Category: psychologist

The Healing Power of Caring and Hope in Psychotherapy

On By A.P.In psychiatrist, Psychiatry, psychologist, psychologyLeave a comment

By Allen Frances, MD

There are 3 consistent research findings that should make a world of difference to therapists and to the people they treat.

1. Psychotherapy works at least as well as drugs for most mild to moderate problems and, all things being equal, should be used first

2. A good relationship is much more important in promoting good outcome than the specific psychotherapy techniques that are used

3. There is a very high placebo response rate for all sorts of milder psychiatric and medical problems

This is partly a “time effect”—people come for help at particularly bad times in their lives and are likely to improve with time even if nothing is done. But placebo response also reflects the magical power of hope and expectation. And the effect is not just psychological—the body often actually responds to placebo just as it would respond to active medication.

These 3 findings add up to one crucial conclusion—the major focus of effective therapy should be to establish a powerfully healing relationship and to inspire hope. Specific techniques help when they enhance the primary focus on the relationship; they hurt when they distract from it.

The paradox is that therapists are increasingly schooled in specific techniques to the detriment of learning how to heal. The reason is clear—it is easy to manualize technique, hard to teach great healing.

I have, therefore, asked a great healer, Fanny Marell, a Swedish social worker and licensed psychotherapist, to share some of her secrets. Ms Marell writes:

Many therapists worry so much about assessing symptoms, performing techniques, and filling out forms that they miss the wonderful vibrancy of a strong therapeutic relationship.

Thinking I can help someone just by asking about concerns, troubles, and symptoms is like thinking that I can drive a car solely by looking in the rearview mirror. Dreams, hopes, and abilities are seen out of the front window of the car and help us together to navigate the road ahead. Where are we going? Which roads will you choose and why? It surely will not be the same roads I would take. We are different—we have to find your own best direction.

If we focus only on troubles and diagnosis, we lose the advantage of capitalizing on the person’s strengths and resources. If I am to help someone overcome symptoms, change behaviors, and climb out of difficult situations, I need to emphasize also all the positives he brings to the situation. Therapy without conversations about strengths and hopes is not real therapy.

And often most important: Does the patient have a sense of humor? Laugh together! Be human. No one wants a perfect therapist. It is neither credible nor human.

Symptom checklists and diagnoses play a role but they do not give me an understanding of how this person/patient understands his world and her troubles.

And don’t drown in manuals, missing the person while applying the technique.

People come to me discouraged and overwhelmed—their hopes and dreams abandoned. Early in our time together, I ask many detailed questions about how they would like life to change. What would you do during the day? Where would you live? What would your relationship to your family be like? What would you do in your spare time? What kind of social circle would you have? By getting detailed descriptions, I get concrete goals (eg, I want to go to school, argue less with my parents, spend more time with friends).

Almost always, working with the family is useful; sometimes it is absolutely necessary. What would be a good life for your child? How would it affect you?

Sometimes our dreams are big, perhaps even too extravagant; sometimes they are small and perhaps too cautious. But dreams always become more realistic and realizable when they are expressed. Sharing a dream and making it a treatment goal helps the person make a bigger investment in the treatment, and to take more responsibility for it. He becomes the driver and the therapist may sit in the back seat.

Because my first conversation is not just about symptoms and troubles, we start off on a basis of realistic hope and avoid a negative spiral dominated only by troubles. Problems have to be faced, but from a position of strength, not despair and helplessness.

Having a rounded view of the person’s problems and strengths enriches the therapeutic contact and creates a strong alliance.

Thanks, Ms Marell, for terrific advice. Some of the best natural therapists I have known have been ruined by psychotherapy training—becoming so preoccupied learning and implementing technique that they lost the healing warmth of their personalities.

Therapy should always be an exciting adventure, an intense meeting of hearts and minds. You can’t learn to be an effective therapist by reading a manual and applying it mechanically.

I would tell therapists I supervised never to apply what we discussed to their next session with the patient, lest they would always be a week behind. Therapy should be informed by technique, but not stultified by it.

See more at: http://www.psychiatrictimes.com/blogs/couch-crisis/magical-healing-power-caring-and-hope-psychotherapy?GUID=C523B8FD-3416-4DAC-8E3C-6E28DE36C515&rememberme=1&ts=16072015#sthash.2AOArvAW.dpuf

Medication for Parkinson’s disease shown to lower morality and increase willingness to harm others

On By A.P.In Depression, morality, neurodegeneration, Neurology, Neuropsychiatric Disease, Parkinson's disease, Psychiatry, psychologist, psychology, psychopath, psychopathic personality, psychopathyLeave a comment


Healthy people who are given commonly prescribed mood-altering drugs see significant changes in the degree to which they are willing to tolerate harm against themselves and others, according to a study published Thursday. The research has implications for understanding human morality and decision-making.

A team of scientists from the University College London (UCL) and Oxford University found that healthy people who were given the serotonin-boosting antidepressant citalopram were willing to pay twice as much to prevent harm to themselves or others, compared to those given a placebo. By contrast, those who were given a dose of the dopamine-enhancing Parkinson’s drug levodopa made more selfish decisions, overcoming an existing tendency to prefer harming themselves over others.

The researchers said their findings, published in the journal Current Biology, provided clues to the neurological and chemical roots of common clinical disorders like psychopathy, which causes people to disregard the emotions of others.

The researchers compared how much pain subjects were willing to anonymously inflict on themselves or other people in exchange for money. Out of 175 subjects, 89 were given citalopram or a placebo and 86 were given levodopa or a placebo.

They were anonymously paired up into decision-makers and receivers, and all subjects were given shocks at their pain threshold. The decision-makers were then allowed to choose a different amount of money in exchange for a different amount of shocks, either to themselves or the receivers.

On average, people who were given a placebo were willing to pay about 35p per shock to prevent harm to themselves and 44p per shock to prevent harm to others. Those who were given citalopram became more averse to harm, paying an average of 60p to avoid harm to themselves and 73p per shock to avoid harm to others. This meant that citalopram users, on average, delivered 30 fewer shocks to themselves and 35 fewer shocks to others.

However, those who were given levodopa became more selfish, showing no difference in the amount they were willing to pay to prevent shocks to themselves or others. On average, they were willing to pay about 35p per shock to prevent harm to themselves or others, meaning that they delivered on average about 10 more shocks to others during the trial than those who took a placebo. They also showed less hesitation about shocking others than those given the placebo.

Similar research conducted by the same team in November found that subjects were willing to spare the stranger pain twice as often as they spared themselves, indicating that they preferred harming themselves over others for profit, a behavior known as “hyper-altruism.”

“Our findings have implications for potential lines of treatment for antisocial behavior, as they help us to understand how serotonin and dopamine affect people’s willingness to harm others for personal gain,” Molly Crockett of UCL, the study’s lead author, said in a press release. “We have shown that commonly-prescribed psychiatric drugs influence moral decisions in healthy people, raising important ethical questions about the use of such drugs.

“It is important to stress, however, that these drugs may have different effects in psychiatric patients compared to healthy people. More research is needed to determine whether these drugs affect moral decisions in people who take them for medical reasons.”

http://www.ibtimes.com/antidepressants-affect-morality-decision-making-new-study-finds-1995363

New study shows that use of psychedelic drugs does not increase risk of mental illness

On By A.P.In Anxiety, Depression, Drugs, LSD, lysergic acid diethylamaide, mental health, mental illness, Neuropsychiatric Disease, psilocin, Psilocybin, psychedelic, psychiatrist, Psychiatry, psychologist, psychology1 Comment

An analysis of data provided by 135,000 randomly selected participants – including 19,000 people who had used drugs such as LSD and magic mushrooms – finds that use of psychedelics does not increase risk of developing mental health problems. The results are published in the Journal of Psychopharmacology.

Previously, the researchers behind the study – from the Norwegian University of Science and Technology in Trondheim – had conducted a population study investigating associations between mental health and psychedelic use. However, that study, which looked at data from 2001-04, was unable to find a link between use of these drugs and mental health problems.

“Over 30 million US adults have tried psychedelics and there just is not much evidence of health problems,” says author and clinical psychologist Pål-Ørjan Johansen.

“Drug experts consistently rank LSD and psilocybin mushrooms as much less harmful to the individual user and to society compared to alcohol and other controlled substances,” concurs co-author and neuroscientist Teri Krebs.

For their study, they analyzed a data set from the US National Health Survey (2008-2011) consisting of 135,095 randomly selected adults from the US, including 19,299 users of psychedelic drugs.

Krebs and Johansen report that they found no evidence for a link between use of psychedelic drugs and psychological distress, depression, anxiety or suicidal thoughts, plans and attempts.

In fact, on a number of factors, the study found a correlation between use of psychedelic drugs and decreased risk for mental health problems.

“Many people report deeply meaningful experiences and lasting beneficial effects from using psychedelics,” says Krebs.

However, Johansen acknowledges that – given the design of the study – the researchers cannot “exclude the possibility that use of psychedelics might have a negative effect on mental health for some individuals or groups, perhaps counterbalanced at a population level by a positive effect on mental health in others.”

Despite this, Johansen believes that the findings of the study are robust enough to draw the conclusion that prohibition of psychedelic drugs cannot be justified as a public health measure.

Krebs says:

“Concerns have been raised that the ban on use of psychedelics is a violation of the human rights to belief and spiritual practice, full development of the personality, and free-time and play.”

Commenting on the research in a piece for the journal Nature, Charles Grob, a paediatric psychiatrist at the University of California-Los Angeles, says the study “assures us that there were not widespread ‘acid casualties’ in the 1960s.” However, he urges caution when interpreting the results, as individual cases of adverse effects can and do occur as a consequence of psychedelic use.

For instance, Grob describes hallucinogen persisting perception disorder, sometimes referred to as “a never-ending trip.” Patients with this disorder experience “incessant distortions” in their vision, such as shimmering lights and colored dots. “I’ve seen a number of people with these symptoms following a psychedelic experience, and it can be a very serious condition,” says Grob.

http://www.medicalnewstoday.com/articles/290461.php

Selfies Linked to Narcissism, Psychopathy

On By A.P.In psychiatrist, Psychiatry, psychologist, psychology, Uncategorized1 Comment

Men who post selfies on social media such as Instagram and Facebook have higher than average traits of narcissism and psychopathy, according to a new study from academics at Ohio State University.

Furthermore, people who use filters to edit shots score even higher for anti-social behaviour such as narcissism, an obsession with one’s own appearance.

Psychologists from the University of Ohio sampled 800 men aged 18 to 40 about their photo-posting habits on social media.

As well as questionnaires to test their levels of vanity, they were also asked if they edited their photos by cropping them or adding a filter.

Assistant Professor Jesse Fox, lead author of the study at The Ohio State University, said: ‘It’s not surprising that men who post a lot of selfies and spend more time editing them are more narcissistic, but this is the first time it has actually been confirmed in a study.

‘The more interesting finding is that they also score higher on this other anti-social personality trait, psychopathy, and are more prone to self-objectification” she said.

http://www.timeslive.co.za/lifestyle/2015/01/08/men-who-post-selfies-have-narcissistic-and-psychopathic-tendencies-study

Acceptance and Commitment Therapy (ACT) shows that self-compassion may be more important than self-esteem

On By A.P.In mental health, mental illness, psychologist, psychology, Science, The Brain1 Comment

Few concepts in popular psychology have gotten more attention over the last few decades than self-esteem and its importance in life success and long-term mental health. Of course, much of this discussion has focused on young people, and how families, parents, teachers, coaches, and mentors can provide the proper psychological environment to help them grow into functional, mature, mentally stable adults.

Research shows that low self-esteem correlates with poorer mental health outcomes across the board, increased likelihood of suicide attempts, and difficulty developing supportive social relationships. Research also shows that trying to raise low self-esteem artificially comes with its own set of problems, including tendencies toward narcissism, antisocial behavior, and avoiding challenging activities that may threaten one’s self-concept.

This division in the research has led to a division amongst psychologists about how important self-esteem is, whether or not it’s useful to help people improve their self-esteem, and what the best practices are for accomplishing that.

In one camp, you have people who believe improving self-esteem is of paramount importance. On the other side of the fence are those who feel the whole concept of self-esteem is overrated and that it’s more critical to develop realistic perceptions about oneself.

But what if we’ve been asking the wrong questions all along? What if the self-esteem discussion is like the proverbial finger pointing at the moon?

New research is suggesting this may indeed be the case, and that a new concept — self-compassion — could be vastly more important than self-esteem when it comes to long-term mental health and success.

Why the Self-Esteem Model Is Flawed

The root problem with the self-esteem model comes down to some fundamental realities about language and cognition that Acceptance and Commitment Therapy (ACT, pronounced all as one word) was designed to address.

The way psychologists classically treat issues with self-esteem is by having clients track their internal dialog — especially their negative self talk — and then employ a number of tactics to counter those negative statements with more positive (or at least more realistic) ones. Others attempt to stop the thoughts, distract themselves from them, or to self sooth.

Put bluntly, these techniques don’t work very well. The ACT research community has shown this over and over again. There are many reasons that techniques like distraction and thought stopping tend not to work — too many to go into all of them here. For a full discussion, see the books Acceptance and Commitment Therapy or Get Out of Your Mind and Into Your Life. For the purposes of our discussion here, we will look at one aspect of this: How fighting a thought increases its believability.

Imagine a young person has the thought, “There is something wrong with me.” The classic rhetoric of self-esteem forces this person to take the thought seriously. After all he or she has likely been taught that having good self-esteem is important and essential for success in life. If they fight against the thought by countering it, however, that means the thought is confirmed. The thought is itself something that is wrong with the individual and has to change. Every time they struggle against it, the noose just gets tighter as the thought is reconfirmed. The more they fight the thought, the more power they give it.

This is a classic example of why in ACT we say, “If you are not willing to have it, you do.”

The simple fact is, we can’t always prevent young people from experiencing insecurity and low self-esteem. Heck, we can’t eliminate those feelings in ourselves. All people feel inadequate or imperfect at times. And in an ever-evolving, ever-more complex world, there is simply no way we can protect our young people from events that threaten their self-esteem — events like social rejection, family problems, personal failures, and others.

What we can do is help young people to respond to those difficult situations and to self-doubt with self-compassion. And a couple of interesting studies that were recently published show that this may indeed offer a more useful way forward not only for young people, but for all of us.

What Is Self-Compassion?

Before we look at the studies, let’s take a moment to define self-compassion.

Dr. Kirstin Neff, one of the premier researchers in this area, defines self-compassion as consisting of three key components during times of personal suffering and failure:
1. Treating oneself kindly.
2. Recognizing one’s struggles as part of the shared human experience.
3. Holding one’s painful thoughts and feelings in mindful awareness.

Given this context, the negativity or positivity of your thoughts isn’t what’s important. It’s how you respond to those thoughts that matters. Going back to the example above — “There is something wrong with me” — instead of fighting against that thought or trying to distract yourself from it, you could notice this thought without getting attached to it (become mindful), understand that it is common to all humans and part of our shared experience as people, and then treat yourself kindly instead of beating yourself up.

Does this approach really work better than simply improving self-esteem?

It seems it does.

A just-published longitudinal study that followed 2,448 ninth graders for a year found that low self-esteem had little effect on mental health in those who had the highest levels of self-compassion. That means that even if they had negative thoughts, those thoughts had minimal impact on their sense of well-being over time as compared to peers who didn’t have self-compassion skills.6

This suggests that teaching kids who suffer from self-esteem issues to be more self-compassionate may have more benefit than simply trying to improve their self-esteem.

The question is: How do we do that?

As it turns out, this is exactly where ACT excels.

Using ACT to Enhance Self-Compassion

Knowing that enhancing self-compassion has been shown not only to mitigate problems with self-esteem, but also impacts other conditions including traumatic stress. Jamie Yadavaia decided to see in his doctoral project if we could enhance self-compassion using ACT.

The results were promising.

A group of 78 students 18 years or older was randomized into one of two groups. The first group was put in a “waitlist condition” which basically means they received no treatment. The other group was provided with six hours of ACT training.

As anticipated, ACT intervention led to substantial increases in self-compassion over the waitlist control post-treatment and two months after the intervention. In this group self-compassion increased 106 percent — an effect size comparable to far longer treatments previously published. Not only that, but the ACT treatment reduced general psychological distress, depression, anxiety, and stress.

At the heart of all these changes was psychological flexibility, this skill seemed to be the key mediating factor across the board, which makes sense. After all, learning how to become less attached to your thoughts, hold them in mindful awareness, and respond to them with a broader repertoire of skills — like self-kindness, for example — has not only been posited in the self-compassion literature as a core feature of mental health but proven time and again in the ACT research as essential for it.

Taken together these studies have an important lesson to teach all of us.

It’s time for us to put down the idea that we have to think well of ourselves at all times to be mature, successful, functional, mentally healthy individuals. Indeed, this toxic idea can foster a kind of narcissistic ego-based self-story that is bound to blow up on us. Instead of increasing self-esteem content what we need to do is increase self-compassion as the context of all we do. That deflates ego-based self-stories, as we humbly accept our place as one amongst our fellow human beings, mindfully acknowledging that we all have self-doubt, we all suffer, we all fail from time to time, but none of that means we can’t live a life of meaning, purpose, and compassion for ourselves and others.

http://www.huffingtonpost.com/steven-c-hayes-phd/is-selfcompassion-more-im_b_6316320.html

Psychedelic mushrooms put your brain in a “waking dream,” study finds

On By A.P.In Anxiety, Depression, mental health, mental illness, Neuropsychiatric Disease, psychedelic, psychedelic renaissance, psychiatrist, Psychiatry, Psychological Medicine, Psychological Science, psychologist, psychology, Steven Weihing1 Comment

imrs

Psychedelic mushrooms can do more than make you see the world in kaleidoscope. Research suggests they may have permanent, positive effects on the human brain.

In fact, a mind-altering compound found in some 200 species of mushroom is already being explored as a potential treatment for depression and anxiety. People who consume these mushrooms, after “trips” that can be a bit scary and unpleasant, report feeling more optimistic, less self-centered, and even happier for months after the fact.

But why do these trips change the way people see the world? According to a study published today in Human Brain Mapping, the mushroom compounds could be unlocking brain states usually only experienced when we dream, changes in activity that could help unlock permanent shifts in perspective.

The study examined brain activity in those who’d received injections of psilocybin, which gives “shrooms” their psychedelic punch. Despite a long history of mushroom use in spiritual practice, scientists have only recently begun to examine the brain activity of those using the compound, and this is the first study to attempt to relate the behavioral effects to biological changes.

After injections, the 15 participants were found to have increased brain function in areas associated with emotion and memory. The effect was strikingly similar to a brain in dream sleep, according to Dr. Robin Carhart-Harris, a post-doctoral researcher in neuropsychopharmacology at Imperial College London and co-author of the study.

“You’re seeing these areas getting louder, and more active,” he said. “It’s like someone’s turned up the volume there, in these regions that are considered part of an emotional system in the brain. When you look at a brain during dream sleep, you see the same hyperactive emotion centers.”

In fact, administration of the drug just before or during sleep seemed to promote higher activity levels during Rapid Eye Movement sleep, when dreams occur. An intriguing finding, Carhart-Harris says, given that people tend to describe their experience on psychedelic drugs as being like “a waking dream.” It seems that the brain may literally be slipping into unconscious patterns while the user is awake.

Conversely, the subjects of the study had decreased activity in other parts of the brain—areas associated with high level cognition. “These are the most recent parts of our brain, in an evolutionary sense,” Carhart-Harris said. “And we see them getting quieter and less organized.”

This dampening of one area and amplification of another could explain the “mind-broadening” sensation of psychedelic drugs, he said. Unlike most recreational drugs, psychotropic mushrooms and LSD don’t provide a pleasant, hedonistic reward when they’re consumed. Instead, users take them very occasionally, chasing the strange neurological effects instead of any sort of high.

“Except for some naïve users who go looking for a good time…which, by the way, is not how it plays out,” Carhart-Harris said, “you see people taking them to experience some kind of mental exploration, and to try to understand themselves.”

Our firm sense of self—the habits and experiences that we find integral to our personality—is quieted by these trips. Carhart-Harris believes that the drugs may unlock emotion while “basically killing the ego,” allowing users to be less narrow-minded and let go of negative outlooks.

It’s still not clear why such effects can have more profound long-term effects on the brain than our nightly dreams. But Carhart-Harris hopes to see more of these compounds in modern medicine. “The way we treat psychological illnesses now is to dampen things,” he said. “We dampen anxiety, dampen ones emotional range in the hope of curing depression, taking the sting out of what one feels.”

But some patients seem to benefit from having their emotions “unlocked” instead. “It would really suit the style of psychotherapy where we engage in a patient’s history and hang-ups,” Carhart-Harris said. “Instead of putting a bandage over the exposed wound, we’d be essentially loosening their minds—promoting a permanent change in outlook.”

Thanks to Steven Weihing for bringing this to the attention of the It’s Interesting community.

http://www.washingtonpost.com/news/to-your-health/wp/2014/07/03/psychedelic-drugs-put-your-brain-in-a-waking-dream-study-finds/

New research confirms that looking angry gets people to do what you want.

On By A.P.In Amanda L. Chan, anger, Neuroscience, psychiatrist, Psychiatry, Psychological Science, psychologist, psychology, ScienceLeave a comment

by Amanda L. Chan

If you’ve ever gotten the death glare from your parent, child or S.O., you already know the results of this new study to be true.

New research in the journal Psychological Science shows that people are more likely to give in to an unfair demand when they are presented with a threatening facial expression.

For one of the experiments in the study, 870 people played a negotiation game, which involved deciding how to split $1 between two people. In each scenario, there was a “proposer,” who decided how the dollar would be split and a “responder.” However, before making the decision, the proposer was shown a video clip of the responder making either a neutral facial expression or an angry one. (Little did the study participants know, the responder was actually an actress who was instructed to portray a certain facial expression in each scenario).

In addition to viewing the facial expressions of the responder, the proposer received a written demand from the responder for either half of the amount (considered a “fair” request), or 70 percent of the amount (an “unfair” request). If the responder didn’t accept the proposer’s deal, neither party would get the money.

Researchers found an association between the offer made by the proposer and the facial expression of the responder. If the responder made an angry face and requested the 70 percent, the proposer was more likely to give the 70 percent.

Meanwhile, if the responder made an angry face and only requested the 50-50 split, this didn’t seem to affect how much the proposer offered, likely because the request was already deemed fair. (Something to consider: Because a woman actor was used for the experiment and female and male anger can be perceived differently, the results of the study apply only in the context of a woman’s angry facial expressions being able to influence giving into an unfair demand.)

http://www.huffingtonpost.com/2014/06/09/look-angry-facial-expression-demand_n_5473238.html

Thousands of Toddlers Are Inapprorpiately Medicated for A.D.H.D., Report Finds, Raising Worries

On By A.P.In A.D.H.D., Adderall, ADHD, Alan Schwarz, American Academy of Pediatrics, Anita Zervigon-Hakes, attention deficit hyperactivity disorder, C.D.C., CDC, Doris Greenberg, Food and Drug Administration, Georgia Mental Health Forum, Keith Conners, Lawrence H. Diller, Medicaid, methylphenidate, Nancy Rappaport, National Institute of Mental Health, Neuropsychiatric Disease, New York Times, NIMH, psychiatrist, Psychiatry, psychologist, psychology, Ritalin, Susanna N. VisserLeave a comment

By ALAN SCHWARZ

More than 10,000 American toddlers 2 or 3 years old are being medicated for attention deficit hyperactivity disorder outside established pediatric guidelines, according to data presented on Friday by an official at the Center.

The report, which found that toddlers covered by Medicaid are particularly prone to be put on medication such as Ritalin and Adderall, is among the first efforts to gauge the diagnosis of A.D.H.D. in children below age 4. Doctors at the Georgia Mental Health Forum at the Carter Center in Atlanta, where the data was presented, as well as several outside experts strongly criticized the use of medication in so many children that young.

The American Academy of Pediatrics standard practice guidelines for A.D.H.D. do not even address the diagnosis in children 3 and younger — let alone the use of such stimulant medications, because their safety and effectiveness have barely been explored in that age group. “It’s absolutely shocking, and it shouldn’t be happening,” said Anita Zervigon-Hakes, a children’s mental health consultant to the Carter Center. “People are just feeling around in the dark. We obviously don’t have our act together for little children.”

Dr. Lawrence H. Diller, a behavioral pediatrician in Walnut Creek, Calif., said in a telephone interview: “People prescribing to 2-year-olds are just winging it. It is outside the standard of care, and they should be subject to malpractice if something goes wrong with a kid.”

Friday’s report was the latest to raise concerns about A.D.H.D. diagnoses and medications for American children beyond what many experts consider medically justified. Last year, a nationwide C.D.C. survey found that 11 percent of children ages 4 to 17 have received a diagnosis of the disorder, and that about one in five boys will get one during childhood.

A vast majority are put on medications such as methylphenidate (commonly known as Ritalin) or amphetamines like Adderall, which often calm a child’s hyperactivity and impulsivity but also carry risks for growth suppression, insomnia and hallucinations.

Only Adderall is approved by the Food and Drug Administration for children below age 6. However, because off-label use of methylphenidate in preschool children had produced some encouraging results, the most recent American Academy of Pediatrics guidelines authorized it in 4- and 5-year-olds — but only after formal training for parents and teachers to improve the child’s environment were unsuccessful.

Children below age 4 are not covered in those guidelines because hyperactivity and impulsivity are developmentally appropriate for toddlers, several experts said, and more time is needed to see if a disorder is truly present.

Susanna N. Visser, who oversees the C.D.C.’s research on the disorder, compiled Friday’s report through two sources: Medicaid claims in Georgia and claims by privately insured families nationwide kept by MarketScan, a research firm. Her report did not directly present a total number of toddlers 2 and 3 years old nationwide being medicated for the disorder, however her data suggested a number of at least 10,000 and perhaps many more.

Dr. Visser’s analysis of Georgia Medicaid claims found about one in 225 toddlers being medicated for A.D.H.D., or 760 cases in that state alone. Dr. Visser said that nationwide Medicaid data were not yet available, but Georgia’s rates of the disorder are very typical of the United States as a whole.

“If we applied Georgia’s rate to the number of toddlers on Medicaid nationwide, we would expect at least 10,000 of those to be on A.D.H.D. medication,” Dr. Visser said in an interview. She added that MarketScan data suggested that an additional 4,000 toddlers covered by private insurance were being medicated for the disorder.

Dr. Visser said that effective nonpharmacological treatments, such as teaching parents and day care workers to provide more structured environments for such children, were often ignored. “Families of toddlers with behavioral problems are coming to the doctor’s office for help, and the help they’re getting too often is a prescription for a Class II controlled substance, which has not been established as safe for that young of a child,” Dr. Visser said. “It puts these children and their developing minds at risk, and their health is at risk.”

Very few scientific studies have examined the use of stimulant medications in young children. A prominent 2006 study found that methylphenidate could mollify A.D.H.D.-like symptoms in preschoolers, but only about a dozen 3-year-olds were included in the study, and no 2-year-olds. Most researchers on that study, sponsored by the National Institute of Mental Health, had significant financial ties to pharmaceutical companies that made A.D.H.D. medications.

Some doctors said in interviews on Friday that they understood the use of stimulant medication in 2- and 3-year-olds under rare circumstances.

Keith Conners, a psychologist and professor emeritus at Duke University who since the 1960s has been one of A.D.H.D.’s most prominent figures, said that he had occasionally recommended it when nothing else would calm a toddler who was a harm to himself or others.

Dr. Doris Greenberg, a behavioral pediatrician in Savannah, Ga., who attended Dr. Visser’s presentation, said that methylphenidate can be a last resort for situations that have become so stressful that the family could be destroyed. She cautioned, however, that there should not be 10,000 such cases in the United States a year.

“Some of these kids are having really legitimate problems,” Dr. Greenberg said. “But you also have overwhelmed parents who can’t cope and the doctor prescribes as a knee-jerk reaction. You have children with depression or anxiety who can present the same way, and these medications can just make those problems worse.”

Dr. Visser said she could offer no firm explanation for why she found toddlers covered by Medicaid to be medicated for the disorder far more often than those covered by private insurance.

Dr. Nancy Rappaport, a child psychiatrist and director of school-based programs at Cambridge Health Alliance outside Boston who specializes in underprivileged youth, said that some home environments can lead to behavior often mistaken for A.D.H.D., particularly in the youngest children.

“In acting out and being hard to control, they’re signaling the chaos in their environment,” Dr. Rappaport said. “Of course only some homes are like this — but if you have a family with domestic violence, drug or alcohol abuse, or a parent neglecting a 2-year-old, the kid might look impulsive or aggressive. And the parent might just want a quick fix, and the easiest thing to do is medicate. It’s a travesty.”

Psychopaths: how can you spot one?

On By A.P.In antisocial personality, Bernie Madoff, brain, California, Crime, criminal psychology, David Eagleman, Empathy, Human Behavior, James Fallon, Joanna Dennehy, Jon Ronson, Lying, Murder, Neuroscience, neuroscientist, psychologist, psychology, psychopath, psychopathic personality, psychopathy, Robert Hare, Steve Weihing, Ted Bundy, Violence, Wealth and Power3 Comments

There are a few things we take for granted in social interactions with people. We presume that we see the world in roughly the same way, that we all know certain basic facts, that words mean the same things to you as they do to me. And we assume that we have pretty similar ideas of right and wrong.

But for a small – but not that small – subset of the population, things are very different. These people lack remorse and empathy and feel emotion only shallowly. In extreme cases, they might not care whether you live or die. These people are called psychopaths. Some of them are violent criminals, murderers. But by no means all.

Professor Robert Hare is a criminal psychologist, and the creator of the PCL-R, a psychological assessment used to determine whether someone is a psychopath. For decades, he has studied people with psychopathy, and worked with them, in prisons and elsewhere. “It stuns me, as much as it did when I started 40 years ago, that it is possible to have people who are so emotionally disconnected that they can function as if other people are objects to be manipulated and destroyed without any concern,” he says.

Our understanding of the brain is still in its infancy, and it’s not so many decades since psychological disorders were seen as character failings. Slowly we are learning to think of mental illnesses as illnesses, like kidney disease or liver failure, and developmental disorders, such as autism, in a similar way. Psychopathy challenges this view. “A high-scoring psychopath views the world in a very different way,” says Hare. “It’s like colour-blind people trying to understand the colour red, but in this case ‘red’ is other people’s emotions.”

At heart, Hare’s test is simple: a list of 20 criteria, each given a score of 0 (if it doesn’t apply to the person), 1 (if it partially applies) or 2 (if it fully applies). The list in full is: glibness and superficial charm, grandiose sense of self-worth, pathological lying, cunning/manipulative, lack of remorse, emotional shallowness, callousness and lack of empathy, unwillingness to accept responsibility for actions, a tendency to boredom, a parasitic lifestyle, a lack of realistic long-term goals, impulsivity, irresponsibility, lack of behavioural control, behavioural problems in early life, juvenile delinquency, criminal versatility, a history of “revocation of conditional release” (ie broken parole), multiple marriages, and promiscuous sexual behaviour. A pure, prototypical psychopath would score 40. A score of 30 or more qualifies for a diagnosis of psychopathy. Hare says: “A friend of mine, a psychiatrist, once said: ‘Bob, when I meet someone who scores 35 or 36, I know these people really are different.’ The ones we consider to be alien are the ones at the upper end.”

But is psychopathy a disorder – or a different way of being? Anyone reading the list above will spot a few criteria familiar from people they know. On average, someone with no criminal convictions scores 5. “It’s dimensional,” says Hare. “There are people who are part-way up the scale, high enough to warrant an assessment for psychopathy, but not high enough up to cause problems. Often they’re our friends, they’re fun to be around. They might take advantage of us now and then, but usually it’s subtle and they’re able to talk their way around it.” Like autism, a condition which we think of as a spectrum, “psycho­pathy”, the diagnosis, bleeds into normalcy.

We think of psychopaths as killers, criminals, outside society. People such as Joanna Dennehy, a 31-year-old British woman who killed three men in 2013 and who the year before had been diagnosed with a psychopathic personality disorder, or Ted Bundy, the American serial killer who is believed to have murdered at least 30 people and who said of himself: “I’m the most cold-blooded son of a bitch you’ll ever meet. I just liked to kill.” But many psychopathic traits aren’t necessarily disadvantages – and might, in certain circumstances, be an advantage. For their co-authored book, “Snakes in suits: When Psychopaths go to work”, Hare and another researcher, Paul Babiak, looked at 203 corporate professionals and found about four per cent scored sufficiently highly on the PCL-R to be evaluated for psychopathy. Hare says that this wasn’t a proper random sample (claims that “10 per cent of financial executives” are psychopaths are certainly false) but it’s easy to see how a lack of moral scruples and indifference to other people’s suffering could be beneficial if you want to get ahead in business.

“There are two kinds of empathy,” says James Fallon, a neuroscientist at the University of California and author of The Psychopath Inside: A Neuroscientist’s Personal Journey into the Dark Side of the Brain. “Cognitive empathy is the ability to know what other people are feeling, and emotional empathy is the kind where you feel what they’re feeling.” Autistic people can be very empathetic – they feel other people’s pain – but are less able to recognise the cues we read easily, the smiles and frowns that tell us what someone is thinking. Psychopaths are often the opposite: they know what you’re feeling, but don’t feel it themselves. “This all gives certain psychopaths a great advantage, because they can understand what you’re thinking, it’s just that they don’t care, so they can use you against yourself.” (Chillingly, psychopaths are particularly adept at detecting vulnerability. A 2008 study that asked participants to remember virtual characters found that those who scored highly for psychopathy had a near perfect recognition for sad, unsuccessful females, but impaired memory for other characters.)

Fallon himself is a case in point. In 2005, he was looking at brain scans of psychopathic murderers, while on another study, of Alzheimer’s, he was using scans of his own family’s brains as controls. In the latter pile, he found something strange. “You can’t tell just from a brain scan whether someone’s a psychopath,” he says, “but you can make a good guess at the personality traits they’ll have.” He describes a great loop that starts in the front of the brain including the parahippocampal gyrus and the amygdala and other regions tied to emotion and impulse control and empathy. Under certain circumstances they would light up dramatically on a normal person’s MRI scan, but would be darker on a psychopath’s.

“I saw one that was extremely abnormal, and I thought this is someone who’s way off. It looked like the murderers I’d been looking at,” he says. He broke the anonymisation code in case it had been put into the wrong pile. When he did, he discovered it was his own brain. “I kind of blew it off,” he says. “But later, some psychiatrist friends of mine went through my behaviours, and they said, actually, you’re probably a borderline psychopath.”

Speaking to him is a strange experience; he barely draws breath in an hour, in which I ask perhaps three questions. He explains how he has frequently put his family in danger, exposing his brother to the deadly Marburg virus and taking his son trout-fishing in the African countryside knowing there were lions around. And in his youth, “if I was confronted by authority – if I stole a car, made pipe bombs, started fires – when we got caught by the police I showed no emotion, no anxiety”. Yet he is highly successful, driven to win. He tells me things most people would be uncomfortable saying: that his wife says she’s married to a “fun-loving, happy-go-lucky nice guy” on the one hand, and a “very dark character who she does not like” on the other. He’s pleasant, and funny, if self-absorbed, but I can’t help but think about the criteria in Hare’s PCL-R: superficial charm, lack of emotional depth, grandiose sense of self-worth. “I look like hell now, Tom,” he says – he’s 66 – “but growing up I was good-looking, six foot, 180lb, athletic, smart, funny, popular.” (Hare warns against non-professionals trying to diagnose people using his test, by the way.)

“Psychopaths do think they’re more rational than other people, that this isn’t a deficit,” says Hare. “I met one offender who was certainly a psychopath who said ‘My problem is that according to psychiatrists I think more with my head than my heart. What am I supposed to do about that? Am I supposed to get all teary-eyed?’ ” Another, asked if he had any regrets about stabbing a robbery victim, replied: “Get real! He spends a few months in hospital and I rot here. If I wanted to kill him I would have slit his throat. That’s the kind of guy I am; I gave him a break.”

And yet, as Hare points out, when you’re talking about people who aren’t criminals, who might be successful in life, it’s difficult to categorise it as a disorder. “It’d be pretty hard for me to go into high-level political or economic or academic context and pick out all the most successful people and say, ‘Look, I think you’ve got some brain deficit.’ One of my inmates said that his problem was that he’s a cat in a world of mice. If you compare the brainwave activity of a cat and a mouse, you’d find they were quite different.”

It would, says Hare, probably have been an evolutionarily successful strategy for many of our ancestors, and can be successful today; adept at manipulating people, a psychopath can enter a community, “like a church or a cultural organisation, saying, ‘I believe the same things you do’, but of course what we have is really a cat pretending to be a mouse, and suddenly all the money’s gone”. At this point he floats the name Bernie Madoff.

This brings up the issue of treatment. “Psychopathy is probably the most pleasant-feeling of all the mental disorders,” says the journalist Jon Ronson, whose book, The Psychopath Test, explored the concept of psychopathy and the mental health industry in general. “All of the things that keep you good, morally good, are painful things: guilt, remorse, empathy.” Fallon agrees: “Psychopaths can work very quickly, and can have an apparent IQ higher than it really is, because they’re not inhibited by moral concerns.”

So psychopaths often welcome their condition, and “treating” them becomes complicated. “How many psychopaths go to a psychiatrist for mental distress, unless they’re in prison? It doesn’t happen,” says Hare. The ones in prison, of course, are often required to go to “talk therapy, empathy training, or talk to the family of the victims” – but since psychopaths don’t have any empathy, it doesn’t work. “What you want to do is say, ‘Look, it’s in your own self-interest to change your behaviour, otherwise you’ll stay in prison for quite a while.’ ”

It seems Hare’s message has got through to the UK Department of Justice: in its guidelines for working with personality-disordered inmates, it advises that while “highly psychopathic individuals” are likely to be “highly treatment resistant”, the “interventions most likely to be effective are those which focus on ‘self-interest’ – what the offender wants out of life – and work with them to develop the skills to get those things in a pro-social rather than anti-social way.”

If someone’s brain lacks the moral niceties the rest of us take for granted, they obviously can’t do anything about that, any more than a colour-blind person can start seeing colour. So where does this leave the concept of moral responsibility? “The legal system traditionally asserts that all people standing in front of the judge’s bench are equal. That’s demonstrably false,” says the neuroscientist David Eagleman, author of Incognito: The Secret Lives of the Brain. He suggests that instead of thinking in terms of blameworthiness, the law should deal with the likelihood that someone will reoffend, and issue sentences accordingly, with rehabilitation for those likely to benefit and long sentences for those likely to be long-term dangers. The PCL-R is already used as part of algorithms which categorise people in terms of their recidivism risk. “Life insurance companies do exactly this sort of thing, in actuarial tables, where they ask: ‘What age do we think he’s going to die?’ No one’s pretending they know exactly when we’re going to die. But they can make rough guesses which make for an enormously more efficient system.”

What this doesn’t mean, he says, is a situation like the sci-fi film Minority Report, in which people who are likely to commit crimes are locked up before they actually do. “Here’s why,” he says. “It’s because many people in the population have high levels of psychopathy – about 1 per cent. But not all of them become criminals. In fact many of them, because of their glibness and charm and willingness to ride roughshod over the people in their way, become quite successful. They become CEOs, professional athletes, soldiers. These people are revered for their courage and their straight talk and their willingness to crush obstacles in their way. Merely having psychopathy doesn’t tell us that a person will go off and commit a crime.” It is central to the justice system, both in Britain and America, that you can’t pre-emptively punish someone. And that won’t ever change, says Eagleman, not just for moral, philosophical reasons, but for practical ones. The Minority Report scenario is a fantasy, because “it’s impossible to predict what somebody will do, even given their personality type and everything, because life is complicated and crime is conceptual. Once someone has committed a crime, once someone has stepped over a societal boundary, then there’s a lot more statistical power about what they’re likely to do in future. But until that’s happened, you can’t ever know.”

Speaking to all these experts, I notice they all talk about psychopaths as “them”, almost as a different species, although they make conscious efforts not to. There’s something uniquely troubling about a person who lacks emotion and empathy; it’s the stuff of changeling stories, the Midwich Cuckoos, Hannibal Lecter. “You know kids who use a magnifying glass to burn ants, thinking, this is interesting,” says Hare. “Translate that to an adult psychopath who treats a person that way. It is chilling.” At one stage Ronson suggests I speak to another well-known self-described psychopath, a woman, but I can’t bring myself to. I find the idea unsettling, as if he’d suggested I commune with the dead.

http://www.telegraph.co.uk/culture/books/10737827/Psychopaths-how-can-you-spot-one.html

Thanks to Steven Weihing for bringing this to the attention of the It’s Interesting community.

Scientists have identified the age at which most childhood memories fade and are lost forever

On By A.P.In brain, childhood amnesia, Emory University, memory, neuroplasticity, Neuroscience, Patricia Bauer, Psychological Science, psychologist, psychology, Psychology and Aging, Science, The Brain1 Comment

child_2787607b

Most adults struggle to recall events from their first few years of life and now scientists have identified exactly when these childhood memories fade and are lost forever.

A new study into childhood amnesia – the phenomenon where early memories are forgotten – has found that it tends to take affect around the age of seven.

The researchers found that while most three year olds can recall a lot of what happened to them over a year earlier, these memories can persist while they are five and six, but by the time they are over seven these memories decline rapidly.

Most children by the age of eight or nine can only recall 35% of their experiences from under the age of three, according to the new findings.

The psychologists behind the research say this is because at around this age the way we form memories begins to change.

They say that before the age of seven children tend to have an immature form of recall where they do not have a sense of time or place in their memories.

In older children, however, the early events they can recall tend to be more adult like in their content and the way they are formed.

Children also have a far faster rate of forgetting than adults and so the turnover of memories tends to be higher, meaning early memories are less likely to survive.

The findings also help to explain why children can often have vivid memories of events but then have forgotten them just a couple of years later.

Professor Patricia Bauer, a psychologist and associate dean for research at Emory college of Arts and Science who led the study, said: “The paradox of children’s memory competence and adults’ seeming “incompetence” at remembering early childhood events is striking.

“Though forgetting is more rapid in the early childhood years, eventually it slows to adult levels.

“Thus memories that “survived” early childhood have some likelihood of being remembered later in life.”

Professor Bauer and her colleagues studied 83 children over several years for the research, which is published in the scientific journal Memory.

The youngsters first visited the laboratory at the age of three years old and discussed six unique events from their past, such as family outings, camping holidays, trips to the zoo, first day of school and birthdays.

The children then returned for a second session at the ages between five years old and nine years old to discuss the same events and were asked to recall details they had previously remembered.

The researchers found that between the ages of five and seven, the amount of the memories the children could recall remained between 63-72 per cent.

However, the amount of information the children who were 8 and nine years old dropped dramatically to 35 and 36 per cent.

When the researchers looked closely at the kind of details the children were and were not able to remember, they found marked age differences.

The memories of the younger children tended to lack autobiographical narrative such as place and time. Their memories also had less narrative, which the researchers believe may lead to a process known as “retrieval induced forgetting” – where the action of remembering causes other information to be forgotten.

As they children got older, however, the memories they recalled from early childhood tended to have these features.

Professor Bauer said: “The fact that the younger children had less-complete narratives relative to the older children, likely has consequences for the continued accessibility of early memories beyond the first decade of life.

“We may anticipate that memories that survive into the ninth or tenth year of life, when narrative skills are more developed, would continue to be accessible over time.”

http://www.telegraph.co.uk/science/science-news/10564312/Scientists-pinpoint-age-when-childhood-memories-fade.html