ADHD Treatment: Behavior Therapy & Medication Seem To Positively Affect The Brain In The Same Way
(Information provided by The Wellcome Trust 1 April 2010)
Read the original research paper HERE (PDF)
Medication and behavioural interventions help children with attention deficit hyperactivity disorder (ADHD) better maintain attention and self-control by normalising activity in the same brain systems, according to research funded by the Wellcome Trust.
In a study published today in the journal ‘Biological Psychiatry’, researchers from the University of Nottingham show that medication has the most significant effect on brain function in children with ADHD, but this effect can be boosted by complementary use of rewards and incentives, which appear to mimic the effects of medication on brain systems.
ADHD is the most common mental health disorder in childhood, affecting around one in 20 children in the UK. Children with ADHD are excessively restless, impulsive and distractible, and experience difficulties at home and in school. Although no cure exists for the condition, symptoms can be reduced by a combination of medication and behaviour therapy.
Methylphenidate, a drug commonly used to treat ADHD, is believed to increase levels of dopamine in the brain. Dopamine is a chemical messenger associated with attention, learning and the brain’s reward and pleasure systems. This increase amplifies certain brain signals and can be measured using an electroencephalogram (EEG). Until now it has been unclear how rewards and incentives affect the brain, either with or without the additional use of medication.
To answer these questions, researchers at Nottingham’s Motivation, Inhibition and Development in ADHD Study (MIDAS) used EEG to measure brain activity while children played a simple game. They compared two particular markers of brain activity that relate to attention and impulsivity, and looked at how these were affected by medication and motivational incentives.
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The team worked with two groups of children aged nine to 15: one group of 28 children with ADHD and a control group of 28. The children played a computer game in which green aliens were randomly interspersed with less frequent black aliens, each appearing for a short interval. Their task was to ‘catch’ as many green aliens as possible, while avoiding catching black aliens. For each slow or missed response, they would lose one point; they would gain one point for each timely response.
In a test designed to study the effect of incentives, the reward for avoiding catching the black alien was increased to five points; a follow-up test replaced this reward with a five-point penalty for catching the wrong alien.
The researchers found that when given their usual dose of methylphenidate, children with ADHD performed significantly better at the tasks than when given no medication, with better attention and reduced impulsivity. Their brain activity appeared to normalise, becoming similar to that of the control group.
Similarly, motivational incentives also helped to normalise brain activity on the two EEG markers and improved attention and reduced impulsivity, though its effect was much smaller than that of medication.
“When the children were given rewards or penalties, their attention and self-control was much improved,” says Dr Maddie Groom, first author of the study. “We suspect that both medication and motivational incentives work by making a task more appealing, capturing the child’s attention and engaging his or her brain response control systems.”
Professor Chris Hollis, who led the study, believes the findings may help to reconcile the often-polarised debate between those who advocate either medication on the one hand, or psychological/behavioural therapy on the other.
“Although medication and behaviour therapy appear to be two very different approaches of treating ADHD, our study suggests that both types of intervention may have much in common in terms of their affect on the brain,” he says. “Both help normalise similar components of brain function and improve performance. What’s more, their effect
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is additive, meaning they can be more effective when used together.”
The researchers believe that the results lend support from neuroscience to current treatment guidelines
for ADHD as set out by the National Institute for Health and Clinical Excellence (NICE). These recommend that behavioural interventions, which have a smaller effect size, are appropriate for moderate ADHD, while medication, with its larger effect size, is added for severe ADHD.
Although the findings suggest that a combination of incentives and medication might work most effectively, and potentially enable children to take lower doses of medication, Professor Hollis believes more work is needed before the results can be applied to everyday clinical practice or classroom situations.
“The incentives and rewards in our study were immediate and consistent, but we know that children with ADHD respond disproportionately less well to delayed rewards,” he says. “This could mean that in the ‘real world’ of the classroom or home, the neural effects of behavioural approaches using reinforcement and rewards may be less effective.”
Read the original research paper HERE (PDF)
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Mid Life – What’s The Crisis?: Why Self Esteem Peaks In The Middle-Aged
Credit: LiveScience
Read the original research article HERE (PDF)
Bad vision and other physical ailmen
ts aren’t the only things that seem to get worse as people grow old. Self-esteem also declines around the age of retirement, a new study finds.
The study involved 3,617 American men and women ranging in age from 25 to 104. Self-esteem was lowest among young adults, but increased throughout adulthood, peaking at age 60, before it started to decline.
Several factors might explain this trend, the researchers say.
“Midlife is a time of highly stable work, family and romantic relationships. People increasingly occupy positions of power and status, which might promote feelings of self-esteem,” said study author Richard Robins of the University of California, Davis. “In contrast, older adults may be experiencing a change in roles such as an empty nest, retirement and obsolete work skills in addition to declining health.”
Measuring self-esteem
The participants were surveyed four times between 1986 and 2002. They were asked to rate their level of agreement with statements such as: “I take a positive attitude toward myself,” which suggests high self-esteem; “At times I think I am no good at all,” and “All in all, I am inclined to feel that I am a failure,” which both suggest low self-esteem.
Subjects also indicated their demographics, relationship satisfaction, and whether they had experienced stressful life events, including suddenly losing a job, being the victim of a violent crime, or experiencing the death of a parent or child.
On average, women had lower self-esteem than men throughout most of adulthood, but self-esteem levels converged as men and women reached their 80s and 90s. Blacks and whites had similar self-esteem levels throughout young adulthood and middle age. In old age, average self-esteem among blacks dropped much more sharply than self-esteem among whites. This result held even after accounting for differences in income and health.
Future research should further explore these ethnic differences, which might lead to better interventions aimed at improving self-esteem, the study authors say.
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More self-esteem factors
Education, income, health and employment status all had some effect on the self-esteem trajectories, especially as people aged.
“People who have higher incomes and better health in later life tend to maintain their self-esteem as they age,” Orth said.
“We cannot know for certain that more wealth and better health directly lead to higher self-esteem, but it does appear to be linked in some way. For example, it is possible that wealth and health are related to feeling more independent and better able to contribute to one’s family and society, which in turn bolsters self-esteem.”
People of all ages in satisfying and supportive relationships tend to have higher self-esteem, according to the findings.
However, despite maintaining higher self-esteem throughout their lives, people in happy relationships experienced the same drop in self-esteem during old age as people in unhappy relationships.
“Thus, being in a happy relationship does not protect a person against the decline in self-esteem that typically occurs in old age,” said study author Kali H. Trzesniewski of the University of Western Ontario.
With medical advances, the drop in self-esteem might occur later for baby boomers, Orth said. Boomers might be healthier for longer and, therefore, able to work and earn money longer.
Read the original research article HERE (PDF)
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Exercise DOES Help Improve Mood! And Just 25 Minutes Worth Will Decrease Stress & Increase Energy
Having an Honors degree in Human Movement Studies and working in gyms in a former life while studying for my Clinical Masters degree, I have seen this to be true. Of course it seems self evident, but these researchers have used great science with an excellent and now research-proven written program and workbook. These, along with their recent meta-analytic research review, show just how effective exercise can be in improving mood.
Credit: PhysOrg.com) — Exercise is a magic drug for many people with depression and anxiety disorders, according to researchers who analyzed numerous studies, and it should be more widely prescribed by mental health care providers.
“Exercise has been shown to have tremendous benefits for mental health,” says Jasper Smits, director of the Anxiety Research and Treatment Program at Southern Methodist University in Dallas. “The more therapists who are trained in exercise therapy, the better off patients will be.”
The traditional treatments of cognitive behavioral therapy and pharmacotherapy don’t reach everyone who needs them, says Smits, an associate professor of psychology.
“Exercise can fill the gap for people who can’t receive traditional therapies because of cost or lack of access, or who don’t want to because of the perceived social stigma associated with these treatments,” he says. “Exercise also can supplement traditional treatments, helping patients become more focused and engaged.”
The Program used in the study is available from bookstores-Click Image to view description
Smits and Michael Otto, psychology professor at Boston University, presented their findings to researchers and mental health care providers March 6 at the Anxiety Disorder Association of America’s annual conference in Baltimore.
Their workshop was based on their therapist guide “Exercise for Mood and Anxiety Disorders,” with accompanying patient workbook (Oxford University Press, September 2009).
The guide draws on dozens of population-based studies, clinical studies and meta-analytic reviews that demonstrate the efficacy of exercise programs, including the authors’ meta-analysis of exercise interventions for mental health and study on reducing anxiety sensitivity with exercise.
“Individuals who exercise report fewer symptoms of anxiety and depression, and lower levels of stress and anger,” Smits says. “Exercise appears to affect, like an antidepressant, particular neurotransmitter systems in the brain, and it helps patients with depression re-establish positive behaviors. For patients with anxiety disorders, exercise reduces their fears of fear and related bodily sensations such as a racing heart and rapid breathing.”
After patients have passed a health assessment, Smits says, they should work up to the public health dose, which is 150 minutes a week of moderate-intensity activity or 75 minutes a week of vigorous-intensity activity.
At a time when 40 percent of Americans are sedentary, he says, mental health care providers can serve as their patients’ exercise guides and motivators.
The patient workbook which accompanies the program - Click image to view description
“Rather than emphasize the long-term health benefits of an exercise program — which can be difficult to sustain — we urge providers to focus with their patients on the immediate benefits,” he says. “After just 25 minutes, your mood improves, you are less stressed, you have more energy — and you’ll be motivated to exercise again tomorrow. A bad mood is no longer a barrier to exercise; it is the very reason to exercise.”
Smits says health care providers who prescribe exercise also must give their patients the tools they need to succeed, such as the daily schedules, problem-solving strategies and goal-setting featured in his guide for therapists.
“Therapists can help their patients take specific, achievable steps,” he says. “This isn’t about working out five times a week for the next year. It’s about exercising for 20 or 30 minutes and feeling better today.”
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You Can Trust Me More Than You Can Trust Them: Cynicism & The Trust Gap
Read the original research paper HERE (PDF)
Credit: Jeremy Dean from Psyblog
How do people come to believe that others are so much less trustworthy than themselves?
Much as we might prefer otherwise, there’s solid evidence that, on average, people are quite cynical. When thinking about strangers, studies have shown that people think others are more selfishly motivated than they really are and that others are less helpful than they really are.
Similarly in financial games psychologists have run in the lab, people are remarkably cynical about the trustworthiness of others. In one experiment people honored the trust placed in them between 80 and 90 percent of the time, but only estimated that others would honor their trust about 50 percent of the time.
Our cynicism towards strangers may develop as early as 7 years old (Mills & Keil, 2005). Surprisingly people are even overly cynical about their loved ones, assuming they will behave more selfishly than they really do (Kruger & Gilovich, 1999).
What could create such a huge gap between how people behave themselves and how they think others behave?
Trust me
People often say that it’s experience that breeds this cynicism rather than a failing in human nature. This is true, but only in a special way.
Think about it like this: the first time you trust a stranger and are betrayed, it makes sense to avoid trusting other strangers in the future. The problem is that when we don’t ever trust strangers, we never find out how trustworthy people in general really are. As a result our estimation of them is governed by fear.
If this argument is correct, it is lack of experience that leads to people’s cynicism, specifically not enough positive experiences of trusting strangers. This idea is tested in a new study published in Psychological Science. Fetchenhauer and Dunning (2010) set up a kind of ideal world in the lab where people were given accurate information about the trustworthiness of strangers to see if that would reduce their cynicism.
They recruited 120 participants to take part in a game of economic trust. Each person was given €7.50 and asked if they’d like to hand it to another person. If the other person made the same decision the pot would increase to €30. They were then asked to estimate whether the other person would opt to give them their half of the total winnings.
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The participants watched 56 short videos of the people they were playing against. The researchers set up two experimental conditions, one to mimic what happens in the real world and one to test an ideal world scenario:
1. Real life condition: in this group participants were only told about the other person’s decision when they decided to trust them. The idea is that this condition simulates real life. You only find out if others are trustworthy when you decide to trust them. If you don’t trust someone you never find out whether or not they are trustworthy.
2. Ideal world condition: here participants were given feedback about the trustworthiness of other people whether or not they decided to trust them. This simulates an ideal-world condition where we all know from experience just how trustworthy people are (i.e. much more trustworthy than we think!)
Breaking down cynicism
Once again this study showed that people are remarkably cynical about strangers. Participants in this study thought that only 52 percent of the people they saw in the videos could be trusted to share their winnings. But the actual level of trustworthiness was a solid 80 percent. There’s the cynicism.
That cynicism was quickly broken down, though, by giving participants accurate feedback about others’ trustworthiness. People in the ideal world condition noticed that others could be trusted (they upped their estimate to 71 percent) and were also more trusting themselves, handing over the money 70.1 percent of the time.
People in the ideal world condition could even be seen shedding their cynicism as the study went on, becoming more trusting as they noticed that others were trustworthy. This suggests people aren’t inherently cynical, it’s just that we don’t get enough practice at trusting.
Self-fulfilling prophecy
Unfortunately we don’t live in the ideal world condition and have to put up with only receiving feedback when we decide to trust others. This leaves us in the position of trusting to psychology studies like this one to tell us that other people are more trustworthy than we imagine (or at least people who take part in psychology studies are!).
Trusting others is also a kind of self-fulfilling prophecy, just as we find in interpersonal attraction. If you try trusting others you’ll find they frequently repay that trust, leading you to be more trusting. On the other hand if you never trust anyone, except those nearest and dearest, then you’ll end up more cynical about strangers.
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Read the original research paper HERE (PDF)
Multitasking: New Study Challenges Previous Cognitive Theory But Shows That Only A Few “Supertaskers” Can Drive And Phone
Read The Original Research Paper HERE (PDF – internal link)
A new study from University of Utah psychologists found a small group of people with an extraordinary ability to multitask: Unlike 97.5 percent of those studied, they can safely drive while chatting on a cell phone.
These individuals – described by the researchers as “supertaskers” – constitute only 2.5 percent of the population. They are so named for their ability to successfully do two things at once: in this case, talk on a cell phone while operating a driving simulator without noticeable impairment.
Jason Watson, a University of Utah psychologist, negotiates cybertraffic in a driving simulator used to study driver distractions such as cell phones and testing. While many people think they can safely drive and talk on a cell phone at the same time, Watson's new study shows only one in 40 is a "supertasker" who can perform both tasks at once without impairment of abilities measured in the study. Credit: Valoree Dowell, University of Utah
The study, conducted by psychologists Jason Watson and David Strayer, is now in press for publication later this year in the journal Psychonomic Bulletin and Review.
This finding is important not because it shows people can drive well while on the phone – the study confirms that the vast majority cannot – but because it challenges current theories of multitasking. Further research may lead eventually to new understanding of regions of the brain that are responsible for supertaskers’ extraordinary performance.
“According to cognitive theory, these individuals ought not to exist,” says Watson. “Yet, clearly they do, so we use the supertasker term as a convenient way to describe their exceptional multitasking ability. Given the number of individuals who routinely talk on the phone while driving, one would have hoped that there would be a greater percentage of supertaskers. And while we’d probably all like to think we are the exception to the rule, the odds are overwhelmingly against it. In fact, the odds of being a supertasker are about as good as your chances of flipping a coin and getting five heads in a row.”
The researchers assessed the performance of 200 participants over a single task (simulated freeway driving), and again with a second demanding activity added (a cell phone conversation that involved memorizing words and solving math problems). Performance was then measured in four areas—braking reaction time, following distance, memory, and math execution.
As expected, results showed that for the group, performance suffered across the board while driving and talking on a hands-free cell phone.
For those who were not supertaskers and who talked on a cell phone while driving the simulators, it took 20 percent longer to hit the brakes when needed and following distances increased 30 percent as the drivers failed to keep pace with simulated traffic while driving. Memory performance declined 11 percent, and the ability to do math problems fell 3 percent.
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However, when supertaskers talked while driving, they displayed no change in their normal braking times, following distances or math ability, and their memory abilities actually improved 3 percent.
The results are in line with Strayer’s prior studies showing that driving performance routinely declines under “dual-task conditions” – namely talking on a cell phone while driving – and is comparable to the impairment seen in drunken drivers.
Yet contrary to current understanding in this area, the small number of supertaskers showed no impairment on the measurements of either driving or cell conversation when in combination. Further, researchers found that these individuals’ performance even on the single tasks was markedly better than the control group.
“There is clearly something special about the supertaskers,” says Strayer. “Why can they do something that most of us cannot? Psychologists may need to rethink what they know about multitasking in light of this new evidence. We may learn from these very rare individuals that the multitasking regions of the brain are different and that there may be a genetic basis for this difference. That is very exciting. Stay tuned.”
Watson and Strayer are now studying expert fighter pilots under the assumption that those who can pilot a jet aircraft are also likely to have extraordinary multitasking ability.
The current value society puts on multitasking is relatively new, note the authors. As technology expands throughout our environment and daily lives, it may be that everyone – perhaps even supertaskers – eventually will reach the limits of their ability to divide attention across several tasks.
“As technology spreads, it will be very useful to better understand the brain’s processing capabilities, and perhaps to isolate potential markers that predict extraordinary ability, especially for high-performance professions,” Watson concludes.
Information from University of Utah
Read The Original Research Paper HERE (PDF – internal link)
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Sticking To The Status Quo: Why Habits Are So Tough To Break
Read the original Research Paper HERE (PDF internal link)
Kelly McGonigal, Ph.D. @ Psychology Today (excerpted)
A new study from the Proceedings of the National Academy of Sciences confirms what many confused shoppers, dieters, and investors know first-hand: when a decision is difficult, we go with the status quo or choose to do nothing. [..
..] Researchers from the Wellcome Trust Centre for Neuroimaging at University College London created a computerized decision-making task. Participants viewed a series of visual tests that asked them to play a referee making a sports call (e.g., whether a tennis ball bounced in our out of bounds).
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Before each test, participants were told that one of the responses (in or out) was the “default” for this round. They were asked to hold down a key while they watched. If they continued to hold down the key, they were choosing the default. If they lifted their finger, they were choosing the non-default. Importantly, the default response (in or out) switched randomly between rounds, so that a participant’s response bias (to make a call in or out) would not be confused with their tendency to stick with the status quo.
The researchers were interested in two questions:
1) Does the difficulty of the decision influence the participants’ likelihood of choosing the default?
2) Is there a neural signature for choosing the default vs. overriding the status quo? [..
As the researchers].. predicted, participants were more likely to stick with the default when the decision was difficult. It didn’t matter whether the default was in or out. If they couldn’t make a confident choice, they essentially chose to do nothing. And as the researchers point out, this tendency led to more errors.
What was happening in the participants’ brains as they chose? The researchers observed an interesting pattern when participants went against the default in a difficult decision. There was increased activity in, and increased connectivity between, two regions: the prefrontal cortex (PFC) and an area of the midbrain called the subthalamic nucleus (STN). The PFC is well-known to be involved in decision-making and self-control. The STN is thought to be important for motivating action.
The researcher’s analyses couldn’t determine for sure what the relationship between the PFC and STN was, but the observations were consistent with the idea that the PFC was driving, or boosting, activity in the STN.
These brain analyses suggest that going against the default in difficult decisions requires some kind of extra motivation or confidence. Otherwise, the decider in our mind is puzzled, and the doer in our mind is paralyzed
Knowing this can help explain why changing habits can be so difficult. If you aren’t sure why you’re changing, don’t fully believe you’re making the right choice, or question whether what you’re doing will work, you’re likely to settle back on your automatic behaviors. That’s why self-efficacy-the belief that you can make a change and overcome obstacles-is one of the best predictors of successful change. The decider and the doer need a boost of confidence.
It also helps explain why we love formulaic diets, investment strategies, and other decision aids. Formulas feel scientific, tested, and promising. They also give us a new default. We can rely on the rules (no eating after 7 PM, automatically invest X% of your income in mutual funds twice a month) when we’re feeling overwhelmed. A new automatic makes change much easier.
So next time you’re trying to make a change, figure out what your current default is, and remind yourself exactly why it isn’t working. Then look for ways to change your default (clean out your fridge, set up direct deposit) so you don’t have to fight the old default as often. And feel free to be your own cheerleader when the going gets rough. Look for the first evidence (a pound lost here, a dwindling credit card statement there) that what you’re doing is paying off. The status quo is seductive, and we all need a little encouragement to lift our fingers off the keyboard..
Study cited:
Fleming, S.M., Thomas, C.L., & Dolan, R.J. Overcoming status quo bias in the human brain. PNAS. Published online before print March 15, 2010. doi:10.1073/pnas.0910380107
Read the original Research Paper HERE (PDF internal link)
Just Do It: Asking For Help & Why People Are Twice as Likely to Assist as You Think!
In everyday life asking others for help can be embarrassing, perhaps even a painful experience. Requesting help potentially show
s our own weakness and also opens us up to rejection. It’s a relief when people say yes.
Perhaps this explains the conclusion of new research published in the Journal of Personality and Social Psychology that finds we grossly underestimate just how willing others are to help us out.
In a series of studies Francis Flynn and Vanessa Lake of Columbia University tested people’s estimation of how likely others were to help them out. They got people to ask others to fill in questionnaires, to borrow cell phones and to escort them to the gym.
Across these studies they found that people underestimated how likely others were to help them by as much as 100%.
This is such a high figure that it demands an explanation – what’s going on here?
Part of the answer is our egocentric bias – we find it difficult to understand what others are thinking and feeling because we are stuck inside our own heads.
But it’s more than just that, argue Flynn and Lake, it’s also the fact that we underestimate just how much social pressure there is on other people to say yes. In effect, when you ask someone to help you, it’s much more awkward and embarrassing for them to say ‘no’ than you might think.
In two further studies Flynn and Lake supported this intuition by asking participants to put themselves in either the role of someone asking for help, or someone being asked for help.
They found that when people were help-seekers they reliably played down the social costs of saying no. But when they were the potential helper they realised how difficult it was to say no.
There’s two very practical messages coming out of this research:
- If you want help, just ask. People are much more likely to help than you think, especially if the request is relatively small. Most people take pleasure in helping others out from time-to-time.
- Make it easy for others to say no. The other side of the coin is that most of us don’t realise just how hard it is to say no to a request for help. Other people feel much more pressure to say yes to our requests than we realise. If the help you need is likely to be burdensome then think about ways of making it easier to say no.
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About Peter
Peter Brown BHMS (Hons) MPsychClin MAPS
I’m a Clinical Psychologist and have a private practice and consultancy in Brisbane Australia. I have 24 years experience in child, adult and family clinical psychology. I have a wonderful wife and three kids.
I am co-founder of Christian Wholeness Counselling Services.
I like researching issues of the brain & mind, reading and seeking out new books and resources for myself and my clients. I thought that others might be interested in some of what I have found also, hence this blog…
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