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.

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Performance under pressure

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!

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Mindfulness update: 6 months on

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? 

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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 ;)

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!

A 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.


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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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Conference review, Part 2: APS Young Investigator Colloquium

The Young Investigator Colloquium is a satellite event for the American Psychosomatic Society Meeting. The aim is to bring 25 young investigators together with 10 senior researchers to receive mentorship about their research ideas. As a participant at this year’s colloquium, I am a member of the Engel group, with Susan Lutgendorf and Redford Williams as mentors.

Young investigators present their research ideas for 5 minutes. This is followed by 15 minutes of feedback from mentors and then 10 minutes of feedback from the other young investigators. This pretty much inverts the usual ratio of presentation:feedback within a talk. It's a nice way to take the focus of rehearsing your speech about what you know already and bring the focus to getting more perspectives on how your work could be different. 

One point that was brought up across the board was the potential to incorporate genetics into our work. In the research I work on, we already have plans to look at the genetics of the microbiota, although perhaps the human genome is something I have dragged my heels about learning about. Another suggestion was to make better use of models in writing grant proposals (you can’t go too wrong with more boxes with arrows). I suppose it does no harm to get a review written before asking for money for research, so you can include your article’s figure as well for a cheeky self-citation. The peer review was also mutually beneficial-we discussed topics such as trade-offs between using double-blind design and completing a trial quickly if placebos take a long time to produce, employing mixed methods with qualitative methods and chasing different sources of funding.

When many conferences are talk-poster-talk-sponsor table-talk, it is forward-thinking to have a more active learning activity like this, not to mention generous of mentors to give up half a day for the event. I don’t think my project will undergo a sea change as a result of the Colloquium. However, I don't this was really the aim; one of the objectives was to improve the writing of our research proposals, as well as critiquing the research ideas themselves. It does seem a pity that close collaborations between people in our group didn’t seem to suggest themselves by the end of the half day, but then there was a diversity in our research topics as well as underlying similarities. Later in the conference we were treated to lunch with the mentors. It was a good chance for the organisers to plug next year's meeting. Given that it will be at the closer venue of Seville Spain, and as Colloquium participants get free registration for the following year, I'm inclined towards attending.

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APS conference review