Tuesday, December 27, 2016

Year in review: 2016


Somewhat of an annus horribilis, opening with the abhorrent mass attack on women in Cologne, and where the deaths of (increasingly) numerous celebrities was broadly overshadowed by the political upsets of Brexit and the election of Donald Trump. The questions that have interested me in the last few years may seem to be more "micro" compared to these bigger trends, and yet they still remain...

In ketamine and depression research, it was interesting to see some preclinical work published in super journal Nature examining if ketamine metabolites may have similar antidepressant effects with a less severe side effect profile, seemingly through their impact on a more specific set of receptors. Although I would question the scope for modelling ketamine side effects as psychologically complex as dissociation in animals, it will be interesting to see human trials in future.

With research that I had been involved with getting exposure, it was also of interest to see a trial on probiotics in depression indicate promising results. Researchers from Iran ran a double-blind, placebo-controlled trial in patients with depression, and found that patients who took a mix of probiotic bacteria had reduced depression scores compared to those who took a placebo.

The dialogue concerning people's first-hand experiences of mental health continued, from a viral video of a young Irish man discussing his experience of depression (despite a happy-go-lucky outward appearance), to a former Trinity classmate of mine "outing himself" as having bipolar disorder, to an interesting account of a psychologist who described how his experience of manic periods were overall a positive thing for him (albeit he did encounter problems with them).

In the arts world, Dublin writer Rob Doyle's book of short fiction This is the Ritual contained a number of pieces with a strong psychological focus. The story of a young man trying to write a book about Nietzsche, but unable to begin due to his perceived lack of knowledge of the contemporary intellectual context of the philosopher, touches on themes of motivation, sustained attention and imposter syndrome. Other pieces stray into fairly Burroughs-like "Naked Lunch" territory, but the collection as a whole is a good intro to his style. However, if you haven't checked out Doyle's debut novel"Here are the Young Men" yet, please do!

A debut novel from an author from further afield, Emma Cline's The Girlsdealt with a somewhat masochistic protagonist who takes up with a group of charismatic characters. It is essentially a roman a clef about Charles Manson from the point of view of a woman who was involved with his group. However, the focus is generally drawn away from the crimes to broader trends in the character's psyche.

Next year should be an interesting one-watch this space for microbiota and stress stuff coming from my current research program. Some reviews are also hitting the presses that I'll be commenting on next month.

Related posts

Sunday, November 27, 2016

Probiotics and cognition

Calvin: "I wish I could just take a pill to be perfect and I wish I could just push a button to have anything I want"
Hobbes: "The American Dream lives on"
Calvin & Hobbes, Bill Watterson

The dream Hobbes refers to is, of course, shared by many outside of the United States. There is an obvious demand for dietary supplements that can improve health in some way. Given the general lack of adverse side effects, probiotics represent an attractive opportunity for improving health.

Previous research has indicated that consuming a fermented milk product with probiotic can alter a network of brain regions associated with emotional-as well as visceral-processing. Sadly, the article did not report how people performed on the task the researchers used. As this task just involved classifying emotions on faces, I suspect that maybe performance was too close to ceiling to demonstrate an effect of the probiotic.

As noted in a recent post, we found that participants reported less stress over weeks of consuming probiotic compared to a strain of Bifidobacerium longum. Interestingly, we also found that participants performed best at a test of visuospatial memory after having consumed the probiotic strain. This particular memory test we looked at (paired associates learning) is dependent upon the hippocampus, a region of the brain that can be affected by cortisol secretion following stress. It may thus be the case that a lower level of stress may account for the improved performance on the memory test.

We also assessed electroencephalography (a method of measuring brain activity via electrodes placed on the scalp), and observed that there was enhanced activity at frontal regions following probiotic consumption, consistent with improved memory. This is not just another way of showing what had already been demonstrated with the participant's memory performance, as frontal processing is associated with top-down processing (i.e. processing relating to motivation and broader context, as opposed to bottom-up/driven by the sensation or perception).

However, the picture is complicated by a more recent study from our group seeking to show similar effects with a different probiotic strain; the results here did not indicate effects on cognition (or stress), despite the fact that we used the same assessments, and despite very promising initial results in animal models with this second bacteria. It thus seems to be the case that specific effects go with specific bacteria. Perhaps we are just at the beginning of understanding how gastrointestinal health can be harnessed to improve brain health.

John R. Kelly, Andrew P. Allen, Andriy Temko, William Hutch, Paul J. Kennedy, Niloufar Farid, Eileen Murphy, Geraldine Boylan, John Bienenstock, John F. Cryan, Gerard Clarke, Timothy G. Dinan, (in press). Lost in Translation? The potential psychobiotic Lactobacillus rhamnosus (JB-1) fails to modulate stress or cognitive performance in healthy male subjects, Brain, Behavior, and Immunity. doi: 10.1016/j.bbi.2016.11.018.

Related posts:
Probiotics and stress
Myelin and the gut
Irritable bowel syndrome

Sunday, November 6, 2016

Probiotics and stress

With the increased research interest in the interactions between the brain and the gut, people are curious whether we can affect the brain in desirable ways by targeting the gut. Existing evidence from France has indicated that taking a probiotic can reduce psychological distress and urinary levels of cortisol (a hormone associated with stress).

Previous research from our own group in animal models indicated that a strain of bacteria-Bif. Longum 1714-could reduce the physiological stress response. The 1714 strain was associated with reduced stress-induced hyperthermia, as well as reduced depression-like behaviour. Given these findings, there was interest in whether the bacteria could have similar stress-reducing effects in humans.

Participants took the probiotic for 4 weeks and the placebo for 4 weeks. (Both came in the form of a white powder that one mixes into milk each morning). Participants filled in daily online questionnaires assessing their perceived stress levels-during probiotic supplementation stress levels started off at a similar level, but were reduced by the final week of taking the probiotic.

So far, the results were similar to what the group in France found. But we took things a step further by seeing how people would respond to a controlled stressor after taking the probiotic. At baseline and following each of the 4 week periods they were exposed to a socially evaluated cold pressor test. One has to immerse one's hand in ice cold water for up to 3 minutes. After taking the probiotic, participants showed lessened cortisol output in response to the stressor. Furthermore, although anxiety levels were heightened by the stressor at all visits, the increase was lessened following the probiotic.

Interesting stuff, but further research will be needed to determine how the bacteria is having these effects-we know that bacteria can produce neurochemicals that affect factors such as mood, but we're still in the early days of trying to work out the process through which this leads to knock-on effects on the brain.

We have presented the findings at conferences such as Neuroscience Ireland and Society for Neuroscience (you can download the relevant posters from the Department of Psychiatry website) and the results  have received coverage in numerous mainstream outlets, including The Guardian and The Huffington Post. As usual, things move a bit more slowly in academia, but we have the research paper out now too-it's open access, so anyone with an internet connection can access it:

Allen, A. P., Hutch, W., Borre, Y. E., Kennedy, P. J., Temko, A., Boylan, G., Murphy, E., Cryan, J.F. Dinan, T.G., & Clarke, G. (2016). Bifidobacterium longum 1714 as a translational psychobiotic: modulation of stress, electrophysiology and neurocognition in healthy volunteers. Translational Psychiatry6(11), e939.

Related posts:
Irritable bowel syndrome
Myelin and bacteria
From the depths came the form

Sunday, October 23, 2016

Why a randomer could NOT have told you that

(The title is a play on Susie Hodge's book on visual art, "Why your five year old could not have done that")

As someone who studies psychology, few things grind my gears like someone pointing out that the latest psychological findings are something that their grandmother could have told them. Regardless of how much psychological insight their own grandmothers may have, there are always some people willing to tell you that you are wasting public or private funds on investigating a question to which people have known the answer for generations.

If someone says they are a quantum physicist or a brain surgeon, most people who do not share the profession would be hesitant to try and opine on quantum physics or brain surgery. Regardless of what you do in life, however, it is likely that your mind is geared to some extent towards developing theories about the thoughts of others around you. You see two managers in work who employ very different management styles, and you come up with hypotheses as to why each manager chose that style, as well as which style works best with which employee. You are spending a few weeks studying for exams, so you test which learning strategies work best to help you memorise as much information as you can.

..and people have been doing this since before there was a discipline called psychology. So of course, when you see a news report on a new finding from a psychological study, it chimes with something you heard from someone else, who was really just speaking from good old-fashioned experience and a bit of introspection. When you remember what that person said, it may feel that what you’re hearing is not really news at all.

So why bother doing psychological research? Here’s a couple of quick reasons why…

At a basic level, empirical psychology can be used to quantify the extent of phenomena we may already be aware of. The fact that people were willing to comply with Milgram’s commands to administer high electric shocks to strangers may chime with people’s intuitions, but the rate of compliance was considerably higher than predicted. We all know that staying awake all night is generally not good for reaching optimal performance, but is it enough to make junior doctors perform worse at the level of basic attention? This is an empirical question.

But we can go further in saying that psychological research can often demonstrate the direction of an effect (i.e. whether x increases or decreases y), where everyday theorising would fail. Why? It’s worth bearing in mind that intuition can come up with two opposing predictions that both make sense at an a priori level.  What effect does stress have on cognition? Well, it’s distracting, so it should have a negative effect on how you think. No wait, it’s motivating, so it should have a positive effect. But when people see a report that confirms one, they may only think of the intuition that chimed with the observed effect, thereby making seem that the researchers were just stating the obvious.

Even when armchair psychology is prone to predicting an effect in a particular direction, the research may contradict this. A while back BPS digest published an interesting post concerning counter-intuitive findings in psychology. Check it out!

Monday, October 17, 2016

The autocerebroscope

The Autocerebroscope


*Wind chimes sound as Andrew opens the office door”

Why hello Andrew, what brings you here?

Hello Professor, I’ve been studying the brain and the mind for some time now, but I want to find some way of gaining greater insight into how the function of the mind-you know, thinking, emotion and so on-is produced by the physical brain. I just want an intuitive, first-hand sense of how it all 

Well Andrew, I have just the thing for you! This is the autocerebroscope; a device will allow you to see inside your own brain as it works. Let’s say you’re eating a delicious falafel-flavoured chocolate. The autocerebroscope will show you the oxygenated blood flowing to your occipital lobe as you process the visual stimulus, your motor cortices working to chew the food, your nucleus accumbens going into overdrive as you feel the intense pleasure of the tasty choco…the works!

Sounds amazing-so I’ll be able to see changes in my own brain activity as they happen-I’ll take it home and try it out!

*Andrew exits*

*Wind chimes jangle*

Well well Andrew, what can I do you for?

Hello Professor, I’m blown away by this thing! The autocerebroscope does exactly what you said that it would.

Pretty impressive, yes?

Absolutely! It’s just…


The problem is that I want to know more than which brain regions are being activated. I want to gain some insight into how they are working together to produce the workings of the mind. At the moment I can say that when I’m involved in problem solving I’m using my prefrontal cortex, but I’m not sure how the various sub-regions of this cortex are working together to solve the problem.

Okay, well how about I give you insight not only into which regions of the brain are being activated as you think, but also which neural impulses are going from one part of the brain to the other?

That sounds great, but I can foresee a roadblack; I can only process so much information in real time within my own brain as this same brain generates its vastly complex activity.

No problemo, We will give you an add-in that produces a summary of the inputs that are being sent from one brain region to the other. You may have to use memory a bit, as there may be a bit of a lag, but it should give you an even deeper insight into the workings of your own brain! I’ll see you later-take your time practicing with that bad boy.

*Ding a ling a ling*

Hello Professor, good to see you again.

You must have some tremendous insights by now Andrew!

To be honest, I feel that I’ve made less progress this time. When I read the outputs, well, they do seem to be a summary of very many neural impulses.

Yeah, pretty cool, right?

Absolutely! It’s just that there doesn’t seem to be fully meaningful correspondence between the concepts as I experience them and the information going from one brain region to the other. When I was smelling a half-empty crisp packet that I found in the rubbish the other day I could see a whole hosts of impulses in my brain corresponding to constituent compounds making up the smell. In theory these impulses based on compounds should add up to the overall sense of the odour, but when I looked at the outputs coming and going between the various parts of the brain I couldn’t see the Gestalt of the scent as a whole.

Hmm, it seems like these concepts are being produced by the interaction of various activities between various different brain regions.

But I want a real-time readout that will allow me to gain sufficient insight into the workings of my own brain that correspond to the actual overall feeling of my experience! Furthermore, if I could do as much it would be great as well to consciously change the activity of my brain to re-wire my conscious lived experience.

Like a process of biofeedback?


Er- okay…you are setting the bar rather high…but if you collect it from my assistant in the next couple of weeks I’m sure we’ll have something cooked up for you.

*Andrew bursts through the office door*

Yes! You’ve done it Professor! I can perceive and understand the exact workings of my brain generating this feeling, even as I subjectively feel it! Now, with a bit of effort I can tweak the activity of my hypothalamus to dampen the release of stress hormones-excellent-now I can optimise connectivity in the prefrontal cortex to improve my planning of this biofeedback process itself-soon I will have cognition second to none!


Are you okay, Professor? This is tremendous! Why do you seem so negative? Are you worried about me abusing my power?

No, it’s more an intellectual concern. What you’re saying is all well and good, but it just applies for you. Who’s to say that my experience is not generated by different brain processes, or that my subjective states of mind feel the same?

Well Professor, I’m sure that you probably do use your brain in somewhat different ways to me. In terms of how things feel, well, at the same time as the autocerebroscope is showing me in the inner workings of my brain, I can also see the nerves and how they are projecting to and from other parts of the body. Feelings are tied up with a visceral response that extends throughout the body, so I’m sure that even if we did have the exact same types of brains that happened to be wired up and working in exactly the same way, then subjective feelings would still feel different, given differences elsewhere in our bodies.

Yes yes yes, but who’s to say that for some people these workings of the brain feel like anything at all?

……Eh, I don’t know, but surely the fact that it can be the case even for one person is important? This is a clear demonstration that conscious experience is possible without having to appeal to some immaterial ectoplasm-type stuff?

Not necessarily, Allen! It may only produce something that’s conscious experience-or something like consciousness- for you. But not like qualia for most people. Without access to your experience how do I know you’re really linking the brain activity with the bare bones of qualia (as I experience it) or rather with some easy problem like how your brain is processing a particular sensory input, which may anyway be enough for you to count as qualia, but not enough to count as qualia for someone with such depth of feeling as myself?

To me, this seems like a dichotomous, either/or approach to consciousness. Even if your experience is more complex than mine, then surely if I can tell you how the workings of my brain make up my awareness of the world, then that would show that consciousness can be explained by the workings of the brain?

More complex? Andrew, the mere fact that I can engage in more complex information processing and emotion is beside the point. Consciousness is fundamental-that is, it is so simple it cannot be broken down into any simpler parts!

If you’re right, then the only way for you to know is to have the insight into your own brain…why don’t you try the autocerebroscope on yourself Professor, and see what it’s like?

I’m sorry, it gives me a tension headache. Anyway, I have some papers to write up on why human experience is irreducible to brain states.

*Andrew rolls eyes and leaves office with his new toy*

Apology 1: The device pictured is, needless to say, not the mythical final version of the autocerebroscope described in the story below, but rather an electroencephalogram (which reads the neural activity via electrodes-like all current brain imaging technologies, it is quite far from doing what gets described in the latter parts of the story below).

Apology 2: This story is influenced by numerous thinkers I’ve read over the years-sorry I can’t remember all of my influences here to attribute them. Let me know in the comments if anyone stands out as deserving more of a mention here.

Relevant posts:

Saturday, August 20, 2016

Brief thoughts on compassion fatigue

Brooks originally wanted to design the doll so that it cried more and more hysterically until it got what it wanted, but Hasbro said this was unworkable. The doll had to remain at the level of entertainment, rather than become an actual simulation of human life.
Gaby Wood, "Living Dolls"

When a small boy washed up on the coast of Turkey a couple of years ago, a cartoon in Charlie Hebdo provoked a small outcry when it depicted the youth, in a counterfactual universe, growing up to be a man who harasses women (“our” women!). I’m not sure what the original intent of the author was, although it seems like an ironic comment on the racist double standard whereby well-off white lads are given lenient sentences when they actually do commit an assault, but dead Arab boys who have yet to hit puberty are a sad case, but maybe let’s not get TOO upset, because who knows what they'll be like if they grow up

Although such prejudices may exaggerate a lack of compassion, many people saw the sadness at an individual level but then simply felt overwhelmed by the scale of the issue. Most people that I know want to have some kind of compassion towards the many unfortunate people out there. However, as individuals we can only do so much while trying to live our own lives successfully. When compassion fatigue sets in, burnout may follow.

Burnout is characterised by an increased cynicism and emotional fatigue, as well as doubts about the value of one's work. Within the helping professions (e.g. counsellors, mental health nurses) occupational burnout is quite prevalent. Furthermore, within these professions burnout should be of particular concern, as it has the potential to quickly affect others; a burnt out psychologist won't offer the same quality of care to a client. Indeed, this is also the case among informal caregivers (e.g. people caring for a relative with dementia); a burnt out family carer is more likely to see their relative go into long-term care outside their own home. To put the impact of burnout in context, the state of the art in this area is still unclear on the distinction between burnout and depression. Perhaps the lack of a consensus on how exactly burnout should be defined doesn't help.

I suspect that a major risk factor for compassion fatigue and burnout is overly high expectations in helping, and perhaps high expectations of the person receiving help. Help offered in a psychological context is rather more complex than the endangerment of a small child's life. No one who seeks help is perfect, and sadly many people engage in self-destructive and self-sabotaging behaviour. When does sympathy give way to frustration, which gives way to apathy? How long does one bang one’s head over the misattributions some people make before one stops trying to point them out? Self-care is important, so is self-awareness, and so too awareness of the other.  

Perhaps there’s something more fundamental underneath all this. Do we want to go beyond compassion and understanding to something deeper? It’s prosaic to say that a display of emotion (e.g. sadness) in another person can make us feel sad in our own way. But can true empathy (feeling what another person feels) truly exist? Or are feelings that appear to be shared simply a simulacrum of what we perceive to be the other person's emotion? The answer is the latter. Each consciousness is private. Will a difficulty in accepting this worsen compassion fatigue?

Related posts

Saturday, August 6, 2016

From the depths came the form: gut microbiota and brain cells

As I mentioned previously in a recent post, germ-free rodents have given us a greater understanding of the interaction between the brain and the gut, with animals deficient in microbiota displaying altered anxiety-like and social behaviour.

New research (open access research that is!) from the mighty APC Microbiome Institute has indicated alteration in the brains of these animals. Compared to normal control animals, germ-free animals had increased volume of both the amygdala and hippocampus, regions of the brain associated with processing of emotional and stressful stimuli. This was despite the fact that overall brain volume was not changed, suggesting a proportionate increase in regions of the brain associated with the kind of function that is demonstrably impaired in germ-free animals.

The researchers decided to look further, examining not only regions of the brain, but also brain cells. Using previously established methods they were able to categorise the neurons into different classes. They analysed the extent and complexity of dendrites (the branch-like structures at the end of neurons that receive neurochemical input from other neurons). They found more highly developed dendritic material in a number of different types of neurons in the brain regions of interest. It would thus seem that the lack of microbiota is impacting at a more microscopic level within the brain.

The authors point out the regions of the brain in which they found these alterations interact with (among other things) the hypothalamic-pituitary-adrenal axis, which is responsible for hormonal responses to stress. The impact of the microbiota on these specific brain regions are thus likely to impact upon other brain regions, notwithstanding a lack of change in overall brain volume.

The outstanding question is how the gut microbiota has such a striking effect upon the microstructure of the brain. There a number of different candidate explanations. For example, there is evidence that gut bacteria can use nutrients from the diet to produce neurochemicals. However, the process whereby these neurochemials within the gut lead to serious changes in the brain remains (to the best of my knowledge) somewhat of a mystery. Research that brings us closer to solving this problem will no doubt be generating a lot of buzz in the coming years.

Luczynski, P., Whelan, S. O., O'Sullivan, C., Clarke, G., Shanahan, F., Dinan, T. G., & Cryan, J. F. (2016). Adult microbiota‐deficient mice have distinct dendritic morphological changes: differential effects in the amygdala and hippocampus. European Journal of Neuroscience.

(Banner image for this blog post is a detail from Figure 3, Luczynski et al., 2016).

Related posts:
Wrap you brain with germs

Sunday, July 17, 2016

Wrap your brain with germs: Myelin and bacteria

One of my main areas of interest is the interaction between the brain and the gut. In trying to better understand how this can happen, a powerful animal model has been the interesting case of the germ free animal, which is born (believe it or not) without a microbiota. As one can imagine, this can lead to major effects upon digestion, but increasing evidence has also suggested that germ free animals have altered behaviour, such as changes in anxiety-like behaviour and reduced social behaviour. This suggests an impact of gut microbes on the brain, and has ignited interest in what kind of factors might be mediating this relationship.

Recent research from APC Microbiome Institute, UCC, suggests that germ-free mice have increased levels of myelin, the fatty sheath that surrounds brain cells and assists in the transmission of brain signals. This change in myelin was clearly observed in the prefrontal cortex, a region of the brain responsible for more complex cognition, including behavioural changes that have previously been shown in germ free mice. Interestingly, giving the mice a microbiota restored typical myelination, deepening the evidence for a causal link between the two, and suggesting that the effects were reversible.

The authors believe the findings could have relevance for multiple sclerosis, which is a disorder of myelination, although one would imagine translation from quite a blue-skies study like this to the clinic will clearly take time. Multiple sclerosis is also related to dysfunction of the immune system, which has been implicated as a pathway within the gut-brain axis, so perhaps this will be a key topic within future research within this area.

It was encouraging to see the findings being picked up by The Guardian and other news outlets, which will hopefully help further fire up the public imagination about the gut-brain-microbiota axis. Stay tuned next month for more on this topic!

Hoban AE, Stilling RM, Ryan FJ, Shanahan F, Dinan TG, Claesson MJ, Clarke G, Cryan JF. (2016). Regulation of prefrontal cortex myelination by the microbiota. Translational Psychiatrydoi: 10.1038/tp.2016.42.

(Banner image for this blog post is a detail from Figure 3, Hoban et al., 2016).

Sunday, July 3, 2016

Book review: "The Stress Test" by Ian Robertson

I recently had the pleasure of seeing Professor Ian Robertson speak at our Dept of Psychiatry international seminar series, having seen him previously at the School of Applied Psychology. His latest book looks at how differing levels of stress can impact upon our ability to think well. Aimed at a broad audience, the book is a page-turner (I read the first 100 pages in almost one sitting). It has a strong sense of narrative drive, with Robertson following each of his research findings with a questing curiosity to know more about why people are thinking/acting the way they are.

In addition to being Professor of Psychology at Trinity College Dublin, Robertson has worked as a clinical psychologist. The cognitive and emotional problems that have beset the clients he describes in this book have acted as catalysts for his work in trying to understand processes like stress and attention. Neuroskeptics within psychology may roll their eyes at Robertson referring to brain regions being activated during anecdotal illustrations of behaviour. However, Robertson does not simply use experimental neuroimaging work to speculate on the brains of clients or other interesting people; he describes how he has been involved in developing a relatively simple, non-invasive biomarker for noradrenaline levels; pupillary dilation. This marker has been useful in numerous contexts, such as studying how people of varying IQ's respond to tasks of varying levels of challenge, in terms of their noradrenergic activity.

Probably the key idea running through the book is not a novel idea, but one of the classic ideas in psychology; that of the Yerkes-Dodson law. Basically, when arousal is either low (e.g. fatigue) or high (e.g. bad stress), performance will be sub-optimal, but when it is moderate (e.g. a little stress, but not too much) performance will be better. For those interesting in digging a bit deeper into this, this law is not without criticisms of oversimplification, with some suggesting that reduced information processing induced by very high stress may be a good thing under certain conditions (e.g. where focused attention on a very dangerous stimulus is required and a simple response that is not too cognitively taxing is required). Nonetheless, Robertson illustrates interesting applications, and his case acts as an antidote to the promises of eliminating stress one often hears coming from those trying to sell a stress reduction technique.

I have been interested in the interaction between stress and sustained attention for a while, but Robertson's insight (and research) that people who are more prone to mind wandering are more unhappy is quite a new idea for me. The underlying mechanism is that we are prone to a certain negativity bias in daydreaming. This suggests a possible psychological mechanism for stress-reducing effects of mindfulness, by maintaining attention on the present moment rather than fitful daydreaming about anxieties around the future. It could also explain why Csikszentmihalyi's concept of flow is often described as a positive feeling.

The Stress Test makes suggestions throughout about how to respond to stress and other potentially difficult feelings*. These suggestions are generally rooted in a cognitive-behavioural perspective (you see a classic CBT concept making an appearance when Robertson blames a lack of any stress in childhood for catastrophising stressors in adulthood). One interesting titbit is the re-direction of high-arousal negative emotions (like anxiety) towards emotions that are still high-arousal, but more positive (like excitement), as a more workable alternative than trying to get rid of the negative feeling altogether.

The question of to what extent people feel empowered to help themselves arises in an epilogue, where Robertson suggests that the widespread use of medication to tackle emotional problems may undermine clients' sense of agency around their own emotional lives, by making them see their problems as something external to themselves that has "come upon" them. He suggests that such a lack of agency is rooted in a folk understanding of human biology as more fixed or unchangeable than human psychology. I would suggest that there may be a greater need for public understanding of how intertwined biology and psychology are. To take the example of genetics, the public should be more aware that although one is endowed with a genotype at birth, given gene X environmental interactions and epigenetic mechanisms, one's genes need not act as a life sentence, particularly for complex social psychological processes. Nor should (one would hope) the use of psychiatric medication strip people of their agency, or indeed of a sense of responsibility to work through their own psychological issues at the level of cognition and behaviour.

"The Stress Test" is a compelling book on what places us under pressure, how to deal with that pressure, and-more interestingly-how to use that pressure. It deserves to be read by people who are experiencing stress, which I dare say is most people.

*Although thankfully it avoids the three-actual-ideas-to-two-hundred-anecdotes ratio one sees in too many self-help books!

Related posts:
Performance under pressure
Pay attention
Healthy Ageing: Focus on Caregiver Stress

Monday, June 27, 2016

International seminar review: "Healthy Ageing: Focus on Caregiver Stress"

As the global population ages, an increasing number of people are caring for family members who no longer care for themselves. Research is needed to better understand potential risks for caregiver health, and the best means for intervention where needed. Four leading researchers in this area, both Irish and international, gathered at the Brookfield Health Sciences Complex, University College Cork, to present their work.

At the first session, chaired by Professor Timothy Dinan, Professor Ian Robertson, Trinity College Dublin, highlighted the resilience of caregivers, outlining findings that most caregivers report good (or better than good) mental health. He drew on the classic Yerkes-Dodson law to outline how a medium level arousal is generally optimal for performance-so perhaps the stress that caregivers experience may not be detrimental unless it is quite high, or if it is coming on top of existing stressors.

Professor Janice Kiecolt-Glaser, Ohio State University, drew on her substantial catalogue of research in this area to highlight the often detrimental impact on immune system of dementia caregiving. Carer burden may heighten inflammation that is often already elevated by the ageing process in older spousal caregivers (a bit like a physiological version of the Yerkes-Dodson law highlighted by Ian Robertson). It can also be associated with heightened activity of the HPA axis, with increased release of the stress hormone cortisol being evident in caregivers.

At the second session, chaired by Professor D. William Molloy, Dr Rónán O'Caoimh, NUI Galway, highlighted the excellent work he has done with Professor D William Molloy and others to develop a tool for assessing risk of negative outcomes for dementia patients in the community. This work places an emphasis on the caregiver network- a primary caregiver typically has support from others around them (e.g. a spousal caregiver with adult children who pitch in at evenings/weekends). He raised the interesting point that although an increased network may intuitively seem positive, it may actually be a warning that an extended family is trying to rally around an increasingly impaired patient, or primary caregivers who are becoming less capable of coping with their role. 

Professor Constança Paúl, University of Porto, highlighted the complexity of factors moderating the caregiver experience and whether it leads to stress. Factors such as the relationship between the caregiver and the care recipient and length of care were highlighted. Age is generally considered and controlled for in studies, although Professor Paúl made the important point that stage of life is important too (e.g. two people caring for their mother could be the same age, but one has children of their own aged 21-25 whereas the other has children aged 8-12). She also highlighted some broader trends that could have large implications for care requirements in the near future-for example, within the EU, almost half of woman aged 85 or more are living alone.

There was a great dialogue at the end of the session. Although the seminar had been primarily advertised as a researcher/clinician event, a number of carers were in attendance who brought their own perspective. An interesting point was the highlighting of issues around guilt in seeking help outside the home among some caregivers, and how this may lead to a reluctance to explore the option of long-term care, or even to seek respite, regardless of the quality of care available.

The session would not have been possible without generous funding from the Health Research Board, as well as the substantial organisational work of Poonam Gururajan (check out her wedding blog here) and the experienced guidance of our PI Dr Gerard Clarke.

Related posts:
He ain't heavy, he's my carer
Performance under pressure

Sunday, June 26, 2016

Mindfulness update: One year on

For the last year, I have been getting into mindfulness, which uses various techniques to cultivate a non-judgemental awareness of the current moment. With mindfulness and meditation, one's practice can wax and wane over the course of a year (as it can with many things), and I'm no exception; up until about a month ago I was practising meditation quite rarely, although I was trying to have a mindful attitude when stressors arose.

But a few weeks ago I was brought back into the swing of mindfulness. A seasoned instructor in mindfulness-based stress reduction (MBSR) gave me a lend of the book "A Year of Living Mindfully" by Anna Black-funnily enough, this happened about one year after I finished her MBSR course. It has spurred me to get back on the horse for year 2 of my practice.

One thing that has stood out so far in this book: an attitude the author suggests one should cultivate as a practitioner of mindfulness is non-striving. Although I'm not particularly prone to stress as such, non-striving is one attitude that does push against my personality. I am someone who strives to do well/get on with it/get the most out of life. Although I don't think it's realistic for me to get rid of my aspirations in any lasting sense, like anyone I can let them go when I don't need to be actively working towards them. Easier said than done-a certain restlessness hangs over ambition.

I think I am starting to become more mindful at certain times when I am not actively meditating, for example when exercising. I think this is my second favourite time to be mindful (after times when I am confronted with a stressor), as it is an activity that for me does not feel like moving towards a particular end (even though it is, of course, aimed towards better health). Its repetitive, cyclical nature differs from the more progressive (and sometimes frustrating) nature of research work.

Speaking of work, we're hoping to trial-run some recordings of mindfulness activities over the coming week. The overall aim is to put together a mindfulness podcast with the previously mentioned MBSR instructor. Should be fun!

Related posts:
Mindfulness and the mind
Mindfulness update: 6 months on

Sunday, May 29, 2016

The up and downs of reaching out

Isn't there always something awkward about telling a friend that you think they have a problem? And yet... 

Time and again, when someone takes their own life we hear people wondering aloud why the person didn’t reach out to someone. These stories can motivate us to make more of an effort to try and reach out to family and friends around us who we are concerned may be having mental health trouble. If someone we care about is down, it seems natural to reach out to them. However, it needs to be recognised that when one makes a proactive attempt to reach out to others they may not welcome this.

It’s natural to focus on the most salient aspect of a person’s life and character in any specific interaction. When we wish to talk to someone about problems with their mental health, this is what stands out for us going into the encounter. But people with mental health problems are not just a “victim”, of their mental health issues or of other problems they may have. I certainly don’t mean to imply that everyone with problems is at fault for their issues either, but simply that people have complex lives. One of the symptoms of depression is excessive guilt. However, one can have depression without having excessive guilt. And what if a person has proportionate guilt for a terrible thing they’ve done? If you reach out to this person, and if they do “open up”, what if their opening reveals something that you seriously dislike? Of course, this could be true of anyone without mental health problems as well-the point is that it's good to have a follow-up plan of how to get extra support if a person's opening up leads to stuff that you feel you can't handle yourself. 

For whatever reason, some people may just have a short fuse about the way you speak to them. Advice may be perceived as prosaic or patronising. The suggestion to visit a GP may be greeted with a reminder that the person is well aware that that is an option, thanks. Nonetheless, it may give the person that extra encouragement to go. It’s probably best to phrase advice in such a way as to leave the ball in the person’s court, rather than presenting a suggestion as an original idea or as a command.

Depression is perhaps the condition that’s most discussed in this context. Despite the prevalence of non-response to treatment, it is quite a treatable disorder, and many people do recover with time (notwithstanding the potential for relapses). The encouragement to seek professional help might be the beginning of a road to recovery. But consider personality disorders. These can a substantial amount of time and psychological therapy to ameliorate. Furthermore, if you try to suggest to someone that they should seek help, even if this person can see that their behaviour is leading to difficulties with their life, might you be perceived as trying to change them at some fundamental level? The fact that you may be perceived as doing this when you are a friend rather than a professional may also complicate matters.

I think most people realise at a cognitive level that you can’t just make someone’s problems go away by having a frank discussion with a friend. Nonetheless, when we say “if only” a person had reached out, are we not believing at some gut level that maybe we could have saved them if we had reached out first? And if that's the case, then maybe we should have saved them somehow? Be gentle with yourself.

I am not trying to tell you that you shouldn’t try to speak to people you think may need help. I'm sure the anticipated regret of not having said something will still be a motivator for many people to speak up. I suppose my take-home message here is to manage your expectations when you take it upon yourself to speak to someone you think may be in bad distress, and don’t take it personally if they don't take it too well.

If you are interested in reaching out in a broader way, why not volunteer for an organisation like the The Samaritans or Aware

Related posts
I felt a funeral, in my brain

Saturday, May 7, 2016

I wanna get technical: notes on writing a systematic review

Just recently I had the pleasure of clicking "submit" on the longest academic paper I have written so far-nearly 30,000 words long. It is a systematic review of cognition and biomarkers of stress in dementia caregivers. It's an important topic, but today I'd like to talk specifically about the method of doing a systematic review and what that entails.

The process of systemically reviewing the literature allows you to take steps to ensure that a review of research literature is not an incomplete or partisan exercise. However, writing a systematic review, particularly a large systematic review, can really take the pleasure out of reading a research article. Interesting discussion sections are raced past when one has over 100 articles from which to extract key methodological details. Here's what you do:

Firstly, one needs to see what literature is out there. After making searches for caregiver stress and a host of stress biomarkers (e.g. cortisol) on a number of research databases, the second reviewer and I found ourselves with circa 4,000 abstracts and titles to look though. Some of these were almost immediately identifiable as not really relevant to the review in question. However, some required a pretty careful reading of the abstract, and about for about 250 we had to look through the full text of the article. For example, we were interested in the impact of dementia caregiving stress on cognition, but it might not be immediately apparent if cognitive assessment was performed on the carers or just the patients with dementia.

Once you've whittled things down to just the articles you want to include in the review, it's time for data extraction. You get an Excel sheet with a whole host of bits of info (e.g. inclusion criteria, sample size, age/gender of the participants, location where the study was run, etc. etc.) and fill in this form for each study. I should say that in the case of this review we had 151 full papers to go through. A mountainous (albeit physically sedentary) task. The second reviewer blasted through the task quite a bit faster than I did-I'm going to assume it's because she is more experienced at conducting systematic reviews, as the alternatives are not so good for my ego.

Anyways, when the data extraction is done you THEN need to assess the quality of the research literature. Another template is put together in an Excel file and again you wade through the articles, ticking boxes about whether or not the articles have fulfilled certain criteria (did they control for potential confounding variables, was the statistical analysis appropriate). In fairness, there's often some overlap here between the data extraction, although not enough in this case to avoid going back through the articles again!

THEN you need to write the thing. When you have results from over 150 research articles to summarise, the mere process of checking the formatting within your tables becomes a dull and onerous task. Uughhhh. Still, when it's finished you can say that you've gone to lengths to avoid being selective in either assessing or reporting the published research in the field.

Obviously this is one account-there are more/less complex ways of doing a systematic review. Generally there will not be quite so many articles included in a systematic review, and if the outcome is more focused one may wish to do a meta-analysis. I think as time goes by more journals will start to strongly encourage or demand that review papers are systematic. All I can say about my near future is the next couple of reviews I write will not be systematic in nature.

If/when the article of this systematic review is published I'll be letting you know about the results ;)

Sunday, April 10, 2016

What's it like to be me?

When people use the word "consciousness", they can be referring to many things. At a simple level, they could be referring to being simply awake, or having some awareness of the world. At a more complex level, they could be discussing awareness of one's own self. But there is another thing people talk about when they speak of consciousness-the ineffable sense of what it is like to be oneself. It seems reasonable to most people that the human brain should be capable of dealing with waking, as well as the harder task of thinking about one's own cognition.

However, it is less popular to think that the brain can produce this intangible feeling that we can only really observe in ourselves. Many people believe that this feeling will continue after death has taken our fleshy brain from us. Some people believe that the scientific study of consciousness will progress better if we treat consciousness as a fundamental property, something which cannot be broken down into something simpler, such as the biological and chemical processes underlying brain function (much like electric charge became seen to be a fundamental property in the 19th century,).

However, if our conscious experience really is just the product of our feverish brains, than perhaps the holy grail of neuroscience is to find what it is in the brain that brings this about...

The neural correlate of consciousness!

cool paper by Naotsugu Tsuchiya and colleagues discusses the search for correlates of consciousness with and without self-report. Self-report can be combined with clever methods used to make the same sensory input, depending on context, available or unavailable to awareness. Continuous flash suppression involves presenting one eye with a flashing stimulus and the other eye with a more constant stimulus. The flashing stimulus can lead to the other stimulus (which, remember, doesn't change) slipping out of consciousness, even though the sensation should still be there.

So let's say you're a research participant being subjected to continuous flash suppression. The experimenters need you to tell them what you're consciously perceiving, in order for them to observe what is happening in your brain as the subjective experience changes. However, in order to self-report on what one perceives, one needs to draw on cognitive processes other than "raw" consciousness. If you have to say what you see, you're using language processing. If you have to press a button when you see the white elephant, you need to use motor processing. Control conditions have to be carefully designed!

So there are a number of caveats about self-report. Methods that do not use self-report are not perfect either though-it's harder to tell whether the thinker is really (self-)aware of the information they're processing. However, what's really neat about a lack of self-report is that it can be applied in contexts where self-report may be difficult or impossible, for example in babies or in animals.

Of course, you might object that much of this is just about the not-so-hard problems of how we are aware or self-aware, not about what consciousness is like. I think this takes us from the methodology we use to study consciousness, to our account of what "ineffable" consciousness is about. Our subjective sense of what experience is like involves combining a wide variety of sensory inputs (not to mention memories, body schemas etc. etc.) into a unitary experience. The binding problem poses the question of how we perceive our experience as a unified stream of consciousness.When we talk of a "neural correlate of consciousness" it's probably too simple to think that one part of the brain can "bring it all together". In order to integrate various sensory inputs together we have to combine sensory processing occurring in distinct regions of the brain. Gerald Edelman has suggested that the thalamus plays a key role, as it carries information from the senses to various parts of the cortex. It is the re-entrant nature of these connections that may help to explain the process (as opposed to the place) where experience comes together to make up a unitary sense of consciousness.

You may hold fast to the idea that your experience cannot be just the product of your brain (and its interaction with the rest of your body). But if so, let me pose this question: just how complex is your conscious experience really? Are you sure it is more complex than the interactions of the trillions of neurons in your brain? If you or someone else really understood how it all worked, are you so confident that they might not be able to explain your lived experience, with no need to discuss anything outside the biological and chemical processes within you?

Tsuchiya, N., et al. (2015). No-report paradigms: extracting the true neural correlates of consciousness. Trends in Cognitive Sciences, 19(12), 757-770.

Related post
Where does the mind begin and end?
A review of "Intuition pumps" by Daniel Dennett

Saturday, April 2, 2016

Pay attention

I tried to read my school books despite the fact that my mind wandered a thousand miles away. I would come back to whatever I had been reading wondering to myself where I had been for the last five or ten minutes. It was not that I could not remember what I had read. Rather, I had never read the page I was staring at for that period of time. (Allan Schwartz, 2007)

This account of ADHD is something most people can identify with to some extent. Going over a lecture on attention for a neuroscience module at UCC, I'm thinking again about sustained attention. What can neuroscience tell us about how we focus our minds on a particular stream of information?

In studying sustained attention, a typical experimental task will ask participants to attend to a fairly boring set of stimuli for a prolonged time and produce a periodic response to an occasional target stimulus (e.g. a repetition of a number in a series of generally non-repeating numbers). Cognitive psychology giant Michael Posner and colleagues have suggested that the right cortex is key for this form of attention. However, other research has suggested that when a target is less salient (which made the task more difficult), activation was bilateral (i.e. activation occurred on both sides of the brain). It's a reminder that the nature of a task is key in the brain activity involved. Indeed, given that sustaining attention to such a task becomes more difficult as time goes by, the same task becomes a more difficult job over time within the same person. 

Isn't it almost redundant to say you need motivation to sustain attention on something? If something is interesting then it's inherently motivating to attend to it, but if it's boring you need something to threaten/entice you into attending to it. Given its influence on the reward system, it has been suggested that dopamine may influence sustained attention through its impact on motivation. Methylphenidate (often sold under brand name “Ritalin”) is used in the treatment of ADHD, and it is used to increase the extracellular level of dopamine. Speaking of dopamine-our familiar friend caffeine, which enhances dopamine, has been shown to enhance subjective alertness and improved sustained attention performance on a simulated driving task

However, as most people consume caffeine, experimental control is required to ensure that any effects are not due to withdrawal reversal. If you want to run a study on caffeine effects, you can ask people taking part to avoid caffeine for long enough before a study for any caffeine to have left the body. So now you can say that if you give 200mg of caffeine it's not being added to another 200mg the person drank an hour ago. However, long enough to get caffeine out of the system is not necessarily long enough for withdrawal symptoms to have passed. So there is a risk that the enhancing effects are only shown because you give a person caffeine when they are withdrawn. I should note that there has been some debate about the extent to which withdrawal reversal has confounded research on caffeine, including evidence to the contrary

Evidence for a role for noradrenalin comes from the spontaneously hypertensive rat (SHR). As the name suggests, it is prone to high blood pressure. However, it can also act as a model of ADHD-although it has its critics, this type of rat has been shown to demonstrate a number of traits associated ADHD (including impulsiveness as well as inattention). Noradrenalin has been implicated in the ADHD-like behavior of this rat by the alteration of such behavior by the noradrenergic drug Guanfacine. 

I can close with a quick tip on sustaining attention, as someone who has had his mind drift far away at many a lecture. When I decide I really need to focus on a talk, I try to think of a question as early on as possible in the talk. I then try to see if anything in the talk answers this question. Whether or not I will actually ask the speaker this question aloud, I imagine that I will have to ask it, and thus motivate myself not to look foolish by asking a question that has been answered by the content of the talk. I don't have any great solution for when one is sleep-deprived and heavily sleepy though-suggestions welcome!

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