NICE endorses computerised CBT
Two forms of computerised cognitive behaviour therapy (CCBT) have
won the National Institute for Clinical Excellence (NICE) seal of
Beating the Blues, developed by Ultrasis in collaboration with a team at the Institute of Psychiatry, led by Dr Judy Proudfoot and including the late Jeffrey Gray, is recommended as part of a wider stepped-care approach for the treatment of mild to moderate depression. FearFighter, developed by Stuart Poole and Professor Isaac Marks, is recommended for the management of panic and phobia. Lack of evidence meant endorsement was not given for two other packages, COPE and OCFighter.
Beating the Blues consists of a 15-minute introductory video with eight one-hour interactive CBT-based computer sessions, plus homework. FearFighter consists of nine computer sessions, with therapist contact for five minutes before, and up to 15 minutes after, each session.
The guidelines were welcomed by David Shapiro, honorary professor at the Psychological Therapies Research Centre at the University of Leeds, and at the University of Sheffield, who acknowledged a vested interest, having acted as research consultant for the company behind Beating the Blues. ‘My motivation to get involved was as a way to overcome the shortage of therapists in this country. The computerised approach has a very important part to play in bringing cognitive-behavioural principles to a larger number of patients than could ever be possible with face-to-face CBT,’ he told us. ‘The therapeutic alliance is of course very important but when face-to-face contact is unavailable, I felt that there are features of CBT that lend themselves particularly well to computerised delivery. It’s not perfect, it won’t help everyone, but there is good evidence that CCBT is beneficial compared with no treatment.’
However, the overwhelming emphasis on CBT continues to raise concerns among some psychologists. ‘I feel that evidence for CBT is often welcomed too uncritically,’ said Dr Nick Bolsover, a chartered clinical psychologist based in Yorkshire. ‘There is evidence that it is helpful, but it’s not so overwhelming as enthusiasts would have us believe. The randomly controlled trials used to support CBT are often flawed. They are not double-blind and often lack a placebo or treatment control. I fear that research into other approaches is suffering because all the emphasis is being placed on CBT. And that in part is happening because of the pressures to find quick and cheap approaches that fit into the medical model and its diagnostic system, a situation
I know a lot of psychologists are uncomfortable with.’
Shapiro agreed that other approaches are in danger of being left behind but explained this was unfortunately part of a chicken-and-egg situation – with NICE guidelines requiring evidence to be there, and research funding more likely to be awarded for therapeutic approaches that already have a strong evidence base. ‘But that is not an argument against CCBT,’ Shapiro said. ‘CCBT is certainly not the only way, but CBT is the best evidenced therapy, and in the absence of enough therapists, offering CCBT adds significantly to the choices available to patients.
I understand the concerns about adhering to the medical model, but in a way it is a marriage of convenience. CBT has adapted itself to the prevailing paradigm, but at its heart are psychological principles about how people change, about learning, empowerment and self-help.’ CJ
Psychologists awarded prestigious prize for brain research
THE Centre for Brain Function and Development at Birkbeck,
University of London has been presented with one of the Queen’s
Anniversary Prizes for Higher and Further Education.
The research centre is led by Professors Martin Eimer, Mark Johnson and Dr Denis Mareschal from Birkbeck’s School of Psychology. It investigates the neural basis of human mental abilities, particularly the development of these abilities during infancy and childhood. The centre’s research aims to be socially, educationally and clinically relevant in that it includes the study of dysfunctional brain states resulting from developmental disorders (such as autism) or brain injury.
BPS member and counselling psychologist Jo Nisbet from Kingston,
Surrey, has won the London regional final of the Undiscovered Authors
National Writing Competition in the non-fiction category. Her book,
Laughing Star, is an autobiographical account of a mother dealing with
two children with ADHD. Jo wins £1000, publication of her book and a
place in the national final.
MENTAL HEALTH AND MEDIA REPORTING
A NEW report on media coverage of mental health has been published
by Shift. Mind over Matter: Improving Media Reporting of Mental Health
finds that public understanding of mental health has improved
enormously over recent years, as has media reporting. But prejudiced
attitudes still remain deeply ingrained in society – and in the media.
The report makes a series of recommendations on how to improve media
reporting. The publication is intended to kick-start a debate in the
media about the reporting of mental health.
- Shift is a government programme to reduce the stigma of mental health, run by the National Institute for Mental Health in England. The report can be downloaded from tinyurl.com/hx8nw.
Signing away safety
A TRANSPORT industry conference in February has been told that
excessive road signage combined with a proliferation of in-car gadgets
was threatening drivers’ safety by causing them information overload. A
‘motoring psychologist’ from the RAC Foundation said that ‘five plus or
minus two’ is the amount of messages or points of information that we
can think of and take in at any one time, and that beyond that drivers
could easily miss vital information or hazards.
Nilli Lavie is professor of psychology and brain sciences at the Department of Psychology and Institute of Cognitive Neuroscience, University College London, where she heads the Attention Lab. ‘I agree wholeheartedly with this assessment,’ she told us. ‘In fact, research in our lab has shown that people can only take in up to five units of information at once, and that any visual information beyond that is simply not perceived, even if it appears exactly where someone is looking – a state known as “inattentional blindness”.
‘Other experiments have shown that when faced with attentional overload, people also lose their ability to detect change, a phenomenon known as change blindness. In our studies they failed to detect one face changing to another, but this could easily be equated with driving stimuli, for example changing traffic lights.’
Professor Lavie and her collaborators have now tested more than 4000 people over three years as part of the Live Science programme at the Science Museum. In some experiments they varied the level of information load – new stimuli appeared on a computer screen and participants had to detect a given shape or letter (e.g. L) as quickly as possible from among several other shapes or letters. In other experiments they tested the effects of mental load – participants were presented with just one shape, but they had to concentrate very hard on that shape in order to make a perceptual decision (for example, to say which of the cross arms was slightly longer). These experiments showed that when more than five stimuli were presented, or when people were concentrating hard on one shape, they failed to notice the presence of another shape on the screen, even when it appeared exactly where they were looking. In a variation of the task, information overload also impaired participants’ ability to detect when a stimulus on the screen changed.
‘I would recommend that before a busy junction drivers should stop talking, turn off the radio or other distractions, and leave their mind available for what lies ahead,’ Professor Lavie said. CJ
- Professor Lavie’s Attention Lab: tinyurl.com/q8g2c.
Lavie, N. (2005). Distracted and confused? Selective attention under load. Trends in Cognitive Sciences, 9, 75–82. [see tinyurl.com/n99ov for PDF file]
Bruce Wayne's worlds
IF only James Bond and Batman could team up to tackle the world’s
evil-doers. On second thoughts, that’s a daft idea – not only would
Bond get jealous of the gadgets on Batman’s utility belt but, more
importantly, the two heroes occupy different fantasy worlds. That’s
right, as adults, not only can we distinguish between fantasy and
reality, but we also understand that each fictional world is
independent and self-contained. So, of course, whereas Batman knows
Robin is real, we know the only place he’ll see Bond is at the cinema.
But would that statement make sense to a child? Do they realise that
there are multiple fantasy worlds?
In an initial study, Deena Skolnick and Paul Bloom at Yale University found that, like adults, 24 children aged between three and six knew that their friends were real, whereas characters like SpongeBob were ‘make-believe’. They even understood that a character from one fictional world would think a character from a different fictional world was unreal. But crucially, they tripped up when it came to the perspective of one fictional character towards another in the same fantasy world. For example, many children said that Batman thinks Robin is make-believe.
However, it occurred to Skolnick and Bloom that the children might have been struggling to answer a conceptual question from Batman’s perspective. So in
a second study, they asked 25 children more physical questions like ‘Can Batman touch Robin?’. Now the children’s performance was more adult-like. They answered that fictional characters from different fantasy worlds could not act on each other, but that fictional characters from within the same fantasy world could. ‘This allows us to reject the hypothesis that children make only a binary reality/fantasy distinction,’ the researchers said. ‘We found that both adults and children judge that characters from different worlds are fictional to each other, indicating that they divide the fictional space finely, perhaps creating a new fictional world for each story that they encounter.’ A report on the research will be published in the journal Cognition. CJ
Health research awards for psychologists
TWO psychologists are winners in the latest Leading Practice Through
Research Awards, organised by the independent charity the Health
Susan Clarke, a consultant clinical psychologist and head of the Intensive Psychological Therapies Service at Dorset Health Care NHS Trust, receives £100,508 to enhance services for patients with personality disorder by improving the way their care professionals are trained. Susan said: ‘This award will give me an opportunity to focus systematically and creatively on training issues, to improve the ability of staff to manage patients whose behaviour challenges their capacity to act effectively. By improving the commitment, understanding and psychological hardiness of staff and assisting them to reach their full potential, we can reduce absenteeism and turnover and improve clinical quality.’
Carol Percy, a senior lecturer in psychology at Coventry University, will use her £44,950 in a project focusing on identifying and developing the most effective patient support programme for women with polycystic ovarian syndrome (PCOS). Carol said: ‘The NHS Improvement Plan 2004 made a commitment to roll out the Expert Patients Programme throughout the NHS by 2008. Programmes need to be evaluated and may have to be tailored to specific health conditions to ensure they are truly patient-centred, effective and appropriate for the individuals and groups who use them. Warwick Hospital already runs an award-winning service for women with PCOS, and
I hope to see how this might inform the development of an EPP for the condition.’ JS
Debilitating effects of chronic deja vu
PSYCHOLOGISTS at the University of Leeds and the Research Institute
for the Care of the Elderly in Bath are researching a recently
identified symptom that is like a persistent form of déjà vu – the
typically fleeting sensation of having experienced a novel situation
Dr Chris Moulin and his colleagues believe they’ve now identified between 10 and 15 people who experience the chronic sensation, including two in Japan and several in Canada. ‘Sufferers of the chronic déjà vu feeling tend to be older adults who have been referred with memory problems. They will often say they’ve stopped watching television, particularly the news, because they’ve seen it all before,’ Moulin told us. ‘The more novel and striking a situation, the more likely sufferers are to report the feeling of familiarity, whereas it doesn’t occur with mundane activities like showering or getting dressed.’
Although there are obvious parallels with fleeting déjà vu, there is a clear distinction between the two experiences. When healthy people have that momentary sense of having been in a situation before, part of the reason it feels so odd is that they know the feeling is inappropriate. In contrast, sufferers of chronic déjà vu really believe that the present is repeating itself.
Moulin believes the symptom may be caused by cell loss in the temporal lobes, a brain area known to be implicated in the sense of familiarity and recollection. Antipsychotic medication has failed to ease the chronic déjà vu feelings, suggesting the symptom is not a form of hallucination.
The persistent sense of life repeating itself has left several of the sufferers feeling like they were going mad, so simply hearing that there are other people out there experiencing the same sensations has been a relief to the people Moulin and his collaborators are working with. However, one intervention they’re now investigating to help relieve the déjà vu sensation involves encouraging the sufferers to distract themselves with a secondary task.
‘Research with healthy people has shown that the sense of recollection and familiarity is effortful,’ Moulin explained. ‘For example, if healthy people perform a memory task while they are distracted doing something else, they will subsequently
be able to identify previously learned items, but will report an absence of familiarity for those items. It’s a sense of “knowing” in the absence of “remembering”. So one intervention we want to test is whether dividing patients’ attention could help prevent their sense of familiarity. For instance, it might help if patients try knitting while they are watching television.’ CJ
- Related journal articles are available via Chris Moulin’s website: tinyurl.com/mgg64 and tinyurl.com/pmbhl.
Want to learn how the media works?
Experience firsthand how science is reported by spending three to
eight weeks on a summer placement gaining experience of working within
a media organisation. Come away better equipped to communicate your
research and expertise to the public and your colleagues. Learn to work
within the conditions and constraints of the media to produce accurate
and well-informed pieces about developments in science.
The British Association Media Fellowships are intended to create a greater awareness and understanding of the workings of the media among practising scientists, clinicians, social scientists and engineers. Fellowships provide placements working with a national press, broadcast or internet journalist.
o For further information and online application see www.the-ba.net/mediafellows. Deadline is 18 April.
Faces and fortunes
UNATTRACTIVE people have a hard time of it – they earn less than
their more beautiful peers, enjoy poorer promotion prospects, and tend
to be perceived as less smart and less sociable. Now a newly published
working paper from the National Bureau of Economic Research in America
suggests all this means they are also more likely to become criminals.
Naci Mocan at the University of Colorado and Erdal Tekin at the Andrew Young School of Policy Studies took advantage of data collected as part of the National Longitudinal Survey of Adolescent Health (www.cpc.unc.edu/addhealth). Over 20,000 teenage participants were interviewed during three waves of assessment between 1994 and 2002, by which time the oldest participants were 26.
Mocan and Tekin found that the 7 per cent of participants judged to be unattractive by their interviewers were more likely to report lower earnings at the final wave, and to say that they had been involved in a range of crimes, including burglary and selling drugs, than were the 50 per cent of participants rated as attractive. The association between attractiveness and criminality, which was stronger for female participants, held even after controlling for a raft of personal and socio-economic factors, such as the participants’ health and their mothers’ level of education.
The researchers suggest that as well as poorer earnings providing a greater incentive for less attractive people to turn to crime, the causes of the association might also originate at school where, for example, research has shown teachers pay more attention to more attractive pupils. Consistent with this idea, the study found, for women, that high-school attractiveness was associated with success at school (as indicated by exam success, problems with teachers and suspensions). In turn, high-school attractiveness was associated with levels of adult criminal activity, even while controlling for adult attractiveness.
‘Unattractive high school students, especially females, obtain lower-quality schooling. Based on prior research, we argue that this might be because of issues related to peer relations, socialisation, teacher treatment, etc. Thus, when they are young adults in the labour market, they have a disadvantage because their human capital is not as high,’ Professor Mocan told us.
Elsewhere, Ingrid Olson and Christy Marshuetz at the Universities of Pennsylvania and Yale have turned to the cognitive processing of attractiveness for answers to why beautiful people enjoy such social advantages. In an initial study, they presented 10 participants with very brief (13ms) images of 40 ugly and beautiful faces that were sandwiched between distracting stimuli designed to interrupt processing of the faces. Not surprisingly, the participants said they couldn’t see the faces, but when they were asked to guess at their attractiveness, they consistently rated the beautiful faces as more attractive than the ugly ones. ‘Seen rapidly, viewers were able to make what amounted to an unconscious, albeit accurate, assessment of physical beauty,’ the researchers said.
A second study showed that subliminally presented attractive faces acted as positive primes, allowing participants to categorise words like joy and peace as ‘positive’ more quickly than if such words appeared after an unattractive face. A similar effect wasn’t found using images of beautiful vs. ugly houses.
‘In a way, pretty faces are rewarding; they make us more likely to think good thoughts,’ said Olson. ‘There are some underlying processes going on in the brain that prejudice us to respond to attractive people better even if we are not aware of it,’ she added. A report on the findings was published recently in the journal Emotion.
Research funding news
The Australian Academy of Science’s Selby Travelling Fellowships are
awarded to distinguished overseas scientists to enable them to visit
Australia for public lecture/seminar tours and to visit scientific
centres in Australia. The lectures are
to increase public awareness of science and scientific issues in the general lay public. Funding of up to AU$10,000 is available for air travel and subsistence. The deadline for applications is 1 September 2006.
- For further details see the Australian Academy of Science website: www.science.org.au/awards/index.htm.
The Alcohol Education and Research Council was established by
the government in 1982 to administer the Alcohol Education and Research
Fund. This fund finances projects within the United Kingdom for
education and research on alcohol-related issues. The main aims of the
Council are to increase the capacity of individuals and organisations
to deal with alcohol issues and also to develop the evidence base.
Funding is available from their Research Grant scheme, at the level of
approximately £50,000 per project. The closing date for applications is
5 September 2006. They also provide Small Grants of up to £5000 –
applications can be made at any time.
o For further details see the Alcohol Education and Research Council website www.aerc.org.uk/grants.htm.
A Fast-Track Grant scheme has been initiated by the Parkinson’s Disease Society. Funding is for:
l pilot projects, which may lead to a subsequent application for a full project grant or fellowship to the PDS or other appropriate grant-giving organisations;
l initial studies by people who may be currently carrying out research but wish to engage specifically in research in Parkinson’s disease;
l research into practical improvements for the lives of people who have Parkinson’s, and their carers;
l ‘process’ research examining the progression and delivery of healthcare to people with Parkinson's, for example the interaction between agencies and sectors of care;
l evaluation of previous studies (e.g. a Cochrane review) prior to the submission of an application for the funding of a clinically based study.
Up to £10,000 of funding is available per project. Applications can be made at any time.
o For further details see website www.parkinsons.org.uk.
Can babies count?
IT seems they can match the sound of two or three voices with the
right number of faces. When American researchers sat 20
seven-month-olds in front of two silent videos – one showing two women
speaking, the other showing three – they found that babies who were
played the sound of two women speaking, spent more time looking at the
video of two women; while babies played the sound of three women,
looked more at the video of three women.
‘This is a jolly clever study that provides a very nice demonstration that babies this young can discriminate between small numerosities presented across two different senses,’ said Professor Brian Butterworth, a leading expert on mathematical cognition. ‘It’s been widely believed that babies have this ability, but never demonstrated empirically before now,’ he told us. Crucially, the method of using just one trial per infant allowed researchers to rule out the possibility that the babies might somehow learn the correct association between voices and videos according to intensity or complexity.
A numerical sense like that shown by the infants here has also been demonstrated in monkeys, pointing to the evolution of an innate number sense. Professor Butterworth, who researches into the genetics of mathematical abilities, said that if there is indeed a genetic basis for number sense, some people could be born with an impairment, perhaps leading to dyscalculia.
If we were able to identify babies with an apparent weakness for numbers, could anything be done to help at such an early age? ‘That’s the million pound question,’ Butterworth said. ‘At the moment we don’t know if dyscalculia is associated with a particular difference in brain structure or function. We don’t know which brain areas the infants used in the task reported here. We don’t even know how numerical ability develops and changes into adulthood. Once we know the answers to some of these questions, we could then look to see how possible interventions were affecting the relevant brain activity. But thanks to this research, what we do now know is that the “starter kit” for numbers is already up and running at seven months of age.’ CJ
o The findings were published online in the Proceedings of the National Academy of Sciences: tinyurl.com/zgzgc.
Familiarity increases distance
THE road less travelled seems shorter, according to new research.
Andrew Crompton, an architecture lecturer at the University of Manchester (see www.cromp.com/work), asked 140 students in their first, second and third years to estimate the distance from the student union building to familiar destinations along a straight road. The more times students had walked the route, the further they estimated the journey to be. First-year students, for example, estimated a mile-long path to be around 1.24 miles on average, while third-year students stretched it to 1.45 miles. Crompton says that the critical thing about familiarity is that ‘detail accumulates’. Professor Terence Lee, an environmental psychologist at the University of St Andrews, said: ‘This is an interesting finding which is, so far as I know, new.’
Environmental psychologists have done a lot of work on distance estimation, and the literature suggests that there are many possible variables involved. For example, the type of destination in these familiar journeys may be critical. In the USA some research has found that perceived distances in a downtown direction appear longer, whereas Professor Lee’s research in Dundee found that they were judged to
be shorter. ‘Perhaps the difference was that the focal interests in US cities are usually located on the periphery, whereas in the UK the town centre is the centre of attraction,’ commented Lee.
Professor Lee theorises that distances are foreshortened if the destination is attractive, and that journeys also seem shorter if the intervening environment is attractive and interesting – variables that may be correlated with unfamiliarity and novelty. He added that it is not only the physical attributes of a destination that matter: ‘One of my research students, Sean McBride, has shown that estimates of the distance to the homes of friends and acquaintances is correlated with the degree to which they are liked, or more specifically, the degree to which the respondent would wish to extend the friendship.’
It appears that distance-estimation research has thrown up many other important variables, which Lee says ‘include the number of turnings in a journey, the intervening barriers – for example, trees and hills on the journey lead to overestimation – and whether the environment is “chunkable”, allowing an estimate of distance based on adding the chunks together’.
In a second study (in press in Environment and Behaviour), Crompton took students to the eccentric Welsh village of Portmeirion, packed with small and colourful buildings. Students guessed that a 500-metre-long path in the village was almost a mile long: the same students estimated a 500-metre path in Manchester to be around 1.6 times its length.
Crompton believes urban planners could fill cities with irregularities and noticeable details in order to make them feel more spacious. JS
Crompton, A. (2006). Perceived distance in the city as a function of time. Environment and Behavior, 38, 173–182.
UNDER increasing pressure to reduce household waste, Guildford
Borough Council recently commissioned the Environmental Psychology
Research Group at the University of Surrey to develop innovative
methods to increase participation in Guildford’s Kerbside Collection
Drawing on theories of social norms and planned behaviour, neighbourhoods in the borough were identified to receive feedback about how well their street was doing in terms of recycling participation. Participation levels in the kerbside collection scheme were monitored over the 10 weeks during which households were receiving different forms of feedback involving comparisons with other areas, their own previous performance and local authority targets, and compared with a control group. Recycling rates rose to 90 per cent participation in some streets and remained high (80 per cent) even after the feedback had been discontinued.
The approach is now being rolled out across the borough, which recruited a team of volunteer Community Recyclers to act as ‘Recycling Champions’ in their local communities. The local authority said: ‘The results provided incontrovertible proof that campaigning at a grassroots level in recognisable local communities is extremely effective. The work being carried out by our Community Recyclers combined with service improvements to our recycling schemes is beginning to pay real dividends with our latest figures showing a recycling rate of 33 per cent.’
Professor David Uzzell, a member of the group along with Dr Dennis Nigbur and Dr Evanthia Lyons, commented: ‘This is an excellent example of the imaginative application of theoretically driven applied environmental psychological research on behaviour change that can lead to significant practical outcomes.’ JS
National Refugee Integration Forum – a new website for those working with refugee children, launched by the Home Office in February
A free online patient safety resource – articles, case studies, discussion forums, etc.
A new online community promoting the development and discussion of web-based research
If you come across a website that you think would be of interest to our readers, let us know on [email protected].
A round-up of research from the latest BPS journals In the first study to examine the effect of intensive repeated personalised feedback in the treatment of patients with eating disorders, Schmidt et al. found that adding feedback to CBT-guided
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