Sunday, November 24, 2019

What's leading to burden in dementia carers?

For the second half of my time with University College Cork, I was involved in a project researching carer burden in people caring for family members with dementia. As part of this project, I had the opportunity to sit in on a specialist memory clinic, as well as a parallel old age psychiatry clinic. Although some people (usually with less severe problems with memory) attended the clinic by themselves, the large majority of patients would have family members with them.

Over the space of two years we collected caregivers' responses to a series of short questionnaires assessing carer burden, as well information on challenging behaviours (e.g. shouting), levels of help required for activities of daily living (e.g. getting dressed) , cognitive performance, and patient safety (e.g. driving, risk of falling). Driving can be a particularly thorny issue for older people living in rural areas, where stopping driving represents a major loss of independence.

The results indicated that patient age, cognition, and level of dependence were associated with carer burden, and even after controlling for these factors, safety issues and challenging behaviours were associated with further increases in burden. We also followed up a subset of carers at 6 months and 12 months, and changes in patient safety seemed to be the most powerful predictor of changes in carer burden. I should note this data was only available for those who had follow-up data from repeat visits, so it is likely these carers could differ in systematic ways from those who did not attend again. Nonetheless, I would speculate that those who do not attend the clinic again within a year are probably likely to have experienced less change in the care situation than those who attend again (the latter are likely to have some change, leading to greater motivation to attend).

One reviewer of a draft of the paper suggested that safety could be highlighted and discussed in greater detail. It was one of those occasions when a peer reviewer suggested that a manuscript might be underselling an aspect of the findings. The literature in this area has tended to focus more on behaviors that can challenge caregivers or increased dependency of patients. However, safety issues are a major source of anxiety for carers, and can be the decisive factor in whether a person with dementia will go into long-term care home. Carer training programs and easily available information on how to address or minimize problems around safety can save carers a lot of distress.

Allen, A.P., Buckley, M.M., Cryan, J.F., Ní Chorcoráin, A., Dinan, T.G., Kearney, P.M., O'Caoimh, R., Calnan, M., Clarke, G., Molloy D.W. (in press). Informal caregiving for dementia patients: The contribution of patient characteristics and behaviours to caregiver burden. Age & Ageing. doi: 10.1093/ageing/afz128

Related posts
He ain't heavy, he's my carer

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Monday, October 28, 2019

Film review: "Hereditary" (2018)

"Hereditary" is the debut feature film of Ari Aster, who more recently has released "Midsommar", and previously directed a number of short films, including "The Strange Thing about the Johnsons". Although Aster's work in general tends towards the scary, "Hereditary" is his film most firmly placed within the horror genre, though at its heart it is a family tragedy. Ellen, the late matriarch of the family, doesn't have a speaking role in the film. Nonetheless, her death is a catalyst for the story, or rather it is at a surface level, as the events that unfold appear to have already been part of Ellen's more long-term machinations.

Grief is a clear theme of this film, but guilt is also dealt with in some depth. In the aftermath of death, Annie (played by Toni Colette) argues not only about to whom blame should be given, but also about the depiction of the death in her own work as an artist. When her husband confronts her about how her son will react to it, she asserts that her work is a neutral or objective view of the incident. From the outside looking in, the work does appear to be reasonably objective, but of course no family member can approach such personal work without baggage. The apparent absence of guilt on Ellen's part (a note from Ellen cryptically promises "our rewards will be great") thus contrasts with her daughter's nuclear family, where guilt is deeply felt and passed from one person to the next.

Psychological disorder has been alluded to in many scary films over the years, with a differing level of flippancy, sympathy or exploitation. Annie's psychiatrist husband assumes that her fears of a supernatural evil are just manifestations of a disturbed mind, although Annie's view is ultimately vindicated. Perhaps more interesting is how Annie refers to a history of schizophrenia and psychotic depression in her family during a group therapy session. The idea of inheriting psychological disorder is always in the background, as discussed in some depth elsewhere, but given the supernatural element later in the film the viewer is left to wonder if mental disorder (at least in this family) is reified as a curse. Or perhaps paranoia and self-destruction are being framed as rational coping strategies in the face of some terrible, transcendent evil.

The film indulges in a few horror tropes while also adding some striking and original imagery. Towards the climax of the film, a sense of the uncanny is realised through the use of sound (or lack thereof) and unnaturally fluid or jerky movements. This creates a sense of unfamiliar terrain that's too often lacking in the horror genre. Small details are easy to miss-Annie appears to knock over a small bottle of paint, but on careful viewing it's clear that it falls over of its "own accord".

"Hereditary" is a rich and detailed movie that bears repeated viewing. Aster has said in interview that he wanted this film to be in the vein of modern horror classics of the 1970's such as "Don't Look Now" or "Rosemary's Baby". I think this film will be regarded as a classic of the genre decades from now. Having enjoyed "Midsommar" (though it's not quite so scary as this film), I am curious to see where Aster (who's still only 33) will go next.

Related posts
The psychology of tension and suspense

You can follow me on Twitter: @ArchivePsych

Wednesday, September 11, 2019

Conference review: reserve and resilience in cognitive ageing and dementia workshop 2019

Having had the good fortune of receiving a generous travel award from its committee, I visited Washington D.C. for the Reserve and Resilience workshop. The meeting is the first of three annual meetings that aim to create a consensus around definitions of key concepts in this area, such as cognitive reserve, brain reserve, and resilience.

The conference had a very focused structure, with keynote speakers giving very brief presentations restricted to three PowerPoint slides. Each was required to give the definitions they used for key terms relevant to the meeting, such as cognitive reserve, brain reserve and resilience. This made visible some of the distinctions between how people in the field had somewhat different conceptualisations of the same words. To give just one example, in defining resilience, Catherine Kaczorowski included the repair and replenishment of the brain in response to damage, whereas Emrah Duzel was working with a definition of resilience as preventing a decline in neural resources in the presence of manifest pathology.

Such differences in how the same concept may be understood or operationalised could undermine replicability of research. For any given study, larger researcher degrees of freedom allowed by different definitions of the "same thing" could lead to Type 1 errors, and even if a further piece of research is labelled as a conceptual replication at one level, if the concept in question is being operationalised in different ways then it may not be that findings relating to specific outcomes are as reliable as we might think.

The keynote presenters talks were kept unusually short in order to allow more time for questions from the floor. Although this sometimes fell into people trying to plug their pet projects rather than grappling with the key problem of the meeting, there was some very productive discussion. One  point that influenced a lot of subsequent discussion is how the definitions we work with can be looked at at a conceptual, operational, and mechanistic level. There was also some discussion about whether to combine some terms, such as brain and cognitive reserve, although my impression was that by the end of the meeting the delegates felt that it still be useful to have the distinction between brain and cognition (notwithstanding the occasional statement that came close to endorsing a simplistic one-to-one correspondence between the brain and cognition).

The meeting closed with a commitment to continue working together between now and next year's meeting. The organisers are keen to promote data-sharing between people involved at the meeting to further collaboration. They have also helpfully made the presentation slides available online.

At larger conferences it can be easy to get lost when their range of topics are so broad and aims so diffuse, but this was a smaller and intensely focused meeting. The inclusion of three key papers to read posted in advance on the conference website was surely a statement of intent, and the organisers were careful throughout to keep pushing for the key aims of the meeting to try and sound out how we should talk about these concepts. By the close of the third meeting it is hoped that there should be some broad consensus on reserve and resilience-for anyone working in this area it will be worth feeding into this process in the coming two years.

Related posts
Conference review: APS Young Investigator colloquim

You can follow me on Twitter: @ArchivePsych

Saturday, August 17, 2019


Media doesn't come to us from without- we get the media we demand. Stories that tap into the fear and neurosis of our times sell.

I'd rather raise questions than level accusations, but it's worth thinking about the number of times dementia has come up in recent and not-so-recent TV shows. While the older Sherlock Holmes sketch in Mitchell and Webb show has a high degree of pathos, a sketch from a reunion of The Fast Show is played more for laughs, albeit there is pathos (I think) here as well. Besides comedy, the Black Mirror episode Playtest plays dementia for the horror genre.

It is perhaps not surprising that the horror and comedy have dealt with dementia-these genres often trade on the collision between our subjective sense of self and the objective world around us, seen at a distance from a third person's perspective. What could be a more intense version of this than the juxtaposition of a person's subjective life story and their sense of autonomy with the undermining of this by dementia?

Where does entertainment or even raising awareness etc. start to descend into exploitation? There are many facets to this, but one point I'll make is that although depictions of dementia can be used to inject an emotional punch into a story, this isn't so great if it just leaves the viewer with a sense that dementia is the worst thing that could happen to anyone, as if there were no help whatsoever. People with dementia can have a good quality of life. The understand together campaign is aiming to tackle stigma towards people with dementia:

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Stigma "goes meta"
The loved ones

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Sunday, July 28, 2019

It's all in your body, mind or soul: causal attributions for depression

Given how depression can manifest in different ways, and the multiple methods of intervention from talk therapy to pharmacological to lifestyle change to ECT, it is hardly surprising that people hold mixed opinions on where depression "comes from", and what the best choices are for help-seeking and therapeutic intervention.

A cool new study employed an online survey platform to run an experimental study of how different vignettes emphasising different causal attributions for depression might affect attitudes towards intervention, both in terms of help-seeking and treatment options. Although lifestyle interventions or psychotherapeutic treatment were generally preferred to medical intervention, a vignette that emphasised biological attributions (compared to social or biopsychosocial attributions) for depression reduced the perceived efficacy of less biological treatments

The results suggest that encouraging a less Cartesian, body OR mind understanding of the etiology of depression might affect attitudes towards different intervention modalities. Such an approach may help to overcome ethical concerns the authors raise of "manipulating" patient's attitudes/causal attributions towards major depression. Of course, it can be easier to say this than it is to achieve it, when it is so easy to lapse into traps such as, for example, using phrases like "medical treatment" to mean pharmacological treatment, even though many physicians prescribe things like exercise or going to a therapist for cognitive behavioural therapy.  

Interestingly, a clear majority of respondents to the online survey reported a history of major depression. Those with a personal history tended to rate a more medical approach to treatment more highly than people with no personal history of depression. Having a high proportion of respondents with a personal history of depression is not unusual or surprising, particularly as the study was advertised as examining treatment preferences for depression. It might nonetheless be interesting to see whether one would observe similar results in a large cohort of more clearly "naive" respondents (e.g. with no personal history of depression or history of depression in family/close friends, and who report no training/particular interest in major depression).

Nolan, A. & O'Connor, C. (2019). The Effect of Causal Attributions for Depression on Help-Seeking and Treatment Preferences. Journal of Affective Disorders, 257, 477-485.

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Saturday, July 20, 2019

Revisiting Recall

In a recent Irish Times obituary for actor Karl Shiels, Peter Crawley recalls "...he once played a role in the Gate Theatre, and a role in the Abbey Theatre, on the same damn night, dashing down O’Connell Street to make his entrance" 

Many people's autobiographies contain a wealth of these tidbits alongside the broader changes in life. I think one of the best things to come out of the reminiscence project I was working on with Richard Roche, Caoilainn Doyle and others was the archive we created of participant's memories. Some of my personal favourites include:

Teaching in Nigeria in the 1960's: This one captures a formative time near the start of a young woman's career-the other people in the group were keen to hear of her experiences in Africa.

Early morning weddings and the mail train: A reminiscence that wryly captures the difference between experience in the moment and hindsight, and subtly tells of major changes in Irish society.

Emigration to UK and USA: A familiar experience to many Irish people; this individual emigrated to different countries at different phases in life.

Nuclear war fear: A moment in history from a child's eye view-captures the anxiety of the time, but still packs a laugh-out-loud moment near the end.

Mining in Connacht in the 1950's: Memories of a father's working in the mines, an accident at work and its aftermath.

These are just a handful of selections from the collection. Although material on the internet can disappear over time if it's not maintained, as this archive is on the Digital Repository of Ireland, these recordings will be preserved for posterity. People wishing to make use of this archive for social sciences/humanities research are free to do so-just get in touch!  

Related articles: 

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Saturday, June 29, 2019

Creativity: new stages from old pages?

Having written an article on applying stage theories of creativity, I was aware that different thinkers have broken the creative process down into different numbers of stages. However, I was unaware that another stage was hidden in plain sight in the classic 1920's work of Wallas. Typically, those citing Wallas's work refer to four main stages in the creative process: (1). an initial preparatory phase, (2) an incubation phase when the creative task is left aside for sometime (and, it is often presumed, unconscious processes are at work), (3). an illumination phase, when there is some kind of breakthrough in the creative process and (4). a verification phase, when the creative idea is tested, probed or checked for its quality.

However, in a recent article, Eugene Sadler-Smith proposes that intimation is a further stage in the creative process, between incubation and illumination. This is described as a fringe consciousness that links incubation to illumination. It could be described as straddling conscious and unconscious thinking. An indicative description (taken from conversation with a civil servant) is how a person can sense that the solution is coming, but they do not yet know what form this solution will take.

A bit embarrassing that I only encountered this idea recently, but the 4-stage description has been quite pervasive. To me, this extra stage does seem to place an emphasis on more active unconscious processes than other factors that break "writer's block" or comparable phenomena in other creative domains, such as forgetting an unhelpful conceptualisation of a problem, reduction in fatigue or serendipitous discovery of a helpful method of approaching the problem. It will be interesting to see if more researchers and thinkers start trying to pin this stage down in more detail in the coming years.

Sadler-Smith, E. (2015). Wallas’ four-stage model of the creative process: More than meets the eye? Creativity Research Journal27(4), 342-352.

Related posts: 
Two different ways 

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Sunday, May 26, 2019

International literature festival Dublin: Insider's guide to publishing

The International Literature Festival Dublin is a great series of events-I had the good fortune to attend Patrick McCabe and Nicole Flattery in conversation about their influences (with Flattery counting McCabe, author of "The Butcher Boy" as one).

Given that I'm currently writing a book, I was particularly psyched to attend the full-day Insider's Guide to Getting Published.

The first panel, of five different agents, didn't always have the same preferences for submissions or how to handle them. Nonetheless, they give a clear sense of an agent's remit (and repeatedly emphasize not to sign a contract with a publisher until the agent has had a look!) We also get some useful advise on editing, and three authors (with work spanning literary to more commercial work) describe how their debuts got published. Vanessa Fox-O'Loughlin (who writes as Sam Blake) also delivers a commendably clear solo masterclass on nailing your synopsis, pitch and cover letter.

The main reason I'm at this event is that I was selected for a 10 minute one-on-one with a literary agent. The 60 people put forward for this 'date' with an agent have been selected from circa 480 submissions. Speaking to a few of them during the day, I was surprised at the extent to which some struggled to give a concise pitch about their work. Even when getting set up to meet an agent, it's easy to forget that beyond writing your work, there is a separate skillset to flogging your work!

Not that I'm so great in this regard either. I have a few pithy elevator pitch statements to make about my book, but at the meeting with the agent it's clear that my synopsis can undermine the apparent marketability of the book. It can be difficult to sell something that's straddling two different areas of literature, particularly at as broad a level as combining fiction and non-fiction (what shelf is the book going to go on?). So even if I go with fiction with non-fiction elements, it's best to pigeonhole the book as one or the other. Given that I'm not going "high" literary with this book, the agent's suggestion that I include a student's perspective on the lectures makes a lot of sense (it might be a big ask for a mainstream audience to spend an entire book in the mind of such an unlikeable/alienating protagonist as David Hector).

It's certainly made me think a bit about what I want to do with my book. From the Q & A at the broader sessions, it's clear most people taking part (myself included) are probably engaging in certain number of cognitive biases (confirmation) to keep ourselves going in the face of the challenge of actually getting published. But who knows-one of the debut authors giving a talk was in the audience five years ago.

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Friday, April 19, 2019

Conference review: British Neuroscience Association Festival of Neuroscience

For the first time, the British Neuroscience Association held its Festival of Neuroscience outside the UK. Risking a Brexit crash-out which thankfully didn't come to pass a couple of weeks before the festival, BNA2019 was co-hosted with Neuroscience Ireland at the Convention Centre in Dublin city. The venue was a good size for the meeting. Although the posters covered everything from benchwork to animal models to my own poster describing reminiscence therapy and a rare memory disorder, the poster space was physically concentrated enough to get a good level of engagement going. The exhibitors included not just the usual publishing houses and companies with new toys for technique junkies, but also a career zone for job networking and a "credibility zone" to act as a thinktank for increasing factors such as reproducibility to allow neuro- and other scientists to be better able to stand over the validity of findings.

Speaking of which, a highlight of the conference was the chance to see autism researcher Uta Frith grapple with the thorny issue of the replication crisis within psychology (and empirical research in general). She called for a move towards "slow science", with theories being tested more carefully, and resisting the temptation to publish anything as fast as you can out of a fear of getting scooped. Perhaps the most impressive research plenary came from Ileana Hanganu-Opatz, who is using electrophysiological techniques to study connectivity in the brain. John Cryan (pictured centre below), whose group I have worked with, also chaired an interesting symposium on diet, brain and microbiome.

There was a great breakout session on political advocacy. Although it could have been better attended, there was a serious discussion from those in attendance about issues around how to make biggest impact in getting through to politicians (and indeed others in the public sector who are less visible but perhaps more influential) about the importance of investing in neuroscience funding. There was a particularly interesting case study of when the BBSRC made major cuts to brain research around the start of this decade, and how brain scientists leveraged the media to push back.

But this wasn't just talks and posters: this was a festival of neuroscience. There were a ton of events around the city, including theatre, dance, music and visual art. I got to the opening of Joanna Hopkin's "Connecting" exhibition. (I felt I had better show up as I had helped Hopkins to access an MRI scanner to inform this piece.) The minimal techno of the scanner pervaded the exhibit, a highlight of which was the strange homonculus pictured below. The work conjures up images of embodied cognition under an anatomical gaze. 

The Age of Arts was a great way to finish up, with a performance from the MISA choir and a commandeering of the audience by Jane Bentley to produce a percussive musical act. There were also talks from a number of people at the Global Brain Health Institute, and a representative from the Bealtaine festival, with a spirited discussion on whether the intersection between art, science and health could be used to undermine the inherent value of the arts. As a psychologist I know that it's easy to describe projects in any funding bid I write as being about all these things and more.

BNA2019 has been a huge undertaking, and any individual's perspective can only capture a snapshot of this event. I've come away with a renewed enthusiasm for the creativity that goes into both science and art. Francesca Farina noted at Age of Arts that science and art may not always have been thought of as separate endeavours; perhaps they are drawing closer together once again.

You can follow me on Twitter: @ArchivePsych

Sunday, April 14, 2019

Back with blog and book

Hello there, after a hiatus I'm back to this blog. Since my last post I have been working on an awesome/cool/savage podcast with writer and broadcaster Gareth Stack, Psychology in Mind.  I've also set up a Twitter specific to my blog: follow @ArchivePsych 

I've been working on a book, a sort of fiction/non-fiction hybrid. Expect some excerpts to appear here in the coming months. Here's a brief outline:

"Manipulate" (working title) comprises an introductory lecture series to psychology, juxtaposed with the life of Professor David Hector, who is delivering these lectures. During his lectures, David espouses high ethical standards (albeit in a cynical manner). Outside of teaching hours, David emotionally abuses his husband and mistress, bullies his colleagues and is facing accusations of sexual harassment. Although he has thus far led a charmed life, his increasingly brazen manipulation of others is causing his professional and personal life to unravel.

The segments of the book include (a). events in David’s personal life, (b). a lecture from his introduction to psychology module - these lectures are interspersed with David’s thoughts as he delivers the lecture, and (c). events in his work at the university.