facial morphing methodology. Hypothesised relationships with other-race social anxiety and contact were not supported. (BJDP, September)

The Patients' Charter for Mental Health Services states that a patient is entitled to both know and understand their diagnosis, but personality disordered clients are not always properly informed because of concern that to do so would damage the therapeutic alliance. Now a study by Penelope Banerjee (East Midlands Centre for Forensic Mental Health) and others has found that a psychoeducation programme that informs about personality disorder actually resulted in a positive change in four of the five measured components of the therapeutic alliance. This change was rated more strongly by clients than therapists. (PAPTRAP, September)

Offenders often attribute their behaviour to external factors, and rehabilitation often focuses on reversing these 'cognitive distortions'. But Shadd Maruna (Queen's University Belfast) and Ruth Mann argue that excuse-making is normal and frequently healthy; that behaviours frequently do have external causes. Those concerned with understanding offending, whether through research or clinical practice, may pay too little attention to other, perhaps more important, cognitive phenomena. (LCP, September)

The frequent use of 'not' and 'never' by a client at the start of psychotherapy is predictive of poor outcome, according to a study by Werdie Van Staden (University of Pretoria, South Africa). (PAPTRAP, September)

In a microgenetic study of stability and continuity in theory of mind development, Emma Flynn (University of St Andrews) concluded that the development of, or at least the demonstration of, theory of mind skills (i) occurs gradually, (ii) is stable with occasional small regressions in performance, (iii) is predicted by early verbal skills, (iv) can be facilitated by the repeated presentation of tests without explicit feedback, and (v) involves a period in which children no longer rely on reality to explain an individual's behaviour, but instead choose to give no response. (BJDP, September)

According to Rob Ranzijn (University of South Australia) and colleagues, there is a 'lost generation' of mature-aged unemployed people, who may live for another 30 or more years without ever finding satisfactory employment. Interviews identified an inability to use their talents, with consequent skill depreciation, leading to what the authors label the 'peg-down phenomenon': an intermediate step between becoming unemployed and entering the ranks of the discouraged job-seekers that ultimately leads to a premature exit from the workforce.  (JOOP, September)

Can acts of domestic violence be categorised as either predatory attack or affective defence? Ian Mitchell (University of Birmingham) and Elizabeth Gilchrist argue that some perpetrators report committing their offences whilst in a high affective state, a red mist, which is accompanied by palpitations and high autonomic arousal similar to panic attacks. The authors hypothesise that in addition to showing hostile dependency, fear of abandonment and anxiety about the possibility of narcissistic injury the offenders should display a tendency to misinterpret their own physiological responses to anxiety such that they become a source of anxiety in their own right. They suggest that serotonin 'agonists' and benzodiazepines would diminish the incidence of domestic violence in this subgroup of offenders. (LCP, September)

Police officers' recall performance can be affected both qualitatively and quantitatively by witnessing an arousing event such as a shooting. That's according to Lynn Hulse and Amina Memon (University of Aberdeen), who used a firearms training simulator to present 70 experienced police officers with either a shooting or a domestic dispute scenario containing no weapons. After a 10-minute delay, a structured interview showed that officers who had seen the shooting had memories for the event that were less complete, but more accurate (they recalled fewer of the relevant details, but the ones they did recall were more likely to be correct). (LCP, September)

Gender role (i.e. a person's position on masculine/feminine scales) is much more important than biological sex in determining interpersonal distance. That's according to a new study by David Uzzell (University of Surrey) and Nathalie Horne, using innovative experimental techniques. (BJSP, September)

Anorexia nervosa is highly valued by people with the disorder, and it is very visible, evoking intense emotional responses from those closest to the person. Ulrike Schmidt (Institute of Psychiatry) and Janet Treasure propose a 'culture-free' model of understanding that does not emphasise the role of weight and shape-related factors.Instead it focuses on perfectionismcognitive rigidity, experiential avoidance, proanorectic beliefs, and the response of close others. In a separate study, Anna Lavender (Institute of Psychiatry) and colleagues found that eating-disordered participants showed high levels of magical ideation beliefs; for example that 'horoscopes are right too often for it to be a coincidence'. (BJCP, September). And in an analysis of 'pro-anorexia' websites, David Giles (Lancaster University) shows how various identities are managed and defended. 'Wannabes' are treated as naive interlopers orienting to anorexia as a trendy lifestyle choice; 'haters' are quickly 'flamed'; and 'anas' and 'mias' (bulimics) are at loggerheads. (BJSP, September)

Developing their previous work in identifying leaders of rape groups, Louise Porter and Laurence Alison (University of Liverpool) have coded 105 cases of group robbery for each participant's involvement in decisions, actions and orders. Potential leaders were identified in 103 of the groups. Two thirds of groups comprised a dichotomous leader/follower distinction, whilst the remaining third comprised more dispersed, linear and lieutenant hierarchies. Robberies appear to evolve through a series of decisions of one individual who then either participates first or gives orders to his fellow group members to participate, although the former seems far more frequent. (LCP, September)

We are probably all familiar with our worries keeping us awake at night. But a new study from Markus Jansson (Orebro University, Sweden) and Steven Linton suggests that the relationship between worry and subjective sleep perception changes over time: the longer a patient is distressed by insomnia, the stronger the association between worry and subjective sleep perception becomes. (BJHP, September)

White, native English-speaking adults have a preference for UK-trained medical doctors of the same gender, according to a study by Adrian Furnham (University College London) and colleagues. There were more significant effects in GP ratings than with consultants, perhaps because patients recognise they have less choice at this level and are grateful to see any suitably qualified person. (BJHP, September)

- Society members can subscribe to BPS journals for just £19 per year (£14 for students). See www.bpsjournals.org.uk.

What's the worst idea on the mind?

PREFRONTAL leucotomy is the worst idea on the mind, according to the audience vote at a debate hosted by the Royal Institution. The idea that mental illness can be successfully treated by cutting nerve fibres in the front of the brain, beat off stiff competition from three rivals: Freud's notion of hysteria; the practice of post-trauma counselling or 'debriefing'; and the 'chemical imbalance' model of mental illness.

Hysteria
Richard Webster, author of Why Freud Was Wrong: Sin, Science and Psychoanalysis, kicked off the debate with a story from the 1960s about a girl who suffered from painful muscular convulsions. Doctors couldn't find a physical explanation for the girl's illness, and following an account from her parents that the symptoms only began shortly after a boy pulled down her pants, psychiatrists diagnosed the girl with conversion hysteria. In other words, they believed her physical symptoms had a psychological cause. They even locked her in isolation and made her crawl to reach her food in the belief this would help cure her. It was only some time later that neurologists realised the girl had the rare physical condition dystonia musculorum deformans.
Although made (in)famous by Freud, it was in fact his teacher, the 19th century French neurologist Jean-Martin Charcot, who proposed that it was a patient's 'idea' of his or her trauma that could manifest as physical symptoms. In Charcot's day, closed head injury without outward signs of injury, and frontal lobe epilepsy, were both routinely misdiagnosed as conversion hysteria, 'probably the most profound medical misunderstanding of the last 150 years', said Webster. 

Post-trauma counselling
Sixteen randomly controlled trials have now shown that psychological debriefing after a trauma definitely does not work, and in fact probably increases the risk of post-traumatic stress disorder, said Professor Simon Wessely from the Institute of Psychiatry. Talking to a counsellor soon after being traumatised can interrupt natural recovery processes, can cause re-traumatisation, and by describing to people some of the symptoms they could suffer, counsellors may actually induce those symptoms by power of suggestion. And yet, whenever a major incident occurs, an exasperated Wessely observed, we still hear that trained counsellors are on hand (for example, a witness to the killing of Jean Charles de Menezes, was apparently immediately offered counselling by police: see tinyurl.com/c4jof). 'And why', Wessely asked, 'is it always 'trained' counsellors? We'd find it odd if airplane pilots introduced themselves as 'trained pilots',' he said.
There's nothing wrong with talking after a trauma, Wessely clarified – it's the idea that you need to speak to a professional. He pointed to an article he co-authored in BMJ last year that surveyed a sample of Londoners in the weeks after the July terrorist bombings; 76 per cent had attempted to speak to friends or family immediately after the bombings, but just 1 per cent wanted counselling (tinyurl.com/zqr6o).
'Post-traumatic counselling is a bad idea and a bad intervention,' Wessely argued. 'It assumes normal people are too incompetent to deal with adversity and it takes attention and resources away from those people who really do need help from interventions that work, like CBT.'

The chemical imbalance model 
Dr Joanna Moncrieff at UCL argued the worst notion on the mind is the theory that mental distress is caused by some kind of chemical imbalance – an idea propagated doggedly by drugs companies. 'Most people think the link between depression and the neurotransmitter serotonin is established,' she said, 'and yet there's no evidence for it at all.'
Moncrieff explained that it's not even possible to measure serotonin directly in the brain. Instead, most studies rely on measuring serotonin receptors, especially the 5-HT1 receptor. Some of these studies have found the receptor is lowered in depression, Moncrieff said, but others have found it the same or raised. 'Don't just take my word for it,' Moncrieff added, pointing to a quote from David Burns, the Stanford psychiatrist who won an award from the Society for Biological Psychiatry for his research on serotonin metabolism – 'I spent the first several years of my career doing full-time research on brain serotonin metabolism, but I never saw any convincing evidence that any psychiatric disorder, including depression, results from a deficiency of brain serotonin' (PLOS Medicine). With 11 per cent of women in the USA now taking anti-depressants, Moncrieff said the chemical imbalance idea has moral and political implications. It promotes dissatisfaction in people and implies there's some kind of ideal balance that we should all be striving for. And
it is used to justify harmful interventions. Most recently, drug company-funded research has identified intermittent explosive disorder and compulsive shopping as new conditions treatable with antidepressants…

Leucotomy
But the historian Professor Edgar Jones at the Institute of Psychiatry successfully persuaded the audience that neither hysteria, trauma counselling, nor the chemical imbalance idea, are as bad as leucotomy (also known as frontal lobotomy).
'I won't show you any pictures of the operation because that would give me an unfair advantage over my colleagues,' Jones began. The Portuguese neurologist Egas Moniz, who ironically won the Nobel Prize for Medicine in 1949, was the driving force behind the first lobotomy conducted in 1935, Jones told the audience. But it was actually the American neurologist Walter Freeman, in partnership with his neurosurgeon colleague James Watts, who really championed and developed the procedure, claiming it was a cheap, effective treatment for young sufferers of psychosis that would save state hospitals countless dollars.
However, Freeman and Watt's only outcome measure was whether a patient had returned to some kind of employment, and their irreversible procedure, which lacked any evidence base or ethical approval, left patients brain damaged with profoundly altered personalities. Despite this, Jones said that by the early 1950s, the procedure had been performed on over 50,000 patients, including traumatised soldiers from WWII.
Leucotomy received 61 votes; the chemical imbalance model 48 votes; trauma counselling 43 votes; and hysteria 16 votes. The prequel to this debate – who is the greatest mind to have changed our minds? – took place in April; see June news.     CJ

PUTTING TELEPATHY TO THE TEST

A COLLABORATION between the University of Manchester's Schools of Computer Science and Psychological Sciences has created a virtual computer world designed to test telepathic ability. Project researcher David Wilde, of the School of Psychological Sciences, said: 'By using this technology we aim to provide the most objective study of telepathy to date. Our aim is not to prove or disprove its existence but to create an experimental method which stands up to scientific scrutiny.'

MILLION-POUND PROBE

RESEARCH at Cardiff University's School of Medicine and School of Psychology has already shown a link between depression in adults and their children. Now the interdisciplinary team has secured a million-pound grant from the Sir Jules Thorn Trust to investigate the reasons behind the link. The team will investigate what factors influence at what age adolescent depression begins. The aim is to develop a software package for GPs and hospital-based clinicians that will enable them to assess and monitor adults with depression and identify the warning signs of their children becoming sufferers.

WELLCOME CHANGE

FROM 1 October, any research articles funded in part or whole by the Wellcome Trust, the UK's largest independent funding body for biomedical research, must be deposited with the open-access digital archive PubMed Central within six months of their official publication date.
The new rule comes after research (in PLOS Biology) found that open-access papers published in the Proceedings of the National Academy of Sciences have been cited significantly more often than non-open-access papers published in the same journal. 
Several bodies have developed forms for authors to retain the rights they need from publishers in order to satisfy new open-access rules.

Bipolar guidelines

THE National Institute for Health and Clinical Excellence (NICE) has published new guidance relating to the diagnosis and treatment of bipolar disorder in adults and children, and to training programmes for parents and carers managing conduct disorder in children aged under 12.
The guidance on bipolar disorder recommends that patients with depressive symptoms who do not respond to drugs should be offered psychological therapy focused on the depressive symptoms, and that befriending should be offered to patients who would benefit from additional social support. The guidance also advises clinicians to respect the patient's knowledge and experience of their illness, and to consider the needs of the patient's relatives or carers.
Stephen Pilling, Consultant Clinical Psychologist and Joint Director of the National Collaborating Centre for Mental Health that developed the guideline on behalf of NICE, said: 'It can take on average around eight years from onset of first symptoms to receiving a diagnosis of bipolar disorder. This is far too long. More needs to be done to improve awareness, identification and recognition of this problem so that appropriate treatments are prescribed and symptoms can be better controlled.'
The guidance on training programmes for the management of child conduct disorder, which was developed in association with the Social Care Institute for Excellence, recommends group-based training programmes for parents and carers, based on social-learning theory and incorporating role-playing tasks and relationship-enhancing strategies. 
Andrea Sutcliffe, the Deputy Chief Executive of NICE said: 'Many children with conduct disorders will have problems that persist into adolescence and adulthood, resulting in future health and social problems for the child, their families and society. Effectively addressing the situation in childhood benefits not only the families involved, but also creates cost savings for a range of public services, including health, social care and education.'    CJ

The secret of happiness - no psychologists?

THE Pacific island nation of Vanuatu is the happiest place on earth, according to an index published by the New Economics Foundation. It also has no psychologists: is there a link, and if so in which direction?
We spoke to Peter Forster, who wrote about Vanuatu in The Psychologist's international series of articles. 'Vanuatu is a very poor country in some ways of measuring that. Very few people have access to any of the governmental safety nets we take for granted when people have problems. In their place they have very strong social support systems within their villages and extended families. When they are fit and healthy they work for their community. When they go through hard times they are supported by others. Studies under the mantle of positive psychology indicate that it is our positive, supportive relationships that contribute most to our happiness so I am not surprised to find that Vanuatu tops the list. It is very striking when walking around Vanuatu, just how many strangers smile, wave and greet you as you go by. I miss Vanuatu more than most places I have been.
'If the processes of urbanisation (mainly people moving from outer islands to the capital in search of money and jobs) continues, which disrupts their traditional sources of support and their family and communal relationships, they will have more of the problems that we have and, if they can afford them, will have to replace their traditional supports with psychologists
and social workers, etc. Their happiness will decline and the number of psychologists will increase, but it won't be a causal relationship!'
In another analysis, based on data from over a hundred studies, Adrian White (Leicester University) declared Denmark to be the happiest nation.