I felt a funeral, in my brain

"I just didn't want it to hurt any more"
Mark Henick, mental health advocate who attempted suicide


Suicide is the leading cause of death in young males in Ireland. Not everyone who experiences major depression will attempt suicide, and indeed not everyone who attempts suicide is depressed. Nonetheless, the spectre of suicide hangs over major depression. Even where major depression is not so extreme, it takes a terrible toll; a WHO report has identified it as the world's leading cause of disability.

In our discourse on depression, one sometimes sees an attitude that people need to snap out of it, sometimes even that depression doesn't exist. Without wanting to pander to the view that mental disorder is just the fictitious cousin of physical illness, we can counter the non-existence argument by simply pointing out how depression has pervasive effects on the body.

A biological marker of biomarker can be decribed as a "an indicator of a physiological or pathological state that can be objectively measured and evaluated" (Spiller, 2011). A biomarker may reach the status of surrogate endpoint if it can be used as a substitute for more direct clinical outcomes (e.g. reduced quality of life or worsened apathy in depression). We're probably a long way off identifying a surrogate endpoint for depression. Depression is still identified using the person's self-report, although for various reasons people may deny or minimise their experience of depression if questioned about it. Nonetheless, a number of physiological variables do seem to be affected by major depression.

Brain derived neurotrophic factor is one example. It is a protein that is associated with the development of neurons, and with learning and memory. There is increasing evidence that BDNF levels in the blood are lowered in depression, and successful antidepressant treatment can restore BDNF levels. Not only is circulating BDNF reduced, but there is post mortem evidence from suicide victims that BDNF is indeed reduced in the central nervous system (although this finding did not appear to be specific to depression). Not surprising then that there's evidence that depression can have a negative effect on cognition, with worse severity of depression being associated with worse episodic memory and executive function.

So it seems depression is bad for the brain, but it is also bad for the rest of the body. Major depression can also have an impact on the immune system. It can increase inflammatory cytokines-these moderate the immune system by increasing its defences. This is useful for fighting infection, but may not be so hot if it is occurring chronically in the absence of infection. Furthermore, these cytokines can also moderate neurochemical signalling in the central nervous system, potentially exacerbating the depressive state. The immune system may be involved in the development of depression-chronic stress is associated with the development of depression, and stress can activate the types of immune system activity involved in depression.


But one shouldn't make the scenario seem simpler than it is. Part of the difficulty in identifying biomarkers if that, of course, depression hits differently for different people. Although every person's experience is unique, there are some consistencies in diversity. Melancholic depression is associated with anhedonia (a lack of enjoyment or positive response to things that used to cheer one up), early waking time, feeling worse in the morning, weight loss and agitation. There is evidence that the hypothalamic-pituitary-adrenal axis (HPA axis) is more highly activated in people suffering from melancholic depression, compared to those with non-melancholic depression. In the HPA axis, the hypothalamus (a region of the brain) initiates a chain reaction of neurochemical processes, resulting in the release of cortisol from the adrenal gland. Cortisol is a hormone released in response to stress, helping to mobilise the body for the so-called "fight or flight" response. It can permeate to tissues throughout the body, so whatever affects cortisol release can have pervasive effects on our physiology, including the immune system.

So, different sub-types of depression can guide the study of its biological effects. In the future, it may be the case that the search for biological changes in major depression will lead to depression being broken down into further sub-categories. If these categories don't line up with some aspect of the depressive experience, they will have to be evaluated against some other yardstick, such as predicting effectiveness of treatment for depression. Genetic and neurological technologies are developing all the time-perhaps the data sometimes comes in too fast for researchers to analyse and understand in its full depth. For the foreseeable future we will probably still be relying on the person's experience to identify depression and what goes with it. It's important as individuals and communities that we encourage people to seek help if they need it.

If you are or think you may be suffering from depression, whether or not you are suicidal, please do seek help. You could speak to family/friends, to a counsellor/your GP, or get in touch with the Samaritans by phone at 116123 (Republic of Ireland) or by email at jo@samaritans.org.

The hangover

The brother was over for a visit to my current home city of Cork. At a certain craft-beer establishment I partook of a few imperial stouts. Although not overly drunk when I returned home, on waking the next day I found it unusually difficult to keep anything in my stomach. Thankfully it was a Sunday, so there was no need to drag my sorry carcass into the workplace. The most complex thing I could handle was gawking at a movie with the brother. ("Reincarnated", the moving tale of Snoop Dogg's transition to Snoop Lion-truly the "Citizen Kane" of hip-hip to raggae crossover movies). Had I been that bad on a Monday morning I've little doubt my performance would have suffered.

The full economic cost of hangover is difficult to estimate-although sickies will lead to obvious losses, when asked to think of an example of presenteeism (turning up for work when you're not capable of working to your usual capacity) many of us will think of a hangover incident.

But what's the hard evidence for hangover effects? An interesting review by Richard Stephens and colleagues has discussed the impact of hangover on cognition. A majority of studies in this area have NOT shown an effect of hangover on cognitive performance, although Stephens contends this may sometimes be due to the use of insensitive measures. One study that did show an effect administered alcohol or placebo in the evening, and the next morning found worse delayed recall for a word list during hangover, despite an absence of an effect on a vigilance task, suggesting the memory effect was not simply due to fatigue. The other study found that psychomotor speed was slowed in addition to memory performance, suggesting sluggishness might have been at least part of the problem. This latter study used the more naturalistic approach of studying people after a normal night's drinking.

Stephens et al. suggest that the spectre of demand characteristics may hang over (heh heh) this research area. As mentioned above, one may study hangover in a controlled manner by giving a fixed amount of alcohol in a hangover condition. However, one may instead get some participants to come into the lab when they are hungover (after a night's drinking in a pub) and some to come in when they are not hungover. This second approach appears to more successful in demonstrating cognitive effects of hangovers. However, if invited to take part in such a study, one is essentially taking part in an "open-label" investigation. One may perform worse on cognitive tests during hangover, simply because this is what the experimental situation suggests to you.

However, Stephens et al. suggest an ingenious way around this. One can schedule some students to take part in your study on a morning after a popular drinking evening, and other students on a day when they are less likely to be drunk on the job. With enough numbers, you are likely to have a substantial proportion of the study participants attending while hungover (although perhaps the more severe cases will stay at home).

Even where performance is relatively preserved, the nauseous and draining subjective impact of heavy hangover does beg the question of whether we owe our future selves a lighter night's drinking. In many cases, I dare say a good behavioural medicine would be learning how to be a little less socially inhibited without having to resort to a few too many bevvies.

Stephens, R.; Ling, J.; Heffernan, T.M.; Heather, N. & Jones, K. (2008). A review on the cognitive effects of alcohol hangover. Alcohol & Alcoholism, 43(2), 163-170.

Book review: "The Worry Cure" by Robert L Leahy

"You should only worry if you don't have this book" a rave review intones from the cover-thankfully I sorted that out!

"The Worry Cure" is a book aimed at helping the reader address excessive worry and anxiety. Although I am prone to checking things a lot (particularly if I unplugged the iron), I'm not really much of a worrier myself. Nonetheless, I couldn't resist getting a bit of insight into how cognitive therapists such as author Robert L. Leahy help people think their way through anxiety and worry.

The book opens with quite a bit of descriptive exposition that is likely to reflect the worrier's cognitive habits back at them. Leahy gets a few fair digs in at unhelpful advice others often give to people riddled with anxiety, and suggests why these tips might not work. He then has the largesse to include a few questionnaires that help the reader to identify what type of worrier they are. It may at first blush seem a bit needless for the reader to answer such questionnaires for their own insight (instead of informing a new clinician of their worry), but as Leahy notes from experience not everyone has great insight into their own thought processes. (Later on he suggests keeping diaries, a handy way to avoid trying to gain insight to your own past thoughts via memory).

Dr Leahy is not short of ideas of how to think differently about life. Although he proposes seven overall steps to fighting anxiety, some chapters come with very long lists of sub-strategies (20 different ways of turning "failure" into opportunity). It would be good to group them together in order to make more of them easier to remember. I was interested to see that some ideas from mindfulness (e.g. awareness of the present moment) get an outing-although this should come as little surprise given that mindfulness-based CBT is a big thing on campus these days.

Strategies to think differently about sources of worry are liberally peppered with clinical anecdotes. Oftentimes the man makes it look too easy. It's only natural to highlight successful cases to show how things can go right (and encourage optimism in the reader), but I can't help but imagine it is a very drawn-out process with many clients. In fairness, Leahy does allude to this in places, and as he notes himself, worry can persist in people because they feel that worrying helps them in some way. A counter-intuitive example would be that worry can help you to avoid intense emotion-by thinking about many ways things can go wrong and how you might avoid it, you don't have to spend time imagining what the worst outcome might be.

The latter portion of the book is dedicated to specific worries-work worries, relationship worries, health worries etc. Leahy applies his 7-step program to these different areas of life, suggesting a broad applicability. In the section on work anxiety, he does have the social awareness to add a preface on the increase in job insecurity over the past few decades.

Will reading this book solve people's anxiety? Like the typical CBT course, there's more to it than the 8 or so hours you spend in the therapist's company. Entrenched anxiety can take a long time to work through, but if you work through the exercises in this book you are likely to know your worry better, and it should hopefully sound like less of a broken record. (Although it will sound like this if using the exposure techniques!)

20 Questions

Since I started studying psychology a little over a decade ago I've probably come across more questions than answers. Whether they're research questions, excerpts from questionnaires, or otherwise, and regardless of how well they've been answered so far, here are some of my favourites.

1. If you can't tell where you got an idea from, how did it come about?

2. How do you know if other species are conscious, and if so, what is their consciousness like?

3. Can you be addicted to food?

4. When can stress make you think better?

5. Why does the same amount of money seem so different when you gain it compared to when you lose it?

6. Are you satisfied with your bowel habit?

7. Why is it people underestimate how long it will take to do something, even when reminded about how much longer it took to complete similar projects in the past?

8. How is the vast amount of information that hits our senses parsed into the small amount of information we attend to?

9. Do only humans have minds?

10. How do the bacteria in our gut influence our mood and cognition?

11. How do you treat someone who has antisocial personality disorder?

12. How do you study human behaviour without altering the behaviour of the people you are studying?

13. How do you interpret statistical effects of the same magnitude when one set of stats is trying to demonstrate an obvious, almost prosaic point and the other set of stats is trying to demonstrate an outlandish hypothesis?

14. Can chewing gum or drinking caffeine make you more alert?

15. Is there a difference between teaching something so that people remember versus so that they fully understand it?

16. What is wisdom?

17. If your country's society were a ladder with 10 rungs, with those on the highest rung having the best jobs, the most education, and the highest income, where would you place yourself?

18. What can we learn about human brains and behaviour by studying non-human animals?

19. Why is it that we can remember so much of the past, yet it is so difficult to remember to do something?

20. Are you happy?

And the least interesting:

1. Will this be on the exam?

Mindfulness and the mind

I've had a lot of worries in my life, most of which never happened
Attributed to Mark Twain

How much of our lives is spent ruminating on the potential misfortunes that will befall us if our luck runs out, or daydreaming of the fights we might pick with those who slighted us in the past? Mindfulness is described as a non-judgmental awareness of the present moment. Mindfulness-based approaches are becoming increasingly popular as a means of reducing stress, as well as ameliorating psychological disorders. If mindfulness can promote ways of thinking that may differ from most of our everyday streams-of-consciousness, how might this impact upon our brain and cognition?

If mindfulness can change your way of thinking, it seems it can change your performance on cognitive tests. A mindfulness-based mind fitness training program has been found to reduce attentional lapses in a military cohort. However, mindfulness-based stress reduction (MBSR) did not have a clear effect upon sustained attention in a clinical trial, although the authors suggested that different results might be apparent for vigilance (i.e. sustained attention for a rarely occurring target). Outside the lab, an interesting field study indicated that providing mindfulness training to low-income children improved reported classroom behaviour-the one positive effect of mindfulness that extra sessions seemed to enhance was improved attention. Although the evidence is not final, it certainly seems plausible that techniques aiming to help you bring your attention back to the present moment when it wanders to the past or the future could lead to greater practice of cognitive control.

A number of recent studies have looked at changes in brain structure associated with mindfulness. A lot of studies examining the effects of meditation on brain structure have compared meditators to non-meditators. However, a recent study looked at changes in brain structure within the same people, before and after mindfulness-based stress reduction (MBSR). The findings suggest that MBSR led to higher levels of grey matter* in regions of the brain stem. These were regions associated with the production of neurochemicals that modulate mood and cognition (e.g. the locus coeruleus, which produces norepinephrine). However, the findings should be taken with a pinch of salt, as they suffer from some of the common problems with brain imaging studies (e.g. fishing for regions of activation, then labelling an observed area in the scan as corresponding to a known region in the brain, even when the use of relatively low-resolution scanners makes it difficult to know if it really is the region you specified that you were looking at). However, perhaps a more promising finding from this same group was enhanced gray matter in the hippocampus, which they had previously specified as a region of interest.

Compared to when I was a teenager, the use of the internet to flit through different sites and ideas has possibly worn down my sustained attention skills to some extent. With regard to stress, I think my levels are pretty moderate these days (perhaps I'm settling in to life as a grown-up), but there is always room for improvement**. In the interest of finding out more about mindfulness for my research (and maybe some self-improvement), I will be starting a course in mindfulness-based stress reduction shortly-should be a great chance to get a first-person view. Will let you know how I am on the far side of it!

UPDATE: It is also worth mentioning a recent review that grapples with the neuroscience of mindfulness-the senior author is Michael Posner, a major figure in the psychology of attention.

*Grey matter is made up of the cell bodies, dendrites and unmyelinated axons of neurons, the brain cells that process information. White matter, in contrast, gets its characteristic colour from the myelin that sheaths axons (allowing information to travel along the neuron more quickly).

**Note: I'm not trying to say no stress is a good thing!

A helping hand: time or money?

A poverty is sweeping the land. Fridges are full, cars are running and banks keep trucking. But an impatience grips the citizens. They are impatient with one another, flitting from task to task, constantly facing new deadlines and missing old ones. The fact that people are bad at estimating how long it will take to do things (the planning fallacy) doesn't help. Some people wondering if they should put off sleep for another hour or two to keep the show on the road.

It's the affliction of time poverty. Brother, can you spare a minute?

When someone asks for your time, you may expect them to reciprocate in future, but there's a good chance that you're giving up your time to help your fellow human. Research on the topic of altruism has tended to look at when people give up their money. Studies looking at such financial altruism may simply look at willingness-to-donate via self-report. Of course, willingness-to-donate and amount actually donated may not correspond closely, so actual helping behaviour is better to study.

A new paper describes an approach to looking at overt, altruistic behaviour, and particularly how much time people give up for an altruistic cause.

The paper initially looks not at altruistic helping but at altruistic punishment-giving of yourself in order to punish someone who violates social norms. Participants had to complete simple but time consuming tasks (like an arithmetic problem) in order to increase the size of the punishment. Although the vignettes they read were not real, it was real time the study participants were giving up. When people read an account of someone  violating a social contract (e.g. talking on mobile phone while driving) they spent longer on the puzzles, racking up a bigger punishment (e.g. bigger fine), They were more lenient (and so solved fewer puzzles) for a scenario less indicative of a social contract violation (e.g. how long you'd wait before revisiting a cinema when the programme is changed from previously advertised).

Participants also spent longer solving puzzles to give a harsher punishment to someone who deliberately violates the social contract (pushing in front to use an ATM) that someone who accidentally breaks the rules (someone rushes to train so fast they forget to buy a ticket).

The researchers found that this also works for helping behaviours. Instead of looking at the impact of social violations on altruistic punishment, they primed participants by making them watch videos of a dog shelter (empathy), a report on police shooting a dog (anger) or an instructional video on brushing a dog (neutral). Those who watched the "empathy clip" spent more time solving puzzles in order to bring about a bigger altruistic outcome (e.g. money given to pay a stray dog's vet bills).

Clearly, as the set-up in these experiments simply asked participants what they would like to happen, it would be interesting to see what would happen in a situation where giving up time led directly to real altruistic helping or punishment (or at least where participants believed as much). Nonetheless, it's quite impressive that the researchers were able to make people give up their time to punish or help a vignette character. Then again, how much time do any of us give up already fantasizing about revenge, or of being a hero, when this will not actually help/hurt those around us?

What I find interesting about time (and the authors allude to this in their discussion) is that people vary not only in terms of how much money they have, but also how much free time they have. So giving up an hour is a more onerous task for a CEO than it is for a JobBridge intern. The authors assert that there are bigger differences between people with the most and the least money than those with the most and the least free time (so perhaps there is less "time inequality" in our society??). In any case, good luck getting the CEO to take part in a study using this method...

Farrelly et al. (2015). Evidence for an alternative currency for altruism in laboratory-based experiments. Europe's Journal of Psychology, 11(1), 100-111.

Sweating rhymes: Stress and creativity

"I've lost the flow" Oh no oh no oh no oh no oh no. My mouth had run dry, but more importantly so had my flow. I had agreed to take part in a "present your research in a 3-minute, engaging talk for a general audience" event, and had decided to set myself apart by rapping. After hours of practice under the spotlight I cracked through 50 seconds of rhymes before hitting a memory block. "I've lost the flow" I announced aloud to the crowd. (Thankfully I wasn't trying to play a load of savage guitar solos at the same time or no doubt I would've choked 10 seconds in).

Painted into a corner by the stagelights and the attentive audience behind them, I had to keep going, but with the rhythm gone, I spoke in prose, with the very structure of the talk coming apart as my nerves shredded the talk to sentence salad.

After having put something creative together oneself, presenting it to the world as a performance can be nerve-racking. But notwithstanding that creative performance itself can be stressful (particularly in front of the baying mob), what impact may stress have upon creativity?

Kenneth Hammond had some interesting things to say about stress and creative thought. As I was saying previously in this blog, two different types of thought (one rapid/automatic, the other slow/sequential) may be involved in creative thinking. Hammond suggested that stress may shift us from one form of thinking to another-if this shift leads us to a style of thought better suited to the task at hand, then creativity may result. He gives the example of a firefighter fleeing a fire where simply outrunning the fire (the standard procedure) wouldn't work. The firefighter used intuitive thinking by setting a small fire and putting it out, thereby leaving the burnt area without fuel for the big fire he was running away from.

Conversely, I recall Billy Corgan mentioning how some days intuitive thinking would get him nowhere, so he would try going through chords step-by-step until he found a progression that sounded a bit different or interesting. When under time pressure to release new work, such step-by-step thinking would no doubt test anyone's patience, but may prove useful when the initial approch isn't working.

A new paper has found that stressors which are perceived as challenges (e.g. long working hours) are positively related to idea generation, whereas those which are perceived as hindrances (e.g. red tape) have a negative effect. The sample is interesting; staff from R&D departments, so people who are likely to be under pressure to be creative. It's unfortunate that an actual test of creative performance wasn't used-the methods are pretty much entirely questionnaire based. It's also unfortunate that by deciding which are stressors are good and bad in advance, and then asking people which of these they have experienced, then the appraisal of a potentially stressful event is ignored, even though this could be critical to how the event will impact upon the psychology (and physiology) of stress.

But, I will admit, dropping the flow on stage is likely to be regarded as stressful by almost all people.

What was cool about this paper was that they also asked people about the organisational innovation climate (again, I could nitpick about the specifics, such as "sufficient resources" being a sub-group of questions on this.) What they found was that hindrance stressors had a serious negative effect on the benefits of a pro-innovation working climate, with the generation and implementation of new ideas suffering when employees were up against office politics that blocked creative output. There seems to be some conceptual overlap here, as some of the hindrance stressors themselves are part of the organisational culture-it could be that some companies hinder as much as they help. I'll let you speculate on which departments help and which departments hinder ;)

Ren, F. & Zhang, J. (2015). Job stressors, organisational innovation climate, and employee's innovative behaviour. Creativity Research Journal, 27(1), 16-23.