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Including pollution, child and mental health services, buggies, Manchester Lectures and much more

Negative effects of polluted air apparent in cognition
A ground-breaking pilot study conducted in Mexico City suggests air pollution isn’t just a threat to pulmonary and cardiovascular health – it can also have serious effects on brain maturation, thereby putting at risk children’s future mental health (Brain and Cognition; http://tinyurl.com/6xm5qw).

Psychologist and co-author on the study Professor Randall Engle (Georgia Institute of Technology) told The Psychologist that he’d like governments to pay more attention to the effects of environmental pollution on cognition and behaviour, not just disease states. However, he conceded that ‘the present paper is limited in what a careful scientist would conclude’.

Engle, together with lead author Lilian Calderón-Garcidueñas of the Instituto Nacional de Pediatría in Mexico City, and a team of over 20 other colleagues, tested the cognitive functioning and scanned the brains of 55 clinically healthy, nine-year-old, middle class children in Mexico City and 18 similarly healthy, ten-year-old middle class children in Polotitlan city.

Mexico City has extremely high levels of particulate matter pollution in the air due to its local geography combined with high levels of industry and traffic (some London districts reach similarly high levels, but only on certain days of the year). By contrast, Polotitlan enjoys relatively clean air. There were no differences in the educational backgrounds of the mothers of the children from the two cities and all of the households had kitchens separate from living and sleeping areas.

Crucially, the researchers found that after adjusting for age differences, the children in Mexico City demonstrated significantly poorer cognitive test performance compared with the socio-demographically matched children in Polotitlan. Fluid cognition, memory, and executive functions were particularly affected, with city of origin accounting for between two to six per cent of the variance in performance.

Engle told us that he expects these cognitive differences to be increased when a larger investigation is repeated and ‘once we use the right “microscope” of cognitive measures that reflect the components of cognition rather than the global measures used in this study.’

Together with the psychometric data, 20 of the 36 children from Mexico City also had their brains scanned, revealing signs of lesions to the front of their brains. By contrast, just one of the 13 children from Polotitlan who also underwent scanning had similar lesions.

This evidence of brain damage in the pollution-exposed children was supported by neuropathological examination of healthy dogs exposed  to the Mexico City air, who also showed signs of frontal brain damage when compared with dogs from the clean air city of Tlaxcala. The pollution-exposed dogs also showed signs of upregulation of two important inflammatory genes known to be associated with brain injury and neurodegeneration.

The researchers propose that air pollution causes a sustained state of brain inflammation, in turn leading to widespread and diffuse vascular pathology. This could affect the development of the subcortical pathways that link the frontal and prefrontal cortex with areas crucial for cognition, including functions such as working memory.

‘The issue of air pollution causing cognitive deficits and brain structural changes in healthy children with all their potential consequences ought to be of major public importance,’ the researchers wrote. They also warned that the effects of air pollution could have long-lasting consequences: ‘Alterations in measures of fluid intelligence and cognitive control predict school performance, complex learning, ability to control attention and avoid distraction, reading and listening comprehension, reasoning, and of key importance from the social point of view: the ability to block impulsive anti-social behaviour.’

Dr Brian Stollery, a psychologist and expert in neurotoxicology based at the University of Bristol, said that while the possible ‘neurodegenerative effects’ of air pollution remain under explored, there were some important methodological flaws in the current study. One key issue not addressed by the paper is the fact that air pollution often correlates with noise pollution, with the latter known to affect children’s reading comprehension and digit span performance. Another issue was the paper’s failure to explain on what basis the subset of children who were brain-scanned were selected.

Stollery added, however, that ‘it is essential to achieve a balance between the never-ending search for confounders and the existing evidence of impaired function. The issues raised by the paper are clear and have a obvious public health significance – and like the issue with childhood lead exposure, small changes
in the distribution of IQ have large consequences at a population level.’
 

Boost for child mental health services
Child and adolescent mental health services (CAMHS) are to benefit from a package of government measures, including a National Advisory Council and extra support for children in schools.

Children’s Secretary Ed Balls said: ‘The CAMHS review sets out a clear vision of how we can intervene early where signs of severe mental health issues such as self-harm indicate a mental health problem. Where there are early signs of severe behavioural problems, parents need to know who they can turn to and that everything will be done to support them.’

Health Secretary Alan Johnson said he has asked the Council for an update on progress in one year. ‘I want to hear that services for children with mental health problems have improved dramatically in that time.’
Key recommendations of the report were access to high-quality, timely and responsive mental health and psychological well-being services that span the full spectrum of needs; effective transitional arrangements for young adults who are approaching 18 and who are being supported by CAMHS; and for all local areas to set out a clear description of the services that are available.

Professor Peter Kinderman, Chair of the British Psychological Society’s Standing Committee for Psychologists in Health and Social Care, said: ‘The Society has consistently called for this kind of investment in our young people, and this announcement is excellent news. I’m sure that applied psychologists, who provide many of these services, will help in whatever ways we can.’

Dr Paul Wallis, Chair of the Society’s Faculty for Children and Young People, added: ‘Investment which signals a move towards more coherent, organised and nationally agreed standards for CAMHS is long overdue. There is an urgent need for greater education and skills training regarding the understanding and early identification of psychological difficulties for young people and their families. CAMHS services need to cover the age range of children and young people from early years, schools and transitional services. They also need to ensure delivery to children, young people and families/carers, who may have complex additional needs. I’m sure that our membership will continue working to promote these aims.’

However, Simon Lawton Smith, Head of Policy at the Mental Health Foundation, said that the review ‘suggests no new policy, and makes no major suggestions for structural changes…it is primarily a plea to implement existing policy.’ He added that the Council ‘will only have an impact if it is given some teeth and can hold the government properly to account.’     www.dcsf.gov.uk/camhsrevie

From Kosovo to Luton 
The University of Bedfordshire has welcomed staff from the University of Pristina in Kosovo as part of a special EU project to train a new generation of psychologists.

The project, part of the Tempus scheme (tinyurl.com/tempus), is designed to improve Kosovo’s postgraduate psychology curriculum in the wake of the genocide. It is being delivered by a European consortium led by Dr Ian Robertson, Head of Psychology at the University of Bedfordshire. During their visit, the lecturers and new graduates from Pristina attended Postgraduate Certificate in Academic Practice sessions, as well as workshops on identifying academic sources and clinical instruments that would be relevant in clinical psychology master’s teaching and research.

Dr Robertson told The Psychologist that he has been ‘very impressed by the knowledge and dedication of the visitors. It’s dealing with the infrastructure that is harder: we’ve also equipped a new teaching laboratory in the University of Pristina with IT equipment and psychometric tests. But dealing with constant electricity cuts is quite a challenge!’

The project is also helping to establish a Kosovan Psychological Society and to publicise the role of psychologists in education and in dealing with trauma. Dr Robertson says that coordinating a Tempus project is a ‘big job. But there is much to be done to initiate the process of post-war recovery in Kosovo, and this project constitutes a good starting point.’

 

United nations briefing
Professor David Uzzell (University of Surrey) was invited to speak at the United Nations in November. An audience of Member States, United Nations officials and psychologists heard him talk on the subject of ‘Human Behavior and Climate Change: A Social Justice Issue’ as part of a half-day briefing on ‘Psychology and Social Justice Related to the UN Global Agenda’.

Professor Uzzell said: ‘The purpose of the briefing session was to inform the UN about current applied psychological and social research on the mitigation of climate change, the adaptation to changing environments and the reduction of suffering especially in respect of physical and mental health. The meeting also identified priority areas for future research.’

Uzzell was invited to represent the international psychological community by the American Psychological Association and nine other international psychological associations.

Next month’s Psychologist will feature articles on environmental issues, by David Uzzell and others.

Gene scans and health behaviour
The promise of genetic screening raises a pressing question for health psychology – just how much will knowledge of their dispositions to disease change people's behaviours? A new large-scale study, backed by a consortium involving Scripps Translational Science Institute (STSI: www.stsiweb.org), Navigenics Inc., Affymetrix and Microsoft, aims to find out. Up to 10,000 staff, family and friends of the Scripps Health Care system in San Diego will be offered the chance to have their genes scanned, after which their behaviours will be assessed for the next 20 years.

‘Our study will prospectively evaluate the effect that state-of-the-art gene scans have on people’s lifestyles, behaviours, diets and psyches,’ said Eric J. Topol, director of STSI and the study's principal investigator.

Business award
System Concepts, an independent usability, health, safety and ergonomics consultancy, was a finalist in the National Business Awards 2008 in the category Health, Work and Wellbeing Award for Small Business.

System Concepts joint MD and Chartered Psychologist Tom Stewart explained: ‘We believe that organisations benefit from putting people first – in designing their products, software and websites, and looking after their employees. We practise what we preach and are delighted to have been short-listed for this award and have our efforts to improve the well-being of our staff recognised.’

Untoward effects of buggies
The most popular style of baby buggies – those that face away from the pusher, could be impacting negatively on children’s development. According to a new study for the National Literacy Trust, children in such buggies are significantly less likely to talk, laugh and interact with their parents, than are those in buggies that face the pusher.

The research, an observational study of 2722 parent–infant pairs across the country, was carried out for the ‘Talk To Your Baby’ early language campaign by developmental psychologist Dr Suzanne Zeedyk (Dundee University). She also carried out a smaller experimental study of 20 babies being wheeled in pushchairs across a one-mile stretch in the centre of Dundee. Half the journey was spent in an away-facing buggy and half in a toward-facing buggy.

Dr Zeedyk said: ‘These studies have highlighted a number of questions we could and should be asking, both in the literature and in society. For example, there’s a socio-economic implication: toward-facing buggies are more expensive. The experimental work was done to see the extent to which changing the direction of a buggy really changes interaction. The results showed that, simply by turning the buggy into
a toward-facing position, parents’ rate of talking to their baby doubled. Babies’ heart rates also fell, and they were twice as likely to fall asleep in this orientation, both of which could be taken as possible indicators of reduced stress levels.’

The study was described as the first ever study on the psychological effects of buggies, and Dr Zeedyk said: ‘Even as a developmental psychologist, this was not an issue I had previously thought about, and I was surprised to find that no-one else seemed to have investigated it either. There were no reports we could find in the literature. Given everything we now know about the sophistication and lasting impact of early parent–infant interaction, it seems a great candidate for illustrating and even testing some of our developmental theories. Maybe we haven’t looked at it more closely because away-facing buggies have become so normal in our Western culture. It makes sense that if you can’t see the baby, you are going to talk to it less. The important point is that if babies spend a long time in buggies without parents interacting with them, this is likely to influence a number of areas of development – language, self-regulation, stress and neurology, among others.’

The research received extensive and global coverage. Although Dr Zeedyk reports that the response was largely positive, she also said: ‘The press turned this into a scare-the-parents story, which undermines one of the aims that the National Literacy Trust had in commissioning the work to give parents some information about how to choose amongst buggies on the market. I wasn’t surprised, but it was still frustrating. The findings become yet another thing for parents to worry about, when they have enough of that already. We have tried to stress in our interviews that the key message to be taken from this work is to talk to your baby – whatever kind of buggy you have at the moment. And also – if there is any chance at all that baby buggies do affect infant development, then don’t we want to know more about that, as a society and as researchers? I mean, the whole country is being raised in them

For the full research report, see tinyurl.com/5js7yv


Forensic mental health research ‘at risk’
The ‘fragile’ forensic mental health research community is at risk following closure at the end of 2007 of the NHS Forensic Mental Health R&D Programme. That’s according to Keith Soothill of Lancaster University and colleagues who said researchers in this field in England will now have to compete with all other health sectors for funding, rather than having their own ring-fenced funds to apply for.

The warning came as the group published their analysis of the relative success of the different professions in obtaining funding through the 12-year history of the NHS R&D Programme (Journal of Forensic Psychiatry and Psychology: tinyurl.com/5rjmoq). Somewhat worryingly for psychology, psychologists were found proportionately to be the least successful grant bidders, despite being the most prolific – they had a 13 per cent success rate versus a 51 per cent success rate for psychiatrists. Psychiatry also tended to dominate in terms of named principal investigators, with psychiatrists filling 63 per cent of these roles compared with psychologists filling 14 per cent.

‘This may be because psychiatrists produced better proposals and focused on topics more welcome to the advisory committee,’ the authors wrote, ‘or it may be that the committee was, albeit unconsciously, biased towards accepting proposals from psychiatrists.’

Cognitive benefits of video games
Bad news for casual video-gamers – psychologists at the University of Illinois at Urbana-Champaign have failed to replicate many of the previously reported cognitive benefits of short-term game playing (Acta Psychologica: tinyurl.com/68jw64). Walter Boot and colleagues found that 20 hours playing three genres of video game brought no benefits to non-gamers, with one exception: the puzzle game Tetris led to improvements in mental rotation ability. Meanwhile, a group of expert gamers outperformed the non-gamers on a number of mental tasks, including those involving object tracking and visual short-term memory.

Together the findings suggest that cognitive benefits from video-game playing require far more extensive practice, or that people with superior cognitive skills are more likely to play video games – thus explaining the positive findings of some earlier studies.

New guidelines for older people’s well-being
The National Institute for Health and Clinical Excellence (NICE) has published new guidelines on promoting mental well-being in people aged 65 years and over. The guidance, which is aimed at health professionals and lay carers, recommends that older people are offered regular group or individual sessions encouraging them to ‘identify, construct, rehearse and carry out daily routines and activities that help to maintain or improve their health and wellbeing’. Other recommendations concern the development of tailored exercise regimes by physiotherapists and other professionals; community exercise programmes; local walking schemes; and training for a range of professionals in the principles and methods of occupational therapy and health and well-being promotion, as well as effective communication skills to engage with older people and their carers.

Professor Catherine Law, Chair of the Public Health Interventions Advisory Committee (PHIAC) at NICE and Professor of Public Health and Epidemiology, UCL Institute of Child Health, said there is evidence that many older people live with low levels of life satisfaction and well-being: 40 per cent of older people attending GP surgeries, and 60 per cent living in residential institutions are reported to have ‘poor’ mental health. ‘All people coming into contact with older people, including health and social care professionals, have the potential to promote and maintain physical activity, health and independence, factors frequently mentioned by older people as important to their mental well-being,’ she said.

Not punching our weight
Humanities and Social Science disciplines are not ‘punching their weight’ in contributing to public policy making, according to a new report from the British Academy.

A working party, chaired by Professor Sir Alan Wilson, took extensive soundings from both policy makers and academics. Both sides were in agreement that a greater contribution was needed, especially as the challenges confronting policy makers are growing in complexity.

Sustainability and well-being are cited as examples of these complex challenges, and the report says that ‘interdisciplinary research involving culture, economics and psychology has begun to uncover a complex and subtle picture of individual motivation. In so doing, it has pointed to ways in which the efficacy of government policy can be enhanced, sometimes by stepping in, say, to set default options, but often by stepping back and delegating power to significant figures and institutions capable of influencing individuals’ behaviour.’

The report makes 20 practical recommendations designed to improve dialogue, innovation and knowledge transfer between leading academics and policy makers in Westminster, Whitehall, the devolved administrations and town halls and other public bodies. They include reducing the high proportion of Government research budgets which, contrary to the Government’s own guidelines, is allocated to short-term projects; strengthening Government departments’ peer review mechanisms to ensure they commission the highest quality research; and improving training for PhD students to meet the future needs of policy makers and other user communities.

Universities are also called upon to take more account of public policy engagement in their criteria for academic promotion; and Government departments are advised to set and publish targets to increase two-way secondments with Universities and research organisations. To download the report, see www.britac.ac.uk/reports/wilson/index.cfm

 

Social identity showcase 
The ESRC-funded research programme on Identities and Social Action, directed by Professor Margaret Wetherell (Open University) came to an end in December. The five-year programme consisted of 25 research projects, bringing together expertise across the social sciences.

The programme was the most over-subscribed in the ESRC’s history, with over 330 applications. Nine of the successful bids were led by social psychologists, and the programme became a major show case for the latest research from social identity theorists, conversation analysts and discursive psychologists, psychoanalytically influenced psychosocial researchers, experimental social psychologists and ethnographers (see www.identities.org.uk for the key findings).

Professor Wetherell told us: ‘This research did much
to clarify the relationship between identity and social action, demonstrating, for instance, how women’s identifications with their mothers were acted out in relation to their own babies and how more complex and multi-layered senses of identity moderate group conflict. The discursive research was able to show in detail how particular social categorisations of oneself and others impact on what can happen next in the interaction, with consequences for the identities people can carry forward. A number of studies focused on affect and the ways in which group-based emotions drive responses and, indeed, how whole communities construct affective environments for their members with implications for coping with collective trauma.’

Much of the research attracted a great deal of media and policy interest. The findings on mixing in Northern Ireland, and in England around young children’s integration patterns, were taken up by the Commission on Integration and Cohesion. Research on young people’s drinking patterns provided some key data and analysis confounding the usual tenor of alcohol advice.

CBT in Pakistan
Perinatal depression carries severe consequences for mothers and their infants yet tends to go untreated in many developing countries. However, a new study found that rates of perinatal depression were more than halved simply by integrating a cognitive behaviour therapy-based intervention into the routine work of community-based primary health workers in rural Pakistan (The Lancet: tinyurl.com/6d3gkd).

Professor Atif Rahman (University of Liverpool) and colleagues trained primary health workers attending to 463 mothers, while untrained health workers made an equal number of visits to a control group of 440 mothers. At six months follow-up, 53 per cent of mothers in the control condition still had depression versus 23 per cent of mothers in the intervention group – an effect that was sustained at 12 months. Other benefits included greater uptake of immunisation and contraception. ‘This intervention has the potential of providing mental health care at the doorstep to a very high proportion of women with this highly prevalent and disabling mental disorder in Pakistan and other low-income countries,’ the researchers said.

Bullies’ brains

When aggressive children with a history of bullying, thieving and lying see someone in pain, their brains respond differently from the way the brains of children without such a history do (Biological Psychology: tinyurl.com/ 6jjnrt). Lead researcher Jean Decety at the University of Chicago said this was the first brain-imaging study of its kind and that the work ‘will help us better understand ways to work with juveniles inclined to aggression and violence’.

Decety and her co-workers scanned the brains of eight children diagnosed with conduct disorder (CD) aged between 16 and 18 years and eight healthy, age-matched controls while they viewed brief photographic animations of people experiencing painful situations that were either accidental (e.g. trapping their fingers in a car door) or intentional (e.g. a person stamping on someone’s foot).Contrary to theories that have suggested children who bully may have an empathy deficit, children with CD actually showed a greater response to scenes of accidental pain than did control children. Specifically, there was greater activation in the amygdala, ventral striatum and temporal poles of the children with conduct disorder. The researchers said this may represent activity associated with sadistic pleasure, but other interpretations cannot be ruled out.

In response to scenes of intentionally inflicted pain, the brains of the controls showed greater activity in several regions relative to the children with CD, including areas associated with moral reasoning, theory of mind and emotional regulation –  for example, there was less coupling between the prefrontal cortex and the amygdala.

One interpretation is that seeing someone in distress provokes negative affect in all children, but those with conduct disorder are unable to cognitively regulate this and so respond aggressively.

Therapy for therapists

The majority of mental health professionals in America and Europe undergo therapy themselves. Moreover, most of those who do so report that it brings both professional and personal benefits. And yet a significant minority – between 20 and 25 per cent – consistently abstain from seeking therapy. In a new survey published in the Journal of Clinical Psychology (tinyurl.com/6xpe7n), John Norcross (University of Scranton) and colleagues found that 119 of 727 psychotherapists had never undertaken therapy for themselves. The likelihood  of having abstained did not vary with profession (psychologist, social worker, or counsellor) or with gender, but did vary with therapeutic orientation. Cognitive behavioural therapists were significantly more likely to have abstained from therapy than humanistic or psychodynamic therapists. Abstainers tended to rate therapy as less important for training and CPD and to say that they dealt with stress in other ways, including having ample support from friends and co-workers. Just 31 per cent of the therapy abstainers said they would be somewhat or very likely to consider therapy in the future, with loss of a loved one or loss of personal function cited as the likely motivation for doing so. ‘These reasons are nearly identical to the presenting problems of psychotherapists actually receiving personal treatment,’ the researchers said.

International self-harm data

The CASE (Child and Adolescent Self-harm in Europe) Study, involving more than 30,000 teenagers has reported its results (tinyurl.com/3oywy4). The study was conducted in six European countries – Belgium, England, Hungary, Ireland, the Netherlands and Norway – and in Australia. Three in ten girls and one in ten boys said they had self-harmed over the last year, or thought about doing so. Overall, cutting was the most common form of self-harm. The most frequently cited reason for engaging in self-harm was to ‘to get relief from a terrible state of mind’ followed by ‘to die’. Many teenagers said they did not attend hospital or tell anyone what they’d done.

Lead researcher, psychologist Nicola Madge of Brunel University, said the findings showed self-harm is ‘an international, widespread yet often hidden problem, particularly among young girls. What’s needed now is more research into the factors that prevent self-harm thoughts leading to action, and the distinctions between those who harm themselves with and without suicidal intent.’

Reviving hypnosis
Overshadowed by its on-stage cousin, clinical hypnosis has struggled to be taken seriously. The British Medical Association published a favourable report on hypnosis in 1955, but somehow this failed to spark much of a revival. Now the clinical hypnotherapist Ursula James, a visiting fellow at Oxford University Medical School, has written a paper describing the Medical School Hypnosis Association (MSHA), which she founded recently in the hope of reinvigorating quality research into the procedure (tinyurl.com/5v86gp).

The MSHA is an entirely independent body with no affiliation to a profit-making training school. ‘The aim is not only to facilitate high-quality research,’ James writes, ‘but to create an arena where medical and nonmedical practitioners of hypnotherapy can forge links at a local level, thus allowing doctors to have access to skilled clinical hypnosis practitioners to whom they can also refer privately.’

James told us she’d welcome contact from any psychologists interested in research in the this area. ‘The more rigorous, multidisciplinary research takes place, the sooner this technique can be standardised and incorporated into mainstream therapeutic techniques,’ she said.

important work
The evidence base for effective interventions for mental health problems is currently expanding at an impressive rate. In an attempt to ensure that clinical practice is guided by these findings, many government and professional bodies produce clinical guidelines for healthcare professionals. Now a special issue of Psychology and Psychotherapy: Theory, Research and Practice reviews the implementation of clinical guidelines across a range of key common mental health problems.

Opening papers discuss the rationale and process for the development of clinical guidelines for mental health, along with the work of the National Institute for Health and Clinical Excellence. The remaining papers focus on the key implementation issues for some specific disorders, including obsessive-compulsive disorder, body dysmorphic disorder, self

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